Diseases & Conditions

 

Acquired Immune Deficiency Syndrome

Diseases & Conditions

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV) that destroys the body’s natural protection from illness. HIV attacks and destroys white blood cells known as T-helpers that are essential to the body's immune system. The immune system weakens to the point where it can be invaded by "opportunistic" infections and certain cancers. These infections would not cause problems for healthy people. For people with AIDS, they may cause serious or even life-threatening problems.1

Since the beginning of the epidemic, almost 78 million people have been infected with the HIV virus and about 39 million people have died of HIV. Globally, 35 million people were living with HIV at the end of 2013.2

To date, Saudi Arabia remains a country with low HIV infections, with approximately 1.5 newly detected HIV infections per 100,000 per year among Saudi nationals, and 1.2 per 10,000 among non-Saudis according to the 2014 national AIDS program manager for Saudi Arabia.3

How is HIV transmitted?

One can get infected with HIV from anyone who is infected, even if they don’t look sick and even if they have not tested HIV positive yet.4

The main ways that HIV can be transmitted from one person to the other are:

  • Through unprotected sexual contact (anal or vaginal sex without a condom)
  • By sharing needles or other equipment (to inject drugs, to get a tattoo, piercing, etc.)
  • Mother-to-child transmission if the mother was pregnant
  • Mother-to-child transmission through breastfeeding

HIV is not usually spread through normal day-to-day contact, like:

  • Touch
  • Handshakes
  • Sitting with others
  • Embracing
  • Kissing
  • Eating with others

 

Therefore, HIV cannot be spread through ordinary social contact or by coughing or sneezing. In other words, HIV is only transmitted through the ways mentioned above. Therefore, patients with HIV should live their lives as normally as possible in the society.

How HIV transmission can be prevented?

A person must be aware that it is impossible to detect someone's HIV-infection status simply from his or her physical appearance. Individuals who look perfectly clean and healthy may be infected even if they are unaware of it themselves and hence, capable of infecting others. In order to prevent HIV transmission, one should know his partner very well, understand which sexual acts put them at most risk, one must always use a condom during penetrative sexual acts, and consider carrying sterile disposable needles and syringes for personal use (in case of diabetes for example to inject insulin).5

What are the symptoms and signs of AIDS?

HIV infection comes in three stages:6

  1. The first stage is called acute infection, and it typically happens within two to six weeks after exposure or becoming infected. During this first stage, a person can show symptoms similar to a normal flu like headache, diarrhea, nausea and vomiting, fatigue, aching muscles, sore throat, and fever.
  2. The second stage is a period without symptoms during which the HIV is destroying the body’s defence. During this period, people may not know they are infected and can transmit HIV to others.
  3. The third stage appears when the virus had killed the majority of the T-helpers white cells. At this stage, a person is diagnosed with AIDS. 

How is HIV detected?

If a person has HIV, their body will make antibodies to fight it. These antibodies will be detected in a blood test. Therefore, the standard tests to determine whether a person is infected with HIV are based on detection of antibodies to HIV in the blood, not of the virus itself. 7

Two main tests used to find antibodies to HIV are:

  • Enzyme-linked immunosorbent assay (ELISA)
  • Simple rapid (S/R) tests

If the result of these screening tests was negative, the person is considered HIV-negative and no further tests are required. However, if these tests resulted positive, the results must be confirmed. Confirmatory tests must be done such as the Western Blot or line immunoassays (LIA) in order to obtain a reliable result and to avoid errors.

How is HIV treated?

Enormous advances in HIV/AIDS treatment have been made in the past three decades. HIV/AIDS which was initially considered as a death sentence is now perceived as a chronic manageable condition. The introduction of antiviral treatment regimens has changed the landscape of this disease. Approximately, 25 drugs have been approved for the treatment of HIV offering flexibility in the choice of drugs to suit individual needs of each patient. Current medications do not eliminate the virus from the body but tend to decrease its amount in the blood, thereby reducing the mortality rate. The best standard of care is to use combinations of antiretroviral drugs rather than one medication. This will help to fight the virus even if the other drug fails. However, use of combination therapy may cause side effects as well as the many number of pills can be cumbersome for patients. Not taking medications as prescribed is one of the main reasons for treatment failure and can lead to drug-resistant strains of HIV.

