Leprosy

Definition:
Leprosy is an infectious disease that has been known since biblical times. It is characterized by disfiguring skin sores, peripheral nerve damage, and progressive debilitation.
Alternative Names:
Hansen's disease
Causes, incidence, and risk factors:
Leprosy is caused by the organism Mycobacterium leprae . It is not very contagious (difficult to transmit) and has a long incubation period (time before symptoms appear), which makes it difficult to determine where or when the disease was contracted. Children are more susceptible than adults to contracting the disease.
Leprosy has two common forms, tuberculoid and lepromatous, and these have been further subdivided. Both forms produce sores on the skin, but the lepromatous form is most severe, producing large, disfiguring nodules (lumps and bumps).
All forms of the disease eventually cause peripheral neurological damage (nerve damage in the arms and legs) which causes sensory loss in the skin and muscle weakness. People with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from lack of sensation.
Leprosy is common in many countries worldwide, and in temperate, tropical, and subtropical climates. Approximately 100 cases per year are diagnosed in the U.S. Most cases are limited to the South, California, Hawaii, and U.S. island possessions.
Effective medications exist, and isolation of victims in "leper colonies" is unnecessary. The emergence of drug-resistant Mycobacterium leprae , as well as increased numbers of cases worldwide, have led to global concern about this disease.
Signs and symptoms
The earliest sign of leprosy is commonly a spot on the skin that may be slightly redder, darker, or lighter than the person's normal skin. The spot may lose feeling and hair. In some people the only sign is numbness in a finger or toe.
If left untreated, leprosy has serious effects on the body, including:
Hands and feet - Leprosy bacteria attack the nerves in the hands and feet and cause them to become numb. A person may get cuts or burns on the numb parts and not know it, leading to infections which cause permanent damage. Fingers and toes may be lost to infection. Serious infections in the feet may require amputation. Paralysis may cause the fingers and toes to curl up permanently.
Eyes - Leprosy bacteria attack the nerves around the eyes causing the loss of blinking reflex (which protects the eye from injury and moistens the surface). The eyes become dry and infected, and blindness may result. Because of numbness of the eye, the person cannot feel dirt or scratches in the eye.
Face - Damage to the internal lining of the nose causes scarring and eventual collapse of the nose.
Diagnosis;
Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. These are easy to observe and elicit by any health worker after a short period of training. In practice, most often persons with such complaints report on their own to the health centre. Only in rare instances is there a need to use laboratory and other investigations to confirm a diagnosis of leprosy.
In an endemic country or area, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs:
skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves
positive skin smears
The skin lesion can be single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common. Sensory loss is a typical feature of leprosy. The skin lesion may show loss of sensation to pin pick and/or light touch. Thickened nerves, mainly peripheral nerve trunks constitute another feature of leprosy. A thickened nerve is often accompanied by other signs as a result of damage to the nerve. These may be loss of sensation in the skin and weakness of muscles supplied by the affected nerve. In the absence of these signs, nerve thickening by itself, without sensory loss and/or muscle weakness is often not a reliable sign of leprosy. The clinical system of classification for the purpose of treatment includes the use of number of skin lesions and nerves involved as the basis for grouping leprosy patients into multibacillary (MB) and paucibacillary (PB) leprosy.
Positive skin smears:
In a small proportion of cases, rod-shaped, red-stained leprosy bacilli, which are diagnostic of the disease, may be seen in the smears taken from the affected skin when examined under a microscope after appropriate staining. Leprosy can be classified on the basis of clinical manifestations and skin smear results. In the classification based on skin smears, patients showing negative smears at all sites are grouped as paucibacillary leprosy (PB), while those showing positive smears at any site are grouped as having multibacillary leprosy (MB).A person presenting with skin lesions or with symptoms suggestive of nerve damage, in whom the cardinal signs are absent or doubtful should be called a "suspect case" in the absence of any immediately obvious alternate diagnosis . Such individuals should be told the basic facts of leprosy and advised to return to the centre if signs persist for more than six months or if at any time worsening is noticed. Suspect cases may be also sent to referral clinics with more facilities for diagnosis.
Treatment:
Medications used to eliminate the microorganism and to reduce symptoms include:
Dapsone
Rifampin
Clofazimine
Ethionamide
Aspirin, prednisone, or thalidomide are used for the control of inflammation (e.g., "erythema nodosum leprosum") that may occur with therapy
Possible Complications
Permanent nerve damage
Cosmetic disfigurement
Prevention
Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease).

