Explainer: What you need to know about HIV and AIDS

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What is HIV?

HIV, or Human Immunodeficiency Virus, attacks and damages the human immune system. When left untreated, HIV kills a type of immune cell called a T-Cell.

As the condition progresses more T-Cells get attacked. This makes the body become increasingly susceptible to a range of illnesses and cancers.

HIV is not airborne, neither does it spread through water or casual, physical contact. Instead, HIV is transmitted via the following bodily fluids:

● Semen
● Blood
● Vaginal secretions
● Rectal fluids
● Breast milk

The virus does its work by inserting itself into the DNA of cells. Therefore, there is no known drug capable of removing it from the body, even as medical science strives for a cure.

At the moment, a treatment called antiretroviral therapy makes it possible for a person with HIV to live with the virus for many years. Without such therapy, a person infected with HIV is likely to develop the condition known as Acquired Immunodeficiency Syndrome, or AIDS.

What is AIDS?

AIDS is when the immune system is weakened to the point where it is unable to properly and sufficiently counteract infections. If left untreated, people with end-stage AIDS have about 3 years to live. This is why antiretroviral therapy is important for people who have HIV, as it enables them to live as long as people who do not have HIV.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer.

When AIDS develops, a person is seriously susceptible to illnesses like:

  • Tuberculosis
  • Cytomegalovirus
  • Toxoplasmosis
  • Cryptosporidiosis
  • Various cancers

These illnesses can become severe, and shorten the lifespan of a person.

How does HIV progress to AIDS?

While related, HIV and AIDS are different things. It takes a period of time for HIV to progress to AIDS, which means that when action is taken, there is a possibility of preventing HIV’s progress to AIDS.

HIV cases progress through 3 distinct stages:

First Stage: Acute stage – First few weeks after infection

Second Stage: Chronic Stage

Third Stage: Progress to AIDS

As HIV progresses, the CD4 cell count slowly goes down. While an uninfected adult’s CD4 cell count runs between 500 to 1500 per cubic millimeter, a person with AIDS has a CD4 cell count that is sub-200 count per cubic millimeter.

The speed of HIV progression from stage 2 to stage 3 depends on the person. Some people can stay in stage 2 for a decade without treatment. However, with treatment, they can stay in stage 2 indefinitely. As mentioned above, there is no cure for HIV. However, antiretroviral therapy can give a near-normal life expectancy.

Similarly, there is no way to cure AIDS. However, treatment that can increase the CD4 count above 200 per cubic millimeter of blood exists. This means that they can be considered to no longer have AIDS.

The facts of HIV transmission

No one is immune to HIV, and anyone can contract the virus. Here are some ways that HIV can be transmitted between people:

● Unprotected vaginal or anal sex — This is the most common route of transmission
● Sharing drug paraphernalia
● Unsterilized tattoo equipment
● Pregnancy, labor, or delivery from a pregnant person to their baby
● Breastfeeding
● Premastication – the act of chewing a baby’s food before feeding it to them

Very rarely, HIV is transmitted via blood transfusion or organ donation.

It is extremely rare for HIV to be transmitted through:

● Oral sex
● Being bitten by a person with HIV
● Contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transmit through:

● Unbroken skin-to-skin contact
● Casual contact like shaking hands
● Air or water
● Sharing food or drinks, including drinking fountains
● Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
● Insect bites

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Early symptoms of HIV

In the acute infection stage, there can be symptoms. At this stage, the virus is reproducing rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this acute infection stage, some people have no symptoms, while others might have the following symptoms:

● fever
● chills
● swollen lymph nodes
● general aches and pains
● skin rash
● sore throat
● headache
● nausea
● upset stomach

These symptoms are similar to the common flu. This is why infected people might not think that they need to see a doctor.

During this acute infection stage, the HIV viral load in the person is high, and this means that the virus can be easily passed on to another person during this period.

The acute stage symptoms resolve themselves within a few months as the person enters the chronic stage of HIV, which can last for decades with the appropriate treatment.

