HIV and AIDS - Lloydspharmacy.com Health

Reviewed by Dr David Delvin, GP and family planning specialist

What is HIV?

HIV means 'human immunodeficiency virus'. This is the virus that causes AIDS.

HIV first emerged as a threat to humanity in the early 1980s. It spread so fast that initially there were fears that it might wipe us all out. Happily, there now seems no danger of that.

However, in 2010 the worldwide situation is this.

About 34 million people have HIV.
Around half of these are women.
Over two million children have the virus.
Each year, about 2.7 million people catch HIV.

In some countries, particularly those located in Sub-Saharan Africa, the HIV rates are very high. For instance, in the Republic of South Africa it's estimated that about 11 per cent of the population is HIV-positive.

This is currently a source of international concern.

What is the HIV situation in Britain?

Although the HIV figures in the UK are far lower than those in Africa, there's no room for complacency.

For instance:

it's estimated that in Britain 83,000 people now have HIV, and over a quarter of these people don't know that they have the virus
the HIV figures are going up, by over 7,000 cases per year
there's been a dramatic increase in the number of women, who have developed HIV
most of these women have acquired the virus through heterosexual (vaginal) intercourse.

What are the common myths about HIV?

Many people believe the following stories that have become commonplace during the 26 years since HIV first emerged.

‘You can tell if someone is HIV-positive by looking at them.’ This is nonsense. The great majority of people with HIV look perfectly normal.
‘You can’t get HIV from straight sex.’ This isn't true. Vaginal intercourse is now the most common way of acquiring the virus.
‘Only gay men get HIV.’ This is also untrue. In Britain, ‘straight’ sex has been the most common way of catching HIV, since as long ago as 1999. Currently the majority of people who get HIV are heterosexual.

How does HIV infect people?

There are four main ways in which it can enter the body.

During sex. Rectal intercourse is a very ‘efficient’ way of transmitting the virus from one person to another. But nowadays, the majority of infections worldwide are caused by vaginal intercourse with an infected person.
Through sharing injection needles. Intravenous drug users are at particular risk, if they use needles that have already been used by someone else and which therefore may be contaminated with the virus.
From infected blood products. In some parts of the world blood intended for transfusion is still not tested for HIV. However, this is NOT the case in the UK.
Though infection of a baby by its mother.

A tiny number of cases occur for other reasons, for instance as a result of organ donation or sperm donation from a person who is HIV-positive.

How does HIV attack the human body?

HIV cannot live on its own in the environment. So, in order to survive, the virus has to attack other living cells and use their metabolism to make copies of itself.

Unfortunately, HIV attacks some of the human cells that are vital to a healthy immune system, including the white blood cells known as T-helper cells or CD4 cells.

At the start of HIV infection – the primary HIV infection – there are two possible outcomes. You can either have a short, flu-like illness that occurs one to six weeks after infection, or you can have a so-called 'dumb' infection, with no symptoms at all.

However, even if you don't have any symptoms – you can still infect other people.

Six to 12 weeks after the infection, the white blood cells have produced so many antibodies against HIV that they can be measured by a blood test. If you have HIV antibodies in your blood, you are now HIV-positive (HIV+).

An infected person will feel well for a long time. But the infection is still active inside the body and the virus, which can infect and destroy new blood cells, is constantly being produced.

The number of T-helpers in the blood will slowly be reduced and when, after a number of years, the immune system has been weakened, the infected person will start showing symptoms of AIDS.

What is AIDS?

AIDS means 'acquired immune deficiency syndrome'.

It's a condition that sets in when the HIV virus has killed so many T-helper cells that the immune system is no longer able to recognise and react to attacks from everyday infections.

HIV may also attack the nervous system, possibly causing dementia. And it may affect the skin, on which small tumours develop. This condition is known as Kaposi’s sarcoma.

