AIDS
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Piedmont
General information
- HIV
- Immunity
- AIDS
- Seropositivity for HIV
- Confirming seropositivity
- The “window period”
- When should the HIV test be done?
- Incubation period
- The HIV virus outside the human organism
Contamination and prevention
- The transmission of the HIV infection
- The bodily fluids that transmit the virus
- The bodily fluids that do not transmit the virus
- The precautions to avoid the infection
- Are intravenous-drug users particularly in jeopardy for HIV infection?
- And what about other drug or alcohol-addicts?
- What to do in case of being stung by a used needle
- Can HIV get through intact tissues?
- Living and working with an AIDS sick or a seropositive person
- Is it possible to be infected using the same objects as a seropositive person or facilities like WC, clubs, telephones or public transport?
- The transmission by insects or pets
- Can other sexually-transmitted diseases pose a major risk for the HIV infection?
- How to prevent the maternal infection of the fetus
- Safe sex
- The diffusion of HIV infection
General information
HIV
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Actually there are two species of viruses called HIV-1 and HIV-2. The two human viruses have developed from similar animal viruses largely present in apes.
HIV is a member of the genus Lentivirus. Lentiviruses have many common morphologies and biological properties. Many species are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period. Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry of the target cell, the viral RNA genome is converted to double-stranded DNA by a virally encoded reverse transcriptase that is present in the virus particle. This viral DNA is then integrated into the cellular DNA by a virally encoded integrase, along with host cellular co-factors, so that the genome can be transcribed. After the virus has infected the cell, two pathways are possible: either the virus becomes latent and the infected cell continues to function or the virus becomes active and replicates, and a large number of virus particles that can then infect other cells are liberated.
The initial infection with HIV generally occurs after transfer of body fluids from an infected person to an uninfected one. The first stage of infection, the primary, or acute infection, is a period of rapid viral replication that immediately follows the individual's exposure to HIV leading to an abundance of virus in the peripheral blood with levels of HIV commonly approaching several million viruses per mL.
HIV, multiplying within the cells, kills them and provoke that the immune system begins to fail, leading to life-threatening opportunistic infections. HIV is present as both free virus particles and virus within infected immune cells. The body becomes progressively more susceptible to opportunistic infections. Most people die from opportunistic infections or malignancies associated with the progressive failure of the immune system.
Immunity
Immunity is a biological term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. Immunity involves both specific and non-specific components. The non-specific components act either as barriers or as eliminators of wide range of pathogens irrespective of antigenic specificity. Other components of the immune system adapt themselves to each new disease encountered and are able to generate pathogen-specific immunity. Innate immunity, or nonspecific, immunity is the natural resistance with which a person is born. It provides resistance through several physical, chemical, and cellular approaches. Adaptive immunity is often sub-divided into two major types depending on how the immunity was introduced. Naturally acquired immunity occurs through contact with a disease causing agent, when the contact was not deliberate, whereas artificially acquired immunity develops only through deliberate actions such as vaccination. Both naturally and artificially acquired immunity can be further subdivided depending on whether immunity is induced in the host or passively transferred from a immune host. Passive immunity is acquired through transfer of antibodies or activated T-cells from an immune host, and is short lived - usually lasting only a few months - whereas active immunity is induced in the host itself by antigen, and lasts much longer, sometimes life-long.AIDS
AIDS is the ultimate clinical consequence of infection with HIV, the human immunodeficiency virus. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. When CD4+ T cell numbers decline below a critical level of 200 cells per µL, cell-mediated immunity is lost, and infections with a variety of opportunistic microbes appear. Common opportunistic infections and tumors, most of which are normally controlled by robust CD4+ T cell-mediated immunity then start to affect the patient. Later, reactivation of latent herpes viruses may cause worsening recurrences of herpes simplex eruptions, shingles, Epstein-Barr virus-induced B-cell lymphomas, or Kaposi's sarcoma.Seropositivity HIV
Being seropositive means having neutralizing antibodies in individuals who have been exposed to the human immunodeficiency virus. Seropositive refers to the presence of the specific antibodies that were being tested for. These tests are most commonly used to identify HIV infection. To understand the result, it is necessary to know what antibodies the test was looking for, because a person who is seropositive for any one condition is not any more likely to be seropositive for another, unrelated condition. All the seropositive people can have no symptoms and not get sick for years, but they can transmit it.Confirming seropositivity
HIV antibody tests are specifically designed for routine diagnostic testing; these tests are inexpensive and extremely accurate. They are a simple blood test, which is articulated in two levels: level tests, the most known of which is ELISA test (a person's serum is diluted 400-fold and applied to a plate to which HIV antigens have been attached), after which a confirmation test follows. This is generally the Western Blot, an antibody detection test.The test is free-of-charge at the public structures (hospitals, local health units, universities) and the result is anonymous. The test must be done soon after a risky contact and repeated after 3-6 months (after the window period).
