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The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: “Why not self-medicate?”. The human immunodeficiency virus (HIV) is a slowly progressive infectious disease that affects the immune system. The pathogen destroys and weakens the function of immune cells that have specific receptors (CD4+). As a result, the body’s ability to resist primarily infectious diseases and oncological pathologies is slowly decreasing. The disease proceeds in several stages, the most recent being acquired immunodeficiency syndrome (AIDS). The lethal outcome often comes from secondary opportunistic diseases that the body is unable to fight. There are no specific drugs for the treatment of HIV infection, but with timely and high-quality  antiretroviral therapy the life of the patient is extended to 70-80 years.

Myth or Reality

An outbreak of an unknown disease was registered for the first time in the United States of America over 40 years ago. Reports accumulated in the scientific literature that young and healthy people were dying from absolutely banal infections. In 1981, the US Centers for Disease Control and Prevention first reported an unknown disease among men of non-traditional sexual orientation, which was defined as “cancer of the homosexuals.” But over time, it became clear that the same symptoms are common among drug addicts and sex workers.

Until 1981, immune deficiency was considered as a congenital pathology in premature babies and newborns in dysfunctional families. But in the case of homosexuals and sex workers, the symptom was acquired. The first attempts to find out the etiology and origin of the pathogen led scientists to Haiti, and from there to central Africa.

In 1985, it became clear that the infection was transmitted through body fluids. The first HIV test was also created. Soon, a team of scientists from Oxford University began to create a “family tree” of the virus. Samples were taken selectively from 800 patients to determine the genotype of the virus, which mutates, adapting to living conditions. Thus, based on the assessment of mutations, it is possible to determine when genomic sequences had a common ancestor.

Using the example of mutations in the body of all primates, it was found that the common ancestor of chimpanzees and humans existed 7 million years ago. However, when studying HIV, it turned out that the virus mutates so quickly that the primary genome appeared no more than 100 years ago. Prior to this, monkeys carried a different kind of retrovirus, similar to HIV. Similar viral particles have been found in other mammals, but they are safe for humans. Obviously, for a sharp outbreak of the “plague of the XNUMXst century”, close interaction between apes and humans was required.

An Oxford team led by Nuno Faria has identified the location of the start of the pandemic by compiling a “genetic tree” of the virus. In the 1920s, the city of Leopoldville (today Kinshasa) became the capital of the Congo. Then it was a Belgian colony, and today the country has the status of a Democratic Republic. From here, according to scientists, the virus began to spread among people. Presumably: the local population ate the meat of infected monkeys.

The new capital was closely connected with other African countries and cities thanks to the railroad. It concentrated cheap labor and workers of the “most ancient profession”. By the 1960s, the infection had spread far beyond Kinshasa. In the same period, workers from Haiti began to come to the country. Returning home, they brought home a new disease. It is assumed that the infection came to America thanks to tourists and guest workers.

HIV hit the American continent at the “right” time. In the 1970s, the country was engulfed in a sexual revolution, New York and San Francisco became a mecca for homosexuals. Here, scientists sounded the alarm about an unknown disease. In parallel, the virus spread from Africa to other regions and remains a major public health problem worldwide. According to WHO statistics 75,7 [55,9–100] million people have become infected with HIV since the beginning of the epidemic, (2019) – 32,7 [24,8–42,2] million people have died from AIDS-related diseases since the beginning of the epidemic . (2019)

HIV in the environment

The rapid increase in the incidence and the lack of a cure have created a lot of misconceptions around HIV. Despite mass informing the population, many still do not know anything about the causative agent of the infection. The immunodeficiency virus can only live long in the human body. In the external environment, it dies under normal conditions for a period of several minutes to several hours. The higher the temperature, the faster the pathogen is destroyed.

