SHOULD PEP BE USED FOR NON-OCCUPATIONAL EXPOSURE?

SHOULD PEP BE USED FOR NON-OCCUPATIONAL EXPOSURE?

HIV exposure at work is usually a one-time accident. Other HIV exposures may be due to unsafe behaviors that can occur many times. Some people think that PEP might encourage this unsafe behavior if people think that PEP is an easy way to avoid HIV infection.

There are other reasons why PEP might not be a good idea for non-occupational exposure:

* There is no research to show that PEP works for non-occupational exposure. We don’t know how soon after exposure to HIV someone has to start PEP.
* PEP is not a “morning-after pill.” It is a program of several drugs, several times each day, for at least 30 days. PEP costs between $600 and $1,000.
* For best results, you have to take every dose of every PEP medication. Missing doses could mean that you develop HIV infection. It could also allow the virus to develop resistance to the medications. If that happens they would no longer work for you.
* The medications have serious side effects. About 40% of health care workers did not complete PEP because of the side effects.

Despite these concerns, there is growing interest in PEP for non-occupational exposure. Most programs include counseling to inform and encourage people to avoid exposure to HIV.

WHO SHOULD USE PEP?

WHO SHOULD USE PEP?
Workplace exposure

PEP has been standard procedure since 1996 for healthcare workers exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the exposure is from a “needle stick,” when a health care worker accidentally gets jabbed with a needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace exposures by 79%. However, some health care workers who take PEP still get HIV infection.
Other exposure

In 2005, the Centers for Disease Control reviewed information on PEP. They concluded that it should also be available for use after HIV exposures that are not work-related. People can be exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they share needles for injecting drugs. Infants can be exposed if they drink breast milk from an infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one person became infected with HIV.

WHAT IS POST-EXPOSURE PROPHYLAXIS?

WHAT IS POST-EXPOSURE PROPHYLAXIS?

Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking antiretroviral medications (ARVs) as soon as possible after exposure to HIV, so that the exposure will not result in HIV infection. These medications are only available with a prescription. PEP should begin within as soon as possible after exposure to HIV but certainly within 72 hours. Treatment with 2 or 3 ARVs should continue for 4 weeks, if tolerated.

WHAT IF I’VE BEEN EXPOSED?

WHAT IF I’VE BEEN EXPOSED?

If you think you have been exposed to HIV, talk to your health care provider or the public health department, and get tested. For more information on HIV testing, see Fact Sheet 102.

If you are sure that you have been exposed, call your healthcare provider immediately to discuss whether you should start takingantiretroviral drugs (ARVs). This is called “post exposure prophylaxis”or PEP. You would take two or three medications for several weeks. These drugs can decrease the risk of infection, but they have some serious side effects. Fact Sheet 156 has more information on PEP.
THE BOTTOM LINE

HIV does not spread easily from person to person. To get infected with HIV, infected blood, sexual fluid, or mother’s milk has to get into your body. HIV-infected pregnant women can pass the infection to their new babies.

To decrease the risk of spreading HIV:

* Use condoms during sexual activity
* Do not share drug injection equipment
* If you are HIV-infected and pregnant, talk with your health care provider about taking ARVs.
* If you are an HIV-infected woman, don’t breast feed any baby
* Protect cuts, open sores, and your eyes and mouth from contact with blood.

If you think you’ve been exposed to HIV, get tested and ask your health care provider about taking ARVs.

HOW CAN YOU PROTECT YOURSELF AND OTHERS?

HOW CAN YOU PROTECT YOURSELF AND OTHERS?

Unless you are 100% sure that you and the people you are with do not have HIV infection, you should take steps to prevent getting infected. People recently infected (within the past 2 or 3months) are most likely to transmit HIV to others. This is when theirviral load is the highest. In general, the risk of transmission ishigher with higher viral loads. This fact sheet provides an overview ofHIV prevention, and refers you to other fact sheets for more details on specific topics.
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. See Fact Sheet 152 for more information on the risks of various behaviors.

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.

For more information on safer sex, see Fact Sheet 151.
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. Fact Sheet 154 has more details on drug use and HIV prevention.

Some communities have started exchange programs that give free, clean syringes to people so they won’t need to share.
Vertical Transmission

With no treatment, about 25% of the babies of HIV-infected womenwould be born infected. The risk drops to about 4% if a woman takes AZTduring pregnancy and delivery, and her newborn is given AZT. The riskis 2% or less if the mother is taking combination antiretroviral therapy(ART). Caesarean section deliveries probably don’t reduce transmissionrisk if the mother’s viral load is below 1000.

Babies can get infected if they drink breast milk from an HIV-infected woman. Women with HIV should use baby formulas or breast milk from a woman who is not infected to feed their babies.

Fact Sheet 611 has more information on HIV and pregnancy.
Contact with Blood

HIV is one of many diseases that can be transmitted by blood. Be careful if you are helping someone who is bleeding. If your work exposes you to blood, be sure to protect any cuts or open sores on your skin, as well as your eyes and mouth. Your employer should provide gloves, facemasks and other protective equipment, plus training about how to avoid diseases that are spread by blood.

HOW DO YOU GET INFECTED WITH HIV?

HOW DO YOU GET INFECTED WITH HIV?

The Human Immunodeficiency Virus (HIV) is not spread easily. You can only get HIV if you get infected blood or sexual fluids into your system. You can’t get it from mosquito bites, coughing or sneezing, sharing household items, or swimming in the same pool as someone with HIV.

Some people talk about “shared body fluids” being risky for HIV, but no documented cases of HIV have been caused by sweat, saliva or tears. However, even small amounts of blood in your mouth might transmit HIV during kissing or oral sex. Blood can come from flossing your teeth, or from sores caused by gum disease, or by eating very hot or sharp, pointed food.

To infect someone, the virus has to get past the body’s defenses. These include skin and saliva. If your skin is not broken or cut, it protects you against infection from blood or sexual fluids. Saliva contains chemicals that can help kill HIV in your mouth.

If HIV-infected blood or sexual fluid gets inside your body, you can get infected. This can happen through an open sore or wound, during sexual activity, or if you share equipment to inject drugs.

HIV can also be spread from a mother to her child during pregnancy or delivery. This is called “vertical transmission.” A baby can also be infected by drinking an infected woman’s breast milk. Fact Sheet 611 has more information on pregnancy. Adults exposed to breast milk of an HIV-infected woman may also be exposed to HIV.

IS THERE A CURE FOR AIDS?

IS THERE A CURE FOR AIDS?

There is no cure for AIDS. There are drugs that can slow down the HIV virus, and slow down the damage to your immune system. There is no way to “clear” the HIV out of your body.

Other drugs can prevent or treat opportunistic infections (OIs). In most cases, these drugs work very well. The newer, stronger ARVs have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat. See Fact Sheet 500 for more information on opportunistic infections.

HOW DO I KNOW IF I HAVE AIDS?

HOW DO I KNOW IF I HAVE AIDS?

HIV disease becomes AIDS when your immune system is seriously damaged. If you have less than 200 CD4 cells or if your CD4 percentage is less than 14%, you have AIDS. See Fact Sheet 124 for more information on CD4 cells. If you get an opportunistic infection, you have AIDS. There is an “official” list of these opportunistic infections put out by the Centers for Disease Control (CDC). The most common ones are:

* PCP (Pneumocystis pneumonia), a lung infection;
* KS (Kaposi’s sarcoma), a skin cancer;
* CMV (Cytomegalovirus), an infection that usually affects the eyes
* Candida, a fungal infection that can cause thrush (a white film in your mouth) or infections in your throat or vagina

AIDS-related diseases also includes serious weight loss, brain tumors, and other health problems. Without treatment, these opportunistic infections can kill you.

The official (technical) CDC definition of AIDS is available at AIDS is different in every infected person. Some people die a few months after getting infected, while others live fairly normal lives for many years, even after they “officially” have AIDS. A few HIV-positive people stay healthy for many years even without taking antiretroviral medications (ARVs).

WHAT HAPPENS IF I’M HIV POSITIVE?

WHAT HAPPENS IF I’M HIV POSITIVE?

You might not know if you get infected by HIV. Some people get fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash for one or two weeks. Most people think it’s the flu. Some people have no symptoms

he virus will multiply in your body for a few weeks or even months before your immune system responds. During this time, you won’t test positive for HIV, but you can infect other people.

