HIV / AIDS
First reported in the United States in 1981, the AIDS epidemic has now infected more than 30 million people worldwide. One million are infected in the USA. In some African countries over 20% of the population is infected. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males. Infection rates are six times higher in African-Americans and three times higher in Hispanics than in Caucasians.
HIV / AIDS is now one of the leading causes of death in male adults between 25 and 44 years of age. More than 50% of the reported AIDS cases in 1992 were among men with homosexual and bisexual contacts, but this percentage has been declining over the past few years.
Infection in the female population has also risen. AIDS is now recognized as the fourth leading cause of death in women. Anyone can be infected and it is no longer affecting just one portion of the population.
The impact of AIDS on mortality is most noticeable in larger metropolitan areas, but is also increasing in smaller areas across America and worldwide.
At this time there is no cure for HIV/AIDS.
- Unlike most immune deficient conditions you are not born with this disease.
*You can only be born with AIDS if your mother had AIDS when pregnant.
- The disease is characterized by a weakened or ineffective immune system with no resistance to infections.
AIDS is a combination of signs and symptoms which occur together due to the HIV infection as well as other infections that occur as a result of the immunodeficiency.
The definition of AIDS relates to:
CD4+ T-cells Count:
- Healthy adults usually have CD4+ T-cell counts of 1,000 or more
- Aids and some HIV sufferers have less than 200 CD4+ T-cells
AIDS Clinical Conditions
There are over 26 clinical conditions affecting people with advanced HIV disease. These conditions are usually opportunistic infections, which can sometimes be fatal. This is because the immune system is so damaged by HIV that it is unable to fight off other microbes.
HIV stands for Human Immunodeficiency Virus, the virus that causes AIDS. It is an infection of the immune system which destroys the body’s ability to fight infections. HIV may also enter a cell and then remain quiet for a long time. Drug therapy only destroys the active virus. HIV infects the immune system cells known as T Lymphocytes, thereby weakening the entire system.
HIV has been located in fluids such as:
- breast milk
- vaginal fluids
It appears that the disease can only be transmitted through:
- blood products
- sexual fluids
People can be infected and NOT look sick or even have AIDS but can still transmit HIV. This is a problem for drug therapy because drugs destroy the virus while it is active.
How HIV becomes AIDS
This video helps to explain the process:
Opportunistic infections common in people with AIDS cause such symptoms as:
- abdominal cramps
- difficult or painful swallowing
- extreme fatigue
- lack of coordination
- mental symptoms such as confusion and forgetfulness
- ulcers in the genital region
- pelvic inflammatory disease
- persistent or frequent yeast infections (oral or vaginal)
- persistent skin rashes or flaky skin
- severe and persistent diarrhea
- severe headaches
- shortness of breath
- sore throat
- swollen lymph glands
- weight loss
- vision loss
as well as severe Herpes infections causing:
- anal sores
- genital sores
- mouth sores
- shingles, a painful nerve disease
Children with AIDS are prone to the same opportunistic infections as adults. As well they may experience severe forms of bacterial infections such as:
- conjunctivitis (pink eye)
- ear infections
as well as
- delayed development
- failure to thrive
AIDS sufferers commonly develop various cancers caused by viruses, such as:
- Cervical Cancer
- Kaposi’s Sarcoma
as well as
Cancers of the immune system (lymphomas) which are more aggressive and difficult to treat in AIDS sufferers. They appear in light-skinned people as:
- round brown, reddish or purple spots which develop in the skin or in the mouth.
In dark-skinned people:
- the spots are more pigmented.
People with AIDS may experience phases of intense life-threatening illness followed by phases of normal functioning. However, many people are too debilitated by the symptoms of AIDS to hold steady employment or do household chores.
Less than 50 people are known who were first infected with HIV over 10 years ago and who have not developed symptoms of AIDS.
Studies are being undertaken to determine the causes for this, such as:
- Genetic make-up which may protect them from the effects of HIV.
- Particular immune system characteristics,
- Whether the infection was a less aggressive strain of the virus.
HIV can lay dormant for years after infection. In untreated cases, the average time for the disease to develop is 10 years or more, or within 2 years in children born with HIV.
However, HIV infection is also associated with an acute illness in many infected persons. This illness, called acute HIV infection, begins within 1-3 weeks of exposure and usually involves a combination of symptoms.
- HIV is present in large quantities in genital secretions.
- Symptoms are often mistaken for those of other viral infections and are very infectious during this period.
Periods of asymptomatic infection is highly variable with some people:
- beginning symptoms within a few months
- having no symptoms for 10 years or more
- having symptoms resolve themselves within 1-3 weeks.
During the asymptomatic period HIV actively multiplies, infecting and killing immune system cells causing:
- A decline in blood levels of CD4+ T cells (T4 cells), the immune system’s main infection fighters.
- Cells to be disabled or destroyed by the virus without causing symptoms.
