
- hiv testing in pregnancy should be done early so as standard care can be taken for the pregnant women.


- this hiv testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with hiv-seronegative and also in pregnant women who are at a high risk of developing hiv infection.


- expedited hiv tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for hiv. The results of the test should be available in one hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.


- women who have not been able to be tested for hiv at the time of labor and delivery are suggested expedited screening for hiv. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental hiv tests are negative. In infants with positive hiv, prophylaxis should be discontinued and antiretroviral drug therapy should be started.


- in case of acute hiv infection during pregnancy, that is in the intrapartum period, or during breast feeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (dna, rna) are necessary for the diagnosis of the hiv infection.
- if the mother is hiv positive then this information must be documented in the infant's medical record and also communicated to the infants care provider.
The knowledge of an antenatal maternal hiv infection allows the:
- women with hiv infection to get the correct antiretroviral therapy along with prophylaxis for the infections which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
- when there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the hiv.
- the hiv infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the hiv.
- the hiv women should be counseled about the risk of breastfeeding.

Identification and Management of Perinatal HIV Treatment

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

HIV/AIDS is a STD 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 disorder caused by HIV infection. This disorder destroys the human immune system which might lead to other life- threatening diseases such as cancer. If diagnosed with HIV, one must necessarily maintain a healthy dietary regime because the nutrients one derives go on to contribute to the development of the immune system, thus providing resistance to the side effects of the HIV medicines.

The early symptoms of HIV/AIDS appear within a few weeks after sexual contact. The early symptoms include a headache, pain in the muscles and the joints, rashes and inflamed lymph nodes. The early symptoms tend to disappear within 2 to 3 weeks. The next set of symptoms might appear after a few years which might be persistent. The symptoms include fatigue, loss of body weight, inflated lymph nodes, fever and sweat during the 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 and Food Safety You Must Follow

An STD is transmitted by means of physical contact and intercourse. These diseases are caused by parasites, virus or bacteria. Usually, STDs are preventable provided you make the right choices concerning your sexual health. Refraining from sex isn t a feasible idea at all. 

But fortunately there are alternatives too to curb the menace that STDs are:

Abstain: The most effective way to avoid STIs is to abstain from sex.
Mutual monogamy: Two people who have sex only with one another don t have any opportunity to bring a new STD into the relationship. If you and your partner have been tested and are healthy, remaining faithful to each other is a very good way to reduce your chances of contracting an STD.
Get Vaccinated: One important prevention tool against STIs is vaccination. Currently, vaccines are available to protect against infection with HPV, hepatitis A and hepatitis B. Talk to your healthcare provider to see which vaccines might be recommended for you.
Protect Yourself: Condoms work really well in stopping most STIs from being passed from an infected partner to another when they are used consistently and correctly every time a person has oral, vaginal or anal sex. Consistently and correctly means that a person makes sure they use a condom every time they have oral, vaginal or anal sex and put it on and use it the right way.
Avoid alcohol and drug use: Avoiding alcohol and recreational drug use reduce the risk of contracting an STI, having an unwanted pregnancy, or being coerced to have sex. Alcohol and drug use can reduce our ability to make good decisions. It may also make us more likely to be talked into participating in an activity without being able to give our full consent.
Coping and Support
It's traumatic to find out you have an STI. You might be angry if you feel you've been betrayed or ashamed if there's a chance you infected others. At worst, an STI can cause chronic illness and death, even with the best care in the world.

Between those extremes is a host of other potential losses   trust between partners, plans to have children, and the joyful embrace of your sexuality and its expression. If in doubt, don't hesitate to visit a skin specialist or a physician.

STDs - 5 Ways You Can Avoid Them

Certain diseases are a major cause of concern as often these diseases can cause severe health complications. Various campaigns and awareness have been spread both by the government and NGOs for practicing safe sex to fight against these sexually transmitted diseases. Here are a few tips on how to avoid contracting sexually transmitted diseases.

1. Selective Abstinence: Selective abstinence is when people indulge in certain sexual activities, but limit in what they do to avoid the chances of contracting sexually transmitted diseases. People who do practice selective abstinence run a lower risk of contracting sexually transmitted diseases, which is also dependent on the type of sexual activity they indulge in as certain sexual acts have a higher chance of spreading STDs than others.

2. Using condoms: Using latex condoms decreases the chances of contracting sexually transmitted diseases. If you use lubricants, make sure that they are water based. Condoms are however not 100% effective at preventing sexually transmitted diseases, but reduce the chance of infection to a great extent. It is highly advised to learn how to properly use condoms.

3. Mutual monogamy: Another way to avoid getting infected by STDs is to practice mutual monogamy. If you and your partner do not have sex with anyone else, then it greatly reduces the chances of getting infected with sexually transmitted diseases.

4. Getting tested: Getting tested for sexually transmitted diseases as well as asking your partner to do so decreases the chances of transmitting sexually transmitted diseases. Refrain from having sex if either of you test positive.

5. Avoid alcohol and recreational drugs: Avoiding the usage of recreational drugs and alcohol reduces the chances of contracting STDs. Indulging in sexual activities while being highly intoxicated can both cause you to forget practicing safe sex.

6. Practicing healthy habits: Practicing certain healthy habits also reduces the chances of contracting sexually transmitted diseases. These include avoiding sharing towels and undergarments, washing before and after sexual intercourse and getting a vaccination for hepatitis B.

7. Low risk and high risk activities: Certain sexual activities such as open mouth kissing and hand to genital contact have a lower risk of infection. Other activities such as oral sex, vaginal intercourse, and genital to genital contact have a higher chance of infection. Understanding the risks better would allow you to avoid contacting diseases easily.

7 Tips to Avoid Sexually Transmitted Diseases

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!

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