HIV/AIDS FAQs

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the name used to describe a combination of potentially life-threatening infections and cancers, which can develop when someone’s immune system has been damaged by HIV.

AIDS is the name used to describe a combination of potentially life-threatening infections and cancers that can develop in people who have HIV.

Over time, infection with HIV damages the immune system, This means that the body cannot fight off a number of infections and cancers, which are sometimes called 'AIDS-defining'.

Treatment with combinations of anti-HIV drugs can keep the immune system strong, and because of this, the number of people who are diagnosed with AIDS has fallen. Thanks to an effective anti- HIV treatment, many people who developed AIDS are now very well and can look forward to a long and healthy life.

This varies from person to person. The only way to be sure if you have been infected with HIV is to have an HIV test. You cannot tell from symptoms alone.

Many people have an illness, often called a 'seroconversion' illness, soon after they are infected with HIV. Typical symptoms include a fever, sore throat, headache, aches and pains, and a skin rash.

In some people, this illness is so mild that it passes without being noticed. Some people mistake it for flu, but for some people, it is severe and they may need to see a doctor. However, because the symptoms are similar to symptoms of many other conditions, HIV might not be diagnosed at this time.

If you've had unprotected sex and notice these symptoms about two weeks later, you should consider having an HIV test.

After this initial illness, it's not uncommon for people to live with HIV and not to have any symptoms at all. But the virus will still be causing damage to the immune system and without treatment, most people with HIV will eventually become ill because of it. HIV-related illnesses can cause a wide range of symptoms. These can include fevers and night sweats, a high temperature, a cough that won't go away, unexplained weight loss, severe diarrhoea, severe headache, or persistent mouth and skin problems. Of course, these can all have other causes.

An HIV test can tell if you have become infected with HIV. HIV tests are extremely accurate.

Modern tests can tell if you've been infected with HIV very soon after exposure to the virus - normally within two to three weeks.

If you have HIV, it's very important that it's diagnosed. This will give you the best chance of getting the treatment and care you need to stay well.

However, Elisa test positive needs to be confirmed by another antibody test which is Western blot. Same way, Negative HIV test is to be repeated every 6/12/24 weeks to be confirmed that you have not acquired HIV. You may also under go PCR test to make sure you don't have HIV.

The United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) released their annual figures on World AIDS Day in 2009. They said that at the end of 2008, there were 33.4 million people living with HIV. In 2008, there were 2.7 million new infections and 2 million HIV-related deaths.

It’s difficult to say for sure how many people have HIV, as often people do not realise they have been infected and may live with HIV for some time before they are diagnosed.

The United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) produce figures for the global epidemic and also for individual countries, based on numbers collected by the health services in each country.

With modern HIV treatment, many people with HIV are living long and healthy lives. In fact, some doctors are hopeful that many people with HIV will live to a near-normal life expectancy.

A lot of effort is going into making effective anti- HIV treatment available to everyone who needs it. However, this is not always possible in some parts of the world. Without treatment, people with HIV will almost always eventually become ill and their lives may be shortened.

Your best chance of staying well is to start treatment at the right time. To do this, you need to know you have HIV. Many of the people who die from HIV-related illnesses in countries where treatment is easily available were diagnosed very late, often not until they were already very ill. Test and Treat is the best way to fight against the AIDS.

HIV is very similar to a virus called SIV (simian immunodeficiency virus), which is found in monkeys.

There's now good evidence that it jumped species from chimpanzees to man in the early 20th century.

Untreated HIV eventually leads to AIDS. The first cluster of AIDS cases were reported in New York and San Francisco in 1981. Doctors noticed that gay men were becoming ill with a rare form of pneumonia (PCP) and a cancer called Kaposi's sarcoma.

Researchers worked out that these men had an underlying infection, and that it was likely to be sexually transmitted and blood-borne.

Further cases of AIDS were soon reported in gay men in other countries, including the UK. But it quickly became apparent that AIDS was affecting other groups as well.

In 1985, the virus that is now known as HIV was identified.

Even before HIV was discovered, safer sex and safer drug use had become established ways of reducing the risk of the illness.

As the virus spread around the world and deaths mounted, research went into finding a cure or vaccine. The first drug found to have an effect against HIV was AZT.

Other drugs were developed as it became clear that treatment with one drug alone did not work well in the long term.

Treatment with two anti-HIV drugs was shown to have more benefit, but the real breakthrough came with development of new anti-HIV drugs that worked against the virus in a number of different ways.

