A Brief introduction to HIV/AIDS

More than 36.7 million people are positive for human immunodeficiency virus (HIV) and India has the third largest HIV epidemic in the world, overall, there is a decline in the country with a decline of 54% of AIDS related deaths between 2007 and 2015.

World AIDS day is commemorated on December 1^st every year to show support to the people suffering from AIDS and to bring about awareness and remove the stigma surrounding the disease.

AIDS was discovered in the 1980s and HIV was isolated to be the cause in the year 1983.

Before we go into the details of the disease, let us know the terminologies, an HIV positive individual is one that is tested positive to have the virus, whereas HIV-AIDS (acquired immunodeficiency syndrome) is when the individual’s CD4+ cell counts are low, causing them to have dangerous infections. A person who is HIV positive need not necessarily have AIDS, but every AIDS patient is HIV positive.

Common AIDS related question

What causes AIDS?

A virus known as the Human immunodeficiency virus causes AIDS

How is AIDS transmitted?

• Sexual transmission is the most common route of transmission through penetrative sex (both vaginal and anal) as body fluids contain the virus.
• Blood transfusions from an infected person, an individual who required repeated blood transfusions is at a higher risk of being infected.
• Sharing of needles and syringes, IV drug users (heroin users) are at high risk.
• Transmission from mother to baby.
• Routed by which AIDS in NOT transmitted
• Close personal contact.
• Kissing
• Hugging
• Sharing of utensils
• Household contact
• Contact at schools, touching, playing.
• Swimming together.

Can AIDS be transmitted through kissing?

HIV is not transmitted through saliva, but through blood and sexual fluid, so if the person has bleeding sores in the mouth, only then is there a risk of transmission.

Can it be transmitted through oral sex?

Yes, it can be transmitted through oral sex but the risk of transmission is lowered if the man is wearing a condom, it can also be transmitted through the female.

Can I recover from HIV/AIDS?

As of now, there is no cure for it but there are drugs that control the viral load and prevent progression of the disease and the complications, people go on to live with HIV for years.

Can I get pregnant if I have HIV without transmitting it to the baby?

Yes, you can get pregnant if you are HIV positive, you just need to be regular with your medication and the baby needs to be delivered by C section and the baby will also need precautionary drugs after delivery.

Can you breastfeed if you are positive?

It is recommended to not breastfeed if the mother is positive to prevent transmission from mother to baby, however if no other alternative is available, it can be done with precaution, as guided by your obstetrician and pediatrician, studies have shown that exclusive breastfeeding has lower rates of transmission as compared to breastfeeding along with additional feeding to the baby, please contact our doctors for further guidance.

How can transmission be prevented?

• Regular use of condoms, they not only prevent the transmission of HIV but also other sexually transmitted diseases.
• Do not share needles or syringes with anyone, this also reduces the risk of transmission of hepatitis which is a lot more contagious than HIV.
• Mother to child transmission can also be prevented by regular care during pregnancy and guidance from healthcare workers.

What happens when you get HIV?

There are cells in our body known as CD4 cells which are immune cells that fight infections, HIV enters the body, replicates and attacks these cells and lowers their number and a low count means that there aren’t enough of them to fight infections, causing a threat to our lives. The symptoms of HIV depend on the number of CD4 cells.

Who is at risk of getting AIDS?

• Sex workers
• Hemophilia and thalassemia patients
• Failure of practicing safe sex
• Drug abusers
• Health care workers
• When is AIDS transmission most likely?
• Coexisting STD
• Bleeding sores
• In the acute infectious stage where the viral load is high

Can children with HIV get vaccinated?

Children with HIV cannot get certain vaccines that are live attenuated, like oral polio vaccine, etc, contact your paediatrician for more information on this, the reason these vaccines are dangerous is because in HIV, the immunity is lowered and the vaccine can cause the active disease as the immune system cannot make adequate antibodies to fight it, this state is known as immunosuppressed state.

