16 | PagePeterTHE COMPTON SCHOOLHIV – The Undercover Killer WIPBY PETER GALATIContentsBiology of HIV / AIDS 2Symptoms of HIV / AIDS 4Causes of HIV / AIDS 4Factors Influencing the Spread of HIV / AIDS 7Control Measures 10Current Situation 12       Biology of HIV / AIDSFigure 1 – Photo Credit: C. Goldsmith Content Providers: CDC/ C. Goldsmith, P. Feorino, E. L. Palmer, W. R. McManus – This media comes from the Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with identification number #10000.HIV (human immunodeficiency virus) is a virus which directly attacks the immune system. 1 The virus does this by attaching itself to ‘CD4’ cells (a type of white blood cell) before killing them, over time. 2 Eventually, your CD4 count will be so low that the infected person’s immune system is effectively useless (also known as ‘immune deficiency’.) 3 In turn, the outcome could result in their body failing to deal with even the most common of viruses such as a cold. Because our body would have no way of defending itself, you would eventually die. The reason why CD4 cells are so important is that, to put it simply, they are the ‘commander’ of the army of white blood cells. In other words, they lead the attack against infections such as the flu or salmonella.AIDS is not a separate virus by itself per say but a symptom of HIV. It is also the last (and most deadly) stage of HIV. 4 Should insufficient medication is taken death can and will occur. Although there is no cure, there are several types of HIV/AIDS medications which can improve your quality of life. The main ones include:Nucleoside Reverse Transcriptase Inhibitors (NRTIs) – NRTIs were the first treatment available and yet are still one of the most effective. They work by preventing the virus (HIV) from duplicating. Because of this, the process of the development of HIV drastically slows down. Protease Inhibitors (PI) – PIs work in a similar way to NRTIs in the way that they prevent the virus from replicating itself. The only difference being PIs do this at a later stage in the diseases life cycle.Fusion Inhibitors – This is a relatively new drug. Fusion Inhibitors work by preventing the HIV virus from entering the CD4 cells (part of the immune system). Because of this, the virus can’t do it’s ‘job’ – to enter CD4 cells and slowly killing them off.Keep in mind that because HIV is a virus, so antibiotics won’t work against the actual virus itself. However, antibiotics are an effective treatment for treating secondary infections resulting from the weakened immune system. We can measure how strong someone’s immune system is (and therefore how bad their case of HIV is) by doing something called a ‘T-cell count’. 5 This is done by measuring the number of CD4 cells per cubic millimetre of blood. 6 The higher the number, the stronger your immune system, the lower the number the weaker your immune system is. The average healthy person has between around 500 – 1500 CD4 cells / mm³ of blood. 7 However, if your count drops below 200, you, by clinical definition, have AIDS. 8Symptoms of HIV / AIDSIn terms of HIV, about 80% of individuals experience a flu-like illness within 2 – 6 weeks following infection. This includes things like high temperature, sore throats, rashes and less commonly muscle pain, tiredness, swollen glands and joint pain. These symptoms generally last for no longer than 2 weeks but can last longer. This is a sign that your immune system is working and fighting against the virus… but not for long. The virus then begins its potential 10-year incubation period. During this time, the virus slowly destroys your immune system whilst not showing any symptoms. During this time the virus is slowly destroying your immune system until AIDS develops. At this stage, symptoms get a lot more serious. This includes skin problems, weight loss, chronic diarrhoea, recurrent infections (as a result of a weak immune system), night sweats and, in serious cases, death.Causes of HIV / AIDSHIV was believed to have originated in West Africa and was believed to have descended from chimpanzees in a similar variation called SIV (simian immunodeficiency virus). 9 It was then transferred to humans and then mutated into what we now call HIV. 10 This most likely happened when someone was in contact with infected chimpanzee meat and therefore their blood when going hunting. The first reported case of HIV was in 1959 from a man in Congo via a blood analysis in which he was tested positive for HIV-1 (the most common strain of the virus). 11 People only started becoming aware of HIV however in 1982 in America when a group of gay men reported a type of “cancer”. 12 This was later found out as a condition which is now called AIDS. 13Figure 2 – Photo Credit: https://evolution.berkeley.edu/evolibrary/news/081101_hivoriginsHIV (human immunodeficiency virus) is the causative agent of AIDS. 14 HIV isn’t passed on easily unlike viruses such as the flu which is easily transmitted via the air. HIV on the other hand “lives in the blood and in some bodily fluids”. 15 In other words, the virus essentially comes part of the bloodstream. This means that we can generalise HIV transmission by contact with infected blood and bodily fluids. HIV itself can be transmitted by a number of different factors however the main ones are as follows:Sexual contact – this includes unprotected vaginal and anal sex. It is transmitted from one person who is HIV positive and is normally passed on through semen. Although less common, another way in which HIV can be transmitted is via oral sex however broken and/or damaged skin e.g. bleeding gums can increase the risks. 