Understanding AIDS

As we are entering the end of the year, there’s another important day worth highlighting and that is World Aids Day. Falling on the first of December, World Aids Day is celebrated annually to honor the millions of lives lost to AIDS, fight against the stigma and negative connotations around it and at the same time raise awareness on this potentially life-threatening disease. More importantly, it is commemorated to invite more people to be committed in the effort to tackle AIDS. In this article, we wish to address some of the commonly asked questions and myths surrounding AIDS and what we, as society can partake to prevent it from happening.

What is AIDS

The acronym AIDS stands for Acquired Immune Deficiency Syndrome. It is the last and most serious stage (Stage 3) of an Human Immunodeficiency Virus (HIV) infection. In patients with AIDS, their white blood cells are often very low since it has been compromised by the HIV virus. Thus, they may be seen to suffer from other additional illnesses since their immune system is invaded.

While AIDS is not transmissible from one individual to another, the HIV virus is highly contagious and can be transmitted through various routes such as the sharing of the same needles/syringes, unprotected sexual intercourses and the breastfeeding or childbirth from an infected mother. However, good news is, not everyone who is infected with the HIV virus will eventually get AIDS. In fact, some HIV positive patients can live till the normal lifespan without ever getting AIDS since there is now the magical existence of antiretroviral medications targeting the HIV virus. 

Can I have AIDS if I’m not infected by the HIV virus?

No. Theoretically you can't get AIDS if you’re NOT HIV positive since AIDS itself IS caused by the HIV virus. Experts have also predicted that without treatment, HIV infections can progress to AIDS in a span of just 10 years. 

How do I know if I have AIDS?

AIDS is only diagnosed when your CD4+ (the main target of HIV virus) count falls below 200 cells/mm3 or when you have AIDS-defining complications such as a serious infection or cancer. 

What does AIDS do to a person?

Since HIV destroys our immune system and leaves us vulnerable to tons of infections, AIDS patients are often observed having opportunistic infections such as tuberculosis, pneumocystis pneumonia PCP, candidiasis, just to name a few.
Opportunistic infections are infections that a healthy immune system can typically fight off.

Besides, AIDS can also result in significant weight loss that is accompanied with diarrhea (also sometimes referred to as wasting syndrome), extreme tiredness even after lots of rest, mouth or genital ulcers, fever, night sweats and skin discoloration. In some cases, cancers such as Kaposi sarcoma, cervical cancer in women, and non-Hodgkin's lymphoma may also happen.

Is there a cure for HIV/AIDS?

To date there is still no active cure for HIV/AIDS but there are medications that can control the spread of infection and prevent the progression of the deadly disease. Antiviral treatments for HIV have been found to significantly reduce AIDS death around the world and also minimize the progression of HIV to AIDS as much as possible.

Is HIV forever?

Unfortunately, yes. The HIV (antiretroviral therapy) treatment prescribed is NOT an active cure to completely eradicate the virus in your system but only to suppress its amount, enhance quality of life, maintain a high CD4+ count and to reduce the risk of spreading HIV to others.

There may be periods while you’re on medication where the virus may be dormant and go undetected on your blood HIV test. However, you should never assume that they’re gone and stop taking your medications, even if you don’t feel sick or experience improvement in symptoms. By missing your medications, HIV will weaken your immune system until it goes from bad to worse, losing the ability to fight off other serious diseases.
 

What can we do to prevent AIDS then?

Prevention and proper education. To help prevent AIDS is to first address the root cause of it, preventing the spread of HIV virus. One can: 

1. Consider getting pre-exposure prophylaxis (PrEP) if you’re at high risk
   PrEP is the combination of oral drugs for people who are at high risk for HIV  either from injection drug use or from frequent sexual intercourses with different partners without the habit of using condoms. According to the Centers for Disease Control (CDC), PrEP has the ability to reduce one’s risk from getting HIV from sex by about 99% and from injection use by at least 74%. Hence, by preventing or halting the spread of the virus, AIDS can be prevented.
   PrEP is now available in Malaysia as a registered Antiretroviral treatment (ART), however it is yet to be licensed for HIV prevention. Individuals who wish to get PrEP can however go through their GPs and request to get supply upon valid reasons and verifications of blood tests.
    

2. Be compliant to your ART if you’re HIV positive
   If you’ve been diagnosed with HIV by your doctor, taking HIV medications can protect your partner and loved ones from HIV infection. By taking your HIV medications as instructed, you can also prevent the progression of the virus and the damage it causes to your immune system which subsequently could minimise the risk of getting AIDS as much as possible. It is also highly encouraged that you follow up with your doctor from time to time to monitor your condition.
    

3. Get post-exposure prophylaxis (PEP) ASAP if you’ve been exposed to HIV
   If you found out that you’ve been exposed to HIV either by means of sharing needles or unprotected sex with a HIV positive individual, contact your nearest healthcare provider the soonest you can and get treated accordingly. It has been reported that taking PEP as soon as within the first 72 hours can vastly reduce your risk of being infected with HIV. Downside is, you will need to take the medication for at least 28 days. It is also worth noting that PEP is only indicated for emergency use and does not replace other precautions such as the use of condom during sexual intercourse.
    

4. To use a new condom each time you have sex
   Since we know one of the more common ways HIV spreads is through sexual engagements, practising safe sex by using a condom makes all the difference, especially when you know your partner is HIV positive or your new partner has yet to be tested for a while.
    

5. Notify your sexual partners if you have HIV
   It is only right to inform all your current and past sexual partners that you are HIV-positive as soon as you know about it. No matter how long it has been, your partners will need to be tested for HIV to prevent the spread to more and more partners.
    

6. Never share needles with anyone for whatever reason
   Needles aren’t expensive and should never be shared among each other, even with family under any circumstance. Make sure every time you inject something to your body, the needle is 100% sterile and has never been used before.
    

Can I still get pregnant if I’ve been diagnosed with HIV?

Yes. Doctors from all over the world have come around to verify that if a woman takes her HIV medications daily accordingly throughout her entire pregnancy (including labor and delivery) and continues taking those medications for her baby for as long as 4-6 weeks after birth, the risk of transmitting HIV to her baby can be as low as 1% or less.

Furthermore, pregnant mothers can also opt to undergo C-section and/or bottle feeding with formula after childbirth to minimise the risk of transmitting HIV to her new born baby since neither of these involves the routes HIV can transmit.

In a nutshell

It is impossible to transmit AIDS, but it IS possible to spread HIV from person to person. The key in fighting against AIDS is therefore dependent on how the individual control his/her HIV viral load by medication compliance and practice safe sex as well as avoid sharing needles with anyone at all costs. In the event you suspect you may have been infected with HIV, do seek professional medical advice and attention urgently. 

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US),
reviewed by Dr. Izzan Nadira binti Ismi, MB Bch BAO (DOC2US)

References.

1. AIDS and other opportunistic infections - CDC. Available at: https://www.cdc.gov/hiv/basics/livingwithhiv/opportunisticinfections.html Accessed on 30th November 2022 

2. HIV & AIDS - Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/4251-hiv-aids. Accessed on 30th November 2022 

3. HIV/AIDS - MayoClinic. Available at: https://www.mayoclinic.org/diseases-conditions/hiv-aids/. Accessed on 30th November 2022 

4. PrEP initiatives in Malaysia. Available at: https://www.apcom.org/prep-initiatives-in-malaysia/. Accessed on 30th November 2022 

5. Explaining HIV & AIDS - Medical News Today. Available at: https://www.medicalnewstoday.com/articles/17131. Accessed on 30th November 2022 

Written by

Janelle Leong, Bpharm(Hons)