HIV/AIDS

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Overview

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused

by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your
body's ability to fight infection and disease.

HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from
mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years
before HIV weakens your immune system to the point that you have AIDS.

There's no cure for HIV/AIDS, but medications can dramatically slow the progression of the disease.
These drugs have reduced AIDS deaths in many developed nations.

Symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters the
body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible signs and
symptoms include:

Fever

Headache

Muscle aches and joint pain

Rash

Sore throat and painful mouth sores

Swollen lymph glands, mainly on the neck

Diarrhea

Weight loss

Cough

Night sweats

These symptoms can be so mild that you might not even notice them. However, the amount of virus in
your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily
during primary infection than during the next stage.

Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many people
may not have any symptoms or infections during this time.

This stage can last for many years if you're not receiving antiretroviral therapy (ART). Some people
develop more severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight
off germs — you may develop mild infections or chronic signs and symptoms such as:

Fever

Fatigue

Swollen lymph nodes — often one of the first signs of HIV infection

Diarrhea

Weight loss

Oral yeast infection (thrush)

Shingles (herpes zoster)

Pneumonia
Progression to AIDS

Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS.
Untreated, HIV typically turns into AIDS in about 8 to 10 years.

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop
opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause illness in a
person with a healthy immune system.

The signs and symptoms of some of these infections may include:

Sweats

Chills

Recurring fever

Chronic diarrhea

Swollen lymph glands

Persistent white spots or unusual lesions on your tongue or in your mouth

Persistent, unexplained fatigue

Weakness

Weight loss

Skin rashes or bumps

When to see a doctor

If you think you may have been infected with HIV or are at risk of contracting the virus, see a doctor as
soon as possible

What is AIDS?

If a person develops certain serious opportunistic infections or diseases – as a result of damage to their
immune system from advanced stage 3 HIV infection – they are said to have AIDS.
If you have advanced HIV (with AIDS-defining symptoms), it’s important to get the right treatment as
soon as possible. With treatment a person can recover from AIDS-related infections and diseases, and
bring HIV under control.

The earlier you’re diagnosed with HIV and start treatment, the better your health will be. You can avoid
getting opportunistic infections and stage 3 HIV, by adhering to antiretroviral treatment and looking
after your health.

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)

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Key messages

HIV infection must be notified by medical practitioners and pathology services in writing within 5 days of
diagnosis.

AIDS is not notifiable.

Male-to-male sexual contact, including homosexual and bisexual contact, accounts for the majority of
new diagnoses in men. In females, heterosexual contact and injecting drug use are the most common
risk factors.

Antiretroviral drug therapy is used to treat established HIV infection. Due to the dynamic nature of the
treatment, medical practitioners specialising in HIV should manage the therapy.

Notification requirement for HIV infection and AIDS

HIV is a ‘routine’ notifiable condition and must be notified by medical practitioners and pathology
services in writing within 5 days of diagnosis.

AIDS is not notifiable.

To maintain confidentiality, only the name code (the first two letters of the surname followed by the
first two letters of the first name) is required.

This is a Victorian statutory requirement.

Primary school and children’s services centre exclusion for HIV infection and AIDS

Exclusion is not required.

Infectious agent of HIV infection and AIDS

Human immunodeficiency virus (HIV) types 1 and 2 are members of the family Retroviridae. A number
of subtypes exist within HIV-1 and HIV-2.

Identification of HIV infection and AIDS

Clinical features

AIDS is a severe, life-threatening disease that represents the late clinical stage of infection with HIV. HIV
weakens the immune system by destroying a type of white blood cell (CD4 or T-helper lymphocytes).
Several weeks after infection with HIV, a number of infected individuals will develop a self-limiting
glandular fever–like illness lasting for a week or two (seroconversion illness). Infected people may then
be free from clinical signs or symptoms for months or years.

