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AIDS

AIDS Pictures | AIDS Support

| General | Symptoms | Diagnosis | Treatment | Transmission | Prevention |

GENERAL AIDS INFORMATION

First reported in the United States in 1981 the Aids epidemic has now infected more than 30 million people worldwide with 1 million infected in the USA.  In some African countries over 20% of the population is infected. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males (six times higher in African-Americans and three times higher among Hispanics than among caucasians).       

Infection in the female population has risen, now being  recognized as the fourth leading cause of death in women and one of the leading causes of death in male adults 25 - 44 years of age. More than 50% of the reported AIDS  cases, in 1992, were among men with homosexual and bisexual contacts, but this percentage has been declining over the past two years, the impact on mortality being noticed in larger metropolitan areas, but is also heading towards smaller areas across America and worldwide. Anyone can be infected, it is no longer affecting just one specific portion of the population. At this time there is still no cure for HIV.    

AIDS       

Aids stands for: 

Acquired which means:

• you were not born with the disease compared to most immune deficient conditions

*You can only be born with AIDS if your mother had AIDS when pregnant

Immunodeficiency which means: 

• the disease is characterized by a weakened or ineffective immune system with no resistance to infections

Syndrome which means:

AIDS is a combination of signs and symptoms which occur together due to the HIV infection as well as many other infections as a result of the immunodeficiency 

The definition of AIDS relates to:

CD4+ T-cells Count:

• Healthy adults usually have CD4+ T-cell counts of 1,000 or more

• Aids and some HIV sufferers have less than 200 CD4+ T-cells

Clinical Conditions

There are over 26 clinical conditions affecting people with advanced HIV disease. These conditions  are usually opportunistic infections, which can sometimes be fatal because the immune system is so damaged by HIV that it is unable to fight off certain bacteria, viruses and other microbes. 

HIV

HIV stands for Human Immunodeficiency Virus, the virus causes AIDS, and is an infection of the immune system which destroys the body's ability to fight off infections. HIV may also enter a cell then remain quiet for a  long time and drug therapy only destroys the active virus. HIV infects the cells (T Lymphocytes) of the immune system weakening the entire system.  

HIV has been located in fluids such as:

• blood

• breast milk

• saliva

• semen

• tears

• vaginal fluids

It appears that the disease can only be transmitted through:

• blood

• blood products

• sexual fluids

People can be infected and NOT look sick or even have AIDS but can still transmit HIV. This is a problem for drug therapy because drugs destroy the virus while it is active.

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Transmission

The AIDS virus is transmitted from one person to another through several methods:

• Blood or blood products

• Mother to infant 

• Sexual contact

• Sharing of needles or syringes

Blood

• Accidents in health care (i.e., needle stick or other medical instruments) 

• Ear piercing

• Needle sharing with an infected person for any reason (IV drug needles [only minute amounts of blood are needed]

• Receiving a blood transfusion with infected blood (blood donations in the U.S. have been screened for HIV since 1985)

• Steroid needles

Blood or blood products

Prior to 1985 HIV was frequently transmitted by blood transfusions because there was no effective way to test blood for the AIDS virus. 

Contact with infected blood

HIV was transmitted through transfusions of contaminated blood or blood components, prior to the screening of blood for HIV infection and before the introduction in 1985 of heat-treating techniques to destroy HIV in blood products. The risk of acquiring HIV from transfusions today is extremely small. 

Sexual Contact       

The virus can be spread in: 

• Artificial insemination with semen from an infected person

• Body fluids including sperm    

• Oral sex

The infection can be spread from unprotected sex  (sex without condoms) with an infected partner, including:

• anal intercourse

• oral intercourse

• vaginal intercourse

and is spread from:

• men to men

• men to women

• women to men

• women to women  

The virus can enter the body during sex through the:

• lining of the vagina

• mouth

• penis

• rectum

• vulva

You are also at risk if you have another sexually transmitted disease such as:

• Bacterial Vaginosis

• Chlamydia

• Gonorrhea

• Herpes

• Syphilis

as you are more susceptible to acquiring HIV infection during sex with an infected partner

HIV has been detected in the saliva of infected individuals, however, no evidence exists that the virus is spread by contact with saliva. Tests show saliva has natural compounds that inhibit the infectiousness of HIV. No evidence has been found that the virus is spread to others through saliva such as by kissing. No one knows, however, the risk of infection from so-called "deep" kissing, involving the exchange of large amounts of saliva. 

