HIV/AIDS

HIV/AIDS

Defining HIV/AIDS

What is HIV?

Illustration showing the structure of HIV.HIV (human immunodeficiency virus) is a medically classified disease which can lead to the development of AIDS (acquired immunodeficiency syndrome). A destructive virus without a cure, HIV constantly attacks the body’s CD4 cells (also known as T cells – these cells identify and destroy virus infected cells), effectively working against the immune system.

Normally the body’s immune system is able to fight off infection. The forceful nature of HIV means that the virus reduces the number of CD4 cells in the body, making an infected individual more vulnerable to a variety of other infections or other infection-related conditions, such as tuberculosis, candidiasis and cancer. The HIV virus uses proteins in the CD4 cells to produce a copy of itself, before destroying these cells.

This process is constant and can happen daily for as many as 10 years or more, even without the display of obvious symptoms. The constant battle within the body means that over time, it becomes more and more difficult for the body to protect itself and fend off illness. An infected person will constantly have their CD4 cell count monitored through treatment.

The virus is a life-long one with no cure and requires constant medical care and treatment in order to control it. Once infected, a person has a constant battle with a weakened immune system. The earlier an individual begins a treatment programme the better for their quality of life and ultimately, life expectancy.

One of the most important things regarding treatment with antiretroviral therapy (ART) is to prevent (or lower the risk of) further transmission (spreading of the virus), as well as to control the progression of the disease, prolonging the life of the infected person. If treatment is administered before the disease is too far advanced, a person’s life expectancy can be almost as long as someone without an infection.

The importance of testing can’t be stressed enough. It is the only way to determine the presence of the virus in the body. The process for testing is not nearly as complicated as you may think and can be requested at most medical clinics, hospitals, community health centres and even substance abuse programmes around the world.

What is AIDS?

Illustration showing the structure / anatomy of the AIDS virus (disease).When a person is diagnosed with HIV, it does not mean that they automatically have AIDS. Acquired immunodeficiency syndrome is the most advanced state of HIV (i.e. the final stage) and effectively happens when the virus destroys so many CD4 cells that the body is barely able to fend off illness and disease. Not every person with HIV, however, will develop AIDS. The disease may never advance this far and can take years before an HIV infection advances to the stage of AIDS.

If it happens, what this advanced stage effectively means is that the body’s immune system is so badly damaged that a person is at their most vulnerable for a variety of what is often termed, ‘opportunistic infections’. ‘Most vulnerable’ means that a person’s CD4 cell count has fallen below the 200 cells per cubic millimetre of blood mark (200 cells/mm3).

AIDS is classified as chronic and is considered potentially life-threatening. The life expectancy once this stage is reached can be anywhere between a year (without medical treatment) to 3 years (with medical treatment). Before the development of medical treatment, the advancement from HIV to AIDS could progressively occur within a handful of years. Now, if treatment is administered early enough following diagnosis, an HIV positive individual may never reach the most advanced stage of the virus.

Recent HIV/AIDS statistics

Upwards of 36.7 million people are currently living this HIV/AIDS across the world (as recorded at the end of 2015) according to UNAIDS (The Joint United Nations Programme on HIV/AIDS). Of these, an estimated 1.8 million infections are recorded in children. The vast numbers of infection mean that the disease is regarded as one of the world’s most serious health challenges.

Other facts include:

  • During 2015, an estimated 2.1 million people across the world became newly infected with HIV, including at least 150 000 children.
  • It is estimated that only 60% of those living with HIV have been tested and know their status. The remaining 40% are noted as having little access to testing services. The vast majority of these infections are those who reside in sub-Saharan Africa (low and middle-income countries).
  • Across the world, an estimated 18.2 million who are living with HIV have access to ART.
  • Since the start of the epidemic in the early 80s, an estimated 35 million individuals have died from HIV/AIDS related health conditions and illnesses. In 2015 alone, 1.1 million people were recorded to have died from HIV/AIDS related medical problems.
  • Mother-to-child transmission of HIV has been notoriously high in low and middle-income countries. By the end of 2015, as much as 77% of infected pregnant women were provided access to ART medications which dramatically lowered the risk of transmission to their babies. Since 2010 mother-to-child transmission has declined by 50%, which marks significant progress in keeping new infections at bay.

Is HIV/AIDS contagious?

Virus transmission has been something of immense concern since the emergence of HIV during the early 1980s. A lack of knowledge about the virus and how it is spread is the main reason for the incredible spike of infections during the past three decades.

