What is HIV?

What is HIV?

HIV stands for Human Immunodeficiency Virus and is a virus which attacks the immune system ( your body's defence against infection). HIV is the virus which can lead to AIDS.

What is AIDS?

AIDS stands for Acquired Immune Deficiency Syndrome. It is a collection of Illnesses, not a particular disease. Being HIV positive does not mean that you automatically have AIDS. It is the name given to certain infections and illnesses which you may be at risk of if your immune system is weakened by HIV.

How does HIV affect the immune system?

The immune system is the body's defence against attack by bacteria (micro-organisms) and viruses. In the main, it is white blood cells which form the immune system and roam around the body, playing different roles in recognising, disabling and removing infections or organisms which may be infecting, invading or harming the body.

Some white blood cells can recognise infections or organisms which the body has been exposed to in the past.

Specific immune cells are called lymphocytes and protect only against certain infections, against which they make antibodies.

Non-specific white cells can attack and protect against a wider range of organisms.

In the case of HIV, it is the lymphocytes which are targeted by the virus, effectively knocking out or removing an essential barrier in the body's defence, eventually allowing other organisms, which may cause AIDS, to invade and go unchecked, until such time that the other immune cells are so out numbered they are unable to cope and stop the infection.

There are two main types of lymphocytes:

B-lymphocytes (or B-cells), which make antibodies. Antibodies are special proteins which can lock onto the a distinctive part of an invading organism, neutralising it until the other immune cells can come and remove it. This is how vaccines work, by stimulating B-cells to produce antibodies against harmful infections (such as Hepatitis B), by exposing them to an altered or non-harmful replica of the organism for which the vaccine has been developed.

T-lymphocytes (or T-cells) are responsible for stimulating the other immune cells to act against the invading organism or infection. They are classified (or named) according to the different molecules on their surface:CD4 cells (or CD4 T-lymphocytes, T-helper cells) act as the watch guards or lookouts of the immune system. They help the B-lymphocytes to recognise organisms. They also send out chemical messages to the enable CD8 cells to reproduce and to activate the macrophages (cells which "engulf" and neutralised foreign infections or organisms and destroy them) to kill many organisms.

CD8 cells (or CD8 T-lymphocytes, cytotoxic T-cells) attach to abnormal cells, mainly those affected by viruses and destroy them.

In order to understand how the new combination therapies work (the new drugs which fight HIV by interfering with how the virus reproduces within the human cell), it is important to understand how the virus invades and takes over the human cell.
After infection with HIV, viral particles within the blood stream will attach to the cell membranes of the CD4 cells, because HIV particles have an outer membrane with surface structures that allow them to "lock-on" to receptive sites of the CD4 cells. Then, by a complex bio-chemical process, the two membranes will merge allowing the HIV particle to release its core of genetic material (an RNA chromosome).

Using a unique enzyme called reverse transcriptase it converts or changes it's single stranded RNA into a double stranded DNA, where it can join itself to the cell nucleus of the CD4 cells and become integrated into the human chromosome.
Once this has occurred, the new viral material will stimulate the nucleus of the CD4 cells to copy the viral chromosome and produce new viral particles in the same way that the cell would do normally for its own growth and reproduction. These new forms of viral particles are then released through the cell membrane, where with the help of viral enzymes, they mature and are then able to infect another CD4 cells.

That’s all very complicated, put simply the HIV locks onto and invades the CD4 cell. Once inside it uses biochemical reagents to enter the cell nucleus or control centre of the cell, where it re-codes or re-programmes the cell to make new HIV particles rather than new CD4 cells.

Combination Therapies

There are new drugs available, which can be used to treat people with HIV, and prevent many of the illnesses and opportunistic infections, which can cause AIDS. These drugs are not a cure, they simply help to keep people with HIV well.
They work by interfering with the process by which HIV replicates within the CD4 cells as previously described. They fall into two main categories:

1. Reverse transcriptase inhibitors - these target the viral enzyme
reverse transcriptase and try to prevent the viral RNA chromosomes
converting into DNA.
There are three classes - nucleoside reverse transcriptase inhibitors -
AZT (zidovudine, Retrovir), ddI (didanosine, Videx), ddC (zalcitabine,
Hivid), d4T (stavudine, Zerit), abacavir [ Ziagen] and 3TC (lamivudine, Epivir) - non-
nucleoside reverse transcriptase inhibitors – nevirapine [ Viramune] and efavirenz [ Sustiva] and the new nucleotide reverse transcriptase inhibitor tenofivir [ Viread].