Virus dies:

1. From ultraviolet radiation, including from exposure to sunlight.
2. In alkaline and acidic environments: at pH values ​​above 8 or below 7, the virus dies faster than in a normal environment. Therefore, healthy women are less likely to become infected, since the natural microflora of the genital organs is characterized by increased acidity. For the same reason, the pathogen is almost instantly destroyed in alkaline environments.
3. From high temperatures. On the surface of objects at moderate temperatures, HIV can live up to 2 hours. However, when heated above 60 degrees, it dies in 1-2 minutes. When boiling – instantly.
4. When disinfecting. The pathogen does not withstand the action of chlorine and disinfectants containing it, the most popular of which is household “Whiteness”. The same action causes 6% hydrogen peroxide, kills the pathogen and 70% ethyl alcohol. At the same time, alcohol solutions, such as vodka, are ineffective due to their low concentration. Mixtures with an alcohol content of more than 70% have a tanning, rather than a disinfecting property.

For the longest time, HIV retains its ability to infect in biological fluids, in particular, a dried drop of blood contains an active virus for 3-4 days under normal conditions. Other fluids on objects can keep the infection for 2-3 days. The lower the ambient temperature, the longer the virus persists. microorganism. Saliva contains too little of the pathogen and is quickly neutralized outside the body, so it cannot be a source of infection.

The skin is a natural barrier to HIV. If blood or other liquid gets on an undamaged part of the body, a person does not become infected from this. The risk of infection increases if the pathogen enters the open wound surface. Since the virus does not spread in the external environment and quickly dies, the disease is not transmitted by household means. Not a single case of infection through the shared use of the bathroom, toilet, dishes has been registered.

It is also impossible to get infected through handshakes and hugs. The risk of transmitting the virus through saliva is negligible. This situation can be realized with very close contact with an HIV carrier, who must have a large viral load (the amount of virus in the blood).

Virus classification

In the course of studying the origin of the epidemic, it turned out that HIV is caused by several types of pathogen. All of them belong to lentiviruses, which in Latin means “slow”. They got this name because of the long period of development of the infection. In the body, HIV reproduces itself, while it is characterized by a high mutation rate. It turned out that each virus differs in structure from its predecessor by at least one nucleotide.

Research has shown that there are several varieties of HIV. Today, two main types of pathogens have been identified – HIV-1 and HIV-2 (in the English abbreviation – SIV-1 and SIV-2). Both lead to a gradual decrease in immunity, but SIV-2 is less pathogenic, characterized by a lower titer of viral particles in the blood, so it is transmitted less often and does not lead to AIDS as often.

HIV-1 is most prevalent among key populations, having spread from Africa to Haiti and other continents. Usually, when talking about HIV infection, they mean its mutated subspecies, which lead to the same consequences, but differ in the structure of the genome.

In addition to the SIV-1 family, the symptoms of infection are caused by another group of pathogens, which is called SIV-2 (HIV-2). It differs in that it is closer in structure to mangabey primates, and less to HIV-1. It also includes subgroups, among which there are two main ones – A and B. They are more common in Africa and Asia, very rare in Europe and America.

What is dangerous infection

The disease is dangerous, first of all, for the infected. Once in the blood, the pathogen gradually destroys the cells of the immune system. This process can be slowed down with antiretroviral therapy, but cannot be completely stopped. As a result, the body cannot resist external infections. Various bacteria and fungi are found in every body, such as candida. They do not multiply and do not lead to diseases due to strong immunity. In an HIV-positive person, the body cannot control the vital activity of such microorganisms.

Most often, patients develop thrush, stomatitis, prolonged diarrhea, frequent acute respiratory viral infections, etc. The longer the pathogen is in the human body, the more it multiplies and reduces the number of immune cells.

With the progress of the disease, secondary pathologies such as:

• tuberculosis;
• oncological diseases;
• lesions of the peripheral nervous system;
• Kaposi’s sarcoma, etc.

The infection can manifest itself in all organs and systems, often the lesion becomes systemic. With appropriate treatment of associated exacerbated conditions, an acceptable standard of living can be maintained for the patient. The main danger of immunodeficiency is AIDS, as the last stage of the disease. In the terminal phase, severe secondary diseases become irreversible, the average life expectancy at this stage is up to 9 months. Although with a positive psychological state and proper therapy, a longer life expectancy of the patient is possible.