When your immune system responds, it starts to make antibodies. When this happens, you will test positive for HIV.

After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer. But during this time, HIV is damaging your immune system.
One way to measure the damage to your immune system is to count your CD4 cells you have. These cells, also called “T-helper” cells, are an important part of the immune system. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of blood.Without treatment, your CD4 cell count will most likely go down. You might start having signs of HIV disease like fevers, night sweats, diarrhea, or swollen lymph nodes. If you have HIV disease, these problems will last more than a few days, and probably continue for several weeks.

How HIV Causes AIDS

How HIV Causes AIDS

HIV destroys CD4 positive (CD4+) T cells, which are white blood cells crucial to maintaining the function of the human immune system. As HIV attacks these cells, the person infected with the virus is less equipped to fight off infection and disease, ultimately resulting in the development of AIDS.

Most people who are infected with HIV can carry the virus for years before developing any serious symptoms. But over time, HIV levels increase in the blood while the number of CD4+ T cells decline. Antiretroviral medicines can help reduce the amount of virus in the body, preserve CD4+ T cells and dramatically slow the destruction of the immune system.

Normal T-cells Credit: NIAID.	HIV-infected T-cells Credit: NIAID.

People who are not infected with HIV and generally are in good health have roughly 800 to 1,200 CD4+ T cells per cubic millimeter (mm³) of blood. Some people who have been diagnosed with AIDS have fewer than 50 CD4+ T cells in their entire body.

WHAT’S MY RISK OF GETTING INFECTED WITH HIV?

WHAT’S MY RISK OF GETTING INFECTED WITH HIV?

Most people know how HIV is transmitted (see fact sheet 150). They also know about safer sex guidelines (see fact sheet 151). However, they may still be exposed to HIV. This can be by accident or because they take part in some risky behavior. When this happens, they always want to know how likely it is that they got infected with HIV.

THERE ARE NO GUARANTEES!

You can’t be sure that you’re not infected with HIV unless you are 100% certain that you did not engage in any risky behavior and that you were not exposed to any HIV-infected fluids.

The only way to know for sure whether you have been infected is to get tested. You should wait for 3 months after a possible exposure. Then get an HIV blood test (see fact sheet 102).

You might feel that you have been exposed to HIV by sharing needles, an accident, or unsafe sexual activity. In these cases, talk to your health care provider immediately . Ask whether you can use HIV treatments to prevent infection. Fact sheet 156 has more information on "post-exposure prophylaxis."

AIDS and the Law

AIDS and the Law provides comprehensive coverage of the complex legal issues, as well as the underlying medical and scientific issues, surrounding the HIV epidemic. Covering a broad range of legal fields from employment to health care to housing and privacy rights, this essential resource provides thorough up-to-date coverage of a rapidly changing area of law.

AIDS and the Law is updated annually; the most recent update was issued for 2011.

The new Fourth Edition of AIDS and the Law brings you up-to-date on the latest developments, including:

• Explanation of why asymptomatic HIV infection is a disability under the Americans with Disabilities Act and similar federal and state nondiscrimination statutes – including an update on the ADA Amendments Act of 2008 as it applies to HIV
• Analysis of factors involved in complying with state statutory standards on HIV testing and confidentiality of HIV-related information
• Critical assessment of the courts’ rulings on knowing transmission, or risk of transmission, of HIV as a criminal offense under federal and state law

Highlights of the 2011 update include:

• Analysis of how the 2010 federal health care reform legislation – the Patient Protection and Affordable Care Act – will affect insurance coverage for persons with HIV/AIDS
• Discussion of the first reported employment discrimination ruling, Horgan v. Simmons, in which a plaintiff with HIV prevailed under the expanded definition of disability set forth in the 2008 amendments to the Americans with Disabilities Act
• Analysis of the lifting of the HIV ground of inadmissibility, which for 22 years barred HIV-positive travelers from entering the United States and immigrants with HIV from becoming permanent residents
• Summary of the EEOC’s proposed regulations under the amended Americans with Disabilities Act as they pertain to claims of HIV/AIDS discrimination
• Review of the congressional repeal of a 20-year ban on use of federal funds to support access to sterile syringes as an HIV prevention measure
• Analysis of the U.S. Justice Department’s groundbreaking announcement that the ADA prohibits Title II public entities from denying a person with HIV an occupational license or admission to a trade school because of his or her HIV status
• Discussion of the U.S. Department of Health and Human Services Office of Civil Rights’ rejection of the direct threat defense relied on by a surgeon who refused to operate on a patient with HIV
• Summary of the court’s grant of summary judgment for the plaintiff with HIV in Doe v. Deer Mountain Day Camp, Inc., a significant ruling in which the court concluded that there could be no reasonable dispute that a 10-year old boy with HIV did not pose a direct threat to himself or others as a result of his participation in a summer basketball day camp

What medicines are used for HIV infection?

What medicines are used for HIV infection?
There are several kinds of medicines are used to fight HIV infection. The first kind is called nucleoside analog reverse transcriptase (say trans-krip-tase) inhibitors, or "nukes." When HIV infects a healthy cell, it needs the cell's DNA, or genetic instructions, to build copies of itself. These drugs act by blocking the HIV's ability to copy a cell's DNA. Without complete DNA, HIV can't make new virus copies. These medicines include the following:

* Abacavir
* Didanosine
* Emtricitabine
* Lamivudine
* Stavudine
* Tenofovir DF
* Zidovudine
* Combination of Abacavir, Lamivudine and Zidovudine
* Combination of Abacavir and Lamivudine
* Combination of Emtricitabine and Tenofovir DF
* Combination of Lamivudine and Zidovudine

The second kind of medicine is called a non-nucleoside reverse transcriptase inhibitor. These drugs also prevent HIV from using a healthy cell's DNA to make copies of itself, but in a slightly different way. This group includes the following medicines:

* Delavirdine
* Nevirapine
* Efavirenz
* Etravirine

The third kind of medicine is called protease (say pro-tee-ase) inhibitors. These medicines work by preventing infected cells from releasing HIV into the body. This group includes the following medicines:

* Amprenavir
* Atazanavir
* Darunavir
* Fosamprenavir
* Indinavir
* Nelfinavir
* Ritonavir
* Saquinavir
* Tipranavir
* The combination of Lopinavir and Ritonavir

The fourth kind of medicine is called a fusion inhibitor. This medicine works by preventing the entry of the HIV virus into your body's healthy cells. This medicine is injected by a doctor. This group includes the following medicines:

* Enfuvirtide
* Maraviroc

The last type of medicine is called an integrase inhibitor. This medicine works by disabling integrase. Integrase is a protein that HIV uses to insert its genetic material into the genetic material of CD4 cells. This group includes the following medicine:

* Raltegravir

The different kinds of medicines are often used together (in combination) to reduce the amount of HIV in the body.

When different drugs are combined with the purpose of reducing the amount of HIV in your blood to very low levels, the resulting treatment regimen is called highly active antiretroviral therapy (HAART). Your doctor must watch you closely when you are being treated with these drugs to see how well they lower the amount of virus in your body. Your doctor also wants to make sure you aren't having side effects like nausea, vomiting, fatigue, anemia or peripheral neuropathy (a numb feeling in your hands or feet).

Current estimates

Current estimates

In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated that there were more people with HIV in India than in any other country in the world.19 In 2007, following the first survey of HIV among the general population, UNAIDS and NACO agreed on a new estimate – between 2 million and 3.1 million people living with HIV.20 In 2008 the figure was estimated to be 2.31 million.21 In 2009 it was estimated that 2.4 million people were living with HIV in India, which equates to a prevalence of 0.3%.22 While this may seem low, because India's population is so large, it is third in the world in terms of greatest number of people living with HIV. With a population of around a billion, a mere 0.1% increase in HIV prevalence would increase the estimated number of people living with HIV by over half a million.

