How does HIV spread to different body fluids during early infection. What are the implications for HIV testing and diagnosis. How does viral shedding in various fluids impact transmission risk and public health strategies. What insights does this provide for early HIV treatment approaches.

HIV Dissemination to Body Fluids in Early Infection

Understanding how HIV spreads to different body fluids during the early stages of infection is crucial for improving diagnosis, treatment, and prevention strategies. This study examined HIV RNA levels in various body fluids of individuals with primary HIV infection, comparing them to those with established infections.

Key Findings on HIV RNA Levels in Different Fluids

• Blood plasma: Highest HIV RNA levels were found closest to symptom onset
• Saliva: Similar pattern to blood plasma, with highest levels early in infection
• Cerebrospinal fluid (CSF): Levels appeared lower closer to symptom onset but were higher overall compared to established infections
• Seminal plasma: Reached levels seen in chronic infection within 3-5 weeks of symptom onset
• Cervicovaginal fluid: Also reached chronic infection levels within 3-5 weeks

These findings highlight the rapid dissemination of HIV to various bodily fluids during primary infection. This has important implications for transmission risk and diagnostic approaches in early infection.

Implications for HIV Testing and Diagnosis

The study’s results have significant implications for HIV testing strategies, especially during the critical early stages of infection. How do these findings impact current diagnostic approaches?

Challenges in Early HIV Detection

Detecting HIV in its earliest stages can be challenging due to the “window period” – the time between infection and when standard tests can reliably detect the virus. This study suggests that different body fluids may have varying levels of detectable virus during early infection, which could influence testing accuracy.

Potential for Improved Testing Strategies

• Blood tests remain the gold standard, with highest viral loads early in infection
• Saliva testing may be a promising non-invasive option for early detection
• CSF testing could be valuable in cases of suspected neurological involvement
• Genital fluid testing may not be as reliable in the very early stages

Understanding these patterns could lead to more targeted and effective testing protocols, potentially reducing the window period for diagnosis.

Transmission Risk During Primary HIV Infection

The high viral loads observed in various body fluids during primary infection have significant implications for HIV transmission risk. How does this impact public health strategies?

Elevated Risk of Transmission

Primary HIV infection is associated with a substantially higher risk of transmission due to the following factors:

• Very high viral loads in blood and genital fluids
• Individuals may be unaware of their infection status
• Standard HIV tests may not yet detect the infection

Public Health Implications

These findings underscore the importance of:

1. Targeted education about the risks of primary HIV infection
2. Promoting regular testing, especially for high-risk individuals
3. Developing and implementing more sensitive early detection methods
4. Considering pre-exposure prophylaxis (PrEP) for partners of newly diagnosed individuals

By focusing on these areas, public health initiatives can potentially reduce the impact of highly infectious individuals during the primary infection stage.

Early Treatment Strategies for HIV

The study’s insights into viral dissemination during primary infection have important implications for treatment approaches. How might these findings influence early HIV treatment strategies?

Benefits of Early Antiretroviral Therapy

Initiating antiretroviral therapy (ART) during primary HIV infection may offer several advantages:

• Rapid reduction of viral load in multiple body fluids
• Potential preservation of immune function
• Possible reduction in the size of the latent HIV reservoir
• Decreased risk of onward transmission

Treatment Considerations

When considering early treatment initiation, healthcare providers should take into account:

1. The potential for drug resistance if therapy is started before resistance testing results are available
2. The need for high adherence to prevent resistance development
3. Possible short-term side effects of ART
4. The long-term benefits of early treatment in terms of overall health outcomes

Balancing these factors is crucial in developing optimal treatment strategies for individuals with primary HIV infection.

HIV in the Central Nervous System During Early Infection

The study’s findings regarding HIV RNA levels in cerebrospinal fluid (CSF) provide valuable insights into the virus’s impact on the central nervous system during primary infection. What are the implications of these observations?

