What Happens If Hiv Is Left Untreated

HIV attacks the immune system, making it hard to fight off infections. If not treated, HIV can lead to AIDS and serious health issues¹. In the U.S., most people with HIV don’t get AIDS because of treatment. But, without treatment, HIV usually turns into AIDS in 8 to 10 years¹.

Untreated HIV weakens the immune system. This makes the body more likely to get sick from infections and cancers. These can cause severe illnesses and even death¹.

Untreated HIV can also cause cancers like lymphoma and Kaposi sarcoma¹. It can lead to wasting syndrome, where a person loses a lot of weight. It can also cause confusion and dementia¹. Liver disease is another serious problem, especially for those with hepatitis¹.

Getting tested for HIV early is very important. Antiretroviral therapy (ART) has greatly reduced AIDS deaths worldwide¹. Starting treatment early can stop HIV from turning into AIDS and lower the chance of spreading the virus.

Key Takeaways

• Untreated HIV weakens the immune system, leaving the body vulnerable to opportunistic infections and cancers.
• Common complications of untreated HIV include pneumocystis pneumonia, candidiasis, tuberculosis, lymphoma, and Kaposi sarcoma.
• Neurological complications, such as confusion and dementia, can occur in individuals with untreated HIV.
• Early HIV testing and treatment with antiretroviral therapy can prevent progression to AIDS and improve quality of life.
• Adhering to HIV treatment also reduces the risk of transmitting the virus to others.

Stages of Untreated HIV Infection

HIV goes through several stages if not treated. The first stage, acute HIV infection, starts 2 to 4 weeks after infection. It lasts about 2 weeks². People may feel flu-like, with fever, fatigue, and swollen glands³.

After the acute stage, HIV moves to the clinical latent infection phase, or chronic HIV. This stage can last 10 years or more for some². People might not know they have HIV for up to a decade³. But, the virus keeps multiplying, weakening the immune system.

As HIV progresses, people may get mild infections and symptoms. Without antiretroviral therapy, HIV can turn into AIDS in 8-10 years. AIDS is when CD4 cells drop below 200 per cubic millimeter of blood².

Many factors can affect HIV’s progression, like age and health before infection³. But, early diagnosis and treatment can greatly improve life with HIV. Treatment can lower viral activity, boost immunity, and reduce transmission risk³.

Primary Infection (Acute HIV)

The acute HIV stage has a high viral load. Symptoms include:

• Fever
• Chills
• Rash
• Night sweats
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Mouth ulcers

Clinical Latent Infection (Chronic HIV)

In the chronic HIV stage, the virus multiplies at low levels. People might not have severe symptoms. But, the virus is still active and can be spread to others. It’s important to monitor viral load and CD4 cell count regularly.

Symptomatic HIV Infection

As HIV weakens the immune system, symptoms appear. These can include:

• Persistent fever
• Chronic diarrhea
• Weight loss
• Oral thrush
• Shingles
• Pneumonia

Progression to AIDS

Without treatment, HIV turns into AIDS in 8-10 years. People with AIDS usually live about 3 years without treatment². AIDS is marked by a severely weakened immune system. This makes it easier to get opportunistic infections and cancers².

Immune System Deterioration

HIV attacks the immune system if not treated. It weakens the body’s defense against infections and diseases. The virus mainly targets CD4 T cells, which are key to the immune system. This leads to fewer CD4 T cells and a weakened body⁴.

This makes people more likely to get sick from opportunistic infections and cancers.

CD4 T Cell Depletion

CD4 T cells are vital for the immune system. Without them, the body can’t fight off diseases well. Studies show HIV patients have less type I interferon, which helps fight infections⁴.

As HIV destroys CD4 T cells, the body’s defense weakens. This is shown by a lower CD4 count. A low CD4 count means serious immune damage.

Increased Susceptibility to Infections

As CD4 counts drop, the risk of infections goes up. These infections are rare in healthy people but can be deadly in those with HIV⁴. Some common infections include:

• Pneumocystis pneumonia (PCP)
• Candidiasis (thrush)
• Tuberculosis (TB)
• Cytomegalovirus (CMV)
• Toxoplasmosis

The HIV/AIDS pandemic has killed over 35 million people. Today, 37 million live with HIV⁵. Sadly, nearly a million die from AIDS each year, showing HIV’s devastating effect⁵.

The fewer CD4 T cells, the weaker the immune system becomes, leading to a higher risk of opportunistic infections and cancers.

Opportunistic Infections

When HIV is not treated, it weakens the immune system. This makes people more likely to get opportunistic infections (OIs). These infections can cause serious illness in those with advanced HIV. Thankfully, OIs are less common today than they were in the early days of HIV and AIDS⁶.

People with HIV are at higher risk of OIs when their CD4 cell count drops below 200. Some OIs can occur even when the CD4 count is below 500⁶. To avoid OIs, it’s key for those with HIV to take their antiretroviral therapy (ART) as directed. Keeping the viral load undetectable is also important. Medicines can prevent certain OIs if the CD4 count is below 200⁶.