Infection is primarily transmitted through sexual contact (exchanged bodily fluids such as infected blood, vaginal secretions or semen), as well as through childbirth (from mother-to-child) or breastfeeding (breast milk):

  • Sexual contact (unprotected): The virus is easily transmitted through the exchange of bodily fluids during vaginal, oral or anal contact with an infected person. Fluids the virus infects are semen, blood and vaginal secretions. Once these enter the body, infection is spread from one person to another. Sometimes an infection can be transmitted through mouth sores or small tears that can sometimes occur during sexual activity. Only certain bodily fluids carry the virus making contact possible with certain behaviours, including sexual activity. Fluids that place you at risk when engaging in sexual activity with an infected individual include blood, pre-seminal fluid (pre-cum), semen (cum), vaginal and rectal fluids. HIV is not spread through saliva.
  • Sharing of needles or syringes: The use of needles, whether for illicit drug use, piercings or tattoos, that are not hygienically maintained can transmit the virus through contaminated blood. Other viral infections, such as hepatitis are also at elevated risk of being transmitted this way. HIV can ‘live’ for up to 40-odd days on an infected / used needle.
  • Needles used in medical care: Healthcare workers are frequently at risk for possible infection when handling needles in medical environments. Workers are trained to take special precautions when handling HIV-infected blood (on needles or when infected blood is splashed during medical handling of an infected person). It is rare, but infection transmission can happen this way.
  • Blood transfusions and organs: Infection via a blood transfusion occurs less frequently as all blood products are screened for HIV infections before being used for medical purposes. It can happen, in very rare instances, that infected blood transmits the virus to an otherwise negative status individual during a transfusion procedure. Organ and other tissue transplants contaminated with the virus is another rare, but possible means of transmission if not rigorously tested before use.
  • Pregnancy, childbirth and breastfeeding: A woman infected with HIV can pass on the disease to her unborn baby during pregnancy, through childbirth or while breastfeeding (breast milk). If an expectant mother receives treatment during her pregnancy, risk of mother to child transmission is considerably lowered.

Used syringe with blood in the hand of a person.

Other means of HIV transmission

As not all bodily fluids carry the virus, those that do must come into contact with damaged tissue (broken skin or a tear) or mucous membranes (such as those found in the vagina, penis, mouth and rectum) in order for an infection to spread.

Theoretically, it is possible to spread an infection through oral sex, but in general transmission in this way is highly unlikely. To transmit infection this way, the mouth must come into contact with an infected person’s penis, anus or vagina (through fellatio, rimming or cunnilingus), as well as through ejaculation in the mouth. The risk of infection is increased if the person giving oral sex has mouth sores, cuts or bleeding gums or the person receiving oral sex has genital sores or cuts, and either party is HIV positive with a detectable viral load.

Other ways HIV can be transmitted theoretically, although extremely rare, include:

  • Eating foodstuffs that have been pre-chewed by an infected individual. The only known cases reported are those of infants whereby a caregiver whose infected blood has mixed with food in the mouth while chewing before being exposed to an infant.
  • A very small number of recorded cases have shown occurrences of infection through extensive tissue damage following being bitten by an infected individual. Transmission through biting is possible with the presence of contaminated blood coming into contact with broken skin.
  • Also, theoretically possible, is contamination through deep, open-mouthed kissing. Saliva does not carry the virus so the exchange of this fluid will not transmit an infection from one person to another. If there is a presence of contaminated blood in the mouth of an infected individual (due to bleeding gums or mouth sores) at the time when it comes into contact with the others’ bloodstream, transmission can occur this way.

Ways HIV is not transmitted

The virus itself cannot reproduce itself outside the human body, and thus does not typically ‘live’ for very long. Therefore HIV/AIDS cannot be spread in any of the following ways:

  • Through water or air
  • Through contact with saliva, sweat or tears (that aren’t mixed with contaminated blood)
  • Through the bites of insects, ticks or mosquitoes (that may have bitten infected individuals)
  • Through physical touch, such as closed-mouth kissing, hugging or shaking hands with an HIV positive person.
  • By sharing cutlery or crockery with an infected person, as well as a toilet that an infected person has used.
  • By sharing food or drinks with an infected person (that aren’t mixed with contaminated blood).

Signs, symptoms and stages of HIV

A person cannot rely on symptoms alone to determine an HIV status. Symptoms vary according the phase of infection (the weakening of the immune system due to destroyed CD4 cells and the physical effects this has on the body). The only sure way to know if a person has an infection is through testing.

Signs and symptoms according to infection stage

An HIV infection progresses through three stages, each presenting different sets of symptoms and complications. Not all HIV positive individuals will progress through all three stages. Some never develop full-blown AIDS. An HIV infection, however, lasts the remainder of a person’s life once contracted and cannot be cured. The three stages and their associated symptoms are:

