Are you aware of HIV and AIDS? Let's talk about these dangerous conditions (HIV & AIDS)!

When you hear the words HIV and AIDS, you probably feel a little nervous, right? Although there are many stories about these in society, it is very important to know exactly what they are, how they are caused, and how to protect yourself. So today, we will talk about these in detail, in a way that you can understand.

What is HIV? (What is HIV?)

Simply put, HIV stands for Human Immunodeficiency Virus. When this virus enters our bodies, it attacks our immune system. In particular, the main target of this virus is CD4 cells, a type of white blood cell that protects our bodies from diseases. As the HIV virus destroys these cells, our body's ability to resist diseases gradually decreases.

This HIV virus works in a very cunning way. It inserts its own instructions into the DNA of our cells. We call viruses that work backwards like this a retrovirus .

So what is AIDS? (What is AIDS?)

AIDS stands for Acquired Immunodeficiency Syndrome . This is the final and most severe stage of HIV infection. A person with AIDS means that their immune system has been severely weakened by the HIV virus, and their CD4 cell count has dropped significantly. This makes them susceptible to various diseases (opportunistic infections) and even cancers that a normally healthy person would not easily develop.

Typically, if HIV infection is left untreated, it can progress to AIDS within about 10 years.

What is the difference between HIV and AIDS?

Many people confuse the two. HIV is a virus. It is the virus that weakens our immune system. AIDS is the severe condition caused by HIV infection. It is a collection of diseases that occur when the immune system is severely weakened.

The most important thing is that a person who is not infected with HIV cannot develop AIDS.

With today's advanced treatments, not everyone infected with HIV will develop AIDS. However, if left untreated, many people infected with HIV are at risk of developing AIDS.

What does the HIV virus do to a person?

When the HIV virus enters our body, it goes straight to find the CD4 cells (Helper T cells) in our immune system. It then destroys these cells. This reduces the number of white blood cells in our body. As a result, our body's defense system, which is usually able to recover easily even if we get sick, becomes weak. Even a minor illness can become serious.

When you first get HIV, you may experience symptoms like a cold or flu. Then, the virus can lie dormant in your body for years without any symptoms. During that time, it stealthily destroys your CD4 cells.When the number of CD4 cells drops significantly, or when you start to develop illnesses that healthy people don't get, it can be said that HIV infection has progressed to AIDS.

When you develop AIDS, you may suddenly start to lose weight, feel extremely tired, develop sores in your mouth or genitals, develop fever, sweats at night, and have skin discoloration. Also, people with AIDS can develop other diseases and cancers, so symptoms related to those may also appear.

Let's learn a little about what a retrovirus is.

Our body's cells work according to a blueprint (a set of instructions) called DNA. This DNA creates a message called RNA, and according to that message, the proteins our body needs are made.

However, retroviruses work the other way around. Their instructions are written in RNA. When a virus enters our cells, it modifies its RNA to look like the DNA in our cells. Then, it cuts the DNA in our cells and inserts its instructions into it. Then, our cells work according to the virus's instructions. HIV is one such retrovirus.

Who is most affected by HIV?

The popular belief that "only certain people get HIV" is completely wrong. Anyone who is exposed to the virus can get HIV. Unprotected sex and sharing needles to inject drugs are the main ways HIV spreads.

However, according to statistics, some groups of people are more affected by HIV. These include:

• Gay, Bisexual, MSM.
• Some ethnic groups, for example blacks and Hispanics (this is less relevant to Sri Lanka, but this is the global situation).
• People who provide sexual services in exchange for money or other things are at higher risk of contracting HIV.

These people are not the only ones affected by HIV. However, these groups face multiple barriers to HIV prevention, testing, and access to appropriate treatment. Homophobia, racism, poverty, and the stigma surrounding HIV prevent many from accessing high-quality health services.

How common is HIV?

The number of new HIV infections in the world has now decreased slightly. But a significant number of people are still living with HIV. Importantly, a significant number of people infected with HIV do not even know they have it. That is why it is important to get tested for HIV regularly.

What are the symptoms of HIV?

You can be infected with HIV even if you have no symptoms. That's why it's important to get tested for HIV even if you don't feel sick.