How can we diagnose HIV?

There are a few tests that can be used to diagnose HIV.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 2 to 4 weeks after someone initially contracts HIV.

These tests check the blood for both HIV antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for HIV antibodies. 3 weeks to 3 months after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a clinic.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their doctor to confirm.

HIV Viral RNA PCR or Nucleic acid test (NAT) – HIV Test

Viral PCR or NATs are expensive, and used for those who have early symptoms of HIV or have a known risk factor. This test looks for copies of the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

If you have queries, or think that you need a HIV screening test, please reach out to any of our DTAP clinics for a confidential and professional diagnosis. Anonymous HIV testing and rapid HIV test is also available.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy: a cocktail of daily medications that stop the virus from reproducing. Antiretroviral therapy protects CD4 cells, keeping the immune system strong enough to respond to disease.

Antiretroviral therapy also prevents HIV from progressing to AIDS, and reduces the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in viral PCR test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Types of HIV medications

HIV medications work to prevent reproduction of HIV, stopping it from destroying CD4 cells.
These antiretroviral medications are grouped into six classes:

● nucleoside reverse transcriptase inhibitors (NRTIs)
● non-nucleoside reverse transcriptase inhibitors (NNRTIs)
● protease inhibitors
● fusion inhibitors
● CCR5 antagonists, also known as entry inhibitors
● integrase strand transfer inhibitors

HIV Medication Side Effects

Antiretroviral therapy side effects differ, but may include nausea, headache, and dizziness. These side effects are not permanent, and will often get better over time.
However, serious side effects can include swelling of the mouth and tongue, as well as liver or kidney damage. If you encounter these side effects, speak to your doctor about adjusting medications.

Preventing HIV

There is no cure for HIV, or AIDS. That is why It is important to know how to prevent the transmission of HIV.

Safer sex

HIV is most commonly transmitted via unprotected vaginal or anal sex. Short of abstinence, the only other way to prevent transmission is through protection via condom or another barrier method.

If you are concerned about HIV risks:

● Get tested for HIV.
● Always use condoms. Be sure to know how to use them correctly, as incorrect usage can expose you to HIV risks.
● Take medication as directed if you have HIV. This lowers the risk of transmitting the virus to your sexual partner.
● Take medication called PrEP (Pre-Exposure Prophylaxis). This can be prescribed by your doctor.

Other prevention methods

There are a few other things you can do to prevent transmission of HIV:

● Do not share needles or other drug paraphernalia. Needle sharing can spread HIV through blood contact.
● Consider PEP. If you know that you have been exposed to HIV, talk to your doctor about getting post-exposure prophylaxis (PEP), which can reduce your risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure. – HIV PEP Singapore

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV.

HIV mutates quickly, and can often fend off immune system responses. Only a small number of people with HIV develop broadly neutralizing antibodies.

The good news is that in 2016, the first HIV vaccine efficacy study in 7 years was done in South Africa. This experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A follow-up after vaccination showed that the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involved 5,400 men and women from South Africa.

CD4 Count VS Viral Load – What do you need to know?

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The Immune system is made up of a large network of cells that work together to combat infections. Helper T Lymphocytes are a particular type of immune cell that expresses a molecule called the Cluster Determinant 4 (CD4). Helper T lymphocytes are hence commonly known as CD4 cells. The Human Immunodeficiency Virus (HIV) selectively targets CD 4 cells and uses them as hosts for viral replication. As the virus replicates, it destroys its host cell as it releases new copies of the virus. Therefore, as the viral load (which is a measure of the amount of virus present in the body) increases and the host CD 4 cells will decrease. 

HIV Pro Viral DNA Test

HIV Infection

During the early stages of a HIV infection, viral replication occurs at a very fast rate at the expense of CD 4 host cells. A vicious cycle occurs, wherein an increase in HIV viral load attracts more CD4 cells which get infected and become hosts to further increase the viral load. Within the first few weeks of a HIV infection, the CD 4 count falls precipitously. Such a sharp fall in CD4 cells is the hallmark of a HIV infection. 

