World AIDS Day: prevention goes beyond condoms

With access to treatment, PEP and PrEP, it is possible to end this epidemic

This week, on the eve of World AIDS Day (celebrated today), Unaids (the United Nations program focused on the disease) recalled that 630,000 people worldwide will die from AIDS-related diseases in 2023, and 1 .3 million have contracted HIV. The data contrasts with the fact that we have never had so many resources to prevent new infections and, above all, deaths from the disease.

In this Red December, the disease awareness month, it is essential that everyone knows how to avoid HIV infection and, once infected, have access to treatment, which is free. See some relevant questions and answers about HIV/AIDS below.

What is the difference between HIV and AIDS?

HIV is the virus that causes human immunodeficiency syndrome (AIDS). But it is possible for a person to become infected with the HIV virus and never develop AIDS. HIV is a retrovirus [armazena suas informações genéticas no RNA e não no DNA, como a maioria dos seres vivos]. It therefore presents characteristics that influence the patient’s clinical conditions, such as having a prolonged incubation period. The onset of signs and symptoms of the infection is also slow.

In summary: AIDS is a disease caused by the HIV virus, which attacks the immune system of the infected patient, but not all individuals diagnosed positive for the virus will develop the disease. HIV can be transmitted, not AIDS.

How is HIV transmitted?

• Penetrative sex (anal or vaginal) without a condom;
• Oral sex without a condom (even if the risk in this case is very small, it exists);
• Sharing syringes or other puncturing or cutting instruments that contain contaminated blood;
• Contaminated blood transfusion;
• From mother to child during pregnancy, through childbirth or during breastfeeding.

How is HIV not transmitted?

Does having an undetectable viral load prevent transmission?

Yes, and this is very important information! A person with serology [exame do soro sanguíneo] HIV positive and taking antiretroviral treatment (ART) correctly will not be detectable [terá carga viral em níveis muito baixos] in a matter of time. According to the Ministry of Health, even an undetectable person is untransmissibletherefore, it no longer transmits the virus. So when a person takes antiretroviral drugs, it reduces the amount of virus circulating in their body so much that it becomes very difficult to find HIV in the blood, and that’s great, because then they don’t transmit this virus. to someone else. In other words: one of the most important forms of prevention against HIV infection is antiretroviral therapy.

What are the signs and symptoms of the infection?

The clinical picture presented by patients who contract HIV is very varied and can go unnoticed. In general, between 2 and 4 weeks after infection, a series of signs and symptoms occurs that is called acute retroviral syndrome and may include:

• Fever (around 38.5º);
• Headache (headache);
• Asthenia (weakness);
• Pharyngitis;
• Myalgia (muscle pain);
• Reddish spots on the body;
• Adenopathy (enlarged nodes).

But as soon as these symptoms appear, they also disappear. Therefore, the condition can be confused with any other type of infectious process. It is therefore estimated that more than 112 thousand Brazilians are not aware of having the virus (according to 2019 data).

The clinical latency phase of HIV is characterized by the decline of CD4+ cells [do sistema imune] and increased viral load circulating in the untreated body. This stage of the infection can last for yearswithout the individual knowing that they have positive serology for the virus.

The CD4+ T cell is part of our immune system. As the CD4+ count decreases in the body, the person with HIV becomes exposed to other infections and diseases and also begins to experience more specific signs and symptoms of significant immunosuppression, such as:

• Chronic diarrhea;
• Neurological changes;
• Bacterial infections;
• Oral lesions;
• Respiratory infections.

A person enters the AIDS phase when the CD4+ count drops below 200 cells per mm³ of blood. It is in this phase that the so-called opportunistic infections arise, such as: pneumocystosis (lung disease caused by a fungus); neurotoxoplasmosis (central nervous system infection); Kaposi’s sarcoma (cancer of the blood vessels); atypical and disseminated (miliary) pulmonary tuberculosis; and persistent oral candidiasis.

