World AIDS Day tomorrow:

Safe sex - the best form of protection

By Carol Aloysius

As the death toll and morbidity level of HIV/AIDS mounts relentlessly across the world, this disease which for nearly three decades has devastated individuals, continues to place severe social and financial constraints on families of patients, and an unbearable strain on national budgets. Despite falling prevalence rates in some countries due to raised awareness and advances in treatment and care, the AIDS epidemic shows no signs of abating, judging by the number of new cases that have emerged daily especially in African countries. Latest statistics cited by the Foundation For AIDS Research indicated that in 2013, 1.5 million people died from AIDS and 88,000 new cases were reported in Western, Central Europe and North America while Africa leads the world in respect of both HIV and AIDS prevalence rates.

The greatest tragedy is its impact on children. It is estimated that over 1,000 babies are born with HIV every day, many destined to die before age two if they don't receive medication. Mothers with AIDS also continue to die, while adolescents are increasingly being infected with HIV because they have neither the access to services to protect themselves.

However, with advocacy and investment on behalf of children currently showing positive impact, the goal of eliminating mother to child transmission by 2015 appears within reach.Infertility Gynaecologist, Dr HELARUWAN PASAN KUMARA discusses how HIV and AIDS are caused, their impact on health of both adults and children, strategies to treat the disease, and most importantly how it can be prevented.

Safe protected sex with a single partner is the key, he stresses in this interview with the Sunday Observer.

Excerpts ...

Q. The number of HIV/AIDS cases worldwide has risen to a new level despite interventions on the part of governments to curb its spread. This rise has been partly due to ignorance about the disease. Could you tell us more about the virus HIV that leads to AIDS? – e.g. how the HIV virus enters the body and causes immune deficiency.

A. The human immunodeficiency virus is a lentivirus that causes the acquired immunodeficiency syndrome, a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. HIV virus attack special immune cells , type of Lymphocytes, which lead to failure of immune system.

The ways HIV enters body are as follows:

* Via unprotected vaginal or anal sex (without using a condom) with someone who has HIV.

* Sharing needles, syringes and other injecting equipment or having a needle-stick injury

* Blood transfusions and treatment with other blood products

* Unprotected oral sex (male and female) - this activity has an extremely low transmission rate and infection is unlikely, although ejaculation and the presence of gum disease increases the risk slightly

* From a mother who has HIV to a child - during pregnancy, birth or when breastfeeding.

There is NO evidence to suggest that HIV is spread by ordinary social or family contact such as hugging, shaking hands, sharing household items or through toilets seats, swimming pools or pets. HIV doesn’t live long outside the body. It can be killed by ordinary household bleach, or soap and warm water.

Q. The acronym AIDS stands for Acquired Immune Deficiency Syndrome. What do each of these words mean in medical terms?

A.Immune deficiency means your body fails to attack organisms entering the body from outside as well as reduce killing power of cancer cells produced in the body. ‘Acquired’ means it alters your immune system due to organism enters from outside the body. Some congenital diseases can alter your immune system by altered genes inside our body.

Q. Once the HIV virus enters one’s body what does it do?

A. HIV infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells. HIV infection leads to low levels of CD4+ T cells through a number of mechanisms, including apoptosis of uninfected bystander cells,direct viral killing of infected cells, and killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognise infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Q. What is the first symptom of HIV?

A. Many symptoms of HIV are the same as those experienced in a number of other illnesses. If you think you have been put at risk of getting HIV, or if you have any of the signs below (or a combination of them) for a month or longer, you should consult your doctor.

Symptoms can include:

* flu-like symptoms
* extreme and constant tiredness
* fevers, chills and night sweats
* rapid weight loss for no known reason
* swollen lymph glands in the neck, underarm or groin area
* white spots or unusual marks in the mouth
* skin marks or bumps, either raised or flat, usually painless and purplish
* continuous coughing or a dry cough
* diarrhoea
* decreased appetite.

Q. How long does it take for the initial symptoms to be evident? Days? Months? Years?

A. A blood test can detect HIV antibodies and tell if you are infected with the virus. If a person has HIV, their body will produce antibodies to the virus. There is a short period of time (six to 12 weeks) when the antibodies against HIV can’t be detected in the blood.

This is often referred to as the ‘window period’. If your blood test shows that antibodies are present, you are infected with HIV (also known as being ‘HIV-positive’).

If you have no antibodies in your blood (HIV-negative), it is possible you are not infected with HIV. But a negative result might also mean you have been infected in the past six to 12 weeks (in the ‘window period’) and you might need a follow-up blood test to make sure.

Q. How do you diagnose HIV? What are the tests?

A. HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus.

Unfortunately, it takes time for your body to develop these antibodies - usually up to 12 weeks.In rare cases, it can take up to six months for an HIV antibody test to become positive.

