How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent Hiv Transmission To A Baby During Breastfeeding
Without HIV treatment, the risk for HIV transmission through breastfeeding is estimated to be roughly 15%. The rates of HIV transmission through breastfeeding for people who are taking HIV treatment are much lower. A systematic review of HIV transmission in breastfed infants of cisgender women on treatment found that the risk of transmission after birth was 1% after six months of breastfeeding, rising to almost 3% after one year. However, in these studies, the women were on treatment for varying amounts of time and did not continue treatment beyond six months after giving birth. The systematic review did not account for adherence or for viral load, which means that even though the women were taking HIV treatment we do not know how many of them had a detectable viral load at the time of transmission.
There is very limited research on the impact of treatment and an undetectable viral load on HIV transmission during breastfeeding. A study in Tanzania between 2013 and 2016 found two HIV transmissions among 177 infants who were breastfed by cisgender women who started treatment before the infant was born. However, in both cases the women had a detectable viral load. No transmissions occurred in the context of treatment and an undetectable viral load.
Highly Active Antiretroviral Therapy
In 1996, highly active antiretroviral therapy was introduced for people with HIV and AIDS. HAART â often referred to as the anti-HIV “cocktail” â is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests.
One Mans Cure Gave Hope
Only one person is known to have been cured of HIV infection, a man who had a cell transplant a decade ago from a donor with natural immunity to the virus. The donor lacked a common gene that makes an entryway HIV uses to infect T cells, immune system soldiers in the blood.
The transplant gave the recipient that protection, but procedures like that are too risky and impractical for wide use. Scientists have been trying to find a way to create similar immunity by altering some of a patients own cells. They use a gene editing tool called zinc finger nucleases, which cut DNA at a precise spot to disable the HIV entryway gene.
The California company that makes the editing tool, Sangamo Therapeutics, sponsored the initial studies.
It worked, the T cells were edited, said Sangamos president, Dr. Sandy Macrae. But it didnt work quite well enough: The altered T cells were outnumbered by T cells that were not altered and could still be infected.
Now, Dr. John Zaia at City of Hope, a research center in Duarte, California, is trying the approach with a twist. Hes using blood stem cells parent cells that produce many others. Once a stem cell is altered the benefit should multiply and last longer, Zaia said.
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What Is Involved In The Consistent And Correct Use Of Hiv Treatment To Maintain An Undetectable Viral Load For Hiv Prevention
The consistent and correct use of HIV treatment to maintain an undetectable viral load includes:
- high adherence to medications, to achieve and maintain an undetectable viral load
- regular medical appointments to monitor viral load and receive adherence support, if needed
Regular testing and treatment for sexually transmitted infections is also important because HIV treatment does not protect against STIs.
A person on HIV treatment needs to work with their doctor to determine an appropriate schedule for medical checkups and viral load monitoring.
Growing Older With Hiv
Today, thanks to improvements in the effectiveness of treatment with HIV medicine , people with HIV who are diagnosed early and who get and stay on ART can keep the virus suppressed and live long and healthy lives. For this reason, nearly half of people living with diagnosed HIV in the United States are aged 50 and older. Many of them have been living with HIV for many years others were diagnosed with HIV later in life.
Thats a significant change from the early years of the epidemic when people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after their diagnosis. This meant that the issues of aging were not a major focus for people with HIV disease.
According to the Centers for Disease Control and Prevention , in 2018, over half of people in the United States and dependent areas with diagnosed HIV were aged 50 and older. In addition, people aged 50 and older accounted for 17% of the 37,968 new HIV diagnoses in 2018 in the United States and dependent areas. Though new HIV diagnoses are declining among people aged 50 and older, around 1 in 6 HIV diagnoses in 2018 were in this group.
People over age 50 with HIV make up 46.8% of the over half a million clients served by the Ryan White HIV/AIDS Program . In 2019, 92.2% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average .
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Stage : Acute Hiv Infection
After a person comes into contact with HIV, the virus replicates quickly, and the blood contains high levels of the virus. At this time, it can easily transmit to others through blood, semen and preseminal fluids, rectal fluid, vaginal fluid, and breast milk.
Within 24 weeks of exposure to the virus, some people develop a nonspecific syndrome with a fever and other flu-like symptoms. This may last for several days or weeks.
Not everyone experiences these symptoms, however. If a person does not undergo testing, it is possible for HIV to progress without any indication that it is in the body.
