What causes HIV And AIDS?
HIV is transmitted in body fluids through unprotected sex, blood transfusions, the sharing of infected needles, childbirth and occasionally breast-feeding. It is not possible to become infected with HIV by giving blood. Although the HIV virus is present in saliva, it is not clear whether kissing can allow for it to be transmitted from one person to another - the medical profession is divided on this point. The largest group of individuals infected with HIV are homosexual and bisexual males, and intravenous drug users who share needles. Other 'at risk' groups include the sexual partners of high-risk individuals, patients who have frequently received blood products in the past, and infants born to infected women. A small percentage of patients have no identifiable risk factors. The number of people worldwide infected with HIV is expected to reach over 45 million by the year 2000, with the greatest increase being in Africa.
What are the signs and symptoms Of HIV And AIDS?
Most people infected with HIV feel completely well early on in the disease, often being unaware they are infected and so potentially spreading the infection themselves. It is usually the case that a series of unusual infections or cancers suggests the diagnosis - patients with HIV and AIDS are susceptible to microorganisms that would usually not cause problems in people with normal immune systems.
Examples of these infections include;
¤ Candida albicans (thrush) - in the mouth, genital area or gullet. This is a whitish film in appearance and can cause painful swallowing or genital irritation.
¤ Herpes simplex virus - these painful ulcers can appear in the mouth and gullet, and affect swallowing.
¤ Toxoplasmosis - parasites found in cat and bird faeces. This can cause brain and lung infections in AIDS sufferers.
¤ Cytomegalovirus (CMV) can cause pneumonia, bowel infection and bloody diarrhoea, and severe eye infections which may end in blindness.
¤ Mycobacterium tuberculosis is an 'opportunistic' infection that can trigger pneumonia, but can also spread to the bones and brain, and Cryptosporidium is a parasite which can cause profuse and disabling diarrhoea in AIDS sufferers.
If the central nervous system is affected, HIV can inflame these cells causing brain cell inflammation (encephalopathy) and the brain lining (meningitis). Symptoms include amnesia, loss of balance, limb weakness, tremor and incontinence and is usually a progressive condition. The commonest cancers in patients with AIDS are usually two-fold; Kaposi's sarcoma and B cell lymphomas. The sarcomas are purple-coloured spots or lesions on the skin or lining of the mouth, and B cell lymphomas are lymph gland cancers that primarily affect the brain, bone marrow and gut.
Will I have any tests or investigations?
Blood tests are the way HIV is diagnosed, with the detection of HIV antibodies in the blood being crucial. These are special proteins whose job is to help the body fight off attack from infection by attaching particles to any attacking organism. Unfortunately, these do not appear to be adequate in defending against HIV disease which is why HIV is so severe a problem.
However, these antibodies can be detected in the blood, proving past infection with HIV. This test is known as the ELISA (Enzyme Linked Immunosorbent Assay) test, and is almost 100% sensitive in detecting HIV antibodies. As there is a six-month period after infection where detectable levels of antibodies may not have built up, a negative test in this time may need to be repeated again after this period.
All positive tests are repeated to ensure they are correct. There is also a blood test that checks for the number of 'T cells' in the blood. These are normal 'helper' cells which are produced to defend the body against attack by the HIV virus but which are usually steadily reduced in numbers as the virus progresses. The lower the 'T cell count', the weaker the immune system of the body and the higher the risk of infections and cancers developing. There are two types of HIV - known as HIV 1 and HIV 2. HIV 1 is the virus that causes AIDS, found worldwide whereas HIV 2 is more commonly seen in Africa.
What treatment will I need?
There is a major problem with the treatment of HIV, in that the virus appears to be extremely effective in developing drug-resistant strains. It is now more usual to use a 'cocktail' of drugs rather than only one particular type, with the aim of disrupting and slowing the production of the virus. Examples of such treatments include Zidovudine, Lamivudine and Didanosine but each patient will receive a particular combination suitable for them after discussion with their specialist. Other drugs should be discontinued, including any 'recreational' drugs, as should cigarettes and alcohol and a diet rich in fresh fruit and vegetables is also recommended.
What course will the HIV illness follow?
There are a number of recognised phases of HIV infection;
¤ Phase 1 - this is the time immediately after infection has occurred, and the patient is infectious. However, blood tests may be negative and there are no symptoms. This can last weeks or months.
¤ Phase 2 - this is also known as the 'acute' stage of infection and is usually around the time when HIV antibodies become detectable in the blood. There may be fflu-like symptoms, diarrhoea and swollen lymph glands for a number of days or weeks before settling down again. Many people pass these symptoms off as viral illnesses or influenza, and do not see a doctor at this time.
¤ Phase 3 - this phase is extremely variable in length, lasting from under a year to over 15 years. Symptoms are few in this time, but HIV testing remains positive and the patient remains infectious. It is during this time that treatments will be most effective in helping to prevent the progression to AIDS.
¤ Phases 4 and 5 - these are later periods, when the body begins to weaken as its defences gradually fail. The commoner symptoms of AIDS become more apparent here, with the main ones being diarrhoea and weight loss, profuse sweating (especially at night), fatigue and neurological problems. It is during these phases that the opportunistic infections as well as cancers appear. The terminal stages of AIDS usually involve an overwhelming and fatal body infection, often as a pneumonia.
Can I do anything to help myself?
There is currently no cure for the HIV virus - once it is present in the body it cannot be removed. However, a healthy diet rich in fresh fruit and vegetables, coupled with regular exercise and a positive mental attitude appear to help a great many people with HIV. Support groups are also extremely helpful in providing information and support to sufferers and their partners or carers.
Tell Your Doctor
1. When did you begin to feel unwell?
2. Do you engage in unprotected sex?
3. Have you had a number of sexual partners, or sex with someone who may be HIV positive?
4. Have you used or shared hypodermic needles for any reason?
5. Have you lost weight or had a number of unexplained infections recently?
Ask Your Doctor
1. Will I ever know exactly where I contracted HIV?
2. Is there any vaccine I can have against it?
3. Do I have to inform my partner by law?
4. How often will I need blood tests?
5. Do I have to inform my employers?
By Dr Roger Henderson, MB BS Lond., LMSSA Lond.
Free Medical Advice Published by http://www.viviennebalonwu.com.
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