AIDS and HIV
Last Updated : 9/8/2008
Dr. Ira Shah
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What is AIDS?
AIDS denotes Acquired Immune Deficiency Syndrome. It is caused by the HIV virus (Human Immunodeficiency Virus). AIDS is the final disease stage of HIV whereby the patient's immune system is completely destroyed and the patient suffers from variety of problems.

Is AIDS the same as HIV infection?
HIV infection means that a patient is infected with HIV virus. A patient with HIV infection may look completely healthy (asymptomatic carrier state), may have opportunistic infections such as TB, pneumonia or may finally go into full-blown AIDS. AIDS is the condition where the patient's immune system is completely destroyed and the patient succumbs to various infections, has wasting and develops symptoms such as cancers, fever and diarrhea.
REMEMBER, NOT EVERY HIV INFECTED PERSON HAS AIDS.

How does one get

HIV infection

?

- Unprotected sexual intercourse with an infected person
- Sharing infected syringes and needles (as seen in drug abusers)
- Transfusion with contaminated blood & blood products.
Over 80% of HIV infection worldwide is sexually acquired.
In children, in addition to the above-mentioned routes of transmission, mother to child transmission during pregnancy, at birth or through breast feeding is the predominant mode of transmission and accounts for almost 80-85% of HIV infection in children.

What happens when a person acquires HIV infection?
Soon after contracting HIV, some persons may develop flu like illness with swollen lymph nodes, fever, malaise and rash lasting for 2 to 3 weeks. This is called as Acute (Primary) HIV infection. This stage is usually not seen in children as the primary infection is acquired at the time of pregnancy or at birth due to mother to child transmission.
Following the primary infection, a patient may remain and feel completely healthy. This is known as the asymptomatic stage. This stage usually lasts for 8-10 years in adults. However, in children this stage is shortened. During this stage, the virus is actively replicating in the body but the body's immune system is also working hard to control the infection. Hence the patient remains asymptomatic. In children, the immune system is not fully mature. As a result, the virus soon overcomes the immune system and the patient starts manifesting signs and symptoms of the disease.
Once, the immune system breaks down, patient develops various infections such as TB, Pneumonia, Diarrhea, Herpes zoster etc. The virus may also affect various organs of the body such as lungs, eyes, gastrointestinal tract, brain, heart, liver and skin and cause various organ dysfunctions. During advanced stage of the disease, patient develops unexplained weight loss, fever; infections by unusual organisms and in adults - rare cancers (Lymphoma & Kaposi's sarcoma) can also develop. With development of AIDS, patient usually succumbs to the disease until and unless intervention with drugs is given.

I know an HIV infected person. Can I get HIV through such a contact?
No, HIV is not transmitted through casual contact at home or elsewhere. Sharing toilets, utensils, swimming pools, working in the same office, going to same school, insect bites do not transmit the virus. There is also no risk of contracting HIV while donating blood, as all equipments used are sterile, used only once and discarded.

How does one

test for the HIV virus

?

Once a person gets HIV infection, the antibody against HIV appears in the blood only after 3-6 months after the virus has entered the body. The routine test (ELISA) detects the antibody to HIV virus. A positive test means that the person is infected with HIV. A negative test result means that no antibodies were detected at the time of the test. This would mean that either the person is uninfected or is in the window period (The period where the HIV virus is present in the body but antibodies have not developed). If there is a strong suspicion of exposure to the virus, a repeat test may be required after few weeks to overcome the window period. Confirmation of HIV infection can be done by other tests such as Western-Blot test. To detect the virus itself, tests such as PCR tests and viral culture are available. These tests are especially useful to diagnose HIV infection in infants as they may have maternal antibodies to HIV virus in their blood, which may give a false positive ELISA test. These tests can also be used to diagnose HIV infection during window period.

REMEMBER, A POSITIVE TEST DOES NOT MEAN THE PERSON HAS AIDS. IT INDICATES THAT THE PERSON IS HIV INFECTED.

Is there any

treatment for HIV infection and AIDS

?

At present there is no cure for this disease. Certain drugs called as antiretroviral drugs (ART) slow down the progression of the disease and can help the patient lead a normal, healthy life. Certain vaccines are being developed against the HIV virus, however they are still in the trial phase. Thus, the best treatment is prevention against the infection.

What are the

precautions that an HIV infected person undertake

?

