From testing to prevention, you will find on this page answers to questions such as "What is HIV", "What are the side effects of HIV medication", and many more...
HIV or the Human Immunodeficiency Virus is a virus that only infects humans.
A person diagnosed with HIV infection is referred to as being HIV positive.
Once HIV enters the bloodstream, it inserts itself into the cells that make up the immune system and then begins to multiply. The HIV virus attacks the immune system slowly making it easier for a person to get a variety of illnesses known as opportunistic infections. In some cases it may take years for a person to start feeling and looking ill as a result of being HIV positive. During this symptom-less or ‘asymptomatic period’, an HIV positive person can still infect others with the disease.
AIDS stands for Acquired Immunodeficiency Syndrome. AIDS is caused by prolonged infection with HIV. Once HIV infection has significantly weakened an individual’s immune system to the point where they are unable to fight off opportunistic infections, that person is diagnosed as having AIDS.
HIV does not discriminate; anyone who has engaged in a risk activity can be infected with HIV regardless of age, gender, economic back ground, sexual orientation, race, religion, ethnic origin, etc.
HIV attaches itself to a T cell and enters it. Once inside the T cell, HIV is able to multiply, which eventually leads to the destruction of the T cell. As more and more T cells become infected by HIV and destroyed, the immune system is weakened and becomes less able to fight off germs and bacteria.
Some people with HIV develop symptoms which can be like those of many other conditions:
Such symptoms are often caused by common illnesses and not by HIV infection. If you have concerns about these symptoms, you should check with a doctor or health care practitioner.
The window period is the time between when you are exposed to HIV and when a blood test will be able to measure the antibodies your immune system creates to fight HIV. It can take anywhere from four weeks to three months after HIV enters your body to develop enough antibodies to be measured on an HIV test. Most people will develop enough antibodies to test accurately for HIV from four to six weeks.
There may be some short term symptoms of infection, but without an HIV test you won't know for sure if you have the virus.
The asymptomatic period is the time when HIV is in your body but your immune system is strong so there may be no symptoms of infection. The virus may be active and harming your immune system but you can feel as healthy as ever.
The symptomatic period is when HIV becomes more active in your body. The virus has weakened your immune system after living in your body for a while. Symptoms of HIV infection may begin to appear, or re-appear.
A person is diagnosed with AIDS when he/she has HIV plus one or more of the illnesses specific to the syndrome. At this stage a person has generally been living with HIV for many years and the immune system is severely damaged.
In most cases one of the "opportunistic infections" will eventually cause the death of the person living with AIDS.
While AIDS can still be a fatal illness, some drugs are now being used that can reduce HIV's damage to the immune system, delay symptoms, prevent opportunistic infections, and prolong life.
As the end of 2005, an estimated range of 8,600 - 12,200 people in B.C. were living with HIV and AIDS (Source: BC Ministry of Health)
More HIV statistics can be found here.
At the end of 2005, an estimated 58,000 people were living with HIV (including AIDS). It is also estimated that 27% of HIV positive Canadians are unaware of their infection.
Source: Public Health Agency of Canada. Estimates of HIV prevalence and incidence are produced by PHAC every three years. The next HIV estimates for 2008 will be published in 2009.
More HIV statistics can be found here.
As of December of 2007, it was estimated that 33.2 million people are living with HIV/AIDS. (UNAIDS)
More HIV statistics can be found here.
HIV is transmitted through the following activities:
Some activities are considered more high risk than others such as, unprotected sex or sharing needles, versus sex with a condom or using a new or sterilized needle. A good way to understand HIV risk is to consider the transmission equation which helps to illustrate what three things are required to potentially transmit HIV.
Examples of what does NOT transmit HIV:
The following do not transmit the HIV virus:
Some activities are considered more high risk than others, such as unprotected sex or sharing needles, versus sex with a condom or using a new or sterilized needle. A good way to understand HIV risk is to consider the following transmission equation which helps to illustrate what three things are required to potentially transmit HIV.
| HIV TRANSMISSION EQUATION | ||||
| BODY FLUID WITH HIGH LEVELS OF HIV | ACTIVITY | DIRECT ACCESS FOR THE VIRUS TO ENTER THE BLOODSTREAM | ||
|
+ |
|
+ |
|
| = | ||||
| RISK OF HIV TRANSMISSION | ||||
T cells play a very important role in the effective functioning of the human immune system.
