HIV - no longer detectable under therapy

HIV is a common worldwide chronic infection, affecting 38 million people of which about 16,600 live in Switzerland. Approximately a third of people who are HIV positive are unaware of their Infection.

The cornerstone of modern HIV management is the use of antiretroviral therapy (HAART). HAART has led to people living with HIV having a viral load under the level of detection (undetectable viral load), which means they:

  • do not transmit the virus through sexual contact to their partner.
  • are less likely to transmit the virus through other ways of transmission.
  • less likely to become sick because of HIV
  • have a near normal life span.
  • have children who are not infected with HIV.

Transmission

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The main routes of transmission are through blood or body fluids:

  • Sex is the most common route of transmission
  • Blood and blood products like sharing needles, blood transfusions in some countries
  • Mother to child- through childbirth and breast feeding

For HIV to be transmitted there must be contact with blood or body fluid from a person who is infected with HIV and has a detectable viral load (HIV is not controlled with medication).

The HIV virus survives for only a few minutes long outside the body, but can last much longer within needles

Treatment with HAART means that the person does not transmit HIV through sex, and the risk via the other routes is significantly decreased.

HIV negative people who are at ongoing risk of acquiring HIV can protect themselves by taking Pre-Exposure Prophylaxis (PREP) medication, enrolling in opioid agonist therapy (substitution programme) and using Post Exposure Prophylaxis (PEP) medication as necessary.

Sexual Risk
The risk of HIV transmission via sexual contact is highest through unprotected (without condom) anal intercourse followed by vaginal intercourse – BUT ONLY from a contact whose HIV virus is detectable.

Oral sexual intercourse (fellatio and cunnilingus) have very low risk of HIV transmission.

Blood and blood products
Sharing needles for injecting recreational drugs is a small but important avenue for HIV transmission. The use of HAART and having an undetectable viral load decreases the risk of HIV transmission, but it is unclear by how much. Which is the reason that needle exchange programmes are so important in protecting the injecting community, not only for providing clean needles and a safe injecting space, but also the support for those who would like to stop injecting.

Mother to Child
With modern HIV management by the use of HAART, the risk of mother to child transmission is less than 1%. HAART is easy to take, with minimal side effects for the mother and baby. The mother can have a normal vaginal delivery (so long as there are no obstetric reasons for a Caesarean section). The information around the risks and benefits of breast-feeding is complex and needs to be discussed with the HIV Specialist Doctor.

Diagnosis and support

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HIV is diagnosed by a HIV blood antibody test.

Some people find it difficult to accept that they are living with HIV, for those individuals we offer support through the medical team as well as our highly trained psychology and psychiatry colleagues within our team. There is also social work support for those who need it and good links with external organisations that offer complimentary services.

Assesment

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HIV is a chronic condition and therefore a holistic approach is necessary to ensure that not only the HIV is controlled and the medical long-term effects are actively looked for and managed, but that the person is also psychologically and socially supported to help them make the best decisions about their care.

In Arud we aim to provide holistic person centred multidisciplinary care under one roof. We have a team of specifically trained HIV specialist doctors who have extensive training and experience in managing people living with HIV, supported by a multidisciplinary team including nurses, psychiatrists, psychologists and social workers, as well as strong links with other external services that are important for people attending our clinic.

Treatment

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HIV treatment usually consists of a combination medication called antiretroviral therapy (HAART), often in the form of one tablet a day. It is recommended that people start on the antiretroviral medication as soon as possible after their diagnosis. Once stable, follow-up is between 2 and 4 times a year.

Over 95% of the people who take their HAART medication regularly maintain an undetectable viral load. With good medical care, most people living with HIV live a near normal lifespan.

Contact

Would you like to get in touch or do you have any questions regarding treatment? We are there for you, with straightforward and confidential help.

+41 58 360 50 00
You can contact us from Monday to Friday from 8am to 6pm.
mail

Write to us:

For information

Claudia Bernardini
Senior Consultant in General Internal Medicine +41 58 360 50 00 mail c.bernardini@arud.ch
Lina Hijazi
Attending Physician General Internal Medicine +41 58 360 50 00 mail lina.hijazi@checkpoint-zh.ch