First and foremost, the person suspected to have HIV infection should consult an HIV counselor and an HIV physician to understand the disease, various treatment options available and to ensure a normal healthy life as long as possible. Such a person should not have casual sex, should not donate blood or organs and in case of a female should avoid getting pregnant.
Adults should follow the following precautions:
- Advocate monogamous relationship with one uninfected partner.
- Avoid casual sex and practice safer sex (e.g., use of condoms)
- Do not inject drugs or share needles & syringes
- Receive only safe blood products
- Ensure that ear piercing; tattooing and acupuncture instruments are sterilized.
To avoid mother to child transmission of HIV following steps have found to be beneficial:
- ART to pregnant lady and to the baby after birth.
- Elective caesarian section (this prevents contact of baby to vaginal secretions at time of birth).
- Avoiding breast feeding (Breast milk is known to transmit HIV virus).
A pregnant lady should undergo voluntary testing for HIV infection and it found positive should consult an HIV specialist for prevention of mother to child transmission of HIV.

Myths and Misconceptions

HIV in children

is not an individual disease but a disease that affects the entire family. With the advent of antiretroviral therapy, pediatric HIV has evolved from a rapidly progressive fatal disease to a chronic infection with prolonged survival. Being a chronic disease, it affects the overall lifestyle, physical and even social functioning. With fear of AIDS (acquired immune deficiency syndrome) and social stigmatization; families live in fear, grief, guilt and depression.
Due to

misconceptions about transmission and mode of inheritance

by the general public and even medical staff, patients who are HIV positive are almost discriminated and treated as untouchables. This attitude is depressing, misconceptual and almost suicidal for the patients. Hence it's very important to understand correct mode of transmission, precautions while handling biological wastes of HIV positive children and how to enable these children to be a part of society.

Mode of transmission:


- HIV virus is not transmitted through everyday contact. It is not transmitted through sneezing, coughing, hugging, touching or sharing food.
- HIV is transmitted on contact to body fluids such as blood, seminal secretions only if there is breach of the mucous membranes and skin. It is not transmitted through saliva, urine or stools until and unless the child has bleeding in these sites.
- Infected breast milk is another source of transmission in infants.

Waste disposal of an HIV positive child


-Changing diapers: While changing diapers of an HIV positive child, it is preferable to wash hands with soap and water before and after changing a diaper. Disposable gloves should be used if there is blood in the stool or urine, and if the caretaker has a rash or open cut on the hands. Disposable diapers should be placed in a leak -proof plastic bag and put in the trashcan. Reusable or washable nappies should be washed separately and presoaked with detergent heavily. Bleach should be added to the soiled clothes to inactivate the virus.
- Washing clothes: Clothes of an HIV positive child can be washed with everyone else's clothes. However, if the clothing is soiled by blood, semen, urine, feces or vomit, it should be washed separately with addition of bleach to inactivate the virus.
- Body fluid spills: In case of spilling of blood, urine, vomit, stools, bloody saliva of an HIV +ve child, the spills should be cleaned wearing disposable gloves and wiped with disposable rags or paper towels. The surface should be cleaned with a bleach solution (1/4 cup bleach to 2.5 litres of water). The surface should be washed and air-dried. The disposable gloves, rags should be placed in a leak-proof plastic bag and put in the trashcan.

Meal times


No eating restrictions are needed for an HIV positive child. The child can eat together with everyone and can be served from a common serving dish. The child should use the same dishes, glasses, spoons & forks every time. The dishes and utensils need not be washed separately. All dishes should be washed in hot, soapy water.

- Sharing toys :- Toys can be shared as normally as sharing toys does not transmit HIV. However if a child who is HIV positive has put a toy in his/her mouth, the toy should be thoroughly washed in soap and water before another child plays with it.

Injuries and Accidents


HIV transmission due to accidents and injuries may occur only if :-
-There is a bleeding wound or oozing skin lesion in HIV infected child.
-Presence in a susceptible child of a skin lesion or exposed area that could serve as a portal for systemic entry of the virus.
- Sustained contact between the portal of entry of the susceptible child and infective material. Thus fresh blood to blood transmission is extremely rare.

In case of cuts and sores in an HIV +ve child, the area should be washed immediately with soap and water. Caretaker should wear disposable gloves and clean the blood spills as discussed earlier. The wound should be immediately cleaned with an antiseptic and closed dressing with gauze and bandage should be done. Waste should be disposed in a leak- proof plastic bag. Tetanus toxoid and tetanus immune globulin may be administered if vaccination of the child is incomplete.

Sharing information


Parents are not obligated to tell school authorities or friends about the child's HIV status if they fear discrimination. However, universal precautions have to be advocated.
Disclosure to the children of the nature of their illness is essential. Information given should be according to the child's development level to ensure child's acceptance of the disease and he/she should follow the precautions to prevent spread to others.

Thus it is important for caretakers to develop heath policies that include universal precautions and proper hygiene for all children. These precautions decrease the risk of transmission of not only HIV but also other infections. Infact the risk for other infections is far greater than that of HIV virus.



Contributor Information and Disclosures

Dr. Ira Shah
Consultant Pediatrician, B.J.Wadia Hospital for Children, Mumbai, India


First Created : 3/5/2001

References

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