World AIDS Day

What is HIV?

  

  The human immunodeficiency virus (HIV) targets cells of the immune system, the so-called CD4 cells, which help the body respond to infection. HIV replicates in CD4 cells and in turn destroys the cells. If there is no effective treatment through the combined use of antiretroviral drugs, the immune system will gradually weaken to the point where it can no longer fight infections and diseases.

Important facts

HIV remains a major global public health problem, causing nearly 33 million deaths so far. However, as people increasingly receive effective HIV prevention, diagnosis, treatment, and care measures, including measures against opportunistic infections, HIV infection has become a manageable chronic health disease. People living with HIV Able to live a healthy and long life.
There is no cure for HIV infection, but there are effective preventive interventions: prevention of mother-to-child transmission, use of male and female condoms, interventions to reduce harm, pre-exposure prevention, post-exposure prevention, voluntary male medical circumcision Surgery and antiretroviral drugs, these drugs can control the virus and help prevent transmission to others.
At the end of 2019, there were an estimated 38 million people living with HIV.
In order to achieve the newly proposed global 95/95/95 target, we need to redouble our efforts to avoid the worst-case scenario, that is, half a million people die in sub-Saharan Africa, and the interruption of HIV services during the COVID-19 epidemic has led to an increase in infections. And the response of the public health sector to HIV has slowed.
Human immunodeficiency virus (HIV) attacks the immune system, weakening the body's defenses against many infections and certain cancers. As the virus destroys and damages the function of immune cells, the infected person's immune system will gradually become defective. Immune function is usually measured by CD4 cell count.

HIV-related immunodeficiency makes it more susceptible to various infections, cancers, and other diseases that people with healthy immune systems can overcome.

Acquired immunodeficiency syndrome (AIDS) refers to the most advanced stage of HIV infection. Depending on the individual's personal circumstances, it can develop many years after infection without treatment. AIDS is defined as the appearance of certain cancers, opportunistic infections, or other serious long-term clinical symptoms.

Symptoms and signs

The symptoms of HIV infection vary according to the stage of infection. People living with HIV are often the most infectious in the first few months after infection, but many people do not realize their infection until later, so they will continue to spread the virus without treatment. In the first few weeks after the initial infection, people may be asymptomatic or have flu-like illness symptoms such as fever, headache, rash, or sore throat.

As HIV infection gradually weakens the human immune system, people may experience other symptoms and signs, such as enlarged lymph nodes, weight loss, fever, diarrhea, and cough. Without treatment, serious diseases such as tuberculosis, cryptococcal meningitis, severe bacterial infections, and cancer (such as Kaposi's sarcoma and lymphoma) may also occur.

spread

HIV can be transmitted by exchanging blood, breast milk, semen, vaginal secretions and other body fluids with an infected person. HIV can also be passed from mother to child during pregnancy, childbirth and breastfeeding. General daily contact such as kissing, hugging, shaking hands, or sharing personal belongings, food or water will not infect people.

It is worth noting that HIV carriers who are being treated with antiretroviral drugs and the virus is suppressed will not pass HIV to their sexual partners. Therefore, early access to antiretroviral drugs for people living with HIV and support for their adherence to treatment are crucial to improving their health and preventing the spread of HIV.

Risk factors

Some of the high-risk behaviors and situations in which people are infected with HIV are:

Have unprotected anal or vaginal sex;
Has been infected with other sexually transmitted diseases, such as syphilis, herpes, chlamydia and gonorrhea;
Sharing contaminated needles, syringes and other injecting equipment and drug injections when injecting drugs;
Accept unsafe injections, blood transfusions, tissue transplants, and inadequately sterilized cutting or puncture medical operations;
Health personnel were accidentally stabbed by needles.

Diagnosis

HIV can be diagnosed through rapid diagnostic testing, and the test results can be obtained on the same day. This greatly promotes early diagnosis and the connection with treatment and care measures. People can also use HIV self-test kits for self-testing. However, no single test can provide a complete HIV diagnosis; WHO recommends a strategy of three consecutive tests to confirm the diagnosis. These tests require qualified and well-trained sanitation or community work in the home, community center or health service facility The person proceeded. The use of WHO pre-certified test kits in nationally approved testing strategies can detect HIV infection status very accurately.

Most of the widely used HIV diagnostic test kits can detect the antibodies produced by the body during the immune response to HIV. In most cases, people will develop HIV antibodies within 28 days of infection. During this period of time, people will experience the so-called "window period"-during this period the HIV antibodies produced have not yet reached the level that can be detected by standard testing methods, and may not have signs of HIV infection, but can transmit HIV To others. After being infected, people can pass HIV to their sexual partners or partners who take drugs together, or from pregnant women to their babies during pregnancy or breastfeeding.