In 1996, triple-drug HIV treatment was introduced. This treatment was able to reduce the amount of virus in the blood and allow the immune system to strengthen. Thanks to this treatment, the number of AIDS deaths fell dramatically in countries where treatment was widely available.

However, HIV was spreading rapidly in some of the world's poorest countries, especially in southern Africa, and wider access to HIV treatment in these countries is only now starting to become a reality.

The early HIV treatment combinations were difficult to take and many caused unpleasant and long-term side-effects.

More powerful, easier-to-take and safer drugs gradually became available. Thanks to these, and other improvements in HIV care, doctors have become increasingly hopeful that many people with HIV will be able to live a near-normal lifespan.

Nevertheless, HIV continues to spread. The infection is spreading rapidly in Eastern Europe, China, India and south-east Asia.

HIV is now firmly established as one of the leading health concerns of the 21st century, and one of the most significant causes of illness and death in human history.

Tuberculosis and hepatitis are two conditions that are very common in people who also have HIV. These are diseases that can have an effect on HIV and can also be affected by HIV. They are sometimes referred to as co-infections.

Hepatitis B and C are transmitted in similar ways to HIV: by contact with infected body fluids like blood, semen and vaginal fluid, and from a mother to her baby during pregnancy or delivery.

Both these types of hepatitis can cause serious liver damage, and liver disease is a major cause of serious illness and death in co-infected patients.

There is a vaccine against hepatitis B. It works well in people with HIV, and everyone who is HIV-positive should receive it.

There is no vaccine against hepatitis C. Hepatitis C can be cured with treatment which needs to be taken for up to a year. The best results are seen if treatment is provided soon after a person is infected with the virus.

Tuberculosis, or TB, is one of the most common AIDS-defining illnesses. In many cases, HIV was only diagnosed because people became ill with TB. Worldwide, TB is the leading cause of illness and death in people with HIV.

TB is passed on through infected saliva from the coughs or sneezes of an infected person. Once infected, you may not have any symptoms of illness for a very long time.

TB causes fever, cough, chest pain and weight loss. It mostly affects the lungs but can affect other parts of the body. Abdominal TB is not uncommon and one can suffer from fever, diarrhea and weight loss.

TB is treated with a combination of anti-TB drugs, which is normally taken for six months. In some cases, it may be necessary for treatment to last longer.

HIV is found in body fluids. It is present in enough quantity to be infectious in genital fluids, blood and breast milk.

The main ways in which HIV is passed on are unprotected anal, vaginal and oral sex, by sharing injecting equipment, and from a mother to her baby during pregnancy, birth or breastfeeding.

Condoms provide excellent protection against HIV transmission during sex.

If you inject drugs, you can reduce the risk of HIV and other infections by not sharing needles or other injecting equipment.

With the right treatment and care during pregnancy and birth, and by not breastfeeding, it's nearly always possible to prevent mother-to-child transmission of HIV.

You cannot get HIV from kissing, by hugging, or by shaking hands with somebody with HIV - or any other normal social contact.

Nor can you get HIV by being in the same place as someone with HIV, or by sharing household items such as crockery, cutlery, or bed linen.

HIV is not passed on by spitting, sneezing or coughing. HIV is not transmitted by mosquito bite.

Kissing, hugging, massage, and mutual masturbation are all completely safe.

Condoms provide excellent protection against HIV when used properly for vaginal, anal or oral sex.

The risk of HIV transmission from oral sex is much lower than that for anal or vaginal sex. Some people choose to use condoms or dental dams for oral sex to reduce this risk even further.

If you inject drugs, you can reduce the risk of HIV and other infections by not sharing needles or other injecting equipment.

Many people who are HIV-negative are in successful, loving, and intimate relationships with a HIV-positive partner.

Modern HIV treatment and care can significantly improve your partner's health and life expectancy. Many people with HIV can expect to have a near-normal lifespan. There's a lot of support available to help you deal with the stresses and strains related to HIV that may arise in your relationship.

It may be reassuring to know that you can stay HIV-negative. It's completely safe to kiss and hug your partner. What's more, many couples have intimate and fulfilling sex lives without passing on HIV

An HIV test can tell if you have become infected with HIV. HIV tests are extremely accurate. Modern tests can tell if you've been infected with HIV very soon after exposure to the virus - normally within two or three weeks.

If you have HIV, it's very important that it's diagnosed. This will give you the best chance of getting the treatment and care you need to stay well.

HIV tests are available in lots of healthcare settings. This might be in a sexual health clinic, doctor's hospital or private clinic, for example. In many countries, there are also places where you can be tested in your local community like Integrated Counseling and Testing Centres (ICTC) in India.

