Some basic facts to know about HIV/AIDS

Asha Sougaijam & Dr. B. Gururaja *

One Day Training Program on HIV/AIDS Awareness organised by Tribal Research Institute on June 20 2012 :: Pix by Bunti Phurailatpam

Every human being has an efficient body mechanism to protect it against disease. This mechanism is called the immune system. Without us knowing, the immune system is at work constantly, recognizing foreign bodies (eg. Bacteria, virus, micro organisms) and fighting them. The immune system fights the foreign bodies by producing specific chemicals called antibodies, which neutralize the foreign bodies. The white blood cells are the key cells of the immune system which fight against the various diseases.

In case of HIV, it takes 3-6 months for the body to begin producing the antibodies against HIV. This period of time when the virus is present but the antibodies are not, is called the window period. Tests to determine the presence of HIV actually look for these antibodies. Therefore, tests are ineffective during the window period (the first 3-6 months after the virus enters the body) because there are no antibodies produced yet.

When HIV enters our body and attacks the immune system, making the immune system weak, our body becomes vulnerable to a variety of germs that the body would normally be able to fight off. Similarly, due to HIV when our immune system completely breaks down, no matter how much medicine is taken (like ammunition), the body does not respond to these medicines and the person suffers and dies.

While there have been great strides in the prevention of HIV transmission and care of HIV infection and AIDS since AIDS was first recognized in 1981, many people still have questions about HIV and AIDS. The information below is designed to answer some of these questions based on the best available science.

What are the stages of HIV infection?

The HIV destroys our immune system gradually. The person infected today, does not die immediately. The infection spreads in the body through different stages. It is important to know these stages because every stage has different features and characteristics.

Infection

This is the moment when HIV enters the body (While dealing with the routes of transmission we would know how it enters the body). There is no indication of the infection.

Window period:

3-6 months. This is the gestation period of the HIV. There are no symptoms or any form of indication of the infection at this stage. This is a very crucial period because even the HIV test do not show positive result despite the presence of the virus. The person in the window period of the infection keeps on spreading the infection. The pre-test counselling in HIV should confirm the last risk encounter the person undergoing the test. If it is within three months, he/she should be asked to undergo the test once again after three months and to avoid any risk behaviour within those three months.

Asymptomatic stage:

In this stage, the test result becomes positive but the person looks absolutely without any symptoms. In this period HIV starts multiplying rapidly. This is the most important stage for intervention as behaviour can be modified to stop the rapid spread of the virus. The life of the infected person can also be prolonged.

Symptomatic stage:

Slowly the immune system breaks down and the other infections invade the body. The person starts showing symptoms like-

• Persistent cough for one month
• Prolonged fever over a month
• Prolonged diarrhoea over a month
• Loss in the body weight by 10% and more

Other symptoms:

• Open TB
• Oral candidiasis
• Herpes zoster
• Kaposis sarcoma

Full-blown AIDS stage:

At this stage, the immunity collapses completely. There are one or more Opportunistic Infection(OI), opportunistic tumors or sometimes the person just wastes away without any clinically diagnosed OI. This is also considered to be the last stage of infection. Generally at this stage palliative care is the only care given to the person.

Routes of transmission

• Blood route- by receiving HIV infected blood
• Sexual route- by indulging in unprotected penetrative sexual act with the infected partner
• Unsterilized injectibles- by sharing and using unsterilized needles and syringes and/or by getting pierced/wounded by soiled instruments
• Congenital route- from HIV infected mother to her newborn. This may happen during:- at foetus, during child-birth/labour and during breastfeeding

Prevention methods

• Using HIV tested blood
• Practicing safe sex methods
• Using disposable needles and syringes
• Cover up wounds/ use gloves while caring an HIV patient or handling surgicals.

Value education

• Abstain from sexual encounter till marriage
• Be faithful to one sexual partner, avoid extramarital sex
• Remain faithful to married partner
• Abstain from having sex with multiple and unknown partners

How is HIV spread?