A newer type of test that checks for HIV antigen, a protein produced by the virus immediately after infection, can confirm a diagnosis within days of infection.

An earlier diagnosis may prompt people to take extra precautions to prevent transmission of the virus to others. There is also increasing evidence that early treatment may be of benefit.

Tests

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you have. These tests include:

CD4 count. CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV.

A healthy person's CD4 count can vary from 500 to more than 1,000. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 count dips below 200.

Viral load. This test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.

Drug resistance. This blood test determines whether the strain of HIV you have will be resistant to certain anti-HIV medications.

Q. Are they available here?

A. Yes.

Q. Does HIV virus always lead to AIDS, or are there exceptions due to good health, nutrition etc?

A. People with HIV are said to have AIDS when they develop certain infections or cancers or when their CD4 count is less than 200. CD4 (T-cell) count is determined by a blood test in a doctor's office. Having HIV does not always mean that you have AIDS.

It can take many years for people with the virus to develop AIDS. Good health and nutrition can delay the onset of full blown HIV.

Q. How long does it take for HIV to develop into full blown AIDS?

A. According to the Centre for Disease Control and Prevention, a person is considered to have AIDS when they have a T cell count (also called CD4 cell count) of 200 or less (healthy T cell levels range from 500 to 1500) or they have an AIDS-defining condition.

Without medication, HIV turns into full-blown AIDS approximately 10 years after initial infection with the HIV .

Q. How is HIV treated?

A. Although there is no cure for acquired immunodeficiency syndrome (AIDS), medications have been highly effective in fighting HIV and its complications. Drug treatments help reduce the HIV virus in your body, keep your immune system as healthy as possible and decrease the complications you may develop. There are currently five different “classes” of HIV drugs. Each class of drug attacks the virus at different points in its life cycle - so if you are taking HIV meds, you will generally take three different antiretroviral drugs from two different classes.

This regimen is standard for HIV care - and it’s important.

Taking three different HIV medicines is the best way to control the amount of virus in your body and protect your immune system.

Taking more than one drug also protects you against HIV drug resistance. When HIV reproduces, it can make copies of itself that are imperfect - and these mutations may not respond to the drugs you take to control your HIV.

If you follow the 3-drug regimen, the HIV in your body will be less likely to make new copies that don’t respond to your HIV medications.

Q. Is there a difference in the symptoms of an HIV patient and AIDS patient?

A. Infected with HIV may not show any symptoms till you develop into AIDS.

Q. How do you detect the symptoms of AIDS? What are they?

A. The following symptoms are usually an indication of advanced immune deficiency:

* Oral and vaginal thrush infections which are very persistent and recurrent (Candida)

* Recurrent herpes infections such as cold sores (herpes simplex)
* Recurrent herpes zoster (or shingles)
* Bacterial skin infections and skin rashes
* Fever for more than a month Night sweats
* Persistent diarrhoea for more than a month
* Weight loss (more than 10 percent of the usual body weight)

* Generalised lymphadenopathy (or, in some cases, the shrinking of previously enlarged lymph nodes)

* Abdominal discomfort, headaches
* Oral hairy leucoplakia (thickened white patches on the side of the tongue)
* Persistent cough and reactivation of tuberculosis
* Opportunistic diseases of various kinds

Q. Are HIV and AIDS treatable?

A. No. Only supportive therapy is available to patients.

Q. In Sri Lanka what is the commonest mode of transmission for both HIV and AIDS?

Heterosexual relationships? Intravenous injections? Blood donations? Homosexual relationships, anal sex etc?

A. Hetero sexual unprotected sex.

Q. How is AIDS Not transmitted?

A. Prevent contact of body fluids with an HIV positive person. Use a condom.

Q. What is the position of infants born to HIV mothers? How vulnerable are they?

A. Women who are planning on becoming pregnant or who are pregnant should be tested for HIV as soon as possible. The woman’s partner should also be tested. The March of Dimes recommends that all women of childbearing age who may have been exposed to HIV should be tested before becoming pregnant.

Women who have not been tested before becoming pregnant should be offered counselling and voluntary testing during pregnancy. Women who have not been tested during pregnancy can be screened during labour and delivery with rapid tests which can produce results in less than one hour.

This allows for treatment to protect the baby, should the results be positive. If a woman is infected with HIV, her risk of transmitting the virus to her baby is reduced if she stays as healthy as possible.

New treatments can reduce the risk of a treated mother passing HIV to her baby to a two percent or less chance.

