NAV JIVAN Hospital: Fully described HIV and AIDS ?

HIV and AIDS

What is HIV?

HIV means 'human immunodeficiency virus'. This is the virus that causes AIDS.
HIV first emerged as a threat to humanity in the early 1980s. It spread so fast that initially there were fears that it might wipe us all out. Happily, there now seems no danger of that.
However, in 2012 the worldwide situation is this.

About 34 million people have HIV.
Around half of these are women.
Over two million children have the virus.
Each year, about 2.7 million people catch HIV.

In some countries, particularly those located in Sub-Saharan Africa, the HIV rates are very high. For instance, in the Republic of South Africa it's estimated that about 11 per cent of the population is HIV-positive.
Therefore, you should bear in mind that having sex with a new partner in certain areas of the globe could be very dangerous.
Please note that there are now known to be two types of HIV – called HIV-1 and HIV-2. The latter one is more common is some parts of the world, notably West Africa.

What are the common myths about HIV?

Many people believe the following stories that have become commonplace during the 30 years since HIV first emerged.

'You can tell if someone is HIV-positive by looking at them'. This is nonsense. The great majority of people with HIV look perfectly normal.
'You can't get HIV from straight sex'. This isn't true. Worldwide, vaginal intercourse is now the most common way of acquiring the virus.
'Only gay men get HIV'. This is also untrue. Very large numbers of heterosexual men and women get it.

How does HIV infect people?

There are four main ways in which it can enter the body.

During sex. Rectal intercourse is a very 'efficient' way of transmitting the virus from one person to another. But nowadays, the majority of infections worldwide are caused by vaginal intercourse with an infected person.
Through sharing injection needles. Intravenous drug users are at particular risk, if they use needles that have already been used by someone else and which therefore may be contaminated with the virus.
From infected blood products. In some parts of the world blood intended for transfusion is still not tested for HIV. However, this is NOT the case in the UK.
Though infection of a baby by its mother.

A tiny number of cases occur for other reasons, for instance as a result of organ donation or sperm donation from a person who is HIV-positive, though these occurrences are very unlikely in the UK.

How does HIV attack the human body?

HIV cannot live on its own in the environment. So, in order to survive, the virus has to attack other living cells and use their metabolism to make copies of itself.
Unfortunately, HIV attacks some of the human cells that are vital to a healthy immune system, including the white blood cells known as T-helper cells or CD4 cells.
At the start of HIV infection – the primary infection – there are two possible outcomes. You can either have a short, flu-like illness that occurs one to six weeks after infection, or you can have a so-called 'dumb' infection, with no symptoms at all.
However, even if you don't have any symptoms – you can still infect other people.
Six to 12 weeks after the infection, the white blood cells have produced so many antibodies against HIV that they can be measured by a blood test. If you have HIV antibodies in your blood, you are now HIV-positive (HIV+).
An infected person will probably feel well for a long time. But the infection is still active inside the body and the virus, which can infect and destroy new blood cells, is constantly being produced.
The number of T-helper cells in the blood will slowly be reduced and when, after a number of years, the immune system has been weakened, the infected person will start showing symptoms of AIDS.

What is AIDS?

AIDS means 'acquired immune deficiency syndrome'.
It's a condition that sets in when the HIV virus has killed so many T-helper cells that the immune system is no longer able to recognise and react to attacks from everyday infections.
HIV may also attack the nervous system, possibly causing dementia. And it may affect the skin, on which small tumours develop. This condition is known as Kaposi’s sarcoma.
A number of different symptoms can occur in people who have AIDS:

fatigue
inexplicable weight loss
repeated bronchial and skin infections that do not react to normal treatment
fever
swollen lymph nodes
diarhhoea
night sweats
outbreaks of previous infections that have remained dormant (herpes and other conditions)
so-called 'opportunistic infections' – serious infections by micro-organisms of the type normally prevented by the immune system. These in turn could lead to a number of related illnesses, such as cancer or dementia.

In the end, the disease can become so serious that the infected patient dies.

How common is AIDS?

In Britain during 2011, only 350 people were identified as new cases of AIDS.
But a total of well over 25,000 people have now been diagnosed with AIDS in the UK. Sadly, more than 19,000 of these have died.
Worldwide, about two million men and women die from AIDS each year.
In Britain, 375 people died from this disease in 2011.
On a positive note, modern treatments for HIV have greatly prolonged the lives of many people who have the virus.

How do you get infected?

