HIV AND AIDS
Definition of AIDS and HIV Infection
AIDS stands for Acquired Immune Deficiency Syndrome.
AIDS is a serious condition that weakens the body's
immune system, leaving it unable to fight off illness.
AIDS is the last stage in a progression of diseases
resulting from a viral infection known as the Human
Immunodeficiency Virus (HIV or AIDS virus).
The diseases include a number of unusual and severe
infections, cancers and debilitating illnesses,
resulting in severe weight loss or wasting away,
and diseases affecting the brain and central nervous system.
There is no cure for HIV infection or AIDS nor is there
a vaccine to prevent HIV infection. However, new
medications not only can slow the progression of the
infection, but can also markedly suppress the virus,
thereby restoring the body’s immune function and
permitting many HIV-infected individuals to lead a
normal, disease-free life.
Description of AIDS and HIV Infection
The immune system is a network of cells, organs and
proteins that work together to defend and protect the
body from potentially harmful, infectious microorganisms
(microscopic life-forms), such as bacteria, viruses,
parasites and fungi. The immune system also plays a
critical role in preventing the development and spread
of many types of cancer.
When the immune system is missing one or more of its
components, the result is an immunodeficiency disorder.
AIDS is an immunodeficiency disorder.
Lymphocytes (white blood cells) are one of the main types
of immune cells that make up the immune system. There are
two types of lymphocytes: B cells and T cells. (T cells
are also called CD4 cells, CD4 T cells, or CD4 cell
lymphocytes). B cells secrete antibodies (proteins)
into the body's fluids to ambush and attack antigens
(foreign proteins such as bacteria, viruses or fungi).
T cells directly attack and destroy infected or malignant
cells in the body.
There are two types of T cells: helper T cells and killer
T cells. Helper T cells recognize the antigen and activate
the killer T cells. Killer T cells then destroy the antigen.
When HIV is introduced into the body, this virus is too
strong for the helper T cells and killer T cells. The virus
then invades these cells and starts to reproduce itself,
thereby not only killing the CD4 T cells, but also spreading
to infect otherwise healthy cells.
The HIV virus cannot be destroyed and lives in the body
undetected for months or years before any sign of illness
appears. Gradually, over many years or even decades, as the
T cells become progressively destroyed or inactivated, other
viruses, parasites or cancer cells (called "opportunistic
diseases") which would not have been able to get past a
healthy body's defense, can multiply within the body without
fear of destruction. Commonly seen opportunistic diseases
in persons with HIV infection include: pneumocystis carinii
pneumonia, tuberculosis, candida (yeast) infection of the mouth,
throat or vagina, shingles, cytomegalovirus retinitis and
Kaposi's sarcoma.
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Causes and Risk Factors of AIDS and HIV Infection
AIDS is transmitted via three main routes:
The most common mode of transmission is the transfer of body
secretions through sexual contact. This is accomplished through
exposure of mucous membranes of the rectum, vagina or mouth
to blood, semen or vaginal secretions containing the HIV virus.
Blood or blood products can transmit the virus, most often through
the sharing of contaminated syringes and needles.
HIV can be spread during pregnancy from mother to fetus.
You cannot get AIDS/HIV from touching someone or sharing items,
such as cups or pencils, or through coughing and sneezing.
Additionally,
HIV is not spread through routine contact in restaurants,
the workplace or school. However, sharing a razor does pose
a small risk in that blood from a minor nick can be
transmitted from one person to another.
Symptoms of AIDS and HIV Infection
Immediately following infection with HIV, most individuals
develop a brief, nonspecific “viral illness” consisting of
low grade fever, rash, muscle aches, headache and/or fatigue.
Like any other viral illness, these symptoms resolve over a
period of five to 10 days. Then for a period of several years
(sometimes as long as several decades), people infected with
HIV are asymptomatic (no symptoms). However, their immune
system is gradually being destroyed by the virus. When this
destruction has progressed to a critical point, symptoms of
AIDS appear. These symptoms are as follows:
extreme fatigue
rapid weight loss from an unknown cause (more than 10 lbs.
in two months for no reason)
appearance of swollen or tender glands in the neck, armpits
or groin, for no apparent reason, lasting for more than four weeks
unexplained shortness of breath, frequently accompanied by
a dry cough, not due to allergies or smoking
persistent diarrhea
intermittent high fever or soaking night sweats of unknown origin
a marked change in an illness pattern, either in frequency,
severity, or length of sickness
appearance of one or more purple spots on the surface of the
skin, inside the mouth, anus or nasal passages
whitish coating on the tongue, throat or vagina
forgetfulness, confusion and other signs of mental deterioration
It can take as short as a year to as long as 10 to 15 years to go
from being infected with HIV to "full-blown" AIDS.
