The human immunodeficiency virus (HIV) preys on the immune system and erodes people's resistance to a variety of illnesses and cancers that healthy immune systems are better able to combat. Infected individuals eventually lose their immunological capacity as the virus kills and damages immune cells. CD4 cell count is commonly used to assess immune function.
Depending on the individual, acquired immunodeficiency syndrome (AIDS), the most advanced stage of HIV infection, might take many years to manifest. The emergence of certain tumors, infections, or other serious long-term clinical symptoms is what defines AIDS.
Depending on the stage of infection, the symptoms of HIV change. Although those who have HIV are typically most contagious in the first few months after becoming infected, many don't become aware of their condition until much later. People may suffer no symptoms in the first several weeks following first infection or flu-like symptoms, such as fever, headache, rash, or sore throat.
They may also have other signs and symptoms like swollen lymph nodes, weight loss, fever, diarrhea, and cough as the virus gradually weakens the immune system. In addition, they run the risk of contracting life-threatening conditions such as Kaposi's sarcoma and lymphomas, as well as cryptococcal meningitis, severe bacterial infections, and tuberculosis (TB).
Blood, breast milk, semen, and vaginal secretions are just a few of the bodily fluids from infected people that can spread HIV. During pregnancy and delivery, a mother's HIV infection might pass to her kid. Normal daily interactions like kissing, hugging, shaking hands, or sharing of personal items, food, or water do not cause an infection in a person.
It is crucial to remember that HIV-positive individuals who are on ART and have their viral load lowered do not transfer the virus to their sexual partners. Therefore, early access to ART and encouragement to continue treatment are essential not just to improve the health of those living with HIV but also to stop the spread of HIV.
Risk Elements
Individuals are more likely to get HIV if they engage in the following behaviors and conditions:
sharing contaminated needles, syringes, and other injecting equipment and drug solutions when injecting drugs; engaging in condom-free anal or vaginal sex; having another STI like syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; using harmful alcohol and drug use during sexual activity; receiving unsafe injections, blood transfusions, and medical procedures that involve unsterile instruments;
Diagnostic
Rapid diagnostic assays with immediate findings can be used to diagnose HIV. This makes it much easier to correlate early diagnosis with care and therapy. Self-tests for HIV are another option for people. A confirmatory test must be performed by a certified and trained health or community worker in a community center or clinic because no one test can fully diagnose HIV positivity. Using WHO prequalified assays within a nationally accepted testing strategy and methodology, HIV infection can be found with high accuracy.
The majority of commonly used HIV diagnostic tests look for antibodies that an individual produces as part of their immunological response to combat HIV. People typically produce anti-HIV antibodies within 28 days after infection. People go through a period of time known as the "window period" during which they may have no symptoms of HIV infection and no high enough levels of HIV antibodies have been developed to be detected by routine tests, but they are also at risk of spreading the virus to others. After becoming infected and going without treatment and viral suppression, a person may pass HIV to a partner with whom they engage in sexual activity or drug use, or in the case of pregnant women, to their unborn child while they are nursing.
Prior to beginning lifelong therapy after receiving a positive diagnosis, individuals should be retested to rule out any possible testing or reporting error. When there are doubts regarding the veracity of an HIV patient's diagnosis or when they discontinue medication and care and need to be re-engaged, it is crucial to encourage them in continuing their treatment and to offer counseling messages and services.
While testing for teenagers and adults has become quick and easy, this is not the situation for infants born to mothers who are HIV-positive. Rapid antibody testing is insufficient for detecting HIV infection in children under the age of 18 months; virological testing must be done as early as at birth or at 6 weeks of age. It is now possible to run this test at the point of care and have results the same day, which will hasten the proper linkage to therapy and care.
Treatment
Antiretroviral (ARV) medication combinations can be used in treatment plans to control HIV illness. Antiretroviral therapy (ART) as it is practiced now slows viral replication while allowing an individual's immune system to recover, strengthen, and restore the ability to combat opportunistic infections, some malignancies, and HIV infection.
Since 2016, WHO has advocated Treat All, which calls for all HIV-positive individuals—including children, adolescents, adults, pregnant women, and nursing mothers—to get lifelong ART, regardless of their clinical status or CD4 cell level.
By June 2022, 189 nations had already enacted this suggestion, providing care for 99% of all HIV-positive individuals worldwide. In addition to the Treat All plan, WHO advises a prompt ART introduction for all HIV-positive individuals, including providing ART to those who are prepared to begin treatment the same day as their diagnosis. Nearly two-thirds of the 97 nations that reported adopting this strategy by June 2022 said it had been implemented nationally.
In 2021, 28.7 million HIV-positive individuals received ART globally. In 2021, there was 75% [66-85%] global ART coverage. To scale up treatment, though, additional work is required, especially for kids and teenagers. By the end of 2021, only 52% [42-65%] of youngsters (0-14 years old) were receiving ART.
The HIV response continues to struggle with advanced HIV illness. People who have advanced immune suppression continue to seek medical attention or re-seek it, which increases their risk of contracting opportunistic infections. To lower illness and mortality, WHO is assisting nations in implementing the advanced HIV disease package of care.
Prevention
By reducing their exposure to risk factors, individuals can lower their risk of contracting HIV. The following are important HIV preventive strategies that are frequently combined:
The use of male and female condoms;
HIV prevention, testing, and counseling;
voluntary medical male circumcision (VMMC);
the use of antiretroviral drugs (ARVs) for prevention (oral PrEP and long-acting products), the dapivirine vaginal ring, and injectable long-acting cabotegravir;
harm reduction for people who inject drugs and use drugs; and the abolition of mother-to-child transmission (MTCT) of HIV.
An essential feature of HIV prevention is expanding access to testing and promoting linkage to ART because HIV cannot be transmitted if a person's sexual partner is virally suppressed on ART.
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