The window period
The ‘window period’ is a term used to describe the period of time between HIV infection and the production of antibodies. During this time, an antibody test may give a ‘false negative’ result, which means the test will be negative, even though a person is infected with HIV. To avoid false negative results, antibody tests are recommended three months after potential exposure to HIV infection. A negative test at three months will almost always mean a person is not infected with HIV. If an individual’s test is still negative at six months, and they have not been at risk of HIV infection in the meantime, it means they are not infected with HIV. It is very important to note that if a person is infected with HIV, they can still be carriers and transmit the virus to others during the window period.When should the HIV test be done?
1. Conditions linked to the individual behaviour- people that have sex with a lot of partners or use scarce protections
- people that prostitute themselves
- people that use drugs
- men that have sex with men
- particular exposure
- health staff that get the infection being exposed to blood at work
- attacks with used needles or human bites
- rape
- unprotected sex with seropositive people
2. Various clinic conditions
- patients suffering from tuberculosis or uterus cancer
- patients suffering from HIV suggestive infection symptoms
- patients with sexually transmitted infections
- pregnant women
3. Particular epidemiologic situations
- people coming from countries where HIV is widespread (Africa, South-East Asia and South America in particular)
Incubation period
Incubation period is the time elapsed between exposure to a pathogenic organism and when symptoms and signs of AIDS are first apparent. The period of HIV may be as long as years and vary from person to person.
The HIV virus outside the human organism
HIV is low resistant virus: it does not resist to dryness, ultra-violet rays, alcohol and bleach. Once in contact with air, it dies immediately.The transmission of the HIV infection
The main transmission routes of HIV are:
- through unprotected sexual relations - vaginal, anal and oral penetration (the person runs the risk to be in contact with the partner’s genital organ). The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex; the sexual transmission is more effective from man to woman than from woman to man;
- through blood exposure, needle-stick injuries with contaminated items (for intravenous drug-users), exposure of the skin or mucous membranes to blood borne pathogens;
- mother-to-child during the pregnancy, birth-giving or breast-feeding for a seropositive woman;
- in very rare cases of blood transfusion, organs and tissues transplant, artificial insemination with blood, tissues and sperm donated by seropositive subjects in the window period.
A person can get the HIV infection in a way and transmit in another. This can occur in those who have risky behaviours, like drug-addicts exchanging needles and having unprotected sex.
The bodily fluids that transmit the virus
HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, pre-seminal fluid, and breast milk. People can contain high concentrations of HIV. Other bodily fluids can contain minimum quantities of HIV.
The bodily fluids that do not transmit the virus
The virus is not transmitted by: tears, sweat, saliva, urine, feces, nasal secretions, vomit, unless infected by blood.
The precautions to avoid the infection
- The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex. During a sexual act, only male or female condoms can reduce the risk of infection with HIV. The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.