According to the Center for Disease Control and Prevention, a person
is considered to have AIDS when they have a T cell count
(also called CD4 cell count) of 200 or less (healthy T cell
levels range from 500 to 1500) or they have an AIDS-defining
condition. The AIDS-defining conditions are:
· Candidiasis
· Cervical cancer (invasive)
· Coccidioidomycosis, Cryptococcosis, Cryptosporidiosis
· Cytomegalovirus disease
· Encephalopathy (HIV-related)
· Herpes simplex (severe infection)
· Histoplasmosis
· Isosporiasis
· Kaposi's sarcoma
· Lymphoma (certain types)
· Mycobacterium avium complex
· Pneumocystis carinii pneumonia
· Pneumonia (recurrent)
· Progressive multifocal leukoencephalopathy
· Salmonella septicemia (recurrent)
· Toxoplasmosis of the brain
· Tuberculosis
· Wasting syndrome
People who are not infected with HIV may also develop these diseases;
the presence of any one of these conditions does not mean the person
has AIDS. To be diagnosed with AIDS, a person must be infected with HIV.
Some people infected with HIV may develop a disease that is less serious
than AIDS, referred to as AIDS Related Complex (ARC). ARC is a condition
caused by the AIDS virus in which the patient tests positive for AIDS
infection and has a specific set of clinical symptoms. However, ARC
patients' symptoms are often less severe than those with classic AIDS
because the degree of destruction of the immune system has not progressed
as far as it has in patients with classic AIDS.
Symptoms of ARC may include loss of appetite, weight loss, fever, night
sweats, skin rashes, diarrhea, tiredness, lack of resistance to infection
or swollen lymph nodes.
Note: Not everyone who has been infected with HIV develops AIDS. Very rarely,
some individuals can be infected with HIV yet maintain normal immune function
and general good health even after 20 years of infection.
Diagnosis of AIDS and HIV Infection
Screening for HIV infection is most commonly done by testing blood for HIV
antibodies. A newer test, the Orasure test, involves collecting secretions
between the cheek and gum and evaluating them for HIV antibodies. Orasure
is essentially as accurate as a blood test, and, because it doesn't involve
a needle stick, it is favored by many individuals. Orasure is available
through physicians’ offices and many public health clinics. Finally, a
new urine test available for screening, although if the test is positive,
blood tests need to be performed for confirmation of the presence of HIV.
In 1996, a home HIV blood test (called Home Access) became available to the
public. These home kits are available in pharmacies and by mail. The kit
contains a few sharp tools called lancets, a piece of blotting paper marked
with a unique identification number and a prepaid return envelope with a
protective pouch. After pricking the finger with the lancet, a few drops
of blood are blotted onto the paper, sealed into the envelope and sent to
the address on the envelope. In about a week, the person calls a toll-free
number to get the results of the test.
Treatment of AIDS and HIV Infection
Anti-HIV (also called antiretroviral) medications are used to control the
reproduction of the virus and to slow or halt the progression of HIV-related
disease. When used in combinations, these medications are termed Highly Active
Antiretroviral Therapy (HAART). HAART combines three or more anti-HIV
medications in a daily regimen, sometimes referred to as a "cocktail".
Anti-HIV medications do not cure HIV infection and individuals taking
these medications can still transmit HIV to others. Anti-HIV medications
approved by the U.S. Food and Drug Administration (FDA) fall into four classes:
1. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs), such as nevirappine
(Viramune) and efavirenz (Sustiva), bind to and block the action of reverse
transcriptase, a protein that HIV needs to reproduce.
2. Nucleoside Reverse Transcriptase Inhibitors (NRTIs), such as zidovudine
(Retrovir), tenofovir DF (Viread), and stavudine (Zerit), are faulty versions
of building blocks that HIV needs to make more copies of itself. When HIV
uses an NRTI instead of a normal building block, reproduction of the virus is stalled.
3. Protease Inhibitors (PIs), such as lopinavir/ritonavir (Kaletra),
disable protease, a protein that HIV needs reproduce itself.
4. Fusion Inhibitors, such as enfuvirtide (Fuzeon ), are newer treatments
that work by blocking HIV entry into cells.
(View more complete list of HIV drugs).
How many pills you will need to take and how often you will take them depends
on what medications you and your doctor choose.
There is no one "best" regimen. You and your doctor will decide which medications
are right for you. For people taking HAART for the first time, the recommended regimens are:
Sustiva + Truvada, Sustiva + Epzicom, or Atripla
Kaletra + Truvada, Kaletra + Epzicom, or Kaletra + Combivir
In general, taking only one or two drugs is not recommended because
any decrease in viral load is almost always temporary without three
or more drugs. The exception is the recommendation for pregnant women,
who may take Combivir plus nevirapine to reduce the risk of passing HIV
to their infants. If you are pregnant or considering becoming pregnant,
there are additional treatment considerations. Recently, a number of
drugs have been developed that combine two or even three separate
medications in a single pill. Some of these, such as Truvada
(emtricitabine + tenofovir) and Epzicom (abacavir + lamivudine)
need be taken only once daily. Atripla (emtricitabine + tenofovir + efavirenz)
combines three drugs in one pill and needs to be taken only once daily,
thereby providing a complete HAART regimen with one pill once daily.
