Elevated Risk For HIV Infection

Routes of transmission

Discuss about the Elevated Risk for HIV Infection.

The HIV is a retrovirus which infects the cells inside the immune systems thus altering or damaging their ability to function. Sub Saharan Arica still continues to bear the largest burden of HIV burden. Some of the most common routes of HIV transmission include heterosexual intercourse, female sex worker, injection drug use, and mother to child transmission (Awoleye, & Thron, 2015). There is a growing need to shift the perception of HIV risk to be in a way that an individual person views HIV as being influenced by politics, culture, social, and economic determinants (Ho & Holloway, 2016). There are very many social as well as economic factors like education, marital status and wealth accumulation which are known to affect the rate of managing HIV infections. Considering the numerous effects that HIV infection causes, it is crucial for the government and other stakeholders to come up with programs which aim at communication, change of behaviors and seeking of medical care services. It is clear that the effectiveness s of HIV awareness program sis that there is other factor like poor coordination, politics and poor political will (Dube, et al., 2016). Even when considering the people with formal employment, there is stigma as well as fear which causes late disease presentation (Dijkstra et al., 2016). This means that the there are other problems which results from this and includes low survival rates, and more infection rates.

Generally, HIV is a viral infection which make the host immune system to be weak. It is among the highest contributor of morbidity, and it is considered to be the sixth cause if mortalities globally. In fact, the life expectancy of an HIV infected people has significant process. This is true because of the effectiveness conferred by the antiretroviral drugs which has enabled many people to cope with HIV infections following the advancement to chronic infections (Barskey et al., 2016). The initial efforts in HIV managements mainly focused on prevention strategies as well as the treatment of symptomatic illnesses. The count of CD4 indicate that there is a high level of immunosuppression. It is therefore evident that early diagnosis of people with HIV leads to an improvement of the effectiveness on the ARVs.  Human immunodeficiency virus infects humans and chimpanzees and two thirds of global HIV infection is found in Sub Saharan Africa (UNAIDS, 2006).

Impact of HIV infection

Generally, HIV infections are life threatening and chronic illnesses which increases the risks of mortality among the infected people. When left untreated, HIV destroys the numbers of white blood cells to a level whereby the infected body cannot fight any type of infections, indicating that any opportunistic infections like cancer, malaria and flue can easily lead to the death of the victim. In most cases, when a person is unable to fight opportunistic infections, there are high chances that the white blood cells count is usually at very low a concentration (Serrano-Villar et al., 2014) It is characterized by acute viremia in excess of five million viral particles per milliliter of serum. It has also been found that HIV among IDUs is transmitted through sharing of needles (Baral et al., 2007). Mortality rates have recently decreased due to the improved effectiveness of highly active antiretroviral therapy. In the year 2013, Kenya had 88,620 new HIV infections among adults and 12,940 among children (NASCOP 2014). In 2012, Mombasa county had an adult HIV prevalence of 11.1 % (NASCOP 2014). Since injection drug use is a common global phenomenon (Dore et al., 2010), infection and transmission of HIV occurs through sharing of contaminated drug injection equipment’s to either inject or split drugs. Others include risky sexual behaviors like homosexuality, prostitution, unprotected sex and engaging in sexual behaviors under the influence of drugs or in exchange of drugs (Chu et al., 2013).

Sub-Saharan Africa contains only 10% of the world’s population and remains the “global epicenter” of the HIV/AIDS epidemic (UNAIDS, 2006). This is because in 2005, an estimated 24.5 million people were living with HIV/AIDS in this region, whereby 2.7 million people had new viral infections, 930,000 died of AIDS. The report further indicates that in Kenya, 38.7% (278/719) of drug users reached through community outreach were reported to be sharing needles, cookers, filters, rinse water and injection solution. Adoption of a high risk injection practice called “flash blood” is common among male and female drug users in Tanzania. This is a practice in which an IDU who cannot afford to purchase heroin injects the blood of another IDU who recently injected, in the belief that the blood contains heroin and can prevent withdrawal. In Mombasa, of the 1000 drug users referred through community outreach to HIV counseling and testing, 31.2% (43/138) of IDUs and 6.3% (352/1546) of non-injection drug users were HIV positive (Deveau et al., 2006). Some of the abused drugs in this county are heroin, morphine, cocaine and cannabis. Various classes of drugs are used for HIV management. In the class of nucleoside reverse transcriptase inhibitors, lamivudine, entecavir and emitricitabine are examples.

