HIV: QUICK FACTSIntroductionThe human immunodeficiency virus (HIV) is a subgroup of retrovirus (lentivirus) that causes HIV infection. After a period of time, this infection leads to what is called acquired immunodeficiency syndrome (AIDS).

Epidemiology

According to the Centers for Disease Control and Prevention (CDC), from 2010-2015, the estimated rate of HIV infection in all 50 US states decreased from 14.2 per 100,000 population in 2010 to 12.3 per 100,000 population in 2015. In 2015, 39,513 individuals were diagnosed with HIV infection. From 2010 to 2014, the annual number of new HIV infections decreased by 9%.

Virology HIV-1 and HIV-2 are retroviruses in the Retroviridae family, Lentivirus genus. They are enveloped, diploid, single-stranded RNA viruses with a DNA intermediate.Upon entry into the target cell, the viral RNA genome is converted into double-stranded DNA by an enzyme, reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded enzyme, integrase. HIV contains three retroviral genes, namely gag, pol, and env.

Gag gene: Encodes group-specific antigen; the inner structural proteins
Pol gene: Encodes polymerase; it also contains integrase and protease
Env gene: Encodes the viral envelope, the outer structural proteins responsible for cell-type specificity. Glycoprotein 120, the viral envelope protein, binds to the host CD4+molecule
Pathophysiology

HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells and leads to cellular immune deficiency. This results in the development of opportunistic infections and neoplastic processes.

Mode of Transmission
Sexual intercourse: Unprotected sexual intercourse; especially receptive anal intercourse and different sexual partnersContact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids infected with the virus.Spread from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid.

Signs and Symptoms There are 3 categories of infection 

Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions
Category B: HIV infection with symptoms that are directly attributable to HIV infection
Category C: HIV infection with AIDS-defining opportunistic infections
Investigation

A high-sensitivity enzyme-linked immunosorbent assay (ELISA) should be used for screening.

Management

Start with antiretroviral therapy (ART) in all HIV-infected adults ready to start therapy. 
CD4 count is no longer a criterion for starting the therapy.
Use of nucleoside reverse transcriptase inhibitors and protease inhibitors.
For refractory cases, during the failing treatment regimen and before switching therapy, use rapid confirmation, perform resistance testing and reevaluate.

HIV - Quick Facts Need To Know!

The human immunodeficiency virus or hiv is a virus which causes hiv infection and leads to" acquired immunodeficiency syndrome" or aids. Hiv is transmitted by different means and ways.


Unprotected sex is a primary mode of transmission of the hiv virus from an infected person to a healthy person. Unprotected sex refers to having sexual intercourse without using a condom or any other mode of protection. It leads to hiv transmission along with other sexually transmitted infections.


How does hiv occur from unprotected sex?
While having sex without protection, the hiv present in the body fluids such as blood, sperm, vaginal fluid, pre-cum or anal mucus of an hiv infected patient can pass on to the body of his/her partner. The transmission occurs through the membranes of the penis in men, vagina in women, the rectum and also through mouth and throat. It is more likely for an hiv patient to pass on the virus during the first few months after getting infected. This is because the virus spreads over body fluids during this stage.


Which types of sex are more risky?
Hiv is transmitted the most by having vaginal or anal sex. Anal sex accounts for being the riskiest because the lining present in the anus is much more delicate than the vaginal lining. It is prone to more damage, easily. There are two types of anal sex: receptive anal sex and insertive anal sex. Receptive anal sex is more risky.


Hiv can also be acquired from oral sex. This can happen in case the person giving oral sex has ulcers in the mouth, sore and bleeding gums. In case the person receiving the oral sex is already infected, the other person gets hiv.


A person who has sex with multiple partners regularly is at a high risk of getting hiv because of unprotected sex.