The treatment of HIV infection and AIDS is in a highly dynamic state.
Individuals with this condition are advised to seek out experts in
local community who are current with the latest modes of therapy and
ongoing clinical trials for evaluating newer therapies.
The following is a partial list of drugs approved for the treatment of HIV infection.
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Delavirdine (Rescriptor, DLV) Pfizer
Efavirenz (Sustiva, EFV) Bristol-Myers Squibb
Nevirapine (Viramune, NVP) Boehringer Ingelheim
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Abacavir (Ziagen, ABC) GlaxoSmithKline
Abacavir,Lamivudine, Zidovudine (Trizivir) GlaxoSmithKline
Didanosine (Videx, ddI, Videx EC) Bristol-Myers Squibb
Emtricitabine (Emtriva, FTC, Coviracil) Gilead Sciences
Lamivudine (Epivir, 3TC) GlaxoSmithKline
Lamivudine, Zidovudine (Combivir) GlaxoSmithKline
Stavudine ( Zerit, d4T) Bristol-Myers Squibb
Tenofovir DF (Viread, TDF) Gilead Sciences
Zalcitabine (Hivid, ddC) Hoffmann-La Roche
Atripla (tenofovir, emtricitabine, efavirenz) Gilead Sciences
Zidovudine (Retrovir, AZT, ZDV) GlaxoSmithKline
Protease Inhibitors (PIs)
Amprenavir (Agenerase, APV) GlaxoSmithKline, Vertex Pharmaceuticals
Atazanavir (Reyataz, ATV) Bristol-Myers Squibb
Fosamprenavir (Lexiva, FPV) GlaxoSmithKline, Vertex Pharmaceuticals
Indinavir (Crixivan, IDV) Merck
Lopinavir, Ritonavir (Kaletra, LPV/r) Abbott Laboratories
Nelfinavir (Viracept, NFV) Agouron Pharmaceuticals
Ritonavir (Norvir, RTV) Abbott Laboratories
Saquinavir (Fortovase, SQV) Invirase Hoffmann-La Roche
Tipranavir (Aptivus) Boehringer-Ingelheim
Darunavir (Prezista) Tibotec Therapeutics
Fusion Inhibitors
Enfuvirtide (Fuzeon, T-20) Hoffmann-La Roche, Trimeris
Prevention of AIDS and HIV Infection
The only way to protect from contracting AIDS sexually is to abstain from sex outside of
a mutually faithful relationship with a partner whom the person knows is not infected
with the AIDS virus. Otherwise, risks can be minimized if they:
Don't have sexual contact with anyone who has symptoms of AIDS or who is a member of a
high risk group for AIDS.
Avoid sexual contact with anyone who has had sex with people at risk of getting AIDS.
Don't have sex with prostitutes.
Avoid having sex with anyone who has multiple and/or anonymous sexual partners.
Avoid oral, genital and anal contact with partner's blood, semen, vaginal secretions,
feces or urine. Unless they know with absolute certainty that their partner is not
infected, a latex condom should be used during each sexual act, from start to finish.
The use of a spermicidal agent may provide additional protection.
Avoid anal intercourse altogether.
Don't share toothbrushes, razors or other implements that could become contaminated
with the blood of anyone who is or might be infected with the AIDS virus.
Exercise caution regarding procedures, such as acupuncture, tattooing, ear piercing,
etc., in which needles or other nonsterile instruments may be used repeatedly to
pierce the skin and/or mucous membranes.
Such procedures are safe if proper sterilization methods are employed or disposable
needles are used. Ask what precautions are taken before undergoing such procedures.
If an individual is scheduling surgery in the near future, and is able, they could
consider donating blood for their own use. This will eliminate completely the
already very small risk of contracting AIDS through a blood transfusion. It will
also eliminate the risk of contracting other bloodborne diseases (such as hepatitis)
from a transfusion.
If a person is an IV drug user, adhere to the prevention tips mentioned earlier, as well as:
Get professional help for terminating the drug habit.
Do not share needles or syringes. Be aware that some street sellers are resealing previously
used needles and selling them as new.
Clean the needle before using.
Some people apparently remain well after infection of the AIDS virus. They may have
no physically apparent symptoms of illness. However, if proper precautions are not
used with sexual contacts and/or intravenous drug use, these infected individuals can
spread the virus to others.
Anyone who thinks he or she is infected, or who is involved in high-risk behaviors,
should not donate his/her blood, organs, tissues, or sperm as they may now contain
the AIDS viru
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