HIV has not been found to spread through:

• feces

• sweat

• tears

• urine

Families of HIV-infected people have shown clearly that HIV is not spread through:  

Casual Contact such as :

• biting insects such as mosquitoes or bedbugs

• sharing of bedding

• sharing of food utensils

• sharing of towels

• swimming pools 

• telephones 

There is no risk of transmission through: 

• Donating blood when sterile needles are used   

• Embracing or cuddling 

• Kissing without exchange of saliva

• Sharing utensils

• Touching an HIV infected person 

or through touching objects such as:

• clothes

• door knobs

• toilet seats      
   

Peri-natal

HIV can be spread from Mother to infant during:     

• Birth (Peripartum)

• Breast feeding

• Pregnancy (Intrauterine)

Treating Pregnant Mothers

During pregnancy or birth women can transmit HIV to their fetuses. Approximately 1/4 to 1/3 of all untreated pregnant women infected with HIV will pass the infection to their babies, but it can also be spread to babies through the breast milk of infected mothers.  

Help Factors

• Anti-HIV drugs are very effective in limiting transmission to infants but some transmission still occurs

• The risk of transmission further diminishes with a Cesarean section

• The drug AZT taken during pregnancy reduces significantly the chance of transmitting HIV to the baby

• AZT treatment of mothers combined with cesarean sectioning to deliver infants reduces infection rates to 1%

Babies born to mothers infected with HIV:

• may or may not be infected with the virus

• share their mothers' antibodies to HIV for several months

If these babies lack symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be made until after 15 months of age. By this age babies are unlikely to still carry their mothers' antibodies and will have produced their own if they are infected. 

New technologies are being used  to detect HIV  infection in infants (3-15 months).  A number of blood tests are being used to detect the virus in babies younger than 3 months.

       

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Symptoms

Aids

Opportunistic infections common in people with AIDS cause such symptoms as: 

• abdominal cramps 

• coma 

• coughing 

• difficult or painful swallowing

• extreme fatigue  

• fever

• lack of coordination 

• mental symptoms such as confusion and forgetfulness    

• mouth ulcers in the genital region

• nausea

• pelvic inflammatory disease  

• persistent or frequent yeast infections (oral or vaginal)

• persistent skin rashes or flaky skin 

• seizures 

• severe and persistent diarrhea 

• severe headaches   

• shortness of breath 

• sore throat

• sweats  

• swollen lymph glands 

• weight loss 

• vision loss    

• vomiting 

as well as severe Herpes infections causing:

• anal sores

• genital sores

• mouth sores

• Shingles, a painful nerve disease   

Children with AIDS are prone to the same opportunistic infections as adults, but as well experience severe forms of bacterial infections such as:  

• conjunctivitis (pink eye) 

• ear infections  

• tonsillitis      

• delayed development or failure to thrive.      

as well as

• delayed development

• failure to thrive     

AIDS sufferers commonly develop various cancers caused by viruses such as:  

• Cervical Cancer  

• Kaposi's Sarcoma

as well as  

Cancers of the immune system (lymphomas) which are more aggressive and difficult to treat in AIDS sufferers and which appear in light-skinned people as:

• round brown, reddish or purple spots which develop in the skin or in the mouth

In dark-skinned people:

• the spots are more pigmented

People with AIDS may experience phases of intense life-threatening illness followed by phases of normal functioning. However, many people are too debilitated by the symptoms of AIDS to hold steady employment or do household chores.  

Less than 50 people first infected with HIV over 10  years ago have not developed symptoms of AIDS. 

Studies are being undertaken to  determine the causes for this, such as:

• Genetic make-up which may protect them from the effects of HIV

• Particular immune system characteristics

• Whether the infection was a less aggressive strain of the virus

AIDS can  lay dormant until years after infection, and in untreated cases the average time for the disease to develop is 10 years or more. 

