There are 36.9 million people world-wide living with HIV. Of this number, around 21,7 million have access to antiretroviral therapy.

No treatment is yet available to cure HIV but if it detected early there are effective treatments to control the illness and delay or avoid serious complications.

There are various researches and experiments are currently undergone and the outcome is promising . These are very promising times in HIV vaccine research, with multiple efficacy clinical trials ongoing, new approaches in development, and a growing sense that we may be getting closer to an effective vaccine.

There are very effective post exposure antiviral propilaxis in case of suspicious exposure.

We also have preexposure propilaxis which was introduced recently and it is 99% effective with proper use.

HIV is a retrovirus with two known strains that cause a similar spectrum of disease process: HIV-1 and HIV-2 . It infects T-helper cells bearing the CD4 receptor. It is infectious mainly through injection of illicit drugs, past blood transfusions, unprotected sexual activities and partners.

Presentation and progression of HIV

Primary infection which is also called HIV seroconversion illness causes  fever, lymphadenopathy, lethargy and possibly sore throat, and a generalised rash.Then, the patient goes to a long recovery phase where no symptoms can be identified which may last 5 to 10 years. The only sign may be generalised lymphadenopathy.

Later constitutional symptoms develop along with minor opportunistic infections such as oral candidiasis, herpes simplex and herpes zoster.

Early symptomatic symptoms includes oral hairy leukoplakia, seborrhoeic dermatitis, psoriasis, recurrent varicella zoster infection, cervical dysplasia, unexplained fever, sweats, weight loss, diarrhoea and reactivation of  tuberculosis.

Kaposi sarcoma, oesophageal candidiasis, cerebral toxoplasmosis, lymphoma, HIV-1 associated dementia complex, cryptococcal meningitis were identified as late symptomatic period followed by advanced stage complicate with  CMV retinitis, cerebral lymphoma, Mycobacterium avium complex infections.

Investigations  for HIV

There are three common types of screening tests that use a blood specimen

  1. HIV antibody tests
  2. a fourth-generation combination antibody/antigen test that detects both antibodies and a piece of the virus called the p24 antigen;
  3. RNA tests (HIVPCR);
  4. in addition, a blood test called a Western blot is necessary to confirm the diagnosis.

Multiple investigations are recommended for the newly diagnosed patient with HIV including CD4, HIV viral load, standard biochemistry, glucose, lipids, urinalysis, and hepatitis A, hepatitis B and hepatitis C  serology.  Consider screening for tuberculosis.

Prevention  of HIV

Still the prevention of HIV is the 100% effective way to HIV while waiting for a forthcoming new era of  medication to cure HIV and vaccination to prevent HIV.

1 Have sex with a single partner who is known to be uninfected.

2 Use a condom in other situations. Condoms offer protection if used properly and consistently. Occasionally, they may break or leak. Only condoms made of latex should be used. Only water-based lubricants should be used with latex condoms; petroleum jelly dissolves latex.

3 Use condoms the right way every time you have sex. Learn the right way to use a male condom.

4 Choose less risky sexual behaviors. Anal sex is the highest-risk sexual activity for HIV transmission, especially for the receptive partner.

 5 Oral sex is much less risky than anal or vaginal sex. Sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission.

6 Do not inject street drugs.

7 If you do inject drugs, never share your needles or works. Use only sterile needles.

Be careful not to get someone else’s blood on your hands or your needle or works.

Dispose of needles safely after one use.

8 If you work in a health care field, follow recommended guidelines for protecting oneself against needle sticks and exposure to contaminated fluids.

Pubudu Jayaweera ( reference – Up todate, medL)

 

 

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