Hiv – Signs and Symptoms of Hiv

HIV, or the human immunodeficiency virus, is a sexually transmitted disease that assails the immune system. The virus attacks your CD4 cells (or T4 cells), which are necessary to fight off illnesses. Eventually, the virus overwhelms the CD4 cells and your body becomes unable to fight off diseases and infections. Once your body’s CD4 cell count falls below 200 per cubic millimeter of blood, and/or an opportunistic infection takes hold of your weakened immune system, you will be diagnosed with AIDS (Acquired Immunodeficiency Syndrome). Symptoms of HIV vary according to what stage of the infection you are in.

Signs and Symptoms of HIV

Symptoms that could serve as warning signals of HIV infection may go ignored because many women do not perceive themselves at risk. Symptoms include recurrent yeast infections (vaginal candidiasis), pelvic inflammatory disease, abnormal changes or dysplasia (growth and presence of precancerous cells) in cervical tissue, genital ulcers, genital warts, and severe mucosal herpes infections may also accompany HIV infection in women.

The first symptoms of HIV infection can resemble symptoms of common cold or flu viruses. The symptoms of early infection can also be similar to the symptoms of other sexually transmitted diseases and other infections such as "mono" or hepatitis, which are much more commonly and more easily transmitted. Stress and anxiety can also produce symptoms in some people, even though they do not have HIV.

HIV is diagnosed by testing your blood or oral mucus for the presence of antibodies to the virus. Unfortunately, HIV tests aren't accurate immediately after infection because it takes time for your immune system to make these antibodies — usually about 12 weeks after infection. Rarely, it can take up to six months for an HIV test to become positive

Skin, mouth, genital symptoms — A characteristic feature of acute HIV infection is open sores or ulcers involving the mucous membranes and skin in certain areas of the body. They may be located in the mouth; the esophagus (throat, which extends from the mouth to the stomach); the anus; or the penis. Ulceration involving the esophagus often causes pain during swallowing. The ulcers tend to be shallow, with sharply defined edges, and are typically swollen and painful.

Everyone has had days where they were feeling a little "blue". We all have been "down in the dumps" or felt "blah" But when these feelings last longer than a couple weeks you may be suffering from depression.

HIV-infected individuals are more prone to severe malaria than non-infected individuals. Malaria also causes a seven-fold increase in the HIV viral load of people with HIV infection. People with HIV infection should therefore take extra precautions when visiting malarial areas.

In most patients, symptoms of HIV begin about two to four weeks after exposure. However, there have been instances in which up to 10 months have passed between exposure and the first signs and symptoms of HIV infection.

Weight loss is a common problem in HIV and AIDS. Unless you are actively trying to lose weight by exercising and watching what you eat, weight loss is a serious problem.

Many illnesses have flu-like symptoms or cause swollen glands. You cannot have HIV unless you have been directly exposed to the virus. HIV can be transmitted during sexual intercourse with an infected person, through contact with infected blood or breastmilk, or during unsafe injections or medical procedures.

More serious symptoms include heavy bleeding if you are injured. Rarely, brain infections such as meningitis can affect people with HIV infection.

Gender Awareness, Stepping Stone to Hiv Prevention

The spread of HIV and STI is mounting in developing countries through gender inequality and taboos around sexuality. It results in discrimination and stigma associated with drastic poverty and marginalization. Leading to empowerment, happiness and well being, gender awareness can help to promote both rights to be free of violence and coercion around sexuality. Sexual rights, an inclusive framework, guide to have knowledge of the links between different sexuality issues thoroughly recognizing that campaign against sexual violence must continue.

The number of women living with HIV is mushrooming than the number of men through out the world. In 2004, the number of women (15+) living with HIV was 12.7 million in Sub-Saharan Africa. But the number was increased to 13.3 million in 2006. HIV epidemic is disproportionately affecting women of South Africa. Young women (15-24 years) are four times more likely to be infected by HIV than are young men in this region. Prevalence among young women was 17% compared with 4.4% among young men in 2005.

HIV/AIDS entrenches gender inequality, denial and as well as threats to basic human rights. The relationship between HIV, gender and sexuality may be intertwined as a vicious circle. Unfortunately this aftermath limits women’s access to reproductive health information, STI (Sexually Transmitted Infection) prevention technologies and treatment. There is no doubt that gender inequality makes women experience poverty and vulnerable to STIs gravely.

