CONDITIONS

What Is AIDS/HIV

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HIV (Human Immunodeficiency Virus) is the virus responsible for AIDS (acquired immune deficiency syndrome). Once infected by HIV, the body can never rid itself completely of the virus. Though HIV is a precursor to AIDS, HIV infection does not guarantee the development of AIDS. The HIV virus can lay dormant in the body for years before becoming active, or it may never become active at all. New technologies and treatments have allowed scientists to better control the activity of HIV, making it possible to delay or prevent the development of AIDS.

There are three stages of HIV infection:

STAGE 1: Acute infection. This stage occurs 2-4 weeks after the initial exposure to the virus and is characterized by severe flu-like symptoms. During this time, the virus rapidly reproduces itself within CD4 cells, which are a subtype of white blood cells, and then destroys them, causing blood levels of HIV viruses to rapidly rise and CD4 cells to rapidly fall. High blood levels of the HIV virus make the infected individual highly contagious (though the disease can still only be contracted through contact with infected fluids.) The flu-like symptoms experienced during this stage are referred to as “acute retroviral syndrome” and may include:

  • Fever
  • Swollen glands
  • Muscle aches
  • Headache
  • Fatigue
  • Sore throat

STAGE 2: Clinical Latency. During this stage, HIV reproduction slows dramatically. Individuals are still infectious, though their symptoms may decrease or go away entirely. The duration of the clinical latency period varies from patient to patient. Antiretroviral therapy is a form of treatment developed in the late 1980s that has since been found to be extremely effective at lengthening the clinical latency period and delaying the onset AIDS, the third and final stage of an HIV infection. Before antiretroviral therapy, HIV infections typically progressed to AIDS within a few years. With antiretroviral treatment, the progression can take decades or may not occur at all.

STAGE 3: AIDS. (Acquired Immune Deficiency Syndrome) is a syndrome, meaning a collection of symptoms, which occurs in the final stage of HIV infection. HIV infection becomes AIDS once the virus has weakened the immune system enough to allow for a serious ‘opportunistic infections’. The list of possible symptoms produced by AIDS related infections is almost infinite, given the wide range of possible infection types.

The following conditions are the most common of these ‘opportunistic infections’:

  • Pneumocystis pneumonia (an infection of the lung)
  • Kaposi’s sarcoma (a type of skin cancer)
  • Cytomegalovirus infection (viral infection typically affecting the eyes)
  • Candida (candida albicans infection)

The transition from HIV to AIDS can also be determined by CD4 counts in the blood. A healthy adult CD4 count ranges from 500 cells/mm3 to 1,200 cells/mm3. An HIV patient is said to have AIDS once their CD4 count is below 200.

The CDC estimates that more than 1.1 million people in the Unites States are living with HIV infection, though 1 in 6 do not know it. In 2011, an estimated 49,273 new cases of HIV were diagnosed. In the same year, 32,052 new AIDS diagnoses were made. It is estimated that approximately 35 million people are living with HIV infection around the globe. HIV is spread through contact with infected fluids. This transmission most often occurs sexually, though it may also occur through the use of shared needles, consumption of infected breast milk, in utero from mother to fetus, or any other instance of contact with infected body fluids.

What Causes AIDS/HIV

AIDS is the last stage of an HIV infection and develops after the HIV virus has caused extensive damage to the immune system.

Once the HIV virus enters the body, the body is unable to get rid of it. The virus can lay dormant for long periods of time before becoming active and attacking the body’s T-cells and CD4 cells. T-cells and CD4 cells are both critical components of the body’s immune response. The transition from HIV to AIDS occurs when the damage to the T-cells and CD4 cells is so extensive that the body develops either one of several opportunistic infections,  cancers, or other potentially fatal diseases.

HIV is spread through contact with infected bodily fluids. HIV transmission may occur through:

  • Sexual contact with an infected person
  • Sharing infected needles and syringes
  • Blood transfusions with infected blood (very low risk, as all blood donors are now screened for HIV)
  • Transmission from mother to child via pregnancy and/or breastfeeding

Risk Factors For AIDS/HIV

There are many factors that can influence your risk of contracting HIV. These include:

  • Sex. The majority of new cases of HIV are diagnosed in men.
  • Geography. According to the Foundation for AIDS Research, approximately 70% of people with HIV worldwide live in sub-Saharan Africa.
  • Sexual activity. According to the CDC, the majority of new cases of HIV are transmitted by unprotected male to male sexual contact. The risk of contracting HIV from male to male sexual contact is higher if both or one partner has multiple partners. Sex workers are also at a higher risk of contracting HIV.
  • Drug use. People who frequently use shared, unsterilized needles for drug and/or steroid injections are more likely to contract HIV
  • Infected mother. Children may contract HIV from their infected mother in utero or through breast feeding.