The asymptomatic stage of HIV is dangerous for the patient and for others. An infected person does not receive the right treatment on time, which reduces the chances of future effectiveness of therapy. Also, out of ignorance, the infection can be transmitted to other people through unprotected intercourse. Public awareness has worked well, reducing new HIV infections by 2000% between 2019 and 39, reducing HIV-related deaths by 51%, and 15,3 million lives saved through ART.

HIV testing detects the presence of antibodies in the blood. They are produced in the period from 3 weeks to 3 months after the pathogen enters the bloodstream. Although, against the background of initially poor health, antibodies may not be detected within a year. Due to the long asymptomatic period, a myth has appeared that HIV may not be detected in the test until 10 years, here we can most likely talk about a latent long period of the course of the disease. But the antibodies that detect the infection appear in the body, as a rule, already within six months. Therefore, it is recommended to take tests at least 2 times a year, even for married couples.

Causes and ways of infection

Viral immunodeficiency has assumed the proportions of a world epidemic, and at first due to lack of information and a “fortunate” set of circumstances such as the sexual revolution. But in an era when the ways of infection and the consequences are well understood, the virus continues to “walk” around the planet. The centers of infection are countries with a low level of income and quality of life. Despite the charitable work of WHO and UNICEF, millions of people do not receive the necessary therapy and access to free testing.

The human factor can be called the main reason for the mass spread of the “plague of the XXI century”. The ways of transmission of the virus are discussed even in schools, however, unprotected sexual contacts remain the main ones in the spread of the pathogen. Information about HIV does not always work as planned: some see the infection everywhere, others believe that they will not get infected. As a result, HIV-positive people turn into outcasts, while healthy people continue to get infected.

The pathogen can be transmitted through:

1. Blood. Mainly when transfusing or reusable instruments. Today, all donated blood and organs are mandatory tested for HIV, hepatitis, etc. Disposable medical and cosmetic instruments are used. Reusable instruments are thoroughly disinfected.
2. Vaginal secretions and seminal fluid. In these fluids, the amount of virus is less than in the blood. Therefore, for sexual partners, positive and HIV-negative, the risk of the disease is reduced. It is important to note that people living with HIV who are on ART and who have a reduced viral load do not transmit HIV to their sexual partners. Thus, ensuring rapid access to ART and support to continue treatment is not only critical for improving HIV health -infected, but also to prevent HIV transmission
3. Breast-feeding. In an adult, enzymes in saliva and stomach destroy the virus. But babies don’t have these enzymes, so HIV-positive mothers shouldn’t breastfeed their babies.

In other biological fluids (tears, urine, sweat, saliva) there is also a pathogen, but it is too small for infection. In addition, in order to become infected, you need to keep a large amount of such fluid on an open wound. But even in this case, the bleeding wound pushes the blood out, and does not suck it in. However, such a way of spreading the infection is not completely excluded.

Symptoms

The clinical manifestations of HIV infection are extremely diverse, which is due to both the direct effect of the virus on the body and secondary changes associated with immune disorders that have developed under the influence of the virus. Therefore, HIV infection is a set of symptoms of secondary diseases, such as candidiasis, tuberculosis, infectious mononucleosis, pneumocystis pneumonia, viral encephalitis, multiple sclerosis, diarrhea, oncoprocesses and others. It does not have its own list of signs, but a certain sequence in pathogenesis has already been identified. At the first stages, there is an increase in lymph nodes, subfebrile temperature, stomatitis, rashes, diarrhea, weakness. But more often the initial phase is asymptomatic. With the progress of the disease, the subclinical stage is replaced by the clinical stage, and its signs develop. The body becomes weaker, more and more diseases join.

The first sign of the disease after an asymptomatic period is an increase in lymph nodes. On examination, it is not possible to establish the cause of this phenomenon, therefore generalized lymphadenopathy is the reason to be tested for HIV. Lymph nodes, as a rule, do not hurt, are mobile, skin color does not change. The symptom lasts up to several months, after which weight loss progresses.

