What is HIV?

The human immunodeficiency virus (HIV) is a virus whose target is the immune system. It weakens people’s defence against many infections and some cancers. When the virus destroys and impedes on the body’s defense mechanisms, infected persons become immunodeficient over time. This means that their body systems are not able to fight a wide range of infections, cancers and other diseases that people with intact immune systems can normally fight off. As immune function is generally measured by the CD4 count, these CD4 cells are depleted by the virus.
When this infection advances without treatment after many years, it becomes acquired immunodeficiency syndrome (AIDS). The manifestations of AIDS are development of severe long-term diseases and certain types of cancers, for example the lymphomas and karposi’s sarcoma.
The symptoms manifested by an infected person depend on the stage of the infection. In the first few months after being infected, individuals may not experience any symptoms at all; some develop influenza-like illness including fever, headache, sore throat or rash. They tend to be more infectious during the first few months after being infected. When the infection progresses, other signs appear, such as weight loss, swollen lymphnodes, fever, cough and diarrhea. If no treatment is given, other illnesses such as tuberculosis , cancers, and severe bacterial infections begin to develop.
HIV can be transmitted through exchange of body fluids from infected people such as blood, vaginal secretions and semen. HIV can also be transmitted from mother-to-child during pregnancy, delivery and breastfeeding. HIV cannot be transmitted through everyday-contact such as hugging, shaking hands, sharing personal objects like cutlery, cups, plates, etc. Ordinarily, one cannot contact HIV through kissing, except there is an injury to the mucous membranes of the mouth, such that there is an exchange of blood from an infected person.
Worthy of note is the fact that people with HIV who are taking antiretroviral drugs and have suppressed the virus up to a point where it is not detectable (but still in the body system), do not transmit HIV to their sexual partners. Therefore, for persons diagnosed with HIV, early initiation of antiretroviral therapy and support to remain in care is essential to improving their health, as well as preventing HIV transmission.
Lifestyle and conditional risk factors that predispose one to contracting HIV include:
1) Having unprotected anal or vaginal sexual intercourse
2) Having another sexually transmitted infection (STI) such as herpes, chlamydia, gonorrhea, syphilis and bacterial vaginosis
3) Sharing contaminated needles, syringes and other injecting equipment.
4) Receiving infected blood through blood transfusion, tissue transplantation, unsafe injections and medical procedures that involve use of unsterilized equipment to cut and pierce.
5) Having an accidental needle stick injuries, mostly among health workers.
HIV infection can be diagnosed through rapid diagnostic tests that provide same-day results. Rapid tests facilitate early diagnosis and linkage to care and treatment. Selt-test kits are also available. However, single tests are not confirmatory for HIV infection; infection is properly established by confirmatory tests carried out by a qualified and trained health care personnel at a HIV clinic or community health centre. Retesting is important before enrolment to treatment and care to rule out any potential testing or reporting errors.
When a person gets infected, there occurs antibodies production as part of the immune response to fight the virus. Most widely-used HIV diagnostic tests detect these antibodies when they are high enough to be detected. These antibodies are developed within 28 days of infection also called the window period. Therefore, a person may be infected but not show a positive HIV diagnosis if the testing was done before the antibodies which should be detected by the diagnostic tests have been released. Infected persons still in the window period may still transmit the virus to others. For children less than 18 months of age, rapid diagnostic tests are not used, rather, virological tests are used to detect the virus itself even when antibodies against the virus have not been formed.
HIV testing should be voluntary and persons have a right to decline testing as coerced testing by health care personnel, family member, or an authority not only undermines public health practice, but also infringes on human rights. All HIV testing services must follow the WHO-recommended principles known as the “5 Cs”: informed consent, confidentiality, counseling, correct test results and connection (linkage to care, treatment and other services).
People can reduce their risks of HIV infection by using these key approaches:
Male and female condom use, testing and counseling for HIV and other STIs, Voluntary medical male circumcision, use of antiretrovirals (ARVs) for prevention, harm reduction for people who inject and use drugs and elimination of mother-to-child-transmission.
The use of ARVs for prevention of HIV can be classified into:
Pre-exposure prophylaxis (PrEP) for HIV-negative persons who at risk of contracting the virus, for example for a person whose partner is HIV- positive, men who have sex with men, people who inject drugs, sex workers and transgender women.
Post-exposure prophylaxis for HIV (PEP) for use within 72 hours of exposure to HIV to prevent infection. It involves counseling, care, HIV testing and administration of a 28-day course of ARVs with follow-up care.
Secondary prevention: this involves a HIV-positive person taking antiretroviral therapy (ART) consistently so that they are virally suppressed and do not transmit the virus to their sexual partners.
Harm reduction for people who inject and use drugs: this involves precautions taken by this group of people, such as the use of sterile needles and syringes for each injection, treatment of drug-dependence, HIV testing and counseling, access to condoms and management of STIs, tuberculosis and viral hepatitis.

HIV can be highly suppressed, not treated, using treatment regimen that comprises 3 or more ARVs. Since 2016, WHO recommended that all people, including children, adolescents, adults, pregnant and breastfeeeding women living with HIV be provided with lifelong ART, irrespective of CD4 count. HIV treatment is not an emergency; individuals should be counseled on what the treatment process entails and if they are willing to start and be retained in care.
Expanding access to treatment for all is at the heart of set targets to end AIDS by 2030.

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