Table of Contents
- General FAQs
- What body fluids contain the HIV virus?
- In what ways can HIV be transmitted?
- Is there a risk of transmission of HIV via kissing or deep kissing?
- Is there a risk of transmission of HIV via tattooing or getting body piercings?
- Is there a risk of transmission of HIV by sharing of razor blades with a HIV infected person?
- Can I safely have sex with an individual who is infected with HIV?
- Can two people who are living with HIV freely engage in unprotected sex only with each other?
- How can one prevent infection with HIV?
- What does the term safer sex mean?
- Are condoms truly effective in the prevention of HIV transmission?
- How do I make the best choice of condoms to use?
- Is it okay to use lubricant together with a condom?
- What is post exposure prophylactic treatment?
- In what ways can injecting drug users lower their risk of getting HIV?
- Can mother to child transmission (MTCT) be prevented? How?
- What are universal precautions?
- Does HIV have a cure?
- What are the available treatments for HIV?
- What is the mechanism of action of antiretroviral drugs?
- Are antiretroviral drugs efficacious?
- What are HIV tests?
- How soon after I have been exposed can I get tested for HIV?
- What is the need to have the HIV test?
- What places can I go to get tested for HIV?
- Are my HIV test results private?
- What is my next step if I test positive to the virus?
- What is the meaning of a HIV negative test results?
HIV is a virus which infects and attacks the cells of the immune system. The immune system is the body's natural defence which it puts up to fight against infections.
When the virus infects the immune cells, it destroys the T-helper cells (white blood cells which are also known as CD4 cells) and begins to replicate within them.
Eventually with continued viral replication and destruction of CD4 cells, the person's immunity becomes weakened. In this weak state of immunity, it is very difficult to fight off diseases, especially if the individual is not started on treatment.
It could take about 10 to 15 years to get the immune system destroyed to the point of no defence if treatment is not commenced. This rate of progression however may be different depending on the age group, the initial state of health of the individual, and the presence of concurrent illnesses.
AIDS means acquired immune deficiency syndrome. This is the advanced(late) stage of the HIV infection. It develops when the individuals immunity has been so weakened as to be unable to put up a defence against infections and diseases. At this point the CD4 cell count is extremely low and death is a likely possibility.
People who have HIV do not necessarily progress to AIDS especially if they are compliant with treatment.
When someone has been exposed to HIV and they get infected, the initial first few weeks after this is referred to as the stage of acute infection. Viral replication during this period is rapid. The body reacts to this infection by producing antibodies to fight it.
A person who is infected newly may not be aware of it as it is largely asymptomatic. This does not however prevent them from being able to transmit the virus to others.
In some people the infection is followed by flu-like symptoms which may range from mild to severe, and could last from just a few days to as long as several weeks. These symptoms are mostly non-specific and include:
- sore throat
- body aches and pains
- stomach upset
- skin rashes
- lymph node enlargement, etc
Due to the non-specificity of the symptoms, they are often easily overlooked or misdiagnosed. The acute stage usually resolves and then the clinical latency stage commences which can last for several years.
A person is said to have AIDS when they have advanced to the late stages of the HIV infection. This is the point when the body's immune defences are down, the levels of the T-helper (CD4) cells are extremely low, and the individual is very vulnerable to opportunistic infections (infections which do not usually affect healthy individuals because of their ability to fight them off easily).
It takes an average of about 10 years for an untreated individual to progress to AIDS. When a person is compliant with treatment with antiretroviral drugs, the state of chronic HIV infection can be maintained for decades without progression to AIDS.
Some of the indications that HIV is progressing to AIDS include:
- persistent fever
- shortness of the breath
- persistent diarrhoea
- night sweats
- fatigue not related to stress or sleep deprivation
- recurrent fungal infections in the mouth, throat, or vagina in women enlargement of the lymph nodes in the armpits neck or groin.
Some of the opportunistic infections associated with AIDS include:
- Kaposi's sarcoma which is the cancer that causes tumors to grow in the skin, the lymph nodes, the internal organs, and the mucous membrane of the oral cavity.
