HIV or the human immunodeficiency virus is a retroviral agent that causes the immune system of the body to weaken and lead to cause the acquired immune deficiency syndrome (AIDS). It is now treatable. Research is being conducted all over the world to formulate a targeted drug therapy for combating this life-threatening disease. No vaccine is available, which renders the world population highly susceptible to contract the infection.

HIV infection spreads from an infected person through contact with certain bodily fluids like blood and semen. Spread from one human being to another is called as transmission of HIV. Mother to child transmission, i.e. perinatal transmission is also common. Healthcare and hospital staff are at a great risk of occupational transmission. Other causes of transmission include sharing intravenous drug equipment, needle prick injury, organ transplantation and artificial insemination. Since vaccination and targeted drug therapy for remission are not available, prevention strategies play an important role in curbing the spread of infection.

A three-level prevention strategy is implemented for HIV infection.

Primary prevention- Activities that focus on prevention of uninfected people being infected.
Secondary prevention- Aimed at the provision of proper health care and behavioral facilities for HIV infected people like lifestyle changes, welfare rights advice, anti-discrimination measures.
Tertiary prevention- Aimed at minimizing the symptoms of an infected person; includes the provision of prophylactic drugs and complementary therapies.
The risk avoidance approach for transmission of HIV infection includes certain measures like practicing mutual monogamy & delayed sexual activity in the young population. Safe and appropriate use of syringes and needles is advised. Unnecessary blood transfusions should be completely avoided. Routine screening of HIV antibody should be done.

Risk reduction approach propagates the mandatory use of condoms during sexual intercourse. Sexually transmitted diseases should be treated to avoid the risk of transmitting infection. Sterile syringes should be used. If blood transfusion is necessary, then blood transfused should be evaluated well to meet the quality standards.

If HIV infection is suspected, anti-retroviral drug therapy should be started.
The only universally approved method of HIV transmission during sexual activity is the use of condoms.
Pharmaceutical methods for prevention and treatment include antibiotic drug therapy for sexually transmitted diseases, anti-retroviral drugs for infected individuals, pre and post-exposure prophylaxis and use of low space dead syringes.
Pre-exposure prophylaxis is advised for people who are at a higher than average risk of contracting the infection.
Drug therapy consisting of a combination of Tenofovir and Emtricitabine is prescribed, one per day.
Visit the physician at regular intervals and routine screening is done. Post-exposure prophylaxis is considered to be effective if the treatment is started within an hour of exposure, to effectively reduce the risk of seroconversion. A drug combination of Emtricitabine, Tenofovir and Raltegravir is given.
Social initiatives are undertaken to spread awareness and educate people regarding AIDS. Behavioral change and acceptance of social message is necessary to benefit from the social initiatives. Sex education, LGBT sex education and awareness, safe injection use programs, needle exchange programs, safe sex practice education are some social strategies implemented.
Prevention of transmission of HIV from mothers to children involves anti-retroviral drug therapy during pregnancy and post birth in the newborn child. Breastfeeding is avoided and bottle feeding is advised.

HIV Transmission - How Can It Be Prevented?

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?

What is Monogamous Relationship?

You (who have been tested for STD/STIs and don't have any) are having sex with only one partner (who also has been tested for STD/STIs and doesn't have any) who only has sex with you. And you both keep it that way! 

Stated another way, you are both STD/STI free and only have sex with each other. People of any sexual orientation can engage in monogamous relationships. The only thing implied by the term monogamy is that the relationship consists of two people who are romantically and/or sexually exclusive. Theoretically, outside of abstinence, this is really the safest type of "safer sex" that you can have. 

Celebrated on 1st December of each year, World AIDS Day, aims to spread awareness about HIV / AIDs. It is an STD wherein, HIV stands for human immunodeficiency infection and AIDS stands for acquired immune deficiency syndrome. The disease hinders the immune system in keeping up our body s security against sickness. HIV causes individuals to end up wiped out with infections that regularly would not affect them and HIV leads to AIDS.

Understanding the Symptoms:

HIV has few or no signs or symptoms for up to ten years or more before side effects of AIDS tends to manifest. There is no cure for HIV/AIDS, yet treatment is accessible. A few people have HIV symptoms not long after being infected. These include:

There are a few phases of HIV illness. The primary HIV side effects may include swollen glands in the throat, armpit, or crotch.
Other early HIV symptoms incorporate slight fever, headaches, exhaustion, and muscle throbs.
These symptoms may keep on going for just a couple of weeks. At that point, there are typically no HIV indications for a long time. That is the reason it can be difficult to know whether or not a person is suffering from HIV.
The symptoms of AIDS show up in the most advanced phase of the HIV disease. These are as follows:

Along with a severely damaged immune system, a person with AIDS may likewise have thrush. A thrush is a thick, whitish covering on the tongue that is brought about by a yeast infection and now and then joined by a sore throat.
Serious or repetitive vaginal yeast infection.
Pelvic inflammatory illness.
Serious and frequent infections.
Unexplained fatigue that might be followed by headaches, dizziness.
Loss of more than ten pounds of weight that is not because of physical exercise or consuming fewer calories.
Risk Factors: There are a lot of ways in which you can get the infection. HIV is transmitted through blood, semen, vaginal fluids and breast milk. The most well-known ways in which HIV is spread, are:

Having sexual intercourse without a condom with somebody who has HIV/AIDS.
Using needles or syringes that have been used by someone who has HIV/AIDS.
Being punctured with a needle or surgical instrument that has been contaminated with HIV.
Getting HIV blood, semen or vaginal discharge into open injuries or wounds.
Babies born to women with HIV/AIDS can get HIV from their mothers during birth or from breastfeeding.
There are numerous ways in which you can protect yourself from HIV. These are as follows:

The most secure way is to limit the number of sexual partners you take on.
Try to have safer sex and always use protection.
Get your partners tested for HIV.
HIV tests are a typical piece of social insurance.
In case that you think you may have been infected by HIV, talk to a specialist or a doctor about testing. Discussing what risks you might have taken can help you choose whether testing is ideal for you.

