CPHMLS - HIV

• HIV


  Human immunodeficiency virus that attacks the body's immune system
• HIV

  • From the FAMILY: Retroviridae → Subfamily/Genus: Lentivirinae (slow infection)
  • HIV infection in humans came from a type of chimpanzee in Central Africa
  • The chimpanzee version of the virus is called simian immunodeficiency virus
• HIV remains a major global public health issue, having claimed 40.4 million [32.9–51.3 million] lives so far with ongoing transmission in all countries globally; with some countries reporting increasing trends in new infections when previously on the decline
• There is no cure for HIV infection. However, with 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
• AIDS


  The most advanced, and the final stage of HIV disease
• Types of HIV virus

  • HIV-1
  • HIV-2
• HIV-1


  • Identified by Luc Montagnier of France (1983); Robert Gallo and Jay Levy of U.S. in 1984)
  • Responsible for causing majority of AIDS
  • Subclassified into 4 groups: Group M, Group O, Group N, Group P
  • Group "M" is responsible for majority of HIV-1 infection worldwide (pandemic)
• HIV-2

  • Occurred in West Africa
  • Transmitted in the same manner as HIV-1
  • May also cause AIDS, but it is less pathogenic and has lower rate of transmission
• Major routes of HIV transmission

  • Sexual contact
  • Blood or other body fluid contact (semen, breast milk, vaginal fluid, CSF, Synovial fluid, Pleural fluid)
  • Perinatally (vertical; mother-to-infant)
• SALIVA CANNOT TRANSMMIT THE VIRUS except saliva from dental procedures
• Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low
• People cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water
• Blood transfusion can also transmit the virus, but less frequently occur
• CDC estimated approximately 0.3% of health-workers who are at risk for transmission after a percutaneous exposure to infected blood, and about 0.09% after mucous membrane exposure
• The risk of transmission is increased in exposures involving a large quantity of blood, hollow-bore needles placed directly into an artery or vein, or deep tissue injury
• The risk of infection is also increase if the patient is in acute or advance stages of HIV infection
• HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces
• Risk factors for HIV transmission

  • Having condomless anal or vaginal sex
  • Having another sexually transmitted infection (STI)
  • Engaging in harmful use of alcohol and drugs in the context of sexual behaviour
  • Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs
  • Receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing
  • Experiencing accidental needle stick injuries, including among health workers
• HIV pathogenesis

  • HIV targets and infects a particular type of T-cell called CD4 'helper' cells
  • After entering a host's body, HIV rapidly seeks out the CD4 cells and infects them
  • The virus commandeers the function of the CD4 cells, turning them into factories that produce multiple new copies of the virus
  • Once infected, CD4 cells develop a much shorter lifespan and are eventually destroyed; their progressively declining number in the host causes immunological failure and susceptibility to infection
• Stages of HIV

  • Acute HIV infection
  • Chronic Latent or Clinical Latency
  • Advanced HIV Infection (previously called AIDS)
• Acute HIV infection

  • 2-4 weeks of infection; in some cases, it can be as long as 10 months
  • Flu-like symptoms ▪ Fatigue

  ▪ Muscle pain

  ▪ Headache

  ▪ Sore throat

  ▪ Joint pain

  ▪ Night sweats

  ▪ Diarrhea

  ▪ Skin rash

  • Body's natural response to infection activates
  • Large amount of virus in the blood and are VERY INFECTIOUS
• Chronic Latent or Clinical Latency

  • Period can last a decade or longer
  • HIV is still active and continue to reproduce, thus can still be transmitted to others
  • Asymptomatic
  • End of this phase, a person's viral load starts to go up and the CD4 cell count begins to go down
  • People who take HIV treatment as prescribed may never move into stage 3
• Advanced HIV Infection (previously called AIDS)


  • Have a high viral load and may easily transmit HIV to others
  • Opportunistic illnesses
  • Cd4 cell count of <200/mm3
  • Without HIV treatment, people with AIDS typically survive about three years
• HIV prevention methods

  • Using a male or female condom during sex
  • Being tested for HIV and sexually transmitted infections
  • Having a voluntary medical male circumcision
  • Using harm reduction services for people who inject and use drugs
  • Antiretroviral drugs (ARVs)
• Antiretroviral therapy (ART)


  Does not cure HIV infection but allows a person's immune system to get stronger, helping them to fight other infections
• CART (combination antiretroviral therapy)


  A combination of drugs from at least two of the antiretroviral drug classes. HIV-infected patients who are treated appropriately with CART can be expected to live 50 years longer
• HIV stigma


  Negative attitudes and beliefs about people with HIV. It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable
• Examples of HIV stigma

  • Believing that only certain groups of people can get HIV
  • Making moral judgments about people who take steps to prevent HIV transmission
  • Feeling that people deserve to get HIV because of their choices
• HIV stigma is rooted in a fear of HIV. The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV
• Talking openly about HIV can help normalize the subject. It also provides opportunities to correct misconceptions and help others learn more about HIV
• We can do our part to stop HIV stigma by being intentional and thoughtful when choosing our words and choosing to use supportive—rather than stigmatizing— language when talking about HIV