Q. What are HIV and AIDS?

AIDS (acquired immunodeficiency syndrome) is the late stage of infection with human immuno-deficiency virus (HIV). AIDS can take more than 8-10 years to develop after infection with HIV. HIV-infected people can live symptom-free lives for years; however most people in developing countries die within three years of being diagnosed with AIDS.

Q. How do people get infected with HIV?

HIV is transmitted mostly through semen and vaginal fluids during unprotected sex without the use of condoms. Globally, most cases of sexual transmission involve men and women, although, in some developed countries homosexual activity remains the primary mode. Besides sexual intercourse, HIV can also be transmitted during drug injection by the sharing of needles contaminated with infected blood; by the transfusion, of infected blood or blood products; and from an infected woman to her baby – before birth, during birth or just after delivery.

HIV is not spread through ordinary social contact; for example by shaking hands, travelling in the same bus, eating from the same utensils, by hugging or kissing. Mosquitoes and insects do not spread the virus nor is it water-borne or air-borne.

Q. How many people are affected with HIV?

Global HIV & AIDS statistics — Fact sheet

Preliminary UNAIDS 2021 epidemiological estimates

GLOBAL HIV STATISTICS

• 37.6 million [30.2 million–45.0 million] people globally were living with HIV in 2020.
• 1.5 million [1.1 million–2.1 million] people became newly infected with HIV in 2020.
• 690 000 [480 000–1 million] people died from AIDS-related illnesses in 2020.
• 27.4 million [26.5 million–27.7 million] people were accessing antiretroviral therapy in 2020.
• 77.5 million [54.6 million–110 million] people have become infected with HIV since the start of the epidemic.
• 34.7 million [26.0 million–45.8 million] people have died from AIDS-related illnesses since the start of the epidemic.

People living with HIV

• In 2020, there were 37.6 million [30.2 million–45.0 million] people living with HIV.
• 35.9 million [28.9 million–43.0 million] adults.
• 1.7 million [1.2 million–2.2 million] children (0–14 years).
• 84% [68– >98%] of all people living with HIV knew their HIV status in 2020.
• About 6.0 million [4.8 million–7.1 million] people did not know that they were living with HIV in 2020.

People living with HIV accessing antiretroviral therapy

• As at the end of December 2020, 27.4 million [26.5 million–27.7 million] people were accessing antiretroviral therapy, up from 7.8 million [6.9 million–7.9 million] in 2010.
• In 2020, 73% [57–88%] of all people living with HIV were accessing treatment.
• 74% [57–90%] of adults aged 15 years and older living with HIV had access to treatment, as did 53% [37–68%] of children aged 0–14 years.
• 79% [61– >98%] of female adults aged 15 years and older had access to treatment; however, just 68% [52-83%] of male adults aged 15 years and older had access.
• 84% [63– >98%] of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2020.

New HIV infections

• New HIV infections have been reduced by 47% since the peak in 1998.
• In 2020, around 1.5 million [1.1 million–2.1 million] people were newly infected with HIV, compared to 2.8 million [2.0 million–3.9 million] people in 1998.
• Since 2010, new HIV infections have declined by 30%, from 2.1 million [1.5 million–2.9 million] to 1.5 million [1.1 million–2.1 million] in 2020.
• Since 2010, new HIV infections among children have declined by 52%, from 320 000 [210 000–500 000] in 2010 to 160 000 [100 000–240 000] in 2020.

AIDS-related deaths

• AIDS-related deaths have been reduced by 61% since the peak in 2004.
• In 2020, around 690 000 [480 000–1 million] people died from AIDS-related illnesses worldwide, compared to 1.8 million [1.2 million–2.6 million] people in 2004 and 1.2 million [840 000–1.8 million] people in 2010.
• AIDS-related mortality has declined by 42% since 2010.

Women

• Every week, around 5000 young women aged 15–24 years become infected with HIV.
• In sub-Saharan Africa, six in seven new HIV infections among adolescents aged 15–19 years are among girls. Young women aged 15–24 years are twice as likely to be living with HIV than men.
• More than one third (35%) of women around the world have experienced physical and/or sexual violence by an intimate partner or sexual violence by a non-partner at some time in their lives.
• In some regions, women who have experienced physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced such violence.
• Women and girls accounted for about 50% of all new HIV infections in 2020. In sub-Saharan Africa, women and girls accounted for 63% of all new HIV infections.

What is 90–90–90 ?

In order to achieve an AIDS-free generation, the UNAIDS has set an ambitious target code named 90-90-90, which aims to ensure that 90% of all people living with HIV will know their status, 90% of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral suppression, all by 2020 .

• In 2020, 84% [68– >98%] of people living with HIV knew their HIV status.
• Among people who knew their status, 87% [67– >98%] were accessing treatment.
• And among people accessing treatment, 90% [70– >98%] were virally suppressed.
• Of all people living with HIV, 84% [68– >98%] knew their status, 73% [57–88%] were accessing treatment and 66% [53–79%] were virally suppressed in 2020.

Q. Does AIDS also affect our region?

Yes, HIV/AIDS affect our country too . As per the latest HIV estimates report (2019) of the Government, India is estimated to have around 23.49 lakh people living with HIV/AIDS(PLHIV) in 2019. The HIV epidemic has an overall decreasing trend in country with estimated annual New HIV infections declining by 37% between 2010 and 2019.

Ministry of Health and Family Welfare

India has the third largest HIV epidemic in the world, with 2.34 million people living with HIV. India’s epidemic is concentrated among key affected populations, including sex workers and men who have sex with men.