These are the major risk factors.

Unprotected sex – that is, sex without a condom. However, condoms cannot give you complete protection. Occasionally, they break. Rectal sex carries a higher risk than any other type of sexual activity.
Blood-to-blood infection, when using a contaminated needle (which has been used by someone else) or through transfusions of contaminated blood. Today, all blood that's donated in the UK is tested for HIV, so this route of infection is now almost unknown in Britain.
Mother infecting her child. The child can be infected during the pregnancy, during labour or after the delivery, through the brast milk.

Ordinary social interaction with HIV-positive people is not contagious.

Who is at risk?

It's common for HIV-campaigners to say that 'we are all at risk'.
Technically, this is so. But in reality, there are many factors that affect your level of risk.
For instance, if you live in a part of the world where HIV is still rare and only have sex with your spouse – you're not likely to get it.
In the UK, people who are at 'above-average' levels of risk include the following.

Heterosexual men and women who do not practise safe sex, especially if their partners originate from areas of the world where HIV is widespread – Africa (south of the Sahara Desert), parts of Asia and some of the Caribbean Islands.
Homosexual and bisexual men, who go in for anal sex with many different partners and who do not practise safe sex.
Women who have unprotected sex with many different partners, especially if these include bisexual men or intravenous drug users.
'Straight' men who have unprotected sex with many different partners.
Prostitutes who don't practise safe sex. Also at risk are their customers and these customers' other sexual partners.
drug addict who share needles.
Hospital workers whose work involves real risk of pricking or cutting themselves with infected instruments or needles.
Babies of an HIV-infected mother.
People who have had many blood transfusions overseas or who were treated with blood products before 1985.

How do you avoid infection?

use a condom. This is not a guaranteed method of avoiding infection, but using a condom reduces the risk considerably. It must be worn all the way through sex.
Avoid using recreational drugs that are injected with a syringe. Do not share syringes or needles with others.
Avoid blood transfusions in certain countries, where they may not test the blood for HIV.

I might be infected – what should I do?

If you have been exposed to infection, you should contact a doctor as soon as possible for advice, testing and treatment.
In the UK, the best place to go is a genitourinary medicine (GUM) clinic because they're used to dealing with possible HIV cases. Also, their technical facilities are very good indeed.
Traditional HIV tests don't become positive until about three months after exposure to infection. But newer tests are now coming in, and these can provide an earlier diagnosis (see below).
If you know or suspect that your partner is HIV-positive or if you have been exposed to infection by accident – for instance through pricking yourself with a contaminated needle – treatment will be started to prevent an actual HIV infection. To be effective, it must commence within 72 hours of exposure.
The treatment may have some unpleasant side-effects, so before going ahead the real risk of infection should be estimated.
This should be decided by you, your doctor and your local HIV consultant.

How do I get tested?

If you're going to have an HIV test: you should talk to a doctor or counsellor first, in order to discuss the possible implications of the result.
Under the NHS, an HIV test at a GUM clinic is free of charge and anonymous. You can also have a free HIV test arranged by your GP, but this will appear on your medical records for the rest of your life.
Some people go for private HIV tests at one of the many commercial clinics that advertise their services in London and other large cities. Currently, the routine test will cost you about £110. The clinic shouldn't tell anyone else the result unless you authorise them to.
You might also encounter circumstances where HIV testing is obligatory. For instance, when people want to take out a large insurance policy, it is quite common for the company to ask for a preliminary HIV test.
Also, you're required to have a test if you want to do any of the following:

become a blood donor
donate some of your organs for transplantation
use your sperm for artificial insemination
adopt a child
contribute an egg for transplantation.

What are the tests for HIV?

There are now various different tests for infection. Be guided by the GUM clinic or HIV consultant.

HIV antibody test

This is the basic, traditional test for HIV, and it's sometimes referred to as the INSTI test because you can get the result almost instantly.
It depends on the fact that when a man or woman gets infected with HIV, the body slowly reacts by producing protective proteins, called 'antibodies'.
These usually develop within three months of infection, so there's no point in doing the INSTI test before then.
It's possible to test for the antibodies in blood and saliva. If the result is negative, it's probably a good idea to have a re-test in a few months.

P24 (antigen) test

An antigen is the part of a virus that provokes the development of antibodies. In the case of HIV, the most important antigen is called 'P24'.
This antigen can often be detected in the early weeks after HIV infection.

