What are HIV and AIDS?

HIV is the abbreviation used for the human immunodeficiency virus. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease.

HIV attacks the body's immune system. Normally, the immune system produces white blood cells and antibodies that attack viruses and bacteria. The infection-fighting cells are called T-cell lymphocytes. Months to years after a person is infected with HIV, the virus destroys the T-cell lymphocytes.

When the T-cell lymphocytes are destroyed, the immune system can no longer defend the body against diseases and tumors. Various infections called opportunistic infections develop. They are called opportunistic because they take advantage of the body's weakened immune system. These infections would not normally cause severe or fatal health problems. However, when you have AIDS, the opportunistic infections eventually cause death because your body can no longer defend itself against them. AIDS is the condition of the body being overwhelmed by opportunistic infections and/or tumors.

How does it occur?

The AIDS virus is NOT spread through the air, in food, or by casual social contact such as shaking hands or hugging. It is passed on only when the blood or body fluids of an infected person mix with someone else's body fluids. This mixing can occur during activities such as:

• unprotected sexual activity

• sharing IV needles

• birth to an HIV-infected mother

• blood transfusions.

The following groups have the highest risk for HIV infection and possible development of AIDS:

• sexually active homosexual men

• bisexual men and their partners

• intravenous drug users and their sexual partners

• people who share needles (for IV drug use, tattooing, or piercing)

• heterosexuals with more than one sexual partner

• people given transfusions of blood or blood products, especially people given emergency transfusions of unscreened blood and people given transfusions in countries where the blood is not rigorously screened

• immigrants from areas with many cases of AIDS (such as Haiti and east central Africa)

• people who have sex with anyone in the above groups

• people who have sex with an HIV-infected partner

• infants born to mothers who are HIV infected.

What are the symptoms?

The symptoms of HIV infection and AIDS are usually the symptoms of the diseases that attack the body because of a weakened immune system:

• fever that lasts from a few days to longer than a month, with no other disease present and no other obvious cause

• prolonged periods of chills and sweats

• chronic or long-lasting fatigue for which other causes have been ruled out

• loss of appetite or weight, especially loss of more than 10% of body weight, with no other disease or condition present

• chronic muscle and joint pain for no known reason

• unexplained, long-lasting sore throat

• unexplained, prolonged swelling of the lymph nodes

• diarrhea, especially if it lasts longer than a month and no other disease is present

• repeated, severe yeast infections in your mouth or vagina despite proper treatment

• a certain kind of sores or changes in the skin (herpes) that last more than 4 weeks.

The opportunistic diseases that most frequently affect someone with AIDS include Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), tuberculosis, meningitis, and herpes simplex infections.

How is it diagnosed?

The ELISA test is the first blood test done to see if you are infected with HIV. If this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the results.

Once you have confirmed positive HIV test results, you must have a thorough medical exam. Your doctor will ask about your medical history and symptoms, if any, and will examine you.

The complete medical history and physical exam includes discussing your history of sexual practices and sexually transmitted diseases. Your doctor will also ask about any history of drug abuse.

The results of your physical and lab exams give your health care provider a baseline for comparison if you develop symptoms later. It is also necessary to screen for certain infections, such as tuberculosis (TB), syphilis, and hepatitis B, which may worsen rapidly or pose a serious risk to others. HIV-positive women should have a Pap smear according to the schedule recommended by their doctor (usually every 6 to 12 months).

How is it treated?

Your treatment will include:

• lab tests to see how well your immune system is working, to measure the amount of HIV present in your blood, and to screen for infections or other medical problems

• antiviral treatment, such as with the drugs zidovudine (also called ZDV or AZT), didanosine (ddI), lamivudine (3TC), and the newer protease inhibitors.

• regular dental exams because people who are HIV positive have a high rate of mouth abnormalities, including gum disease

• preventive treatment for such diseases as:
  • Pneumocystis carinii pneumonia (PCP)

  • tuberculosis

  • toxoplasmosis (you should also avoid raw meat and cat litter boxes)

  • tetanus

  • hepatitis B

  • pneumococcus

  • flu
• treatments for opportunistic infections and tumors as they develop.

