Understanding HIV

Introduction

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is left untreated, it can lead to acquired immunodeficiency syndrome
AIDS is the final stage of HIV infection. It happens when the body's immune system is damaged because of the virus
HIV person is progressed to develop AIDS if the number of CD4 cells falls below 200 cells/mm³
In a healthy person CD4 count ranges from 500 - 1600 cells/mm³

Statistics

The first case of HIV infection in the Philippines was reported in the year 1984
A total of 81,789 confirmed HIV cases were reported to the HIV/AIDS & ART Registry of the Philippines
94% (76,804) of those diagnosed were male and 6% (4,974) were female
More than half (51%, 41,490) were 25-34 years old while 23,460 (29%) were youth, i.e., 15-24 years old
The median age was 28 years old (age range: 1 month - 82 years)
13% (10,690) of the reported cases experienced the clinical manifestations of advanced infection

HIV/AIDS Trends in Philippines

Number of HIV cases and advanced infections reported from Jan 1984 - Nov 2020

Number of newly diagnosed cases in Philippines

Nearly, there were 620 confirmed HIV-positive individuals reported to the HIV/AIDS & ART Registry of the Philippines (HARP) in November 2020

Number of newly diagnosed cases per month, 2018-2020

Mode of transmission in Philippines

The primary mode of transmission in Philippines is predominant among:

Males who have sex with males [MSM] - 86%
Sexual contact among male –female – 10%
From 1984 to 2006, the predominant MOT was male-female sex and in 2007 HIV cases were reported among MSM
The transmission through sharing of infected needles was less than one percent from 1984 – 2004
Cases among people who inject drugs (PWID) increased in 2010

Cumulative number of people diagnosed per year by MOT, Jan 1984 – Nov 2020

Mode of transmission in Philippines

Mode of transmission among children and adolescents, Jan 1984 – Nov 2020
Mode of transmission in youth 15 -24 years old, Jan 1984 – Nov 2020

Females diagnosed with HIV in Philippines

The number of females diagnosed with HIV from past ten years (2011 -2020) has been increasing
Data shows that From January to November 2020, 375 females were diagnosed with HIV, which was three times higher compared with cases reported in 2011 (139)
All female cases which were reported since 1984 were in the reproductive age group (15-49 years old) at the time of testing

Number of females diagnosed per year, Jan 1984 - Nov 2020

Number of newly diagnosed cases in Philippines

In November 2020, there were 563 people with HIV who were initiated on anti-retroviral therapy

Number of art initiation per month 2018- 2020

90/90/90 Target

90 Percent of people who are living with HIV know their status
90 Percent of people living with HIV who know their status are receiving treatment
90 Percent of people on treatment have suppressed viral loads

Spread of the virus

Vaginal sex:
- Either partner can get HIV during vaginal sex
- Women with HIV is mostly through vaginal sex
- Men can also effected with HIV during vaginal sex
- The risk of vaginal sex is less to get HIV
Anal sex:
- It is the highest risk of transmitting HIV
Sharing needles, syringes, injecting drugs:
- Sharing needles, syringes, and other injection equipment can carry HIV from person who is infected with HIV
- People who inject drugs are at risk for HIV because of unprotected sexual behavior
Blood transfusion:
- People are at high risk of transmitting HIV through blood transfusions, blood products, or organ and tissue transplants
From mother to baby:
- The transmission of virus from mother to baby is called perinatal transmission or mother-to-child transmission
- HIV can be transmitted to baby during pregnancy, delivery, breast feeding
- If pregnant woman takes HIV medicines daily as prescribed then the chance of transmitting HIV to baby can be less than 1%

HIV is not spread through

Not transmitted

Sharing dishes

Closed mouth kissing

Shaking hands

Sharing toilets

Hugging

Mosquitoes or
other insects

Saliva, tears

Risk factors

People who have unprotected anal or vaginal sex

People who are infected with sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis

People who share contaminated needles, syringes and other injecting equipment

People who receive unsafe injections, blood transfusions, tissue transplantation

People who experience unexpected needle stick injuries

Stages of HIV

Acute HIV infection

It is earliest stage of HIV infection
It is also known as primary HIV infection
In this phase people have large amount of HIV in their blood
Antigen/antibody tests or nucleic acid tests is used to diagnose acute infection

