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HIV

  • HIV, the virus that can cause AIDS, is found in blood, semen, vaginal fluids, and breast milk.
  • HIV is spread most often by having sex without using a condom or by sharing needles.
  • People can be infected with HIV without knowing it. An HIV test is the only way to know for sure.
  • There are treatments that help people with HIV stay healthier, but there is still no cure.
  • Choosing not to have sex and never sharing needles are good ways to protect yourself.
  • Practicing safer sex means always using a new condom with a water-based lubricant.
  • You cannot get HIV from shaking hands, water fountains, bathrooms, or eating utensils.

What is HIV?

HIV or Human Immunodeficiency Virus is a virus that kills your body’s “CD4 cells.” CD4 cells (also called T-helper cells) help your body fight off infection and disease. HIV can be passed from person to person if someone with HIV infection has sex with or shares drug injection needles with another person. It also can be passed from a mother to her baby when she is pregnant, when she delivers the baby, or if she breast-feeds her baby.

Acquired Immunodeficiency Syndrome (AIDS) is a disease you get when HIV destroys your body’s immune system. Normally, your immune system helps you fight off illness. When your immune system fails you can become very sick and can die from an illness as common as the flu.

It is important to remember that AIDS is not synonymous with HIV. AIDS results from specific damage to the immune system and can actually be triggered by many different infections or diseases, one of which is HIV.

Do I have HIV?

The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of HIV infection:

  • Rapid weight loss
  • Dry cough
  • Recurring fever or profuse night sweats
  • Profound and unexplained fatigue
  • Swollen lymph glands in the armpits, groin, or neck
  • Diarrhoea that lasts for more than a week
  • White spots or unusual blemishes on the tongue, in the mouth, or in the throat
  • Pneumonia
  • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
  • Memory loss, depression, and other neurological disorders

HIV & Oral Sex

It is possible for either partner to become infected with HIV through performing or receiving oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV.

The risk of HIV transmission increases if the person performing oral sex:

  • Has cuts or sores around or in their mouth or throat
  • If the person receiving oral sex ejaculates in the mouth of the person performing oral sex
  • If the person receiving oral sex has another sexually transmitted infection (STD).
  • Not having (abstaining from) sex is the most effective way to avoid HIV.

Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission when used correctly and consistently.

If you choose to perform oral sex and your partner is male use a latex condom on the penis. If you or your partner is allergic to latex, plastic (polyurethane) condoms can be used. If you choose to have oral sex, and your partner is female use a latex barrier (such as a natural rubber latex sheet, a dental dam, or a cut-open condom that makes a square) between your mouth and the vagina. A latex barrier such as a dental dam reduces the risk of blood or vaginal fluids entering your mouth.

If you choose to perform oral sex with either a male or female partner and this sex includes oral contact with your partners anus (analingus or rimming) use a latex barrier (such as a natural rubber latex sheet, a dental dam, or a cut-open condom that makes a square) between your mouth and the anus. Plastic food wrap also can be used as a barrier.

What about kissing? Since HIV is not in saliva, most kissing is perfectly safe. There’s a remote risk that if you or your partner had a mouth sore, French kissing could spread HIV. But it’s extremely unlikely, experts say. So, other contact, like cuddling and hugging are safe. And you can satisfy each other sexually in safer ways, using your hands or your bodies.

What if me and my partner both have HIV?

You still need to use protection. You could catch a different strain of HIV from your partner, which could make your disease worse or mean that you need to change medications.

How do you treat HIV?

There is no cure for HIV. Anti-retroviral drugs are used to treat the symptoms of HIV and slow the progress of the disease.

If you have HIV, one of the most important ways you can protect yourself and your partner is to stick with your antiretroviral treatment. Treatment can reduce the amount of virus in your body called the viral load, so much that it doesn’t show up in tests.

This is like a “morning-after pill” for HIV. If you think you’ve been exposed to HIV — maybe the condom broke — see a doctor right away. You may be given antiretroviral drugs for 28 days. It’s generally effective, but get it as soon as possible — within 72 hours of exposure and preferably sooner.

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HIV and other STDs

Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.

STDs appear to increase susceptibility to HIV infection. Genital ulcers caused by diseases like syphilis or herpes create a portal of entry for HIV. Additionally, inflammation resulting from genital ulcers or non-ulcerative STDs, like chlamydia, gonorrhea, and trichomoniasis, increase the concentration of cells in genital secretions that can serve as targets for HIV.

STDs also appear to increase the risk of an HIV-infected person transmitting the virus to his or her sex partners. Studies have shown that HIV-infected individuals who are also infected with other STDs are particularly likely to shed HIV in their genital secretions. For example, men who are infected with both gonorrhea and HIV are more than twice as likely to have HIV in their genital secretions than are those who are infected only with HIV. Moreover, the median concentration of HIV in semen is as much as 10 times higher in men who are infected with both gonorrhea and HIV than in men infected only with HIV. The higher the concentration of HIV in semen or genital fluids, the more likely it is that HIV will be transmitted to a sex partner.

STD treatment reduces an individual’s ability to transmit HIV. HIV testing should always be recommended for individuals who are diagnosed with or suspected to have an STD.

WHAT IS HIV PEP / HIV POST EXPOSURE PROPHYLAXIS?

HIV POST-EXPOSURE PROPHYLAXIS (PEP) is short-term antiretroviral treatment to reduce the chance of HIV infection after potential exposure, through sexual intercourse.

Antiretroviral therapy (ART) offered as PEP has become the standard of care for healthcare workers who have had occupational exposure to HIV. A case-control study has demonstrated that HIV PEP was associated with an 81% decrease in the odds of HIV transmission with a percutaneous exposure in the occupational setting. Although there is no data to show that ART is effective at preventing transmission from non-occupational exposures, the principles of managing patients with recent HIV exposure are similar whether the exposure occurs in an occupational or non-occupational setting.

However, take note that HIV PEP does not guarantee someone exposed to HIV will not become infected with HIV. It is also not a substitute for other HIV prevention methods such as the correct use of condoms.

HIV PEP may be considered in the following situations where there is high-risk exposure (any unprotected anal or vaginal intercourse, receptive oral intercourse with ejaculation) with:

  • a partner known to be HIV-infected, or
  • in HIV risk group (commercial sex workers, IV drug users, men who have sex with men/ bisexual men), or
  • sexual assault

HIV PEP should be started as soon as possible after exposure up to 72 hours. The ideal time period to start PEP is within 24 hours from exposure, although it has been shown to be effective up to 72 hours post-exposure.

The earlier HIV PEP is started, the more effective it is in preventing HIV transmission and infection. If the exposure is more than 72 hours, HIV PEP will be considered on a case by case basis depending on the risk of exposure.

The most common side effects of PEP treatment are nausea, diarrhoea and/or anorexia. Other less common side effects include rare haemotological, dermatological, vascular and neurological side effects. These side effects are generally not serious and not permanent and should resolve after the medication is stopped or completed.

Baseline Tests and Follow Up

  • Baseline HIV test is performed.
  • Baseline full blood count, liver and renal function tests will be performed to detect any pre-existing abnormality prior to treatment and can be repeated at 2 weeks.
  • There will be a follow-up visit after 4 weeks to repeat full blood count, liver and renal function tests as well as and a HIV test.

Follow-up HIV tests are recommended at 3 and 6 months post exposure.