HIV infection is also associated with an acute illness in most infected persons. This illness, called acute HIV infection begins within 1-3 weeks of exposure, and usually involves a combination of symptoms. 

• HIV present in large quantities in genital secretions 

• Symptoms are often mistaken for those of other viral infection and are very infectious during this period

• Symptoms may not surface for years after HIV first enters the body in adults, or within 2 years in children born with HIV

Period of asymptomatic infection is highly variable with some people:

• beginning symptoms within a few months

• having no symptoms for 10 years or more

• having symptoms resolve themselves within 1-3 weeks 

During the asymptomatic period HIV actively multiplies infecting and killing immune system cells causing:  

• A decline in blood levels of CD4+ T cells (T4 cells), the immune system's main infection fighters 

• Cells to be disabled or destroyed by the virus without causing symptoms

Stages of HIV Infection

Acute HIV Syndrome

First stage seroconversion

• virus rapidly spreads to organs, especially the lymphoid tissues

• HIV virus not very aggressive in causing diseases or severe symptoms

Asymptomatic State 

• infection is latent  

• virus starts to grow and multiply in the lymph nodes

Symptomatic Disease/AIDS

• Viremia (spread of virus in the blood) 

• Loss of immune system, mainly due to infection of CD4+ T-Lymphocytes

End stage Disease

• immune system collapses

• virus continues to slowly destroy the Immune System for up to 10 years 

• usually an opportunistic infection is the cause of death

Conditions relating to HIV

Viral infections

• Herpes Simplex

• Human papillomavirus  

• Molluscum Contagiosum

• Varicella zoster

Fungal infections  

• Candidiasis

• Dermatophyte infections

• Pityrosporum Folliculitis  

Inflammatory Conditions  

• Eczema

• Psoriasis

• Seborrhoeic Dermatitis

Malignancies

• Kaposi's sarcoma

• Lymphomas

Others

• Bacillary angiomatosis

• Drug eruptions

• Non-specific e.g. hair, nail changes

• Nonspecific folliculitis

• Scabies

 

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Diagnosis

The AIDS test is a test that measures the immune response to HIV, consisting of antibodies that are generated in response to the infection. 

Standard AIDS Test 

The Standard AIDS Test measures antibodies.  These take time to develop, so in the very early stages of infection there may be a negative antibody test even though the person can be infected

Under these circumstances HIV infection can be checked by measuring the virus in the blood using either:

• a p24 antigen test (available through health care professionals)

• a viral load assay

Tests should be carried out on:

• anyone who had a blood transfusion before 1985

• anyone who has had unprotected sex with an infected person

• infants of infected mothers

HIV 

The standard blood test for HIV is negative in persons with acute HIV infection, so a special blood test has to be used if this diagnosis is suspected. 

There are two tests to diagnose acute HIV infection: 

• HIV viral load  

• HIV p24 antigen test (both available through health care professionals)  

Tests should be carried out:

On persons who have had a known exposure to the infection through:

• sharing needles

• unprotected sex

and on persons 

• who have symptoms of acute HIV infection

Standard blood test becomes positive about 4-6 weeks after infection.  HIV is mainly detected by testing a blood sample  for the:  

• presence of antibodies (disease-fighting proteins) to HIV

HIV antibodies generally do not reach detectable levels until 1-3 months following infection, sometimes  taking up to 6 months to be generated in large enough quantities  to show up in standard blood tests 

HIV testing is also carried out on samples of:

• saliva

• urine 

Early testing for HIV infection should be carried out as soon as antibodies to the virus develop to enable:

• Appropriate treatment to be received when they are most able to combat HIV  

• The emergence of certain opportunistic infections to be prevented 

• HIV-infected people to be alerted

• High-risk behaviors that could spread HIV to others to be avoided 

HIV testing and counselling are available  in most doctors' offices or health clinics. Individuals can be tested anonymously at many sites if they have particular concerns about confidentiality. In addition, blood samples for anonymous HIV testing may now be collected at home. Home-based test kits are available by telephone order or over the counter at pharmacies.

