HIV AND AIDS Basic Facts

The Immune System T Cells (CD4 Cells) = Part of body’s immune system ! The Immune System T Cells (CD4 Cells) = Part of body’s immune system CD4 The average person has between 800 & 1500 CD4 cells per cubic millimetre of blood The immune system helps fight diseases CD4 Disease Disease IMMUNE SYSTEM ATTACKS DISEASE KILLS DISEASE

What does HIV stands for? H Human I Immuno-deficiency: because the virus causes a deficiency which means that the body’s immune system is unable to work properly V Virus: because the HIV is a virus it is unable to reproduce by itself. It has to take over the other cells in the body and use them to help it reproduce.

? How can you get HIV? 1. Through these bodily fluids BREAST MILK VAGINAL SECRETIONS BLOOD CERVICAL SECRETIONS SEMEN 2. Through these acts: H INFECTED MOTHER: DURING 1. PREGNANCY 2. BIRTH 3. BREAST FEEDING UNPROTECTED PENETRATIVE INTERCOURSE (HOMOSEXUAL OR HETEROSEXUAL) WITH SOMEONE WHO IS INFECTED 1. INJECTION OR TRANSFUSION OR INFECTED BLOOD / BLOOD PRODUCTS 2. SHARING UNSTERALISED NEEDLES WITH SOMEONE WHO IS INFECTED

HIV Myths of transmission: ! 1. You cannot catch HIV from kissing. 2. You cannot catch HIV from sitting on a toilet seat 3. You cannot catch HIV from coughing or sneezing 4. You cannot catch HIV from sharing cutlery 5. You cannot catch HIV from drinking out of the same glass 6. You cannot catch HIV from holding hands 7. You cannot catch HIV from hugging

Are some people more susceptible HIV? Females are 3 times more easily infected compared to males as the vagina is more susceptible to lesions allowing the virus to pass into the body, and semen can remain in the body for up to three days. People with other STIs are up to 10 times more at risk as many of the STI will result in cuts and open sores giving the HIV more chance to enter the body. Some Statistics ●Worldwide 75% of HIV is transmitted sexually. ¾ of infections are through heterosexual sex and ¼ are homosexual sex. ●In the UK in 2002 54% of infections were through heterosexual sex, 32% through homosexual and 2% through drug use. ●300,000 young people (15-24) get infected with an STI every day. ●In the UK there has been a sharp rise in STIs in young people these include gonorrhoea, herpes, thrush and Chlamydia. Chlamydia has risen 108% from 1996 to 2001. !

How can HIV be prevented? Unprotected Penetrative Intercourse: A latex condom used correctly every time you have sex, is highly effective in providing protection against HIV. Female condoms also prevent transmission. The only way to be 100% safe is to abstain from sexual intercourse. Mother to child transmission: Pregnant women can take a short course of anti-HIV drug just before the birth which she must keep using after. Caesarean section for delivery, and avoiding breast feeding also reduce the risk. All three can reduce the chance of transmission to 2%. Sharing non sterilised needles: By not sharing needles when injecting drugs a person will reduce the chance of infection. Many places have needle exchange programmes where old needles can be swapped for new ones. 4. Contaminated blood and blood products: In the UK all blood and tissue donations are tested for HIV and have been since1985.

HIV and the Immune System When HIV enters the body it must enter a cell to live and reproduce. The HIV virus attacks CD4 cells, eventually killing them The newly produced HIV then moves into new CD4 cells and infects them. The body’s immune system tries to replace the lost CD4 cells, but over time it is unable to keep these levels up. CD4 HIV HIV HIV HIV CD4 HIV HIV Replicates Kills CD4 Cells HIV Enters CD4 Cells

HIV and the CD4 Count As the amount of HIV in the body increases the amount of CD4 cells in the body decreases When the CD4 count becomes low the body is less able to fight off any disease. CD4 Amount in Body HIV

What is AIDS? A Acquired: because it is a condition that the person must acquire or get infected with. It is not transmitted through genes. I Immune: because it effects the immune system D Deficiency: because it makes the immune system deficient, it stops it working S Syndrome: because someone with AIDS may experience a wide range of symptoms Many doctors no longer use the term AIDS Instead they will refer to late-stage or advanced HIV infection. This is because a persons CD4 count can vary around the 200 level, sometimes it may be higher or lower

When does HIV become AIDS? 1500 to 800 CD4 - Average healthy person Below 500 CD4 - HIV+ person at risk from Opportunistic Infections 200 CD4 Person is considered to have AIDS CD4 COUNT ! In many developing countries they are unable to conduct the difficult CD4 count tests. In these countries AIDS is diagnosed by looking at the symptoms that the person has.

