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Acquired Immunodeficiency Syndrome
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Overview
AIDS (Acquired Immuno-Deficiency Syndrome) is a disease caused by a virus called HIV (Human Immunodeficiency Virus). HIV attacks the body's immune system.
A healthy immune system is what keeps you from getting sick. When people have AIDS, their bodies can't fight disease. They get sick easily and have trouble getting well. They usually die of an infection or cancer.
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Causes
Transmission of the virus occurs: - Through sexual contact -- including oral, vaginal, and anal sex
- Through blood -- via blood transfusions or needle sharing
- From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her milk
(Details: open / close) Other transmission methods are rare and include accidental needle injury, artificial insemination with donated semen, and organ transplants.
HIV infection is not spread by casual contact such as hugging, by touching items previously touched by a person infected with the virus, during participation in sports, or by mosquitoes. |
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Epidemiology
A total of 39.5 million people were living with HIV in 2006 (2.6 million more than in 2004). Sub-Saharan remains the most affected region in the world. Increasing numbers of women have been affected in all regions. The 17.7 million women living with HIV in 2006 represent an increase of over one million compared with 2004.
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Prevention
The best ways to protect yourself from getting infected with HIV are to: - Not have sex with a person who is infected or is having sex with others.
- Practice "safer" sex if you do have sex.
- Not share needles and syringes.
(Details: open / close) If you are having sex, "safer" sex is sex between 2 people who don't have HIV infection, only have sex with each other and don't abuse injectable drugs.
Safer sex also means using condoms if you have any doubts about whether your partner is infected or whether he or she is having sex with someone else. |
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Symptoms
Some people have a flu-like illness within several days to weeks after exposure to the virus. These symptoms usually disappear on their own within a few weeks. Following initial infection, you may have no symptoms from a few months to more than 10 years. During this period, the virus continues to multiply actively and infects and kills the cells (CD4 cells) of the immune system. Once the immune system weakens, a person infected with HIV can develop symptoms.
(Details: open / close) They include:
Lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections, mouth, genital or anal sores from herpes infections. AIDS is the most advanced stage of HIV infection. Some of the common symptoms include the following:
Cough and shortness of breath, seizures and lack of coordination, difficult or painful swallowing, mental symptoms such as confusion and forgetfulness, severe and persistent diarrhea, fever, vision loss, nausea, abdominal cramps and vomiting, weight loss and extreme fatigue. People with AIDS are prone to develop various cancers such as Kaposi sarcoma, cervical cancer, and cancers of the immune system known as lymphomas. Kaposi sarcoma causes round, brown, reddish or purple spots that develop in the skin or in the mouth. After the diagnosis of AIDS is made, the average survival time has been estimated to be 2-3 years. |
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Diagnosis
Screening for HIV infection is most commonly done by testing blood for HIV antibodies. A newer test, the Orasure test, involves collecting secretions between the cheek and gum and evaluating them for HIV antibodies. Finally, a new urine test is available for screening, although if the test is positive, blood tests need to be performed for confirmation of the presence of HIV.
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Treatment
According to current guidelines, treatment should focus on achieving the maximum suppression of symptoms for as long as possible. This aggressive approach is known as highly active antiretroviral therapy (HAART). The aim of HAART is to reduce the amount of virus in your blood to very low, or even nondetectable, levels, although this doesn't mean the virus is gone. This is usually accomplished with a combination of three or more drugs.
Antiretroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle. Six classes of these drugs are available.The goal of AIDS treatment is to find the strongest possible regimen that is also simple and has the fewest side effects
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Living day to day
There are many things you can do, day to day, to stay healthy. Here are a few: - Make sure you have a health care provider who knows how to treat HIV. Begin treatment promptly once your doctor tells you to. Keep your appointments. Follow your doctor's instructions. If your doctor prescribes medicine for you, take the medicine just the way he or she tells you to because taking only some of your medicine gives your HIV infection more chance to fight back.
- If you get sick from your medicine, call your doctor for advice; don't make changes to your medicine on your own or because of advice from friends.
- Get immunizations (shots) to prevent infections such as pneumonia and flu. Your doctor will tell you when to get these shots.
- Practice safe sex to reduce your risk of getting a sexually transmitted disease (STD) or another strain of HIV.
- If you smoke or use drugs not prescribed by your doctor, quit.
- Eat healthy foods. This will help keep you strong, keep your energy and weight up, and help your body protect itself.
- Exercise regularly, get enough sleep and take time to relax. Many people find that meditation or prayer, along with exercise and rest, help them cope with the stress of having HIV or AIDS.
