Overview

Introduction

HIV (Human Immunodeficiency Virus) refers to a virus that causes AIDS (Acquired Immune Deficiency Syndrome). AIDS is a collection of specific illnesses and conditions which occur as a result of damage to the immune caused by HIV. The virus is present in the infected person’s bodily fluids, such as blood, semen, vaginal secretions, pre-ejaculation fluid, and breastmilk. HIV is transmitted when an uninfected person’s blood or mucous membranes come into direct contact with infected bodily fluids. This can occur through sexual intercourse (vaginal, anal or oral) with an infected person, blood transfusions, sharing contaminated hypodermic needles or other instruments that pierce the skin, e.g. razors, or from mother to child during pregnancy, delivery or breastfeeding.

HIV attacks the immune system, breaking down those cells responsible for providing the body with immunity. The compromised immunity makes the body vulnerable to various cancers and to other opportunistic infections that a healthy immune system can normally fight off. Consequently, most people with AIDS die from these opportunistic infections which would not cause serious disease in healthy individuals.

It is estimated that as of 2006, 39.5 million people were living with HIV worldwide; of those 4.3 million had newly contracted the virus during that year. An additional 2.9 million adults and children died of AIDS during 2006.[1] HIV/AIDS has a very strong impact on communities as many of those that have died are in the prime of their lives. Many have left behind families and orphans who depend on them.

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Testing

HIV is diagnosed by testing for antibodies produced by the immune system in response to the presence of the virus in the blood. To determine if someone is infected with HIV, blood is drawn from the individual and tested for the HIV antibody.

The virus has an incubation rate of two to three months. Consequently, HIV tests may not detect the virus as soon as a person is infected, because antibodies will still not have developed in the blood. At this point an individual is considered seronegative (-ve). Once antibodies develop in the blood a person becomes seropositive (+ve) and can test positive for HIV. The sooner one is tested the better the chance treatment has of controlling the infection and delaying/preventing the onset of AIDS.

Stages, Signs, and Symptoms

A person who becomes infected with HIV usually experiences several stages. The first stage is called the window period and refers to the time between when a person becomes infected and when he/she develops detectable antibodies against the infection. Some people infected with HIV may experience flu-like symptoms including high fever and laryngitis within 1-2 weeks from being infected. During this stage although the person is infected, he/she will still test negative because antibodies have still not developed. However, an infected person can be highly infectious during this period.

There are two main tests to monitor HIV infection: a CD4 count and an HIV RNA count. The first test, counts the number CD4 cells, which are a type of white blood cells that fight infection, in the blood. These cells are destroyed by HIV. The second test counts the amount of HIV genetic material in an infected person’s system. This allows the doctor to gauge how effectively the immune system is controlling the virus.

It is very important that women who are pregnant get an antenatal HIV test, especially if they believe they have been exposed to the virus. Receiving treatment if infected can minimize the fetus’ chance of contracting the virus during pregnancy, delivery and post-delivery through breastmilk.

HIV attacks the immune system, breaking down those cells responsible for providing the body with immunity. The compromised immunity makes the body vulnerable to various cancers and to other opportunistic infections that a healthy immune system can normally fight off. Consequently, most people with AIDS die from these opportunistic infections which would not cause serious disease in healthy individuals.

It can take three to six months for detectable antibodies to develop (seroconversion) at which point an infected person will test positive for the disease. There may be no symptoms associated with this phase (asymptomatic), although the immune system is gradually deteriorating as the virus multiplies. Infected individuals continue to be highly contagious. This phase can range from six months to over ten years, depending on how rapidly the virus is replicating in a person’s body and how the immune system is reacting.

Asymptomatic HIV generally progresses to early symptomatic HIV and then develops into full-blown AIDS. If untreated infected individuals can live with AIDS for one to two years before eventually dying. As the immune system weakens, and infected individuals grow increasingly vulnerable to opportunistic infections, they can experience a variety of symptoms including fever, weight loss, and chronic diarrhea. AIDS-related illnesses that can develop include tuberculosis, Lymphoadenopathy, encephalitis, and various cancers.

Prevention

There are several measures people can take to help protect themselves from HIV infection. These include, consistent and correct use of male or female condoms, use of microbicides, having sex with an uninfected individual, treating any RTIs/STIs as soon a possible, always using clean skin-cutting instruments, such as needles, blades, tattooing instruments, surgical instruments and ensuring strict measures are in place for blood testing and transfusion guidelines at health facilities.

HIV/AIDS carriers should inform their sexual partner(s) and medical service provider(s) of their status. In order to prevent further transmission of the disease, people infected with HIV should always use condoms and microbicides during sex and not donate blood or bodily organs. Those infected with HIV should also not share their personal hygiene items with others, especially razors and toothbrushes. Infected items should be cleaned with chlorine bleach or any other disinfectant. Women with HIV/AIDS should avoid getting pregnant. If they do become pregnant, recommendations to minimize the risk of transmission to the fetus include taking antiretroviral treatment, scheduling a cesarean section before the onset of labor and membrane rupture, and feeding their infant artificial milk.

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Treatment, Care, and Support

There is no cure for AIDS. The main goal of treatment is to slow and minimize the replication of the virus inside the body and to increase the number of immune system cells (CD4+). Studies have shown that using anti-HIV treatment (anti-retroviral therapy) increases a patient’s chance for a more normal and longer life.

There are a variety of HIV/AIDS treatment regimens currently available; the one prescribed usually depends on the individual patient’s circumstances and the stage of the disease. Some medications may not be effective for particular strains of HIV. All forms of treatments have certain side effects; before starting any treatment the patient should be made aware of potential side effects and ways to deal with them. Adhering to a treatment regimen requires commitment and consistency on the part of the patient. People infected with HIV should receive counseling to ensure they understand the purpose of HIV treatment and what it involves so that they can make an informed decision about whether and when to start treatment. The sooner an infected individual begins treatment the better his/her body’s chances are of fighting the disease. To learn more about treatment regimens and when to start treatment go to Project Inform or AIDS.gov.

Treatment for HIV/AIDS needs to happen in the context of a caring and supportive environment. HIV patients require support in coping with their situation and learning to live with the infection/disease. Health services providers and the community, particularly family, friends and relatives should be part of the supportive network for people living with HIV/AIDS. Awareness programs play an important role in the effort to reduce discrimination against people living with HIV/AIDS.

There are many things an individual living with HIV/AIDS can do to help his/herself and others. In many areas there are HIV/AIDS support groups which individuals can join for support. Self-education about the disease and seeking counseling and medical assistance are important first steps. Once a treatment regimen has been chosen it is very important to follow the doctor’s instructions and take the medication consistently. It is also critical to protect oneself from other infections and repeated infections because of a weakened immune system. Finally, it is equally important to take the measures discussed in the HIV/AIDS prevention section so as not to transmit the disease to others.

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[1] 2006 AIDS epidemic update: December 2006 (UNAIDS/WHO)
http://data.unaids.org/pub/EpiReport/2006/02-Global_Summary_2006_EpiUpdate_eng.pdf

References