Where is HIV transmitted, and are HIV and AIDS the same?

December 1 marks World AIDS Day. AIDS is a disease that affects thousands of people around the world and for which there is currently no definitive cure.Despite this, there are some treatments to alleviate the symptoms caused by this pathology.

AIDS is caused by HIV (human immunodeficiency virus), which destroys the cells of the immune system and weakens the entire human organism .

HIV can be transmitted through a number of different routes, one of which is through contact with fluids such as semen or vaginal secretions.

What is the difference between HIV and AIDS?

It is very common to confuse the terms HIV and AIDS, but in reality they are not the same. To follow, we will describe what each of these concepts is:

HIV

human immunodeficiency virus. This is the virus that causes the disease. HIV is a retrovirus that affects the immune system of infected persons by destroying the lymphocytes (white blood cells) responsible for the production of antibodies.

AIDS

acquired immunodeficiency syndrome. This term is used to describe the last stage of HIV infection, where the immune system has been gretly weakened and severe symptoms appear. At this point the so-called opportunistic diseases, infections or neoplasms appear. These threaten the life of the infected person because their body is not able to defend itself.

Progression of HIV to AIDS

It is very important to note that not all HIV-positive (HIV-infected) people eventually develop AIDS. Today, antiretroviral treatments allow HIV positive people to keep their viral load under control and lead a normal life.

How does HIV infection work?

The HIV virus first invades a host cell. Once there it cannot replicate by itself. To replicate itself and create more copies of the virus, it needs to use the internal replication machinery of some cells.

Generally, HIV targets T4 lymphocytes of the immune system, although it also invades other cell types such as macrophages and dendritic cells.

The binding between the virus and the lymphocyte takes place through the CD4 receptors that these cells possess.

HIV then inserts its genetic material into the cell interior, which is integrated into the lymphocyte's DNA and can then multiply.

Viral load refers to the number of copies of the virus in the blood of those affected. The higher the viral load, the lower the population of healthy lymphocytes and the weaker the immune system.

What are the routes of HIV transmission?

HIV is one of the most feared sexually transmitted diseases (STD). This is due to the serious effects it causes and the fact that there is no definitive cure. The main routes of HIV infection are as follows:

• Blood.
• Fluids such as semen and vaginal secretions.
• Pregnancy and breastfeeding.

As such, HIV can be transmitted through sexual intercourse, open wounds, exchange of syringes or any other sharp material.

Routes of HIV transmission

It should be noted that the concentration of viral load in blood is much higher than in seminal and vaginal fluid. A small amount of blood can cause transmission, while the risk of transmission would be lower for the same amount of sexual fluids.

In any case, sexual practices without a condom with a person with HIV are risky. During intimate relations it is easy for small wounds to occur that may favor blood transmission of the virus.

To follow, we are going to explain these routes of transmission in more detail.

By blood

As we have said, blood is the fluid with the highest HIV infectivity capacity. Therefore, any contact of wounds or mucous membranes with the blood of a person with HIV will have a high risk of contagion. Some examples are:

• Sharing syringes, needles or other injection material.
• Sharing any sharp instruments that have been in contact with infected blood, such as razors.
• Communal use of non-sterile sharp and cutting instruments for skin piercing, such as those used in tattooing, piercings, acupuncture, ear piercing, etc.

Route of HIV blood transmission

It should be noted that, with the right temperature conditions, HIV could live in a used needle for up to 42 days.

Blood transfusions are no longer considered a means of contagion, thanks to the strict controls carried out on donated blood.

Unprotected sex

Both vaginal and anal sex are the most common ways in which HIV is transmitted. For this reason, it is recommended that both heterosexual and homosexual relations be protected, i.e., with barrier protection methods such as condoms.

On the other hand, although saliva is not a means of transmission, oral sex is not totally excluded from the probability of transmission. Although it is true that the risk is lower, there may be small wounds in the mouth that allow transmission through the bloodstream.

Semen is the best known means of sexualtransmission of HIV. Specifically, semen is composed of spermatozoa and seminal fluid. Virus particles are suspended in this seminal fluid or may even adhere to the spermatozoa.

