HIV

 

Introduction

HIV stands for Human Immunodeficiency Virus

 

HIV is a virus that attacks the immune system, and weakens your ability to fight infections and disease. It's most commonly caught by;

Having sex without a condom.

Sharing infected needles and other injecting equipment

From an HIV-positive mother to her child during breastfeeding.

 

There is no cure for HIV, however there are treatments to enable most people whom have the virus to live a long and healthy life.

 

AIDS stands for Acquired Immune Deficiency Syndrome

AIDS is the final stage of the HIV infection, when your body can no longer fight life-threatening infections. With early diagnosis and effective treatment, most people with HIV will not go on to develop AIDS.

 

How common is HIV?

At the end of March 2015, there were an estimated 4967 people in Scotland living with HIV. The majority were infected through sex! An estimated 70% of cases since 2004 have been from gay & bisexual men or men who have sex with men (MSM)

An estimated 25% of people with HIV do not know they are infected.

The World Health Organization estimates that around 35 million people in the world are living with HIV and is more common in many sub-Saharan African countries.

 

How is HIV Transmitted?

HIV is found in the bodily fluids of an infected person, which includes semen, vaginal and anal fluids, blood, and breast milk. It is a fragile virus that does not survive for long outside the body.

HIV cannot be transmitted through saliva, sweat or urine.

 

Sexual contact

The main routes of HIV transmissions are unprotected vaginal and anal sex. It is also possible to catch HIV through unprotected oral sex, but the risks are much lower (estimated 0.004% risk).

Performing oral sex on a man with HIV carries some risk, particularly if he ejaculates (cums) in your mouth and/or you have ulcers, bleeding of the gums or other infections.

It is also possible to catch HIV by performing oral sex on a woman with HIV, particularly if she is having a period, although this is considered to be extremely low risk.

 

Other risk behaviours

Other ways of getting HIV include:

Sharing needles, syringes and other injecting equipment

From mother to baby by breastfeeding

Sharing sex toys without cleaning or using a condom

Healthcare workers accidentally pricking themselves with an infected needle (this risk is extremely low)

Blood transfusion (now very rare in the UK, but still a problem in developing countries)

 

How HIV infects the body

The virus enters cells in the immune system called CD4 cells, which protect the body against viruses, bacteria and other germs causing progressive damage and eventually making it unable to fight off infections.

It uses the CD4 cells to make thousands of copies of itself. These copies then leave the CD4 cells and go on to produce even more.

This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working.

 

Symptoms of HIV

Most people who are infected with HIV experience a short, flu-like illness or unexplained rash that occurs two to six weeks after infection. After this, HIV often causes no symptoms for several years.

The illness that often occurs a few weeks after HIV infection is also known as seroconversion illness. It's estimated that up to 80% of people who are infected with HIV experience this illness.

The most common symptoms are:

fever (raised temperature)

sore throat

body rash

Other symptoms can include:

tiredness

joint pain

muscle pain

swollen glands (nodes)

The symptoms usually last 1 to 2 weeks but can sometimes be longer. They are a sign that your immune system is putting up a fight against the virus.

However, these symptoms are extremely common and caused by conditions other than HIV, and do not mean you have the virus.

If you have several of these symptoms, and you think you have been at risk of HIV infection within the past few weeks, you should get an HIV test.

After the initial symptoms disappear, HIV will often not cause any further symptoms for many years. During this time, known as asymptomatic HIV infection, the virus continues to be active and causes progressive damage to your immune system. During which you will feel and appear well.

Once the immune system becomes severely damaged symptoms can include:

weight loss

chronic diarrhoea

night sweats

skin problems

recurrent infections

serious life-threatening illnesses

Earlier diagnosis and treatment of HIV can prevent these problems.

 

Preventing HIV

Anyone who has sex without a condom or shares needles is at risk of HIV infection.

The best way to prevent HIV is to use a condom for sex and to never share needles or other injecting equipment (including syringes, spoons and swabs). Knowing your HIV status and that of your partner is also important. Keeping this up to date is essential, so it is recommended you get a test at least every 3 months.

For people with HIV, effective antiretroviral therapy (ART) significantly reduces the risk of passing HIV to your sexual partners.

 

PrEP

Pre-Exposure Prophylaxis (PrEP) is now available through the NHS for some people living in Scotland. PrEP is usually a pill you take daily to prevent you from becoming HIV+ to get more information on PrEP please visit https://www.iwantprepnow.co.uk/ or visit your local GUM Clinic.

 

Emergency HIV drugs

If you think you have been exposed to the virus within the last 72 hours (three days), anti-HIV medication may stop you becoming infected.

For it to be effective, the medication, called post-exposure prophylaxis (PEP), must be started within 72 hours of coming into contact with the virus, but the sooner the better. The longer the wait, the less chance of it being effective.

PEP is only recommended following higher risk exposure, particularly where your sexual partner is known to be positive and not undetectable.

PEP has been widely called a “morning-after pill” for HIV – a reference to the emergency pill women can take to prevent getting pregnant after having unprotected sex.

But this claim is entirely false. PEP is a month-long treatment, which may have serious side effects and is not guaranteed to work. The treatment involves taking the same drugs prescribed to people who have tested positive for HIV for 28 days. Stopping the treatment before the 28 days will drastically reduce its chance of being effective and you could still become HIV positive.

You should be able to get PEP from:

sexual health clinics, or genitourinary medicine (GUM) clinics

hospitals – usually accident and emergency (A&E) departments

 

Getting tested for HIV

Seek medical advice as soon as possible if you think you might have been exposed to HIV.

The only way to find out if you have HIV is to have an HIV test. This involves testing a sample of your blood or saliva for signs of the infection.

An early HIV diagnosis means you can start treatment sooner, which can improve your chances of controlling the condition long term.

HIV tests may need to be repeated one to three months after potential exposure to HIV infection, this is known as the ‘window period’, but you shouldn't wait this long to seek initial help!

You can get tested in a number of places, including your;

GP surgery

sexual health clinic

clinics run by charities

home-testing or home-sampling kits are available to buy or order online or from pharmacies – depending on the type of test you use, your result will be available in a few minutes or a few days.

 

If you test positive

If your first test suggests you have HIV, a further blood test will need to be carried out to confirm the result, as initial tests can show a false positive. If the second test is positive, you'll be referred to a specialist HIV clinic for some more tests (viral load and CD4 count) and a discussion about your treatment options.

 

If you are diagnosed with HIV, you will have regular blood tests to monitor the progress of the HIV infection before starting treatment.

This involves monitoring the amount of virus in your blood (viral blood test) and the effect HIV is having on your immune system (CD4 count).

Treatment is usually recommended to begin when your CD4 cell count falls towards 350 or below, whether or not you have any symptoms. In some people with other medical conditions, treatment may be started at higher CD4 cell counts. In recent years prescription for prevention has been used for many people living with HIV. This means, as long as it does not affect your own health, you could be offered medication before your CD4 count reaches lower levels. The aim of this is usually towards people that are highly sexually active as reducing the viral load decreases the possibility of passing on the virus to others.

When to start treatment should be discussed with your doctor.

 

The aim of the treatment is to reduce the level of HIV in the blood, allow the immune system to repair itself and prevent any HIV-related illnesses.

If you are on HIV treatment, the level of the virus in your blood is generally very low and it is unlikely that you will pass HIV on to someone else.