Pertemuan 1

HIV/AIDS
Masroni, S.Kep., Ns., M.S. (in Nursing)
Institut of Health Sciences Banyuwangi
 Introduction
Key facts
▸ HIV continues to be a major global public health issue, having
claimed 36.3 million [27.2–47.8 million] lives so far.
▸ There is no cure for HIV infection. However, with increasing
access to effective HIV prevention, diagnosis, treatment and
care, including for opportunistic infections, HIV infection has
become a manageable chronic health condition, enabling people
living with HIV to lead long and healthy lives.
▸ There were an estimated 37.7 million [30.2–45.1 million] people
living with HIV at the end of 2020, over two thirds of whom (25.4
million) are in the WHO African Region.
▸ In 2020, 680 000 [480 000–1.0 million] people died from HIV-
related causes and 1.5 million [1.0–2.0 million] people acquired
HIV.

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 What is HIV?

▸ HIV (human immunodeficiency virus) is a virus

that attacks the body’s immune system. If HIV
is not treated, it can lead to AIDS (acquired
immunodeficiency syndrome).
▸ There is currently no effective cure. Once
people get HIV, they have it for life.
▸ But with proper medical care, HIV can be
controlled. People with HIV who get effective
HIV treatment can live long, healthy lives and
protect their partners.
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 Signs and Symptoms

▸ 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.

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 How do I know if I have HIV?

The only way to know for sure whether you have HIV is
to get tested. Knowing your HIV status helps you make
healthy decisions to prevent getting or transmitting HIV.

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 What kinds of tests are available, and
how do they work?
There are three types of tests available: nucleic acid tests (NAT), antigen/antibody tests, and antibody tests. HIV
tests are typically performed on blood or oral fluid. They may also be performed on urine.
▸ A NAT looks for the actual virus in the blood and involves drawing blood from a vein. The test can either tell if a person
has HIV or tell how much virus is present in the blood (known as an HIV viral load test). While a NAT can detect HIV
sooner than other types of tests, this test is very expensive and not routinely used for screening individuals unless they
recently had a high-risk exposure or a possible exposure and have early symptoms of HIV infection.
▸ An antigen/antibody test looks for both HIV antibodies and antigens. Antibodies are produced by your immune system
when you’re exposed to viruses like HIV. Antigens are foreign substances that cause your immune system to activate. If
you have HIV, an antigen called p24 is produced even before antibodies develop. Antigen/antibody tests are
recommended for testing done in labs and are now common in the United States. This lab test involves drawing blood
from a vein. There is also a rapid antigen/antibody test available that is done with a finger prick.
▸ HIV antibody tests only look for antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood
from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. Most
rapid tests and the only currently approved HIV self-test are antibody tests.

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 How long does it take to get results?
▸ Laboratory tests (NAT and antigen/antibody) require blood to be
drawn from your vein into a tube and then that blood is sent to a
laboratory for testing. The results may take several days to be
available.
▸ With a rapid antibody screening test, usually done with blood from a
finger prick or with oral fluid, results are ready in 30 minutes or less.
▸ The rapid antigen/antibody test is done with a finger prick and takes
30 minutes or less.
▸ The oral fluid antibody self-test provides results within 20 minutes.

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 How soon after an exposure to HIV can a
test detect if I have the virus?
No HIV test can detect HIV immediately after infection. If you think you’ve been exposed to HIV in the last 72
hours, talk to your health care provider about post-exposure prophylaxis (PEP), right away.
The time between when a person may have been exposed to HIV and when a test can tell for sure whether they
have the virus is called the window period. The window period varies from person to person and depends on the
type of test used to detect HIV. Ask your health care provider or test counselor about the window period for the test
you’re taking.
1.A nucleic acid test (NAT) can usually tell you if you have HIV infection 10 to 33 days after an exposure.
2.An antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18
to 45 days after an exposure. Antigen/ antibody tests done with blood from a finger prick can take longer to
detect HIV (18 to 90 days after an exposure).
3.Antibody tests can take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and self-
tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after
infection than tests done with blood from a finger prick or with oral fluid.