The flu-like symptoms of a stage 1 HIV infection may include:
- swollen glands
- nausea or vomiting
These symptoms are collectively known as a seroconversion illness. They represent the bodys natural response to an infection as it attempts to kill off the virus. However, the human body cannot completely remove this virus once it is present.
At this stage, the virus replicates using the bodys CD4 T cells and spreads throughout the body. In doing so, it destroys CD4 T cells.
Eventually, this process stabilizes. The immune system reduces the number of viral particles, and levels of CD4 T cells may rise. However, the number of these cells may not return to its original level.
What Happens If I Delay Starting Hiv Treatment
In the past people could delay treatment if they werent ready to start. However, this isnt recommended now. If you have HIV, the sooner you start treatment, the better it is for your health.
The START trial found that there was a 53% reduction in the risk of death or serious illness if treatment was started when the CD4 count was still above 500.
Its common for people to feel apprehensive about taking treatment but all you need to remember is that:
- It will enable you to live a normal lifespan.
- When you’re on effective treatment you won’t be able to pass on HIV.
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It’s Time To Change Our Attitudes About Hiv/aids
As we approach World AIDS Day on December 1, the world will take time to reflect on the most misunderstood sexually transmitted infection. Though the virus itself hasn’t changed in the last 30 years, the reality for people who contract the virus in the developed world is drastically different now than it was in decades past. In the 1980s, HIV infection was considered by most to be a death sentence and sex education drew heavily on fear around HIV infection as a way to promote safer sex.
However, in the last few decades the reality for those able to afford treatment has shifted drastically. Newer, more effective treatments are now available that can help people who are HIV positive live unencumbered by HIV for just as long as they would have otherwise.
Some 15.8 million people are now on HIV treatment and a five-year strategy to end the threat of a never-ending AIDS pandemic is starting to show results. These insights have led to the “fast-track” approach to ending the epidemic, which includes the 90-90-90 targets for 2020: 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90 per cent of all people receiving ART will have viral suppression. Additionally, Truvada, a drug that can be taken by the non-infected as a guard against infection, is available for people who have an HIV positive partner or want to be extra careful.
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Where Did Aids Come From
Scientists have traced the origin of HIV back to chimpanzees and simian immunodeficiency virus , an HIV-like virus that attacks the immune system of monkeys and apes.
In 1999, researchers identified a strain of chimpanzee SIV called SIVcpz, which was nearly identical to HIV. Chimps, the scientist later discovered, hunt and eat two smaller species of monkeysred-capped mangabeys and greater spot-nosed monkeysthat carry and infect the chimps with two strains of SIV. These two strains likely combined to form SIVcpz, which can spread between chimpanzees and humans.
SIVcpz likely jumped to humans when hunters in Africa ate infected chimps, or the chimps infected blood got into the cuts or wounds of hunters. Researchers believe the first transmission of SIV to HIV in humans that then led to the global pandemic occurred in 1920 in Kinshasa, the capital and largest city in the Democratic Republic of Congo.
The virus spread may have spread from Kinshasa along infrastructure routes via migrants and the sex trade.
In the 1960s, HIV spread from Africa to Haiti and the Caribbean when Haitian professionals in the colonial Democratic Republic of Congo returned home. The virus then moved from the Caribbean to New York City around 1970 and then to San Francisco later in the decade.
International travel from the United States helped the virus spread across the rest of the globe.
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Hiv Treatment As Prevention
Treatment as prevention refers to taking HIV medication to prevent the sexual transmission of HIV. It is one of the highly effective options for preventing HIV transmission. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
TasP works when a person living with HIV takes HIV medication exactly as prescribed and has regular follow-up care, including regular viral load tests to ensure their viral load stays undetectable.
Having A Diagnosis Of Aids
Acquired immune deficiency syndrome is the name used to describe a range of illnesses which can develop when someones immune system has been significantly weakened by HIV.
Depending on where you live, the way an AIDS diagnosis is given will vary. In some countries, someone will be given an AIDS diagnosis if they develop an AIDS-related illness. In others you will be given an AIDS diagnosis if your CD4 count is below 200.
Being diagnosed with AIDS does not mean that your health will continue to deteriorate. Many people diagnosed with AIDS have become healthy again, with good treatment and care.
