Basics of HIV and HIV Virus

What is HIV?

HIV (Human Immunodeficiency Virus) is a virus that causes AIDS. This virus is passed from one person to another through unprotected sexual contact with infected person, infected blood and using infected needles/ syringes. In addition, infected pregnant women can pass HIV to her baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people develop AIDS as a result of HIV infection.

These body fluids have been proven to spread HIV:

  • blood
  • semen
  • vaginal fluid
  • breast milk
  • other body fluids containing blood.
Other additional body fluids that may transmit the virus that health care workers may come into contact with are:

  • cerebrospinal fluid surrounding the brain and the spinal cord
  • synovial fluid surrounding bone joints
  • amniotic fluid surrounding a foetus.

How does HIV virus look like?

Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions). The surface of each particle is studded with lots of little spikes.

The size of HIV virus is

  • 0.1 microns
  • 4 millions of an inch

Unlike most bacteria, HIV particles are much too small to be seen through an ordinary microscope. However they can be seen clearly with an electron microscope.

HIV particles surround themselves with a coat of fatty material known as the viral envelope (or membrane). Projecting from this are around 72 little spikes, which are formed from the proteins gp120 and gp41. Just below the viral envelope is a layer called the matrix, which is made from the protein p17.

Figure: The proteins gp120 and gp41 together make up the spikes that project from HIV particles, while p17 forms the matrix and p24 forms the core.

The viral core (or capsid) is usually bullet-shaped and is made from the protein p24. Inside the core are three enzymes required for HIV replication called reverse transcriptase, integrase and protease. Also held within the core is HIV's genetic material, which consists of two identical strands of RNA.

What is RNA?

HIV belongs to a special class of viruses called retroviruses. Within this class, HIV is placed in the subgroup of lentiviruses. Other lentiviruses include SIV, FIV, Visna and CAEV, which cause diseases in monkeys, cats, sheep and goats. Almost all organisms, including most viruses, store their genetic material on long strands of DNA. Retroviruses are the exception because their genes are composed of RNA (Ribonucleic Acid).

RNA has a very similar structure to DNA. However, small differences between the two molecules mean that HIV's replication process is a bit more complicated than that of most other viruses.

How many genes does HIV have?

HIV has just nine genes (compared to more than 500 genes in a bacterium, and around 20,000-25,000 in a human). Three of the HIV genes, called gag, pol and env, contain information needed to make structural proteins for new virus particles. The other six genes, known as tat, rev, nef, vif, vpr and vpu, code for proteins that control the ability of HIV to infect a cell, produce new copies of virus, or cause disease.

At either end of each strand of RNA is a sequence called the long terminal repeat, which helps to control HIV replication (multiplication).

What is the life cycle of HIV virus?

HIV can only replicate (make new copies of itself) inside human cells. The process typically begins when a virus particle attaches to a cell that carries on its surface a special protein called CD4. The spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to fuse with the cell membrane. The contents of the HIV particle are then released into the cell, leaving the envelope behind.

What is Reverse Transcription and Integration of HIV virus ?

Once inside the cell, the HIV enzyme reverse transcriptase converts the viral RNA into DNA, which is compatible with human genetic material. This DNA is transported to the cell's nucleus, where it is integrates with the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is known as provirus.

What is Transcription and Translation of HIV virus?

HIV provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human genes. First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used as a blueprint for producing new HIV proteins and enzymes.

Among the strands of messenger RNA produced by the cell are complete copies of HIV genetic material. These gather together with newly made HIV proteins and enzymes to form new viral particles. The HIV particles are then released or 'bud' from the cell. The enzyme protease plays a vital role at this stage of the HIV life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores.

TThe newly matured HIV particles are ready to infect another cell and begin the replication process all over again. In this way the virus quickly spreads through the human body. And once a person is infected, they can pass HIV on to others in their bodily fluids.

What is the difference between HIV-1 and HIV-2?

There are two types of HIV: HIV-1 and HIV-2. Both types are transmitted by sexual contact, through blood, and from mother to child, and they appear to cause clinically indistinguishable AIDS. However, it seems that HIV-2 is less easily transmitted, and the period between initial infection and illness is longer in the case of HIV-2.

Worldwide, the predominant virus is HIV-1, and generally when people refer to HIV without specifying the type of virus they will be referring to HIV-1. The relatively uncommon HIV-2 type is concentrated in West Africa and is rarely found elsewhere.

What is AIDS? What causes AIDS?

AIDS stands for Acquired Immunodeficiency Syndrome. The last stage of HIV infection is called AIDS. An HIV positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g. AIDS indicator illnesses).

Infection with HIV weakens the immune system to the point that body has difficulty fighting against certain infections. These type of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system to cause illness.

Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention is required to prevent or treat serious illness.

Where did HIV come from?

We do not know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasha, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

We do know that the virus existed in the United States since at least the mid to late 1970s. From 1979-1981 rare type of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems.

In 1982 public health officials began to use the term "Acquired Immunodeficiency Syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in healthy men. Formal tracking (surveillance) of AIDS cases began that year in the United States.

The cause of AIDS is a virus that scientists isolated in 1983. The virus was at first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy-associated virus) by an international scientific committee. This name was later changed to HIV (Human Immunodeficiency Virus).

How long does it take for HIV to cause AIDS?

Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviours.

Why is the AIDS epidemic considered so serious?

