I had a real problem writing this text. When I wrote about vaginal infections, I could assume with a great deal of certainty that most of you have had or will have a problem with them at least once. When I talked about cytology, I knew that each of you had already had it done or at least planned to. When I guided you through your first visit to the gynecologist, I knew that every girl simply had to experience it. The topic of HIV ( Human Immunodeficiency Virus ) and AIDS ( Acquired Immunodeficiency Syndrome ) is not that close to us. Most of us will never come into contact with it and will not even know a person infected with it. And yet it is an important topic, because it is a human virus. And we must not only be aware of its existence and the threat it poses to our health, but also know enough about it not to marginalize people infected with it. How to balance the topic so as not to bore you with the virus's replication cycle, while at the same time conveying the most important content? I hope that I will at least partially succeed and maybe start from the basics. In this text I will use various terms that may be understandable to some of you, but I will allow myself to write a little about them. Viremia is nothing more than the presence of the virus in the blood or other secretions of our body (I will write about which ones it is in and which are safe later). The level of viremia affects the infectiousness of the virus, i.e. how many people an infected person can infect. I hope the rest will be clear, and if not - I invite you to use the sources below the text ;)
HIV is a virus that eventually leads to AIDS - Acquired Immune Deficiency Syndrome. You can be infected with the virus and not have AIDS. The stages of HIV infection are divided into:
- a) primary HIV infection, i.e. from the entry of the virus to the production of anti-HIV antibodies by the body (the first after 3-4 weeks, some up to half a year),
- b) chronic HIV infection,
- c) symptomatic phase (AIDS) its occurrence is caused by a significant decrease in immune cells in our body.
In the primary infection, an acute retroviral disease very often occurs, which is no different in its course from the flu or cold. Fever, malaise, or muscle and joint pain are rather symptoms that everyone knows well. Then we go into an asymptomatic period, which lasts for years, depending on how hard our body defends itself. When the number of our immune cells (specifically CD4+ lymphocytes) drops significantly, we enter the symptomatic phase, i.e. AIDS. As the name suggests, it is a syndrome encompassing numerous diseases, from which so-called indicator diseases (highly characteristic of AIDS) have been distinguished:
- cancers (Kaposi's sarcoma, lymphomas, cervical cancer)
- opportunistic infections (including candidiasis, PCP, tuberculosis, toxoplasmosis, cytomegalovirus...)
- disease syndromes (encephalopathy, cachexia).
Of course, this is just the tip of the iceberg, because in AIDS we are dealing with a lack of immunity in the body, which does not have the strength to defend itself against external factors, and therefore infected people not only suffer from diseases that are extremely rare in the healthy population, but also become infected with other infectious agents with incredible ease.
HIV infection was first described in the early 1980s, and unfortunately, homosexual relations between men were initially notorious, because the first wave of the epidemic spread mainly among them, which also affected drug addicts who shared needles. Today we know that the virus spreads through blood (sexual intercourse, intrauterine from mother to fetus, during childbirth, transfusions), semen ( including pre-ejaculate !), vaginal secretions, breast milk, body cavity fluids (e.g. peritoneal fluid). The situation is different with saliva (I wrote about this in the text on sexually transmitted diseases ), sweat, urine, feces, vomit and tears, which are not considered infectious material. Since we live in the 21st century, I think there is no need to explain to anyone that you can safely eat meals or cuddle with an HIV-infected person.
The most dangerous form of intercourse in the context of HIV is anal intercourse. And of course it doesn't matter whether it's same-sex or heterosexual intercourse, it's just that the walls of the rectum have almost no natural lubrication, are delicate and more susceptible to damage, and therefore contact with blood. The vagina is an organ with a much thicker wall, which is why vaginal intercourse is safer. Unfortunately, if we're talking about the vagina, it's impossible not to mention that in heterosexual intercourse, women are more susceptible to HIV from men than the other way around. What's the cause? A larger surface area through which the virus can enter the body (vagina and cervix), while men only have a small fragment of mucous membrane on the penis. A larger surface area of penetration also means a larger area that is susceptible to injury, and additionally, semen stays in the vagina longer, which gives them more time to be exposed to the virus. And men? You just go to the bathroom to wash up. Sperm is also more contagious than vaginal secretions (sources below). What about oral sex? It carries the least risk, but it is still not completely free from it. Infection is facilitated by micro-wounds in the mouth and contact of sperm with mucous membrane. What does this mean? That love is love, but you always have to protect yourself, unless you have a negative partner result in black and white.
Of course, the ideal option is to get tested before starting sex (this is possible free of charge at Consultation and Diagnostic Points, the addresses of which you will find below the text). Often, however, in a situation of sexual and love tension, we do not have the head to think about visiting a laboratory, which is why it is important to use condoms :) Of course, this does not give us 100% certainty (like nothing in our lives), but it significantly reduces the probability of transmitting the virus.