2. Protease inhibitors - these are drugs which block the viral enzyme
protease which help in the production of new viral particles after the HIV has
joined with the DNA of the CD4 cell. By blocking protease such drugs
prevent an infected CD4 cell from producing new infectious virus particles.
They include drugs such as nelfinavir [ Viracept], indinavir [ Crixivan], ritonavir [ Norvir], saquinavir [ Invirase; Fortovase], amprenavir [ Agenerase] and lopinavir / ritonavir [ Kaletra].

While these drugs when used in combination are very powerful at suppressing HIV replication, they can be difficult to take and patients often experience side effects with the medication in the first few weeks. Many of the side effects will reduce with time, as the body learns to tolerate the drugs. However, as many patients often feel well when they start on therapy, the side effects can make it hard to continue taking the drugs. Most treatment centres will support patients closely when first starting to take combination therapy or HAART (Highly Active Anti-Retroviral Therapy) and will suggest other therapies alongside the HIV drugs to reduce potential side effects.

For the drugs to be most effective they are used in combinations of three or more drugs, usually of more than one class.

Combination therapy or HAART is NOT a cure, but can help people with HIV to stay fit and healthy and continue to undertake their normal daily activities without the interruption of illness or HIV related problems.

The drugs need careful storage and to be taken at regular intervals without missing doses. Missing doses of a drug or drugs allows the levels of the drug/s in the blood to fall and the virus can quickly build resistance against the drug, making the treatment less likely to work. The risk of resistance is reduced by taking a drug combination, as it is harder for the virus to mutate or fight against several drugs at the same time. Combination therapy drugs are also very expensive and the cost of providing them is beginning to have an effect on the funding of HIV services in the National Health Service.

The final note on combination therapy is that we do not know how long it will be effective for. Studies show that people do very well on HAART, with their immune systems becoming healthy again, T-cell counts rising and viral loads in the blood falling to very low levels (see tests for HIV). Since the introduction of HAART in the UK the rates of AIDS diagnoses and deaths from HIV /AIDS have fallen dramatically. However, it is not yet possible to know how long the good effects of HAART will last in an individual person, although HIV doctors are very optimistic.


For more information on HIV treatment therapies, check the following links:

AIDSMAP
http://www.aidsmap.com

This site has information from the National AIDS Manual and HIV and AIDS treatment directory.

National AIDS Treatment Advocacy Project
http://www.natap.org

Has the latest information in treating developments, along with reports from the International conferences.

http://www.acas.org/treatment

This site is the only site thus far (as we know) that has HIV treatment information in Asian languages (Chinese, Tagalog, Vietamese and English).

Tests for HIV

Antibody tests - the most commonly used test for HIV checks for antibodies against the virus in a persons blood - a person would not have these antibodies unless they had been infected with HIV. However, it can take up to three months from time of being exposed to HIV (e.g. fucking without a condom) for seroconversion (the making of the antibodies) to occur. This three month period is called the window period. It can be much quicker than this, and current research suggests that for most people infected with HIV, seroconversion will occur within a month to six weeks. Very rarely seroconversion may take longer, up to 18 months. However, in the majority of people infected with HIV, antibodies would be detectable in the blood within three months, so this is considered the gold standard.

Viral load tests - these tests measure how many HIV particles are in a sample of blood plasma (plasma is the liquid component of blood in which the cells float). They are also known as HIV RNA assays as they measure the number of copies of HIV RNA per millilitre (copies/ml).

