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HIV/AIDS

Published by Bupa's health information team, January 2008.

This factsheet is for people with HIV/AIDS, or who would like information about it.

Human immunodeficiency virus (HIV) is an infection. It's passed from person to person via unprotected sex, from needles contaminated with infected blood, through blood transfusion or organ donation from people with the virus, and from mother to baby.

AIDS (acquired immune deficiency syndrome) is diagnosed when the immune system has been weakened so much by HIV that it can't fight certain life-threatening infections and illnesses.

Worldwide figures estimate that over 40 million people are living with HIV and around three million people die each year from AIDS-related illnesses.

• HIV in the UK
• HIV and the immune system
• Causes
• Symptoms
• Diagnosis
• Treatment
• Prevention
• Living with HIV
• Questions and answers
• Related topics
• Related Bupa products and services
• Further information
• Sources

HIV in the UK

The number of people living with HIV in the UK has increased steadily since the 1980s when the virus was discovered. Official figures for 2005 put this at nearly 63,500 people.

Most HIV infections in the UK occur in homosexual men. Transmission of the virus through heterosexual contact has significantly increased in recent years. However, the majority of these infections are in people who have come to live in the UK from countries where HIV is widespread and have been diagnosed since living in the UK.

HIV and the immune system

The immune system protects your body against infection. A key part is white blood cells. These cells find and destroy invading germs, such as bacteria and viruses, preventing the development of serious diseases and damage to your body. HIV avoids being destroyed by the immune system by repeatedly changing its outer "coat". It multiplies (replicates) within the special type of white blood cells called CD4 cells. These cells are normally involved in helping other types of immune cell to attack and destroy disease-causing germs.

As HIV multiplies, it destroys CD4 cells, so there are less of them. The reduction in CD4 cells means that the body's ability to fight infection is weakened.

Causes

HIV infection can be passed via blood, semen, breast milk and vaginal fluids. Therefore, you can pass or have HIV passed to you during unprotected anal or vaginal sex.

There is a small chance of infection through unprotected oral sex. It's estimated around three in every 100 homosexual men with HIV get it through unprotected oral sex with a man who has HIV. The risk of oral transmission from women is extremely low.

The virus can be passed from mother to baby if she has HIV during pregnancy, childbirth or when breastfeeding. HIV can also be passed on if you use infected needles for injections, piercings or tattoos.

HIV is not found in high enough levels in other body fluids such as saliva, sweat, urine or on the skin to cause an infection from contact with these fluids.

HIV can't be passed on through normal day-to-day activities, such as sharing cutlery, sitting on toilet seats or by shaking hands.

HIV and blood or organ donation

In the past, people have become infected with HIV through blood or organ donations. All donations in the UK are now screened for HIV, so the chances of this happening are extremely low.

Symptoms

The period immediately after a person becomes infected with HIV is called primary HIV infection. At this point you are very infectious because the level of the virus will be high in the blood. You will have symptoms of HIV infection but you may miss them because they are like other infections such as flu. Early symptoms usually start about two to six weeks after the infection and last approximately five to 10 days. Some symptoms may last longer.

Signs of primary HIV include:

• fever
• swollen glands
• sore throat
• rash on the body or face
• painful muscles or joints
• headache
• feeling sick and vomiting
• ulcers on the mouth, genitals and oesophagus (tube that goes to the stomach)

More serious symptoms include heavy bleeding if you are injured. Rarely, brain infections such as meningitis can affect people with HIV infection.

After the early symptoms, HIV may remain undetected for a number of years until your body's ability to fight infections is reduced. When this happens the number of cells which fight infections has decreased so much that your immune system can't function properly. This leaves the body vulnerable to infections. If a person develops certain life-threatening illnesses it is known as AIDS or advanced HIV disease.

AIDS

Once the immune system has been damaged, infections appear. Common infections include a type of pneumonia called pneumocystis, and tuberculosis.

Other AIDS-related illnesses can include:

• various cancers
• fungal, bacterial or viral infections
• sight problems
• dementia

Diagnosis

It's important to have an HIV test if you think you have been at risk of HIV infection. There are powerful and effective treatments that slow the virus. Early diagnosis can help ensure you get the best treatment so you can live a full and active life.

To test for HIV, blood is taken. HIV testing in the laboratory involves looking at a blood sample for HIV antibodies, the body's defence chemicals produced in response to infection. Testing can be done four to six weeks after infection but the virus may not be detected in the blood for up to three months in some people.

Testing is usually carried out at genitourinary medicine (GUM) clinics, where sexually transmitted infections are diagnosed and treated. Sometimes results are available after a week, some clinics offer same day HIV testing.

Before you have a blood test for HIV you may be able to see a counsellor. The test can be explained and the implications of a possible positive diagnosis discussed. You can also talk about the test results with your GP or a counsellor.

Treatment

There is no cure for HIV infection, but treatment with anti-HIV medicines dramatically slows the progress of the disease and has significantly reduced the number of deaths caused by AIDS-related illnesses. When used appropriately and taken properly, anti-HIV medicines can mean a person with HIV has a near normal life expectancy.

HIV treatment is managed by specialist out-patient clinics, staffed by doctors, nurses and other health professionals. The status of your immune system and your general health is reviewed on a regular basis.

Usually, once the number of CD4 white blood cells has fallen to a low level, or if the amount of virus in your blood is very high, your specialist will recommend starting drug treatment. Treatment may be started if you develop a serious infection.