The History of HIV/AIDS in India

The History of HIV/AIDS in India

At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide,2 India had no reported cases of HIV or AIDS.3 There was recognition, though, that this would not be the case for long, and concerns were raised about how India would cope once HIV and AIDS cases started to emerge. One report, published in a medical journal in January 1986, stated:

“Unlike developed countries, India lacks the scientific laboratories, research facilities, equipment, and medical personnel to deal with an AIDS epidemic. In addition, factors such as cultural taboos against discussion of sexual practices, poor coordination between local health authorities and their communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood would severely hinder the ability of the Government to control AIDS if the disease did become widespread.”4

Later in the year, India’s first cases of HIV were diagnosed among sex workers in Chennai, Tamil Nadu.5 It was noted that contact with foreign visitors had played a role in initial infections among sex workers, and as HIV screening centres were set up across the country there were calls for visitors to be screened for HIV. Gradually, these calls subsided as more attention was paid to ensuring that HIV screening was carried out in blood banks.6 7

In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. Its activities covered surveillance, blood screening, and health education.8 By the end of 1987, out of 52,907 who had been tested, around 135 people were found to be HIV positive and 14 had AIDS.9 Most of these initial cases had occurred through heterosexual sex, but at the end of the 1980s a rapid spread of HIV was observed among injecting drug users (IDUs) in Manipur, Mizoram and Nagaland - three north-eastern states of India bordering Myanmar (Burma).10

At the beginning of the 1990s, as infection rates continued to rise, responses were strengthened. In 1992 the government set up NACO (the National AIDS Control Organisation), to oversee the formulation of policies, prevention work and control programmes relating to HIV and AIDS.11 In the same year, the government launched a Strategic Plan, the National AIDS Control Programme (NACP) for HIV prevention. This plan established the administrative and technical basis for programme management and also set up State AIDS Control Societies (SACS) in 25 states and 7 union territories. It was able to make a number of important improvements in HIV prevention such as improving blood safety.
A human daisy chain on World Aids Day in India, December 2004. A human daisy chain on World Aids Day in India, December 2004.

By this stage, cases of HIV infection had been reported in every state of the country.12 Throughout the 1990s, it was clear that although individual states and cities had separate epidemics, HIV had spread to the general population. Increasingly, cases of infection were observed among people that had previously been seen as ‘low-risk’, such as housewives and richer members of society.13 In 1998, one author wrote:

“HIV infection is now common in India; exactly what the prevalence is, is not really known, but it can be stated without any fear of being wrong that infection is widespread… it is spreading rapidly into those segments that society in India does not recognise as being at risk. AIDS is coming out of the closet.”14

In 1999, the second phase of the National AIDS Control Programme (NACP II) came into effect with the stated aim of reducing the spread of HIV through promoting behaviour change. During this time, the prevention of mother-to-child transmission (PMTCT) programme and the provision of free antiretroviral treatment were implemented for the first time.15 In 2001, the government adopted the National AIDS Prevention and Control Policy and former Prime Minister Atal Bihari Vajpayee referred to HIV/AIDS as one of the most serious health challenges facing the country when he addressed parliament. Vajpayee also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for HIV/AIDS prevention.16

The third phase (NACP III) began in 2007, with the highest priority placed on reaching 80 percent of high-risk groups including sex workers, men who have sex with men, and injecting drug users with targeted interventions.17 Targeted interventions are generally carried out by civil society or community organisations in partnership with the State AIDS Control Societies. They include outreach programmes focused on behaviour change through peer education, distribution of condoms and other risk reduction materials, treatment of sexually transmitted diseases, linkages to health services, as well as advocacy and training of local groups. The NACP III also seeks to decentralise the HIV effort to the most local level, i.e. districts, and engage more non-governmental organisations in providing welfare services to those living with HIV/AIDS.18

Human immunodeficiency virus

Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS),[1][2] a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (perinatal transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.

HIV infection in humans is considered pandemic by the World Health Organization (WHO). Nevertheless, complacency about HIV may play a key role in HIV risk.[3][4] From its discovery in 1981 to 2006, AIDS killed more than 25 million people.[5] HIV infects about 0.6% of the world's population.[5] In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, of which more than 570,000 were children. A third of these deaths are occurring in Sub-Saharan Africa, retarding economic growth and increasing poverty.[6] According to current estimates, HIV is set to infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.[7] Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.[8]

HIV infects primarily vital cells in the human immune system such as helper T cells (to be specific, CD4+ T cells), macrophages, and dendritic cells.[9] HIV infection leads to low levels of CD4+ T cells through three main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosis in infected cells; and third, killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Most untreated people infected with HIV-1 eventually develop AIDS.[10] These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[11] HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some will take much longer.[12][13] Treatment with anti-retrovirals increases the life expectancy of people infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with antiretroviral therapy was estimated to be more than 5 years as of 2005.[14] Without antiretroviral therapy, someone who has AIDS typically dies within a year.[15]

HIV positive people

HIV positive people
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Question book-new.svg
This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (April 2008)
This article may contain original research. Please improve it by verifying the claims made and adding references. Statements consisting only of original research may be removed. More details may be available on the talk page. (April 2008)
World map of travel & residence restrictions against people with HIV/AIDS
Legend:
Confirmed restrictions
Contradictory information, restriction is possible
No specific entry or regulation
No information about this country

HIV positive people are people who have the human immunodeficiency virus HIV, the agent of the currently incurable disease AIDS.

Over the years of coping with the stigma and discrimination that accompany the diagnosis in most societies, a large number of support groups have been formed. In these groups, the term most often applied to people who are HIV positive is "People Living With HIV/AIDS". This is often abbreviated as "PLWHA", "PLWA", or even "PLA". Recently, "People Living Positively" has also been used.[1]

The largest and oldest of the worldwide networks of people living with HIV is the Global Network of People Living With HIV/AIDS (GNP+), which has affiliate networks on every continent.

Currently, UNAIDS estimates the number of people living with HIV at over 40,000,000. However, fewer than 20% of them are actually aware of the infection. Infection with HIV is determined by an HIV test.

HIV positive people are often discriminated against because of (often unfounded) fears of infection and because the infection is negatively associated with promiscuity, homosexuality, and drug addiction. In recent years, the rights of HIV positive people have been a major source of debate and controversy.[citation needed]

On January 20, 2004, the Bombay High Court ruled that HIV positive people cannot be denied jobs because they are HIV positive. Doing so infringes their constitutional right to earn a livelihood and right to equality. See Constitution of India.
[edit] See also

The Impact of HIV/AIDS

The Impact of HIV/AIDS
Over the past 27 years, nearly 25 million people have died from AIDS.1 HIV/AIDS causes debilitating illness and premature death in people during their prime years of life and has devastated families and communities. Further, HIV/AIDS has complicated efforts to fight poverty, improve health, and promote development by:2

* Diminishing a person’s ability to support, work and provide for his or her family. At the same time, treatment and health-care costs related to HIV/AIDS consume household incomes. The combined effect of reduced income and increased costs impoverishes individuals and households.

* Deepening socioeconomic and gender disparities. Women are at high risk of infection and have few options for providing for their families. Children affected by HIV/AIDS, due to their own infection or parental illness or death, are less likely to receive an education, as they leave school to care for ailing parents and younger siblings.

* Straining the resources of communities – hospitals, social services, schools and businesses. Health care workers, teachers, and business and government leaders have been lost to HIV/AIDS. The impact of diminished productivity is felt on a national scale.

Through unprecedented global attention and intervention efforts, the rate of new HIV infections has slowed and prevalence rates have leveled off globally and in many regions. Despite the progress seen in some countries and regions, the total number of people living with HIV continues to rise.

* In 2008, globally, about 2 million people died of AIDS, 33.4 million were living with HIV and 2.7 million people were newly infected with the virus.

* HIV infections and AIDS deaths are unevenly distributed geographically and the nature of the epidemics vary by region. Epidemics are abating in some countries and burgeoning in others. More than 90 percent of people with HIV are living in the developing world.3

* There is growing recognition that the virus does not discriminate by age, race, gender, ethnicity, sexual orientation, or socioeconomic status – everyone is susceptible. However, certain groups are at particular risk of HIV, including men who have sex with men (MSM), injecting drug users (IDUs), and commercial sex workers (CSWs).

* The impact of HIV/AIDS on women and girls has been particularly devastating. Women and girls now comprise 50 percent of those aged 15 and older living with HIV.1

* The impact of HIV/AIDS on children and young people is a severe and growing problem. In 2008, 430,000 children under age 15 were infected with HIV and 280,000 died of AIDS.1, 4 In addition, about 15 million children have lost one or both parents due to the disease.4

* There are effective prevention and treatment interventions, as well as research efforts to develop new approaches, medications and vaccines.