AIDS affects people primarily when they are economically productive and leads to premature death thereby severely affecting the socioeconomic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and sexual practices being essentially a private domain, these issues are difficult to address.

Prevention from HIV

How can I avoid being infected through sex?

AIDS affects people primarily when they are economically productive and leads to premature death thereby severely affecting the socioeconomic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and sexual practices being essentially a private domain, these issues are difficult to address.

How can children and young people be protected from HIV?

Children and adolescents have the right to know how to avoid HIV infection before they become sexually active. As some young people will have sex at an early age, they should know about condoms and where they are available. Parents and colleges share the responsibility of ensuring that children understand how to avoid HIV infection, and learn the importance of tolerant, compassionate and non-discriminatory attitudes towards people living with HIV/AIDS.

Can injections transmit HIV infection?

Yes, if the injecting equipment is contaminated with blood containing HIV. Avoid injections unless absolutely necessary. If you must have an injection, make sure the needle and syringe come straight from a sterile new package or have been sterilised properly; a needle and syringe that has been cleaned and then boiled for 20 minutes is ready for reuse. Finally, if you are injecting drug users of whatever kind, do not share the needle and syringes.

What about having a tattoo or your ears pierced?

Tattooing, ear piercing, acupuncture and some kind of dental work all involve instruments that must be sterile to avoid HIV, Hepatitis B and Hepatitis C infection. In general, you should avoid from any procedure which involves piercing of skin, unless absolutely necessary.

But how can there suddenly be a disease that never existed before?

If we look at AIDS as a worldwide pandemic, it appears as if it is something new and rather sudden. But if we look at AIDS as a disease and at the virus that causes it, we get a different picture. We find that both the disease and the virus are not new. They were there well before the epidemic occurred. We know that viruses sometimes change. A virus that was once harmless to humans can change and become harmful. This is probably what happened with HIV long before the AIDS epidemic.

What is new is the rapid spread of the virus. Researchers believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed – people moved more often and traveled more, they settled in big cities and lifestyles changed, including patterns of sexual behaviour. It became easier for HIV to spread through sexual intercourse and contaminated blood. As the virus spread, the disease which was already in existence became a new epidemic.

Infected person at work place

Is it safe to work with someone infected with HIV?

Yes. Most workers face no risk of getting the virus while doing their work. The virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people's work, most workers are safe.

What about working every day in close physical contact with an infected person?

There are no risks involved. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection.

Who is at risk while at work?

Those who are likely to come into contact with blood that contains the virus are at risk. These include healthcare workers - doctors, dentists, nurses, laboratory technicians, and a few others. Such workers must take special care against possible contact with infected blood, as for example by using gloves.

If a worker has HIV infection, should he or she be allowed to continue work?

Workers with HIV infection who are still healthy should be treated in the same way as any other worker. Those with AIDS or AIDS-related illnesses should be treated in the same way as any other worker who is ill. Infection with HIV is not a reason in itself for termination of employment.

Does an employee infected with the virus have to tell the employer about it?

Anyone infected, or thought to be infected, must be protected from discrimination by employers, co-workers, unions or clients. Employees should not be required to inform their employer about their infection. If correct information and education about AIDS are available to employees, a climate of understanding may develop in the workplace protecting the rights of the HIV-infected person.

Should an employer test a worker for HIV?

Testing for HIV should not be required of workers. Imagine that you are a worker with HIV infection and are healthy and able to work. As far as your work is concerned, the information about the infection is private. If it is made public, you could be a target for discrimination. If AIDS-related illness makes you unfit for a particular job, you should be treated in the same way as any other employee with a chronic illness. A suitable alternative job can often be arranged by the employer. The employers in different parts of the world are beginning to deal with these problems more humanely. Their associations and workers' unions can be consulted for advice.

What if you are already infected with HIV? Can you still travel?

If you are already infected, consult your healthcare provider for guidance well before you plan to travel. Some immigration officials insist on an HIV free certificate. Your travel counsellor will advise you.

'AIDS is mainly a problem of developing countries.' or 'No, AIDS is really a problem of developed countries'. Which of these opinions is more accurate?

Many people would like to claim that AIDS only affects others - other people or other countries. AIDS breaks the patterns that we associate with major diseases, for example, linking malaria with the tropics or perhaps heart disease with the industrialised world. AIDS affects both developing and industrialised countries, both cold and hot countries. HIV can spread anywhere where people live and have sex.

How do AIDS problems in different countries relate to each other?

They are related in at least three ways. First, in every country, AIDS is always spread by a virus transmitted through sexual intercourse and through blood. Specific actions by people are therefore required for it to spread in all countries.

Second, AIDS can be prevented in all countries by people if they change their sexual behaviour, by screening blood for transfusion, and by sterilising needles and syringes.

Third, the prevention and control of AIDS bring most countries of the world together in joint action. They have the same basic problems to solve. For example, donated blood must be tested and everyone must benefit from the availability of simple, reliable and cheap blood tests to detect the virus.

If a person becomes infected with HIV, does that mean he has AIDS?

No, HIV is an unusual virus because a person can be infected with it for many years and yet appear to be perfectly healthy. But the virus gradually multiplies inside the body and eventually destroys the body's ability to fight off illnesses.

It is still not certain that everyone with HIV infection will get AIDS. It seems likely that most people with HIV will develop serious health problems. But this may be after many years. A person with HIV may not know he is infected but can pass the virus on to other people.

