Patient Education
What is AIDS?
AIDS denotes Acquired Immune Deficiency Syndrome. It is caused by the HIV virus (Human Immunodeficiency Virus). AIDS is the final disease stage of HIV whereby the patient's immune system is completely destroyed and the patient suffers from a variety of problems.
Is AIDS the same as HIV infection?
HIV infection means that a patient is infected with the HIV virus. A patient with HIV infection may look completely healthy (asymptomatic carrier state), may have opportunistic infections such as TB, pneumonia, or may finally go into full-blown AIDS. AIDS is the condition where the patient's immune system is completely destroyed and the patient succumbs to various infections, has wasted and develops symptoms such as cancers, fever, and diarrhea.
REMEMBER, NOT EVERY HIV INFECTED PERSON HAS AIDS.
How does one get HIV infection?
- Unprotected sexual intercourse with an infected person
- Sharing infected syringes and needles (as seen in drug abusers)
- Transfusion with contaminated blood & blood products.
Over 80% of HIV infection worldwide is sexually acquired.
In children, in addition to the above-mentioned routes of transmission, mother to child transmission during pregnancy, at birth or through breastfeeding is the predominant mode of transmission and accounts for almost 80-85% of HIV infection in children.
What happens when a person acquires HIV infection?
Soon after contracting HIV, some persons may develop a flu-like illness with swollen lymph nodes, fever, malaise, and rash lasting for 2 to 3 weeks. This is called Acute (Primary) HIV infection. This stage is usually not seen in children as the primary infection is acquired at the time of pregnancy or at birth due to mother to child transmission.
Following the primary infection, a patient may remain and feel completely healthy. This is known as the asymptomatic stage. This stage usually lasts for 8-10 years in adults. However, in children, this stage is shortened. During this stage, the virus is actively replicating in the body but the body's immune system is also working hard to control the infection. Hence the patient remains asymptomatic. In children, the immune system is not fully mature. As a result, the virus soon overcomes the immune system and the patient starts manifesting signs and symptoms of the disease.
Once, the immune system breaks down, the patient develops various infections such as TB, Pneumonia, Diarrhea, Herpes zoster, etc. The virus may also affect various organs of the body such as lungs, eyes, gastrointestinal tract, brain, heart, liver, and skin and cause various organ dysfunctions. During the advanced stage of the disease, the patient develops unexplained weight loss, fever; infections by unusual organisms, and in adults - rare cancers (Lymphoma & Kaposi's sarcoma) can also develop. With the development of AIDS, the patient usually succumbs to the disease until and unless intervention with drugs is given.
I know an HIV infected person. Can I get HIV through such a contact?
No, HIV is not transmitted through casual contact at home or elsewhere. Sharing toilets, utensils, swimming pools, working in the same office, going to the same school, insect bites do not transmit the virus. There is also no risk of contracting HIV while donating blood, as all equipment used are sterile, used only once, and discarded.
How does one test for the HIV virus?
Once a person gets HIV infection, the antibody against HIV appears in the blood only after 3-6 months after the virus has entered the body. The routine test (ELISA) detects the antibody to the HIV virus. A positive test means that the person is infected with HIV. A negative test result means that no antibodies were detected at the time of the test. This would mean that either the person is uninfected or is in the window period (The period where the HIV virus is present in the body but antibodies have not developed). If there is a strong suspicion of exposure to the virus, a repeat test may be required after a few weeks to overcome the window period. Confirmation of HIV infection can be done by other tests such as the Western-Blot test. To detect the virus itself, tests such as PCR tests and viral culture are available. These tests are especially useful to diagnose HIV infection in infants as they may have maternal antibodies to the HIV virus in their blood, which may give a false positive ELISA test. These tests can also be used to diagnose HIV infection during the window period.
REMEMBER, A POSITIVE TEST DOES NOT MEAN THE PERSON HAS AIDS. IT INDICATES THAT THE PERSON IS HIV INFECTED.
Is there any treatment for HIV infection and AIDS?
At present, there is no cure for this disease. Certain drugs called antiretroviral drugs (ART) slow down the progression of the disease and can help the patient lead a normal, healthy life. Certain vaccines are being developed against the HIV virus, however, they are still in the trial phase. Thus, the best treatment is prevention against the infection.
What are the precautions that an HIV infected person undertake?
First and foremost, the person suspected to have HIV infection should consult an HIV counselor and an HIV physician to understand the disease, various treatment options available, and to ensure a normal healthy life as long as possible. Such a person should not have casual sex, should not donate blood or organs and in case a female should avoid getting pregnant.
Adults should follow the following precautions:
- Advocate monogamous relationship with one uninfected partner.
