AIDS - HIV
(see HIV-Aids connection: NIH Publication, Sept. 1995)
AIDS stands for acquired immunodeficiency syndrome. This condition was first reported in the United States in 1981 and has since become a major worldwide epidemic. The term AIDS applies to the most advanced stages of HIV infection (NIH definition 2007). AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers.
AIDS – HIV Prevention – general
- Avoid multiple sex partners
- Avoid unprotected sex
- Get screened immediately if you suspect that you have a sexually transmitted disease
- Avoid the use of intravenous drugs
- do not share needles if you use intravenous drugs
AIDS – HIV Prevention – drug users
A comprehensive HIV/AIDS prevention approach for any population includes three complementary approaches. This is especially pertinent for drug users. Each of these approached must also include HIV testing and counseling:
- Community-based outreach
- Drug abuse treatment
- Sterile syringe access programs.
In addition these complementary approaches, the practice of “safe sex” is a requirement in any program of HIV prevention.
AIDS – HIV – Pregnancy and transmission
- Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding. A mother can significantly reduce the chances that her baby will get infected with HIV by adopting the following measures:
- Taking anti-HIV drugs during pregnancy
- Delivering the baby by cesarean section, and doing so before the mother’s uterine membranes rupture naturally, reduces transmission that may occur during the birth process.
- Avoidance of breastfeeding by an HIV-infected mother. HIV can be spread to babies through the breast milk of mothers infected with the virus. (see also American Pregnancy Association Forum: HIV/AIDSduring Pregnancy: April 2007)
AIDS – HIV and Safe Sexual Practices
AIDS – HIV and Immune System disorders
The specific immunologic profile that typifies AIDS is a progressive reduction of CD4+ T cells. This results in a persistent CD4+ T lymphocytopenia and a near loss of cellular immunity. These factors make the infected patients very susceptible to opportunistic and community acquired infections
AIDS - HIVand CD 4 cells
AIDS - HIV–Opportunistic Infections in
AIDS – HIV – Viral Load in
Numerous studies show that people with high levels of HIV in their bloodstream are more likely to develop new AIDS-related symptoms or die than those with lower levels of virus. The viral load test provides important information that is used in conjunction with the CD4 cell count:
- to monitor the status of HIV disease,
- to guide recommendations for therapy, and
- to predict the future course of HIV.
Evidence shows that keeping the viral load levels as low as possible for as long as possible decreases the complications of HIV disease and prolongs life.
Public health guidelines state that treatment should be considered for asymptomatic HIV- infected people who have viral loads higher than 30,000 copies per milliliter of blood using a test known as a branched DNA test, or more than 55,000 copies using an RT-PCR test. (©2001-2007 American Association for Clinical Chemistry)
HIV – Testing for
HIV ELISA/Western blot is a set of blood tests used in the diagnosis of chronic infection with human immunodeficiency virus (HIV). The HIV ELISA is a screening test for the diagnosis of HIV infection. If this test is positive, it must be confirmed with a second test called the Western blot, which is more specific and will confirm if someone is truly HIV positive (there are other conditions that may produce a falsely positive ELISA test result, including Lupus, Lyme disease, and Syphilis.
AIDS – HIV – Viruses (RNA and DNA)
A virus is a capsule that contains genetic material — DNA or RNA. Viruses are even smaller than bacteria. For example, if you were to enlarge an average virus to the size of a baseball, the average bacterium would be about the size of the pitcher’s mound. Measured on this same scale, just one of your body’s billions of cells would be the size of the entire ballpark.
The main mission of a virus is to reproduce. To survive, a virus needs to enter one of the cells of your body in order to reproduce itself. When a virus invades one of the cells of your body (host cell), it takes over the cell, and literally tells the host cell what the virus needs in order to reproduce itself. The host cell is eventually destroyed during this reproduction process. Polio, AIDS and the common cold are all viral illnesses
HIV belongs to a class of viruses called retroviruses. Retroviruses are RNA (ribonucleic acid) viruses, and in order to replicate (duplicate). They must make a DNA (deoxyribonucleic acid) copy of their RNA. It is the DNA genes that allow the virus to replicate.
Like all viruses, HIV can replicate only inside cells, commandeering the cell’s machinery to reproduce. Only HIV and other retroviruses, however, once inside a cell, use an enzyme called reverse transcriptase to convert their RNA into DNA, which can be incorporated into the host cell’s genetic makeup.
