HIV/AIDS

What is HIV/AIDS?

HIV, or human immunodeficiency virus, attacks CD4 T lymphocytes, or white blood cells that help coordinate the body’s immune response. If HIV is not treated, the number of CD4 cells may gradually decline, increasing susceptibility to opportunistic infections and certain cancers.

AIDS, or acquired immunodeficiency syndrome, is the most advanced stage of HIV infection. A person living with HIV may be diagnosed with AIDS when:

• The CD4 count falls below 200 cells/mm³; or

• An AIDS-defining infection, cancer or other condition develops.

AIDS does not mean that the virus has suddenly appeared or spread throughout the body. HIV is already present before this stage develops. Early diagnosis and effective antiretroviral therapy can prevent or greatly delay progression to AIDS.

Types and Stages of HIV Infection

HIV progresses to AIDS when left untreated. The table below shows the progression stages of HIV:

How Common is HIV/AIDS in India?

India has a relatively low national HIV prevalence, but a high absolute number of people living with the infection because of its large population. According to the latest NACO estimates, adult HIV prevalence among people aged 15 - 49 years in India was approximately 0.20% in 2024, with around 25.61 lakh people living with HIV in the country. An estimated 64,470 new HIV infections and 32,160 AIDS-related deaths occurred during the year.

NACO estimates also suggest that since 2010, annual new HIV infections have declined by approximately 49%, while AIDS-related deaths have fallen by approximately 81%. However, HIV prevalence varies considerably between states and districts, making continued testing, early diagnosis and treatment essential.

Symptoms of HIV/AIDS

Symptoms of HIV vary according to the stage of infection and the extent of immune system damage. Common early warning signs and advanced stage symptoms of HIV/AIDS are listed below:

Diseases Similar to HIV

HIV may resemble other infections that can be transmitted through sexual contact or infected blood. However, these conditions differ substantially in their causative organisms, affected body systems, complications and treatment outcomes.

A comparative overview of three such conditions is given below for your understanding:

HIV vs Hepatitis B vs Syphilis

Causes of HIV Infection

HIV can be transmitted when infected blood, semen, pre-seminal fluid, vaginal fluid, rectal fluid or breast milk enters another person’s bloodstream or comes into contact with damaged tissue or a mucous membrane.

Common routes of HIV transmission are given below:

• Sexual Contact: HIV may spread through anal or vaginal sex when effective preventive measures are not used.

• Shared Needles or Syringes: HIV can also be transmitted by using injection equipment contaminated with infected blood.

• Pregnancy and Childbirth: A mother living with HIV may transmit the virus to her baby during pregnancy or delivery.

• Breastfeeding: HIV can pass through breast milk. Antiretroviral treatment, infant preventive medicines and appropriate feeding guidance substantially reduce this risk.

• Unsafe Blood or Organ Exposure: Transmission may occur through infected blood products or transplanted organs, although screened blood makes this uncommon.

• Occupational Exposure: Can be acquired by healthcare workers, in some cases, through a needlestick injury or contact with infected blood and through broken skin or mucous membranes.

Factors such as another sexually transmitted infection, a high HIV viral load and sharing injection equipment may increase transmission risk. However, a person taking HIV treatment who maintains an undetectable viral load does not transmit HIV through sex.

HIV does not spread through hugging, touching, sharing food or utensils, toilets, coughing, sneezing, sweat, tears or mosquito bites.

What are the Complications of Untreated HIV?

Untreated HIV can lead to the following complications:

• Opportunistic Infections: Tuberculosis, severe fungal infections, Pneumocystis pneumonia and other infections may develop when immunity becomes weak.

• HIV-Associated Cancers: The risk of Kaposi sarcoma, certain lymphomas and cervical cancer may increase.

• Neurological Problems: Advanced HIV or related infections may affect memory, thinking, coordination or movement.

• Wasting Syndrome: Severe weight loss, weakness and chronic diarrhoea may occur.

• Organ Disease: HIV, coinfections or treatment-related factors may affect the kidneys, liver, bones, heart or nervous system.

• Progression to AIDS: Untreated HIV may eventually cause severe immune suppression.

Modern ART greatly reduces the risk of these complications. Tuberculosis remains an especially important opportunistic infection among people living with HIV in India.

When Should You See a Healthcare Provider?

It is recommended to seek medical advice or HIV testing when:

• A possible sexual or blood exposure has occurred.

• A condom broke during a potentially risky exposure.

• Needles or injection equipment were shared.

• A sexual partner has received an HIV diagnosis.

• A needlestick or occupational blood exposure occurred.

• Pregnancy is planned or confirmed.

• Recurrent infections, unexplained weight loss or persistent fever develop.

• Routine screening is due.

How is HIV Diagnosed?

HIV cannot be diagnosed through symptoms, medical history or physical examination alone. Laboratory testing is required. In India, a reactive screening result must be confirmed through the testing algorithm recommended by NACO.

An overview of the diagnostic process used for HIV testing is given below:

How is HIV Managed or Treated?