The CD4 lymphocyte cell count is an important lab test. CD4 cells are a type of white blood cell. They are the best indicator of how well the immune system of an HIV-positive person is functioning. If the first CD4 cell count is greater than 600 per microliter of blood, the test should be repeated every 6 months. When the count begins to decrease, more frequent counts will be necessary.

Another test, the viral load test, measures the amount of HIV in your blood. Levels above 10,000 viral copies per milliliter of blood are considered high and usually require prompt treatment.

The CD4 count and the viral load test are the most common standards for deciding when to start anti-virus drugs and anti-pneumonia drugs. Zidovudine (AZT) is prescribed when the CD4 count falls below 500 or the viral load is higher than 10,000. AZT is still the first drug administered in most cases. Your doctor may prescribe didanosine (ddI) or dideoxycitidine (ddC) if side effects from AZT develop or if your symptoms get worse in spite of AZT. It is also now common to start treatment with two or more of these drugs, such as AZT and lamivudine (3TC).

Drugs such as AZT, ddI, and the newer protease inhibitors are often prescribed for people in both the early and late stages of HIV infection. They may slow the onset of the disease, but they are not a cure. Many other drugs and drug combinations are being prescribed or investigated.

Drug treatment to prevent Pneumocystis carinii pneumonia should be started when the CD4 count is less than 200. It may be started sooner if you have a previous history of PCP.

Vision problems are often an early indicator of opportunistic infection in HIV-positive individuals. Tell your doctor promptly about any eye symptoms, especially persistent blurry vision or partial loss of vision.

Getting care in an office or clinic that uses the case management concept of care is perhaps the most important aspect of your treatment. This approach emphasizes team care coordinated by a case manager. The case manager helps you communicate with all who are providing your care. Other advantages include:

• Up-to-date medical care will be available to you.

• Treatment of both medical and social aspects of your illness will be brought together.

• You will have help in locating resources (medical, social, financial).

How long do the effects last?

The full effects of AIDS may not appear until 5 to 10 years after you are first infected with the virus. Although AIDS is a fatal disease, life expectancy has increased as new treatments continue to be developed.

How can I take care of myself?

If you are in a high-risk group but have not tested positively for HIV, see your doctor regularly. He or she will examine you for signs of HIV-associated infections and will recommend testing your blood regularly to screen for HIV infection.

If you are HIV positive, discuss your treatment with your doctor. See your doctor on a regular schedule to keep up to date on new treatments available. Call or see the doctor when you have new or persistent symptoms. Whenever you notice a change in body function that concerns you, discuss it with your doctor.

Contact a local AIDS support network. Your doctor should be able to help you find one.

How can I help prevent spreading the HIV virus?

If you are HIV positive, you should:

• Practice safe sex: Avoid sharing sexual secretions and blood in any way.

• Ask sexual partners to be tested for the presence of HIV.

• Tell your health care providers that you are HIV positive.

In addition:

• Do not share needles for drug use, tattooing, or body piercing.

• Try to avoid becoming pregnant.

• Do not donate blood, plasma, semen, or body parts.

How can I keep up to date on treatments for HIV infection?

Research continues to increase knowledge of the human immunodeficiency virus. As a result, recommended treatments for infection with the virus change often. Keeping up with these changes can be difficult and frustrating. Two ways you can seek up-to-date information and care are:

• Obtain health care from a case management model facility and follow the recommended appointment schedule.

• Contact the national or state AIDS Hotline with specific questions or to find other resources.

For more information on risk factors or HIV testing, contact your doctor or the National AIDS Hotline at 1-800-342-AIDS (24 hours, 7 days a week). Hotline numbers are also available for Spanish-speaking persons at 1-800-344-7432 (8 a.m. to 2 a.m., EST, 7 days a week), and for the hearing impaired at TDD 1-800-243-7889 (10 a.m. to 10 p.m., EST, Monday through Friday). These hotlines are provided by the Centers for Disease Control and Prevention.