AIDS: The most talked about disease of the century

36.7 million people are living with HIV globally and  30% of them are not aware about their  status. 2.1 million are effected by HIV in India. There are 80,000 new HIV infections every year in India. 50% of adults and 33% of children are on antiretroviral treatment. Since the start of the epidemic, an estimated 78 million people have become infected with HIV and 35 million people have died of AIDS-related illnesses. In 2016, 1 million people died of AIDS-related illnesses.(Source: Avert)  So why am I discussing all these statistics with you? On this World Aids Day, lets discuss about this disease so that we can educate ourselves and others.

Gone are those days when discussing about HIV was frowned upon and was considered as a taboo in the society. Today with so much of exposure people have understood the causes of HIV and that it is not a sin to have HIV. However, there are still certain areas where there is a lack of proper information and confusion which needs to be talked on. Let us read on further to clarify some of our doubts.

Origin of HIV

The origin of the Human Immunodeficiency Virus (HIV) has been a subject of scientific research and debate since the virus was identified in the 1980s. There is now a lot of evidence on how, when and where HIV first began to cause illness in humans. HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the Simian Immunodeficiency Virus (SIV) attacks the immune systems of monkeys and apes or the Feline Immunodeficiency Virus (FIV) affecting the cat family. Research found that HIV is related to SIV and there are many similarities between the two viruses. HIV-1 is closely related to a strain of SIV found in chimpanzees, and HIV-2 is closely related to a strain of SIV found in sooty mangabeys. It has been theorized that the same virus has been transferred from monkeys to humans by the butchering and consumption on chimps and monkeys. Still there are many debates on sudden emergence of HIV infections in the 1970s.

Symptoms and Impact of HIV

Our body plays a very concerted mechanism in balancing the immune status. Some cells like CD4 helps us to boost immunity and fight foreign invaders, while the CD8 cells lower the immune reactions and keep unnecessary actions against suspected individuals. Just think of CD4 boosting the symptoms of allergy which may be fatal too and CD8 keeping the reactions at a low level and keeping us safe and calm.. Over time, the virus attacks the body’s CD4 cells. Living with HIV/AIDS can result in a weakened immune system. This makes the body more susceptible to a host of illnesses. Meanwhile the CD8 cells get higher in ratio and thus reduces the willingness of the body to fight the illness even if it could do so.

The initial stage of  AIDS infection is quite asymptomatic . One may have a phase of fever which will subside soon. Simultaneously some swelling of lymph nodes may swell .it is easily confused as a general symptom and soon the virus hits itself within cells of the body and goes over a silent phase of replication. This period of no apparent infection or disease may last for ten 10 years and this window period is very critical as one unsuspecting individual with unaltered lifestyle may keep infecting other healthy subjects. The virus is active and remains highly contagious during this time.

As the disease progresses some symptoms include swollen lymph nodes, recurrent fevers, fatigue, aches and pains, nausea, vomiting, diarrhea, weight loss, skin rashes, oral yeast infections or other infections. Last stage of AIDS may induce dementia too. But it is not AIDS that causes mortality; most patients succumb to various opportunistic infections that needs proper treatment. With the use of antiretroviral therapy, chronic HIV can last several decades. Without treatment, HIV can be expected to progress to AIDS sooner. By that time, the immune system is quite damaged and has a hard time fighting off infection and disease.

Opportunistic Infections

We are regularly exposed to many pathogens but generally they cannot infect us if the immune status is good. Opportunistic pathogens cause infections and cause more severity  in individuals with weaker immune systems. These illnesses may have little to no significant impact on an individual with a healthy immune system. However, they can cause devastating effects for people with HIV/AIDS. OIs typically present when your CD4 count drops below 200 cells per cubic millimeter of serum. They are considered AIDS-defining conditions as per WHO guidelines. As this stage becomes irreversible. In general, a person with HIV will not present with OIs if their CD4 count is above 500 cells per cubic millimeter.

These are the most common Ols which have been defined by the Centers for Disease Control and Prevention as AIDS-defining illnesses:

• Herpes simplex virus 1 (HSV-1) infection—a viral infection that can cause lesions (sores) on the mouth and face
• Salmonella infection—a bacterial infection that affects the intestines (the gut)
• Candidiasis (or thrush)—a fungal infection of the mouth, esophagus, or vagina
• Toxoplasmosis—a parasitic infection that can affect the brain
• Tuberculosis— This disease is most common in low-income areas of the world. It can be successfully treated in most cases if caught early.

Are Ols common in people with HIV?

Before HIV medicines were available to treat HIV infection, OIs were the main cause of illness and death in people with HIV. HIV medicines are now widely used in the United States so fewer people with HIV get OIs. By preventing HIV from damaging the immune system, HIV medicines reduce the risk of OIs.

