latency period of AIDS



OVERVIEW

Definition

The AIDS incubation period is the time from infection with the human immunodeficiency virus (HIV) until the onset of AIDS-related signs and symptoms.

The HIV incubation period is usually 2 to 15 years, with an average of 7 to 10 years and a maximum of 14.2 years [1-3].

The incubation period is not a safe period, the virus will continue to replicate in the body, which is destructive to the human immune system, and patients in this period are contagious and an important source of infection.

Morbidity

There is no clear data on the morbidity of HIV incubation period, mainly related to the morbidity of HIV-infected patients and patients with AIDS (AIDS).

As of October 2021, there are approximately 1.14 million people living with HIV and AIDS in China [4].

In 2019, 1.2 million people were living with HIV in the United States, and about 13% were unaware of their condition [5].

By the end of 2021, about 38.4 million people will be living with HIV or AIDS globally, with 1.5 million new HIV infections in that year, and 75% of people living with HIV or AIDS are receiving antiretroviral therapy [5].

Causes

Causes of disease

The basic conditions that lead to infection include infectious agents, routes of transmission, and susceptible populations.

Sources of infection

Asymptomatic HIV-infected patients and AIDS patients are sources of infection, and HIV-infected patients carry the virus in their blood, semen, vaginal secretions, breast milk, amniotic fluid, and other body fluids.

Routes of transmission

HIV cannot be transmitted through the respiratory tract, food, sweat, tears, saliva, cutlery, handshake, sharing office supplies, etc. The specific ways of transmission are as follows.

Sexual contact is the main way of HIV transmission, including sexual contact between homosexuals and heterosexuals, especially male homosexuals are more likely to be infected.

Blood transmission includes transfusion of HIV-contaminated blood or blood products, sharing HIV-contaminated needles with intravenous drug addicts, transplanting or receiving organs from HIV-infected people, and medical staff being stabbed by HIV-contaminated medical instruments.

HIV-infected mothers transmit HIV to their newborns through the placenta, birth canal and breastfeeding.

Susceptible Population

People are generally susceptible.

Male homosexuals, polygamists, intravenous drug users, spouses or sexual partners of HIV-infected persons, and infants of HIV-positive mothers are among the high-risk groups.

Pathogenesis

HIV enters the human body and replicates in the body. The genes of the virus are integrated with human DNA through reverse transcription, resulting in a long incubation period.

HIV virus mainly attacks CD4+ T lymphocytes, causing a continuous decrease in the number of CD4+ T lymphocytes, leading to immunodeficiency of the body, secondary to a variety of opportunistic infections and malignant tumors, etc., causing the corresponding clinical manifestations, which belongs to the incubation period before the appearance of clinical symptoms [1].

Symptoms

Clinically, AIDS is often divided into three stages: acute infection, asymptomatic stage and AIDS stage, of which the latent stage is the asymptomatic stage of AIDS, during which there are often no AIDS-related symptoms and signs.

It should be noted that filiform warts are not a manifestation of the latent stage of AIDS. Filiform warts are lesions caused by human papillomavirus (HPV) infection of the skin and mucous membranes, whereas AIDS is caused by human immunodeficiency virus (HIV) infection, and the two are not related.

Consultation

Department of Medicine

Department of Infectious Diseases

If you have high-risk behaviors for HIV infection, such as unprotected sex, sharing syringes for intravenous drug use, etc., you can consult the Department of Infectious Diseases for further diagnosis.

Fever Clinic

If you are at high risk for HIV infection and have symptoms such as fever, malaise, sore throat, myalgia, anorexia, nausea, etc., you can also consult the Fever Clinic.

Dermatologic and Venereal Disease Clinic

If you suspect that you may be infected with HIV, you may also visit the Dermatology and Venereology Clinic to be tested for HIV and STDs.

Preparation

How to get to the clinic: registering, preparing documents, and frequently asked questions.

Tips for the doctor

If you have a fever, you may apply physical cooling measures such as applying ice on the forehead and warm water to the armpits before seeking medical treatment.

Preparation Checklist

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Any fever, malaise, rash, sore throat, myalgia, anorexia, nausea, etc.?

Is there unprotected male-to-male sex?

Are there multiple sexual partners?

Any history of intravenous drug use?

Test results in the last 1 month that can be brought to the doctor’s office

Laboratory tests: blood test, liver and kidney function, coagulation function, HIV antibody, etc.

Imaging tests: chest CT, etc.

