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HIV/AIDS

Key facts

  • •    To reach the new proposed global 95–95–95 targets set by UNAIDS, we will need to redouble our efforts to avoid the worst-case scenario of 7.7 million HIV-related deaths over the next 10 years, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.

  • HIV continues to be a major global public health issue, having claimed 40.1 million [33.6–48.6 million] lives so far.

  • In 2021, 650 000 [510 000–860 000] people died from HIV-related causes and 1.5 million [1.1–2.0 million] people acquired HIV.

  • There is no cure for HIV infection. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.

  • There were an estimated 38.4 million [33.9–43.8 million] people living with HIV at the end of 2021, two thirds of whom (25.6 million) are in the WHO African Region.

  • Uganda has implemented the “test and treat” policy for all HIV-infected children, pregnant and breastfeeding women, HIV and TB or Hepatitis B co-infected people, the HIV-infected partner in a serodiscordant relationship and HIV-infected individuals among key populations since 2014.

  • The 2016 guidelines expanded this policy to all adolescents and adults living with HIV. The test and treat policy involves providing lifelong ART to people living with HIV irrespective of CD4 count or clinical stage.

  • The 2018 version of the guidelines recommended optimizing ART using Dolutegravir-based regimen as preferred first-line for eligible PLHIV considering the rising levels of pre-treatment drug resistance to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These guidelines also provided operational and service delivery guidance to districts and health facilities to implement other new approaches including:

    • HIV Self-Testing and Assisted Partner Notification.o    

    • Effective integration of elimination of mother-to-child HIV transmission (eMTCT) services into maternal, newborn, child and adolescent health services(MNCAH).

    • Differentiated service delivery, which reduces clinic visits and allows community ART distribution to PLHIV who are stable on ART.

    • Working with community structures to optimize delivery of HIV services; and

    • Retention, adherence to treatment, adolescent-friendly and responsive health services.

  • The 2020 version of the guidelines recommend the optimization of ART using Dolutegravir-based regimens as preferred first line for all eligible PHLIV including pregnant and breastfeeding adolescent girls and women. The guidelines also recommend procedures for ARV substitution in adults, adolescents, and children already on first-line ART and recommend options for subsequent second- and third-line regimens. These guidelines also emphasize the importance of Pharmacovigilance (PV) and describe the procedures for identifying, investigating, reporting, and managing adverse effects of ART, anti-TB and other medications.


What is HIV?
HIV stands for human immunodeficiency virus. It harms your immune system by destroying a type of white blood cell that helps your body fight infection. This puts you at risk for serious infections and certain cancers.


What is AIDS?
AIDS stands for acquired immunodeficiency syndrome. It is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.


How does HIV spread?
HIV can spread in different ways:

  • Through unprotected sex with a person with HIV. This is the most common way that it spreads.

  • By sharing drug needles.

  • Through contact with the blood of a person with HIV.

  • From mother to baby during pregnancy, childbirth, or breastfeeding.


Who is at risk for HIV infection?
Anyone can get HIV, but certain groups have a higher risk of getting it:

  • People who have another sexually transmitted disease (STD). Having an STD can increase your risk of getting or spreading HIV.

  • People who inject drugs with shared needles.

  • Gay and bisexual men.

  • Black/African Americans and Hispanic/Latino Americans. They make up a higher proportion of new HIV diagnoses and people with HIV, compared to other races and ethnicities.

  • People who engage in risky sexual behaviors, such as not using condoms.

  • Factors such as stigma, discrimination, income, education, and geographic region can also affect people's risk for HIV.


What are the signs and symptoms of HIV/AIDS?

The symptoms of HIV and AIDS vary, depending on the phase of infection.


Primary infection (Acute HIV)

Some people infected by HIV develop a flu-like illness within 2 to 4 weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks.


Possible signs and symptoms include:

  • Fever

  • Headache

  • Muscle aches and joint pain

  • Rash

  • Sore throat and painful mouth sores

  • Swollen lymph glands, mainly on the neck

  • Diarrhea

  • Weight loss

  • Cough

  • Night sweats


These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.


Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many people may not have any symptoms or infections during this time.


This stage can last for many years if you're receiving antiretroviral therapy (ART). Some people develop more severe disease much sooner.


Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells - the cells in your body that help fight off germs - you may develop mild infections or chronic signs and symptoms such as:

  • Fever

  • Fatigue

  • Swollen lymph nodes - often one of the first signs of HIV infection

  • Diarrhea

  • Weight loss

  • Oral yeast infection (thrush)

  • Shingles (herpes zoster)

  • Pneumonia


Progression to AIDS

Access to better antiviral treatments has dramatically decreased deaths from AIDS worldwide, even in resource-poor countries. Thanks to these life-saving treatments, most people with HIV in the Uganda are adhering and don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.


When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop diseases that wouldn't usually cause illness in a person with a healthy immune system. These are called opportunistic infections or opportunistic cancers.


The signs and symptoms of some of these infections may include:

  • Sweats

  • Chills

  • Recurring fever

  • Chronic diarrhea

  • Swollen lymph glands

  • Persistent white spots or unusual lesions on your tongue or in your mouth

  • Persistent, unexplained fatigue

  • Weakness

  • Weight loss

  • Skin rashes or bumps


Some people may not feel sick during the earlier stages of HIV infection. So the only way to know for sure whether you have HIV is to get tested.


How do I know if I have HIV?

A blood test can tell if you have HIV infection. Your health care provider can do the test, or you can use a home testing kit.


HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage with treatment and care. People can also use HIV self-tests to test themselves. However, no single test can provide a full HIV positive diagnosis; confirmatory testing is required, conducted by a qualified and trained health or community worker. HIV infection can be detected with great accuracy using WHO prequalified tests within a nationally approved testing strategy and algorithm.


Most widely-used HIV diagnostic tests detect antibodies produced by the person as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called window period – when HIV antibodies haven’t been produced in high enough levels to be detected by standard tests and when they may have had no signs of HIV infection, but also when they may transmit HIV to others. After infection without treatment and viral suppression, an individual may transmit HIV transmission to a sexual or drug-sharing partner or for pregnant women to their infant during pregnancy or the breastfeeding period.


Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error prior to starting life-long treatment. It is important to support people with HIV to stay on treatment and provide counselling messages and services when there are concerns about the accuracy of their diagnosis or if they stop treatment and care and need to be re-engaged.


While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. For children less than 18 months of age, rapid antibody testing is not sufficient to identify HIV infection – virological testing must be provided as early as birth or at 6 weeks of age. New technologies are now available to perform this test at the point of care and enable same-day results, which will accelerate appropriate linkage with treatment and care.


What are the treatments for HIV/AIDS?

There is no cure for HIV infection, but it can be treated with medicines. This is called antiretroviral therapy (ART). ART can make HIV infection a manageable chronic condition. It also reduces the risk of spreading the virus to others.


Most people with HIV live long and healthy lives if they get and stay on ART. It's also important to take care of yourself. Making sure that you have the support you need, living a healthy lifestyle, and getting regular medical care can help you enjoy a better quality of life.


Can HIV/AIDS be prevented?

You can reduce the risk of spreading HIV by:

  • Getting tested for HIV.

  • Choosing less risky sexual behaviors. This includes limiting the number of sexual partners you have and using latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

  • Getting tested and treated for sexually transmitted diseases (STDs).

  • Not injecting drugs.

  • Talking to your health care provider about medicines to prevent HIV:

    • PrEP (pre-exposure prophylaxis) is for people who don't already have HIV but are at very high risk of getting it. PrEP is daily medicine that can reduce this risk.

    • PEP (post-exposure prophylaxis) is for people who have possibly been exposed to HIV. It is only for emergency situations. PEP must be started within 72 hours after a possible exposure to HIV.

    • HIV is not transmitted if a person’s sexual partner is virally suppressed on ART, so increasing access to testing and supporting linkage to ART is an important component of HIV prevention


A note from Pan Medical Kampala

The human body can’t get rid of HIV and no effective HIV cure exists. So, once you have HIV, you have it for life. Luckily, however, effective treatment with HIV medicine (called antiretroviral therapy or ART) is available. If taken as prescribed, HIV medicine can reduce the amount of HIV in the blood (also called the viral load) to a very low level. This is called viral suppression. If a person’s viral load is so low that a standard lab can’t detect it, this is called having an undetectable viral load.

 

People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex.

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