Upon diagnosis of HIV, it is crucial that the patient’s CD 4 and viral load are measured. The CD 4 count allows the medical team to determine the state of the immune system and plan the appropriate treatment. If the CD 4 count is below 200 units, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) is established. AIDS is a serious complication of HIV infection and can be fatal, therefore, if the patient is diagnosed with AIDS he/she requires immediate medical attention in a hospital.The viral load will give an indication of how fast the virus is replicating. Current medication used to treat HIV infection targets different parts of  viral replication and interfere in the process of new viruses being produced. Therefore, a fall in viral load after commencing medication is an indicator that the medication is working. 

People Living With HIV

For People Living with HIV (PLHIV), the main goal of therapy is to increase CD4 cell numbers and decrease the viral load to an undetectable level. Monitoring these 2 parameters will guide the treatment regime. In general viral load is measured 2 weeks after starting medications for HIV, then at 4 to 8 week intervals. The expected fall in viral load should be to approximately < 500 copies/ml by week 8 – 16 and < 50 copies /ml by week 16- 24. CD 4 recovery is slower, the first CD4 test is done 3 months after commencing treatment and every 6 months after. In general, a CD 4 count > 300 cell/uL with a low viral load is a good level to ensure that PLHIV does not encounter any opportunistic infections.

Also read: U=U: Science, Not Stigma

CD 4 and Viral load measurements are essential parameters in guiding the medical therapy for PLHIV. Regular check of these parameters ensure that PLHIV are able to maintain an active lifestyle and avoid any infections that may occur due to a lowered immunity.

HIV Screening Singapore

 
 
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HIV Elite Controllers and Long-term Non-progressors

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Elite controllers are defined as those individuals who have been infected with HIV but is able to achieve undetectable levels of virus (<50 copies/ml) without any medication. While long-term controllers are those who have been able to achieve low but detectable levels of HIV (<2000 copies/ml) without treatment.

There are many theories as to how these individuals are able to control the virus:

  • These individuals CD4 cells are less susceptible to infection by the HIV virus
  • Infected with defective strains of the HIV virus that makes the virus less able to produce copies of itself.
  • Individuals’ whose immune system is able to mount an effective response to the virus
  • Individuals’ immune system causes less inflammation when the HIV virus is encountered and thus limiting the exposure of the virus to CD4 cells.

There is a fair amount of evidence to suggest that perhaps the main mechanism that allows for control of the HIV virus is that an effective and potent immune response by an individual. Studies have shown that when only CD4 cells of elite controllers were isolated without CD8 cells, and then infected with HIV virus, the CD4 was just as easily infected as non-elite controllers thus giving evidence that the elite controllers CD4 cells were just as susceptible to HIV infection as non-elite individuals.
In recent months, researchers in Sydney, Australia has reported a case of a known HIV person who has spontaneously cleared HIV infection with no treatment. This patient was infected due to a blood transfusion back in 1981. The patient was able to suppress the HIV virus in his body through his own immune system and have undetectable levels of the virus since 1997. Most recently, they tried to look for traces of the HIV virus in his blood, intestines and lymph nodes but did not detect any traces of the virus, thus the researchers believe this is the first case of spontaneous clearance of HIV infection in humans.

So what factors may have contributed to this patient being able to clear the virus from his body?

