General description
The human immunodeficiency virus (HIV) targets the immune system and weakens a person’s defences against many infections and some types of cancer that people with healthy immune systems can fight more easily. As the virus destroys and impairs the function of immune cells, infected people gradually become immunocompromised. Immune function is usually measured by the CD4 cell count.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if left untreated, depending on the individual. AIDS is defined by the development of certain types of cancer, infections or other serious long-term clinical manifestations.
Signs and symptoms
The symptoms of HIV vary depending on the stage of the infection. Although people living with HIV tend to be most infectious in the first few months after becoming infected, many are unaware of their status until later stages. In the first few weeks after the initial infection, people may have no symptoms or may develop an influenza-like illness, including fever, headache, rash, or sore throat.
As the infection progressively weakens the immune system, they may develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea, and cough. Without treatment, they could also develop serious diseases such as tuberculosis (TB), cryptococcal meningitis, serious bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.
Transmission
HIV can be transmitted through the exchange of a variety of bodily fluids from infected people, including blood, breast milk, semen, and vaginal secretions. HIV can also be passed from a mother to her child during pregnancy and childbirth. People cannot become infected through normal everyday contacts, such as kissing, hugging, shaking hands, or sharing personal items, food, or water.
It is important to note that people with HIV who are taking ART and are virally suppressed do not transmit HIV to their sexual partners. Therefore, early access to ART and support to continue treatment is essential not only to improve the health of people with HIV but also to prevent HIV transmission.
Risk factor’s
Behaviours and conditions that put people at higher risk of contracting HIV include:
- having anal or vaginal sex without a condom;
- have another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis;
- engage in the harmful use of alcohol and drugs in the context of sexual behaviour;
- sharing contaminated needles, syringes and other injection equipment and drug solutions when injecting drugs;
- receiving injections, blood transfusions and dangerous tissue transplants, and medical procedures involving unsterile cutting or piercing; Y
- accidental needlestick injuries, including among healthcare workers.
Diagnosis
HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage to treatment and care. People can also use HIV self-tests to self-test. However, no single test can provide a complete diagnosis of HIV positive; Confirmatory tests are required, performed by a qualified and trained health or community worker at a community centre or clinic. HIV infection can be detected with high precision using WHO-prequalified tests within a nationally approved testing strategy and algorithm.
The most widely used HIV diagnostic tests detect the antibodies produced by the person as part of the person’s immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called window period: when antibodies to HIV have not been produced at high enough levels to be detected by standard tests, and when they may not have had any signs of HIV infection. , but also when they can transmit HIV. to others. After infection without treatment and viral suppression, a person can transmit HIV transmission to a sexual or drug-sharing partner or, in the case of pregnant women, to their baby during pregnancy or while breastfeeding.
After a positive diagnosis, individuals should be retested before enrolling in treatment and care to rule out any potential testing or reporting errors before beginning lifelong treatment. It is important to support people with HIV to stay on treatment and to provide them with messages and counselling services when there are doubts about the accuracy of their diagnosis or if they discontinue treatment and care and need to re-engage.
While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. For children under 18 months of age, rapid antibody tests are not sufficient to identify HIV infection; Virologic testing should be performed from birth or 6 weeks of age. New technologies are now available to perform this test at the point of care and allow for same-day results, which will speed up appropriate linkage to treatment and care.
Prevention
People can reduce the risk of HIV infection by limiting exposure to risk factors. Key HIV prevention approaches, often used in combination, include:
- use of male and female condoms;
- prevention, testing and counselling for HIV and STIs;
- Voluntary Medical Male Circumcision (VMMC);
- use of antiretroviral (ARV) drugs for prevention (oral PrEP and long-acting products), the dapivirine vaginal ring, and long-acting injectable cabotegravir;
- harm reduction for people who inject and use drugs; Y
- elimination of mother-to-child transmission (MTCT) of HIV.
HIV is not transmitted if a person’s sexual partner is virally suppressed on ART, so increasing access to testing and supporting linkage to ART is an important component of HIV prevention.
Treatment
HIV disease can be controlled by treatment regimens consisting of a combination of antiretroviral (ARV) drugs. Current antiretroviral therapy (ART) does not cure HIV infection, but it suppresses viral replication and allows a person’s immune system to become stronger and regain the ability to fight opportunistic infections and some cancers. Since 2016, WHO has recommended Treat All – that all people living with HIV receive ART for life, including children, adolescents, adults, and pregnant and lactating women, regardless of clinical status or CD4 cell count.
By June 2022, 189 countries had already adopted this recommendation, covering 99% of all people living with HIV worldwide. In addition to the Treat All strategy, WHO recommends rapid initiation of ART for all people living with HIV, including offering ART on the day of diagnosis to those ready to start treatment. By June 2022, 97 countries reported that they had adopted this policy, and almost two-thirds of them reported its implementation across the country.
Globally, 28.7 million people living with HIV were receiving ART in 2021. Global ART coverage was 75% [66–85%] in 2021. However, more efforts are needed to scale up treatment, particularly for children and adolescents. Only 52% [42–65%] of children (0–14 years) were receiving ART at the end of 2021.
Advanced HIV disease remains a persistent problem in the HIV response. People continue to present or re-present for care with advanced immunosuppression, putting them at increased risk of developing opportunistic infections. WHO is supporting countries to implement an advanced care package for HIV disease to reduce illness and death.
