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Acquired Immune Deficiency Syndrome or HIV infection
Description
AIDS is caused by infection with the human immunodeficiency
virus HIV-1. The HIV virus infects cells in the body that
fight infection. The primary cell infected is the CD4 lymphocyte,
but it infects other infection-fighting cells as well. This
results in the body's immune system being compromised, causing
the body difficulties fighting infections. Because the immune
system has a role in cancer prevention, there is also an
increase in certain cancers. To be HIV positive means that
one is infected with the HIV virus. To be given the diagnosis
of AIDS, one must be infected with HIV, which means that
the HIV infection has compromised the immune system to the
extent that an AIDS-defining illness (one of multiple illnesses)
has occurred. Before current "triple therapy" was developed,
nearly all those who were HIV positive went on to develop
AIDS. Now it is not the case. But, not all persons respond
to "triple therapy" and a proportion still goes on to develop
AIDS.
Causes
HIV can be found in many types of bodily secretions (i.e.,
semen, urine, tears, saliva, blood, breast milk, spinal
fluid, vaginal secretions). However, the risk of transmission
is highest through semen and sexual activities.
Anal sex-highest transmission rate
Heterosexual sex, homosexuals, bisexual males who engage
in unprotected sex
Intravenous drug abusers who share needles
Oral Sex-lower, but risk still present
Blood and blood product transfusions between 1977-1985
(now rare, because blood products are carefully screened)
Contaminated needle stick as in healthcare professionals
(1:300 risk)
Children born to mothers with HIV infection
Not spread through casual contact such as touching, hugging,
or sharing toilet seats
Not transmitted by insect bites such as mosquitoes
No documented cases of HIV infection from saliva or tears;
however, if there is an open sore on the skin or mouth,
the risk increas
Diagnosis
Examination:
May be normal
Signs & symptoms of AIDS-defining illnesses (see below)
Laboratory Findings:
HIV antibody test¨úthe HIV virus multiplies in the body
for weeks or months before the body responds by making antibodies
to it, at which time the HIV test is considered positive.
Decreased CD4 lymphocyte (also known as T-helper cells)
count (the lower the count the more likely to develop infections
and illness)
Symptoms begin to occur with CD4 count falling below 350/ml
Anemia
Polyclonal hypergammaglobulenimia
High cholesterol
Skin antigen testing fails to react
Symptoms
HIV syndrome occurs 3 to 6 weeks after infection and includes:
Fever
Sweats
Sore throat
Enlarged lymph glands
Headaches
Weight loss
Joint aches
Muscle aches
Diarrhea
Rash
Oral ulcers
Symptoms of any opportunistic illness (i.e., bacteria,
fungi, protozoa, and viruses)
Some may not develop any symptoms for years after exposure.
Candidiasis (white patches in mouth)
Pneumocystis carinii (lung infection characterized by
dry cough and shortness of breath)
Herpes simplex (causes ulcers that persist over 1 month)
Lymphoma (enlarged glands)
Kaposi's sarcoma (purple skin lesions)
Diarrheas--cryptosporidosis and isoporiasis
Recurrent pneumonias
Tuberculosis (cough)
HIV encephalopathy (dementia)
HIV wasting syndrome
Cytomegalovirus infection /blindness
Cryptococcosis (especially meningitis)
Disseminated coccidiomycosis (fungal infection found in
Southwest United States, typically affects lungs, but in
HIV may go into spinal fluid and cause meningitis)
AIDS wasting (weight loss) syndrome
Depression and
Similar conditions
Tuberculosis
Many cancers
Hyperthyroidism
Endocarditis
Systemic lupus erythematosus
Chronic meningitis
Ulcerative colitis
Crohn
Treatment
The goal of treatment is to keep CD4 count above 200/ml,
prevent/control opportunistic infections, and improve the
quality of life.
Anti-retroviral drugs (Highly Active Anti Retroviral Therapy
or HAART)-these interfere with the HIV virus' ability to
replicate. Some common ones are listed below:
Nucleoside analogs
Zidovudine (AZT)
Zalcitabine (ddC)
Lamivudine
Staviudine
Protease inhibitors
Inadinavir
Ritonavir
Nelfinavir
Saquinavir
Triple therapy-it has been found that by combining two
nucleoside analogue drugs with one protease inhibitor can
substantially reduce the viral burden, infection rate, and
death rate in HIV infection.
Post-exposure prophylaxis (e.g., after a needle stick)
AZT probably beneficial
AZT plus other antiretroviral drugs probably will be shown
to be more effective.
Prevention
Before the more effective "triple therapy" was developed, various
regimens were recommended to prevent specific infections. For
example, Trimethoprim-Sulfamethoxazole for Pneumocystitis carinii
included various regimens that are now reserved for those who
fail to respond or are intolerant of "triple therapy." eserved
for those who fail to respond or are intolerant of "triple therapy."
Abstinence
Safe sex (use of condoms and oral barriers)
HIV testing prior to a relationship
Stop intravenous drug abuse, sharing of dirty needles,
and other high-risk behaviors.
Healthy lifestyle and join support groups if at risk