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 Cont…

If you get an HIV test after a potential HIV exposure

and the result is negative, get tested again after the
window period. Remember, you can only be sure you
are HIV-negative if:
▸ Your most recent test is after the window period.
▸ You haven’t had a potential HIV exposure during the window
period. If you do have a potential exposure, then you will need to
be retested.

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 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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 Are there symptoms?

Some people have flu-like symptoms within 2 to 4

weeks after infection (called acute HIV infection).
These symptoms may last for a few days or several
weeks. Possible symptoms include:
▸ Fever, • But some people may not feel sick during
acute HIV infection. These symptoms don’t
▸ Chills, mean you have HIV. Other illnesses can
▸ Rash, cause these same symptoms.
• See a health care provider if you have these
▸ Night sweats, symptoms and think you may have been
▸ Muscle aches, exposed to HIV. Getting tested for HIV is the
▸ Sore throat,
only way to know for sure

▸ Fatigue,
▸ Swollen lymph nodes, and
▸ Mouth ulcers.

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 What are the stages of HIV?

When people with HIV don’t get treatment, they typically progress through
three stages. But HIV medicine can slow or prevent progression of the
disease. With the advancements in treatment, progression to Stage 3 is less
common today than in the early days of HIV.
Stage 1: Acute HIV Infection
▸ People have a large amount of HIV in their blood. They are very
contagious.
▸ Some people have flu-like symptoms. This is the body’s natural response
to infection.
▸ But some people may not feel sick right away or at all.
▸ If you have flu-like symptoms and think you may have been exposed to
HIV, seek medical care and ask for a test to diagnose acute infection.
▸ Only antigen/antibody tests or nucleic acid tests (NATs) can diagnose
acute infection.

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 Cont…

Stage 2: Chronic HIV Infection

▸ This stage is also called asymptomatic HIV infection or clinical latency.
▸ HIV is still active but reproduces at very low levels.
▸ People may not have any symptoms or get sick during this phase.
▸ Without taking HIV medicine, this period may last a decade or longer, but some may progress
faster.
▸ People can transmit HIV in this phase.
▸ At the end of this phase, the amount of HIV in the blood (called viral load) goes up and the CD4
cell count goes down. The person may have symptoms as the virus levels increase in the body,
and the person moves into Stage 3.
▸ People who take HIV medicine as prescribed may never move into Stage 3.

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 Cont…

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

▸ The most severe phase of HIV infection.
▸ People with AIDS have such badly damaged immune systems that they get an
increasing number of severe illnesses, called opportunistic infections.
▸ People receive an AIDS diagnosis when their CD4 cell count drops below 200
cells/mm, or if they develop certain opportunistic infections.
▸ People with AIDS can have a high viral load and be very infectious.
▸ Without treatment, people with AIDS typically survive about three years.

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 Prevention

Individuals can reduce the risk of HIV infection by limiting exposure to risk
factors. Key approaches for HIV prevention, which are often used in
combination, include:
▸ Male and female condom use;
▸ Testing and counselling for HIV and STIs;
▸ Testing and counselling for linkages to tuberculosis (TB) care;
▸ Voluntary medical male circumcision (VMMC);
▸ Use of antiretroviral drugs (ARVs) for prevention;
▸ Harm reduction for people who inject and use drugs; and
▸ Elimination of mother-to-child transmission of HIV.

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 Treatment

▸ HIV disease can be managed by treatment regimens composed

of a combination of three or more antiretroviral (ARV) drugs.
▸ Since 2016, WHO has recommended that all people living with
HIV be provided with lifelong ART, including children,
adolescents, adults and pregnant and breastfeeding women,
regardless of clinical status or CD4 cell count.
▸ Globally, 27.5 million [26.5–27.7 million] people living with HIV
were receiving ART in 2020. This equates to a global ART
coverage rate of 73% [56–88%]. However, more efforts are
needed to scale up treatment, particularly for children and
adolescents. Only 54% [37–69%] of children (0–14 years old)
were receiving ART at the end of 2020.

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 “ HIV does not make people
dangerous to know, so you
can shake their hands and
give them a hug : heaven
knows they need it.
Princess Diana

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