Neurological Involvement in Early HIV

The presence of HIV RNA in CSF during primary infection suggests early neurological involvement. This has several important implications:

• Potential for early cognitive and neurological effects
• Need for vigilance in monitoring neurological symptoms in newly diagnosed patients
• Importance of selecting antiretroviral drugs with good central nervous system penetration

Research and Clinical Directions

These findings open up new avenues for research and clinical practice:

1. Further studies on the long-term neurological outcomes of early CNS involvement
2. Development of neurological screening protocols for primary HIV infection
3. Investigation of neuroprotective strategies that could be implemented early in the course of infection

Understanding the early dynamics of HIV in the central nervous system could lead to improved management of HIV-associated neurocognitive disorders.

Viral Shedding in Genital Fluids: Implications for Sexual Transmission

The study’s observations on HIV RNA levels in seminal plasma and cervicovaginal fluid provide crucial information about sexual transmission risk during primary infection. How do these findings impact our understanding of HIV transmission and prevention?

Rapid Establishment of Genital Viral Shedding

The study found that HIV shedding in genital fluids reached levels observed in chronic infection within 3-5 weeks of symptom onset. This has significant implications:

• High risk of sexual transmission very early in the course of infection
• Potential for rapid spread within sexual networks
• Need for early intervention to prevent onward transmission

Prevention Strategies

Based on these findings, several prevention strategies should be emphasized:

1. Promotion of condom use, especially for individuals with recent high-risk exposures
2. Increased availability and uptake of pre-exposure prophylaxis (PrEP) for partners of newly diagnosed individuals
3. Rapid initiation of antiretroviral therapy to reduce viral load and transmission risk
4. Enhanced contact tracing and partner notification programs

By implementing these strategies, the high transmission risk associated with primary HIV infection could potentially be mitigated.

Saliva as a Potential Diagnostic Fluid for Early HIV Detection

The study’s findings on HIV RNA levels in saliva during primary infection suggest potential applications for non-invasive early HIV detection. How might saliva testing contribute to improved HIV diagnosis and screening?

Advantages of Saliva-Based Testing

Saliva testing for HIV offers several potential benefits:

• Non-invasive collection method
• Potentially earlier detection compared to antibody-based tests
• Increased acceptability for frequent testing in high-risk populations
• Possibility of self-testing or home-based testing

Challenges and Future Directions

While promising, saliva-based testing for early HIV detection faces some challenges:

1. Need for highly sensitive assays to detect lower viral loads compared to blood
2. Validation of accuracy and reliability across different populations
3. Development of point-of-care testing platforms for rapid results
4. Integration into existing testing algorithms and public health programs

Further research and development in this area could lead to improved early detection strategies, potentially reducing the window period for HIV diagnosis and facilitating earlier treatment initiation.

Implications for HIV Cure Research

The study’s insights into early viral dissemination have potential implications for HIV cure research. How might understanding primary infection dynamics contribute to cure strategies?

Targeting the Early Establishment of Viral Reservoirs

The rapid spread of HIV to various body compartments during primary infection suggests that early intervention might be crucial for limiting the establishment of viral reservoirs. This has several implications for cure research:

• Potential for very early ART to limit reservoir size
• Identification of key timepoints for intervention to prevent widespread viral seeding
• Importance of understanding tissue-specific viral dynamics

Future Research Directions

These findings suggest several avenues for future cure-oriented research:

1. Studies on ultra-early ART initiation and its impact on reservoir establishment
2. Investigation of tissue-specific interventions to target viral reservoirs
3. Development of strategies to enhance immune control during primary infection
4. Exploration of combination approaches targeting multiple body compartments

By leveraging our understanding of primary HIV infection dynamics, researchers may be able to develop more effective strategies for achieving long-term HIV remission or cure.

In conclusion, this study provides valuable insights into the early dissemination of HIV to various body fluids during primary infection. These findings have far-reaching implications for HIV diagnosis, treatment, prevention, and cure research. By applying this knowledge, healthcare providers and researchers can work towards more effective strategies to combat HIV infection at its earliest stages, potentially improving long-term outcomes and reducing transmission rates.

HIV in body fluids during primary HIV infection: implications for pathogenesis, treatment and public health

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. 2001 May 4;15(7):837-45.

doi: 10.1097/00002030-200105040-00004.

