[ Acquired Immunodeficiency Syndrome ]
What is HIV or AIDS?
HIV stands for the Human Immunodeficiency Virus, a virus which, in its advanced stages, leads to AIDS or Acquired Immunodeficiency Syndrome. A positive diagnosis of HIV does not indicate that a person has AIDS, but HIV can develop into AIDS. HIV destroys the body’s ability to fight off infection by destroying T-cells (CD4 lymphocytes). T-cells are a group of white blood cells which help defend against attacks by germs, bacteria, and viruses. As HIV destroys the T-cells, AIDS patients have such weaken immune systems, they become vulnerable to disease, and during the later stages may develop pneumonia or cancer, which can lead to death. The Center of Disease Control’s (CDC’s) definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease.
Transmission of HIV - AIDS
HIV is primarily spread through unprotected sexual activity: vaginally, anally, or orally. Transmission occurs through blood, including menstrual blood, vaginal secretions, and semen. Infants can contract HIV from their HIV positive mothers during pregnancy, birth, or through breast milk. It can also be spread through any direct blood contact such as shared needles by intravenous drug users, blood transfusions or blood products, or accidents in health care procedures. Before donated blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely minimal.
To prevent the transmission of HIV, avoid risky behavior that may result in contact with blood, body fluids with visible blood, semen, or vaginal secretions. Many people infected with HIV have no symptoms, so he most reliable way to avoid HIV is to abstain from sexual intercourse, or to be in a mutually monogamous relationship with an uninfected person. Both partners should get tested for STDs, including HIV, before initiating sexual intercourse, but if not tested, always use latex condoms for vaginal, anal, and oral sex for each sex act. Always use water-based lubricants. Do not share needles with an infected person. Do not share personal items such as toothbrushes, razors, and sex toys, which may have been contaminated with blood, semen, or vaginal fluids. Although some laboratory evidence shows that spermicides can kill HIV, researchers have not found that these products can prevent you from getting HIV infection.
Women can transmit HIV to their babies during pregnancy or birth. Approximately 1/4 to 1/3 of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus. Certain drugs taken by the mother during pregnancy, can significantly reduce the chances that her baby will get infected with HIV. If health care providers treat HIV-infected pregnant women and deliver their babies by cesarean section, the chances of the baby being infected can be reduced to a rate of 1 percent. With appropriate treatment, HIV infection of newborns has been almost eradicated in the United States.
Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect, and the amount of virus in saliva appears to be very low. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva by kissing. The lining of the mouth, however, can be infected by HIV, and instances of HIV transmission through oral intercourse have been reported.
Scientists have found no evidence that HIV is spread through sweat, tears, urine, or feces.
Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.
If you have a sexually transmitted infection (STI) such as syphilis, genital herpes, Chlamydia infection, gonorrhea, or bacterial vaginosis appears, you may be more susceptible to getting HIV infection during sex with infected partners.
AIDS is a reportable disease in every state. AIDS is the largest global epidemic since the Bubonic Plague. Every 10 seconds someone dies from AIDS. More than 900,000 cases of AIDS have been reported in the United States since 1981. HIV infection is reportable in many states; HIV reports are kept strictly confidential.
Symptoms of HIV - AIDS
Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms.
As the immune system worsens, a variety of complications start to take over. For many, the first signs of infection are large lymph nodes or swollen glands of the immune system easily felt in the neck and groin, that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS, are flu-like symptoms which might include fever, joint pain, sore throat, chills, rashes, night sweats, lack of energy, weight loss, persistent or frequent yeast infections (oral or vaginal), pelvic inflammatory disease in women that does not respond to treatment, and short-term memory loss. Some have symptoms so mild,they go unnoticed or dismissed as a cold or flu.
As HIV progresses, it damages the immune system’s ability to fight “opportunistic” infections. These infections, which are usually controlled by a healthy immune system, take the “opportunity” to thrive in a compromised immune system with AIDS. Most symptoms of AIDS such as severe diarrhea and weight loss, fever, headache, fatigue, night sweats, or shortness of breath, are caused by an opportunistic infection or another condition due to a weakened immune system.
These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.
More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years. Therefore, there is no way of knowing with certainty whether your sexual partner is infected unless he or she has repeatedly tested negative for the virus and has not engaged in any risky behavior.
