WHERE DOES HIV COME FROM?

Aids (acquired immune deficiency syndrome) was first described in  the early 1980s. The HIV virus (human immunodeficiency virus) was discovered as the cause of Aids in 1983.There are many convincing theories, but it is still unclear exactly where the virus originated.

Global factors that have caused the virus to spread rapidly include:

• socio-economic instability.
• multiple sexual partners.
• intravenous drug use.
• migration of people across large distances.

 SPREAD OF THE HIV VIRUS

The virus is generally spread in one of three ways:

• Sexual intercourse.
• Mother to child transmission (MTCT) during pregnancy, birth and breast-feeding.
• HIV-infected blood passing directly into the body (e.g. needle-stick injury).

THE HIV VIRUS CANNOT BE SPREAD BY:

• Kissing
• Touching
• Hugging
• Shaking hands
• Sharing food and utensils
• Contact with toilet seats

STAGES OF THE ILLNESS

The three stages of the illness can roughly be divided into:

• Being well with no symptoms.
• Mild disease episodes
• Severe illness

HOW DOES THE HIV VIRUS WORK?

The HIV virus attacks and slowly destroys the immune system.

• Rapid progressors: Some people with HIV infection are called rapid progressors. In these individuals the disease progresses quickly and becomes very active.
• Slow progressors: Other people are slow progressors who remain generally very well for 15 years or more.
• Becoming ill is fraught with anxiety, fear and apprehension. It is a time when you need support and compassion from friends and loved ones.
• You also deserve the best medication, assistance and guidance from professionals.
• Unfortunately, coupled with becoming ill, many people are living in panic of being found out as being HIV-positive.
• People do not feel ashamed to be found out to have diabetes, arthritis or cancer. Similarly, if you are HIV-positive, you should not have to be ashamed. You did not bring it upon yourself. It is not your fault. But it is your responsibility. Important
• It is up to you to take action and do everything you can to optimise your condition.
• With early diagnosis and treatment with antiretroviral medication (ARVs), HIV has been transformed from a terrible death sentence to a chronic and manageable disease, and good quality of life may continue for many years.

TESTING FOR HIV

• Establishing your HIV status is one of the most important steps in dealing with this illness.
• HIV diagnostic testing can only be done with your consent. And it should only be done after a counselling session explaining what HIV is all about and what to do if you test positive. This process is called VCT (voluntary counselling and testing).
• Knowing your status is the single most important step you can take. It is important to understand what testing is all about. The test does not pick up the actual virus. What the test detects is the antibodies that are produced in your body in response to the presence of an HIV infection.
• What is often a very difficult concept to grasp is that the test will always be negative immediately after an exposure to the HIV virus. This is because of something called the ‘window period’

 THE WINDOW PERIOD

• Antibodies are produced as an immune response to all infections, but they take a short while to be formed.
• With HIV infection, the antibodies are produced from about three to six weeks after the infection and only become detectable in the blood from about six weeks after infection.
• This six-week period between infection and a positive test is called the window period.
• In many people it can take up to three months before testing positive. Therefore, even if an initial test is negative, it is recommended that a follow-up test be done after three months.

 TYPES OF TESTS

1. ELISA test

This is the most widely used test. It stands for enzyme-linked immunosorbent assay. ELISA tests must be done in a laboratory. Blood is taken in a tube and sent to a laboratory for testing. If the test is positive, the laboratory will retest it with at least one other type of ELISA test.

2. Rapid HIV test

This test is performed by a healthcare professional in a clinic or hospital. The results can be available within15 mints. Two separate tests should be performed to confirm the diagnosis because both false positive and false negative results are possible. It is usually accurate, but false positives are possible from cross- reacting antibodies. However, the latest tests almost never give false positives.

3. Testing in the early stage 7-14dayes.

A-For the first 7-14d, the blood contains the  HIV RNA which interferes with standard testing. It is, therefore, essential to test for the virus itself. This test is called a PCR or polymerase chain-reaction test.

B- The HIV p24 antigen test

The HIV p24 antigen test.  The p24 antigen test can detect the protein on average 14 to 28 days after infection with HIV. the p24 antigen test will be able to give an accurate result two to four weeks following infection and the PCR test will be accurate in as little as seven to 14 days after infection.

