HIV & AIDS NOTES

HIV stands for

 Human immunodeficiency virus
 It is the virus that attacks the immune system
 The immune system fights infections and diseases in a person’s body.
 Overtime, HIV weakens a person’s immune system, so it has a very hard time fighting
diseases.
 HIV causes AIDS
 AIDS stands for acquired immunodeficiency syndrome
 People with HIV can have it for many days before it develops into AIDS.

SPREAD OF HIV
 HIV is pasted from an infected person to an uninfected person and also infected
person.
 This happens when a person with HIV gets his/her blood, semen, vaginal fluids, breast
milk inside another person’s body.
 There is no risk of getting HIV from the persons urine, sweat, saliva or vomits unless
there is also blood in it.
 A person of any age, sex, ethnic group, religion, economic background or sexual
orientation can get HIV.
 Sexual orientation, gay, lesbian etc.
 It is not who you are, it is what you do that puts you at a risk.
 Any one who shares needles or has unprotected sexual intercourse with some one who
has HIV is at a very high risk of getting infection.
 A mother with HIV can also pass the virus to her baby (3 ways)
During pregnancy stage
During delivery
During breast feeding
 It is not possible to tell if people have HIV by looking at them
 People can have HIV for many years not knowing they have it
 They can also pass it to others without knowing it. That’s why its important to get
tested.
 People with HIV who look and feel health or have very low / undetectable levels of
virus can still pass HIV to others.

WHAT ARE THE SYMPTOMS OF HIV?

You can have HIV without having any symptoms. This is why it’s important to get tested
even if you don’t feel sick.
Sometimes you’ll have flu-like symptoms when you first get infected with HIV. These can
include:

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  Fever.
 Chills.
 Fatigue.
 Sore throat.
 Muscle aches.
 Night sweats.
 Rash.
 Swollen lymph nodes.
These symptoms will go away without treatment but HIV stays in the blood where it will
grow and begin to destroy the immune system

SYMPTOMS IN A BABY WITH HIV

 Slow growth (not gaining weight)
 Slow learning in walk and talk
 Frequent diarrhea
 Swollen glands
 Thrush (fungal infection)
 Enlarged liver and spleen
 Lung infection
 Not health looking

DIAGNOSIS (HIV TEST)

 HIV can be diagnosed through rapid diagnostic tests that provide same-day results.
 This greatly facilitates early diagnosis and linkage with treatment and prevention.
 People can also use HIV self-tests to test themselves.
 However, no single test can provide a full HIV positive diagnosis; confirmatory testing
is required, conducted by a qualified and trained health or community worker at a
community clinic.
 HIV infection can be detected with great accuracy using WHO prequalified tests
within nationally approved testing strategic centres.
 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 are in the so-called window period when they have low levels
of antibodies which cannot be detected by many rapid tests, but may transmit HIV to
others.
 People who have had a recent high-risk exposure and test negative can have a further
test after 28 days.
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  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.
 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, rapid antibody 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 available to perform this test at the point of care and enable
same-day results, which will accelerate appropriate linkage with treatment and care.
 There are also at-home HIV test kits. Some are rapid tests, where you use a stick with
a soft, flexible tip to rub your gums.
 Then you put the stick in a tube with a special solution to get your results. Results
show up in 15 to 20 minutes.
 Other at-home tests use a device to prick your finger with a small needle. You put a
drop of blood on a card and send the test kit through the mail to a lab to get your
results.
 If your, at-home test result is positive, you should contact your healthcare provider for
additional testing to confirm your result.
 There are three types of HIV tests:
Antigen/antibody tests,
Antibody tests and
Nucleic acid tests (NATs).

TREATMENT
There is no cure for HIV infection. It is treated with antiretroviral drugs, which stop the virus
from replicating in the body.
Current antiretroviral therapy (ART) does not cure HIV infection but allows a person’s
immune system to get stronger. This helps them to fight other infections. ART must be taken
every day for the rest of a person’s life.
ART lowers the amount of the virus in a person’s body. This stops symptoms and allows
people to live a full and healthy life. People living with HIV who are taking ART and who
have no evidence of virus in the blood will not spread the virus to their sexual partners.
Pregnant women with HIV should have access to and take ART as soon as possible. This
protects the health of the mother and will help prevent HIV from passing to the fetus before
birth, or to the baby through breast milk.
Antiretroviral drugs given to people without HIV can prevent the disease.
When given before possible exposures to HIV it is called pre-exposure prophylaxis (PrEP)
and when given after an exposure it is called post-exposure prophylaxis (PEP). People can
use PrEP or PEP when the risk of contracting HIV is high; people should seek advice from a
clinician when thinking about using PrEP or PEP.

