HIV after one exposure: Risks, transmission, and what it means during pregnancy

HIV (Human Immunodeficiency Virus), a retrovirus, is believed to have originated from chimpanzees in West Africa in the 1930s, and was transmitted to humans through the transfer of blood during hunting. Over decades, the virus spread throughout Africa and other parts of the world, only to be discovered in 1981 in the USA when unusually high rates of rare forms of pneumonia and cancer were seen in young gay men. It was labelled Gay-Related Immune Deficiency (GRID) then.In 1982, the disease was renamed AIDS. It was also observed that many women were infected with the virus and that it was being transferred to babies during pregnancy and delivery. According to 2020 WHO data, 37.7 million people globally are living with HIV, of which 16.7 million are men and 19.3 million are women. Among them, 1.3 million are pregnant women and 1.7 million are children under 15 years of age.The virus was found to be transmitted through blood and body fluids such as semen and vaginal fluids.Unprotected intercourse with an infected person, whether vaginal, oral, or anal, is a risk factor.Sharing needles and shaving blades (through accidental cuts) of infected drug users is another risk factor.Use of infected surgical blades and injection needles (not disposable ones) also risks infection, although this is rare now due to the use of disposable syringes and blades.Transplacental transfer from an infected pregnant mother to her baby can occur during pregnancy and delivery.Tattooing and body piercing in unsterile conditions also carry a risk of transmission.HIV does not spread by shaking hands, working together, eating together, or using toilet seats, doorknobs, or dishes.Once in the blood, HIV attacks the helper T cells (CD4 cells), which are very important for the body’s defence mechanisms. The virus then uses the machinery of the CD4 cells to multiply and spread throughout the body. As the CD4 cells die, the body’s defence system starts collapsing, and the person becomes prone to infections.Once infected, in the initial stage, the patient may have a short flu-like illness lasting from one to six weeks. Symptoms like fever, sore throat, muscle pain, joint pain, skin rash, nausea, vomiting, diarrhoea, mouth ulcers, fatigue, and genital ulcers may occur.In most cases, these symptoms gradually resolve over a few weeks. Some patients may have mild symptoms or none at all. This is a period of latency and can last for up to ten years.As the virus progressively damages the immune system, it becomes unable to protect the person from serious infections. At this stage, HIV infection is termed AIDS. Laboratory tests will show a high viral load and reduced CD4 cell count.Some symptoms of AIDS include oral thrush, tiredness, headaches, dry cough, weight loss, intermittent diarrhoea, and loss of muscle strength.HIV-positive patients can easily contract infections like COVID, Hepatitis B and C, tuberculosis, and opportunistic infections such as fungal infections.Patients with HIV infection and AIDS are also known to develop Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cancers of the oral cavity, pharynx, anus, lungs, and liver.In the 1980s, the average life expectancy following an AIDS diagnosis was approximately one year.Antiretroviral therapy (ART) has transformed HIV infection from an almost fatal disease into a manageable chronic condition. Today, with combination antiretroviral drugs started early in the course of infection, people living with HIV can expect a near-normal lifespan.Prevention involves avoiding risky sexual behaviour, avoiding multiple sexual partners, and using condoms to prevent transmission.Avoid sharing needles and blades used by infected individuals.Avoid tattooing and body piercing in unsafe conditions.Get tested for HIV and other STDs.People already living with HIV, including pregnant women, should continue ART regularly.Planned caesarean section reduces the risk of viral transmission to the baby compared to normal delivery, especially when the viral load is high or unknown. Babies born to HIV-positive mothers receive ART for 4 to 6 weeks. Breastfeeding is discouraged in HIV-positive mothers who are not adhering to ART treatment.COVID vaccination is encouraged in these patients.HIV patients are prone to depression, anxiety, and stress. Suicidal thoughts are not uncommon. Joining support groups, meditation, yoga, and deep breathing are encouraged. Good food, adequate rest, and proper sleep are essential for the immune system to recover.