- In body care (tattoos, piercing and other treatments that use sharp or cutting tools) needles and tools must be single use and sterile only. Blades, scissors, nail files, combs, tooth-brushes must be strictly personal.
- In health care: in dentistry, in gynecology and in blood tests only sterile and single use tools must be used.
Are intravenous-drug users particularly in jeopardy for HIV infection?
Sharing syringes and other equipment for drug injection is a well known route of HIV transmission, yet injection drug use contributes to the epidemic’s spread far beyond the circle of those who inject. They must be advised to always use sterile injection equipment; warned never to reuse needles, syringes, and other injection equipment; and told that using syringes or other objects that have been cleaned with bleach or other disinfectants is not as safe as using new, sterile tools.
And what about other drug or alcohol-addicts?
Those who use drugs like cocaine, but above all abuse alcohol, are particularly in jeopardy to have behaviours that expose them to the virus, like having unprotected sex.
What to do in case of being stung by a used needle
In case of traumatic accident through the needle of a used syringe, it is fundamental to wash the part with soap and water and then sanitize it with alcohol. It is also fundamental to go to the First Aid immediately to check whether a prophylaxis for tetanus or hepatitis B is necessary.
Can HIV be contracted through intact tissues?
Definitely not. There is no risk if a drop of infected blood comes into touch with intact skin. The skin protects our organism also from viruses. Naturally, in situations where it is possible to get injured, like in hospital environments or in first aid, it is necessary to use precautions (e.g. gloves) avoiding the contact with blood as much as possible.
Living and working with a HIV infected or seropositive person
In families, treatment centres, welcome centres and therapeutic centres that host seropositive people there has never been a case of HIV infection for sharing the same places. Hand-shaking, hugs, caresses, kisses and other physical contacts (excluding sexual contacts) have never been a risk of infection. The infection is not transmitted though sneezes, cough, urine, feces, vomit, tears, etc. It is important to remember, though, in some situations there can be traces of blood in feces (e.g. in case of hemorrhoids) or in vomit (e.g. in case of ulcers), therefore it is advisable to use protective gloves in case of maneuvering such substances.
Is it possible to be infected using the same objects as a seropositive person or facilities like WC, clubs, telephones or public transport?
The infection is not transmitted by touching or using non-cutting and non-abrasive objects, used by a seropositive person. For instance, a normal washing of dishes, clothes and linens with water and detergent is able to eradicate the HIV, if it were. There is no danger about the use of canteens, restaurants, toilets, beds, showers, WC, gyms or swimming pools. It is advised though not to touch objects that could cause the contact blood-to-blood or injuries or stings (blades, tooth-brushes, scissors, etc.).
The shared use of the above-mentioned objects is not recommended in any case: this general hygiene rule is fundamental to avoid the exchange of bacteria and other agents that could determine different types of pathologies.
The transmission by insects or pets
Pets cannot be vehicle of infection because the transmission man/animal and vice versa is not possible. This virus can only be transmitted by an infected human being to another. There are no proves that mosquitoes or other insects have ever transmitted AIDS. The virus, in fact, does not survive inside the salivar apparatus of mosquitoes. Moreover, the quantity of blood that a mosquito can carry biting an infected person and biting again a healthy person immediately afterwards is not sufficient to determine the infection.
Can other sexually-transmitted diseases pose a major risk for the HIV infection?
The other sexually transmitted diseases can favour the acquisition or transmission of the virus. Several studies have revealed that sexually transmitted diseases, particularly those causing genital ulcers (herpes, syphilis, chancroid ulcer), increase both the risk of HIV infection and both the contraction of the virus being already seropositive. The use of condoms is effective not only in fighting the HIV infection, but also most of the sexually transmitted diseases.
How to prevent the maternal infection of the fetus
The seropositive women during pregnancy must take antiretroviral medicines, give birth through caesarean section and avoid breast-feeding. In this way the risk of infection of the baby is reduced.