Typhoid

Introduction
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world. Typhoid fever spreads through contaminated food and water or through close contact with someone who's infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications.
Vaccines against typhoid fever are available, but they're only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.
Causes
Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they're related, this isn't the same as the bacteria responsible for salmonellosis, another serious intestinal infection.
Fecal-oral routeThe bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up the typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn't washed carefully after using the bathroom. You can also become infected by drinking water contaminated with the bacteria.
Typhoid carriersEven after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.
Risk factors
Typhoid fever remains a serious threat in the developing world, where it affects more than 12 million people annually. The disease is endemic in India, Southeast Asia, Africa, South America and in many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you're at increased risk if you:
§ Work in or travel to areas where typhoid fever is endemic
§ Have close contact with someone who is infected or has recently been infected with typhoid fever
§ Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
§ Drink water contaminated by sewage that contains S. typhi

Symptoms
The symptoms of typhoid fever start 7-14 days after consuming food or drinks contaminated with the Salmonella typhi bacteria.Untreated typhoid runs a course having four classical stages each lasting for about a week.
Fever with headache, malaise, relatively slow heart beats and cough.
There may be abdominal pain and episodes of bleeding from the nose.
Into the second week of untreated infection, symptoms seen are:
Fever hovers around 40°C (104°F) with relatively low pulse rate.
The abdomen seems bloated, distended and painful in the right lower quadrant. The bowel sounds are loud and audible.
Minute 'rose-colored' skin rash over the lower chest and upper abdomen, occur in nearly 50% of cases and last for 3 to 5 days.
The person may appear to be in a delirious state, constantly muttering to himself or picking at the bed-sheets.
Diarrhea may occur in this stage. Around 5 to 8 diarrheal stools, greenish, and looking like pea-soup are seen. However, constipation is more commonly seen.
Joint pains may be present.
The liver and spleen may seem enlarged.
The 3rd week of untreated typhoid can present with life-threatening emergencies:
Intestinal perforation ' perforation of the walls of small intestine can be lfe-threatening.
Bleeding into the intestines
Spread of the infection to the brain via the blood causing inflammation of the brain.
Inflammation of the gall-bladder, heart muscles; infections in the bones, and formation of abscesses within other important internal organs.
Diagnosis
Important changes seen in laboratory investigations are:
Complete Blood Count:In the first week of infection the blood counts will show
Reduction in the total number of white blood cells (leucopenia) and eosinophils
Increased number of and lymphocytes.
Blood Cultures: cultures come positive in the 1st and 2nd weeks of infection.
Widal Test: This test is negative in the 1st week and strongly positive from the 2nd week of infection.
Liver Function Tests: from the second week onwards, the liver transaminases appear to be elevated
Treatment
Antibiotic therapy is the only effective treatment for typhoid fever.
Commonly prescribed antibiotics
In the United States, most doctors prescribe ciprofloxacin for nonpregnant adults. Women who are pregnant and children most often receive ceftriaxone (Rocephin) injections, because ciprofloxacin has been associated with problems in these groups. All of these drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.
Problems with antibiotic resistance
In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of severe side effects, a high relapse rate and widespread bacterial resistance. In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin.
Supportive therapy
Other treatment steps aimed at managing symptoms include:
§ Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you're severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).
§ Eating a healthy diet. Nonbulky, high-calorie meals can help replace the nutrients you lose when you're sick.
Drugs used in the treatment of this disease:
· Cefotaxime sodium (Ceftriaxone-BC)
· Amoxycillin(Chem mart Amoxycillin)
· Ciprofloxacin hydrochloride(Ciproxin)
Complications
Intestinal bleeding or perforation The most serious complication of typhoid fever — intestinal bleeding or perforation — may develop in the third week of illness. About 5 percent of people with typhoid fever experience this complication.
Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed by the appearance of blood in your stool.
A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening emergency requires immediate medical care.
Other, less common complications Other possible complications include:
§ Inflammation of the heart muscle (myocarditis)
§ Pneumonia
§ Inflammation of the pancreas (pancreatitis)
§ Kidney or bladder infections
§ Infections of the spine (osteomyelitis)
§ Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
§ Psychiatric problems such as delirium, hallucinations and paranoid psychosis
With prompt treatment, nearly all people in industrialized nations recover from typhoid. Without treatment, some people may not survive complications of the disease.
Prevention
In many developing nations, the public health goals that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither is 100 percent effective, and both require repeat vaccinations.
If you're traveling to an area where typhoid fever is endemic, consider being vaccinated. But because the vaccine won't provide complete protection, be sure to follow these guidelines as well:
§ Wash your hands. Frequent hand washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn't available.
§ Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
§ Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
§ Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors — it's more likely to be contaminated.
To prevent infecting othersIf you're recovering from typhoid, these measures can help keep others safe:
§ Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
§ Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
§ Avoid handling food. Avoid preparing food for others until your doctor says you're no longer contagious. If you work in the food service industry or a health care facility, you won't be allowed to return to work until tests show that you're no longer shedding typhoid bacteria.
§ Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