AIDS – HIV – and T-Cell (See HIV and CD4 Cells)
AIDS – HIV – Antiviral Therapy
Potent combinations of three or more anti-HIV drugs known as highly active antiretroviral therapy, or HAART, can reduce a person’s “viral load” (amount of virus in the circulating blood) to very low levels and in many cases delay the progression of HIV disease for prolonged periods. A treatment goal of anti-viral therapy, along with reduction of viral load, is the reconstitution of the person’s immune system, which may have become sufficiently damaged that it cannot replenish itself. Before the introduction of HAART therapy, 85 percent of patients survived an average of 3 years following AIDS diagnosis. Today, 95 percent of patients who start therapy before they get AIDS survive on average 3 years following their first AIDS diagnosis. For those who start HAART after their first AIDS event, survival is still very high at 85 percent, averaging 3 years after AIDS diagnosis. (NIH: “How HIV causes AIDS”: Nov. 2004)
AIDS – HIV – and Sexually Transmitted Diseases (STD’s)
Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites and viruses. There are more than 20 types of STDs, including
- Chlamydia
- Gonorrhea
- Herpes Simplex
- HIV/AIDS
- HPV
- Syphilis
- Trichomoniasis
Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby. (data from the National Library of Medicine)
AIDS – HIV - Karposi’s Sarcoma in Kaposi's sarcoma is a cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organs. The patches are usually red or purple and are made of cancer cells and blood cells. The red and purples patches often cause no symptoms, though they may be painful. If the cancer spreads to the digestive tract or lungs, bleeding can result. Lung tumors can make breathing hard.
Before the AIDS epidemic, KS usually developed slowly. In AIDS patients, though, the disease moves quickly. Treatment depends on where the lesions are and how bad they are. Treatment for the AIDS virus itself can shrink the lesions. However, treating KS does not improve survival from AIDS itself.
AIDS – HIV - and Gay Lifestyle
Gay and bisexual males who indulge in risky sexual behavior are at high risk for contracting HIV. Gay and bisexual males must be particularly careful and always use latex condoms. Using condoms is the only way to protect against human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and many other diseases that are spread during anal, vaginal or oral intercourse. Condoms also help to prevent pregnancy during vaginal intercourse.
Lesbians and bisexual females also must always use protection such as latex dental dams and condoms to avoid sexually transmitted diseases and unplanned pregnancies.
AIDS – HIV - and Intravenous Drug use - overview
People who inject themselves with drugs also risk infecting themselves with HIV. Many people who use needles to take intravenous drugs or steroids share the needles with others. If a person with HIV shares a needle, he or she also shares the virus, which lives in the tiny amounts of blood attached to the needle. Sharing needles can also pass hepatitis and other serious infections to another person.
AIDS – HIV - Childhood Aids (see Children and HIV: AIDSInfonet.org)
Most children with HIV were born to mothers with HIV. Others got a transfusion of infected blood. In the developed world, blood for transfusions is screened and most pregnant women are taking Anti Retro-viral drugs (ARV’s).
Treatment of HIV-infected children is complicated. Not all anti-HIV medications are approved for use by children. The correct dosing is not always known. Children may have a difficult time tolerating medications and taking every dose as scheduled.
AIDS – HIV - and Condom use
If used consistently and correctly, male latex condoms provide protection against HIV, gonorrhea, and unintended pregnancy. Depending on the meta-analysis or model used to study condom effectiveness, consistent use reduces HIV incidence by at least 80 percent and perhaps as much as 97 percent. For protection against unintended pregnancy, male latex condoms are 86 percent to 97 percent effective, depending on whether use is typical or ideal, respectively. Scientific evidence to support these conclusions is not complete, but it is strong and consistent enough to produce the solid public health recommendation that condoms work. Most HIV and other sexually transmitted infections (STIs) or unplanned pregnancies likely occur because of condom non-use or inconsistent use, so the challenge is to increase the consistency of male condom use during risky sexual contacts.
As is true of the male latex condom, the female condom has been found to be impermeable to various STIs, including HIV, in the laboratory. In theory, the device should protect against STIs in people as well, but more research is needed to confirm its effectiveness. (See Monograph on Contraceptives and HIV: Family Health International©, 2006)
AIDS – HIV Prevention - Sex education
In its most basic form, sex education refers to the practice of teaching children and young adults the basics of the anatomy and function of the human reproductive organs, what constitutes safe sexual practices and the importance of maintaining safe sexual practices.
AIDS – HIV - Treatment (overview)
The overall goal of anti-HIV therapy is to slow or stop the ability of HIV to reproduce, and thereby slow or stop the progression of HIV disease and the destruction of the immune system. While other approaches of combating HIV infection have been proposed and tested, thus far only anti-HIV therapy has been proven to slow disease progression and extend life.
The goals of anti-HIV therapy should be to:
- Prolong life and improve quality of life for the long-term;
- Suppress virus to below the limit of detection on current tests (<50 copies HIV RNA), or as low as possible, for as long as possible;
- Optimize and extend the usefulness of the currently available therapies; and
- Minimize drug toxicity and manage side effects and drug interactions.