* The sixth Millennium Development Goal (MDG) focuses on stopping and reversing the spread of HIV/AIDS by 2015.

* Global funding is increasing, but global need is growing even faster – widening the funding gap. Services and funding are disproportionately available in developed countries.

What is HIV and What is AIDS?

What is HIV and What is AIDS?

HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS. AIDS stands for Acquired Immune Deficiency Syndrome.

HIV can be transmitted through the blood, sexual fluids, or breast milk of an HIV-infected person. People can get HIV if one of these fluids enters the body and into the bloodstream. The disease can be passed during unprotected sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment.

Over time, infection with HIV can weaken the immune system to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. These infections are usually controlled by a healthy immune system, but they can cause problems or even be life-threatening in someone with AIDS. The immune system of a person with AIDS has weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

A blood test can determine if a person is infected with HIV, but if a person tests positive for HIV, it does not necessarily mean that the person has AIDS. A diagnosis of AIDS is made by a physician according to the CDC AIDS Case Definition. A person infected with HIV may receive an AIDS diagnosis after developing one of the CDC-defined AIDS indicator illnesses. A person with HIV can also receive an AIDS diagnosis on the basis of certain blood tests (CD4 counts) and may not have experienced any serious illnesses.

About IAS-USA

About IAS-USA


The International AIDS Society-USA (IAS-USA) is a 501(c)(3) not-for-profit professional organization that has been sponsoring continuing medical education (CME) programs for physicians since 1992 and is accredited by the Accreditation Council for Continuing Medical Education (ACCME).

The International AIDS Society-USA has a clearly defined mission, an extensive network of experienced and committed HIV/AIDS experts, and is recognized for high-quality, independent educational programs. The primary educational and informational programs sponsored by the International AIDS Society-USA include CME Courses, Cases on the Web, development of Treatment Guidelines, and publication and distribution of Topics in HIV Medicine®.

The International AIDS Society-USA is not affiliated with worldwide IAS (an international organization of members working in HIV/AIDS).


Content Development and Objectivity Policies for CME Activities

The IAS-USA was founded on the commitment to produce Continuing Medical Education (CME) activities and services of the highest quality in the field of HIV/AIDS and that are absolutely free of commercial bias. All of the IAS-USA programs – such as conferences, Web-based CME publications, and treatment guidelines – are offered as part of a nationwide effort to inform HIV health care practitioners about the evolving challenges of caring for patients with HIV disease.

To further ensure complete independence of its program and content from commercial interests, the IAS-USA has adopted a policy that prohibits health care providers who participate in commercial marketing or promotional activities from being involved in IAS-USA programs and activities. Information about the policy on the separation of promotional and marketing activities from IAS–USA CME activities, adopted in January 2009, can be found here.

The excellence of the IAS-USA programs is driven by a broad faculty of clinicians and researchers who are experts in HIV/AIDS and by the organization’s volunteer board of directors. The board and faculty determine issues that are most relevant to the clinical management of patients and guide the development of program content. New faculty members are screened by the IAS-USA in order to promote a diversity of clinical views.

The IAS-USA strives to maintain an objective, balanced, and scientifically rigorous program that is free from commercial bias. Funding for some organization programs may originate from educational grants from commercial companies or from Federal agencies. For CME activities that are designated to receive commercial support, the IAS-USA adheres to the following policies that prevent the involvement of outside entities in the planning and provision of program content:

* Commercially supported programs do not receive funding from a single source; funds must be received from several companies with competing products, and is pooled to be used at IAS-USA discretion.

* The IAS-USA maintains a firewall between commercial funding sources and CME program content by internally managing every aspect of the planning, development, and delivery of its CME activities.

* The IAS-USA requires full disclosure of relationships—financial and otherwise—that its faculty or other persons in control of content with commercial organizations and other outside entities.

* When a real or potential conflict of interest is determined to exist, the IAS-USA resolves the conflict before permitting a faculty member to participate in CME program development or implementation.

* Finally, the IAS-USA undertakes an independent peer review of the content and recommendations of all of its CME activities.

HIV testing overview

In the UK, current approaches to HIV testing are to make it a normal rather than exceptional medical event, for it to be offered in a wide range of settings, and to use newer technologies that are more effective in identifying recent infections than previous techniques.

For many years, the majority of HIV diagnostic tests looked for HIV antibodies only. One or two weeks after initial exposure to HIV, antibodies to HIV antigens begin to appear in the blood, as a result of the immune system’s defence against infections . These antibodies persist for life, providing distinctive markers which can be identified by screening tests.

Most HIV antibody tests are in an ELISA or EIA format (enzyme-linked immunosorbent assay). The first generation of ELISA tests for HIV antibodies were introduced in 1985, and third-generation ELISAs are still widely used in a number of countries.

The accuracy of third-generation ELISAs (i.e. their sensitivity and specificity) is excellent. However they are less good at detecting primary infection than fourth-generation tests, so their use is no longer recommended in the UK and a number of other countries.

Fourth-generation ELISAs test for both HIV antibodies and p24 antigen. High levels of p24 are present in the blood of newly infected individuals during the short period between infection and seroconversion, making p24 antigen assays useful in diagnosing primary HIV infection.

The window period of a fourth-generation test is approximately five days shorter than that of a third-generation test. The ‘window period’ refers to the period after infection during which markers of infection (antibodies, antigen) are absent or too scarce to be detectable.

The duration of the window period varies between individuals. Moreover, different authorities give slightly different estimates for its length, but when a fourth-generation test is used, it is usually considered to be somewhere between two and four weeks.

Fourth-generation tests are extremely accurate - an evaluation of ten tests found that all except one had a sensitivity of 100% (in other words, all HIV-positive people tested were correctly diagnosed). Moreover, all had a specificity of 99.7% or over (in other words, if 1000 HIV-negative people were tested, 997 would be correctly diagnosed as such).

HIV RNA tests (viral load tests) are primarily used to monitor disease progression, and are only licensed for this purpose. However they can also help diagnose primary infection, and are sometimes used for screening in the United States and elsewhere. The tests’ window periods are short, but false positives are fairly common.

The tests described so far all require a blood sample, usually taken from a vein in the arm. (Antibody testing of urine is possible, but rarely used.) However rapid tests are available, which require the less invasive samples of finger-prick blood or ‘saliva’ (in fact, oral fluid from around the gums).

Rapid tests are often referred to as point-of-care tests because rather than sending a blood sample to a laboratory, the test can be conducted and the result read in a doctor’s office or a community setting, without specialised laboratory equipment.

The result can usually be given within 20 or 30 minutes.

Almost all rapid tests look for HIV antibodies only. However a combined antibody / p24 antigen rapid test was introduced in 2009 (Determine HIV-1/2 Ag/Ab Combo).

However, some laboratory professionals have viewed these tests with scepticism, noting inferior performance to fourth-generation tests and raising concerns about how quality control can be maintained away from the lab. While a number of tests have sensitivities and specificities of 99% or above, comparison evaluations of different rapid tests often show a wide range in performance, with some tests being much less sensitive and specific. Moreover, window periods tend to be a few days longer than for equivalent laboratory tests.

In addition, rapid tests that use saliva rather than blood may be subject to more sampling variation, influencing the accuracy of the test.

For more information on the accuracy of rapid tests, see NAM’s publication HIV Transmission and Testing.

The Children's HIV Association

The Children's HIV Association of the UK and Ireland is an association of professionals who are committed to providing excellence in the care of children infected or affected by HIV and their families. CHIVA Projects is the wing of CHIVA that undertakes direct work with children, young people and families on a national level. The projects includes supporting the CHIVA Youth Committee, the development of this website and a summer camp for HIV positive 13-17 year olds.

Stages of HIV infection

With treatment, the course of disease is not always toward progression. Individuals can be diagnosed at all stages and many respond well to treatment. Viral loads can be reduced for indefinite amounts of time and CD4 counts also rise, as well as fall. For some people, their condition can remain stable over time and earlier problems or opportunistic infections may abate. The timing and occurrence of opportunistic infections, the response of the immune system, and the response to treatment are highly individual.

