• HIV and AIDS

    (Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome)

    Definition

    HIV is a virus that attacks white blood cells called helper T cells (CD4). These cells are part of the immune system. They fight off infections and disease. As a result, an HIV infection can leave you vulnerable to severe illnesses.
    AIDS is a late stage of HIV infection. It reflects severe damage to the immune system. One or more opportunistic infections will also likely exist. This is a type of infection that only occurs in people with compromised immune systems.

    Causes

    The HIV virus is spread through contact with HIV-infected blood or other body fluids. This includes semen, vaginal fluid, and breast milk.
    AIDS is caused by the destruction of T cells. The destruction is caused by the HIV virus.
    Immune System
    Immune system white blood cell
    HIV destroys white blood cells vital to the immune system.
    Copyright © Nucleus Medical Media, Inc.
    HIV is spread through:
    • Sexual contact with an HIV-infected person, especially intercourse or anal sex
    • Transfer of HIV from a mother to child during pregnancy, childbirth, or breastfeeding
    • A prick from an HIV-contaminated needle
    • A blood transfusion with HIV-infected blood (rare today, due to testing of all donated blood for HIV infection beginning in 1985)
    Rarely, HIV can be spread through:
    • Blood from an HIV-infected person getting into an open wound of another person
    • Being bitten by someone infected with HIV
    • Sharing personal hygiene items with an HIV-infected person (razors, toothbrushes, etc.)

    Risk Factors

    Factors that increase your chance of getting HIV include:
    • Having multiple sexual partners
    • Being a man who has sex with other men and engages in other high-risk behavior (having unprotected sex, using drugs during sex)
    • Being a woman who has sex with other women and men and also engages in high-risk behavior
    • Injecting illegal drugs, especially with used or dirty needles
    • Having regular exposure to HIV-contaminated blood or other body fluids (a concern for healthcare workers and people who work in correctional facilities)
    • Being born to an HIV-infected mother
    • Receiving donor blood products, tissue, organs, or artificial insemination
    • Being an immigrant from geographic locations with high numbers of AIDS patients
    • Having a sexual relationship with a high-risk individual or a partner already infected with HIV
    The risk factor for AIDS is having HIV.

    Symptoms

    HIV may not cause symptoms for a number of years.
    Early symptoms may appear a month or two after becoming infected. They may last a couple of weeks. These include:
    • Rapid weight loss
    • Dry cough
    • Sore throat
    • 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
    • Memory loss or other neurological disorder
    After these initial symptoms pass, there may be no symptoms for months to years. Then, the following symptoms may occur over the course of 1-3 years:
    • Swollen lymph glands all over the body
    • Fungal infections of the mouth, fingernails, toes
    • Repeated vaginal infections (yeast and Trichomonas)
    • Development of lots of warts
    • Exacerbations of prior conditions, such as eczema, psoriasis, herpes infection
    • Shingles
    • Night sweats
    • Weight loss
    • Chronic diarrhea
    It can be 10 years or more before HIV progresses to AIDS. This happens when T helper cell levels fall below certain levels and opportunistic infections arise. Examples of opportunistic infections and other complications of AIDS include:

    Diagnosis

    The doctor will ask about your symptoms, medical history, and risk factors. A physical exam will be done. Your doctor may order tests, such as:
      ELISA test—used to detect HIV infection
      • 95% will have a positive test within three months of infection
      • 99% will have a positive test within six months of infection
      • If an ELISA test is negative, but you think you may have HIV, test again in 1 to 3 months
    • Western blot blood test—usually done to confirm the diagnosis if ELISA was positive

    Treatment

    Medicines can prevent, delay, or control the development of AIDS in many people infected with HIV.

    Drugs That Fight HIV

    These drugs are often given in combination. They include:
    Nucleoside reverse transcriptase inhibitors:
    • AZT (Zidovudine or ZDV)
    • ddC (Zalcitabine)
    • ddI (dideoxyinosine)
    • d4T (Stavudine)
    • 3TC (Lamivudine)
    • Emtricitabine (Emtriva)
    • Abacavir (Ziagen)
      • In some patients, abacavir can cause a hypersensitivity reaction, which can be life threatening. Researchers found that screening for a particular gene can help to prevent this reaction.
    Nucleotide reverse transcriptase inhibitors:
    • Delavirdine (Rescriptor)
    • Nevirapine (Viramune)
    • Efavirenz (Sustiva)
    • Etravirine (Intelence)
    Protease inhibitors:
    • Ritonavir (Norvir)
    • Saquinavir (Invirase)
    • Indinavir (Crixivan)
    • Amprenavir (Agenerase)
    • Fosamprenavir (Lexiva)
    • Nelfinavir (Viracept)
    • Lopinavir (Kaletra)
    • Atazanavir (Reyataz)
    • Tipranavir (Aptivus)
    • Darunavir (Prezista)
    Combination pill:
    • Atripla (Efavirenz, Tenofovir, and Emtricitabine)
    Others:
    • Enfuvirtide (Fuzeon)
    • Raltegravir (Isentress)
    • Maraviroc (Selzentry)