People diagnosed as positive for the virus must be tested again before joining the treatment and care program to rule out any possible tests or report errors. It is important to note that once people are diagnosed with HIV and start treatment, they should not be tested again.

Although HIV testing for adolescents and adults has become simple and effective, this is not the case for babies born to HIV-positive mothers. For children under 18 months of age, serological testing is not sufficient to detect HIV infection, because HIV antibodies can be passively transferred from the mother to the baby during pregnancy and breastfeeding; it must be at birth or 6 weeks of age Perform a virological test. It is now possible to carry out tests at treatment points through new diagnostic technology, and obtain test results on the same day, which will speed up the proper connection with treatment and care.

HIV testing service

HIV testing should be done voluntarily. People have the right to refuse testing, and this should be recognized and supported. Health care providers, administrative departments, or partners or family members must not force or coerce testing, as this would trample on good public health practices and violate human rights.

New technologies that help people to self-test are being adopted, and many countries use self-testing as an additional option to encourage HIV diagnosis. When people want to know their HIV infection status, they can use the self-inspection procedure. They can collect specimens in private or with someone they trust, perform the test, and interpret the test results. HIV self-test is not the final diagnosis of HIV positive; it is a preliminary test that needs to be further tested and confirmed by the community or health workers. Many countries are currently using innovative methods to develop and support HIV self-testing, using digital platforms and online support to help people understand the testing procedures and link with related services.

Sex partners of people who are diagnosed with HIV infection and injecting drug users are more likely to be HIV-positive at the same time. WHO recommends voluntary assisted partner notification services as an easy and effective way to reach such partners-many of them are not diagnosed and do not understand their HIV exposure status, and may be happy to receive support and access to HIV Testing opportunities. The acceptance of partner services will be high and very effective, but it should always be provided in a manner that respects the choice of the person being served. Such services must always be voluntary, and provide support and options to avoid possible social harm.

All HIV testing services must follow the “5C” principles recommended by WHO:

Informed consent
Keep secret
consult
The test result is correct
Contact (connect with care, treatment and other services).

Prevention

People can reduce the risk of HIV infection by limiting exposure to risk factors. The main measures to prevent HIV infection listed below are usually combined.

Use male and female condoms

Adhere to the correct use of male or female condoms during vaginal or anus insertion can prevent the spread of sexually transmitted infections, including HIV. There is evidence that the protection rate of male latex condoms against HIV and other sexually transmitted infections can reach more than 85% under persistent use.

Help people who inject drugs and drug users reduce harm

Injecting drug users can take measures to avoid HIV infection, including using sterile injection equipment (including needles and syringes) for each injection, and not sharing drug use tools and drug solutions. Opioid replacement therapy for people with opioid dependence can also help reduce the risk of HIV transmission and help adhere to antiretroviral treatment. A set of HIV prevention and treatment interventions for injecting drug users includes:

Needle and syringe plan;
Opioid replacement therapy and other evidence-based drug dependence treatments for opioid dependent persons;
HIV testing and counseling;
HIV treatment and care;
Risk reduction information and education, and provision of naloxone to prevent opioid overdose;
Provide condoms;
Manage sexually transmitted infections, tuberculosis and viral hepatitis.

HIV and sexually transmitted infection testing and counseling

It is strongly recommended that all people facing any risk factors get tested for HIV and other sexually transmitted infections. This allows people to understand their HIV status and get necessary prevention and treatment services without delay. WHO also recommends testing partners or couples. In addition, WHO recommends the use of voluntary assisted partner notification services, so that people living with HIV can notify their partners on their own or with the help of health care providers with support. Supporting people to carry out testing projects in social networks may be an effective and acceptable method for some groups of people.

Testing and consultation in connection with tuberculosis treatment

Tuberculosis is the most common disease among people living with HIV. If undetected or untreated, tuberculosis is the leading cause of death among people living with HIV, causing nearly one-third of HIV-related deaths.

Early detection of tuberculosis and timely establishment of links between tuberculosis treatment and antiretroviral drug treatment can prevent such deaths. HIV care service agencies should routinely provide tuberculosis screening services. Routine HIV testing should be provided to all patients presumed and confirmed to have tuberculosis. Preventive treatment for tuberculosis should be provided to all people living with HIV who do not have active tuberculosis. People diagnosed with HIV infection and active tuberculosis should urgently initiate effective tuberculosis treatment (including treatment for multidrug-resistant tuberculosis) and antiretroviral drug therapy.

