Explainer: What you need to know about HIV and AIDS

What is HIV?

HIV, or Human Immunodeficiency Virus, attacks and damages the human immune system. When left untreated, HIV kills a type of immune cell called a T-Cell.

As the condition progresses more T-Cells get attacked. This makes the body become increasingly susceptible to a range of illnesses and cancers.

HIV is not airborne, neither does it spread through water or casual, physical contact. Instead, HIV is transmitted via the following bodily fluids:

● Semen
● Blood
● Vaginal secretions
● Rectal fluids
● Breast milk

The virus does its work by inserting itself into the DNA of cells. Therefore, there is no known drug capable of removing it from the body, even as medical science strives for a cure.

At the moment, a treatment called antiretroviral therapy makes it possible for a person with HIV to live with the virus for many years. Without such therapy, a person infected with HIV is likely to develop the condition known as Acquired Immunodeficiency Syndrome, or AIDS.

What is AIDS?

AIDS is when the immune system is weakened to the point where it is unable to properly and sufficiently counteract infections. If left untreated, people with end-stage AIDS have about 3 years to live. This is why antiretroviral therapy is important for people who have HIV, as it enables them to live as long as people who do not have HIV.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer.

When AIDS develops, a person is seriously susceptible to illnesses like:

  • Tuberculosis
  • Cytomegalovirus
  • Toxoplasmosis
  • Cryptosporidiosis
  • Various cancers

These illnesses can become severe, and shorten the lifespan of a person.

How does HIV progress to AIDS?

While related, HIV and AIDS are different things. It takes a period of time for HIV to progress to AIDS, which means that when action is taken, there is a possibility of preventing HIV’s progress to AIDS.

HIV cases progress through 3 distinct stages:

First Stage: Acute stage – First few weeks after infection

Second Stage: Chronic Stage

Third Stage: Progress to AIDS

As HIV progresses, the CD4 cell count slowly goes down. While an uninfected adult’s CD4 cell count runs between 500 to 1500 per cubic millimeter, a person with AIDS has a CD4 cell count that is sub-200 count per cubic millimeter.

The speed of HIV progression from stage 2 to stage 3 depends on the person. Some people can stay in stage 2 for a decade without treatment. However, with treatment, they can stay in stage 2 indefinitely. As mentioned above, there is no cure for HIV. However, antiretroviral therapy can give a near-normal life expectancy.

Similarly, there is no way to cure AIDS. However, treatment that can increase the CD4 count above 200 per cubic millimeter of blood exists. This means that they can be considered to no longer have AIDS.

The facts of HIV transmission

No one is immune to HIV, and anyone can contract the virus. Here are some ways that HIV can be transmitted between people:

● Unprotected vaginal or anal sex — This is the most common route of transmission
● Sharing drug paraphernalia
● Unsterilized tattoo equipment
● Pregnancy, labor, or delivery from a pregnant person to their baby
● Breastfeeding
● Premastication – the act of chewing a baby’s food before feeding it to them

Very rarely, HIV is transmitted via blood transfusion or organ donation.

It is extremely rare for HIV to be transmitted through:

● Oral sex
● Being bitten by a person with HIV
● Contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transmit through:

● Unbroken skin-to-skin contact
● Casual contact like shaking hands
● Air or water
● Sharing food or drinks, including drinking fountains
● Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
● Insect bites

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Early symptoms of HIV

In the acute infection stage, there can be symptoms. At this stage, the virus is reproducing rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this acute infection stage, some people have no symptoms, while others might have the following symptoms:

● fever
● chills
● swollen lymph nodes
● general aches and pains
● skin rash
● sore throat
● headache
● nausea
● upset stomach

These symptoms are similar to the common flu. This is why infected people might not think that they need to see a doctor.

During this acute infection stage, the HIV viral load in the person is high, and this means that the virus can be easily passed on to another person during this period.

The acute stage symptoms resolve themselves within a few months as the person enters the chronic stage of HIV, which can last for decades with the appropriate treatment.

How can we diagnose HIV?

There are a few tests that can be used to diagnose HIV.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 2 to 4 weeks after someone initially contracts HIV.

These tests check the blood for both HIV antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for HIV antibodies. 3 weeks to 3 months after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a clinic.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their doctor to confirm.

HIV Viral RNA PCR or Nucleic acid test (NAT) – HIV Test

Viral PCR or NATs are expensive, and used for those who have early symptoms of HIV or have a known risk factor. This test looks for copies of the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

If you have queries, or think that you need a HIV screening test, please reach out to any of our DTAP clinics for a confidential and professional diagnosis. Anonymous HIV testing and rapid HIV test is also available.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy: a cocktail of daily medications that stop the virus from reproducing. Antiretroviral therapy protects CD4 cells, keeping the immune system strong enough to respond to disease.

Antiretroviral therapy also prevents HIV from progressing to AIDS, and reduces the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in viral PCR test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Types of HIV medications

HIV medications work to prevent reproduction of HIV, stopping it from destroying CD4 cells.
These antiretroviral medications are grouped into six classes:

nucleoside reverse transcriptase inhibitors (NRTIs)
● non-nucleoside reverse transcriptase inhibitors (NNRTIs)
protease inhibitors
● fusion inhibitors
● CCR5 antagonists, also known as entry inhibitors
● integrase strand transfer inhibitors

HIV Medication Side Effects

Antiretroviral therapy side effects differ, but may include nausea, headache, and dizziness. These side effects are not permanent, and will often get better over time.
However, serious side effects can include swelling of the mouth and tongue, as well as liver or kidney damage. If you encounter these side effects, speak to your doctor about adjusting medications.

Preventing HIV

There is no cure for HIV, or AIDS. That is why It is important to know how to prevent the transmission of HIV.

Safer sex

HIV is most commonly transmitted via unprotected vaginal or anal sex. Short of abstinence, the only other way to prevent transmission is through protection via condom or another barrier method.

If you are concerned about HIV risks:

Get tested for HIV.
Always use condoms. Be sure to know how to use them correctly, as incorrect usage can expose you to HIV risks.
Take medication as directed if you have HIV. This lowers the risk of transmitting the virus to your sexual partner.
● Take medication called PrEP (Pre-Exposure Prophylaxis). This can be prescribed by your doctor.

Other prevention methods

There are a few other things you can do to prevent transmission of HIV:

Do not share needles or other drug paraphernalia. Needle sharing can spread HIV through blood contact.
Consider PEP. If you know that you have been exposed to HIV, talk to your doctor about getting post-exposure prophylaxis (PEP), which can reduce your risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure. – HIV PEP Singapore

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV.

HIV mutates quickly, and can often fend off immune system responses. Only a small number of people with HIV develop broadly neutralizing antibodies.

The good news is that in 2016, the first HIV vaccine efficacy study in 7 years was done in South Africa. This experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A follow-up after vaccination showed that the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involved 5,400 men and women from South Africa.

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