Introduction
As the virus destroys and impairs the function of immune cells, an infected person gradually becomes immunodeficient. AIDS is a gradual and persistent decline and failure of the immune system, resulting in a heightened risk of a life-threatening infection (Centers for Disease and Prevention, 2022). In most cases, HIV transmission happens when an infected person has unprotected sex with an uninfected partner. However, it can also be transmitted from mother to child during childbirth through breastfeeding. It can also occur through sharing injection equipment such as needles, sharp objects like razor blades, blood transfusion, or an accident.
The disease is widespread across the globe, but more particularly across sub-Saharan Africa. According to a global burden of disease study, almost a million people died of HIV/AIDS in 2017, just over 50% higher than the number of deaths from malaria in 2017 (Lu et al., 2020). AIDS is the leading cause of death in most countries in sub-Saharan Africa and one of the largest killers globally. Studies show that globally, 1.5% of deaths in 2019 resulted from AIDS.
Most people at risk are young adults aged between 15 to 49 years (WHO, 2019). Since HIV is primarily a sexually transmitted infection through having unprotected sex with an infected person, most people who are at risk are sexually active young adults. However, higher death rates are also witnessed among young children under five breastfeeding infected mothers.
Prevalence and Incidence
Globally, in 2021, 38.4 million people were living with HIV, with 36.7 million adults 15 years or older), 1.7 million children (0-14 years), 54% of all people living with HIV, were women and girls (Centers for Disease and Prevention, 2022). 85% (75-95%) of all people living with HIV knew their status in 2021. About 5.9 million people did not know they were living with HIV in 2021. At the end of December 2021, 28.7 million people were accessing antiretroviral therapy, up from 7.8 million in 2010. In 2021.75% (66-85%) of all people were accessing treatment—76% were adults aged 15 years and older, and 52% were children 0-14 years (Centers for Disease and Prevention, 2022).
New infections have been reduced by 54%. Since 2010, new infections have declined by 32%, from 2.2 million to 1.5 million people in 2021. AIDS-related deaths have been reduced by 68% since the peak in 2004 and by 52% since 2010. AIDS-related mortality has declined by 57% among women and girls and by 47% among men and boys since 2010 (Hantalo et al., 2020; WHO, 2019).
Pathophysiology of HIV/AIDS
After this virus is acquired, rapid replication leads to abundant viruses in the peripherical blood. During primary infection, the level of HIV may reach a million virus particles per millimeter of blood. This response is accompanied by a marked drop in circulating CD4+T cells. This acute viremia is associated in virtually all people with the activation of CD4+T cells, which kill HIV-infected cells, and subsequently with antibody production or seroconversion (Centers for Disease and Prevention, 2022; Fauci & Lane, 2020). The CD8+T cell response is essential in controlling virus levels, which rise and decline as CD4+T cell counts rebound. Good CD4+T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.
Ultimately, HIV causes AIDS by depleting CD4+T helper lymphocytes. It weakens the immune system and allows opportunistic infections. T lymphocytes are essential to immune response for defense against opportunistic proliferation. The mechanism of CD4+T cells differs in acute and chronic phases. During the acute phase, HIV-induced cell lysis and the killing of infected cells by cytotoxic T cells account for CD4+T cell depletion, although apoptosis may also be a factor (Remien et al., 2019). During the chronic phase, the consequences of generalized immune activation coupled with gradual loss of the ability to generate new T cells appear to account for the slow decline in CD4+T cell numbers.
A bulk of CD4+T cells occurs during the first weeks of infection, especially in the mucosa, harboring the majority of lymphocytes in the body. However, the symptoms of AIDS do not appear for years after a person is infected. The reason is a preferential loss of mucosa CD4+T cells in mucosal CD4+T cells express the CCR5coreceptor, whereas a small fraction of CD4+T cells in the bloodstream do so (Fauci & Lane, 2020).
HIV seeks to destroy CCR5-expressing CD4+ cells during acute infection. A vigorous immune response controls the infection and initiates the clinically latent phase. However, CD4+ cells in mucosal tissues remain depleted through the infection, although enough remains to ward off life-threatening infections initially. Continuously, HIV replication results in generalized immune activation persisting through the chronic phase. Immune activation, which is reflected by increased activation of the state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and immune response to ongoing HIV replication (Lu et al., 2020).
Another cause is the breakdown of the immune surveillance system of the mucosal barrier caused by the depletion of mucosal CD4+T cells during the phase of the disease. This results in the systematic exposure of the immune system to microbial components of the gut’s normal flora, which in a healthy person is kept in check by the mucosal immune system. The activation and proliferation of T cells that result from immune activation provide new targets for HIV infection (WHO, 2019). However, direct killing by HIV alone cannot account for the observed depletion of CD4+T cells since only 0.01-0.10% of CDA+T cells in the blood are infected.
