HIV and AIDS

HIV (Human Immunodeficiency Virus) is a blood borne pathogen, meaning that it is an infection that lives in blood. The two main ways that HIV is transmitted is through sex and drug use. Proper harm reduction techniques can reduce the risk of transmission. Examples of these include using sterile drug equipment and using condoms.

The Basics About HIV:

HIV is a virus that weakens your body’s immune system, your body’s built in defense against disease.

HIV is most often spread through unprotected sexual intercourse (anal, vaginal), sharing needles and syringes, or from a mother to her baby.

Without treatment HIV can lead to AIDS (Acquired Immune Deficiency Syndrome)

There is no cure for HIV, but there is treatment.

There is no vaccine to prevent HIV infection, but there are things you can do to avoid passing or getting HIV.

People can look and feel well, and still have HIV. You may not look or feel sick for years, but you can still pass the virus on to other people. To be sure whether or not you have the virus, an HIV antibody blood test is required.

What to be familiar with if you have HIV:

Being HIV positive is not a death sentence. Today, HIV can be managed and monitored. Most people with HIV can avoid getting AIDS and live a long life. The virus is comparable to the care for diabetes.

ART (Antiretroviral therapy) is the combination of several different medicines used to slow down the rate that HIV multiplies in the body.

Understanding the medical commitment: Staying on your daily dosage of ART, having regular 3 month visits to Southern Alberta Clinic (located in Calgary) or Northern Alberta Clinic (located in Edmonton), eating well and maintaining a healthy lifestyle are all important to your health.

Disclosure: Because of current stigma and the laws surrounding HIV it is important to know when to disclose your status. If you have HIV, you have a legal duty to tell your sex partner(s) before having any kid of sex that poses a “realistic possibility of transmitting HIV.” People with HIV have been convicted of serious crimes for not telling their sex partners they have HIV. See the disclosure box below for more information.

Understanding the term undetectable. Taking ART medication reduces the amount of virus in your body. If your viral load is undetectable it means that the level of virus in the blood of a person with HIV is so low that it cannot be measured. An undetectable viral load is a highly effective way to prevent HIV. The risk of contracting HIV from sexual intercourse with someone who has an undetectable viral load is very low.

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How Does HIV affect the body?

Once in the body, the virus infects and compromises the immune system. HIV infects certain white blood cells called CD4 cells, and uses the body’s natural method of cell replication to mass produce itself. This process multiplies the disease, and destroys the immune system along the way. As the virus is hidden within the body’s defense system, the body has no way of fighting and eradicating the infection. This also leaves the body defenseless against other infections, known as opportunistic infections, which take advantage of the body’s weakened state.

What is AIDS?

Acquired Immuno-Deficiency Syndrome. AIDS is the most advanced stage of an untreated HIV infection. It can take up to ten years to reach this stage, during which time the body’s white blood cell count diminishes and the viral load increases. Once a HIV positive person has a CD4 (white blood cell) count less than 250 per blood sample, the person is considered to have AIDS.

Usually at this point, the virus will also be combined with one or more opportunistic diseases. No one dies of HIV or AIDS, but rather of AIDS-related illnesses.

How is HIV transmitted?

HIV is transmitted through five bodily fluids.

Blood
Semen
Vaginal Fluid
Anal Fluid
Breast Milk

For HIV contraction to occur, one of these fluids from an untreated HIV positive person must come in contact with either an open wound, or a soft, absorbing tissue, usually of the vagina or anus. Though technically possible, HIV infection rarely (if ever) occurs through the mouth or digestive system.

The most common methods of transmission are the sharing of needles for intravenous drug usage, and unprotected vaginal/anal sex.

Some other less common ways are:

Mother to child during pregnancy, birth or breastfeeding.
Occupational exposure, such as an accidental needle poke during a medical examination.
Fights or biting, when there is blood present
Blood transfusions
Tattoos

HIV cannot be transmitted through saliva, sweat, or tears.

What are the symptoms of HIV?

In about 60-90% of people who contract HIV, flu-like symptoms can occur 2-4 weeks after infection. This is the body’s initial response to a foreign invader. These can include fever, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The flu-like symptoms can last a few days to a few weeks.

After this, the virus hides itself within the white blood cells, and most people do not experience any symptoms for a long time. This is known as the incubation period, as the virus is multiplying itself within the body. The incubation period can be up to 10 years long.

Once the immune system is compromised to the point that opportunistic infections can infect the body, symptoms will depend on the infection contracted.

How is HIV treated?

HIV is incurable, but we do have a very effective way of treating the virus. Antiretroviral Therapy, otherwise known as ART, is a combination of medications that prevent HIV from replicating itself within the body. The different drugs each fight the replication process in different ways, ensuring that they work effectively. Unfortunately the drugs cannot completely eradicate the virus, but it can lower the viral load till a person has reached “undetectable levels”.

