HIV-AIDS

HIV-AIDS

What is it?

• The HIV-AIDS pandemic, which began in the early 1980s, is one of the most devastating events in modern history in global health. About 35 million people have already died of AIDS; and despite a slow decline, the mortality rate of this disease is currently around one million people per year.

• The majority of deaths attributable to this disease occur in sub-Saharan Africa, where some 25 million people living with HIV were counted in 2015, and about two-thirds of new infections occur.

• The term "AIDS" is a common name derived from the acronym "AIDS", which means "acquired immunodeficiency syndrome"; this syndrome refers to the gradual destruction of the immune system by the human immunodeficiency virus (HIV). AIDS is almost universally fatal, but with appropriate treatment, people with HIV do not reach AIDS; some of them can even have a long and healthy life.

• Some rumors, stories, and assumptions that HIV does not cause AIDS to persist. However, these are totally unfounded and therefore constitute a threat to public health.

The outbreak of HIV (colored green) from a T lymphocyte

What are the symptoms?

• The first stage of HIV infection, called "acute infection," usually occurs a few weeks after the virus has entered the body. Common symptoms include fever, inflammation of the lymph nodes (lymphadenopathy), rash, angina, and mouth or genital pain. Some people also have nausea, vomiting, and diarrhea.

• These symptoms usually disappear after a few weeks. At this stage, the genetic makeup of the virus becomes embedded in the host cell's DNA and begins a "latency period" during which symptoms are rare or absent. The duration of the latency period varies from a few years to more than twenty years. However, sooner or later, people infected with HIV will experience fever, weight loss, and other problems.

• Without treatment, most patients eventually reach the third clinical stage of the infection: AIDS. HIV is infecting and destroying more and more CD4 + T cells, a type of white blood cell that plays an important role in the fight against infections. As a result, patients become vulnerable to infections caused by several other pathogens (viruses, bacteria, fungi, parasites). The nature of infections that may occur depends in part on the environment and patient behavior; however, almost one-third of all HIV-related deaths are caused by tuberculosis (TB).

• Patients also become vulnerable to viral cancers, including Kaposi's sarcoma (a type of skin cancer) and lymphoma. Other symptoms observed include long fevers, weight loss, night sweats, weakness, and diarrhea.

How does this disease spread?

• Unprotected sex is the main route of HIV transmission. On a global scale, transmission occurs mainly through heterosexual contact; but in many western countries, the majority of new infections occur among men who have sex with men. People with other sexually transmitted infections or genital ulcers are even more likely to contract HIV. In addition, the level of risk depends greatly on the amount of virus that circulates in the body of sexual partners.

• HIV is also transmissible through blood and blood products when, for example, people exchange needles to inject intravenous drugs, receive a transfusion, or undergo medical procedures performed using unsterilized medical equipment.

• HIV is also transmissible from mother to child during pregnancy or delivery, or through breast milk following birth.

• HIV can not be transmitted by kissing, hugging, shaking hands, or sharing personal items, food or drinks. Neither can it be transmitted by mosquito bites.

How is this disease treated?

• There is still no medicine to treat HIV infection. However, progression to AIDS can be slowed with highly active antiretroviral therapy (HAART), which is a combination of at least three different drugs that can kill the virus. TAHA is so effective that it is subsequently impossible to detect HIV using traditional methods. This treatment greatly reduces the risk of death.

• TAHA should be administered as soon as a person is diagnosed with HIV. However, many people do not know they have HIV. That's why it's so important to screen people who are at risk.

How to prevent the spread of this disease?

• Although several vaccines have been tested in humans, none currently work. Many other measures can, however, be taken to prevent the spread of HIV. The use of male or female condoms for vaginal penetration and the use of male condoms for anal penetration is the most important prophylactic measures.

• People at risk should periodically be tested for HIV; if they are diagnosed with HIV, they can register for an HIV post-test counseling service, including advice on how to avoid transmitting the virus to others. Infected persons should also be treated. Due to the fact that HIV drugs can almost completely eliminate HIV, people who are infected with medication have a much lower chance of passing it on. (In other words, HIV treatment is one way to prevent its spread.)

• Sex partners of HIV-infected people can take antiretroviral drugs to avoid becoming infected; this strategy is called "pre-exposure prophylaxis" (PrEP). In order to avoid becoming infected, people who have been exposed to the virus - for example, during unprotected sex, or contact with tainted blood - may take antiretroviral drugs for four weeks, in addition, to get counseling and get tested; this strategy is called post-exposure prophylaxis (PEP).

• The risk of infection with blood can also be greatly reduced. For example, sterile needles can be offered to people who inject drugs, blood and blood products for transfusions can be screened, and medical equipment can be properly sterilized.

• Mother-to-child transmission can be prevented almost completely if the mother is taking HIV medications during pregnancy and childbirth, and if the newborn receives it for four to six weeks after birth.

The number of people taking antiretroviral drugs has risen sharply over the last decade. 

What are the prospects?

• In 2014, UNAIDS adopted target 90-90-90 as part of its plan to eradicate AIDS: "By 2020, 90% of people living with HIV know their HIV status. By 2020, 90% of all HIV-infected people screened are receiving sustainable antiretroviral therapy. By 2020, 90% of people receiving antiretroviral therapy have a sustainably suppressed viral load. (These targets should all be raised to 95% by 2030.) However, these are ambitious targets that will require additional investments of billions of dollars.