The human immunodeficiency virus (HIV)

What is HIV?

The human immunodeficiency virus (HIV) infects cells of the immune system, destroying or impairing their function. Infection with the virus results in progressive deterioration of the immune system, leading to “immune deficiency.” The immune system is considered deficient when it can no longer fulfil its role of fighting infection and disease. Infections associated with severe immunodeficiency are known as “opportunistic infections”, because they take advantage of a weakened immune system.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is a term which applies to the most advanced stages of HIV infection. It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers.

How is HIV transmitted?

HIV can be transmitted through unprotected sexual intercourse (vaginal or anal), and oral sex with an infected person; transfusion of contaminated blood; and the sharing of contaminated needles, syringes, surgical equipment or other sharp instruments. It may also be transmitted between a mother and her infant during pregnancy, childbirth and breastfeeding.

How many people are living with HIV?

According to estimates by WHO and UNAIDS, 36.7 million people were living with HIV globally at the end of 2015. That same year, some 2.1 million people became newly infected, and 1.1 million died of HIV-related causes.

How quickly does a person infected with HIV develop AIDS?

The length of time can vary widely between individuals. Left without treatment, the majority of people infected with HIV will develop signs of HIV-related illness within 5–10 years, although this can be shorter. The time between acquiring HIV and an AIDS diagnosis is usually between 10–15 years, but sometimes longer. Antiretroviral therapy (ART) can slow the disease progression by preventing the virus replicating and therefore decreasing the amount of virus in an infected person’s blood (known as the ‘viral load’).

What is the most common life-threatening opportunistic infection affecting people living with HIV?

Tuberculosis (TB) killed 390 000 people living with HIV in 2015. It is the number one cause of death among people with HIV in Africa, and a leading cause of death in this population worldwide. There are a number of core health care strategies that are critical to prevent and manage TB infection among people living with HIV:

routine-TB symptom screening at each healthcare visit
management of latent TB infection (e.g. with isoniazid preventive treatment)
TB infection control
early initiation of antiretroviral therapy.

How can I limit my risk of HIV transmission through sex?

Use male or female condoms correctly each time you have sex.
Take antiretroviral drugs for pre-exposure prophylaxis of HIV (PrEP).
Practice only non-penetrative sex.
Remain faithful in a relationship with an uninfected equally faithful partner with no other risk behaviour.

Does male circumcision prevent HIV transmission?

Male circumcision reduces the risk of female-to-male sexual transmission of HIV by around 60%.

A one-time intervention, medical male circumcision provides life-long partial protection against HIV as well as other sexually transmitted infections. It should always be considered as part of a comprehensive HIV prevention package and should never replace other known methods of prevention, such as female and male condoms.

How effective are condoms in preventing HIV?

When used properly during every sexual intercourse, condoms are a proven means of preventing HIV infection in women and men. However, apart from abstinence, no protective method is 100% effective.

What is a female condom?

The female condom is the only female-controlled contraceptive barrier method currently on the market. The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse. It entirely lines the vagina and provides protection against both pregnancy and STIs, including HIV, when used correctly in each act of intercourse.

What is the benefit of an HIV test?

Knowing your HIV status can have 2 important benefits.

If you learn that you are HIV positive, you can take steps before symptoms appear to access treatment, care and support, thereby potentially prolonging your life and preventing health complications for many years.
If you know that you are infected, you can take precautions to prevent the spread of HIV to others.

What are antiretroviral drugs?

Antiretroviral drugs are used in the treatment and prevention of HIV infection. They fight HIV by stopping or interfering with the reproduction of the virus in the body, reducing the amount of virus in the body.

What is the current status of antiretroviral therapy (ART)?

By mid-2016, 18.2 million people were receiving HIV antiretroviral therapy (ART) globally. While this number illustrates a formidable success in HIV treatment scale up over the past decade, it accounts for only 46% of people who are eligible for ART. More than half of people who need treatment access are still waiting for it.

Is there a cure for HIV?

No, there is no cure for HIV. But with good and continued adherence to ART, the progression of HIV in the body can be slowed to a near halt. Increasingly, people living with HIV can remain well and productive for extended periods of time, even in low-income countries. WHO now recommends treatment for all people living with HIV.

What other kinds of care do people living with HIV need?

In addition to ART, people with HIV often need counselling and psychosocial support. Access to good nutrition, safe water and basic hygiene can also help an HIV-infected person maintain a high quality of life.