How Does Adenovirus Affect Individuals With Hiv

Introduction

Adenovirus and human immunodeficiency virus (HIV) are both viruses. Whilst adenovirus usually causes more cold-like illness, HIV causes debilitating and deadly disease if left untreated by weakening your immune system. Since HIV weakens the immune system, it allows for more serious adenovirus infection with possible grave complications. 

Adenovirus: Understanding the basics

What is it?

Adenovirus is mostly a respiratory virus although it can target other parts of the body. It commonly causes infections during the winter or early spring and tends to cause mild, self-limiting illnesses, with severe illness being rare. It can affect a wide range of age groups but it is common in children under the age of 5.¹ 

How is it transmitted?

Adenovirus is highly contagious and may easily spread through close contact like hugging, or even shaking hands. It may also be spread by infected individuals coughing or sneezing, releasing respiratory droplets into the air. The individuals may still shed the virus for days or weeks post-infection, even when symptoms subside. Adenovirus may also be spread by touching contaminated surfaces and then touching your mouth, nose, or eyes. Less likely transmission routes include the faecal-oral route by coming into contact with the stool of an infected individual, or by contaminated water, or food. Its transmissibility is also high as it survives even when a surface is cleaned with a certain disinfectant.¹ 

What are the usual symptoms?

Adenovirus usually causes quite mild, cold-like symptoms. These include:

• Runny/blocked nose
• Cough
• Fever
• Sore throat
• Sometimes it may lead to conjunctivitis (pink eye ) or an ear infection

The virus may also cause gastrointestinal symptoms like:

• Diarrhoea
• Stomach/intestinal inflammation can then cause nausea, diarrhoea, vomiting, and stomach pain¹

Human immuno-deficiency virus (HIV): Understanding the basics

What is it?

HIV is a virus, which attacks immune cells. It is commonly associated with acquired immunodeficiency syndrome (AIDS), however the two are not the same. HIV is the virus causing infection, whilst AIDS is the result of the HIV infection. AIDS often results from the depletion of a large amount of immune cells, leading to an extremely weakened immune system, which makes one susceptible to an array of opportunistic infections.²

How does it affect the immune system?

HIV mainly targets CD4+ T cells leading to a gradual decline in their numbers. CD4+ T cells are key in immune system regulation and in infection clearance. For example, they promote antibody production (a protein made in response to a foreign molecule in your body) by B cells and induce CD8+ T cell killing action (CD8+ T cells release chemicals that destroy infected cells). They are also necessary for CD4+ memory T cells, which are important in mounting a fast response in future reinfection. Therefore, the loss of these cells causes great disturbance to the immune response, leaving infected individuals vulnerable to infection.³

Transmission

HIV is transmitted through bodily fluids like blood, semen, vaginal secretions, or breast milk. It is not, transmitted through saliva so neither kissing, nor sharing bottles will lead to transmission. Infected mothers may also transmit the disease to their children during pregnancy or delivery.

Risk factors

Based on the routes of HIV transmission, certain risk factors for contracting the disease are:

• Vaginal, anal, or oral (oral has a lower risk but does not rule out the possibility of infection) sex without a condom
• Sharing contaminated injecting equipment or drug solutions, e.g. during drug use
• Having another sexually transmitted infection like, e.g. gonorrhoea, chlamydia, herpes
• Having an accident involving an accidental needle prick (possibly during healthcare work)
• Undergoing an unsafe blood transfusion, transplantation, injection, or piercing due to unsanitary practice⁴
• Having sex under the influence of drugs or with a partner, who has used injectable drugs
• Having a current or previous partner who either has HIV or is from an area of high HIV prevalence
• Living in an area with a high HIV burden
• Being a victim of rape
• Having multiple sexual partners⁵

Symptoms

HIV often starts with the following symptoms:

• Fever
• Sore throat
• Rash
• Swelling in glands
• Muscle and joint pain
• Tiredness