A person is undetectable when the amount of virus in their blood cannot be measured on a blood test. When a person is undetectable the chance of transmitting the virus is very low. A person reaches undetectable status when they maintain their course of ART regularly and consistently.

How effective is HIV treatment at preventing HIV infection?

Antiretroviral treatment and an undetectable viral load is a highly effective HIV prevention strategy. Two studies in which one partner was HIV positive and was undetectable on ART, clearly demonstrate this for both heterosexual and gay male sero-discordant (one partner is positive and the other is negative) couples.

The HPTN study looked at 1,764 ser-discordant couples and found the risk of HIV transmission was lowered by 93% when the positive partner was undetectable on ART.

The PARTNER study included 482 heterosexual and 282 same-sex male sero-discordant couples in which condoms were not being used and the HIV-positive partner was already on treatment and receiving routine care. Preliminary results in 2014 showed no HIV infections despite over 44,000 condomless sex acts when the viral load was undetectable.

The results of both HPTN 052 and PARTNER affirm that ART is a highly effective strategy to prevent the transmission of HIV.

It is important to remember:

It is possible for viral load to increase if ART stops working due to poor adherence to medications or drug resistance. Regular adherence to medications and viral load testing is important to ensure that ART is working and an undetectable viral load is maintained
It can take up to six months for the viral load to reach undetectable levels once treatment has started. It is generally recommended that the viral load be undetectable for at least six months prior to using ART as a prevention strategy.

References

Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine. 2016;375:830–9. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1600693
Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association. 2016;316(2):171–81. Available from: http://jama.jamanetwork.com/article.aspx?articleid=2533066

When do I have to disclose my status if I am HIV positive?

In Canada you have a legal duty to tell your sex partner(s) before having any kind of sex that poses a “realistic possibility of transmitting HIV.”

You DO have a legal duty to disclose your HIV status before having:

vaginal or anal sex without a condom (regardless of your viral load); or

vaginal or anal sex when your viral load is not undetectable (or not low), even if you use a condom.

You do NOT have a legal duty to disclose your HIV status before having:

vaginal sex if your viral load is low (or undetectable) and you use a condom. It is not clear whether this also applies to anal sex.

It is not clear how the law applies to oral sex (with or without a condom).

For more information on HIV and the criminal law in Canada click here

How can HIV be prevented?

The easiest ways to protect against the virus is to use a condom when having any form of sex, and using clean, sanitary products for intravenous drug use. STI testing is important to catch any STI during their earlier stages, making treatment options more effective. Another form of protection is knowledge. Staying informed will help fight stigma and allow for conversations about safer sex with partners.

For more information about testing services within Lethbridge, or where to find free safe sex supplies, click here

What is PrEP?

PrEP (Pre-exposure Prophylaxis) is a prevention strategy against HIV where an HIV-negative individual takes an oral medication once a day before coming into contact with HIV to reduce their risk of infection. Taking PrEP involves medical visits every three months for HIV testing, screening for other STIs, monitering for possible side effects, and ongoing support. Most people on PrEP take it every day, and some take it only on days before and after having sex (this is called on-demand PrEP). Talk to a doctor about what works best for your. PrEP only helps to prevent HIV – it does not protect against other STIs.

What is PEP?

PEP (post-exposure prophylaxis) is also a medication for HIV-negative people to take after coming into contact with HIV. This must be started within 72 hours after HIV exposure.

What about HIV and pregnancy?

The transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding is called mother-to-child transmission. If you are HIV-positive and pregnant you can reduce the chances of your child bring HIV-positive to less than 1 percent by getting proper HIV treatment and care and not breastfeeding after birth.

For more information on HIV and Pregnancy see this booklet:

http://www.catie.ca/en/practical-guides/pregnancy

Where did HIV come from?

The origin of the virus is hard to trace, but it is believed to have originated from chimpanzees, who can carry the virus without negative side effects. It was passed to humans in Africa, sometime in the early 1920’s. There is evidence to show earlier origins of the virus, but it was in 1959 that the earliest sample was confirmed from a chimpanzee.

The virus then spread to Haiti in the 1960’s, and from there it spread to three major cities in the U.S.: New York, San Francisco and Los Angeles. The virus first caught the attention of the medical community when it starting affecting young gay men in the early 80’s.

Though it wasn’t until 1981 that the virus was noticed, many people were probably infected throughout the 70’s, as HIV can take up to 10 years to demonstrate any symptoms.

Because the virus seemed to only be affecting gay men, the virus was originally called Gay Related Immune Deficiency, or GRID. Despite being renamed AIDS a few months later, the idea that it was a gay-related disease remained the popular thought throughout the 80’s and 90’s.

Common myths about HIV

There are many myths regarding HIV. Here are some of the most common:

HIV is not contracted casually- Casual contact includes things like: