HIV/AIDS: Causes, Symptoms, Risk Factors, Complications And Prevention
AIDS (acquired immunodeficiency syndrome) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.
HIV is a
sexually transmitted infection. It can also be spread by contact with infected
blood or from mother to child during pregnancy, childbirth or breast-feeding.
It can take years before HIV weakens your immune system to the point that you
have AIDS.
There's no
cure for HIV/AIDS, but there are medications that can dramatically slow disease
progression. These drugs have reduced AIDS deaths in many developed nations.
But HIV continues to decimate populations in Africa, Haiti and parts of Asia.
SYMPTOMS OF HIV AIDS
The
symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection
The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include:
- Fever
- Headache
- Muscle aches
- Rash
- Chills
- Sore throat
- Mouth or genital ulcers
- Swollen lymph glands, mainly on the neck
- Joint pain
- Night sweats
- Diarrhea
Although
the symptoms of primary HIV infection may be mild enough to go unnoticed, the
amount of virus in the bloodstream (viral load) is particularly high at this
time. As a result, HIV infection spreads more efficiently during primary
infection than during the next stage of infection.
Clinical latent infection
In some
people, persistent swelling of lymph nodes occurs during clinical latent HIV.
Otherwise, there are no specific signs and symptoms. HIV remains in the body,
however, and in infected white blood cells.
Clinical
latent infection typically lasts eight to 10 years. A few people stay in this
stage even longer, but others progress to more severe disease much sooner.
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Early symptomatic HIV infection
As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic signs and symptoms such as:
- Fever
- Fatigue
- Swollen lymph nodes — often one of the first
signs of HIV infection
- Diarrhea
- Weight loss
- Cough
- Shortness of breath
- Progression to AIDS
If you
receive no treatment for your HIV infection, the disease typically progresses
to AIDS in about 10 years. By the time AIDS develops, your immune system has
been severely damaged, making you susceptible to opportunistic infections —
diseases that wouldn't trouble a person with a healthy immune system.
The signs and symptoms of some of these infections may include:
- Soaking night sweats
- Shaking chills or fever higher than 100 F (38 C)
for several weeks
- Cough
- Shortness of breath
- Chronic diarrhea
- Persistent white spots or unusual lesions on your
tongue or in your mouth
- Headaches
- Persistent, unexplained fatigue
- Blurred and distorted vision
- Weight loss
- Skin rashes or bumps
CAUSES OF HIV AIDS
Scientists
believe a virus similar to HIV first occurred in some populations of chimps and
monkeys in Africa, where they're hunted for food. Contact with an infected
monkey's blood during butchering or cooking may have allowed the virus to cross
into humans and become HIV.
How does HIV become AIDS?
HIV
destroys CD4 cells — a specific type of white blood cell that plays a large role
in helping your body fight disease. Your immune system weakens as more CD4
cells are killed. You can have an HIV infection for years before it progresses
to AIDS.
People infected with HIV progress to AIDS when their CD4 count falls below 200 or they experience an AIDS-defining complication, such as:
- Pneumocystis pneumonia
- Cytomegalovirus
- Tuberculosis
- Toxoplasmosis
- Cryptosporidiosis
How HIV is transmitted
To become
infected with HIV, infected blood, semen or vaginal secretions must enter your
body. You can't become infected through ordinary contact — hugging, kissing,
dancing or shaking hands — with someone who has HIV or AIDS. HIV can't be
transmitted through the air, water or via insect bites.
You can become infected with HIV in several ways, including:
By having sex. You may become infected if you
have vaginal, anal or oral sex with an infected partner whose blood, semen or
vaginal secretions enter your body. The virus can enter your body through mouth
sores or small tears that sometimes develop in the rectum or vagina during
sexual activity.
From blood transfusions. In some cases, the virus may be
transmitted through blood transfusions. American hospitals and blood banks now
screen the blood supply for HIV antibodies, so this risk is very small.
By sharing needles. HIV can be transmitted through
needles and syringes contaminated with infected blood. Sharing intravenous drug
paraphernalia puts you at high risk of HIV and other infectious diseases, such
as hepatitis.
During pregnancy or delivery or through
breast-feeding.
Infected mothers can infect their babies. But receiving treatment for HIV
infection during pregnancy, mothers significantly lower the risk to their
babies.
RISK FACTORS
When
HIV/AIDS first surfaced in the United States, it mainly affected men who had
sex with men. However, now it's clear that HIV is also spread through
heterosexual sex.
Anyone of
any age, race, sex or sexual orientation can be infected, but you're at
greatest risk of HIV/AIDS if you:
Have unprotected sex. Unprotected sex means having sex
without using a new latex or polyurethane condom every time. Anal sex is more
risky than is vaginal sex. The risk increases if you have multiple sexual
partners.
Have another STI. Many sexually transmitted
infections (STIs) produce open sores on your genitals. These sores act as
doorways for HIV to enter your body.
Use intravenous drugs. People who use intravenous drugs
often share needles and syringes. This exposes them to droplets of other
people's blood.
Are an uncircumcised man. Studies indicate that lack of
circumcision increases the risk of heterosexual transmission of HIV.