C D Pilcher 
¹
, D C Shugars, S A Fiscus, W C Miller, P Menezes, J Giner, B Dean, K Robertson, C E Hart, J L Lennox, J J Eron Jr, C B Hicks

Affiliations

Affiliation

• ¹ School of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA.

• PMID:

  11399956

• DOI:

  10.1097/00002030-200105040-00004

C D Pilcher et al.

AIDS.

2001.

. 2001 May 4;15(7):837-45.

doi: 10.1097/00002030-200105040-00004.

Authors

C D Pilcher 
¹
, D C Shugars, S A Fiscus, W C Miller, P Menezes, J Giner, B Dean, K Robertson, C E Hart, J L Lennox, J J Eron Jr, C B Hicks

Affiliation

• ¹ School of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA.

• PMID:

  11399956

• DOI:

  10.1097/00002030-200105040-00004

Abstract

Objective:

To describe initial viral dissemination to peripheral tissues and infectious body fluids during human primary HIV infection.

Design:

Observational cohort study.

Methods:

Blood plasma, cerebrospinal fluid (CSF), seminal plasma, cervicovaginal lavage fluid and/or saliva were sampled from 17 individuals with primary HIV infection (range of time from symptoms onset to sampling, 8–70 days) and one individual with early infection (168 days). Subjects’ HIV-1 RNA levels in each fluid were compared with levels from antiretroviral-naive controls with established HIV infection. For study subjects, correlations were assessed between HIV-1 RNA levels and time from symptoms onset. Responses to antiretroviral therapy with didanosine + stavudine + nevirapine +/- hydroxyurea were assessed in each compartment.

Results:

HIV-1 RNA levels were highest closest to symptoms onset in blood plasma (18 patients) and saliva (11 patients). CSF HIV-1 RNA levels (five patients) appeared lower closer to symptoms onset, although they were higher overall in primary versus established infection. Shedding into seminal plasma (eight patients) and cervicovaginal fluid (two patients) was established at levels observed in chronic infection within 3–5 weeks of symptoms onset. High-level seminal plasma shedding was associated with coinfection with other sexually transmitted pathogens. Virus replication was suppressed in all compartments by antiretroviral therapy.

Conclusions:

Peak level HIV replication is established in blood, oropharyngeal tissues and genital tract, but potentially not in CSF, by the time patients are commonly diagnosed with primary HIV infection. Antiretroviral therapy is unlikely to limit initial virus spread to most tissue compartments, but may control genital tract shedding and central nervous system expansion in primary infection.

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Screening and diagnosis for HIV: MedlinePlus Medical Encyclopedia

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In general, testing for the human immunodeficiency virus (HIV) is a 2-step process that involves a screening test and follow-up tests.

HIV testing can be done by:

• Drawing blood from a vein
• A finger prick blood sample
• An oral fluid swab
• A urine sample

SCREENING TESTS

These are tests that check if you’ve been infected with HIV. The most common tests are described below.

An antibody test (also called immunoassay) checks for antibodies to the HIV virus. Your health care provider may order the test for you to have done at a lab. Or, you may have it done at a testing center or use a home kit. These tests can detect antibodies starting a few weeks after you’re infected with the virus. Antibody tests can be done using:

• Blood — This test is done by drawing blood from a vein, or by a finger prick. A blood test is the most accurate because blood has a higher level of antibodies than other body fluids.
• Oral fluid — This test checks for antibodies in the cells of the mouth. It is done by swabbing the gums and inside cheeks. This test is less accurate than the blood test.
• Urine — This test checks for antibodies in the urine. This test is also less accurate than the blood test.

An antigen test checks your blood for an HIV antigen, called p24. When you’re first infected with HIV, and before your body has a chance to make antibodies to the virus, your blood has a high level of p24. The p24 antigen test is accurate 11 days to 1 month after getting infected. This test is usually not used by itself to screen for HIV infection.

An antibody-antigen blood test checks for levels of both HIV antibodies and the p24 antigen. This test can detect the virus as early as 3 weeks after getting infected.