These may last 1-2 weeks after which you may feel better. You then may experience no symptoms for even up to 10 years but once the disease has massively progressed, it will cause symptoms such as:

• Night sweats
• Chronic diarrhoea
• Weight loss
• Constantly recurring infections
• Skin issues (often associated with opportunistic infection)
• Serious, life-threatening disease⁶

Interaction between Adenovirus and HIV

As HIV weakens the immune system, it will allow a more serious adenovirus infection involved with dissemination. The adenovirus can cause disease in organs other than just the respiratory tract and cause diseases like pneumonia, cystitis, viral encephalitis, hepatitis, and severe hemorrhagic gastroenteritis.⁷

Pneumonia

Pneumonia involves the inflammation of the lungs and the build-up of fluid, which can cause serious complications like difficulty breathing, coughing up blood, wheezing, and even death.⁸ 

Cystitis

Cystitis may also be referred to as a urinary tract infection, which may cause a burning, or stinging sensation when urinating, feeling the urge to go to the toilet urgently and more often, having pain in the lower abdomen, and passing dark, or foul smelling urine.⁹

Viral encephalitis

Adenovirus infection may spread to the brain, leading to brain inflammation. This is a serious condition that may lead to life-altering complications if not treated promptly. These include seizures, memory loss, chronic tiredness, difficulties with attention, concentration, and or problem-solving , and personality changes. Common symptoms to look out for are flu-like symptoms which may later become accompanied by confusion, seizures, issues with speaking, weakness or loss of movement in certain body parts, personality changes, and or loss of consciousness.¹⁰ 

Hepatitis

Hepatitis means inflammation of the liver, which can lead to more serious conditions like cirrhosis (scarring of the liver), or liver failure. These can also progress to portal hypertension (enlargement and even rapturing of blood vessels connected to the portal vein) and liver cancer as a result of the recurrent inflammation.¹¹

Severe hemorrhagic gastroenteritis

In simpler terms, this is bloody diarrhoea. It may cause rapid dehydration, depleting your body of necessary electrolytes and water, which may in extreme cases lead to death.¹² 

Diagnosis of adenovirus 

To confirm the presence of adenovirus in an HIV-positive patient, the doctor would take a swab of the nose, or throat, or use a bodily fluid sample like mucus. The samples would then undergo testing by antigen detection or by a polymerase chain reaction.¹³

Treatment and management

Usually, adenovirus goes away on its own, however, in someone who is immunocompromised, antiviral therapy may be used. This would include drugs like Cidofovir, or Ribavirin. Both of these drugs inhibit viral replication, helping the body combat the infection.¹ 

Prevention

ART

Antiretroviral therapy helps to stop viral replication, keeping viral load low. This allows the repair of the immune system, decreasing the individual’s susceptibility to serious infection. If taken properly, the drug may decrease the viral load to undetectable levels. An HIV-positive individual taking this medication would be much less susceptible to serious adenovirus infection compared to an HIV-positive individual who does not receive any treatment.¹⁴

Hygiene

It is also important to prevent catching the adenovirus in the first place, which may be done by practising good hygiene. This would include regular hand washing with soap and warm water, avoiding touching your face if you have not washed your hands, staying away from sick individuals and avoiding close contact, avoiding sharing utensils or water bottles, and disinfecting surfaces using a mixture of water and bleach.¹ 

FAQs

Is HIV an adenovirus?

No, the two are separate viruses belonging to two different families of viruses.

When should you go to the hospital for adenovirus?

You should go to the hospital if you have a persisting long lasting high fever and trouble breathing. 

Summary

HIV and adenovirus are two viruses, which cause very different diseases. Adenovirus usually causes mild illness whilst HIV greatly damages the immune system, leaving the individual immunocompromised. This immunocompromisation allows the adenovirus to cause more serious diseases like encephalitis, pneumonia, hepatitis, or bloody diarrhoea, which could result in death. It is important to try to avoid this by taking ART HIV treatment to prevent susceptibility to infection, and have good hygiene practises to minimise the risk of catching adenovirus.