Glossary

9.3 HIV/AIDS: epidemiology, prevention, and management

9 min read•august 1, 2024

HIV/AIDS is a critical topic in sexually transmitted infections. This virus attacks the immune system, leading to AIDS if left untreated. Understanding transmission, prevention, and treatment is crucial for public health and individual well-being.

HIV spreads through unprotected sex, sharing needles, and . Antiretroviral therapy has transformed HIV from a death sentence to a manageable condition. However, and access to care remain significant challenges in addressing the global epidemic.

HIV vs AIDS

HIV: The Virus

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  • HIV (Human Immunodeficiency Virus) is a retrovirus that attacks the immune system, specifically CD4 T cells, leading to a gradual decline in immune function
    • HIV belongs to a class of viruses known as retroviruses, which use RNA as their genetic material
    • The virus targets and destroys CD4 T cells, a critical component of the immune system responsible for coordinating immune responses
    • As HIV replicates and destroys more CD4 T cells, the immune system becomes increasingly compromised over time
  • HIV is the virus that causes AIDS, but not all individuals with HIV develop AIDS
    • The progression from HIV infection to AIDS can take several years, depending on factors such as , CD4 count, and access to treatment
    • With proper antiretroviral treatment, many people living with HIV can maintain healthy immune function and may never develop AIDS

AIDS: The Advanced Stage of HIV Infection

  • AIDS (Acquired Immunodeficiency Syndrome) is a condition that develops in advanced stages of HIV infection when the immune system is severely compromised
    • AIDS is diagnosed when an individual with HIV has a CD4 count below 200 cells/mm³ or the presence of specific opportunistic infections
    • Opportunistic infections are illnesses that occur more frequently or are more severe in people with weakened immune systems, such as those with untreated HIV
    • Examples of opportunistic infections associated with AIDS include Pneumocystis pneumonia, Kaposi's sarcoma, and toxoplasmosis
  • AIDS is not a specific disease but rather a syndrome characterized by a set of symptoms and illnesses that result from severe immune system damage
    • Individuals with AIDS are at high risk for life-threatening infections, cancers, and other complications due to their severely compromised immune function
    • Without proper treatment, AIDS can lead to significant morbidity and mortality

HIV Transmission Modes

Sexual Transmission

  • Sexual transmission through unprotected vaginal, anal, or oral sex with an HIV-positive partner is the most common mode of HIV transmission globally
    • HIV can be present in sexual fluids, such as semen, vaginal secretions, and rectal fluids
    • The risk of HIV transmission is highest during anal sex, followed by vaginal sex and oral sex
    • Factors that increase the risk of sexual transmission include high viral load in the HIV-positive partner, the presence of other sexually transmitted infections, and the absence of barrier protection (condoms)
  • High-risk sexual behaviors that increase the likelihood of HIV transmission include:
    • Having multiple sexual partners
    • Engaging in unprotected sex
    • Having a history of sexually transmitted infections (STIs)

Bloodborne Transmission

  • Sharing of contaminated needles, syringes, or other injection drug equipment can transmit HIV through infected blood
    • HIV can survive in used needles and syringes for up to 42 days, depending on temperature and other factors
    • Injection drug use is a significant driver of HIV transmission in many regions, particularly among people who inject drugs (PWID)
    • strategies, such as needle and syringe exchange programs, can help reduce the risk of HIV transmission among PWID
  • Occupational exposure to HIV-infected blood or body fluids, particularly in healthcare settings, can occur through needlestick injuries or other accidents
    • Healthcare workers, such as nurses, doctors, and laboratory technicians, are at risk for occupational HIV exposure
    • Proper use of personal protective equipment (PPE) and adherence to universal precautions can help minimize the risk of occupational HIV transmission

Mother-to-Child Transmission

  • Mother-to-child transmission can occur during pregnancy, childbirth, or breastfeeding if the mother is HIV-positive and not receiving proper treatment
    • HIV can be transmitted to the fetus during pregnancy through the placenta
    • During childbirth, the infant can be exposed to HIV through contact with the mother's blood and other bodily fluids
    • Breastfeeding can also transmit HIV from an infected mother to her infant through breast milk
  • Prevention of mother-to-child transmission (PMTCT) strategies, such as providing antiretroviral therapy to pregnant women and delivering through cesarean section when appropriate, can significantly reduce the risk of vertical transmission
    • With effective PMTCT interventions, the risk of mother-to-child transmission can be reduced to less than 5%

Global HIV/AIDS Impact

Epidemiology

  • Since the beginning of the epidemic, over 75 million people have been infected with HIV, and approximately 32 million have died from AIDS-related illnesses worldwide
    • In 2020, an estimated 37.7 million people were living with HIV globally, with 1.5 million new infections and 680,000 AIDS-related deaths
    • Despite significant progress in the global response to HIV/AIDS, the epidemic continues to disproportionately affect certain regions and populations
  • Sub-Saharan Africa remains the most severely affected region, accounting for approximately two-thirds of all people living with HIV globally
    • In 2020, an estimated 25.4 million people were living with HIV in Sub-Saharan Africa, representing 67% of the global total
    • The region also accounts for the majority of new HIV infections and AIDS-related deaths worldwide
  • Key populations at higher risk of HIV infection include:
    • Transgender individuals
    • People who inject drugs (PWID)
    • Sex workers
    • Prisoners

Social and Economic Consequences

  • HIV/AIDS has significant social and economic consequences, particularly in heavily affected regions
    • The epidemic can lead to increased healthcare costs, reduced productivity, and the loss of skilled workers in affected communities
    • HIV/AIDS can also exacerbate poverty, as affected individuals and households may face reduced income and increased expenses related to healthcare and support
  • The impact of HIV/AIDS extends beyond the individual level, affecting families, communities, and entire nations
    • Children orphaned by AIDS may face challenges in accessing education, healthcare, and other essential services
    • The loss of young adults to AIDS can lead to demographic shifts and increased dependency ratios in affected populations
  • Addressing the social and economic consequences of HIV/AIDS requires a comprehensive, multisectoral approach that includes poverty reduction, social protection, and support for affected communities

Antiretroviral Therapy for HIV

Benefits of ART

  • involves the use of a combination of drugs to suppress HIV replication and prevent the progression of HIV infection to AIDS
    • ART works by targeting different stages of the HIV life cycle, preventing the virus from replicating and infecting new cells
    • Combination ART typically includes drugs from different classes, such as nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase inhibitors
  • ART helps to restore and maintain immune function, reduce the risk of opportunistic infections, and improve overall quality of life for people living with HIV
    • By suppressing viral replication, ART allows the immune system to recover and maintain higher CD4 T cell counts
    • Effective ART can reduce the risk of opportunistic infections and other HIV-related complications, leading to improved health outcomes and increased life expectancy
  • Early initiation of ART, regardless of CD4 count, is now recommended for all individuals diagnosed with HIV to improve health outcomes and reduce the risk of transmission
    • Studies have shown that early ART initiation can lead to better long-term health outcomes and reduced risk of HIV-related morbidity and mortality
    • Early treatment also reduces the risk of HIV transmission to sexual partners, as individuals with suppressed viral loads are less likely to transmit the virus

Adherence and Drug Resistance

  • Adherence to ART is crucial for maintaining viral suppression and preventing the development of drug resistance
    • Consistent, daily adherence to ART is necessary to maintain high levels of the drugs in the body and effectively suppress HIV replication
    • Missed doses or inconsistent adherence can lead to suboptimal drug levels, allowing the virus to replicate and potentially develop resistance to the medications
  • Drug resistance occurs when HIV mutates and becomes less susceptible to the effects of specific antiretroviral drugs
    • Resistance can develop due to inconsistent adherence, as partially suppressed virus has the opportunity to mutate and develop resistance mutations
    • Transmitted drug resistance can also occur when an individual is infected with a strain of HIV that is already resistant to certain medications
  • Monitoring adherence and regular viral load testing are important components of HIV care to ensure treatment effectiveness and detect potential drug resistance early

Prevention Strategies using ART

  • and post-exposure prophylaxis (PEP) are ART-based strategies used to prevent HIV infection in high-risk individuals or after potential exposure
    • PrEP involves the use of antiretroviral drugs by HIV-negative individuals to prevent infection before potential exposure
    • PrEP has been shown to be highly effective in reducing the risk of HIV acquisition, particularly among high-risk populations such as MSM and serodiscordant couples
    • PEP involves the use of antiretroviral drugs within 72 hours after a potential exposure to HIV, such as through or occupational exposure
    • PEP can reduce the risk of HIV infection by stopping the virus from establishing itself in the body after exposure

Social Challenges of HIV/AIDS

Stigma and Discrimination

  • Stigma and associated with HIV/AIDS can lead to social isolation, rejection, and difficulty accessing healthcare and support services
    • HIV-related stigma often stems from misconceptions about the virus, fear of transmission, and moral judgments about the behaviors associated with HIV acquisition
    • Stigma can manifest as social rejection, verbal or physical abuse, and exclusion from family, community, or religious activities
    • Discrimination can occur in various settings, such as healthcare, employment, education, and housing
  • HIV-related stigma and discrimination can also contribute to human rights violations
    • Individuals living with HIV may face employment discrimination, such as being denied jobs or promotions due to their HIV status
    • Housing instability and homelessness can result from discrimination in rental agreements or mortgage applications
    • In some cases, individuals living with HIV may experience violence, including intimate partner violence and hate crimes

Disclosure and Mental Health

  • Disclosure of HIV status to partners, family, and friends can be a significant source of stress and anxiety for people living with HIV
    • Fear of rejection, stigma, and discrimination can make disclosure a daunting prospect
    • Disclosure can also raise concerns about confidentiality and privacy, particularly in settings where HIV-related stigma is high
  • Mental health conditions, such as depression and anxiety, are common among individuals living with HIV and can impact adherence to treatment and overall well-being
    • The stress of living with a chronic illness, combined with the social and emotional challenges of HIV, can contribute to the development of mental health issues
    • Untreated mental health conditions can lead to poor adherence to ART, increased risk behaviors, and worse health outcomes
  • Addressing mental health is an important component of comprehensive HIV care
    • Screening for and treating mental health conditions can improve adherence to ART, quality of life, and overall health outcomes for people living with HIV
    • Psychosocial support, including counseling and peer support groups, can help individuals cope with the challenges of living with HIV and improve mental well-being

Comprehensive Care and Support

  • Comprehensive care for people living with HIV/AIDS should address not only medical needs but also psychosocial support
    • Medical care should include regular monitoring of CD4 count and viral load, screening for and treatment of opportunistic infections, and management of ART
    • Psychosocial support should include counseling, peer support groups, and access to mental health services
    • Social services, such as assistance with housing, employment, and legal issues, can also be critical components of comprehensive care
  • Addressing the is essential for improving outcomes for people living with HIV
    • Poverty, lack of education, and limited access to healthcare can all contribute to the challenges faced by individuals living with HIV
    • Interventions that address these underlying social and structural factors, such as income support, job training, and community-based healthcare, can help improve the health and well-being of people living with HIV

Key Terms to Review (18)