Medication in the last 1 month, if available, bring along the box or package for medical consultation

Antipyretic and analgesic drugs: ibuprofen, acetaminophen, etc.

Diagnosis

Diagnosis is based on

Medical history

Patients with this disease may have a history of the following.

History of multiple sexual partners.

Male-to-male sexual behavior.

History of shared syringe intravenous drug use.

History of sexually transmitted diseases.

Working in a job that provides sexual services.

Importation of untested blood or blood products.

Clinical manifestations

Patients in the latent phase of the disease have essentially no AIDS-related symptoms.

Laboratory Tests

White blood cells, red blood cells, hemoglobin and platelets, and lymphocytes may be decreased to varying degrees or may be normal.

T-lymphocyte subpopulation examination may suggest an inverted CD4/CD8 cell ratio and a decrease in CD4+ T-lymphocytes, but they are usually still greater than 2000/mm3.

Tests such as enzyme-linked immunosorbent assay, chemiluminescence, and immunofluorescence can detect antibodies to HIV antigens as a primary screening test. If the initial screening test is positive, a confirmatory HIV antibody test (immunoblotting, strip/linear immunoassay, etc.) can be performed to confirm the diagnosis of HIV infection.

HIV nucleic acid is detected by qualitative or quantitative methods.

HIV can be isolated and cultured by PCR from blood, semen, cerebrospinal fluid, and other specimens, but the procedure is complicated and is currently used only for scientific research.

Diagnostic Criteria

Epidemiologic history, combined with positive HIV antibody primary screening test and confirmatory test or positive HIV nucleic acid, quantitative HIV nucleic acid >5000 copies/ml can be diagnosed, combined with the absence of any AIDS-related symptoms, then it is considered that it may be the latent stage of AIDS [7].

Differential diagnosis

Both diseases can lead to a decrease in CD4+ T lymphocytes, decreased immune function, and increased opportunistic infections. However, primary CD4+ T lymphocytopenia is not caused by HIV infection and can be differentiated by HIV antigen antibody or nucleic acid testing.

Decreased CD4 cell counts can also occur in patients with tumors receiving radiation or chemotherapy, or in patients with organ transplants or autoimmune diseases receiving glucocorticoids or immunosuppressive drugs. This can be differentiated by medical and medication history, or by HIV-related testing.

Treatment

Aims of treatment: to control HIV viral load, rebuild immune function, delay disease progression, reduce mortality, prolong survival, improve quality of life, and reduce HIV transmission.

Treatment principle: Currently there is no cure for AIDS, and comprehensive treatment measures such as antiretroviral and supportive therapy are adopted.

Antiviral treatment

At present, there are more than 30 kinds of antiviral drugs in 6 categories, including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, integrase inhibitors, and co-receptor antagonists, which are often used in combination, and all of them are required to be used under the guidance of doctors.

Nucleoside reverse transcriptase inhibitors (NRTIs)

NRTIs selectively bind to HIV reverse transcriptase and inhibit HIV replication and transcription. Common drugs include tenofovir, propofol tenofovir, lamivudine, emtricitabine, azulfidine, zidovudine, and abacavir.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs bind noncompetitively to HIV reverse transcriptase and inhibit HIV replication. Commonly used drugs include efavirenz, nevirapine, rilpivirine, doravirine, and enoxaparin.

Protease inhibitors

Protease inhibitors can effectively prevent the further processing of HIV precursor proteins and inhibit the synthesis of HIV progeny. Commonly used drugs include Lopinavir, Ritonavir, Darunavir, Atazanavir, etc.

Fusion inhibitors

Fusion inhibitors block the fusion of HIV with the cell membrane, thus inhibiting viral replication. Commonly used drugs are Enfuvirtide and Ebovitide.

Integrase inhibitors

Integrase inhibitors block the integration of viral genes into the body’s DNA, thus preventing the creation of a viral reservoir. Commonly used drugs are dolutegravir, bictegravir, raltegravir, and elviravir.

Co-receptor antagonists

Co-receptor antagonists act on the second receptor to mutate its gene, thus preventing the HIV virus from entering the target cells, and at the same time, the body can obtain natural immunity against HIV-1. The most commonly used drug is maraviroc.

Supportive therapy

Supportive therapy includes psychotherapy, immunomodulation and so on.

Patients with HIV latency are prone to negative emotions such as low self-esteem, depression, fear, etc. Family members or the society should provide psychological support, and patients can undergo psychotherapy when necessary.

If necessary, interferon, interleukin 2, gammaglobulin, etc. can be used for immune regulation to help rebuild the immune function.

