By Isatou Jasseh, final year medical student
It is that season of the year again where semesters, tourists and the list goes on visit the smiling coast of Africa for its beautiful, loving and hospitable nature but also a time of high profitable business to sex workers and some of our innocent teenagers.
Sex recently has been a mainstay of most relationships especially to the unmarried. Nowadays, having sex is not really the problem because either we like it or not teenagers are having sex but are they practicing safe sex? Is the big question we must ask ourselves. In the society we lived in, parents don’t or rarely advised their children on reproductive health but rather their main fear is pregnancy rather than the diseases they can get from having intercourse.
Recent studies have showed that there is an increase in HIV especially in Banjul but mind you I can tell you that there is more to the undiagnosed population, that report is just the tip of the iceberg. It is disheartening and really sad especially to those of us working in the hospital to see very young people being diagnosed of HIV and mind you the elderly population too is on the rise so as the little children which most of them acquire through infected mothers (mother to child transmission). HIV continues to be a major global public health issue, claiming 42.3 million lives so far (as of 2023).
Now let’s dive into the main man, HIV.
What is HIV?
HIV first of all stands for human immunodeficiency virus.
It is the virus that attack the immune system and causes the infection.
AIDS: acquired immunodeficiency syndrome
It is the state in which the virus has been in the body for a long time and affects the entire system by a breakdown of the immune system, allowing the appearance of opportunistic diseases. It is the most advanced stage of HIV infection
Do you know the body has soldiers?
Oh yes, our body is guarded same way as the president is or the country is as a whole is. We have the commander of chief which is us (our body) and then the line of defense (the soldiers). The soldiers is called the IMMUNE SYSTEM
The functions of the immune system: Protect the body, recognizing and attacking foreign / invading bacteria, virus, fungi and parasites.
Consist in immune cell, lymphoid tissue organs, vessels and skin.
Now a bit of history of hiv and aids
AIDS was first recognized in the United States in the summer of 1981, when the U.S. Centers for Disease Control and Prevention reported the unexplained occurrence of Pneumocystis jiroveci pneumonia in five previously healthy homosexual men in Los Angeles and of Kaposi’s sarcoma with or without Pneumocystis jiroveci in 26 previously healthy homosexual men in New York and Los Angeles.
The disease became recognized in male and female injection drug users (IDUs) and soon thereafter in recipients of blood transfusions and in hemophiliacs.
In 1983, human immunodeficiency virus was isolated from a patient with lymphadenopathy.
In 1984 it was demonstrated clearly to be the causative agent of AIDS.
In 1985, a sensitive enzyme-linked immunosorbent assay (ELISA) was developed.
Characteristics of the virus.
It is a human Retrovirus belonging to the genus Lentivirus, which is characterized by infecting and replicating in a wide variety of cells of the immune system:
such as dendritic cells of the gastrointestinal, genitourinary, respiratory system, TCD4 lymphocytes, macrophages, CNS microglia,
but it is the TCD4 lymphocyte (Activator and maintenance of the immune response) infection which produces the most catastrophic effects.
THE CAUSATIVE AGENTS
HIV-1 (world and US)
HIV-2 (west Africa): has a slower progress
Who are at high risks of getting hiv and aids?
Unprotected sexual relations(via anal, oral,vaginal)
Vertical (mother to child transmission)
Drug addicts.
Homosexuals.
Health workers through infected needles, hence medical students, nursing students etc. especially those just starting clinicals should be very much oriented and take necessary precautions.
Uncontrolled blood products
How can one get HIV and aids?
predominant mode remains sexual transmission (semen & vaginal fliud): 85%
Direct exposure to body fluids: breast milk (MTCT: 15%), blood (transfusion), delivery, bleeding wounds, sharing contaminated needles & syringes, needle stick injuries, sharing unsterilized razors or knives during cutting or other traditional cutting/surgical practices, organ donations): 5% saliva, tears and urine have not been incriminated in transmission
Now why is it so important to know this disease?
Well, here are some statitics to keep up-to-date with this dangerous virus. According to WHO:
Apprimately 39.9 million people are living with HIV at the end od 2023, of which
1.4 million children (0-14 years old)
38.6 adults (15 years and above).
630 000 people died from HIV-related causes globally in 2023 of which 76 000 are children and 560 000 are adults.
African region is the most affected region by HIV, with 26 million people living with HIV in 2023. This region also accounts for 50% of new HIV infections globally.
37.9 (32.7- 44.0) million people live with AIDS.
1.7 (1.4-2.3) million people contract the infection.
are aware and do not receive treatment 49%.
9% develop TB.
95% in the Middle East and North Africa.
80% in sub-Saharan Africa TB patients may be coinfected with HIV. 770,000 people died of AIDS. (2019 who 2019).
The information changes.
The WHO’s goal is to end AIDS as a public threat by 2030. To achieve this, the United Nations has sets targets to reduce the number of people acquring HIV to les tan 370,000 in 2025, and to reduce HIV-related deaths to les tan 250,000.
How does the virus attack the body?
The virus has a lipid layer where it has a protein called gp120, which binds to TCD4 lymphocyte receptors.
