Dr Asif Channer
WORLD AIDS Day was first declared by the World Health Organization and the United Nations General Assem-bly in 1988. It is recalled on December 01, every year and is dedicated to raise awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease.
The red ribbon is the global symbol for solidarity with HIV-positive people and those living with AIDS. The theme for World AIDS Day 2016 is Leadership. Commitment. Impact.
The word AIDS is an acronym for Acquired Immune Deficient Syndrome because this disease is Acquired, not inherited, it weakens the Immune system, creates a Deficiency of CD4 cells in the immune system and it is a Syndrome which means a group of illnesses taking place at the same time.
The causative agent is Human Immunodeficiency Virus (HIV).Two most common types of HIV exist, HIV-1 and HIV-2. HIV-1 is more virulent, is more easily transmitted and is the cause of the vast majority of HIV infec-tions globally.
The first case of HIV infection in a human was identified in 1959. However, the transfer of the HIV disease from animal to human likely occurred several decades earlier. The infected individual lived in the Democratic Republic of the Congo. He did not know and research could not identify how he was infected. Moreover, there is a great deal of conjecture in the late 1980’s about Patient Zero, identified as Gaetan Dugas – a Canadian flight atten-dant who purportedly knowingly infected as many as 250 men a year on both sides of the Atlantic – said to have single handedly started the epidemic.
In USA it was first recognized as a new disease in 1981 when increasing numbers of young homosexual men succumbed to unusual opportunistic infections and rare malignancies.
In Pakistan first case was recorded in 1987.The statistics of National AIDS Control Program Pakistan (NACP) reflects that there are 76000 to 1250000 estimated people with HIV across the country but only 17224 are regis-tered and 8133 are receiving treatment. There is high prevalence of AIDS in Sind as compared to other Provinces of Pakistan.
HIV continues to be a major global public health issue, having claimed more than 35 million lives so far. In 2015, about 1.1 million people died from HIV-related causes globally.
There were approximately 36.7 million people living with HIV at the end of 2015 with about 2.1 million peo-ple becoming newly infected with HIV in 2015 globally.
The vast majority of people living with HIV are in low- and middle-income countries. According to WHO, sub-Saharan Africa is the most affected region, with 25.6 million people living with HIV in 2015. Sub-Saharan Africa accounts for two-thirds of the global total of new HIV infections.
The HIV epidemic not only affects the health of individuals, it impacts households, communities, and the de-velopment and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infec-tious diseases, food insecurity, and other serious problems.
There is no cure for HIV infection. However, effective antiretroviral (ARV) drugs can control the virus and help prevent transmission so that people with HIV, and those at substantial risk, can enjoy healthy, long and pro-ductive lives.
It is estimated that currently only 60% of people with HIV know their status. The remaining 40% or over 14 million people need to access HIV testing services. By mid-2016, 18.2 (16.1–19.0) million people living with HIV were receiving antiretroviral therapy (ART) globally.
Between 2000 and 2015, new HIV infections fell by 35%, AIDS-related deaths fell by 28% with some 8 mil-lion lives saved. Expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million AIDS-related deaths and 28 million new infections by 2030.
The Human Immunodeficiency Virus (HIV) targets the immune system and weakens person’s defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, in-fected individuals gradually become immune deficient. Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.
The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations.
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months, many are unaware of their status until later stages. The first few weeks after initial infection, individuals may experience no symptoms or an influenza-like illness including fever, head-ache, rash or sore throat.
As the infection progressively weakens the immune system, an individual can develop other signs and symp-toms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis, cryptococcal meningitis, and cancers such as lymphomas and Ka-posi’s sarcoma, among others.
HIV can be transmitted via the exchange of a variety of body fluids from infected individuals, such as blood, breast milk, semen and vaginal secretions. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water
There are certain Behaviours and conditions that put individuals at greater risk of contracting HIV which in-clude: 1) having unprotected anal or vaginal sex;2)having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis; 3) sharing contaminated needles, syringes and other inject-ing equipment and drug solutions when injecting drugs;4)receiving unsafe injections, blood transfusions, tissue transplantation, medical procedures that involve unsterile cutting or piercing and experiencing accidental needle stick injuries, includingdental procedures.
HIV infection is often diagnosed through rapid diagnostic tests (RDTs)or enzyme immunoassays (EIAs), which detect the presence or absence of HIV antibodies. Most often these tests provide same-day test results; es-sential for same day diagnosis and early treatment and care.It is important to note that serological tests detect anti-bodies produced by an individual as part of their immune system to fight off foreign pathogens, rather than direct detection of HIV itself.
Most individuals develop antibodies to HIV-1/2 within 28 days and therefore antibodies may not be detectable early after infection, the so-called window period. This early period of infection represents the time of greatest infectivity; however HIV transmission can occur during all stages of the infection.
All HIV testing services must include the 5 C’s recommended by WHO: informed Consent, Confidentiality, Counselling, Correct test results and Connection (linkage to care, treatment and other services).
Key approaches for HIV prevention, which are often used in combination, include (1) male and female con-dom use: Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of sexually transmitted infections, including HIV. Evidence shows that male latex condoms have an 85% or greater protective effect against HIV and other sexually transmitted infections (STIs). (2) Testing and counselling for HIV and sexually transmitted infections (STIs).Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors. WHO also recommends offering testing for partners or couples.(3) Testing and counselling, linkages to tuberculosis care as tuberculosis (TB) is the most common presenting illness and cause of death among people with HIV. It is fatal if undetected or untreated and is the leading cause of death among people with HIV.TB is responsible for 1 of every 3 HIV-associated deaths. Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths. TB preventive therapy should be offered to people with HIV who do not have active TB. (4).Voluntary medical male circumcision. Medical male circumci-sion, when safely provided by well-trained health professionals, reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This is a key intervention supported in 14 countries in Eastern and South-ern Africa with high HIV prevalence and low male circumcision rates. (5) Antiretroviral (ARV) drug use for pre-vention. A 2011 trial has confirmed if an HIV-positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%.
Post-exposure prophylaxis (PEP) is the use of ARV drugs within 72 hours of exposure to HIV in order to pre-vent infection. PEP includes counselling, first aid care, HIV testing, and administering of a 28-day course of ARV drugs with follow-up care.
People who inject drugs can take precautions against becoming infected with HIV by using sterile injecting equipment, including needles and syringes, for each injection and not sharing other drug using equipment and drug solutions.
The transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breast-feeding is called vertical or mother-to-child transmission (MTCT). In the absence of any interventions during these stages, rates of HIV transmission from mother-to-child can be between 15-45%. MTCT can be nearly fully pre-vented if both the mother and the child are provided with ARV drugs throughout the stages when infection could occur.