HIV is spread primarily by:

• Not using a condom when having sex with a person who has HIV. All unprotected sex with someone who has HIV contains some risk.
  However:
• Unprotected anal sex is riskier than unprotected vaginal sex.
• Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.
• Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex. Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex.
• Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection.
• Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breast-feeding.
  Less common modes of transmission include:
• Being "stuck" with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare workers.
• Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely remote due to the rigorous testing of the blood supply and donated organs/tissue.
• HIV may also be transmitted through unsafe or unsanitary injections or other medical or dental practices. However, the risk is also remote with current safety standards.
• Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver's mouth mixes with food while chewing. This appears to be a rare occurrence and has only been documented among infants whose caregiver gave them pre-chewed food.
• Being bitten by a person with HIV. Each of the very small number of cases has included severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.
• Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare.
• There is an extremely remote chance that HIV could be transmitted during "French" or deep, open-mouth kissing with an HIV-infected person if the HIV-infected person's mouth or gums are bleeding.
• Tattooing or body piercing present a potential risk of HIV transmission, but no cases of HIV transmission from these activities have been documented. Only sterile equipment should be used for tattooing or body piercing.
• There have been a few documented cases where infants have been infected by unsafe injections and then transmitted HIV to their mothers through breastfeeding. There have been no documented cases of this mode of transmission.

HIV cannot reproduce outside the human body. It is not spread by:

• Air or water.
• Insects, including mosquitoes. Studies conducted by researchers and others have shown no evidence of HIV transmission from insects.
• Saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting.
• Casual contact like shaking hands or sharing dishes.
• Closed-mouth or "social" kissing.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from Government.

How do HIV tests work?

The most commonly used HIV tests detect HIV antibodies – the substances the body creates in response to becoming infected with HIV. There are tests that look for HIV's genetic material or proteins directly; these may also be used to find out if someone has been infected with HIV.

It can take some time for the immune system to produce enough antibodies for the antibody test to detect, and this "window period" between infection with HIV and the ability to detect it with antibody tests can vary from person to person. During this time, HIV viral load and the likelihood of transmitting the virus to sex or needle-sharing partners may be very high. Most people will develop detectable antibodies that can be detected by the most commonly used tests within 2 to 8 weeks (the average is 25 days) of their infection. Ninety-seven percent (97%) of persons will develop detectable antibodies in the first 3 months.

Even so, there is a small chance that some individuals will take longer to develop detectable antibodies. Therefore, a person should consider a follow-up test more than three months after their last potential exposure to HIV. In extremely rare cases, it can take up to 6 months to develop antibodies to HIV.

Conventional HIV tests are sent to a laboratory for testing, and it can take a week or two before the test results are available. There are also rapid HIV tests available that can give results in as little as 20 minutes. A positive HIV test result means that a person may have been infected with HIV. All positive HIV test results, regardless of whether they are from rapid or conventional tests, must be verified by a second "confirmatory" HIV test.

How can HIV be prevented?

Because the most common ways HIV is transmitted is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV, it is important to take steps to reduce the risks associated with these. They include:

• Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once. If you are at increased risk for HIV, you should be tested for HIV at least once a year.
• If you have HIV, you can get medical care, treatment, and supportive services to help you stay healthy and reduce your ability to transmit the virus to others.
• If you are pregnant and find that you have HIV, treatments are available to reduce the chance that your baby will have HIV.
• Abstain from sexual activity or be in a long-term mutually monogamous relationship with an uninfected partner.
• Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with HIV or another STD.
• Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually transmitted diseases. "Natural" or lambskin condoms do not provide sufficient protection against HIV infection.
• Get tested and treated for STDs and insist that your partners do too.
• Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex.
• Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop injecting drugs, use clean needles and works when injecting.
• Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly. This is called post-exposure prophylaxis.
• Participate in risk reduction programs. Programs exist to help people make healthy decisions, such as negotiating condom use or discussing HIV status. Your health department can refer you to programs in your area.

While there have been great strides in the prevention of HIV transmission and care of HIV infection and AIDS since AIDS was first recognized in 1981, many people still have questions about HIV and AIDS. No one should become complacent about HIV and AIDS. While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person's life, need to be carefully monitored, and come with costs and potential side effects.

At this time, there is no cure for HIV infection. Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk behavior, and find needed services.

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* Asha Sougaijam & Dr.B.Gururaja wrote this article for e-pao.net
The writer can be contacted at asha_sougaijam(at)yahoo(dot)co(dot)in
This article was posted on June 24 2012

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