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Advanced HIV disease remains a persistent problem in the HIV response. WHO is
supporting countries to implement the advanced HIV disease package of care to reduce
illness and death. Newer HIV medicines and short course treatments for opportunistic
infections like cryptococcal meningitis are being developed that may change the way people
take ART and prevention medicines, including access to injectable formulations, in the
future.

MEDICATIONS USED TO REDUCE HIV

Each type of pill used in ART has a different way of keeping HIV from making more copies
of itself or from infecting your cells. There can be many different brand names of the same
type of ART drug.

Types of ART medications include:

1. Nucleoside reverse transcriptase inhibitors (NRTIs).
2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
3. Protease inhibitors (PIs).
4. Fusion inhibitors.
5. CCR5 antagonists.
6. Integrase strand transfer inhibitors (INSTIs).
7. Attachment inhibitors.
8. Post-attachment inhibitors.
9. Pharmacokinetic enhancers.
10.Combination of HIV medicines

PREVENTION
HIV is a preventable disease.
Reduce the risk of HIV infection by:
 using a male or female condom during sexual intercourse
 being tested for HIV and sexually transmitted infections
 having a voluntary medical male circumcision
 using harm reduction services for people who inject themselves drugs.
Doctors may suggest medicines and medical devices to help prevent HIV, including:
 antiretroviral drugs (ARVs), including oral PrEP and long-acting products
 dapivirine vaginal rings
 injectable long acting cabotegravir.
ARVs can also be used to prevent mothers from passing HIV to their children.

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People taking antiretroviral therapy (ART) and who have no evidence of virus in the blood
will not pass HIV to their sexual partners. Access to testing and ART is an important part of
preventing HIV.

RISK FACTORS
Behaviours and conditions that put people at greater risk of contracting HIV include:
 having condomless anal or vaginal sex intercourse;
 having another sexually transmitted infection (STI) such as syphilis, herpes,
chlamydia, gonorrhoea and bacterial vaginosis;
 engaging in harmful use of alcohol and drugs in the context of sexual behaviour;
 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.

OPPORTUNISTIC INFECTIONS
Opportunistic infections that make the person living with AIDS vulnerable to, including:
 pneumonia
 tuberculosis
 oral thrush, a fungal condition in the mouth or throat
 herpes virus infection (cytomegalovirus-CMV).
 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

HIV WINDOW PERIOD

As soon as someone contracts HIV, it starts to reproduce in their body. The person’s immune
system reacts to the antigens (parts of the virus) by producing antibodies (cells that take
countermeasures against the virus).
The time between exposure to HIV and when it becomes detectable in the blood is called the
HIV window period. Most people develop detectable HIV antibodies within 23 to 90 days
after transmission.
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If a person takes an HIV test during the window period, it’s likely they’ll receive a negative
result. However, they can still transmit the virus to others during this time.

LIFE EXPECTANCY
It is a dramatic improvement, due in large part to antiretroviral therapy. With proper
treatment, many people with HIV can expect a normal or near- normal lifespan. Of course,
many things affect life expectancy for a person with HIV. Among them are:
 CD4 cell count
 viral load
 serious HIV-related illnesses, including hepatitis
 misusing drugs
 smoking
 access, adherence, and response to treatment
 other health conditions
 age
 where a person lives also matters

STRUCTURE OF HIV
 HIV is a complex RNA virus of the genus lentivirus within the Reoviridae family.
 Has two major envelope glycoproteins gp120 and gp41
 Two major types of HIV are HIV 1 and HIV 2
 The major serological differences reside in the surface protein gp120.
DRAW THE DIAGRAM AND BE ABLE TO LABEL IT.
RNA DISEASES
 SARS
 AIDS
 Influenza
 Hepatitis
 Common cold

ORIGIN OF HIV AND AIDS

The origin of the Human Immunodeficiency Virus (HIV) has been a subject of scientific
research and debate since the virus was identified in the 1980s. There is now a wealth of
evidence on how, when and where HIV first began to cause illness in humans.

