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WHERE ARE WE WITH HIV IN 2020?
HIV continues to be a major global public health issue.1a
There were an estimated 38 million people living with HIV at the end of 2019.1b
Africa remains most severely affected, accounting for more than two-thirds of all people living with HIV worldwide.1c
There is still a great need to further increase awareness and enable better access to affordable medications, thereby improving the quality of life for all people living with HIV.1m
WHAT IS HIV / AIDS?
HIV | human immunodeficiency virus
HIV destroys the ability of the body’s immune cells to function and so over time, people gradually become immunodeficient (unable to fight off infection).1d
AIDS | acquired immunodeficiency syndrome (AIDS)
When HIV is left untreated, it leads to the disease AIDS – this is the most advanced stage of HIV infection. A person with AIDS is more susceptible to developing a wide range of infections, certain cancers and other severe long-term clinical complications.
HOW DOES HIV CAUSE DISEASE?
HIV attacks and destroys the CD4 cells of the immune system. CD4 cells are a type of white blood cell that play a major role in protecting the body from infection. The loss of CD4 cells makes it difficult for the body to fight off infections and certain cancers.3a,b
HIV uses the CD4 cells to multiple and spread throughout the body. HIV can also ‘hide out’ inside these cells for years forming a ‘latent’ HIV reservoir. At any time, cells in the latent reservoir can become active again and start making more HIV.3b,c
The virus at work:
HOW DO YOU GET HIV?
HIV is spread through the exchange of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and birth.1i
HIV is not transmitted through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, sharing a toilet, urine, food or water.1i
DID YOU KNOW?
People living with HIV who are on HIV treatment and who are virally suppressed do not transmit HIV to their sexual partners.1j
Early access to HIV treatment and support to remain on treatment is critical not only to improve the health of people living with HIV but also to prevent the spread of HIV.1j
SIGNS AND SYMPTOMS
The symptoms of HIV depend on the stage of infection.1f,4a-d
WHO IS AT RISK OF CONTRACTING HIV?
Certain behaviours can increase people’s risk of getting HIV. These include:1k
- Having unprotected anal or vaginal sex
- Having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis
- Sharing contaminated needles, syringes when injecting drugs
- Receiving unsafe injections, blood transfusions and medical procedures that involve unsterile cutting or piercing
- Accidental needle stick injuries, including among health workers
HOW DO YOU FIND OUT IF YOU HAVE HIV?
There are normally 2 tests that can be done to diagnose and confirm HIV infection.5a HIV testing services is the main entry point to continued HIV care.5b HIV testing can usually be accessed from outpatient clinics, medical, surgical and paediatric wards, emergency units, and maternal/child health clinic services.5c Counselling will be provided before and after you are tested for HIV.5d
You can also buy an HIV testing kit at your nearest pharmacy and self-test at home.3i If you’re positive, it is important to get to your doctor or local clinic as soon as possible.5e
It is important to know your own HIV status so that necessary prevention and/or treatment can be started.5f,g For more information on prevention of HIV infection (pre-exposure prophylaxis and post-exposure prophylaxis): read here.
For any questions and support, The National AIDS Helpline contact details are 0800 012 322.5h
WHAT IS THE ‘WINDOW PERIOD’?
When a person is infected with HIV, the body may take up to 28 days to produce antibodies in high enough levels to be detected by a test this is called the window period. It is during this time that a person can unknowingly transmit HIV to other individuals who are for example their sexual or drug-sharing partner.1l
All people with HIV should have regular blood tests. The two most important blood tests are for CD4 count and viral load.6a
VIRAL LOAD AND VIRAL SUPPRESSION
Antiretroviral medicines suppress the amount of virus in the blood, called viral load:7a
What is viral suppression? When antiretroviral therapy reduces a person’s viral load to an undetectable level. Viral suppression does not mean a person is cured, HIV still remains in the body. If treatment is stopped, the person’s viral load will start to increase again.7b,c
WHAT IS THE GOAL OF TREATMENT?
The main goal of ART is to reduce a persons viral load to an undetectable level and restore or preserve immune function which will lead to a reduction in risk of illness and death.8a,b,9a
Patients should be prepared for lifelong ART with good adherence to medications – this is a critical component of achieving effective viral suppression.8c,d
HIV treatment involves taking medicine that reduces the amount of HIV in your body. HIV medicine is called antiretroviral therapy (ART).10a
It is important to know that:
- There is no effective cure for HIV. But with proper medical care, you can manage HIV.10b
- Taking HIV medicine does not prevent transmission of other sexually transmitted diseases.10b
HIV medicine is recommended for all people with HIV – children, adolescents, adults, pregnant and breastfeeding women – regardless of how long they’ve had the virus or how healthy they are.5i,10c
HOW DO THEY WORK?
People on ART take a combination of HIV medicines from at least two different HIV drug classes every day. Different classes of HIV medicines are designed to target specific steps in the HIV life cycle – ART is therefore very effective at preventing HIV from multiplying.3j
For more on how these medicines work and specific treatment regimens for people with HIV, you can read further here – HIV treatment for Adults.
Speak to your doctor or pharmacist for further advice on your condition and the best treatment options for you.
- World Health Organisation (WHO) Key Facts; Updated Date. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids Last accessed August 2020.
- Number of people (all ages) living with HIV Estimates by country [Last updated 09.07.2020]. Available from: https://apps.who.int/gho/data/view.main.22100?lang=en Last accessed August 2020.
- AIDSINFO, National Institutes for Health (NIH). HIV Overview. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/ Last accessed August 2020.
- Weinberg J and Kovarik CL. The WHO Clinical Staging System for HIV/AIDS. Virtual Mentor2010;12(3):202-206. doi: 10.1001/virtualmentor.2010.12.3.cprl1-1003.
- National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.
- CD4 and viral load [January 2017]. Available from: https://www.aidsmap.com/about-hiv/basics/cd4-and-viral-load Last accessed August 2020.
- AIDSinfo, National Institutes for Health (NIH). Understanding HIV/AIDS Glossary. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/1650/viral-suppression Last accessed August 2020.
- Meintjes G, Moorhouse MA, Carmona S, et al. Adult antiretroviral therapy guidelines 2017. S Afr J HIV Med 2017;18(1):a776. https://doi.org/10.4102/ sajhivmed.v18i1.776.
- AIDSinfo, National Institutes for Health (NIH). HIV Treatment: The Basics [Last reviewed March 2, 2020]. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/51/hiv-treatment–the-basics Last accessed August 2020.
- Centers for Disease Control and Prevention (CDC). HIV Treatment [Online; Last reviewed October 21, 2020]. Available at: https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html Last accessed November 2020.
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HIV 3 – Treatment in Children
While significant progress has been made in preventing HIV infections in children,1a HIV remains a significant contributor to under-five deaths in South Africa.2a