Antiretroviral therapy (ART): Antiretroviral therapy (ART) is a medical treatment for individuals infected with the Human Immunodeficiency Virus (HIV), aimed at controlling the virus and preventing the progression to Acquired Immunodeficiency Syndrome (AIDS). ART involves a combination of at least three antiretroviral medications that work together to reduce viral load, improve immune function, and enhance the overall health of those living with HIV. It is critical for managing HIV/AIDS, contributing to both individual well-being and public health efforts to reduce transmission rates.
Centers for Disease Control and Prevention (CDC): The Centers for Disease Control and Prevention (CDC) is a national public health agency in the United States focused on disease prevention, health promotion, and safety. It plays a crucial role in addressing public health issues, including the prevention and treatment of sexually transmitted infections (STIs), HIV/AIDS epidemiology and management, and understanding the types and transmission of STIs through research and guidelines.
Discrimination: Discrimination refers to the unfair or prejudicial treatment of individuals based on their perceived or actual characteristics, such as race, gender, sexual orientation, or socioeconomic status. It often manifests in various forms, including systemic barriers and social stigma, impacting marginalized groups in profound ways. Understanding discrimination is crucial for addressing inequalities within society and fostering inclusivity.
Harm reduction: Harm reduction is a public health strategy aimed at minimizing the negative consequences associated with certain behaviors, particularly those related to substance use and sexual health. This approach acknowledges that while some individuals may engage in high-risk activities, it’s crucial to implement measures that reduce harm without necessarily eliminating the behavior itself. By focusing on practical solutions and support, harm reduction promotes safer practices and ultimately improves health outcomes for individuals and communities.
Health disparities: Health disparities refer to the differences in health outcomes and access to healthcare that exist among different population groups. These disparities can be influenced by various factors, including socioeconomic status, race, ethnicity, gender, geographic location, and other social determinants of health. Understanding health disparities is crucial for addressing the inequities in healthcare access and outcomes, particularly in the context of HIV/AIDS epidemiology, prevention, and management.
Incidence: Incidence refers to the number of new cases of a disease or condition that occur in a specific population during a defined time period. Understanding incidence is crucial for tracking the spread of diseases, assessing public health risks, and planning prevention strategies. This term helps in evaluating how often certain health issues arise within a community, providing insights into trends and potential outbreaks.
Intravenous drug users (IDUs): Intravenous drug users (IDUs) are individuals who administer drugs directly into their bloodstream using a syringe or needle. This method of drug use is associated with a higher risk of various health issues, particularly the transmission of infectious diseases like HIV and hepatitis C, due to sharing needles and other injecting equipment.
Men who have sex with men (MSM): Men who have sex with men (MSM) refers to individuals who identify as male and engage in sexual activity with other males, regardless of their sexual orientation or identity. This group is significant in the context of HIV/AIDS, as it has been identified as a key population disproportionately affected by the virus due to various factors including social stigma, lack of access to healthcare, and specific sexual behaviors that may increase risk of transmission.
Mother-to-child transmission: Mother-to-child transmission (MTCT) refers to the process by which an infectious disease, such as HIV, is transmitted from a mother to her child during pregnancy, childbirth, or breastfeeding. Understanding this term is essential in the context of HIV/AIDS as it highlights the significant public health challenge of preventing the spread of the virus to infants and young children. Effective strategies for preventing MTCT are crucial for managing and reducing the incidence of pediatric HIV infections.
Pre-exposure prophylaxis (PrEP): Pre-exposure prophylaxis (PrEP) is a preventive strategy that involves the use of antiretroviral medications by HIV-negative individuals to reduce the risk of contracting HIV. This approach is particularly crucial in managing HIV/AIDS, as it provides a proactive measure to safeguard high-risk populations and complements other prevention methods such as condom use and regular testing.
Prevalence: Prevalence refers to the total number of cases of a specific condition or disease within a given population at a particular time. It helps in understanding how widespread a health issue is and can influence public health strategies, resource allocation, and prevention efforts related to various conditions, including sexually transmitted infections and HIV/AIDS.
Safe sex practices: Safe sex practices refer to behaviors and techniques that reduce the risk of sexually transmitted infections (STIs) and unintended pregnancies during sexual activities. These practices promote healthy sexual relationships and emphasize the importance of communication, consent, and the use of protective measures such as condoms or dental dams.
Sexual contact: Sexual contact refers to any physical interaction or activity between individuals that involves the genitalia, breasts, or other intimate parts of the body. This term encompasses a wide range of behaviors, from kissing and touching to intercourse, and is essential in understanding how sexually transmitted infections (STIs) and conditions like HIV/AIDS can be transmitted. Recognizing the various forms of sexual contact helps inform effective prevention strategies and awareness around sexual health.
Social determinants of health: Social determinants of health are the conditions in which people are born, grow, live, work, and age that affect their health and quality of life. These factors include socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to healthcare. Understanding these determinants is crucial for addressing health disparities and implementing effective strategies for prevention and management of diseases like HIV/AIDS.
Stigma: Stigma refers to the negative attitudes and beliefs that society holds towards certain characteristics, behaviors, or identities, often resulting in discrimination and social exclusion. It can lead to harmful consequences for individuals, especially those who belong to marginalized groups, as stigma can affect their mental health, access to resources, and overall quality of life.
Testing and Counseling: Testing and counseling refers to the processes involved in the diagnosis and management of HIV/AIDS, where individuals undergo testing to determine their HIV status and receive counseling to understand the implications of the results. This approach not only focuses on the medical aspects but also emphasizes emotional support, education about transmission, prevention strategies, and coping mechanisms for those affected by HIV/AIDS.
Viral load: Viral load refers to the amount of HIV (Human Immunodeficiency Virus) present in a person's blood. This measurement is crucial in understanding the progression of HIV infection and helps in monitoring treatment effectiveness. High viral loads indicate active viral replication, which can lead to a higher risk of transmission and faster progression to AIDS (Acquired Immunodeficiency Syndrome), while lower viral loads can signify effective management and control of the virus through treatment.
World Health Organization (WHO): The World Health Organization (WHO) is a specialized agency of the United Nations responsible for coordinating global health efforts, setting health standards, and providing leadership on public health issues. It plays a crucial role in the prevention and treatment of sexually transmitted infections (STIs) and HIV/AIDS by developing guidelines, conducting research, and supporting countries in their health initiatives.
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