Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

Backgrounder

Introduction

Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. HIV targets and kills cells in your blood called “CD4+ cells*,” also known as “T cells*.” These cells help protect your body from disease. As the virus impairs or destroys the functioning of these immune cells, infected individuals gradually become immunodeficient, a state in which the immune system’s ability to fight infectious diseases and cancer is either compromised or entirely absent. If HIV is not treated—for example, by antiretroviral medications (ART)*—it can lead to AIDS (Acquired Immunodeficiency Syndrome). There is currently no cure for HIV. Once people get HIV, they have it for life. However, with proper medical care, HIV and AIDS can be controlled. HIV-positive* people and people with AIDS can live long, healthy lives and protect others from becoming infected.

 

How is HIV spread?

 

HIV is spread through direct contact with bodily fluids that contain the HIV virus. This includes blood, semen and pre-seminal fluid*, rectal and vaginal fluids, and breast milk from a person with HIV who has a detectable viral load. For transmission to occur, the HIV in these fluids must get into the bloodstream of an HIV-negative* person through a mucous membrane (found in the rectum, vagina, mouth, or tip of the penis), through open cuts or sores, or by direct injection (from a needle or syringe).

HIV can be spread:

• During unprotected sexual contact.
• From an infected mother to her child through pregnancy, birth, and breastfeeding.
• By sharing needles to inject drugs.

HIV is NOT transmitted through:

• Air or water.
• Saliva, sweat, or tears.
• Hugging or kissing.
• Insects or pets.
• Sharing a toilet, food, or drinks.

People with HIV who are taking ART and are virally suppressed* do not transmit HIV to their sexual partners.

 

What are the symptoms of HIV?

 

HIV starts 2-4 weeks after exposure to the virus as an acute infection* with flu-like symptoms, including tiredness, headache, a rash, or sore throat. Since these symptoms are not specific to HIV, people often do not recognize them as signs of HIV and may be misdiagnosed by doctors. Having these symptoms by itself does not mean you have HIV.

After the initial symptoms resolve, a person with HIV may by symptom-free for three to 20 years. Symptoms usually appear within 10 years of the initial exposure. Near the end of the symptom-free stage, many people experience fever, weight loss, swollen lymph nodes, and muscle pain. If a person with HIV does not receive treatment at this stage and the infection becomes severe, the infection usually progresses to become AIDS within 10 years.

 

What is AIDS?

 

AIDS is the most advanced stage of HIV infection. It is a stage mainly characterized by the development of chronic diseases such as certain cancers and other severe long-term signs and symptoms that can be observed externally or experienced internally. AIDS greatly damages the immune system, making people vulnerable to other infections, including infections that a healthy immune system would normally heal, for example, pneumonia, tuberculosis, fungal infections, and herpes. AIDS also greatly increases the risk of many types of cancers. Symptoms of AIDS include prolonged fever, excessive sweating, fatigue, and rapid weight loss. Left untreated, people generally live one to three years after being diagnosed with AIDS.

 

How do I know if I have HIV or AIDS?

 

The only way to know if you have HIV is to get tested. HIV tests collect a sample of blood through a finger prick test* or by collecting blood from a vein or a sample of other bodily fluids, such as oral fluid (a mixture of saliva and other materials found in the mouth), or urine. Depending on the kind of test, the results can be ready within half hour or a few weeks. In sub-Saharan Africa, the most common tests are carried out on blood samples as rapid or PCR tests *.

 

How can we prevent HIV?

 

There are five main ways to prevent HIV:

• Use condoms during sex: Using a condom during sex is a very effective way to prevent HIV. Condoms are the only form of contraception that can protect you from HIV. Both male condoms (also known as external condoms*) and female condoms* (also known as internal condoms) are effective at preventing HIV and both kinds of condoms decrease the risk of infection for both men and women.
• Drug harm reduction*: It is very important for people who inject drugs to use new, clean needles each time they inject and not share needles with anyone.
• Reducing mother-to-child transmission*: If a person is pregnant and has HIV, they can avoid transmitting HIV to their baby by taking HIV medicine (see “How can we treat HIV?” below) and avoiding breastfeeding.
• Pre-exposure prophylaxis (PrEP): PrEP is a type of medication that reduces the chances of getting HIV from sex or injecting drugs for people that are at risk of contracting HIV. PrEP can be taken as pills or shots.
• Post-exposure prophylaxis (PEP): PEP is a type of medication that can help prevent HIV after possible exposure. PEP must be started within 72 hours after a potential exposure to HIV to be effective.