AIDS - HIV - What is HIV-AIDS?
Answer: AIDS stands for acquired immunodeficiency syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses. An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).
HIV - Screening test (What does a Positive test mean?)
A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a health practitioner, using certain currently accepted clinical criteria (e.g., AIDS indicator illnesses).
AIDS – HIV – and Opportunistic Infections
Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness.
Many of the opportunistic infections that cause problems and threaten the lives of people with AIDS are usually controlled by a healthy immune system in normal individuals. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness.
HIV-AIDS - Cure for?
Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care.
HIV – AIDS - Treatment of (Overview)
Question: I am HIV-infected, but do not have any symptoms. My doctor recently told me that my viral load measurement was increasing, and I should consider starting antiviral medication. What does viral load mean?
Answer: Viral load testing measures the number of HIV particles in your blood. There are two common laboratory techniques used in viral load testing: “Polymerase Chain Reaction” (PCR) and branched-chain DNA (bDNA). These tests detect a kind of protein strand called RNA that contains the HIV genes. Each HIV particle has two copies of RNA. The “Viral Load” test determines the number of copies of HIV RNA molecules in a milliliter (ml) of blood. The viral load test actually measures only the level of virus circulating in your blood. This value is a good indicator of the amount of virus in your entire body.
Your viral load test result provides important information that is used in conjunction with your CD4 cell ("T-cell") count to monitor the status of HIV disease, to guide recommendations for therapy, and to predict the future course of the disease. In general, viral load testing should not be performed during a new illness or soon after a vaccination, because each of these may temporarily affect the results. The CD4 count is a marker of the health of your immune system (higher value is better), but viral load testing directly measures the number of HIV particles circulating in your blood (lower value is better). There is substantial evidence that keeping your viral load as low as possible over time will decrease your likelihood of developing HIV disease complications and will prolong life. The presence or absence of symptoms is not sufficient to follow the course of HIV infection.
Doctors use viral load measurements to determine when you should begin antiviral therapy and whether the drugs you are receiving are effective. In general, antiviral therapy is recommended in persons with high viral loads (greater than 10,000 copies/ml by bDNA or greater than 20,000 by PCR) regardless of their CD4 count results or whether they have any symptoms.
After HIV infection is diagnosed, it is a good idea to have two viral load tests performed at separate visits. This will establish a reliable measure of your baseline HIV level. If your viral load is low and CD4 count is normal, your doctor may not recommend antiviral therapy but will repeat both laboratory tests at 3-month intervals to monitor the status of your infection. If your viral load increases over time, your doctor may suggest that you start antiviral therapy.
Once antiviral therapy is initiated, you should have a follow-up viral load test and CD4 count performed about 1 month later. In general, effective therapy should result in a significant drop in your viral load. This is defined as dropping to a number that is no more than one-third of the number obtained before therapy began (for example, from 9,000 to less than 3,000). In some persons, it is possible to suppress the viral load below the lower limit of detection of the test (20-50 copies/ml) within several months of starting therapy. Once on a stable antiviral regimen, you should have follow-up laboratory studies performed every 3-4 months to confirm that the medications you are receiving continue to keep your viral level low.
AIDS – HIV - Anti-viral Treatment: importance of compliance
Question: I have HIV and recently started antiviral medications. They make me feel sick occasionally, and I sometimes miss doses. Is this dangerous?
Answer: Medication for HIV should be taken as closely as prescribed as possibly. Frequently missed doses will make the medications permanently ineffective. In order to understand why this is true, it is necessary to be familiar with certain characteristics of HIV. This virus reproduces rapidly in most people who are not on antiviral therapy. However, in doing so, the virus makes a lot of random mistakes, some of which have the effect of producing resistance to specific medications. If you are prescribed antiviral therapy and taking it reliably, these resistant viral strains will not usually develop. But if you take the medication inconsistently, these resistant viruses will grow well and "take over" as the predominant strain. Once this occurs, your medications will no longer work, even if you then start to take them reliably.
AIDS – HIV Medicines – Problems with compliance
There are many factors that may make taking antiviral medications regularly difficult:
- Lack of education about HIV.
- Denial, anxiety, or depression.
- Alcohol or drug use.
- Poor social support.
- Inadequate health insurance.
- Too many pills.
- Dosing with food or on empty stomach.
- Side effects.
Before starting medicines for HIV, your doctor should discuss with you the medications being prescribed and review any issues that may interfere with your ability to take them reliably. Once you start the medications, it is important to be honest about how well you are doing. Most doctors understand that taking antiviral therapy is not easy for many people.
