HIV and AIDS
What is it?
HIV stands for human immunodeficiency virus. It
is an infection that steadily attacks and destroys
the body’s infection fighting cells, called
lymphocytes, and causes the disease called AIDS
(acquired immunodeficiency syndrome). HIV was
identified in the United States in 1981. So many
cases have been reported that HIV/AIDS is
considered an epidemic.
Who gets it?
HIV and AIDS have been reported throughout the
United States and the world, affecting all age
groups, including infants born to mothers who are
HIV infected. Certain groups of people are at a
higher risk for getting HIV and eventually
developing AIDS. These include homosexual and
bisexual men, people who use intravenous (IV)
drugs, people who share needles (for drug use,
tattooing, or body piercing), heterosexuals who
have more than one sexual partner, and anyone who
has sex with anyone in these groups or has a
sexual partner who has tested positive for HIV.
Also at risk are people who receive transfusions
of blood or blood products that haven’t been
tested for HIV. While all donated blood is now
carefully screened for HIV, that was not the case
before HIV was identified. For this reason, men
who have a blood condition called hemophilia were
more likely to develop HIV through transfusions of
blood and blood products. Healthcare professionals
who are accidentally pricked by a contaminated
needle also risk developing the infection. Many
cases of AIDS have been reported in Haiti and east
central Africa, so immigrants to the United States
from these areas are also at higher risk.
What causes it?
HIV is caused by a retrovirus, which is a type
of virus that releases its genetic code, called
RNA, into a healthy cell. The virus also contains
an enzyme called reverse transcriptase that
converts the virus’ RNA to DNA and allows it to
reproduce. This is how the virus attacks the
immune system. The body’s immune system fights
infection by producing white blood cells, called
T-cell lymphocytes, and proteins called
antibodies. HIV reproduces inside the T-cells.
Eventually, this destroys the cells and releases
particles of the virus, which then attack other
T-cells and the damage continues. As more and more
T-cells are destroyed, the immune system is
weakened to the point that the body becomes unable
to fight infections. The patient develops other
diseases and cancers, called opportunistic
infections because they take advantage of the
patient’s weakened immune system. When this
occurs, the patient is diagnosed with full-blown
AIDS. You cannot get HIV through casual contact,
such as hugging or shaking hands, by eating food
prepared by someone with the virus, or through the
air. HIV is spread by direct contact with infected
bodily fluids, which includes blood, semen, or
vaginal secretions. Direct contact refers to sex,
HIV-infected blood transfusions or organ
transplants, and needle sharing. Small amounts of
HIV have also been found in saliva, tears, breast
milk, cerebrospinal fluid (CSF), urine, and feces.
What are the symptoms?
Within weeks to months after being infected
with HIV, a person may feel flu-like symptoms,
such as a fever, swollen lymph nodes, headache,
gastrointestinal disorders, skin rashes, loss of
appetite, and general fatigue. These symptoms are
referred to as acute retroviral syndrome and may
come and go as the virus goes to work, reproducing
and destroying lymphocytes. This is referred to as
the latency period, and may last for as long as 10
years. While the patient may have no significant
symptoms during this time, the lymph nodes in the
jaw, neck, armpits, and groin usually remain
enlarged. Symptoms of full-blown AIDS may not
appear for months to even years. However, during
this time the virus that causes HIV is circulating
in the bloodstream and can be passed on to others
through bodily fluids. Symptoms of AIDS include
swollen lymph nodes, a fever that comes and goes
and lasts anywhere from a few days to a month,
chills, sweats, significant weight loss, fatigue,
diarrhea, joint and muscle pain, sore throat, a
fungal infection of the mouth called thrush,
chronic vaginal yeast infections, and viral skin
infections, such as herpes sores around the mouth.
Opportunistic infections also indicate AIDS, and
can include cancers such as Kaposi's sarcoma (a
tumor that appears as red to purple raised patches
on the skin), non-Hodgkin’s lymphoma, and cervical
cancer; pneumonia caused by the fungus
Pneumocystis carinii (PCP); tuberculosis;
meningitis; and kidney disease. AIDS patients are
very susceptible to viral infections, such as
cytomegalovirus (CMV), herpes simplex virus (HSV),
varicella zoster virus (VZV), and Epstein-Barr
virus (EBV). CMV can affect the retina of the eye
and cause blindness. In fact, vision problems may
be one of the first signs of an opportunistic
infection. AIDS can also affect the nervous
system, with infection causing symptoms ranging
from general weakness to a feeling of numbness or
burning in the feet or lower legs. Symptoms such
as a loss of strength in the arms or legs and
problems with coordination and balance indicate a
viral infection of the brain called progressive
multifocal leukoencephalopathy (PML). AIDS
dementia complex, which causes difficulty with
reasoning, memory, and concentration, is another
symptom of late stage AIDS. Children with HIV have
symptoms that include growth problems, frequent
infections, recurring fevers, and low blood cell
counts. Children with AIDS generally develop lung
inflammations, AIDS-related brain disorders, and
bacterial infections.
