Introduction

The Human immunodeficiency virus (HIV) is a viral contamination that attacks the body defense system, specifically the white blood cells referred to as CD4 cells. When untreated, HIV reduces the CD4 count, thus weakening the immune system and makes the body susceptible to other infections such as tuberculosis and some cancers. By 2016, the CDC estimated that there were 1,140,400 people 13 years and above living with HIV in the U.S but only 977,900 were diagnosed. Among the 1,140,400, 77% were males, and 23% were female (Spach, 2019). 57% of the infections were from male to male sexual activities and injections for drugs which can explain the high rate of males. In terms of race, the African Americans had the highest rate at 42%, followed by whites at 30%, Hispanics at 22% and other races at 6%. The prevalence was high among the age group of 45-54 and 55 and above years. 61% of those living with HIV were 45 years and above. In 2017, an estimated 38,281 new infections occurred with this number being 81% males and 19% females. It is evident from figures that HIV is more prevalent in males than females in the U.S more so due to increased male to kale sexual encounters and drug use (Spach, 2019).

Etiology and risk factors

HIV as an illness is caused by the human immunodeficiency virus, which is commonly spread through connection with semen, blood and virginal fluid. The most common way through which the virus is spread is by participating in sex with an infected person without protection. Another risk factor is sharing injection needles with infected people which is common with illegal drug users. Furthermore, the virus can be shared by the mother to her baby during pregnancy or after birth through breastfeeding. Globally, women account for more than half of people living with HIV. Studies have shown that individuals with two copies of CCR5-delta32 acquired from both parents have a low risk of acquiring HIV-1 (Ni, Wang & Wang, 2018). The prevalence based on gender varies with regions. In Africa, where the epidemic is worse, women have a higher prevalence than men. In Ethiopia, for example, the HIV prevalence for women is 1.62 times more than for men (Girum et al., 2018).

Pathophysiological processes

HIV has two cylindrical centers enclosed by a lipid bilayer envelope. The bilayer has two virus-related glycoproteins which facilitate the acknowledgement of CD4+ cells as well as chemokine receptors, thus allowing the virus to assign itself to the CD4+ cells. Cells infected have a short lifespan in that the virus uses them as a factory to reproduce. HIV is thus forced to use new cells to reproduce daily. Within five days of infection, the affected cells reach the peripheral blood, and lymph nodes and replication become rapid. The HIV lifecycle has six stages, including binding and entry, reverse transcription, integration, replication, budding, and maturation (Calles, Evans & Terlonge, 2010, p. 10). After maturation, an infected person can take years to portray any signs or symptoms but can develop molluscom contagiosum, herpes zoster, candidiasis or persistent hepatosplenomegaly.

Clinical manifestation & complications

In considering the presence of HIV, several physical signs and symptoms are significant. A major sign is a red rash on the torso that does not itch, arching muscles, swollen lymph nodes, fever or headache. Symptoms that contribute to the diagnosis of the condition include rapid weight loss, unceasing fever, extreme fatigue, extended swelling of the lymph nodes in the neck, groin and armpits, severe headaches, joint aches and spells of diarrhea lasting longer than one week (Hoenigl et al., 2016). HIV weakens the immune system and increases the risk of developing other infections as well as some cancers. When HIV is currently not curable, there are medications that keep the virus suppressed. If untreated, however, HIV turns into acquired immunodeficiency syndrome (AIDS). At this phase, the immune system is brutally damaged, increasing the risk of developing infections that are not common to those who are not infected increases. The CD4 cells count at this stage is low making it hard for the body defense mechanism to fight off a wide range of infections.

Diagnosis

There are several tests that are used to diagnose HIV, as discussed below.

• HIV antibody tests: HIV has several inimitable proteins. Once infected, the body produces antibodies that label the virus for removal by the defense system (Alexander, 2016). While the antibodies cannot eradicate the virus, they act as an indication of HIV presence in the body and an antibody tests detects the presence of the antibodies. The test is done on a blood sample.
• HIV RNA tests: HIV has a unique RNA from human RNA, and there are tests that detect the presence of HIV RNA in the body (Alexander, 2016). A common test is the polymerase chain reaction but is costly and not commonly used for diagnosis.
• HIV antibody-antigen test: This test spots the antibodies focused towards HIV-1 and 2 as, (Alexander, 2016).

References

Alexander, T. S. (2016). Human immunodeficiency virus diagnostic testing: 30 years of evolution. Clin. Vaccine Immunol., 23(4), 249-253.

Calles, N. R., Evans, D., & Terlonge, D. (2010). Pathophysiology of the human immunodeficiency virus. HIV curriculum for the health professional. Baylor Pediatrics International AIDS Iniciative, Texas, USA, Baylor College of Medicine, 7-14.

Girum, T., Wasie, A., Lentiro, K., Muktar, E., Shumbej, T., Difer, M., … & Worku, A. (2018). Gender disparity in epidemiological trend of HIV/AIDS infection and treatment in Ethiopia. Archives of Public Health, 76(1), 51.

Hoenigl, M., Green, N., Camacho, M., Gianella, S., Mehta, S. R., Smith, D. M., & Little, S. J. (2016). Signs or symptoms of acute HIV infection in a cohort undergoing community-based screening. Emerging infectious diseases, 22(3), 532.

Ni, J., Wang, D., & Wang, S. (2018). The CCR5-Delta32 genetic polymorphism and HIV-1 infection susceptibility: a meta-analysis. Open Medicine, 13(1), 467-474.

Spach, D. (2019). Core Concepts – Epidemiology of HIV – Screening and Diagnosis – National HIV Curriculum. Retrieved 9 February 2020, from https://www.hiv.uw.edu/go/screening-diagnosis/epidemiology/core-concept/all