    Drugs That Fight AIDS-Related Infections and Cancers

    People who have developed AIDS are treated with numerous drugs that help prevent:

    Prevention

    To prevent becoming infected with HIV:
    • Abstain from sex.
    • If you do have sex use a male latex condom. This includes any sexual act that results in the exchange of bodily fluids.
    • Do not share needles for drug injection.
    • Limit your number of sexual partners.
    • Avoid sexual partners who are HIV-infected or injection drug users.
    • Avoid receiving transfusion of unscreened blood products.
    • If you are a healthcare worker or work in a correctional facility:
      • Wear appropriate gloves and facial masks during all procedures.
      • Carefully handle and properly dispose of needles.
      • Carefully follow universal precautions.
      If you live in a household with an HIV-infected person:
      • Wear appropriate gloves if handling HIV-infected bodily fluids.
      • Cover all cuts and sores, yours and the HIV-infected person's, with bandages.
      • Do not share any personal hygiene items such as razors, toothbrushes, etc.
      • Carefully handle and properly dispose of needles used for medication.
    Recent studies found that circumcised men were significantly less likely to develop HIV infection compared to uncircumcised men.
    To prevent spreading HIV to others if you are HIV infected:
    • Abstain from sex.
    • If you do have sex, use a male latex condom. This includes any sexual act that results in the exchange of bodily fluids.
    • If you are prescribed medicines, be sure that you are taking them.
    • Inform former or potential sexual partners.
    • Do not donate blood or organs.
    • Ask your doctor about contraception.
    • If you do wish to become pregnant, talk to your doctor. There are ways to lower your baby's risk of being born infected with HIV.
    • If you have a baby, do not breastfeed.

    RESOURCES

    American Foundation for AIDS Research http://www.amfar.org

    Centers for Disease Control and Prevention http://www.cdc.gov

    CANADIAN RESOURCES

    AIDS Committee of Toronto http://www.actoronto.org

    Canadian AIDS Society http://www.cdnaids.ca

    References

    Adult male circumcision significantly reduces risk of acquiring HIV [press release]. National Institutes of Health website. Available at: http://www3.niaid.nih.gov/news/newsreleases/2006/AMC12%5F06.htm. Accessed June 13, 2008.

    AIDS Info. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. AIDS Info website. Available at: http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf. Accessed August 9, 2010.

    Berkow R. The Merck Manual of Medical Information. New York, NY: Simon and Schuster, Inc.; 2000.

    Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. 2010;59(No. RR-12):1-110.

    HIV/AIDS A-Z index. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hiv/az.htm. Accessed June 13, 2008.

    Montaner JS. Treatment as prevention: a double hat-trick. Lancet. 2011 Jul 16;378(9787):208-209.

    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchstp/od/nchstp.html. Accessed June 13, 2008.

    Rey D, Krebs M, Partisani M, Hess G, et al. Virologic response of zidovudine, lamivudine, and tenofovir disoproxil fumarate combination in antiretroviral-naive HIV-1-infected patients. J Acquir Immune Defic Syndr. 2006;43: 530-534.

    Ross LL, Parkin N, Gerondelis P, et al. Differential impact of thymidine analogue mutations on emtricitabine and lamivudine susceptibility. J Acquir Immune Defic Syndr. 2006;43(5):567-570.

    3/8/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Auvert B, Taljaard D, Lagard E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298. Epub Oct 25, 2005. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-656. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-666.

    2/21/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mallal S, Phillips E, Carosi G, et al. HLA-B5701 screening for hypersensitivity to abacavir. N Engl J Med. 2008;358:568-579.

    6/11/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Del Romero J, Castilla J, Hernando V, Rodríguez C, García S. Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study. BMJ. 2010:c2205.

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