HIV/AIDS - And what you can do to prevent it

What is AIDS?

AIDS is the abbreviation for "Acquired ImmunoDeficiency Syndrome" and stands for a certain combination of symptoms. Numerous individual diseases can occur in the course of AIDS. AIDS is a disease caused by the human immunodeficiency virus (HI) virus. It is often a long time from infection with the virus to the first symptoms of the disease. During this time, however, the HI virus can already be passed on to other people, e.g. the sexual partner. In the last 25 years, the spread of the HI virus has expanded into a pandemic that has already claimed around 25 million lives. Today more than 30 million people worldwide are already infected with the HI virus. The number is steadily increasing worldwide. In Germany, however, it has fortunately fallen in the last year, according to the latest figures from the Robert Koch Institute.

The AIDS disease progresses in several phases. The more advanced the disease is, the more symptoms appear. The weakened body can no longer defend itself against infections that cannot harm a healthy person (opportunistic infections). These diseases gradually lead to the full onset of AIDS and ultimately death.

If you suspect that you have been infected, you should see a doctor as soon as possible, ideally within two hours, to have PEP (post-exposure prophylaxis) carried out! This no longer makes sense after 72 hours or more.

What is HIV?

HIV is a virus, the human immunodeficiency virus (HI) virus. There are two different types of the HI virus. Type 1 was first described in 1983 (type 2: 1986). However, the first documented HIV infection was in Zaire in 1959. However, the time of the very first human HIV infection is probably even earlier, in the early 20th century. How the virus developed is unclear. What is certain, however, is where it came from: from a virus (SIV) that first only occurred in monkeys, and later also in great apes. There are different types of the HI virus, which occur in different concentrations depending on the region.

The HI virus is a retrovirus that attaches itself to human cells, which then become host cells. The HI virus consists partly of human cell components. As a result, it "hides" itself from the human immune system, so to speak. It destroys the host cells and other surrounding cells. In the early stages, this cell loss can be compensated for by the formation of new cells. At the same time, the HI virus ensures that the human body can no longer fight other viral diseases over time. Because in the attempt, instead of fighting the disease, more HI viruses are released. This is what makes treatment so difficult!

Untreated HIV infection progresses through several phases. Acute HIV infection occurs shortly after infection and lasts four weeks at most. Due to the strong similarity to an ordinary viral flu, it usually remains undetected. An early diagnosis is immensely important for therapy and the prevention of further new infections!

In the subsequent latency phase ("resting phase"), which lasts several years, there are hardly any symptoms. A gradual change in blood values, the first illnesses that indicate a poorly functioning immune system, and gradual lipodystrophy (a change in the subcutaneous fatty tissue with the risk of developing diabetes/cardiovascular diseases) usually go unnoticed.

After that, a severe immune deficiency gradually develops, which eventually leads to AIDS. Since an HIV infection cannot be cured, it inevitably leads to the death of the person affected sooner or later. Good drug treatment as early as possible not only slows down the course of the disease, but also significantly improves the quality of life.

How is HIV transmitted? And how not?

HIV is a virus that is relatively difficult to transmit. It is already rendered harmless by the usual hygiene measures (in the home, hospital, tattoo studio, etc.).

According to current knowledge, infection through tears, faeces, urine, sweat and saliva is very unlikely. Firstly, the concentration of the HI virus is very low and secondly, the way it is spread speaks against a so-called droplet infection. HIV cannot be transmitted through biting insects or other animals either.

Many people are afraid to touch or work with an HIV-positive person. For this reason, here is a brief overview of how not to get infected:

Through kisses
Drinking together from a glass, using the same plate/cutlery
When hugging, shaking hands, caressing
When playing and exercising
When visiting a swimming pool or sauna
Shared use of toilets, towels, bed linen
By coughing/sneezing
When working/living together

And here is a (certainly incomplete) summary of possible transmission routes:

blood transfusions
"Needle sharing" in drug addicts
all kinds of sexual contacts (oral, vaginal and anal)
via breast milk
at birth
if open wounds or easily injured areas come into contact with HIV-infected blood/sperm/vaginal secretions/liquor

Viral load (and thus the likelihood of infecting someone) is particularly high in HIV-infected people soon after infection, as well as late in the course. In between she takes something off.

A possible infection via blood transfusions is hardly likely in Germany (0.0001%), since there are now reliable HIV tests for donated blood. A great deal is also made possible for HIV-positive (expectant) mothers in Germany, including through education, in order to prevent the child from being infected (the risk is then around 2%). Non-profit associations and aid organizations undertake the educational work for drug addicts, especially in large cities. Clean needles etc. are also distributed there.

