HIV

HIV (Human Immunodeficiency Virus)

What is HIV ?

HIV = Human Immunodeficiency Virus
AIDS = Acquired Immune Deficiency Syndrome

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). HIV attacks the immune system, making the body less able to fight certain infections. When an HIV carrier comes down with one or several opportunistic infections (see the list below), that person is given a diagnosis of AIDS. It may take several years before a carrier of HIV develops AIDS. With appropriate treatment, a person diagnosed with AIDS may become healthy again and be less likely to catch opportunistic infections.

A person may be an HIV carrier without necessarily developing AIDS. However, once someone has been a carrier of HIV, that person is always contagious, regardless of whether he or she contracts AIDS or not.
The virus is very fragile and sensitive and cannot survive for long outside the body in the air, in water or on objects.

Despite scientific progress and medications, there is no cure for HIV-AIDS. Furthermore, this epidemic continues to grow, and in Quebec, men who have sex with men are most affected by this virus.

How do you get HIV ?

There are four body fluids that may contain enough of the virus to transmit HIV:

• Sperm or pre-ejaculate
• Vaginal secretions
• Blood
• Breast milk

HIV may be transmitted by:

• Unprotected sexual relations (vaginal or anal penetration, sharing sex toys, etc.);
• Tattooing with contaminated equipment;
• Sharing contaminated needles or implements (crack pipe, straw, etc.);
• Other contact with body fluids that may contain the virus (secretions, wounds, etc.). Healthy skin is an effective barrier against the virus.

HIV is not transmitted by saliva, sweat, tears, urine or stool, unless these body fluids contain tainted blood. HIV is not transmitted by sharing clothing, utensils or dishes. Toilet seats are not transmission channels for the virus.

What are the symptoms of HIV ?

Primary or Acute HIV Infection

The infection develops within 2 to 8 weeks after HIV enters the body. It may take from 3 weeks to 3 months before an infected person develops antibodies and becomes HIV positive.

Approximately 40% of people will develop flu-like symptoms which will disappear within 2 to 4 weeks.

Symptoms may include:

• Fever
• Sore throat
• Swollen lymph nodes
• Headache
• Skin rash
• Loss of appetite

Asymptomatic Infection

An infected person may be in perfect health for up to 12 years, or even longer. The maximum incubation period is still unknown.

Symptomatic Infection

Some infected people may develop the following symptoms:

• Constant fatigue
• Unexplained weight loss
• Persistent and voluminous diarrhea
• Swelling of the lymph nodes
• Fever, night sweats

AIDS (Acquired Immune Deficiency Syndrome)

When an HIV carrier comes down with one or several opportunistic infections (see the list below), that person is given a diagnosis of AIDS. It may take several years before an HIV carrier develops AIDS. With appropriate treatment, a person may become healthy again and be less likely to catch opportunistic infections, or that person may be a carrier of HIV without necessarily developing AIDS.

Opportunistic Infections (caused by bacteria):

• Pneumocystis carinii pneumonia
• Toxoplasmosis
• Cytomegalovirus
• Mycobacterium avium complex
• Candidiasis
• Kaposi’s sarcoma
• There are other opportunistic, but are less frequent

Certain cancers

• Kaposi’s Sarcoma
• Lymphoma
• Invasive cervical cancer

Other manifestations

• HIV Encephalopathy (dementia)
• HIV wasting syndrome

How is HIV diagnosed ?

It is important to consult a health care professional if you have or believe you have been exposed to HIV. Early detection of the infection enables a quick follow-up and reduces the risk of transmission.

Furthermore, preventative treatment is available if you have been injected with a used needle or if you think you have been exposed to HIV during sexual relations. You must act quickly – within a maximum of 72 hours – following possible exposure, and you must consult a doctor. This prophylactic post-exposure (PPE) consists of a 30-day anti-retroviral treatment.

Regular testing is recommended if you have several sex partners.

How to know if you are HIV-positive

A simple blood test, called the HIV antibody test, can determine if you are a carrier of HIV. Antibodies develop from 2 weeks to 3 months following infection.

The most common HIV test involves the taking of a blood sample followed by lab analysis. Results are available 2 to 4 weeks later. A counselling session is often made available at the time of the blood test and when results are disclosed.

