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Human Immunodeficiency Virus (HIV)

HIV stands for human immunodeficiency virus. If it left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).

Unlike some other viruses, the human body can’t get rid of HIV completely. So once you have HIV, you have it for life.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections.

If left untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get infections or infection-related cancers.

Transmission

 

  • Only certain body fluids from a person who has HIV can transmit HIV; blood, semen, pre-seminal fluid (same meaning as pre-cum or pre-ejaculatory fluid), rectal fluids, vaginal fluids and breast milk.

 

  • These body fluids must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.
  • Scientists and medical authorities agree that HIV does not survive well outside the body, making the possibility of environmental transmission remote.

HIV needs really specific conditions to survive outside the body. Typically air tight and climate controlled. As far as inanimate objects, needles are found to be one place the virus can survive a bit longer. This is due to the airtight space between the needle tip and the plunger also known as the “sweet spot”.

How common

It is estimated that 1.7 million people in the U.S. have been infected with HIV since 1981 and approximately 1.1 million Americans are currently living with the infection. Every 9½ minutes, someone in the U.S. is infected with HIV. It is estimated that there are over 56,000 new cases of HIV in the U.S. each year. In 2013, there were an estimated 1.1 million people living with HIV in Eastern Europe and Central Asia. Sub-Saharan, Africa is the most affected region, with 25.8 million people living with HIV in 2014. Also sub-Saharan Africa accounts for almost 70% of the global total of new HIV infections.

Chances of being infected

The estimated risk per sex act is 0.08% to 0.19% for receptive vaginal intercourse (i.e., male-to-female); and approximately 0.05% to 0.1% for insertive vaginal intercourse (i.e., female-to-male).

Estimated HIV transmission risk per exposure:

  • Vaginal sex, female-to-male, studies in high-income countries 0.04% (1:2380)
  • Vaginal sex, male-to-female, studies in high-income countries 0.08% (1:1234)
  • Vaginal sex, female-to-male, studies in low-income countries 0.38% (1:263)
  • Vaginal sex, male-to-female, studies in low-income countries 0.30% (1:333)
  • Vaginal sex, source partner is asymptomatic (No symptoms) 0.07% (1:1428)
  • Vaginal sex, source partner has late-stage disease 0.55% (1:180)

How to detect if someone has it

Unfortunately it is not possible to know if someone has HIV by looking at him or her. In fact, HIV often presents no physical symptoms. A person who is infected with HIV may thus not know that he or she has been infected. But for AIDS symptoms appear in the most advanced stage of HIV disease. In addition to a badly damaged immune system, a person with AIDS may also have thrush — a thick, whitish coating of the tongue or mouth that is caused by a yeast infection and sometimes accompanied by a sore throat, swelling or hardening of glands located in the throat, armpit, or groin, the appearance of discolored or purplish growths on the skin or inside the mouth.

The manifestations of HIV are dependent on the WHO stage that a person is in. Most of these symptoms are non-specific and having any one of them does not necessarily mean that one is infected by HIV .

Stage 1.

lymph nodes - Detect

Most patients in this stage are asymptomatic. The only finding might be persistent generalized lyphadenopathy. The lymph nodes of these patients will appear persistently swollen.

Stage 2

weight loss - Detect

This stage is characterized by some weight loss (not more than 10% of the body weight). Upper respiratory tract infections and skin infections will manifest at this stage.

Stage 3

This stage will be characterized by severe weight loss (more than 10% of the body weight). Pulmonary tuberculosis is common at this stage, other severe presumed bacterial infections, persistent oral thrush unexplained anemia among other infections.

Stage 4

This is the stage of ‘full blown AIDs’. It is characterized by PCP pneumonia, HIV wasting syndrome, extrapulmonary tuberculosis, chronic herpes simplex infections, oropharyngeal candidiasis and the AIDs defining malignancies (Kaposi sarcoma, cervical cancer). At this stage the body is very susceptible to fungal infections.

