Combating HIV

What is HIV

HIV stands for Human Immunodeficiency Virus. As its name suggests, this virus damages your immune system (a network that protects your body from bacteria, viruses and more).

White blood cells are a key part of the immune system. However, untreated HIV infects and kills a type of immune cell called a T cell. If a lot of T cells are destroyed, the body can no longer defend itself against foreign invaders and infection.

This means that as time passes your risk of getting various types of conditions and cancers will increase.

HIV is transmitted through bodily fluids (fluids naturally occurring/produced by the body) that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

The virus is not transferred in air or water, or through casual contact (shaking hands, hugging, etc).  Because HIV inserts itself into the DNA of cells, it is a lifelong condition.  There is no current drug that can cure HIV, but with proper treatment, the condition can be kept under control.

If the person with HIV does not seek treatment, they will likely develop a serious condition called Acquired Immunodeficiency Syndrome (AIDS).  The immune system is now extremely weak, and is not able to fight against other diseases and infections which regular people can handle.

Untreated, HIV can develop into AIDS within a decade – The life expectancy with end stage AIDS is roughly 3 years. However, with antiretroviral therapy, HIV can be well-managed. People with HIV can live almost as long as someone who has not contracted HIV.

What is AIDS

AIDS is the most severe and the last stage of HIV.

A person with HIV whose CD4 (a type of T cell) count is below 200 per cubic millimeter will be diagnosed with AIDS.

Another way someone can be diagnosed with AIDS is if they have HIV and develop a type of infection or cancer that’s rare in regular people (called opportunistic infections)

For example, an opportunistic infection such as Pneumocystis jiroveci pneumonia is one that only occurs in someone whose immune system is very weak, such as someone with advanced HIV infection (AIDS). If someone with HIV develops this infection, they will be diagnosed with AIDS, regardless of their T-cell count.

If AIDS does develop, it means that the immune system is severely weakened, which causes the person to become vulnerable to a wide range of illnesses, including pneumonia, tuberculosis, and cancer.

The shortened life expectancy linked with untreated AIDS is not a direct result of the syndrome itself. Instead, it is due to the many diseases that become a problem when your immune system is weakened by AIDS.

Along those same lines, there’s technically no cure for AIDS currently

Causes of HIV infection

You can get HIV if you come into contact with infected bodily fluids like blood, semen, or vaginal fluids. Some other ways include:

• Having sex with someone who is HIV-positive without protection
•  Sharing needles with someone who is HIV-positive
• HIV-positive mother can pass the virus to her baby during pregnancy, birth, or breastfeeding.

HIV cannot survive for long outside of the body. Hence, it cannot be spread by casual contact like kissing or sharing food and drinks

HIV does NOT transfer through:

• touching someone skin to skin
• hugging, shaking hands
• sharing food or drinks
• saliva, tears, or sweat (unless it is mixed with HIV-positive blood)
• sharing a toilet, towels, or bedding

If a person living with HIV is undergoing treatment and has a persistently undetectable viral load, it’s basically impossible for them to transmit the virus to another person.

Risk Factors

Some behaviours and conditions that can increase your risk of contracting HIV include:

• having anal or vaginal sex without protection
• Men having sex with another man
• having another sexually transmitted infection (STI) like syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis
• sharing contaminated needles, syringes or other injecting equipment and drug solutions
• receiving unsafe injections, medical procedures or blood transfusions and tissue transplantation,
• experiencing accidental needle stick injuries, including among health workers

Signs and Symptoms

Around 80% of people who are HIV-positive will experience flu-like symptoms within two to four weeks. This is an acute HIV infection. It is the first stage of HIV and will last until the body creates antibodies (substances produced in the blood to destroy other substances which cause diseases) against the virus. The most common symptoms of this stage of HIV include:

• body rash
• fever
• sore throat
• bad headaches

Less common symptoms may include:

• fatigue (tiredness)
• swollen lymph nodes (see picture on the left)
• ulcers in the mouth or on the genitals
• muscle aches
• joint pain
• nausea and vomiting
• sweating at night

Symptoms of HIV are not very different between those in women and men.

• HIV symptom that only men have is an ulcers on the penis.
• HIV may lead to hypogonadism (poor production of sex hormones) in both men and women. It can lead to erectile dysfunction (ED).

Diagnosis and testing

There is a range of tests to diagnose HIV. However, when you take the test is also important. The HIV window period is the time between someone’s exposed to HIV and when it becomes detectable in the blood.

Most people only develop detectable antibodies against the virus within 23 to 90 days after transmission. If someone takes an HIV test during the window period, they will probably receive a negative result as their body has not produced enough antibodies to be detected. However, they can still pass on the virus to others during this time.

If someone thinks they may have been exposed to HIV but tested negative, they should repeat the test in a few months to confirm. They should also use condoms or other barrier methods to prevent possibly spreading HIV to other people. Some common HIV tests are listed below. Antibody/antigen tests

These are the most commonly used tests. Positive results are shown typically within 18–45 days after someone initially contracts HIV.

Antibody tests

These tests check for only antibodies in the blood. Most people develop detectable HIV antibodies 23-90 days after transmission. Since these antibodies can be found in the blood or saliva, the tests are done typically using blood tests or mouth swabs -No preparation is necessary.