(Details: open / close) - If you are a woman with HIV, your doctor should check you for STDs and perform a Pap test at least once a year. As a woman with HIV, you are more likely to have abnormal Pap test results.
- If you are thinking about avoiding pregnancy, talk with your doctor about methods of birth control.
- If you become pregnant, talk to your doctor right away about medical care for you and your baby. You also need to plan for your child's future in case you get sick.
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Illustrations
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News
HIV Can Spread Without Symptoms
People With Moderate Amount of HIV Particles in Their Blood Can Spread Virus
Monday, October 22nd 2007
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Adherence to HIV therapy linked to health literacy
Thursday, November 15th 2007
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Some AIDS vaccines may damage the immune system
Monday, November 19th 2007
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Scientific Articles (a selection for patients)
Systematic review of the efficacy of antiretroviral therapies for reducing the risk of mother-to-child transmission of HIV infection.
(Details: open / close) Objective: To evaluate the effectiveness of antiretroviral therapies in reducing the risk of mother-to-child transmission of HIV infection. Method: Trials evaluating the effects of antiretroviral therapy (ART) on mother-to-child transmission (MCT) were reviewed. 15 such trials were chosen. The drugs evaluated were: Zidovudine, Lamivudine and Nevirapine Results: Nevirapine given as a single dose to both mother and child reduced MCT as compared to a course of Zidovudine given during labour and after birth.
Zidovudine and Lamivudine reduced the chances of MCT, but adding Nevirapine to this combination did not change the results significantly.
Zidovudine and single dose Nevirapine given to babies gave similar results to only single dose Nevirapine.
In mothers who had already been given a course of Zidovudine, a two dose course of Nevirapine to both mother during the birth process and to the baby following birth showed reduction of MCT and infant death. Conclusion: The available evidence suggests that Zidovudine alone or in combination with Lamivudine and single dose Nevirapine is effective for the prevention of mother-to-child transmission of HIV and may reduce infant death.
Also, while on Zidovudine, giving a single dose of Nevirapine during labour and to the infant after birth may further decrease the risk of MCT and infant death. The above is a summarization of the following:
Full reference of the article: Suksomboon N, Poolsup N, Ket-Aim S. "Systematic review of the efficacy of antiretroviral therapies for reducing the risk of mother-to-child transmission of HIV infection" Journal of clinical pharmacy and therapeutics 2007 Jun;32(3):293-311. |
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Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men
(Details: open / close) | Background: There is a need for female-controlled methods of HIV prevention. Vaginal microbicides, substances inserted into the vagina to prevent women acquiring HIV and sexually transmitted infections (STIs) from men, could be useful in this regard. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9). Objectives: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of HIV infection by women from men. Method: Relevant studies were gathered from the internet, 5 trials being ultimately chosen for final analysis. Results: There was no significant difference in the HIV transmission between women using N-9 and women using palcebos. In fact, there was a greater risk of genital lesions in the women using N-9. Conclusions There is no evidence that nonoxynol-9 protects against vaginal acquisition of HIV infection by women from men. There is evidence that it may do harm by increasing the frequency of genital lesions The above is a summarization of the following article:
Full reference of the article: Wilkinson D, Ramjee G, Tholandi M, Rutherford G. "Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men" Cochrane Database Syst Rev 2002;(4):CD003936. |
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Condom effectiveness in reducing heterosexual HIV transmission
(Details: open / close) Background: The amount of protection that condoms provide for HIV and other sexually transmitted infections is not exactly known. Condom effectiveness is the proportionate reduction in disease due to the use of condoms. Objective: The objective of this review is to estimate condom effectiveness in reducing heterosexual transmission of HIV. Method: Numerous studies were reviewed as possible candidates for the study. From this, 14 studies were included in the final analysis. 2 different groups were identified in these 14 studies; those who always use condoms and those who never use condoms during heterosexual intercourse. Results: The overall reduction of HIV seroconversion (conversion from HIV negative to HIV positive) was seen to be 80%. Conclusions: This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse. This study did not take into account the efficacy of condom usage as it did not focus on how the condoms were used. The above is a summarisation of the following article:
Full reference of the article: Weller SC, Davis-Beaty K. "Condom effectiveness in reducing heterosexual HIV transmission." Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD003255. DOI: 10.1002/14651858.CD003255 |
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Medical Journals (for health professionals)
A list of medical journals containing articles on HIV/AIDS.
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Clinical trials
A list of clinical trials of AIDS/HIV
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