1. What is HIV, and how is it different from AIDS?
- Answer:
- HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, specifically targeting CD4+ T cells, weakening the body’s ability to fight infections.
- AIDS (Acquired Immunodeficiency Syndrome) is the most severe stage of HIV infection, where the immune system is significantly weakened, leading to opportunistic infections and certain cancers. Not everyone with HIV develops AIDS if treated effectively.
2. How is HIV transmitted?
- Answer:HIV is transmitted through contact with specific body fluids from an infected person, such as:
- Blood
- Semen and pre-seminal fluids
- Vaginal fluids
- Rectal fluids
- Breast milkCommon transmission routes include:
- Unprotected sexual intercourse
- Sharing needles or syringes
- Mother-to-child transmission during childbirth or breastfeeding
- Blood transfusions or organ transplants with infected blood (rare in countries with stringent screening).
3. Can HIV be transmitted through casual contact?
- Answer:No, HIV is not spread through casual contact such as hugging, shaking hands, sharing food or drinks, using the same toilet, or through mosquito bites. It requires the exchange of specific body fluids.
4. What are the early symptoms of HIV infection?
- Answer:Early symptoms, also known as acute HIV infection, may appear 2-4 weeks after exposure and can include:
- Fever
- Fatigue
- Sore throat
- Swollen lymph nodes
- Rash
- Muscle and joint painSome people may have no symptoms during this stage.
5. How can HIV infection be prevented?
- Answer:
- Use condoms consistently and correctly during sexual intercourse.
- Get tested and know your partner’s HIV status.
- Use pre-exposure prophylaxis (PrEP) if at high risk of HIV.
- Avoid sharing needles or syringes.
- Ensure blood products are screened before transfusion.
- Pregnant HIV-positive women can take antiretroviral therapy (ART) to prevent mother-to-child transmission.
6. Can HIV be cured? And Why is HIV difficult to treat?
a) Can HIV Be Cured?
- Answer:There is currently no cure for HIV. However, antiretroviral therapy (ART) can effectively manage the virus, suppress its replication, and allow people with HIV to live long and healthy lives. Although currently, there is no universal cure for HIV, but significant progress has been made. While a functional cure (long-term control of the virus without therapy) has been achieved in a few rare cases, most treatments focus on controlling the virus rather than eliminating it.
Exceptions:
A few people, like the “Berlin Patient” and “London Patient,” were effectively cured after receiving bone marrow transplants from donors with a CCR5-Δ32 mutation. However, these cases are rare and not practical as a widespread treatment due to the risks and complexities involved.
b) Why Is HIV Difficult to Treat?
HIV is challenging to cure for several reasons related to its biology and interaction with the human immune system:
i. Integration into Host DNA
- HIV integrates its genetic material into the DNA of infected host cells (primarily CD4+ T cells). This means the virus becomes a permanent part of the host cell’s genome, making it difficult to eliminate without destroying the host cells.
ii. Latent Reservoirs
- After infection, HIV can establish latent reservoirs in long-lived cells (e.g., memory T cells). In these cells, the virus remains dormant and is not actively replicating, making it invisible to both the immune system and antiretroviral drugs.
- These reservoirs can “reactivate” at any time, allowing the virus to restart replication if treatment is stopped.
iii. High Mutation Rate
- HIV has an extremely high mutation rate due to its error-prone reverse transcriptase enzyme. This allows the virus to rapidly evolve and develop resistance to antiretroviral drugs and immune responses.
iv. Hiding from the Immune System
- HIV attacks and destroys the very cells (CD4+ T cells) that are central to orchestrating immune responses, weakening the body’s ability to fight the virus.
- It also cloaks itself with the host’s cellular components, reducing its visibility to the immune system.
v. Diverse Viral Strains
- HIV exists as many genetically diverse strains (quasispecies) within the same individual, making it harder to develop treatments or vaccines that target all variants.
vi. Immune System Exhaustion
- Chronic HIV infection leads to immune exhaustion, where the immune system becomes less effective over time. This makes it harder for the body to mount a strong defense against the virus.
vii. Challenges with Bone Marrow Transplants
- While bone marrow transplants have cured a few individuals, this approach is impractical for widespread use due to the risks of graft-versus-host disease, difficulty in finding suitable donors, and the invasive nature of the procedure.
Current Treatment Strategies
- Antiretroviral Therapy (ART):
- ART is the mainstay treatment for HIV. It suppresses viral replication, allowing the immune system to recover and preventing disease progression.
- It does not eradicate the virus but reduces viral load to undetectable levels, which also prevents transmission.
- Functional Cure Research:
- Efforts are ongoing to achieve a functional cure by targeting latent reservoirs, boosting the immune response, or using gene-editing techniques like CRISPR to remove HIV from infected cells.
c) Why Is a Cure Still Possible?
Despite these challenges, ongoing research has made breakthroughs that suggest a cure might be achievable in the future, including:
- Gene-editing tools to delete the virus or modify host genes (e.g., CCR5).
- Immunotherapy approaches to “wake up” and eliminate latent reservoirs.
- Novel drugs targeting specific steps in the viral lifecycle.
7. How is HIV diagnosed?
- Answer:HIV is diagnosed through blood or oral fluid tests, including:
- Antibody tests: Detect antibodies the body makes against HIV.
- Antigen/antibody tests: Detect both the virus and the antibodies.
