GENERALITIES ON HIV

By James Achanyi-Fontem, camlinknews

As we dispense anti-retroviral drugs, we need to eucate the population on HIV prevention. This article give a global view of the generalities of HIV. HIV is a Sexually Transmitted Infection(STI) :. This is any disease contracted through unprotected sex. HIV: Human Immunodeficiency Virus. This virus attacks the body's immune system, weakens it, and exposes it to opportunistic infections. This virus is responsible for AIDS. There are 2 types of viruses: Type 1, which is the most widespread, the most contagious, the most virulent; and type 2, which is less widespread, less virulent and rare in Central Africa. A person can have both types of viruses. AIDS: Acquired immune deficiency syndrome. This is the advanced stage of the disease. It is at this stage that the PLHIV has opportunistic infections. PLHIV: Person Living with HIV .Opportunistic infection: It is a disease that takes advantage of the weakness of the human body's immune system to install itself. It can be an infection (Cryptococcus’s, tuberculosis ...) or cancer (Kaposi ...). Viral load (VL): It is the amount of virus per millilitre of blood present in the body and determining the degree of infectivity. A person who has an undetectable viral load has a very low risk of transmitting HIV. CD4 lymphocyte: This is a type of white blood cell that helps the body to fight against diseases. It is this defence cell that HIV primarily attacks and destroys. Accidental Exposure Biological Fluids (AEBF) : It is any accidental contact of a mucosa or damaged skin with body fluids (blood, sperm, vaginal secretions, etc. ...) or tissues likely to be infected. Antiretroviral treatment (ART): Any drug capable of preventing the proliferation of HIV. It can be used for preventive purposes (prevention of mother-to-child transmission of HIV (PMTCT), post-exposure prophylaxis (PEP)) or curative (HIV infected persons). EPIDEMIOLOGY  Situation in the world in 2016: - 36.9 million people are living with HIV worldwide. - 17.1 million people are not aware they were HIV carriers. - 2 million people were newly infected with HIV, that is 5600 new infections per day, a third of which are young people between 15 and 24 years old. - 15.8 million people with HIV had access to antiretroviral therapy. However, 22 million still do not have access to ARVs.Situation in Cameroon - The Republic of Cameroon has a generalized HIV epidemic with an estimated prevalence of 4.3% in the general population (15-49 years) in 2011. - This epidemic affects more women (5.6% in women against 2.9% in men) and a peak in the 35-39 years (8.1%). It is more urban (4.8%) than rural (3.8%) with a great disparity between regions ranging from 1.2% in the Far North region to 7.2% in the South region. In the two big cities Yaounde and Douala, it is respectively 6.3% and 4.6%1. Prevalence among adolescents aged 15 to 19 years is 1.2% (2.2% for girls and 0.4% for boys). Situation in Cameroon - The Republic of Cameroon has a generalized HIV epidemic with an estimated prevalence of 4.3% in the general population (15-49 years) in 2011. - This epidemic affects more women (5.6% in women against 2.9% in men) and a peak in the 35-39 years (8.1%). It is more urban (4.8%) than rural (3.8%) with a great disparity between regions ranging from 1.2% in the Far North region to 7.2% in the South region. In the two big cities Yaounde and Douala, it is respectively 6.3% and 4.6%1. Prevalence among adolescents aged 15 to 19 years is 1.2% (2.2% for girls and 0.4% for boys). In Cameroon PLHIV were estimated at 612,445 in 20142. According to the 2014 UNAIDS report, 45,000 (39,000 - 55,000) new HIV infections occurred in 2013, including 9,500 in children below 15 years of age. The rate of MTCT was estimated at 25% in 2013, compared to 33% in 2009. - The epidemic affects the key populations more, notably sex workers (SW) with 36.7% prevalence in 2014 and a national prevalence of 24% among men having sex with men (MSM) , with a peak of 44% prevalence for MSM in Yaounde and Douala in 2014. - 205382 patients were on ART as at late December 2016 (ARV coverage of 37%). TRANSMISSION MODES OF HIV AND MEANS OF PREVENTION . Localization of the virus in the body: The virus is found in all fluids of the body, but not all are contaminating. HIV is not spread through saliva and sweat. . Localization of the virus in the body: The virus is found in all fluids of the body, but not all are contaminating. HIV is not spread through saliva and sweat.There are three (3) modes of HIV transmission : • There are three (3) modes of HIV transmission : Sexual route, Blood transfusion and vertical transmission SEXUAL ROUTE Contamination by genital secretions (presence of HIV in sperm and vaginal secretions) : • From man to woman • From woman to man • From Man to Man (MSM) Risk factors are : • Risky sexual practices (Behaviour, type of sexual acts, etc.) • Absence of the use or misuse of condoms • Presence of ulcerative STIs in any of the partners UNSAFE BLOOD Contamination by blood or blood derivatives through: • Direct contact with infected blood or blood derivative (transfusion, AEBFs, etc.) • Object stained with infected blood (syringes of drug addicts, acupuncture needles, tattoo needles etc.) Risk factors - Manipulation (use) of contaminated soiled objects without protection - Accidental direct contact with blood or blood derivatives - Untested blood transfusion VERTICAL TRANSMISSION  It is the transmission of HIV from a mother to her child during: • Pregnancy, • Childbirth • Breastfeeding RISK FACTORS - STI in the mother - Ignorance of the status of the mother - Absence of ANC - Nutritional factors (breastfeeding) - Practices during childbirth - Placental pathologies NON-TRANSMISSION ROUTES Saliva, urine, tears etc. are non-contaminating probably due to the low virus concentration in these milieus or the presence of neutralizing factors. MEANS OF PREVENTION Purpose of prevention: Avoid contamination Application of the AGC rule of safer sex:  A: Abstinence B: Good fidelity C: Condom  Voluntary testing  Application of infection prevention standards and protocols (health workers and individuals) Early Management of Blood Exposure Accidents (BEAs)  Diagnosis and treatment of STIs  Blood transfusion with tested blood  Prevention of mother-to-ch