- Avoid casual sex and practice safer sex (e.g., use of condoms)
- Do not inject drugs or share needles & syringes
- Receive only safe blood products
- Ensure that ear-piercing; tattooing and acupuncture instruments are sterilized.
To avoid mother to child transmission of HIV following steps have found to be beneficial:
Myths and Misconceptions
HIV in children is not an individual disease but a disease that affects the entire family. With the advent of antiretroviral therapy, pediatric HIV has evolved from a rapidly progressive fatal disease to a chronic infection with prolonged survival. Being a chronic disease, it affects the overall lifestyle, physical, and even social functioning. With the fear of AIDS (acquired immune deficiency syndrome) and social stigmatization; families live in fear, grief, guilt, and depression. Due to misconceptions about transmission and mode of inheritance by the general public, people living with HIV are stigmatised. This attitude needs to be changed. Hence it's very important to understand the correct mode of transmission, precautions while handling biological wastes of HIV positive children and how to enable these children to be active part of society.
Mode of transmission:
- HIV virus is not transmitted through everyday contact. It is not transmitted through sneezing, coughing, hugging, touching, or sharing food.
- HIV is transmitted on contact to body fluids such as blood, seminal secretions only if there is a breach of the mucous membranes and skin. It is not transmitted through saliva, urine, or stools until and unless the child has bleeding in these sites.
- Infected breast milk is another source of transmission in infants.
Waste disposal of an HIV positive child:
- Changing diapers: While changing diapers of an HIV positive child, it is preferable to wash hands with soap and water before and after changing a diaper. Disposable gloves should be used if there is blood in the stool or urine, and if the caretaker has a rash or open cut on the hands. Disposable diapers should be placed in a leak-proof plastic bag and put in the trashcan. Reusable or washable nappies should be washed separately and presoaked with detergent heavily. Bleach should be added to the soiled clothes to inactivate the virus.
- Washing clothes: Clothes of an HIV positive child can be washed with everyone else's clothes. However, if the clothing is soiled by blood, semen, urine, feces, or vomit, it should be washed separately with the addition of bleach to inactivate the virus.
- Body fluid spills: In case of spilling of blood, urine, vomit, stools, bloody saliva of an HIV +ve child, the spills should be cleaned wearing disposable gloves and wiped with disposable rags or paper towels. The surface should be cleaned with a bleach solution (1/4 cup bleach to 2.5 liters of water). The surface should be washed and air-dried. The disposable gloves, rags should be placed in a leak-proof plastic bag and put in the trashcan.
Mealtimes: No eating restrictions are needed for an HIV positive child. The child can eat together with everyone and can be served from a common serving dish. The child should use the same dishes, glasses, spoons & forks every time. The dishes and utensils need not be washed separately. All dishes should be washed in hot, soapy water.
Sharing toys: Toys can be shared as normally as sharing toys does not transmit HIV. However, if a child who is HIV positive has put a toy in his/her mouth, the toy should be thoroughly washed in soap and water before another child plays with it.
Injuries and Accidents:
HIV transmission due to accidents and injuries may occur only if:
- There is a bleeding wound or oozing skin lesion in HIV infected child.
- Presence in a susceptible child of a skin lesion or exposed area that could serve as a portal for systemic entry of the virus.
- Sustained contact between the portal of entry of the susceptible child and infective material. Thus fresh blood to blood transmission is extremely rare.
In the case of cuts and sores in an HIV +ve child, the area should be washed immediately with soap and water. The caretaker should wear disposable gloves and clean the blood spills as discussed earlier. The wound should be immediately cleaned with an antiseptic and closed dressing with gauze and bandage should be done. Waste should be disposed of in a leak-proof plastic bag. Tetanus toxoid and tetanus immune globulin may be administered if vaccination of the child is incomplete.
Sharing information:
Parents are not obligated to tell school authorities or friends about the child's HIV status if they fear discrimination. However, universal precautions have to be advocated.
Disclosure to the children of the nature of their illness is essential. Information given should be according to the child's development level to ensure a child's acceptance of the disease and he/she should follow the precautions to prevent spread to others.
Thus it is important for policymakers to develop health policies that include universal precautions and proper hygiene for all children. These precautions decrease the risk of transmission of not only HIV but also other infections. In fact, the risk for other infections is far greater than that of HIV virus.
Although there is no complete cure available yet but with medicines the virus load can become undetectable. These medicines can also decrease the chances of infection if exposed to HIV as after needle stick injury, babies born to HIV positive mothers.Hence, one should discuss with their healthcare providers in case there is a possibility of risk of HIV exposure. The stigmatization of HIV needs to be ended with proper health education.