Prevention
Getting hiv from unprotected sex can be avoided if you use these precautions:


- condoms
Condoms offer the precaution against hiv infection from anal or vaginal sex. They should be used by men before any kind of sexual contact to restrict the passing of semen or fluid, which may be infected by hiv.


- lubricants
Sex is made easier by using lubricants and reduces the risk of tearing in the vagina or anus due to friction. The risk of a condom breaking is reduced using lubricants.


- dental dams
This is another precautionary device, which is a small sheet of plastic. It has to be placed to cover the mouth of the vagina or anus and reduce the risk of hiv transmission.
Unprotected sex is the primary cause of hiv and people who do not take precautions before sex are likely to be infected by hiv.

HIV and Sex

For nearly 30 years, HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) have been shrouded in myths and misconceptions. In some cases, these mistaken ideas have prompted the very behavior that cause more people to become HIV positive. Here are the top five myths about HIV, along with the facts to dispute them.

Myth No. 1: I can get HIV by being around people who are HIV-positive.

The evidence shows that HIV is non communicable and does not spread through touch, tears, sweat or saliva. You cannot catch HIV by:

    Breathing the same air as someone who is HIV-positive
    Touching a toilet seat or doorknob handle after an HIV-positive person
    Drinking from a water fountain
    Hugging, kissing, or shaking hands with someone who is HIV-positive
    Sharing eating utensils with an HIV-positive person
    Using exercise equipment at a gym

You can get it from infected blood, semen, vaginal fluid, or mother's milk.

Myth No. 2: I can get HIV from mosquitoes.

Because HIV is spread through blood, people have worried that biting or bloodsucking insects might spread HIV. Several studies, however, show no evidence to support this, even in areas with lots of mosquitoes and cases of HIV. When insects bite, they do not inject the blood of the person or animal they have last bitten. Also, HIV lives for only a short time inside an insect.

Myth No. 3: I'm HIV positive, my life is over.

In the early years of the disease epidemic, the death rate from AIDS was extremely high. But today, antiretroviral drugs allow HIV positive people and even those with AIDS to live much longer, normal and productive lives.

Myth No. 4: My partner and I are both HIV positive there's no reason for us to practice safer sex.

Practising safer sex, wearing condoms or using dental dams can protect you both from becoming exposed to other (potentially drug resistant) strains of HIV.

Myth No. 5: You can't get HIV from oral sex.

It's true that oral sex is less risky than some other types of sex. But you can get HIV by having oral sex with either a man or a woman who is HIV positive. Always use a latex barrier during oral sex.

Top 5 Myths & Misconceptions About HIV & AIDS!

The HIV (human immunodeficiency virus) is a critical disease. This virus invades a person's immune system which is the body's defense against infections such as viruses and bacteria. The immune system doesn't work properly and becomes deficient once attacked by HIV. One social acknowledgement to HIV that has gained enough recognition is the HIV counselling due to the crucial need to counsel the patient about sexual behavior and the risks associated with it. 

Importance of HIV counselling 
The human immunodeficiency virus has become an epidemic in nature and has reached to a distressing proportion worldwide as it is in its third decade. Thus, counselling becomes remarkably crucial part of the treatment. 

HIV prevention counselling is a significant mode of behavioral invasion particularly in the deficiency or lack of an effective curative treatment or vaccine. HIV counselling varies from other forms of counselling sessions. Apart from being a health obstacle, the disease is equally overwhelming for the family as well as people around you. family. It is also connected with endless and intense human suffering which stimulates multiple emotional responses. Such reactions involve self-denial, grief, fear, loss, anxiety, anger, annoyance, depression self-blaming, pity, self-condemnation isolation and suicidal thoughts. 

Also, the risk of passing the virus to the partner during sexual activity is high and the patient must be aware of safe sex and the risks associated with unprotected sex. Hence, counselling becomes paramount. 

