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What is HIV/AIDs?


 

What is HIV and what types of HIV are there?

How is HIV Transmitted?

Testing for HIV

How does HIV work?

What is AIDS?

Monitoring the progress of HIV to AIDS

Positive Lifestyle

Treatment

Contacts and Website


What is HIV and what types of HIV are there?

»  HIV stands for Human Immunodeficiency Virus (HIV). It is a retrovirus, which means a virus that uses the body’s own cells to reproduce itself.

»  The 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.

»  There are currently two types of HIV: HIV-1 and HIV-2.

»  HIV-1 is predominant worldwide and mutates very easily. Different strains of HIV-1 also exists, these can be categorized in groups and subtypes (clades).

»  There 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 and India.

»  HIV-2 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.

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How is HIV Transmitted?

HIV is transmitted through body fluids such as blood, semen, vaginal fluid, breast milk and other fluids containing blood.

The virus is transmitted through

    • Having unprotected penetrative sex with an infected person. Condoms are the only means through which the transmission of HIV can be prevented.
    • Through infected blood received during blood transfusion where the blood has not been screened for the virus, or the use of unsterilised needles.
    • By sharing needles for intravenous drug use with an infected person.
    • Pregnant women can also pass the virus to their babies during pregnancy or delivery as well as through breast-feeding.

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Testing for HIV

»  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 counselling.

»  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).

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How 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. The 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:

»  The primary infection (Seroconversion), when most HIV infected people will not be immediately 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 basis.

»  AIDS, which stands for Acquired Immune Deficiency Syndrome, is the final stage and is usually characterized by a CD4 count of less than 200.

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What is AIDS?

»  AIDS, 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.

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Monitoring the progress of HIV to AIDS

There are two tests available that allow for monitoring the progression of HIV/AIDS:

»  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.

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Positive Lifestyle

»  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 a healthy 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.

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Treatment

»  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:

o   Nucleoside 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).

o   Non-nucleoside 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).

o   Protease Inhibitors (PI’s) 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:

o   Ziduvidine (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)

o   Nevirapine: 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.

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Contacts and Website

Helplines

AIDS Helpline: 0800 0123 22

ThetaJunction:  0800 121 900

Stop Women Abuse Helpline: 0800 150 150

AIDS Training Information and Counselling Centres (ATICCs) Eastern Cape

ATICC – East London
Mrs D Jackson
Tel: 041 506 1415
Fax: 041 506 1486
Email: No
Fax: No
Website: No

Description: Training, HIV testing, condom distribution, information, referral, advocacy.

ATICC - Umtata
Ms N Mzinyati
Tel: 047 531 2673
Fax: 047 531 5186
Email: No
Fax: No
Website: No

Description: Support, counselling, condom distribution, information, networking

Gauteng

Community AIDS Centre - Johannesburg
Ms Makie Kunene
Tel: 011 725 6711/2
Fax: 011 725 2579
Email: No
Website: No

Description: HIV testing, training, information

ATICC – Pretoria
Ms C Chonga
Tel: 012 308 8743
Fax: 012 308 8754
Email: No
Website: No

Description: Counselling, Information and Support

KwaZulu-Natal

ATICC – Durban
Jabulile Madondo
Tel: 031 300 3104
Fax: 031 306 9294
Email: madondoj@durban.gov.za
Website: No

Description: HIV Testing, Counselling and Training.

ATICC – Pietermaritzburg
Mr H E Smith
Tel: 051 290 2365
Fax: 015 290 2364
Email: aticcpmb@satweb.co.za
Website: No

Description: Counselling, condom distribution, youth activities, support groups.

Western Cape

ATICC – Cape Town
Tel: 021 797 3327
Fax: 021 797 3356
Email: caljacobs@pgwc.wk.gov.za
Website: No

Description: Information and Counselling

Medical Organisations

South African HIV Clinicians Society
Penny Penhall

Tel: (011) 453 5066
Fax: (011) 453 5059

Email: sahivsoc@iafrica.com
Website: N/a

Description: The Southern African HIV Clinicians Society is the largest Special

Interest Group registered with the South African Medical Association. It has approximately 2 500 members, mostly doctors - GPs and specialists. The major objective is to disseminate locally generated guidelines and 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 Association.

South African Medical Association
Dr Kgosi Letlape, Chairperson of SAMA

Tel: 012 481-2037
Mobile: 082 881 295
Email: kgosil@samedical.org

Description: Tshepang (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 sponsors.

Perinatal HIV Research Unit (PHRU)
Dr James McIntyre / Dr Glenda Grey / Dr Avye Violar
Tel: 11 989 9700
Fax: 11 938 397 3
Email: violari@mweb.co.za
Website: www.hivsa.com

Description: The PHRU is a AIDS research centre working in collaboration with local and international partners in the areas of Mother to child transmission of HIV, treatment trials for adults and children, TB and HIV prevention research, psychosocial research, training and policy development.

South African AIDS Vaccine Initiative
Dr Tim Tucker
Tel: +27 (0) 21 938 0262
e-mail: saavi@mrc.ac.za

The 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 Africa. 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.

Medical Practitioners

Medical Practitioners – Supplied by the SA HIV Clinicians Society
Dr Des Martin

Tel: (011) 453 5066
Fax: (011) 453 5059
Email:
desm@iafrica.com

Dr Steve Andrews
Secretary: Simona
Tel: (021) 510 1569/81
Fax: (021) 510 1590
Email: steve@iafrica.com

Prof Raziya Bobat
KwaZulu/Natal
Tel: (031) 260 4355
Fax: (031) 260 4388
Email: bobat@nu.ac.za

Prof Gary Maartens
GS: (021) 404 9111
ID Unit: (021) 406 4346 (IDUnit)
Fax: (021) 406 6896
Website: gary@curie.uct.ac.za

Prof Robin Wood & Dr LG Bekker
Tel: (021) 402 6393
Fax: (021) 425 2021
Email: docrob@iafrica.com

Dr Koleka Mlisana
Tel: (031) 260 4562
Fax: (031) 260 4566
Email: mlisanak@nu.ac.za

Dr Leighton McDonald
Tel: (011) 777 8000
Fax: (011) 787 0772
Email: lmcdonald@mhg.co.za

Networks and Associations of People living with HIV/AIDS

National Association of People living with HIV/AIDS
Thandoxolo Doro
Tel: 011 872 0975
Fax: 011 872 1343
Email: napnet@apc.sn.org
Website: www.napwa.org.za

Description: NAPWA is a national organization representing the needs, aspirations and resources for people living with HIV/AIDS

Treatment Action Campaign
Zachie Achmat, Nathan Geffen
Tel: 021 Telephone: (27) (21) 788 3507
Fax: (27) (21) 788 3726
E-mail:
info@tac.org.za
Website: www.tac.org

Description: 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.

AIDS Consortium
Mapule Khanye
Tel: 011 403 0265
Fax: 011 339 4450
Email: tech@aidsconsortium.org.za
Website: www.aidsconsortium.co.za

Description: 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.

NACOSA – Western Cape
Lu-anne Hatange
Tel: 021 425 4308
Fax: 021 421 8754
Email: nacosawc@new.co.za
Website: www.wc-nacosa.co.za

Description: 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.

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