Treatment with combination antiretroviral therapy (cART) has resulted in vast reductions in cases of
AIDS and mortality. The burden of illness is now increasingly due to non-AIDS infections and
malignancies, neurological and psychiatric manifestations of HIV, and coronary artery disease
accelerated by a pro-inflammatory state induced by HIV. Newer cART regimens are much less toxic, but
significant long-term side effects (including effects on blood glucose, cholesterol and bone health) still
occur.

Untreated individuals are at risk of specific opportunistic infections and malignancies, and a range of
other AIDS-defining illnesses, including:
Pneumocystis jirovecii pneumonia

oesophageal candidiasis

Kaposi’s sarcoma

chronic herpes simplex infection, or herpetic oesophagitis

cryptococcosis

cryptosporidiosis

toxoplasmosis

cytomegalovirus infection

mycobacteriosis, including tuberculosis

lymphoma

HIV encephalopathy

HIV wasting disease

recurrent bacterial pneumonia

progressive multifocal leukoencephalopathy.

Diagnosis

Careful history and physical examination, looking for risk factors and clinical manifestations of
immunodeficiency, are necessary.

Diagnostic testing generally involves detection of HIV antibody/p24 antigen by a fourth-generation

combination screening test, and confirmation by western blot analysis. Molecular techniques, such as
polymerase chain reaction (PCR) to detect proviral DNA sequences, are occasionally necessary to clarify
indeterminate results.

Incubation period of HIV

The period from infection to the primary seroconversion illness is usually 1 to 4.weeks. The period from
infection to development of anti-HIV antibodies is usually less than 1 month but may be up to 3 months;
newer tests have a shorter window period, where a false negative result may be obtained early in
infection.
The interval from HIV infection to the diagnosis of AIDS ranges from about 9 months to 20 years or
longer, with a median of 12 years. There is a group of people with a more rapid onset of disease who
develop AIDS within 3–5 years of infection, and another smaller group who do not seem to progress to
AIDS.

Public health significance and occurrence of HIV infection and AIDS

Occurrence is worldwide. More than 30 million people were living with HIV/AIDS by the end of 2009,
and an estimated 1.8 million people died from HIV-related illnesses that year. The vast majority of HIV
infections occur in developing countries.

For the period 1983–2003, there was a cumulative total of 4,680 HIV diagnoses in Victoria. This
represents about 21 per cent of Australia’s total. Males accounted for 94 per cent of the diagnoses.
Male-to-male sexual contact, including homosexual and bisexual contact, accounts for the majority of
new diagnoses in men. In females, heterosexual contact and injecting drug use are the most common
risk factors.

Reservoir of HIV

Humans are the reservoir.

Mode of transmission of HIV

HIV can be transmitted from an infected person by:

sexual exposure to infected semen, vaginal fluids and other infected body fluids during unprotected
sexual intercourse with an infected person; this includes unprotected oral sex Transmission risk
following unprotected anal or vaginal sex with a person with HIV is estimated to be 0.1–2 per cent. It is
highest following unprotected receptive anal intercourse

inoculation with infected blood or blood products, transplantation of infected organs such as bone grafts
or other tissues, or artificial insemination with infected semen

breastfeeding of an uninfected infant by an HIV-positive mother. Use of cART during pregnancy

decreases the risk of vertical transmission from an infected woman to her child; caesarean section may
be recommended if an infected mother has a detectable viral load. Avoiding breastfeeding decreases
transmission postpartum; newborns are commonly given ART as post-exposure prophylaxis for potential
exposure to HIV during delivery. With these interventions, the risk of mother-to-child HIV transmission is
less than 5 per cent. If there is no intervention, including cART during pregnancy, the risk of mother-to-
child HIV transmission has been estimated to be 20–45 per cent.

sharps injuries, including needlestick injuries or other exposure to blood and body fluids. The rate of
seroconversion following a needlestick injury involving HIV-infected blood is said to be less than 0.5 per
cent, but this is dependent on the type of needlestick injury (deep versus shallow) and the viral load of
the infected person. Post-exposure prophylaxis following needlestick injury is given in cases of known
HIV-infected blood or body fluids, or high-risk exposures.

Period of communicability of HIV infection and AIDS

All antibody-positive people carry the HIV virus.

