World AIDS Day: Creating Awareness Is Sharing Responsibility

World AIDS Day, designated on 1 December every year since 1988, is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection and mourning those who have died of the disease.

World AIDS Day was commemorated by people around the globe. In Nepal, they lit oil lamps. They released balloons in Berlin. And in Romania, medical students danced during a flash mob event. In San Francisco, a haunting sculpture went on view made entirely of syringes, a reference to the transmission of HIV through intravenous drug use.

HIV infection in humans came from a type of chimpanzee in Central Africa. The chimpanzee version of the virus (called simian immunodeficiency virus, or SIV) was probably passed to humans when humans hunted these chimpanzees for meat and came in contact with their infected blood.

Studies show that HIV may have jumped from chimpanzees to humans as far back as the late 1800s.

Over decades, HIV slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid to late 1970s.

World AIDS Day began in 1988. Back then, James Bunn, a public information officer in Geneva at the Global Program on AIDS, part of the World Health Organization and his colleague, Thomas Netter, came up with the idea. He says that the stigma that surrounded AIDS was actually twofold. One of it was what you could easily argue had to do with homophobia. But also there was a stigma of fear. There was a lot that people felt they did not know about the epidemic and they were afraid.

Thereby, it becomes extremely important to educate ourselves and get to know about the disease.

HIV is a virus that damages the immune system. Untreated HIV affects and kills CD4 cells, which are a type of immune cell called T cell. Over time, as HIV kills more CD4 cells, the body is more likely to get various types of conditions and cancers.

HIV is transmitted through bodily fluids that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

The virus isn’t transferred in air or water, or through casual contact. Because HIV inserts itself into the DNA of cells, it’s a lifelong condition and currently there’s no drug that eliminates HIV from the body, although many scientists are working to find one.

However, with medical care, including treatment called antiretroviral therapy, it’s possible to manage HIV and live with the virus for many years.

Without treatment, a person with HIV is likely to develop a serious condition called the Acquired Immunodeficiency Syndrome, known as AIDS.

At that point, the immune system is too weak to successfully respond against other diseases, infections, and conditions.

Untreated, life expectancy with end stage AIDS is about 3 years. With antiretroviral therapy, HIV can be well-managed, and life expectancy can be nearly the same as someone who has not contracted HIV.

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 millimetre. A person with HIV whose CD4 count falls below 200 per cubic millimetre 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 years. 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.

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 is 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

As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimetre. 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 is 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.

HIV and AIDS are related, but they are not the same thing.

Anyone can contract HIV. The virus is transmitted in bodily fluids that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

Some of the ways HIV is transferred from person to person include:

• through vaginal or anal sex- the most common route of transmission
• by sharing needles, syringes, and other items for injection drug use
• by sharing tattoo equipment without sterilizing it between uses
• during pregnancy, labour, or delivery from a pregnant person to their baby
• during breastfeeding
• through “pre-mastication,” or chewing a baby’s food before feeding it to them
• through exposure to the blood, semen, vaginal and rectal fluids, and breast milk of someone living with HIV, such as through a needle stick

The virus can also be transmitted through a blood transfusion or organ and tissue transplant. However, rigorous testing for HIV among blood, organ, and tissue donors ensures that this is very rare in the United States.

It is theoretically possible, but considered extremely rare, for HIV to be transmitted through:

• oral sex (only if there are bleeding gums or open sores in the person’s mouth)
• being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s mouth)
• contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transfer through:

• skin-to-skin contact
• hugging, shaking hands, or kissing
• air or water
• sharing food or drinks, including drinking fountains
• saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
• sharing a toilet, towels, or bedding
• mosquitoes or other insects

It is important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Causes of HIV

HIV is a variation of a virus that can be transmitted to African chimpanzees. Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed chimpanzee meat containing the virus.

Once inside the human population, the virus mutated into what we now know as HIV. This likely occurred as long ago as the 1920s.

HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959.

It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public consciousness until the 1980s.

Causes of AIDS

AIDS is caused by HIV. A person can’t get AIDS if they haven’t contracted HIV.