Earlier diagnosis: the HIV DUO test

This is a newer test, which detects antibodies to both HIV-1 and HIV-2, as well as the P24 antigen. It becomes positive about 28 days after infection.
At private clinics, it currently costs about £110. Results should be available the same day.

Very early diagnosis: the HIV-1 Proviral (PCR) test

Also known as the RNA PCR test, this detects the genetic material in the HIV virus, and it can identify the virus within only about 14 days of infection.
Results take a few days to come back. If done privately, it is expensive – currently it's about £250.
A major drawback of this test is that it only detects HIV-1 infection, and not HIV-2.
So if you have recently had a sexual contact in West Africa, this would not be the ideal test for you.

Home tests

In 2012, a number of commercial companies are offering home tests for HIV. But this practice is illegal in some countries.
It's far better to have your test done by a specialist doctor, who can explain its implications to you.
Nevertheless, in July 2012 the American Food & Drug Administration approved a self-administered over-the-counter test called OraQuick.
You do the OraQuick test by taking a swab of your saliva and putting it into a tube containing a reactant.
If you think that the result is positive, you should then go and get more reliable testing from a clinic.

Treatment: what does it involve and what medication is used?

If you do have HIV, you should have expert treatment from a specialist. Please don't be persuaded by alternative 'cures'.
Rather alarmingly, statistics suggest that quite a lot of people who are HIV-positive and who need treatment are not actually receiving it.
In the first years of the HIV epidemic, back in the early 1980s, there was no specific treatment. And many people died very quickly of AIDS.
But in the late 1980s, it was discovered that treatment with virus-fighting drugs called anti-retrovirals could slow the onset of the disease. The first and most well-known of these drugs was zidovudine(azt). Unfortunately, it had many side-effects, and very often the HIV virus became resistant to it.
Happily, in the 1990s, other drugs from the same group as AZT (called 'reverse transcriptase inhibitors') became available. Shortly after that, several other classes of anti-virals were discovered, notably the protease inhibitors.
These days, people who have HIV, and whose CD4 cell count has dropped to dangerous levels, are treated with a combination of different groups of drugs – mainly as tablets or capsules.
These combinations reduce the chance of resistance occurring, and greatly increase the prospects of long life.
This combined treatment is generally known by the name HAART, which stands for highly active antiretroviral therapy.
All of the drugs which are used in HAART can have side-effects. But they do give you a really worthwhile lease of life.
As a result of HAART, there has been a very sharp decline in AIDS deaths in the UK.
New and more efficient treatments to fight HIV and reduce the content of virus in the blood are being developed all the time.
In additiion to anti-virus treatment, you will almost certainly need the following at times:

Specific treatment of infections occurring as a result of HIV; please note that these can include tuberculosis.
vaccination against illnesses such as flu, pneumonia and infectious hepatitis.
Therapy for the symptoms connected with HIV infection and AIDS, for instance treatment of nausea and loss of appetite.

What can I do for myself?

If you do not have anyone to talk to about the situation, you might like to visit your GP, a counsellor with relevant experience or a psychotherapist. You should discuss your worries and the depression, which often follows the discovery that you are HIV-positive.
Your partner, if you have one, may well need counselling too.

You should be treated for all infections and illnesses that result from the HIV virus. If these are serious, you will have to go to hospital.
You should contact AIDS and HIV sorroport gp because these organisations can be helpful.
Make sure you eat a varied and healthy diet.
Avoid smoking and exessive drinking.
Get adequate exercise.

Possible deterioration

Eventually, serious illnesses may develop as a result of HIV infection.
Commonly, these include infections that are normally prevented by the immune system.
These inlude:

tubuculosis
pneumonia caused by the germ Pneumocystis carinii
toxoplasmosis infection in the brain
reactivation of the germ cytomegalovirus
infections involving the fungus candida albicans and also other fungal diseases
cancer, especially skin cancer, and cancer in the lymph nodes
meningitis and encephalopathy, a brain disease that may cause dementia.

Death may occur as a result of these illnesses. But at the present time, large numbers of HIV-positive patients are managing to avoid those complications and to remain perfectly well.

Future prospects

AIDS is not yet curable.
However, many of the illnesses resulting from the condition can be treated.
Generally, between 5 and 20 years pass from the time of infection until AIDS actually develops.
Previously, those infected only lived for a couple of years after developing AIDS.
Fortunately, with the new types of treatment available, the survival rate has greatly improved. There are patients alive today who caught the infection over 30 years ago.

Fully described HIV and AIDS ?