FOLLOW-UP TESTS

A follow-up test is also called a confirmatory test. It is usually done when the screening test is positive. Several kinds of tests may be used to:

• Detect the virus itself
• Detect antibodies more accurately than screening tests
• Tell the difference between the 2 types of virus, HIV-1 and HIV-2

No preparation is necessary.

When taking a blood sample, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away.

There is no discomfort with an oral swab test or the urine test.

Testing for HIV infection is done for many reasons, including for:

• Sexually active individuals
• People who want to be tested
• People in high-risk groups (men who have sex with men, injection drug users and their sexual partners, and commercial sex workers)
• People with certain conditions and infections (such as Kaposi sarcoma or Pneumocystis jirovecii pneumonia)
• Pregnant women, to help prevent them from passing the virus to the baby

A negative test result is normal. People with early HIV infection may rarely have a negative test result.

A positive result on a screening test does not confirm that the person has HIV infection. More tests are needed to confirm HIV infection.

A negative test result does not rule out HIV infection. There is a period of time, called the window period, between HIV infection and the appearance of anti-HIV antibodies. During this period, antibodies and antigens may not be measured.

If a person might have acute or primary HIV infection and is in the window period, a negative screening test doesn’t rule out HIV infection. Follow-up tests for HIV are needed.

With the blood test, veins and arteries vary in size from one patient to another, and from one side of the body to the other. Taking blood from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

There are no risks with the oral swab and urine tests.

HIV testing; HIV screening; HIV screening test; HIV confirmatory test

• Blood test

Bartlett JG, Redfield RR, Pham PA. Laboratory tests. In: Bartlett JG, Redfield RR, Pham PA, eds. Bartlett’s Medical Management of HIV Infection. 17th ed. Oxford, England: Oxford University Press; 2019:chap 2.

Centers for Disease Control and Prevention website. HIV testing. www.cdc.gov/hiv/guidelines/testing.html. Updated January 21, 2020. Accessed August 9, 2021.

US Preventive Services Task Force; Owens DK, Davidson KW, et al. Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321(23):2326-2336. PMID: 31184701 pubmed.ncbi.nlm.nih.gov/31184701/.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

AIDS All about HIV infection

Brief historical information For the first time in the United States in the mid-70s, doctors noticed that patients with practically no immunity began to appear. They could not understand the reason for this, therefore the term AIDS appeared. After how many years the viral nature of the occurrence of immunodeficiency was proven.

For the first time in the USA in the mid-70s, doctors noticed that patients began to appear with practically no immunity. They could not understand the reason for this, therefore the term AIDS appeared. After how many years the viral nature of the occurrence of immunodeficiency was proven.

There are several versions of the origin of HIV:

• The immunodeficiency virus appeared about 100 years ago, but did not become widespread due to restrictions in the field of sex. The spread of the virus is associated with the fact that there was a sexual revolution, so the first cases appeared in the United States.
• In the beginning, the virus was in great apes, then a mutation occurred and the virus passed to humans. This explains the fact that the highest infection rates are in Africa and India.
• Created biological weapons. The secret laboratory was in the jungle. There was a leak, the locals got sick. Then the virus came to the United States, and due to permissiveness in sexual relations and sexual life in the United States, the disease spread.

Concept of HIV infection

HIV infection is a slowly progressive infectious disease caused by the human immunodeficiency virus. It is characterized mainly by damage to the immune system. As a result, the human body becomes highly susceptible to opportunistic (opportunistic) bacteria and tumors, from which it eventually dies.

The disease has a long course. Possibly longer than 10 years.

The latency period can vary from 5 to 10 years.
There is a known case when the clinic came 22 years after infection.
The average life expectancy of an infected person in Russia is 10-15 years.

AIDS (Acquired Immunodeficiency Syndrome) is not an independent disease, but one of the manifestations of the infectious process.
With HIV infection, AIDS develops in the final terminal stage.
AIDS can also occur with any other infectious disease, but unlike HIV, immunity can be restored, and with HIV, immunity is slowly but surely reduced to almost zero.

Etiology, epidemiology and pathogenesis

The causative agent of HIV infection is a virus of the subfamily of lentiviruses, a family of retroviruses. Currently, 2 types are distinguished: HIV-1 and HIV-2, which in turn are divided into subspecies and are indicated by small Latin letters.