  • Acute HIV (the primary infection stage): Once the virus has entered the body, initial symptoms may show up within two to four weeks or up to a month or two (when the body’s immune system kicks into gear to fend off signs of infection). The acute stage typically shows up flu-like symptoms which can linger for a few days or up to several weeks. Common symptoms include headache, fever, nausea and vomiting, joint pain, muscle aches, body chills, a sore throat, swollen lymph nodes (in the neck), mouth ulcers and a red (inflamed) rash. Symptoms range from mild to severe and depend on the amount of the virus present in the bloodstream (the viral load). Symptoms such as these can also appear due to other infections in the body. The virus is more easily spread during this stage of infection, especially if the viral load (amount of virus in the bloodstream) is particularly high. Even if a person does not display obvious symptoms at this stage, they can still easily transmit the disease through relevant spreading behaviours.
  • Chronic HIV (the clinical latent or asymptomatic infection stage): During this stage, there are no specific signs and symptoms of the virus, but many can experience persistently swollen lymph nodes. The virus remains in the infected white blood cells for up to 10 years without treatment before progressing to the next stage. With treatment, this stage can last several decades as the virus slowly progresses by multiplying and destroying cells and although the virus is still very much active at this stage, it reproduces (copies itself) at a lower rate than the previous stage. Transmission of the virus is still very much possible during this stage even if ART treatment is being administered. Treatment can help an infected person’s body to suppress the virus (i.e. there will be low levels of the virus in the bloodstream), but spreading of the disease is still very much possible.
  • Progression to AIDS: As the disease progresses, a person may develop a range of mild infections and other chronic ailments (and associated symptoms). These can include persistent or frequent fevers, fatigue, diarrhoea, swollen lymph nodes (in the neck, armpits and groin), rapid weight loss, thrush (oral yeast infections), sores (in the mouth, genitals and anus) or shingles (herpes zoster). Once the disease has progressed to this advanced stage, the body’s immune system has been severely compromised (damaged). A person is at their most vulnerable to opportunistic infections (i.e. other infections mild enough that a normally healthy individual is able to fend off naturally or with very little medical intervention) and thus experiences associated symptoms such as persistent fever, soaking night sweats, chronic diarrhoea, unexplained or persistent fatigue, weight loss, unexplained bruising (sometimes this can include bleeding), skin rashes or bumps, white spots and unusual lesions that are red, brown, purplish or pink in colour (particularly on the eyelids, or in the nose, in the mouth and on the tongue). During this stage, an infected person is also prone to bouts of pneumonia, neurological disorders, memory loss and even depression. The most severe symptoms typically are as a result of opportunistic infections due to immune system damage and can be life-threatening. Diagnosis of AIDS usually happens when a person’s CD4 cell count drops below 200 or if it becomes apparent that an ‘AIDS-defining illness’ has developed, such as a form of skin cancer, known as Kaposi’s sarcoma or lung condition such as pneumonia (pneumocystis pneumonia).

Who is most at risk?

Anyone and everyone is able to contract HIV, no matter their age, sex, sexual orientation or race (ethnicity). Through many, many cases of the disease over the years and countless studies, it has been ascertained that a person is at greatest risk in the following circumstances:

  • If a person engages in unprotected sexual activity, especially anal sex. Risk also increases with multiple partners.
  • If a person already has another sexually transmitted infection (STI), and especially so if a person has open sores on their genitals.
  • If a person uses intravenously administered drugs (recreational and illicit used with shared needles and syringes).

The importance of testing

Early detection means all sorts of things can be done to help you. The earlier you know, the more you can do to help yourself. This can also delay the need for ARVs for many years and when you need the ARVs, go on them when you are still healthy. It is easier to keep healthy than it is to try and bring you back from the verge of death.

David Ross Patient, also affectionately known as “The Great White Hope” (A South African HIV positive man who has been living with the condition for more than 30 years – one of the longest medically documented people living with HIV).

Red mark and blood sample in tube for CD4 cell testing

As many as 30% of new infections go undiagnosed and carriers unknowingly transmit the virus. The risk is two-fold, making this disease an incredibly difficult one to contain. New infections may go without getting treatment during the early stages of the disease, as well as spread the virus without carriers being aware of their illness.

One way healthcare professionals are working tirelessly to curb increases in undiagnosed new infections is to provide access to routine screening, which forms part of standard healthcare practices. The challenge is getting all providers to effectively implement these screening practices all over the world. Testing can be offered in an anonymous capacity and in some places in the world screening is offered for free.

The CDC (Center for Disease Control and Prevention) encourages all healthcare centres across the world to perform routine HIV testing for all those vulnerable or whom fall into a high-risk group for the disease. The recommendation for high-risk groups extends to adhering to annual screenings (at least once a year). These groups include those who engage in unprotected sexual activity with one or more partners, or who have partners who are HIV positive, as well as those who intravenous (illicit) drug users.

Due to the prevalence of the disease the world-over, the CDC highly recommends getting tested for HIV in all of the following instances:

  • At the beginning of a new sexual relationship
  • As soon as a pregnancy is confirmed
  • If other symptoms associated with other STIs (sexually transmitted diseases) are noted

Why is screening so important?

Most importantly, testing is the only confirmed means of diagnosis. Another reason screening is important relates to the potential to improve a person’s outlook with early detection. If detected in the earlier stages of the disease, treatment is more effective and can help to considerably improve a person’s quality of life (lengthening life expectancy) by reducing the risk of developing AIDS, as well as reduce the risk of transmitting the virus to others.

The best way to treat this disease is to implement treatment as soon as possible. If a person suspects having been exposed to the virus, immediate medical assistance for screening should be sought. Post-exposure prophylaxis are medications that, in some cases, can be prescribed to considerably reduce a person’s risk of contracting the virus.