Is it true that male circumcision may provide protection against HIV infection?

Yes, the interior side of the foreskin has a mucosal surface, which is more susceptible to trauma than the tougher skin of the penile shaft or the glans. The foreskin also contains high levels of HIV target cells such as Langerhan’s cells. Recent study in Chicago has found out that foreskin mucosal tissue has a seven fold greater susceptibility to HIV-1 than cells in cervical tissue under same condition.

Is oral sex unsafe?

Oral sex (one person kissing, licking or sucking the sexual areas of another person) does carry some risk of infection. If a person sucks the penis of an infected man, for example, infected fluid could get into the mouth. The virus could then get into the blood if you have bleeding gums or tiny sores somewhere in the mouth. The same is true if infected sexual fluids from a woman get into the mouth of her partner. But infection from oral sex alone seems to be very rare.

What about getting AIDS from body fluids like saliva?

Although small amounts of HIV have been found in body fluids like saliva, faeces, urine and tears, there is no evidence that HIV can spread through these body fluids.

Could I be at risk?

Unless they know someone who has HIV, many people think this disease can't happen to them. Unfortunately, it can happen to all kind of people if there is history of exposure to unprotected sex with infected partner, use of unsafe blood or infected needle or syringe. By looking at your current and past sexual and drug practices (and your transfusion history), you can get a picture of your risk for HIV. Also you can figure out, how you can reduce your future risk for HIV infection.

Integrated Counselling and Testing Centre (ICTC)

How can I tell if I have HIV infection?

The only way to know for sure if you have this virus is by taking a blood test." The HIV test can tell you if you have the virus and can pass it to others in the ways already described.

If your test result is "positive," it means you have HIV infection and could benefit from special medical care. Additional tests like CD4 count can tell you how strong your immune system is and whether drug therapy is indicated. Some people stay healthy for a long time with HIV infection, while others develop serious illness and AIDS more rapidly.

If your test is "negative," and you do not have HIV for three months prior to taking the test or it means you do not have HIV infection. You can stay free of HIV by following prevention guidelines.

What is ICTC?

ICTC stands for Integrated Counselling and Testing Centre.

What is the role of ICTC in the prevention of HIV/AIDS?

As the HIV problem intensifies, the issues of care and support for affected individuals, and prevention of HIV transmission to those who are not affected, become even more critical. Integrated Counselling and Testing (ICT) is now seen as a key entry point for a range of interventions in HIV prevention and care. It provides people with an opportunity to learn and accept their HIV status in a confidential and enabling environment and to cope with the stress arising out of HIV infection. ICTC has become an integral part of HIV prevention programmes, as it is a relatively cost-effective intervention in preventing HIV transmission.

Could I be at risk?

Unless they know someone who has HIV, many people think this disease can't happen to them. Unfortunately, it can happen to all kind of people if there is history of exposure to unprotected sex with infected partner, use of unsafe blood or infected needle or syringe. By looking at your current and past sexual and drug practices (and your transfusion history), you can get a picture of your risk for HIV. Also you can figure out, how you can reduce your future risk for HIV infection.

The potential benefits of ICT are:
  • Earlier access to care and treatment
  • Providing factual information about HIV /AIDS and clearing misconceptions
  • Reduction of fear and stigma through counselling
  • Creating enabling environment for PLHA
  • Emotional support
  • Better ability to cope with HIV related anxiety
  • Improved health status through good nutritional advice
  • Motivation to initiate or maintain safer sexual practices and behaviour change
  • Prevention of HIV related illness
  • Motivation for drug related behaviour
  • Safer blood donation
  • Motivating HIV infected person to involve spouse/partner for future spread and care.

What is the setup at ICTC?

ICTC is not a place just for testing a sample for HIV, but much more than that. One of the basic elements involved is a confidential discussion between the client and the trained counsellor and the focus is on emotional and social issues related to possible or actual HIV infection. The aim of the ICTC is to reduce psycho-social stress and provide the client with information & support necessary to make decisions, therefore it needs a private and peaceful setting.

Separate enclosures for male & female clients have been set up to provide confidential environment for encouraging disclosure and providing IPC.

For the effective functioning of the ICTCs, one trained counsellors and one laboratory technician have been provided in each ICTC.

In order to ensure that the result of the HIV test is given on same day to the individual after post-test counselling, Rapid HIV Test Kits have been supplied to these centres or the client is asked to meet the same counsellor for post test counselling on appointed date.

Waiting space, trained Microbiologist/Pathologist, training to staff functionaries of ICTC, two trained counsellors and one laboratory technician have been provided in each ICTC.

In order to ensure that ICTCs provide quality counselling services, stress has been laid on pre-placement in-service training of counsellors & technicians by master trainers & resource persons.

Orientation training is also conducted for these functionaries.

What has been done to make ICTCs user-friendly?