Safe sex
It is possible to list, generally speaking, the situations based on the risk factor (low, medium and high)
Practices considered safe
- Sexual fantasies (including phone-sex and cyber-sex)
- Masturbation, even mutual but without penetration
- Sexual contact without penetration (massages, petting with clothes)
- Kissing
- Using sexual tools without exchanging them
Sufficiently safe practices
- Oral sex with condom or other protection (dam)
- Vaginal sex with condom
- Anal sex with condom
- Oral-anal contact with a barrier
- Finger and fisting with protection (e.g. a glove)
Less safe practices
- Unprotected oral sex
- Unprotected fingering and fisting
- Exchanging sexual tools/vibrators without cleaning or condom
Unsafe practices
- Unprotected vaginal sex
- Unprotected anal sex
- Unprotected cunnilingus during the menstrual period
The diffusion of HIV infection
The IHV infection is worldwide spread. According to the data updated to 2005, it was estimated that over 40 million living people are seropositive or HIV infected. To those the million dead must be added. It is a doubled figure compared with 1995, when the cases had been a little less than 20 million (19.9). In 2000 about 34 million people were estimated. It is evident that the infection is growing everywhere. These are the incredible figures of the new cases every year in the world: 4.1 million with 2,8 million dead in 2004, against 4.9 million new infections (4.2 million adults and 700 thousand children under the age of 15) and 3.1 million dead in 2005, of which 570 thousand children. In 2005, the total number of seropositive women reached 17.5 million. In Italy the seropositive people are estimated around 130-140 thousand, with 3,500-4,000 cases of new infections every year. One case every hour. The confirmed HIV infection cases have been 50 thousand. At present, the groups of population most involved into the infection are the heterosexuals, followed by men having sex with other men and then drug-addicts. Africa has the highest number of HIV infected people, with figures ranging from 5% to 55% in every state. India is the country of the new emergency though, with the highest percentage of infections. According to the data collected in 70 countries, people that do the anti-AIDS test are 4 times more than 5 years ago.
DIFFUSION TABLE FOR AREAS:* |
||
REGION |
PERSONS THAT LIVE WITH THE VIRUS |
NEW CASES 2005 |
Sub-Saharan Africa |
25.8 million |
3.2 million |
North Africa-MO |
510,000 |
67,000 |
South and South-East Asia |
7.4 million |
990,000 |
East Asia |
870,000 |
140,000 |
Latin America |
1.8 million |
200,000 |
Caribbean |
300,000 |
30,000 |
From Eastern Europe to central Asia |
1.6 million |
270,000 |
Western and Central Europe |
720,000 |
22,000 |
North America |
1.2 million |
43,000 |
Australia and New Zealand |
74,000 |
8,200 |
TOTAL |
40.3 million |
4.9 million |
*UN statistics
INFECTION TABLE IN 2005:*
- TOTAL 4.9 MILLION
- Adults 4.2 million
- Children (under 15) 700,000
People that live with HIV/AIDS
- TOTAL 40.3 MILLION
- Adults 38 million
- Women 17.5 million
- Children 2.3 million
Dead caused by AIDS in 2005
- TOTAL 3.1 MILLION
- adults 2.6 million
- children 570,000.
* UN statistics
Treatment and psychological and social aspects
The therapies for the HIV infection
Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. This has been highly beneficial to many HIV-infected individuals since its introduction. Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents.
In developed countries where HAART is available, doctors assess the viral load, CD4 counts, rapidity of CD4 decline and patient readiness while deciding when to recommend initiating treatment. Traditionally, treatment has been recommended for otherwise asymptomatic patients when CD4 cell counts fall to 200-250 cells per microlitre of blood. However, beginning treatment earlier may significantly reduce the risk of death.
Standard goals of HAART include improvement in the patient’s quality of life, reduction in complications, and reduction of HIV viremia below the limit of detection, but it does not cure the patient of HIV nor does it prevent the return, once treatment is stopped, of high blood levels of HIV, often HAART resistant. Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.