Prevalence of HIV infection

Nucleotide reverse transcriptase inhibitors are tenofovir, and adefovir. The class of non-nucleoside reverse transcriptase inhibitors includes etravirine, rilpivirine, nevirapine, interferons and efiverenz (Zhan and Liu, 2011). Out of the approximately 16 million IDUs worldwide, 3 million are infected with HIV-1. A study to show the incidence of HIV-1 in a cohort of IDUs in central Sydney showed an HIV-1 incidence of 0.17% per 100 people among 426 initially seronegative IDUs. HIV-1 has two surface proteins (Gp 41 and Gp 120) for viral entry, enzymes (integrase, reverse transcriptase and protease), and two non-covalently linked single stranded RNA genome. It is 9,800 base pairs long and has nine genes: vif, pol, gag, env, tat, rev, bif, vpr and either vpu or vpx. HIV-1 is transmitted via sex with infected persons, mother-to-child, sharing of sharp infected objects, injection drug use, breastfeeding, and blood transfusion. In 2005, of the 820,000 newly HIV-1 infected infants, 360,000 of them were through breastfeeding by infected mothers.

Dallas, a city in the United States is among the many cities which have a high prevalence for HIV infections. For instance, in the year 2014, Dallas city had more than 16,000 people who were living with HIV, which was a 124% increase since the year 2004 (Dallas County Health and Human Services (2017). The American Africans are the class of people who have recorded the highest cases of HIV infections between the ages of twenty-five to fifty-four years. In the United States for instance, the HIV spread so fast because it was linked too social stigma. Moreover, this pandemic did not receive any support from the government in terms of research funding and treatments by the CDC. Francis, 2012 reports that when the disease begun escalating, there were more than 10,000 cases in the United States. In the year 1990, the United States congress passed an act (Ryan White comprehensive AIDS resource emergency). This act provided more than 220.5 million dollars to support all programs related to control, research and management of HIV among its people (HRSA 2011). As Holtgrave et al., 2012 reports, the most recent progress in HIV management was the introduction of the national HIV/AIDS strategy during the reign of president Obama. However, it is worth noting that the HIV programs are still not given the necessary support in form of funding that they actually need. All the prevalence of HIV/AIDS has had a remarkable decrease in the cases of this disease in the United States although there are still some problems in terms of program implementation.

HIV in the United States

Acute HIV-1 infection is characterized by appearance of the viral markers and antibodies in blood (Cohen et al., 2011). If left untreated, HIV-1 leads to hyper activation of CD8 and CD4 cells resulting in progression to AID. HIV attacks the white blood cells which are important in fighting infections, and more specifically, the virus attacks the CD4+ cells. The virus attacks these cells and destroys them such that the body can no longer fight infections. At this point when the CD4+ count is very low, the AIDS begins to develop, though this can take varied periods of time. This is the prime reason as to why a person can live with HIV for many years without having developed to AIDS.  Chronic HIV-1 infection results in development of several AIDS related cancers associated with human papilloma virus, HBV, hepatitis C virus and herpes simplex virus due to immunosuppression (Guiguet et al., 2009). Kaposi’s sarcoma (caused by herpes simplex virus) is a cancer that affects the skin due to immunosuppression in HIV-1 patients. Non-Hodgkin lymphoma consists of lymphoproliferative diseases which affects the brain, lungs and spinal fluid.

