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.