HIV

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HIV : Background HIV : Treatment
HIV : Risk Factors HIV : Prevention
HIV : Signs and Symptoms HIV : Outlook
HIV : Complications HIV : References
HIV : Diagnosis

Background

HIV VIRUSHIV (human immunodeficiency virus) is a viral infection that gradually weakens the body’s immune system. The virus attacks a certain type of white blood cell called CD4 cells or T cells. Over time, HIV can kill so many of these cells that the body loses its ability to fight off infections and disease. When the level of CD4 cells drops below 200 cells per cubic millimeter, the disease is considered to have progressed to AIDS (acquired immunodeficiency syndrome).

About 41,400 new cases of HIV occur in the U.S. each year, according to an analysis published by the Centers for Disease Control (CDC) in February 2013. More than 1.1 million Americans are living with HIV/AIDS. According to the World Health Organization (WHO), more than 25 million people worldwide have died of HIV/AIDS, making it one of the worst pandemics in history.

A person can become infected with HIV by having vaginal, oral, or anal sex with an infected partner. The virus enters the body through small breaks in the skin surface or in the mucous membranes lining the genitals. HIV can also be transmitted by exposure to contaminated blood or by sharing infected needles during illicit drug use. Although blood transfusions were a risk factor between 1978 and 1985, better screening tests have made transmission through blood transfusions extremely rare. Furthermore, HIV cannot be transmitted through routine daily activities such as using a toilet seat, sharing towels or drinking glasses, shaking hands, or kissing.

HIV can be passed from an infected mother to her child during pregnancy, childbirth, or breastfeeding. However, it can be difficult to determine if a baby born to an infected mother is actually infected because babies carry their mothers’ HIV antibodies for several months.

There is no cure for HIV. Once a person is infected, the virus stays in the body forever. However, with the introduction of antiretroviral therapy (ART) in the mid 1990’s, a diagnosis of HIV is no longer regarded as a death sentence. If treated early, the disease can be controlled and infected persons can have a nearly normal life expectancy.

Scientists believe that a virus similar to HIV first occurred in some populations of chimpanzees in West Africa in the late 1800s. Humans hunted these chimpanzees for meat and likely came in contact with infected blood during butchering or cooking. Over several decades, the virus slowly spread across Africa and later into other parts of the world. The virus has existed in the United States since at least the mid- to late 1970s.

Risk Factors

HIV/AIDS is most common among homosexual men, bisexual men, and intravenous drug users. However, it is important to understand that others are at risk too. Women now comprise the most rapidly growing segment of the HIV-infected population in the United States. Young women age 16 to 21 have an HIV infection rate that is 50% higher than young men in the same age group. African Americans also tend to be disproportionately impacted, especially women. Although African American women comprise only 12 percent of the female population in the United States, they account for 64 percent of women living with AIDS. HIV/AIDS is the leading cause of death in African American women 25 to 34 years old.
HIV is not necessarily related to promiscuity, although sexually active individuals who have multiple partners are certainly more susceptible. People who have sex with an HIV-infected partner are at very high risk, especially if they do not always use a latex or polyurethane condom. A person is 3 to 5 times more likely to acquire HIV when other STDs (such as syphilis, genital herpes, chlamydia, gonorrhea, or trichomoniasis) are also present.

Signs and Symptoms

Many people infected with HIV have no signs or symptoms initially. Some people have flu-like symptoms in the first few weeks after infection. This is a result of the HIV virus being rapidly replicated in the body and CD4 cells being destroyed. Symptoms of the acute infection may include fever, headaches, dry cough, swollen lymph glands in the armpits or neck, fatigue, diarrhea, and a rash on the face or abdomen. These symptoms typically go away after about 2 weeks as the body’s natural immune system restores the CD4 cells and brings the amount of virus in the body down to a more stable level.

After the acute infection, there is typically a period of wellness for months or even years. This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active, but replicates at very low levels. It is important to remember that HIV can still be transmitted to others during this period (although treatment with ART greatly reduces the risk).

After the asymptomatic period, the immune system weakens and the CD4 cells are destroyed again. A person may develop signs such as oral thrust or a vaginal yeast infection. An infection from a past virus, such as herpes or chicken pox, may reappear.

As the immune system becomes badly damaged, symptoms become more frequent and severe. When the CD4 cell count drops below 200 cells per cubic millimeter, the disease is considered to have progressed to AIDS. During this period, a person may experience chronic diarrhea, weight loss, cough with or without blood, white or unusual spots in the mouth or throat, fever, rash or other skin changes, profuse night sweats, hair or vision loss, confusion, memory loss, and depression. Not all HIV-infected persons develop AIDS, although most probably will as time progresses.

Complications

A person infected with AIDS is unable to fight off serious infections or tumors. Opportunistic infections develop. The infections are called opportunistic because they take advantage of the body’s weakened immune system. These infections would not normally cause severe health problems, but with a badly damaged immune system, the infections can become serious and even fatal. Examples of opportunistic infections include pneumonia, thrush, toxoplasmosis, and tuberculosis.