According to the findings of BEES (Bangladesh Extension Education Services), 95% of the rural adolescent girls in Bangladesh are vulnerable to STIs and ill health due to gender discrimination, sexual violence and lack of knowledge regarding reproductive health. They do not know how to protect themselves from HIV/AIDS. Rainbow Nari O Shishu Kallyan Foundation found that adolescent girls are two times more vulnerable to HIV and STD (Sexually Transmitted Disease) than the adolescent boys in urban areas of Bangladesh because of sexual harassment. In the name of so called gender equality, their reckless free mixing subculture is making them vulnerable significantly as well.

To curb the spread of HIV/AIDS, it is necessary to challenge the stigmatization and discrimination faced by women living with HIV/AIDS. Counting on collective action at all levels from community to national level, gender equality can strengthen the HIV and STI prevention through a coordinated action for establishing the right of safe sex. In 2005, half of the new HIV infections occurred due to unprotected sex in China. Moreover with HIV spreading successively from most-at-risk population to general population, the number of HIV infections among women is increasing fast.

In the developing countries, most of the women have very little or no knowledge about HIV transmission as well as risk before they are diagnosed HIV positive. Married women do not want to think that they may be at risk of infection. In Bangladesh, the women are induced by their family members to conceive. On the other hand, they feel under presser from healthcare workers to avoid conception. But in most cases, none of them provides necessary information clearly to help the vulnerable women conceive safely or to lessen risk of mother to child transmissions.

Involving women living with HIV, national social welfare organizations, community based organizations (CBOs), academies and policymakers, there may be a promising plan to develop advocacy strategies and extend counseling to women diagnosed in antenatal clinics. It will highlight the necessity to ameliorate the plight as for gendered response to the needs and desires of vulnerable women. Consequently it will be possible to build their life skills to enable them to work with field workers, researchers, monitors, evaluators, policymakers at all levels of program design and implementation, research, monitoring, evaluation and policymaking. Then it would be possible to keep HIV in bay effectively stamping out discrimination, stigmatization and sexual violence through gender awareness as a whole.

HOW DOES HIV SPREAD DURING SEX?

HOW DOES HIV SPREAD DURING SEX?

To spread HIV during sex, HIV infection in blood or sexual fluids must be transmitted to someone. Sexual fluids come from a man’s penis or from a woman’s vagina, before, during, or after orgasm. HIV can be transmitted when infected fluid gets into someone’s body.

You can’t spread HIV if there is no HIV infection. If you and your partners are not infected with HIV, there is no risk. An “undetectable viral load does NOT mean “no HIV infection.” If there is no contact with blood or sexual fluids, there is no risk. HIV needs to get into the body for infection to occur.

Safer sex guidelines are ways to reduce the risk of spreading HIV during sexual activity.

Asymptomatic HIV infection

After seroconversion, HIV in the peripheral blood usually drops to a low level. A person generally feels healthy and a period of asymptomatic infection may last for several months or many years. Someone with asymptomatic HIV infection may have swollen glands, a condition known as persistent generalised lymphadenopathy.

At this stage, the damage caused by HIV has no clinical effect, but various laboratory tests will usually indicate some degree of immune damage. For example, the CD4 cell count may be below normal levels and viral load tests that track the amount of HIV RNA in the body will indicate that HIV is actively replicating. At no time is the virus truly latent.

Multiple targets – combination therapy

HIV often makes errors as it copies itself; unlike human cells, it cannot detect or fix these errors. These genetic changes, known as mutations, cause the wrong amino acid building blocks to be inserted into proteins. Some of these mutations will lead to the production of defective virions that cannot infect new cells. But by chance, other changes will allow HIV to continue replicating despite the presence of antiretroviral drugs. This is known as drug resistance.

In general, antiretroviral drugs are most effective against ‘wild-type’, or non-mutated HIV. When a mutation in an HIV enzyme occurs, a specific drug may no longer be able to block its action, but a different drug might still do so. The more drugs there are, the harder it is for the virus to make new copies that can still infect cells. This is why combination therapy is more effective than a single drug.

In the mid-1990s, results from the Delta and ACTG 175 trials showed that combinations of two nucleoside reverse transcriptase inhibitors (NRTIs) were more effective than a single drug alone at delaying disease progression. Later studies demonstrated that triple-drug combinations consisting of two NRTIs plus either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor work even better than two-drug regimens. Further research showed that adding an entry inhibitor improved treatment effectiveness in patients who had developed resistance to the older drug classes. More recently, studies demonstrated the benefits of combination therapy using the two newest types of drugs, CCR5 antagonists and integrase inhibitors.