After that, the clinic observes:

• pneumonia and/or tuberculosis;
• stomatitis;
• secondary infections (thrush, herpes, cytomegalovirus infection);
• Kaposi’s sarcoma;
• damage to the peripheral and / or central nervous system;
• shingles;
• prolonged diarrhea.

The number of symptoms and their severity depends on the patient’s lifestyle, treatment, psycho-emotional health. HIV can proceed in different ways and with different intensity. For women, the first signs are often recurrent thrush, menstrual irregularities, herpes, salpingitis. In men, lymph nodes in the armpits, neck, and groin are more often enlarged. Symptoms of HIV in young children often include CNS damage, physical and mental retardation.

Stages

The development of the disease is divided into stages. Today, several classifications of HIV phases are used in the world: proposed by the CDC, according to Pokrovsky V.V. and WHO. In the post-Soviet space, the classification proposed by V.V. Pokrovsky. It includes the incubation stage and the initial manifestations stage, the acute phase, the latency period, Pre-AIDS and the terminal phase.

The incubation period

The incubation period is the length of time from the entry of the pathogen into the blood until the first symptoms appear or the production of antibodies. In the case of HIV infection, it goes unnoticed. Even if a person suspects an infection and passes tests, tests do not detect the disease in this phase. Incubation involves the introduction of the virus into cells and replication, multiplication of viruses.

The primary phase lasts up to 3 months, sometimes longer. At this time, the pathogen multiplies in the body, the person is the carrier of the infection. An infected person can infect healthy people, but with a slightly lower probability than at other stages.

Acute phase

Following incubation, an acute course of the disease occurs. This period lasts up to a year and is not always accompanied by severe clinical symptoms.

This stage is divided into three types of flow:

• no signs of infection, the virus is already detected in the tests;
• without concomitant diseases, there may be symptoms of other diseases (diarrhea, fever, swollen lymph nodes);
• with secondary diseases: thrush, stomatitis, pharyngitis, SARS, etc.

Often, patients do not attach due importance to the first symptoms, despite the difference in such signs in a slow and long course for no apparent reason. When examining, doctors can also not always suspect HIV. Outwardly, a set of symptoms looks like simple diseases. Considering that after the acute phase, the latent phase occurs – the patient forgets about the first symptoms.

latent period

This is the longest stage of the disease, which can stretch from 2 to 20 years. Most often, this phase takes 6-7 years. During this period of time, the virus continues to multiply in the body and the number of T-helpers decreases. A balance is established between the immune response and the rate of reproduction of the pathogen. Most of this stage passes without any signs, the only thing that can cause suspicion is enlarged lymph nodes.

In the latent period, the asymptomatic phase may be replaced by secondary diseases. The patient develops:

• recurrent diseases of a fungal and bacterial nature;
• inflammation of the mucous membranes and respiratory tract;
• sharp weight loss;
• decrease in physical activity and deterioration of the psycho-emotional state;
• very long diarrhea;
• swollen lymph nodes.

Depending on the lifestyle of the patient, several secondary diseases or symptoms may occur at once. Identification of the disease and the use of highly active antiretroviral therapy (HAART) can extend the latency period by decades. Compliance with the recommendations of the doctor, the correct lifestyle and treatment support the normal quality of life of the patient.

Without the use of therapy in the latent phase, more severe secondary diseases develop. The more bad habits, stress and concomitant diseases a person has, the faster the immune system is suppressed. As a result, the number of T cells decreases rapidly, tuberculosis, benign tumors, pneumonia, fungal and bacterial infections join. A patient without proper treatment can quickly move to the third stage – “Pre-AIDS” or AIDS-associated complex.

Pre-AIDS

During this period, the suppression of the immune system especially progresses. Based on a set of symptoms, a doctor may suspect an infection before a laboratory test. In humans, herpes recurs with long non-healing wounds. It is sometimes accompanied by leukoplakia in the tongue, bacterial and ulcerative stomatitis, candidiasis of the genital and internal organs.

Tuberculosis most often joins at the stage of Pre-AIDS.