In order to make the services more user-friendly following efforts are being made:
  • i.ICTCs are located in easily accessible areas mostly in Out Pateint Department of hospital.
  • Informed consent in local language is taken before HIV testing. Clients are informed about the nature and consequences of HIV test before their consent is taken. It is emphasized that testing should not be forced but left at the will of the client.
  • Here it is emphasized that counsellors should not be changed from centre to centre and from one day to another since the rapport between the counsellor and client is very essential.
  • Adequate supply of condoms is made available in these counselling centres. Individuals attending the ICTC are also made aware about the outlets from which they can get condoms under various schemes.
  • Counselling is integrated into other services, including STI, antenatal and RCH clinics.
  • Referral system has been developed in consultation with NGOs, community based organisations, hospitals and PLWA networks.
  • Counsellors are provided adequate training and ongoing support and supervision to ensure that they give good quality counselling and avoid burnout.
  • Linkages with NGOs for social support, follow-up counselling and care for those tested zero positive are emphasised.
  • Innovative ways of scaling up ICT services and making them more accessible and available is the endeavour.
  • There is an emphasis to make it more client-friendly and service based by augmenting the following services:
    • Anti retroviral drugs in PPTCT
    • Anti-tubercular treatment in HIV-TB co-infection
    • Free treatment of STI & opportunistic infections
    • Follow up services & networking among patients living with AIDS.

Should I take the HIV test?

For some people taking the HIV antibody test can be a scary decision. Some people get tested every six months, even if they practice safer sex. No matter what the reasons are, taking the HIV antibody test can be a good idea. Sometimes taking the test is a way to make a new found commitment towards safer practices.

One thing that is important to remember is that getting tested for HIV will not change your HIV status. It just tells you whether or not you have it. With all the new treatments available, finding out your HIV status early can extend your life.

To find out if you are at risk for HIV, ask yourself the following questions:
  • Have you had unprotected vaginal, oral or anal sex (e.g., intercourse without a condom, oral sex without a latex barrier)?
  • Have you shared needles to inject street drugs or steroids or to pierce your skin?
  • Have you had a sexually transmitted infection (STI) or unwanted pregnancy?
  • Have you had a blood transfusion or received blood products from unlicensed blood bank ?

If I am HIV Positive, what should I do?

If you have tested positive for HIV, consider the following:
  • Meeting a doctor for a complete medical check-up for HIV infection and advice on treatment and health maintenance. Make sure
  • you are tested for TB and other STDs. For women, this includes a regular gynaecological examination.
  • Inform your sexual partner(s) about their possible risk for HIV.
  • Protect others from the virus by following the precautions like always using condoms and not sharing needles with others Do not donate blood to others.
  • Protect yourself from any additional exposure to HIV.
  • Avoid drug and alcohol use, practice good nutrition, and avoid fatigue and stress.
  • Seek support from trustworthy friends and family when possible, and consider for professional counseling at ART centre.
  • Find a support group of people who are going through similar experiences at positive network Drop in centre.
  • Do not donate blood, plasma, semen, body organs or other tissue.

Why do people who are infected with HIV eventually die?

When people are infected with HIV, they do not die of HIV or AIDS. They die due to the effects that the HIV has on the body. With the immune system down, the body becomes susceptible to many infections, from the common cold to cancer. It is actually those particular infections, and the body's inability to fight the infections that cause these people to become so sick, that they eventually die.

Symptoms of HIV

How can I tell if I am infected with HIV? What are the symptoms?

The only way to determine for sure whether you are infected is to be tested for HIV infection. Free and confidential HIV testing is available at Integrated Counseling and Testing Centre (ICTC) .You cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of infection with HIV:If you have tested positive for HIV, consider the following:
  • rapid weight loss
  • dry / productive cough
  • recurring fever or profuse night sweats
  • profound and unexplained fatigue
  • swollen lymph glands in the armpits, groin, or neck
  • diarrhoea that lasts for more than a week
  • white spots or unusual blemishes on the tongue, in the mouth, or in the throat
  • pneumonia
  • red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
  • memory loss, depression and other neurological disorders.

However, no one should assume he is infected if he has any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.

How long after a possible exposure should I wait to get tested for HIV?

The tests commonly used to detect HIV infection actually look for antibodies produced by your body to fight HIV. Most people will develop detectable antibodies within three months after infection, the average being 25 days. In rare cases, it can take upto 6 months. For this reason, the NACO currently recommends testing 3 months after the last possible exposure (unprotected vaginal, anal or oral sex or sharing needles). It would be extremely rare to take longer than six months to develop detectable antibodies.

If I test HIV negative, does that mean that my partner is HIV negative also?

No, your HIV test result reveals only your HIV status. Your negative test result does not tell you whether your partner has HIV or not. HIV is not necessarily transmitted every time there is an exposure. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected.

Can I get HIV from anal sex?

Yes, it is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions or open sores on the penis.

Having unprotected (without a condom) anal sex is considered to be a very risky behaviour. If people choose to have anal sex, they should use a latex condom. Most of the times, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use a water-based lubricant in addition to the condom to reduce the chances of condom breaking.

Why is injecting drugs a risk for HIV?

At the start of every intravenous injection, blood is introduced into needles and syringes. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing") carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream.

In addition, sharing drug equipment (or "works") can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by:
  • using blood-contaminated syringes to prepare drugs
  • reusing water
  • reusing bottle caps, spoons or other containers ("spoons" and "cookers"
  • used to dissolve drugs in water and to heat drug solutions
  • reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.

"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. It is important to know that sharing a needle or syringe for any use, including skin piercing and injecting steroids, can put one at risk for HIV and other blood-borne infections.

Are patients in a dentist's or doctor's office at risk of getting HIV?