HIV-positive boys have reduced bone

HIV-positive boys have reduced bone density

HIV-positive pubescent boys have significantly lower bone mineral content and density than their HIV-negative peers, US investigators report in the online edition of AIDS. The researchers also found that treatment with Kaletra was associated with reduced bone mineral content and density.

“We evaluated bone mass across stages of puberty in a randomly selected group of perinatally HIV-infected compared to uninfected children/youth of similar Tanner stage and sociodemographic status”, write the investigators, “our most striking finding was that HIV-infected boys had significantly lower spinal and total bone mineral mass relative to uninfected boys”.

Several studies have found that bone mass is lower in children with HIV than HIV-negative children of the same sex and age. The reasons for this, and its association with the long-term fracture risk, are not yet fully understood.

Full bone density is achieved by the age of 30, but approximately 80% of this is attained by the age of 18.

The greatest gains in bone in the hip and spine occur in puberty: between the ages of 11 and 14 (Tanner stage 2-4) for girls and the ages of 13 to 17 (Tanner stage 4) for boys.

HIV treatment has significantly improved the prognosis of children infected with HIV at birth. In the US and similar countries, many of these children are now pubescent. Therefore to gain a better understanding of the impact of HIV infection on bone mass development, investigators from the Pediatric AIDS Clinical Trials Group P1045 team designed a cross-sectional study comparing bone mineral content and bone mineral density between HIV-positive individuals aged between 7 and 24 years olds and a group of age and sex matched HIV-negative controls.

A total of 236 HIV-positive patients and 143 HIV-negative controls were included in the analysis. All the HIV-positive individuals had been infected with the virus since birth

Height and weight were measured and stage of puberty (Tanner stage 1 - 5) was determined after a physical examination.

Information was obtained on factors known to affect bone metabolism including nutritional intake, vitamin D and calcium supplementation, exercise frequency, cigarette smoking and hours of television viewing (a marker for a sedentary lifestyle).

For the patients with HIV, data were obtained on CD4 cell, viral load, and medical history, including the use of antiretroviral therapy.

Dual-energy X-ray absorptiometry (DEXA) scans were performed on the whole body to assess whole bone mineral content, bone mineral density, and lean body mass.

There were no significant differences between the HIV-positive patients and the controls in terms of race and stage of puberty.

However, those with HIV had significantly lower age-adjusted height, weight, and body mass index (BMI) Z-scores. Dietary intake did not differ between the two groups, but the HIV-positive individuals were more likely to be taking vitamin D and calcium supplements (p <>

Almost three-quarter of the HIV-positive children had a CD4 cell count above 500 cells/mm³ and a CD4 cell percentage above 25%. Viral load was below 400 copies/ml in 56%.

All the HIV-positive children were taking nucleoside reverse transcriptase inhibitors (NRTIs), 56% had ever received a non-nucleoside reverse transcriptase inhibitor (NNRTI) and 67% had taken a protease inhibitor at some point.

For boys who were either pre-pubescent or in the very early stage of puberty (Tanner stages 1 and 2), bone density was similar between those who were HIV-positive and the HIV-negative controls.

However, by mid-puberty (Tanner stages 3 and 4), the HIV-positive boys had significantly lower bone mineral content than their HIV-negative peers. By the final stage of puberty (Tanner stage 5), total body and spinal bone mineral density were lower in boys with HIV-positive patients compared to the HIV-negative male controls (all p <>

When the investigators compared bone density in HIV-positive and HIV-negative females, they found no significant differences.

Next the investigators analysed the impact of antiretroviral drug use on bone density.

They found that individuals who took an NNRTI had significantly higher bone mineral content (p = 0.047) and higher spinal bone mineral density (p = 0.021) than patients who did not take this class of drug.

Next, the impact of individual antiretroviral drugs was examined. The investigators found that therapy with lopinavir/ritonavir (Kaletra) was associated with both significantly lower bone mineral content (p = 0.008) and total bone mineral density (p = 0.004).

By contrast, treatment with nevirapine (Viramune) was associated with significantly higher spinal bone mineral density (p = 0.039). AZT (zidovudine, Retrovir) was associated with a non-significant reduction in bone mineral content.

The investigators conclude, “longitudinal studies that examine changes within individuals will help to clarify the effect of puberty and sex on bone acquisition and inform the design and interventions to improve bone accrual and prevent skeletal losses in HIV-infected patients.”