Some tests are even able to provide results in 30 minutes or less and can be done in a clinic.

Did you know that antibody tests can be even carried out at home? Here are some convenient tests:

• Ora Quick HIV Test. The test uses an oral swab which can give you results in as little as 20 minutes.
• Home Access HIV-1 Test System. They will send your blood sample (done through a finger prick) to a lab.

If you tested negative in a home test but are still worried about HIV exposure,  what you can do is to repeat the test in 3 months and continue using condoms and/or barrier methods.

Nucleic acid test (NAT)

This test is rather expensive and is not used for general screening. It is only recommended for people who have early symptoms of HIV or know that they have a risk factor. The test looks for the virus itself instead of antibodies.

. An advantage of this test is that it can spot acute HIV infections, which may not be spotted by normal antibody tests due to their early stage.

Complications

HIV infections weaken your immune system. That increases your risk of getting certain infections and cancers.

Infections commonly found in people with HIV/AIDS

• Pneumocystis pneumonia (PCP) – A fungal infection that can cause severe illness.
• Candidiasis (thrush). It causes inflammation and a thick, white coating on your mouth, tongue, esophagus (part of the body that connects the throat to the stomach), or vagina.
• Tuberculosis (TB). In people with AIDS, TB causes the most number of deaths.  Click here for more information on TB
• Cytomegalovirus. It can damage your eyes, digestive tract, lungs, or other organs.
• Cryptococcal meningitis. It can cause headaches, fever, and neck pain. Can be fatal if untreated.
• Toxoplasmosis. Heart disease and seizures are some problems when it spreads to the brain.
• Wasting syndrome. It can cause significant weight loss and weakness
• Neurological problems like confusion and memory loss or anxiety
• Kidney disease
• Liver disease

Treatment

HIV can be kept under control with antiretroviral treatment. With the right medication, you can keep your viral load very low, and possibly even to the point where it is virtually undetectable – In this case, it is almost impossible for the person to spread HIV to an HIV-negative sexual partner.

Furthermore, taking HIV medication consistently, as prescribed, can help to prevent drug resistance. Drug resistance occurs when people with HIV are inconsistent with their treatment as prescribed, causing the virus to mutate (change). The virus might no longer respond to certain HIV medications, limiting your treatment options.

Consistent antiretroviral treatment helps to reduce the chances of your condition progressing toward the final stage of HIV, or AIDS. This can help to improve your prognosis as well. Testing of blood can help to determine if the treatment plan is working and help to maintain a low viral count and a high T cell count.

While HIV medication used to be extremely expensive in the past, it has become more affordable with the help of governmental subsidies. Just last year, the Ministry of Health added 16 antiretroviral drugs used for the treatment of HIV to its list of subsidised drugs.

Patients who are struggling to afford HIV drugs can seek assistance under the Medical Assistance Fund – All subsidised patients who purchase any of the drugs in the scheme will receive 50 percent or 75 percent worth of subsidies, depending on their needs.

Side Effects

Taking HIV medication can result in side effects for certain people.  These side effects include:

• Nausea and vomiting
• Diarrhea,
• Difficulty sleeping
• Dry mouth
• Headache
• Rash
• Dizziness
• Fatigue
• Pain.

Although a lot of work has been done to develop one, there’s currently no vaccine available to prevent the transmission of HIV.

Some other methods you can try to reduce your risk

Safer sex

The most common way HIV is transferred is through anal or vaginal sex without a condom or other barrier methods. Unless you completely avoid sex, it is impossible to have zero risk. However, the risk can be lowered by taking a few precautions.

A person who is worried about contracting HIV can:

• Get tested for other sexually transmitted infections (STIs). Having other STIs may increase the risk of contracting HIV.
• Get tested for HIV – figure out if they or their partner have the disease
• Use condoms
• Avoid sharing needles
• Take their medications as per the doctor’s instructions

If a person has a partner with HIV, they can suggest PrEP (pre-exposure prophylaxis) or PEP (post-exposure prophylaxis).

PrEP

• a form of daily medicine that can reduce the risk of HIV spreading throughout your body if you one day are exposed to HIV

PEP

• is recommended for people who think they might have possibly been exposed to HIV
• a form of emergency medication started within 72h of exposure

Bookmarked Info

HIV progresses through three stages:

• stage 1: acute stage, the first stage that happens the first few weeks after transmission
• stage 2: Chronic stage – You may not experience symptoms.
• stage 3: AIDS

More information about symptoms of other later HIV stages

Chronic HIV (after the initial acute infection phase)

• coughing
• breathing difficulties
• weight loss
• diarrhea
• fatigue
• high fever

In some cases, chronic HIV has no symptoms (latent infection) This period can last up to 10 years.

AIDS (final stage of HIV infection)

• persistent high fevers of over 37.8 degrees Celsius
• severe chills
• night sweating
• white spots in the mouth
• genital or anal sores
• rashes (brown, red, purple, or pink in colour)
• regular coughing and breathing problems
• significant weight loss
• persistent severe headaches
• memory problems
• pneumonia