Several factors may also influence the progression of HIV to aids. These include:

  • Age. Studies have shown that HIV infections progress quicker as age increases.
  • Access to treatment. Without access to effective treatment, the rate of HIV progression is much faster. In countries or populations where health care is not accessible, patients are much more likely to quickly progress to aids. This is supported by studies showing progression rate disparities between the United States/Europe and parts of Africa and Asia. Europe and the United States showed much slower rates of progression. Those of lower socioeconomic status within all countries are also at a higher risk of HIV progression due to lack of health care accessibility.

Diagnosing AIDS/HIV

HIV can be diagnosed by a blood test that checks for the presence of HIV-antibodies, proteins that your body produces as a result of HIV infection. For information on where to get tested for HIV, visit National HIV and STD Testing Resources.

AIDS is diagnosed when HIV infection has caused sufficient damage to the T-cells and CD4 cells of the immune system to allow for an opportunistic infection or disease. For a complete list of opportunistic infections and diseases associated with AIDS, visit AIDS.gov. Alternatively, AIDS can be diagnosed by a blood test measuring CD4 cell levels.  A healthy adult CD4 count ranges from 500 cells/mm3 to 1,200 cells/mm3. An HIV patient is said to have AIDS once their CD4 count is below 200.

Symptoms of AIDS/HIV

Symptoms of HIV infection vary from stage to stage.

Acute infection symptoms occur 2-4 weeks after exposure to the HIV virus and may not appear for all patients. These include:

  • Fever
  • Swollen glands
  • Sore throat
  • Muscle aches
  • Fatigue
  • Rash
  • Headache

Clinical latency. After the acute stage of HIV infection, the disease moves into what is called the “clinical latency” stage. “Latency” means a period where the HIV virus is living or developing in a person, but is not producing symptoms, or only very mild ones. People in this “symptom-free” stage are still able to transmit HIV to others, even if on anti-retroviral medication (though this greatly reduces the risk of transmission).

AIDS. Symptoms of AIDS vary from case to case. According to AIDS.gov, these may include:

  • Rapid weight loss
  • Recurring fever
  • Profuse night sweats
  • Extreme fatigue
  • Prolonged swelling of the lymph glands in the armpits, groin, or neck
  • Prolonged diarrhea (lasting more than a week)
  • Sores of the mouth, anus, or genitals
  • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eye lids
  • Memory loss
  • Depression or other neurologic disorders

The reason that AIDS is so dangerous is that it decimates the immune system to the point that a person is susceptible to certain viruses, bacteria, or parasites that they would, if not infected with the HIV virus, have no reaction to. Those living with HIV/AIDS, however, may face serious health threats from what is referred to as “opportunistic” infections. These infections are called “opportunistic” because they take advantage of the HIV weakened immune system, and can cause devastating illnesses.

Opportunistic infections are the most common cause of death for people with HIV/AIDS.Most life-threatening opportunistic infections occur when your CD4 count is below 200 cells/mm3.

The CDC has developed a list of more than 20 opportunistic infections that are considered “AIDS-defining conditions”—if you have HIV and one or more of these infections, you will be diagnosed with AIDS, no matter what your CD4 count is:

  • Candidiasis of bronchi, trachea, esophagus, or lungs
  • Invasive cervical cancer
  • Coccidioidomycosis
  • Cryptococcosis
  • Cryptosporidiosis, chronic intestinal (greater than 1 month’s duration)
  • Cytomegalovirus disease (particularly CMV retinitis)
  • Encephalopathy, HIV-related
  • Herpes simplex: chronic ulcer/s that last more than 1 month’s duration)
  • Histoplasmosis
  • Isosporiasis, chronic intestinal (for more than 1 month’s duration)
  • Kaposi’s sarcoma
  • Lymphoma, multiple forms
  • Mycobacterium avium complex
  • Tuberculosis
  • Pneumocystis carinii pneumonia
  • Pneumonia, recurrent
  • Progressive multifocal leukoencephalopathy
  • Salmonella septicemia, recurrent
  • Toxoplasmosis of brain
  • Wasting syndrome due to HIV

It is essential to understand the signs, symptoms, prevention, and management of opportunistic infections, as they can be so dangerous for a person with HIV/AIDS.