Voluntary medical circumcision for men

Voluntary medical circumcision for men can reduce the risk of men acquiring HIV infection through heterosexual behavior by approximately 50%-60%, including in the "real world" environment. As the coverage of antiretroviral therapy and its secondary prevention effects has expanded, this practice has also increased. In 2020, the WHO updated the 2007 recommendations on voluntary medical circumcision for men and continued to use it as an additional preventive intervention for men aged 15 and over. This is an important intervention in a comprehensive prevention strategy taken when HIV is highly prevalent, especially in eastern and southern African countries. Voluntary medical circumcision for men also reduces the risk of other sexually transmitted infections. As of the end of 2019, 27 million adolescents and adult men in Eastern and Southern Africa had received a package of services. Between 2016 and 2019, more than 15 million male voluntary medical circumcisions were performed. The package of services includes education on safe sex and condom use, provision of HIV testing, management of sexually transmitted infections (including necessary treatment connections) and surgical procedures. Adult and adolescent men often do not like to seek medical treatment. Voluntary medical circumcision for men is considered a good contact point between them and medical services. In some contexts, other services are also provided, such as conducting hypertension screening.

Antiretroviral drugs for prevention

The secondary prevention benefits of antiretroviral drugs

Several studies have confirmed that if HIV-positive people are receiving antiretroviral drugs and the virus is suppressed, they will not transmit HIV to their uninfected sexual partners. WHO recommends early antiretroviral treatment for all people living with HIV, the main purpose of which is to save lives and reduce the spread of HIV.

Provide pre-exposure prevention for HIV-negative partners

The pre-exposure prevention method for HIV is to make people who are not infected with HIV take antiretroviral drugs every day to block HIV infection. More than 10 randomized controlled studies conducted in a large number of populations have proven that pre-exposure prevention methods can effectively reduce HIV transmission. These populations include single-positive heterosexual couples (one partner is infected and the other is not), men who have sex with men, Transgender women, high-risk heterosexual couples, and people who inject drugs.

As part of a comprehensive prevention approach, WHO recommends pre-exposure prevention as a prevention program for people at significant risk of HIV infection. WHO also expanded these recommendations to HIV-negative pregnant or breastfeeding women. For men who have sex with men, "on-demand" pre-exposure prevention is also an effective option. Specifically, two tablets are taken 2 to 24 hours before sex; then, the third tablet is taken 24 hours after the first dose, and the fourth tablet is taken 48 hours after the first dose. This is often referred to as the 2+1+1 scheme. Two randomized trials have shown that long-acting pre-exposure prophylaxis products are highly effective in preventing HIV infection, including intramuscular injections of cabotegravir (cabotegravir, CAB-LA) every eight weeks. In 2021, Cabotwe will submit for regulatory approval; further open label expansion trials are underway to solve safety and implementation issues. Therefore, it is unlikely that Cabotwe will be available outside the research environment before 2022. From two randomized controlled trials, it was found that Dapivirine vaginal ring has a certain degree of HIV prevention effect, but it has good safety for women. Better efficacy was also seen in the open label expansion test. The European Medicines Agency recently put forward a positive opinion on Dapivirine vaginal ring (DVR). This paves the way for its use in low- and middle-income countries, and provides additional preventive options for women who are unwilling or unable to take oral pre-exposure prophylaxis on a daily basis.

Preventive measures after HIV exposure

Post-exposure prevention refers to the use of antiretroviral drugs within 72 hours of HIV exposure to prevent infection. Post-exposure prevention includes counseling, emergency care, and HIV testing, as well as 28-day antiretroviral treatment and follow-up. WHO recommends that post-exposure prevention be used after occupational and non-occupational exposures, which can be used by both adults and children.

Eliminate mother-to-child transmission of HIV

The transmission of HIV to babies by HIV-positive mothers during pregnancy, childbirth, delivery or breastfeeding is called vertical transmission or mother-to-child transmission. If no intervention is taken at these stages, the mother-to-child transmission rate of HIV may be between 15% and 45%. If antiretroviral drugs are provided to mothers and babies as early as possible during pregnancy and breastfeeding, the risk of mother-to-child transmission can almost be eliminated.

WHO recommends that all people living with HIV receive antiretroviral treatment for life, regardless of their CD4 count and clinical stage of the disease, including pregnant and breastfeeding women. In 2019, of the estimated 1.3 million HIV-infected pregnant women worldwide, 85% received antiretroviral treatment to prevent transmission of the virus to their children. More and more countries and territories are achieving extremely low rates of mother-to-child transmission of HIV, and some of them have officially confirmed the elimination of mother-to-child transmission of HIV as a public health problem (Anguilla, Antigua and Barbuda, Armenia , Belarus, Bermuda, Cayman Islands, Cuba, Malaysia, Maldives, Montserrat, Saint Kitts and Nevis and Thailand). Some countries with a high burden of HIV infection are also moving towards elimination.

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