- Nucleic acid tests (NATs): Detect the virus’s genetic material and are used for early detection.
8. What is the life expectancy of someone living with HIV?
- Answer:With effective ART, people with HIV can live nearly as long as those without the virus. Early diagnosis and consistent treatment are critical for better outcomes.
- Studies show:
- With Effective ART: A person diagnosed at age 20 and treated effectively can expect to live into their 70s or beyond, similar to the general population.
- Without ART: Untreated HIV progresses to AIDS, and life expectancy is significantly shortened, often to 1-3 years after the onset of AIDS.
Key Takeaway
HIV is no longer a death sentence. With early diagnosis, adherence to ART, and proper medical care, people living with HIV can enjoy long, fulfilling lives. Regular check-ups and a healthy lifestyle further improve outcomes.
9. Can a mother with HIV have a healthy baby?
- Answer:Yes. a mother with HIV can have a healthy, HIV-negative baby with proper medical care and precautions, including ART during pregnancy and delivery, the risk of mother-to-child transmission can be reduced to less than 1%. Advances in antiretroviral therapy (ART) and strategies to prevent mother-to-child transmission (MTCT) have made this highly achievable.
- How to Prevent Transmission to the Baby
- Start Antiretroviral Therapy (ART) Early
- The mother should take ART throughout pregnancy, labor, and delivery. ART reduces the viral load to undetectable levels, significantly lowering the risk of transmitting HIV to the baby.
- ART should ideally begin before conception or as soon as pregnancy is confirmed.
- Care During Delivery
- The method of delivery (vaginal or cesarean) is determined based on the mother’s viral load:
- Undetectable viral load: Vaginal delivery is generally safe.
- Detectable viral load: A planned cesarean delivery may be recommended to reduce the risk of transmission.
- ART for the Baby
- After birth, the baby is given ART (usually in syrup form) for 4-6 weeks to further reduce the risk of infection.
- Avoid Breastfeeding (if recommended)
- In some regions, especially where safe alternatives to breastfeeding are available, HIV-positive mothers are advised to use formula instead of breastfeeding to eliminate the risk of transmission through breast milk.
- In low-resource settings where formula feeding may be unsafe, exclusive breastfeeding combined with ART for the mother and/or baby is recommended.
- Regular Monitoring
- Both the mother and baby should be regularly monitored, including:
- HIV testing for the baby at multiple intervals (e.g., birth, 6 weeks, and 12 months).
- Monitoring the mother’s viral load during pregnancy and after delivery.
Success Rates
- With effective ART and adherence to prevention measures, the risk of transmission can be reduced to less than 1%.
- Without treatment, the risk of MTCT is significantly higher (15-45%).
Key Takeaway
With proper medical care, adherence to ART, and appropriate delivery and feeding practices, HIV-positive mothers can have healthy, HIV-negative babies. Early and consistent medical intervention is critical for the best outcomes.
10. How does HIV affect the immune system?
- Answer:HIV infects and destroys CD4+ T cells, which are crucial for immune defense. As the number of CD4+ T cells declines, the body becomes more vulnerable to opportunistic infections and diseases.
11. What is ART, and how does it work?
- Answer:ART (Antiretroviral Therapy) is a combination of medications that suppress HIV replication in the body. It helps maintain a low viral load, preserves immune function, and reduces the risk of HIV transmission.
12. What does it mean to have an undetectable viral load?
- Answer:An undetectable viral load means that the amount of HIV in the blood is so low that it cannot be detected by standard tests. This is achieved through consistent ART use and indicates effective treatment. People with an undetectable viral load cannot transmit HIV to others through sexual contact.
13. Can someone get HIV from oral sex?
- Answer:The risk of acquiring HIV from oral sex is very low but not zero. The risk increases if there are open sores, bleeding gums, or other sexually transmitted infections (STIs) present.
14. Can HIV-positive people have relationships with HIV-negative people?
- Answer:Yes, this is referred to as a serodiscordant or mixed-status relationship. The risk of transmission can be minimized with ART, PrEP, and safe sexual practices.
15. What is PEP, and when should it be used?
What is PEP?
PEP (Post-Exposure Prophylaxis) is a short-term emergency treatment started within 72 hours of potential HIV exposure to prevent infection. It involves taking antiretroviral drugs for 28 days to prevent HIV infection after potential exposure to the virus. PEP is most effective when started promptly and is not a substitute for regular prevention methods like condoms or PrEP (Pre-Exposure Prophylaxis).
When Should PEP Be Used?
PEP should be used in the following situations:
1. Occupational Exposure
- Healthcare workers or others exposed to HIV-contaminated blood or body fluids through needlestick injuries or mucous membrane exposure.
2. Non-Occupational Exposure
- Unprotected sexual intercourse with a person who is HIV-positive or whose HIV status is unknown.
- Sharing needles, syringes, or other injecting equipment.
- Sexual assault survivors exposed to a risk of HIV.
3. Other High-Risk Situations
- Any other accidental exposure to blood or body fluids that might carry HIV.
Key Takeaway
PEP is an emergency tool to prevent HIV infection after potential exposure. It must be started promptly (within 72 hours), taken consistently for 28 days, and accompanied by follow-up care. If you think you might need PEP, seek medical attention immediately.
16. Are there individuals who are resistant to HIV? Why?