Pneumocystis Pneumonia (PCP)

Pneumocystis pneumonia is a lung infection caused by a fungus. It’s one of the most dangerous OIs for people with untreated HIV.

Candidiasis (Thrush)

Candidiasis, or thrush, is a fungal infection caused by Candida yeasts. It can affect the mouth, throat, and esophagus in those with weakened immune systems due to untreated HIV.

Tuberculosis (TB)

Tuberculosis is a bacterial infection that mainly affects the lungs. People with untreated HIV are more likely to get active TB disease because their immune systems are weakened.

Cytomegalovirus (CMV)

Cytomegalovirus is a common viral infection that can cause severe illness in those with weakened immune systems. It can affect various organs, including the eyes, lungs, and digestive system.

Cryptococcal Meningitis

Cryptococcal meningitis is a fungal infection that affects the brain and spinal cord. It’s a serious OI that can happen in individuals with advanced untreated HIV.

Toxoplasmosis

Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii. In people with untreated HIV, toxoplasmosis can cause severe brain inflammation and damage.

Untreated HIV can also lead to certain cancers. Men are three times more likely than women to develop Kaposi’s sarcoma. Women, on the other hand, are more likely to get infections like HPV, which can cause reproductive system cancers like cervical cancer⁷.

Early HIV testing and treatment are key to preventing opportunistic infections and other complications from untreated HIV.

HIV-Related Cancers

People with untreated HIV are at a higher risk of getting certain cancers. Their immune system is weakened, making them more likely to get cancers that others might not get⁸. The most common cancers linked to HIV are lymphoma, Kaposi sarcoma, and HPV-related cancers.

Lymphoma

Lymphoma is a cancer that starts in white blood cells. People with HIV are 12 times more likely to get non-Hodgkin lymphoma than others⁹. They are also more likely to get fast-growing types of lymphoma, like diffuse large B-cell lymphoma⁸.

Before effective HIV treatment, aggressive B-cell lymphomas were common in AIDS patients¹⁰.

Kaposi Sarcoma

Kaposi sarcoma is a tumor that affects blood vessel walls. It can cause skin lesions and affect organs. People with HIV are 500 times more likely to get Kaposi sarcoma than others⁹.

In the U.S., most Kaposi sarcoma cases are linked to HHV-8 and HIV infection⁸. Although Kaposi’s sarcoma rates dropped after the 1990s, they have risen in black men in the southern U.S¹⁰..

Human Papillomavirus (HPV)-Related Cancers

HIV-infected people are at higher risk for HPV-related cancers, like anal, oral, and cervical cancers. They are 3 times more likely to get cervical cancer and 19 times more likely to get anal cancer⁹. Most cervical cancers are caused by HPV, and those with HIV and HPV are at higher risk for pre-cancerous changes⁸.

Regular cervical cancer screenings and HPV vaccination are key for HIV-infected individuals⁹.

It’s important for HIV-positive people to get regular cancer screenings and stick to ART. ART can greatly reduce cancer risk by controlling HIV⁸. HAART in the 1990s lowered Kaposi sarcoma and non-Hodgkin lymphoma rates⁹. But, non-AIDS-defining cancers are now a bigger problem in the HIV-positive community¹⁰.

Neurological Complications

HIV can cause many neurological problems, especially in late stages. These issues can really affect a person’s life, making it hard to think, move, and feel well¹¹. About half of adults with AIDS face nervous system problems linked to HIV¹¹¹².

HIV-Associated Dementia (HAD)

HIV-associated dementia (HAD) is a severe problem, found in about 15% of AIDS patients¹³. It leads to memory loss, confusion, and trouble with everyday tasks¹¹. HIV can directly harm the brain, causing dementia in very late stages¹¹.

HIV-Associated Neurocognitive Disorders (HAND)

HIV-associated neurocognitive disorders (HAND) include various cognitive problems. Despite treatment, about 50% of people with HIV get HAND¹³. Asymptomatic neurocognitive impairment can lead to more severe symptoms, affecting 20-30% of HIV-positive individuals¹³.

Peripheral Neuropathy

Peripheral neuropathy causes pain, numbness, and weakness in hands and feet. It’s common in late HIV stages, especially when it causes major pain or weakness¹¹¹². About 5-10% of primary HIV infections have peripheral neuropathy¹³.

Untreated HIV can also lead to deadly infections like cryptococcal meningitis and toxoplasma encephalitis¹¹¹². Vacuolar myelopathy, affecting the spinal cord, is common in untreated AIDS¹¹¹². Mental health issues like anxiety and depression often appear after HIV progresses to AIDS¹¹¹².

Early diagnosis and treatment of HIV are key to preventing and managing these neurological problems. Treatment and tailored medications, along with regular check-ups and a healthy lifestyle, can improve life quality for those with HIV¹¹.

