Diagnosis, Treatment, Life expectancy, Prevention and Living with HIV


There is currently no cure for HIV or AIDS. However, treatments can stop the progression of the condition and increase life expectancy and quality of life.

May 4, 2018

Diagnosis, Treatment, Life expectancy, Prevention and Living with HIV

HIV is a virus that damages the immune system making people much more vulnerable to infections and diseases. The immune system helps the body fight off infections. Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, the body is more likely to get various types of infections and cancers as HIV kills more CD4 cells. HIV is found throughout all the tissues of the body. It is transmitted through the body fluids of an infected person which include semen, vaginal and rectal fluids, blood, and breast milk.

Diagnosis of HIV:

Diagnosis is made through a blood test that screens specifically for the virus. The blood is re-tested several times before giving a positive result, if the test result is positive. The treatment will be more likely successful if HIV is detected earlier.
Several different tests can be done to diagnose HIV. These include:

Antibody/antigen tests:

Antibody/antigen tests are the most commonly used tests which checks the blood for antibodies and antigens. Antibody is a type of protein the body makes to fight an infection where as antigen is the part of the virus that activates the immune system.
These test can show positive results typically within 18 to 45 days after someone initially contracts HIV.

Antibody tests:

These tests are done to check for antibodies in the blood. These test can show positive results typically between 23 and 90 days after transmission. During this period most people will develop detectable HIV antibodies, which can be found in the blood or saliva. There is no preparation necessary before the test and can be performed in a healthcare provider's office or clinic. These tests are done using blood tests or mouth swabs. The results can be ready in 30 minutes or less.
Antibody tests that can be done at home are:

OraQuick HIV Test:

An oral swab provides results in 20 minutes or less.

Home Access HIV-1 Test System:

After pricking your finger, you can send a blood sample to a licensed laboratory. Results will be available the next business day.
If HIV home test is negative, you should repeat the test in three months in case of exposure to HIV. You should follow up with your healthcare provider to confirm the disease if HIV home test is positive.

Nucleic acid test (NAT):

As this is an expensive test, it isn't used for general screening. It is used for people who have early symptoms of HIV or have a known risk factor. This test looks for the virus rather than antibodies. It takes from 5 to 21 days for HIV to be detectable in the blood. The result of this test alone can't confirm the disease. This test is usually accompanied or confirmed by an antibody test.

Treatment of HIV:

There is currently no cure for HIV or AIDS. However, treatments can stop the progression of the condition and increase life expectancy and quality of life. Earlier HIV antiretroviral treatment can improve quality of life, extends life expectancy, and reduces the risk of transmission. Someone living with HIV can reduce his or her viral load to such a degree that it is no longer detectable with proper treatment. Individuals who have undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV negative partner which is known as undetectable = untransmittable.

Emergency HIV pills:

Post-exposure prophylaxis (PEP) is a medication that should be taken after an exposure to prevent getting HIV. PEP needs to be taken as soon as possible after the exposure,no later than 72 hours. This may stop infection. The treatment last for 4 weeks. Monitoring for HIV will be continued after completion of the treatment.
Pre-exposure prophylaxis (PrEP) is a combination of HIV drugs taken before potential exposure to HIV. PrEP can lower the risk of contracting or spreading HIV when taken consistently. 

Antiretroviral medications:

Antiretroviral therapy medications are used to prevent HIV from reproducing and destroying CD4 cells, which help the immune system fight infection. This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.
Generally, people living with HIV take a combination of medications called HAART (highly active antiretroviral therapy) or cART (combination antiretroviral therapy). There are a number of subgroups of antiretrovirals. These include:

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs):

These medications are also referred as nukes. Because of mutation these medications can interfere with HIV by making its own replicate. NRTIs include abacavir, lamivudine or zidovudine, and emtricitabine.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs):

NNRTIs work in a similar way to NRTIs, making it more difficult for HIV to replicate.

Protease inhibitors:

Protease is an enzyme that HIV replicate for its progression. Protease inhibitors bind to the enzyme and inhibit its action, preventing HIV from making copies of itself. These include atazanavir/cobicistat, lopinavir/ritonavir, and darunavir/cobicistat.

Integrase inhibitors:

HIV needs the integrase enzyme to infect T cells. Integrase inhibitors bind to the enzyme and inhibit its action, preventing HIV from making copies of itself. These are often used effectively in the first line treatment for many people because of their minimal side effects. Integrase inhibitors include elvitegravir, dolutegravir, and raltegravir.

Chemokine co-receptor antagonists:

These are also known as CCRF and works by blocking HIV from entering cells. These are rarely used because of less efficacy compared to other medications.

Entry inhibitors:

Entry inhibitors prevent HIV from entering T cells. Without access to these cells, HIV cannot replicate. Like chemokine co-receptor antagonists, they are rarely used.
Generally it is recommended to start regimen of three HIV medications. You should include at least two of these drug classes in your regimen. This combination helps prevent HIV from forming resistance to medications. Based on your overall health and personal circumstances, the regimen can be decided by your healthcare provider. HIV treatment is based on routine dosage. These medications must be taken every day, exactly as prescribed. Viral resistance can develop if they are not taken appropriately and a new regimen may be needed. Blood testing will help determine if the regimen is working or not by looking in to CD4 count. A regimen is consider to work properly if the viral load is down and the CD4 count is up.
If an antiretroviral therapy regimen isn't working, your healthcare provider will switch them to a different regimen that’s more effective.

