HIV and AIDS

Posted in Disease Information

Introduction

HIV is a virus most commonly caught by having unprotected sex or by sharing infected needles and other injecting equipment to inject drugs.

HIV stands for human immunodeficiency virus. The virus attacks the immune system, and weakens your ability to fight infections and disease.

AIDS is the final stage of HIV infection, when your body can no longer fight life-threatening infections.

There is no cure for HIV, but there are treatments to enable most people with the virus to live a long and healthy life.

How is HIV spread?

HIV is not spread as easily as some other viruses, such as colds or flu.

HIV is found in the body fluids of an infected person, which includes semen and vaginal fluids, blood, inside the anus and breast milk.

HIV cannot be transmitted by saliva alone. But the saliva of a person with HIV can be infectious if it contains blood or other body fluids.

This can include vaginal, anal and oral sex.

Other ways of getting HIV include:

• Using a contaminated needle, syringe or other injecting equipment to inject drugs
• Tranmission from mother to baby, before or during birth, or by breastfeeding

Getting tested

The only way to find out if you have HIV is to have an HIV test.

If you think you might be at risk of HIV, you should have a test immediately. The earlier HIV is detected, the more likely it is that treatment will be successful.

Emergency anti-HIV medication called PEP (post-exposure prophylaxis) may stop you becoming infected, but treatment must be started within three days of coming into contact with the virus.

It can take several weeks after infection before the virus is picked up in testing, so after your initial test you will be advised to have another one a few weeks later.

You may get the results in hours, days or weeks, depending on where you were tested.

If your test is positive you will be referred to a specialist HIV clinic where you’ll have more blood tests to show what effect HIV is having on your immune system and be able to discuss treatment options.

HIV is disproportionately common among men who have sex with men.

Living with HIV

Although there is no cure for HIV, treatments are much more successful than they used to be, enabling people with HIV to lead as normal a life as possible.

Medication, known as antiretrovirals, works by slowing down the damage the virus does to the immune system. These medicines come in the form of tablets, which need to be taken every day.

You will be encouraged to take regular exercise, eat a healthy diet, stop smoking and have yearly flu jabs and five-yearly pneumococcal vaccinations to minimise the risk of getting serious illnesses.

Someone with HIV is said to have AIDS when investigations show their immune system has stopped working and they develop life-threatening illnesses such as cancer.

Preventing HIV

HIV can affect anybody.

The best way to prevent HIV is to practise safe sex and use a condom. If you inject drugs, do not share needles, syringes or other injecting equipment such as spoons and swabs.

How common is HIV?

That total includes an estimated 40,100 gay men, and an estimated 47,000 heterosexual men and women.

The World Health Organization estimates that around 34 million people in the world are living with HIV.

The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique.

Symptoms of HIV

Most people who are infected with HIV experience a short, flu-like illness that occurs two to six weeks after infection. After this, HIV often causes no symptoms for several years.

A person with HIV can pass the virus to others whether or not they have any symptoms. People with HIV are more infectious in the weeks following infection.

Sexual contact

The main routes of transmission are unprotected vaginal and anal sex. although it is also possible to catch HIV through unprotected oral sex with a person who has HIV, but the risk is much lower than that for vaginal and anal sex.

If a person performing oral sex has HIV, transmission of the virus can occur if blood from their mouth passes into the body of the other person. If the person receiving oral sex has HIV, transmission can occur if their semen, vaginal fluid or blood gets into the mouth of the other person.

Other forms of transmission

Other ways of getting HIV include:

• Sharing sex toys with someone infected with HIV
• Sharing needles, syringes and other injecting equipment among drug users
• From mother to baby, before or during birth, or by breastfeeding
• Healthcare workers accidentally pricking themselves with an infected needle (this risk is extremely low)
• Blood transfusion.

How HIV spreads

HIV is not passed on easily from one person to another. The virus does not spread through the air like cold and flu viruses.

HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood.

