Is AIDS a communicable disease?
HIV AIDS> General
1. The most important things in a nutshell
HIV is an incurable viral infection that affects the immune system. Thanks to medication, people with HIV can live well and long today. If the HIV infection is left untreated, it will develop into AIDS. The HIV virus is transmitted through direct contact with infected body fluids, especially blood, semen and vaginal secretions. Most infections occur during sexual intercourse and intravenous drug use.
HIV is only transmitted through direct contact with certain body fluids that contain large amounts of the virus. The main ways HIV is transmitted are:
- Contact with infected blood, mostly during sexual intercourse (due to tiny injuries), especially during anal intercourse, including vaginal intercourse, very rarely oral intercourse. HIV can also be transmitted through needle sharing while using drugs. Infection in the medical field rarely occurs, e.g. as a result of a needlestick injury. Transmission through blood transfusions is virtually impossible in Germany today, as the donor blood is consistently examined.
- Sexual contact with the transfer of infected semen or infected vaginal fluid via the mucous membranes of the vagina, cervix, penis, mouth or rectum. This is particularly possible with unprotected anal and vaginal intercourse, and very rarely with oral intercourse.
- From mother to child during pregnancy (through the placenta), childbirth (through contact with blood and vaginal secretions) or through breastfeeding (through breast milk). However, this can be prevented by taking preventive measures.
The risk of transmission is increased
- if there are sexually transmitted diseases or injuries, as this makes it easier for the HI viruses to penetrate.
- if the person infected with HIV has a high viral load because there are many HIV viruses present.
2.1. Transmission during sex
The most common HIV infection occurs through unprotected anal and vaginal sex. If the infection is untreated, there are many HI viruses in semen, vaginal fluid and menstrual blood. The sensitive mucous membranes of the rectum, vagina, cervix and the inside of the foreskin and urethra can absorb the virus very easily. There is also a risk of transmission for the intruding person because the intestinal and vaginal mucosa can contain a large number of viruses.
With oral sex, the risk of transmission is extremely low because the mucous membrane in the mouth is very stable and offers good protection against the penetration of the virus. There are only a few known cases in the world of HIV being transmitted through oral sex.
2.2. Transmission through drug use
If syringes and needles are used together when using drugs, the risk of infection is very high, because the virus can survive for a few days in the moist blood residue of a syringe and, if it is used further, it enters the bloodstream directly.
Infection through a needle lying around is not known worldwide, because these are usually needles with a small diameter, on which only a small amount of blood remains, which dries in the air. In addition, unlike drug consumption, the blood residues do not get back into a solution from which they are passed on. Infection with hepatitis B and hepatitis C through syringes lying around is possible. Therefore, in the event of needle contact, seek medical treatment as soon as possible. Infection with hepatitis B can be prevented within 48 hours, hepatitis C can be treated well.
2.3. No risk of infection
Not HIV can be transmitted in liquids that contain only small amounts of the HI virus, e.g. tears, sweat, saliva, food or drinking water. That is, a transfer is Not possible through:
- Body contact such as kissing, handshake, hugging, caressing
- Droplet transfer, e.g. when coughing or sneezing
- Shared use of toilets, towels and dishes
- Swimming or bathing together
- Working and living with people infected with HIV
- First aid services, provided that the hygienic regulations (e.g. gloves) are observed
- Medical and cosmetic treatments (dentist, foot care, etc.) as well as care, provided that the hygiene regulations are observed
- Tattooing and piercing under hygienic conditions
- Insect bites or other animal contact
The protective barrier of intact skin also prevents pathogens from entering. In addition, the HI virus is not infectious for long outside the body, which is why transmission without direct contact is impossible.
2.4. Therapy minimizes the risk of infection
Successful antiretroviral therapy (ART) can reduce the viral load in the plasma below the detection limit of the available test methods (currently approx. 20 virus copies / ml). This also significantly reduces the risk of infection. With successful ART, the HIV virus cannot be transmitted sexually and pregnant women can give birth and breastfeed vaginally. More information under HIV AIDS> Treatment.
3. Symptoms and course
An HIV infection runs in several phases and, if left untreated, leads to the outbreak of AIDS. The exact course of the infection depends on many factors and therefore varies from person to person. Therefore, the time information in the following descriptions in particular can only provide a rough guide.
HIV is the abbreviation for "Human Immunodeficiency Virus", so it is a "human immune deficiency virus" from the group of retroviruses.
There are two types of HIV, each of which can be divided into several subgroups. In Germany, the HIV-1 type is the most common. HIV-2, on the other hand, is only responsible for about 0.5% of all cases and occurs mainly in West Africa.
The infection with HIV proceeds in several phases:
3.1.1. Acute infection
The HI virus attacks the immune system by penetrating certain immune defense cells, the so-called T helper cells or CD4 cells. The virus uses a special enzyme ("reverse transcriptase") to transcribe and integrate its genetic material (RNA) into the host cell's genetic material (DNA), thereby stimulating the cell to produce virus genetic material and ultimately to multiply the HIV virus . The helper cells become fewer and the body can then no longer defend itself against infections as well. But it also forms antibodies that can be detected in the blood.
After infection, the HI viruses initially multiply strongly. The immune system defends itself against it and flu-like symptoms occur after a period of about 2 to 4 weeks, which are often not recognized as an HIV infection. Typical are e.g. fever, swelling of the tonsils and lymph nodes, skin rash, tiredness and fatigue, heavy night sweats and muscle pain.