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What Is Viral Suppression
Antiretroviral therapy keeps HIV from making copies of itself. When a person living with HIV begins an antiretroviral treatment regimen, their viral load drops. For almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less. Continuing to take HIV medications as directed is imperative to stay undetectable.
How Are Hiv And Aids Treated
The most effective treatment for HIV is antiretroviral therapy . This is a combination of several medicines that aims to control the amount of virus in your body. Antiretroviral medicines slow the rate at which the virus grows. Taking these medicines can reduce the amount of virus in your body and help you stay healthy.
After you start treatment, it’s important to take your medicines exactly as your doctor tells you. When treatment doesn’t work, it is often because HIV has become resistant to the medicine. This can happen if you don’t take your medicines correctly.
Other steps you can take include the following:
- Keep your immune system strong by eating right, quitting smoking, and learning how to avoid infection.
- Monitor your CD4+ counts to check the effect of the virus on your immune system.
- See a counselor to help you handle the strong emotions and stress that can follow an HIV diagnosis.
- Reduce stress so that you can better manage the HIV illness.
Starting treatment
Medical experts recommend that people begin treatment for HIV as soon as they know that they are infected. Treatment is especially important for pregnant women, people who have other infections , and people who have symptoms of AIDS.
Research suggests that treatment of early HIV with antiretroviral medicines has long-term benefits, such as a stronger immune system.
Treatment to prevent HIV infection
Other treatments for HIV
Treatment for AIDS
Living with HIV
If your partner has HIV:
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What Is The Difference Between Hiv And Aids
HIV is a potentially deadly virus that attacks the bodys immune system, specifically the T cell lymphocytes or CD4 cells. AIDS is a collection of symptoms and illnesses that can develop when HIV goes untreated and the CD4 cell count drops below 200.
There are four stages of HIV . People are diagnosed as having AIDS when their HIV is classifiedor if it has ever been classifiedas Stage 3, when people experience such symptoms as rapid weight loss, recurring fever or night sweats, body sores, memory loss, and fatal infections.
It first came to attention in the early 1980s when doctors started reporting unusual infections and rare malignancies in gay men. HIV is believed to have transferred from animals to humans possibly as far back as the late 1800s from a type of chimpanzee in Africa. This likely occurred when hunters looking for meat came in contact with infected blood from the animal. HIV is transmitted between humans through bodily fluids, specifically blood, semen, vaginal secretion, and breast milk.
Ways Hiv Cannot Be Spread
HIV is not spread by:
- Air or water
- Mosquitoes, ticks or other insects
- Saliva, tears, or sweat that is not mixed with the blood of a person with HIV
- Shaking hands hugging sharing toilets sharing dishes, silverware, or drinking glasses or engaging in closed-mouth or social kissing with a person with HIV
- Drinking fountains
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The Immune System And Hiv
The immune system’s different cells work together to protect the body against pathogens such as viruses and bacteria.
The human immunodeficiency virus mainly infects the CD4 cells in the immune system. Over years of untreated HIV infection, CD4 cell numbers usually drop gradually, but constantly, and the immune system is weakened. If nothing is done to slow or halt this destruction, it becomes unable to fight infections and you become ill.
Antiretroviral drugs interrupt this process. The aim of treatment is to reduce levels of HIV in your body , so your CD4 count increases and your bodys ability to fight infections improves.
Will There Ever Be A Cure For Hiv
Researchers and scientists believe we can find a cure for HIV. We know a lot about HIV, as much as certain cancers. Scientists are researching two types of cure: a functional cure and a sterilising cure.
There is no ‘natural cure’ or ‘herbal cure’ for HIV. Antiretroviral treatment is the only medication that is proven to effectively control HIV.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthDepartment of Health and Human ServicesBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Understanding Hiv And Aids
Generally speaking, the time it takes to go from HIV infection to AIDS is around five to 10 years if no medical intervention is made. Differences in time can be due to any number of factors, including:
- The genetic strain of HIV a person has been infected with
- The general health of the individual
- The place where the person lives
- A person’s genetics or family history
- Smoking and other personal lifestyle choices
This is, of course, if the person receives no treatment. The picture changes entirely if he or she does.
Since 1996, the introduction of antiretroviral drugs has dramatically altered the natural progression of HIV infection. While HIV still cannot be cured, people newly diagnosed with HIV who get treated and stay in care can be expected to have near-normal to normal life expectancies. As with other chronic diseases, early detection is key to identifying and treating the infection as soon as possible.
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