Counselling session s information Self-care counselling: 
The patient must be well informed about the disease and should be supported in embracing attitudes, actions, and beliefs which will defend and serve as a protective shield to the body s immune system. Improving, enhancing, and transforming nutrition is required. A few other things that are emphasized are, encouraging physical activity, avoiding objects, actions, and events that threaten the body, overcoming anxiety and stress that compromise the psychological, mental, physical and welfare of the body, and seeking and giving support for self-care. 

Types of counselling: 

Patient centered counselling: It changed the focus of counselling from a single informative one to one that concentrated on a patient s circumstances and needs. This involved active listening, to render better support and managing client's particular prevention needs. 
Risk reduction counselling: This includes examining client s awareness about sexual activity and their feelings.Using their current HIV knowledge as an appealing tool, the limitations they have for protected sex is discussed. A better understanding is ensured in the patients so that unsafe behaviors can be avoided. 
Grief counselling: People who are contaminated with HIV have an elevated risk of acquiring depression. Counselling helps you to deal with any emotional outburst. 
Aims of counselling in HIV infection-

Prevention is the first purpose of HIV counselling. It decides whether the lifestyle puts that individual at a higher risk. Helping to recognize and distinguish the definitions of high-risk behavior. The counselling contributes to behavioral change and also aims at working with the person and his family to obtain and sustain that change in approach and behavior.

HIV Counselling - Why It Is Important To Get It?

Spread of HIV infection from a woman who has transmits HIV to her child during pregnancy, childbirth (labor and delivery), or breastfeeding (breast milk) is called as  Mother to child  transmission (MTCT) of HIV. It is also termed as the perinatal transmission of the HIV infection or  vertical  transmission. In the absence of medical intervention, perinatal transmission rates are very high, between 20-45% in different parts of the world. In various regions of the African subcontinent a large number of HIV infected children are present. It is a major cause of deaths in teens and adolescents in that region. 

Almost 90% of all HIV infected children live in the sub-Saharan Africa. In some districts of AP, Karnataka, Maharashtra and TN that were highly HIV-prone, we have several HIV infected children and adolescents. The virus replicates in the body and affects the immune system. Due to decreased immunity, various opportunistic infections enter the body and cause AIDS related symptoms. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. MTCT HIV infection can be prevented with adequate measures by way of Anti-retroviral treatment (ART). All expecting mothers who are HIV infected should have access to the preventive medical services throughout the gestation period, during labor and also during breastfeeding. 



Proper provision of resources with skilled staff and awareness programs can help in avoiding new infection cases. Breastfeeding is the primary source of transmission of infection from mother to child. Basically, once ART is started in an HIV infected pregnant woman that should continue forever. With proper ART course, chances of MTCT are near Zero. At the Unison Medicare & Research Centre; which is India s first fully comprehensive clinic for HIV Care and infectious Diseases, during last decade, not a single MTCT has occurred after treating more than 160 such HIV infected mothers. Even prior to that MTCT rate was lower than 1%. Our motto has been making the mothers virally suppressed commensurate with the global principle of  Undetectable = Untransmittable ! In fact now more and more HIV infected couples have been coming forward for an elective pregnancy. Even HIV un-infected children orphaned by AIDS or living with sick caregivers are at the great risk of emotional and physical abuse, which in turn increases the child s vulnerability to HIV infection. 

Reduction of risks to these vulnerable children is of great importance and various programs are being implemented for the welfare of orphans and vulnerable children. Various risk factors that are implicated in the transmission of HIV infection from mother to child are as follows: 