- Candidiasis of the oesophagus trachea bronchi or lungs. These are areas that normally would not be affected with the organism in healthy individuals.
- Invasive cervical cancer. This is cancer that begins in the lower part of the uterus (cervix) and which spreads (metastasis) to other organs.
- Opportunistic infections of the lungs such as coccidioidomycosis, acquired by the inhalation of fungal spores and cryptococcosis caused by infection with the fungus cryptococcus neoformans. The latter can spread other body parts including the brain where it causes swelling (cerebral edema).
- Chronic diarrhoea lasting more than one month due to cryptosporidium infection, isosporiasis or salmonellosis.
- Cytomegalovirus (CMV) retinitis affecting the eyes.
- HIV encephalopathy affecting the brain and altering its function.
- Herpes simplex (HSV) causing chronic ulcers, bronchitis, esophagitis, or pneumonitis.
- Hodgkin's and non-Hodgkin's lymphoma.
- Tuberculosis, a chronic lung infection caused by the bacteria mycobacterium tuberculosis which also in some cases affect other body parts such as the bones, kidneys, brain, or lymph nodes. Recurrent pneumonia, lung infection caused commonly by streptococcus pneumoniae.
- HIV wasting syndrome which is defined as the unintentional weight loss of more than 10% of total body weight in the presence of chronic diarrhoea, fever, and weakness for 30 days or more.
This is dependent on some factors like whether or not the individual is on antiretroviral therapy and their general health background but on the average, it takes about 10 to 15 years to progress to AIDS. It could be longer or shorter. Regular treatment with antiretroviral drugs can reduce HIV viral load to undetectable levels which prevent the progression to AIDS.
The HIV virus has been demonstrated to be present in certain body fluids in high concentrations such as blood, semen, pre-seminal fluid, vaginal secretions, rectal secretions and breastmilk. Body fluids which may possibly contain the virus and could pose a risk of transmission are amniotic fluid and cerebrospinal fluid.
Transmission via sexual intercourse
Engaging in penetrative sexual intercourse with an infected person without using protection (condoms) or taking drugs to prevent HIV infection prophylaxis puts you at risk.
The highest risk posed by penetrative sex is anal sex which which is reportedly 10 times more risky than vaginal sex. Receptive anal sex also known as bottoming and insertive anal sex also known as topping both carry risks of transmission but the former is higher.
Also the chances of transmission via sexual intercourse is higher if the infected individual has an untreated sexually transmitted infection with sores, ulcers, or discharge.
Oral sex can be a means of transmission but this carries a lower risk compared to penetrative sex.
Transmission via the sharing of sharp objects like hair clippers, syringes and needles.
HIV can be transmitted when sharps like needles syringes or hair clippers are shared. Even rinse water and any instrument or equipment used in the preparation of drugs for injection for an infected person can be a source of infection of another person. Needles and syringes are not to be re-used as it has been established that the virus can survive in them for as long as 42 days in varying conditions.
Transmission from mother to child (MTCT)
An infected mother can spread the virus to her baby either via pregnancy, during childbirth, or while breastfeeding. The risk of mother-to-child transmission is about 15 to 30%. This risk of transmission is not as high as the aforementioned ones but could be higher when they infected mother is untreated. The world Health organisation recommends that every pregnant woman be screened for HIV so that treatment can be quickly instituted to reduce the rate of mother-to-child transmission.
Transmission via blood transfusion
The risk of transmission of HIV is very high with transfusion of unscreened and infected blood and blood products, as well as receiving organ or tissue transplants. This risk is about 90%. Proper selection of blood donors, screening of donated blood, and implementation of blood safety standards ensures that this risk is reduced as much as possible or totally eliminated.
If the two partners have sores in the mouth or oral cavity, or bleeding gums, an infection could occur if the infected blood gets into the bloodstream of the unaffected partner. There has to be broken skin or mucosa to allow the transmission as the virus is not present in saliva. Other than that, there is no risk of HIV transmission with kissing.
