is HIV and what types of HIV are there?
is HIV Transmitted?
does HIV work?
the progress of HIV to AIDS
is HIV and what types of HIV are there?
stands for Human Immunodeficiency Virus (HIV). It is a retrovirus,
which means a virus that uses the body’s own cells to reproduce itself.
origins of HIV are unclear, The earliest known case was from a blood
sample collected in 1959 from a man in Kinshasa in the
Democratic Republic of Congo. It is not known how he became infected.
are currently two types of HIV: HIV-1 and HIV-2.
is predominant worldwide and mutates very easily. Different strains
of HIV-1 also exists, these can be categorized in groups and subtypes
are two groups, group M and group O. Within group M there are at least
10 genetically distinct subtypes. These are subtypes A-J. Subtype
B is mostly found in America, Japan,
Australia, the Caribbean and Europe.
Subtype C is found in South Africa
was identified in 1986 and was originally prevalent in West
Africa. There are many similarities between HIV-1 and
HIV-2 e.g. both are transmitted in the same way, both are associated
with similar opportunistic infections and AIDS. In persons infected
with HIV-2, immunodeficiency seems to develop more slowly and to be
milder. Compared with persons infected with HIV-1, those with HIV-2
are less infectious early in the course of infection.
is HIV Transmitted?
is transmitted through body fluids such as blood, semen, vaginal fluid,
breast milk and other fluids containing blood.
virus is transmitted through
unprotected penetrative sex with an infected person. Condoms are
the only means through which the transmission of HIV can be prevented.
infected blood received during blood transfusion where the blood
has not been screened for the virus, or the use of unsterilised
sharing needles for intravenous drug use with an infected person.
women can also pass the virus to their babies during pregnancy
or delivery as well as through breast-feeding.
HIV infection can be diagnosed through an HIV antibody test.
When a person is infected with HIV, antibodies are produced within
3-8 weeks. The period following infection but before antibodies can
be detected by the test is known as the window period.
Tests can be conducted using samples of blood, saliva or urine.
Rapid tests are available and provide a result within 10-20
minutes. Rapid tests are used at most HIV antibody testing site.
A positive result usually requires a further confirmatory test.
Testing for HIV should be conducted along with pre- and post-test
In South Africa an
HIV test may be undertaken through private doctors, at public (i.e
government) clinics and hospitals, or at laboratories. In some urban
areas tests can be undertaken at the AIDS Training, Information and
Counselling Centre (ATICC).
does HIV work?
To understand how the virus works, one must understand how
the body’s immune system works. The immune system defends the body
against infection. It consists of many types of cells. Of these cells
the T-helper cell is crucial because it co-ordinates all other immune
cells. The T-helper cell has a protein on its surface called CD4.
HIV enters the blood and gains entry to the T-helper cell by
attaching itself to the CD4 protein. Once inside, the viral genetic
material called RNA (ribonucleic acid) changes into viral DNA (deoxyribonucleic
acid) by an enzyme called reverse transcriptase. The viral DNA becomes
part of the human DNA, which, instead of producing more cells of it’s
own type, starts producing HI viruses.
Another enzyme, protease, organizes these viral chemicals
to form new viruses. These new viruses then exit the cell and float
freely in the blood stream, and are able to infect more cells. This
is a gradual process that eventually damages the body’s immune system
and leaves the body vulnerable to infections and other diseases.
time it takes to do this varies from person to person.
The body’s natural response to an infection is to fight infected
cells and replace the cells that have been lost. This response encourages
the virus to reproduce itself.
The normal range for CD4+T cells in a healthy person is 800-1200
cells per cubic millilitre of blood. When an HIV infected person’s
CD4+ T cell count falls below 200, he or she becomes increasingly
vulnerable to opportunistic infections.
Opportunistic infections are infections that arise when the
immune system is suppressed. In a person with a healthy immune system
these infections would not normally be life threatening but to an
HIV infected person they could be fatal.
Without treatment, the viral load, which refers to the relative
amount of free virus in the blood plasma, will increase to the point
where the body can no longer fight it.
HIV progression can be divided into 4 stages:
primary infection (Seroconversion), when most HIV infected people
will not be
aware that they are infected.
The asymptomatic stage, where no symptoms are manifest, but
the virus remains active.