  • The virus that originally infected that patient was lacking in a gene called nef. In HIV virus deficient in this gene, the virus replicates more slowly and thus is associated with lower viral loads.
  • The patient was born with 1 copy of a gene called CCR5. The gene is required for HIV to attach to human immune cells. Thus persons with only one copy of the gene would make it more difficult for the HIV virus to attach on to the immune cells. (See: CCR5 HIV Test)
  • It was also found that the patient’s immune cells were naturally more able to recognise a protein called gag made by the HIV virus. This protein is found on the surface of infected human cells. Thus allowing his immune system to better recognise cells that have been infected with HIV virus and aid in their destruction.
  • In addition, the patient was born with 2 specific immune-cell genes called HLA-B57 and HLA-DR13 and in combination allows his immune system to be more effective in responding to HIV infection.
  • As a result of his strong response by his CD4 cells as a result of the presence of the HLA-B57, he is able to mount a bigger immune response by his CD8 cells. CD8 cells are required to activate cytotoxic T cells which as the name suggests are immune cells that kills defective or infected human cells.

In essence, the combined effects of each of the above factors contributed to the clearance of the HIV virus from this particular patient. To replicate this combined effect artificially at this point in time is not possible. However, perhaps in the future with further development of gene therapy, we may be able to achieve this unique set of host factors to achieve clearance of HIV virus.

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Tag: hiv test

What are the Common Misconceptions that People have about HIV?

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There are multitude of misconceptions associated with HIV. These are some of the most common ones:
1) HIV is the same as AIDS. HIV (Human Immunodeficiency Virus) refers to the virus itself, whereas AIDS (Acquired Immunodeficiency Syndrome) refers to a spectrum of potentially life-threatening conditions that are caused by the virus.

Read: HIV, AIDS & Opportunistic Infection

2) HIV is a death sentence. This may have been the case several decades ago, where without prompt and adequate treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV infected patients today may never develop AIDS. This is why it is imperative to be on treatment, ideally as soon as possible after a diagnosis of HIV is made. It is also important to undergo regular HIV screening.

READ: HIV Treatment & Management

3) HIV can be spread by kissing, sharing of food or close contact. It is extremely unlikely to contract HIV via these methods as HIV is not spread by saliva. However, if the person you are in contact with has mouth sores/ulcers, bleeding gums or open wounds then there is a possible risk. HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids/tissues such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission.

READ: How Long Can HIV Survived Outside The Body

Is a person infected by HIV any different from that of an uninfected person?

With or without treatment, a person infected with HIV may not appear any different from that of an uninfected person.
HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage may present with lymph node swelling, but most patients do not have any symptoms at all. The second stage (Clinical Latency) can last anywhere from a few years to over 20 years. Thus, many HIV infected patients, especially during this stage, may not even know that they have contracted HIV. Lastly, the third stage is the presentation of AIDS symptoms.
HIV infected patients should receive prompt long term treatment and undergo regular follow up blood tests in order to reduce the viral load in their bodies to low levels. This allows their immune system to continue to function well and minimizes the risk of progression to AIDS. By doing so, they can essentially live very normal lives not any different from that of an uninfected person.

What are some of the treatments that a patient will receive upon diagnosis of HIV infection?

Upon diagnosis of HIV infection, a patient will have to start taking a combination of long-term daily medications. These are antiviral medications that work to prevent the virus from replicating. The patient will then be required to return regularly for blood tests to monitor the levels of HIV and the immune system. The goal of treatment is to keep the levels of HIV low, and thus allow the immune system to continue to function well.

How does AIDS affect a person’s health? What do AIDS patients die of?

Without adequate treatment, up to 50% of HIV infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. HIV Related Opportunistic infections such as tuberculosis, recurrent pneumonia and esophageal candidiasis,  may occur as well. AIDS patients could also develop various viral-induced cancers.
The leading causes of death worldwide in patients with AIDS are, as mentioned, opportunistic infections and cancer.

Recently it was reported that in London, an HIV patient who underwent a bone marrow transplant subsequently had undetectable HIV levels. Does this mean that he is fully cured of HIV?