When should a person consider testing?

Any risk factor for HIV infection should be taken seriously. Testing is highly recommended in any of the following instances:

  • When a person has had several sexual partners during their lifetime
  • When a person engages in unprotected sexual activity with another whose sexual history is not known
  • When a person engages in unprotected sexual activity with another who is high-risk or confirmed as HIV positive
  • When a person injects illicit drugs using a needle, syringe or other associated equipment that has been used by someone else
  • When a person has been exposed to any other STDs (sexually transmitted diseases) or who has had TB (tuberculosis)

It is also very important for a woman who has recently fallen pregnant to ensure that she is also tested for HIV. Usually a doctor will recommend this once a pregnancy is confirmed. Alternatively, a woman can seek screening from any clinic or hospital.

Diagnosing HIV/AIDS

What tests are used for HIV diagnosis?

Testing will require blood or other bodily fluid samples for laboratory analysis. Several types of tests are available, many of which are able to detect an infection almost right away. That said, an infection can only show up within 6 months following contraction even if testing has occurred during the period of time before, as the body takes time to produce antibodies. The white blood cells in the body typically increase, producing antibodies, when there is the presence of any infection. The increase in production of these cells can sometimes take a little time to happen following exposure to infection.

When it comes to an HIV infection, the sooner you are tested and diagnosed the better. Tests available for making a diagnosis are:

  • Antibody screening tests (immunoassay or ELISA tests): This testing methods checks for the production of protein (antibodies) that the body will naturally produce in response to the presence of an infection. This test is ideally done between 2 and 8 weeks following exposure. Early infections are not usually determined with this screening test, but are fairly accurate for diagnosis. To perform this test, a medical professional (doctor) will take a small sample of blood for assessment in the laboratory. A doctor can also use samples of urine or fluids, other than saliva, taken from the mouth. Blood samples are preferred as more antibodies can be found in the blood compared to other fluids. There are rapid versions of this test available which can be made available within 30 minutes if necessary. Rapid tests have been known to give false negative results, however.
  • Antigen / antibody combination tests: This screening test also uses a blood sample and can detect an HIV infection up to 20 days earlier than an antibody screening test. In the laboratory, a technician will assess a blood sample for the HIV antigen (known as p24), which is a protein that forms part of the virus. This protein is usually present within 2 to 4 weeks following exposure to the infection. A technician will also check for HIV antibodies. Rapid tests are also available for this screening option and can be ready within 20 minutes.
  • RNA test: This screening method can detect the HIV virus itself within 10 days after exposure. This test will be favoured if a person falls in a high-risk group or displays obvious initial stage symptoms. The test is expensive and thus isn’t usually the first test performed for diagnosis.
  • FDA-approved in-home test kits: In the USA, approved home screening kits are available for private testing use. The kits require a person to take their own blood (through pricking a finger) or oral samples (a swab of mouth fluids) and send these to a laboratory for analysis. Results are usually available within a few business days. Oral fluid results may take a little longer. If preferred, this process can be handled anonymously. If results are positive, however, a follow-up test will be recommended. In most cases, it is best to seek medical assistance for screening as these can be done safely, and in some cases anonymously as well.

Results of an HIV test, marked as positive.

Follow-up testing for positive results

If traces of HIV are found in screening samples, a positive result will be given. All rapid tests which have positive results will be followed up with a standard laboratory test to confirm a diagnosis and ensure there are no false negative results. Positive results from a standard laboratory test will undergo more detailed testing using the same blood sample as well. These detailed screenings will involve:

  • Antibody differentiation between infection strains (HIV-1 or HIV-2)
  • An indirect immunofluorescence assay (Western blot)
  • An HIV-1 nucleic acid test
  • An RNA test

Results obtained within 3 months following exposure may be followed up with repeat testing at the 6-month mark. Antibody production is best observed at this time and produces the most accurate result, particularly if an HIV infection is present in the body.

Tests required to monitor an HIV infection

If a result is positive for HIV, doctors will highly recommend follow-up testing to monitor the nature of the infection on an on-going basis. Common tests for monitoring purposes include:

  • Monitoring CD4 count: A healthy individual usually has a CD4 count of well over 500 white blood cells per cubic millimetre. An HIV infection targets these cells and progressively destroys them as the disease advances through its stages. Doctors use ongoing tests to measure CD4 counts as a means to stay abreast of the disease progression. Once this count drops below 200 cells per cubic millimetre, the disease is effectively in its most advanced state and an AIDS diagnosis will be made. With treatment, doctors can slow down the progression, levelling out or increasing the CD4 count and many HIV positive individuals never reach the most advanced stage of their disease. Monitoring CD4 counts is also a valuable indicator for a doctor as to whether treatment is working and can give a fairly accurate overall assessment of a person’s immune function as a whole. Where CD4 counts drop, a doctor may recommend various medications as preventative measures for other possible infections which will lead to period of illness. CD4 counts may be tested every 3 to 6 months.
  • Monitoring viral load: The amount of virus in the bloodstream varies from person to person. Doctors will also wish to assess this amount on an ongoing basis. A load that is low will not typically affect a person’s overall health too negatively in terms of symptoms. A low load also means that the virus is more difficult to spread (but this is not impossible). A doctor will constantly measure viral load as another means to monitor the effectiveness of treatment, as well as the stage status of the disease. As well as working to prevent lowered CD4 counts, treatment is also designed to reduce viral load in an effort to curb advancement to the final stage of the disease. Viral load screenings will likely be recommended every 3 to 4 months.
  • Monitoring HIV strains and medication resistance: If at any stage, it is suspected that a person’s strain of HIV is possibly resistant to any medications used during treatment, tests may be ordered to check or confirm this. Resistance can hamper the progress of treatment and medication options may need to be adjusted to prevent this.
  • Tests (as required) for complication management: Side-effects and various health complications are common for those living with HIV. During check-ups doctors may perform various other tests to assess a person’s liver and kidney function, as well as a check for any changes to metabolic or cardiovascular functions too. HIV is capable of changing or mutating in the body which can have adverse effects on the body, bringing with it a variety of other health concerns. Other tests a doctor is likely to recommend would be to check for the presence of other infections which can lead to other ailments and complications. These include checks for other STIs (such as gonorrhoea, herpes, chlamydia and syphilis), tuberculosis, toxoplasmosis and urinary tract infections. Regular blood samples may be recommended to test for anaemia and assess blood sugar levels. A doctor will also test triglyceride and cholesterol levels regularly as both the virus and ART medications can contribute to raised levels.

All positive HIV infections should be carefully monitored by healthcare professionals on an ongoing basis. The disease cannot yet be cured, but it can be reasonable controlled with careful treatment practices. Any changes to a person’s physical state must be discussed with a doctor and is likely to occur from time to time. An HIV positive person has a compromised immune system for life and will experience symptoms of other illnesses periodically. Doctors will be able to better manage a person’s overall health when in the know about new or recurring symptoms which could indicate new infections or serve as an indication that treatment is no longer effective.

Treatment and living with HIV/AIDS

Medical treatment

An HIV positive individual will need to come to terms with continuously being subjected to various medical checks and testing procedures for the remainder of their lives. Medications will be prescribed and taken on a continuous basis too.

There is no cure and neither is there an effective vaccine for HIV/AIDS as yet. It is thus imperative that medical treatment is adhered to for the best quality of life possible post diagnosis.

Doctors will recommend a variety of medications that can be used in combination as a way to best control the effects of the virus in the body. Anti-HIV medications are classified in different tiers. Each class (or tier) works to block the virus in different ways. A doctor will usually prescribe at least 3 medications from two different classes to best accomplish this. Combination treatment has shown to be most effective for avoiding the development of different strains of HIV in the body that become immune or resistant to medications.

Anti-HIV medication (ARTs) classes include:

  • NNRTIs (non-nucleoside reverse transcriptase inhibitors): These medications disable the protein (antibody) the virus makes use of to copy itself in the body.
  • NRTIs (nucleoside or nucleoside reverse transcriptase inhibitors): These medications are designed as faulty versions of the antibodies (protein building blocks) that the virus uses to make copies of itself in the body. The faulty versions thus prevent the ability to do so.
  • PIs (protease inhibitors): Another protein the virus feeds on to produce copies of itself is protease. These medications disable the protein to prevent this.
  • Fusion or entry inhibitors: These medications work to block the ability of the virus to target (enter) the body’s CD4 cells.
  • Integrase inhibitors: HIV makes use of another protein called integrase to insert its genetic material in the body’s CD4 cells. These medications work to block this action and effectively disable the protein.

Treatment with antiretroviral medications (ART) will require multiple pill-taking in specific dosages and at certain times of the day, every day for the remainder of a person’s life. The sooner medications are used, the better for the individual with HIV.

Currently, a doctor has more than two dozen ART medication options to choose from in order to treat an infection. Each medication works differently to control the virus in the body and will be prescribed as appropriate on an individual basis. A doctor will take into account how well a person’s immune system is functioning, and all related medical health issues that are being experienced too. As and when new symptoms arise, other medication to treat these may be prescribed from time to time. 

The body’s response to treatment may fluctuate. Monitoring from medical professionals will serve an infected person well and ensure their best quality of life. Doctors will work to achieve an undetectable viral load with treatment. This effectively will not mean that an infection ‘has been cured’, but rather that the load is low enough not to cause too many associated complications.

All treatment programmes will need to be tailored to the individual. An HIV positive person must disclose their entire medical history to ensure that their doctor prescribes the best course of action that doesn’t compromise the effectiveness of their treatment. A doctor will wish to know about all previous health concerns and diagnosed problems, as wells make note of any medications and supplements (prescribed or over-the-counter) an HIV positive person is taking. If any recreational or illicit drugs are being used, this needs to be disclosed as well.

Medical professionals around the world are constantly working to develop better treatment management options to ensure longer and improved quality of life for all HIV positive individuals. Treatment options today are far better than they were just a handful of decades ago.