Transmission of HIV through semen

Finally, it is important to note that HIV infection can occur both from male to female and female to male. It can also occur between people of the same sex.

Vertical transmission

Vertical transmission of HIV refers to the transmission of the virus from mother to baby during pregnancy, childbirth or breastfeeding.

Mothers with a high viral load have an increased risk of transmitting HIV to their child during gestation due to shared blood circulation through the placenta and umbilical cord.

There is also a risk of transmission during breastfeeding, as HIV can be found in breast milk. Therefore, it will be necessary to resort to formlula feeding in cases of HIV-positive mothers.

Where is HIV not transmitted?

Unlike other types of viruses, HIV is not transmitted through the air or water.This is because it is not able to survive outside the human body.

The following situations are not routes of HIV infection:

• Contact with saliva, tears, sweat, feces or urine. Therefore, there is no problem in touching or kissing a person with HIV.
• Sharing dishes, food or beverages.
• Sharing shower, toilet or towels.
• Mosquito bites. Neither animals nor insects carry HIV.

Routes through which HIV is not transmitted

Generally, there is no risk in living with a person with HIV. In addition, breakthroughs in antiretroviral treatment have enabled seropostive people to reduce their viral load to undetectable levels (<50 copies/ml).

FAQs from users

What reproductive options are available to serodiscordant couples to have a child without risk of infection?

A serodiscordant couple is defined as a couple where one partner has a communicable infectious disease such as HIV and the other does not. It can also apply to other diseases such as hepatitis C and hepatitis B.

In cases where the male partner has the disease, the main way to eliminate the risk of infection is to perform a seminal lavage. The semen is processed in the laboratory, the semen is washed and a fraction is sent to confirm by molecular biology techniques that there are no traces of infection in the sample. If this is the case, the sample, which will remain frozen, can be used safely for subsequent treatment.

If the woman is the carrier of the infection, it is important that she has an undetectable or low viral load before starting treatment. In cases with a high viral load, it is recommended that the relevant treatment be carried out before the assisted reproduction treatment, in order to reduce the presence of the virus as much as possible and thus the risk of transmission to the child. Likewise, if treatment is required during pregnancy, it must be appropriately adjusted and approved for pregnancy by the specialist who is following the patient. In this situation of adequate treatment and undetectable viral load, the risk of transmitting the infection to the foetus is very low.

What are the chances of catching HIV using a condom?

If sexual relations with an HIV-positive person are maintained with a condom, the probability of contagion is very low, since the condom will prevent contact between sexual fluids and also contact with blood that may be released both vaginally and through any wound that may have occurred.

Can HIV be transmitted by rubbing genitals?

Although the probability is low, if the rubbing of genitals is direct, i.e., without underwear, contagion is possible, provided that there has been contact of sexual or blood fluids even though there has been no penetration.

Is there a risk of HIV transmission by accidental puncture wounds?

As mentioned in the article, one of the strongest routes of infection is via blood, since the concentration of virus in the blood of an infected person is high. For this reason, an accidental or voluntary puncture with a syringe or any sharp material can be a reason for contagion.

Is there a probability of HIV infection due to condom breakage?

If the condom has broken and there has been contact with the seminal fluid of a male carrier, the woman has a high risk of being infected.

Can HIV particles be present in pre-ejaculatory fluid?

Yes, viral particles are mainly found in the plasma of the seme, which the pre-ejaculatory fluids are made from. Hence the pre-ejaculatory fluids can be a means of HIV transmission.

Can AIDS be transmitted through pre-seminal fluid?

Pre-seminal fluid is a fluid that may contain HIV virus particles and could therefore be considered a route of HIV transmission. However, pre-seminal fluid would have to contain a high viral load for this to occur according to numerous studies.

Recommended reading

If you are interested in learning more about the relationship between HIV and pregnancy, you can continue reading here: Can you have a healthy pregnancy if you are HIV positive?

Fore more information about reproduction options where the male is HIV positive you can access this article: Sperm washing for assisted reproduction in HIV positive patients.