A number of different symptoms can be observed in people who have AIDS:

fatigue
inexplicable weight loss
repeated bronchial and skin infections that do not react to normal treatment
fever
swollen lymph nodes
diarrhoea
small, deep ulcers often preceded by small blisters
night sweats
outbreak of previous infections that have remained dormant (herpes, toxoplasmosis, shingles and other conditions)
so-called 'opportunistic infections' – serious infections by micro-organisms of the type normally prevented by the immune system. These in turn could lead to a number of related illnesses, such as cancer or dementia.

In the end, the disease can become so serious that the infected patient dies.

How common is AIDS?

In Britain, well over 25,000 people have now been diagnosed with AIDS. Sadly, over 19,000 of these have died.

Worldwide, about two million men and women die from AIDS each year.

On a positive note, modern treatments for HIV have greatly prolonged the lives of many people, who have the virus.

How do you get infected?

These are the major risk factors.

Unprotected sex – that is, sex without a condom. However, condoms cannot give you complete protection. Occasionally, they break.
Blood-to-blood infection, when using a contaminated needle (which has been used by someone else) or through transfusions of contaminated blood. Today, all blood that's donated in the UK is tested for HIV, so this route of infection is now almost unknown in Britain.
Mother infecting her child. The child can be infected during the pregnancy, during labour or after the delivery, through the breast milk.

Ordinary social interaction with HIV-positive people is not contagious.

Who is at risk?

It's common for HIV-campaigners to say that ‘we are all at risk’.

Technically, this is so. But in reality, there are many factors that affect your level of risk.

For instance, if you live in a part of the world where HIV is still rare and only have sex with your spouse – you're not very likely to get it.

In the UK, people who are at ‘above-average’ levels of risk include the following.

Heterosexual men and women who do not practise safe sex, especially if their partners originate from areas of the world where HIV is widespread – Africa (south of the Sahara Desert), parts of Asia and some of the Caribbean Islands.
Homosexual and bisexual men, who go in for anal sex with many different partners and who do not practise safe sex.
Women who have unprotected sex with many different partners, especially if these include bisexual men or intravenous drug users.
‘Straight’ men who have unprotected sex with many different partners.
Prostitutes who don't practise safe sex. Also at risk are their customers and these customers' other sexual partners.
Drug addicts who share needles.
Hospital workers whose work involves real risk of pricking or cutting themselves with infected instruments or needles.
Babies of an HIV-infected mother.
People who have had many blood transfusions overseas or who were treated with blood products before 1985.

How do you avoid infection?

Use a condom. This is not a guaranteed method of avoiding infection, but using a condom reduces the risk considerably. It must be worn all the way through sex.
Avoid using recreational drugs that are injected with a syringe. Do not share syringes or needles with others.
Avoid blood transfusions in certain countries, where they may not test the blood for HIV.

I might be infected – what should I do?

If you have been exposed to infection, you should contact a doctor as soon as possible for advice, testing and treatment.

In the UK, the best place to go is a genitourinary medicine (GUM) clinic because they're used to dealing with possible HIV cases. Also, their technical facilities are good.

Traditional HIV tests don't become positive until about three months after exposure to infection. But newer tests are now coming in, and these can provide an earlier diagnosis.

If you know or suspect that your partner is HIV-positive or if you have been exposed to infection by accident – for instance through pricking yourself with a needle – in some cases, treatment will be started to prevent an actual HIV infection.

This preventative therapy should preferably begin a few hours after the time of exposure. The treatment may have some unpleasant side-effects, so before going ahead the real risk of infection should be estimated.

This should be decided by you, your doctor and your local HIV consultant.

How do I get tested?

If you're going to have an HIV test: you should talk to a doctor or counsellor first, in order to discuss the possible implications of the result.

Under the NHS, an HIV test at a GUM clinic is free of charge and anonymous. You can also have a free HIV test arranged by your GP, but this will appear on your medical records for the rest of your life.

Some people go for private HIV tests at one of the many commercial clinics that advertise their services in London and other large cities. Currently, this should cost you less than £100. The clinic shouldn't tell anyone else the result unless you authorise them to.

You might also encounter circumstances where HIV testing is obligatory. For instance, when people want to take out a large insurance policy, it is quite common for the company to ask for a preliminary HIV test.

