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Overview of HIV and AIDS

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Acquired immunodeficiency syndrome (AIDS) is a life-threatening infection caused by the human immunodeficiency virus (HIV). According to the latest figures published in the UNAIDS/WHO 2006 AIDS Epidemic Update, an estimated 39.5 million people are living with HIV, worldwide. In 2006, 2.9 million people died of AIDS-related illnesses all over the world.1

The new 2006 estimates released by the National AIDS Control Organization (NACO), supported by UNAIDS and WHO, indicate that nationwide adult HIV prevalence in India is approximately 0.36%, which corresponds to an estimated 2–3.1 million people are living with HIV in the country.2

The HIV infection results from two similar viruses either HIV-1 or HIV-2. Countries in the Western hemisphere, Europe, Asia, and central, south, and east Africa are mostly affected by HIV-1 virus;, while HIV-2 virus causes most cases in parts of west Africa and appears to be less virulent than HIV-1.3,4

What Does the HIV Do?

Human immunodeficiency virus creates a DNA version of its genes and continually copies itself by using the resources from the host’s body. They gradually spread all over the body and begin destroying one of the important defence cells known as CD4 cells. These CD4 cells along with other similar cells normally protect the body from infections that can be sometimes mortal to the human body. The HIV both affects these defence cells, which are already present in the body and also prevents their full scale production in the body.3

Once the body is devoid of the defence cells it becomes prone to a number of infections, the severity of which increases as the amount of defence becomes progressively less. Death is usually due to such opportunistic infections that affect the weakened immune system.

Modes of Transmission of HIV

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The transmission of HIV requires contact with body fluids such as blood, semen, vaginal secretions, breast milk, saliva or secretions from wounds or skin lesions, which generally contain the free viruses or infected cells in varying quantities. Although the possibility of transmission from saliva is extremely rare, as it generally does not contain enough viruses to result in an infection.

The common modes by which the HIV can be transmitted include:

  • Sexual contact with an infected person.
  • Sharing needles and/or syringes (primarily for drug injection) with an infected person.
  • Through transfusions of infected blood or blood clotting factors (now very rare in countries, where blood is screened for HIV antibodies).
  • Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.

The following individuals are considered to be at high-risk for contracting the HIV infection and possible development of AIDS:

  • Homo- or bisexual men, who are sexually active.
  • Intravenous drug users and their sexual partners.
  • Men and women who share needles (for tattooing or piercing).
  • Men and women with more than one sexual partner.
  • Sexual intercourse with an HIV-infected partner without using a latex or polyurethane condom.

In case of healthcare workers, HIV infection can occur after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose). The risk of transmission following skin penetration with a medical instrument contaminated with infected blood is about 1/300, on average without treatment, which reduces to 1/1500 after immediate antiretroviral treatment.5–7

HIV/AIDS does not spread by

  • talking, touching or hugging an infected individual;
  • Sharing clothes or utensils;
  • through the air or food;
  • mosquito bites; and
  • kissing.

Symptoms and Signs of AIDS

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AIDS is characterised by a wide spectrum of manifestations that may affect different organs and tissues of the body and range from an asymptomatic infection to life-threatening conditions such as severe infections and cancers. The progression and outcome of HIV/AIDS is influenced by factors such as initial health and nutritional status of the individual, environmental factors, endemic diseases and access to the treatment.

Clinically, the HIV infection can be categorized into three phases:

  1. Acute HIV infection/initial phase
  2. Clinically latent phase
  3. AIDS characterised by certain specific illnesses that include candidiasis, oral hairy leukoplakia, Chronic herpes simplex ulcers, etc.)

Initially, patients with primary HIV infection may be asymptomatic or may present with nonspecific symptoms that persist for sometime. These symptoms usually begin within 1–4 weeks of infection and lasts for 3–14 days. The common symptoms noted during this acute phase include fever, general body aches, rashes, joint pain, generalized swelling of the lymph nodes (lymphadenopathy) and sometimes aseptic meningitis.

During the second phase, the virus is actively multiplying and spreading throughout the body. The affected individual may remain asymptomatic during this phase that may last for several months or years. When symptomatic the commonly noted features include: Clinical features such as chronic fever, persistent cough for more than 1 month, chronic diarrhea, oral candidiasis, severe chronic herpes simplex virus (HSV) infection, >10% loss of body weight within 1 month and tuberculosis (TB).  

The third phase during which the individual is characterized as having AIDS tends to suffer from a wide variety of infections and conditions due to the weakened immune system. The individual is at high-risk of developing infections such as TB, pneumonia, toxoplasmosis and meningitis. Other infections include herpes zoster, herpes simplex, candidiasis and recurrent Salmonella spp. infections. Some individuals may present with cancers such as Kaposi’s sarcoma.3,7

How is AIDS/HIV Infection Identified?