HIV/AIDS Patients in India

As per the latest HIV estimates report (2019) of the Government, India is estimated to have around 23.49 lakh people living with HIV/AIDS (PLHIV) in 2019. The HIV epidemic has an overall decreasing trend in country with estimated annual New HIV infections declining by 37% between 2010 and 2019.

HIV infection in India is mainly caused by engagement in high risk behaviours. The main high-risk behaviours identified for HIV infection in India includes unprotected heterosexual behaviour, unprotected homosexual behaviour, and unsafe injecting drug use behaviour.

There are no dedicated hospitals for the treatment of HIV/AIDS patients. However, under the National AIDS Control Programme (NACP) of the Government, as on July 2020, there are 570 Anti-retroviral treatment (ART) Centers and 1264 Link ART Centers.

Q. Why is the AIDS epidemic considered so serious?

AIDS affects people primarily when they are most productive and leads to premature death thereby severely affecting the socio-economic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and with sexual practices being essentially a private domain, these issues are difficult to address.

Q. How serious is the interaction between HIV and TB in South-East Asia?

HIV weakens the immune system, increasing the risk of TB in people with HIV. Infectionwith both HIV and TB is called HIV/TB coinfection. Untreated latent TB infection is more likely to advance to TB disease in people with HIV than in people without HIV.

TB services in the South East Asia region have largely been delivered through vertical TB programmes that are ‘passive’, in the sense that they are contingent on a TB symptomatic presenting for care. Evidence suggests that – while TB patients managed by this system have signicantly improved outcomes compared to the pre-DOTS era, there is a need to considerably expand the coverage of TB patients that can benet from these quality TB services (as measured by the ‘case detection rate’ .

Although HIV is a major driver of TB on the global level, in SEA it is not the driving factor for TB epidemiology that it is, for example, in sub-Saharan Africa: in 2019, HIV/TB coinfection accounted only for roughly 3% of TB incidence in the region. Nonetheless there is some variation across countries (ailand’s TB epidemic is the most affected, with an estimated 10% of incident TB cases being HIV coinfected) as well as within countries (India’s southern states – Andhra Pradesh, Telangana, Karnataka and Tamil Nadu – account for 60% of known HIV/TB coinfections in the country .

Q: Is there a treatment for HIV/AIDS?

Treatment
Currently, there’s no cure for HIV/AIDS. Once you have the infection, your body can’t get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications.

ART is usually a combination of three or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine three HIV medications into one pill, taken once daily.

Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:

• Account for individual drug resistance (viral genotype)
• Avoid creating new drug-resistant strains of HIV
• Maximize suppression of virus in the blood

Two drugs from one class, plus a third drug from a second class, are typically used.

The classes of anti-HIV drugs include:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant) and doravirine (Pifeltro).
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
• Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
• Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).
• Entry or fusion inhibitors block HIV’s entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Starting and maintaining treatment

Everyone with HIV infection, regardless of the CD4 T cell count or symptoms, should be offered antiviral medication.

Remaining on effective ART with an undetectable HIV viral load in the blood is the best way for you to stay healthy.

For ART to be effective, it’s important that you take the medications as prescribed, without missing or skipping any doses. Staying on ART with an undetectable viral load helps:

• Keep your immune system strong
• Reduce your chances of getting an infection
• Reduce your chances of developing treatment-resistant HIV
• Reduce your chances of transmitting HIV to other people

Staying on HIV therapy can be challenging. It’s important to talk to your doctor about possible side effects, difficulty taking medications, and any mental health or substance use issues that may make it difficult for you to maintain ART.

Having regular follow-up appointments with your doctor to monitor your health and response to treatment is also important. Let your doctor know right away if you’re having problems with HIV therapy so that you can work together to find ways to address those challenges.

Treatment side effects

Treatment side effects can include:

• Nausea, vomiting or diarrhea
• Heart disease
• Kidney and liver damage
• Weakened bones or bone loss
• Abnormal cholesterol levels
• Higher blood sugar
• Cognitive and emotional problems, as well as sleep problems

Treatment for age-related diseases

Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It’s important to talk to your doctor about your other health conditions and the medications you’re taking.

If you are started on medications by another doctor, it’s important to let him or her know about your HIV therapy. This will allow the doctor to make sure there are no interactions between the medications.

Treatment response

Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. These will be initially checked at two and four weeks, and then every three to six months.

Treatment should lower your viral load so that it’s undetectable in the blood. That doesn’t mean your HIV is gone. Even if it can’t be found in the blood, HIV is still present in other places in your body, such as in lymph nodes and internal organs.

What tests are required to know at what stage the disease is and proceeding with treatment ?

Tests to stage disease and treatment

If you’ve been diagnosed with HIV, it’s important to find a specialist trained in diagnosing and treating HIV to help you:

• Determine whether you need additional testing
• Determine which HIV antiretroviral therapy (ART) will be best for you
• Monitor your progress and work with you to manage your health

If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment, including:

• CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200.
• Viral load (HIV RNA). This test measures the amount of virus in your blood. After starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces your chances of opportunistic infection and other HIV-related complications.
• Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions.

Tests for complications

Your doctor might also order lab tests to check for other infections or complications, including:

• Tuberculosis
• Hepatitis B or hepatitis C virus infection
• STIs
• Liver or kidney damage
• Urinary tract infection
• Cervical and anal cancer
• Cytomegalovirus
• Toxoplasmosis