In term of skin, there are four skin symptoms that may appear:

    • Xerosis skin - Detect Xerosis skin, typically appear when the body has been infected by the virus for about 20%.
    • Atopic dermatitis skin - Detect Atopic dermatitis skin, when the body has been infected by 30-50%, skin can be scaly, red and rashes appear.
    • Prurigo nodularis - Detect Prurigo nodularis, the lumps on the skin will cause itchiness and scab-like appearances

 

    • Eosinophilic Folliculitis - Detect Eosinophilic Folliculitis, red bumps centered on the hair follicles, body surface and tend to cluster on the upper body.

Prevention

  • Wear condom

Condom effectiveness is estimated at 86.8% with the male-to-female data used as the denominator, 84.7% with the female-to-male data.

  • Pre-Exposure Prophylaxis (PrEP) – prescription

PrEP” stands for Pre-Exposure Prophylaxis. The word “prophylaxis” means “to prevent or control the spread of an infection or disease. PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day. The pill contains two medicines that are also used to treat HIV. If you take PrEP and are exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from taking hold in your body.

However, PrEP is not for everyone. Centers for Disease Control and Prevention recommends PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection. Example: heterosexual couples where one partner has HIV and the other does not.

  • According to iPrEx study, forty-one people out of 1603 participants (2.6%) became HIV positive during the study of PrEP. It’s also found that HIV infection rates in people on PrEP were 36% lower than in people not on PrEP. Adjusting for the higher risk of HIV acquisition in people taking PrEP resulted in an effectiveness of 49%.
  • Post-exposure prophylaxis (PEP)

This is a regimen given within 72 hours of presumed exposure to HIV. This can happen in the case of condom accidents. The preferred PEP regimen is tenofovir + emtricitabine plus raltegravir.

  • Male circumcision

According to Public Health Agency of Canada, male circumcision decreases the risk of female-to-male sexual transmission of HIV by 50% to 60%. However, there is little epidemiological evidence to suggest that circumcision reduces the risk of transmission to female partners of circumcised men or is effective in the prevention of HIV among men who have sex with men (MSM).

Condom effectiveness

Condom effectiveness is estimated at 86.8% with the male-to-female data used as the denominator, 84.7% with the female-to-male data. Condom failure against HIV has two sources; user failure and method failure. The rates have varied for each from 0.5% to 6.7% for breakage and 0.1% to 16.6% for slippage.

 

For information, quality control standards set by the Food and Drug Administration allow four out of 1,000 condoms in any given batch to leak water.  Quality control standards for condom manufacture are not consistent around the world, and condoms may be subjected to extremes in temperature or stored for long periods of time in some settings. All of these factors contribute to higher failure rates and potentially lower effectiveness in real-life settings.

Treatment

HIV medicines are grouped into six drug classes according to how they fight HIV. All of these drugs do not eliminate the virus from the body. Some prevent or slow down the replication of the HIV virus by blocking the cycle at different stages.

The six drug classes (all are prescription) are:

  1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  2. Nucleoside reverse transcriptase inhibitors (NRTIs)
  3. Protease inhibitors (PIs)
  4. Fusion inhibitors
  5. CCR5 antagonists (CCR5s) (also called entry inhibitors)
  6. Integrase strand transfer inhibitors (INSTIs)

The six drug classes include more than 25 HIV medicines that are approved to treat HIV infection. Some HIV medicines are available in combination (in other words, two or more different HIV medicines are combined in one pill.)

According to the U.S. Department of Health and Human Services (HHS) guidelines on the use of HIV medicines to treat HIV infection, it is recommended to start ART (Anti-Retroviral Therapy) with a regimen of three HIV medicines from at least two different drug classes. The choice of HIV medicines to include in an HIV regimen depends on a person’s individual needs and following factors:

  • Other diseases or conditions that the person with HIV may have
  • Possible side effects of HIV medicines
  • Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking
  • Results of drug-resistance testing (and other tests). Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV.
  • Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is convenient to follow.
  • Any issues that can make it difficult to follow an HIV regimen, such as a busy schedule that changes from day to day
  • Cost of HIV medicines

Best sources for more information

The risk chart is the heart of this guide, and it can be found here

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