Other Complications of Untreated HIV

Untreated HIV can lead to many complications that harm your health. These issues can affect different parts of your body. They weaken your immune system and raise the risk of serious diseases.

Wasting Syndrome

Wasting syndrome is a big problem for those with untreated HIV. It causes a lot of weight loss, diarrhea, weakness, and fever. This condition makes life very hard and lowers your quality of life¹⁴.

Kidney Disease

HIVAN is a serious kidney problem that happens when HIV is not treated. It’s more common in Black and Hispanic people¹⁴. It causes kidney inflammation. People with HIV often have low-level inflammation, which can lead to kidney disease¹⁵.

Liver Disease

Liver disease is a big worry for those with untreated HIV, especially if they also have hepatitis B or C. About one-third of people with HIV in the U.S. have hepatitis B or C¹⁵. But, treatment for Hepatitis C can cure about 97% of people, including those with HIV, in just 8-12 weeks¹⁵.

Other problems that can happen with untreated HIV include:

• Cardiovascular disease: People with HIV are 50-100% more likely to get heart disease¹⁵.
• Diabetes: HIV causes chronic inflammation, which raises the risk of diabetes¹⁵.
• Bone disease: Untreated HIV increases the risk of bone disease due to ongoing inflammation¹⁵.
• Cognitive disorders: HIV can cause faster memory and thinking decline as people age¹⁶. The inflammation in the brain is linked to cognitive problems¹⁶.

The beginning of advanced cases of HIV leaves individuals vulnerable to various infections and diseases.

It’s important to take HIV medication as directed, practice safe sex, get vaccinated, wash hands, exercise, eat well, drink safe water, and quit smoking. These steps help prevent infections and complications in people with advanced HIV¹⁴.

Increased Risk of HIV Transmission

Untreated HIV is a big risk for the person with the virus and for others. It makes it easier for the virus to spread through sex, needle sharing, or from mother to child during pregnancy or breastfeeding¹⁷. In 2023, 39.9 million people were living with HIV, with 65% in Africa¹⁷.

Without treatment, most people with HIV will show AIDS signs in 8-10 years. But, this time can vary a lot, from 10-15 years or more¹⁸. In 2023, 630,000 people died from HIV-related causes, and 1.3 million got HIV¹⁷. Untreated HIV leads to serious illnesses like tuberculosis and cancers¹⁷.

Some actions increase HIV transmission risk a lot. Sharing needles is very effective at spreading HIV¹⁸. There’s also a high risk of HIV from mother to child if the mom isn’t on treatment, and a big risk from infected blood¹⁸.

To lower HIV transmission risk, several steps can be taken:

• Use quality condoms correctly during sex¹⁷¹⁸
• Get tested for HIV and other STIs often¹⁷
• Consider voluntary medical male circumcision¹⁷
• Use harm reduction services for drug users¹⁷
• Stay in monogamous relationships and treat the infected partner¹⁸

The table below shows the risk levels for different activities:

Antiretroviral drugs (ARVs) are key in managing HIV. They stop the virus from copying itself and help the immune system get stronger¹⁷. By 2025, the goal is for 95% of HIV-positive people to be diagnosed, 95% on treatment, and 95% of those on treatment to have a low viral load¹⁷.

Importance of Early HIV Testing and Treatment

Early detection and treatment of HIV are key to managing the infection and stopping it from turning into AIDS. Routine HIV screening is essential. It allows for early diagnosis and treatment, which greatly improves life expectancy and stops the virus from spreading¹⁹. The CDC and USPSTF suggest that everyone aged 15 to 65 should get tested for HIV at least once. Those at higher risk should get tested more often²⁰²¹. It’s important to make HIV testing optional and free from pressure in all healthcare settings²⁰.

Antiretroviral Therapy (ART)

ART involves taking a mix of medicines to slow down the virus. Starting ART early in HIV infection is advised. It greatly lowers the chance of passing the virus to others, improves health markers, and helps keep the immune system strong²⁰. Starting treatment when CD4 counts are above 350 cells/mm3 can prevent many HIV cases¹⁹. Taking antiretroviral drugs regularly can make life expectancy almost normal and almost completely stop HIV transmission²¹.

Viral Load Suppression

Following ART can keep the viral load low, boost the immune system, and greatly lower HIV transmission risk. Those who wait to start cART until CD4 counts are below 350 cells/mm3 face a higher risk of death. Starting cART with counts between 350-500 cells/mm3 is safer¹⁹. Studies have shown big drops in HIV transmission risk when couples start cART before CD4 counts fall below 250 cells/mm3 or before AIDS symptoms appear¹⁹.

Improved Quality of Life

Starting treatment early not only keeps life quality high but also lowers the risk of severe problems. The value of life years saved by early treatment is in the billions of dollars. This shows how crucial early action is¹⁹. By focusing on early HIV testing and sticking to treatment, people can keep the virus under control. This leads to better health and less chance of passing the virus to others.