Sometimes, when you first become infected with HIV, you may experience symptoms similar to a fever or a cold. This is called "Acute Retroviral Syndrome" (ARS) . These symptoms include:

• Fever
• I'm getting cold.
• Tiredness
• Sore throat
• Muscle pain
• Night sweats
• Skin rash
• Swollen lymph nodes
• Mouth sores

These symptoms usually subside within a week or two, or even a month.

What are the stages of HIV?

There are three main stages of HIV infection:

Stage 1: Acute HIV Infection

Some people may experience symptoms such as a fever or a cold within a month or two of becoming infected with HIV. These symptoms often go away within a week or a month. During this time , the virus is multiplying rapidly in the body, so there is a high risk of infecting others.

Stage 2: Chronic HIV Infection/Clinical Latency

After the acute phase, you can live with HIV for years without feeling sick. This is called the “chronic phase” or “clinical latency.” The important thing to remember is that even if you don’t feel sick, you can still pass HIV to others. If you don’t get treatment, this phase can last for 10 years or more. But for some people, this phase can end quickly. People who get treatment can stay in this phase for decades.

Stage 3: AIDS

AIDS is the most severe stage of HIV infection. At this stage, the HIV virus has severely weakened your immune system, making you more susceptible to opportunistic infections .

Opportunistic infections are infections that are usually easily controlled by a person with a healthy immune system. However, when the immune system is weakened by HIV, these infections can cause great harm to the body.

The risk of developing certain types of cancer is also increased in people with AIDS. These cancers and opportunistic infections are collectively known as "AIDS-defining illnesses."

For someone to be diagnosed with AIDS, they must be infected with HIV and have at least one of the following conditions:

• Having fewer than 200 CD4 cells per cubic millimeter of blood (200 cells/mm3).
• Having one or more "AIDS-defining illnesses".

What are the AIDS-defining illnesses?

These include opportunistic infections, some cancers (often caused by viruses), and some diseases of the nervous system. Some examples are:

• Burkitt lymphoma
• Candidiasis of bronchi, esophagus, trachea or lungs
• Chronic intestinal isosporiasis (cystoisosporiasis) lasting more than a month
• Coccidioidomycosis, disseminated/extrapulmonary
• Chronic intestinal cryptosporidiosis lasting more than a month
• Cytomegalovirus disease (excluding liver, spleen, or lymph nodes), occurring in people older than one month.
• Cytomegalovirus retinitis (with vision loss)
• Encephalopathy attributed to HIV
• Extrapulmonary cryptococcosis
• Herpes simplex ulcers (lasting more than a month)
• Herpes simplex bronchitis, pneumonitis or esophagitis (occurring in people older than one month)
• Histoplasmosis, disseminated/extrapulmonary
• HIV wasting syndrome (HIV wasting syndrome - extreme weight loss)
• Invasive cervical cancer
• Immunoblastic Lymphoma
• Kaposi sarcoma
• Multiple or recurrent bacterial infections
• Mycobacterium avium complex (MAC), disseminated/extrapulmonary
• Mycobacterium kansasii, disseminated/extrapulmonary
• Mycobacterium tuberculosis (TB) in any location
• Other mycobacterial species or unidentified species, disseminated/extrapulmonary
• Pneumocystis jirovecii pneumonia (PCP)
• Primary lymphoma of the brain
• Progressive multifocal leukoencephalopathy (PML)
• Recurrent pneumonia
• Recurrent Salmonella septicemia (nontyphoid)
• Toxoplasmosis of the brain (occurs in people older than one month)

What are the symptoms of AIDS?

The symptoms of AIDS can be caused by HIV infection itself, as well as by other diseases that take advantage of your weakened immune system. Some of these include:

• Losing weight quickly
• Frequent fever or excessive night sweats
• Feeling excessively tired for no reason
• Swelling of the armpits, groin, or neck area
• Diarrhea that lasts for weeks
• Sores in the mouth, anus, or genital areas
• Pneumonia
• Red, brown, pink, or purple patches on the skin, inside the mouth, nose, or eyelids
• Memory loss, depression, and other neurological disorders

What causes HIV/AIDS?

HIV is caused by a virus called the Human Immunodeficiency Virus . This virus attacks the CD4 cells (helper T-cells) of our immune system.They attack and destroy them, which weakens the immune system.

AIDS occurs when HIV greatly reduces the number of immune cells, weakening the immune system to the point where it is unable to fight off other diseases.

How is HIV spread?