You may also be offered an HIV test as a part of care for another health matter, such as maternity care, or as part of a sexual health check-up.

'Home testing' kits are generally not recommended, as there is no guarantee these will be reliable. In some countries, including the US and the UK, you can buy 'home sampling' kits, where you take a sample of blood or saliva yourself at home, but then send it to a laboratory to be analysed.

In the UK, you can get a free and confidential HIV test at any NHS sexual health or GUM (genitourinary medicine) clinic. These clinics are linked into specialist HIV services, and there'll be support available to you if your result is positive.

There are several different types of HIV tests. Often a small sample of blood is taken and analysed in a laboratory. Other tests give an initial rapid result using finger-prick blood, or even saliva. It's often possible to get a test result the same day.

The tests used today can usually tell if a person has HIV within two to three weeks of infection. In the past, you might have had to wait three months to be certain that your test result is accurate.

It's a good idea to talk to the person giving you the HIV test if you have any questions about it.

HIV testing

Current approaches to HIV testing are to make it a normal rather than an exceptional medical event, for it to be offered in a wide range of settings, and to use newer technologies that are more effective in identifying recent infections than previous techniques.

These developments may have a number of advantages. The most important will be to allow more people who are living with HIV, but unaware of the fact, to have the benefit of appropriate treatment, care and support.

Effective antiretroviral treatment means that most people living with HIV can lead long, healthy and active lives. However, the benefits of treatment are greatest for those who start treatment promptly, and over half of new HIV diagnoses are currently in people whose CD4 count has already dropped below 350 cells/mm3, the stage at which starting HIV treatment is recommended.
Early diagnosis also gives people a chance to reduce their risk of transmitting the virus to others.

For people who find out that they are HIV negative, testing also has advantages in terms of certainty and peace of mind. In stable relationships, testing HIV negative can allow partners to make more informed decisions about sexual risks.

As testing technologies change and more people take HIV tests, the following sections aim to clarify which tests are used, how accurate they are, how their results should be interpreted and when testing is appropriate. Later sections also address issues that may be of concern to people getting tested, including where to test, consent, confidentiality and implications for employment and insurance.

What tests look for

The most widely known tests detect HIV antibodies. However detection of p24 antigen is now an important part of HIV-testing strategies.

HIV antibodies

Antibodies are protein molecules produced by the immune system in response to allergens, infectious organisms (including viruses, bacteria, fungi and parasites), and sometimes (in autoimmune disorders) the body's own components.

Infectious organisms and allergens display characteristic proteins called antigens. The immune system recognises and responds to antigens by generating corresponding antibodies. An antibody is designed to 'fit' only one particular antigen, rather like a key in a lock. (The word 'antigen' in fact derives from antibody generation.) By locking on to the antigen-bearing intruders, antibodies aim to render them harmless, to kill them outright, or to 'tag' them for destruction by other components of the immune system.

One or two weeks after initial exposure to HIV, antibodies to HIV antigens begin to appear in the blood, at concentrations which continue to increase for several more months. These antibodies persist for life, providing distinctive markers which can be identified by HIV screening tests.

Antibodies are generated in response to many different viral antigens. Antibodies to p24 antigen (see below) are generally first to appear, followed by antibodies to gp120 and gp41 - envelope proteins which appear on the outer surface of the virus. Test assays are most often geared to antibodies to these envelope proteins.

For many years, the majority of HIV diagnostic tests looked for HIV antibodies only, and some of these tests are still in use (third-generation tests). Moreover, almost all rapid tests look for antibodies only. The fourth-generation tests that are recommended for use in India look for both HIV antibodies and p24 antigen.

p24 antigen

One distinctive HIV antigen is a viral protein called p24, a structural protein that makes up most of the HIV viral core, or 'capsid'. High levels of p24 are present in the blood serum of newly infected individuals during the short period between infection and seroconversion, making p24 antigen assays useful in diagnosing primary HIV infection.

Antibodies to p24 are produced during seroconversion, rendering p24 antigen undetectable after seroconversion in most cases. Therefore, p24 antigen assays are not reliable for diagnosing HIV infection after its very early stages. However, HIV infection can be reliably diagnosed earlier with combined antibody/antigen tests than with purely antibody-detecting tests, and fourth-generation antibody/antigen tests are now the standard screening assay in India and some other countries.

HIV RNA

The genetic material of HIV (its genome) is composed of ribonucleic acid (RNA), a close cousin to the deoxyribonucleic acid (DNA) that makes up human and nearly all other genomes.