16 You can also still pass on HIV even if you don’t show any symptoms. It often lives in the body for years without any symptoms until AIDS develops. Many real-world HIV prevention adverts today advise condoms as they prevent the transition of HIV. Contact with blood – as stated before, HIV lives in the blood. 17 Because of this fact, any contact with infected blood could result in the transmission of the disease. A more real-world example of this would be using an infected needle or syringe. Reusing someone’s HIV positive needle for drugs (or anything for that matter) for example can be very dangerous and is the transmission of the disease is almost inevitable. “HIV can live in a used needle up to 42 days depending on temperature and other factors.” 18. Although even after this time period it can still stay in the needle so it’s best to use new needles.As well as the clear ways HIV can be transmitted, there are many misconceptions on HIV regarding ways of transmission. Some ways in which HIV cannot be transmitted include:Air or water 18Sharing toilets and or swimming pools 20Insect bites 21Food – even with blood in it 22Saliva (kissing, mouth – to mouth resuscitation etc.) 23In a lot of these cases transmission is not possible because there is no contact with blood or exchange of bodily fluids. In addition, “HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host.” 24Factors Influencing the Spread of HIV / AIDSFigure 3 – Photo Credit: WHO, http://www.who.int/gho/hiv/en/Figure 4 – Photo Credit: Max Roser, https://ourworldindata.org/hiv-aids/In addition to direct factors such as blood contact, unprotected sex etc., there are also many indirect factors that affect the long-term rates. For example, as shown in figure 3, we can see that most cases of HIV occurred in Sub – Saharan Africa with prevalence rates ranging from 1% to 34%. Compared to a country like the UK for example, which has a prevalence rate of less than half a percent. And this is no coincidence. As shown in figure 4, we can see that the four countries, Zimbabwe, Uganda, Rwanda and Zambia (all Sub – Saharan countries) have very low rates of people getting tested for HIV. We can also see that as the level of education increases, so does the percentage of people getting tested. In Zambia for example, only 27% of women with no education whatsoever got tested for HIV whereas 56% of women with a secondary education or higher got tested. This shows that there is a direct correlation between education rates and the percentage of people getting tested. And as stated before, getting tested for HIV is one of the best ways to help lessen the chances of transmission to both you and others. Because of this data, we can make an inference that had these countries had higher education rates, the prevalence of HIV would drop accordingly. (2006-2007)Figure 5 – Photo Credit: CDC, https://www.cdc.gov/hiv/group/poverty.htmlPoverty is also a major factor which contributes to your likelihood of being diagnosed as being HIV positive. In 2006 in the US, the poverty threshold of a house of one person was $9,800. Judging by the graph in figure 5, we can see that roughly 2.8% of individuals earning 0-$9,999 per year were HIV positive. In contrast, only 0.4% of people making 50,000$ or more per year were diagnosed as HIV positive. By comparing 2.8% to 0.4%, we can see that there is a clear connection to your average income and whether you are HIV positive or not. This could be a result of a number of factors: America is infamous for having some of the highest healthcare costs in the world as they don’t have a national healthcare system such as the NHS. When someone is living on less than $10,000 a year, sometimes they just can’t afford to pay these fees. Being in poverty requires strict money management. Because of this, priorities don’t go towards condoms but towards food and shelter as they often cannot afford to pay for them.Although not specifically about the US, people living in poverty often need to find any possible way to make money. Unfortunately, many of these people need to turn to prostitution to make an income. On average, a prostitute is raped once per week, probably without a condom. Because of this, STDs are much more common amongst prostitutes. In fact, sex workers are 10 times more likely to be HIV positive than the rest of the population.https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/48/the-basics-of-hiv-preventionhttps://owlcation.com/stem/What-Factors-Contribute-to-the-Spread-of-HIVAIDS-in-Kenyahttps://www.ncbi.nlm.nih.gov/books/NBK11782/https://www.hiv.gov/hiv-basics/overview/data-and-trends/statisticshttps://www.avert.org/global-hiv-and-aids-statisticsControl MeasuresThere are a number of control measures against HIV / AIDS. This includes both things that the general public is advised to do as well as things that are done on a more global scale.An example of a local control measure is by simply using a condom during sex. Condoms act as a physical barrier which prevents any contact of bodily fluids between both parties. In fact, this is one of the biggest selling points of condoms as they are the best way to prevent HIV transmission (or any STI for that matter).Figure 6 – Photo Credit: doitlondon, http://doitlondon.org/gallery-1/Figure 7 – Photo Credit: doitlondon, http://doitlondon.org/about/Shown above (Figure 6 & 7) are 2 posters as a part of an advertising campaign