Healthy individuals have a CD4 count of 500 to 1,500 per cubic millimetre. Without treatment, HIV continues to multiply and destroy CD4 cells. If a person’s CD4 count falls below 200, they have AIDS.

Also, if someone with HIV develops an opportunistic infection associated with HIV, they can still be diagnosed with AIDS, even if their CD4 count is above 200.

What tests are used to diagnose HIV?

Several different tests can be used to diagnose HIV. Healthcare providers determine which test is best for each person.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 18–45 days after someone initially contracts HIV.

These tests check the blood for antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for antibodies. Between 23 and 90 days after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a healthcare provider’s office or clinic.

Other antibody tests can be done at home:

OraQuick HIV Test: An oral swab provides results in as little as 20 minutes.

Home Access HIV-1 Test System: After the person pricks their finger, they send a blood sample to a licensed laboratory. They can remain anonymous and call for results the next business day.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their healthcare provider to confirm.

Nucleic acid test (NAT)

This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or have a known risk factor. This test doesn’t look for antibodies; it looks for the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

Today, it’s easier than ever to get tested for HIV.

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.

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.

If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm (the timing depends on the test used). And during that time, they need to use condoms or other barrier methods to prevent possibly spreading HIV.

Someone who tests negative during the window might benefit from post-exposure prophylaxis (PEP). This is medication taken after an exposure to prevent getting HIV.

PEP needs to be taken as soon as possible after the exposure; it should be taken no later than 72 hours after exposure but ideally before then.

Another way to prevent getting HIV is pre-exposure prophylaxis (PrEP). A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or transmitting HIV when taken consistently.

Early symptoms of HIV

The first few weeks after someone contracts HIV is called the acute infection stage.

During this time, the virus reproduces rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this stage, some people have no symptoms at first. However, many people experience symptoms in the first month or so after contracting the virus, but they often don’t realize HIV causes those symptoms.

This is because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses, such as:

• they may be mild to severe
• they may come and go
• they may last anywhere from a few days to several weeks

Early symptoms of HIV can include:

• fever
• chills
• swollen lymph nodes
• general aches and pains
• skin rash
• sore throat
• headache
• nausea
• upset stomach

Because these symptoms are similar to common illnesses like the flu, the person who has them might not think they need to see a healthcare provider.

And even if they do, their healthcare provider might suspect the flu or mononucleosis and might not even consider HIV.

Whether a person has symptoms or not, during this period their viral load is very high. The viral load is the amount of HIV found in the bloodstream.

A high viral load means that HIV can be easily transmitted to someone else during this time.

Initial HIV symptoms usually resolve within a few months as the person enters the chronic or clinical latency, stage of HIV. This stage can last many years or even decades with treatment.

After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades.

Some people don’t have any symptoms during this time, while others may have minimal or nonspecific symptoms. A nonspecific symptom is a symptom that doesn’t pertain to one specific disease or condition.

HIV symptoms in men: Is there a difference?

Symptoms of HIV vary from person to person, but they’re similar in men and women. These symptoms can come and go or get progressively worse.

If a person has been exposed to HIV, they may also have been exposed to other sexually transmitted infections (STIs). These include:

• gonorrhoea
• chlamydia
• syphilis
• trichomoniasis

The symptoms they experience overall may differ based on the different risks men and women face if they have HIV.

Both men and women with HIV are at increased risk for STIs. However, women, and those with a vagina, may be less likely than men to notice small spots or other changes to their genitals.

In addition, women with HIV are at increased risk for:

• recurrent vaginal yeast infections
• other vaginal infections, including bacterial vaginosis
• pelvic inflammatory disease (PID)
• menstrual cycle changes
• human papillomavirus (HPV), which can cause genital warts and lead to cervical cancer

While not related to HIV symptoms, another risk for women with HIV is that the virus can be transmitted to a baby during pregnancy. However, antiretroviral therapy is considered safe during pregnancy.