As HIV progresses, it damages the immune system’s ability to fight “opportunistic” infection. These infections, which are usually controlled by a healthy immune system, take the “opportunity” to thrive in a compromised immune system with AIDS. Most symptoms of AIDS such as severe and persistent diarrhea, nausea, abdominal cramps, and vomiting, weight loss, fever, severe headaches, extreme fatigue, night sweats, coughing or shortness of breath, seizures and lack of coordination, difficult or painful swallowing, mental symptoms such as confusion and forgetfulness, vision loss, and coma are caused by an opportunistic infection or another condition due to a weakened immune system.
Children with AIDS may get the same opportunistic infections as do adults with the disease. In addition, they also have severe forms of the typically common childhood bacterial infections, such as conjunctivitis (pink eye), ear infections, and tonsillitis.
People with AIDS are also particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.
During the course of HIV infection, most people experience a gradual decline in the number of CD4+ T cells, although some may have abrupt and dramatic drops in their CD4+ T-cell counts. A person with CD4+ T cells above 200 may experience some of the early symptoms of HIV disease. Others may have no symptoms even though their CD4+ T cell count is below 200.
Treatment - Is there a cure for HIV or AIDS?
Without treatment, because of the inherent infections, HIV develops more rapidly into AIDS. After receiving a positive diagnose, a course of action should be discussed with your health care provider. The Center for Disease Control (CDC) recommends getting vaccines such as hepatitis vaccines, bacterial pneumonia vaccines, and an annual influenza vaccination, since these diseases could pose a serious threat for those with suppressed immune systems. Many doctors also advocate starting anti-viral treatment as the T-cell count falls below 500. Follow-up is important throughout the treatment so doctors can assess medical care regularly. Counseling and emotional support should also be used to help people deal with the diagnosis, provide a positive approach to maintaining optimum health, and advise them about risk reduction and high risk behaviors.
There is NO cure for AIDS, but by using antiviral treatments and protease inhibitors, including immune boosting therapy, and treating/preventing specific opportunistic infections, many have been allowed to live relatively normal lives with increased quality and longevity.
The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections. This class of drugs, called nucleoside analogs, include AZT (Azidothymidine), ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), 3TC (lamivudine), Abacavir (ziagen), and Tenofovir (viread).
Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as Delavridine (Rescriptor), Nevirapine (Viramune), and Efravirenz (Sustiva) (in combination with other antiretroviral drugs).
The FDA also has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle. These drugs include Ritonavir (Norvir), Saquinivir (Invirase), Indinavir (Crixivan), Amprenivir (Agenerase), Nelfinavir (Viracept), Lopinavir (Kaletra), Atazanavir (Reyataz), and Fosamprenavir (Lexiva).
The FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV's ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti- HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules.
Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS.
Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.
Despite the beneficial effects of HAART, there are side effects associated with the use of antiviral drugs that can be severe. Some of the nucleoside RT inhibitors may cause a decrease of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause inflammation of the pancreas and painful nerve damage. There have been reports of complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore, health care experts recommend that you be routinely seen and followed by your health care provider if you are on antiretroviral therapy.
The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs resulting in serious side effects. Fuzeon may also cause severe allergic reactions such as pneumonia, trouble breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure. Local skin reactions are also possible since it is given as an injection underneath the skin.
Testing for HIV - AIDS
The body produces antibodies as it fights viruses; tests for HIV detect the antibodies or disease-fighting proteins, not the virus itself. There are different types of testing for HIV antibodies. The ELISA, which in most cases uses a blood sample, although some types of ELISAs use urine or saliva, is almost always the first screening test. When an ELISA is positive, the test must be confirmed by supplemental testing. The Western Blot or an indirect immunofluorescence assay (IFA) test can be used to confirm the diagnosis. The CDC states the combined accuracy of the ELISA and a confirmatory Western Blot or IFA to be 99%.
Most health care providers can do HIV testing and will usually offer you counseling at the same time. Of course, you can be tested anonymously at many sites if you are concerned about confidentiality.
If you have been exposed to the virus, you should get an HIV test as soon as you are likely to develop antibodies to the virus, within 6 weeks to 12 months after possible exposure to the virus, the “ window period” or the time it takes for antibodies to appear most of the time. Multiple testing may be in order to assure a proper diagnosis.
By getting tested early, if you are infected, you can discuss with your health care provider when you should start treatment to help your immune system combat HIV and help prevent the appearance of certain opportunistic infections. With early testing, you will also know to avoid high-risk behaviors that could spread the virus to others.
National STD and AIDS Hotline:
1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)
Herpes Hotline: 1-888-411-4377