Additionally, the person also experiences unexplained weight loss (<10% do peso), febre persistente por mais de um mês (>37.6º) and night sweats.

I had a suspicious relationship; When do I take the test?

Between exposure to the HIV virus and the production of antibodies, the body takes, on average, 15 to 30 days to react to the virus. In other words, to have a reliable diagnosis, excluding the possibility of a false negative result, the exposed person should try to perform the test after this period, called the immunological window, since serological tests detect the antibody in the body.

It is possible to carry out the rapid test at a Testing and Consultancy Center which constitutes the Sexually Transmitted Infections (STI) treatment network of the Ministry of Health. Elisa and Western Blot are tests that can also detect HIV and are commonly requested by the doctor if the disease is suspected.

How is HIV infection treated?

With a positive HIV diagnosis in hand, the patient has the right to access medications through the SUS. Early treatment is an important prevention measure and guarantee of quality of life. Therefore, adhering well to the treatment proposed by the infectious disease specialist prevents opportunistic diseases and a poor prognosis.

Medicines have progressed a lot and today side effects are less and less frequent and a person on antiretroviral treatment can live normally, as if they had any other chronic disease, such as hypertension or diabetes.

How is HIV prevented?

There are several ways to prevent HIV. Condoms, both penile and vaginal, play an important role in preventing not only this virus, but countless other sexually transmitted diseases as well. But there are also other very important resources, such as PrEP and PEP.

PrEP – Pre-Exposure Prophylaxis

PrEP is an antiretroviral drug taken daily that prevents HIV infection. It is a combination of antiretrovirals that are intended to create a sort of shield in the body of a person who comes into contact with the virus. If this happens, infection does not occur, because PrEP circulates in that individual’s blood, which explains why it is a pre-exposure prophylactic measure. An injectable version of this drug, with a prolonged effect, can bring a number of benefits to users, but is not yet widely available.

PrEP is currently indicated for:

• Gay, bisexual and other men who have sex with men;
• Trans people (trans women, transvestites, trans men and non-binary people);
• Sex workers or people who may receive money or benefits in exchange for sexual services;
• People who are in a relationship with a person affected by HIV (serodifferent couples).

PEP – Post-Exposure Prophylaxis

It’s like the morning after pill, but for HIV prevention. A person who has been exposed to the virus, either through unprotected sexual intercourse or even due to an accident at work, can turn to a specialized service and request the drugs that make up the PEP program. In short: PEP is recommended for anyone who has been exposed to the risk of contracting HIV.

However, it is important to underline this: you have up to 72 hours after exposure to start post-exposure treatment and the drugs must be taken correctly for 28 days.

Is there a cure for HIV?

The scientific community currently considers some rare cases of “cure” of the disease. These are patients with controlled HIV who have undergone a bone marrow transplant due to haematological cancer. This forced them to eliminate the altered cells and also the HIV-infected cells. It is worth remembering that transplantation is an expensive procedure, carries a number of risks and, to date, few patients have been treated in this way, despite dozens of similar attempts.

Other very rare cases of recovery concern the so-called “elite controllers”, i.e. rare situations in which the person’s own immunity against HIV is so effective as to keep the virus under control and undetectable even without antiviral treatment. These are episodes monitored by scientists and which give rise to hope that, one day, it will be possible to transform other people into “elite controllers”.

Is there a vaccine in sight?

For decades, several global initiatives have been engaged in the search for an HIV vaccine, including in Brazil. But none have yet brought results comparable to those of vaccines like Covid, for example. One justification is that HIV is a much more complex and variable virus than other microorganisms, such as the coronavirus itself.

Source: Terra

Rose

Rose James is a Gossipify movie and series reviewer known for her in-depth analysis and unique perspective on the latest releases. With a background in film studies, she provides engaging and informative reviews, and keeps readers up to date with industry trends and emerging talents.