Wednesday, January 3, 2018
Understanding Human Immunodeficiency Virus
There is a well-known saying; “knowledge is power.” In respect to sexually transmitted infections (STIs), knowledge of the facts, such as how infections are spread, give people the power to protect themselves and stay safe. Statistics from the World Health Organization states that one in four people contract an STI at least once in their lifetime, (WHO, 2016), yet most patients seem genuinely surprised and horrified when they receive their diagnosis. Social stigmas and negative consequences present significant barriers to being tested. Failure to be tested prevents early detection, increasing the risk of spreading infections to others, especially with the college-aged population. (Barth et al., 2010). However, protection and prevention are possible through education, and can decrease the likelihood of infection. This paper will focus on HIV, or Human Immunodeficiency Virus, one of the most debilitating types of STIs. There are many different types of STIs. Some of the most common forms of STIs include genital herpes, genital warts, gonorrhea, chlamydia, and syphilis. Antibiotics can be used to treat some infections, such as herpes; however, some infections such as Human Immunodeficiency Virus (HIV) have no permanent cure. STIs are transmitted through direct contact with contaminated bodily fluids from someone who has already been infected. Fluids that carry the infection are blood, urine, saliva and semen. Healthcare professionals take precautions such as wearing rubber gloves, gowns and masks when bodily fluids are exposed. Sexualy active adults and teens can also learn to take precautions such as wearing a condom or limiting the amount of sexual partners. Unfortunately, if a person contracts HIV, there is no permanent cure for individuals living with the virus. It can be managed and treated to mitigate the damage and symptoms; but once a person becomes infected, they will struggle with this illness, and be a carrier, for the rest of their life. When HIV infection enter the bloodstream, the virus targets CD-4 cells, also referred to as t-cells; a form of white blood cells that help comprise the immune system. The t-cell is an important cell in the immune system because it coordinates all the other cells and functions of the immune system. The virus attacks the T-cell lymphocyte, or “helper cell,” which inhibits the cell's’ ability to control or direct an immune response when the body is threatened with an illness. The virus attaches and gains entry into the t-cell and replicates or makes copies of itself. This process is possible due to the outer layer of HIV cells called Glycoproteins that mutate frequently, tricking t-cell receptors not to recognize the virus. Once attached to t-cell proteins, the viral cell membrane fuses with the membrane of the t-cell, then enters the t-cell and releases two viral RNA strands and three essential replication enzymes. Next, the RNA encoding of the HIV cell is transcribed into a DNA structure, whereby the new DNA coding is integrated into the host cell, the t-cell, genome. When the DNA of the HIV cells attach to the DNA of the t-cells, the t-cells treat viral genes like their own and make more copies of the virus. These new virus cells leave the t-cells, mature and find new t-cell hosts.This replicating ability of the HIV virus is why it is called a retrovirus. During this process the infected t-cell cells die while HIV virus cells seek out other t-cells to infect. Circulating t-cell cells are targeted and infected by the newly replicated HIV virus cells. HIV cells have a high mutation rate; during the replication process more than ten billion virions are created a day. The t-cell count in the blood decreases as infected cells are destroyed by the HIV virus and the body is left in a weakened state of defence against other infections and becomes susceptible to cancer and opportunistic infections (Lckovics et al., 2001) . When t-cells fall below two hundred cells for cubic millimeter of blood the virus is considered to have progressed to acquired immune deficiency syndrome (AIDS). The characteristic feature of the progression of the HIV virus is the decline in t- cell count in the blood. Healthy people have between 600 and 1,200 cells in a mm of blood (Luckheeram et al., 2012). Therefore, if immunodeficiency levels are low, clinicians use this as a marker of HIV infection. More specifically, levels below 200 mm are considered to be an advanced stage of AIDS. As discussed, when t-cells reach very low levels patients are at risk for getting serious infections or cancers. These illnesses are known as opportunistic infections because they take advantage of the body’s weakened defenses. However, decline in t-cells in the blood stream can take