The body fluids that contain enough HIV to infect someone are:

• Semen
• Vaginal fluids, including menstrual blood
• Breast milk
• Blood
• Lining inside the anus

Other body fluids, like saliva, sweat or urine, do not contain enough of the virus to infect another person.

The main ways the virus enters the bloodstream are:

• Cuts and sores in the skin
• Thin lining on or inside the anus and genitals
• Thin lining of the mouth and eyes

You cannot catch HIV from an infected person from:

• Kissing
• Spitting
• Being bitten
• Contact with unbroken, healthy skin
• Being sneezed on
• Sharing baths, towels or cutlery
• Using the same toilets and swimming pools
• Mouth-to-mouth resuscitation
• Contact with animals or insects such as mosquitoes

How HIV infects the body

HIV infects cells of the immune system, the body’s defence system, making it unable to fight off infections.

The virus enters the immune system’s CD4 cells, which protect the body against various bacteria, viruses and other germs.

It uses the CD4 cells to make thousands of copies of itself. These copies then leave the CD4 cells, killing them in the process.

This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working.

This can take about 10 years, during which time you will feel and appear well. Find out more about the symptoms of HIV.

Risk groups

People who are at high risk of catching HIV include:

• Men who have had unprotected sex with men
• Women who have had unprotected sex with men who have sex with men
• People who have lived in or travelled extensively in black Africa
• People who have had unprotected sex with a person who has lived in or travelled in black Africa
• People who inject illegal drugs
• People who have had unprotected sex with somebody who has injected illegal drugs
• People who have caught another sexually transmitted infection
• People who have received a blood transfusion while in Africa, eastern Europe, the countries of the former Soviet Union, Asia or central and southern America

Origins of the disease

HIV is thought to originate in Africa, where humans caught it from chimpanzees. The primates suffered from a very closely related virus called SIVcpz (simian immunodeficiency virus).

The SIVcpz virus spread to humans following contact with infected chimpanzee blood during the hunting of chimpanzees.

It is thought that for many years, the human form of HIV was limited to a remote part of Africa. However, new transports links enabled the virus to spread to other parts of Africa, before spreading across the world.

HIV testing

Many people living with HIV have no signs and symptoms at all.

People who have recently been infected with HIV often experience a short, flu-like illness two to six weeks after infection. Symptoms include fever, sore throat, and body rash. See symptoms of HIV for more information.

You can only be certain you have HIV if you have an HIV test.

If you think you might be at risk, you should have a test immediately. The earlier HIV is detected, the more likely it is that treatment will be successful.

If you do have HIV, delaying treatment will allow the virus to spread in your system and damage your health.

The sooner you get tested, the sooner you can start life-saving treatment and avoid spreading the virus to someone else..

HIV tests

The most common form of HIV test is a blood test, in which a small amount of blood is taken and examined.

In some areas, saliva tests are available. In this test, a sample of saliva is taken using a mouth swab. In some areas dried blood spot tests are available, in which the finger or heel is pricked and a spot of blood is blotted onto filter paper.

It can take between three weeks and three months after you have been infected with HIV for the virus to show up in testing.

If your most recent risk of getting HIV was within the last three months you can test straight away, but you will be advised to have another one a few weeks later.

If the test finds no signs of infection, then your test result is “negative”. If the HIV virus has been found in your blood then the test result is “positive”.

Before someone is given a positive result the blood is tested several times to be completely sure.

If you test positive for HIV, you will undergo a number of tests to monitor the progress of the infection to work out when HIV treatment should be started.

Where to get tested

There are various places to go for an HIV blood test, such as:

• Sexual health clinics, also called genitourinary medicine (GUM) clinics
• Some contraception and young people’s clinics
• Local drugs agencies
• At an antenatal clinic, if you are pregnant
• A private clinic

What are the treatment options?

There is no cure for HIV, but treatments are much more successful than they used to be, enabling people with the virus to stay healthy and live longer.

Emergency HIV drugs

If you think you have been exposed to the virus within the last 72 hours (three days), anti-HIV medication may stop you becoming infected.

For it to be effective, the medication, called post-exposure prophylaxis or PEP, must be started within 72 hours of coming into contact with the virus.