This stage is also called asymptomatic HIV infection or clinical latency
No signs or symptoms are seen in people with HIV
Viral replication takes place at this stage and immune response against the virus is effective
People can transmit HIV in this phase
At the end of this stage the viral load tends to persist and CD4 cell count declines

Chronic HIV infection

Acquired Immunodeficiency Syndrome (AIDS)

The most severe phase of HIV infection
In this phase people’s immune system is damaged and opportunistic infections begin to develop
CD4+ T-cell count less than 200/µL is also used as a measure to diagnose AIDS
People with AIDS have high viral load
People with AIDS can survive only for three years, if they are not taking any proper medicines

Symptoms

After being infected with HIV, people experience flu-like symptoms within
2 to 4 weeks where they last for few days or several weeks

Fever
Chills
Rash
Night Sweats
Muscle ache
Sore throat
Fatigue
Swollen lymph nodes

What are the symptoms based on the stages of HIV infection?

Acute HIV infection

Symptoms appear within 2 to 6 weeks
They last for one or two weeks
Symptoms include: Fever, Fatigue, Sore throat, Aching muscles, Swollen lymph nodes, Rash

Individuals in this phase start to feel better and no symptoms were observed. Hence this phase is also known as asymptomatic stage

Chronic HIV infection

Acquired Immunodeficiency Syndrome

Symptoms include: Fever for more than 10 days, Tiredness, Shortness of breath, Diarrhea, Weight loss, Bleeding, Swollen lymph nodes

How to identify HIV rash?

HIV rash can be itchy, red or purple, or painful. It is a symptom observed in early or later stages of HIV infection

Difference between HIV 1 and HIV 2

There are two main different types of HIV. They are HIV 1 & HIV 2
HIV-1 infection causes AIDS worldwide, but in West Africa, HIV-2 is prevalent. Most patients infected with HIV-2 do not progress to AIDS. HIV-2 infection protects against subsequent HIV-1 infection and slows the rate of HIV-1 disease progression

What are the symptoms observed in HIV women?

Symptoms are same for both men and women. But women experience different problems from men:

Disturbances in menstrual cycle
High risk of cervical cancer
A higher risk of osteoporosis
Repeated vaginal infections
Pain in lower belly

Testing

HIV test helps to know the status of HIV

Who should get tested:

Individuals above 13 years of age
Individuals who are at risk of HIV infection
Individuals who had sex with HIV infected person
Individuals who had sex with more than one partner
Individuals who had injected drugs, shared contaminated needles and syringes
Individuals who had been treated for other sexually transmitted diseases

What are the types of HIV test

Three types of test are available:

1. Nucleic acid test
2. Antigen/Antibody test
3. Antibody test

Nucleic acid test:

In this test blood is drawn from a vein
This test helps to diagnose the HIV positive person
This test also helps to know the amount of viral load present in the blood
The results of this test may take for several days

Antigen/Antibody test:

This test involves drawing blood from a vein
Antigens: They are the foreign substances which activate the immune system
Antibodies: They are produced by immune system when exposed to viruses
The results may take for 30 minutes or less

Antibody test:

This test helps to estimate amount of antibodies to HIV in blood
The results may take for 30 minutes or less

HIV testing options in Philippines

Facility-based testing

Both public and private health facilities provide HIV testing and counselling performed by health care professionals

This test provides the advantage of faster medical-decision making from health professionals

HIV
self-screening:

In this test person has to collect his or her own specimen and then performs an HIV test using self-test kits
HIV self-test kits are not available in the Philippines

Community-based screening:

These organisations offer HIV testing and screening, performed by trained volunteers or health workers

Mental Health of HIV person

How HIV effects a person life negatively?

Individuals face stigma and discrimination
Mental health of well being is disturbed
Violation of human rights may occur
Isolated by family members

What can be done to avoid HIV stigma?

Provide awareness on the facts and myths of HIV
Emphasise in understanding the rights of people living with HIV
Protect anti-discrimination laws
Encourage to provide treatment access to all people who live with HIV

Can HIV effect mental health of a person?

Yes. HIV can be the major source of stress. It can have effect on well being of an individual
HIV can effect the nervous system and can lead to behavioural change

What is the meaning of self/internalised stigma?

This is when a person diagnosed with HIV feels like he/she is isolated, discriminated or judged badly for their HIV status then they take negative ideas and start to apply to themselves

Is it safe to touch HIV person?

It is safe to touch an HIV person because it is not transmitted through touching, hugging or shaking hands