Prognosis

HIV progression rates vary from person to person, but effective treatment (antiretroviral therapy and other modern drugs) slows the progression of HIV in most patients. Due to advancements in diagnostic tests, treatment methods, and medical technologies, most people who are diagnosed with HIV do not progress to AIDS.

Living With AIDS/HIV

Receiving an HIV diagnosis can be difficult, but it is important to remember that an HIV or AIDS diagnosis is not a fatal diagnosis. The following tips can help you live a healthy and happy life with HIV/AIDS:

  • Educate yourself about your disease, especially treatment options. Knowing about your disease can help you better understand and process your experiences. Being familiar with treatment options can help you make informed decisions about your care.
  • Share your diagnosis only when you are ready, with the exception of sexual partners and people with whom you may have shared bodily fluids with. HIV is infectious and those people should know about their possibility of being infected as soon as possible. When it comes to friends and family, share your diagnosis only when and with whom you feel comfortable.
  • Maintain a healthy diet. HIV can interfere with the body’s ability to digest food and absorb nutrients, so maintaining a healthy, balanced diet with supplements when necessary is key to living a long life with HIV. Talk to a doctor or registered dietitian about developing a diet plan that best works for you.
  • Stay positive. HIV isn’t the death sentence that it used to be. Thousands of Americans live healthy, full lives with HIV infections. Try to keep a positive mentality about your disease and prognosis.
  • Make changes to your sex life to protect uninfected partners. Be sure to inform any new partners about your disease and always use condoms. Oral sex is least likely to cause HIV transmission, followed by vaginal sex. Anal sex is the most likely to cause transmission. If both partners are infected, the same concern of transmission does not exist.

Screening

Since HIV is contagious and benefits from early treatment, regular screening tests for the disease are extremely important. Sexually active individuals between the ages of 13 and 64 should be tested for HIV (and other STDs) once yearly as part of a reproductive health routine. Individuals with multiple sex partners or those that frequently engage in unprotected sex  should get tested more frequently (3 to 6 months).

Prevention

HIV infection can be prevented by proper and regular use of condoms with all sexual partners. Reducing your number of sexual partners can also decrease your risk of contracting HIV. HIV is also commonly spread through the use of contaminated needles. Do not use needles for injections unless both your environment and the needles are sterile. Regular testing for HIV can help you receive prompt treatment in the event that you do contract the virus. Proper treatment for HIV greatly reduces the risk of progression to AIDS.

Medication And Treatment

There are currently over 30 approved drugs to treat HIV infection, with many more being developed in research. Treatment for HIV is generally referred to as antiretroviral therapy or highly active antiretroviral therapy, because it involves a combination of drugs that target the HIV virus at various stages of its life cycle. Antiretroviral therapy involves a combination of several different classes of drugs, including:

  • Nucleoside/nucleotide Reverse Transcriptase Inhibitors (NRTIs),which block the reproduction of viral DNA by interfering with the HIV’s ability use of reverse transcriptase, a crucial DNA replication enzyme.
  • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs), which block the reproduction of viral DNA by preventing the reproductive enzyme reverse transcriptase from functioning closely. This class of medication is closely related to the NRTIs, but is different in that it works directly on the enzyme rather than on the virus.
  • Protease Inhibitors (PIs), which interferes with the functioning of protease, another key enzyme in DNA replication.
  • Entry/Fusion Inhibitors, which work by preventing the virus from attaching and entering the body’s cells.
  • Integrase Inhibitors, which interfere with viral DNA reproduction by blocking the functioning of integrase, an enzyme involved in DNA reproduction.

Most often treatment plans consist of a mixture of the above medication classes. Speak with your doctor about what classes of medication are right for you and your HIV.

If your HIV infection has progressed to the AIDS stage, your doctor may prescribe you other medications to help prevent infection and control symptoms. These vary widely, as the number of possible infections and symptoms is very large.

Complementary and Alternative Treatment

There are a number of treatment methods that can serve as an alternative or complement to traditional treatment therapies. Though there is anecdotal evidence to support these methods, there is little scientific data to support the claims. Talk to your doctor before trying any alternative or complementary treatments, as certain supplements and alternative treatments can interfere with prescribed HIV medicines and cause potentially serious side effects.