Infectivity is presumed to be lifelong, although successful therapy with cART can lower the viral load in
blood and semen to undetectable levels.

Susceptibility and resistance to HIV infection

Everyone is susceptible to infection.

The presence of other sexually transmissible infections, especially those with skin or mucosal ulceration,
may increase susceptibility.

Control measures for HIV infection

Preventive measures

Preventive measures for HIV centre on personal and institutional factors.

Personal factors include the following:

Public education should be provided on the use of condoms and safer sex practices.
Public education should stress that having unprotected sex with unknown or multiple sexual partners
and sharing needles (drug users) increase the risk of infection with HIV.

Unprotected sexual intercourse with people with known or suspected HIV infection should be avoided.

HIV-infected people should be offered confidential counselling, access to screening and treatment for
sexually transmissible infections, and appropriate antiviral therapy for HIV.

Care should be taken when handling, using and disposing of needles or other sharp items.

Use of needle exchange programs by injecting drug users should be facilitated.

Institutional factors include the following:

Appropriate infection control measures (standard precautions) should be used by all healthcare and
emergency workers.

Appropriate infection control measures should be used in all premises where skin penetration is carried
out – for example, electrolysis, tattooing or body piercing.

Blood and blood products for transfusion, and the donors of tissues and body fluids, such as semen,
should be assessed for risk and tested for the presence of markers of HIV.

Sharps injuries, including needlestick injuries, and parenteral exposure to laboratory specimens
containing HIV should be dealt with according to Australian guidelines for the prevention and control of
infection in healthcare.

Nonoccupational exposure to infected blood or body fluids should be assessed and managed according
to Australian national guidelines for post-exposure prophylaxis after non-occupational exposure to HIV.

Control of case

See ‘Standard precautions – Appendix 3’ of the Blue Book, which applies to all patients.

Additional transmission-based precautions apply for specific infections that occur in AIDS patients, such
as tuberculosis. Equipment contaminated with blood or body fluids should be cleaned, and then
disinfected or sterilised as appropriate.

Patients and their sexual partners should not donate blood, organs or other human tissue.
All HIV-infected people should be evaluated for the presence of tuberculosis.

Treatment

Antiretroviral drug therapy is used to treat established HIV infection. Because such treatment is
specialised and constantly changing, only those doctors experienced in HIV management should
prescribe antiretroviral therapy. For further information, see the current edition of Therapeutic
guidelines: antibiotic and the Australasian Society for HIV Medicine website. Other treatment includes
specific treatment or prophylaxis for the opportunistic infectious diseases that result from HIV infection.

Control of contacts

If a person is diagnosed as having HIV infection, the diagnosing practitioner has a responsibility to
ensure that sexual and needle-sharing contacts are followed up, where possible.

Assistance with partner notification may be provided by the department through its partner notification
officers.

Pre- and post-test counselling must be provided for all contacts seeking HIV testing.

Control of environment

The procedure for dealing with spills of blood and body fluids is in Appendix 5.

Outbreak measures for HIV infection

The epidemiology of HIV is closely monitored in Victoria. Public health action is informed by enhanced
epidemiological information notified to the department.

Special settings

Healthcare workers

Registration boards should be consulted in relation to their policies regarding healthcare workers with
bloodborne viruses. F. Recommendations are also included in the Communicable Diseases Network of
Australia publication, Australian Guidelines for the management of health care workers known to be
infected with blood-borne viruses.

Antenatal care

Antenatal care should include a comprehensive assessment of HIV risk factors. All pregnant women
should be encouraged to undergo HIV testing after appropriate pre-test counselling.

Other settings

All workplaces should have policies and procedures in place regarding action to be taken in the event of
a blood spill or sharps injury. Refer to Australian guidelines for the prevention and control of infection in
healthcare.

International measures

The World Health Organization initiated a global prevention and control program in 1987. Since 1995,
the global AIDS program has been coordinated by the Joint United Nations Programme on HIV/AIDS
(UNAIDS). Nearly all countries have developed an AIDS prevention and care program.