The impact of HIV infection on modern medicine as well as human life during the last decade stands unmatched. The HIV epidemic soon turned into pandemic and this infection has now become endemic in many countries, including India. Rapid strides have been made in our understanding of HIV infection. New drugs that inhibit HIV virus replication are available in the Indian market and prices of these are coming down. It is estimated that 4 million Indians are infected with the HIV virus. Recent studies have shown an increase in the number of deaths due to AIDS in Mumbai city. HIV infection is increasingly being diagnosed in housewifes and pregnant women, showing spread in the community.

HIV is transmitted by the following routes:-

• Sexual transmission
• Transfusion of infected blood and blood products
• Maternal transmission to child during birth
• HIV contaminated instruments

Tests used to diagnose HIV infection are:-

• ELISA - initial screening test
• Western Blot - confirmatory test
• PCR assay

A person is said to have HIV infection when the HIV virus enters the body. When CD4 (a type of white blood cells) decrease below 200 cells/ull or the person starts suffering from characteristic range of opportunistic infections, the person is said to be suffering from AIDS.

Treatment of HIV positive patient involves:-

• Nutrition
• Treatment of opportunisitic infections like TB
• Psycho-social support
• Anti-retroviral therapy

Anti-retroviral therapy is started when CD4 count goes below 300 cells/ull or patient is suffering from AIDS.

It is important to take anti-retroviral therapy lifelong. Blood tests are needed every 3 to 6 months to check on the progress of the disease. There are long term side-effects of the drugs, which need to be monitored by a physician.

Patients should understand that:-

• Therapy available today is suppressive and not curative. However, treatment helps the patient lead a more productive life
• The duration of therapy is life-long. HIV may be regarded as a chronic illness, just like diabetes or hypertension
• Long term adverse effects may occur, but can be managed by a physician
• There is a potential for interaction with other medication
• Adherence to the regime of anti-retroviral drugs is critical, else the virus quickly develops resistance
• It is important to inform patients that even though they are receiving treatment, they should not donate blood and should practice safe sex, as they are capable of infecting others.

Dr. Kiran Godse Skin Specialist Laksh-Deep Hospital