HIV
Infection and AIDS
 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:
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:
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-Pneumocystis
carinii pneumonia (PCP)
-tuberculosis
-toxoplasmosis (you should also avoid raw meat and cat
litter boxes)
-tetanus
-hepatitis B
-pneumococcus
-flu
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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.
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