Although HIV transmission is possible in health care settings, it is extremely rare. Medical experts emphasise that the careful practice of infection control procedures, including universal precautions, protects patients as well as health care providers from possible HIV infection in medical and dental offices.

In 1990, the CDC reported on an HIV-infected dentist in Florida who apparently infected some of his patients while doing dental work. Studies of viral DNA sequences linked the dentist to six of his patients who were also HIV-infected. The CDC has as yet been unable to establish how the transmission took place.

Further studies of more than 22,000 patients of 63 health care providers who were HIV-infected have found no further evidence of transmission from provider to patient in health care settings.

Should I be concerned about getting infected with HIV while playing sports?

There are no documented cases of HIV being transmitted during participation in sports. The very low risk of transmission during sports participation would involve sports with direct body contact in which bleeding might be expected to occur.

If someone is bleeding, his participation in the sport should be interrupted until the wound stops bleeding and is both antiseptically cleaned and securely bandaged. There is no risk of HIV transmission through sports activities where bleeding does not occur.

On viral load tests, what is considered a high viral load and what is considered a low one? What are these tests used for?

Viral load tests measure how much of the HIV virus is in the bloodstream. They are very new tests and can be very expensive. Insurance companies may or may not cover the cost of the test. A result below 10,000 is considered a low result. A result over 100,000 is considered a high result. The primary use of these tests is to help determine how well a certain antiviral drug is working. If the viral load is high, your physician may consider switching you to another drug therapy. The viral load tests are best used if trends in results are compared over time. If the viral load increases over time, then the drug treatment may need to be changed. If the viral load goes down over time, antiviral treatment may be working for you. So rather than just taking one test, a series of viral load tests gives much more useful information. Of course, antiviral therapy must not be determined by this test alone. Other tests (like CD4 cell counts) are also important indicators as to how well antiviral therapy is working. It is presently not known what a test result between 10,000 and 100,000 means. That's why trends in viral load tests are of much greater value.

Is there a vaccine for HIV?

Most experts believe that an effective and widely available preventive vaccine for HIV may be our best long term hope to control the global pandemic.

Globally, most people who are carrying the AIDS virus live in countries with very limited budgets for health care. This means that in practice, there is little or no money for things like HIV testing, condoms, STI (Sexually Transmitted Infection) treatment and prevention. In settings like this, a vaccine would be very cost-effective.

Developing an effective and safe vaccine has proven to be a difficult challenge. A number of leading researchers are working on this problem, but no one knows when will they succeed.

Why is there so much difference between the reported and estimated number of HIV infections? Why is there so much difference between the reported and estimated number of HIV infections? When was the first AIDS case reported in India

The first AIDS case was reported from Chennai, Tamil Nadu in the year 1986.

Why is there so much difference between the reported and estimated number of HIV infections? Why is there so much difference between the reported and estimated number of HIV infections?

HIV is a chronic infection and may take five to nine years to develop its manifestations in the form of opportunistic infections and other forms of symptoms and signs. During this period, the HIV infected person remains asymptomatic and does not come in contact with hospitals where his/her HIV status can be detected.

What are the common opportunistic infections encountered by HIV/AIDS patients?

The common opportunistic infections encountered by HIV/AIDS patients are:
  • Tuberculosis (Pulmonary and extra-pulmonary)
  • Candidiasis
  • Pneumocysitis carini
  • Toxoplasmosis
  • Cryptococcosis
  • Cryptosporidial Diarrhoea
  • Cytomegolo virus infections
  • P. Marneffea infections (a fungus infection in North Eastern part of the country) HIV-TB.

Prevention of Parent to Child Transmission (PPTCT)

Can a baby have the HIV test?

The routine antibody test cannot detect HIV status of the baby , immediately after birth. This is because the test is for HIV antibodies and all babies born to HIV infected mothers are born with HIV antibodies. Babies who are not infected lose their antibodies by the time they are about 18 months old. However most babies can be diagnosed as either infected or uninfected by the time they are three months old by using a different test, called a PCR test. The PCR test is more sensitive than the HIV test, and is not used in the standard HIV testing of adults. It looks for the presence of HIV itself, not antibodies.

What are the possible advantages of undergoing HIV testing during pregnancy?

If a pregnant woman is HIV positive test result , there are medicines available that can reduce the risk of passing HIV to her baby in the womb or at birth. Delivery by planned Caesarean Section also reduces the risk of a baby becoming infected. It is usually best for babies to be breast-fed exclusively for first 6 months , followed by supplementary feeding at 6 months. This feeding method prevent infant death among HIV exposed babies in Indian Scenario.

How does a mother transmit HIV to her unborn child?

An HIV-infected mother can infect the child in her womb through her blood. The baby is more at risk if the mother has been recently infected or is in a later stage of AIDS. Transmission can also occur at the time of birth when the baby is exposed to the mother's blood and to some extent transmission can occur through breast milk.

Are all pregnant women tested?

In all government hospital pregnant women is offered HIV test. Free and confidential HIV testing is available at all Integrated Counseling and Testing Centre and many of 24*7 Primary Health Centre in Karnataka.

What happens when pregnant women goes to ICTC?

