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Human immunodeficiency virus (hiv) and Small Fiber Neuropathy (SFN)

Introduction to Human immunodeficiency virus (HIV)

Description:

Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. If left untreated, HIV reduces the number of CD4 cells in the body, making the person more likely to get infections or infection-related cancers. Over time, HIV can lead to acquired immunodeficiency syndrome (AIDS), the most severe phase of HIV infection.

Prevalence:

According to the World Health Organization (WHO), as of the end of 2019, approximately 38 million people globally were living with HIV. In the same year, around 1.7 million people became newly infected with HIV and about 690,000 people died from HIV-related causes globally.

Risk Factors:

  • Unprotected Sex: Having anal or vaginal sex without a condom or without taking medicines to prevent or treat HIV with someone who has the virus increases the risk of infection.
  • Multiple Sexual Partners: The more sexual partners a person has, the more likely they are to have a partner with HIV whose virus is not well controlled or to have a partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV infection.
  • Injecting Drugs: Sharing needles, syringes, rinse water, or other equipment used to prepare drugs for injection with someone who has HIV.
  • Mother to Child Transmission: The virus can be passed from mother to child during pregnancy, birth, or breastfeeding.

Prognosis:

Without treatment, people with HIV may progress to AIDS in 10 to 12 years, although the period can be shorter. The critical factor is the number of CD4 cells in the body. A healthy range is between 500 and 1,600 cells per cubic millimeter. A person with HIV is considered to have progressed to AIDS when the number of their CD4 cells falls below 200 cells per cubic millimeter. Severe symptoms and illness occur at this stage.

Prevention:

  • Condom Use: Using a condom correctly every time during sex can reduce the risk of HIV transmission.
  • Pre-exposure prophylaxis (PrEP): People at high risk of HIV can take HIV medicine daily to prevent HIV infection.
  • Post-exposure prophylaxis (PEP): Taking antiretroviral medicines after being potentially exposed to HIV can prevent becoming infected.
  • Regular Testing: Regular testing for HIV allows for early detection and treatment.
  • Needle Exchange Programs: These programs provide free sterile needles and syringes to reduce the spread of HIV among people who inject drugs.

Epidemiology:

HIV affects all demographic groups, but certain groups are more affected than others. According to the Centers for Disease Control and Prevention (CDC), gay and bisexual men are the population most affected by HIV in the United States. In terms of age, young people aged 13-24 are especially affected, accounting for an estimated 21% of all new HIV diagnoses in 2018. Globally, the prevalence of HIV is highest in Sub-Saharan Africa, where nearly 1 in every 25 adults (3.6%) lives with HIV, accounting for nearly two-thirds of the global total of new HIV infections. There is no significant difference in infection rates between men and women globally.## Human immunodeficiency virus (HIV) connection to Small Fiber Neuropathy (SFN)

Association:

The Human Immunodeficiency Virus (HIV) is known to be associated with Small Fiber Neuropathy (SFN). The exact mechanism of how HIV leads to SFN is not fully understood, but several theories have been proposed:

  • Direct viral damage: HIV may directly infect the neurons causing damage and leading to SFN.
  • Immune-mediated damage: The immune response to HIV infection may inadvertently damage the small fibers. This is thought to occur when the immune system attacks the virus but also damages the body’s own tissues, including the small nerve fibers.
  • Antiretroviral therapy (ART): Some antiretroviral drugs used in the treatment of HIV are known to be neurotoxic and may contribute to SFN.

Research Updates:

Recent research continues to explore the connection between HIV and SFN. Here are some highlights:

  • A 2019 study published in “Clinical Infectious Diseases” found that HIV patients with SFN had higher levels of inflammatory markers, suggesting that inflammation may play a role in the development of SFN in these patients.
  • A 2020 study in “Neurology” found that HIV patients with SFN had a higher prevalence of pain and sleep disturbances compared to those without SFN. This suggests that SFN may contribute to these symptoms in HIV patients.
  • A 2021 study in “Journal of NeuroVirology” found that HIV patients with SFN had a higher prevalence of metabolic syndrome, suggesting a possible link between metabolic disorders and SFN in HIV patients.

Please note that while these studies provide valuable insights, more research is needed to fully understand the connection between HIV and SFN.

Symptoms of Human immunodeficiency virus (HIV)

List of Symptoms:

Human immunodeficiency virus (HIV) can present with a wide range of symptoms. Some of these symptoms are also seen in patients with small fiber neuropathy (SFN).

  • Acute illness: Some people may experience a flu-like illness within 2 to 4 weeks after infection (Stage 1 HIV disease). This can include fever, headache, fatigue, and swollen lymph nodes in the neck and groin area.
  • Asymptomatic period: HIV may not cause any symptoms for several years. During this time, the virus continues to multiply and destroy immune cells.
  • Advanced infection: If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS), the most severe phase of HIV infection. Symptoms can include rapid weight loss, recurring fever, prolonged swelling of lymph glands, sores of the mouth, anus, or genitals, and neurological complications such as memory loss and depression.
  • Neurological complications: HIV can cause neurological symptoms due to direct damage to the nervous system by the virus or due to secondary infections. Symptoms can include cognitive impairment, motor dysfunction, and sensory abnormalities. Peripheral neuropathy, including small fiber neuropathy, is a common neurological complication of HIV.

Severity:

The severity of HIV symptoms can vary greatly from person to person. In the early stages, symptoms may be mild and flu-like, while in the later stages, they can be severe and life-threatening. The severity of symptoms often depends on the individual’s immune system response and whether they are receiving antiretroviral therapy.