3.1.2. HIV infection without symptoms: asymptomatic latency phase
The number of HIV viruses ("viral load") then drops and the virus is difficult to detect. However, the antibodies, which are usually used to diagnose HIV, remain detectable (for more information, see HIV AIDS> Tests).
The infected person usually does not feel any physical changes during this time. However, the HI virus continues to multiply. T helper cells are destroyed, but the body can reproduce them in sufficient numbers. The symptom-free latency period can last several years.
3.1.3. HIV infection with symptoms
The body is no longer able to produce enough T-helper cells, so that the immune system is weakened and diseases occur more frequently. Those affected develop unspecific complaints, i.e. they are complaints that can occur with various diseases. Typical are, for example, a poor general condition, changes in the skin and mucous membranes, long-lasting swelling of the lymph nodes or gastrointestinal problems. The symptoms as well as their frequency and severity vary greatly from person to person.
AIDS is the abbreviation for "Acquired Immune Deficiency Syndrome", translated as "Acquired Immune Deficiency Syndrome".
One speaks of AIDS only when life-threatening infections occur as a result of the damaged immune system. Typical are a special form of pneumonia caused by a fungus (Pneumocystis jirovecii), fungal infections of the mucous membranes (Candida albicans), brain abscesses as a result of a toxoplasma infection or serious diseases of the eyes, lungs, brain or intestines caused by an existing herpes Virus.
One speaks here of "opportunistic infections". These are infections that only occur when the immune system is already severely weakened by another disease, in this case by the HIV infection.
In addition, certain diseases can appear again. Cancer types caused by viruses are typical of AIDS, e.g. Kaposi's sarcoma (cancer of the mucous membranes) and B-cell lymphoma (cancer of the lymph cells), or acute tuberculosis. These diseases, the opportunistic infections and a weight loss of over 10% for no apparent cause (wasting syndrome) are among the so-called AIDS-defining diseases. Even if the helper cells drop to less than 200 per microliter of blood, it is called AIDS.
3.3. HIV co-infections
HIV co-infections are infections with other sexually transmitted diseases (STIs), e.g. infections with chlamydia, human papillomavirus, hepatitis C or syphilis. Some STIs can be particularly severe in HIV. Co-infection also increases the risk of other people becoming infected with HIV. People infected with HIV should therefore be checked for hidden infections every year.
Hepatitis (inflammation of the liver) is particularly dangerous, especially if it is caused by viruses. There are more harmless and more dangerous types. Hepatitis B and C can develop more severely, especially in people with immune disorders, including those with HIV.
There are vaccinations against hepatitis A and B, which HIV-positive people should take as much as possible. More information under Hepatitis C> Treatment
Information on STI is available from the German STI Society (DSTIG) at www.dstig.de.
4. Data protection and reporting requirements
Unfortunately, HIV and AIDS are still very stigmatized and there are many people who are not sufficiently informed and have prejudices. It is therefore important to know to whom there is a notification obligation and to whom the confidentiality obligation applies.
4.1. Notification obligation
In Germany there is no law that obliges you to notify your sexual partner. Therefore, the person affected decides who to inform about their infection. However, it is crucial that it prevents infection through safer sex measures. If he has unprotected sex without informing his partner about the infection beforehand, he is liable to prosecution for attempted assault.
There is no legal obligation to notify doctors and authorities. However, it is advisable to inform all treating physicians about the HIV infection so that interactions can be avoided and side effects can be properly classified. In some cases it is also necessary to inform service providers about the infection, e.g. if a pension is applied for due to the AIDS illness.
Doctors are obliged to report to the Robert Koch Institute (RKI) if they become aware of an infection. However, the notification does not have to be made by name. Voluntary and anonymous case reports from treating physicians to the central AIDS case register are also possible.
Doctors and other health care workers have a duty of confidentiality that may only be broken in the event of a justifiable emergency. In practice, however, a justifying state of emergency is not easy to justify and is therefore only present in exceptional cases. Even if third parties are at risk (e.g. if an HIV-infected person has unprotected sexual intercourse with his partner and he is not informed about the infection), confidentiality initially applies. All measures (e.g. urgent information about the consequences of the action) must first be exhausted before the doctor is allowed to break his duty of confidentiality and inform the sexual partner.
A doctor is also not allowed to pass on his knowledge of an infection to other clinic employees at will. The patient's consent to the communication to third parties only extends to employees who are directly involved with the patient. The confidentiality also applies to the documentation and transfer of findings as well as the billing with the health insurance company. The result of an HIV test, for example, must not be passed on in a doctor's letter without the consent of the patient. If there is no consent, the doctor can enter an indication of incompleteness. The person concerned can then, however, object to the forwarding of such a doctor's letter.
Private individuals are also bound to secrecy by virtue of general personal rights. Anyone who passes on the knowledge of an infection can be sued for damages.
For more information on how to deal with an HIV infection, see HIV AIDS> Career and Pension and HIV AIDS> Family Life Travel.
5. Who can help?
Deutsche Aidshilfe offers advice in various ways
In addition to those affected, partners and relatives can also take advantage of the advice. If necessary, the contact details of local AIDS support organizations and nationwide advisory projects on medical issues can be provided.
6. Practical advice
Free download: HIV and AIDS guide as a PDF with information on all of the above topics and the information in the articles linked below.
7. Related links
HIV AIDS> Prevention
HIV AIDS> Tests
HIV AIDS> Treatment
HIV AIDS> Rehabilitation
HIV AIDS> Job and Pension
HIV AIDS> Family Life Travel
HIV AIDS> Financial aid
HIV AIDS> Age and Care
HIV AIDS> severe disability
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