What are Opportunistic Infections? As the CD4 count of the HIV infected person drops their immune system becomes less effective. They are more vulnerable to other infections which would be effectively kept under control with a healthy immune system. These infections are known as opportunistic infections, as they take the opportunity to take advantage of the weak immune system. It is gradually these infections rather than the HIV that will kill the infected person. Some of the most common opportunistic infections are: PCP: a rare type of pneumonia. CMV: a type of herpes that can cause blindness, brain and lung problems. Cancers: as the immune system is unable to keep the growth of cells under control. TB

How long does it take for HIV to turn into AIDS? There is not just one straight forward answer. A lot depends on what part of the world the HIV+ person is from. Developed World: On average a person can live for up to 10 years before they get ill. Without treatment the time between AIDS and death is about 12-24 months. Now that there are anti-HIV drugs it is thought that people will be able to live longer. Developing World: On average an HIV+ person can live up to between 6 and 8 years before they get ill. In most developing countries there is minimum access to drugs and the time between illness and death is shorter. This is because people in developing countries are unable to eat enough nutritious food; they lead stressed filled lives and are often exposed to multiple infections.

What are Anti Retroviral (ARV’s) Drugs and how do they work? They stop HIV replicating in the CD4 Cells and stop newly produced HIV from infecting other cells. This means that the amount of HIV in the body is reduced and the damage that it can do to the immune system is limited. The Science Bit! Chemicals, called enzymes, are important in making the HIV copies. There are two important enzymes involved in HIV: Reverse Transcriptase: drugs that stop this enzyme from working stop HIV from being made. Protese: drugs that stop this enzyme from working results in ‘bad’ HIV being made. This HIV is unable to infect CD4 cells Most people will take a combination of these drugs known as Combination therapy, as this works better than just taking one. !

Does Combination therapy always work? Combination therapy can fail for a number of reasons. In order for the drug to work effectively the person has to keep a certain level of the drug in their blood. If a person misses doses, doesn’t take drugs on time and doesn’t follow dietary instructions, then the levels of the drug in their blood will fall and the drug will be unable to work. The problem of Resistance: A person’s body may develop resistance to one the drugs in the combination therapy. Studies have shown that resistance is growing. How? The HIV in the body can change (mutate) slightly which means that it can carry on replicating and damaging the CD4 cells even when the person is taking the drug. Cross- resistance: if HIV is resistant to one type of drug it may also be resistant to all drugs in the same group. Drug-resistant HIV infection: some people have become infected with drug-resistant HIV which means that their treatment options are limited.

Are there side effects? Yes! Some are general and others vary depending on the drugs that are being taken. General side effects: Tiredness. Nausea. Vomiting. Diarrhoea. Muscle pains. Headaches. Skin rashes. Side effects specific to certain drugs: Numbness or pain in the hands or feet. Skin rashes and liver problems. Increased blood sugar levels Increased levels of fats in the blood.

Is combination therapy available to everyone? Although the price of these drugs has been lowered due to public pressure and generic drug companies (which make cheaper versions of the drug) they are still too expensive for many people in less developed countries. Some statistics Only 5% of those people who require treatment in these developing countries have access to the medicines. In Africa only 1 in 1000 HIV+ people are receiving the drug. Is combination therapy a cure for HIV and AIDS? NO! It only reduces the amount of HIV, and allows them to manage the infection and delay the onset of death. No drug has been found which eliminates or destroys HIV. That is why it important to protect yourself against the disease.

WORLD VIEW 34 - 46 MILLION INFECTED AT END OF 2003 AIDS HAS CLAIMED JUST UNDER 25 MILLION LIVES SINCE IT WAS DISCOVERED 20 YEARS AGO. Eastern Europe & Central Asia 1.2 – 1.8 Million SINCE HIV/AIDS WAS DISC0VERED 60 MILLION PEOPLE (THE POPULATION OF UK) HAVE BEEN INFECTED Western Europe 520,000 – 680,000 North America 790,000 – 1.2 million East Asia & Pacific 700,000 - 1.3 million North Africa & Middle East 470,000 – 730,000 Caribbean 350,000 – 590,000 South & South–East Asia 4.6 – 8.2 million Latin America 1.3 – 1.9 million Sub-Saharan Africa 25.0 – 28.2 million Australia & New Zealand 12,000 – 18,000 2.7 MILLION PEOPLE WITH AIDS ARE CHILDREN UNDER 15. HALF OF NEW INFECTIONS OCCUR IN 15-24 YEAR OLDS 17.6 MILLION PEOPLE WITH AIDS ARE WOMEN.