Acquired Immunodeficiency Syndrome (AIDS/HIV)

Reporting Obligations

Laboratory confirmed cases of HIV must be reported to the Thunder Bay District Health Unit by fax, phone or mail.

Fax: (807) 625-4866
Phone: (807) 625-5676 or toll-free at 1-888-294-6630, ext. 8318
Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7

Epidemiology

Community Outbreak - Thunder Bay - June 2019

A community outbreak of HIV was declared on June 25, 2019. Updates were sent to health care providers and are available below:

Aetiologic Agent:

The human immunodeficiency virus (HIV) is a retrovirus of which two types have been identified: type 1 (HIV-1) and type 2 (HIV-2). They are serologically and geographically distinct but have similar epidemiological characteristics. The pathogenicity of HIV-2 may be lower than that of HIV-1; they have genotypic and phenotypic differences. HIV-2 has lower disease progression and lower rates of mother-to-child transmission.

Clinical Presentation:

AIDS is a severe, life-threatening clinical condition and is an advanced HIV-related disease. This syndrome represents the late clinical stage of HIV infection resulting from progressive damage to the immune system, leading to one or more of many opportunistic infections and cancers of which bacterial pneumonia is one of the common presentations.

Symptoms of acute HIV infection may include fever, arthralgia or myalgia, rash, lymphadenopathy, sore throat, fatigue, headache, oral ulcers and or genital ulcers, weight loss, nausea, vomiting or diarrhea. Acute symptoms, if present, occur two to four weeks after the initial infection and last from one to two weeks or as long as several months.

AIDS is diagnosed when a person with HIV develops one or more “AIDS-defining” symptoms.

Modes of Transmission:

Contact with infected body fluids: sexual fluids, blood, and breast milk
The use of HIV infected-contaminated needles and syringes and some drug paraphernalia, including sharing by people who inject drugs
Transfusion of infected blood or its components, organ and tissue transplants (before 1985)
Contact of abraded skin or mucosa with body secretions such as blood, semen and CSF
The presence of another STI in either the source or the exposed person, particularly ulcerative lesions such as syphilis or genital herpes, increases the potential for sexual transmission of HIV.
Occupational exposure to HIV infection: percutaneous injury with a sharp object potentially contaminated with blood or other bodily fluid: mucous membrane exposure to blood or other bodily fluid
Vertical transmission to infant during pregnancy, delivery or breastfeeding
While virus has occasionally been found in saliva, tears, urine and bronchial secretions, transmission after contact with these secretions in the absence of blood has not been reported

Incubation Period:

Variable: time from initial infection to detectable antibodies (window period) is usually 1-3 months. The time from HIV infection to diagnosis of AIDS has an observed range of less than one year to 15 years or longer.

Period of Communicability:

Not known precisely; begins early after onset of HIV infection presumably extending throughout life. Infectivity during the first months is considered to be high; it increases with viral load, with worsening clinical status and with the presence of other STIs.

Risk Factors/Susceptibility

According to the Ontario Advisory Committee on HIV/AIDS, new HIV diagnoses in Ontario are concentrated in the following populations:

Gay, bisexual and other men who have sex with men, including trans men
•   African, Caribbean and Black populations
•   People who use drugs
•   Indigenous Peoples
•   Cis and trans women, including those from the communities above, who face systemic and social inequities, and are more likely to be exposed to HIV through a sexual or drug using partner.

Members of these populations also face stigma, discrimination and/or other barriers related to the social determinants of health that may make them more vulnerable to HIV infection and affect their ability to access services. It is important to note that while most people diagnosed with HIV in Ontario are members of these populations, not everyone in these populations is at risk of HIV.

See Modes of Transmission above for specific risk factors.

Diagnosis & Laboratory Testing

The diagnosis of HIV infection is based primarily on a positive serologic test. Persons with HIV infection may be totally asymptomatic. Therefore, serologic testing is recommended when there is a high index of suspicion (e.g., high-risk behaviour and/or suspicious clinical symptoms and signs). Persons may also present with specific opportunistic infections or other conditions indicative of underlying immunosuppression.

Testing Information & Requisition

Treatment & Case Management

The Canadian Guidelines on Sexually Transmitted Infections provides information related to: counseling, transmission, diagnosis, management, treatment, and follow-up of patients.

Patient Information

Elevate N.W.O. is the AIDS service organization (ASO) serving Northwestern Ontario.

CATIE: Canadian HIV guidelines.

References

Ministry of Health and Long Term Care, Infectious Diseases Protocol - Appendix 1 (2022) Acquired Immunodeficiency Syndrome (AIDS).
Public Health Agency of Canada, Canadian Guidelines on Sexually Transmitted Infections, evergreen edition.
Heymann, D.L., Control of Communicable Disease Manual (20th Ed.), Washington, American Public Health Association, 2015.