       4. Tests to determine how advanced the HIV infection is: The test

Most commonly done is a CD4 count. A normal CD4 count is 800 or more. In the earlier stages, an HIV-infected person has counts of about 300–500 and in late stages the count is usually less than 200. immune system is functioning.

CD4 cells (also known as CD4+ T cells) are white blood cells that fight infection. The more you have, the better. These are the cells that the HIV virus kills. As HIV infection progresses, the number of these cells declines.

iii)A test can also be done to measure the viral load, that is the amount of virus in the blood. It shows how rapidly the virus is multiplying and is a very useful test to show how the virus is responding to ARVs.

TREATMENT OF HIV INFECTION

Treatment with antiretroviral (ARV) medication is the only way to inhibit the growth of the virus. There is no doubt within the scientific community that ARVs allow you to improve your condition and extend your life. Even NEW drugs CAN nearly completely destroy or get rid of the virus,and they can slow down the multiplication of the virus and, therefore, prolong the symptom-free period of the disease.

WHEN TO START TREATMENT

The two factors that determine when to start treatment are:

• The CD4 count
• The presence of symptoms of HIV infection

There are various approaches to treatment and the international guidelines are revised every year. The guidelines state when to start therapy, as well as which drugs are best in each situation and how to monitor the patient on the treatment. It is believed that it is best not to start treatment too early so as to avoid the development of viral resistance (when the virus becomes resistant to the medication) and to minimise the side effects.

 CD4 COUNT

The CD4 cell is an important type of immune cell present in the  bloodstream. The CD4 count determines how badly affected the immune system is. According to most current guidelines, even if there are no symptoms, a CD4 count of between 200 and 350 would indicate the need to start antiretroviral treatment.

 WHAT ARE ANTIRETROVIRALS (ARVS)?

HIV falls into the category of viruses called retroviruses, so ARVs are simply medications which target retroviruses. The names of the drugs are very complicated as they describe how the medication interferes with the DNA replication of the virus.

WHAT IS THE DIFFERENCE BETWEEN BEING HIV-POSITIVE AND HAVING AIDS?

• When the virus is initially contracted, one experiences mild flu-like symptoms for a week or so. This is often called a seroconversion illness, which simply means that antibodies are forming.
• There is absolutely nothing to distinguish this fever and symptoms from any other causes of fever.
• However, even during this symptom-free stage you can already infect others and condemn them to the same fate.
• It is important to discover as early as poss­ible that you are HIV-positive so that you can plan treatment and make sure you do not crash your immune system and develop full-blown Aids.
• All this time the virus is very slowly making its way into your immune system and slowly destroying immune function by embedding into the DNA of your immune cells.
• This is what is called HIV-positive status or HIV infection. You are not ill, but as your CD4 count drops to below certain levels, you may begin to develop illnesses due to poor immunity.
• Tuberculosis, or TB, is one of the commonest. TB is a devastating illness, but completely treatable and curable with an intensive course of medication, taken reliably every day for six months.

 A person with a positive HIV status may go on feeling and looking really well for five to ten years. There is no evidence of the presence of HIV, except in a blood test.

As your HIV illness progresses, your CD4 count drops until you can develop a host of opportunistic infections. The most common are:

• Pneumocystis carinii pneumonia
• Meningitis
• Shingles (herpes zoster)
• Kaposi’s sarcoma – a severe soft tissue cancer
• Candidiasis of the mouth and genitalia
• Severe diarrhoea

This is now called full-blown Aids. Once any of these opportunistic infections has occurred it means your CD4 count is very low.

“It is not yet clear“whether every HIV-infected person will progressto develop Aids. Approximately 80% of HIV-infected people will have developed Aids within 12 years of acquiring the infection.” On average it takes about eight years to progress, but ARVs can possibly prevent the development of full-blown Aids.

Most important HIV facts:

• Women are at a much higher risk of contracting the virus, as HIV is transmitted much more easily from men to women than from women to men.
• The risk of infection is even higher with anal intercourse, or if you have a vaginal infection.
• Always use a condom. Even if you are already HIV-positive, a new partner who is HIV-positive can make you sicker by increasing your viral load. Birth control methods such as oral contraceptive pills and diaphragms do not provide protection against HIV.

“This is the one area of good news in the whole HIV pandemic EARLY DIAGNOSIS EARLY treatment WILL LIVE NEARLY NORMAL LIFE WITHOUT ANY RISK EVEN TO YOUR PARTNER.