Common myths about how HIV is spread

Common myths about how HIV is spread

These are some of the circumstances you don't have to worry about because they will not put you at risk for becoming infected with HIV:

	Being bitten by a mosquito or other bugs, being bitten by an animal.
	Eating food handled, prepared or served by somebody who is HIV positive.
	Sharing toilets, telephones or clothing.
	Sharing forks, spoons, knives, or drinking glasses.
	Touching, hugging or kissing a person who is HIV positive.
	Attending school, church, restaurants, shopping malls or other public places where there are HIV-positive people.
	HIV cannot be transmitted though urine, feces, vomit, or sweat. It is present, but only in negligible quantities, in tears and blister fluid. It is present in minute amounts in saliva in a very small number of people.

hy do I need to know my status?

hy do I need to know my status?

With regard to HIV, IGNORANCE IS DEFINITELY NOT BLISS.

Not knowing your HIV status can be very dangerous. If you test positive, knowing your status as early as possible after seroconversion has taken place puts you in the best position to preserve your health, as well as that of your partner(s), and your children, if you have or are planning to have a family.

Effective medications and good health care are enabling many thousands who are HIV-positive to live successful and fulfilling lives. Not knowing if you are HIV positive means you are not getting the health care you need to stay well. You may also be putting others in your life at risk.

If you test negative, that knowledge can be a powerful incentive to consistently follow the guidelines that will help you to remain HIV negative. It can also spare you a lot of unnecessary worrying and stress that often occurs when someone's uncertain about their status.

HIV causes AIDS

Infection with HIV is the necessary precondition for the development of AIDS; a fact widely acknowledged throughout the scientific community.

It is possible for someone's immune system to be compromised through mechanisms other than HIV infection, leading to some of the same infections that are seen in AIDS. A number of rare congenital immunodeficiencies, certain blood diseases, chemotherapy, the drugs given after organ transplantation, and idiopathic CD4 lymphocytopenia can all cause immune suppression.

Although it is clear that HIV has a central role in the development of AIDS, questions remain concerning some of the specific mechanisms by which HIV damages the immune system. This system is complex and can be affected in many ways by a retrovirus such as HIV. The role that other co-factors play in the development of immune damage is under investigation.

There are a minority who deny that HIV causes AIDS. Claims have been made that AIDS is the result of an immoderate lifestyle; that an artificial link was created in the interests of profit by scientists and pharmaceutical companies; or that AIDS and/or the drugs developed to treat HIV are part of a racially motivated conspiracy. While no back-up for these theories has been found, the arguments are used to bring welcome notoriety to some or as a justification for others in a position of power to withhold funding of treatment. Absence of treatment has led to increased transmission and unnecessary morbidity and mortality.

There are three established criteria used to prove a link between a pathogenic (capable of causing disease) agent and a disease. There must be an epidemiological association. That is, the suspected cause must be strongly associated with the disease. Numerous studies, done over time and around the world, demonstrate that people with AIDS have antibodies to HIV. Modern culture techniques and tests such as the polymerase chain reaction (PCR) can identify the presence of HIV in patients with AIDS.

Secondly, there must be the ability to propagate the pathogen outside the host. This has been done with animal models.

The third tenet, that transfer of a pathogen from one person to someone previously uninfected can produce disease, has been made obvious in many ways including accidental occupational exposures resulting in AIDS or a diagnosis of AIDS in infants born to HIV-infected mothers. The notion that HIV does not cause AIDS bears discussion only because it is still being used by some to justify the denial of treatment and care to others.

Origin of HIV

Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans.

The virus most likely jumped to humans when humans hunted these chimpanzees for meat and came into contact with their infected blood.

Over several years, the virus slowly spread across Africa and later into other parts of the world.

For more information view CDC's
question and answer on the origin of HIV

Antiretroviral Drugs—PEP, PrEP and Treatment as Prevention

Antiretroviral Drugs—PEP, PrEP and Treatment as Prevention

Researchers are exploring three ways to use HIV drugs to prevent HIV transmission:
Post-exposure prophylaxis (PEP): PEP involves taking a short course of ARV drugs, usually for a month, after a high-risk exposure. Though experts believe that PEP works, based on large amounts of data in health care workers who were exposed to infected blood, it is not possible to ethically test this in humans for sexual exposure. To be most effective, PEP should be started immediately after possible exposure, waiting no more than 72 hours. If you suspect a high-risk exposure to HIV—semen leaking out of a condom during intercourse with an HIV-positive insertive partner; receptive anal sex without a condom with a partner who is either HIV positive or whose status you do not know or you have shared drug-injection works with someone who is either HIV positive or whose status you do not know—contact your health care provider or local hospital emergency room as soon as possible.


Pre-exposure prophylaxis (PrEP): PrEP involves having an uninfected person take ARV drugs—usually Viread (tenofovir) or Truvada (tenofovir plus emtricitabine)—before, during and after possible high-risk exposures to reduce the risk of becoming infected. The earliest PrEP studies call for taking either Viread or Truvada every day, even during periods of minimal or low-risk sexual activity. Future studies may explore intermittent dosing strategies (e.g., using PrEP only during periods of high-risk sexual or drug-using activity). A recent study found that taking the oral HIV drug Truvada (tenofovir plus emtricitabine), when combined with condoms and counseling, was able to prevent infection by 44 percent in men who have sex with men (MSM) and transgender women who have sex with men. In those who reported taking at least 90 percent of their doses correctly, Truvada cut infections by 73 percent. The CDC, however, is cautioning people not to begin using PrEP on their own.

There are a number of reasons for this, including the fact that we don't yet know how frequently a person needs to get tested while on PrEP. If a person does become infected, and continues to use Truvada before they next get tested, they could become resistant to one or both of the drugs contained in the combination pill. Second, the study was only conducted in MSM and we don't yet know how well it will work to prevent transmission from vaginal sex or from injection drug use. There are four other PrEP studies currently in progress, and it will be important to see how well PrEP works in other populations and settings before firm recommendations can be issued. The CDC is currently working on interim guidelines for providers.
Treatment-as-prevention: In 2009, a Swiss medical committee issued a statement concluding that if an HIV-positive person's viral load is undetectable for at least six months while using ARV therapy, the risk of transmitting this virus to an HIV-negative partner is essentially nil (both partners also need to be free of other sexually transmitted diseases). This statement has been controversial, as the studies referenced in the statement primarily involved heterosexual couples in long-term monogamous relationships and do not account for the variables in real-world situations (e.g., HIV-positive individuals with multiple partners, individuals engaging in unprotected anal sex, people on ARV treatment with drug resistance and detectable viral loads, etc.). Though the risk may not necessarily be zero, experts agree that an HIV-positive person with an undetectable viral load is significantly less likely to transmit his or her virus to an HIV-negative partner. This understanding has prompted additional research to explore not only the personal benefits of treatment—AIDS-free survival for the person infected with HIV—but also the public health implications of getting all HIV-positive people, especially those who are unaware of their status, in to care and on treatment to reduce the ongoing spread of HIV. Studies are getting under way now to help determine whether very early treatment of people with HIV—started as soon as possible after testing positive—might help reduce the overall number of new infections within a community. In the interim, public health officials in some cities have already begun recommending that all people with HIV begin taking antiretroviral therapy regardless of their current CD4 count.

What is AIDS?

AIDS stands for acquired immune deficiency syndrome.

AIDS is the result of damage to the immune system. A damaged immune system is unable to protect the body against certain specific 'opportunistic' infections and tumours.

These infections and tumours are called opportunistic because they are caused by organisms normally controlled by the immune system, but that 'take the opportunity' to cause disease when the immune system has been damaged.

The timing and types of clinical problems affecting persons with AIDS can vary widely and this is why it is termed a syndrome. AIDS is a collection of different signs and symptoms that are all part of the same underlying medical condition, human immunodeficiency virus infection.

What about PEP and PrEP?

What about PEP and PrEP?

PEP stands for Post-Exposure Prophylaxis. PrEP stands for Pre-Exposure Prophylaxis. Both involve using antiretroviral drugs to prevent HIV infection.

PEP has long been used in hospitals and other "occupational" settings. It involves giving a short course of antiretroviral treatment to someone who may have been exposed to HIV, such as a hospital worker who is accidentally stuck with a sharp instrument or needle that was recently used on someone known to be infected with the virus. In this situation, a 28-day course of HIV treatment—usually a combination of two or three approved antiretrovirals—is started to help prevent the virus from establishing infection in the body.