called ‘doitlondon’. Doitlondon is backed by 31 London boroughs and aims to spread awareness on HIV around London. These posters are displayed all around London whether it’s on a bus, a tube station or a billboard. Although no number is published, the scale of this campaign means that millions of Londoners are being informed on HIV prevention and are given advice on how to prevent transmission such as the use of condoms and getting tested. The doitlondon campaign acts as a control measure as it aims to reduce HIV numbers, particularly around London. In my opinion, it is extremely effective as one of the main reason why HIV is so big is due to the ignorance of the issue (around 13,500 people are unaware of their HIV infection in the UK). By informing people on the issue, ignorance isn’t such a big factor thus HIV rates (in theory) should drop accordingly. But only time will tell.Another way in which HIV awareness is through school education. Particularly in the UK, these types of lessons are mandatory by law through key stages 1-3. Through sex education lessons, today’s kids are informed about a number of things on HIV. Ranging from safe sex by using condoms to general advice on preventing HIV (getting tested, etc.), all are excellent control measures in order to make tomorrows generation one step closer to HIV free.https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/ukhttps://www.avert.org/global-hiv-and-aids-statisticsInclude details on world AIDS dayWill make graphs for each picture.Current Situation(million people)Source: UNAIDS Data 2017In 2016, there were an estimated 36.7 million people living worldwide with HIV. Judging by the graph below, we can see that (according to the trend line) HIV numbers worldwide are rising. However, there is good news. Although we can see that HIV numbers are rising, judging by the orange line below, we can also see that the amount of people receiving treatment are rising even faster. By continuing both lines, we eventually get to the point where the number of people receiving treatment surpasses the total number of people living with HIV. This shows that there is a bright future for people living with HIV and that, one day, HIV may just be an afterthought.Source: UNAIDS Data 2017Source: UNAIDS Data 2017The graph above shows the percentage of people with HIV in various parts of the world. Judging by the graph above, we can see that over half of all HIV positive people are living in ‘East and Southern Africa’, 53% to be exact (2016). In contrast, we can see that ‘West and Central Europe and North America’ only has 5.7% of the global HIV positive. This is mainly because places in Europe and North America have invested significantly more in things such as HIV awareness campaigns than parts in Africa.To conclude, the future is bright for HIV treatment. With continuing support from HIV research charities, we are getting closer and closer to a potential HIV cure in the near future. Even now, almost all developed countries have wide access to HIV treatment allowing the infected to live normal, happy lives. And although there still are some developing countries who still don’t have access to treatment, one day this will be a thing of the past. References 1.   “WHAT ARE HIV AND AIDS?”, https://www.avert.org/about-hiv-aids/what-hiv-aids 5 December 20172.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/ 5 December 20173.   “HIV/AIDS”, http://www.who.int/features/qa/71/en/ 5 December 20174.   “WHAT ARE HIV AND AIDS?”, https://www.avert.org/about-hiv-aids/what-hiv-aids 5 December 20175.   “T Cell Count”, https://www.healthline.com/health/t-cell-count 5 December 20176.   “Factsheet CD4 Cell Count”, https://www.aidsmap.com/CD4-cell-counts/page/1044596/ 5 December 20177.   “Factsheet CD4 Cell Count”, https://www.aidsmap.com/CD4-cell-counts/page/1044596/ 5 December 20178.   “CD4 count (or T-cell count)”, https://www.hiv.va.gov/patient/diagnosis/labs-CD4-count.asp 5 December 20179.   “Where did HIV come from?”, http://www.theaidsinstitute.org/node/259  6 December 201710.   “Where did HIV come from?”, http://www.theaidsinstitute.org/node/259  6 December 201711.   “Where did HIV come from?”, http://www.theaidsinstitute.org/node/259  6 December 201712.   “Kaposi’s sarcoma in homosexual men-a report of eight cases.”, https://www.ncbi.nlm.nih.gov/pubmed/6116083  6 December 2017 13.   “Current Trends Update on Acquired Immune Deficiency Syndrome (AIDS) –United States”, https://www.cdc.gov/mmwr/preview/mmwrhtml/00001163.htm 6 December 201714.   Taylor Morgan, “HIV/AIDS”, http://www.austincc.edu/microbio/2421a/aids 6 December 201715.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/, 7 December 201716.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/, 7 December 201717.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/, 7 December 201718.   “HIV Transmission”, https://www.cdc.gov/hiv/basics/transmission.html, 8 December 201719.   “HIV Transmission”, https://www.cdc.gov/hiv/basics/transmission.html, 8 December 201720.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/, 8 December 201721.  “Ways that HIV is not transmitted”, http://i-base.info/guides/testing/ways-that-hiv-is-not-transmitted, 8 December 201722.   “Ways that HIV is not transmitted”, http://i-base.info/guides/testing/ways-that-hiv-is-not-transmitted, 8 December 201723.   “HIV and AIDS”, https://www.nhs.uk/conditions/hiv-and-aids/causes/, 8 December 201724.   “HIV Transmission”, https://www.cdc.gov/hiv/basics/transmission.html, 8 December 2017