Individuals suffering from constant infections or conditions given above are suspected to have contracted the HIV infection if they also have a history of:

  • Multiple sexual partners
  • Unsafe sexual practices
  • Transfusion of unscreened blood or blood products in hospitals and illnesses
  • Babies of infected mothers
  • Accidental skin contact with blood (such as needle stick injuries and treating wounds)

In adults and older children, blood tests such as enzyme-linked immunosorbent assay (ELISA) test and Western blotting are the methods used initially to detect HIV infection. An initial negative result though signifies the absence of infection, the individual with such symptoms cannot be declared free of infection until another negative test is elicited after about 6 months of the initial test.

Positive results confirm the individual is infected with the virus and needs further testing to confirm the status of the infection. The doctor may advise several additional tests to either confirm or rule out the presence of other infections or conditions.     

What is the Treatment?

Although death cannot be prevented, the life expectancy of individuals infected with HIV has significantly increased with introduction of newer antiretroviral drugs. These antiretroviral drugs which are generally advised in combination are effective in preventing the multiplication of the viruses to a certain extent.

The doctor may advise other specific treatments and further investigations depending on the type of infection or condition an individual is suffering from.

The antiretroviral drugs may be advised to prevent HIV infection if one has been exposed to HIV through sexual intercourse, sexual assault, injection drug use or an accident. The treatment should be started within 72 h after a high-risk exposure to someone known to be infected with HIV or is suffering from AIDS. The antiretroviral treatment lasts for 28 days. However, this is not effective in individuals who fall in the high-risk category specified earlier.

Mortality in patients with AIDS is generally related to widespread opportunistic infections, which may not respond effectively to treatment or to the development of unusual cancers 7.

How Can One Prevent Him-/Herself from Getting Infected?

Simple steps can prevent a major tragedy.

  • Practice monogamy and avoid multiple sex partners.
  • Always ask the new sexual partner about his or her sexual history.
  • Practice safe sex, use latex or polyurethane condoms and seek periodic HIV testing if you fall under the high-risk group.
  • Do not share needles.
  • If you are a healthcare worker always wear protective gloves in situations that involve exposure to blood or other body fluids.

The risk of an infected mother transmitting the HIV infection to her unborn child is reduced by two–third if she is administered a proper course of antiretroviral drug. Delivery by caesarean section also tends to reduce the chances of the child being infected. Consuting the healthcare provider is necessary, if a woman is suffering from HIV infection and is diagnosed to be pregnant.8,9   

If You are HIV Positive!!

Meet your doctor immediately to discuss the treatment and prevention of complications

See your doctor on a regular basis to ensure optimal health and know about new treatments

Get in touch with a local AIDS support group  

How Can You Prevent Others from Getting Infected?

If you have had a positive ELISA test recently or have been diagnosed to be suffering from AIDS you can prevent the infection from being spread to others by:

1.Informing your healthcare provider that you are infected.

2.Practising safe sex. Avoid exposure to blood, semen and other secretions during foreplay or intercourse.

3.Use condoms (latex or polyurethane) for all oral, vaginal or anal sexual activity

4.Do not share needles.

5.Do not donate blood or semen.

6.Do not plan to donate any organ.

References

1.UNAIDS: 2.5 million people in India living with HIV, according to new estimates: Improved data from more sources gives better understanding of AIDS epidemic in India, WHO, Press Release on: 6 July, 2007.

2.Volberding PA, Baker KR, Levine AM. Human immunodeficiency virus hematology. Hematology Am Soc Hematol Educ Program. 2003; 294–313.

3.Kumarasamy N, Vallabhaneni S, Flanigan TP, Mayer KH, Solomon S.Clinical profile of HIV in India. Indian J Med Res 2005; 121: 377–394.

4.MMWR [homepage on the Internet]. Washington, DC: Centers for Disease Control and Prevention; Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm, Updated on: 2001 February; cited on: 2007 July 10.

5.Adler MW. ABC of AIDS: Development of the epidemic. BMJ. 2001;322:1226–229.

6.Grant AD, De Cock KM. ABC of AIDS: HIV infection and AIDS in the developing world. BMJ. 2001; 322: 1475–1478.

7.Risbud A. Human immunodeficiency virus (HIV) & sexually transmitted diseases

8.(STDs). Indian J Med Res. 2005; 121: 369–376.

9.Saag MS. Perspective: Initiation of antiretroviral therapy: Implications of recent findings. Topics in HIV Medicine. 2004; 12(3): 83–88.

Written by: Dr vijay soni

Date last updated: January 15, 2015