HIV and AIDS: A Global Scourge That Spares No One
Overview
Human Immunodeficiency Virus (HIV) is an infection that targets the body's immune system. The most advanced stage of HIV infection is known as Acquired Immunodeficiency Syndrome (AIDS).
HIV specifically targets white blood cells, weakening the immune system and making affected individuals more susceptible to certain diseases like tuberculosis, infections, and some cancers.
HIV is transmitted through the bodily fluids of an infected person, including blood, breast milk, semen, and vaginal secretions. It cannot be transmitted through casual contact like kissing, hugging, or sharing food. It can also be passed from mother to child.
HIV can be treated and prevented through Antiretroviral Therapy (ART). If left untreated, it can progress to AIDS, typically after many years.
The World Health Organization (WHO) now defines advanced HIV infection as having a CD4 cell count below 200 cells/mm3 or WHO clinical stage 3 or 4 in adults and adolescents. All HIV-positive children under 5 years old are considered to have advanced HIV infection.
Signs and Symptoms
Symptoms of HIV vary depending on the stage of infection.
The disease is most easily spread during the initial months after the initial infection, but many people remain unaware of their status until later stages. In the first few weeks after infection, individuals may not display any symptoms. Others may experience flu-like symptoms, including:
- Fever
- Headaches
- Skin rash
- Sore throat
As the infection gradually weakens the immune system, additional signs and symptoms may develop:
- Enlarged lymph nodes
- Weight loss
- Fever
- Diarrhea
- Cough
Without treatment, people infected with HIV can also develop severe illnesses, such as:
- Tuberculosis
- Cryptococcosis
- Severe bacterial infections
- Cancers like lymphoma and Kaposi's sarcoma
HIV can exacerbate other infections, including hepatitis C, hepatitis B, and simian varicella virus.
Transmission
HIV can be transmitted through the exchange of bodily fluids from individuals living with HIV, including blood, breast milk, semen, and vaginal secretions. It can also be transmitted from mother to child during pregnancy and childbirth. Casual contact in everyday life, such as kissing, hugging, shaking hands, or sharing personal items, water, or food, does not transmit the virus.
It's important to note that individuals living with HIV who are on antiretroviral treatment (ART) and have suppressed viral loads do not transmit the virus to their sexual partners. Therefore, ensuring early access to ART and providing support to maintain treatment is essential not only for the health of people living with HIV but also for preventing the transmission of the virus.
Risk Factors
Behaviors and situations that increase the risk of contracting HIV include:
- Unprotected anal or vaginal intercourse
- Presence of another sexually transmitted infection (STI), such as syphilis, herpes, chlamydia, gonorrhea, or bacterial vaginosis
- Sexual behaviors involving harmful alcohol use and drug consumption
- Sharing needles, syringes, and other drug injection equipment that are contaminated
- Risky injections, blood transfusions, tissue transplants, or medical procedures that involve cutting or piercing the skin under non-sterile conditions
- Accidental needlesticks, especially among healthcare workers
Diagnosis
HIV can be diagnosed using rapid diagnostic tests that provide results on the same day, greatly facilitating early diagnosis and linkage to treatment and care. Self-testing for HIV is also an option. However, no single test can definitively diagnose HIV. Confirmation tests are required, performed by a healthcare worker or trained community worker in a community center or clinic. HIV infection can be accurately detected using WHO-prequalified tests within a national screening strategy and algorithm.
Most common HIV screening tests detect antibodies produced by the infected person as part of their immune response to the virus. Typically, antibodies to HIV are produced by the body within 28 days of infection. During this period known as the "serological window," an infected person may have low levels of antibodies that cannot be detected by many rapid tests but can still transmit HIV to others. Individuals who have recently been exposed to a high-risk situation and test negative may undergo another test after 28 days.
After a positive diagnosis, another test should be conducted before starting treatment and care to rule out any screening or notification errors. While HIV testing for adolescents and adults has become simple and effective, the same cannot be said for children born to HIV-positive mothers. Before the age of 18 months, the rapid antibody test is not sufficient to identify HIV infection, and virological testing must be performed (from birth or at six weeks of age). However, new techniques now allow this type of testing to be done on-site and provide same-day results, expediting appropriate referrals to treatment and care services.
Prevention
HIV is a preventable disease.
The following prevention measures can reduce the risk of HIV infection:
- Use of male or female condoms during sexual intercourse
- Testing for HIV and other sexually transmitted infections
- Voluntary medical male circumcision
- Harm reduction services for people who inject drugs
- The use of antiretroviral drugs, including oral pre-exposure prophylaxis (PrEP) and long-acting formulations
- Dapivirine vaginal rings
- Injectable long-acting cabotegravir
Antiretroviral drugs can also be used to prevent mother-to-child transmission of HIV.
People living with HIV who are on ART and have undetectable viral loads do not transmit the virus to their sexual partners. Access to HIV testing and treatment is a crucial component of HIV prevention.
Treatment
There is no cure for HIV infection. It is managed with antiretroviral medications, which prevent the virus from replicating in the body.
Currently, antiretroviral therapy (ART) does not cure HIV but allows the immune system of the infected person to strengthen, enabling them to fight off other infections.
ART is a lifelong treatment that must be taken daily.
It reduces the amount of virus in the body, halts symptoms, and enables affected individuals to lead healthy lives. People living with HIV who are on ART and have undetectable virus levels do not transmit the virus to their sexual partners.
Pregnant women living with HIV should have access to ART and initiate treatment as soon as possible. This safeguards the health of both the mother and helps prevent mother-to-child transmission of HIV during pregnancy or through breastfeeding.
Administering antiretroviral drugs to HIV-negative individuals can also prevent the disease.
When given before possible exposure to HIV, this is pre-exposure prophylaxis (PrEP), and when given after exposure, it is post-exposure