Viral load tests are only done on people known to be infected with HIV because they have a positive HIV antibody test. It is a good way of monitoring the effect of combination therapy or the progression of HIV in a person as readings over time can reflect changes and give an indication of when to start treatments. When people have an “undetectable viral load”, it does not mean they are "cured" or free of HIV, just that each testing kit has a threshold under which it cannot detect the HIV RNA, most being at about 50 copies/ml.

To test or not to test?

Even with all the advances in HIV care and management already outlined in this section, having an HIV test, especially if you have been at risk, remains an issue which needs careful consideration.

It is important to say that having an HIV test is your decision, no one should be tested without their permission. There should be staff available at every sexual health clinic who can give you information about HIV/AIDS and the antibody test and with whom you can discuss the pros and cons of having a test, which may help you to decide if you are not certain. Records and patients files at sexual health clinics are protected and ensure confidentiality by law under the Venereal Diseases Regulations (amended in 2001). At many clinics you do not even have to provide a real name, so whether or result is negative or positive, it remains confidential.

HIV Transmission

In a person infected with HIV, traces of the virus will be detectable in most of their body fluids, but in varying amounts. We know from research that for them to infect another individual, there has to be an exchange of body fluids which contain enough of the virus to possibly infect the other person. These fluids are blood, sexual fluid (semen and vaginal secretions) and breast milk from an infected mother to her baby.

You CANNOT catch HIV from everyday social contact, such as:

• breathing the air in the same room as a person with HIV
• sharing cutlery or eating utensils
• using the same towels or sitting on the same toilet seat
• shaking hands with someone
• using swimming pools or gyms

Therefore, you are at risk of catching HIV from sexual contact, drug use, receiving blood products or organ donation, and/or tattoos & piercing.

Tattoos & Piercing - HIV can be passed on by dirty equipment used for tattoos and body piercing, if it is not cleaned properly between people. This is due to blood remaining on needles etc. Always use an approved and licensed parlour rather than a back street one, or clean equipment if doing it yourself.
NEVER share equipment.

Drugs - many men fuck without condoms when they are 'off their head' on drugs or alcohol. This is one of the most commonly cited reasons given for why unsafe sex occurs, especially between gay men. Often, many regret this when they come down or sober up. Always take condoms with you when you go out to clubbing or drinking or anywhere else where you know you might be taking drugs - plan ahead.
Sharing works (needles, syringes, spoons, filters) allows blood to be passed directly from one person to another. If you do inject drugs, always use your own works, keep them safe and never share them.

Blood products and organ donation - since the mid-1980's, when sensitive and reliable tests became available for the screening of HIV, all blood and tissue products have been tested for HIV in the developed and industrialised countries of the world. They are not used if there is a hint of any risk. However, in less developed parts of the world, where funding is not available, this cannot be guaranteed. If you are concerned about foreign travel you should seek advice before departure.

Safer Sex - Sexual Activities

This section looks at the relative risks of infection from various commonly practised sexual activities. For each activity we discuss the risk of HIV transmission and then other sexually transmitted infections (STIs):

Kissing, wet kissing & tonsil tickling - there is no risk of catching HIV from kissing. Studies have shown that the tiny amount of HIV contained in an infected persons saliva (spit) is so minute, that you would need to exchange several gallons of saliva before possible risk of infection, and every the most passionate of kissers can't achieve that!

Other STIs - The biggest risk from kissing, especially between men is Hepatitis B. This virus, unlike HIV is very infectious, and someone with acute infection or who is a carrier of the virus could infect a partner during a heavy kissing session. There is also a suggestion that some bacterial infections such as Chlamydia and Gonorrhoea may be passed on from the back of the throat if very deep kissing, but the evidence for this is circumstantial. However, if you are aware that you have one of these infections in your throat, it is probably advisable to avoid very deep kissing until treatment has been completed. Oral herpes (or coldsores) may be transmitted in this way.

Sensual massage and touching – there is no risk of HIV transmission as there is no exchange of body fluids.

Other STIs - again, more or less safe, although parasitic infestations such as pubic lice (crabs) and scabies may be passed from one person to another through intimate contact such as this.

