HIV AIDS

AIDS (Acquired Immuno Deficiency Syndrome) is caused by HIV (Human Immunodeficiency virus) by progressively destroying the body's immune system. HIV breaks down the body's ability to fight infections and certain cancers. People diagnosed with HIV may develop opportunistic infections, which are caused by microbes such as viruses or bacteria that take advantage of the weakened immune system. What would normally be an infection or virus that could fought off by an otherwise healthy person, could become debilitating or even deadly to one with HIV. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can come in the form of anal, vaginal or oral sex, blood transfusion, contaminated intravenous needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding, or other exposure to one of the above bodily fluids. Untreated HIV disease is characterized by a gradual deterioration of immune function. Most notably, crucial immune cells called "CD4 positive T cells" are disabled and killed during the typical course of infection. These cells, also called "T-helper cells," play a key role in the immune system's communication process, signaling other cells in the immune system to perform their special functions. AIDS is the resulting collection of symptoms and infections from the damage to the immune system caused by infection with the human immunodeficiency virus (HIV). 1

Also known as Acquired immune deficiency syndrome, the late stage of the condition leaves individuals prone to opportunistic infections and tumors. There have been several advancements in the treatments for AIDS and HIV including the ability to slow the virus's progression. Presently there is no known cure. HIV may not cause symptoms for a number of years. Early symptoms that you may experience a month or two after becoming infected may last a couple of weeks. These include :

Rapid weight loss Dry cough Recurring fever Night sweats Extreme, unexplained fatigue Swollen lymph nodes in armpits, neck, or groin White spots on the tongue or in the mouth or throat Headache Discomfort from light Rash Depression Irritable mood

After the initial symptoms are gone, there may be no symptoms for months to years. Then, the following symptoms may occur over the course of 13 years:

Swollen lymph glands all over the body Fungal infections of the mouth, fingernails, toes Repeated vaginal infections (yeast and trichomonas) 2

Development of lots of warts Exacerbations of prior conditions, such as eczema, psoriasis, herpes infection Shingles Night sweats Weight loss Chronic diarrhea

These HIV symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids. More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years. Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood-the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms. A healthy, uninfected person usually has 800 to 1,200 CD4+ T cells per cubic millimeter of blood. If the HIV infection goes untreated, the amount of these cells in a individual's blood progressively declines. When the CD4+ T cell count falls below 200/mm3, a person 3

becomes increasingly vulnerable to the opportunistic infections and cancers that typify AIDS, the end stage of HIV disease. As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than 3 months. Once HIV has progressed to AIDS, the immune system has become quite weakened. Opportunistic infections are infections that people with a normal immune system don't usually get. These infections occur in patients with AIDS because the immune system isn't able to fight them off. People with AIDS often suffer from debilitating weight loss, diarrhea, infections of the intestinal tract, brain, eyes, and other organs, such as the lungs resulting in pneumocystis carinii pneumonia (PCP), and cancers such as Kaposi's sarcoma and certain types of lymphomas. Several of the most common opportunistic infections and other complications of AIDS include:

Thrush (an overgrowth of yeast) Pneumonia Invasive fungal infections (resulting in brain and/or lung infections) Toxoplasmosis infection Tuberculosis Viral brain infection Kaposi's sarcoma Lymphoma Cervical cancer 4

Eye disease due to cytomegalovirus infection Intestinal infections, typically due to Shigella, Salmonella, and Campylobacter Severe weight loss Severe skin rashes Reactions to medications Psychiatric problems, including depression and dementia

A blood test called an ELISA test is used to detect HIV infection. If an ELISA test is positive, the Western blot blood test is usually done to confirm the diagnosis. The ELISA test may be negative if you were infected with HIV recently. Many people (95%) will have a positive test within three months. Most people (99%) will have a positive test within six months. If an ELISA test is negative, but you think you may have HIV, you should be tested again in 13 months. The CDC (Centers for Disease Control and Prevention) estimates that approximately 40,000 persons in the United States become infected with HIV each year. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV and about one-fourth have not yet been diagnosed and are unaware of their infection. Currently there are no available drugs that cure the HIV infection or AIDS. They can suppress the virus, even to undetectable levels, but are unable to completely eliminate HIV from the body. Hence, infected patients still need to take antiretroviral drugs.

The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections. Also approved is a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle. FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV's ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules. Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS. Antiretroviral Therapy (HAART). As HIV reproduces itself, different strains of the virus emerge, some that are resistant to antiretroviral drugs. Therefore, doctors recommend patients infected with HIV take a combination of antiretroviral drugs known 6

as HAART. This strategy, which typically combines drugs from at least two different classes of antiretroviral drugs, has been shown to effectively suppress the virus when used properly. Developed by NIAID-supported researchers, HAART has revolutionalized how we treat people infected with HIV by successfully suppressing the virus and decreasing the rate of opportunistic infections. Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated. HIV Transmission and Antiretroviral Drugs. Although the use of HAART has greatly reduced the number of deaths due to HIV/AIDS, this powerful combination of drugs cannot suppress the virus completely. Therefore, people infected with HIV who take antiretroviral drugs can still transmit HIV to others through unprotected sex and needle sharing. People infected with HIV have impaired immune systems that can leave them susceptible to opportunistic infections (OIs) and AIDS-associated co-infections, caused by a wide range of microorganisms such as protozoa, viruses, fungi, and bacteria. One example is hepatitis C virus (HCV) infection which can lead to liver cancer.

Potent HIV therapies such as HAART, however, have produced dramatic responses in patients by suppressing HIV and slowing the progression of OIs and AIDS-associated co-infections. These therapies allow the immune system to recover, sustain, and protect the body from other infections. Hence, antiretroviral drugs provide a way for the immune system to remain intact and effective, thereby improve the quality and duration of life for people with HIV.

References

Hiv Aids, About.com,<http://www.emedicinehealth.com/hivaids/page3_em.htm>, viewed 26 April 2011, Hiv Aids, Mayoclinic,<http://www.mayoclinic.com/health/hivaids/DS00005/DSECTION=symptoms>, viewed 26 April 2011, Hiv Aids, About.com,<http://aids.about.com/od/newlydiagnosed/a/hivsymptom.htm>, viewed 26 April 2011,