Two different types of antibody tests are used to diagnose HIV infection:

• ELISA

• Western Blot

If a person is highly likely to be infected with HIV and yet both tests are negative, a doctor may test for the presence of HIV itself in the blood, with a repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.

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Treatment

When AIDS first surfaced in the United States, no drugs were available to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. However, during the past 10 years, therapies have been developed to fight both HIV infection and its associated infections and cancers.

The Food and Drug Administration (FDA) has approved a number of drugs for the treatment of HIV infection including:

• Abacavir Succinate

• Nucleoside Analog Reverse Transcriptase inhibitors (NRTIs) 

• Didanosine (ddI) 

• Lamivudine (3TC) 

• Stavudine (D4T) 

• Zalcitabine (ddC) 

• Zidovudine (also known as AZT) 

These drugs slow the spread of HIV and delay the onset of opportunistic infections. The drugs do not prevent transmission of HIV to other individuals                                                       

Also available for use in combination with other antiretroviral drugs during stages of HIV infection  are Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as: 

• Delavirdine 

• Efavirenz 

• Nevirapine 

Virus replication is interrupted at a later step by anti-HIV drugs, called protease inhibitors such as:

• Indinavir 

• Nelfinavir 

• Ritonavir 

• Saquinivir 

HIV can become resistant to each class of drugs, so a combination treatment using both is necessary to effectively lower the amount of virus in the blood. It appears this cocktail will no longer result in complete eradication of the virus. Persons who have stopped the drug cocktail even after two years of treatment have generally had a rapid return of the virus.

Antiretroviral drugs do not cure HIV infection or AIDS and can have severe side effects:

AZT may cause:

• red or white blood cell depletion, especially when taken in the later stages of the disease

If the loss of blood cells is severe:

• treatment with AZT must be discontinued

DdI can cause: 

• diarrhea 

• gastrointestinal  disorders associated with protease inhibitors                                   

• nausea 

• painful nerve damage 

• pancreas inflammation

Protease inhibitors can interact with other drugs resulting in serious side effects such as: 

• abnormal redistribution of body fat among some individuals receiving protease inhibitors

Drugs available to treat opportunistic infections include:

• Foscarne

• Ganciclovir

used to treat cytomegalovirus eye infections 

• Fluconazole

used to treat yeast and other fungal infections 

• Pentamidine

• TMP/SMX

used to treat Pneumocystis carinii pneumonia (PCP)  

Adults with HIV whose CD4+ T-cell counts drop below 200 are given treatment to prevent the occurrence of PCP. Children are given PCP preventive therapy when their CD4+ T-cell counts drop to levels considered below normal for their age group.

Research

It is unsure whether anti viral drugs given after exposure to HIV can prevent infection. There are trials going on in most large cities to treat people exposed to HIV referred to as "post-exposure prophylaxis."

In carefully controlled experiments doctors are trying to determine if the immune system, the body's natural defense mechanism, can keep the virus under control after drug therapy is stopped.  

Results show  that persons who are treated with potent anti- viral drugs (often referred to as HAART - highly active antiretroviral therapy) develop strong responses to the virus as soon as they become infected, possibly strong enough to successfully control the virus. 

About 1 in 100 HIV infected persons is a so-called long-term non-progressor, meaning that they have been infected for up to 20 years and still have a normal CD4 count and low viral load, showing the virus has caused little damage so far.

A number of  different methods are being tried to make an effective AIDS vaccine.  Since anti viral drugs are extremely expensive, the only hope for worldwide control of HIV is  the development of an effective vaccine. Clinical trials of AIDS treatments involve comparing the effects of one treatment compared to another.

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Prevention

Because many people infected with HIV have no symptoms, it is not known with certainty whether a sexual partner is infected unless he/she has been tested repeatedly for the virus or has not engaged in any risky behavior. 

Help Factors

• Abstinence from sex

• Use of male latex condoms whenever having oral, anal or vaginal sex is recommended for protection

• Use of water-based lubricants should be used with latex condoms 

• Some spermicides can kill HIV organisms

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