T cells are important because they stimulate other immune cells to respond to infection. Without T cells, the immune system cannot protect the body against many types of germs.
T cells can also be called CD4+ cells.
A CD4+ cell count measures the number of T cells in a cubic millilitre of blood. A measure of CD4+ cells indicates how healthy the immune system is and, in people who are HIV positive, can help to indicate how far the disease has progressed.
In a person with a healthy immune system, a CD4+ cell count generally falls between 500 and 1500. A CD4+ cell count of 200 or less in a person living with HIV may mean a higher susceptibility to opportunistic infections.
People who are HIV positive should monitor their CD4+ cell counts, and their viral load counts, regularly. Results are generally passed along and reviewed by health care professionals to support case-by-case, individualized planning in order to establish at what point an individual should consider starting or adjusting anti-HIV medications.
Viral load refers to the amount of HIV in a person’s blood. It is very important that Persons living with HIV/AIDS (PWAs) monitor their viral load on a regular basis. Results of viral load testing can help indicate:
In the human body there are many germs such as bacteria, protozoa, fungi and viruses. When the human immune system is working well, it is able to control these germs. However, when the immune system is weakened or compromised, these germs may get out of control and cause health problems.
Opportunistic infections are mild to severe infections caused by microorganisms (pathogens), which can include bacteria (such as staph), viruses (such as HIV), and fungi (such as yeast). While these microorganisms usually do not cause serious disease in healthy individuals, individuals with compromised immune systems (such as individuals infected with HIV) will be less likely to resist such opportunistic infections.
Symptoms of opportunistic infections will vary according to the microorganism that caused the infection and by the individual infected. Treatment or medical management of opportunistic infections may be difficult because some of these microorganisms may be resistant to standard antibiotic therapy. For example, since antibiotics target bacterial structure and function, and since viruses and bacteria are structurally different, antibiotics will have no effect on viruses.
There are many different kinds of opportunistic infections. The following is a list of some common opportunistic infections:
Bacterial Infections:
Bacterial Diarrhea
Tuberculosis (TB)
Syphilis & Neurosyphilis
Bacterial Pneumonia
Malignancies:
Anal Dysplasia/Cancer
Cervical Dysplasia
Kaposi’s Sarcoma (KS)
Lymphomas
Viral Infections:
Hepatitis C
Herpes Virus (Shingles)
Herpes Simplex Virus (Oral and genital)
Human Papiloma Virus (HPV, genital warts and anal and cervical cancer)
Fungal Infections:
Aspergilosis
Candidiasis (Thrush, yeast infection)
Coccidioidomycosis
Histoplasmosis
Protozoal Infections:
Cryptosporidiosis
Psoriasis
Pneumocystis Pneumonia (PCP)
Taxoplasmosis
Neurological Conditions:
AIDS Dementia Complex (ADC)
Peripheral Neuropathy
If you are HIV positive there are many things that can help to decrease the chance of infecting your baby with HIV such as early testing, have good prenatal care, talk to your health care professional about treatment, and have a delivery plan for the baby.
Testing babies for HIV is done after birth. Most babies born to infected mothers will initially test positive for HIV antibodies. Babies when they are first born take on their mother’s antibodies, which is why many babies when first tested after birth will test positive. This doesn’t necessarily mean your baby is positive. To determine your baby’s actual HIV status, doctors will recommend several tests. These HIV tests will look for the virus itself and not just the HIV antibodies. The first test will be administered at your baby’s birth. Follow up tests are administered at two weeks, four to six weeks and after three months. If babies are infected with HIV, their own immune system will start to make antibodies. These babies will continue to test positive meaning they are HIV infected. If the baby receives at least two negative tests results after one month of age, your baby is not infected. If the baby is not infected, the mother’s antibodies will disappear and the baby will begin to create its own antibodies. Your baby will be tested again about twelve to eighteen months later to confirm all HIV antibodies have cleared.
Many HIV positive women give birth to healthy babies who are HIV negative. If you take HIV medication as prescribed by a doctor, your baby has less than a 2% (2 in 100) chance of becoming infected. Without medication this chance increases to about 25% (25 in100).ÂÂ
There is no way to know for sure if your baby will be born with HIV. Women with higher viral loads are more likely to give birth to babies infected with HIV but no viral load is low enough to ensure a baby will not become HIV positive. Following prescribed drug therapy treatment may help prevent the spread of HIV to the fetus.