Because HIV can be transmitted via a needle stick injury, getting a tatto or body piercing with unsafe or unsterilised instruments can infect you with the virus especially if it is being shared with other persons who my be infected. While there are no documented cases of HIV transmission via tattooing or body piercings, the risk certainly exists and it is advised that instruments which cut through the skin be used only once and discarded afterwards.
There is a potential risk of getting infected with the sharing of razor blades and indeed knives and other sharp objects with infected persons. It is advised that you have your personal items or have general ones sterilized before they are re-used.
Yes you can have good sex with a partner who is infected as long as they are on antiretroviral therapy, and you can also use condoms for protection. Antiretroviral therapy reduces the viral load to very low levels, making it less likely for a transmission to occur. You can also take pre-exposure prophylaxis as directed by your healthcare provider.
There are different types and strains of the HIV virus. Being infected with one strain does not confer immunity from infection with the others. It is therefore advisable to take precautions to prevent infection with different strains. Use condoms during sex.
You cannot as yet be vaccinated against HIV. Neither is there a cure for HIV/AIDS. This is why a lot of emphasis is laid on the prevention of disease. The precautionary steps which can be taken include:
- Avoid having multiple sexual partners. Do not reuse condoms.
- Use new condoms every time you have sex.
- Have non penetrative sex as this has been shown so curry a much lower risk of transmission does penetrative sex. Be consistent with antiretroviral drug therapy if you are HIV-positive to keep your viral load low and protect your uninfected partner.
- Take pre-exposure prophylaxis if you are HIV-negative and have sex with a HIV-positive individual.
- Use clean needles, syringes, and razors.
- Get medical care immediately if you are HIV positive and become pregnant.
- Consider voluntary medical male circumcision which has been shown to reduce the chances of HIV infection in males.
As they say, the only safe sex is no sex at all, ie abstinence. But safer sex involves precautions, methods, or devices employed during sexual activity to greatly lower the chances of HIV transmission, as well as the timely treatment of other sexually transmitted infections.
Safer sex still carries some risk but is much lower than otherwise. These precautions include:
- Consistent and proper use of protection (male and female condoms) during sex.
- Have only one sexual partner who also is having sex with you alone.
- Oral sex and non penetrative sex are considered safer sex and can be made even more so by the use of dental dams and condoms.
- Take pre-exposure prophylaxis if you are at risk of HIV infection.
- Take antiretroviral drugs consistently if you are hiv-positive in order to achieve an undetectable viral load.
If you consistently and properly use condoms, they are highly effective in protecting against HIV transmission. They equally protect against other sexually transmitted infections like chlamydia and gonorrhea. However for sexually transmitted infections which are spread via skin to skin contact such as genital herpes, genital warts, and syphilis, they are less protective.
Even though they are highly effective, there's still a chance of HIV transmission so it is recommended that you add other methods of prevention to further reduce the risk.
Generally, most condoms are made of latex and polyurethane. The latter is suitable for those who have latex sensitivity or allergies. It is also what female condoms are made of.
These materials have been shown to effectively prevent the passage of hepatitis, herpes virus, and of course the HIV virus. Condoms made of natural substances (lambskin) are not able to do this.
There are some condoms designed for sexual stimulation and not protection against sexually transmitted disease. These typically do not say anything about disease prevention on the package. Also condoms should be of appropriate length, covering the entire penis.
For condoms that are not already lubricated, you may apply some lubricant yourself. Some of them however are already lubricated using jellies, creams, and silicone.
Using a lubricant helps to prevent irritation or breakage while in use. Water-based lubricants are recommended.
Avoid oil based or petroleum based ones as they can cause damage to the latex material, making them prone to micro tears.
Post-exposure prophylaxis is a short-term course of HIV drugs which is taken just after an individual has been potentially exposed to the virus.
It is used only in cases of emergencies and not on a regular basis when exposure is continuous or frequent.
It consists of antiretroviral medication which is highly effective in HIV prevention if taken properly. It should ideally be taken not later than 72 hours post exposure.