Tuberculosis

Definition of Tuberculosis
Tuberculosis is a chronic infection caused by the bacteria Mycobacterium tuberculosis (and occasionally other variants of Mycobacterium). It usually involves the lungs, but other organs of the body can also be involved.
Tuberculosis Causes
All cases of TB are passed from person to person via droplets. When someone with TB infection coughs, sneezes, or talks, tiny droplets of saliva or mucus are expelled into the air, which could be inhaled by another person.
Once infectious particles reach the alveoli, small sacs in your lungs, another cell called the macrophage engulfs the TB bacteria.
Then the bacteria are transmitted to your lymph system and bloodstream and spread to other organs.
The bacteria further multiply in organs that have high oxygen pressures, such as the upper lobes of your lungs, your kidneys, bone marrow, and meninges—the membranelike coverings of your brain and spinal cord.

When the bacteria cause clinically detectable disease, you have TB.
People who have inhaled the TB bacteria, but in whom the disease is controlled are referred to as infected. They have no symptoms, frequently have a positive skin test, yet cannot transmit the disease to others.
Risk factors for TB include the following:
HIV infection
Low socioeconomic status
Alcoholism
Homelessness
Crowded living conditions
Diseases that weaken the immune system
Migration from a country with a high number of cases
Health care workers
Tuberculosis Symptoms
You may not notice any symptoms of illness until the disease is quite advanced. Even then the symptoms–loss of weight, loss of energy, poor appetite, fever, a productive cough, and night sweats–might easily be blamed on another disease.
Only about 10% of people infected with M tuberculosis ever develop tuberculosis disease. Many of those who suffer TB do so in the first few years following infection, but the bacillus may lie dormant in the body for decades.
Although most initial infections have no symptoms and people overcome them, they may develop fever, dry cough, and chest x-ray abnormalities.
This is called primary pulmonary tuberculosis.
Pulmonary tuberculosis frequently goes away by itself, but in 50-60% of cases the disease can return.

Tuberculous pleuritis may occur in 10% of people who have the lung disease from tuberculosis.
The pleural disease occurs from the rupture of a diseased area into the pleural space, the space between your lung and the lining of the abdominal cavity.
These people have a nonproductive cough, chest pain, and fever. The disease may go away and then come back at a later date.

In a minority of people with weakened immune systems, TB bacteria may spread through their blood to various parts of their body.
This is called miliary tuberculosis and produces fever, weakness, loss of appetite, and weight loss.
Cough and difficulty breathing are less common.

Generally, return of dormant tuberculosis infection occurs in the upper lungs.
Common cough with a progressive increase in production of mucus
Coughing up blood
Other symptoms include the following:
Fever
Loss of appetite
Weight loss
Night sweats

About 15% of people may develop tuberculosis in an organ other than their lungs. About 25% of these people usually had known TB with inadequate treatment. The most common sites include the following:
Lymph nodes
Genitourinary tract
Bone and joint sites
Meninges
The lining covering the outside of the gastrointestinal tract
Exams and Tests
The doctor will complete the following tests to diagnose tuberculosis. You may not be hospitalized for either the initial tests or the beginning of treatment.
Chest x-ray: The most common diagnostic test that leads to the suspicion of infection is a chest x-ray.
In primary TB an x-ray will show an abnormality in your mid and lower lung fields, and lymph nodes may be enlarged.
Reactivated TB bacteria infiltrate the upper lobes of your lungs.
Miliary tuberculosis exhibits diffuse nodules.

Mantoux skin test: This test helps identify people infected with M tuberculosis but who have no symptoms. A doctor must read the test.
The doctor will inject 5 units of purified protein derivative (PPD) into your skin. If a raised bump of more than 5 mm (0.2 in) appears at the site 48 hours later, the test may be positive.
This test can often indicate disease when there is none (false positive). Also, it can show no disease when you may in fact have TB (false negative).