Persons infected with HIV can also develop certain cancers such as Kaposi’s sarcoma and non-Hodgkin’s lymphoma. Women infected with HIV are at a higher risk for cervical cancer and cancer of the anus, vulva, and vagina. Women with HIV also have higher rates of yeast infections.

Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. People with AIDS need medical treatment to prevent death.

Diagnosis

The presence of HIV is established by a blood test that detects antibodies to HIV. Most people will develop detectable antibodies within 3 months after the acute infection. If the HIV test is positive, a second test is usually done to confirm the results.

If the HIV test is positive, another blood test will be administered to determine the CD4 cell count. A normal CD4 count usually ranges from 550 to 1000. If the CD4 count is lower than the normal range, it means that the immune system has been affected by HIV.

Blood tests will also reveal the viral load. This is the amount of HIV in your blood at any given time. As HIV progresses, the viral load increases.

Treatment

There is no cure for HIV. However, new medications have dramatically improved the lives of many HIV-infected persons. These medications have delayed the progression of HIV to AIDS, as well as the progression of AIDS to death.

The most common treatment for HIV is antiretroviral therapy (ART), which has been available since the mid 1990’s. There are 31 antiretroviral drugs approved by the Food and Drug Administration (FDA). Some medications are designed to reduce the viral load, while others are designed to increase the CD4 cell count.

There are five different classes of treatment: entry inhibitors, which prevent the virus from entering the CD4 cell; nucleoside reverse transcriptase Inhibitors (NRTIs or nukes), which pretend to be the chemicals that the virus needs to multiply and prevent the virus from replicating; non-nucleoside reverse transcriptase inhibitors (NNRTIs or non-nukes), which bind tightly to the protein that the virus needs to replicate, making the protein unusable; integrase inhibitors, which block the virus from entering the DNA of the CD4 cell; and protease inhibitors (PIs), which interfere with the proteins the virus needs to replicate.

One of the most well-known ARTs is azidothymidine (AZT) which is manufactured under the trade name Retrovil by Glaxo SmithKline. Retrovir, approved by the FDA in 1987, was the first drug licensed to treat HIV infection. It belongs to the NRTI class and was considered the first breakthrough in AIDS therapy. The patent on AZT has now expired and generic versions are available.

The current standard of care is Highly Active Antiretroviral Therapy (HAART), a combination of at least 3 medications from at least 2 different classes. This treatment – sometimes referred to as an anti HIV “cocktail” – is designed to reduce the viral load, maintain function of the immune system, and prevent opportunistic infections. Although generally quite effective, HAART medications are very expensive and often have negative side effects. Further, drug resistance to newer treatments is increasing.

In addition to HAART, treatment for HIV/AIDS may include preventative medicines to protect against opportunistic infections, antimicrobial medicines to kill infections, and immunizations for flu, pneumonia, hepatitis, and other infections.

Prevention

Because HIV is transmitted mainly during sexual activity, the most reliable way to prevent infection is to abstain from oral, vaginal, and anal sex or to have a mutually monogamous relationship with an uninfected sex partner. Latex condoms are also highly effective when used consistently and correctly. However, since condoms are not 100% effective, the addition of other prevention measures can further reduce the risk. For example, water-based or oil-based lubricants can prevent condoms from breaking.

For persons who practice oral sex, the most reliable prevention methods are avoiding ejaculation in the mouth and using barriers such as condoms, natural rubber latex sheets, and dental dams. It is also wise to avoid oral sex if one of the participants has bleeding gums, ulcers, cuts, or sores in the mouth.

People should not share grooming products or other items that might have blood on them, including razors, toothbrushes, fingernail clippers, etc. People who inject themselves with drugs should not share needles, syringes, or other equipment. People who get tattoos or body piercings should ensure that their artist sterilizes all needles and equipment, uses disposable gloves, and washes hands properly.

Pregnant women should be tested for HIV since new drugs can lower the chance of passing the virus to the infant. HIV-infected mothers should not breast feed.

There is also a treatment called post-exposure prophylaxis (PEP) that can prevent HIV if started within 3 days of possible exposure. PEP prevents HIV from making copies of itself and turning into infection. It involves taking 2-3 antiretroviral medications for 28 days. It is not intended for long-term use and should not be regarded as a substitute for other proven prevention methods, such as consistent condom use. The medications can have serious side effects that make it difficult to complete the treatment regimen.

Outlook

There is tremendous hope for those who test positive for HIV. With early treatment and proper care, most people can expect to live long and productive lives. Eating a balanced diet, exercising regularly, looking after your mental health, not smoking, taking medications regularly, and having regular checkups can all increase life expectancy and improve quality of life.

References:

1) HIV/AIDS Fact Sheets
Source: Centers for Disease Control and Prevention

2) Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States – CDC Fact Sheet
Source: Centers for Disease Control and Prevention

3) Sexually Transmitted Diseases
Source: The Center for Menstrual Disorders and Reproductive Choice

4) HIV/AIDS
Source: National Institutes of Health

5) HIV/AIDS
Source: Mayo Clinic

6) HIV & AIDS Health Center
Source: WebMD

7) HIV/AIDS Basics
Source: Aids.gov

8) HIV/AIDS
Source: Emedicinehealth.com

Posted in STI.