How is it diagnosed?
HIV is diagnosed through a blood test called
the ELISA test, which detects HIV antibodies. If
the ELISA test is positive for HIV, your doctor
will order additional blood tests, such as one
called the Western blot test, to confirm the
result. If you are diagnosed with HIV, your doctor
will perform a complete physical exam and take a
complete medical history, including a discussion
of your sexual history, any sexually transmitted
diseases you have had, and any history of drug
use. Your doctor will order tests for other
infections that can become worse if you have HIV.
These include hepatitis B, tuberculosis, and
syphilis. He or she will also order tests for
opportunistic infections, according to the types
of symptoms you are having.
What is the treatment?
Once HIV has been diagnosed, you will have
regular laboratory tests to measure the
progression of the disease. One of these is called
a CD4 lymphocyte cell count. This test measures
the number of CD4 cells, a white blood cell, in
the blood. High levels mean the immune system is
working well. If levels are good, your doctor will
repeat the test every six months. Once levels drop
below 600 per microliter of blood, the test will
be performed more frequently. The viral load test
measures the amount of HIV in your blood. Levels
above 10,000 viruses per milliliter of blood are
considered high. Treatment for HIV and AIDS
focuses on slowing down or stopping the ability of
the virus to reproduce and destroy healthy
lymphocytes, and begins when the CD4 lymphocyte
cell count and viral load test show the disease is
progressing. Antiretroviral drugs such as
zidovudine (ZDV or AZT), didanosine (ddI),
lamivudine (3TC), and other drugs called protease
inhibitors (saquinavir, ritonavir, indinavir, and
nelfinavir) all stop the virus from reproducing
and slow the progression of the HIV infection.
Other drugs called non-nucleoside reverse
transcriptase inhibitors, such as nevirapine and
delavirdine, are also used. However, after a
period of time, HIV develops a resistance to these
drugs. For this reason, the drugs are used in a
combination that may need to be changed
frequently. These drugs do have possible side
effects, which your doctor will discuss with you.
Drugs are also prescribed to prevent infections
such as pneumocystis pneumonia, tetanus,
tuberculosis, and hepatitis B. Patients who have
recurring thrush usually are given an antifungal
drug such as fluconazole. Those who have repeated
herpes simplex infections take the antiviral drug
acyclovir. Pregnant women who are HIV positive can
be treated with AZT during pregnancy to decrease
the risk of passing the virus on to the baby. It
is important to have regular dental exams if you
have HIV so any infections in the mouth are
identified quickly. Once HIV develops into AIDS,
your doctor will prescribe additional and
appropriate treatments for any opportunistic
infections. New drug treatments have greatly
improved the prognosis for someone with HIV or
AIDS. Many people also turn to alternative
treatments to help boost the immune system,
control pain, and relieve the side effects of
HIV/AIDS medications. These include herbal
medicines, special diets, vitamin therapy,
acupuncture, meditation, massage, chiropractic
therapy, and creative visualization.
Self-care tips
You can prevent infection with HIV by
practicing safe sex and choosing your sexual
partners carefully. Never use intravenous drugs or
share needles. If you have decided to get a tattoo
or body piercing, make sure the person providing
the service is using only clean, sterile needles
that have not been used on anyone else. While it
is now highly unlikely that you will develop HIV
from an infected blood transfusion, you can donate
your own blood before any surgeries to ensure the
safety of the blood if you need a transfusion. If
you engage in activities that put you at a high
risk for HIV and AIDS, get tested. Even if your
test is negative, you should follow your doctor’s
recommendations for a schedule of retesting. If
you have been diagnosed with HIV or AIDS, follow
your doctor’s treatment recommendations. If you
are sexually active, always use a condom and tell
your partner that you are HIV positive. Call your
doctor immediately if your symptoms change in any
way. Never donate blood or blood products, semen,
or any organs.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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