Disease Description (Causes and Symptoms)
- Definition: Asymptomatic HIV infection refers to a state in which a person is infected with human immunodeficiency virus (HIV), but clinical symptoms have not yet appeared.
- Causes·Pathophysiology: HIV primarily infects and destroys CD4-positive T lymphocytes, gradually impairing immune function. Even during the initial clinical latency period, the virus continues to replicate and slowly reduces the number of immune cells. Over time, it may progress to AIDS, in which opportunistic infections and malignant tumors can occur.
- Main Features and Symptoms: Basically asymptomatic (no symptoms), although a temporary acute seroconversion syndrome (fever, sore throat, swollen lymph nodes, muscle aches, rash, etc.) may occur early in the infection. A person remains infectious even during the asymptomatic period. Routes of transmission include sexual contact, sharing injection needles, blood transfusion (rare in modern times), and mother-to-child transmission.
Treatment
- Treatment Principles
- Even if there are no symptoms, antiretroviral therapy (ART) is recommended for all people living with HIV (for the purpose of immune recovery and reducing transmission).
- Treatment goals: To suppress blood HIV RNA (viral load) to an undetectable level and promote recovery of the CD4 count.
- U=U (Undetectable = Untransmittable): This means that when complete and sustained suppression is maintained, the risk of sexual transmission is significantly reduced.
- Initial Evaluation (Recommended Tests Before Starting Treatment)
- HIV RNA (viral load), CD4 count
- Antiretroviral resistance testing (genetic testing)
- Liver and kidney function tests, blood glucose, lipids, electrolytes
- Hepatitis B and C tests, syphilis and other sexually transmitted infection tests
- Pregnancy status (women), medication history (to identify interactions)
- Tuberculosis risk assessment, vaccination status check
- Standard Drug Therapy (Examples)
- The current standard is generally a three-drug combination regimen based on 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) + 1 integrase strand transfer inhibitor (INSTI), usually using a once-daily fixed-dose combination. Examples: dolutegravir- or bictegravir-based therapy + tenofovir (TAF or TDF) + emtricitabine or lamivudine.
- The choice of medication varies depending on the individual’s condition (kidney or liver function, pregnancy, coinfections, resistance, etc.).
- Monitoring
- Assess viral load and side effects 2–8 weeks after starting treatment (or according to national guidelines), and then monitor every 3–6 months once suppression is achieved. The interval for CD4 monitoring may be extended once it has stabilized after suppression.
- Prevention·Adjunctive Treatment
- PEP (post-exposure prophylaxis) for exposed individuals and PrEP (pre-exposure prophylaxis) for people at high risk
- Vaccinations (influenza, pneumococcal, hepatitis B, etc.) are recommended
- Precautions
- Do not stop treatment on your own, as rapid viral rebound and worsening immune function may occur after treatment interruption
- Be aware of drug interactions (antituberculosis drugs, some antifungals and antibiotics, certain lipid-lowering drugs, etc.)
- Long-term medication-related side effects: metabolic abnormalities (lipids and blood glucose), impaired kidney function (with certain medications), changes in bone mineral density, hepatotoxicity, etc.—regular testing is necessary
- If planning a pregnancy or already pregnant, be sure to consult about medication selection and safety
Outpatient Visit Checklist (Including Example Questions)
- Items and Information to Prepare
- A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements)
- Previous test results (if possible, including HIV test results, viral load, CD4 count, liver and kidney tests, etc.)
- History of allergies (including drug allergies)
- A record of recent symptom changes (fever, weight loss, swollen lymph nodes, etc.)
- Information about sexual activity and sexual partners (including safer-sex practices and the partner’s HIV status), and whether there has been any recent exposure to injection needles
- Whether there are plans for pregnancy (women)
- Questions to Prepare for the Outpatient Visit (Examples)
- What treatment is expected to be started (type of medication, how to take it, and duration)?
- What are the main side effects of the medication, and what should I do if they occur?
- Which tests are used to assess treatment effectiveness, and how often should they be performed?
- What additional measures should I take to prevent transmission?
General Example Questions to Ask the Doctor
- When should I start this treatment? (Is it recommended to start now?)
- What are my current viral load and CD4 count, and what is my prognosis?
- What are the main side effects and interactions of the recommended medication?
- If I am pregnant (or planning a pregnancy), will the choice of medication or management be different?
Examples of Condition-Specific Questions
- In my case (based on my current viral load and CD4 count), which initial medication combination would be most appropriate? What alternative options are available if side effects occur?
- Once treatment makes the virus undetectable, what is the risk of sexual transmission, and what additional preventive measures should I follow in daily life?