An Overview of HIV/AIDS

US Pharm. 2022;47(12):5-6.

The human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. If HIV is not properly treated, it can lead to acquired immunodeficiency syndrome (AIDS). Studies show that HIV may have jumped from chimpanzees in Central Africa to humans as far back as the late 1800s.¹ The chimpanzee version of the virus is called simian immunodeficiency virus. It was probably passed to humans when they hunted these chimpanzees for meat and came in contact with their infected blood. Over decades, HIV slowly spread across Africa and later into other parts of the world. The virus has existed in the United States since at least the mid to late 1970s.¹

There is currently no effective cure for HIV. People infected with HIV have it for life, but with proper medical care, HIV can be controlled. AIDS Healthcare Foundation (AHF) is the largest provider of HIV/AIDS care in the world. AHF offers multiple services to complete an easy-to-use circle of care.²

Initial Symptoms

Most people with HIV show flu-like symptoms within 2 to 4 weeks of infection. Symptoms may last for a few days to several weeks. Other illnesses cause similar symptoms, and some people show no symptoms at all, so the only way to know if someone has HIV is to get tested.³

Flu-like symptoms can include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers.³

HIV Stages

When people with HIV do not get treatment, they typically progress through three stages, but proper treatment can slow or prevent progression of the disease. With advances in HIV treatment, progression to stage III (AIDS) is less common today than in the early years of HIV.^1,4

Stage I: Acute HIV Infection

• People have a large amount of HIV in their blood and are very contagious.
• Many people have flu-like symptoms.
• Testing is required to determine whether a person has HIV.

Stage II: Chronic HIV Infection

• Also called asymptomatic HIV infection or clinical latency.
• HIV is active and continues to reproduce in the body.
• People may not have any symptoms or get sick during this phase, but they can transmit HIV.
• Without HIV treatment, this stage may last longer, or may progress faster. At the end of this stage, the amount of HIV in the blood (viral load) goes up, and the person may move into stage III (AIDS).
• With an undetectable viral load, persons can live and have a long and healthy life and will not transmit HIV to their HIV-negative partners through sex.
• If the viral load is detectable, the person can transmit HIV during this stage, even when they have no symptoms. It is important to regularly test the viral load.

Stage III: Severe HIV Infection

• People with AIDS can have a high viral load and may easily transmit HIV to others.
• People with AIDS have badly damaged immune systems. They can get an increasing number of opportunistic infections or other serious illnesses.
• Without HIV treatment, people with AIDS typically survive about 3 years.

Symptoms of AIDS include⁵:

• Rapid weight loss
• Recurring fever or profuse night sweats
• Extreme and unexplained tiredness
• Prolonged swelling of the lymph glands in the armpits, groin, or neck
• Diarrhea that lasts more than a week
• Sores of the mouth, anus, or genitals
• Pneumonia
• Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
• Memory loss, depression, and other neurologic disorders.

If a person is HIV-positive, a healthcare provider will diagnose whether the HIV has progressed to stage III (AIDS) based on certain medical criteria. Many of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that occur because the body’s immune system has been damaged.⁶

Treatment

The treatment for HIV is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines, called an HIV treatment regimen, every day. ART is recommended for everyone who has HIV. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives.⁷

Most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take the entirety of the prescribed medication daily to maintain durably undetectable status.

Although there is no cure for HIV, early diagnosis can aid in timely initiation of ART that can stop the virus from damaging the immune system. An HIV patient who has received timely treatment can live a normal and long life without progressing to late-stage HIV.

First-line ART regimens consist of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs; zidovudine or stavudine and lamivudine) and one nonnucleoside reverse transcriptase inhibitor (nevirapine or efavirenz), while second line consists of ritonavir-boosted lopinavir with two NRTIs.⁷

The mostly used regimen is Biktarvy. Biktarvy is indicated as a complete regimen for the treatment of HIV-1 infection in adult and pediatric patients weighing ≥25 kg who have no ART treatment history or to replace the current ART regimen in those who are virologically suppressed (HIV-1 RNA <50 copies per mL) on a stable ART regimen with no history of treatment failure and no known resistance to any component of Biktarvy.⁸

Biktarvy is a complete HIV-1 treatment that combines three powerful medicines (bictegravir, emtricitabine, and tenofovir alafenamide) into one small pill, and it is taken once a day with or without food.⁸

Patient Recommendations

• Find an HIV testing site nearby. People can get an HIV test at the primary care provider’s office, local health department, health clinic, or many other places.
• Request an HIV test for recent infection. Most HIV tests detect antibodies, not HIV itself, but it can take a few weeks for the body to produce these antibodies. There are other types of tests that can detect HIV infection sooner.
• Know your status. Persons who are HIV-positive must see a healthcare provider as soon as possible so they can start treatment with HIV medicine.
• Be aware. Persons who are in the early stage of infection are at high risk of transmitting HIV to others. It is important to take steps to reduce risk of transmission. If persons are HIV-negative, there are prevention tools like preexposure prophylaxis that can help them stay negative.⁹

Future Directions

A major goal of the National Institute of Allergy and Infectious Diseases—which supports research on HIV treatment—is to develop long-acting therapies that require daily dosing to be taken only once a week, once a month, or even less often. Such long-acting therapies might be easier for many people to stick to than daily pills and might also be less toxic and cost effective. The types of approaches under study are long-acting drugs, broadly neutralizing antibodies, and therapeutic vaccines.

REFERENCES

1. World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunologic classification of HIV-related disease in adults and children. Geneva, Switzerland: World Health Organization; 2007:1-48.
2. CDC. Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep. 2014;63:1-10.
3. Lagathu C, Cossarizza A, Bereziat V, et al. Basic science and pathogenesis of ageing with HIV: potential mechanisms and biomarkers. AIDS. 2017; 31(suppl 2):S105-S119.
4. National Academies of Sciences, Engineering, and Medicine. HIV Screening and Access to Care: Exploring the Impact of Policies on Access to and Provision of HIV Care. Washington, DC: National Academies Press; 2011.
5. Donnell D, Baeten JM, Kiarie K, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092-2098.
6. National HIV/AIDS Housing Coalition. 2010. HOPWA. http://nationalaidshousing.org/legisadvocacy/hopwa/. Accessed September 29, 2022.
7. Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA Panel. JAMA. 2020;324:1651-1669.
8. Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) package insert. Foster City, CA: Gilead Sciences; 2021.
9. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013; 8:e81355.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

To comment on this article, contact rdavidson@uspharmacist.com.