 

Consequences of HIV and AIDS

 

• In 2021, an estimated 650,000 people died from HIV-related causes and 1.5 million people acquired HIV.
• There were an estimated 38.4 million people living with HIV at the end of 2021, two-thirds of whom (25.6 million) were in World Health Organization’s Africa Region (which includes almost all African nations except for Somalia and a few countries in North Africa.)
• Living with HIV or AIDS can be a major source of stress, which can negatively impact mental health. People with HIV have a higher chance of developing mental illnesses such as depression and anxiety, as well as cognitive disorders. *
• People living with HIV often experience stigma and discrimination, which contributes to a loss of social support and decreased confidence in their ability to cope with physical and mental health challenges.
• The HIV epidemic has cost the global economy over half a trillion dollars since 2000. Between 2000 and 2015, a total of $562.6 billion was spent on overall HIV care, treatment, and prevention. Much of this is due to the fact that living with HIV and AIDS can be a significant financial burden for individuals and families. People may be unable to work because of their symptoms. HIV medications and the time off work needed to seek treatment can be costly and cause long-lasting financial deprivation.
• The HIV and AIDS epidemic has had a significant effect on the economic development of sub-Saharan African nations. HIV and AIDS-related deaths and disability have greatly reduced the number of people in the workforce, increased the number of orphans, and exacerbated poverty while putting tremendous pressure on health and other social services.

 

How can we treat HIV?

 

There are medications that people can take to reduce the amount of HIV and increase the number of CD4 cells in their bodies.

People with HIV should start taking HIV medicines as soon as possible after being diagnosed with HIV. These medicines do not cure HIV, but can help people live a longer, healthier life. These medicines also lower the risk of giving HIV to someone else.

HIV is commonly treated with antiretroviral therapy (ART). ART is a combination of HIV medicines taken together that slows the rate at which HIV multiplies in the body, thereby reducing the amount of HIV virus. Having less HIV strengthens the immune system and helps it regain the capacity to fight off infections and some cancers. It also reduces the risk of transmitting HIV to others. With proper and consistent treatment, a person living with HIV may be able to reduce the amount of HIV in their body to such a low level that there is essentially zero risk of transmitting HIV to others.

It is important for people who are being treated with ART to take their medicines every day, and not skip doses or stop taking medicines without first talking to a healthcare provider. Over time, people can get sick by not taking ART regularly.

Before taking any new ART medicine, people should tell their healthcare provider if they are pregnant or plan to become pregnant.

 

HIV and pregnancy

 

People with HIV can have children without passing HIV to them, but it requires some special attention.

• People who are HIV-positive and pregnant can lower the chance of passing HIV to their unborn baby by taking ART.
  • Some HIV medicines should not be taken from conception through the first trimester of pregnancy because they may harm the unborn baby.
  • Some HIV medicines should not be taken during pregnancy.
  • Due to pregnancy-related changes in the body, the dosage of HIV medication may need to be adjusted during pregnancy.
• Mothers living with HIV are recommended to breastfeed their children in the same way as mothers without HIV, as long as they are taking ART and are adhering to the treatment.
  • It is especially important for breastfeeding mothers to adhere to their ART regimen. HIV can be passed to a child through breastmilk if an HIV-positive mother is not taking medication as directed.

 

Myths and facts about HIV and AIDS

 

Myth: Only certain people can get HIV and AIDS.

Fact: Anyone can get HIV, no matter their age, gender, income, religion, or ethnic group. There are famous religious leaders, artists, judges, politicians, athletes, and physicians with HIV.

Myth: People always die of HIV and AIDS.

Fact: With proper treatment, people with HIV and AIDS can live long and healthy lives.

Myth: People with HIV should not have children.

Fact: When HIV-positive pregnant people adhere to HIV treatment throughout their pregnancy and during breastfeeding, they can give birth to HIV-free children.

Myth: HIV and AIDS can be cured right now.

Fact: Currently, there is no proven cure for HIV. But modern antiretroviral medications allow HIV-positive people to live healthy lives with roughly the same life expectancy as those who are HIV-free.

 

Consequences of neglecting HIV and AIDS during the COVID-19 pandemic

 

Throughout the COVID-19 pandemic, efforts to address HIV and AIDS have been neglected, and progress on preventing and treating HIV prevention has stagnated as funding and research on HIV and AIDS has been re-directed to COVID-19 work.