Side effects:

Each class of ARVs has different side effects. Some possible common side effects include nausea, diarrhea, skin rashes, headache, fatigue and dizziness which are often temporary and disappear with time.   
Swelling of the mouth and tongue and liver or kidney damage are some of the serious side effects. The medications can be adjusted if side effects are severe.

Complementary or alternative medicine:

Although mineral or vitamin supplements may provide some benefits in overall health, alternative or complementary medications, such as herbal ones are not that effective. As vitamin supplements may interact with ARVs, you should discuss these options with your healthcare provider before starting it.

HIV vaccine:

HIV is a complicated virus and it changes rapidly. The immune system responses can be severely affected by HIV. Only a small number of people who have HIV develop neutralizing antibodies. Currently, there are no vaccines to prevent or treat HIV. However, people with HIV can benefit from other vaccines to prevent HIV-related illnesses, such as:

HIV life expectancy:

The life expectancy of a person diagnosed with HIV can be increased by antiretroviral therapy. With proper and timely treatment many people with HIV can expect a normal or near normal lifespan.
There are several things that affect life expectancy for a person with HIV. These include:

  • CD4 cell count
  • viral load
  • serious HIV-related illnesses, including hepatitis infection
  • access, adherence, and response to treatment
  • other health conditions
  • drug use
  • smoking
  • age

Consistent use of antiretroviral therapy helps prevent HIV from progressing to AIDS. When HIV advances to AIDS, life expectancy without treatment is about three years.

HIV prevention:

Currently no vaccine available to prevent the transmission of HIV. However, taking certain steps can help prevent the spread of HIV. These include:

Safer sex:

The most common way of HIV transmission is through anal or vaginal sex without a condom. Unless sex is avoided entirely, this risk can't be completely eliminated. However the risk can be lowered considerably by taking a few precautions. If there is a risk of HIV, a person should:

Get tested for HIV:

It is important they learn their status as well as their partner. Take your medications as directed if you have HIV. This lowers the risk of transmitting the virus to their sexual partner.

Get tested for other sexually transmitted infections (STIs):

Having sex without a condom can put a person at risk of contracting HIV and other sexually transmitted infections (STIs). Because having an STI increases the risk of contracting HIV, they should get it treated, if the test result is positive for one.

Use condoms:

Learn the correct way to use condoms and use them every time you have sex, whether it is through vaginal or anal intercourse. Pre-seminal fluids which come out before male ejaculation can contain HIV.

Limit their sexual partners:

Avoid multiple partner for sex. You should have one sexual partner with whom you have an exclusive sexual relationship.

Avoid Drug injection and needle sharing:

Intravenous drug use can spread HIV. Sharing needles can expose users to HIV and other viruses, such as hepatitis C. Therefore, it must be a clean, unused and unshared, if someone needs to use a needle.

Avoid Body fluid exposure:

Reducing the risk of exposure to contaminated blood can control exposure to HIV. . Healthcare workers should use barriers such as gloves, masks, protective eyewear, shields, and gowns in the appropriate circumstances. Frequent and thorough washing of the skin immediately after coming into contact with blood or other bodily fluids can reduce the chance of infection. 

Follow effective treatment plan in Pregnancy:

Some ARVs can harm the unborn child. But an effective treatment plan can prevent HIV transmission from mother to baby. Delivery through cesarean section may be necessary. As the virus can pass through the breast milk of a HIV infected mother to her infant, avoid breast feeding to be on the safer side. It is important for a new mother to discuss the options with a healthcare provider. However, if the mother is taking the correct medications, the risk of transmitting the virus is greatly reduced.

Consider PEP:

A person who has been exposed to HIV should take post-exposure prophylaxis (PEP) which can reduce the risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible, before 36 to 72 hours of exposure.

Consider PrEP:

A person at a high risk of HIV should take pre-exposure prophylaxis (PrEP). If taken consistently, it can lower the risk of contracting HIV. PrEP is a combination of two drugs available in pill form.

Education:

Teaching people about known risk factors is essential.

Living with HIV:

With effective treatment, many people with HIV can expect to live a long and productive life. An antiretroviral treatment should be started as soon as possible to increase the life expectancy. By taking medications exactly as prescribed, people living with HIV can keep their viral load low and their immune system strong. It is also important to follow up with a healthcare provider regularly.
Other ways to improve the overall health of a person living with HIV include:

  • exercise regularly
  • Have a well-balanced diet
  • get plenty of rest
  • avoid tobacco and other drugs
  • report any new symptoms to your healthcare provider right away
  • focus on your emotional health by taking help from a licensed therapist
  • use safer sex practices by getting tested for HIV and STIs for both the partners
  • use PrEP and PEP if required
  • surround themselves with loved ones
  • join an HIV support group to get support