The symptomatic stage, where the person begins to feel unwell
and experiences opportunistic infections which are not HIV specific
but caused by bacteria and viruses that surround us all on a daily
which stands for Acquired Immune Deficiency Syndrome, is the
final stage and is usually characterized by a CD4 count of less
Acquired Immune Deficiency Syndrome, is the
final stage of HIV infection and is usually characterized by
a CD4 count of less than 200.
AIDS is not a specific
illness but rather a collection of illnesses that affect the body
and to which the weakened immune system cannot respond.
the progress of HIV to AIDS
are two tests available that allow for monitoring the progression
The CD4 test measures
the amount of CD4 or T-helper cells in the blood. The strength of
your immune system is a good predictor of how you will fight infections.
The Viral Load test
measures the amount of HIV in the blood in every millilitre of blood..
The higher the viral load the faster the progress to AIDS.
There is no cure for
HIV or AIDS but living with both is becoming increasingly manageable.
It is possible for
people living with HIV/AIDS to lead a productive life by following
high-protein and high-kilojoule diet, managing stress levels, practicing
safer sex i.e. by using a condom, not drinking unboiled water, drinking
alcohol and smoking in moderation, washing hands, ensuring spiritual
and emotional well-being and treating opportunistic infections early.
People with pets should follow normal precautions ensuring that the
animal's food, litter and bedding are fresh and hygienic at all times.
Care should be taken to avoid licking, scratches and bites and animals
should regularly be washed and vaccinated.
Antiretroviral drugs (ARVs) are not a cure for HIV/AIDS
but do prolong the lives of those infected with HIV. In resource-poor
settings the onset of ARV treatment is usually medically recommended
once the CD4 cell count of the person living with HIV/AIDS is 200
or below. To be effective a combination of three or more ARVs are
taken, this is commonly referred to as Highly Active Antiretroviral
Therapy (HAART). Combinations of the following ARVs may be employed:
Analogue Reverse Transcriptase Inhibitors (NRTI’s), target the
HIV protein reverse transcriptase preventing the translation of viral
RNA into viral DNA (e.g. AZT, ddl, ddC & 3TC).
Reverse Transcriptase Inhibitors (NNRTI’s)
slows the reproduction of HIV by interfering with reverse transcriptase,
an important viral enzyme. This enzyme is essential for HIV to incorporate
its genetic material into cells. NNRTI drugs include: Nevirapine,
delavirdine (Rescripta), efavirenza (Sustiva).
that target the HIV protein Protease and blocks it so that a new virus
cannot assemble in the host cell and be released.
The Prevention of Mother to child Transmission (PMTCT):
A women who is HIV positive can pass on HIV to her baby during pregnancy,
during childbirth and during breastfeeding. In the absence of preventative
interventions, the probability that an HIV-positive woman’s baby will
become infected is approximately 25% - 35%. Two treatment options
are available for to reduce the transmission of HIV/AIDS from mother
to child. These are:
(AZT) can be administered as a long course of 14-28 weeks of pregnancies.
Studies indicate that this reduces the rate of transmission by 67%.
A short course starting late in pregnancy around 36 weeks leads to
a 50% reduction. A very short course starting in labour by 38%. Some
studies have investigated the use of Ziduvidine (AZT) in combination
with lamivudine (3TC)
Is given as a single dose to mother in labour and a single dose to
the baby at around 2-3 days. It is estimated that this reduces HIV
transmission by about 47%. Nevirapine is simple to use with a mother
given a tablet to take home when labour begins, while the baby has
to be given a dose within 3 days.
Post-exposure prophylaxis (PEP) is
a program of several antiviral drugs, that are taken several times
each day, for at least 30 days, to prevent that a person becomes infected
with HIV following exposure either through sexual assault or occupational
exposure. Prior to the onset of use of PEP an HIV test should be taken
to determine the status of the person concerned. Information and counselling
should be given so as to enable the person to understand the drugs,
the necessity of complying, the need to practice safer sex and follow-up
HIV tests. Antiretrovirals recommended for PEP include AZT and 3TC
which are used in combination. The CDC has warned against the use
of Nevirapine as part of PEP owing to risk of liver damage. Following
potential exposure to HIV, PEP treatment needs to be commenced
at least within 72 hours, although there is evidence to suggest that
the sooner the person commences treatment the greater the benefits.
PEP is not recommended for casual exposure to HIV/AIDS as it
is not 100% effective; can have severe side effects and could encourage
unsafe sexual behaviour.
