HIV

What is H.I.V.?

HIV stands for Human Immunodeficiency Virus. This is a virus that people can become infected with and then they can pass on to others.

When someone becomes infected with HIV it begins to attack their immune system which is the body’s defence against illness, this process is not always visible. Once a person becomes infected with HIV they will remain infected for life.

What causes H.I.V. to develop?

Blood is made up of a fluid called plasma and three types of cells. Red blood cells, which give blood it's colour, platelets, which help the blood to clot and white blood cells. It is the white blood cells which defend the body from germs and fight infections. One of the most important white blood cells is called a T-helper cell (commonly called a CD4 cell). The CD4 cell is a crucial cell in the immune system as it co-ordinates all the other immune cells.

HIV infects cells in the immune system and central nervous system. The main cell HIV infects is the CD4 cell. Like all viruses, the HIV virus only wants to do one thing, reproduce itself. Once it has attacked the CD4 cell, it takes it over and reproduces itself. During this process (which takes a couple of days) the infected cell dies and the virus seeks out other CD4 cells to infect.

The CD4 cells of someone infected with HIV will battle against the invading infection and so it may be years before you notice any symptoms. However, the virus is not completely destroyed or eradicated from the body, and will continue to attack the CD4 cells. Eventually as your CD4 cell count goes down you might start having signs of HIV disease like fevers, night sweats, diarrhoea or swollen lymph nodes. These problems may continue for several weeks.

What is A.I.D.S.?

AIDS stands for Acquired Immune Deficiency Syndrome. The term AIDS is very rarely used in the medical profession, they prefer to talk of late stage or advanced HIV infection. Before effective treatments AIDS was a state someone infected with HIV almost inevitably entered, as HIV attacked their immune system. This is no longer the case.

A person was said to have AIDS when, usually after a few years after first becoming infected with HIV, they develop one of a number of rare illnesses or cancers because their immune system is weakened.

How is HIV passed on?

HIV is present in sexual fluids and blood of infected people, it may also be in the breast-milk of infected women. Because of the way in which HIV is spread the 2 most common ways of contracting the virus is through unprotected penetrative sex (where the penis enters the vagina or anus), and the use of infected needles and syringes. HIV can also be passed on to an unborn baby either before or during birth. There is a small risk of you contracting HIV through oral sex but this is very rare.

It is not possible for HIV to be contracted through touching, hugging, sharing cutlery, insect bites, toilet seats or eating food that has been prepared by a person with H.I.V.

How do I avoid catching H.I.V.?

You can avoid catching HIV by practicing safe sex, this refers to any sexual activities which does not involve any sexual fluid from one person getting into another person’s body. Safe sex activities include kissing, touching and mutual masturbation. A condom when used properly and consistently acts as a physical barrier, making it hard for the virus to pass between people.

If you inject drugs make sure you only use your own syringe or needles and always sterilize them before and after use.

What are the symptoms of H.I.V.?

The majority of people who are infected with HIV will have no symptoms in the early stages. People are often unaware they have the infection and so may be spreading the infection to others. A doctor may suspect you have HIV after a series of unusual infections known as 'opportunistic infections' or cancers, examples of opportunistic infections include:

• Thrush - in the mouth, genital area or gullet (oesophagus).
• Herpes simplex virus - a virus which can cause coldsores or genital herpes.
• Toxoplasmosis - parasite that causes lung and brain infections.
• Cytomegalovirus (C.M.V.) - a virus that causes pneumonia, bowel infections and severe eye infections that may end in blindness.
• Mycobacterium Avium Complex (M.A.C.) - a infection that can cause high fever, diarrhoea and weight loss. If it spreads it can cause blood infections, hepatitis or pneumonia.
• Tuberculosis.
• Pneumocystis Carinii Pneumonia (P.C.P.) - a infection that can cause a deadly form of pneumonia.
• Kaposi's sarcoma - a cancer that causes purple-coloured spots or lesions on the skin or lining of the mouth.
• Peripheral neuropathy - a disease of the nerves that may be a side affect of the H.I.V. drugs or a result of one of the other infections mentioned above. Neuropathy can be a minor problem but in serious cases can cause disabling weakness e.g. difficulty in standing or walking.

