Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV). The term HIV/AIDS represents the entire range of disease caused by the human immunodeficiency virus from early infection to late stage symptoms. During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumorsthat do not usually affect people who have working immune systems.
CAUSES
HIV is not spread to a person who donates blood or organs. People who
donate organs are never in direct contact with people who receive them.
Likewise, a person who donates blood is never in contact with the person
receiving it. In all these procedures, sterile needles and instruments
are used.
But HIV can be spread to a person receiving blood or organs from an
infected donor. To reduce this risk, blood banks and organ donor
programs check (screen) donors, blood, and tissues thoroughly.
People at high risk of getting HIV include:
Injection drug users who share needles
Infants born to mothers with HIV who did not receive HIV treatment
during pregnancy
People who have unprotected sex, especially with people who have other
high-risk behaviors, are HIV-positive, or have AIDS
People who received blood transfusions or clotting products between 1977
and 1985, before screening for the virus became standard practice
Sexual partners of those who engage in high-risk activities (such as
injection drug use or anal sex)
After HIV infects the body, the virus has been found in saliva, tears,
nervous system tissue and spinal fluid, blood, semen (including pre-
seminal fluid, which is the liquid that comes out before ejaculation),
vaginal fluid, and breast milk. Only blood, semen, vaginal secretions,
and breast milk have been shown to transmit infection to others.
SYMPTOMS
Symptoms related to acute HIV infection (when a person is first
infected) are often flu-like:
Diarrhea
Fever
Headache
Mouth sores, including yeast infection (thrush)
Muscle stiffness or aching
Night sweats
Rashes of different types
Sore throat
Swollen lymph glands
Many people have no symptoms when they are diagnosed with HIV.
Common symptoms are:
Chills
Fever
Rash
Sweats (particularly at night)
Swollen lymph glands
Weakness
Weight loss
PREVENTION
Preventing HIV/AIDS:
Do not use illegal drugs and do not share needles or syringes. Many
communities now have needle exchange programs, where you can get rid of
used syringes and get new, sterile ones. These programs can also refer
you for addiction treatment.
Avoid contact with another person's blood. If possible, wear protective
clothing, masks, and goggles when caring for people who are injured.
If you test positive for HIV, you can pass the virus to others. You
should not donate blood, plasma, body organs, or sperm.
HIV-positive women who plan to get pregnant should talk to their health
care provider about the risk to their unborn child. They should also
discuss methods to prevent their baby from becoming infected, such as
taking medicines during pregnancy.
Breastfeeding should be avoided to prevent passing on HIV to infants
through breast milk.
Safer sex practices, such as using latex condoms, are effective in
preventing HIV transmission. But there is a risk of getting the
infection, even with the use of condoms. Abstinence is the only sure way
to prevent sexual transmission of HIV.
HIV-positive patients who are taking antiretroviral medicines are less
likely to transmit the virus.
The U.S. blood supply is among the safest in the world. Nearly all
people infected with HIV through blood transfusions received those
transfusions before 1985, the year HIV testing began for all donated
blood.
If you believe you have been exposed to HIV, seek medical attention
right away. Do not delay. Starting antiviral medicines can reduce the
chances that you will be infected. This is called post-exposure
prophylaxis (PEP). It has been used to prevent transmission in health
care workers injured by needle sticks
TREATMENT
There is no cure for AIDS at this time. But treatments are available to
manage symptoms. Treatment can also improve the quality and length of
life for those who have already developed symptoms.
Antiretroviral therapy suppresses the replication of the HIV virus in
the body. A combination of antiretroviral drugs, called antiretroviral
therapy (ART), also known as highly active antiretroviral therapy
(HAART), is very effective in reducing the amount of HIV in the
bloodstream. This is measured by the viral load (how much free virus is
found in the blood). Preventing the virus from reproducing (replicating)
can improve T-cell counts and help the immune system recover from HIV
infection.
People on ART with suppressed levels of HIV can still transmit the virus
to others through sex or by sharing needles. With ART, if the level of
HIV remains suppressed and CD4 count remains high (above 200 cells/mm3),
life can be prolonged and improved.
HIV can become resistant to one combination of ART. This is most true in
patients who do not take their medications on schedule every day. Tests
can check whether an HIV strain is resistant to a particular drug. This
information can be useful in finding the best drug combination and for
adjusting the drug combination when it starts to fail.
When HIV becomes resistant to HAART, other drug combinations must be
used to try to suppress the resistant HIV strain of HIV. There are a
variety of new drugs on the market for treating drug-resistant HIV.
Treatment with ART has complications. Each drug has its own side
effects. Common side effects are:
Collection of fat on the back (buffalo hump) and abdomen
Diarrhea
General sick feeling ( malaise)
Headache
Nausea
Weakness
When used for a long time, these drugs increase the risk of heart
attack, perhaps by increasing the levels of cholesterol and glucose
(sugar) in the blood.
TRENDS IN HIV CURE
One of the major limitations of ART is its inability to act on viral
reservoirs requiring adherence to lifelong treatment. HIV cure has been
currently the main focus area in HIV research to avoid toxicities and
cost of lifelong ART. Strategies attempted so far for HIV cure consist
of purging of HIV reservoir by activation in presence of anti-HIV drugs,
bone marrow transplantation and gene therapy [14]. Initiating ART early
during acute phase of the infection can also help to achieve functional
cure by limiting development of size of the viral reservoir. Recently
reported Mississippi case and a report on Visconti's cohort have
highlighted the benefits of the early treatment. Berlin and Boston cases
reporting HIV cure in cancer patients after bone marrow transplantation
along with the Mississipi case have helped in raising hopes for the HIV
cure.
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