Undetectable = Untransmittable? The Truth About HIV Treatment

1. Etiology

• Pathogen: Human Immunodeficiency Virus (HIV).
• Types:
  • HIV-1 (global, more aggressive).
  • HIV-2 (West Africa, slower progression).
• Action: Destroys CD4+ T-cells, weakening immunity.

2. Transmission

1. Sexual (unprotected vaginal/anal/oral sex).
2. Blood (transfusions, shared needles).
3. Vertical (mother to child during birth/breastfeeding).
4. Rare: Organ transplants, open wounds.

Not transmitted:

• Via saliva, sweat, hugs, household contact.
• Through mosquito bites.

3. Symptoms by Stage

1. Acute phase (2–4 weeks post-infection):

• Fever, fatigue, swollen lymph nodes.
• Rash, sore throat (flu-like symptoms).

2. Latent phase (5–10 years):

• Asymptomatic (virus replicates silently).

3. AIDS (terminal stage):

• Opportunistic infections (TB, pneumonia, candidiasis).
• Weight loss, chronic diarrhea.
• Cancers (Kaposi’s sarcoma, lymphomas).

4. Diagnosis

1. ELISA (HIV antibodies) – detects after 3–12 weeks.
2. PCR (viral DNA) – detects after 2–4 weeks.
3. Rapid tests (blood/saliva) – results in 15–30 min.
4. Western blot – confirmatory test.

Key point:

• “Window period” (3–12 weeks) – tests may be false-negative.
• Re-test at 3 and 6 months if high-risk exposure.

5. Prevention

• Condoms for every sexual act.
• PrEP (pre-exposure prophylaxis) – for high-risk groups.
• Sterile tools (tattoos, piercings, needles).
• Testing all pregnant women.

Emergency PEP:

• Start antiretrovirals within 72 hours after exposure.

6. Treatment (ART – Antiretroviral Therapy)

• Goal: Reduce viral load to undetectable levels.
• Drugs: 3–4 medication combo (e.g., tenofovir + emtricitabine + dolutegravir).
• Lifelong treatment – stopping leads to resistance.

Efficacy:

• With early treatment, life expectancy = general population.
• 96% lower transmission risk to partners.

7. How to Recognize HIV?

Early signs:

• Prolonged fever + rash after unprotected sex.
• Swollen lymph nodes (neck, armpits, groin).

Late signs (AIDS):

• Oral/esophageal thrush.
• Shingles.
• Extreme fatigue.

Crucial: Only testing confirms HIV!

8. Post-Exposure First Aid

1. Within 2 hours:
   • Rinse mucous membranes (mouth, genitals) with antiseptic.
   • For needle sticks – squeeze out blood, disinfect with alcohol.
2. Within 72 hours:
   • Start PEP (post-exposure prophylaxis) prescribed by a doctor.
3. After 1–3 months:
   • Get PCR + ELISA tests.

9. How to Identify HIV in Others?

Visible signs (late-stage only):

• Severe weight loss.
• White mouth patches (thrush).
• Purple skin lesions (Kaposi’s sarcoma).

But:

• 80% of carriers look healthy for years!
• Only a test provides certainty.

HIV vs. AIDS: Key Differences Explained

1. HIV (Human Immunodeficiency Virus)

• What it is: A virus that attacks the immune system (specifically CD4 cells).
• Transmission: Spread through blood, sexual contact, or mother-to-child.
• Symptoms:
  • Early stage: Flu-like illness (fever, rash, swollen lymph nodes).
  • Chronic stage: Often no symptoms for years.
• Treatment: Controlled with antiretroviral therapy (ART). People with HIV can live long, healthy lives.

2. AIDS (Acquired Immunodeficiency Syndrome)

• What it is: The final, most severe stage of untreated HIV infection.
• Diagnosis criteria:
  • CD4 count <200 cells/mm³ (normal: 500–1600).
  • OR the presence of opportunistic infections/cancers (e.g., tuberculosis, Kaposi’s sarcoma).
• Symptoms:
  • Rapid weight loss, chronic diarrhea.
  • Severe infections (pneumonia, meningitis).
  • Skin lesions, neurological damage.
• Treatment: Requires immediate ART but may not fully restore immune function.

Key Differences

Factor	HIV	AIDS
Definition	Virus that weakens immunity	Late-stage HIV (immune system destroyed)
Progression	Can be controlled with medication	Develops after years of untreated HIV
Symptoms	Often asymptomatic for years	Severe, life-threatening illnesses
Transmission	Contagious at all stages	Not “caught” – it’s HIV’s end stage
Life Expectancy	Near-normal with ART	2–3 years without treatment

Critical Notes

• HIV → AIDS: Only happens if HIV is not treated. With ART, most people never develop AIDS.
• “Undetectable = Untransmittable (U=U)”: Proper treatment makes HIV non-contagious (<200 copies/mL).
• AIDS is reversible: Starting ART can rebuild immunity, moving patients back to “HIV” status.