Sputum testing: Sputum testing for acid-fast bacilli is the only test that confirms a TB diagnosis. If sputum (the mucus you cough up) is available, or can be induced, a lab test may give a positive result in up to 30% of people with active disease.
Sputum or other bodily secretions such as from your stomach or lung fluid can be cultured for growth of mycobacteria to confirm the diagnosis.
It may take 1-3 weeks to detect growth, but 8-12 weeks to be certain
Tuberculosis Treatment
Medical Treatment
Today, doctors treat most people with TB outside the hospital. Gone are the days of going to the mountains for long periods of bed rest. Doctors seldom use surgery.
Doctors will prescribe several special medications that you must take for 6-9 months.
Standard therapy for active TB consists of a 6-month regimen:
2 months with Rifater (isoniazid, rifampin, and pyrazinamide)
4 months of isoniazid and rifampin (Rifamate, Rimactane)
Ethambutol (Myambutol) or streptomycin added until your drug sensitivity is known

Treatment takes that long because the disease organisms grow very slowly and, unfortunately, also die very slowly.
Doctors use multiple drugs to reduce the likelihood of resistant organisms emerging.
Often the drugs will be changed or chosen based on the laboratory results.
If doctors doubt that you are taking your medicine, they may have you come to the office for doses. Prescribing doses twice a week helps assure compliance.
The most common cause of treatment failure is people's failure to comply with the medical regimen. This may lead to the emergence of drug-resistant organisms. You must take your medications as directed, even if you are feeling better.

Another important aspect of tuberculosis treatment is public health.
Doctors likely will contact or trace your relatives and friends.
Your relatives and friends may need to undergo appropriate skin tests and chest x-rays.
Prevention
Treatment to prevent TB in a single person aims to kill walled-up germs that are doing no damage right now, but could break out years from now and become active.
If you should be treated to prevent sickness, your doctor usually prescribes a daily dose of isoniazid (also called INH), an inexpensive TB medicine.
You will take INH for up to a year, with periodic checkups to make sure you are taking it as prescribed and that it is not causing undesirable side effects.

Treatment also can stop the spread of TB in large populations.
Tuberculosis vaccine, known as bacille Calmette-Guérin (BCG) may prevent the spread of tuberculosis and tuberculous meningitis in children, but the vaccine does not necessarily protect against pulmonary tuberculosis.
Health officials generally recommend the vaccine in countries or communities where the rate of new infection is greater than 1% per year.