The quicker PEP is started the better, ideally within hours of coming into contact with HIV. The longer the wait, the less chance of it being effective.

PEP has been misleadingly popularised as a “morning-after pill” for HIV – a reference to the emergency pill women can take to prevent getting pregnant.

But the description is not accurate. PEP is a month-long treatment, which has serious side effects and is not guaranteed to work. The treatment involves taking the same drugs prescribed to people who have tested positive for HIV.

You may be able to get PEP from:

• Sexual health clinics, or genitourinary medicine (GUM) clinics
• Hospitals
• If you already have HIV, try your HIV clinic if the PEP is for someone you’ve had sex with

Not all these places in every part of the country will have PEP or be able to give it.

If you test positive

If you are diagnosed with HIV, you will have regular blood tests to monitor the progress of the virus before starting treatment.

You will not normally need to start treatment until the virus has begun weakening your immune system.

This is determined by mainly by measuring your levels of CD4, which are infection-fighting cells, in your blood.

Treatment is usually recommended to begin when your CD4 count falls below 350, whether or not you have any symptoms.

The aim of the treatment is to reduce the level of HIV in the blood and prevent or delay any HIV-related illnesses.

Antiretroviral drugs

HIV is treated with antiretrovirals (ARVs), which work against the HIV infection by slowing down the spread of the virus in the body.

A combination of ARVs is used because HIV can quickly adapt and become resistant to one single ARV.

Patients tend to take three or more types of ARV medication. This is known as combination therapy or highly active antiretroviral therapy (HAART).

Some antiretroviral drugs have been combined into one pill, known as a “fixed dose combination”. This means that the most common treatments for people just diagnosed with HIV involve taking just one or two pills a day.

Different combinations of ARVs work for different people so the medicine you take will be individual to you.

Once HIV treatment is started, you will probably need to take the medication for the rest of your life. For the treatment to be effective, it will need to be taken on time, every time.

Many of the medicines used to treat HIV can react in unpredictable ways if you take them with other types of medicines.

These include herbal remedies such as St John’s Wort, recreational drugs such as cocaine, and some over-the-counter medicines. Always check with Dr. B C Shah  before taking any other medicines.

Pregnancy

ARV treatment is available to prevent a pregnant woman from passing HIV to her child.

Without treatment, there is a one in four chance that your baby will develop HIV. With treatment, the risk is less than one in a hundred.

Advances in treatment mean there is no increased risk of passing the virus to your baby with a normal delivery. However, for some women, a caesarean section may still be recommended.

If you have HIV, do not breastfeed your baby because the virus can be transmitted through breast milk.

If you or your partner has HIV, fertility treatments, such as sperm washing, may be available that will allow you to conceive a child without putting either of you at risk of infection.

Missing a dose

HIV treatment only works if you take your pills on time, every time. Missing even a few doses will increase the risk of your treatment not working.

You will need to develop a daily routine to fit your treatment plan around your lifestyle.

Side effects

HIV treatment can have unpleasant side effects. If you get serious side effects (which is uncommon) you may need to try a different combination of ARVs.

Common side effects include:

• Nausea
• Tiredness
• Diarrhoea
• Skin rashes
• Mood changes
• Gaining fat on one part of your body while losing it on another

People with HIV can get treated by their own doctor or by a specialist at an HIV clinic or a GUM clinic.

Services, including support organisations, may work together to provide specialist care and emotional support.

Preventing HIV

The main way to prevent HIV infection is to avoid activities that put you at risk, such as unprotected sex and sharing needles and other injecting equipment.

If you have HIV you can pass it on to others if you have sex without a condom, or share infected needles, syringes, or other injecting equipment.

It is important to continue to practise safer sex even if you and your sexual partner both have HIV. This is because you can catch another strain of the virus that your HIV medication may not be able to control..

Sex

HIV can be spread by having unprotected vaginal or anal sex. There is also a risk of transmission through oral sex, but this risk is much lower.

HIV can also be caught from sharing sex toys with someone infected with HIV.

See causes of HIV for more on transmission of HIV.