Medication

Current treatments prevent the virus from replicating in the body. This in turn reduces the amount of virus in the blood and allows the immune system to recover. To achieve this, three antiretroviral medicines are usually taken together. They normally have to be taken once a day but some need to be taken up to three times a day and at specific times. This combination therapy is termed highly active antiretroviral therapy (HAART) and has dramatically cut the number of deaths from AIDS-related illnesses since its introduction. There are three main classes of antiretroviral medicine. Combination therapies usually contain medicines from two of these classes.

Nucleoside reverse transcriptase inhibitors (NRTIs)

NRTIs prevent HIV from copying its genetic information and so multiplying. They include abacavir (eg Ziagen), lamivudine (eg Zeffix) and zidovudine (eg Retrovir).

Protease inhibitors (PIs)

PIs prevent the virus from assembling its protective coat before leaving CD4 cells. Ritonavir boosted protease inhibitors may be used to increase the potency of the medicine. They include atazanavir (eg Reyataz) and saquinavir (eg Invirase).

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs are a highly effective class of antiretrovirals, which have a similar mode of action to NRTIs. They include efavirenz (eg Sustiva) and nevirapine (eg Viramune).

HIV fusion-inhibitor

An HIV fusion-inhibitor is a medicine used in combination with other medicines when the infection is no longer controlled by other treatments. There is just one fusion-inhibitor, enfuvirtide (Fuzeon).

Potential new treatments

In the future, further anti-HIV medicines may be produced. These may include medicines that stimulate the patient's own immune system to fight off HIV or target the virus in different ways. Integrase inhibitors are a new class of medicine being developed. One example is raltegravir, which is currently in human trials and is showing promise.

CCR5 inhibitors are also in development, one of which is maraviroc and studies of these medicines are continuing.

Second generation NNRTs such as etravirine have recently been developed but are not widely available yet.

There are also hopes that a cure for HIV infection and a vaccine to prevent infection will be developed.

Side-effects

The combination treatment can cause side-effects. In the first few months, you may feel sick, vomit and have a headache, although these often wear off. Some medicines can cause sleep disturbances or depression. PIs and NRTIs are associated with a syndrome called lipodystrophy, which involves a thinning of the face, arms, legs and buttocks, and a build-up of fat on the belly, breasts and back. The redistribution of fat can be managed, for example, by changing the combination treatment and changing your diet and exercise. Lipodystrophy, caused by PIs, can also increase the risk of heart disease.

Prevention

HIV and body fluids

The risk of HIV infection is dramatically reduced by using a condom. Condoms shouldn't be used with an oil-based lubricant, such as petroleum jelly (eg Vaseline) or baby oil, because this can cause the latex to break down. Use water-based lubricants (eg KY jelly, Sylk) instead, however, remember that condoms they don't completely eliminate the risk. Reducing the number of partners reduces overall risk.

HIV and pregnancy

An HIV test is routinely offered to all pregnant women early on in their pregnancy. If you have HIV you can be treated to reduce the risk of transmitting it to your baby. HIV medicines can be taken during pregnancy, delivery and when breastfeeding. Birth by caesarean section may also be needed if the virus is found in the blood. Your baby may be given medicines in the first few weeks of life to prevent infection. If you have HIV you can consider alternatives to breastfeeding to prevent transmission of the virus.

HIV and needlestick injury for healthcare workers

This can be avoided by using single-use or sterilised needles.

Taking medicines by injection

If you inject medicines you shouldn't share injection equipment.

Living with HIV

In countries where HIV treatment is limited, AIDS-related illness is a common cause of death. In the UK, most people with HIV have access to anti-HIV medicines and go on to lead full and active lives.

Related topics

• Contraception - non-hormonal
• Pneumonia
• Sexually transmitted infections (STIs)
• Tuberculosis

Further information

• Terrence Higgins Trust
  0845 1221 200
  www.tht.org.uk
• NAM
  020 7840 0050
  www.aidsmap.com

Sources

• British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy. HIV Medicine. 2006 7:487-503
  www.bhiva.org
  
• British National Formulary (BNF) September 2006. BMJ Publishing Group, 2007 52:376
• HIV and AIDS. The National Office of Statistics.
  www.statistics.gov.uk
  accessed 18 April 2007
• HIV surveillance, estimations and monitoring and evaluation. WHO.
  www.who.int
  accessed 31 July 2007
• HIV testing for patients attending general medical services. National Guidelines. Number 3. Royal College of Physicians. 2005.
  www.rcplondon.ac.uk
  accessed 25 April 2007
• O'Rellly B, Bottomley C, Rymer J. Pocket Essentials of Obstetrics and Gynaecology. London:Kumar P and Clark M, 2005
• Oral sex and sexually transmitted infections; know about the risks. Health Protection Agency.
  www.hpa.org.uk
  accessed 18 April 2007
• Pattman R, Snow M, Handy P, Sankar K N, Elawad B. Oxford Handbook of Genitourinary Medicine, HIV and AIDS. Oxford:Oxford University Press. 2005
• Raltegravir: a new antiretroviral class for salvage therapy. The Lancet. 2007. 369: 1235-1236
• Standards for HIV Critical Care. The British HIV Association. March 2007.
  www.bhiva.org
  accessed 02 May 2007
• Surveillance of infections in blood donors. The Health Protection Agency.
  www.hpa.org.uk
  accessed 02 May 2007
• The British HIV Association and the National Association of AIDS Care and Treatment. NAM.
  www.aidsmap.com
  accessed 25 April 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: January 2008