Symptoms of HIV

(According to the WHO clinical staging of HIV infection)

• Primary HIV infection – This is the early acute phase or the 6 month period following infection. It starts as a non specific illness during which uncontrolled replication of the virus happens and the patient is highly contagious, the first two weeks following infection are silent and there is no evidence of infection even on tests, following which the following symptoms may occur –
• Sore throat
• Fever
• Weight loss
• Mouth ulcers
• Tiredness and fatigue
• Rashes
• Diarrhoea
• Vomiting
• Headache

The illness lasts 3 weeks and is followed by complete recovery

• Clinical stage 1

There are minimal to no symptoms at this stage, however virus replication is ongoing in the body.

• Clinical stage 2
• Unexplained weight loss
• Recurrent upper respiratory tract illnesses – like sinusitis, pharyngitis
• Herpes infection
• Recurring oral ulcers
• Dermatitis or skin infections
• Fungal nail infections

• Clinical stage 3
• Unexplained severe weight loss
• Diarrhoea for more than a month
• Fever for more than one month
• Oral fungal infections
• Oral hairy leukoplakia – your tongue gets coated with a white patch and hair that does not go away.
• Tuberculosis
• Severe bacterial infections

• Clinical stage 5
• Fungal infections of the wind pipe, food pipe and lungs
• Infections known as opportunistic infections of HIV – which are many and include pneumocystis pneumonia, HIV encephalopathy which is an infection of the brain, toxoplasmosis etc these infections can be bacterial, viral, fungal or parasitic.
• Kaposi’s sarcoma
• Lymphoma

AIDS develops within an average of 7-8 years and the patients present with fever, weight loss, diarrhea, opportunistic infections, neurologic disease and secondary growth of tumors. It is the final phase of HIV.

How do I get tested for HIV?

An antigen/antibody test is done by drawing a sample of blood. In India, there are integrated counseling and testing centers funded by NACO where testing and counseling is done.

When can I get tested for HIV?

• HIV can be detected in the body 1-2 months after exposure.
• Who should get tested for HIV?
• Anyone experiencing the above mentioned symptoms.
• Pregnant women.
• Sex workers.
• Drug users.
• History of frequent unprotected sex.
• History of regular blood transfusions.
• Coexisting other sexual transmitted diseases.

How is HIV managed?

• General measures – This involves a balanced diet, good hygiene, practicing safe sex to prevent infection to others, quit smoking and alcohol, get the required vaccinations, UNLESS contraindicated or recommended by the doctor to not get it, please contact the doctor regarding vaccines as it depends on the viral load.
• Counseling and education regarding the disease is an important aspect.
• An HIV drug regime is in place which involves classes of drugs, which are nucleoside reverse transcriptase inhibitors, nucleotide reverse transcriptase inhibitors, non nucleoside reverse transcriptase inhibitors and protease inhibitors are the first line of choice, which can be altered depending on the individual’s age, pregnancy status and resistance to drugs.
• The opportunistic infections caused by HIV are also promptly treated.          
• Viral load and CD4 count is monitored to assess the stage of the disease.

Are there are any side effects to the treatment?

Yes, nausea, vomiting, diarrhea, kidney and liver damage are common side effects.

Do I need to tell people if I am HIV positive?

HIV positive individuals are legally bound to tell their partners, it is also the duty of the doctors to notify the spouses/partners of the individual.

What can I do as an individual to help HIV patients?

• Talk about HIV, educate and spread awareness regarding it, especially to people without access to the information.
• Prevent prejudice and discrimination against patients.
• Promote blood donation of healthy individuals.
• Advocate for the rights of HIV positive individuals in schools, work places and other institutions.

The stigma surrounding the disease is still prevalent even with the developments made over the past few  years, it is important to make the patient feel included in society and de-stigmatize the illness so we can fight it together as a community and reduce the risk of transmission and bring down the disease burden, which we cannot do if we make the patient feel scared and vulnerable, which prevents them for taking adequate care of themselves, it is crucial to provide sex education in schools and to young adults so they are well informed of risks and are taught to practice safe sex as the golden saying goes, prevention is better than cure.