PEP can also be used in "non-occupational" situations, such as possible exposure to the virus after sexual activity or injection drug use. According to guidelines from the CDC, however, It is only intended for people who have engaged in high-risk activity with someone known to be HIV positive and when the person seeks care within 72 hours of exposure. As with possible occupational exposure to the virus, it is best if PEP is started within hours of a possible non-occupational exposure. It will not likely be effective if started more than 48 to 72 hours after possible exposure.

If you fear that you may have been exposed to HIV and are trying to figure out if PEP is right for you, get in touch with your doctor or a nearby hospital emergency room immediately!

PrEP is an experimental HIV prevention approach. It involves using HIV medications before possible exposure to the virus. The concept of providing a preventive before exposure to an infectious agent is not new. For example, travelers to an area where malaria is common are advised to take medication before and during travel to prevent the disease. The medicine to prevent illness is then already in their bloodstream if they are exposed to the malaria parasite. Researchers believe that the same concept may work to protect people from HIV infection. Theoretically, if HIV replication can be inhibited from the moment the virus enters the body, it may not be able to establish a permanent infection.

PrEP studies are still being conducted to determine if this approach is safe and effective. A recent study found that taking the oral HIV drug Truvada (tenofovir plus emtricitabine), when combined with condoms and counseling, was able to prevent infection by 44 percent in men who have sex with men (MSM) and transgender women who have sex with men. In those who reported taking at least 90 percent of their doses correctly, Truvada cut infections by 73 percent. The CDC, however, is cautioning people not to begin using PrEP on their own.

There are a number of reasons for this, including the fact that we don't yet know how frequently a person needs to get tested while on PrEP. If a person does become infected, and continues to use Truvada before they next get tested, they could become resistant to one or both of the drugs contained in the combination pill. Second, the study was only conducted in MSM and we don't yet know how well it will work to prevent transmission from vaginal sex or from injection drug use. There are four other PrEP studies currently in progress, and it will be important to see how well PrEP works in other populations and settings before firm recommendations can be issued. The CDC is currently working on interim guidelines for providers.

Fixed-dose combinations

In addition, there are also several fixed-dose combination pills that combine two or more NRTIs with an NtRTI in a single tablet:

• AZT + 3TC (Combivir): the two NRTIs zidovudine and lamivudine
• AZT + 3TC + ABC (Trizivir): the NRTIs zidovudine, lamivudine and abacavir
• 3TC + ABC (Kivexa /Epzicom): two NRTIs
• FTC + TDF (Truvada): the NRTI emtricitabine with the NtRTI tenofovir

There is one fixed-dose combination pill combining all three types of reverse transcriptase inhibitors:

• FTC + TDF + EFV (Atripla): one NRTI, one NtRTI, and the NNRTI efavirenz.

Should I get tested for HIV?

Should I get tested for HIV?

Getting tested is recommended if any of the following apply to you:

	You should be tested at least once a year if you are sexually active, particularly with three or more sexual partners in the last 12 months.
	You had a possible exposure to HIV either through vaginal or anal intercourse without the use of a condom or have been involved in any other risky sexual behavior.
	You have shared/reused needles or syringes to inject drugs (including steroids), or for body piercing, tattooing, or any other reason.
	You are a health care worker who's had a work-related accident such as direct exposure to blood or have been stuck with a needle or other object.
	You are uncertain about your sexual partner's risk behaviors or your sexual partner has tested positive for HIV.
	You are pregnant or are considering becoming pregnant.
	You have had certain illnesses including TB (tuberculosis), or an STI (sexually transmitted infection), such as syphilis or herpes.
	You have any reason to be uncertain about your HIV status.

If you have engaged in behaviors that have put you at risk of becoming infected with HIV, you may also have been exposed to other STIs. Some of these can be quite serious and require immediate treatment, such as syphilis or hepatitis C virus (HCV). If you are being tested for HIV you should also discuss with your provider whether you are at risk and should be tested for these STIs.

Toward Resistance

Toward Resistance

If the virus were not so variable, one or two AIDS drugs would suffice. But the virus changes its genome with practically every copy. The reason for such flexibility is that RT lacks a proofreading mechanism and does not repair copy errors. Mutations in the HIV genome can result in changes in the composition of its proteins. Most of these changes are detrimental or even lethal to the virus, but with many millions to even billions of virus copies produced daily in the same patient, chances are high that a viral variant will arise quickly whose target protein remains functional even in the presence of a drug. Such a virus is resistant to the drug.

Suppressing viral replication means reducing the number of experiments the virus can perform to produce a resistant variant. In order to increase the barrier of the virus to escape toward resistance, several drugs targeting different viral proteins are given simultaneously. This scheme, called highly active antiretroviral therapy, or HAART, renders therapies effective for much longer periods of time. The virus always wins. Most current therapies remain effective for only months to a few years.

What medicines are used for HIV infection?

What medicines are used for HIV infection?

There are several kinds of medicines are used to fight HIV infection. The first kind is called nucleoside analog reverse transcriptase (say trans-krip-tase) inhibitors, or "nukes." When HIV infects a healthy cell, it needs the cell's DNA, or genetic instructions, to build copies of itself. These drugs act by blocking the HIV's ability to copy a cell's DNA. Without complete DNA, HIV can't make new virus copies. These medicines include the following:

• Abacavir
• Didanosine
• Emtricitabine
• Lamivudine
• Stavudine
• Tenofovir DF
• Zidovudine
• Combination of Abacavir, Lamivudine and Zidovudine
• Combination of Abacavir and Lamivudine
• Combination of Emtricitabine and Tenofovir DF
• Combination of Lamivudine and Zidovudine

The second kind of medicine is called a non-nucleoside reverse transcriptase inhibitor. These drugs also prevent HIV from using a healthy cell's DNA to make copies of itself, but in a slightly different way. This group includes the following medicines:

• Delavirdine
• Nevirapine
• Efavirenz
• Etravirine

The third kind of medicine is called protease (say pro-tee-ase) inhibitors. These medicines work by preventing infected cells from releasing HIV into the body. This group includes the following medicines:

• Amprenavir
• Atazanavir
• Darunavir
• Fosamprenavir
• Indinavir
• Nelfinavir
• Ritonavir
• Saquinavir
• Tipranavir
• The combination of Lopinavir and Ritonavir

The fourth kind of medicine is called a fusion inhibitor. This medicine works by preventing the entry of the HIV virus into your body's healthy cells. This medicine is injected by a doctor. This group includes the following medicines:

• Enfuvirtide
• Maraviroc

The last type of medicine is called an integrase inhibitor. This medicine works by disabling integrase. Integrase is a protein that HIV uses to insert its genetic material into the genetic material of CD4 cells. This group includes the following medicine:

• Raltegravir

The different kinds of medicines are often used together (in combination) to reduce the amount of HIV in the body.

When different drugs are combined with the purpose of reducing the amount of HIV in your blood to very low levels, the resulting treatment regimen is called highly active antiretroviral therapy (HAART). Your doctor must watch you closely when you are being treated with these drugs to see how well they lower the amount of virus in your body. Your doctor also wants to make sure you aren't having side effects like nausea, vomiting, fatigue, anemia or peripheral neuropathy (a numb feeling in your hands or feet).

What about subtypes of HIV?

What about subtypes of HIV?

Thus far, 11 distinct subtypes, also known as "clades" or "genotypes," have been recognized of HIV-1. More than 96% of the HIV-1 infections in the United States and Europe are caused by subtype B. Subtypes B and F predominate in South America and Asia. Subtypes A through H of HIV-1 are found in Africa, along with HIV-2 in sub-Saharan Africa.

The ELISA/Western blot tests can detect antibodies to all HIV-1 subtypes. Viral load tests can also detect and quantify subtypes of HIV-1. The viral load tests can also detect and quantify HIV-2.

Making good nutrition part of your daily

Making good nutrition part of your daily routine takes real commitment--but it's definitely worth the effort. A good first step is to discuss your diet with your health care provider or nutritionist. There are lots of good books and nutritional guides available, and you can contact The Momentum Project or any of the organizations listed in the online resources section of our website for more information. Nutrition counseling is also available from a number of organizations, including Momentum. Be sure to select a counselor who is qualified to advise you and is familiar with HIV illness and will work cooperatively with your primary care physician. And remember, most of the messages in the popular media about nutrition and dieting are intended for people who are trying to lose weight--and may not be appropriate for people living with HIV/AIDS. Weight loss diets generally don't work and can be dangerous.