Fewer data are available concerning time from a CD4

Fewer data are available concerning time from a CD4 lymphocyte count of 200/µl to death. An analysis of time from a CD4 lymphocyte count of 200/µl to death among two cohorts of homosexual men in San Francisco found the median survival time was 38 months and had increased about 12 months over the median time in the period from 1983 to 1986.(24) Comparable estimates were reported from the Multicenter AIDS Cohort Study; 53% of subjects with a CD4 count in the range 101 to 200 cells/µl survived 30 months in the period from 1985 to 1988 and 71% in the period from 1989 to 1993.(29)

Median survival times reported from clinical trials have been 6 to 18 months longer than the times cited here from cohort studies of HIV-infected persons and from AIDS case registries. Clinical trial participants usually have to meet inclusion criteria that may tend to result in a healthier population than other HIV-infected persons with comparable CD4 lymphocyte counts, and trials necessarily do not include persons who may avoid treatment or may not even be aware of their HIV infection.

In 1996, combination antiretroviral therapy that includes use of a protease inhibitor was widely adopted. From 1996 to 1997, the percentage of HIV-infected persons receiving this therapy increased rapidly. The use of the new combination therapy is having a significant effect in lengthening survival time. The size of this latest treatment effect on survival is still uncertain, but surveillance data showing rapidly declining death rates suggest the short-term effect is dramatic (see Epidemiology of HIV/AIDS in the United States). More direct evidence of longer AIDS survival associated with use of combination antiretroviral therapy is emerging from longitudinal studies. In the Multicenter AIDS Cohort Study, the estimated median time from seroconversion to death for a person infected at age 30 was associated with use of combined therapy and increased nearly 2 years from the 1993 to 1995 period to the 1995 to 1997 period (11.4 years versus 13.3 years).(33) In Ontario province, Canada, where health care access is universal and all treatment is government subsidized, median survival time increased from 19 to 30 months among all AIDS patients over age 35 years with a CD4 lymphocyte count of less than 100 cells/µl and receiving antiretroviral therapy.(34) These early estimates of the impact of the new treatments include individuals diagnosed before they were available and individuals who had previously been treated with monotherapy and were therefore less likely to obtain the full benefit of combination therapy. Although it is still too early for more definitive quantitative estimates of the changes in AIDS survival time, they appear to be significantly greater than the previous increase from the early pre-antiviral treatment era of the epidemic.

Sexual Activity

Sexual Activity

You can avoid any risk of HIV if you practice abstinence (not having sex). You also won’t get infected if your penis, mouth, vagina or rectum doesn’t touch anyone else’s penis, mouth, vagina, or rectum. Safe activities include kissing, erotic massage, masturbation or hand jobs (mutual masturbation). There are no documented cases of HIV transmission through wet clothing.

Having sex in a monogamous (faithful) relationship is safe if:

• Both of you are uninfected (HIV-negative)
• You both have sex only with your partner
• Neither one of you gets exposed to HIV through drug use or other activities

Oral sex has a lower risk of infection than anal or vaginal sex, especially if there are no open sores or blood in the mouth

You can reduce the risk of infection with HIV and other sexually transmitted diseases by using barriers like condoms. Traditional condoms go on the penis, and a new type of condom goes in the vagina or in the rectum. For more information on condoms, see Fact Sheet 153.

Some chemicals called spermicides can prevent pregnancy but they don’t prevent HIV. They might even increase your risk of getting infected if they cause irritation or swelling.

Drug Use

If you’re high on drugs, you might forget to use protection during sex. If you use someone else’s equipment (needles, syringes, cookers, cotton or rinse water) you can get infected by tiny amounts of blood. The best way to avoid infection is to not use drugs.

If you use drugs, you can prevent infection by not injecting them. If you do inject, don’t share equipment. If you must share, clean equipment with bleach and water before every use

WHAT IF BOTH PEOPLE ARE ALREADY INFECTED?

WHAT IF BOTH PEOPLE ARE ALREADY INFECTED?

Some people who are HIV-infected don’t see the need to follow safer sex guidelines when they are sexual with other infected people. However, it still makes sense to “play safe”. If you don’t, you could be exposed to other sexually transmitted infections such as herpes or syphilis. If you already have HIV, these diseases can be more serious.

Also, you might get “re-infected” with a different strain of HIV. This new version of HIV might not be controlled by the medications you are taking. It might also be resistant to other antiretroviral drugs. There is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following the guidelines for safer sex will reduce the risk.