Women who are treated with antiretroviral therapy are at very low risk for transmitting HIV to their baby during pregnancy and delivery. Breastfeeding is also affected in women with HIV. The virus can be transferred to a baby through breast milk.

AIDS

People with HIV may develop AIDS if their HIV is not diagnosed until late or if they know they have HIV but don’t consistently take their antiretroviral therapy.

They may also develop AIDS if they have a type of HIV that’s resistant to (doesn’t respond to) the antiretroviral treatment.

Without proper and consistent treatment, people living with HIV can develop AIDS sooner. By that time, the immune system is quite damaged and has a harder time generating a response to infection and disease.

With the use of antiretroviral therapy, a person can maintain a chronic HIV diagnosis without developing AIDS for decades.

Symptoms of AIDS can include:

• recurrent fever
• chronic swollen lymph glands, especially of the armpits, neck, and groin
• chronic fatigue
• night sweats
• dark splotches under the skin or inside the mouth, nose, or eyelids
• sores, spots, or lesions of the mouth and tongue, genitals, or anus
• bumps, lesions, or rashes of the skin
• recurrent or chronic diarrhoea
• rapid weight loss
• neurologic problems such as trouble concentrating, memory loss, and confusion
• anxiety and depression

Antiretroviral therapy controls the virus and usually prevents progression to AIDS. Other infections and complications of AIDS can also be treated. That treatment must be tailored to the individual needs of the person.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy, a combination of daily medications that stop the virus from reproducing. This helps protect CD4 cells, keeping the immune system strong enough to take measures against disease.

Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

HIV medications

Many antiretroviral therapy medications are approved to treat HIV. They work to prevent HIV from reproducing and destroying CD4 cells, which help the immune system, generate a response to infection.

This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.

These antiretroviral medications are grouped into six classes:

• nucleoside reverse transcriptase inhibitors (NRTIs)
• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• protease inhibitors
• fusion inhibitors
• CCR5 antagonists, also known as entry inhibitors
• integrase strand transfer inhibitors

Treatment regimens

Many of the antiretroviral medications are combined with others so that a person with HIV typically takes only one or two pills a day.

A healthcare provider will help a person with HIV choose a regimen based on their overall health and personal circumstances.

These medications must be taken every day, exactly as prescribed. If they’re not taken appropriately, viral resistance can develop, and a new regimen may be needed.

Blood testing will help determine if the regimen is working to keep the viral load down and the CD4 count up. If an antiretroviral therapy regimen isn’t working, the person’s healthcare provider will switch them to a different regimen that’s more effective.

Side effects and costs

Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These symptoms are often temporary and disappear with time.

Serious side effects can include swelling of the mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be adjusted.

Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage. Some pharmaceutical companies have assistance programs to help lower the cost.

HIV prevention

Although many researchers are working to develop one, there’s currently no vaccine available to prevent the transmission of HIV. However, taking certain steps can help prevent the transmission of HIV.

Safer sex

The most common way for HIV to be transferred is through anal or vaginal sex without a condom or other barrier method. This risk can’t be completely eliminated unless sex is avoided entirely, but the risk can be lowered considerably by taking a few precautions.

Other steps to help prevent the spread of HIV include:

Avoid sharing needles or other paraphernalia. HIV is transmitted through blood and can be contracted by using materials that have come in contact with the blood of someone who has HIV.

Consider PEP: A person who has been exposed to HIV should contact their healthcare provider about obtaining post-exposure prophylaxis (PEP). PEP can reduce the risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure but before 36 to 72 hours have passed.

Consider PrEP: A person has a higher chance of contracting HIV should talk to their healthcare provider about pre-exposure prophylaxis (PrEP). If taken consistently, it can lower the risk of acquiring HIV. PrEP is a combination of two drugs available in pill form.

Healthcare providers can offer more information on these and other ways to prevent the spread of HIV.

Living with HIV

The most important thing is to start antiretroviral treatment as soon as possible. By taking medications exactly as prescribed, people living with HIV can keep their viral load low and their immune system strong.

