HIV & AIDS
The Human Immunodeficiency Virus (HIV) is a retrovirus originating from the chimpanzee Simian Immunodeficiency Virus ( SIV) that initially passed to humans who were exposed to infected chimpanzee blood, while hunting them in central Africa, as early as in late 1800’s.
Since then, the virus spread across and out of Africa over a course of almost 2 centuries.
It was in 1981 that the first case was reported and in late 1982 that the CDC termed and defined AIDS.
HIV infection is transferred through sexual intercourse, exposure to infected semen, vaginal liquid, or blood and infected needles.
HIV weakens the immune system, essential in fighting infections, by destroying the CD4 cells.
Up to October 2020 there were 18.574 reported HIV infection cases: 82.6% were men, 4.414 advanced to AIDS, 11.044 are treated with antiretrovirals, while there were 3.078 deaths reported.
Figure 1. New HIV cases/100.000 population EODY
Fig 2. HIV transmission by category and year of diagnosis (January-October 2010-2020) EODY
(MSM: Men who have sex with men, PWID: Persons who inject drugs, HETERO: heterosexual)
- sexual intercourse (transmitted disease-STD)
- HIV infected sexual partner
- sexual assault (victim)
- unprotected anal sex between men
- unprotected sex with multiple partners
- sexual intercourse for money (or with partners who do)
- sexual intercourse for drugs (or with partners who do)
- shared needles for injecting drugs
- accidental needle/sharp instrument injury (for health professionals)
- unsterilized piercing
TIMELINE AND STAGES OF THE HIV INFECTION
- Transmission of virus
- Acute HIV infection – Stage 1: highly contagious, although may be asymptomatic or with mild, flu like symptoms
- Chronic HIV infection without AIDS– Stage 2: still asymptomatic but contagious
- Chronic HIV infection with AIDS – Stage 3 increased viral load, low CD4 cells and symptoms.
Early initiation of treatment in stage 1 may stop progression to stage 3.
AIDS stands for the Aquired Immunodeficiency Syndrome, defined by reduced CD4 cell count (<200 cells/microL), or by the presence of characteristic conditions such as opportunistic infections.
Initial infection may present with mild symptoms for two weeks, including (fever, sore throat, headache, muscle and joint pain).
The first years post infection may be asymptomatic, or with mild symptoms and lymph node enlargement. Many asymptomatic individuals are not aware they are HIV positive and therefore contagious.
Symptoms of untreated HIV include fever, nausea, vomiting, stomach pain, diarrhea, headache and weight loss. Additionally, the presence of an undetermined febrile illness, painful ulcers, rash, lymphadenopathy, aseptic meningitis, and infections of various organs, including yeast and opportunistic infections, are symptoms that should raise the clinical suspicion for HIV infection.
Is based on the results of laboratory tests that detect:
HIV RNA: Reverse transcriptase-polymerase chain reaction (RT-PCR)
HIV specific antibody
Test results are given as negative, positive, or indeterminate. The attending physician will interpret the result and suggest the most appropriate management plan.
Early diagnosis and consequent antiretroviral treatment is of paramount importance as it reduces the viral load, delays disease progress and reduces transmissibility.
The use of antiretroviral agents has greatly reduced mortality, increased life expectancy and improved quality of life for patients.
There are 6 classes of antiretroviral agents (ART), each targeting one of the 6 phases of the HIV life cycle.
Different combinations of those agents are used to design the appropriate therapeutic regimens applied in clinical practice.
- reduces viral load in the blood
- helps keep higher levels of CD4 cells
- reduces the potential for transmission to others
- prevents drug resistance development provided it is used properly
- greatly reduces mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding: the earliest the initiation of ARV administration to both mother and child the lower the risk of MTCT.
In light of the current SARS-CoV-2 pandemic, individuals with HIV/AIDS should also follow all the protective measures and guidance for COVID-19 prevention. Additionally, it is advised to obtain in advance adequate medication supply and most importantly, to comply with their HIV treatment following their physician instructions, as this will keep the infection under control and will preserve immune system functionality.
Currently there is no vaccine to prevent HIV infection, however there are available medications for prophylactic use under specific circumstances:
Preexposure prophylaxis (PreP) medication for:
- HIV negative individuals, at risk for contracting HIV from sex (HIV positive partner)
- V. drug user (shares needles with HIV positive person)
- Planning pregnancy when partner is HIV positive
Post exposure prophylaxis (PeP):
- medication to prevent HIV infection
- must be administered very soon, within 72 hours after the event of possible exposure
- daily administration for 28 days.
Prophylaxis during sex:
- Safe sexual activities
- Use of condoms
- Choose water/silicone-based lubricants that do not break condoms
- Use pre-exposure prophylaxis if/when indicated
- Get tested regularly
- Encourage your positive partner to get treatment
Prophylaxis for those who inject drugs
- Avoid sharing needles and similar tools
- Avoid sex when not sober
- Take PreP when indicated
Protect others if you are HIV positive
By Anna Tzortzi, MD, Pulmonologist
Scientific Director “George D. Behrakis Research Lab”
Associate Director “Institute of Public Health, The American College of Greece”