A vaginal birth is still recommended for mother and baby, but some doctors and health practitioners may recommend a woman deliver by caesarean section if her viral load puts the baby at greater risk. It is important to keep in mind however that having a caesarean section may not make a difference since in some cases the fetus may have already been infected with HIV before its birth.
Yes, it is your right and your choice to have a baby. Women living with HIV who are in relationship with an HIV positive partner have the right to become pregnant and bear children. There are some issues for consideration including preventing HIV transmission during conception and reducing the chances of mother-to-child transmission.
If a women is HIV positive and would like to become pregnant by her male partner who is HIV negative, this can be done without the risk of HIV transmission from the woman to the man through artificial insemination. If a woman who is HIV negative would like to conceive and her partner is HIV positive, sperm washing can be undertaken to make sure that HIV is not transmitted from the man to the woman.
Doctors will likely recommend an HIV test during prenatal screenings as a preventive measure to help reduce the number of babies born with HIV. While this is a strategy used in Canada, remember it is still your body and therefore you have the right to decide if you wish to be tested. You should also always be given the opportunity to talk about the test, how it is administered, what the results mean and how the results might affect you personally.
Currently the global investment is approximately five hundred million US dollars per year. This cost includes industry and research agencies in industrialized countries. While this number may seem large, the investment must be increased to build capacity in “developing countries†in order to conduct trials.
Research for a vaccine has been and continues to be a long process that includes basic laboratory research, product development, and animal experiments. The next step is to test these products on healthy human volunteers through a number of phases. Since 1987, more than thirty HIV candidate vaccines have been tested in approximately sixty phase one and two trials involving more than ten thousand healthy volunteers. Presently, there are only two candidate vaccines being evaluated in phase three trials.
An ideal vaccine would be safe, accessible, inexpensive, easy to manufacture on a large scale, effective against multiple HIV clades/strains, have long lasting immunity, and be easy to ship and distribute globally.
Current HIV prevention technologies are limited in scope. Currently HIV prevention primarily focuses on either abstinence or condoms, which are effective when used correctly and consistently. Having an HIV vaccine would be an additional prevention tool providing it is safe, accessible and effective. Research has demonstrated that the use of vaccines as a therapeutic intervention tool when used in association with antiretroviral therapies could help to lower the cost of treatments and would increase long term efficacy.
No. Such a product is in various stages of clinical trials but presently it is not available for use.
An HIV vaccine would boost the human immune system so that it would not succumb to the virus that weakens the human immune system.
A vaccine is a substance used to improve the immunity to a particular disease or infection. An individual is injected with a killed microbe (bacteria or virus) which stimulates the immune system to fight against the microbe and therefore prevent the disease.
Sexual activity:
Drug use:
Mother to child transmission:
Blood transfusions and medical procedures:
Tattooing and piercing:
Health care workers:
Microbicides are currently unavailable for use as clinical research is still taking place to ensure the safety and efficacy of these substances. To date, there are at least eleven product leads that have been proven effective and safe on animals and are presently being tested on humans. If one of these leads proves successful, it is possible that microbicides may be available in five to seven years time.
Microbicides are substances that would be able to prevent the transmission of HIV and other STI’s. These substances can take many forms including creams, films, gels, suppositories, or as a sponge or ring that releases the active ingredients over time.
To help prevent the transmission of the HIV (Human Immunodeficiency Virus), individuals should be aware of their own HIV status. In an ideal world, individuals would be aware of their partners’ status. However this is not always the case due to the following reasons:
There are a number of things individuals can do to protect themselves from HIV transmission. Awareness and education are paramount in the prevention of HIV transmission.
Some individuals falsely assume that they are not at risk for HIV because they are not from a group that is currently considered “high risk†in Canada such as gay men, intravenous drug users, or people of Aboriginal descent. However it is important to keep in mind that the face of HIV is complex and more importantly, that HIV does not discriminate and can infect anyone regardless of their age, social status, economic status, sexual orientation, ability and racial or ethnic origin.
STIs do not go away. If you suspect or know you have an infection, make an
appointment with your doctor or health clinic. Even though you may feel uncomfortable
or embarrassed, it is important to get tested and get treatment. This is the only way you
will get better, protect yourself and protect your partner(s). Your partner(s) should get
tested and treated as well. Many STIs can be cured with antibiotics but some are more
complicated and may require further treatment. Your doctor may do an internal
examination as well as blood tests and/or ultrasound. The doctor will discuss all your
treatment options with you.