Tests known as nucleic acid tests (NATs) can be used to detect sequences of RNA unique to HIV. Although such tests have been developed and used for diagnosis of HIV infection - and in fact found to be more sensitive than some earlier antibody tests during the window period - NATs are not in general use for diagnosis of HIV. The principal use of HIV RNA testing is to quantify HIV RNA levels (HIV viral load) in the blood plasma of people who have already been confirmed as HIV-positive by antibody testing.

HIV-1 and HIV-2

There are two major types of the human immunodeficiency virus. HIV-1, which was discovered first, is the most widespread type worldwide. HIV-2 is more than 55% genetically different from HIV-1. Due to this genetic difference, HIV-1 and HIV-2 antigens are distinct enough that if a test is developed only to detect HIV-1, it will not reliably detect HIV-2.

However, tests which are sensitive to both types of the virus have been developed. All the third-generation, fourth-generation and rapid tests which are listed in the following sections are sensitive to HIV-2 antibodies. Moreover, the Health Protection Agency recommends that such a test should be used.

HIV-2 is the most common in western Africa and is becoming more common in India, although numbers there are still relatively small. Small numbers of cases have also been seen in Portugal, France, other European countries including the UK and the Americas, largely in individuals of West African origin or their sexual partners.

Should a laboratory not usually use a test which is sensitive to HIV-2, but the person testing has lived in a country where HIV-2 is common (or has a sexual partner from one of those countries), it is important to use a different test for this person. Moreover, if a person has clinical signs of HIV infection (e.g. recurrent opportunistic infections) but does not test positive to a test which is sensitive only to HIV-1, then testing specifically for HIV-2 would be appropriate.

In this discussion, mention of 'HIV' refers to HIV-1 unless otherwise stated.

Each major type of virus can be further broken down into groups, which themselves can be subdivided into clades or subtypes. HIV-1 comprises groups M (main), O (outlier), and N (non-M or O). Screening tests in developed countries were originally developed to identify the most common HIV subtype in those regions - group M, clade B. Third- and fourth-generation ELISA antibody tests are reliably able to detect group O virus, and group M subtypes other than subtype B.

SAMPLE
Venous blood sample

Most HIV tests use a blood sample that is taken from a vein in the arm, and this is called venous blood. Venepuncture (a term which means 'puncturing the vein') is the procedure used to obtain the sample. For most people, venepuncture is quick, easy, and relatively painless.

A needle is inserted through the skin into a vein. A small amount of blood is withdrawn through the needle into a syringe, which is sent to a laboratory for analysis.

The nurse (or other healthcare professional performing the venepuncture) is usually able to identify a vein in the crook of the elbow that will be easily accessible and applies a tourniquet above the site to make the vein more apparent. Clenching the fist also helps make the vein more prominent. When the needle is inserted under the skin, the patient may feel a slight sting, and there may be additional discomfort when it is withdrawn. Afterward, the patient is asked to apply gentle pressure, over a clean dressing, to help the blood clot and prevent swelling and bruising.

Some tips for people who find venepuncture stressful or uncomfortable:

• Rub or tap the area where the needle will go.
• Establish a slow and steady breathing pattern, and then quietly blow out as you feel the needle being placed.
• Close your eyes and visualise a colour or scene.
• If you are likely to feel woozy or faint, tell the nurse in advance. The blood can be taken while you are lying down, which will help avoid fainting and injury.

Tests may be conducted on whole blood, plasma or serum.

After whole blood has been separated into its liquid and solid components, the clear fluid part is known as plasma. After plasma has been allowed to clot, the remainder is known as serum. Serum and plasma samples can be refrigerated or frozen. Whole blood samples can be refrigerated, but not frozen.

Finger-prick blood sample

A finger-prick (or finger-stick) sample is a sample of whole blood that is obtained from capillaries (tiny blood vessels) in the finger, rather than a vein. The fingertip is pricked with the sharp point of a lancet. This is considered a 'minimally invasive' technique, and most rapid tests use finger-prick samples.

Warming the hand with a warm, moist towel or warm water first will increase the blood flow. Because the finger has many nerves, a finger-prick is not necessarily painless, but it can seem less intimidating than venepuncture with a needle.

Saliva sample

The fluid used for testing is actually crevicular fluid from the gums. The person being tested swabs an absorbent pad around the outer gums, adjacent to the teeth. The roof of the mouth, the tongue and the inside of the cheek should not be swabbed.