HIV pill burden has gradually decreased over the past few years, from taking a cocktail of drugs to one-pill-a-day, thus increasing patient adherence. The development of new drugs to combat HIV took into consideration the numerous mutations of the virus that can contribute to make HIV resistant to treatment.8

In addition to HIV/AIDS medications, it is important to consider drugs for prevention and treatment of opportunistic infections.

HIV vaccines:

The development of a vaccine against HIV is very complicated and has many obstacles to overcome. The major impediment is the HIV’s high mutation rate. The virus evolves very quickly and the immune system cannot make effective antibodies to fight it. In addition, there is no animal model that perfectly replicates the process of HIV infection as seen in humans. Despite these difficulties, studies to develop an effective HIV vaccine continue and the eradication of the disease might be achieved by finding one.9

Can a patient live a normal life with HIV?

Yes, all studies have shown that:

  • The virus is not transmitted through casual contacts. Therefore, family members are not at risk of becoming infected through everyday social contact.10
  • It is perfectly fine to wash your laundry with other people's clothes and use the same dishes and eating utensils
  • It is highly recommended to use latex condoms during sexual intercourse
  • The body should be washed immediately after contact with blood or other body fluids (urine or feces). Blood-stained clothes must be cleaned or hand-washed using detergent with bleach
  • Sharing toothbrush or razor with someone else is not recommended
  • You can use the same toilet as others but it is recommended to use personal towels
  • Soiled sanitary napkins should be placed in a plastic bag for disposal in conventional garbage
  • It is recommended to eat healthy and complete meals. There is no need for special diets, or particular foods

Medications should be taken exactly as prescribed by the doctor.

It is very important to talk with a trusted healthcare professional if you are worried or concerned or have some practical issues you would like to discuss.

Are there any special measures to be taken if a child is infected with HIV?

  • It is very important to encourage HIV-positive children to have a positive outlook on life.
  • If a baby has HIV, his diapers should be washed thoroughly and disposed in conventional garbage.
  • HIV-positive children should attend school in the regular classroom and take part of all activities.
  • It is very important that HIV-positive children take their medicines as directed.

 

References

  1. Fauci, Anthony S. "HIV and AIDS: 20 years of science." Nature medicine 9.7 (2003): 839-843.
  2. HIV/AIDS (WHO). http://www.who.int/gho/hiv/en/ (Accessed December 1, 2015)
  3. "GLOBAL AIDS RESPONSE PROGRESS REPORT COUNTRY PROGRESS REPORT 2014 KINGDOM OF SAUDI ARABIA." UNAIDS. KINGDOM OF SAUDI ARABIA MINISTRY OF HEALTH, 31 Mar. 2014. Web. 1 Dec. 2015. <http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/SAU_narrative_report_2014.pdf>.
  4. HIV/AIDS (WHO). http://www.who.int/mediacentre/factsheets/fs360/en/ (Accessed December 1, 2015)
  5. Prevention of sexual transmission of human immunodeficiency virus. WHO AIDS Series No. 6. Geneva, WHO, 1990.
  6. AIDS and HIV Symptoms and Signs (WebMD) http://www.webmd.com/hiv-aids/guide/understanding-aids-hiv-symptoms (Accessed December 1, 2015)
  7. World Health Organization. "AIDS and HIV infection: information for United Nations employees and their families." AIDS and HIV infection: Information for United Nations employees and their families. World Health Organization, 1991.
  8. Nachega, Jean B., et al. "Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: a meta-analysis of randomized controlled trials." Clinical infectious diseases 58.9 (2014): 1297-1307.
  9. WHO | HIV Vaccines (WHO | HIV Vaccines). http://www.who.int/hiv/topics/vaccines/Vaccines/en/ (Accessed December 8, 2015)
  10. Ways HIV Cannot Be Spread-Topic Overview (WebMD) http://www.webmd.com/hiv-aids/guide/ways-hiv-cannot-be-spread-topic-overview (Accessed December 8, 2015)