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What is AIDS and HIV?

AIDS is the English acronym for Acquired Immune Deficiency Syndrome (a “syndrome” = a complex of various different symptoms). The immune system is there to protect you against the various infections – like bacteria, fungi and viruses – which can get into your body.

AIDS is caused by an infection with HIV, the Human Immunodeficiency Virus. HIV-1 was discovered in 1983/84 followed a little later by HIV-2. Both types of virus and their subgroups (subtypes) show special features and appear with degrees of frequency that vary from continent to continent. But whatever type the virus might be, the selfsame ways of protecting yourself against it still apply. Aids refers to the stage of HIV infection where the body can develop certain life-threatening infectious diseases and tumours.

How does HIV weaken the Immune System?

HIV infects the white blood cells (also known as CD4 cells or T4 cells) and uses them to make new copies of HIV. The white blood cells are important because it is they that set the immune system in motion when the body is invaded by organisms like bacteria and viruses.

When HIV infects a body, the white blood cells mount a defence against it. But the antibodies produced by the defence mechanism cannot rid the body of HIV. A small number of infected CD4 cells are directly destroyed by the virus while many more have their indirect mechanisms damaged by the virus so that the defence they provide is inadequate or faulty. In this way the number of healthy CD4 cells is greatly reduced. And as the number of CD4 cells decline this means that the body is less and less able to defend itself against infection. In an advanced stage of immunodeficiency life-threatening diseases or 'opportunistic infections', allergies and various cancerous growths can occur.

What is the course of an HIV infection and what symptoms are there?

The course of an HIV infection can vary widely from person to person and each single case generally shows a wide degree of fluctuation. Symptoms can – but must not necessarily – appear. And between the various stages of the illness there are often long periods when no symptoms at all appear. A fully developed immunodeficiency can even occur without there being any signs of sickness (= symptoms) until the outbreak of very serious illness.

Measuring the “virus load” (= the number of viruses per millilitre of blood) is a way of showing how far the virus has reproduced itself and damaged the immune system. The greater the virus load is, the quicker the body’s immune system will be destroyed. But also counting the number of white blood cells per millilitre of blood tells us about the condition of the immune system – the fewer CD4 cells there are, the more the immune system is damaged.

The First Weeks

Shortly after infecting a body the HIV virus begins to reproduce itself heavily. In this period the risk of infecting someone else is particularly high! Usually in the first weeks after infection flu-like symptoms appear ('primary effects') which then disappear by themselves after one to two weeks. Many people hardly notice these symptoms or take them to be signs of an ordinary cold or flu. But in each case where there is an HIV infection the body reacts by producing antibodies. And these can usually be reliably diagnosed by an HIV antibody test about 8 to 12 weeks after the initial infection.

Symptom-free Phase

The HIV infection then enters into a discreet phase – in other words there are no noticeable symptoms. This phase can last a few months or a few years. But the virus still continues to reproduce and damage the immune system.

Phase with General Symptoms

At some point symptoms can occur. They are usually general symptoms like prolonged lymph node swellings at various points of the body (under the armpits, around the top of the legs), heavy night sweats and prolonged periods of diarrhoea. The symptoms which appear with an HIV infection are all non-specific – in other words they can equally occur with many other forms of illness. This is why only doctors who are experienced in this field are able to tell whether the immune system has been damaged or not.

Chronic Immunodeficiency

If certain opportunistic infections occur in a person whose immune system has been badly damaged by HIV we speak of 'AIDS'. These opportunistic infections include pneumocistis carinii pneumonia (PCP), a rare form of pneumonia, and infections of body organs like the gullet with the fungus candida albicans. Viruses like herpes simplex and herpes zoster can also cause serious infections. The most common tumours occurring in connection with AIDS are virus-caused forms of cancer like kaposi sarcoma, cervical cancer and lymphomas (malignant immune system tumours). Because HIV also infects the central nervous system, during the course of an HIV infection this can also lead to nerve damage and brain damage which usually begin slowly and without any symptoms.

How is HIV NOT transmitted?

HIV is one the infections which is very difficult to transmit. The virus itself is sensitive and cannot live long outside the human body under normal conditions. Standard hygiene at home and in hospital is enough to make it ineffective. Even so, the virus can still survive for several days in blood smears in used injecting needles!

Although HIV has been detected in urine, shit, spit, sweat and tears, it has been in such very small quantities that there is generally no danger of transmission. This means that there is no danger of transmission through shaking hands, hugging, play and sport, coughing and sneezing or using the same plates, cutlery or glasses. Equally there is no danger of transmission from using the same toilet, towel, bed linen, using the same swimming pool or sauna or working and living with people with HIV/AIDS. Nor is there any danger of HIV transmission with kissing (so long as there are no cuts on the lips or in the mouth). And insects like mosquitoes and animals cannot transmit HIV either.

How CAN HIV be transmitted?

HIV can only be transmitted when a sufficient quantity of it enters into the bloodstream or comes into contact with a mucous membrane. Infection is possible with blood – including menstrual blood – sperm, vaginal fluid and breast milk – all of which can hold high concentrations of the virus. The risk of infecting yourself and others with HIV is also much greater if you already have a sexually transmitted infection like syphilis, gonorrhoea or herpes. This is why it is very important to recognise these infections at an early stage and get them treated!

The HIV Test

An HIV test tells you for sure whether you have an HIV infection ('positive' test result) or not ('negative' test result). Knowing that you have an HIV infection enables you to start an early course of treatment which will stop or slow down serious damage to the immune system and the resultant chronic opportunistic infections.

Whether you take an HIV test or not is your own decision to make. An HIV test should never be made without your knowledge and consent, and nobody should force anyone to take a test. What is truly vital is that you should be given enough information about the test and feel that you have been adequately counselled. A counsellor should also inform you about the possible social and legal disadvantages that could result from the test or a possible positive test result. If you want to know for sure about your HIV status you should take the test three months after the last HIV risk situation at the earliest. But the HIV test is not a preventive measure. You can only protect yourself against HIV by practising Safer Sex and sticking to the Safer Sex guidelines.

Reasons for taking an HIV Test

To be certain after being in a situation where a risk of transmission was involved.
You’re not sure whether you’re infected with HIV because you’ve been in a situation where a transmission risk was present – and you want to know for sure.

Symptoms/ Starting Therapy

You have symptoms that could indicate a HIV infection and/or want to start early treatment. The HIV test has a high therapeutic significance.

Taking out a Health Insurance Policy

Some insurance companies require you to take an HIV test or present the result of a recent test before you can take out a policy.

source: Deutsche AIDS-Hilfe e.V., March 2005; Czech AIDS Help Society, o.s., June 2008

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