  • Acupuncture. Acupuncture is a form of traditional Chinese medicine that involves the insertion of needles at specific points along the body to restore bodily energy and function. Acupuncture can help reduce a number of different symptoms as well as increase overall energy levels.
  • Supplements. Many believe that certain supplements have the ability to fight the HIV virus. These include:
    • Beta glucans, which boost immune function
    • Coenzyme Q-10 (CoQ10), which is thought to increase energy, heart function, as well as regulate diseases such as diabetes, gum disease, Parkinson’s, and chronic fatigue syndrome.
    • Fish oil, which is rich in beneficial omega-3 fatty acids
    • Glutamine, which has been shown to be effective in counteracting the treatment side effects of a variety of diseases.
    • Lentinan, which is thought to enhance the effect of traditional HIV treatments
  • Massage.  Massage therapy works to repair and restore tired and damaged muscles as well as restore the flow of bodily energy. Regular massage has also been shown to decrease overall stress levels and increase feelings of well-being.
  • Mind/body techniques such as yoga, tai-chi, and meditation can help to manage stress and balance the body. These practices can help increase energy levels and overall well-being.

Care Guide

Caring for a loved one with HIV/AIDS can be challenging. The following tips can help make the experience easier:

  • Educate yourself about HIV and AIDS so that you feel prepared during treatment and when and if the disease progresses.
  • Be a source of positivity. Looking towards the future as an HIV patient can be scary. Do your best to be a source of positivity for your loved one when talking about his/her disease. Balance positivity with realistic perspectives, and make it clear to your loved one that you are there to listen to what they want to say, even if all of it isn’t positive.
  • Encourage a healthy lifestyle. Regular exercise and a healthy diet can greatly improve an HIV patient’s quality of life.
  • Communicate regularly with your loved one to avoid any build-up of emotion or information.

When To Contact A Doctor

If you have had sex (protected or unprotected) with someone you know is infected with HIV, visit a doctor or health clinic to get tested for HIV. To find a testing clinic, visit AIDS.gov.

If you have not yet tested positive for HIV and experience any of the following symptoms, you should visit a doctor or health clinic for testing:

  • Fever
  • Swollen glands
  • Sore throat
  • Muscle aches
  • Fatigue
  • Rash
  • Headache

 **These symptoms may also be a sign of the common cold or flu among other diseases. Your doctor will be able to best determine the cause of your symptoms.

If you have been diagnosed with HIV and experience the following symptoms, you should contact your doctor. They may be a sign of progression to AIDS:

  • Rapid weight loss
  • Recurring fever
  • Profuse night sweats
  • Extreme fatigue
  • Prolonged swelling of the lymph glands in the armpits, groin, or neck
  • Prolonged diarrhea (lasting more than a week)
  •  Sores of the mouth, anus, or genitals
  • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
  • Memory loss
  • Depression or other neurologic disorders
  • Symptoms of any of the many opportunistic infections associated with AIDS

Questions For Your Doctor

To find a doctor or health clinic to be tested for HIV, visit AIDS.gov.

To find a doctor who specializes in AIDS treatment, visit The U.S. Department of Health and Human Services Health Resources.

Questions For A Doctor

You may want to ask your doctor the following questions about your HIV diagnosis:

  • What stage is my HIV at?
  • How is it likely that I contracted HIV?
  • Will my HIV progress to AIDS?
  • What treatment options are available to me?
  • What are the side effects of treatment?
  • How concerned about infecting others should I be?
  • Who do I need to tell about my diagnosis?
  • How will this affect my sex life?
  • Can I still have sex with my partner(s)?

Resources

For more information about all things HIV/AIDS, visit www.aids.gov and www.aidsinfonet.org

For more information about all things HIV/AIDS, visit www.aids.gov and www.aidsinfonet.org

For the latest HIV research and information, visit www.avert.org

For statistics about HIV and AIDS infection in the U.S., visit The Center for Disease Control.

For more information on HIV transmission and risk factors, visit National Institute of Allergy and Infectious Disease.

For a guide to online information about HIV/AIDS, visit www.aidsmap.com

For information on HIV testing centers, visit National HIV and STD Testing Resources

For global statistics on HIV/AIDS, visit The World Health Organization

For information on AIDS treatment and prevention, visit AIDS Info