Before taking an HIV test a woman offered pre test counseling ( mode of transmission of HIV is explained , this is followed by consenting for HIV testing. Once consent is given , collection of 2ml of blood from her vein or 3 drops of blood from the finger tip is done by Laboratory Technician.. During counseling . the opportunity to talk to about the test and what the result will mean. Then the woman can make up her mind whether she wants to be tested or not. If a woman has a test, the clinic will tell her when she can come and get the result. The test can be done at any time. But it takes about three months after being infected for a person's blood to have enough antibodies in it for them to show up in the test. For this reason most people are advised to wait at least for three months after their last risk of being infected before they have a test.

When a woman is given the result of her HIV test she should be given the opportunity to talk to someone about it. This is important whether the result says a woman is infected or not.

What happens if a pregnant women woman has a positive test result?

When a pregnant woman has a positive test result she should be able to plan for hospital delivery. The hospital can be of her choice as per her convenience. She could come for regular Ante Natal check up. She will be offered special medical care to reduce the risk of her baby being infected.

Some pregnant women may continue her pregnancy, others any choose to terminate pregnancy.. The decision to terminate a pregnancy is very personal. Medical termination of pregnancy can be done in any Government hospital.

M & E and Research Surveillance

What is HIV Sentinel Surveillance?

HIV Sentinel Surveillance is an epidemiological tool by which samples of pre-designed size are collected over time, from among the identified risk groups known as sentinel groups. This sample size represents the larger group with similar risk and other characteristics.

What is "Unlinked Anonymity" without consent in HIV Sentinel Surveillance?

In HIV Sentinel Surveillance, unlinked anonymity means that the blood is primarily collected for some other purpose and the results are not linked to any individual. This methodology is adopted in order to minimise participation bias in the whole procedure.

Is the HIV Sentinel Surveillance clinic based or general community based?

In order to minimise the selection bias of samples, consecutive sampling procedure is adopted and it is ideally a clinic based approach.

What is the usefulness of HIV Sentinel Surveillance?

HIV Sentinel Surveillance data is used to understand and monitor time trends, know HIV prevalence levels in various risk groups in states/UTs and work out total HIV burden in various sub-populations.

Blood Safety

Is there a National Blood Policy?

There are some guidelines developed by the National Blood Transfusion Council and circulated by NACO, on the amount of service charge that can be charged by blood banks functioning in any sector in the country. These guidelines are as follows:

Blood will be issued for free of cost in following cases:

  • Thallessemia
  • Haemophilia
  • Sickle cell Anaemia
  • HIV infected persons
  • In Govt. Hospitals Blood will be issued free of cost for BPL Card holders and for pregnant woman also.

Cost per unit Blood in all the Blood Banks:

  • Whole Blood – Rs. 700/-
  • Packed Cells- Rs. 600/-
  • Platelets - Rs. 400/-
  • Cryoprecipitate –Rs. 200/-
  • Fresh Frozen plasma- Rs. 200/-

What are the infections for which blood is tested?

The Drugs & Cosmetics Act provides mandatory testing of blood for five major infections viz. HIV, Hepatitis B, Hepatitis C, Syphilis & Malaria. Every unit of blood is tested for all these infections.

What does the term 'Service Charge' means in blood banks?

No charges for blood as such can be levied by any blood bank. However, the blood that is collected from a donor at no cost, needs to be processed to make it free of infection, to ensure that it has certain minimum quality standards. It also needs to be stored and tested with recipient's blood before transfusion. Besides all these, establishment costs for the blood bank like infrastructure maintenance, salaries etc. add to the overall costs of providing a safe unit of blood to the patient. Blood banks attempt to recover these costs as service charge from the consumer.

Is there some uniform service charge fixed for a blood unit?

There are some guidelines developed by the National Blood Transfusion Council and circulated by NACO, on the amount of service charge that can be charged by blood banks functioning in any sector in the country. These guidelines specify that no blood bank will charge more than Rs.500/- for one unit of whole blood.

NBTC was constituted subsequent to Supreme Court judgment in 1996 with the focus of catering to Nation's blood security. The prime objective was to phase out professional donors and focus on voluntary donations. How far has this policy been successful and how much voluntary blood is collected in the country?

Soon after setting up of the National Blood Transfusion Council (NBTC) at the Centre and State Blood Transfusion Councils (SBTCs) in each state/UTs, a complete ban has been imposed on collection of blood from paid donors, with effect from 1st January, 1998. A number of steps were taken by NBTC to keep a strict check on exploitation of the blood users by commercial and private blood banks. SBTCs were provided funds by NBTC to mobilise blood collection through voluntary blood donations. Extensive awareness programmes for donor motivation through Information, Education, Motivation, Recruitment and Retention of voluntary donors was launched. Each state is given an annual target for collection of blood through voluntary sources and this is regularly reviewed by NACO.

Is the blood issued by blood banks safe?

Yes. As per the National Blood Safety Programme of NACO, it is mandatory on the blood banks to test every unit of blood properly for grouping, cross matching and testing for HIV, Syphilis, Hepatitis B & C and Malaria before it is issued for transfusion. Facilities have been provided by NACO to all the government and charitable blood banks like Red Cross to carry out these tests.

Can one acquire HIV infection if one donates blood?

No, this is not possible as all materials used for collection of blood are sterile and disposable. Donating blood is a noble gesture. People who are healthy should come forward for donating blood voluntarily.

Who can donate blood?