This is the 2nd ever reported case of an HIV patient being “cured” of HIV. In 2007, a patient in Berlin was also reported to have been cleared of the virus. Both of these cases have similarities: both HIV infected patients concurrently suffered from cancer (Berlin patient had Acute Myeloid Leukaemia; London patient had Hodgkin’s Lymphoma) and both patients received bone marrow transplant by donors who carried the rare CCR5 genetic mutation.
CCR5 is a protein on the surface of white blood cells that is involved in the immune system. It is one of the co-receptors that HIV uses to enter target immunological cells. This means that via CCR5, HIV is able to gain a mode of entry into a person’s immune system. People with CCR5 genetic mutation have resistance to HIV infection because the virus is unable to enter into their immune system like it usually does.
In the case of the London patient, subsequent blood tests have shown that the virus cannot be detected. However, this does not necessarily mean that he has been fully “cured” – the virus may simply be in a dormant, or “sleeping” state.
While the outcome was favourable in the two examples stated above, this form of treatment is not a viable large-scale strategy because bone marrow transplants carry significant risks and are extremely costly. However, it is undeniable that these two cases are landmark moments in the war against HIV as scientists continue to hunt for a cure. The hope is that by conducting more research on the editing of the CCR5 gene, we will one day be able to develop a safe, cost-effective and easy solution.

READ: HIV CCR5 Mutation & CCR5 Testing

Do you think that mankind can eradicate HIV eventually? Before this happens, what kind of support can we give to HIV infected patients?

I believe that with continued advances in medical research, there is hope of a cure for HIV in the future. However, this is a long and slow process that may require many years or decades. Until then, the best option is to ensure that the public are able to gain access to undergo HIV screening even if the risk is not high, and that HIV infected patients are able to receive prompt and long term treatment.
From the initial shock and disbelief of receiving a diagnosis of HIV; having to accept the reality of the situation; to having to live with HIV daily, these are just a few examples of the tremendous challenges that HIV patients face in their lives, and for many patients these have a detrimental impact on their psychosocial well-being.
There is still a terrible stigma today surrounding HIV, and it remains very much a taboo subject that most people are afraid to speak about or face up to. Nevertheless, we can offer many forms of support for HIV patients. For starters, government and healthcare organisations need to continue in their best efforts to increase awareness and educate the public about HIV and its misconceptions. If you have a family member or loved one who lives with HIV, the best kind of support would be your understanding, care and acceptance.
Lastly, if you are a person living with HIV, do not despair. Seek the appropriate treatment that you require, and turn to your family and friends for moral support.
Take Care!
Tags: hiv screening singapore, hiv test

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  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
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  10. An Overview of Gonorrhoea
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  14. HIV Pro-Viral DNA Test

 

Advisory: On the Unauthorised Possession and Disclosure of Information from MOH’s HIV Registry

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Singapore, 28 January 2019 – Singapore’s Ministry of Health (MOH) held a press conference to inform the public that the confidential information of 14,200 people living with HIV were leaked. This included 5,400 Singaporeans and 8,800 foreigners (source: https://www.straitstimes.com/singapore/data-of-14200-singapore-patients-with-hiv-leaked-online-by-american-fraudster-who-was). The records of the 5,400 Singaporeans leaked were up to January 2013. The records of the 8,800 Foreigners leaked were up to December 2011.

This is a trying time for people living with HIV in Singapore. For Singaporeans diagnosed after January 2013, there is no need to be concerned until more information is available from MOH. For queries, we urge you to contact the MOH hotline on +65 6325-9220.

 

Under the Infectious Diseases Act of Singapore, we would like to remind the community that it is an offence to disclose the identity of a person living with HIV except under very specific conditions (see Addendum 1 below). If anyone comes into contact with such information, we urge you to notify the Singapore police immediately at https://eservices.police.gov.sg/homepage.

We hope that even if the identities of people living with HIV are leaked that they are shown the same support and respect we have always given them. People living with HIV are no different from any of us. They are also of no danger to anyone. You cannot get HIV from casual contact such as shaking hands, hugging, sharing food or sharing a toilet.

We hope in this difficult time all Singaporeans can band together to show support for people living with HIV. They are our loved ones, our colleagues, our friends and our families.