What are the stages of H.I.V. infection?

HIV can usually be broken down into 4 stages: -

Stage 1- Primary stage.

This stage of infection lasts a few weeks and will often be accompanied by a flu like illness which occurs just after infection. A HIV test at this time may not yet prove positive.

Stage 2 - Clinically asymptomatic stage.

This stage can last for an average of 10 years and as its name suggests usually has no symptoms, although there may be swollen glands. HIV remains infectious and will now show up positive in a test.

Stage 3 - Symptomatic H.I.V. infection.

Over time the immune system loses the struggle to contain HIV, this is for 3 main reasons: -

1. The lymph nodes and tissues become damaged because of activity over the years's.

2. HIV becomes stronger and more varied, leading to more CD4 cell destruction.

3. The body fails to keep up replacing the CD4 cells that are lost.

As a results you may get infections and cancers (see symptoms above) that normally the immune system would prevent causing 'symptomatic HIV infection'.

Stage 4 - Progression from HIV to AIDS now properly called advanced HIV infection.

As the immune system becomes more and more damaged the illnesses that occur become more and more severe leading to an AIDS diagnosis. People can be very ill with HIV but not have an AIDS diagnosis.

What treatment is available for H.I.V.?

There is no cure for AIDS and at present there is no vaccine to prevent people from becoming infected with HIV

However, there are a wide range of treatments now available and recent research has shown that taking a combination of anti-HIV drugs (combination therapy) can slow down the damaging effect of HIV on the immune system. When the treatment is successful, it can improve and sustain the health of someone with HIV meaning they are less likely to develop AIDS. defining conditions. There are a minority of people who are unable to benefit from the current anti-HIV drugs but many who were seriously ill with HIV have returned to good health and in many cases returned to work as a result of the drugs.

Some researchers believe that the new strong anti-HIV drugs might kill off all the HIV if taken for several years, but it hasn’t happened as yet.

Should I have an H.I.V. test?

If you have any concerns talk to your doctor or a trained counsellor at a G.U.M. clinic and they can help you decide whether to have a HIV test or not, though the final decision will be left up to you.

There are no specific symptoms which can tell whether a person is infected or not, the only way to know for certain is by having a HIV antibody test. The test looks for HIV antibodies in a person’s blood. Remember, it can take 3 months for HIV antibodies to develop to a level where they will show up on a test result.

The results of a HIV test can take anything from a few hours to a week or more to come back, you may have to book up in advance if you want the result the same day.

If you have a test at a clinic it should be strictly confidential to you and the staff concerned, staff will advise you to tell your doctor but no one will be told without your permission.

Anyone in the U.K. can have a free HIV test, they are available from your doctor and local G.U.M. clinic.

Living with H.I.V.

People living with HIV will need to have 2 tests regularly to monitor the infection and to see how well the treatment is working.

A CD4 (T-helper) count - this measures the number of CD4 cells in the blood, this will give you and your doctor an idea of how the infection is progressing. The lower the amount of CD4 cells (usually below 200) the more prone you are to infections. Healthy people have between 800 and 1,500 CD4 cells in a millilitre of blood.

A viral load test - this measures the amount of HIV in the blood. The higher the viral load the more virus there is in your blood. This test is used along with the CD4 cell count to help your doctor decide when to start or change your treatment.

Your doctor will also advise you to get immunizations to prevent infections such as pneumonia and influenza.

If you are a smoker or use drugs not prescribed by your doctor you should quit. Try to maintain a healthy diet, exercise regularly (if you are able) and find time to relax and ensure you get enough sleep.

What happens if I have H.I.V.?

Living with the knowledge of a life threatening condition is very stressful, you will need to look at ways of taking particular care of your own health. It also means you can pass the virus on to others. You will be offered a referral on to a HIV specialist, to discuss whether to start treatment.

Remember, you are at no risk of getting the infection from normal everyday contact with a person infected with HIV or AIDS.