It is critical that an HIV positive individual not stop taking their prescribed ART medications. Any interruption to treatment allows the virus opportunity to strengthen and do further damage to the body. Ultimately, a person’s quality of life will decline if medication is not taken properly.

Treatment can be a costly exercise. A person with HIV will need to look into what their medical health insurance provider will cover and what may not be claimed for. Those without medical insurance should look into various options that may be available in the country they reside in for assistance.

What types of complications or side-effects are common?

Treatment side-effects

As much as there are valuable benefits to medical treatment, the taking of medications is not without discomfort. Unfortunately, treatment can be troublesome for an HIV positive individual. Common side-effects associated with the taking of ARTs include:

  • Fatigue
  • Dizziness
  • Nausea and vomiting
  • Diarrhoea
  • Rhabdomyolysis (the breakdown of muscle tissue)
  • Bone weakening or bone loss
  • High blood sugar levels
  • Abnormal cholesterol levels
  • Skin rashes
  • Sleeping problems
  • Tingling sensations or numbness

Side-effects may not be constant and can be experienced in varying degrees. Side-effects may be worse at the start of treatment and subside as the body settles (adjusts). If particularly bothersome, a doctor can recommend methods (such as taking medications on an empty stomach) or other medications that can help to alleviate discomfort.

An HIV positive person may have side-effects that linger and become long-term. These can include:

  • Fat re-distribution (lipodystrophy): The body can experience changes in the way it makes, uses and stores fat. A person may lose fat in certain areas, such as the limbs or face, but gain in the abdominal area. Medications can help to prevent worsening of this condition.
  • High blood sugar, cholesterol or triglyceride levels: These can be treated with medications, and changes to diet and exercise activity.
  • Bone density loss: Fractures and breaks are common as a person ages. Walking and weight-lifting may be recommended to build strength. Calcium and vitamin D supplements may also be recommended.
  • Lactic acidosis: It is rare, but it can happen that a build-up of lactic acid (a cellular waste product) develops, causing a range of ailments such as liver failure and muscles ages. Medications may be adjusted to help manage this.

Medical attention is required right away if a person experiences abdominal pain, high fever, a stiff neck or trouble breathing.

HIV-associated complications

With a compromised immune system, an HIV positive person is at high-risk for numerous other infections and ailments or diseases, such as cancer.

The list of common complications and opportunistic infections includes:

  • Tuberculosis (TB)
  • Candidiasis (an HIV-related yeast infection causing inflammation and a thick white coating on the mucous membranes of the oesophagus, mouth, tongue and vagina)
  • Cytomegalovirus (common variation of the herpes virus causing damage to the eyes, digestive tract and organs such as the lungs)
  • Toxoplasmosis (a potentially serious infection affecting the brain caused by the Toxoplasma gondii parasite commonly spread by cats through contact with their stool or faeces)
  • Cryptococcal meningitis (central nervous system infection caused by soil fungi)
  • Cryptosporidiosis (an infection caused by an intestinal parasite found in animals resulting in severe diarrhoea)
  • Kaposi’s sarcoma (a cancerous tumour of the blood vessel walls resulting in pink, red, purple, dark brown or black skin lesions which can also occur in the mouth, or in the digestive tract and lungs)
  • Lymphomas (cancer that develops in the body’s white blood cells and affecting the lymph nodes in the neck, armpits and groin area)
  • Kidney disease (HIV-associated nephropathy / HIVAN causing inflammation in the kidney’s tiny filters which normally remove excess waste and fluid from the bloodstream and expelled through urine)
  • Wasting syndrome (a loss of approximately 10% of body weight due to chronic weakness, diarrhoea and fever)
  • Neurological issues (confusion, depression, forgetfulness, anxiety, difficulties with walking, behavioural changes, diminished mental functioning and AIDS dementia)
  • Histoplasmosis (lung infection)
  • PCP (known as pneumocystis carinii pneumonia or pneumocystis jiroveci pneumonia)
  • Recurrent pneumonia
  • Chronic oral herpes (herpes simplex virus type 1 / HSV-1) ulcers and blisters
  • Mycobacterium avium complex (a bacterial infection)
  • Isosporiasis (disease of the intestine)
  • Recurrent salmonella septicaemia
  • Cervical cancer
  • PML (progressive multifocal leukoencephalopathy – a disease of the brain)

Living with an HIV positive status

Treatment and care extends beyond the walls of medical facilities. An HIV positive person must be encouraged to take an active role in their own care.