Stages of the HIV Infection
Acute HIV Syndrome
First stage seroconversion
- The virus rapidly spreads to organs, especially the lymphoid tissues.
- The HIV virus is not very aggressive in causing diseases or severe symptoms.
- The infection is latent.
- The virus starts to grow and multiply in the lymph nodes.
- Viremia – the spread of the virus in the blood.
- Deterioration of the immune system, mainly due to infection of CD4+ T-Lymphocytes.
- The immune system collapses.
- The virus continues to slowly destroy the immune system for up to 10 years.
- Usually, an opportunistic infection is the immediate cause of death.
Conditions relating to HIV
- Dermatophyte infections
- Pityrosporum folliculitis
- Seborrhoeic Dermatitis
- Kaposi’s sarcoma
- Bacillary angiomatosis
- Drug eruptions
- Non-specific e.g. hair, nail changes
- Nonspecific folliculitis
The AIDS virus is transmitted from one person to another through several methods:
- blood or blood products
- mother to infant
- sexual contact
- sharing of needles or syringes
- accidents in health care (i.e. from an infected needle stick or from other contaminated medical instruments)
- ear and other body piercings
- needle sharing with an infected person for any reason (IV drug needles [only minute amounts of blood are needed]
- receiving a blood transfusion with infected blood (blood donations in the U.S. have been screened for HIV since 1985)
Prior to 1985, HIV was frequently transmitted by blood transfusions because there was no effective way to test blood for the AIDS virus.
In 1985, heat-treating techniques to destroy HIV in blood products was introduced. Because of this, the risk of acquiring HIV from transfusions is now extremely small.
The virus can be spread in:
- artificial insemination with semen from an infected person
- body fluids including sperm
- oral sex
The infection can be spread through unprotected sex (sex without condoms) with an infected partner, including:
- anal intercourse
- oral intercourse
- vaginal intercourse
and is spread from:
- men to men
- men to women
- women to men
- women to women
The virus can enter the body during sex through the:
- lining of the vagina
You are also at risk if you have another sexually transmitted disease such as:
These diseases make you are more susceptible to acquiring HIV infection during sex with an infected partner.
HIV has been detected in the saliva of infected individuals. However, no evidence exists that the virus is spread by contact with saliva. Tests show saliva has natural compounds that inhibit the infectiousness of HIV. However, the risk of infection from so-called “deep” kissing, involving the exchange of large amounts of saliva, is unknown.
HIV has not been found to spread through:
Studies of families of HIV-infected people have shown clearly that HIV is not spread through:
Casual Contact such as:
- biting insects such as mosquitoes or bedbugs
- sharing of bedding
- sharing of food utensils
- sharing of towels
- swimming pools
There is no risk of transmission through:
- donating blood when sterile needles are used
- embracing or cuddling
- kissing without exchange of saliva
- sharing utensils
- touching an HIV-infected person
or through touching objects such as:
- door knobs
- toilet seats
HIV can be spread from Mother to infant during:
- birth (Peripartum)
- pregnancy (Intrauterine)
Treating Pregnant Mothers
During pregnancy or birth, women can transmit HIV to their fetuses. Approximately 1/4 to 1/3 of all untreated pregnant women infected with HIV will pass the infection to their babies. It can also be spread to babies through the breast milk of infected mothers.
- Anti-HIV drugs are very effective in limiting transmission to infants but some transmission still occurs.
- The risk of transmission further diminishes with a Cesarean section.
- The drug AZT taken during pregnancy reduces significantly the chance of transmitting HIV to the baby.
- Treatment of mothers combined with Cesarean sectioning to deliver infants reduces infection rates to 1%.
Babies born to mothers infected with HIV:
- may or may not be infected with the virus
- share their mothers’ antibodies to HIV for several months.
If these babies lack symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be made until after 15 months of age. By this age, babies are unlikely to still carry their mothers’ antibodies and will have produced their own if they are infected.
New technologies are being used to detect HIV infection in infants (3-15 months). A number of blood tests are being used to detect the virus in babies younger than 3 months.
The AIDS test is a test that measures the immune response to HIV, consisting of antibodies that are generated in response to the infection.
Standard AIDS Test
The Standard AIDS Test measures antibodies. These take time to develop, so in the very early stages of infection, there may be a negative antibody test even though the person can be infected.
Under these circumstances HIV infection can be checked by measuring the virus in the blood using either:
- a p24 antigen test (available through health care professionals)
- a viral load assay
Tests should be carried out on:
- anyone who had a blood transfusion before 1985
- anyone who has had unprotected sex with an infected person
- infants of infected mothers
The standard blood test for HIV is negative in persons with acute HIV infection, so a special blood test has to be used if this diagnosis is suspected.
There are two tests to diagnose acute HIV infection:
- HIV viral load
- HIV p24 antigen test (both available through health care professionals)
Tests should be carried out:
On persons who have had a known exposure to the infection through:
- sharing needles
- unprotected sex
and on persons
- who have symptoms of acute HIV infection.