The best way to prevent HIV and other sexually transmitted infections (STIs) is to use a condom for penetrative sex and a dental dam for oral sex.

Condoms

Condoms come in a variety of shapes, colours, textures, materials and flavours. Both male and female condoms are available.

A condom is the most effective form of protection against HIV and other STIs. They can be used for vaginal and anal sex, and oral sex performed on men and women.

HIV can be passed on before ejaculation, through pre-come and vaginal secretions, and from the anus.

It is very important that condoms are put on before any sexual contact occurs between the penis, vagina, mouth or anus.

Lubricant

Lubricant, or lube, is often used to enhance sexual pleasure and safety, by adding moisture to either the vagina or anus during sex.

Lubricant can make sex safer by reducing the risk of vaginal or anal tears caused by dryness or friction, and it can also prevent a condom from tearing.

Only water-based lubricant (such as K-Y Jelly) rather than an oil-based lubricant (such as Vaseline or massage and baby oil) should be used with condoms.

Oil-based lubricants weaken the latex in condoms and can cause them to break or tear.

Dental dams

A dental dam is a small sheet of latex that works as a barrier between the mouth and the vagina or anus to reduce the risk of STIs during oral sex.

Dental dams are available in a variety of flavours and colours, and typically come in two forms:

• A sheet, which can be spread across the vagina or anus and held in place during oral sex by either the giver or the receiver
• A mask with elasticised bands, which is held in place around the ears of the person giving oral sex, leaving the hands free

It is important that dams are only used once, the same side of the dam is always kept against the body, and a new dam is used if a new area of the body is being stimulated. A dam should never be moved from the vagina to the anus or vice versa.

Find out more about what sexual activities can put you at risk of HIV and other STIs.

Sharing injecting equipment

If you inject drugs, don’t share needles or syringes, or other injecting equipment such as spoons and swabs, as this could expose you to HIV and other viruses found in the blood, such as hepatitis C.

Many local authorities and pharmacies offer needle exchange programmes, where used needles can be exchanged for clean ones.

If you are a heroin user, consider enrolling in a methadone programme. Methadone can be taken as a liquid, so it reduces your risk of getting HIV.

Dr. B C Shah should be able to advise you about both needle exchange programmes and methadone programmes.

Living with HIV

How people cope with being diagnosed with HIV, as well as with treatment, varies from person to person.

By properly managing your condition – taking your medication correctly and avoiding illness – you will be able to live as normal a life as possible.

Other issues to consider include getting psychological support, telling people about your HIV, pregnancy and financial support.

Your medication

HIV treatment only works if you take your pills on time, every time. Missing even a few doses will increase the risk of your treatment not working. It can be helpful to develop a daily routine around taking your medication, so that you do not forget to take it.

Many of the medicines used to treat HIV can react in unpredictable ways if you take other types of medicines. These include herbal remedies such as St John’s Wort, recreational drugs such as cocaine, and over-the-counter medicines.

Always check with Dr. B C Shah before taking any other medicines.

Your health

In addition to taking HIV medication, there are many things you can do to improve your general health and reduce your risk of falling ill.

These include:

• Regular exercise
• Healthy eating
• Stopping smoking

Reviewing your treatment

Because HIV is a long-term condition, you will be in regular contact with Dr. B C Shah who will review your treatment on an ongoing basis.

A good relationship with the team means that you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

Vaccines

Everyone with a long-term condition such as HIV is encouraged to get a flu jab each autumn to protect against seasonal flu (influenza).

It is also recommended that they get a pneumoccocal vaccination every five years. This is an injection that protects against a serious chest infection called pneumococcal pneumonia.

Preventing infection

If you have HIV, you should take extra precautions to prevent exposure to infection.

Be careful around animals as they carry parasites that can cause infection in humans.

Avoid coming into contact with cat litter or animal faeces. Wear latex gloves if you need to clean your pet or dispose of their droppings.

Wash your hands regularly, particularly after going to the toilet, before and after preparing food, and after spending time in crowded places. Find out more about food safety.