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.