The virus consists of a protein shell on which the receptors are located. The main receptor glycoprotein 120 (gp-120). Inside the shell is the core, consisting of 2 RNA molecules and the reverse transcriptase enzyme (reverse transcriptase).

A virus lives and reproduces only in a living cell. Unstable in the external environment. At a temperature of +70 +80 dies in 10 minutes. When boiled, it dies in 1-2 minutes. When exposed to disinfectants, it dies after 10 minutes. GI enzymes, saliva and sweat inactivate the virus.

In an infected person, the virus is found in all biological fluids, in all tissues and organs, but the highest concentration is:

• in the blood
• in cum
• in vaginal contents
• in liquor
• in bone marrow
• in breastfeeding mother’s milk

It is through these body fluids that infection occurs. In a dried drop of blood, the virus remains active for 3-7 days. In blood intended for transfusion and frozen serum, it persists for months and even years. Long stored in frozen semen (up to 6 months).

The source of infection is only a person infected with HIV or sick. Becomes contagious from the moment the virus enters the body and for life.

HIV transmission factors AIDS

• Human biological fluids.
• Medical instrument infected with a virus.
• Personal hygiene items: razors, manicure sets, toothbrushes and toothpicks, combs.

Ways of HIV transmission AIDS:

• Sexual
• Parenteral
• Vertical from an infected mother to the child through the placenta during pregnancy, during labor during passage through the birth canal, while breastfeeding.

It is possible for a mother to become infected from an infected child when caring for people who do not follow the rules of personal hygiene.

HIV pathogenesis AIDS:

The HIV virus enters the body only through damaged skin and mucous membranes.

HIV can affect many organs and systems, but the immune system suffers the most.

The main cells of the immune system are lymphocytes: B-lymphocytes are responsible for humoral immunity, that is, for antibody formation, and T-lymphocytes are responsible for cellular immunity, that is, for phagocytosis.

The virus mainly infects T-4 lymphocytes because the T-4 lymphocyte receptor is similar in structure to the virus receptor. Due to this similarity, the virus freely penetrates into T-4 lymphocytes. As a result, the virus multiplies and the lymphocytes die.
In a healthy person, the number of T-4 lymphocytes is from 800 to 1200 cells in one µl of blood. With a decrease in T-4 lymphocytes from 700 cells to 500, the immune system is weakened, and still can cope with the infection. With the number of T-4 lymphocytes from 499-200 cells, the immune system is sharply weakened, any opportunistic infection may develop at any time. With a decrease in T-4 lymphocytes of less than 200 cells, the immune system is completely blocked, a person is defenseless against any infection or tumor.

Clinical and diagnostic HIV AIDS

Clinical manifestations of HIV depend on the stage of the infectious process:

• Incubation period
• Acute phase
• Asymptomatic stage
• Generalized lymphadenopathy
• AIDS related complex
• AIDS.

The incubation period lasts from the moment the virus enters the human body until the formation of antibodies. Its duration is from 2-3 weeks to 1 year, on average 2-3 months.

The acute phase occurs in half of those infected with HIV. This is the primary response to the formation of antibodies. The main symptom is lymphadenopathy. Weakness, night sweats, prolonged subfebrile condition. There may also be various rashes on the mucous membrane and skin, resembling infectious mononucleosis or rubella. There may be arthralgia, myalgia. Could be oral candidiasis.
The acute phase lasts from several weeks to 2-3 months, sometimes longer. It depends on the state of the immune system. When immunity is restored, the acute phase stops.

Asymptomatic stage. The person feels well and does not consider himself sick. The only symptom may be swollen lymph nodes if they were enlarged in the acute phase. If the lymph nodes were not enlarged in the acute phase, then they will certainly increase at the end of the asymptomatic stage.
This stage lasts for several years. Can last up to 10 years.

Generalized lymphadenopathy – characterized by an increase in two or more lymph nodes, in two or more different groups. In adults, sizes are from 1-1.5 cm or more, in children 0.5 cm or more.