Secondary diseases during this period are more generalized than at the latent stage. However, they are treatable and the patient can expect an acceptable quality of life. It is very important at this moment to maintain psycho-emotional health, eat right and take treatment. On average, Pre-AIDS lasts up to 2 years, but it can be extended with comprehensive assistance to the patient.

terminal stage

The final phase of the infection is AIDS (terminal stage). At this stage, life-threatening diseases and concomitant infections appear.

Among them:

• malignant neoplasms;
• pneumocystis pneumonia;
• meningoencephalitis with mental disorders;
• sepsis;
• viral-bacterial diarrhea;
• pancytopenia.

They are difficult to treat, the patient’s weight and physical endurance decrease. As a rule, the deterioration of the psycho-emotional state occurs as a result of multiple physical pathologies. As a result, the patient falls into a vicious circle where stress must be avoided in order for the body to heal, but stress comes from the diseased body. This phase lasts an average of 1-2 years.

HIV progresses to the terminal stage in the presence of bad habits, constant stress, poor nutrition and treatment. Unfortunately, this process accelerates in old age. The younger the patient, the greater the chance of an effect from therapy. Even in the last phase, it is possible to create the most comfortable conditions for the patient, using symptomatic therapy, moral support, creating pleasant living conditions. The average life expectancy in this state is a very relative indicator, it is influenced by many factors.

Diagnostics

Making a diagnosis of HIV infection is a highly complex and responsible task. Overdiagnosis should be absolutely ruled out. In the rather short history of HIV infection, there have been known cases of suicide by people who have been diagnosed with this disease. On the other hand, the negative consequences of insufficiently complete identification of patients and those infected with HIV are also obvious, especially in cases where they are donors, often change sexual partners, etc. Today, combined test systems of the fourth generation are used. They detect both types of the virus and antibodies to it. This allows diagnosing the disease at earlier stages, including latent course.

Methods

Laboratory diagnosis of HIV infection is based on three areas: a) indication of HIV and its antigens; b) detection of specific antiviral antibodies; c) detection of viral RNA or its nucleotide sequences; d) determination of changes in the immune system. Tests can give questionable results, so sometimes you have to combine two types of studies or repeat them.

You can detect the disease using:

1. Polymerase chain reaction (PCR). This is a very sensitive test that detects HIV RNA. With the help of such an analysis, infants from HIV-positive parents are diagnosed, blood is checked for transfusions, and HIV-1 and HIV-2 are differentiated. Such a reaction is effective even during periods of the serological window. The test system allows you to determine the virus 10 days after infection. Due to the high sensitivity of the test, it may react to other viruses. Therefore, based on PCR alone, a diagnosis is not made. Such diagnostics requires complex laboratory equipment and highly qualified medical workers. Other types of surveys are used as free testing among the population.
2. Enzyme immunoassay (ELISA). This method is based on the detection of antibodies in the blood. Approximately 3 months after infection, a sufficient amount of antibodies is produced in the body. Therefore, such an analysis is prescribed at intervals of 1-3-6 months. In about 1% of cases, the diagnosis gives a false result. A false positive value occurs in patients with cancer, chronic infectious and autoimmune diseases. Therefore, in the case of a positive result for ELISA, another test is prescribed – an immunoblot. A false negative value occurs when insufficient antibodies have been produced in the body. Also, in the terminal stage, there is so much virus in the human blood that T-cells and antibodies are not detected.
3. Immunoblotting. This type of monitoring is also based on the search for specific antibodies to individual proteins. It is prescribed mainly in combination with ELISA. It can also give an incorrect result, but if the data of the two tests match, this gives 99,9% certainty in the absence / presence of the virus.

In addition to the three main types of analysis, rapid testing is used. The procedure is also based on the search for antibodies, does not require sophisticated equipment and high qualifications. Use it only in emergency cases, for example, if you need an urgent blood transfusion or during childbirth. However, the indicators of express analysis must be confirmed by one of the previous diagnostic options.

Prepare

There are no specific training requirements. Before taking the test, it is better to follow a few rules that are typical for any type of blood test. It is better to pass the study on an empty stomach, 1 hour before that it is recommended not to smoke or drink coffee. If the patient is taking medication, this should be reported to the doctor. If possible, 2-3 days before you need to stop taking medication.

