In the early 1980s when AIDS first hit international news headlines as a terrifying new deadly virus, it almost would have seemed unimaginable that 40 years later the United Nations (UN) would commit to end the AIDS epidemic by 2030. While there is still no cure and no vaccination to prevent the virus, advancements in technology and medicine have helped turn human immunodeficiency virus (HIV) infection into a chronic disease.
World AIDS Day is on 1 December every year, and this year the theme is “take the rights path” – if we protect basic human rights for people, everyone’s health will be protected and all communities will have access to HIV prevention, testing, treatment and care.
The stigma still exists…
So much has changed since first coming to the world’s attention, however the decades old stigmas around HIV/AIDS still exist – that it is a disease that really only gay men need to worry about contracting, that it’s a death sentence if you are infected with HIV, and that you can catch it from kissing or hugging. None of these misconceptions are true because:
- HIV is not spread from sharing food, water, hugs, kisses or personal objects.
- people living with HIV can live long and healthy lives without ever developing AIDS.
- it is estimated that around 38 million people worldwide are infected with HIV, with heterosexual transmission now the most common.
What does the virus do to the body?
HIV is the virus that infects the body, and AIDS is the end stage disease caused by this infection. The HIV virus attacks the immune system and weakens the ability to fight infection and disease. It specifically targets a type of white blood cell called a CD4 cell that helps the body to fight off infection. CD4 cells are produced in the bone marrow. They stimulate other immune cells such as macrophages and B lymphocytes to destroy viruses, bacteria and pre-cancerous cells.
There are three stages of HIV infection:
- Acute infection: about two to four weeks after exposure a person may experience viral symptoms such as fever and flu-like illness, although some people don’t feel unwell at all. At this stage, there are large amounts of virus in the blood and people are very contagious.
- Clinical latency (HIV inactivity/dormancy): During this stage the virus is still active but reproduces at very low levels. People may have no symptoms and remain physically well. They are said to have an asymptomatic or chronic infection. People are still infectious and can pass the virus on, however if the viral load gets to a point where it is so low it is undetectable, then there is zero risk of transmitting HIV to a HIV-negative partner. Anti-retroviral therapy (ART) can keep people in this state indefinitely. If the viral load starts to increase, the CD4 count will start to decrease, and the person enters Stage 3.
- AIDS: this is the most advanced stage of the disease, as both the immune system is severely damaged and the patient is very infectious. Symptoms include sweats, fever, chills, swollen lymph glands, weight loss and weakness. Once a person’s CD4 count drops below 200 cells/mm the body is less able to fight infection and disease. They may start to develop opportunistic infections like tuberculosis, Kaposi’s Sarcoma or cryptococcal meningitis. Once a person has progressed to this stage their life expectancy is only about three years.
Anti-Retroviral Therapy (ART) and how it works
Without HIV medications being used in the first stage of the infection, HIV advances to AIDS in about ten years.
ART helps prevent the virus spreading to sexual partners, stops the transmission of the virus from mother to baby and helps people stay healthy. Another goal of treatment is to lower the amount of HIV virus in the body and blood so that the immune system is not always ramped up trying to fight it.
The medicines used years ago were well known for their many side effects, and some people said that the treatments were harsher than the disease (nausea, diarrhoea, nerve damage, low blood count). Modern HIV medications are much safer and easier to tolerate. Most involve taking just one or two pills a day.
HIV medicines work in a number of different ways. Some stop the virus getting into cells in the first place, others stop it making copies of itself once inside the cell.
Who is at risk?
In New Zealand the most affected group of individuals are the MSM community (men who have sex with men), however anyone who has unprotected sex is at risk. Other risks include:
- having another sexually transmitted infection (STI)
- sharing injecting equipment
- a needlestick injury
- any unsterile procedure such as an unsafe injection, unsterile cutting or piercing, unsafe blood transfusion
- being born to a parent with untreated HIV
- body fluid contact – the virus is present in blood, breast milk, semen, vaginal and anal fluids.
The future
New medicines are being approved for HIV every year. One exciting advance already being used is some countries is the use of monoclonal antibodies which block the HIV virus attaching to T-cells. Given as an injection or infusion, this medicine helps the body produce the tools it needs to stop infection.
At some stage in the future there may be a vaccine developed against the virus. Prevention is the best way to avoid the burden of disease, with condoms still the most effective low-cost HIV prevention tool.
Worried about your HIV status or possible exposure to HIV?
Get tested if you are unsure of your HIV status. This can be done at a sexual health clinic, your usual health provider or other organisation.
If you think you have been exposed to HIV within 3 days, there is medication available to stop HIV taking hold. Post-exposure prophylaxis (PEP) needs to be taken within 72 hours of possible exposure.
HIV & AIDS support Groups
Community