Wanking (masturbation) - wanking on your own is the safest form of sex and completely natural and healthy. For men especially, it can help stimulate the up keep of sex hormone production (if between partners) and allow for a release of sexual tension or frustration. Fantasy can be realised and you can learn to enjoy your own body, knowing what’s good for you and helping you communicate this to your sexual partners. Care should be taken if wanking a partner, never use their cum (semen or vaginal secretions) as lubricant for wanking, as tears along the penile shaft from "rough" handling could increase risk of exposure to HIV.

Other STIs - like with massage, no risks only, just that of scabies and crabs from intimate contact.

What about infected semen? risk of GC transmission?

Care should be taken if wanking a partner, never use their cum (semen or vaginal secretions) as lubricant for wanking, as tears along the penile shaft from "rough" handling could increase risk of exposure to other STIs.

Sucking (oral sex) - sucking without condoms is low risk for HIV as long as you avoid taking cum or pre-cum into your mouth. A small number of men have caught HIV from swallowing the cum of partners, and there are one or two recorded cases of transmission from pre-cum. The best advice is to use a flavoured condom for sucking or avoid letting partners ejaculate into your mouth, but should this occur, spit it out. The same applies for going down on a women, avoid taking vaginal secretions into your mouth or swallowing her juices if she cums. A small piece of latex called a dental dam or oral shield may be used to create a barrier between her and you, or alternatively a flavoured condom or cling film wrap!

There is no risk for the person being sucked - there are no records of HIV transmission in this way. But I think you have to say that it could happen especially if they have cuts or sores on their penis / genitals.

Other STIs - however, most other STIs can be caught through sucking or being sucked. Hepatitis B is very infectious and easily caught from sucking or being sucked. Some other viruses such as herpes can also be transmitted and it is known for the oral version of herpes (coldsores) to cause genital outbreaks of herpes sores on the shaft or scrotum.

Bacterial infections such as Chlaymdia and Gonorrhoea can be passed from throat to penis/vagina and vice versa through oral sex. Being sucked by someone with a serious bacterial throat infection is also linked with developing non-specific urethritis (NSU). The best way to avoid risks is to use a flavoured condom.

Rimming (Licking Arse) - there is no real risk of catching HIV from rimming or being rimmed. Theoretically, if you are licking someone’s arse and pushing your tongue deep inside, you might swallow small amounts of traces of blood, which could contain HIV. To reduce the risk entirely, you could lick through a dental dam (as described above).

Other STIs - the main risk from rimming is Hepatitis B whether being rimmed or doing the rimming. Also, infection with Hepatitis A can occur if you are rimming, as you may swallow faeces (shit), which contains the virus. Vaccination for both Hepatitis A and B is available from the Working Men Project. Some intestinal parasites, such as thread worm and tape worm may also be accidentally swallowed if rimming someone else. Risk of bacterial STIs such as GC and Chlamydia.

Vaginal Sex (fucking women) - globally, heterosexual transmission (sex between men and women) is responsible for the largest spread of HIV. HIV present in a woman's sexual fluids can enter through your piss hole (meatus) or through breaks in the sensitive skin of the penis, and cause infection. You are at risk of HIV if you fuck without condoms.

Other STIs - it is safe to say that nearly every other sexually transmitted infection can be transmitted or caught from heterosexual sex without condoms (these are detailed in the pictorial gallery of this web site).

Pregnancy can also be an added complication of vaginal sex without condoms, if the women uses no other form of contraception.

Anal Sex (fucking) - this is the highest risk sexual activity for catching HIV. The act of inserting the penis into the arse (of another man or women) is traumatic and can cause the lining of the rectum (arse) to bleed, although most people don't notice this. If you are being fucked without condoms, HIV present in the active partners cum or pre-cum can be absorbed through the lining of your arse during this bleeding. If you are the one doing the fucking, this blood can enter through the piss hole (meatus) or breaks in the skin of the penis. It is therefore very important to use strong condoms and plenty of lube when having anal sex.

While it is less risky if you are the active partner, it is the act of penetration itself not whether you take or give that carries the risk.