Good health of the donor must be fully ensured. The universally accepted criteria for

Donor selection is:

  • Age between 18 and 60 years.
  • Haemoglobin - not less than 12.5 g/dl.
  • Pulse - between 50 and 100/minute with no irregularities.
  • Blood Pressure -Systolic 100-180 mm Hg and Diastolic 50 - 100 mm Hg.
  • Temperature - Normal (oral temperature not exceeding 37.50C).
  • Body weight - not less than 45 Kg.

Is there any inspection of blood banks?

Yes. The blood banks can only function if they are licensed by the Drug Inspectors of the Food and Drug Administration of the respective states. The Drugs & Cosmetics Act provides a legal framework under which the blood banks are inspected and issued a proper license, which is renewed every Five years. Every blood bank has to prominently display its license for anyone to check.

Care , Support and treatment (Antiretroviral Therapy)

What is ART ?

ART stands for Anti Retroviral Therapy (ART).

Is there a treatment for HIV/AIDS?

Yes, Anti Retroviral Therapy (ART) are available for treatment of HIV/AIDS. Though, Antiretroviral Therapy (ART) does not cure HIV/AIDS, but effective antiretroviral regimens inhibit the efficient replication of the HIV virus, and reduce viremia to undetectable levels. This leads to slowing of disease progression and fewer opportunistic infections and helps people lead more productive lives, with perceptibly reduced stigma and discrimination. Successes achieved by ART in terms of delaying the onset of AIDS have transformed the common perception about HIV from being a "virtual death sentence" to a "chronic manageable illness". The free ART initiative in Karnataka was launched on 1st April, 2004. In NACP- III, NACO hopes to provide greater Care, Support and treatment to a larger number of People Living with HIV/AIDS (PLHA).

Do AIDS cases require a separate ward?

NACO does not support separate ward for AIDS patients. AIDS patients are to be treated at par with the general patients and there should be no discrimination.

If testing has to be done in the hospital, is the consent of the patient required?

Yes. Whenever HIV test is done, the consent has to be taken. In case of unconscious patients, the consent of the relatives has to be taken.

What is the importance of ICTC in care and support?

ICTC is an entry point for care and support of HIV/AIDS. Whenever a person feels, he can walk to an ICTC and get himself tested. If tested positive, follow up counselling is suggested at the ICTC for referrals and treatment of HIV/AIDS patients.

What efforts are being made to integrate HIV/AIDS/STD prevention and control activities into primary health care?

Integration into primary healthcare is a priority because it is necessary for ensuring sustainability. Two examples of an integrated approach are the implementation of HIV/AIDS care and STD prevention and control. For example, a continuum of HIV/AIDS care is being promoted as part of primary health care, with linkages to be established between institutional, community and home levels. In the area of STD prevention and control, a syndromic approach to STD diagnosis is most suitable in the developing world as it does not require laboratory tests, and treatment can be given at the first contact with health services.

What steps has the Government of India taken to tackle the dual epidemic of HIV-TB?

NACO does not support separate ward for AIDS patients. AIDS patients are to be treated at par with the general patients and there should be no discrimination.

If testing has to be done in the hospital, is the consent of the patient required?

Recognizing the serious threat posed by HIV-TB co-infection, the Government of India has emphasised the need for strengthening collaboration between TB and AIDS control programmes for better management of HIV-infected patients with TB. The ICTC counselor screen all the ICTC clients for TB symptoms and refer them to laboratory or physicians for TB diagnosis. All TB patients are offered HIV testing, under Revised National Tuberculosis Programme. Thus, these efforts help to establish diagnosis for TB and Directly Observed Treatment–short (DOTS) course is provided for TB patients

What precautions should be taken while treating HIV and TB at the same time?

Certain anti-TB medications may affect the levels of anti-HIV medications and vice versa. Hence treatment of both diseases should be under the supervision of an experienced physician, the dosages should be closely monitored and adjusted as needed. After 2 week of initiation of anti –TB treatment, anti HIV drugs are initiated.

Sexually Transmitted Infections/Reproductive Tract Infections

What is DSRC?

DSRC stands for Designated STI/ RTI clinic. 54 DSRC at located in Karnataka. Treatment of STIs and relies on the health seeking behaviour of individuals with STD. Under the STD Control Programme of NACO, the government has established DSR clinics in each district hospital and some taluk level hospital, all over the country. The STI drugs are provided free of cost by the Government of India and adequate confidentiality is ensured for those attending these clinics. Such clinics are managed by experts trained Medical Officer to treat STIs and trained counselor for providing counseling services. Another major activity of STD Control Programme is Targeted Intervention under which, special facilities are made available easily to commercial sex workers, truckers, migrant workers and other marginalised segments of society. Partner notification, condom promotion and imparting IEC activities through peer-educators are the interventions organised as a part of the programme. STI management through syndromic approach has been now practiced by trained medical officers at peripheral, middle and even at tertiary levels of health care where adequate lab facilities are not available.

What is STI and RTI?

Reproductive Tract Infections (RTI): Any infection of the reproductive tract in males, females and transgender/transsexual

Sexually Transmitted Infections (STI): Infections caused by germs that are passed from one person to another mainly through sexual contact

How RTI spreads?

Overgrowth of normal organisms in the genital system – Eg. Bacterial Vaginosis, Candidiasis

Physician/practitioner/procedure induced infections – Infection following improper procedures during catheterization, IUD insertion, termination of pregnancy, delivery, etc.

Through unsafe sexual practices. these are called as Sexually Transmitted Infections (STI)

What are the Common RTIs?