The pandemic has also caused major disruptions in the availability of medication and the delivery of services, such as HIV testing and HIV prevention programs. The need to avoid close physical contact to prevent COVID-19 transmission, burnout among healthcare professionals, and disruptions in supply chains have all harmed efforts to address HIV and AIDS. In 2021, it was estimated that service disruptions because of COVID could increase AIDS-related deaths in sub-Saharan Africa by 500,000 over the following five years.

Despite these challenges, the lessons we learned from COVID-19 may provide some benefits. The rapid research and distribution of a COVID-19 vaccine provides a model for how to supply vaccines on a mass scale and could help push the development and delivery of an HIV vaccine.

 

New developments in HIV and AIDS treatment and prevention

 

Progress has continued on developing an HIV vaccine. In 2022, a new vaccine candidate* emerged, one that is safe and has the ability to create proteins that allow the immune system to resist specific viruses and bacteria. This is an exciting development, but much more work is needed before the vaccine can be considered for public use.

African nations are leading the world in offering PrEP. Sub-Saharan Africans account for more than half of the world’s PrEP users. In sub-Saharan Africa, the number of new users jumped from slightly over 4,000 in 2016 to more than 517,000 in 2020, representing 56 per cent of the global total. Of the 10 countries with the highest number of PrEP users, seven are in sub-Saharan Arica.

Sub-Saharan African countries have ensured that drugs are available to the general population, as well as to groups at greater risk of infection, such as men who have sex with men and sex workers. There are still opportunities to expand access in sub-Saharan Africa, such as making PrEP available at local pharmacies and better informing the public about these drugs.

 

Gender issues in HIV and AIDS

 

The burden of HIV and AIDS is unevenly distributed by gender. In 2021, women accounted for 63% of new HIV infections in sub-Saharan Africa. Girls and young women are particularly vulnerable. In 2021, women aged 15 to 24 years accounted for 25% of new HIV infections, despite making up only 10% of the population. AIDS-related illnesses were the leading cause of mortality among African women, and adolescent girls and young women were three times more likely than men to get HIV.

In several countries, women living with HIV often have limited access to care and treatment, despite having better treatment outcomes and a higher rate of use of ART than men. Some of the reasons women may delay taking ART are social and family obligations, pregnancy, stigma regarding their HIV status, and being unable to afford ART medication.

 

Definitions

 

Acute infection: A type of infection that develops quickly and lasts for a relatively short period of time.

Antiretroviral therapy (ART): A combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body.

CD4+ cell: A type of cell in the immune system that helps fight infection. Also known as a T cell.

Cognitive disorders: Mental health disorders that primarily affect cognitive abilities, including learning, memory, perception, and problem solving. The most common cognitive disorder caused by HIV is dementia, a condition that causes progressive mental deterioration due to generalized degeneration of the brain.

Drug harm reduction: A public health approach that seeks to reduce the health and social harms associated with addiction and substance use without necessarily requiring people who use substances from abstaining or stopping.

External condom: A thin, protective sheath that fits snugly over a penis or sex toy during sex to prevent pregnancy and/or the transmission of sexually transmitted infections. Also known as a male condom or just a condom.

Female condom: A soft plastic tube with a closed end that is inserted into the vagina to prevent pregnancy and/or the transmission of sexually transmitted infections. Also known as an internal condom.

Finger prick test: A method of medical testing using a lancet (small, sharp blade) to draw a drop of blood from a finger.

HIV positive: Having a positive result on a blood test for HIV, indicating that the HIV virus was detected in the blood.

HIV negative: Having a negative result on a blood test for HIV, indicated that the HIV virus was not detected in the blood.

Mother-to-child transmission: When HIV is passed from a woman with HIV to her child during pregnancy, childbirth, or breastfeeding (through breast milk).

PCR test: Polymerase chain reaction (PCR) tests detect genetic material from a pathogen or abnormal cell sample. Samples are collected in various ways, include nasal or saliva swabs, or a blood test.

Pre-seminal fluid: A liquid that squeezes out of the penis when aroused. It is similar to semen, but has distinct chemical differences and is sometimes called pre-ejaculate.

T cell: A type of cell in the immune system that helps fight infection. Also known as a CD4+ cell.

Vaccine candidate: A vaccine mixture that is being studied for its safety and ability to stimulate immunity to a particular infectious disease.

Virally suppressed: Having a very low viral load, to the point that HIV cannot be detected in the blood when tested. Often refers to the impact of ART.