Norm of CD4+ cells in a healthy person

CD4+ or T-helper cells are white blood cells responsible for fighting fungal, bacterial and viral diseases. In healthy people, their number can be very different, for example:

• in women: from 500 to 1600;
• in men: from 400 to 1500.

At the same time, many factors influence the level of T-helpers. In girls, the level of CD4 + decreases depending on the menstrual cycle, and birth control pills can also reduce this indicator. A smoker has an average of 140 fewer white blood cells. After sleep and rest, CD4+ levels also decrease.

With HIV infection, T-helpers gradually become less and less. At the time of infection, there is a sharp decrease in the level of CD4+, then it is set at around 400-600 cells per milliliter. It is estimated that the average patient loses 45 units in 6 months. This process slows down during treatment, and the patient can maintain an acceptable quality of immunity for decades.

It is important to constantly monitor the percentage of immune cells in a patient. This makes it possible to prescribe antiretroviral therapy in time and delay the onset of AIDS. In the terminal stage, the number of T-helpers is 200 units or less. In such a situation, the body practically does not protect itself from any pathologies.

Is the disease curable

It is impossible to radically cure the infection, but it is possible to slow down its development. Treatment involves three areas:

• fight against the development of the virus;
• immune support;
• treatment of secondary diseases.

Highly active antiretroviral therapy (HAART) is used to control pathogen development and immune suppression. For the treatment of concomitant symptoms and diseases, the course is carefully selected taking into account the patient’s condition. Immunostimulants help maintain barrier function. For each person, an individual therapy regimen is drawn up, which is based on the number of CD4, viral load, and the presence of chronic pathologies.

ART is provided free of charge, but due to insufficient funding, it is often not enough to cover all patients. HIV-positive people are shown to take such medications for life.

During the entire illness, the doctor changes the tactics of therapy several times, as the virus adapts rather quickly. Medicines and procedures for treating opportunistic diseases are also carefully selected according to the stage of HIV.

As part of therapy, the patient must comply with the prescribed dosage of drugs. No less important is the patient’s lifestyle, he is shown emotional peace, proper nutrition, and prevention of infectious diseases. Also, for high-quality treatment, it is important to undergo examination and laboratory examination on time.

Prevention

One of the methods of dealing with a pandemic is the prevention of infection. The problem of mass infection could be solved by a vaccine, but so far it does not exist, like a cure. Therefore, prevention is assigned one of the important roles in the fight against HIV. Awareness and so-called “behavioral interventions” are working, and infection rates are declining around the world. However, tens of thousands more people become “positive” every year.

The main route of transmission of the virus is sexual contact, a slightly smaller proportion is occupied by people who inject drugs. Therefore, proper and consistent use of male and female condoms during vaginal and anal intercourse can prevent the spread of sexually transmitted infections, including HIV. People who inject drugs can take precautions to avoid acquiring HIV and use sterile injecting equipment (including needles and syringes) for each injection and avoid sharing drug-using equipment and drug solutions with others. As you can see, the epidemic is spreading largely due to behavioral factors that people can change and control. Therefore, information about HIV prevention methods is disseminated even among children.

Precautionary measures:

• use only personal hygiene products (toothbrush, razor, manicure accessories, etc.);
• check the disinfection of instruments in a beauty and medical office, a tattoo parlor and during other services where skin can be damaged;
• sexual partners – jointly take tests 2 times a year;

Separate rules for prevention have been drawn up for medical staff, since employees of medical institutions are at risk. To prevent infection, the use of gowns, masks, glasses is mandatory. Gloves should be changed after each patient. In case of suspected or obvious contact with the infected fluid on the wounds, it is urgent to treat the wound with 70% alcohol, then wash with soap and treat again with alcohol or iodine. If a healthcare worker is cut or pricked by an instrument with contaminated fluid, post-exposure infection prophylaxis (PEP) is applied.

Post-exposure prophylaxis (PEP) is the use of ARVs within 72 hours of exposure to an HIV-infected person to prevent infection. PEP includes counseling, first aid, HIV testing, and 28-day ARV treatment followed by health care. For both adults and children, WHO recommends PEP for occupational and non-occupational exposure risks.