This is minimally invasive and tends to be preferred by people testing. However the OraQuick rapid test has been shown to be less accurate when performed with saliva than with blood samples.

In the medical profession this fluid is normally referred to as 'oral fluid'. In these pages, to makes things simple, we call it 'saliva'.

Urine sample

Urine collection is a non-invasive procedure and it is possible to perform HIV antibody tests on urine, but it is not possible to test for p24 antigen, determine subtype or viral type (HIV-1 or HIV-2), or measure viral load with urine samples.

Moreover, urine tests are not as sensitive or as specific as other available tests. For these reasons, urine tests are predominantly used in epidemiological studies, or as an alternative test for individuals unwilling to provide a blood sample.

There is no cure for HIV. There has been, and continues to be, lots of research into possible cures.

But, treatment with anti-HIV drugs means that many people with HIV are living long and healthy lives.

Treatment for HIV involves taking a combination of anti-HIV drugs called Anti-Retro Viral (ARVs).The treatment is called Highly Active Anti-Retroviral Therapy (HAART) This treatment has a very powerful anti-HIV effect and stops the virus from reproducing.

This allows the immune system to strengthen and fight infections effectively.

To get the most benefit from your HIV treatment, you need to take it properly. This is often called 'adherence'.

HIV treatment involves taking anti-HIV drugs every day. These cannot cure HIV. However, they can stop HIV from reproducing. This allows the immune system to stay strong.

There are now more than 20 of these drugs, although they are not all available everywhere in the world. HIV is normally treated with a combination of three different drugs. Most HIV treatment combinations are taken once or twice daily. This treatment has a very powerful anti-HIV effect.

You should aim to take all the doses of your treatment. Missing just a few doses a month can mean that your treatment doesn't work properly and your HIV may become resistant to the drugs that you are taking.

Anti-HIV drugs can interact with other some other prescribed drugs, medications you would buy from a pharmacy, herbal remedies and illegal or 'recreational' drugs. To reduce the risk of interactions, it's important to tell your HIV doctor or pharmacist about any other medicines and drugs you are taking.

You'll be monitored regularly by doing some blood tests like CD4, plasma viral load to see if your treatment is working. If you do encounter a problem with your treatment, it is possible to do something about it like a drug resistance test.

Medical care for HIV happens in a wide range of hospital and other medical settings, depending on where you are in the world. You can find out about treatment centres in the country where you live.

The best treatment and care for HIV is often at specialist HIV clinics. In India, government hospitals' A.R.T. centers are providing free anti retroviral therapy.

There's a lot you can do to look after your physical and mental health and general wellbeing.

Leading a healthy lifestyle is a good start. This includes getting enough sleep, eating a good diet, exercising, not smoking, drinking sensible amounts of alcohol and avoiding or moderating drug use.

Attending your clinic appointments is important and, if you are on HIV treatment, then taking it properly is a very important part of staying well.

Looking after your emotional health is also very important. It's good to have somebody you trust, who you can talk to about your feelings and discuss any problem you may have.

Living with HIV can be hard at times, and most people need the help of others from time to time. Don't be frightened to ask for help.

You have to start Highly Active Anti-retroviral Therapy (HAART). HAART consists of minimum 3 Anti-retroviral drugs (ARVs). You have to under go series of tests so as to avoid possible Immune Reconstitution Inflammatory Syndrome (I.R.I.S.)

When you start highly Active Retroviral Therapy (HAART). HIV in blood is killed or its replication is halted, this will result in building up of the immune system. This will result in immune reconstitution. There will be a rise in the CD4 cell count.

If an opportunistic infection like TB is inadequately treated prior to starting HAART, or T.B. infection is missed before starting HAART, then T.B. flares up and patient's general condition worsens and patient may die. Hence, it is advised to rule out T.B. before starting HAART. The patient may worsen when HAART is stared, this paradoxical reaction is called Immune Reconstitution Inflammatory syndrome (IRIS)

If you need TB treatment, then you can first take anti-TB treatment for about 15 days to 30 days and then simultaneously start HAART therapy.