STI information line: 604-872-6652 or www.optionsforsexualhealth.org
Bacterial vaginosis
Chlamydia
Cytomegalovirus (CMV)
Epididymitis
Gonorrhea (‘the drip’)
Hepatitis B and C
Herpes
Human Immunodeficiency virus (HIV)
Human papillomavirus (HPV; genital warts)
Non-gonococcal urethritis (LGV)
Pelvic inflammatory disease (PID)
Phthirus pubix (crabs; pubic lice)
Scabies
Shigella
Syphilis
Urinary tract infections (UTIs)
Vaginitis (vaginal yeast infections)
Practicing safer sex can reduce your chances of STI infection. Finding creative ways to make sex play as safe and satisfying as possible is also important.
Key ways to reduce risk include:
Symptoms may vary from one person to another and in some cases people may have no symptoms at all which is why testing for STIs is often recommended. Some common signs of infection are:
If you have signs of infection:
STIs are transmitted through sexual activities such as oral, vaginal or anal sex. Some STIs can also be spread through contact with infected blood. STIs are contagious which means you can contract them from your partner(s) if they are infected. STIs will stay with you if you do not receive treatment for them. STIs are most commonly found in the rectum (bum), in or around the vagina, in and around the penis and/or in the mouth.
The acronym “STI†stands for sexually transmitted infections while “STD†stands for sexually transmitted disease. STIs are infections that usually start in your sexual and reproductive organs. Some infections may also infect other parts of your body. STIs are very common: up to 75% of the sexually active population will get an STI of some kind in their lifetime. While some STIs may be painful, it is not unusual to have an STI without experiencing any symptoms for some time. Once symptoms do occur, an STI is considered an STD.
HIV is a reportable disease in British Columbia, just like other sexually transmitted diseases (STDs) like Syphilis and Gonorrhoea. This means that if you test positive for HIV, the clinic or doctor's office where you had the test done must send some information about you to the public health office. The public health office will then check with the clinic or doctor to see if you need help talking to any people that may have been at risk of catching HIV from you.
HIV is detectable by a blood test. The test tells you if you are infected with the Human Immunodeficiency Virus (HIV) by looking for antibodies. HIV antibodies are your immune systems response to HIV in your blood. Antibodies are proteins produced by the immune system to fight a specific germ.
Other tests are used when people already know they are infected with HIV. A viral load test is used to measure how many cells are being infected and killed by the HIV virus and is usually done when an individual is diagnosed with HIV infection and at regular intervals following diagnoses. A CD4 cell count measures the number of CD4 cells in a sample of blood. It is used by health care providers to determine when to begin, interrupt, or halt-anti-HIV therapy, when to give preventive treatment for opportunistic infections, and to measure an individual’s response to treatment. The lower the CD4 count, the higher the risk of an individual developing an opportunistic infection. The healthy range for a CD4 cell count is: 500-1500.
HIV is detectable by a blood test. Newer tests can detect HIV antibodies in mouth fluid (not the same as saliva), urine, or from a scraping sample taken from inside the cheek. "Rapid" HIV test results are available within ten to thirty minutes after a sample is taken. One of these tests has produced a high rate of false positives. A positive result on any HIV test should be confirmed with a second test.
Antibody test results for HIV are accurate more than 99.5% of the time. Once blood has been taken, an Elisa test is used to test for HIV antibodies. A positive test result is then confirmed with a Western blot test.
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Two special cases have been known to give false results:
The result from an HIV test can either be positive or negative.
A positive test result tells you that you have been infected with HIV. Being HIV positive does not mean you have AIDS. By regularly monitoring your health and exploring your treatmentoptions, you can slow the progress of HIV and live a longer, healthier life. You can get support and information about living with HIV. Call your local AIDS Helpline for more information.Your health care provider can also give you information and options on what to do next and how to access services and support.
If the result is positive, you will be asked if you need help identifying people that might have been at risk of getting HIV from you. You have the right to say that you do not need this help. If you do want help, public health staff will work with you and your doctor or clinic in order to identify people that may need to be warned that they have been at risk of HIV infection. If you have questions about this, call your local AIDS Helpline.