For some patients, which can be more than fifty percent of patients, HAART achieves far less than optimal results, due to medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV. Non-adherence and non-persistence with therapy are the major reasons why some people do not benefit from HAART. The reasons for non-adherence and non-persistence are varied. Major psychosocial issues include poor access to medical care, inadequate social supports, psychiatric disease and drug abuse. HAART regimens can also be complex and thus hard to follow, with large numbers of pills taken frequently.
The rights of the seropositive person and the HIV infected person
AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals. For this reason in 1990 a law (Law 135 of 8/6/1990) was passed in order to protect the seropositive person from social, health and work discriminations. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV. The full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups should be guaranteed by: promoting access to HIV education and information; full protection of confidentiality and informed consent; intensifying efforts to ensure a wide range of prevention programmes, including information, education and communication, aimed at reducing risk-taking behaviours and encouraging responsible sexual behaviour, including abstinence and fidelity; expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; expanded access to voluntary and confidential counselling and testing; safe blood supplies; and early and effective treatment of sexually transmitted infections; developing strategies to combat stigma and social exclusion connected with the epidemic. Also foreign citizens with an irregular visa must be ensured health facilities at accredited public centres, and this does not involve the police intervention. Like any other sick worker, the HIV or other related pathologies infected worker cannot be fired during the disease, until the term as established by the contract of the sector, has been reached. The HIV infected person can apply for civil invalidity by forwarding the application at the local health unit.
The prevention decalogue
Prevention risk to be a meaningless word if a general principle of prevention is not accepted by everyone. According to the WHO, there are three universal principles that can be followed by all the countries without cultural differences. These three principles have been called the ABC of prevention, that is:
- A= abstaining from sexual contacts
- B= being faithful reducing sexual contacts
- C= consistently use a latex condom properly
Nevertheless, the first point, though effective, is not easily practicable in certain context, therefore it should be regarded as the ability to say no to unsafe sex. The second point concerns monogamy, that should be mutual in order to be safe. Also in this case, the diffusion of the general principle is not easy, whereas the third point is much more practicable in a lot of context. The stress is put on the correct use anyway.
It is important to remember that there are several points to be considered in terms of prevention:
1. Eradicating silence, stigma and shame
i. These situations still play an important role in contrasting prevention and are culturally determined
2. Informing and training
i. Misinformation is particularly responsible. In prevention, it is essential to give regular information in time, and, above all, to train both those who have to inform and people about the healthiest life style.
3. Giving the opportunity to face life difficulties
i. A lot of risky situations of young people are due to their inability to cope with everyday challenges: we have to be able to give them critical tools on health and life choices;
4. Creating available social and health facilities
i. The accessibility to health services and a more careful human welcome are two successful keys in the fight against AIDS
5. Promoting diagnostic tests
i. Doing the test is a love and generosity action
6. Involving young people in prevention
i. Adolescents have the best opportunities to experiment prevention personally
7. Involving seropositive young people or involved in the problem IST
i. Those who have experienced the disease and the suffering should become the guide for those who have not, rather than become a stigma
8. Creating a social aid and reach the most vulnerable groups
i. Abandonment and sense of solitude kill more than the disease itself
The history of the disease
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC) recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.[154] In the beginning, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined. The CDC, in search of a name, and looking at the infected communities coined “the 4H disease,” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users. However, after determining that AIDS was not isolated to the homosexual community, the term GRID became misleading and AIDS was introduced at a meeting in July 1982. By September 1982 the CDC started using the name AIDS, and properly defined the illness. The earliest known positive identification of the HIV-1 virus comes from Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. A recent study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969.
The information on HIV infection helps to:
- prevent the infection because it can promote the adoption of behaviours that avoid it
- win the unreasonable fear of infection
- recognize and avoid risky situations
- be close to a seropositive or HIV infected person