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WHERE DOES HIV COME FROM?
HIV is thought to have occurred after people ate chimps that were carrying the Simian
Immunodeficiency Virus (SIV).
HIV is a type of lentivirus, which means it attacks the immune system. SIV attacks the
immune systems of monkeys and apes in a very similar way. This suggests HIV and SIV are
closely related, and that SIV in monkeys and apes crossed over to humans to become HIV.

WHERE AND WHEN DID HIV START?

Studies of some of the earliest known samples of HIV provide clues about when it first
appeared in humans and how it evolved. The first verified case of HIV is from a blood
sample taken in 1959 from a man who was living in what is now Kinshasa in the Democratic
Republic of Congo.
Scientists used this sample to create a 'family-tree' of HIV transmission. By doing this, they
were able to trace the first transmission of SIV to HIV in humans, which they concluded took
place around 1920, also in Kinshasa. This area is known for having the most genetic
diversity in HIV strains in the world, reflecting the number of different times SIV was passed
to humans. Many of the first cases of AIDS were recorded there too.

IS THERE ONLY ONE TYPE OF HIV?

No, there are actually two types of HIV: HIV-1 and HIV-2, and they have slightly different
origins.
HIV-1 is closely related to the strain of SIV found in chimps. While HIV-2 is closely related
to the strain of SIV found in sooty mangabeys monkeys. The crossover of HIV-2 to humans
is believed to have happened in a similar way as HIV-1 (by eating monkey meat).
HIV-2 is far more rare, and less infectious than HIV-1, so it infects far fewer people. It is
mainly found in a few West African countries, such as Mali, Mauritania, Nigeria and Sierra
Leone.
To complicate things further, HIV is also classified by four main groups of viral strain (M, N,
O and P), each of which has different genetic make-up. HIV-1 Group M is the strain that has
caused the majority of HIV infections in the world today, meaning it is the dominant strain.

WHY IS HAITI SIGNIFICANT?

In the 1960s, the 'B' subtype of HIV-1 (which belongs to Group M) made its way to Haiti.
This is thought to have happened because many Haitians had been working in the
Democratic Republic of Congo and had then returned to Haiti. Initially, Haitians were

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blamed for starting the HIV epidemic, and suffered severe racism, stigma and discrimination
as a result.

WHY DO SOME PEOPLE SAY HIV STARTED IN THE USA IN THE 1980S?
Because this is when people first became aware of HIV, and it was when HIV was officially
recognised as a new health condition. But HIV had actually been around for decades by
then.
In 1981, rare diseases, such as Kaposi's Sarcoma (a rare cancer) and a lung infection called
PCP, were being reported among gay men in New York and California. Scientists began to
suspect that an unidentified infectious 'disease' was the cause.
At first, the ‘disease’ was called all sorts of names relating to the word ‘gay'. It wasn't until
mid-1982 that scientists realised it was also spreading among other populations, such as
haemophiliacs and people who inject drugs. In September that year, they named it Acquired
Immune Deficiency Syndrome (AIDS).
In 1983, scientists at the Pasteur Institute in France identified the virus linked to AIDS,
which they called Lymphadenopathy-Associated Virus (LAV). Scientists at the USA National
Cancer Institute confirmed this virus was the cause of AIDS and called it HTLV-III. LAV and
HTLV-III were later acknowledged to be the same. A few years later, the virus was renamed
as HIV.

The HIV epidemic began with fear, helplessness and death as the world faced a new virus
that preyed on misunderstanding and marginalisation.

Scientific advances have enabled people with access to treatment to live long and healthy
lives with HIV. While advocacy and campaigning have raised awareness and understanding
of what’s possible, and of the inequalities around the world. These continue to make
accessing the tools and information to prevent HIV and the support and treatment to live
healthily a challenge.

RISK BEHAVIOURS AND STIs

HOW HIV ATTACKS THE IMMUNE SYSTEM

IMMUNITY

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VACCINATION

IMPACT OF HIV ON INDIVIDUAL, FAMILY, AND CHILDREN.

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