Hiv

The infection is caused by a human retrovirus, consisting of ribonucleic acid (RNA). Humans are the only known species affected by HIV-1.
Based on HIV sequences, HIV-1 is the one causing most patients, while HIV-2, whose DNA has 40-60% homology with HIV-1 DNA, is common in West Africa.
Humans are not the only animals to be infected with the immunodeficiency virus: chimpanzees and cats are equally affected by the retroviruses called SIV and FIV, of which the former is the progenitor of HIV-1 and HIV-2.

HIV is usually found in pre-ejaculatory fluid, semen, vaginal secretions, breast milk and, of course, blood.
One can come in contact with infected blood through the exchange of contaminated syringes, through the promiscuous use of scissors, toothbrushes or razors, and also through tools used for tattoos that have not undergone optimal sterilization.
Sexually, transmission can occur during vaginal, oral or anal intercourse between a positive person and a healthy one. In these cases, the risk is aggravated by blood presence (menstrual cycle, gum bleeding, or blood loss from anal trauma).
During pregnancy, childbirth, and natural lactation, direct transfer of infection from mother to child takes place.
The use of toilets, gyms or showers shared by several people, the promiscuous use of glasses and cutlery are excluded from the infectious agents. Saliva, sneezing, coughing, kidney excretions and fecal material do not carry HIV infection, much less handshakes and kissing.

On the European continent, HIV incidence is divided into three ranges: high, intermediate, and low. The average incidence is near 30 percent, and the most affected countries are Poland, Latvia and the Netherlands around 40-50 percent. Those with low incidence are Denmark and Switzerland, while Italy has intermediate incidence as do France, the United Kingdom and Germany around 25 percent.According to 2011 data, 75 percent of cases are found in men with an incidence rate of 6 cases per 100,000 residents. Eighty percent of positives are due to sexual intercourse, with the average age of the infected being 38 for men and 34 for women. One-third of all cases are among immigrant foreigners who then receive a late diagnosis.

An important feature of AIDS is the asymptomatic nature of the HIV-positive individual, especially in the early period after infection. Nonspecific symptoms may alternately occur, such as loss of appetite, nausea, pain along the colon with diarrhea, joint pain, sweating, fever, and lymph nodes that increase in volume. These glands may be affected by noticeable swellings, reaching more than a centimeter in diameter, in extra inguinal sites. Still other symptoms such as fatigue, weight loss, mucosal and skin objectification such as an imposing DS (seborrheic dermatitis), precancerous lesions (oral villous leukoplakia), candidiasis of the oral cavity, Kaposi's sarcoma, and genito-anal condylomata make this early stage characterized by varied symptomatology. Opportunistic infections such as Pneumocystis jirovecii (formerly Pneumocystis Carinii) pneumonia and associated diseases may then incur: hepatitis B and C, syphilis etc.

Infection can be confirmed by blood tests for the detection of specific antibodies, such as:

• Elisa test (enzyme immunoassay) which detects antibodies targeted for HIV and if positive must be confirmed by other test (Western Blot).
• Test for p24 antigen in blood indicates infection in the first weeks after exposure to the virus, before even antibody production (average 16 days after infection then ELISA test after 3 months).
• Fourth generation serologic test (Combo test) simultaneously searches for HIV antibodies and p24 antigen (the viral protein).
• Nucleic Acid Test (NAT) test for the presence of HIV-RNA genetic/viral material in the blood.
• Rapid HIV testing

Today, rapid tests on saliva or blood are available as an alternative to traditional tests. Such tests are capable of detecting the presence of HIV antibodies, have an appreciable level of sensitivity and specificity, and can be performed even in the absence of trained health care personnel. Rapid tests are an aid in early detection of the virus: they can be purchased in pharmacies and can be performed on their own by carefully following the recommendations attached to the kit. However, they are not considered diagnostic and in case of positivity still require confirmation through traditional laboratory testing. Rapid kits are immunochromatographic tests for qualitative detection of HIV type 1, type 2, and subtype 0 antibodies in whole blood, serum, or plasma by drawing from the fingertip of the hand. The blood sample (whole blood, serum or plasma) reacts with particles coated with HIV antigen (recombinant) in the test line. If the sample contains antibodies to HIV-1 and/or subtype 0 or HIV-2, a colored line appears in the area of the test line. If, on the other hand, the sample does not contain antibodies, no line appears and therefore the result is negative. This self-test is reliable for determining HIV infections that have developed in at least the three months prior to testing (window period). It does not detect recent infections and its qualitative nature cannot give quantitative news nor the increase of antibodies. One can perform this type of test if one has occasional intercourse on a periodic basis, all the more so if such intercourse is numerous.

Current antiretroviral therapy suppresses HIV replication, preserves or restores CD4 cell counts (a type of white blood cell) and immune function, reduces morbidity and mortality, and prolongs survival based on that of the general population. Current treatment guidelines worldwide recommend initiating therapy for anyone infected with the virus, regardless of previous disease, symptoms, signs, HIV RNA levels, or on CD4 cell counts. Current first-line therapeutic regimens consist of three antiretroviral drugs, often formulated as a single solution, allowing an oral treatment regimen in a single daily pill. These regimens (called HAART, Highly Active Antiretroviral Therapy) result in virologic suppression for more than 80 percent of HIV-infected patients. Virus-specific enzymes required for multiplication in target cells (CD4+ lymphocytes) such as integrase, reverse transcriptase, protease are blocked by drugs such as:

• Inhibitors of integrase (enzyme for integration of the virus genome within human cell DNA).
• Reverse transcriptase inhibitors.
• Protease inhibitors (enzyme that can break down proteins).
• Fusion inhibitors (which stop the virus from entering CD4+).

These drugs should be used together with multiple antiretrovirals. Therapy cannot eliminate the virus from the body because the virus remains in infected cells. However, the goal of HAART is to block the multiplication of the virus, thus preventing the progression of the infection.

Risky sexual behavior should be avoided, especially if it involves a large number of partners of unknown health status. Exchange of syringes, shared use of toothbrushes, scissors, and razors, and general contact with infected blood should be avoided. The use of condoms reduces the risk of infection. Substantial progress has also been made in developing strategies to prevent HIV transmission and acquisition. In 2016, the United Nations General Assembly agreed that rapid action is needed to eliminate AIDS by 2030 and reduce new HIV infections to less than 500,000 cases per year by 2020 worldwide. The answer is primarily through continued progress toward the 90-90-90 target: that is, by 2020,

• 90% of all people living with HIV will know their HIV status,
• 90% of those diagnosed will receive antiretroviral therapy
• 90% Will have viral suppression through therapeutic treatments

PrEP
Pre-Exposure Prophylaxis (PREP) is a new biomedical HIV prevention intervention that involves the use of daily (or sporadic) antiretroviral drugs to reduce the risk of HIV acquisition in the event of exposure. This type of prophylaxis involves the combination of two drugs and has been shown to be effective in preventing the transmission of HIV infection. As early as the mid-1990s, it has been shown that prophylaxis with antiretrovirals during pregnancy can effectively reduce the risk of maternal-fetal transmission, now estimated at less than 1 percent in the presence of appropriate treatment of the pregnant woman.