Do note that: Early HIV Infection / Serconversion illness: starts at first 6 weeks after infection
Clinical Latency(time between exposure to the virus and the appearance of symptoms) : generally about 11 years.
Now, how can you know when you have the virus in you?
Main symptoms of acute HIV
Prolonged and unexplained exhaustion.
Swollen glands (lymph nodes).
Fever that lasts more than 10 days.
Colds
Excessive sweat, especially at night.
Mouth injuries including sores and swollen and painful gums, oral thrust etc
Sore throat.
Cough.
Shortness of breath
Change in habits, including constipation.
Frequent and prolonged diarrhea
Main symptoms of AIDS
Fever of unknown origin.
Skin rashes, cough
Persistent diarrea
Severe weight loss.
Loss of appetite and extreme fatigue.
Opportunist diseases:
Central nervous system: Toxoplasmosis, cryptococcosis, cytomegalovirus, leukoencephalopathies, dementia.
Pneumoysti carinii, syphilis, TB, mycosis, salmonellosis.
Sarcoma kaposis, lymphomas, herpes, carcinomas.
Note that:
AIDS phase appears where TCD4 lymphocytes are <200 and viral load> 7,500 copies, where opportunistic diseases begin (Kaposi sarcoma, cytomegaly virus, toxoplasma, neurological conditions among others.
CD4 (immunosuppression )/ Viral Load( disease)
Relations between TCD4 cell and viral load: Once the virus in blood increases, TCD4 cells begin to decrease.
Now how do you diagnose HIV?
Diagnosis. (Clinical-laboratory)
Full blood count, elevated sedimentation rate, serology VDRL (for syphilis), hepatitis Ag HepB, C
Blood glucose, urine,kidney Function/Liver Function( profile), cultures of secretions
Abdominal ultrasound, chest x-ray of thorax ,CTscan…
ELISA (sensitivity 99.5% at Agp24).
PCR (HIV1-2 / polymerase chain reaction)
Western Blot (Western blot is considered positive if antibodies exist to two of the three HIV proteins: HIV antibody, gp120/160 membrane, nucleotide p17-24, gp41,.
CD4(cluster of differentiation 4) count
Viral load.
Anti-HIV antibody (IgG) tests
Genome detection
Virus isolation (Research tool)
Take samples between 2-6 week.
Repeat in 3 / 6 / months 1 year- (country protocol).
WHO staging
Stage 1 Asymptomatic, PGL, Karnofsky Performance 1 (normal activity0
Stage 1: Weight loss <10%, minor mucocutaneous manifestations, recurrent upper respiratory tract infection, KPS2: normal activity
Stage 3: Weight loss >10%, unexplained chronic diarrhea for 1month, fever> 1month, oral candidiasis, pulmonary Tuberculosis, severe bacterial infections, KPS 3: bedridden <50% of day
Stage 4: AIDS defining illness: PCP (Pneumoysti carinii pneumonia), Toxoplasmosis, disseminated fungal infection, CMV of nonlymphoid organ etc.
Note: Karnofsky Performance (measures the functional impairment of the patients)
How do we treat HIV?
Some of the drugs we have includes: nucleoside reverse transcriptase inhibitors (NRTI)
non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitor (PI)
Integrase inhibitors
Specific treatment
should be offered to all HIV-infected individuals: but note that there is no cure for HIV but treatment can help you live long and healthy life.
Combination ART (anti-retroviral therapy) essential: suppress HIV, prevent emergence of mutant forms (drug resistant). Combination of 3 ARTs daily for life.
Core: 2 nucleoside reverse transcriptase inhibitors PLUS 1 Other ART class (Protease inhibitor, Integrase inhibitors, NNRTI (non-nucleoside reverse transcriptase inhibitors))
Adherence: Preparation, Continuing Support: patient factors, provider factors, drug factors)
Monitoring for efficacy & adherence:
VL and CD4: before commencement and 6-12 monthly
Pregnant mothers can also take the combined ART to lower the risk of passing the virus to their unborn babies.
Babies born to HIV mothers should also receive ART as soon as possible after birth to prevent/reduced perinatal transmission of HIV. The type of treatment depends on several factors and the country’s protocol.
Strategies for reducing transmission
Increase testing and combined anti-retroviral therapy uptake, including MTCT (mother-to-child-transmission)
Avoidance & protection from risky behaviors (unprotected sex, intra venous drug users.
Sensitization and creating awareness: reproductive health lessons should be included in the school curriculum starting from the grassroots (primary school level). Sex shouldn’t be a taboo in our society but a topic to be discuss on by teachers, parents and everyone. Let’s teach our children about safe sex and how to protect themselves from so many societal hazards. Specific educative dramas can be empowered from both minister of health and minister of children affairs where all these issues can be acted upon and discuss in length.
Pre-exposure prophylaxis
Post- exposure prophylaxis(FIRST 72 hours given : TENOFOVIR , EMTRICITA BINA (RTI) , RALTEGRAVIR(Int.I) ( for 28 DAYS ) then EVALUATE ( 3 WEEKs, 3 MONTHs ,6 MONTHS.)
Now let me leave you my dear gentle readers with this question:
Is HIV really the problem or what the disease comes with?
Thank you all.
