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Continuing the HIV/AIDS conversation

Experts reinforce the need for education, screening and treatment


It’s been more than 30 years since the AIDS crisis began grabbing headlines in the early ’80s. And while awareness and treatment options have greatly improved, statistics show there is continued room for improvement as new HIV cases develop and people with diagnosed HIV don’t seek the treatment they need.

A “second wave”

A whopping 70 percent of Americans (that’s 7 out of every 10 people) with HIV did not have the virus under control in 2011, and approximately two-thirds of those had been diagnosed but were no longer receiving active care, according to a Centers for Disease Control and Prevention report published Nov. 25, 2014. The study underscored the importance of ensuring people with HIV receive ongoing care and treatment, while continuing to educate about prevention.

Globally, approximately 34 million people have HIV and 35 million have died from the virus. In the U.S., 1.2 million Americans were living with HIV in 2011, according to the most recent CDC report.

“It’s really devastating that it seems like HIV and AIDS has had its second wave,” said Dr. Ophelia Garmon-Brown of Novant Health. In October 2014, Novant Health co-hosted two events to educate community leaders about HIV and AIDS in Charlotte, North Carolina, which ranks in the top 20 American metropolitan areas with new HIV diagnoses, according to the CDC.

“This community needs to understand what the world is saying about AIDS,” Garmon-Brown said. “We’re trying to partner with others in the community to raise awareness.”

North Carolina Health and Human Services reported Mecklenburg County, in which Charlotte sits, had 235 new HIV cases from January to June 2014. The next highest county had 116 new cases. Mecklenburg County also had 121 new AIDS cases from January to June 2014. The next highest county had 43.

“We’ve got to raise attention about this,” said Garmon-Brown. “When we look at the numbers, they are increasing.”

What is HIV?

HIV is a virus spread through bodily fluids that affects specific cells of the immune system called T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS. There is no cure for HIV/AIDS.

The CDC also notes that, in the United States, HIV is mainly spread through sex or sharing injection drug equipment. Less commonly, HIV can be spread by the following:

  • Being born to an infected mother; breastfeeding from an infected mother
  • Being stuck with an HIV-contaminated needle or other sharp object
  • Receiving blood transfusions, blood products or organ/tissue transplants that contain HIV
  • Eating food pre-chewed by a person infected with HIV
  • Being bitten by a person with HIV
  • Contact between broken skin and HIV-infected blood or bodily fluids

Diagnosis

The antibody screening test (immunoassay) is the most common HIV test, and detects HIV antibodies in the body. The test can be done in a lab or as a rapid test at a testing site, and can be performed on blood or oral fluid. Blood-based lab tests tend to find the infection sooner after exposure. The rapid test produces quick results in about 30 minutes and is primarily used for screening. Sometimes the rapid test may not find antibodies and may give a false-negative result if the test is conducted in the period after exposure but before the test can find antibodies.

Follow-up testing is done if the first antibody screening test is positive. Subsequent tests may include:

  • An antibody differentiation test.
  • An HIV-1 nucleic acid test that looks or the virus directly.
  • The western blot test, which detects antibodies.

Some tests detect both antibodies and antigen, which is part of the virus itself. These tests can find HIV as soon as three weeks after exposure to the virus, but can only test on blood instead of oral fluid.

There are two home HIV tests – the Home Access HIV-1 Test System and the OraQuick In-home HIV test. The Home Access HIV-1 Test System involves pricking your finger for a blood sample and sending the sample to a lab. You can call next business day for the results. The OraQuick In-Home HIV Test provides results at home. You swab your mouth for an oral fluid sample and use a kit to test it. The results are available within 20 minutes. If you test positive, you will have to have a follow-up test.

Prevention

The CDC recommends limiting your number of sexual partners, never sharing needles and using condoms correctly and consistently as ways to prevent HIV.

There also are newer biomedical options available, such as pre-exposure and post-exposure prophylaxis. Pre-exposure prophylaxis, or PrEP, can lower the risk of getting HIV by taking a pill daily. This preventive medicine is aimed toward people who do not have HIV but who are at substantial risk for getting it, such as someone in a relationship with an HIV-positive partner.

Post-exposure prophylaxis (PEP) is a medicine that can prevent HIV after a possible exposure if the medication is started within three days. You can take PEP for four weeks if you think you may have been exposed to HIV and are not on PrEP. PEP keeps HIV from making copies of itself and turning into an infection.

“Much progress has been made in the past 30 years for HIV and AIDS, but there’s lots more to be done,” Garmon-Brown said. “The medical community can’t become complacent about raising awareness, screening or following up on care for people with HIV and AIDS who need it. Novant Health is committed to continuing the dialogue – both with our patients and within the community at large.”





Published: 1/6/2015