However, OIs are still a problem for many people with HIV. Some people with HIV get OIs for the following reasons: 

• About 20% of people who have HIV don’t know that they are infected. An OI may be the first sign that they have HIV.
• Some people who know they have HIV aren’t getting treatment with HIV medicines. Without HIV treatment, they are more likely to get an OI.
• Some people may be taking HIV medicines, but the medicines aren’t controlling their HIV. Poorly controlled HIV can be due to many factors, including lack of health care, poor medication adherence, or incomplete absorption of HIV medicines. People with poorly controlled HIV have an increased risk of getting an OI.

What can people with HIV do to prevent getting an OI?

For people with HIV, the best protection against OIs is to take HIV medicines every day.

People living with HIV can also take the following steps to reduce their risk of getting an OI.

Avoid contact with the germs that can cause OIs
The germs that can cause OIs can spread in the feces of people and animals. To prevent OIs, don’t touch animal feces. Wash your hands with warm, soapy water after touching anything soiled with human feces, for example, a dirty diaper. Ask your health care provider about other ways to avoid the germs that can cause OIs.

Be careful about what you eat and drink
Food and water can be contaminated with OI-causing germs. To be safe, don’t eat or drink the following foods: 

• Raw or undercooked eggs, for example, in homemade mayonnaise or uncooked cookie dough
• Raw or undercooked poultry, meat, and seafood (especially raw shellfish)
• Unpasteurized milk, cheeses, and fruit juices
• Raw seed sprouts, such as alfalfa sprouts or mung bean sprouts

Only drink tap water, filtered water, or bottled water. Don’t drink water directly from a lake or river.

Travel safely
If you are visiting a foreign country, avoid eating food and drinking water that could make you sick. Before you travel, read this CDC fact sheet on travel abroad for people living with HIV.

Get vaccinated
Vaccines are products that protect people from diseases such as chicken pox, influenza (flu), and polio. Some vaccines can prevent HIV-related OIs. For example, people with HIV can get vaccinated to prevent pneumonia.

NACO Initiatives towards HIV

The National AIDS Control Organisation (NACO), established in 1992 is a division of India’s Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies, and is “the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India. NACO has its Care and Support Centers which focuses on spreading awareness and facilitating the treatment and course of action for HIV. The overall goal of Care, Support and Treatment (CST) component under NACP IV is to provide universal access to comprehensive, equitable, stigma-free, quality care, support and treatment services to all PLHIV using an integrated approach.

The important services provided by the Care and Support Centers are:

• Counseling Services: Counseling support is provided on a wide-range of issues such as psycho-social support, disclosure of HIV status, treatment education and adherence, positive living and positive prevention, nutrition etc. through one-to-one counseling or couple/family counseling.
• Outreach Services: These services include follow up of PLHIV for treatment adherence, repeat CD4 testing; tracking Lost to follow-up (LFU) & MIS cases, and motivating family members for HIV testing; reinforcing counseling messages; and providing/facilitating home-based care.
• Referrals and linkages: Another important service provided by the CSC is the establishment of linkages and provision of referrals to various service providers in the area for addressing medical and non-medical needs. The PLHIVs are also supported to access and avail social entitlements and social welfare schemes.
• Advocacy and communication: To create an enabling environment and access to services without stigma and discrimination, CSC supports the PLHIV through various advocacy initiatives at local, state and national levels. A discrimination response team is set up at the CSC level to respond to incidents of denial of services reported in the area due to discrimination. Quarterly advocacy meetings with various stakeholders and media advocacy events are planned to influence policy.
• Support group meetings: Support group formation is aimed at providing a platform for PLHIV to share their concerns and learn from each other. Regular support group meetings are organized and information on various themes are provided to build skills of PLHIV to lead quality life.

Staying Healthy with AIDS

Introducing approved medication regimens and healHere are some tips:

• Follow a daily medication regimen that includes antiretroviral therapies.
• Get vaccinated. Ask your doctor which vaccines you may need.
• Use condoms consistently and correctly to avoid exposure to sexually transmitted infections.
• Avoid illicit medication use and needle sharing.
• Take extra precautions when working in high-exposure areas, such as day-care centers, prisons, health-care facilities, and homeless centers.
• Avoid raw or undercooked products and unpasteurized dairy products.
• Wash your hands frequently when preparing foods.
• Drink filtered water.

Antiviral medications and a healthy lifestyle greatly decrease the likelihood of contracting an opportunistic infection. Medications developed within the last 25 years have drastically improved the life-span and outlook for people with HIV/AIDS. These daily living habits can produce positive effects in people living with HIV/AIDS.