Dr Devraj Dogra, Dr Mubashar Mir
We have taken great leaps of success in the recent years in our fight against HIV/AIDS with a committed global and national effort, public awareness campaigns, introduction of highly active antiretroviral therapy (HAART) and the behavioral change in the masses. Presently there are more than 25 drugs approved by FDA for treatment of AIDS. The global as well as national trends are encouraging. InIndia the new annual HIV infections have fallen down from 2.7 lakh to 1.1 lakh by 57 percent between the years2000-2011.
It must be understood that not all HIV infected individuals have AIDS, a patient is said to have AIDS only after the infection has progressed to a stage where the clinical manifestations take the center stage.
The challenges ahead
Studies reveal that even the most developed nations are not adequately aware of the disease and its extent. Centre for Disease control and Prevention(CDCP) report revealed that about 21 percent of total American population infected with HIV are unaware of their HIV status and about one -third of them are in the stage of late diagnosis. In India, AIDS as a disease is changing its demographic form with the increase in number of female population getting infected and the shift from urban to the rural areas where the level of preparedness and awareness is much lesser
Origin
Aids is causes by a RNA virus called Human Immunodeficiency virus, the origin of which can be traced back to Simian immunodeficiency virus (SIV) found in the chimpanzees and monkeys of African region, it is thus believed that this virus may have been transmitted to humans from infected animals. The first case of aids was diagnosed in United States in the year 1981 in a group of homosexuals. Since then aids has progressed consistently to become a global pandemic affecting almost all regions and races.
Modes of transmission
It should be understood that not all body fluids transmit HIV from one person to the other. While it may spread via infected blood, semen, breast milk and vaginal secretions it is usually not present in saliva, tears, sweat, urine or stools.
The major modes of transmission are by an unprotected sexual intercourse with an infected partner, from an infected mother to her child and through contaminated blood in the form of blood transfusion or use of infected syringes.
Sexual Transmission:
It accounts for the most common route of spread overall. In India most of the people (over 88 percent) acquire infection through heterosexual or male-female contact. In male-female sexual intercourse females have higher chance of transmission being the receptive partners and the fact that reproductive infections facilitating the transmission are more common in females. While heterogeneous sexual transmission is most common mode of sexual transmissionthe risk in male to male sexual intercourse is 20 times higher .Other factors which increase the risk of spread are uncircumscribed males, unprotected sex, anal sex, multiple partners and presence of other sexual infections.
Mother to Child Transmission:
It accounts for about 5 percent of total cases of HIV. The risk of a baby getting infected from an infected mother is about 30 percent. Breast feeding should be avoided if the mother is HIVinfected. Antiretroviral Therapy to the mother and child during perinatal period dramatically reduces the chances of transmission to the child.
Transmission via blood and blood products:
It constitutes about 2 percent cases of HIV overall. It can be in the form of blood transfusion, use of infected syringes especially in drug abusers and due to accidental needle stick injuries in health workers like doctors and nurses. While a single transfusion of HIV infected blood has over 90 percent chance of transmission, the chances of getting infected by a needle stick injury is about 0.3 percent only.
Course of Disease
The presentation of disease and its progression depends on a variety of factors like the strain of virus, body’s own defense and the presence of other morbidities and sexually transmitted diseases.
Majority of cases survive over a decade. With the use of ART the patient can live a longer and healthy life. The disease starts usually as any other viral infection with patient complaining of general weakness, body aches,fever, sore throat and skin rashes.
After this patient usually remains asymptomatic for the next 2 to 10 years. Patient may notice generalized enlarged lymph nodes at different sites of the body like axilla, groinsetc. Over the years and if left untreated patient may start losing weight and may shows progressively increasing tendency of suffering from other infections due to a constantly deteriorating immunity.
When patient lands into an advanced stage of AIDS the patient starts experiencing other symptoms like chronic diarrhea, unexplained fever lasting over months. More severe forms of infections especially respiratory infections, skin infections and infections of the oral and pharyngeal mucosa start affecting the patient. Such patients have an increased risk of developing nervous system infection besides a carrying a higher risk of developing malignancies. Of these Tuberculosis is the most common associated infection in HIV patients and is the also the most cause of death especially in our country.
Diagnosis
The diagnosis of HIV/AIDS is done by detecting the antibodies produced against the virus by ELISA method and confirmed by western blot method. Newer tests like p24 assay and PCR can detect the infection earlier but are costly.CD4 and plasma viral load counts are used to monitor the progression of disease and the response to treatment.
Treatment
There has been an extensive research going on to find a cure to the disease. There is an armory of highly effective drugs to control the disease and the patient can live a healthy life with the use of suitable ART however a complete cure not yet possible.
The more damaged the immune system is the more grim are the chances of recovery. Thus an early diagnosis of the condition and an early management are mandatory. Putting a patient on anti-retroviral therapy reduces the chances of transmission to others by 96 percent, thus treatment also helps to control the spread of disease.
Lifelong treatment and strict adherence with monitoring for the side effects of drugs is necessary for leading a healthy life. High risk behaviors have to be avoided in order to prevent complications and spread.
Prevention
In the absence of a permanent cure of HIV infection, public education and information remain the corner stone of AIDS prevention programs. Information, education and communication (IEC) campaign is one of the most common cost-effective behavioral intervention strategies implemented so far to fight against HIV/AIDS. The primary goal of such IEC program is to inspire and educate people about prevention, care and/or treatment of HIV/AIDS and for a better understanding of HIV in a more comprehensive way.
To avoid falling into the hands of this dreaded lifelong disease we must practice some basic precautions.
* Abstain from high risk sexual behavior and unprotected sex.
* Blood transmission- do not use syringes for more than a single use and dispose them safely. Blood transfusion should be properly screened for HIV.
* Counselling- It has to be kept in mind that HIV does not spread by touching or sharing towels or food.
* Diet: Healthy and nutritious diet helps to fight against all infections including HIV.
(The authors are the Head of department and MD Resident, Department of Dermatology and Sexually Transmitted Diseases, GMC Jammu)
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