Prevention and Therapeutic Measures
There are things that an individual can do to keep himself or herself from transmitting or getting HIV. These include limiting the number of sexual partners and always using protection when having sex with an individual whose drug or sexual history is unknown. Reducing the number of sexual partners limits the chances of being exposed to sexually transmitted infections.
According to WHO (2019), it is also essential to learn about the risks of sexual activities to reduce them. The use of condoms during sexual intercourse is highly encouraged as it reduces infection. Since sharp objects, such as needles, are risk factors for HIV infection, it is crucial to avoid sharing them and always consider using those that are new and sterilized.
Furthermore, HIV infections can be managed by treatment regimens comprising a combination of antiretroviral drugs (Centers for Disease and Prevention, 2022). The use of antiretroviral therapy has been linked to suppressing viral replication, allowing patients to recover their immune systems. As a result, it strengthens and regains its ability to fight off opportunistic infections.
Current or Future Research Relevant to the Disease
The present clinical research in pursuit of advanced HIV therapy looks into the future of anti-HIV therapeutics. Research efforts have been on improving therapy for HIV-induced immune deficiency through strategies such as immune-based therapies that target stimulation of the immune system and better anti-HIV drugs combined with other drugs that aim at slowing down the multiplication of the disease. In addition, there has also been research on numerous opportunistic pathogen prophylaxis plans to avert HIV-related opportunistic infections (Centers for Disease and Prevention, 2022). It is probable that advancements in HIV/AIDS therapy through consideration of polypharmacy and cost will occur incrementally and require broadened support from the public, physicians, and patients.
Impact of HIV and AIDs on Children
Children, especially in sub-Saharan Africa, are indirectly affected by the loss of their loved ones who have supported them. Less than 10% of children orphaned by AIDS receive public support and services (Centers for Disease and Prevention, 2022). Children who are HIV positive suffer stigma and rejection from society. Especially those affected through mother-to-child transmission or following sexual abuse are often not told what could happen to them and could undoubtedly be frightened when they experience symptoms. Most of them are not prepared and, hence, suffer psychologically.
Parents who fear stigma and emotional distress in their children need professional support on how to handle disclosure. Most children who are HIV positive don’t receive treatment. In middle-income countries, less than 5% of HIV-positive children in need of treatment receive it (WHO, 2019). Due to a lack of affordable pediatric formulations and without being treated, most children die at an early stage. Children are indirectly affected by the loss of their teachers or as they take care of sick relatives. As they care for their ailing parents, they are prone to suffer from long-lasting psychological trauma.
Conclusion
Normal childhood children can be influenced by HIV/AIDS, as they have to overcome psychological stress and reduced parenting capacity, stigmatization, and financial deprivation. These challenges result in behavioral and emotional changes among children, such as delinquency. HIV illness can bring severe and lasting economic deprivation.
Healthcare access comes at a cost, including transport and opportunity costs of clinic visits. It becomes a burden to adults who are affected. Studies show co-occurring economic stressors of adult infections, such as loss of earnings, diversion of income to healthcare expenditure, disruption of savings, and selling of assets to meet healthcare costs. All these create a challenging environment for children to thrive.
References
Centers for Disease and Prevention. (2022). About HIV/AIDS | HIV Basics | HIV/AIDS | CDC. Centers for Disease Control and Prevention. Web.
Fauci, A. S., & Lane, H. C. (2020). Four decades of HIV/AIDS—Much accomplished, much to do. New England Journal of Medicine, 383(1), 1-4.
Hantalo, A. H., Taassaw, K. H., Bisetegen, F. S., & Mulate, Y. W. (2020). Isolation and antibiotic susceptibility pattern of bacterial uropathogens and associated factors among adult people living with HIV/AIDS attending the HIV center at Wolaita Sodo University Teaching Referral Hospital, south Ethiopia. HIV/AIDS (Auckland, NZ), 12, 799-808.
WHO. (2019). HIV/AIDS. World Health Organization. Web.
Lu, D. Y., Wu, H. Y., & Lu, T. R. (2020). HIV/AIDS treatment, therapeutic strategy breakthroughs. Hospice & Palliative Medicine International Journal, 4(2), 34-39.
Remien, R. H., Stirratt, M. J., Nguyen, N., Robbins, R. N., Pala, A. N., & Mellins, C. A. (2019). Mental health and HIV/AIDS: The need for an integrated response. AIDS (London, England), 33(9), 1411-1420.