It is advisable for a doctor to recommend the following tests:

1. HIV Genotyping Drug Resistance test.
2. CD4 cell count and CD4%
3. Plasma Viral Load (PVL)
4. V.D.R.L. or RPR for syphilis
5. Complete Blood Count (C.B.C.)
6. Erythrocyte Sedimentation Rate (E.S.R.)
7. Liver Function Test (L.F.T.)
8. Kidney or Renal Function Test (R.F.T.)
9. Blood Sugar
10. Lipid Profile
11. Hepatitis B virus (HBV)
12. Hepatitis C virus (HCV)
13. Chest X ray
14. Abdominal Ultra Sonography (Abd. USG)
15. mantoux method tuberculin skin test (MT-TST)
16. Sputum for Acid Fast Bacilli (AFB)
17. Stool examination
18. Urine examination
19. HLA-B*5701 (in case Abacavir drug is to be used)
20. HIV tropism assay (in case maraviroc drug is to be used)
21. Pap smear for woman
22. G6-PD

Yes, of course.
CD4+ T-CELL COUNT or CD4 Count

The CD4+ T-cell count (or CD4 count) serves as the major clinical indicator of immune function in patients who have HIV infection. It is one of the key factors in deciding whether to initiate antiretroviral therapy and chemoprophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival according to clinical trials and cohort studies. A significant change (2 standard deviations) between two tests is approximately a 30% change in the absolute count or an increase or decrease in CD4 percentage by 3 percentage points.

• Use of CD4 Count for Initial Assessment. The CD4 count is one of the most important factors in the decision to initiate antiretroviral therapy and/or prophylaxis for opportunistic infections. All patients should have a baseline CD4 count at entry into care.
• Use of CD4 Count for Monitoring Therapeutic Response. An adequate CD4 response for most patients on therapy is defined as an increase in CD4 count in the range of 50–150 cells/mm3 per year, generally with an accelerated response in the first 3 months. Subsequent increases in patients with good virologic control show an average increase of approximately 50–100 cells/mm3 per year for the subsequent years until a steady state level is reached. Some patients who initiate therapy with a severely depleted CD4 count may have a blunted increase in their count despite virologic suppression.

Frequency of CD4 Count Monitoring - In general, CD4 counts should be monitored every 3-4 months to (1) determine when to start antiretroviral therapy in patients not being treated; (2) assess immunologic response to antiretroviral therapy; and assess the need for initiation or discontinuation of prophylaxis for opportunistic infections. For those patients who are adherent to therapy with sustained viral suppression and stable clinical status for more than 2-3 years, the frequency of CD4 count monitoring may be extended to every 6 months.

Factors that affect absolute CD4 count - The absolute CD4 count is a calculated value based on the total white blood cell (WBC) count and the percentages of total and CD4+ T lymphocytes. This absolute number may fluctuate among individuals or may be influenced by factors that may affect the total WBC and lymphocyte percentages, such as use of bone marrow-suppressive medications or the presence of acute infections. Splenectomy or co-infection with HTLV-1 may cause misleadingly elevated absolute CD4 counts. Alpha-interferon, on the other hand, may reduce the absolute CD4 number without changing the CD4 percentage. In all these cases, CD4 percentage remains stable and may be a more appropriate parameter to assess the patient's immune function.

PLASMA HIV RNA TESTING

Plasma HIV RNA (viral load) should be measured in all patients at baseline and on a regular basis thereafter, especially in patients who are on treatment, because viral load is the most important indicator of response to antiretroviral therapy. Analysis of 18 trials that included more than 5,000 participants with viral load monitoring showed a significant association between a decrease in plasma viremia and improved clinical outcome. Thus, viral load testing serves as a surrogate marker for treatment response and can be useful in predicting clinical progression. The minimal change in viral load considered to be statistically significant (2 standard deviations) is a threefold, or a 0.5 log10 copies/mL change. One key goal of therapy is suppression of viral load to below the limits of detection (below 40-75 copies/mL by most commercially available assays). For most individuals who are adherent to their antiretroviral regimens and who do not harbor resistance mutations to the prescribed drugs, viral suppression is generally achieved in 12-24 weeks, even though it may take a longer time in some patients. Recommendations for the frequency of viral load monitoring are summarized below.

• At Initiation or Change in Therapy. Plasma viral load should be measured before initiation of therapy and preferably within 2–4 weeks, and not more than 8 weeks, after treatment initiation or after treatment modification. Repeat viral load measurement should be performed at 4–8-week intervals until the level falls below the assay’s limit of detection.
• In Patients Who Have Viral Suppression but Therapy Was Modified Due to Drug Toxicity or Regimen Simplification. Viral load measurement should be performed within 2–8 weeks after changing therapy. The purpose of viral load monitoring at this point is to confirm potency of the new regimen.
• In Patients on a Stable Antiretroviral Regimen. Viral load should be repeated every 3–4 months or as clinically indicated. In adherent patients who
  have suppressed viral loads for more than 2–3 years and who are at stable clinical and immunologic status, some clinicians may extend the interval to every 6 months.