The most common HIV testing methods are laboratory and rapid tests especially on the fingerprint derived blood sample. The first and the most recommended test is the rapid test which uses the HIV p24 antigens against HIV antibodies (Cohen et al., 2016). For the HIV positive patients, primary care is very crucial role in terms of HIV diagnosis. Therefore, primary care has a role to play in increasing the uptake of HIV diagnostic testing. Dried blood spots for PCR are used in HIV-1 diagnosis in infants to prevent mother to child transmission (Sherman et al., 2005). Screening in children and adults is done using rapid HIV-1 whole blood diagnostic kits such as determine and ungodly which rely on antigen- antibody reactions. HIV-1 viral load determination helps clinicians in making decisions on whether to switch to second line treatment or to prolong the duration of first line treatment regimen. PCR is used to quantify HIV-1 RNA in plasma and it is useful in assessing the antiviral effects early in infection. Flow cytometry is also used to determine the CD4+ cells count because these cells are involved in viral load decline during primary infection.

They are for HIV-1 management and are taken orally (Sung et al., 2008) and they suppress HIV replication by inhibiting DNA polymerase/ reverse transcriptase. Trials of NUCs in HIV patients demonstrate a decrease in viral load, ALT (alanine aminotransferase) levels, and hepatocellular carcinoma incidence. They are more convenient to take than IFN but the eventual development of resistance to these drugs limits their long-term utility. Side effects, which vary by drug, include myopathy and peripheral neuropathy (telbivudine), kidney toxicity and dysfunction (tenofovir and adefovir), decreased bone mineral density (tenofovir), and lactic acidosis in patients with liver disease (entecavir).

Lamivudine for example is a synthetic cytosine nucleoside nucleoside analogue with activity against HIV-1, HIV-2 and hepatitis B virus (Sheldon et al., 2005). It is administered for 12 months, that is, 150 milligrams daily. With time, the HBeAg disappears and HBE antibodies appear. Intracellulary, lamivudine is phosphorylates to its active 5′-triphosphate metabolite, lamivudine triphosphate (L-TP).  L-TP competes with cytosine triphosphates for incorporation into the new DNA strand thereby inhibits HIV-1 reverse transcriptase by DNA chain termination after incorporation of the nucleoside analogue into viral DNA. The HAARTs used to manage HIV-1 are: nucleo(t)side reverse transcriptase inhibitors (lamivudine, efavirenz, combivir, trizivir, truvada, abacavir, zidovudine and emtricitabine), no nucleoside reverse transcriptase inhibitors (efavirenz, etravirine, nevirapine) and oral combination pills (atripla and eviplera), (Sidibe et al., 2014).

HIV vaccine is in the process of development. This process is facing challenges such as lack of validated animal model, varied HIV-1 structure and lack of natural protective immune against HIV-1 (Koff et al., 2013). Current vaccine development focuses on chrystallographic structure of HIV-1 envelope, such that the vaccine will effectively present the viral epitope to the immune system.

Even though the United States government has been distributing the ARV drugs to the people, these drugs might not be of much help especially if the patients do not understand on how to use them well. Lack of treatment adherence is a consequence stigma and long incubation period thus making treatment to be difficult. Although the ARVs have contributed to the management of the disease, the long incubation period allows people to live with the virus for so long without any symptoms. Moreover, there is none of the drugs which is made to cure, but they contain the condition. As such, the people are advised to take care of their sexual behaviors and dietary needs.

Despite the fact that HIV is considered to be a global pandemic, there are some prevention programs and strategies which have been implemented and for sure they are achieving significant results in terms of reducing the infection and transmission rates. According to the UNAIDS 2010 report, within the last ten years, there has been a remarkable decline in the number of new HIV infections (World Health Organization, 2016). Although there are several prevention programs which have been put in place, these programs suffer from several weaknesses. Basically, the main aims of these prevention programs are lowering the rates of individual infections, and to monitor and bring to controls the various factors that are associated with HIV such as social, political, legal, and economical factors which make some groups of people to be more vulnerable to HIV infection than others in the same community or population. When such programs have weak investments in terms of planning, evaluation and monitoring, then they might not achieve the set out objectives.