KNOW WHAT YOU’RE DOING

Using alcohol or drugs before or during sex greatly increases the chances that you will not follow safer sex guidelines. Be very careful if you have used any alcohol or drugs.

SET YOUR LIMITS

Decide how much risk you are willing to take. Know how much protection you want to use during different kinds of sexual activities. Before you have sex,

• think about safer sex
• set your limits
• get a supply of lubricant and condoms or other barriers, and be sure they are easy to find when you need them
• talk to your partners so they know your limits.

Stick to your limits. Don’t let alcohol or drugs or an attractive partner make you forget to protect yourself.

THE BOTTOM LINE

HIV infection can occur during sexual activity. Sex is safe only if there is no HIV, no blood or sexual fluids, or no way for HIV to get into the body.

You can reduce the risk of infection if you avoid unsafe activities or if you use barriers like condoms. Decide on your limits and stick to them.

WHAT IF BOTH PEOPLE ARE ALREADY INFECTED?

WHAT IF BOTH PEOPLE ARE ALREADY INFECTED?

Some people who are HIV-infected don’t see the need to follow safer sex guidelines when they are sexual with other infected people. However, it still makes sense to “play safe”. If you don’t, you could be exposed to other sexually transmitted infections such as herpes or syphilis. If you already have HIV, these diseases can be more serious.

Also, you might get “re-infected” with a different strain of HIV. This new version of HIV might not be controlled by the medications you are taking. It might also be resistant to other antiretroviral drugs. There is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following the guidelines for safer sex will reduce the risk.

KNOW WHAT YOU’RE DOING

Using alcohol or drugs before or during sex greatly increases the chances that you will not follow safer sex guidelines. Be very careful if you have used any alcohol or drugs.

SET YOUR LIMITS

Decide how much risk you are willing to take. Know how much protection you want to use during different kinds of sexual activities. Before you have sex,

• think about safer sex
• set your limits
• get a supply of lubricant and condoms or other barriers, and be sure they are easy to find when you need them
• talk to your partners so they know your limits.

Stick to your limits. Don’t let alcohol or drugs or an attractive partner make you forget to protect yourself.

THE BOTTOM LINE

HIV infection can occur during sexual activity. Sex is safe only if there is no HIV, no blood or sexual fluids, or no way for HIV to get into the body.

You can reduce the risk of infection if you avoid unsafe activities or if you use barriers like condoms. Decide on your limits and stick to them.

HOW DOES HIV SPREAD DURING SEX?

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HOW IS ANEMIA TREATED?

HOW IS ANEMIA TREATED?

Treating anemia depends on its cause.

• First, treat any chronic bleeding. This could be internal bleeding, hemorrhoids, or even frequent nosebleeds.
• Next, correct any shortages of iron, vitamin B12 or folate.
• Stop using, or reduce the doses of medications that cause anemia.

These approaches might not work. It may not be possible to stop using all medications that cause anemia. Two additional treatments are injections of EPO, and blood transfusions.

EPO (erythropoietin) stimulates the production of red blood cells. In 1985, scientists learned how to make synthetic EPO. It is injected under the skin, usually once a week. The most common brand of EPO is Procrit®.

A large study of people with HIV found that EPO injections decreased the risk of death. Transfusions seemed to increase it. Because of the risks of transfusions, they are rarely used to treat anemia.

Blood transfusion used to be the only treatment for severe anemia. However, transfusions can cause infection and suppress the immune system. They appear to cause faster progression of HIV disease and to increase the risk of death for HIV patients.

THE BOTTOM LINE

Anemia increases fatigue and makes people feel bad. It increases the risk of disease progression and death. It can be caused by HIV infection or other diseases. Many drugs used to treat HIV and related infections also cause anemia.

Anemia has always been a problem for people with HIV and AIDS. The rate of serious anemia has dropped considerably since people started using ART. However, almost half of people with HIV still have mild or moderate anemia.

Treating anemia improves the health and survival of people with HIV. Correcting bleeding or shortages of iron, or vitamins are the first steps. If possible, medications that cause anemia should be stopped. If necessary, the patient should be treated with erythropoietin, or, in rare cases, with a blood transfusion.

source: The AIDS Infonet

The UN’s Pursuit of an AIDS Goal Puts Women and Children at Risk

The UN’s Pursuit of an AIDS Goal Puts Women and Children at Risk

FRIDAY, 3 December 2010

FOR IMMEDIATE RELEASE

A set of reports issued by UN agencies in time for World AIDS Day 2010 announced advances in programs aimed at “preventing mother-to-child transmission of HIV (PMTCT).” But the assertions of progress for women set out in the UNAIDS Report on the Global AIDS Epidemic 2010 and UNICEF’s Children and AIDS: 5th Stocktaking Report do not hold up under scrutiny. And claiming that full success can be achieved by 2015 is as misleading as the program’s very name, which points a finger of blame at infected mothers. One simple step toward respect for mothers’ rights would be a change of names, to “prevention of vertical transmission.” Other steps are far more urgently required.

