AIDS (HIV)

1399/08/24 - 14:27 / 35

AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean AIDS will develop. HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,600 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV. An opportunistic infection such as Pneumocystis jiroveci pneumonia is one that only occurs in a severely immunocompromised person, such as someone with advanced HIV infection (AIDS).

Untreated, HIV can progress to AIDS within a decade. There’s currently no cure for AIDS, and without treatment, life expectancy after diagnosis is about 3 yearsTrusted Source. This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.

If AIDS does develop, it means that the immune system is severely compromised, that is, weakened to the point where it can no longer successfully respond against most diseases and infections.

 

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That makes the person living with AIDS vulnerable to a wide range of illnesses, including:

 

  • pneumonia
  • tuberculosis
  • oral thrush, a fungal condition in the mouth or throat
  • cytomegalovirus (CMV)

a type of herpes virus

  • cryptococcal meningitis, ​​​​​a fungal condition in the brain
  • toxoplasmosis, a brain condition caused by a parasite
  • cryptosporidiosis, a condition caused by an intestinal parasite
  • cancer, including Kaposi sarcoma (KS) and lymphoma

 

The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself. Rather, it’s a result of the diseases and complications that arise from having an immune system weakened by AIDS.

 

HIV and AIDS: What’s the connection?

 

To develop AIDS, a person has to have contracted HIV. But having HIV doesn’t necessarily mean that someone will develop AIDS.

Cases of HIV progress through three stages:

  • stage 1: acute stage, the first few weeks after transmission
  • stage 2: clinical latency, or chronic stage
  • stage 3: AIDS

 

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As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.

How quickly a case of HIV progresses through the chronic stage varies significantly from person to person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can last indefinitely.

There’s currently no cure for HIV, but it can be managed. People with HIV often have a near-normal lifespan with early treatment with antiretroviral therapy.

Along those same lines, there’s technically no cure for AIDS currently. However, treatment can increase a person’s CD4 count to the point where they’re considered to no longer have AIDS. (This point is a count of 200 or higher.)

Also, treatment can typically help manage opportunistic infections.

 

 

Signs and symptoms

 

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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 after being infected, many are unaware of their status until the later stages.

In the first few weeks after initial infection people may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.

As the infection progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough.

Without treatment, they could also develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi's sarcoma.

 

Transmission

 

HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.

 

It is important to note that people with HIV who are taking ART and are virally suppressed do not transmit HIV to their sexual partners.  Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.

 

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Risk factors

Behaviours and conditions that put individuals at greater risk of contracting HIV include:

having unprotected anal or vaginal sex;

having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;

sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;

receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and

experiencing accidental needle stick injuries, including among health workers.

 

 

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Diagnosis

 

HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage with treatment and care. People can also use HIV self-tests to test themselves. However, no single test can provide a full HIV diagnosis; confirmatory testing is required, conducted by a qualified and  trained health or community worker at a community centre or clinic. HIV infection can be detected with great accuracy using WHO prequalified tests within a nationally approved testing strategy.

Most widely-used HIV diagnostic tests detect antibodies produced by the person as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called “window” period –  when HIV antibodies haven’t been produced in high enough levels to be detected by standard tests and when they may have had no signs of HIV infection, but also when they may transmit HIV to others. After infection, an individual may transmit HIV transmission to a sexual or drug-sharing partner or for pregnant women to their infant during pregnancy or the breastfeeding period.Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error.

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Notably, once a person diagnosed with HIV and has started treatment they should not be retested. While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. For  children less than 18 months of age, serological testing is not sufficient to identify HIV infection – virological testing must be provided as early as birth or at 6 weeks of age). New technologies are now becoming available to perform this test at the point of care and enable same-day results, which will accelerate appropriate linkage with treatment and care.

 

Treatment

 

HIV can be suppressed by  treatment regimens composed by a combination of 3 or more ARV drugs. Current ART does not cure HIV infection but  highly  suppresses viral replication within a person's body and allows an individual's immune system  recovery to strengthen and regain the capacity to fight off infections.

 

Since 2016, WHO recommended that all people living with HIV be provided with lifelong ART, including children, adolescents and adults, and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count. By the end of 2019, 185 countries had already adopted this recommendation, covering 99% of all people living with HIV globally.

The current  HIV treatment guidelines include new ARV options with better tolerability, higher efficacy, and lower rates of treatment discontinuation when compared with previous recommended medicines. In 2019, WHO recommends the use of dolutegravir-based or low-dose efavirenz for first-line therapy. DTG should also be used in 2nd line therapy, if not used in 1st line and darunavir/ritonavir is recommended as the anchor drug in third- line  or an alternative option second-line therapy.

 

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By mid-2020, transition to dolutegravir has been implemented  in 100 low- and middle-income countries and is expected to improve the durability of the treatment and the quality of care for people living with HIV. Despite improvements, limited options remain for infants and young children. For this reason, WHO and partners are coordinating efforts to enable a faster and more effective development and introduction of age-appropriate paediatric formulations of  new ARV drugs.

In addition, 1 in each 3 people living with HIV present to care with advanced disease, usually with  severe clinical  symptoms, low CD4 cell counts, and at high risk of develop serious illness and death. To reduce this risk, WHO recommends that these individuals receive a “package of care” that includes screening tests and drug prophylaxis for  the most common serious infections that can cause severe morbidity and death, such as TB and cryptococcal meningitis, in addition to rapid ART initiation.

Globally, 25.4 million people living with HIV were receiving ART in 2019. This equates to a global ART coverage rate of 67%. However, more efforts are needed to scale up treatment, particularly for children and adolescents. Only 53% of children were receiving ART at the end of 2019.

Expanding access to treatment is at the heart of a set of targets for 2020, which aim to bring the world back on track to end the AIDS epidemic by 2030.

 

 

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Prepared:
Neshat Khosravi - Microbiologist

 

Reference:

https://www.who.int

 

 



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