This paper provides a detailed examination of human immunodeficiency virus (HIV), covering its biological mechanisms, transmission pathways, and progression to AIDS. It discusses treatment options including pre- and post-exposure prophylaxis (PrEP and PEP) and antiretroviral therapies, and analyzes HIV epidemiology using the epidemiologic triangle and chain of infection frameworks. The paper presents global demographic data showing nearly 36 million people living with HIV, with sub-Saharan Africa accounting for 71 percent of infections. It addresses the challenges of estimating HIV prevalence and incidence, and describes the CDC's role in surveillance, research, and prevention activities across the United States and internationally.
HIV is short for human immunodeficiency virus, a viral infection that can lead to AIDS (acquired immunodeficiency syndrome). The HIV virus remains in the body for life, as the human body cannot rid itself of the virus—this is true even if overt symptoms are absent. The virus spreads through body fluids, affecting specific cells (CD4 or T cells) associated with the immune system. HIV destroys many CD4 cells over time to a degree that compromises the body's overall immune system, leaving it incapable of fighting off infections and disease. This end stage of HIV infection is referred to as AIDS. The CD4 cell count is fundamental to monitoring people living with HIV.
HIV progresses through several stages, with the first stage often—but not always—characterized by severe flu-like symptoms consisting of fever, sore throat, enlarged lymph nodes, and rash occurring two to four weeks following exposure. It is important to note that many people infected with HIV have no symptoms whatsoever for 10 or more years. Even during the symptomatic phase just following exposure to the virus, carriers are highly infectious, but the HIV infection may not appear on an HIV test during this time.
HIV infection in the United States is predominantly a result of having sex or sharing injection drug equipment with HIV-infected people. For women living with HIV, transmission of the disease most frequently occurred as a result of heterosexual sex with a man infected with HIV (80 percent), while for men living with HIV, transmission is predominantly a result of homosexual sex (85 percent). Intravenous drug users may contract HIV through sharing needles, syringes, other equipment, and even rinse water.
The bodily fluids that are known to transmit HIV include blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. In order to transmit the virus, the bodily fluids must come into contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream. Less common transmission of HIV includes passing the virus to an infant during pregnancy, birth, or breastfeeding, or receiving blood transfusion or tissue or organ transplants contaminated by HIV.
Treatment of HIV has evolved over the years and currently includes pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). The use of PrEP is intended for people who are at high risk of contracting HIV; the treatments are used consistently as part of a daily regimen, along with other preventative options such as condoms. PEP is designed to be used after a single high-risk event in order to prevent HIV from replicating and spreading throughout the body. PEP must be started within three days of possible exposure and should be started immediately.
It is important to recognize that viral load can linger at 40 to 75 copies per milliliter of blood, which are undetectable levels. As viral load increases to millions of copies per milliliter of blood, the risk of contagion increases. Stopping medication or catching additional sexually transmitted diseases (STDs) or hepatitis can increase the risk of spreading the disease as much as three to five times compared to if HIV is the only resident infection. Acquiring an STD means that viral load will increase and CD4 cell count will decrease. People whose CD4 levels and viral load reach critical levels are susceptible to the development of AIDS, which leaves them vulnerable to all sorts of opportunistic illnesses, including pneumonia and cancer.
Treatment of people living with HIV includes a regimen of antiretroviral therapy medications, commonly referred to as ART, and highly active antiretroviral therapy (HAART), or cART, which stands for combination antiretroviral therapy, indicating that two or more drug types are used in treatment. cART regimens may include nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleotide reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), or integrase inhibitors, all of which interfere with the HIV infection and replication process at different stages.
With regard to the epidemiologic triangle in HIV infections, the agent factor is biological, as the HIV virus is contracted from infected individuals. The host factors in HIV include lifestyle choices, such as drug abuse and sexual preferences, and the status of an individual's immune system. Environmental factors include sanitation of living conditions and local geography, as HIV is more prevalent in some regions and countries than in others, and the availability of health services.
The chain of infection for the communicable disease referred to as HIV includes the following elements: the infectious agent, the reservoir, the portal of exit, the mode of transmission, the portal of entry, and the susceptible host. The infectious agent is viral and the reservoir is human beings. The portal of exit is an exchange of bodily fluids, the mode of transmission is sexual contact and blood exposure, and the portal of entry includes sexual contact and breaks in mucosal barriers. Matters related to the susceptible host relate most significantly to individual lifestyle choices with regard to injectable drug use and sexual behavior.
The social determinants of health have to do with where people are born, grow up, work, age, and live—and with all the associated systems that are in place or added to those contexts in order to address illness and disease. Naturally, these social determinants of health are aspects of larger categorical forces such as economics, politics, education, and social policies.
"Global infection statistics, regional burden, prevalence versus incidence methodologies"
"Surveillance, research, prevention programs, community health nursing roles"
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