There is a rapid HIV test that allows for results to be made available immediately. It is a HIV antibody detection test. Antibodies to HIV take up to three months to develop after being infected. If results are positive or not conclusive, it is recommended to carry out a standard HIV antibody detection test immediately to confirm with accuracy the presence of antibodies in your body. If results are negative, it is preferred to carry out a rapid HIV test or a standard HIV antibody detection test three months after the last time you were at risk of exposure to HIV in order to confirm with accuracy the presence of antibodies in your body.

What are at-risk behaviours ?

The following behaviours do not lead to HIV transmission:

No risk

• Kissing (without exchange of blood)
• Masturbation (without penetration)
• Receiving unshared sex toys
• Contact with feces or urine (unbroken skin)
• Injecting with new or unshared needles
• Inhaling or smoking a drug with a new or unshared pipe or straw
• Sadomasochistic activities (with universal precautions)
• Tattooing, electrolysis and acupuncture with universal precautions
• Manicures (hand care) or pedicures (foot care)

The following behaviours may lead to HIV transmission:

Negligible risk (very low risk)

• Receiving fellatio
• Receiving cunnilingus
• Performing cunnilingus with barrier
• Receiving or giving fellatio (with a condom)
• Anilingus
• Fingering
• Fisting
• Using shared sex toys with a condom
• Using disinfected sex toys
• Sadomasochistic activities
• Contact with feces or urine and secretions, on broken skin (cut, wound, lesion, ulcer, burn or weeping rash)
• Vulva-to-vulva rubbing
• Docking
• Taking breast milk into the mouth
• Inhaling or smoking drugs with shared equipment (pipe or straw)
• Tattooing, electrolysis and acupuncture with non-disinfected shared equipment
• Fistfighting / wrestling
• Sharing toothbrushes or razors

Low risk

• Kissing (with exchange of blood)
• Performing fellatio (without a condom)
• Performing cunnilingus without a barrier
• Penetration (vaginal or anal) with a condom
• Injecting with a shared, but disinfected needle
• Tattooing, electrolysis and acupuncture with non-professional equipment
• Taking blood in the mouth
• Occupational exposure

High risk

• Penetration (vaginal or anal) without a condom
• Insertion of a shared sex toy without a condom
• Injecting with shared and/or unclean equipment

What is the treatment for HIV ?

Any decision about a specific medical treatment should always be taken in consultation with a qualified health care professional experienced in diseases associated with HIV and their appropriate treatments.

HIV/AIDS is still incurable. Once infected, a person has HIV for life. Several medications on the market can slow the development of the virus, but none of them can cure HIV.

How can HIV be prevented ?

• Discuss HIV and STBBI with your sexual partner(s);
• Consider other forms of activities, such as caressing and touching instead of sexual relations;
• Use condoms during sexual relations (vaginal and anal);
• Remember not to share articles that can lead to an exchange of body fluids (blood, sperm and vaginal secretions). These include sex toys, toothbrushes, razors, and equipment used for drug injection, piercing, and tattooing;
• Do not share toothbrushes, razors, nail files or other personal articles that can carry traces of blood;
• Clean all surfaces contaminated by blood with bleach (one part bleach to nine parts water);
• Do not donate blood or organs; do not donate sperm for artificial insemination;
• If you are pregnant, your baby can be protected if you receive anti-HIV treatment by the beginning of your second trimester.

A better way to reduce the risks of contracting a STBBI is by practicing safe sex. Wearing a condom is usually the best protection against STBBI.

HIV and pregnancy

Without treatment, between 20 and 30% of babies born to HIV carriers will become infected by the virus. It is therefore very important to test pregnant person for HIV, so that, if necessary, treatment may begin by the second trimester and continue until childbirth. With proper treatment, transmission of HIV to the newborn can almost always be prevented.

Additional information

Since 2003, HIV has been declared non-nominative in Quebec. That means that if someone has tested HIV-positive, the relevant epidemiological information will be sent to the public health laboratory with an encrypted Medicare number (allowing the system to follow the evolution of the epidemic, while still protecting the patient’s identity).

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