Genital Ulcer Diseases syndrome – Non Herpetic

Genital Ulcer Disease syndrome – Herpetic

Vaginal /Cervical Discharge Syndrome

Inguinal Bubo Syndrome

Painful Scrotal Swelling Syndrome

Ano-rectal Discharge syndrome

Oral – Anal STI syndrome

Genital Skin ConditionsUrethral Discharge Syndrome

How signs and symptoms are detected ?

Sign/s are observed by doctors during examination

There are external and internal ‘signs’ – and some may only be seen during an internal examination

Symptoms are complaints told by the patient to the doctor

What is asymptomatic?

Sign/s are observed by doctors during examination

There are external and internal ‘signs’ – and some may only When the person with the infection shows no symptoms of that infection, they are called asymptomatic be seen during an internal examination

Symptoms are complaints told by the patient to the doctor

What are the common Signs and symptoms of STI/RTI in Male?

Urethral discharge/Burning or pain during urination/ frequent urination

Genital itching

Swelling in groin/scrotal swelling

Blisters or ulcers on the genitals, anus, mouth, lips

Itching or tingling in genital area

Ano rectal discharge

Warts on genitals, anus or surrounding area

What are the common Signs and symptoms of STI/RTI in Female?

Unusual vaginal discharge

Genital itching

Abnormal and/or heavy vaginal bleeding

Pain during sexual intercourse

Lower abdominal pain (pain below the belly button, pelvic pain)

Blisters/ulcers on the genitals, anus or surrounding area, mouth, lips

How Syphilis cause?

Syphilis is one of the easily treatable Sexually Transmitted Infection caused by Treponema pallidum, which can be transmitted to sexual partners as well as from infected pregnant woman to her new born child.

What Happens if syphilis not treated ?

Untreated syphilis is responsible for multisystem complications and other sickness among infected patients and may cause miscarriages, low birth weight and premature delivery in the pregnant woman.

What is RPR or VDRL tests?

The Rapid Plasma Reagin test or Venereal Diseases Laboratory Test. These tests are the most commonly used screening tests to detect syphilis among individuals.

What is STI-HIV Inter-Relationship?

Both are sexually transmitted Infections

Are STI curable?

All STI except

  • HIV
  • Herpes
  • Hepatitis B

How STI/RTI are treated?

  • To be taken from a trained Doctor
  • To be taken for the duration prescribed
  • To be taken in the dosage prescribed
  • To be given to the sexual partner
  • To use condoms during treatment

Does the presence of other sexually transmitted diseases (STDs) facilitate HIV transmission?

Yes, every STD causes some damage to the genital skin and mucous layer, which facilitates the entry of HIV into the body. The most dangerous are:

  • Syphilis
  • Cancroids
  • Genital herpes
  • Gonorrhoea.

Why is early treatment of STD important?

High rates of STD caused by unprotected sexual activity enhance the transmission risk in the general population. Early treatment of STD reduces the risk of spread to other sexual partners and also reduces the risk of contracting HIV from infected partners. Besides, early treatment of STD also prevents infertility and ectopic pregnancies.

Condom Promotion

What is the government's policy on condoms?

The government policy has been that condoms are an effective, protective measure to prevent the spread of HIV. The government believes that it is necessary to be focused in the promotion of condoms since a large number of infections occur through unsafe sex. For the general population the dual use of condoms for contraception and disease prevention is emphasised by both National AIDS programme and Reproductive & Child Health programme. For the high risk groups, targeted social marketing and free distribution of condoms is being promoted through NGOs.

How safe are condoms in preventing HIV?

Consistent and correct use of Latex condoms are fully effective in preventing the spread of HIV through the sexual route.

HIV-TB Co-infection

How does infection with TB affect the HIV/AIDS scenario?

TB shortens the survival of patients with HIV infection, accelerates the progression of HIV to AIDS as observed by a six- to seven-fold increase in the HIV viral load in TB patients and is the cause of death for one out of every three people with AIDS worldwide. Effective treatment using DOTS not only prolongs the survival of patients living with AIDS, but also improves their quality of life.

What are the clinical features of TB and what type of TB is more commonly seen in HIV positive individuals?

As the HIV infection progresses, the CD4 lymphocytes decline in number and function. Therefore, the immune system is less able to prevent the growth and spread of the TB bacilli. As a result, disseminated and extra-pulmonary TB disease is more commonly seen in the later stages. Nevertheless,pulmonary TB is still the most common form of TB even in HIV-infected patients. Many studies have shown that pulmonary involvement occurs in 70-90 percent of all HIV/AIDS patients with TB.

How does treatment of TB differ in HIV infected and HIV uninfected individuals?

In general, anti-TB treatment is the same for HIV-infected and HIV-uninfected TB patients, with the exception of the use of thiacetazone. Thiacetazone causes severe cutaneous reactions that may be fatal and hence should be avoided. Patients who complete treatment show the same clinical, radiographic and microbiological response to short-course treatment irrespective of whether they are HIV positive or negative. Self-administration of treatment is associated with higher case fatality rates. Directly Observed Treatment–short course (DOTS) is therefore even more important for HIV-infected TB patients. Treatment with DOTS for HIV-infected TB patients improves their quality of life, and also has been shown to prolong their life span. DOTS can prevent emergence of MDR -TB and reverse the trend of MDR-TB.