The UN announced this week that “53 per cent of women in need received antiretrovirals for PMTCT.” Relying on partial data that make true comparisons across years nearly impossible, the reports compared the 2010 percentage with a 15 percent marker reached in 2005. Media packets did not mention that this year’s total included women who were prescribed only single-dose nevirapine. That quick fix is no longer recommended by the World Health Organization (WHO) because it falls so short of acceptable standards of care, but worse, because it puts mothers and babies at risk.

About a third of women who are given a single dose of nevirapine during childbirth will develop resistance to that class of drugs. Later, when their HIV disease progresses and they need treatment to stay alive, the antiretroviral regimens used in most developing countries may not work. Over 50 percent of the babies exposed to single-dose nevirapine will also develop drug-resistant HIV.

Even the pharmaceutical company that patented nevirapine has since discouraged its use in single doses to prevent vertical transmission. But it was still prescribed to many program beneficiaries, and that was still described by the UN as a 2010 success story. Of the four countries in sub-Saharan Africa applauded for achieving the UN’s 80 percent coverage goal, three — Namibia, South Africa and Swaziland — reached the target in part by prescribing single-dose nevirapine; in Namibia, 48 percent of women enrolled in the program received it. In Ethiopia and India, single-dose nevirapine was prescribed to all the women treated, and yet both countries earned a tick on the UN ledger that marks progress toward “virtual elimination of mother-to-child transmission.”

AIDS-Free World’s own stocktaking leads us to conclusions starkly at odds with the UN’s assessment. The truth can be found by poring over this week’s and other recent UN reports, and cobbling together pieces of fact scattered across hundreds of inside pages. They tell a different story than the one presented this week, about a program with five characteristics that the public, the media and HIV-positive women should know:

First, in the UN reports, progress toward ending mother-to-child transmission is not measured by counting the babies protected from HIV. It is estimated by counting the women given drugs to prevent transmission, and then calculating the likelihood that the drugs succeeded. So far, no real data exists that establishes how many infant lives have actually been saved. The claim that an “HIV-free generation” is within reach is based on guesswork, not evidence.

Second, the figures said to represent beneficiaries of “PMTCT” services include not only pregnant positive women who received appropriate antiretroviral drugs (ARVs) and infant feeding counseling and support, but also women who were given nothing more than single-dose nevirapine. Since that drug application is known to endanger the lives of women and children, it should be discontinued, not counted as an achievement.

Third, the vast majority of women offered single-dose nevirapine are deprived of their rights to informed consent. They are told that taking the drug will give their babies half a chance, but they are not informed that drug resistance may jeopardize their own chance of survival. Women have the right to decide for themselves whether that life-threatening risk is worth taking.

Fourth, the UN knows that interventions available in wealthy countries and many other places worldwide can be 99 percent effective. Prescribing effective ARVs, providing correct infant feeding information and addressing the health needs of pregnant women with HIV protects infants from contracting the virus and keeps their mothers alive. Achievement of those goals is neither too complex nor too expensive to consider, if the intent is health equity, not efficiency. But the UN has not pressed hard to ensure that a 99 percent success rate is made available to all. Instead it settles for cheap and easy approaches, which yield low success rates and ignore both babies’ and mothers’ rights to the highest attainable standards of health.

Fifth, UNICEF, the WHO, and UNAIDS appear to have abandoned efforts to support safe breastfeeding. For poor women with limited access to clinics, newly designed Mother-Baby Packs contain take-home ARVs for mothers and babies that extend only about six weeks past childbirth. The drug regimens provided do not last through the 12-month recommended breastfeeding period — and the packs contain no information about exclusive breastfeeding. This runs counter to guidelines revised by WHO in 2010. The health agency now concurs with research showing that HIV-positive women can breastfeed exclusively for six months without risk of transmitting HIV, provided they are given the right information, or ARVs, or ideally, both. Deprived of that guidance and support, mothers face a 15 percent risk that their babies will contract the virus through breastfeeding before reaching age one. The new Mother-Baby Packs do nothing to help mothers avert the risk of HIV transmission during the WHO and UNICEF recommended breastfeeding period.

