Facts, transmission and symptoms

The Health Protection Agency compiles statistics about HIV in the UK. Explore the animated map learn some interesting facts - some of them may surprise you!

What can we learn about HIV from these statistics? Take a moment to think about the health care implications of this information and how it might affect you in your current nursing role. Now that you know these facts, what actions might you take to address them? Select each of the images below to see what other health care workers say.

 

What's the difference between HIV and AIDS?

One of the myths that is ‘busted’ in the 'Stigma and myths surrounding HIV and AIDS' section is that HIV and AIDS are the same thing - they aren’t. It’s common for the terms to be used interchangeably and you may find that your patients, clients, or colleagues do just that. In these situations you may need to clarify with them exactly what they mean. It’s important that you use the correct terms and explain them to those who don’t to ensure that you understand what you’re being told and that the information you provide is understood.

HIV

HIV stands for 'Human Immunodeficiency Virus'.  As the name suggests, HIV is a virus that attacks and destroys the immune system, making it difficult for the body to fight infection or disease. HIV infects a type of lymphocyte (white blood cell) called CD4 (sometimes also referred to as T helper cells) which help protect against infection. Once HIV has found its way into a CD4 cell, it creates copies of itself which then go on to infect other cells. Over time this weakens the body’s immune system and reduces its ability to fight infection and disease. When a person becomes infected with HIV he or she is said to be ‘HIV positive’.

AIDS or late-stage HIV infection

AIDS stands for 'Acquired Immune Deficiency Syndrome'. It is used to describe the most advanced stages of HIV infection. Today, AIDS is often called ‘late-stage HIV infection’. AIDS, or late-stage HIV infection, isn’t one disease, rather, it is a group of diseases that attack a body’s weakened immune system. These diseases are often called ‘opportunistic infections’ because they take advantage of the body’s impaired state. Although it is often said that someone has died of AIDS, in fact, people don’t die of AIDS as such, but of one of the diseases or infections they’ve acquired and cannot fight.

Someone with HIV is diagnosed as having AIDS when their immune system is no longer working effectively. This is generally determined by a CD4 count of less than 200/µl, and the existence of one or more opportunistic infections or certain specified tumours, including:

People with advanced HIV infection also have an increased risk of developing cancer, particularly lymphoma and Kaposi’s sarcoma (a skin cancer).

Transmission

Unlike other viruses, such as cold and flu viruses, HIV is not easily transmitted. HIV is  fragile and can’t survive outside of the body. This means that there is no risk of HIV being passed from one person to another during normal social contact such as touching, kissing, sharing a piece of equipment, or drinking from the same cup. HIV is spread through the exchange of certain body fluids.  These are:

A person becomes infected when the body fluids of an infected person gets into the bloodstream of another person. In the UK, the most common ways of getting HIV are:

The risk of transmission through oral sex is much lower than that for anal or vaginal sex; however, HIV can be transmitted if infected body fluids come into contact with cuts, sores, or ulcers in the mouth. Other body fluids, such as saliva, sweat, or urine, don’t contain enough of the virus for another person to become infected. All blood supplies and organ donations in the UK are screened for HIV. As such, there is relatively no risk of transmission from blood transfusions or organ transplants.

Occupational exposure

It is understandable to be concerned about becoming infected with a blood-borne virus such as HIV while at work. Yet the risk of this happening is very low. In the UK, prior to 1999, five health care workers developed HIV following exposure from needle punctures at work. Since then, there have been no new cases of occupational transmission to HIV (Health Protection Agency, 2008). According to the Department of Health:

How to protect yourself

The standard infection control practices you follow each and every day as a professional health care provider protects you from a range of diseases, illnesses, and accidents, including infection with HIV. In specific environments, for example, surgery or where physical contact with trauma patients who have open fractures may occur, double gloving and the use of personal protective equipment may be recommended or required by your employer - learn the policies, procedures, and risk assessments for your organisation regarding the prevention of blood borne virus transmission.

Outside of these environments, there are no unique or additional protocols for HIV prevention, and you don’t need specialised equipment or protective clothing. Double gloving, which was commonly practiced in the past, isn't necessary and may unintentionally reinforce prejudices and misinformation by suggesting that people with HIV infection are different than those with other illnesses.

What to do if an accident occurs

If you experience an accident that exposes you to the blood, body fluid, or tissue of someone with HIV or someone who is suspected of having HIV, contact your line manager or supervisor immediately. A risk assessment will be done and if it deemed necessary, a course of post-exposure prophylaxis medication (PEP) will be started (more information about PEP is provided in the 'Diagnosis and treatment' section).  The risk assessment will take into account the following:

The types of exposures that are generally considered to be of highest risk are:

If after the risk assessment, it is decided that the risk of exposure to HIV is significant, a course of PEP will be recommended. The sooner PEP is started the better, so it is important that if you believe you were involved in a situation that may have put you at risk of HIV infection, you inform your employer right away. If you experience an accident involving the blood, body fluid, or tissue of a patient, but his or her HIV status is unknown,your risk assessment will be similar to that described above however, it will also consider the patient's risk factors for HIV. Check with your employer or the Department of Health for more information. The "Useful Resources" section also has information and links to some relevant publications.

Symptoms

First stage infection symptoms

Most people when infected with HIV experience flu-like symptoms, usually two weeks from infection, which may last for three to four weeks. This is called 'Primary HIV Infection' (PHI) or 'Seroconversion'. These symptoms can easily be mistaken for other illnesses such as flu. However, unlike with flu, PHI doesn’t include nasal or chest congestion – a ‘red flag’ that should have you thinking about possible HIV infection. Some people develop a more severe illness, while up to 10% of those newly infected don’t experience any symptoms at all. After the initial symptoms disappear a person may live for years without any others occurring. This is known as ‘asymptomatic HIV infection’.

Late stage HIV infection (AIDS) symptoms

Late stage symptoms are non-specific, for example: a dry cough, loss of appetite or a facial skin rash. If your patient or client describes having several of these signs simultanously, consider HIV as potential diagnosis and strongly encourage him or her to be tested. HIV drug therapy can help treat many of these infections and improve a person’s health so it is important that a diagnosis be made.

Explore the animated body image below to see the most common symptoms of PHI and late stage HIV infection.