Monitoring in Patients with Suboptimal Response. In addition to viral load monitoring, a number of additional factors, such as adherence to prescribed medications, altered pharmacology, or drug interactions, should be assessed. Patients who fail to achieve viral suppression should undergo resistance testing to aid in the selection of an alternative regimen.

HLA-B*5701 SCREENING

HLA-B*5701 before starting patients on an abacavir-containing regimen, to reduce the risk of hypersensitivity reaction.

• HLA-B*5701-positive patients should not be prescribed abacavir..
• The positive status should be recorded as an abacavir allergy in the patient’s medical record..
• When HLA-B*5701 screening is not readily available, it remains reasonable to initiate abacavir with appropriate clinical counseling and monitoring for any signs of hypersensitivity reaction..

CORECEPTOR TROPISM ASSAYS

• Coreceptor tropism assay should be performed whenever the use of a CCR5 inhibitor is being considered.
• Coreceptor tropism testing might also be considered for patients who exhibit virologic failure on a CCR5 inhibitor.

Yes, of course.
CD4+ T-CELL COUNT or CD4 Count

The CD4+ T-cell count (or CD4 count) serves as the major clinical indicator of immune function in patients who have HIV infection. It is one of the key factors in deciding whether to initiate antiretroviral therapy and chemoprophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival according to clinical trials and cohort studies. A significant change (2 standard deviations) between two tests is approximately a 30% change in the absolute count or an increase or decrease in CD4 percentage by 3 percentage points.

• Use of CD4 Count for Initial Assessment. The CD4 count is one of the most important factors in the decision to initiate antiretroviral therapy and/or prophylaxis for opportunistic infections. All patients should have a baseline CD4 count at entry into care.
• Use of CD4 Count for Monitoring Therapeutic Response. An adequate CD4 response for most patients on therapy is defined as an increase in CD4 count in the range of 50–150 cells/mm3 per year, generally with an accelerated response in the first 3 months. Subsequent increases in patients with good virologic control show an average increase of approximately 50–100 cells/mm3 per year for the subsequent years until a steady state level is reached. Some patients who initiate therapy with a severely depleted CD4 count may have a blunted increase in their count despite virologic suppression.

Frequency of CD4 Count Monitoring - In general, CD4 counts should be monitored every 3-4 months to (1) determine when to start antiretroviral therapy in patients not being treated; (2) assess immunologic response to antiretroviral therapy; and assess the need for initiation or discontinuation of prophylaxis for opportunistic infections. For those patients who are adherent to therapy with sustained viral suppression and stable clinical status for more than 2-3 years, the frequency of CD4 count monitoring may be extended to every 6 months.

Factors that affect absolute CD4 count - The absolute CD4 count is a calculated value based on the total white blood cell (WBC) count and the percentages of total and CD4+ T lymphocytes. This absolute number may fluctuate among individuals or may be influenced by factors that may affect the total WBC and lymphocyte percentages, such as use of bone marrow-suppressive medications or the presence of acute infections. Splenectomy or co-infection with HTLV-1 may cause misleadingly elevated absolute CD4 counts. Alpha-interferon, on the other hand, may reduce the absolute CD4 number without changing the CD4 percentage. In all these cases, CD4 percentage remains stable and may be a more appropriate parameter to assess the patient's immune function.

PLASMA HIV RNA TESTING

Plasma HIV RNA (viral load) should be measured in all patients at baseline and on a regular basis thereafter, especially in patients who are on treatment, because viral load is the most important indicator of response to antiretroviral therapy. Analysis of 18 trials that included more than 5,000 participants with viral load monitoring showed a significant association between a decrease in plasma viremia and improved clinical outcome. Thus, viral load testing serves as a surrogate marker for treatment response and can be useful in predicting clinical progression. The minimal change in viral load considered to be statistically significant (2 standard deviations) is a threefold, or a 0.5 log10 copies/mL change. One key goal of therapy is suppression of viral load to below the limits of detection (below 40-75 copies/mL by most commercially available assays). For most individuals who are adherent to their antiretroviral regimens and who do not harbor resistance mutations to the prescribed drugs, viral suppression is generally achieved in 12-24 weeks, even though it may take a longer time in some patients. Recommendations for the frequency of viral load monitoring are summarized below.

