Posted: February 16th, 2023
Transmission of HIV occurs through contact with body fluids such as blood, semen or vaginal secretions—through sexual intercourse, mother-to-child transmission during pregnancy or childbirth, sharing contaminated needles or syringes used for injecting drugs and from organ transplants from an infected donor. The risk of infection among adults increases when there is unprotected anal sex between men or when multiple partners are involved in any type of sexual activity.
Following transmission via direct contact with infected body fluids such as blood or semen, the virus replicates within host cells by entering them via receptor-mediated endocytosis after binding to CD4 co-receptor molecules on the cell surface. This initiates an immune response that results in production of antibodies against viral proteins which can then be detected using assays like ELISA (enzyme-linked immunosorbent assay). Once inside the cell, viral RNA replicates into double stranded DNA using reverse transcriptase enzyme which integrates into the host genome resulting in long term persistence even if the virus levels are low in peripheral circulation. This process leads to progressive destruction of CD4 T cells leading to demise of adaptive immunity and development of AIDS defined by CDC criteria based on number of remaining T helper lymphocytes (<200 cells/mm3) causing individuals to succumb to infections caused due diseases like cryptococcal meningitis or toxoplasmosis gondii encephalitis etc., resulting in death unless aggressive drug therapy is initiated early upon diagnosis.
The clinical manifestations associated with HIV/AIDS include symptoms related to various opportunistic infections along with systemic symptoms like fatigue , weight loss , fever , night sweats etc . Various fungal , protozoal & bacterial organisms including Pneumocystis jirovecii pneumonia(PCP), Mycobacterium Avium complex(MAC), Candidiasis , Cryptococcal Meningitis along with Kaposi Sarcoma may develop during advanced stages leading to further decline in health status . The World Health Organization recommends initiating antiretroviral therapy once CD4 counts drops below 500cells/mm3 for HIV positive individuals without any opportunistic complications . Antiretroviral drugs help suppress replication & reduce vial load eventually improving patient’s overall well being provided they adhere strictly & continously take medications as prescribed by physicians . Standard ART regimen includes two nucleoside reverse transcriptase inhibitors combined with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI).
Prevention strategies include avoiding behaviors that put individuals at risk for acquisition such as injecting drugs; having unprotected sex; sharing needles; not adhering strictly while taking medications ; receiving transfusions outside medical settings ; not getting tested before engaging in sexual activities etc., Vaccines are being developed but none have been approved so far hence behavioral interventions remain important for preventing spread among high risk groups. Individuals should use barrier methods whenever possible during sex ; get routinely tested for STDs if engaging in risky behavior ; abstain from injection drugs / sharing needles ; receive counseling support from healthcare providers about safe practices; get vaccinated against common STDs like Hepatitis B & C & HPV viruses etc.,
In addition pregnant women should also receive regular prenatal care alongwith testing earlier enough so necessary treatments can be initiated timely reducing chances passing it on their newborns . Post natal replacement therapies shown great promise too wherein instead delivering baby vaginally breastfeeding mothers are advised cesarean section followed immediately treat their newborns intravenous antiretroviral regimen lasting up six weeks thereby reducing chances infants contracting infection upto 96% efficacy rate achieved thus far . Hence following preventive measures regularly will improve outcomes both short long terms significantly preventing further spread this deadly disease overall population worldwide
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