HIV infection

The HIV virus can infect through body fluids (blood, semen, vaginal fluid) that enter the bloodstream through skin or skin lesions. Anyone who has sex without protection (condoms) or who shares needles or syringes with others can become infected. However, it is important to know that the virus can also be present in breast milk, which is why mothers living with HIV should not breastfeed their babies.

Infection occurs when the virus that enters the bloodstream binds to a vital cell in the immune system, the CD4 immune cell. Once inside the cell, the virus multiplies and kills it in about 48 hours. From the CD4 cell, the virus is released into the bloodstream and the abundant free virus seeks out new CD4 cells. During this process, the number of healthy CD4 cells is steadily reduced. The process is most intense in the first six weeks immediately after infection: at this stage the number of free viruses is very high (4-7 million per microlitre or even higher), making the newly infected person highly infectious.

Body fluids dangerous for infection:

• blood
• semen
• vaginal fluid
• breast milk

Non-infectious body fluids:

• sweat
• tear
• nasal secretions
• saliva
• urine
• stool

Contact routes that pose a risk of infection:

• intravenous drug use with shared needles and syringes
• vaginal (vaginal), anal (rectal) and oral (oral) intercourse without condoms, with penetration of semen
• epithelial penetration (e.g. by fingernails, sexual aids) followed by penetration of semen or vaginal fluid

Non-infectious modes of contact:

• kiss
• handshake
• kissing
• sharing a cup
• sharing cutlery
• sharing towels
• hugging
• sneezing
• coughing

The natural course of HIV infection

The natural course of infection follows a different rhythm for everyone. For some people, AIDS (Acquired Immune Deficiency Syndrome) could develop within a few years, others may be asymptomatic for decades. In general, however, untreated cases develop the indicators of AIDS: opportunistic infectious and cancerous diseases, within 5-12 years.

Acute HIV infection

In the 3-6 weeks following infection, a flu-like condition may occur, which resolves spontaneously within 1-2 weeks. Typical symptoms include sore throat, fever, transient lymph node enlargement, fatigue, malaise, muscle and joint pain, diarrhea and pharyngitis.

Because of the similarity of symptoms to the flu, many people do not think of HIV infection. During this period, CD4 cell counts drop dramatically from their pre-infection levels and HIV virus counts increase (up to several million). The patient is then highly infectious, meaning that the virus can be easily transmitted.

Asymptomatic HIV-infected status

This stage usually starts after week 6 and typically lasts for 2-8 years, but rarely it can last longer than 10 years. There are no warning signs during this period: the infected person believes they are healthy.

Over the years, HIV infection insidiously damages the immune system, leaving the body vulnerable to infections and malignancies. The body becomes less and less able to fight off disease-causing fungi, bacteria, viruses and dangerous cell proliferations. To ensure that treatment is effective later on, it is important that any HIV infection is detected by regular HIV screening during this period. There is no cure for HIV infection, but with appropriate medication, the infection can be well controlled and a full life can be lived.

Symptomatic HIV infection

In this stage, which occurs 2-8 years after infection, the immune system is already so weakened that various infections, recurrent episodes of diarrhea, skin symptoms (fungal infections, shingles, herpes), enlarged lymph nodes, fatigue, lethargy, fever, sore throat and muscle aches are regular.

Starting medication even at this stage can help a lot. Treatment cannot fully restore a weakened immune system, but it can slow further deterioration.

The AIDS stage

In this stage, which occurs 2 to 12 years after infection, the immune system is so weakened that a severe immunodeficiency syndrome (AIDS) develops.

The body is defenseless against external infections and cancers. This condition can last from 6 months to 2 years and can lead to death without medication. For immunocompromised AIDS patients, even infections that are harmless to healthy people can be fatal.

This stage is characterized by so-called opportunistic infections, febrile conditions of unknown origin. These may include stomach and intestinal disorders, chronic diarrhea, severe weight loss, various types of pneumonia, even with HIV-specific pathogens, TB, other viral infections, hepatitis (Hepatitis A, B, C), increased outbreaks of HPV wart viruses, tumor lesions, ulcers, oral complaints (gingival sores, herpes, ulceration), neurological disorders (peripheral neuropathy, ophthalmological complaints caused by CMV virus, and CMV virus induced internal medicine and brain complaints), cerebro-neurological lesions, depression, AIDS dementia, Kaposi's sarcoma (brownish mole-like lesion of larger skin size).

Of course, all of the above symptoms and diseases are also combined, never just one or two symptoms alone. A diagnosis of AIDS always requires a series of specialist examinations and tests. The appearance of the above symptoms should not immediately lead to the diagnosis of AIDS or HIV infection.