HIV Treatment

What is HIV?

The human immunodeficiency virus (HIV) attacks the body's immune system. A healthy immune system is what keeps you from getting sick.

Because HIV damages your immune system, you are more likely to get sick from bacteria and viruses. It is also harder for your body to fight off these infections when you do get them, so you may have trouble getting better. HIV is the condition that causes acquired immunodeficiency syndrome (AIDS).

HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. The most common ways HIV is passed are:

• By having unprotected anal, vaginal or oral sex with an infected person.
• By sharing needles and syringes for injecting drugs with an infected person.

Return to top

How can my doctor tell if I have HIV or AIDS?

First your doctor tests to see if you have HIV infection. Your blood is tested with an ELISA (enzyme-linked immunosorbent assay) test. If this test is positive for HIV, your blood is tested again with the Western blot test. If both tests are positive, you are diagnosed with HIV infection.

Three things show that a person who has HIV infection has developed AIDS. If any one or more of the following are present, the person has AIDS:

• A CD4 cell count (discussed below) of less than 200
• A CD4 cell percentage of less than 14%
• An AIDS-indicator illness

An AIDS-indicator illness is a physician-diagnosed medical problem that occurs in people who have advanced HIV infection. About 25 medical problems are considered AIDS-indicator illnesses. They include conditions like Pneumocystis pneumonia, Kaposi's sarcoma and wasting syndrome. If a person who is infected with HIV gets an AIDS-indicator illness, that person has AIDS.

HIV Virus May Hide in Brain

HIV Virus May Hide in Brain

FRIDAY, Aug. 27 (HealthDay News) — The brain can be a convenient hiding place for HIV, the virus that causes AIDS.

That’s the finding of Swedish researchers who analyzed samples from about 70 HIV-infected patients who’d been taking anti-HIV drugs. The tests showed that about 10 percent of the patients — a larger proportion than expected — had traces of HIV in their spinal fluid but not in their blood.

Another study by the researchers found that 60 percent of 15 HIV-infected patients treated with medication for several years showed signs of inflammation in their spinal fluid, although the levels were lower than they were without treatment.

Anti-HIV drugs can prevent the virus from multiplying, but the virus also infects the brain and can cause damage if the infection isn’t treated, according to lead researcher Dr. Arvid Eden, a doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy at the University of Gothenburg.

“Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in,” Eden said in a university news release. “This means that the brain can act as a reservoir where treatment of the virus may be less effective.”

It is unclear whether small quantities of the virus in spinal fluid represent a risk for future complications, researchers said. Still, the findings indicate that “we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection,” Eden added.

Home > TCM News > HIV > >

The performance of HIV infection - Urinary system

Renal dysfunction, renal structural damage are very common complication of HIV infection, about 5 ~ 10% of HIV patients suffering from a pathological unique kidney disease, known as HIV nephropathy. Such rapid progress is usually in need of kidney dialysis to sustain life by the end of the period of renal disease. Many HIV-related kidney abnormalities, including HIV nephropathy, can occur in any stage of HIV disease, one from the early asymptomatic infection to advanced AIDS, including kidney failure and electrolyte disorders more common in people with AIDS in the. HIV nephropathy HIV can also be an early or only performance in some cases even before the birth of anti-HIT7 antibodies, HIV nephropathy can also be born in serology-positive mothers of infants, one of the important clinical manifestations.


1.HIV-associated nephropathy (HIV AN) HIV's addicted organization is based on the complex, not just because the surface of susceptible cells with CD4 receptors, HIV replication in cells in general have a toxicity. In the kidney, the renal tubular cells, glomerular epithelial cells were seriously damaged, resulting in filtering protein "leakage" producing nephrotic syndrome. Heavy proteinuria is a prelude to HIV nephropathy. Urea, hyperlipidemia, proteinuria, or both occurred in 90% of simultaneous HIV-infected patients, the majority of patients (89%), urinary protein of more than 1 g per day or more.

Focal segmental glomerulosclerosis (FSGS) is the HIV AN patients show a typical kidney disease, HIV disease after renal damage occurs the rapid progress of the discovery of more than 16 weeks after renal injury deaths increased renal pathology can be seen , the cortical surface is smooth. Early kidney damage under a microscope showed diffuse glomerular membrane increased, with minimal glomerular sclerosis. The number of occurrence ranging from segmental glomerular sclerosis, which is characterized by a thick cytoplasm containing vacuoles of epithelial cell proliferation, capillary wall collapse, or because of protein deposition (hyaline degeneration) and to the capillaries disappear, cavity foam cells (lipid filled with mononuclear cells). Glomerular cysts are usually expanded, tubular damage is extensive.

what are the concerns?

what are the concerns?

Public health messages have traditionally urged disclosure to all sexual and drug using partners. In reality, disclosure is complex and difficult. Some HIV+ persons may fear that disclosure will bring partner or familial rejection, limit sexual opportunities, reduce access to drugs of addiction or increase risk for physical and sexual violence. Because of this, some HIV+ persons choose not to disclose. Programs need to accept that not disclosing is a valid option.

Many HIV service agencies and testing and counseling sites routinely offer self disclosure and dual disclosure, working with HIV+ clients by preparing and supporting them to disclose to partners on their own.

Although provider disclosure services have been used for many years with other STDs, there is a wide variety in rates of acceptance of provider disclosure in HIV: in North Carolina, 87% of newly diagnosed HIV+ persons accepted provider disclosure,8 in Florida 63.1%,9 Los Angeles, CA 60%,10 New York State 32.9%,11 Seattle, WA 32%12 and among anonymous testers in San Francisco, CA 3.1%.13 In Los Angeles, the most common reasons for refusal were: already notified partner (23.4%), not being ready to disclose (15.3%), being abstinent (15%) and having an anonymous partner (11%).10

Disclosing HIV status to partners can be scary, but also can be empowering. In one study, HIV+ injection drug users who disclosed their status found increased social support and intimacy with partners, reaffirmation of their sense of self and the chance to share experiences and feelings with sexual partners.14 Another study of HIV+ persons and their partners who received disclosure assistance found that emotional abuse and physical violence decreased significantly after notification.15

what’s being done?

Florida utilizes trained DISs to deliver disclosure assistance for all reported new HIV infections. In 2004, 63.1% of all newly infected HIV+ persons accepted provider disclosure, identifying 4,460 sex or needle-sharing partners. Among those, 21.8% had previously tested HIV+. Of the 2,518 persons notified, 84.2% agreed to counseling and testing and 11.5% were HIV+.9

The Massachusetts Department of Public Health piloted a client-centered model of disclosure assistance that is integrated into the client’s routine prevention, care and support services. The program required significant changes to the standard model of DIS provider disclosure, building close relationships between service providers and DIS to better support clients’ disclosure needs while protecting confidentiality.16

California instituted a voluntary disclosure assistance program that includes counseling and preparing HIV+ persons for self disclosure; anonymous third party provider notification; counseling, testing and referrals for notified partners; and training and technical assistance to providers in public and private medical sites. About one-third of patients opted for provider disclosure and 85% referred partners. Of the partners located, 56% tested for HIV and half had never tested before. Overall, 18% of partners tested HIV+.4

what needs to be done?

New HIV testing technologies can be useful with disclosure assistance services. Improved rapid testing is a potential invaluable tool for offering HIV tests in the field to notified partners. Nucleic acid amplification testing (NAAT) can determine acute infections, that is, new HIV infections that do not show up during the window period of other HIV tests. Combining these testing strategies with disclosure assistance can help identify newly infected persons and provide immediate counseling, support and referrals to medical or social services as needed.17

Disclosure assistance services, and particularly provider disclosure, may need extensive changes from the traditional DIS model in order to work well and be accepted within HIV services. Health departments could forge closer ties between their STD and HIV programs and with outside service agencies. HIV staff also can be trained to be DIS providers to broaden access to and comfort with disclosure services.

Disclosure assistance services should be made available not only upon HIV diagnosis, but on an ongoing basis as HIV+ persons’ circumstances and needs change. It is not the role of providers to decide if a client will need or want disclosure assistance, but to offer clients support and choices, whether or not a client chooses to disclose.

Where can I get condoms?