This World AIDS Day - Let's Spread the Awareness About HIV/AIDS

One of the most common physically transmitted diseases is chlamydia. Chlamydia is a type of infection caused by the bacteria "Chlamydia trachomatis". The symptoms of Chlamydia are similar to the symptoms of Gonorrhoea (a bacterial sexually transmitted infection). Chlamydia infection causes permanent fallopian tube damage in women, leads to future ectopic pregnancy (the fertilised egg attaches itself outside the uterus) and infertility.

Symptoms of Chlamydia 
Men and women afflicted with chlamydia exhibit different symptoms.
The symptoms of chlamydia in women include:
1. Abnormal, sometimes foul-smelling, vaginal discharge
2. Bleeding between menstrual cycles
3. Painful periods
4. Abdominal pain, accompanied with fever
5. Pain during intercourse
6. Burning or itching around or in the vagina
7. Painful urination

Men usually display the following symptoms if they have chlamydia:
1. Minimal amounts of cloudy or clear discharge from the head of the penis
2. Painful urination
3. Itching and burning around the slit of the penis
4. Swollen and painful testicles

Treatment options available
1. Chlamydia is diagnosed by taking a swab from the cervix (in women) or the urethra (in men). These swabs will be sent to the laboratory for analysis. Urine samples can also be taken to check for the appearance of bacteria.

2. Since chlamydia is a bacterial infection, it can be easily treated with antibiotics. Oral antibiotics such as azithromycin or doxycycline are commonly prescribed by doctors. Azithromycin is usually prescribed in a large, single dose. The dose may also be stretched out for five days. Doxycycline is taken two times daily for a week.

3. With the right antibiotic therapy, the infection will clear up in 1 to 2 weeks approximately. It is very important that you finish the medication course if you wish you heal completely without having to suffer from further bouts of this disorder.

4. Women with critical chlamydia may need hospitalisation, pain medicine and IV (intravenous, or directly through the vein) antibiotics. Pregnant women with chlamydia infection can be safely cured with antibiotic such as erythromycin ethylsuccinate, amoxicillin and azithromycin.

Your partner needs testing and treatment as well to avoid further spread and reinfection. It is vital not to engage in any sexual activity while the treatment is ongoing. A further retest should be done three months later to make sure the infection is rectified.

Symptoms of Chlamydia and Ways to Treat the Disease

The year 2014 has seen a massive increase in the number of patients affected by Gonorrhoea. The most infected age group is between 15 and 24. This is mainly due to lack of knowledge in this age group about the disease. Here are some facts about Gonorrhoea that one must know.

Gonorrhoea Transmission
Gonorrhoea, also known as drip, is transmitted when a normal person comes in contact sexually with an infected person. Infected fluid of a mother can also pass to her newborn infant during delivery. The disease can affect both the genders.

Cause of Gonorrhoea
Neisseria gonorrhoeae bacteria cause the disease. The bacteria grow in mucus membranes and usually grow in the warm and moist areas of humans' reproductive tracts such as uterus and fallopian tube of women. These can also grow in anus, mouth as well as throat. As a matter of fact, the infection can be passed even via oral or anal sex.

Symptoms of Gonorrhoea
An infected person will develop symptoms of the disease in 2 to 14 days. Men may feel burning or painful sensation while urinating. Other symptoms are as follows:

1. Swollen and painful testicles
2. Swollen or redness at the tip of the penis
3. Penis may have a drip or discharge
4. Frequent urination
5. Recurrent soreness of throat

Females have milder symptoms of the infection. This makes it difficult to diagnose, and is sometimes misinterpreted as common vaginal yeast or other bacterial infection.

Following are a few symptoms of the disease in women:

1. Burning or painful urination
2. Frequent urination
3. Vaginal discharge
4. Soreness in throat
5. Fever
6. Lower abdominal pain
7. Pain while sexual intercourse

If the disease is not treated, infection spreads in blood stream leading to rashes, fever and even pain in the joints. Such unnoticeable symptoms make it difficult to treat.

Testing Methods of Gonorrhoea
One method is that penile or vaginal discharge samples are taken from patients and examined under a microscope by adding reactive stain. However, this is not an accurate assessment.
Another test is conducted where exposing samples are incubated. In case of infection, colony of gonorrhoea shows growth. Preliminary test may take 24 hours. Final assessment may take around three days. Samples can be from the patient's anus, joint fluid, blood, throat, vagina or tip of the penis.

Treatment
The disease is treatable under proper medical supervision. However, the bacterial resistance to Azithromycin drug has made it more difficult for treatment.

Protection
It is highly recommended to have a protected intercourse. Women of age group less than 25 need to have STI evaluation once a year.

Know All About Gonorrhoea

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!

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