HIV infection: testing, modern therapy and life with a diagnosis - consultation in Tashkent

How it is transmitted and how it is not transmitted

The virus is found in blood, semen, vaginal secretions and breast milk. Concentrations in saliva, tears and sweat are not sufficient to cause infection. Understanding this list removes most of your everyday fears.

• Routes of transmission: unprotected sexual contact, blood entering the bloodstream through shared needles and unsterile instruments, from mother to child during pregnancy, childbirth and breastfeeding
• Not transmitted through handshakes, hugs, kisses, shared dishes and towels
• Not transmitted through the pool, bathhouse, toilet, mosquito bites and other insects
• It is not transmitted by coughing and sneezing, or by working or studying nearby
• Prevention of transmission to the child with timely treatment of the mother works very well: the vast majority of children are born healthy

The virus is unstable in the external environment: outside the body, it quickly loses its ability to infect. Therefore, concerns about handrails in transport, seats, money, public toilets and dishes in cafes are unfounded. Understanding this is important not only for peace of mind: it is everyday fears that underlie the stigma that causes people to put off testing for years and find out about the diagnosis late.

When the test becomes reliable

Time passes between infection and the moment when the test is able to show the infection - this is called the window period. During this period, a person can already transmit the virus, but the test is still negative, so the timing of testing is important.

1. Современные тесты четвёртого поколения определяют одновременно антитела и вирусный антиген p24, и большинство инфекций выявляют уже через 3–4 недели после контакта.
2. Надёжным считается отрицательный результат теста четвёртого поколения через 6 недель, а окончательным — через 12 недель после риска.
3. Экспресс-тесты по капле крови или по слюне определяют только антитела, и период окна у них длиннее — до 12 недель.
4. ПЦР на вирусную РНК выявляет инфекцию раньше всех, примерно с 10–14-го дня, но применяется по конкретным показаниям, а не для скрининга.
5. Любой положительный результат скринингового теста обязательно перепроверяется подтверждающим исследованием: одного анализа для диагноза недостаточно.

What happens after infection

The course of the infection is divided into stages, and knowledge of this sequence explains why it is necessary to be checked even in the complete absence of complaints.

1. Острая стадия, через 2–4 недели после заражения: у части людей возникает состояние, похожее на грипп или мононуклеоз, — температура, боль в горле, сыпь, увеличение лимфоузлов. Оно проходит само, и о нём часто забывают.
2. Латентная стадия: длится годами, самочувствие нормальное, симптомов нет. Вирус продолжает поражать клетки иммунной системы, и именно поэтому человек может годами не знать о диагнозе.
3. Стадия снижения иммунитета: появляются частые и затяжные инфекции, кандидоз, опоясывающий лишай, потеря веса.
4. Продвинутая стадия развивается при выраженном снижении числа лимфоцитов CD4, когда присоединяются тяжёлые оппортунистические инфекции. Современное лечение позволяет до неё не доводить, а начатая терапия способна восстановить иммунитет и на этом этапе.

The main practical conclusion follows from this sequence: it is impossible to suspect HIV infection based on how you feel. Years of the latent stage pass without a single symptom, and all this time treatment would have been possible and effective. Therefore, the test is not about suspicion or lifestyle, but a routine preventive examination, the same as measuring blood pressure or testing for sugar.

Modern treatment and the U=U principle

Antiretroviral therapy suppresses the replication of the virus. In recent years, regimens have become much simpler and better tolerated: for most patients this is one combined tablet per day. Therapy begins immediately after diagnosis, regardless of the CD4 cell count - early start gives the best result.

• The goal of treatment is an undetectable viral load, that is, an amount of virus in the blood that is not detected by tests.
• Typically this goal is achieved within 3–6 months of regular use.
• With a consistently undetectable load, the virus is not transmitted sexually - this is the H=U principle, confirmed by major studies
• Monitoring includes regular measurement of viral load and CD4 cell count, as well as monitoring liver, kidney and metabolic health
• Therapy is taken continuously and without interruptions: omissions lead to the growth of the virus and the development of drug resistance
• A woman receiving therapy can carry and give birth to a child without HIV - the pregnancy is managed jointly by an infectious disease specialist and an obstetrician-gynecologist

The significance of the U=U principle goes beyond medicine. It means that a person on effective therapy does not pose a danger to his partner, and this changes the attitude towards the diagnosis - both among those around him and the person himself.

Prevention

Today there are several prevention tools, and they complement each other. Some of them are designed for constant use, some for a specific situation, and in the latter case, the speed of contacting a doctor is crucial.

1. Презерватив при половых контактах остаётся простым и надёжным средством, защищающим одновременно и от других инфекций.
2. Постконтактная профилактика: курс препаратов, который начинают в первые 72 часа после рискованной ситуации, и чем раньше, тем эффективнее. Назначается врачом.
3. Доконтактная профилактика — регулярный приём препаратов людьми с высоким риском заражения, по назначению и под наблюдением специалиста.
4. Использование только одноразового или надёжно стерилизованного инструмента при любых процедурах, связанных с нарушением целостности кожи.
5. Тестирование при планировании беременности — для обоих партнёров, а при беременности оно входит в стандартное обследование.
6. Регулярное тестирование при наличии факторов риска и хотя бы однократное для всех остальных.

Living with a diagnosis

The diagnosis changes your routine, but does not cancel your life. People with HIV work in any profession, play sports, travel, and raise children. The main thing that is required is daily use of the drug and scheduled visits to the doctor several times a year.

• Eating well and being physically active has the same benefits as everyone else, no special diet required
• Routine vaccination is discussed with an infectious disease specialist: some vaccinations are especially important, and live vaccines are prescribed taking into account the state of immunity
• Regular screening for tuberculosis, viral hepatitis and sexually transmitted infections is included in surveillance
• Smoking in people with HIV causes significantly more harm than average - quitting it brings big benefits
• Psychological support in the first months after diagnosis is a common and useful part of care, not a sign of weakness
• Information about the diagnosis is a medical confidentiality, and the person himself decides who to report it to.