HIV can be transmitted through the blood, semen, vaginal fluids, breast milk, and anal secretions of an HIV-infected person. Anyone of any gender identity or sexual orientation can become infected with HIV and pass it on to others.

The virus can enter your body through your mouth, rectum, penis, vagina, or broken skin. Unless there is a cut or sore on the skin, the virus cannot enter through healthy skin. If you are pregnant and have HIV, the virus can also be passed to your baby.

Having unprotected sex and sharing needles to inject drugs are the main ways HIV is spread. Even if you don't feel sick, you can still pass HIV on to others.

Can HIV be transmitted through kissing?

Since HIV is not transmitted through saliva, it is not common to transmit HIV through kissing. However, if both partners have mouth sores or bleeding gums, there is a very small chance of HIV transmission during deep, open-mouthed kissing, as other bodily fluids can be exchanged.

Also, HIV cannot be transmitted through these things:

• By touching or hugging someone with HIV/AIDS.
• From public toilets or swimming pools.
• Sharing cups, dishes, or phones with someone with HIV/AIDS.
• From biting insects like mosquitoes.
• By donating blood (the equipment used in blood donation in Sri Lanka is very safe).

How do I know if I have HIV?

You can't tell if someone has HIV by looking at them. Also, you can be infected with HIV and not have any symptoms. The only way to know if you have HIV is to get an HIV test.

Because about one in seven people with HIV do not know they have it, it is recommended that everyone between the ages of 13 and 64 get tested for HIV at least once as part of a routine health check. This test is voluntary and confidential.

How is HIV diagnosed? (Diagnosis)

HIV is diagnosed by testing your blood or saliva . You can get this test at home (with at-home test kits), at a doctor's office, or at a testing center in your area.

If your test result is "Negative" , no further testing is needed in these cases:

• If you have not been exposed to HIV in any way within the three months before the test.
• If you have not been exposed to the virus within the "window period" of the blood test (the time it takes for the virus to be detected). (If you are not sure about the window period of the test you have taken, ask your doctor.)

If you were exposed within three months of taking the test, it's a good idea to get tested again to confirm a "no" result.

If your test result comes back "Positive," the lab will do further tests to confirm the result.

What are the types of tests to detect HIV?

There are three main types of HIV tests:

1. Antigen/Antibody Tests:

• Antigen tests look for a marker called p24 on the surface of the HIV virus. Antibody tests look for chemicals our bodies make against those markers. This test looks for both.
• A doctor takes a small sample of blood from a vein in your arm. It is sent to a lab and tested for p24 and antibodies to it. This test can detect HIV between 18 and 45 days after exposure.
• A rapid antigen/antibody test can be done with a fingerstick blood sample. This test can detect HIV at least 18 days after exposure. It can take up to 90 days to get accurate results. ("Rapid" refers to the time it takes to get results, not the time it takes to detect the virus).

2. Antibody Tests:

• These tests look for antibodies to HIV in your blood or saliva. This can be done by taking a blood sample from a vein in your arm, a finger prick, or a saliva sample from a swab of your gums.
• It can take between 23 and 90 days after exposure for an antibody test to detect HIV. Antibody tests, which are done on blood drawn from a vein, can detect HIV more quickly than tests that are done on saliva or blood drawn from a fingerstick.

3. Nucleic Acid Tests (NATs):

• NATs look for the HIV virus in your blood. A doctor takes a small sample of blood from a vein in your arm. It is sent to a lab to be tested for HIV.
• A NAT can usually detect HIV between 10 and 33 days after exposure. However, this test is usually only done if you have had a high-risk exposure.

If your test result is "positive," your doctor will recommend further tests to assess your health. These may include:

• Complete Blood Count (CBC)
• Viral hepatitis screening
• Chest X-ray
• Pap smear (for women)
• CD4 cell count (CD4 count)
• Tuberculosis test

Are there any HIV tests that can be done at home? (At-home tests)

Yes, there are HIV test kits that you can do at home. Some are rapid tests. In them, you rub your gums with a soft, flexible swab. Then, the swab is placed in a tube with a special liquid and the results are read. The results are available within 15-20 minutes.

Other at-home tests use a device to prick your finger with a small needle. A drop of blood is applied to a card, and the test kit is mailed to a lab for results.

If your home test result is "positive," you should definitely see your doctor and get another test to confirm the result.

Is there a cure for HIV?

There is currently no cure for HIV. However, there are many highly effective treatments that can significantly control the progression of HIV.