Also, you're required to have a test if you want to do any of the following:

become a blood donor
donate some of your organs for transplantation
use your sperm for artificial insemination
adopt a child
contribute an egg for transplantation.

What are the tests for HIV?

There are now various different tests for infection. Be guided by the GUM clinic or HIV consultant.

HIV antibody test

When a man or woman gets infected with HIV, the body reacts by producing protective proteins, called ‘antibodies’. These usually develop within three months of infection. It's possible to test for these antibodies in blood and saliva.

P24 (antigen) test

An antigen is the part of a virus that provokes the development of antibodies. In the case of HIV, the most important antigen is called ‘P24’. This antigen can sometimes be detected in the early weeks after HIV infection.

Polymerase chain reaction (PCR) test

This detects the genetic material in the HIV virus, so it can sometimes identify the virus within about three weeks of infection.

Fourth generation test

This means a combined test, testing for antigen and antibody. In January 2010, Abbott Laboratories applied to the American Food and Drug Administration for a licence for the first Fourth Generation test in the USA.

Home tests

In 2010, a number of commercial companies are offering ‘home’ tests for HIV. But this practice is illegal in some countries. It's better to have your test done by a specialist doctor, who can explain its implications to you.

What does the treatment involve and what medication is used?

If you do have HIV, you should have expert treatment from a specialist. Please don't be persuaded by alternative ‘cures’.

New and more efficient treatments to fight HIV and reduce the content of virus in the blood are being developed all the time.

You will almost certainly need one or more of the following.

Antiviral medicines against HIV that stop the virus from spreading in the body (see HAART, below). You will not be cured, and you are still contagious. But the treatment strengthens the immune system, so your risk of getting ill is reduced.
Specific treatment of infections occurring as a result of HIV.
Vaccination against illnesses such as flu, pneumonia, and infectious hepatitis.
Treatment of the symptoms connected with HIV infection and AIDS, for instance treatment of nausea and loss of appetite.

In the UK, the use of a combination treatment called highly effective anti-retroviral therapy (HAART) has caused a steep decline in AIDS deaths and given many people a much longer life expectancy.

You may wonder why men and women need ‘combination’ therapy.

It’s because treatment with just ONE drug rapidly leads to viral resistance. Taking two or three different anti-HIV drugs simultaneously reduces this possibility. There are now over 20 anti-retroviral drugs.

They are divided into five categories, each of which attacks the virus in a different way. It's important to stick to the combination that your specialist prescribes, and not to miss doses.

What can I do for myself?

If you do not have anyone to talk to about the situation, you might like to visit your GP, a counsellor with relevant experience or a psychotherapist. You should discuss your worries and the depression, which often follows the discovery that you are HIV-positive.

Also, please note the following.

You should be treated for all infections and illnesses that result from the HIV virus. If these are serious, you will have to be treated in hospital.
You should contact AIDS and HIV support groups because these organisations can be helpful.
Make sure you eat a varied and healthy diet.
Avoid smoking and excessive drinking.
Get adequate exercise.

Possible deterioration

Eventually, serious illnesses may develop as a result of HIV infection.

Commonly, these include infections that are normally prevented by the immune system. These inlude:

tuberculosis
pneumonia, caused by the germ Pneumocystis carinii
toxoplasmosis infection in the brain
reactivation of the germ cytomegalovirus
infections involving the fungus Candida albicans
cancer, especially skin cancer, and cancer in the lymph nodes
meningitis and encephalopathy, a brain disease that may cause dementia

Death may occur as a result of illness.

Future prospects

AIDS is not yet curable.

However, many of the illnesses resulting from the condition can be treated.

Generally, between 5 and 15 years pass from the time of infection until AIDS actually develops.

Previously, those infected only lived for a couple of years after developing AIDS. Fortunately, with the new types of treatment available, the survival rate has greatly improved.

Based on a text by Dr Flemming Andersen and Dr Court Pedersen, professor and consultant

Last updated 02.06.2010

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