To reduce your risk of HIV infection, as an injection drug user you can do the following:
- Switch from injection drugs and go to oral vacation medication.
- Each time you want to prepare your drugs, make sure it's with new syringes. Don't share your syringes or use them more than once.
- Use water from a trusted source to mix your drugs.
- Ensure you swab the intended injection site with an alcohol wipe or swab.
Mother to child transmission otherwise known as a vertical transmission is responsible for a good majority of cases of HIV infection in children aged 0 to 14 years.
This transmission can occur during pregnancy, childbirth, or via breastfeeding. For an infected mother who is left untreated, the chances of infecting the baby is about 15 to 30%. Breastfeeding also increases the chances considerably. With treatment, it comes down low to 5%.
As a means of curbing this, the World Health Organisation has recommended a program which offers care to HIV positive women from the time of pregnancy through delivery to breastfeeding.
These services include:
- Early infant diagnosis at 4-6 weeks after birth with HIV testing at 18 months and/or commencement of breastfeeding.
- They are to be started on antiretroviral therapy as early as possible if there has been HIV exposure.
- Infected mothers are also to be compliant with their antiretroviral medication.
Universal precautions are a set of guidelines which healthcare workers are expected to follow in order to limit the spread of infection from blood and other body fluids, and thus protect their health and that of the patients in their care.
These precautions include;
- Washing your hands carefully and often with soap and water.
- Use protective barriers like gloves, gowns or aprons and masks when direct contact with blood and other body fluids is expected.
- Safe collection and disposal of needles and "sharps" (boxes for safe disposal are needed for this).
- Follow the right procedures when a needle–stick injury occurs. Wash the area properly with soap and water and dispose of the needle safely (to avoid getting injured a second time), go to the Accident and Emergency immediately so as to be assessed for post exposure prophylaxis).
- Cover all cuts and abrasions with dressings that are waterproof.
- Clean up blood spills and other body fluids with bleach and water solution in the ratio of 1:10.
- Use a different mop for body fluid spillages and meticulously dispose of every equipment used in the clean up of the spillage.
There is no cure for HIV as yet but strict compliance to antiretroviral therapy can greatly suppress the viral load and hence limit the disease progression and also prevent the development of secondary infections and complications. This allows the individuals to live long and healthy lives.
To date, there are still no drugs capable of destroying the virus, but a good number of drugs are available to counteract the replication of the virus.
Depending on their mechanism of action, they are divided into several classes:
- Reverse transcriptase inhibitors (RTI) further divided into nucleoside (NRTI) and non-nucleoside (NNRTI), which are analogues of RNA and DNA constituents.
- Protease inhibitors (IP) which act against the protease enzyme that can "break up" proteins.
- Fusion inhibitors (IF) which block the entry of HIV into CD4 + lymphocytes.
- Integrase inhibitors (INSTI) which inhibit the viral enzyme that integrates the viral genome into the host cell's DNA.
- CCR5 co-receptor inhibitors.
For anti-HIV therapy to be effective, different classes of drugs must be combined. For this reason, combination antiretroviral therapy (cART) is recommended.
The antiretroviral therapy requires the daily intake of drugs according to medical prescriptions. There may be more than one tablet or just one containing different active ingredient in combination.
Although a definitive cure for HIV infection is not yet available, the combined therapy has been able to reduce the mortality and the progression of the disease caused by the virus, making the life expectancy of a person with HIV now almost comparable to that of a healthy person of the same age.
Numerous drugs are now available for HIV therapy. Most of them work by blocking the activity of enzymes (proteins that accelerate and facilitate chemical reactions) specific to HIV and necessary for it to multiply in its target cells. These cells are represented by a subgroup of white blood cells, called CD4+ lymphocytes (ie lymphocytes that express a molecule called CD4 on their surface), which are a part of the immune system and are essential for adequate defense against infections. The HIV enzymes blocked by these drugs are integrase, reverse transcriptase and protease.
