Modern Medical Management of HIV Infection: From Pathogenesis to Comprehensive Treatment

HIV

Human immunodeficiency virus (HIV) is a retrovirus that primarily attacks CD4+ T lymphocytes in the human immune system, leading to progressive immune failure. Without intervention, infection can progress to life-threatening acquired immunodeficiency syndrome (AIDS). This article will provide a comprehensive overview of HIV from four perspectives: pathogenesis, diagnosis, treatment, and prevention.

Pathological mechanism and transmission route

HIV binds to the host’s CD4+ receptors via the gp120 protein on its surface, entering cells and releasing RNA. The reverse transcriptase converts the RNA into DNA and integrates into the host genome. The virus can then remain dormant for extended periods or reactivate, replicating and destroying immune cells. Transmission primarily occurs through sexual contact, blood-to-blood transmission, and vertical transmission from mother to child. The virus is weak in the external environment, and everyday contact, such as shaking hands or sharing meals, does not cause infection.

Diagnosis and Monitoring

Modern HIV diagnosis relies on serological testing (antibody/antigen detection) and nucleic acid testing (viral load testing). Fourth-generation HIV tests can detect the virus within a 2-3 week window period after infection, while nucleic acid testing can further shorten this to 10-14 days. After diagnosis, regular monitoring of CD4+ cell counts (to assess immune status) and viral loads (to reflect viral replication levels) is necessary to guide treatment decisions.ent decisions.

Treatment: Antiretroviral Therapy (ART)

Arterial therapy (ART) is a core approach to HIV management, combining drugs with different mechanisms of action to inhibit viral replication. Common regimens include two or more drug classes, such as an integrase inhibitor (dolutegravir) plus a nucleoside reverse transcriptase inhibitor (tenofovir/emtricitabine). Standard treatment can reduce viral load to undetectable levels (<50 copies/mL) within six months. At this point, the infected individual’s immune function gradually recovers and the virus is no longer sexually transmitted, a status known as “U=U” (Undetectable=Untransmittable).

Prevention Strategies

Pre-exposure prophylaxis (PrEP) is an important preventive measure for high-risk individuals. Daily tenofovir/emtricitabine use can reduce the risk of infection by 99%. Preventive medication (PEP) initiated within 72 hours of exposure can also effectively prevent infection. Furthermore, promoting safe injections, standardizing blood collection and supply procedures, and preventing mother-to-child transmission (ART during pregnancy plus neonatal prophylaxis) are key public health measures.

Challenges and prospects

Although ART has significantly improved patient outcomes, drug resistance, adverse drug reactions, and long-term complications (such as cardiovascular disease) remain clinical challenges. Emerging long-acting injectable formulations (such as cabotegravir) and research on broadly neutralizing antibodies offer insights into future treatments. Ending the HIV epidemic still depends on expanding testing coverage, eliminating social stigma, and strengthening global health collaboration.

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Post time: Aug-27-2025