HIV

Ways of infection with HIV

Although people nowadays are more informed about HIV, there is still a misconception in part of the society that if you touch an infected person or contact surfaces like toilet seats you might get HIV which is not true at all. Additionally, HIV infection is not transmitted through saliva.

Here are the ways that you might get infected with HIV:

• Body fluids, including vaginal secretions, semen, rectal fluids (through sexual contact with an infected person), and blood. However, to get infected with these fluids they must either contact with mucous membranes or go directly into the bloodstream. In terms of HIV transmission, anal sex is considered as the type of sexual activity that increases the risk of transmission.
• Sharing needles or other equipment to inject drugs with someone who has HIV.
• Infected blood or blood products through transfusion. This is very rare nowadays in Australia but can happen in countries where blood and blood donors are not tested for HIV.

Women with HIV infection can transmit the virus to their babies during pregnancy, at the time of birth, or through breastfeeding (4).

At this point, it is important to highlight that people with HIV who are taking antiretroviral therapy and are virally suppressed do not transmit HIV to their sexual partners.  Therefore, antiretroviral therapy is crucial not only to improve the health of people with HIV but also to prevent HIV transmission (5).

Are you at risk for HIV?

There are some specific categories of people who are at greater risk of HIV infection:

• Being a gay or bisexual
• Having unprotected anal or vaginal sex
• Having another sexually transmitted infection such as chlamydia, gonorrhoea syphilis, herpes, and bacterial vaginosis
• Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs
• Receiving unsafe blood transfusions, injections, and tissue transplantation, and medical procedures that involve unsterile cutting or piercing
• Health workers who are experiencing accidental needle stick injuries
• Living in specific geographical areas. Over 2/3 of all people living with HIV live in the WHO African Region (5)
• Exposure to the virus as a fetus or infant before or during birth or through breastfeeding from a mother who is HIV positive (6).

The rate of HIV notifications increased by 41% in the Aboriginal and Torres Strait Islander population between 2013 and 2016, compared with a 12% decline in Australian‑born non‑Indigenous people, and in 2017 remains 1.6 times as high as the Australian‑born non‑Indigenous population (3).

Complications of untreated HIV

In case HIV is untreated, severe illnesses may develop including severe bacterial infections, tuberculosis, cryptococcal meningitis, and cancers such as Kaposi’s sarcoma and lymphomas (5).

HIV Diagnosis

HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage with treatment and care. Despite the fact of widely available HIV self-tests, no single test can provide a full HIV diagnosis; confirmatory testing is required, conducted by a qualified and trained health or community worker at a community centre or clinic (5).

Most widely used HIV diagnostic tests detect antibodies produced by the infected person’s immune system as a response against the HIV infection. Usually, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called “window” period –  when HIV antibodies haven’t been produced in high enough levels to be detected by standard tests and when they may have had no signs of HIV infection, but also when they may transmit HIV to others. Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error (5).

Treatment for HIV

HIV can be suppressed by treatment regimens composed by a combination of 3 or more antiretroviral therapy drugs. HIV infection is not cured by current antiretroviral therapy. However, this therapy highly suppresses viral replication within a person’s body and allows an individual’s immune system recovery to strengthen and regain the capacity to fight off infections. Since 2016, WHO recommended that all people living with HIV be provided with lifelong antiretroviral therapy, including children, adolescents and adults, and pregnant and breastfeeding women, regardless of clinical status. The current HIV treatment guidelines include new antiretroviral options with better tolerability and higher efficacy. In 2019, WHO recommended the use of dolutegravir-based or low-dose efavirenz for first-line therapy (5).