How is HIV treated? (Treatment)

HIV is treated with a daily oral medication called antiretroviral therapy (ART) .

Taking a combination of different drugs, rather than just one drug, is the most effective way to stop HIV from spreading and destroying cells. There are also combination pills that contain several drugs in one pill. Your doctor will carefully choose the right combination for you.

The goal of ART treatment is to reduce the amount of HIV in the blood (viral load) to a level that is undetectable by an HIV test and to control the weakening of the immune system caused by HIV.

Medications used for HIV

Each type of medicine used in ART works in a different way to stop the HIV virus from making more copies of itself or infecting your cells. The same type of ART medicine may have different brand names.

There are several types of ART medications:

• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors
• CCR5 receptor blockers (CCR5 antagonists)
• Integrase strand transfer inhibitors (INSTIs)
• Attachment inhibitors
• Post-attachment inhibitors
• Pharmacokinetic enhancers
• Combination of HIV medicines

How do I take care of myself while living with HIV?

It is very important to take your medication as prescribed, at the right time, and not to skip your doctor's appointments. This is calledIt's called treatment adherence.

If you miss taking your medication, even by accident, the HIV virus can change the way it infects cells (mutate). If that happens, the medication you take may not work. If your work schedule prevents you from taking your medication on time or keeping appointments, talk to your doctor about it.

What should I expect if I have HIV?

If you are diagnosed with HIV, the most important thing to know is that people with HIV who follow treatment instructions correctly can live full, long lives, just like someone without HIV.

Research has shown that if your CD4 cell count is high and your viral load is undetectable within a year of starting treatment, you will have the best results, as long as you continue to follow the treatment plan.

You can improve your outlook by doing these things:

• Get tested as part of a routine health checkup, or if you think you may have been exposed.
• Start ART treatment as soon as possible after being diagnosed with HIV.
• Take your medicine correctly every day.
• Keep appointments with your medical team.

Although ART can reduce the amount of virus in your blood to undetectable levels, it cannot completely eliminate the virus from your body (it can lie dormant inside your cells). If you don't take your medication regularly, the virus can start to spread again and mutate, and your medication may stop working.

If left untreated, it can take about 10 years for HIV to progress to AIDS. If you develop AIDS and are left untreated, you can expect to live for about three more years.

However, among those on treatment, if the CD4 cell count is high and the viral load is undetectable within a year of starting treatment, they can live as long as someone without HIV. If the CD4 cell count is low within a year of starting treatment, or if the viral load is undetectable, they are likely to live 10-20 years less than someone without HIV.

Does HIV go away on its own?

HIV doesn't go away on its own. Because it integrates into your DNA, your cells think it's part of you. Even though you may not have any symptoms for years after the initial infection, and you may not feel sick, the HIV virus can continue to damage your immune system.

While taking medication, there may be times when the virus is too low to be detected on an HIV test. During these times, HIV can remain hidden in your body, undetectable. It can "wake up" in the future and start destroying your cells again.

That's why it's so important to continue taking your HIV medication, even if you don't feel sick or have undetectable levels of the virus. Without treatment, HIV weakens your immune system, eventually making it unable to fight off other serious illnesses.

How can I reduce my risk of contracting HIV?

The best way to reduce your risk of contracting HIV is to be aware of how it is spread and to protect yourself in certain activities. Having unprotected sex and sharing needles to inject drugs are the main ways HIV is spread.

Here are some ways you can reduce your risk:

• Use latex condoms (rubbers) for any type of sexual intercourse (vaginal, anal, or oral). Do not use condoms made from animal products (e.g., sheepskin).
• Use water-based lubricants (lotion).
• Never share needles to inject drugs.
• Get tested and treated for other sexually transmitted infections (STIs). Having other STIs increases your risk of getting HIV.
• Do not get drunk or use drugs to distract yourself. People who are drunk are less able to protect themselves.
• If you are at high risk of being exposed to HIV, ask your doctor if you should take PrEP (pre-exposure prophylaxis) .
• If you think you may have been exposed to HIV, see your doctor as soon as possible to see if you need to take PEP (Post-exposure prophylaxis) .
• Consider getting tested to see if you can pass HIV to others.

Using a condom correctly is very important to protect against HIV. Use a male condom during any sexual activity that involves your penis.