Lymph nodes are painless, elastic, not soldered to each other and surrounding tissues. They can either increase or decrease, this is due to the activity of the virus. Lymph nodes can atrophy in the last terminal stage of HIV. This period lasts from several years to 5.

AIDS-related complex – the number of T-4 lymphocytes 499-200 cells in 1 µl of blood. It is possible at any time the emergence and development of secondary infections caused by conditionally pathogenic flora. Fungal and herpetic lesions of the skin and mucous membranes. Unexplained fever for more than 1 month. Unexplained diarrhea for more than 1 month, with a loss of body weight of more than 10%. Pustular lesions of the skin. Repeated pharyngitis, otitis, sinusitis, which at first respond well to treatment with conventional methods, but gradually become protracted and persistent. There may be focal pulmonary tuberculosis, localized Kaposi’s sarcoma.
Without treatment, the period lasts 12-18 months. With treatment, life can be extended by several years.

AIDS is the final terminal stage. Secondary diseases are characteristic, from which patients die. These are the so-called AIDS marker diseases. They occur when T-4 lymphocytes decrease to less than 200 cells in 1 µl of blood. Without treatment, this period lasts from several months to 1 year. With timely started and effective treatment, the patient can live up to 3-5 years.

HIV diagnostics AIDS

To confirm the diagnosis, the following tests are performed:

• Enzyme-linked immunosorbent assay (ELISA)
• Immune blocking (IB)
• Polymerase chain reaction (PCR)

A mass screening method is the detection of antibodies to HIV using ELISA. False-positive reactions are common among drug addicts, tuberculosis patients and pregnant women.

Prevention of HIV AIDS

The basic principle is sanitary and educational work. All medical workers are required to carry out sanitary and educational work. Promotion of safe sex, less dangerous sex, correct use of condoms, talks about the dangers of drug addiction, talks on the prevention of HIV infection and other sexually transmitted infections with all population groups, and especially with young people.

An important aspect of prevention is the identification of HIV-infected and sick people.

Donors, certain categories of medical workers, pregnant women going for a planned operation are subject to mandatory HIV testing.

Prevention of nosocomial infection:

• Mandatory examination of blood and organ donors on the day of donation and after 6 months.
• Reduction of invasive and parenteral interventions. Carry out only under strict indications.
• Processing reusable medical instruments in accordance with current orders and instructions.

Protection – condom. Currently, this is the only way to protect against infection during sexual contact. With the correct use of these contraceptives, protection is 97%. Many doctors argue that the HIV virus can penetrate through the pores of the latex in a condom, and therefore there is a risk of infection.

HIV test. From the moment of infection to the appearance of antibodies, it takes from two to six weeks, and sometimes three months. During this period, the HIV test may give a negative result, so it is recommended to repeat it after three months.

DETAILS

The first cases of the mysterious disease were recorded in the USA, Sweden, and third world countries in the late 70s. In the Soviet Union, the first case of HIV infection was registered in 1985; until the end of the 90s, the infection in the USSR and Russia developed slowly, but in the early 2000s, the virus deeply affected the environment of drug addicts and the incidence jumped sharply. In the Russian Federation, from 60 to 80 thousand people fell ill every year. In recent years, the situation has remained alarming; the growth rate of HIV infection has not decreased. Every day, 200-300 new cases of HIV infection are registered, and every year 11,000 HIV-infected women in Russia give birth to children. Currently, 6.5 thousand HIV-infected children are registered, 40% of which are orphans.

etiology, modes of transmission, detection |

HIV infection is a disease caused by the human immunodeficiency virus (HIV), a chronic disease characterized by a specific damage to the immune system, leading to its slow destruction up to the formation of acquired immunodeficiency syndrome (AIDS), leading to rapid death of an infected with HIV. The rapid spread of HIV among the young population leads to an increase in mortality, a reduction in the birth rate, a decrease in life expectancy of the population, a reduction in the working population, an increase in healthcare costs, and causes a multifactorial destructive impact on the social and economic life of society.