Various opportunistic infections or tumors secondary to AIDS in the late stage of the disease require appropriate anti-infection or anti-tumor treatment.

Prognosis

Cure

There is no cure for AIDS. If detected and treated early in the latent stage of the disease, progression to the AIDS stage can be delayed and a normal life expectancy may be achieved.

After antiretroviral treatment, the vast majority of patients with HIV/AIDS have their immune abnormalities gradually restored to normal or near-normal levels, i.e., their immune function is rebuilt. 10-20% of patients have poorly rebuilt immune function, and the risk of opportunistic infections rises.

Patients who enter the AIDS stage may die within 2 years if they are not given effective antiretroviral therapy.

Infection in infants and young children due to mother-to-child transmission progresses more rapidly, and most die within 1 to 5 years if left untreated.

The life expectancy of people infected with HIV through the intravenous route of drug addiction is shorter than that of people infected by other routes [1-4,6].

Harmfulness

HIV latency can progress to AIDS stage and there can be severe disruption of immune function leading to increased risk of contracting other diseases such as tuberculosis, Pneumocystis carinii pneumonia, Toxoplasma gondii encephalitis, cryptococcal meningitis, cytomegalovirus retinitis, Kaposi’s sarcoma, and lymphoma to name a few, which can affect life expectancy.

AIDS patients who inadvertently transmit the virus to others may infect them with HIV or develop AIDS, jeopardizing the health of others.

Daily

Daily Management

Diet

There are no special dietary requirements, just follow the principle of “variety, small amount and balance”.

High-protein foods: High-protein foods include fish and shrimp, poultry, soybean products, dairy products, etc. However, a high-protein diet will increase the risk of kidney disease. However, a high protein diet will increase the burden on the kidneys. If you are not feeling well, please contact your doctor or dietitian for appropriate dietary adjustments.

Supplement vitamins and minerals: You should eat more fresh fruits and vegetables, especially foods rich in carotene (e.g. sweet potatoes, pumpkin, carrots), vitamin C (e.g. oranges, broccoli), vitamin E (e.g. pine nuts, pistachio nuts), and zinc-containing foods (e.g. oysters, shellfish, cereals).

Avoid raw, cold, greasy and unbalanced nutrition: raw, cold and greasy food will easily cause diarrhea and affect the absorption rate of food; avoid skipping breakfast, partiality and overeating, which will result in unbalanced nutrition and affect the immune function.

Life management

Do not share personal items that can easily come into contact with blood, such as manual razors, nail clippers and toothbrushes.

Disinfect personal items that have come into contact with blood or body fluids after use by boiling (100°C) for 20 minutes or soaking in 70% alcohol (medical alcohol) to inactivate the virus.

Having a regular sexual partner who is aware of the disease allows for psychological and behavioral precautions to be taken. Use condoms throughout sexual intercourse and do not take any chances.

Spouses should go to the hospital regularly for screening and timely treatment if they are infected with HIV.

Maintain a good mindset, positive treatment, and do not give up on yourself.

Family members should provide patients with care in life and spiritual encouragement, and avoid discrimination.

Inform medical personnel clearly about HIV when seeking medical treatment, especially before blood sampling, gastroscopy, enteroscopy, vaginal examination, anal examination, dental scaling, tooth extraction and other examinations or treatments, so as to avoid spreading the infection to others.

It is strictly prohibited to donate blood, sperm or organs that can be transmitted to others.

Prevention

There is no effective vaccine to prevent AIDS. The main way to prevent AIDS is to cut off the transmission channels, and if there is a risk of exposure, you can use drugs to prevent it.

Cutting off the means of transmission

Establish a healthy concept of sex, use condoms correctly and practice safe sex.

Do not use drugs or share intravenous needles.

HIV-infected persons or patients should inform their sexual partners and not share personal items such as razors.

HIV-infected persons or patients should avoid organ and blood donation.

Pre-exposure prophylaxis

High-risk groups who often face a high risk of infection, such as sex workers and multiple sex partners, can reduce the chance of being infected by taking medications in advance, which need to be applied under the guidance of a doctor [7].

Post-exposure prophylaxis

People who are not yet infected with HIV can take measures such as cleaning and disinfecting the wound and squeezing blood out of the wound to the distal end after being exposed to a high risk of infection, as well as taking a 4-week course of HIV post-exposure blocking medication within 72 hours if possible, to reduce the risk of being infected with HIV [7,10-11].