World AIDS Day announcements strongly implied that success is evident in the number of babies saved from HIV infection. Of all the countries lauded, not one measured its progress by determining whether the babies born to mothers given prophylactic ARVs are now free of the virus, HIV-positive, dead or alive.

Using pass/fail grading systems, countries are said to have achieved the ultimate UN goal for prevention of “mother-to-child transmission” by administering some form of ARV to 80 percent of HIV-positive pregnant women. Equal weight is given to countries that provide the most effective drug regimens and services for both mothers and babies, and to countries that continue to use single-dose nevirapine; that take no steps to prevent nevirapine resistance; that do not provide the continued ARV regimens that protect babies born HIV-negative from contracting the virus later through breastfeeding; that offer no infant feeding information; and that discharge new mothers without first assessing whether they need ARVs for their own health.

Ironically, ensuring that babies remain free of HIV and keeping infected mothers alive and healthy through and well beyond childbirth is easier than any other HIV prevention. Children most likely to contract HIV can be singled out with absolute certainty: their mothers test HIV-positive while pregnant. It is possible to calculate within a few percentage points the best ways to reduce that risk. Needless to say, preventing HIV in a child is only half a success — unless the woman, too, is clinically assessed and treated, a child protected from HIV is placed on a path toward orphanhood.

The UN has focused its attention this year squarely on vertical transmission, since a prevention triumph is more likely there than anywhere else. After decades of inadequate achievement on AIDS, the agencies are desperate to achieve one goal. But if they stay on the current course, the UN will be unfurling its “mission accomplished” banner over the graves of women and children.

Switzerland - Germany - Austria

Switzerland - Germany - Austria

In Switzerland, each year since 1997, 700-800 new people have reported HIV-positive. In Germany, for 2008, 2,800 HIV-infected people were reported, in an upward trend. At the end of 2008, in Germany there were some 63,500 people with the HIV in their blood, some 10,500 of whom were living at that time with the full-blown disease, which is still incurable. In Austria, 505 new infections were established in 2008. That is more than in the years 1994 to 2006, in which the number of newly diagnosed HIV infections was always below 500 per year. In 2006 almost 42% of new infections came from heterosexual contacts (in 1998 it was 27%!), 28.6% via homosexual contacts and 20.5% from intravenous drug taking.

Thanks to the introduction of modern therapy (ART) in 1996, the number of people who became ill or died from Aids fell significantly in all three countries. Nevertheless, every year about 200 people in Switzerland become ill with Aids and more than 100 die from it. The total number of people who live with an HIV infection is also still increasing from year to year in Switzerland. There are currently some 25,000 in Switzerland (cautious estimate by UNAIDS/WHO).

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InfoNet Global Reach

The AIDS InfoNet originally provided its materials in English and Spanish. Through collaborative agreements with AIDS service organizations and individuals in various countries, the InfoNet fact sheets are available in a growing range ot languages. The InfoNet gratefully acknowledges the efforts of our partners, who are involved in the selection of fact sheets, local medical review, translations, and updates, as well as the use of fact sheets in HIV/AIDS educational activities:

WHAT ABOUT DRUG RESISTANCE?

WHAT ABOUT DRUG RESISTANCE?

Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance.

Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance."

Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

Lamivudine seems to be able to reduce resistance to AZT. That is, after people develop resistance to AZT and then take lamivudine, AZT seems to work better for them.

HOW IS LAMIVUDINE TAKEN?

Lamivudine is available in tablets of 150 and 300 milligrams (mg). It is also available in liquid form, manufactured both by GlaxoSmithKline and by Aurobindo Pharma. The normal dose of lamivudine is 300 mg daily: either one 300 mg tablet daily, or one 150 mg tablet twice a day. The dosage should be reduced for people who weigh less than 50 kilograms (110 pounds).

Lamivudine can be taken with food or between meals.

Be sure your health care provider knows if you have had kidney problems: your dose of lamivudine may need to be lowered.

Lamivudine is also available in Combivir, Trizivir and Epzicom. Combivir contains AZT and lamivudine. Trizivir contains AZT, lamivudine, and abacavir. Epzicom includes abacavir and lamivudine. For more information, see Fact Sheet 417 on Combivir, Fact Sheet 418 on Trizivir or Fact Sheet 422 on Epzicom.