Where can I get condoms?

Family planning and sexual health clinics provide condoms free of charge. Condoms are available to buy from supermarkets, convenience stores and petrol/gas stations. Vending machines selling condoms are found in toilets at many locations. You can also order then online from different manufacturers and distributors.

There are no age limits for buying condoms. Buying a condom no matter how old you are shows that you are taking responsibility for your actions.

How can I check a condom is safe to use?

In the UK, condoms that have been properly tested and approved carry the British Standard Kite Mark or the EEC Standard Mark (CE). In the USA, condoms should be FDA approved, and elsewhere in the world, they should be ISO approved. Some countries have their own approval marks. To find out more see our page about condom effectiveness.

Condoms have an expiration (Exp) or manufacture (MFG) date on the box or individual packet - you should not use the condom if this date has passed. It's important to check this when you use a condom. You should also make sure the packet and the condom appear to be in good condition.

Condoms can deteriorate if not stored properly as they are affected by both heat and light. So it's best not to use a condom that has been stored in your back pocket, your wallet, or the glove compartment of your car. If a condom feels sticky or very dry you shouldn't use it as the packaging has probably been damaged.

So when and how do you use a condom?

You need to use a new condom every time you have sexual intercourse. Never use the same condom twice.

• 
• 
• 

Only put on a condom once there is a partial or full erection.

• Open the condom packet at one corner being careful not to tear the condom with your fingernails, your teeth, or through being too rough. Make sure the packet and condom appear to be in good condition, and check that the expiry date has not passed.
• Place the rolled condom over the tip of the hard penis, whilst pinching the tip of the condom enough to leave a half inch space for semen to collect. If the penis is not circumcised, pull back the foreskin before rolling on the condom.
• Roll the condom all the way down to the base of the penis, and smooth out any air bubbles. (Air bubbles can cause a condom to break.)

A video animation showing how to put on a condom.

If you want to use some extra lubrication, put it on the outside of the condom. Always use a water-based lubricant (such as KY Jelly or Liquid Silk) with latex condoms, as an oil-based lubricant will cause the latex to break.

The man wearing the condom doesn't always have to be the one putting it on - it can be quite a nice thing for his partner to do.

If you decide to have anal intercourse after vaginal intercourse, or vaginal intercourse after anal intercourse, you should consider changing the condom.

When you have ejaculated or finished having sex, withdraw the penis before it softens. Make sure you hold the condom against the base of the penis while you withdraw, so that the semen doesn't spill.

What do you do if the condom won't unroll?

The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom.

Appendix 3 – Questions for Key Informants

Appendix 3 – Questions for Key Informants
Opening
• What do you see as the relationship between HIV prevention and sex education in schools?
Development of sex, relationships and HIV education
• How has sex education in schools evolved or developed within your country/region of expertise? What have
been the major infl uences?
• Prompt: Family planning, HIV and AIDS education, religion
• How is sex education regarded by religious leaders and other key stakeholders?
• What examples exist of collaborations with, for example Parent-Teacher Associations, faith-based organizations
and other key stakeholders on the development of sex education in schools?
Any key documents you recommend in this regard?
Content of sex, relationships and HIV education
• Developmentally appropriate
• At what age/level does or should sex education in schools begin?
• How do approaches to sex education differ in primary versus secondary school?
• How do you think they should differ?
• In many countries, children/young people (especially girls) will not go on to secondary education. So, in terms of
sex, relationships and HIV education, what knowledge (attitudes, skills and behaviours) should they possess by
the time they leave school?
• What specifi c examples can you share of developmentally appropriate sex, relationships and HIV education?
Curriculum
• Is sex education included in the national school curriculum?
• Under what subject(s) is sex education taught?
• What are the main components of the sex education curriculum?
• What are the assumptions about human sexual relationships, young people and gender relationships?
• How can sex education explicitly address gender issues?
• What is taught about HIV?
• Is sex education taught in single sex or mixed classes?
• Is sex education taught in mixed age group classes?
• What is taught – if anything – about condoms?
• What is taught – if anything – about contraception?
Teacher support
• What training and support do teachers receive (if any) to prepare them to teach sex education?
• What are the main challenges for training teachers? And what are the most promising approaches?
• Who are the outside resource people that could assist with teacher training? How does one ensure quality?
Policies
• What policies are in place to support sex, relationships and HIV education in schools?
• To what extent is sex education linked to sexual and reproductive health (SRH) services?
Any key documents you recommend in this regard?
Coverage, Quality and Intensity
• What would you estimate is the coverage of sex education in schools in your country/region of expertise?
• Prompt: quality (e.g. gender-specifi city), intensity/exposure.
• What are the main challenges/successes to implementation of sex, relationships and HIV education in schools?
• Can you share any evidence to support this?
Any key documents you recommend in this regard?

infections and vaccinations in HIV

ph

Type-specific testing for HSV-2 infection can be considered if herpes infection status is unknown. A first dose of hepatitis A and hepatitis B vaccine should be administered at this first visit for previously unvaccinated persons for whom vaccine is recommended (see Hepatitis A and Hepatitis B). In subsequent visits, when the results of laboratory tests are available, antiretroviral therapy can be offered based on existing guidance (129). Recommendations for the prophylaxis of opportunistic infections and vaccinations in HIV-infected adults and adolescents are available (130,131).

Providers should be alert to the possibility of new or recurrent STDs and should treat such conditions aggressively. Diagnosis of an STD in an HIV-infected person indicates on-going or recurrent high-risk behavior and should prompt referral for counseling. Because many STDs are asymptomatic, routine screening for curable STDs (e.g., syphilis, gonorrhea, and chlamydia) should be performed at least annually for all sexually active, HIV-positive persons. Women should be screened annually for cervical cancer precursor lesions by cervical Pap tests. More frequent STD screening might be appropriate depending on individual risk behaviors, the local epidemiology of STDs, and whether incident STDs are detected by screening or by the presence of symptoms.

Recently identified HIV infection might not have been recently acquired; persons newly diagnosed with HIV might be at any stage of infection. Therefore, health-care providers should be alert for symptoms or signs that suggest advanced HIV infection (e.g., fever, weight loss, diarrhea, cough, shortness of breath, and oral candidiasis). The presence of any of these symptoms should prompt urgent referral to an infectious diseases provider. Similarly, providers should be alert for signs of psychological distress and be prepared to refer patients accordingly (see Counseling for Patients with HIV Infection and Referral to Support Services).

HIV AIDS historya

HIV AIDS history

HIV AIDS history goes a long way back in time and it is said that the virus actually originated in the non human primates in the sub Saharn Africa. It is also said to have been transferred to humans only in the late ninetieth century or the early twentieth century. There are two kinds of HIV that are known today. These are called HIV I and HIV II. The former is known to be more virile and can be transmitted more easily. HIV AIDS history also tells us that the HIV that was transferred to humans was actually a SIV also called the Simian Immunodeficiency Virus that effected chimpanzees. Specifically speaking this virus was known to have been originated in West Central Africa. While some feel that the origin was in the Cameroon, there are others that hypothesize that the origins lie in the Sanaga River. The hunter theory seeks to explain how the transfer from SIV to HIV actually happened. It is thought that a bushmeat hunter was probably bitten by a chimpanzee while hunting or butchering the animal. Since the exposure happened to blood and bodily fluids there was a transfer of the virus that happened and then slowly spread to other humans as well to now become an epidemic.

The AIDS in Africa history is interesting but the fact is that the condition has now been reported in almost all countries in the world. The spread has not been too rapid but the fact that there is no cure for the disease has resulted in situation where it can only be prevented to some extent and not treated completely.

The history of AIDS also helps us understand that the transfer can still happen today to various other species on earth. But the non curable nature of the condition and the rampant unsafe sex that some societies indulge in does not make things easier for those who would like to prevent the condition from moving further and adding to the already large numbers.

It is also a fact that while the history of HIV AIDS lies in Africa, there are other nations now that are struggling to keep the count of HIV positive people under control. This is specifically challenging since a patient can be HIV positive for some time and yet now show any signs of the disease for many years to come.

This makes the task of those working against the disease a very difficult one and one does not know when to start doing something about the condition. This is why free testing camps are arranged so that those who are perfectly normal also can be tested for the virus to prevent the spread from going as fast as it did during the early years of HIV AIDS history.