COMPLICATIONS
HIV infection weakens your immune system, making you highly susceptible to numerous infections and certain types of cancers.
Infections common to HIV/AIDS
Tuberculosis (TB). In resource-poor nations, TB is
the most common opportunistic infection associated with HIV and a leading cause
of death among people with AIDS. Millions of people are currently infected with
both HIV and tuberculosis, and many experts consider the two diseases to be
twin epidemics.
Salmonellosis. You contract this bacterial
infection from contaminated food or water. Signs and symptoms include severe
diarrhea, fever, chills, abdominal pain and, occasionally, vomiting. Although anyone
exposed to salmonella bacteria can become sick, salmonellosis is far more
common in HIV-positive people.
Cytomegalovirus. This common herpes virus is
transmitted in body fluids such as saliva, blood, urine, semen and breast milk.
A healthy immune system inactivates the virus, and it remains dormant in your
body. If your immune system weakens, the virus resurfaces — causing damage to
your eyes, digestive tract, lungs or other organs.
Candidiasis. Candidiasis is a common
HIV-related infection. It causes inflammation and a thick, white coating on the
mucous membranes of your mouth, tongue, esophagus or vagina. Children may have
especially severe symptoms in the mouth or esophagus, which can make eating
painful.
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Cryptococcal meningitis. Meningitis is an inflammation of
the membranes and fluid surrounding your brain and spinal cord (meninges).
Cryptococcal meningitis is a common central nervous system infection associated
with HIV, caused by a fungus found in soil. The disease may also be associated
with bird or bat droppings.
Toxoplasmosis. This potentially deadly infection
is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected
cats pass the parasites in their stools, and the parasites may then spread to
other animals and humans.
Cryptosporidiosis. This infection is caused by an
intestinal parasite that's commonly found in animals. You contract
cryptosporidiosis when you ingest contaminated food or water. The parasite
grows in your intestines and bile ducts, leading to severe, chronic diarrhea in
people with AIDS.
Cancers common to HIV/AIDS
Kaposi's sarcoma. A tumor of the blood vessel walls,
this cancer is rare in people not infected with HIV, but common in HIV-positive
people.
Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.
Lymphomas. This type of cancer originates in
your white blood cells and usually first appears in your lymph nodes. The most
common early sign is painless swelling of the lymph nodes in your neck, armpit
or groin.
Other complications
Wasting syndrome. Aggressive treatment regimens have
reduced the number of cases of wasting syndrome, but it still affects many
people with AIDS. It's defined as a loss of at least 10 percent of body weight,
often accompanied by diarrhea, chronic weakness and fever.
Neurological
complications. Although AIDS doesn't appear to infect the nerve cells, it can
cause neurological symptoms such as confusion, forgetfulness, depression,
anxiety and difficulty walking. One of the most common neurological
complications is AIDS dementia complex, which leads to behavioral changes and
diminished mental functioning.
Kidney disease. HIV-associated nephropathy (HIVAN)
is an inflammation of the tiny filters in your kidneys that remove excess fluid
and wastes from your bloodstream and pass them to your urine. Because of a
genetic predisposition, the risk of developing HIVAN is much higher in blacks.
Regardless
of CD4 count, antiretroviral therapy should be started in those diagnosed with
HIVAN.
TESTS AND DIAGNOSIS
HIV is
most commonly diagnosed by testing your blood or saliva for antibodies to the
virus. Unfortunately, it takes time for your body to develop these antibodies —
usually up to 12 weeks. In rare cases, it can take up to six months for an HIV
antibody test to become positive.
A newer
type of test that checks for HIV antigen, a protein produced by the virus
immediately after infection, can confirm a diagnosis within days of infection.
An earlier diagnosis may prompt people to take extra precautions to prevent
transmission of the virus to others. There is also increasing evidence that
early treatment may be of benefit.
Tests to tailor treatment
If you
receive a diagnosis of HIV/AIDS, several types of tests can help your doctor
determine what stage of the disease you have. These tests include:
CD4 count. CD4 cells are a type of white
blood cell that's specifically targeted and destroyed by HIV. A healthy
person's CD4 count can vary from 500 to more than 1,000. Even if you have no
symptoms, HIV infection progresses to AIDS when your CD4 count dips below 200.
Viral load. This test measures the amount of
virus in your blood. Studies have shown that people with higher viral loads
generally fare more poorly than do those with a lower viral load.
Drug resistance. This blood test determines
whether the strain of HIV you have will be resistant to certain anti-HIV
medications.
HIV/AIDS TREATMENT
There's no
cure for HIV/AIDS, but a variety of drugs can be used in combination to control
the virus. Each class of anti-HIV drugs blocks the virus in different ways.
It's best to combine at least three drugs from two classes to avoid creating
strains of HIV that are immune to single drugs.
The
classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors
(NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself.
Examples include efavirenz (Sustiva), etravirine (Intelence) and
nevirapine (Viramune).
- Nucleoside reverse transcriptase inhibitors
(NRTIs). NRTIs are faulty versions of building blocks that HIV needs to
make copies of itself. Examples include Abacavir (Ziagen), and the combination
drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine
(Combivir).