Infected parents and their children

HIV-positive couples can have absolutely healthy children. This also applies to those couples where one family member is sick, and those where both are carriers. Of course, the process of conceiving, bearing and raising children in such families is a little more complicated. But with proper monitoring, prevention and treatment of the mother, the risk of infecting the child is reduced to 1-2%.

conception of a child

In a discordant couple, where people have different HIV statuses, the main thing is to take responsibility for any outcome of planning a child. Today, doctors can minimize the risk of fetal infection. But no one can guarantee that the child will not get sick. Therefore, the couple should be informed about what to do if the baby is HIV positive.

Also in planning it is worthwhile to correctly calculate the financial side. The treatment of even one family member requires constant costs. Pregnancy, childbirth and childcare impose additional costs. If everything is planned correctly at the first stage, there will be less problems later. An HIV-positive woman will definitely need physical and moral support. If a couple decides to conceive a child, they are recommended artificial insemination.

If a male is infected in the family, techniques are used to clean the sperm from the virus. The biomaterial is being purified and tested for the pathogen. Unfortunately, such a procedure does not completely exclude infection of a healthy woman or child. But it reduces this risk to a minimum. If a woman is sick in a couple, she must undergo a comprehensive diagnosis before conception. Pregnancy in this case should not cause a significant deterioration in health.

Pregnancy and childbirth

HIV infection is not a contraindication for bearing a child. For a positive woman, a doctor may refuse pregnancy due to opportunistic infections or general health. If the patient maintains an acceptable level of health, she becomes registered in the antenatal clinic, like others. Pregnancy proceeds in exactly the same way as in a healthy woman. There may be swelling, nausea, heaviness in the back and lower abdomen.

Self-medication is excluded, the pregnant woman follows all the recommendations of the obstetrician-gynecologist and infectious disease specialist. In the perinatal period from 22 weeks of gestation, chemoprophylaxis is carried out to reduce the amount of virus in the blood. ART is given until delivery, at which point the woman is given drugs intravenously. Natural childbirth is excluded due to the increased risk of infection.

Lactation

After a caesarean section, chemoprophylaxis for the mother is stopped and the baby is prescribed. Children from HIV-positive women are born with maternal antibodies to the virus. Therefore, at the first stages of life, it is possible to establish whether a child is sick only with the help of PCR. The infant is given ART syrup to prevent illness. In most cases, children tolerate it normally without side effects.

From the first days of life, the newborn is transferred to artificial feeding. When breastfeeding, the risk of transmitting the pathogen to the child increases to 40-50%. This is due to the fact that babies do not have the enzymes to fight the virus, unlike adults.

Living with HIV

Unfortunately, society is only learning to accept HIV-positive people as equals. There are still widespread fears that you can get sick when you touch, kiss, in everyday life. Even infected people do not perceive their status quite correctly. Most people think that such a diagnosis is a sentence of inferior life and imminent death. Although, in fact, living with HIV requires the obligatory fulfillment of the usual norms of life.

Proper nutrition, physical activity, careful hygiene, following the doctor’s recommendations – this is what all people need. But healthy people allow themselves bad habits, fast food, self-medication. While for HIV-positive observance of these norms is mandatory. Contrary to the general belief that society tries to protect itself from a person with a positive status, it is an HIV-positive person who protects himself from society. After all, due to reduced immunity, it is his health that is at risk.

In addition to a healthy lifestyle, a person with HIV takes mandatory ART and is regularly screened. He can work, raise a family, play sports, communicate with friends – everything that others do. Sunbathing, contrary to the opinion of many, is also possible for them, excluding individual cases.

How to live with the infected

If there is only one person in the family – “positive”, there must be a first-aid kit in the house. Its content:

• iodine or brilliant green;
• 70% ethyl alcohol;
• a set of plasters;
• cotton and bandage.

Through dishes, linen and towels, the infection is not transmitted. But for the purpose of general prevention, including secondary infections for the patient, he must use his own towel. It is also recommended to have your own set of dishes: fork, knife, cup, plate. The rest of the family members with wounds, abrasions, scratches should treat the wounds with alcohol, seal with a plaster until healing.