Doctors may recommend the following care considerations:

  • Paleo diet health - fruit, vegetables, nuts and seeds.Diet and nutrition: The destructive nature of HIV on the body’s immune system can significantly weaken a person’s strength and easily deplete energy levels. To support the immune system, build strength and sufficient energy, an HIV positive person should eat a balanced and nutritious diet daily. Fresh fruits and vegetables, lean proteins and whole grains are essential for a healthier and stronger body. Foods to steer clear of include unpasteurised dairy products, raw seafood, and raw egg products. All meat should be cooked well (well done). Foods to limit include sugar and salt. The ideal daily eating plan will include enough calories to maintain lean body mass, lean protein (pork, beef, chicken and fish) to help build a stronger immune system, organs and muscles in the body, carbohydrates for energy and healthy fats for additional energy. Vitamins and minerals are also important to help regulate bodily function and ensure additional help for repairing and healing damaged cells. A nutritionist or dietician can assist in developing a sufficient diet plan, especially if a person has other nutrition related complications. A doctor can also assist with advising what to eat or not to eat when experiencing uncomfortable side-effects. Some foods can aggravate or trigger side-effects. Others can help alleviate discomforts such as nausea and vomiting.
  • Dietary supplements: Some dietary supplements can help to given a person’s immune system a bit of a boost or even counteract some medication side-effects. It is advisable to speak to a doctor before taking any supplements to ensure that they are safe. Supplements that may be helpful include Acetyl-L-carnitine (for the treatment of nerve pain) and whey protein (to help with gaining weight, improving CD4 count and alleviating diarrhoea). Supplements to avoid include St. John’s wort and those that contain garlic. These may reduce the effectiveness of some ART medications. Doctors will be able to recommend a variety of other options which won’t counteract the effectiveness of medical treatment or adversely interact with the cocktail of medications and HIV positive person will be taking.
  • Get frequent vaccinations: As an HIV positive person is more vulnerable to various other infections, receiving relevant vaccinations, such as the flu shot, to prevent illness as much as possible is all the more important. Infections such as flu and pneumonia can become dangerous for an HIV positive individual as a result of their compromised immune systems.
  • Precautions with companion animals / pets: Various animal species that are popular pets can carry parasites which can cause infections. An HIV positive individuals should take extra care when handling cat faeces (which can case toxoplasmosis), reptiles (that can carry salmonella) or birds (that can carry fungi such as histoplasmosis or Cryptococcus). An HIV positive person need not be fearful of keeping pets, but should take precaution when handling animals and always ensure to wash their hands thoroughly thereafter.
  • Seek support where needed: Much of an HIV positive person’s daily life will focus on the physical effects of the disease, but the emotional and mental areas shouldn’t be neglected. A person will feel effects in their social life and also experience financial impacts too. Coping can be a tricky and often, very difficult thing, and not just for the infected person either. Those closest to them may also be impacted. Nowadays there are a variety of services, resources and support groups available for those affected by HIV, whether coping with the disease themselves or in that of a loved one. Most clinics can provide access to counsellors, social workers and other medically qualified individuals who can provide coping support when it comes to home-life, employment, financial or even legal issues. It can be difficult, but it is very important to do everything possible to try and come to terms with a life-long illness such as HIV. Counsellors can also help an HIV positive individual better understand their illness, as well as advise on better ways to interact with others so as not to put them at risk of infection, especially when it comes to sexual activity. Healthier behaviours can make all the difference in a better quality of life outside of medical treatment (medications and testing).
  • Learning to deal with stigma: Disclosing HIV status where necessary shouldn’t be avoided. Ignorance promotes stigma. When it comes to loved ones and especially in relationships, an HIV positive person should feel that they can disclose their status to the individuals concerned. Counsellors can best advise the most appropriate ways to handle various scenarios and communicate with others. It is especially important to disclose an HIV positive status where others have potentially been exposed to the virus. A newly diagnosed individual should get in contact with all others who may have been exposed so that they can get themselves tested and / or treated if necessary. Many countries offer anonymous services which can do this on behalf of an HIV positive person.
  • Learning how to take precautions when it comes to transmission risk: An HIV positive individual must be well-aware of all necessary precautions when it comes to the possible spread of their infection. Correct condom use during sexual activity can go a long way in reducing transmission occurrences. A person can also take extra precautions when it comes to their viral load. An infected person is as higher risk of spreading infection when their viral load is high. Lower loads do not make a person incapable of transmitting the disease. A partner of an infected individual can also take certain precautions. If available, the partner of an infected person can take PrEP medications (pre-exposure prophylaxis) on a daily basis to reduce their risk of exposure and contracting the disease.
  • Make efforts to take the best care: An HIV positive person should do their best to get plenty of exercise, rest, keep all medical check-up appointments, and engage in health social activities. Socialising and support groups can do the world of good for a person learning to live with a life-long disease such as HIV/AIDS.

Can HIV/AIDS be prevented?

Education about the disease and the avoidance of specific behaviours are the best means of prevention when it comes to HIV/AIDS.

There is currently no available vaccine for HIV, nor a cure for the disease in any stage of its progression. Once infected, a person remains HIV positive for the remainder of their lives.

