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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.

Presently, there is no cure for HIV infection or AIDS, nor is there a vaccine to prevent HIV infection. However, there are new medications which help slow the progression of the infection and reduce the seriousness of HIV consequences in many people.

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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.

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. B cells secrete antibodies (protein) into the body's fluids to ambush and attack antigens (foreign protein). T cells 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 the cells and starts to reproduce itself, thereby free 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. With the T cells 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, cytomegalovirus retinitis and Kaposi's sarcoma.

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Causes and Risk Factors

AIDS is transmitted via three main routes:

  • The most common mode of transmission is the transfer of sexual secretions through sexual contact. This is accomplished through exposure of mucous membranes of the rectum, vagina, mouth to blood, semen or vaginal secretions containing HIV.

  • 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.

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Some people infected with HIV are asymptomatic (no symptoms) while others may develop symptoms of HIV from two to 15 years after initial infection. The 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 currently considered to have AIDS when any one of the 26 known opportunistic diseases appear or they have a T cell count of 200 or less. Healthy T cell levels can range from 500 to 1,500.

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.

Signs and 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. However, these people may develop some of the symptoms related to AIDS.

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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, ecause 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, there is 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.

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Over the past 10 years, the FDA has approved several drugs for the treatment of AIDS - including reverse transcriptase (RT) inhibitors (AZT (Retrovir), ddl (Videx), ddC (HIVID), d4T (Zerit), 3TC (Epivir) and Nevirapine (Viramune)) and protease inhibitors (Saquinavir (Invirase), Indinavir (Crixivan) and Ritonavir (Norvir)).

RT inhibitors (also known as nucleoside analogues) help keep HIV from reproducing by blocking the action of an enzyme essential to making new viral particles.

Protease inhibitors interfere with HIV's production of an enzyme called protease. HIV uses protease to cut large proteins into smaller parts which the virus needs to make copies of itself. Without protease, new viruses can be assembled but cannot function to cause further infection.

Prior to 1996, AZT was the standard treatment of AIDS, however, with the approval of the protease inhibitors, doctors are now introducing their patients to combination (cocktail) therapy.

The most common "cocktail" to date is AZT, 3TC and Crixivan or Norvir, but other combinations of RT and protease inhibitors have been used. When HIV enters a cell, AZT and 3TC disrupts the early stage of the virus' reproduction while the protease inhibitors block the final stage of reproduction. The result is that no additional virus is reproduced and the virus is suppressed.

Although this combination therapy has shown promising results in treating AIDS, researchers are still seeking answers to its long term effects, its success on newly-diagnosed AIDS patients and its drug interaction with other AIDS-related conditions, as well as its longevity.

The treatment of HIV infection and AIDS is in a highly dynamic state. Individuals with this condition are advised to seek out experts in their local community who are current with the latest modes of therapy and ongoing clinical trials for evaluating newer therapies.

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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 small risk of contracting AIDS through a blood transfusion. It will also eliminate the more substantial 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 virus.

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Questions to Ask Your Doctor

What tests need to be done to diagnose this condition? How accurate is the test?

Does a positive test mean AIDS?

What type of treatment will you be recommending? How successful is it?

Will you be prescribing any medications to prevent the development of some AIDS related infections?

Are there any alternative treatments avaliable?

Are there experimental protocols in which I might participate?

What are the chances of remaining well? For how long?

Are there any support groups in the area?

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