WHAT ARE THE SIDE EFFECTS?

When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of lamivudine are nausea, vomiting, fatigue, and headaches. Some people have trouble sleeping. There have been rare cases of hair loss.

HOW DOES LAMIVUDINE REACT WITH OTHER DRUGS?

Lamivudine can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.

Lamivudine should not be taken with emtricitabine (Emtriva, FTC) because these drugs are very similar and there is no additional benefit.

Blood levels of lamivudine may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs.

Lamivudine + abacavir (Ziagen) + tenofovir (Viread) or lamivudine + ddI (Videx) + tenofovir (Viread): These combinations are linked to a high rate of treatment failure and should not be used without other ARVs.

WHAT IS COMBIVIR?

WHAT IS COMBIVIR?

Combivir is a pill that contains two drugs used as part of antiretroviral therapy (ART): zidovudine (Retrovir, AZT) and lamivudine (Epivir, 3TC). Combivir is manufactured by GlaxoSmithKline. A generic version manufactured by Ranbaxy was approved in 2005 for sale outside the US.

The drugs in Combivir are called nucleoside analog reverse transcriptase inhibitors, or nukes. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes.

WHO SHOULD TAKE COMBIVIR?

Combivir was approved in 1997 as an antiretroviral drug (ARV) for people with HIV infection. Combivir should not be used by children younger than 12 years old because the individual doses of zidovudine and lamivudine cannot be adjusted.

Some people with HIV had their hepatitis B get worse after they stopped taking lamivudine, a part of Combivir. Get tested for hepatitis B before you start taking Combivir to treat HIV. If you have hepatitis B and stop taking Combivir, your health care provider should carefully monitor your liver function for several months. See Fact Sheet 506 for an overview on hepatitis.

There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. has more information about guidelines for the use of ART.

If you take Combivir with other ARV drugs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.

Children under 12 years old and people with kidney problems should not take Combivir.

Combivir provides two drugs in one pill. It can be more convenient to use Combivir than some other combinations of drugs. This could mean fewer missed doses and better control of HIV.

WHAT IS RESISTANCE?

WHAT IS RESISTANCE?

HIV is "resistant" to a drug if it keeps multiplying rapidly while you are taking the drug. Changes (mutations) in the virus cause resistance. HIV mutates almost every time a new copy is made. Not every mutation causes resistance. The "wild type" virus is the most common form of HIV. Anything different from the wild type is considered a mutation.

An antiretroviral drug (ARV) won?t control a virus that is resistant to it. It can "escape" from the drug. If you keep taking the drug, the resistant virus will multiply the fastest. This is called "selective pressure."

If you stop taking medications, there is no selective pressure. The wild type virus will multiply the fastest. Although tests may not detect any drug resistance, it might come back if you re-start the same drugs.

Resistance testing helps health care providers make better treatment decisions for their patients.

HOW DOES RESISTANCE DEVELOP?

HIV usually becomes resistant when it is not totally controlled by drugs someone is taking. However, more people are getting infected with HIV that is already resistant to one or more ARVs.

The more that HIV multiplies, the more mutations show up. These mutations happen by accident. The virus doesn’t "figure out" which mutations will resist medications.

Just one mutation can make HIV resistant to some drugs. This is true for 3TC (Epivir) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, HIV has to go through a series of mutations to develop resistance to other drugs, including most protease inhibitors.

The best way to prevent resistance is to control HIV by taking strong ARVs. If you miss doses of your medications, HIV will multiply more easily. More mutations will occur. Some of them could cause resistance.

If you have to stop taking any ARV, talk to your health care provider. You may have to stop some drugs sooner than others. If you stop taking drugs while the virus is under control, you should be able to use them again.

Specific Sexual Practices: What are the Risks?

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HOW IS PEP TAKEN?

HOW IS PEP TAKEN?

PEP should be started as soon as possible after exposure to HIV. The medications used in PEP depend on the exposure to HIV. The following situations are considered serious exposure:

* Exposure to a large amount of blood.
* Blood came in contact with cuts or open sores on the skin.
* Blood was visible on a needle that stuck someone.
* Exposure to blood from someone who has a high viral load (a large amount of virus in the blood).

For serious exposures, the U.S. Public Health Service recommends using a combination of three approved ARVs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC.

In January 2001, the Centers for Disease Control warned against using nevirapine for PEP because of the risk of liver damage. See Fact Sheet 431 for more information on nevirapine. The CDC updated its PEP recommendations in September of 2005.