Understanding HIV and AIDS

Ever since 1998, World AIDS Day has been celebrated on December 1. World AIDS Day was founded to create awareness about the disease, and to show support for those living with it. The 30th edition of World AIDS Day was celebrated yesterday by people around the world. According to the United Nations, 1.8 million people were newly infected with HIV in 2017. The UN also reports 940,000 deaths from HIV/AIDS-related illnesses in 2017.

These are the most important facts to know about HIV and AIDS:

1. What HIV and AIDS stand for

HIV stands for Human Immunodeficiency Virus and AIDS stands for Acquired Immunodeficiency Syndrome.

2. What HIV is

HIV is a virus that attacks CD4 or T cells in the body. T cells regulate the body's immune responses. When the T cells are attacked or diminished, it becomes more difficult for the body to fight off infection. There are three stages of HIV infection: (1) acute HIV infection, (2) chronic HIV infection and (3) AIDS. Acute HIV infection develops 2 to 4 weeks after a person gets infected with the virus. The infected person gets to experience flu-like symptoms. Infected persons are more likely to transmit HIV at this stage as they have large amounts of the virus in their blood.

The second stage also called asymptomatic HIV infection or clinical latency involves the continuous multiplication of HIV in the body, but at very low levels. The second stage of HIV is the most critical for treatment as an infected person advances to AIDS in about 10 years without treatment with HIV medicines. Despite being asymptomatic, the HIV virus is still transmissible at this stage.

3. What AIDS is

HIV becomes AIDS when an infected person's T cell count drops below 200 cells per cubic millimeter of blood, or when there is an onset of AIDS-related complications. AIDS is the third and final stage of HIV infection. People with AIDS typically survive only for about 3 years, without treatment.

4. How HIV is transmitted

HIV is spread only in specific body fluids of an HIV-infected person. These are: blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids and breast milk. For transmission to occur, these fluids must come in contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream through a needle or syringe. Mucous membranes are found inside the mouth, penis, vagina, and rectum. HIV can also be transmitted from mother to child during pregnancy, childbirth or breastfeeding.

5. How HIV is prevented

To help prevent HIV transmission, 

• Use a new condom every time you have anal or vaginal sex. 
• Avoid alcohol or drug abuse as such abuses may lead to risky behavior like sharing needles to inject drugs, or having sex without a condom.
• Make use of sterile needles when injecting drugs, and do not share a needle with others.
• Get circumcised if you're a male, as there's evidence that male circumcision can reduce a man's risk of contracting HIV.
• You and your partner should get tested for HIV and other STIs, and discuss the results before sex.
• Be monogamous and faithful. This means you and your partner only have sex with each other.
• Limit your sexual partners, reason being that your risk of getting HIV and other STIs increases as your partners increase.

6. Antiretroviral drugs or Antiretroviral therapy (ART)

Once a person finds out that they are HIV positive, it is recommended that they start antiretroviral treatment as soon as possible. Antiretrovirals will keep an HIV-positive person healthy while reducing the chances of transmission unto other people. Antiretroviral therapy keeps a person's viral load (level of HIV in blood) low. When an HIV-positive person is effectively treated with ART, they achieve an undetectable viral load. A combination of TDF (tenofovir), either 3TC (lamivudine) or FTC (emtricitabine) and EFV (efavirenz) is the ART recommended by the World Health Organization for people starting HIV treatment.

7. Undetectable HIV viral load

When an HIV-infected person's viral load is below 50, it is said to be undetectable. This means the virus is still present in the person's system but is too low to be measured. Having an undetectable viral load improves the overall health of the HIV-infected person, and greatly reduces the risk of transmission to the person's partner(s). It also minimizes the risk of HIV becoming resistant to the anti-HIV drugs being taken. In most cases, and for most people, an undetectable viral load is achieved within six months of treatment with Antiretroviral drugs. 

8. The role played by PrEP and PEP

People at very high risk of getting infected with HIV undergo pre-exposure prophylaxis (PrEP) by taking HIV medicines on a daily basis to prevent HIV infection. PrEP drugs are taken daily over a sustained period to prevent HIV infection before exposure.

If a person is exposed to HIV, they have to start post-exposure prophylaxis (PEP) within 3 days of exposure. PEP involves taking ART for a month, to prevent HIV infection after exposure to HIV. PEP is needed:

• After sex without a condom with a person who has or might have HIV,
• After sharing needles or syringes with a person who has or might have HIV,
• If a condom slips off or breaks during sex.

9. The Berlin patient 

Timothy Brown, dubbed "The Berlin Patient" is thought to be the only person cured of HIV. Brown was pursuing his studies in Berlin, Germany, when he was diagnosed with HIV in 1995. He lived with the virus for 11 years, controlling his infection with ART, before his acute myeloid leukemia diagnosis in 2006. His doctor arranged for him to receive a hematopoietic stem cell transplant from a donor with the "Delta 32" mutation on the CCR5 receptor. The reason for his doctor's choice was the fact that the "Delta 32" mutation causes the body to produce CD4 cells that do not have CCR5 receptors. And without these receptors, HIV cannot bind to the CD4 cells and infect them. 

Brown received two stem cell transplants from a donor who was homozygous for the Delta32 mutation. Persons who are homozygous to the CCR5 mutation are HIV resistant and rarely progress to stage 3 of the infection. Brown stopped taking ART after his first bone marrow transplant, and hasn't had to take them since then. Researches have repeatedly screened his blood several years after the transplant and have nothing but unreplicable traces of the viral genetic material. Nonetheless, scientists still debate today on the nature of his cure - could he have had a "sterilizing" cure - wherein there is no trace of the virus in his body - or a functional cure - wherein he simply no longer needs ART.