Increased viral load 
Genital tract viral load 
Reduced CD4 cell count 
Unprotected sexual intercourse with infected partner 
Smoking, Substance and drug abuse 
Deficiency of Vitamin A and other essential nutrients 
Presence of other Sexually transmitted diseases (STDs) 
Pre-term delivery 
Placental disruption 
Invasive monitoring of the fetus 
Breast feeding In most cases, HIV will not cross through the placenta from mother to baby. 
In an otherwise healthy mother, risk of child getting infected is low. Prenatal visits shouldn t be increased until a complication arises. The physician should observe symptoms of AIDS and pregnancy-related complications on a regular basis. HIV may be the direct cause or a marker of a complex interaction of related medical and social conditions that affect pregnancy. Most HIV positive women are usually asymptomatic and have no major obstetrical problems during their gestation period. They should receive similar obstetric antenatal care as the HIV-negative women, unless indicated by the need to provide specific treatment for HIV related conditions. There is no evidence of a need to increase the number of antenatal visits, provided there are no complications of the HIV infection, although additional counseling sessions may be required to reassure the mother and family. 

Care of the HIV positive woman during pregnancy should include ongoing counseling and support as an integral part of the management. Invasive diagnostic procedures, such as chorionic villus sampling, amniocentesis or cordo-centesis should be avoided wherever possible, due to a possible risk of infection of the fetus. In case you have a concern or query you can always consult an expert & get answers to your questions!

How Can We Achieve HIV-Free Generation?

HIV/AIDS is a type of sexually transmitted disease which is caused by the Human Immunodeficiency Virus (HIV). The HIV virus attacks the immune system and makes the body vulnerable to other diseases. AIDS is the last stage of the HIV infection; HIV takes about 10 to 12 years to fully culminate into AIDS. AIDS completely destroys the immune system and leads to fatal health conditions and diseases such as cancers and other infections because of AIDS.

Causes-

HIV is a retrovirus that infects the vital organs of the human immune system. The virus progresses in the absence of antiretroviral therapy. The rate of virus progression varies widely between individuals and depends on many factors (age of the patient, body s ability to defend against HIV, access to healthcare, existence of coexisting infections, the infected person s genetic inheritance, resistance to certain strains of HIV).

HIV can be transmitted through:

Sexual Transmission. It can happen when there is contact with infected sexual secretions. This can happen while having unprotected sex, including vaginal, oral and anal sex or sharing sex toys with someone infected with HIV.
Perinatal Transmission. The mother can pass the infection on to her child during childbirth, pregnancy, and also through breastfeeding.
Blood Transmission. The risk of transmitting HIV through blood transfusion is nowadays extremely low in developed countries, thanks to meticulous screening and precautions. Among drug users, sharing and reusing syringes contaminated with HIV-infected blood is extremely hazardous.
Contrary to popular belief, HIV can never spread by means of kissing as the virus cannot survive outside the body.

Symptoms-

The early symptoms of HIV appear within a few weeks of contamination by the virus. The early symptoms include headache, pain in the muscles and the joints, rashes and inflated lymph nodes. These symptoms tend to disappear within 2 to 3 weeks.
The next set of symptoms might appear after a few years and these are persistent. The symptoms include, but are not limited to fatigue, loss of body weight, inflated lymph nodes, fever, a sensation of numbness near the limbs, pain when you try to swallow, sores in the mouth and sweating at night.
If you are diagnosed with HIV, you should:

Try to maintain a daily diet containing vegetables, legumes, and fruits which provide you energy.
Try to include a little bit of fat, carbohydrates (at least 3 servings of vegetable per day), calcium (dairy products) and low-fat protein sources (generally 80-150 gram per day of fish, skinned chicken, low-fat cheese etc.) in your everyday meal.
Maintain a daily calorie intake of 17-25 calories per pound depending on whether the person is losing weight.
Vitamins and minerals are particularly necessary to repair the cells damaged by the HIV virus.
So, it is necessary to intake foods such as eggs, milk, peanuts, green vegetables, meat, beans and broccolis on a regular basis, if you have been diagnosed with HIV.

If you are suffering from HIV, you must maintain the following food safety measures:

You should try to restrict the intake of fat
Restrict your alcohol intake
You should try to avoid fast foods
You should also limit your regular sugar intake and should avoid foods with extra sugar

HIV/AIDS - Diet, Nutrition & Food Safety You Must Follow!

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