Standard blood test becomes positive about 4-6 weeks after infection. HIV is mainly detected by testing a blood sample for the:
- presence of antibodies (disease-fighting proteins) to HIV
HIV antibodies generally do not reach detectable levels until 1-3 months following infection. Sometimes they take up to 6 months to be generated in large enough quantities to show up in standard blood tests.
HIV testing is also carried out on samples of:
Early testing for HIV infection should be carried out as soon as antibodies to the virus develop to enable:
- Appropriate treatment to be received when they are most able to combat HIV.
- The emergence of certain opportunistic infections to be prevented.
- HIV-infected people to be alerted.
- High-risk behaviors that could spread HIV to others to be avoided.
HIV testing and counselling are available in most doctors’ offices or health clinics. Individuals can be tested anonymously at many sites if they have concerns about confidentiality. In addition, blood samples for anonymous HIV testing may now be collected at home. Home-based test kits are available by telephone order or over the counter at pharmacies.
Two different types of antibody tests are used to diagnose HIV infection:
- Western Blot
If a person is highly likely to be infected with HIV and yet both tests are negative, a doctor may test for the presence of HIV itself in the blood. Then a repeat antibody testing is carried out at a later date, when antibodies to HIV are more likely to have developed.
When AIDS first surfaced in the United States, no drugs were available to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. However, during the past 10 years, therapies have been developed to fight both HIV infection and its associated infections and cancers.
The Food and Drug Administration (FDA) has approved a number of drugs for the treatment of HIV infection including:
- Abacavir Succinate
- Nucleoside Analog Reverse Transcriptase inhibitors (NRTIs)
- Didanosine (ddI)
- Lamivudine (3TC)
- Stavudine (D4T)
- Zalcitabine (ddC)
- Zidovudine (also known as AZT)
These drugs slow the spread of HIV and delay the onset of opportunistic infections. The drugs do not prevent transmission of HIV to other individuals
Also available for use in combination with other antiretroviral drugs during stages of HIV infection are Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as:
Virus replication is interrupted at a later step by anti-HIV drugs, called protease inhibitors such as:
HIV can become resistant to each class of drugs, so a combination treatment is necessary to lower the amount of virus in the blood. However this cocktail does not result in complete eradication of the virus. Persons who have stopped the drug cocktail even after two years of treatment have generally had a rapid return of the virus.
Antiretroviral drugs do not cure HIV infection or AIDS and can have severe side effects:
AZT may cause:
- red or white blood cell depletion, especially when taken in the later stages of the disease.
If the loss of blood cells is severe:
- treatment with AZT must be discontinued.
DdI can cause:
- gastrointestinal disorders associated with protease inhibitors
- painful nerve damage
- pancreas inflammation
Protease inhibitors can interact with other drugs resulting in serious side effects such as:
- abnormal redistribution of body fat among some individuals receiving protease inhibitors
Drugs available to treat opportunistic infections include:
used to treat cytomegalovirus eye infections
used to treat yeast and other fungal infections
used to treat Pneumocystis carinii pneumonia (PCP)
Adults with HIV whose CD4+ T-cell counts drop below 200 are given treatment to prevent the occurrence of PCP. Children are given PCP preventive therapy when their CD4+ T-cell counts drop to levels considered below normal for their age group.
Overall, a thorough health regime that supports the body and prevents destruction and imbalance within the system is one of the most effective methods of maintaining control of the AIDS/HIV condition.
Because many people infected with HIV have no symptoms, it cannot be known with certainty whether a sexual partner is infected, unless he/she has been tested repeatedly for the virus or has not engaged in any risky behavior.
- abstinence from sex
- use of male latex condoms whenever having oral, anal or vaginal sex is recommended for protection
- use of water-based lubricants should be used with latex condoms
- some spermicides can kill the virus.
Research into AIDS
It is still unproven whether antiviral drugs given after exposure to HIV can prevent infection. There are trials going on in most large cities to treat people who have been exposed to HIV and this is referred to as “post-exposure prophylaxis.”
In carefully controlled experiments, doctors are trying to determine if the immune system, the body’s natural defense mechanism, can keep the virus under control after drug therapy is stopped.
Results show that persons who are treated with potent antiviral drugs (often referred to as HAART – highly active anti-retroviral therapy) develop strong responses to the virus as soon as they become infected, possibly strong enough to successfully control the virus.
About 1 in 100 HIV infected persons is a so-called long-term non-progressor, meaning that they have been infected for up to 20 years and still have a normal CD4 count and low viral load, showing the virus has caused little damage so far.
A number of different methods are being tried to make an effective AIDS vaccine. Since antiviral drugs are extremely expensive, the only hope for worldwide control of HIV is the development of an effective vaccine. Clinical trials of AIDS treatments involve comparing the effects of one treatment to another.