Etiology

The causative agent of HIV infection, the human immunodeficiency virus (HIV), belongs to the lentivirus subfamily of the retrovirus family. There are two types of virus: HIV-1 and HIV-2. HIV-1 is the most common pathogen with pandemic potential, while HIV-2 occurs predominantly in West Africa. HIV-1 and HIV-2 were once acquired by humans from two different species of monkeys, but modern cases of human infection from monkeys have not been recorded. Infected people are considered the only source of HIV. If biological safety requirements are not observed in laboratory conditions, HIV infection is possible. Cases of spontaneous sanitation from the pathogen are not documented. Transmission of the virus from a person is possible at any stage of the disease, including during the incubation period.

Mechanism, factors, ways of HIV transmission

HIV infection can be transmitted through both natural and artificial transmission mechanisms.

The natural mechanisms of HIV transmission include:

– Contact, which occurs mainly through sexual contact (both homo- and heterosexual) and through contact of the mucous or wound surface with blood.

– Vertical (infection of a child from an HIV-infected mother: during pregnancy, childbirth and breastfeeding).

The artificial mechanism of transmission includes:

– Artifical during non-medical invasive procedures, including intravenous drug administration (use of syringes, needles, other injection equipment and materials), tattooing , during cosmetic, manicure and pedicure procedures non-sterile toolkit .

— Artifical for invasive interventions in the MO. HIV infection can occur through transfusion of blood, its components, transplantation of organs and tissues, use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical devices contaminated with HIV and not processed in accordance with with the requirements of regulatory documents.

The main factors of pathogen transmission are human biological fluids (blood, blood components, semen, vaginal discharge, breast milk).

Transmission of HIV through sexual contact. HIV is transmitted primarily through vaginal and anal sex. HIV transmission factors are: semen (in this case, HIV is not in spermatozoa, but in seminal fluid and cells), secretions of the female genital tract. The probability of HIV transmission determines a high level of viral load at the source of infection, which is observed in the early stage of the disease (incubation period, the period of primary clinical manifestation), decreases during the period of latent infection and tends to increase in the late stages of the disease.

Vertical transmission of HIV. The child of an HIV-infected woman can acquire HIV during pregnancy and childbirth, and in the postpartum period through breastfeeding. Transmission factors are blood, pathological discharge and breast milk.

There have been registered cases of HIV transmission from an infected child to a breastfeeding woman in the presence of erosions in the oral cavity of a child who was in the phase of acute HIV – infection and the presence of cracks in the areola in the mother.

Transmission of HIV through transfusion of blood components and organ and tissue transplantation is due to the direct entry of infected material into an uninfected organism. Virtually all tissues and organs of an HIV-infected donor can be a factor in HIV transmission.

Transmission of HIV by artificial insemination is similar to sexual transmission of HIV. Transmission factors are sperm and other donor materials.

HIV transmission through medically invasive procedures is possible when using instruments contaminated with the HIV virus that have not undergone regulated disinfection and sterilization treatment.

HIV transmission through non-medical parenteral interventions: in users of psychotropic substances through intravenous administration (use of shared blood-contaminated needles and syringes by several drug users, exposure of blood of an HIV-infected person to drug solutions, in the liquid used to wash syringes, on other items used when preparing and using a drug solution).

A similar route of transmission can be observed with parenteral administration of anabolics, acupuncture, tattooing, piercing, etc. Isolated cases of HIV transmission have been recorded when the blood of an HIV-infected person comes into contact with damaged skin and mucous membranes of an uninfected person, for example, when providing first aid and treating a wound surface without using gloves or other barriers.

Susceptibility to HIV. Particularly vulnerable groups of the population.

The susceptibility of the population to the HIV virus is high.

Potentially the entire population is more or less vulnerable to HIV infection.

Users of non-medical drugs.

Men who have sex with men.

Persons in prisons may be infected with HIV prior to admission to the penitentiary system (most often as a result of drug use), as well as as a result of heterosexual or homosexual contacts.

KSR – data on HIV testing results of this main vulnerable population group is not recorded in the forms of federal statistical observation.

Patients with STI are a representative group, the detection of HIV infection in which reflects the general patterns of development of the epidemic process of HIV infection in the general population of the population as a whole.

HIV clinic.

