The Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are serious chronic infectious diseases that threaten life. Since its discovery in the 1980s, this disease has become a significant issue in global public health. HIV is a virus that destroys T cells in the immune system, which can ultimately lead to severe immune dysfunction and the development of AIDS. This disease not only affects physical health but can also have profound impacts on the psychological, social relationships, and economic conditions of patients.
According to data from the World Health Organization, approximately 38 million people worldwide are currently infected with HIV. Although medical advancements have turned this disease into a manageable chronic condition, there are still many misconceptions and discrimination surrounding it. Understanding the mechanisms of HIV infection, symptomatology, diagnostic methods, and treatment options is key to promoting prevention, reducing transmission, and improving the quality of life for patients.
HIV is an RNA virus that primarily attacks human T lymphocytes and macrophages, gradually destroying the core functions of the immune system. The virus is transmitted through specific bodily fluids (such as blood, semen, and vaginal secretions), with the main transmission routes including:
After infection, the virus enters the acute phase, asymptomatic latent phase, and AIDS phase. Risk factors include lack of treatment, multiple sexual partners, and lack of proper hygiene knowledge. Studies indicate that injection drug users who share needles have an infection risk more than 30 times higher than the general population.
The HIV virus has a high capacity for mutation, allowing it to evade detection by the immune system. After entering cells through CD4 receptors, the virus uses the host cell's mechanisms to replicate its genes, resulting in the release of a large number of viral particles. Continuous damage to the immune system will gradually decrease the number of CD4 cells in patients, and when the count drops below 200/μL, it meets the diagnostic criteria for AIDS. This process can take several years and is highly insidious.
In the early stages of HIV infection, flu-like acute symptoms may appear, with about 50-90% of infected individuals experiencing the following symptoms 2-4 weeks after infection:
After entering the asymptomatic latent phase, patients may go for years without obvious symptoms, but the virus continues to replicate. When it progresses to the AIDS stage, common symptoms include prolonged fever, unexplained weight loss, recurrent infections (such as pneumocystis pneumonia, and cryptococcal pneumonia), and symptoms of opportunistic infections (such as oral candidiasis and chronic diarrhea). Some patients may experience neurological symptoms, such as memory impairment or coordination difficulties.
The symptoms at the AIDS stage are often related to severe immune system damage, with common symptom combinations including recurrent severe infections, the appearance of specific cancers (such as Kaposi's sarcoma), and persistent systemic symptoms (such as fever lasting more than a month and unexplained weight loss of over 10%). These symptoms vary greatly and require laboratory data for diagnosis.
Diagnosis of HIV infection is primarily through blood tests, including:
After an initial positive screening, a confirmatory test must be conducted, such as a Western blot or PCR nucleic acid test. The criteria for diagnosing AIDS must meet the CDC definition, which is a CD4 cell count below 200/μL, or the presence of specific opportunistic infection indicator diseases (such as toxoplasmosis or pneumocystis pneumonia).
The diagnostic process includes:
Early diagnosis is crucial for treatment effectiveness, and it is recommended that individuals with high-risk behaviors undergo screening every 6-12 months.
Current treatment focuses on antiretroviral therapy (ART), which uses a combination of three or more drugs to effectively suppress viral replication. The treatment goal is to reduce the viral load to an "undetectable level" and restore immune function. Current treatment regimens have evolved to include "single-tablet regimens" to enhance patient adherence to medication.
Treatment effectiveness is closely related to patient adherence; interruption of treatment may lead to viral mutations and drug resistance. Studies show that consistent and regular treatment can allow patients' life expectancy to approach that of uninfected individuals. The latest therapies also include clinical trials for immunomodulatory treatments and gene therapy, providing new directions for future treatment.
Treatment involves not only medication use but also the integration of:
Managing medication side effects is key to successful treatment, with common side effects including lipid metabolism abnormalities and renal function impacts, which need to be closely monitored by the healthcare team.
Preventive measures include:
A 2019 study showed that PrEP can reduce the risk of infection through sexual behavior by up to 99%. Public health policies promoting anonymous testing services and medication subsidies can effectively increase the uptake of preventive measures.
Recent developments in preventive strategies include:
Health education campaigns need to be strengthened for high-risk populations (men who have sex with men, injection drug users) and should integrate legal reforms to protect the rights of those infected to promote proactive healthcare.
Seek medical attention immediately if:
Even if asymptomatic, individuals with the following high-risk behavior history should also get tested:
The World Health Organization recommends that all adults aged 15-64 should be screened for HIV at least once, and high-risk populations should be retested every 3-6 months.
Pregnant women, children, and immunocompromised patients need special attention:
Early medical intervention can significantly improve prognosis, and timely treatment can allow patients' life expectancy to approach that of the general population.
HIV is primarily transmitted through blood, semen, vaginal secretions, and breast milk. Everyday contact such as sharing utensils, shaking hands, or touching open wounds does not transmit HIV. The virus has very low survival ability in the external environment and must enter the bloodstream directly to cause infection; therefore, general social interactions pose no infection risk.
Can HIV be completely cured after receiving antiviral treatment?Currently, antiretroviral therapy (ART) can effectively suppress viral replication, reducing the viral load to undetectable levels, but it cannot completely eliminate the latent viral reservoir in the body. Patients need to take medication for life, and there is currently no cure found in medicine, thus "undetectable = untransmittable" but treatment must not be interrupted.
What should I do if I accidentally get stuck by a potentially contaminated needle?You should immediately clean the wound thoroughly with soap and water and seek medical attention as soon as possible for further assessment. The doctor may recommend starting post-exposure prophylaxis (PEP) within 72 hours and tracking viral indices. Timely handling in this situation can significantly reduce the risk of infection.
Can HIV-infected individuals safely give birth to healthy babies?With regular antiretroviral treatment, maternal viral load can be suppressed to undetectable levels, reducing the vertical transmission rate to below 1%. Under professional medical supervision, the risks of vaginal delivery and breastfeeding are extremely low, and modern medicine has provided a complete plan for safe childbirth.
Do HIV-infected individuals who are diagnosed early and receive treatment have a life expectancy similar to that of the general population?If diagnosed early and adhering to medication, the immune system of infected individuals can remain stable over the long term, and their life expectancy can be comparable to that of the general population. The key lies in strictly following the treatment plan and regular follow-up to avoid complications and medication side effects affecting quality of life.
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