 

Addendum 1: Singapore Infectious Diseases Act

Protection of identity of a person with AIDS, HIV Infection or other sexually transmitted diseases.

 25.—(1)  Any person who, in the performance or exercise of his functions or duties under this Act, is aware or has reasonable grounds for believing that another person has AIDS or HIV Infection or is suffering from a sexually transmitted disease or is a carrier of that disease shall not disclose any information which may identify the other person except —

(a) with the consent of the other person;

(b) when it is necessary to do so in connection with the administration or execution of anything under this Act;

(ba) when it is necessary to do so in connection with the provision of information to a police officer under section 22 or 424 of the Criminal Procedure Code 2010;

[10/2008 wef 10/06/2008]

[15/2010 wef 02/01/2011]

(c) when ordered to do so by a court;

(d) to any medical practitioner or other health staff who is treating or caring for, or counselling, the other person;

[10/2008 wef 10/06/2008]

(e) to any blood, organ, semen or breast milk bank that has received or will receive any blood, organ, semen or breast milk from the other person;

(f) for statistical reports and epidemiological purposes if the information is used in such a way that the identity of the other person is not made known;

(g) to the victim of a sexual assault by the other person;

(h) to the Controller of Immigration for the purposes of the Immigration Act (Cap. 133);

 (i) to the next-of-kin of the other person upon the death of such person;

 (j) to any person or class of persons to whom, in the opinion of the Director, it is in the public interest that the information be given; or

 (k) when authorised by the Minister to publish such information for the purposes of public health or public safety.

[5/92; 13/99]

(2)  Any person who contravenes subsection (1) shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 3 months or to both.

10 Common HIV-related Opportunistic Infections

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In late-stage HIV infection, the virus would have spread through the body and attacked the immune system for many years without treatment. On blood tests, the number of viral copies, or viral load (VL), will be very high, while the CD4 cells of the immune system would be very low.
When the immune system is in this weakened state, it is much easier for certain pathogens (bacterial, viral, fungal etc.) to invade and cause an infection – these types of infections are called Opportunistic Infections (OI’s). Sometimes, these infections can cause certain types of cells to become cancerous, and these are also classified as Opportunistic Infections.

HIV-infection

What is an Opportunistic Infection?

In a healthy and normal functioning immune system, these pathogens do not usually cause infection, or they may cause very mild disease. Apart from advanced HIV infection, Opportunistic Infections may affect people who are on chemotherapy for cancer, immunosuppression for autoimmune diseases or post-organ transplant, among other conditions.
In HIV, many of these Opportunistic Infections are what we also term as “AIDS-defining illnesses” – that is, if these infections are found in someone who has HIV, we would classify them as having AIDS (Acquired Immunodeficiency Syndrome). Many of the symptoms and signs of late-stage HIV infection are due to these Opportunistic Infections rather than directly from the virus itself.

What is HIV Treatment?

HIV treatment and management consists of taking a set of correct HIV medicines to delay the control HIV, monitoring for and treating any opportunistic infections, and taking care of the patient’s general health and well being.

What are the most common Opportunistic Infections?

This is a list of some of the most common HIV-related opportunistic infections:

1) Candidiasis (Esophageal, Tracheal, Bronchial)

Also known as thrush, candida is a very common fungal organism that is found almost everywhere in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection; however, in people with HIV, there can be invasive candida overgrowth in the esophagus and airways. It is often the first sign of a weakened immune system in previously undiagnosed individuals.

2) Cryptococcosis

Caused by the fungus cryptococcus neoformans, this can infect any part of the body, but most commonly will invade the lungs (pneumonia) or the brain (abscesses).

3) Cytomegalovirus (CMV)

Caused by an intracellular virus, this infection can cause inflammation of the brain, lungs, intestines, and eyes. CMV retinitis of the eye is sight-threatening and should be treated as a medical emergency.