Antiretroviral therapy is able to effectively suppress the quantity (viral load) of the virus in the blood, reducing them almost to undetectable levels, to eliminate the risk of transmission of HIV among sexual partners and the risk of transmission from mother to child during pregnancy and childbirth (vertical transmission of HIV).
For antiretroviral therapy to be effective, it is therefore necessary to ensure that HIV is no longer detectable in the blood. This goal can only be achieved if antiretrovirals from different classes are combined.
Otherwise, HIV continues to be present in the blood, to multiply and weaken the immune defenses, and in a short time, it inevitably becomes resistant to the drugs used, making them ineffective.
It is possible to identify the presence of drug-resistant viruses with specific tests, and in these cases, the drugs against which resistance has been identified are replaced with drugs to which sensitivity has been maintained, usually of different classes.
In any case, antiretroviral drugs are not able to eliminate HIV from the body because HIV remains permanently present in already infected cells. Therapy therefore aims to stop the multiplication of the virus in a lasting way.
Once started, the therapy must be followed indefinitely and cannot be interrupted or taken in a discontinuous way.
There are currently no drugs with prolonged time of action to be taken once a week or a month, and it is therefore necessary to take antiretroviral therapy every day respecting the indicated doses and times.
However, very simple combinations are now available, in which it is possible to take all the therapy provided in a single administration a day, sometimes represented by a single tablet to be taken in the evening.
If you have been exposed to HIV infection, the only way to know for sure is through HIV testing. HIV tests are used to detect the virus in the body.
There are various types of tests available which can show this. The choice of each depends on when the exposure took place as it takes some time for the body to start producing antibodies to fight the infection.
This depends on the test type. Mostly it is advisable to wait at least 3 months post exposure before going for the test. This is because of the delay in production of antibodies (window period) by the body.
As the commonest test available (antibody screening test) checks for these antibodies, the chances of getting a false negative are high if you take the test too soon.
For a more sensitive test like the HIV RNA testing which checks for the virus itself, it has the shortest window period and can detect the virus as early as 9 to 11 days after exposure. Although not the first line test, there may be specific occasions where they are requested for. If you need to know your HIV status as early as possible, then the HIV RNA test is the most suitable for you.
The combo test (antibody/antigen test) detects the infection earlier than the antibody screening test. This can be done to 2-4 weeks after exposure.
Early detection of the virus is highly beneficial to you as an individual as well as to your family, friends, and loved ones, as treatment quickly instituted decreases your viral load and reduces your chances of getting them infected. Also, early treatment of HIV especially before symptoms have developed is the most effective.
To reduce the burden of HIV, it is necessary that people who are at risk take the test so that they can promptly access treatment.
If you have never taken the HIV test or if you have but afterwards, you have engaged in other risky behaviour, you should make out time to do it as soon as possible.
There are different places you could go to get tested for HIV: at your doctor's, your local health clinic or health department, hospitals, or you can also do a self test using the self test kit. Ensure you get counceled on HIV wherever you choose to go.
Some centers carry out the test anonymously, others in a confidential manner, while some offer shared confidentiality.
In the first case, no personal document is required, but an encrypted code is used for your identification.
In the second case, it is necessary to show an identification document when the test is performed or the results are withdrawn.
For all the personal data that will be requested both in public and private laboratories, health personnel are bound by professional and official secrecy and must adopt all the security measures necessary to guarantee maximum confidentiality.
Your identity and any information regarding the execution and the test result cannot be disclosed under any circumstances except you give express permission.
If you have just been diagnosed of HIV, the next step is to see a health care provider. You should be counseled and started on therapy as soon as possible as early treatment offers the best outcome.
People living with HIV can now live normal healthy lives as long as they're compliant with treatment.
If your results come out negative after a test, this means that no antibodies were found at the time of the test. You should have another test after the window period of that specific test type has elapsed just to be certain. That means that for the Elisa test for example, you should get tested again three months after the initial test.
Because of the possibility of a false negative result, it is advisable to be careful at this time and not to engage in risky behaviour, in order to protect your family and loved ones from a possible transmission.