The next question is: when and how to do the test if we had risky sex or were otherwise exposed to the virus? Should we run to the lab the next day and be sure whether we are positive or negative? Unfortunately, it is not like that. First, we should do a screening test, which most often detects the presence of anti-HIV antibodies in our blood. Although they can be produced in the body earlier, a negative test is considered to be a negative test performed 12 weeks after the risky situation occurred. We will have to repeat the previously performed tests to confirm their negativity. However, if the screening test is positive, it is not 100% certain that we are infected. Such a result requires a confirmation test using the Western blot method. Only a positive result of this second test confirms HIV infection.
Infection has occurred... and what next? Since 1996, we have developed a therapy called HAART ( Highly Active Antiretroviral Therapy ), the aim of which is to stop the virus from multiplying in the body, but so far only individual cases of recovery have been recorded in the world (the Berlin and London patients, whose stories you can read in the link below). HAART consists of a combination of at least three antiretroviral drugs selected according to one of the schemes. Unfortunately, only half of the infected receive treatment. This is mainly due to the fact that the majority of patients live in Africa (approx. 70%), and unfortunately we all know what the conditions of treatment are on this continent... It is comforting that in the case of treatment, AIDS is another disease that is starting to be considered a chronic disease in our times. The condition is to take medication (preferably from the asymptomatic period - therefore it is reasonable to perform tests). Poland is one of the countries with the lowest HIV infection rate. Data as of 30.09.2019 show that in Poland, since 1985, 25,020 people have been infected, of whom 3,741 have been diagnosed with AIDS. Since the beginning of the epidemic, 1,424 people have died in Poland. Currently, almost 13,000 people are receiving treatment (including 97 children). Another advantage is the fact that we are among the countries where HAART therapy is reimbursed.
It is worth mentioning that being infected with HIV does not mean that a woman cannot give birth to and raise a healthy child. Recently, treatment for women has developed significantly, which aims to prevent transmission of the virus from mother to child, which is why a woman is tested for the presence of anti-HIV antibodies at the first visit to the pregnancy.
There is another option for taking medications, not reimbursed, but effective. It is precisely about pre -exposure prophylaxis (PrEP ). It consists of administering antiretroviral medications (usually two combined in one preparation) to people with a high probability of infection. Of course, we must first exclude the possibility of being infected with HIV. According to the guidelines of the Polish AIDS Scientific Society from 2018, the indications include sexual contact without a condom with potentially infected people, having an STD in the last year, providing sexual services or intravenous drug use. In a word, if there are risky situations - we always have an additional possibility of protection. One tablet is taken orally every day. Protection for anal intercourse is achieved after 7 days, while for vaginal intercourse and intravenous drug use after 20 days. A doctor's qualification is required for the therapy and additionally, throughout the period of taking medications, we are monitored after a month, and then no less than every 3 months. We continue as long as we are exposed to an increased risk of infection.
The next point I wanted to mention is PEP, or post-exposure prophylaxis. We have 48 hours to implement it after a risky situation (e.g. unprotected intercourse, a torn condom, or an injury with a needle of unknown origin), while high-risk exposure allows us to extend this time to 72 hours. Treatment also involves administering antiretroviral drugs, we have a set time for this - 28 days. At the end of the text, I am including a link to the PTN AIDS guidelines, if any of you would like to expand your knowledge on this subject.
World AIDS Day is held annually on December 1. If you are a teacher or a social activist, there are many information materials and leaflets on the websites I have provided below. Let's contribute to the fact that HIV-infected people are not stigmatized in our society. I deeply believe that knowledge and awareness can destroy prejudice. Because caution does not mean rejection.
If you want to know where HIV came from: [LINK]
A website with educational materials and addresses where you can take the tests for free and anonymously: [LINK]
Report on the analysis of surveys completed in PKD in 2013: [LINK]
Guidelines of the Polish AIDS Scientific Society [LINK]
Information for pregnant women infected with HIV [LINK]
The Berlin Patient [LINK 1] [LINK 2]
The London Patient[LINK]
World AIDS Day [LINK]
- 1. Greene W. C. (2007). A history of AIDS: looking back to see ahead. European journal of immunology , 37 Suppl 1, pp. 94–102. [LINK]
- 2. Kahn, J. O., Walker, B. D. (1998). Acute human immunodeficiency virus type 1 infection. The New England journal of medicine , 339(1), pp. 33–39.
- 3. Swaminathan, N. (2007), Male semen makes HIV more potent. Scientific American. https://www.scientificamerican.com/article/male-semen-makes-hiv-more-potent/
- 4. Vernazza, P. L. (2005). HIV in semen: Still more to be learned. AIDS Res Ther, 2, 11. [LINK]
Created at: 13/08/2022
Updated at: 13/08/2022
