Written by Josephine Fagan

Health

AIDS – why all the fuss?

To mark AIDS Awareness Week, we asked Dr Josephine Fagan to give Standard Issue readers the facts about HIV and AIDS.

Today is World Aids day: wear your red ribbon with pride.

Why is there still panic? There is still no vaccine against HIV and no cure. Worldwide, over 35million people are living with HIV, and more than 6000 new diagnoses are made every day (the majority in low-income countries), according to UNAIDS.

After the first cases of HIV were reported 30 years ago, the epidemic appeared to peak in 1997. Since then the number of new cases detected, globally, has fallen by 21%.

Still, the number of people with HIV in the UK has trebled in the last ten years, according to the Health Protection Agency.

Currently, about 100,000 people are living with HIV in the UK, although it’s estimated that about a quarter of those with HIV don’t know they are infected.

What is HIV? HIV or human immunodeficiency virus destroys a type of white blood cell (called CD4 T-cells), which are part of the body’s defence against infection.

What is AIDS? AIDS or acquired immunodeficiency syndrome is a spectrum of infections and illnesses resulting from a weakened immune system caused by HIV.

Remember: people infected with HIV don’t automatically develop AIDS.

What are the symptoms of HIV infection? About 80% of people develop symptoms within a week or two of being infected with HIV: sore throat, fever and a blotchy rash (usually on the chest). They may also develop diarrhoea, nausea, headache, swollen glands, fatigue and general aches and pains. This initial reaction to HIV infection is known as seroconversion.
After a few weeks, initial symptoms disappear and the infected person may remain well for up to ten years, although they may have persistently swollen glands or night sweats.
Eventually, other symptoms develop such as recurring shingles and cold sores, mouth ulcers, skin infections, rashes, diarrhoea, tiredness and weight loss.

What are the symptoms of AIDS? People with AIDS, (now often termed late-stage HIV), typically have a low level of CD4 T-cells, which gives rise to so-called opportunistic infections such as TB, severe fungal and viral infections. They may also have body wasting, AIDS-related brain illness (such as AIDS dementia), and certain cancers such as Kaposi’s sarcoma, (which often begins as a small skin lesion).

What are the main risk factors for HIV / AIDS?
• Anyone who is sexually active, gay or straight, is at risk of HIV, especially if they don’t use condoms. Rates are higher among men who have sex with men, and in African communities living here in the UK.
• Sharing infected needles/drug-injecting equipment increases the risk of HIV.
• Records show only five cases of HIV transmission after accidental needle-stick injury, all in healthcare settings; there have been none since 1999.
• HIV cannot be passed on by sharing cups or plates, kissing or even spitting. But it can, in rare circumstances, be transmitted during oral sex, especially if there are cuts or sores in the mouth, or bleeding gums (again, using a condom reduces the risk).

What if you suspect you have HIV / AIDS?
Most UK sexual health clinics offer free and confidential blood tests that give results within half an hour. GPs can also arrange tests, but the results will appear on NHS records (although these too are confidential). False positive tests are rare, and samples taken by NHS facilities are usually sent to a laboratory to confirm diagnosis.
Some private clinics and pharmacies also offer HIV tests for a fee.
If initial tests confirm HIV, further blood tests are done to assess the amount of virus in the body (viral load), and the number of CD4 T-cells in your blood (CD count).
HIV testing is routinely offered to pregnant women in the UK.

What is PEP?
Post Exposure Prophylaxis is a four-week course of medication that can prevent HIV infection after the virus has entered the body. UK sexual health clinics and A&E departments can prescribe PEP. It should begin within 24 hours of exposure and no later than 72 hours. (HIV testing is mandatory for PEP and prescription is based on clinical assessment of risks and benefits.)

What’s the reality for those with AIDS?
• Modern antiretroviral treatment (ART) has dramatically reduced death rates and, since 2012, it has been free on the NHS. It usually involves taking one or two tablets a day, has fewer side-effects that former treatments, and enables those who need it to live full and active lives, with less risk of passing on HIV.
• With the right support, most HIV positive women in the UK have healthy babies, without passing on HIV.
• Most treatment centres offer specialist counselling and psychological support.

What’s the take home message?
• Avoid unprotected sex – use a condom
• Don’t share drug injecting equipment – go to a needle exchange
• The earlier HIV is diagnosed the better the outcome: a 35-year-old diagnosed with HIV today has a life expectancy into their 70s.
• Sex education is not compulsory in UK schools, so young people still may not be given the information they need to avoid HIV.
• The number of people with HIV over the age of 50 is rising, but many of them remain undiagnosed

But is it enough?
Treatment and outcomes for HIV/AIDS have improved enormously for those with access to modern medicines, but many in poorer countries have seen little benefit. AIDS charities continue to make efforts on this from. AIDS research is coming closer to developing effective vaccines, but HIV/AIDS is still beset by ignorance and stigma. A third of those with HIV in the UK reported negative reactions from others. It’s up to all of us to dispel the myths and lend our support.

Here are some useful websites:
www.nat.org.uk – National AIDs Trust
www.tht.org.uk – Terence Higgins Trust
www.hivaware.org.uk – contains stories from people living with HIV
www.aidsmap.com/e-atlass – contains info about HIV when travelling abroad

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Written by Josephine Fagan

Josephine works as a doctor in urgent and primary care. She’s also a bit of a globetrotter, is working on her first novel, and loves the colour purple.