A negative test result can tell you one of two things:
A negative result doesn't mean you are immune to HIV. You might consider this a good opportunity to look at what you've been doing and what you can do to reduce your risk of infection.
If you think that you have been engaging in activities that put you at risk for HIV transmission, you may want to get tested. You may consider testing if:
Even if a person has no risk factors for HIV infection they may still want to get tested. For many people, HIV testing is something that they choose to do regularly for their own personal reasons. Encouraging everyone to get tested is good practice and a great way to reduce HIV-related stigma. It also encourages responsibility and self-care around HIV prevention.
Some examples of why people choose to test for HIV:
Remember that whatever your reasons are for testing, getting an HIV test is your choice and yours alone. No doctor or health care professional should ever carry out an HIV test without your consent.
From the moment HIV enters a person's body, it takes time for the body's immune system to develop enough HIV antibodies to be measurable by a standard HIV test. The period of time required for the body to produce enough HIV antibodies to become detectable by a standard HIV test is called the "window period". Tests currently administered in British Columbia have a "window period" which can last anywhere from four weeks to three months.
If a person tests negative for HIV during the four week to three month window period, the negative result still cannot be considered confirmatory or accurate. During the window period, a negative test may result because the body has not produced enough HIV antibodies to be measured by a standard HIV blood test. Only after the window period of three months has passed, and providing the individual has not continued to engage in unprotected risk activities during the window period, should negative HIV test results be considered accurate.
HIV testing is available for FREE at community health clinics, sexual health clinics and from your family doctor. Family planning centers or drug treatment facilities also offer testing. See also the list of testing sites in Vancouver and the Lower Mainland.
HIV drug resistance occurs when antiretroviral drugs lose their ability to block the reproduction of the HIV virus within the body. There are several factors which contribute to the accumulation of drug-resistance during antiretroviral therapy. They include:
HIV is a retrovirus. Retroviruses use their RNA as a template for creating DNA when inside a human host cell. This is how retroviruses multiply.
Knowing that HIV is a retrovirus is important to understanding how HIV treatment works. HIV treatment works by preventing HIV from multiplying. It is able to block multiplication by interrupting different stages of the retrovirus multiplication process.
There are many different “classes†of antiretroviral therapy. Each “class†of HIV ART works to fight HIV infection by interrupting various stages of the HIV replication cycle. Some stop or slow down the process of HIV from replicating within the body, while other drugs work by helping the body to fix the damage HIV has done to the immune system. Other drugs work by helping the immune system to become stronger and more effective at warding off illness and infections.
Deciding on a combination of ART is something that an individual usually does in consultation with their doctor or other health care professionals. When deciding upon the most suitable combination for an individual, several factors are considered including but not limited to: viral load, CD4 count, previous treatments and experiences to those treatments, dosages and adherence particulars (how drugs should be taken).
Antiretroviral therapy (often called ‘ARV therapy’ or ‘ART’) is drug therapy that has been developed to disrupt the cycle of HIV replication. ARVs come in a variety of formulations designed to act at different stages of the HIV virus life-cycle. ART usually consists of a combination of three or four different drugs, which can delay HIV replication and immune system deterioration within the body. Administering ARVs in combination is called Highly Active Antiretroviral Therapy (HAART) which is often more casually referred to as a ‘drug cocktail’.
HIV treatment is the use of medications (antiretroviral therapies) which can help keep an HIV infected person healthy. Drug research and development is on-going. While current treatment can help people living with HIV at all stages of the disease, it cannot cure HIV infection. Individuals are unique, from their biology to their lifestyle, and therefore HIV treatment is complex and should be tailored to meet the needs of each individual.
The medicines that make up antiretroviral therapy (ART) cause change within the body and often these changes come with side effects. Different people may have different reactions to the various drug cocktails. Some people experience mild side effects while others may experience more severe side effects. For some, combinations are easily tolerated and no negative side effects are experienced.
Side effects tend to be most common among individuals recently after starting ART or following changes to a treatment regimen. Side effects may be manageable and may improve or disappear over time. They may also persist and impact a person’s quality of life.
Common side effects may include but are not limited to:
Fatigue, headaches, anemia, digestive problems, gas and bloating, dry mouth, diarrhea, nausea.
It is always important to discuss side effects with your doctor. If side effects last longer than a few days or seem to be getting worse, a doctor should be contacted immediately rather than waiting until your next visit.
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