Transmission during life-saving measures has not yet been described. Disposable gloves protect against contact with blood or other body fluids. Fear of HIV is no reason to refrain from life-saving measures!

A much larger proportion of new infections worldwide occur through sexual contact. More on this in the article "Safer Sex - but how?".

Diagnosis of HIV

Important: Any HIV test may only be carried out with the consent of the person concerned. Any other action is not legally permissible. An HIV infection is notifiable in Germany (anonymously!). The costs for an HIV test at the doctor's are not covered by health insurance in Germany! Ask your doctor for the current price. Many health authorities/AIDS organizations offer a cheaper or free HIV test! Find out more about this on site.

There are several types of HIV testing. The search test (e.g. ELISA search test) should detect as many infections as possible. This test is usually carried out by the general practitioner. It takes about 3-4 days from the test to the result. The test is designed to show whether the blood contains antibodies against HIV or a specific protein (p24 antigen) from the virus's envelope. It sometimes gives a false positive result (0.02%). For this reason, it is mandatory in Germany, for example, to carry out a confirmation test (e.g. Western blot confirmation test) for every positive result.

Unfortunately, even a negative result does not automatically mean that you are 100% HIV-free. Because only about 3 months after an infection, this can be determined with a test with relative certainty (95-99%).

The most expensive and safest HIV test is the RT-PCR test, which detects the HI virus itself in the blood. This test is carried out, for example, on blood donations, on newborns (who have an HIV-positive mother) or in the rescue center if an acute HIV infection is suspected. It is also used to monitor the progress of antiretroviral therapy.

There are also point-of-care tests that show results after just a few minutes. Many AIDS organizations in large cities such as Berlin, Frankfurt or Cologne already offer such rapid tests. It is also frequently carried out in developing countries, since it is usually the only way to prove an HIV infection. A quick test is also useful when quick clarification is needed, e.g. during an operation if the surgeon injures himself.

A quick test at home, without medical supervision, is not reliable proof that you are not infected with HIV! If the result is positive, you should consult a doctor for further tests or treatment.

Since in some (African) countries an HIV test is unaffordable or cannot be carried out comprehensively, the diagnosis is carried out using the Bangui definition. A table lists certain symptoms, each of which is worth a certain number of points. If more than 12 points are reached and there are no exclusion criteria (e.g. cancer), the diagnosis AIDS is made. There is also an adapted version of the Bangui definition for children.

Treatment of HIV/AIDS

An HIV infection cannot (currently) be cured. Even if nowadays it is possible to live a relatively long time with the right therapy and the quality of life of those affected has improved significantly - sooner or later an HIV infection leads to AIDS and the death of the infected person. In addition to the therapies listed below against the HI virus itself, the concomitant diseases and AIDS-defining diseases are usually treated separately. For example, it is necessary to use antimycotics against fungal diseases, or antidiabetics if diabetes has developed due to the frequently occurring lipodystrophy. There are also medications to counteract the numerous side effects of ART drugs. In addition, there are medicines and aids (e.g. a mobile oxygen supply) that improve the quality of life of AIDS patients, especially in the final stages. In any case and at any stage of the disease, it is important that the doctor treating you knows exactly what the HIV infection is in order to optimally coordinate the treatment. Here is a brief overview of the most common HIV therapies.

Post-exposure prophylaxis (PEP): PEP is performed as soon as possible after the probable infection. It consists of several measures, starting with general measures such as washing the genitals, expressing puncture wounds (unclean syringes!) or disinfecting wounds. Antiretroviral drugs are also given as a preventive measure. For this reason, it is very important to see a doctor as soon as possible! The duration of treatment is about 4 weeks. The costs for the treatment are covered by health insurance if there was actually a risk of infection. A doctor must assess whether this is the case. It has not been researched with certainty whether PEP really prevents HIV infection.

Antiretroviral Therapy (ART): ART is taking HIV-suppressing drugs. Unfortunately, resistance of the HI virus to the active ingredients quickly develops. Once started, ART should not be aborted! Regular tablet intake is essential. In order to achieve greater success in AIDS therapy, the combination therapy HAART was developed from ART.

Highly activated antiretroviral therapy (HAART): HAART is a drug therapy with a combination of at least three antiretroviral agents. The aim is to delay the outbreak of AIDS as far as possible. The viral load is pushed below the detection limit and the immune system is strengthened. Even successful therapy with HAART does not offer a cure for HIV! Treatment with a HAART is constantly in the development phase. Accordingly, there are always new and nationally different recommendations as to when the best time to start HAART is.

A vaccination against HIV does not yet exist. All attempts have so far failed due to the rapid mutating ability of the HI virus.