0800 121 900
Women Abuse Helpline: 0800
Training Information and Counselling Centres (ATICCs) Eastern
Mrs D Jackson
Tel: 041 506 1415
Fax: 041 506 1486
Training, HIV testing, condom distribution, information, referral,
Ms N Mzinyati
Tel: 047 531 2673
Fax: 047 531 5186
Support, counselling, condom distribution, information, networking
AIDS Centre - Johannesburg
Ms Makie Kunene
Tel: 011 725 6711/2
Fax: 011 725 2579
HIV testing, training, information
Ms C Chonga
Tel: 012 308 8743
Fax: 012 308 8754
Counselling, Information and Support
Tel: 031 300 3104
Fax: 031 306 9294
HIV Testing, Counselling and Training.
Mr H E Smith
Tel: 051 290 2365
Fax: 015 290 2364
Counselling, condom distribution, youth activities, support groups.
Tel: 021 797 3327
Fax: 021 797 3356
Information and Counselling
African HIV Clinicians Society
Tel: (011) 453 5066
Fax: (011) 453 5059
The Southern African HIV Clinicians Society
is the largest Special
Group registered with the South African Medical Association. It has
approximately 2 500 members, mostly doctors - GPs and specialists.
major objective is to disseminate locally generated guidelines
information on the treatment of HIV/AIDS and provides training
for doctors through an HIV Management Course run jointly with the
Foundation for Professional Development of the South African Medical
African Medical Association
Dr Kgosi Letlape, Chairperson of SAMA
Tel: 012 481-2037
Mobile: 082 881 295
(which means ‘to have hope’),
is a joint initiative by The South African Medical Association (SAMA)
and the Nelson Mandela Foundation. It is designed to provide free
antiretroviral treatment (ART) to 9 000 public sector patients at
18 treatment sites countrywide. The estimated cost of this programme
is R80 million, which SAMA hopes to raise from national and international
HIV Research Unit (PHRU)
Dr James McIntyre / Dr Glenda Grey / Dr Avye Violar
Tel: 11 989 9700
Fax: 11 938 397
African AIDS Vaccine Initiative
Tel: +27 (0) 21 938 0262
South African AIDS Vaccine Initiative (SAAVI) was established in 1999
with the national mandate to develop and test an affordable, effective
and locally relevant preventative HIV vaccine for southern
SAAVI was initiated by Eskom and the South African government and
co-ordinates the activities of approximately 175 people who are involved
in many diverse activities related to HIV vaccine development, including
the scientific development of novel vaccines, clinical trials, sophisticated
immunological assessments, the development of ethical protocols and
community education activities.
Practitioners – Supplied by the SA HIV Clinicians Society
Dr Des Martin
Tel: (011) 453 5066
Fax: (011) 453 5059
Tel: (021) 510 1569/81
Fax: (021) 510 1590
Tel: (031) 260 4355
Fax: (031) 260 4388
GS: (021) 404 9111
ID Unit: (021) 406 4346 (IDUnit)
Fax: (021) 406 6896
Robin Wood & Dr LG Bekker
Tel: (021) 402 6393
Fax: (021) 425 2021
Tel: (031) 260 4562
Fax: (031) 260 4566
Tel: (011) 777 8000
Fax: (011) 787 0772
and Associations of People living with HIV/AIDS
Association of People living with HIV/AIDS
Tel: 011 872 0975
Fax: 011 872 1343
NAPWA is a national organization representing the needs, aspirations
and resources for people living with HIV/AIDS
Zachie Achmat, Nathan Geffen
Tel: 021 Telephone: (27) (21) 788 3507
Fax: (27) (21) 788 3726
The countries leading advocacy group for expanding access to treatment,
educating South Africans about living with HIV/AIDS and ultimately
improving the health and lives of those living with HIV/AIDS.
Tel: 011 403 0265
Fax: 011 339 4450
A network of AIDS service organisations (ASOs) predominantly operating
in the Gauteng Province.
The AIDS Consortium provides information service on all aspects pertaining
HIV/AIDS and lobbies for a human rights-based approach to the epidemic.
– Western Cape
Tel: 021 425 4308
Fax: 021 421 8754
A network of AIDS Service Organisations predominantly operating in
the Western Cape.
Has a database of organisations working in the area of HIV/AIDS in
the province. The core mandate of WC-NACOSA is capacity building,
networking and strengthening a multisectoral response to HIV/AIDS
in the Western Cape.