Within a few months after infection with HIV, there may be a short period of acute events resembling acute respiratory infections, rubella or mononucleosis, and then HIV infection for many years proceeds latently without visible manifestations. At this time, HIV infection can only be detected by conducting a special diagnostic laboratory test of blood or other materials for markers of HIV infection. In subsequent years, HIV gradually depletes the human immune system: in 50% within 8-10 years and in 95% within 20 years after infection with HIV develops AIDS, which is expressed in the development of life-threatening opportunistic diseases, usually caused by microorganisms that are not dangerous for healthy people, or tumors etiologically associated with viruses. If untreated, an AIDS patient dies within 1 year. The median life expectancy of a person after HIV infection in the absence of treatment is 10-12 years, individual HIV-infected individuals live more than 20 years, which determines the long duration of possible transmission of the pathogen. The long absence of clinical manifestations and the long existence of potential sources leads to the imperceptible spread of HIV among the population of different countries and territories, and years later – the massive development of AIDS in HIV-infected people and their death in the absence of treatment.

Detection (laboratory diagnosis) of HIV infection.

Diagnosis of HIV infection in the Russian Federation is carried out on the basis of an integrated approach based on epidemiological, clinical and laboratory data.

Laboratory diagnosis of HIV infection is based on the detection of antibodies to HIV and viral antigens, as well as, in special cases, the detection of HIV proviral DNA and HIV viral RNA (in children of the first year of life and persons in the incubation period). Until a positive immune blot test or detection of HIV RNA or DNA is obtained, persons with positive results from other tests, as well as those with questionable immune blot results, are considered suspect for infection with HIV infection, and it is recommended that they be subjected to epidemic control measures, such as suspension from donation, counseling, for pregnant women – planning to start chemoprevention of mother-to-child transmission of HIV.

A negative HIV antibody test result does not always mean that a person is not infected because there is a “seronegative window” (the time between HIV infection and the appearance of antibodies), which is usually about 3 months; during this period, HIV infection may confirm the detection of HIV antigens or HIV gene material. In some cases, with insufficient laboratory confirmation data, it is possible to assume the presence of HIV infection based on epidemiological data (for example, if there is a history of transfusion of blood components from an HIV-infected donor, children born to HIV-infected mothers) and / or clinical manifestations of HIV infection.

In such cases, the organization and implementation of anti-epidemic measures is carried out without waiting for laboratory confirmation, because due to the high viral load in the absence of antibodies in the early stage of the disease, HIV-infected people are the most dangerous sources of HIV infection.

Simple/rapid HIV specific antibody tests (tests that can be performed without special equipment in less than 60 minutes) are used in Russia for timely decision-making, but are not the main method for diagnosing HIV infection. It is advisable to use them for testing various hard-to-reach population groups, including when carrying out preventive measures and actions. Blood, serum, blood plasma and saliva (scraping from the gum mucosa) can be used as the test material.

When HIV infection is detected by simple/rapid tests, it is necessary to inform the patient about preliminary test results and refer him/her as soon as possible to an infectious disease specialist of an authorized specialized medical organization that carries out organizational and methodological work on diagnostic, therapeutic, preventive and anti-epidemic measures for HIV -infections (AIDS Center) for clinical examination, history taking, diagnosis of HIV infection and timely initiation of treatment. If HIV infection is detected among representatives of vulnerable groups of the population, it is advisable to additionally provide them with accompaniment to the above-mentioned specialized medical organizations. Accompaniment can be carried out, including with the help of employees or volunteers of non-governmental organizations in accordance with the approved procedure for interaction between organizations. In case of a negative result of the survey, simple / quick as part of preventive measures and actions, the study by the classical ELISA method is not mandatory, but can be carried out at the request of the subject or when risk factors for HIV infection are identified.

The issuance of a conclusion on the presence or absence of HIV infection only on the results of a simple / rapid test is not allowed.

Laboratory tests for the diagnosis of HIV infection are carried out in institutions of the state, municipal or private healthcare system on the basis of a sanitary and epidemiological report and a license issued in accordance with the procedure established by the legislation of the Russian Federation.