AIDS, the medical challenge
The AIDS virus
The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people’s defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient.
Immune function is generally measured in people with HIV according to their CD4 count, which is the number of a particular type of white blood cells found per milliliter of blood. If the count is fewer than 500, the person is considered to have immunodeficiency.
Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems are able to fight off.
The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations.
Signs and symptoms
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months, many are unaware of their status until later stages. During the first few weeks after initial infection, individuals may experience no symptoms at all, or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, an individual can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhea, and a cough. Without treatment, they could also develop severe illnesses such as tuberculosis, cryptococcal meningitis, and cancers such as lymphomas and Kaposi’s sarcoma, among others.
Many of our children have been affected by pulmonary tuberculosis, sometimes in forms resistant to conventional treatments. In December 2015, we detected a case of early stage pulmonary tuberculosis in one of our children, while another child is currently in a critical condition, whose tuberculosis is spreading: first to the abdomen, then the spinal cord, and now the chest.
There is no cure for HIV infection. However, effective antiretroviral drugs (consisting of 3 or more ARV drugs) can control viral replication. Allowing an individual’s immune system to strengthen and regain the capacity to fight off infections, ART helps prevent transmission so that people with HIV, and those at substantial risk, can enjoy healthy and productive lives.
A 2011 trial has confirmed that if an HIV-positive person adheres to an effective ART regimen, then the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%.
In 2015, WHO released a new “Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.” The guidelines recommend that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible.
Based on these new recommendations, to expand ART to all people living with HIV and offer antiretrovirals as an additional prevention choice for people at “substantial” risk, the number of people eligible for antiretroviral treatment increases from 28 million to all 37 million people. Expanding access to treatment is at the heart of a new set of targets for 2020 which aim to end the AIDS epidemic by 2030.
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)
Pre-exposure prophylaxis (PrEP) for HIV can be taken orally by people who are HIV-negative, and consists of taking daily ARVs to prevent the acquisition of HIV. More than 10 randomized controlled trials have demonstrated the efficacy of PrEP in reducing the transmission of HIV in a number of different populations, including serodiscordant heterosexual couples (when one partner is infected and the other is not).
Post-exposure prophylaxis (PEP) is the use of ARV drugs within 72 hours of exposure to HIV in order to prevent infection. PEP includes counselling, first aid care, HIV testing, and administering a 28-day course of ARV drugs with follow-up care.
Elimination of mother-to-child transmission of HIV (EMTCT)
The transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding is called vertical or mother-to-child transmission (MTCT).
In the absence of any interventions during these stages, rates of HIV transmission from mother-to-child can be between 15-45%. Without treatment, around 15-30% of babies born to HIV-positive women will become infected with HIV during pregnancy and delivery. A further 10-20% will become infected through breastfeeding.
WHO recommends options for prevention of MTCT (PMTCT), which includes providing ARVs to mothers and infants during pregnancy, labor and the post-natal period, and offering life-long treatment to HIV-positive pregnant women regardless of their CD4 count.