AIDS/HIV infection

AIDS/HIV infection

Alternative Names
Acquired immune deficiency syndrome
Definition
AIDS (Acquired Immune Deficiency Syndrome) is the final and most serious stage of HIVDISEASE, which causes severe damage to the immune system.
According to the Centers for Disease Control and Prevention, AIDS begins when a person with HIV infection has a CD4 cell count below 200. CD4 cells are also called "T-cells" or "helper cells"; they are a type of immune cell. AIDS is also defined by numerous opportunistic infections and cancers that occur in the presence of HIV infection.
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 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
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.
Exams and Tests
The following is a list of AIDS-related infections and cancers that people with AIDS acquire as their CD4 count decreases. Previously, having AIDS was defined as having HIV infection and getting one of these additional diseases. Now it is additionally defined as a CD4 count below 200, even without an opportunistic infection. Many other illnesses and corresponding symptoms may develop in addition to those listed here.
Common with CD4 count below 350 cells/ml:
Herpes simplex virus -- causes ulcers/vesicles in the mouth or genitals, occurring more frequently and more severely in an HIV-infected patient than before HIV infection
Tuberculosis -- infection by the tuberculosis bacteria that predominately affects the lungs, but can affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system
Oral or vaginal thrush -- yeast infection of the mouth or genitals
Herpes zoster (Shingles) -- ulcers/vesicles over a discrete patch of skin caused by the varicella zoster virus
Non-Hodgkin's lymphoma -- cancer of the lymph glands
Kaposi's sarcoma -- Cancer of the skin, lungs, and bowel, associated with a herpes virus (HHV-8). Can occur at any CD4 count, but more likely at lower CD4 counts, and more common in men than women
CD4 count below 200 cells/ml
Pneumocystis carinii pneumonia, "PCP pneumonia," now called Pneumocystic jiroveci pneumonia
Candida esophagitis -- painful yeast infection of the esophagus
Bacillary angiomatosis -- Skin lesions caused by a bacteria called Bartonella, which is usually acquired from cat scratches
CD4 count below 100 cells/ml
Cryptococcal meningitis -- infection of the lining of the brain by a yeast
AIDS dementia -- worsening and slowing of mental function, caused by HIV itself
Toxoplasmosis encephalitis -- infection of the brain by a parasite, which is frequently found in cat feces; causes discrete lesions in the brain
Progressive multifocal leukoencephalopathy -- a viral disease of the brain caused by a virus (called the JC virus) that results in a severe decline in cognitive and motor functions
Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV
Cryptosporidium diarrhea -- Extreme diarrhea caused by one of several related parasites
CD4 count below 50/ml
Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis
Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes
In addition to the CD4 count, HIV RNA load, and basic screening lab tests, regular vaginal Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in immunocompromised patients. . Anal Pap smears to detect potential cancers may also be important in both HIV infected men and women.
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 their 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
There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body.
If you're HIV-negativeThe following measures can help keep you from being infected with HIV:
§ Educate yourself and others. Make sure you understand what HIV is and how the virus is transmitted. Just as important, teach your children about HIV.
§ Know the HIV status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HIV.
§ Use a new latex or polyurethane condom every time you have sex. If you don't know the HIV status of your partner, use a new latex condom every time you have anal or vaginal sex. If you're allergic to latex, use a plastic (polyurethane) condom. Avoid lambskin condoms — they do not protect you from HIV. If you don't have a male condom, use a female condom. Use only water-based lubricants, not petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a condom,dental dam — a piece of medical-grade latex —or plastic wrap. Remember that although condoms can reduce your risk of contracting HIV, they don't eliminate the risk entirely. Condoms can break or develop small tears, and they may not always be used properly.
§ Consider male circumcision. A large study in 2006 by the National Institutes of Health showed that medically performed circumcision significantly reduced a man's risk of acquiring HIV through heterosexual intercourse. The study, conducted in Kenya, showed a 53 percent reduction of HIV infection in circumcised HIV-negative men compared with uncircumcised men in the study. The outcome was heralded by the NIH as good news not only because it reduced the number of HIV-infected men, but also because it could lead to fewer infections among women in areas of the world where HIV is spread primarily through heterosexual intercourse.
§ Use a clean needle. If you use a needle to inject drugs, make sure it's sterile, and don't share it. Take advantage of needle exchange programs in your community and consider seeking help for your drug use.
§ Be cautious about blood products in certain countries. Although the blood supply in the United States is now well screened, this isn't always the case in other countries. If an emergency requires that you receive blood or blood products in another country, get tested for HIV as soon as you return home.
§ Get regular screening tests. If you are a woman, have a yearly Pap test. Men and women who engage in anal sex should also have regular tests for anal cancer.
§ Don't become complacent. Because potent antiretroviral medications have reduced the number of AIDS deaths in the United States, you may think that HIV infection is no longer a problem. But HIV/AIDS is still a terminal illness for which there is no vaccine and no cure. Right now, the only way to stay healthy is to protect yourself and others from infection.
If you're HIV-positiveIf you've received a diagnosis of HIV/AIDS, the following guidelines can help protect others:
§ Follow safe sex practices. The only foolproof way to protect others from infection is to avoid practices that expose them to blood, semen or vaginal secretions. Barring that, carefully follow guidelines for safe sex, including using a new latex condom every time you have vaginal or anal sex and using a dental dam, condom or piece of plastic wrap during oral sex. If you use sexual devices, don't share them. It's also important to avoid having unprotected sex with other HIV-positive people because of the risk of acquiring or passing on a drug-resistant strain of the virus.
§ Tell your sexual partner(s) you have HIV. It's important to tell anyone with whom you've had sex that you're HIV-positive. Your partners need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so that they don't infect others.
§ If your partner is pregnant, tell her you have HIV. Even if you're not the father, be sure to tell any pregnant woman with whom you've had sex that you're HIV-positive. She needs to receive treatment to protect her own health and that of her baby.
§ Tell others who need to know. Although only you can decide whether to tell friends and family about your illness, you do need to inform your health care providers of your HIV status. This is not just to protect them, but also to ensure that you get the best possible medical care.
§ Don't share needles or syringes. If you use intravenous drugs, never share your needles and syringes.
§ Don't donate blood or organs. The virus will spread to other people.
§ Don't share razor blades or toothbrushes. These items may carry traces of HIV-infected blood.
§ If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby's risk by as much as two-thirds.