• At Initiation or Change in Therapy. Plasma viral load should be measured before initiation of therapy and preferably within 2–4 weeks, and not more than 8 weeks, after treatment initiation or after treatment modification. Repeat viral load measurement should be performed at 4–8-week intervals until the level falls below the assay’s limit of detection.
• In Patients Who Have Viral Suppression but Therapy Was Modified Due to Drug Toxicity or Regimen Simplification. Viral load measurement should be performed within 2–8 weeks after changing therapy. The purpose of viral load monitoring at this point is to confirm potency of the new regimen.
• In Patients on a Stable Antiretroviral Regimen. Viral load should be repeated every 3–4 months or as clinically indicated. In adherent patients who
  have suppressed viral loads for more than 2–3 years and who are at stable clinical and immunologic status, some clinicians may extend the interval to every 6 months.

Monitoring in Patients with Suboptimal Response. In addition to viral load monitoring, a number of additional factors, such as adherence to prescribed medications, altered pharmacology, or drug interactions, should be assessed. Patients who fail to achieve viral suppression should undergo resistance testing to aid in the selection of an alternative regimen.

HLA-B*5701 SCREENING

HLA-B*5701 before starting patients on an abacavir-containing regimen, to reduce the risk of hypersensitivity reaction.

• HLA-B*5701-positive patients should not be prescribed abacavir..
• The positive status should be recorded as an abacavir allergy in the patient’s medical record..
• When HLA-B*5701 screening is not readily available, it remains reasonable to initiate abacavir with appropriate clinical counseling and monitoring for any signs of hypersensitivity reaction..

CORECEPTOR TROPISM ASSAYS

• Coreceptor tropism assay should be performed whenever the use of a CCR5 inhibitor is being considered.
• Coreceptor tropism testing might also be considered for patients who exhibit virologic failure on a CCR5 inhibitor.

Yes.

Your doctor may ask you to repeat some of these tests in future to

• Asses the efficacy of HAARTT
• know the side effects of HAART.-Following algorithm is followed when HAART is started.

Yes, of course.

There are many Guidelines. In USA, DHHS and International AIDS Society I.A.S.-U.S.A. guidelines, in U.K. BHIVA guideline, in many other countries W.H.O. guidelines and in India National AIDS Control Organization (NACO) guidelines.

Given Below is International AIDS Society I.A.S.-U.S.A. guidelines

All medicines can cause side-effects, and this includes those used to treat HIV. But it's good to know that many people find modern HIV treatment easy to take.

Anti-HIV drugs can cause both short-term and long-term side-effects.

Common side-effects you might have when you first start treatment are diarrhoea, feeling or being sick, and headache. Some drugs can also cause problems sleeping, including vivid dreams, a feeling of being 'spaced out' or depression.

Most people find that these side-effects lessen or go away completely after a couple of weeks.

A few anti-HIV drugs can cause an allergic reaction. You should be screened for risk factors before taking any of these drugs, and then warned about possible symptoms. If you do have any of those symptoms, you should seek medical advice immediately.

Long term side-effects can involve increased levels in blood of fats and sugars, changes in kidney or liver function, or thinning of the bones. You'll be monitored to see if you develop any of these side-effects.

It's worth remembering that you don't always have to put up with side-effects. Mention them to a member of your doctor as it may be possible to do something about them.

If you don't understand anything, or if you want to know more about any subject, ask your HIV specialist doctor. Or there may be another member of your healthcare team who can help with a particular issue.

You should feel able to ask questions or tell your doctor, or another healthcare worker, about things that are bothering you. This will be important in staying as well as possible and increasing the chances of any treatment being successful.

To get the most benefit from your HIV treatment, you need to take it properly. This is often called 'adherence'.

For most people, being diagnosed with HIV is a life-changing experience.

You're likely to be experiencing a whole range of emotions at this time. Finding out that you have HIV is likely to have a whole range of emotional and practical implications.

But it's good to know that finding out that you have HIV means that you're in the best position to look after your health. This is likely to include accessing HIV treatment and care. HIV treatment can mean a longer and healthier life.

There are organisations all over the world that provide supports to people who have just found out they are HIV-positive. In many cases, they will also be able to help you find out how to get the best available treatment and care where you live.

And it's reassuring to know that people with HIV are loved and accepted, maintain and form relationships, have children, and lead fulfilling and productive lives.

Medical care for HIV happens in a wide range of hospital and other medical settings, depending on where you are in the world. You can find out about treatment centres in the country where you live.

The best treatment and care for HIV is often at specialist HIV clinics.

In many parts of the world, most of the care given to people with HIV happens at home. It is provided by family and friends, perhaps with some help from an organisation that provides home-based care.