When it comes to prevention, measures to curb transmission is very important. Some of these include:

  • Safer sexual activity practices: It is best to use a new condom each and every time sexual activity is engaged in. Women can make use of female condoms as well. Water-based lubricants are safer to use than oil-based varieties as these don’t usually weaken condoms, causing tears.
  • HIV and pregnancy: An HIV positive woman who is pregnant must seek medical assistance to reduce the risk of passing on infection to a baby. Treatment received during pregnancy can significantly reduce transmission risk, especially during birth and when breastfeeding.
  • Take care not to believe in treatment myths or ‘cures’: HIV is not at all treatable with oxygen therapy, industrial solvents, intravenously administered aloe vera, electricity, “wonder herbs”, hot baths or sexual intercourse with a female virgin. The only means of treatment is that which is recommended by a medical professional.

Where did HIV come from?

HIV is believed to have originated in Central Africa from a type of chimpanzee. Scientists have determined that these animals do experience a version of the virus known as simian immunodeficiency virus (SIV) which isn’t as harmful to the animal as it is to humans. The virus is believed (by some) to have been transmitted to humans (mutated as a deadly virus) through the consumption of chimpanzee meat.

Others believe that a hunter who killed a chimpanzee (between 1884 and 1924) contracted the virus through exposure to the blood of the animal, entering a wound on the skin. It is suggested that the disease became a pandemic in Congo during the 1920s, before travelling to Haiti in the 1960s, and finally to the West in the early 1980s. HIV has been classified as a serious medical condition since the late 1970s and early 1980s.

The HIV timeline:

  • June – July 1981: The first cases of HIV are medically recognised due to recorded deaths from opportunistic infections and Kaposi’s sarcoma.
  • 1982: The CDC names the disease as AIDS, and mentions homosexual (gay) men as a high-risk group for the illness. Homosexual men responded by forming the first AIDS advocacy groups.
  • 1983 - 1984: The CDC releases a warning that heterosexual individuals are also at risk of infections, and that mother-to-child transmission is a reality. Blood donations from high-risk individuals is also halted. Researchers from the Pasteur Institute detect a virus in the swollen lymph glands of an AIDS patient and name it lymphadenopathy-associated virus (LAV). Another researcher also finds a virus and names it ARV (AIDS-related virus). In 1984, a researcher from the NCI (National Cancer Institute) finds a virus he names HTLV-III, but is later confirmed as the LAV virus. In 1986, all of these determined viruses are named HIV.
  • 1985: The American Foundation for AIDS Research is founded (AmFAR). The first test for HIV is finally licensed for use and blood banks begin screening all donations before use in medical practices (surgeries and transfusions).
  • 1986: A surgeon, General C. Everett Koop publicly voices concern about AIDS and urges parents to start warning young teenagers and children about the risk of transmission.
  • World AIDS Day banner - 1 December (global annual awareness day)1988: The FDA initiates a ‘fast-track policy’ for public access to medications still being tested in clinical trials. The public observe the first ever day for AIDS awareness on 1 December (World Aids Day).
  • 1989: Scientists studying HIV observe and report on the progressive nature of the virus (how it reproduces in the bloodstream) before ever reaching the stage of AIDS. The report recommends treatment options that keep virus reproduction at the lowest possible levels.
  • 1991 – 1992: A symbol for awareness is developed – the red ribbon. AIDS is also recorded as the leading cause of death in the USA, predominantly affecting men between the ages of 25 and 44. The FDA also licenses the first rapid HIV screening test.
  • 1993: The CDC launches televised condom advertisements.
  • 1996 – 1997: A treatment breakthrough is achieved – HAART (highly active anti-retroviral therapy) which reduces viral load. AIDS-related deaths in the USA drop by more than 40%.
  • 1998 – 2000: It is acknowledged that HAART can lead to serious side-effects during treatment. The FDA gets to work on safer treatment options. It is also recognised that no medication can cure the disease.
  • 2001 – 2002: Medication treatment is not yet available to the vast majority of HIV positive individuals. AIDS becomes the leading cause of death worldwide, mostly affecting people between the ages of 15 and 59.
  • 2006 – 2007: An HIV vaccine tested my Merck fails clinical trials. Scientists continue to try and develop a vaccine for HIV. UNAIDS releases a recommendation for adult males to undergo circumcision as a means to reduce risk of transmission to women, particularly in high-risk areas of the world.
  • 2008 - 2010: CDC research indicates a dramatic increase in the number of new infections. It is also made known that less than a third of all infected individuals across the world are receiving treatment for the disease. The researchers from the Pasteur Institute who first detected the presence of the HIV virus receive the Nobel Prize in medicine, acknowledging their discovery. New infections and AIDS-related deaths continue to soar worldwide, especially among homosexual men engaging in sexual activity, making up more than half of new infections.
  • 2012 – 2014: The FDA approves a medication called Truvada as a means to reduce the risk of HIV in those who are at risk of contracting the disease.
  • 2015 - 2016: At the end of 2015, a total of 36.6 million people were announced to be living with HIV, worldwide. A total of 2.1 million of these were new infections and 1.1 million individuals died from AIDS-related complications and diseases. Globally, 18.2 million people were recorded as having access to ART treatment in 2016. Upwards of 78 million people are recorded as having become infected with the virus (with 35 million having died) since the start of the epidemic.

 

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