- Protease inhibitors (PIs). PIs disable protease,
another protein that HIV needs to make copies of itself. Examples include
atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and
ritonavir (Norvir).
- Entry or fusion inhibitors. These drugs block
HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and
maraviroc (Selzentry).
- Integrase inhibitors. Raltegravir (Isentress)
works by disabling integrase, a protein that HIV uses to insert its
genetic material into CD4 cells.
When to start treatment
Guidelines
from the Department of Health and Human Services recommend that everyone with
HIV infection, regardless of CD4 count, be offered antiviral medication.
However, some experts question the guidelines because of concerns about
long-term toxicity of these drugs, drug resistance, cost and difficulty
adhering to the drug regime.
You should
definitely begin treatment, however, if:
- You have severe symptoms
- You have an opportunistic infection
- Your CD4 count is under 350
- You're pregnant
- You have HIV-related kidney disease
- You're being treated for hepatitis B
Treatment can be difficult
HIV
treatment regimens may involve taking multiple pills at specific times every
day for the rest of your life. Side effects can include:
- Nausea, vomiting or diarrhea
- Heart disease
- Weakened bones
- Shortness of breath
- Skin rash
- Bone death, particularly in the hip joints
- Codiseases and cotreatments
Some
health issues that are a natural part of aging may be more difficult to manage
if you have HIV. Some medications that are common for age-related
cardiovascular, metabolic and bone conditions, for example, may not interact
well with anti-HIV medications. Talk to your doctor about other conditions for
which you're taking medication.
LIFESTYLE AND HOME REMEDIES
There's no
vaccine to prevent HIV infection and no cure for AIDS. But it's possible to
protect yourself and others from infection. That means educating yourself about
HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen,
vaginal secretions and breast milk — into your body.
To help prevent the spread of HIV:
Use a new condom every time you
have sex. If you
don't know the HIV status of your partner, use a new condom every time you have
anal or vaginal sex. Women can use a female condom. Use only water-based
lubricants. Oil-based lubricants can weaken condoms and cause them to break.
During oral sex use a condom, dental dam — a piece of medical-grade latex — or
plastic wrap.
Consider
the drug Truvada. In July 2012, the Food and Drug Administration approved the
use of the combination drug emtricitabine-tenofovir (Truvada) to reduce the
risk of sexually transmitted HIV infection in those who are at high risk.
Truvada is also used as an HIV treatment along with other medications.
When used
to help prevent HIV infection, Truvada is only appropriate if your doctor is
certain you don't already have an HIV infection. Your doctor should also test
for hepatitis B infection. If you have hepatitis B, your doctor should test
your kidney function before prescribing Truvada.
Truvada
must be taken daily, exactly as prescribed, and you'll need follow-up HIV and
kidney function testing every few months. Truvada should only be used along
with other prevention strategies such as condom use every time you have sex.
Tell your
sexual partners if you have HIV. It's important to tell anyone with whom you've
had sex that you're HIV-positive. Your partners need to be tested and to
receive medical care if they have the virus. They also need to know their HIV
status so that they don't infect others.
Use a
clean needle. If you use a needle to inject drugs, make sure it's sterile and
don't share it. Take advantage of needle-exchange programs in your community
and consider seeking help for your drug use.
If you're
pregnant, get medical care right away. If you're HIV-positive, you may pass the
infection to your baby. But if you receive treatment during pregnancy, you can
cut your baby's risk by as much as two-thirds.
Consider
male circumcision. There's evidence that male circumcision can help reduce a
man's risk of acquiring HIV.
ALTERNATIVE MEDICINE
People who
are infected with HIV sometimes try dietary supplements that claim to boost the
immune system or counteract side effects of anti-HIV drugs.
Supplements
that may be helpful
Fish oil. Some anti-HIV drugs can cause
increases in cholesterol levels. Studies indicate that fish oil supplements can
help bring those numbers down.
Whey protein. Preliminary evidence indicates
that whey protein, a cheese byproduct, can help some people with HIV gain
weight. Whey protein also appears to reduce diarrhea and increase CD4 counts.
Supplements that may be dangerous
St. John's
wort. Commonly used to combat depression, St. John's wort can reduce the
effectiveness of several types of anti-HIV drugs by more than 50 percent.
Garlic supplements. Although garlic may help
strengthen the immune system, it also interacts with several anti-HIV drugs —
reducing their effectiveness by 50 percent. Occasionally eating garlic in food
appears to be safe.
COPING AND SUPPORT
Receiving
a diagnosis of any life-threatening illness is devastating. But the emotional,
social and financial consequences of HIV/AIDS can make coping with this illness
especially difficult — not only for you but also for those closest to you.
Fortunately, numerous services and resources are available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you with problems directly or put you in touch with people who can. They can arrange for transportation to and from doctor appointments, help with housing and child care, deal with employment and legal issues, and see you through financial emergencies.
Coming to
terms with your illness may be the hardest thing you've ever done. For some
people, having a strong faith or a sense of something greater than themselves
makes this process easier. Others seek counseling from someone who understands
HIV/AIDS. Still others make a conscious decision to experience their lives as
fully and intensely as they can or to help other people who have the disease.