by Dr Izuagba Kelechi. U.
World AIDS Day- 1st of December every year
- HIV stands for human immune deficiency virus.
- HIV belongs to human retrovirus (retroviridae) and the subfamily of lentivirus.
- It is the virus that causes HIV infection and AIDS – the most advanced stage of HIV infection.
- There are 2 strains of HIV – HIV1 and HIV 2
- The HIV 1 is the most common cause of HIV world-wide and was 1st recognized in 1981 while the HIV 2 is most common in West Africa and was 1st reported in 1986 in Nigeria (Lagos state).
- The number of people living with HIV/AIDS (PLWHAS) has increased and most marked in sub-Saharan Africa.
- In Nigeria, the prevalence varies within states.
- Mainly by heterosexual, perinatal and transfusion of blood and blood products which pose great concern
- HIV attacks and destroys the infection-fighting CD4 cells of the immune system, thereby causing inability of the body’s immune system to fight diseases and infections.
- Each year, 1.5 million women living with HIV become pregnant and without Anti-retroviral.
- There’s a 15-45% chance that their baby will also become infected.
- Among pregnant women who take Anti-retroviral to prevent mother-to-child-transmission (PMTCT), the risk of transmission is reduced by <3%.
MODE OF TRANSMISSION
- Sexual contact with an infected person i.e. unprotected sex with homosexuals, heterosexuals etc.
- Sharing of contaminated sharp objects e.g. needles, pins, razor blades etc.
- Mother-to-child transmission or vertical transmission
- Intravenous drug use (by IV drug users)
- Presentation depends on the stage of the disease.
- At the initial stage, it is an acute infection with no signs and symptoms
- Incubation period is variable and could be up to 10 years or more
- Seroconversion normally occurs during 2 to 12 weeks after infection.
- There are basically 4 stages of HIV infection according to WHO.
- At stage 1, patient can be Asymptomatic with normal activity. CD4+ count of >500/ul. There may be generalized Lymph node enlargement.
- At stage 2, patient can be Symptomatic with normal activity. There’s presence of mild symptoms e.g. mucocutaneous manifestations or changes e.g. skin, hair, nail changes. There are also current upper respiratory tract infections with moderate/unexplained weight loss. CD4+ count of <500/ul.
- At stage 3, patient can have advanced symptoms e.g. unexplained diarrhea for >1 month, unexplained prolonged fever > 1month, opportunistic infections e.g. oral candidiasis, pulmonary tuberculosis, oral leukoplakia with severe weight loss. CD4+ count of <350/ul.
- At stage 4, this is the HIV – wasting syndrome stage or stage of full-blown AIDS. Patient presents with severe symptoms e.g. severe weight loss with chronic diarrhea, prolonged fever, opportunistic infections e.g. Kaposi sarcoma, Toxoplasmosis of the brain etc. CD4+ count of <200/ul.
BREASTFEEDING IN HIV
- For most babies, breastfeeding is the best way to be fed.
- About 5-20% of babies infected through mother-to-child-transmission acquire it through breast feeding.
- It is still not understood ho HIV becomes present in breast milk; but HIV infected CD4+ cells have greater capacity to replicate in breast milk than in blood.
- Once the infant ingests this HIV – infected milk, it is believed that the virus enters the body through breeches in the infant’s mucous membrane.
- Exclusive breast feeding is advocated (i.e. 1st 6-months of life) and not mixed feeding; for HIV+ve mothers who choose to breastfeed but must provide infants with once daily nevirapine for 6 weeks.
- Then give complementary feeds and wean baby at 12 months.
- If the mother chooses to do replacement feeding which is the only 100% effective way to prevent mother-to-child transmission “after” birth, then she must meet up with the WHO criteria for replacement feeding which includes: Acceptability, Feasibility, Affordability, Sustainability, and safety.
- It is either Exclusive breast feeding or Replacement feeding but never mixed feeding (i.e. combination of both).
- Mothers who choose replacement feeding must be supported by teaching them how to properly prepare the food and in correct dilusion using clean feeding bottles and utensils.
TREATMENT MODALITIES IN HIV
- Treatment of Acute bacterial infections.
- Prophylaxis and treatment of opportunistic infections e.g. Pnemocystic Jiroveci or Pneumocystic carinii pneumonia (using COTRIMOXAZOLE)
- Anti-retroviral therapy – (ART) using zidovudine, Lamivudine, Efavirenz)
- Maintenance of good nutrition
- Management of AIDS defining illnesses.
- Psychological support from the family
- Palliative care for terminally ill-patients
- Monitor the toxicity of the ARV drugs
PREVENTION OF HIV
- General health promotion measures:
- Practice safe sex
- Be faithful to your partners.
- Avoid unwanted pregnancy for HIV-infected women through family planning and counseling services to prevent mother-to-child-transmission.
- Safe delivery methods, use of anti-retrovirals among HIV-infected women and safer infant
- Feeding options to increase child health and survival
- Health education:
- Use sterile or new sharps like needles, razor blades, etc.
- Avoid illicit drug use (in IV drug users) because they are harmful to health.
- Good personal hygiene e.g. avoid unnecessary injuries, treat wounds to avoid contamination, etc.
- Universal precaution and specific protection:
- Always use screened blood for blood transfusion.
- Give post exposure prophylaxis (PEP) to vulnerable individuals who may be exposed to HIV-infections e.g. rape victims/sexual assault victims. This is also applicable to any health worker who may accidentally get pricked by the needle while managing a HIV – infected patient. N/B: Post exposure prophylaxis (PEP) is therefore NOT recommended as a prevention of HIV following casual consensual sexual intercourse due to toxicity of the drugs.
- Early diagnosis and treatment:
- By voluntary HIV screening and counseling.
- Ensure HIV testing of every pregnant woman with prompt intervention of effective Anti-retroviral therapy
- Support and care for HIV+ve infected women and their families
- Strict adherence to therapy to reduce the viral load
- HIV/AIDS is a very deadly disease in our environment and therefore requires precautionary measures.
- Nigeria is an enormous country with a very high number of people living with HIV.
- The HIV epidemic in Nigeria is concentrated mainly among heterosexuals (accounting for over 80% by route of transmission). Yet the trend is now shifting towards “most-at-risk” in the population.
- Enhanced and more strengthened surveillance system targeting the whole population and with special attention to the “most-at-risk” need to be implemented.
- More prevention campaigns should be planned and carried out while the monitoring system of HIV/AIDS in Nigeria require improvement in terms of data complement and integration in order to allow for for better assessment of the epidemic.
- Efforts should also be made towards effective sexual transmission infection programming, proper integration of HIV/AIDS and sexual and reproductive health services and also fostering of gender equality at the population level.
- Finally, encouraging HIV testing among the Nigerian population to ensure everyone knows their HIV status together with efficient linkage to care for newly diagnosed HIV cases is key to mitigate new infections and provide HIV treatment to all.