Antibodies and viral load used in diagnosis of HIV

HIV infection can be diagnosed when the presence of specific antibodies is indirectly demonstrated or when virus particles are directly detected. In the latter case the presence and the level of HIV-RNA (viral load) in the blood is determined. A prognosis of the progress of the disease can be made on the basis of the identified viral load and the number of detected CD4+ T cells.

Transmission from mother to child does not always occur

HIV can be transmitted from a mother to her baby, but this does not occur in every case. All babies of infected mothers have antibodies in their blood that originate from the mother. These antibodies disappear after about 18 months. Therefore, testing newborn babies on the presence of antibodies does not prove useful, as the antibodies detected may not belong to the baby itself. Therefore, it is only useful to test a baby on antibodies for HIV after 15 months. The direct detection of the virus or parts of the virus does, however, offers a suitable testing method for newborns (Krist & Crawford-Faucher, 2002). Antiretroviral treatment of the mother reduces the risk of transmission to her (unborn) child significantly (McGowan & Shah, 2000a, McGowan & Shah, 2000b, Ioannidis et al., 2001).

No cure for HIV and AIDS but treatment can prolong life expectancy

Both HIV infection and AIDS cannot be cured, but they can be treated. Treatment builds on two measures. The first measure consists of inhibiting the progress of infection through drugs that act against the virus. These drugs are also known as HIV inhibitors or antiretroviral drugs. The second measure aims at preventing and treating opportunistic infections, such as pneumonia, as much as possible.

Since 1996, highly active antiretroviral therapy (HAART) has been generally available. Three to four drugs with different mechanisms are combined in this therapy. The aim is to inhibit the production of the virus, to block the integration in human cells, and subsequently allow the immune system, which is no longer affected, to recuperate. This therapy prolongs the survival of AIDS patients significantly.

Prevention measures in the European Union

Currently, there is no effective vaccine to prevent transmission of HIV. Several candidate vaccines are in development and tested in clinical trials, but so far results have been disappointing. Most European countries have reduced the rate of HIV transmission in medical settings (through blood screening and universal precautions) and from mother to child (through routine screening, use of preventive drugs, preventive measures during the delivery, and advising mothers who are infected not to breastfeed). Countries that have implemented comprehensive harm reduction programmes, (e.g. needle exchange programmes, methadone maintenance), such as the UK, Germany and the Netherlands, have also maintained a very low rate of infection among injecting drug users.

Recently the number of sexual transmitted infections and HIV infections in migrants and men having sex with men has increased. This, together with the increase in unsafe sexual behaviour this emphasises the importance of reinforced prevention programmes aimed at men who have sex with men, migrants from HIV endemic countries, young people, commercial sex workers, drug users and HIV infected people.

The European Commission still considers prevention of new infections as the central instrument in the fight against HIV and pleads in that framework for an evidence-based approach. In such an approach, prevention programmes are combined with a good and accessible information supply, counselling and recommendations, treatment, care and support.

Key priorities on European level includes: increasing voluntary HIV testing, scaling up HIV prevention, reducing risk behaviour in men having sex with men, and providing specific services for migrant communities (Amato-Gauci et al., June 2007), UNAIDS, 2004b, Hamers & Downs, 2004, Hamers et al., 2006).