HIV Prevention, Diagnosis and Management

HIV remains a major global public health issue, having claimed more than 32 million lives (WHO 2019).

While its severity cannot be overstated, HIV infection is now a manageable chronic health condition - people who have HIV are able to live long and healthy lives. This is a result of greater access to effective HIV prevention, diagnosis, treatment, and care (WHO 2019).

Human immunodeficiency virus (HIV) is a virus that affects the immune system. Without treatment, HIV can lead to acquired immunodeficiency syndrome (AIDS) (Kirby Institute 2020).

HIV is transmitted sexually, by blood-to-blood contact including through injecting drug use, and from mother to child (Kirby Institute 2020).

What is the Difference Between HIV and AIDS?

• HIV stands for human immunodeficiency virus.
• AIDS stands for acquired immunodeficiency syndrome.

HIV is the virus that causes HIV infection. AIDS is the most advanced stage of HIV infection.

AIDS is the diagnosis when a person with HIV infection has a very compromised immune system. They then develop a disease caused by an organism that wouldn’t usually affect healthy people as severely (Health NSW 2017).

People with HIV infection who are on effective treatment do not develop AIDS, as the treatment prevents damage to the immune system (Health NSW 2017).

HIV in Australia

The most recent survey of HIV in Australia by the Kirby Institute at the University of New South Wales revealed a trend of decline in HIV rates in Australia overall.

There were 963 new cases of infection in Australia in 2017, compared to 2,412 in 1987, the peak of the epidemic (Sedghi 2018).

In the past few years, Australia has seen a 7 per cent decline in HIV. This is likely due to testing, treatment, and stronger preventative measures (Sedghi 2018).

Other factors include:

• Men are getting tested twice as frequently as they were five years ago.
• The introduction of pre-exposure prophylaxis (PrEP) in the past few years has had an impact.

(Sedghi 2018)

The most significant decrease in rates of HIV has been among gay men and people who identify as bisexual (Sedghi 2018).

However, this decline is not the case for all population groups.

Among First Nations people, there was an increase in notification rate of HIV of a staggering 41% since 2017, compared to a 12% decrease among non-First Nations people.

This is likely due to:

• Broader determinants of health that affect First Nations people such as education, employment, housing and poverty.
• Biomedical prevention methods did not appear to work as well for First Nations populations as they did for non-First Nations populations.
• Reduced access to appropriate preventative and diagnostic healthcare outside of urban environments was also an issue.

(Sedghi 2018)

How is HIV Transmitted?

HIV can be spread via the exchange of certain bodily fluids from people who are infected. Note that HIV cannot be spread through day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects (Better Health Channel 2018).

Situations in which it can be spread include:

• Anal or vaginal sex without condoms or other protection.
• Sharing needles, syringes, or other injecting equipment.
• From mother to child during pregnancy, childbirth, or breastfeeding when the mother is infected with HIV.
• Through tattooing or other procedures that involve unsterile or reused equipment.

(Better Health Channel 2018)

HIV Symptoms

As most people have no symptoms or a mild flu-like illness - symptoms such as fevers, headaches, rashes or a sore throat - when first infected with HIV, it may be difficult to tell these symptoms apart from other viral illnesses (WHO 2019).

As the infection progresses, it gradually weakens the immune system; other signs and symptoms may then occur. These can include swollen lymph nodes, weight loss, fever, diarrhoea and cough (WHO 2019).

Without any treatment, a person who has HIV is at risk of developing severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma (WHO 2019).

Who is at High-Risk of HIV?

• Men who have sex with men;
• People who have sex with people from countries with a high rate of HIV infection;
• People who inject drugs;
• People who had tattoos or other piercings overseas using unsterile equipment;
• People who have sex with a person with a high risk of HIV as listed here.

(Health NSW 2017)

Prevention for HIV

Individuals are able to reduce the risk of HIV infection by limiting exposure to known risk factors.

Key approaches for HIV prevention according to the World Health Organization:

• Condom use for both men and women.
• Testing and counselling for HIV and STIs.
• Testing and counselling linkages to tuberculosis.
• Voluntary male circumcision.
• Not sharing needles, syringes or any injecting equipment.
• Use of ARVs for prevention.
• Harm reduction for people who inject and use drugs.
• Preventing mother-to-child transmission of HIV.

(WHO 2019)

Pre-Exposure Prophylaxis (PrEP)

PrEP consists of two antiretroviral medicines that are also used to treat people who already have HIV. It is advised that condoms are worn even if PrEP is being taken (Health NSW 2017).

PrEP is an HIV prevention option for people who don’t currently have HIV but who are in the high-risk group for contracting HIV. This greatly reduces the chance of someone who is HIV negative contracting HIV from an HIV positive person (Health NSW 2017).

When taken properly, antiretroviral treatment prevents the spread of HIV as the level of virus in the blood of the person with HIV lowers significantly (Health NSW 2017).

Post-Exposure Prophylaxis (PEP)

PEP (post-exposure prophylaxis) is an alternative way to take anti-HIV medication to prevent HIV. Unlike PrEP, PEP is taken post a known or suspected exposure to HIV. PEP is taken for 28 days and has to commence within 72 hours of exposure to HIV (Better Health Channel 2018).

HIV Diagnosis

A blood test is the method of diagnosis. One type of test detects antibodies to the virus, while the other looks for the virus itself. It takes roughly 15-24 days before blood will show a positive test result after an HIV infection, but it can take longer (Health NSW 2017).

Because of this delay, additional blood tests may be necessary after recent exposure to be certain that a new infection has not occurred (Health NSW 2017).

HIV Treatment

Currently, there is no cure or vaccine for HIV infection. However, antiretroviral drugs (ARVs) can control the virus and help to prevent transmission to other people.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People who are on ART take a combination of HIV medicines every day (US Department of Health and Human Services 2019).

ART stops HIV from multiplying, which reduces the amount of HIV in the body (the viral load). Having less HIV in the body protects the immune system and prevents HIV from advancing to AIDS (U.S. Department of Health and Human Services 2019).

ART does not cure HIV, but HIV medicines help people who have HIV to live longer and healthier lives (U.S. Department of Health and Human Services 2019).

Additional Resources

• World Health Organization (WHO), https://www.who.int/news-room/fact-sheets/detail/hiv-aids

References

• Better Health Channel 2018, HIV, Better Health Channel, viewed 25 February 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hiv-and-aids
• Healthdirect 2019, HIV Infection and AIDS, Healthdirect, viewed 25 February 2020, https://www.healthdirect.gov.au/hiv-infection-and-aids
• NSW Health 2017, HIV Infection, NSW Health, viewed 25 February 2020, https://www.health.nsw.gov.au/Infectious/factsheets/Pages/HIV-infection.aspx
• Sedghi 2018, ‘Australian HIV Rates Declining Overall, But Not for Everyone’, ABC News, viewed 25 February 2020, https://www.abc.net.au/news/2018-09-24/australian-hiv-rates-declining/10297546
• World Health Organization (WHO) 2019, HIV/AIDS, WHO, viewed 25 February 2020, https://www.who.int/news-room/fact-sheets/detail/hiv-aids