Other STIs - as with vaginal sex, again, nearly all other infections can be caught from anal sex without condoms. For gay men, anal warts (HPV) is a common problem and one of the most frequently reported diseases found when gay men go to sexual health clinics. This can be a problem even when condoms are used, as the condom just covers the penis shaft, and warts on the inner thigh, base of shaft or scrotal sac (balls) may be transmitted as they brush repeatedly between the arse cheeks during the thrusting action of sex. It is best to get warts treated anywhere on the genitals or arse as soon as you notice them.

Body Rubbing/Thigh Fucking - there is no risk of HIV from rubbing bodies together or thigh fucking, even if you cum over your partner, unless they have a large area of broken or inflamed/sore skin which you ejaculate onto.

Other STIs - the main risk here is from skin viruses such as warts and herpes. Both can be transmitted by repeated, prolonged rubbing of infected skin cells over damaged (from the friction of the rubbing) areas of skin of a sexual partner. Again, the best advice is to seek treatment for either condition as soon as you notice them and do not have this type of sex during times of herpes sores or wart outbreak.

Sharing Sex Toys - sharing sex toys that go inside or penetrate you, such as dildos, carries much the same risk as all other forms of penetrative sex for the transmission of HIV. If you intent to share them, use a condom and change condoms before the toy gets inserted into you.

Other STIs - Remember also, that some viruses and bacteria can survive for some time outside of the body, so clean your toys with hot soapy water between uses, to prevent risk of spread.


Testing HIV Positive

Despite the advances in HIV care and treatment already outlined in this section, testing HIV positive remains a serious issue and the way people cope or adapt to this diagnosis will be different from person to person.

Most centres which offer HIV testing should also offer counselling following a positive diagnosis. Below is a summary of some of the key points which might be discussed with someone shortly after they are given a positive HIV result. It is not meant to represent a definitive or exhaustive guide and obviously issues will vary from person to person :

Who to tell – a lot of people who are diagnosed with HIV have an urge to suddenly tell all they know of the diagnosis, and then regret doing so after wards. The important thing to remember is that there is no rush and you have plenty of time to consider who really needs to know, for example is it actually important that your employer knows or could this count against you? Your counsellor can help you to explore these issues and look at how and why you might tell someone. It is very important to remember that your result is confidential, so no-one can find out your status unless you consent to this.

Sexual partners - as with the previous point, it is your decision whether or not to tell sexual partners (either current or future) of your HIV status and again counsellors can help you explore your feelings around this. By practising safer sex (using condoms and lube) you reduce the risk of passing on the virus, whether you then tell them that you are positive is a matter of personal ethics and choice and remains currently a topic of much debate.

General health - despite the major advances being made in HIV treatment with combination therapies (as previously outlined), it is important to take care of all aspects of your physical and mental health.

Exercise - it is recommended that everyone takes 20 minutes of vigorous exercise 3 times per weak (Department of Health - Health of the Nation). This does not mean that you have to "pump iron" in a local gym, vigorous exercise is defined as any exercise which increases your heart rate and causes you to become slightly breathless (this can include having sex)!. There are many ways in which general fitness can be improved by simple lifestyle changes such as taking the stairs rather than the lift or escalator, walking or cycling rather then using motor transport. Remember to warm up and come down (using stretches) before and after exercise.
Reducing stress and having quality rest - everyone is subjected to different levels of stress throughout their day, some of which is inevitable and cannot be avoided. However, by looking at what causes your blood to boil, it is possible to avoid certain situations or change routines to reduce stress. It is also important to ensure that you take time to unwind and relax at the end of the day, this will aid restful sleep. The quantity of sleep is not as important as the quality. Research show that deep sleep is when cellular repair (including of the immune system) is at it's most active.

Diet - a healthy diet is imperative, and is a question of balance, taking a variety of each of the main food groups on a daily basis. However, people with HIV are advised to avoid some foods, including raw eggs (including mayonnaise) since many contain the bacteria salmonella, which can cause chronic diarrhoea. In addition, under-cooked red meat can increase the risk of exposure to toxoplasmosis.

In general avoid saturated fats, reduce sugar and salt intake and increase the intake of natural fibre, fresh fruits and vegetables for their vitamin and mineral content.