It is imperative to maintain cleanliness in the house, ventilate the premises (the patient should not catch a cold). Periodically it is recommended to carry out wet cleaning with chlorine-containing disinfectants. This measure is more necessary to prevent other infections in the patient. Couples must use condoms. The whole family should be tested at least 1-2 times a year.

Where can the sick work?

People with a “positive status” can enter, study and work in the profession that they like. If you need to decide who can work with HIV, it is better to look at the list of vacancies where you need to report your HIV status. It:

• medical workers;
• food industry workers;
• area of ​​education;
• Ministry of Emergency Situations and police.

However, not all jobs in these industries require an HIV status report. For example, a teacher can teach online; in the field of medicine, not all professions are closed to HIV+. According to the law of any country, “positive” carriers can hold any positions in their field of activity. Except for professions prescribed by law, no organization has the right to require an HIV test. Refusal to work or dismissal on the basis of positive status is the basis for a lawsuit.

Do they take to the army with an infection

Infected young men are not taken into the army. This is argued by the fact that such an event is dangerous for the conscript himself. Therefore, even early asymptomatic stages are the basis for exemption from service. Conscripts with a positive status receive category “D” – not fit in peacetime and wartime.

Food

Diet is an important component of proper lifestyle and treatment. The main rule in the nutrition of HIV-positive people is the naturalness and quality of products. It is also very important to consume a lot of protein and more calories. It is recommended to introduce meat or fish into the diet daily. The diet should include baked goods, beans, butter, nuts. In general, a sick person can do everything that a non-sick person can. But obviously harmful food will have to be abandoned, these are: street food, snacks, alcohol, sweet soda, products of dubious quality.

Avoid unpasteurized milk, undercooked meat and fish, and raw eggs. These products may contain bacteria that are dangerous to the patient. The diet consists of 5-6 meals in small portions. Be sure to drink plenty of water, while the liquid must be purified. Mustard, mayonnaise and ketchup are also not prohibited, but it is better to use homemade analogues of such sauces. You can add spices and herbs to food, flavor enhancers should be excluded.

A special diet may be added to the usual dietary rules. For example, with tuberculosis, additional prohibited and permitted products are prescribed. It is very important to follow all the recommendations of the doctor. The myth is that an HIV-positive person must deny himself a lot. You can eat everything, but in moderation and protect your own body from low-quality food.

Lifespan

In the absence of treatment, the average life expectancy of those infected is from 9 to 11 years. The presence of bad habits, drug addiction, serious illnesses without treatment shorten this period. With timely treatment and compliance with all the recommendations of the doctor, life expectancy with the virus increases to a ripe old age. Modern therapy uses less toxic drugs that inhibit the replication of the pathogen and do not cause a large number of contraindications.

However, one in three people living with HIV does not seek care until late in the disease, usually with severe clinical manifestations, low CD4+ cell counts and a high risk of severe illness and death. To mitigate this risk, WHO recommends providing these patients with comprehensive care that includes, in addition to prompt initiation of ART, services for the diagnosis and preventive treatment of the most common serious and fatal infections, such as TB and cryptococcal meningitis. By mid-2020, more than 26 million people living with HIV were receiving ART worldwide. Thus, global ART coverage was 67%. However, more efforts are needed to scale up treatment coverage, especially for children and adolescents. At the end of 2019, only 53% of children with HIV were receiving ART.

The risk of contracting HIV is also increased in the presence of the following behaviors and conditions:

• unprotected anal and vaginal intercourse;
• having another sexually transmitted infection such as syphilis, herpes, chlamydia, and gonorrhea;
• sharing of contaminated needles, syringes and other injecting equipment, as well as solutions of narcotic substances when injecting drugs;
• unsafe injections, blood transfusions and tissue grafts, and medical procedures involving unsterile incisions or punctures;
• accidental needle stick injuries, including among healthcare workers.

Risk groups

Therefore, each of us must know and apply preventive measures.

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