This method provides good prospects that are useful in addressing some common weaknesses reported in HIV prevention programs. This combination method has been useful in reducing the incidences of HIV infections and spread in varied settings. However, this program depends heavily on the evidence, strategic, and informed use of structural, behavioral and biomedical methodologies (Jones et al., 2014). The combinational approaches are able to achieve effectiveness among individuals, communities and the general society because it is able to address diverse needs of the people with respect to HIV. The success rate of the combination prevention programs is based on the inclusive, transparent, and open programs which are able to engage various stakeholders like the communities, individuals, and governments in making analysis of the risk factors that make people vulnerable to HIV infections. It is also worth noting that the combinational approach helps in building common sense as well as a feeling of being accountable as far as HIV infections prevention is concerned.

It is therefore important that the National AIDS authorities use all the available sources of data to come up with a geographical distribution of new infections and the prevalence of existing infections so as to help in formulating useful priorities. During the process of planning for the HIV programs, the affected communities should be actively involved so as to determine the underlying risk factors and make them active participant in the prevention processes. In some regions especially the developing countries, gender plays a big role in in terms of discrimination, unequal wealth distribution, and violation of human rights of the people vulnerable to HIV infections (Anderson et al., 2014).  Moreover, the health program facilitators involved in HIV prevention programs need to use a common language to organize their schedule and from time to time, they need to carry out program evaluation based on well-defined procedures.

Most adults suffering from HIV live in isolation and hence lack social support. Therefore, such people score little on social networks as well as the level of social support that they get from friends and family members (Volk et al..2015). Most HIV positive patients lack social support because they fear stigma, adopt disclosure and aim at being self-reliant. However, these factors in older HIV positive patients may be affected by gender, races, route of exposure and the duration of infection. Another humiliated cause of HIV is that it causes loss of friends by the victims due to low social networks. It is important to note also that the loneliness and self-perceived support that the HIV patients face affects their health outcomes especially among the older adults who are on treatment. On the other hand, social support among people infected with HIV are associated with adherence to medication, moods and wellbeing (Weiler, 2016). When such patients are offered nonpharmacologic support, this can help them lower the levels of depression.

In order to prevent the increased HIV spread, it is recommended that primary care screening is performed based on age consideration (Probst et al., 2017). The patients should also be asked to refrain from dangerous practices like smoking, and use of alcohol through guidance and counselling. It is however recommended that top level caution is taken during the process of screening especially old patients who might have eco-morbidities and polypharmacies. This is because there could arise some complications during the treatment of these comorbidities and hence the patient may get more harm than the expected benefits. The HIV infected patients can also manage their depression and possible development of opportunistic diseases by use of an alarm clock, urging them to seek social support services and educating patients on the diet and nutrition. The patients can also be counselled so that they can effectively attend the follow ups at the health facilities nearer them so that they can raise their adherence levels.  When HIV is being treated at early, late or chronic stages, the health care professionals, need to make discussions that take note of the student preferences of medications as directed by the law. However, for patients who are in the advanced stages of care, there is a need to avoid prolonged hospitalizations and maintenance of patient dependence.

The transmission of HIV virus from one person to another especially from a terminal disease to a chronic and manageable disease is a clear indication that there is significant increase in HIV treatment. In fact, the most identified problem associated with HIV infection is the management of the aging patients. Although there are many similarities between the HIV infected and negative patients, there distinct properties and problems such as polypharmacy, social isolation, care integration and end of life plans.

Although big and commendable advances have been made concerning the treatment and management of the people suffering from HIV, there has been a common observation that there is a large proportion of women who are still living with this health condition (Shisana et al., 2015). This means that gender and stereotypes need to be evaluated to determine why some of these conditions predispose a certain proportion of people in the sane community as compared to others (Probst et al., 2017). As a result, it is crucial if the stakeholders and health care givers develop a holistic understanding of the impacts of HIV to the society. As such, the research and management program funders are required to raise their funds while scientific and health research is advanced. This would lead to development in the markers and coming up with policies and health services to take care if the women who are infected with HIV. This will in turn reduce the rate of stigmatization thus enhancing the patients’ health outcomes.

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