4) Herpes Simplex Virus (HSV)

Another common virus, Herpes Simplex Virus (HSV) can cause symptoms in people with a normal immune system as well – usually cold sores or blisters around the mouth, genital region or anus.
However, in people with a weak immune system, outbreaks tend to be more frequent, severe, and prolonged in duration, and can also invade the lungs and esophagus.

5) Mycobacterium Tuberculosis (TB) & other Mycobacterial infection

Tuberculosis (TB) would most commonly affect the lungs, but may also spread to lymph nodes, brain, kidneys, or bones. Symptoms of TB include recurrent fever, night sweats, chronic cough, and weight loss. Other mycobacteria are very commonly found in soil and around the environment, and very rarely would cause problems in healthy individuals; as Opportunistic Infections, they will usually affect the lungs but can spread throughout the body.

6) Pneumocystis Carinii Pneumonia (PCP)

Caused by a fungus pneumocystis carinii, now renamed as pneumocystis jirovecii, this infection is commonly one of the first signs of a late-stage HIV infection. Symptoms would include shortness of breath on exertion, dry cough, and high fever, and if left untreated can be deadly.

7) Salmonella septicemia

Salmonella is a common bacteria that is usually found in contaminated food or water. In healthy individuals, this may cause an acute ‘food poisoning’ with vomiting, diarrhoea, and sometimes fever. However, salmonella as an Opportunistic Infection can spread throughout the body and cause septicemia, or blood poisoning, leading to multi-organ failure and death.

8) Toxoplasmosis

This is caused by a parasite called toxoplasma gondii, which is found in the faeces of certain animals (normally cats, rodents, and birds), and can be found in undercooked red meat such as pork. It can cause infection of the lungs, eyes, liver, and brain.

9) Kaposi’s Sarcoma (KS)

This is a type of abnormal growth/tumor of connective tissue – more specifically, of the capillaries (small blood vessels). It can occur anywhere in the body, but if it arises on the skin or mucous membranes, KS will usually appear as firm reddish or purplish lumps. The cancerous changes in the cells are a result of infection by human herpesvirus 8 (HHV8),

10) Invasive cervical cancer

This is a cancer of the cervix, which is the neck of the womb, or uterus. Malignant changes can occur after infection with certain types of human papillomavirus (HPV), and all women (HIV or not) should be screened regularly with pap smears and HPV testing. It is also recommended to get the HPV vaccine (Gardasil 9), to prevent HPV infection, cervical cancer, and genital warts.

How can Opportunistic Infections be prevented?

As these infections only occur in people with a weakened immune system, the most important way to prevent them would be to treat the underlying HIV infection. Highly Active Antiretroviral Treatment (HAART) is very effective at treating HIV and ensuring the virus is adequately suppressed. With a low or undetectable viral load, the body’s immune system has time to recover – and when the CD4 cells have returned to sufficient numbers, the risk of Opportunistic Infections is lowered drastically. The earlier an HIV infection is diagnosed, the earlier treatment can be started and the better the chances of avoiding Opportunistic Infections.
For patients who are diagnosed with HIV later and have low CD4 counts at diagnosis (<500), it is important to consider Opportunistic Infections prophylaxis while we are waiting for HAART to work. This means starting patients on certain medications (e.g. antibiotics, antifungals, and/or antivirals) to prevent some of these specific infections. It may take 6-12 months for the CD4 counts to recover once HAART has been initiated; once the CD4 counts are improved, these prophylactic medications may be stopped.
Other general advice for people living with HIV would include:

  • Reducing or preventing exposure to other sexually transmitted infections
  • Getting vaccinated (e.g. HPV vaccine, annual flu vaccine, pneumococcal vaccine, etc.)
  • Avoiding undercooked or raw foods (including eggs, meat, unpasteurized milks and cheeses, etc.)
  • Avoid drinking untreated water
  • Speak to your doctor about any other changes that may need to be made at home, work, or when on vacation to reduce exposure to OI’s

Take Care!

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