You can protect your vagina or anus with either dental dams or internal condoms (female condoms) . Dental dams are flat pieces of polyurethane or latex that can be placed over the vagina or anus during oral sex. An internal condom can be inserted into the vagina or anus and used.

Only use one type of condom at a time. Do not use both a male condom and an internal condom at the same time.

Can medication prevent HIV?

There are medications that can help prevent HIV for those who have been exposed or those at high risk of exposure. These are called PrEP (Pre-exposure prophylaxis) and PEP (Post-exposure prophylaxis) .

Pre-exposure prophylaxis (PrEP)

PrEP is a pill you take every day if you don't have HIV but are at high risk of infection.

In particular, if you do not have HIV, you have had anal or vaginal sex within the past six months, and any of the following conditions are true, it is recommended to take PrEP:

• Your sexual partner has HIV.
• You haven't always used a condom.
• You have had a sexually transmitted infection (STI) within the last six months.

PrEP is recommended if you do not have HIV, you inject drugs, and if any of the following conditions are true:

• You inject drugs with a partner who has HIV.
• You share needles or other equipment to inject drugs.

PrEP is not a substitute for other forms of protection. Even while taking PrEP, you should still use condoms and avoid sharing needles to inject drugs.

Post-exposure prophylaxis (PEP)

PEP uses HIV medication to try to prevent HIV infection as soon as possible after you have been exposed. PEP is for people who do not have HIV, or who do not know if they have HIV but think they may have been exposed through consensual sex, sexual assault, sharing needles (or other equipment), or work-related exposure.

You should start PEP within 72 hours of exposure and take it every day for 28 days. PEP is for emergencies only, and is not a substitute for other forms of protection, such as condom use.

If I have HIV, how can I prevent it from spreading to others?

The best ways to prevent HIV transmission to others are largely the same as the ways to protect yourself:

• Tell your sexual partners and those who inject drugs with you that you have HIV.
• Follow your treatment plan and don't skip your medication. If your viral load is undetectable, your risk of transmitting HIV through sexual contact is greatly reduced (U=U: Undetectable = Untransmittable).
• Talk to your sexual partner about taking PrEP.
• Even if your viral load is undetectable, wear condoms during vaginal, anal, and oral sex.
• Do not share needles or other equipment used to inject drugs.
• Limit your number of sexual partners.
• If you are pregnant and have HIV, following your treatment plan, including ART medication, can reduce the risk of passing the virus to your baby.

Can I get pregnant if I have HIV?

Some people think that HIV makes it harder to get pregnant, but that's not true. If you have HIV and want to get pregnant, talk to your doctor. Together you can make a plan to keep you, your partner, and your future children healthy.

You can pass HIV to your partner through unprotected sex, and to your baby during pregnancy, childbirth, and breastfeeding. Taking ART can greatly reduce the risk of passing HIV to your baby, especially if your viral load is undetectable. Your doctor may recommend that you give your baby formula instead of breast milk.

When should I see my doctor?

If you think you may have been exposed to HIV, call your doctor immediately. If you have HIV, it is very important to start treatment as soon as possible .

If you already know you have HIV, follow your doctor's instructions about when to talk. It's important to treat any type of infection, so talk to them if you have new symptoms like fever, night sweats, diarrhea, or anything else that worries you.

What questions should I ask my doctor?

• Am I at increased risk of contracting HIV?
• What can I do to reduce my risk of contracting HIV?
• How do I make sure I take my medication correctly?
• What can I do to protect myself from other diseases?
• How to prevent the spread of HIV?
• What do my test results mean?
• What do my blood counts mean?
• What vaccinations should I get?

Finally, things to remember (Take-Home Message)

Treatment options are much better today than they were at the height of the AIDS epidemic. If you are diagnosed early, put on ART, and stick to it, you have the best chance of living a long life. Today, people living with HIV can work, have active social lives, raise families, and have fulfilling relationships. In fact, these things can have a positive impact on your mental well-being.

No matter how far we've come in terms of treatment, unfortunately, the stigma surrounding HIV still exists. In addition to the fear and uncertainty that comes with a new diagnosis, you may also be concerned about how people around you will react. If you're hesitant about getting tested or treated, or if you're unsure about your next steps, talk to a community organization that specializes in HIV. Remember, you have the right to support, compassion, and high-quality health care.

` HIV, AIDS, immune system, retrovirus, CD4 cells, ART treatment, sexual health