HIV is treated with antiretroviral therapy, commonly called ART. It uses a combination of medicines that block HIV at different stages of its replication cycle.

Treatment for HIV should begin as soon as possible after diagnosis. Its aims are to:

• Reduce the viral load to an undetectable level

• Protect and restore immune function

• Prevent opportunistic infections

• Prevent progression to AIDS

• Reduce HIV-related illness and death

• Prevent sexual transmission when viral suppression is maintained

ART must be taken consistently. Missed or irregular doses may allow the virus to multiply and can contribute to treatment failure or drug resistance. Patients also require follow-up for viral load, medicine safety, coinfections and other health needs.

Common Medicines Used to Treat HIV

HIV cannot currently be cured with medicines. Treatment aims to suppress viral replication, preserve CD4 cells, prevent complications and reduce the risk of transmission.

Common medications for HIV treatment include:

• Tenofovir + Lamivudine + Dolutegravir: This fixed-dose combination, commonly called TLD, is a preferred first-line regimen for many adults and adolescents under India’s HIV programme.

• Abacavir + Lamivudine + Dolutegravir: This combination may be used in selected patients, including certain children or people for whom tenofovir is unsuitable.

• Zidovudine + Lamivudine: These medicines may form part of an alternative regimen when the preferred combination is unsuitable.

• Efavirenz: Efavirenz may be included in selected alternative regimens when dolutegravir cannot be used.

• Atazanavir/Ritonavir or Lopinavir/Ritonavir: These boosted protease inhibitors may be used in selected second-line regimens under specialist supervision.

• Cotrimoxazole: Cotrimoxazole may prevent or treat certain opportunistic infections in people with advanced immune suppression. It does not suppress HIV and should not be presented as an antiretroviral medicine.

Note: HIV medicines must be prescribed and monitored by a qualified healthcare professional. HIV treatment is generally lifelong. Do not start, stop or change HIV medicines without medical advice.

Living with HIV: Daily Challenges and Patient Well-Being

HIV is a long-term health condition that usually requires lifelong treatment and monitoring. Effective ART allows many people to work, study, maintain relationships and lead healthy lives.

What is the Prognosis of HIV/AIDS?

The prognosis of HIV has improved substantially with effective antiretroviral therapy. When HIV is diagnosed early and ART is taken consistently, the viral load can become undetectable, immune function can recover and progression to AIDS can usually be prevented.

People who maintain viral suppression can lead long and healthy lives. An undetectable viral load also means that HIV will not be transmitted through sex. However, undetectable does not mean cured. ART must continue unless a qualified HIV specialist changes the treatment plan.

How Can I Prevent HIV Infection?

Some measures can minimise the risk of infection transmission and prevent HIV are:

• Use condoms correctly during anal or vaginal sex.

• Consider pre-exposure prophylaxis, or PrEP, when there is an ongoing risk of acquiring HIV.

• Seek post-exposure prophylaxis, or PEP, within 72 hours of a possible exposure.

• Never share needles, syringes or injecting equipment.

• Use sterile equipment for injections, tattoos and piercings.

• Get tested for HIV and other sexually transmitted infections when appropriate.

• Start and continue ART after an HIV diagnosis.

• Maintain an undetectable viral load to prevent sexual transmission.

• Ensure donated blood and organs undergo the required screening.

• Receive PPTCT care during pregnancy, delivery and breastfeeding.

• Follow clinical advice on maternal ART, infant prophylaxis and infant feeding.

HIV Treatment Cost in India

The cost of HIV treatment in India varies considerably. Government ART services provide medicines free of cost, while private care may involve medicine, consultation and laboratory expenses.

The table below shows the approximate treatment costs of HIV:

Note: The above figures are indicative prices and may vary in reality. Patients should verify the current price directly with the healthcare provider or laboratory before estimating treatment expenses.

Does Health Insurance Cover HIV?

Yes. Health insurance provides coverage for HIV treatment costs in India. It covers the cost of medically necessary in-patient hospitalisation, day care procedures, ambulance charges, second medical opinion, and pre & post-hospitalisation expenses. Some health insurance for HIV patients may also offer an HIV/AIDS hospital cash benefit.

Routine ART, regular outpatient consultations and monitoring tests may be covered only if the policy comes with an OPD benefit. Make sure to read the policy terms and conditions carefully to know the exact scope of coverage.

However, HIV is covered after a waiting period ranging from 30 days to 90 days under most plans.

How Much Health Insurance Coverage is Needed for HIV Treatment?

Antiretroviral therapy is available free of cost through government ART centres. Therefore, health insurance may be more useful for hospitalisation, treatment of opportunistic infections, intensive care and other medical conditions rather than routine ART expenses.

A health insurance policy with a sum insured of at least ₹10 lakh should be purchased to get adequate protection against the cost of hospitalisation for HIV. People seeking greater protection may opt for a higher coverage amount or buy a top-up insurance plan to enhance their coverage.