several years to reach significantly low numbers. This time period is sometimes referred to as the latency period. During this latency period antiretroviral medications can be taken to prevent the maturation and spread of the viral cells. This would protect additional t-cells from being destroyed, slow the progression of the virus and prevent the prevent the virus from turning to AIDS. However, antiretrovirals can only be prescribed early enough if the HIV is detected in time. That is why it is important to get regular testing for HIV and other sexually transmitted diseases if you are sexually active.There are several ways HIV can be transmitted. These include: vaginal sexual intercourse, anal sexual intercourse, and blood exposure; for example, by sharing needles with an infected individual. Although less common, HIV can also be transmitted through blood transfusions, from a mother to child before or during childbirth and through breastfeeding (Paolo et al., 1999). Even if the viral load in the blood is low or undetectable, the virus might still exist in the exposed body fluid; such as semen, urine, vaginal and rectal fluids and breast milk. One of the most common ways that HIV is transmitted is through unprotected vaginal intercourse. In women, HIV can enter the body through small tears in the lining of the vagina and the cervix. In men, HIV can enter the body through the urethra, which is the opening at the tip of the penis, through small cuts and abrasions of the inner foreskin tissue or through open sores on the penis. Research by the authors Andrew and Iryna (2010) indicate that anal intercourse has the highest risk for transmission of any other form of insertive sex. The partner receiving semen is at a greater risk of becoming infected because HIV can enter through the thin lining of the rectum. However, the partner who inserts the semen is also at risk because the virus can enter the body through the urethra or small cuts, abrasions and foreskin tissue, particularly with uncircumcised men or when there are open sores on the penis that have been caused by untreated syphilis or a herpes infection. The rectal lining is believed to be more susceptible to HIV infections than the vaginal lining partly do to its relative fragility and the abundance of cells targeted by HIV in that area (Grulich & Zablotska, 2010). The most effective way to avoid HIV is through abstinence. However, if a person is sexually active, it is important to practice safe sex to reduce the risk of HIV infection. If one chooses to have vaginal, anal or oral sex, a latex condom can help prevent the spread of HIV. The condom offers protection by preventing the exposure of HIV infected semen, and protects the male penis and urethra from HIV infected fluids. However, condoms are not one-hundred percent effective, therefore, partners should be open and honest with one another before conducting any kind of sexual activity. If someone with HIV feels uncomfortable sharing this information they should avoid all sexual activities. In many states, knowingly spreading HIV is considered to be a criminal offense. Another way to avoid HIV is to treat any other STI, such as chancroid and syphilis, immediately, because open sores makes it easier for one to contract HIV. Although at this time, HIV has no known cure, this condition can be managed with medication. Early initiation of antiretroviral drugs, or antiretroviral therapy(ART), for an HIV positive person is extremely important because it greatly lowers the amount of HIV in the body, and therefore reduces the amount of HIV in the sexual secretions. The World Health Organization states that: “ Antiretroviral therapy (ART) has reduced the global number of people dying from HIV-related causes to about 1.1 million in 2015 – 45% fewer than in 2005”. (www.who.int, 2016). ART drugs work by specifically targeting the viral cells that infected t-cells. The drugs help to keep the viral load to a manageable level and prevent HIV from progressing to AIDs. There are five classes of antiretroviral drugs; NRI’s, NNRTI’s protease inhibitors, entry or fusion inhibitors, and integrase inhibitors. Each drug is designed to attack the living virus at different points in its maturation cycle (Engl, 2007) by interrupting the virus and preventing the virus from making new copies of itself. Other drugs stop HIV from spreading in the body by blocking the virus from infecting healthy cells. Since many of these drugs are used to work against the HIV virus differently they are often combined in a cocktail form to prevent the virus from developing resistance and rendering treatment ineffective. Adherence is the most important thing to insure that the treatment is effective and successful (Bhatti el al,. 2007).
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