  • Mild: Flu-like symptoms such as fever, fatigue, and swollen lymph nodes.
  • Moderate: Weight loss, chronic diarrhea or night sweats, oral yeast infection (thrush), and shingles.
  • Severe: Rapid weight loss, recurring fever, prolonged swelling of lymph glands, sores of the mouth, anus, or genitals, pneumonia, memory loss, depression, and other neurological disorders.

Onset:

The onset of HIV symptoms can vary greatly. Some people may experience symptoms within a few weeks of infection, while others may not experience symptoms for several years.

  • Early-stage symptoms: These can occur within 2 to 4 weeks after infection and can include flu-like symptoms such as fever, fatigue, and swollen lymph nodes.
  • Late-stage symptoms: These can occur years after infection and can include severe and life-threatening conditions such as rapid weight loss, recurring fever, prolonged swelling of lymph glands, sores of the mouth, anus, or genitals, and neurological disorders.## Diagnosis of Human immunodeficiency virus (HIV)

Diagnosis of Human immunodeficiency virus (HIV)

Methods:

Diagnosing HIV involves several types of tests:

  • Antibody/Antigen Tests: These are the most common type of HIV diagnostic test. They detect both HIV antibodies and HIV antigens (p24) which can be found in the blood a few weeks after infection. The test is usually done by drawing blood from a vein.
  • Antibody Tests: These tests look for antibodies to HIV in blood or oral fluid. They can take 23 to 90 days to detect HIV infection after an exposure. Rapid tests can provide results in 30 minutes or less but are slightly less accurate than the antibody/antigen tests.
  • Nucleic Acid Tests (NATs): These tests look for the actual virus in the blood (as opposed to antibodies or antigens). They are very expensive and not typically used for screening individuals unless they recently had a high-risk exposure or a possible exposure and have early symptoms of HIV infection.

Differential Diagnosis:

Conditions that might be mistaken for HIV, especially in the context of Small Fiber Neuropathy (SFN), include:

  • Lyme disease: This condition can cause neurological symptoms similar to SFN. It is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected black-legged ticks.
  • Diabetes: Diabetes can cause diabetic neuropathy, which can have similar symptoms to SFN.
  • Sarcoidosis: This disease causes inflammation in various organs and can affect the nervous system, leading to symptoms similar to SFN.
  • Vitamin B12 deficiency: This can cause peripheral neuropathy with symptoms similar to SFN.

Limitations:

There are several limitations or challenges in diagnosing HIV:

  • Window period: There is a period of time after a person is infected during which they won’t test positive. This period can last up to three months after infection.
  • Non-specific symptoms: Early symptoms of HIV are often non-specific and can be mistaken for other illnesses, such as the flu.
  • Lack of symptoms: Many people with HIV do not have symptoms for several years, so they may not think to get tested.
  • False negatives and positives: All tests have a small chance of false negatives or positives. For example, the rapid antibody test has a slightly higher chance of false positives compared to other tests.

Treatments for Human immunodeficiency virus (HIV)

Options:

Treatment for HIV typically involves a combination of antiretroviral therapy (ART) medications. These medications work by preventing the virus from replicating, which helps to reduce the viral load in the body. When HIV is linked to small fiber neuropathy (SFN), the treatment approach may need to be adjusted. Here are some of the commonly used treatments:

  • Nucleoside Reverse Transcriptase Inhibitors (NRTIs): These medications, such as abacavir and lamivudine, work by blocking a protein that HIV needs to replicate.
  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): NNRTIs, such as efavirenz, etravirine, and nevirapine, also block the protein needed for HIV replication.
  • Protease Inhibitors (PIs): PIs, such as atazanavir and darunavir, block a different protein that HIV needs to replicate.
  • Integrase Inhibitors: These medications, including dolutegravir and raltegravir, block yet another protein that HIV uses to replicate.
  • CCR5 Antagonist: This type of medication, such as maraviroc, blocks a protein on the surface of certain immune cells that HIV needs to enter the cells.
  • Fusion Inhibitors: These medications, such as enfuvirtide, prevent HIV from entering the body’s cells.
  • Post-Attachment Inhibitors: These medications, such as fostemsavir, block HIV from attaching to new cells and infecting them.

Effectiveness:

Antiretroviral therapy has been very effective in controlling HIV and preventing its progression to AIDS. It can reduce the viral load to undetectable levels, and individuals with an undetectable viral load have effectively no risk of transmitting HIV to others. However, ART does not cure HIV, and people with HIV must continue taking these medications for life.

In the context of SFN, managing HIV with ART can help to reduce the risk of developing SFN. However, some antiretroviral medications can cause peripheral neuropathy as a side effect, and this may need to be considered when choosing a treatment regimen.

Side Effects:

Side effects of antiretroviral therapy can vary depending on the specific medications used. Some common side effects include:

  • Nausea and vomiting
  • Diarrhea
  • Rash
  • Fatigue
  • Headache

Some antiretroviral medications can also cause more serious side effects, such as liver damage, heart disease, and an increased risk of certain cancers. Peripheral neuropathy is a potential side effect of certain antiretroviral medications, particularly the NRTIs stavudine, didanosine, and zalcitabine.

Recent Advancements:

In recent years, there have been several advancements in the treatment of HIV. One significant development is the approval of long-acting injectable ART, which can be administered monthly or every two months, instead of daily oral pills. This can help to improve adherence to treatment.

Another recent advancement is the development of newer classes of antiretroviral medications, such as integrase inhibitors and post-attachment inhibitors, which have fewer side effects and are less likely to cause resistance.

Gene therapy is also being explored as a potential cure for HIV. This involves modifying a person’s own cells to make them resistant to HIV. However, this is still in the experimental stages and is not yet available as a treatment option.