It’s also important to follow up with a healthcare provider regularly. Other ways people living with HIV can improve their health include:

• Make their health their top priority. Steps to help people living with HIV feel their best include:
• fuelling their body with a well-balanced diet
• exercising regularly
• getting plenty of rest
• avoiding tobacco and other drugs
• reporting any new symptoms to their healthcare provider right away

Focus on their mental health: They could consider seeing a licensed therapist who is experienced in treating people with HIV.

Use safer sex practices: Talk to their sexual partner(s). Get tested for other STIs. And use condoms and other barrier methods every time they have vaginal or anal sex.

Talk to their healthcare provider about PrEP and PEP. When used consistently by a person without HIV, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can lower the chances of transmission. PrEP is most often recommended for people without HIV in relationships with people with HIV, but it can be used in other situations as well. Online sources for finding a PrEP provider include PrEP Locator and PleasePrEPMe.

Surround themselves with loved ones: When first telling people about their diagnosis, they can start slow by telling someone who can maintain their confidence. They may want to choose someone who won’t judge them and who will support them in caring for their health.

Get support: They can join an HIV support group, either in person or online, so they can meet with others who face the same concerns they have. Their healthcare provider can also steer them toward a variety of resources in their area.

HIV life expectancy

In the 1990s, a 20-year-old person with HIV had a 19-year life expectancy. By 2011, a 20-year-old person with HIV could expect to live another 53 years.

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.

Consistent use of these drugs helps prevent HIV from progressing to AIDS. When HIV advances to AIDS, life expectancy without treatment is about 3 years.

In 2017, about 20.9 million people living with HIV were using antiretroviral therapy.

Life expectancy statistics are just general guidelines. People living with HIV should talk to their healthcare provider to learn more about what they can expect.

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV. Research and testing on experimental vaccines are ongoing, but none are close to being approved for general use.

HIV is a complicated virus. It mutates (changes) rapidly and is often able to fend off immune system responses. Only a small number of people who have HIV develop broadly neutralizing antibodies, the kind of antibodies that can respond to a range of HIV strains.

The first HIV vaccine efficacy study in 7 years was underway in South Africa in 2016. The experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand.

A 3.5-year follow-up after vaccination showed the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involves 5,400 men and women from South Africa. In 2016 in South Africa, about 270,000 people contracted HIV. The results of the study are expected in 2021.

Other late-stage, multinational vaccine clinical trials are also currently underway.

Statistics:

In 2019, about 38 million people worldwide were living with HIV. Of those, 1.8 million were children below the age 15 years.

At the end of 2019, 25.4 million people living with HIV were using antiretroviral therapy.

Since the pandemic began, 75.7 million people have contracted HIV, and AIDS-related complications have claimed 32.7 million lives.

In 2019, 690,000 people died from AIDS-related diseases. This is a decline from 1.9 million in 2005.

Eastern and Southern Africa are the hardest hit. In 2019, 20.7 million people in these areas were living with HIV, and 730,000 more contracted the virus. The region has more than half of all people living with HIV worldwide.

Adult and adolescent women accounted for 19 percent of new HIV diagnoses in the United States in 2018. Almost half of all new cases occur in African Americans.

Left untreated, a woman with HIV has a 15–45 percent chance of passing HIV to her baby during pregnancy or breastfeeding. With antiretroviral therapy throughout pregnancy and avoidance of breastfeeding, the risk is less than 5 percent.

In the 1990s, a 20-year-old person with HIV had a life expectancy of 19 years. By 2011, it had improved to 53 years. Today, life expectancy is near normal if antiretroviral therapy is started soon after contracting HIV.

With the increased efforts undertaken to raise public awareness about HIV and AIDS in the last decade, fighting against the human immunodeficiency virus is possible and patients suffering from these diseases now have access to proper medical care.

However, even though the awareness about AIDS and HIV has increased but still millions of people around the world continue to contract HIV and die of the last stage of the virus's infection, AIDS. Therefore, as this pandemic continues to impact human life, it is has become extremely important for people to understand the various facts related to the disease.