Q. Factors that increase risks of transmission?

A. Smoking

Substance abuse

Vitamin A deficiency

Malnutrition

Infections such as STDs

Clinical stage of HIV, including viral load (quantity of HIV virus in the blood)

Factors related to labour and childbirth

Breastfeeding

Q. Can an infant get HIV from its HIV positive mother while being breastfed?

A. Yes.

Q. Do you think it is safe for a HIV or AIDS positive mother to breastfeed her baby?

A. It's controversial issue.

Factors that may decrease the risk of HIV transmission through breastfeeding include:

Shorter duration of breastfeeding. The longer a child is breastfed by an HIV-positive mother the higher the risk of HIV infection. Breastfeeding for 6 months has about one third of the risk of breastfeeding for two years.

Exclusive breastfeeding in the early months. Some immunological studies are finding that there are factors in human milk, especially the milk of the the HIV-infected mother, that will directly combat the cells that contribute to the transmission of the HIV infection.

Prevention and treatment of breast problems is also important. Mastitis and cracked nipples and other causes of breast inflammation can increase risk of HIV-transmission.

Prevention of HIV-infection during breastfeeding. The maternal viral load is higher shortly after a new infection resulting in an increased risk of infection of the child. Early treatment of sores or thrush in the mouth of the infant. Sores in the infant's mouth make it easier for the virus to enter the infant's body.

The risk of HIV-infection has to be compared with the risk of morbidity and mortality due to not breastfeeding. Breastfeeding is protective against death from diarrhoea, respiratory and other infections, particularly in the first months of life, especially in children born to HIV/AIDS mothers having AIDS.

Q. What is the impact of AIDS and HIV on children?

A. It's same as on adult.

Q. Although in Sri Lanka the ratio of HIV and AIDS patients is low (below 0.1 percent) still there is a possibility it can rise sharply due to risky lifestyles and increased migrant returnees. If that happens the NSCAP has said they were considering setting up more home care facilities so that sick patients can be looked after at home. Your comments?

A. I think prevention is better than cure. We need to prevent disease transmission first.

Q. Since AIDS is a chronic disease lasting several months or years, treatment is one of the biggest expenditures in the budget. How do you think we can reduce the burden of AIDS?

A. Education regarding prevention of disease is the best method.

Q. Donated blood if contaminated by an HIV patient can infect a person without the disease. How does the blood bank here prevent this? Do they screen all donor blood?

A. Yes. All blood banks have special protocols for testing blood donors.

Q. What do you see as the biggest challenge to health officials with regard to HIV/AIDS in Sri Lanka in the near future?

A. There may be lot of unknown HIV positive patient in Sri Lanka who live hidden way treating in private sector.

Q. Your message to the public?

A. Always think about AIDS when you are going to have unprotected sex.

As there is no cure, don't waste your valuable life due to uncontrolled feelings.

'Good fat’ could help manage type 2 diabetes

A special type of fat found in some people could be used to manage type 2 diabetes.

Scientists have discovered that brown fat, nicknamed the ‘good fat’ because it warms up the body in cold temperatures, burning up calories in the process, also ‘hoovers up’ excess sugar.

The findings, are significant for people with type 2 diabetes, whose bodies are unable to respond to insulin properly, resulting in elevated blood glucose levels. Researchers believe that if brown fat cells can be activated, blood glucose levels could be controlled without the need for daily insulin injections.

Lead researcher Dr Masaaki Sato from the Monash Institute of Pharmaceutical Sciences (MIPS) said learning more about how brown fat works is critical.

“Brown fat was discovered in adults a few years ago and now research is taking place world-wide to understand why some adults have it and others don't,” he said.

“In theory if we can find out how to stimulate brown fat into action, we could use it, not only to manage obesity, but type 2 diabetes too. Our findings are at a very early stage but they show real potential to find a new way to manage this disease,” Dr Sato said.

Previously brown fat was thought to be present only in animals and babies, but PET scans of adult patients in 2007 proved otherwise. Located on the back, the upper half of the spine and the shoulders, younger people are more likely to have brown fat than people who are overweight or obese. Brown fat is also known to increase in cold weather and decline in warm environments. By observing cells, the research team found that following application of a drug that mimics cold exposure, brown fat produces large amounts of a protein that transports glucose into cells, and importantly does so independently of the way insulin transports glucose into these cells. Closer analysis showed brown fat cells produced 10 times the amount of glucose transporters than insulin. Dr Dana Hutchinson, a co-author on the paper, said what remains unclear is why some people have good fat and others do not.

“We know brown fat absorbs excess glucose in the blood at a much more efficient rate than other mechanisms the body.

Unfortunately If you're diabetic you're far less likely to have it,” Dr Hutchinson said.

“If we can uncover the mystery of why some people have brown fat, we can then look to develop ways to stimulate its growth,” Dr Hutchinson said.

Potentially the research could lead to a completely new medicine to treat type 2 diabetes, offering an alternative to daily insulin injections. The next phase of research will see the team investigate the impact of being obese and diabetic on glucose regulation in brown fat.

- MNT