Health Library

HIV / AIDS

Since people first started hearing about AIDS or acquired immunodeficiency syndrome back in the 1980's, awareness of this illness has grown, as has the number of lives affected by it.

AIDS is caused by the human immunodeficiency virus or HIV. (For specific terms read "Immune System Glossary") This virus is passed from one person to another through blood-to-blood and sexual contact. (Read about "STD's") In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. (Read about "Healthy Pregnancy") The National Institute of Allergy and Infectious Diseases (NIAID) says healthcare workers may also come in contact with certain bodily fluids such as amniotic fluid or cerebrospinal fluid that may transmit the virus if the patient is infected with HIV.

Diagnosing AIDS

HIV weakens the immune system (Read about "The Immune System"), so that an infected person has problems fighting off infections. As a result, infections that a healthy person has no problems with, can often be life threatening for people with AIDS. The National Cancer Institute (NCI) says people who develop AIDS are also at high risk for developing a specific type of cancer called Kaposi's sarcoma (KS).

Kaposi's sarcoma is a disease in which malignant cancer cells are found in the tissues under the skin or mucous membranes that line the mouth, nose and anus. KS causes red or purple patches on the skin and/or mucous membranes and spreads to other organs in the body, such as the lungs, liver or intestinal tract.

NCI says this type of cancer is not directly caused by HIV. Instead, HIV weakens the immune system, making someone more susceptible to viral infection. Infection by a virus called KSHV (Kaposi's sarcoma-associated herpes virus) then appears to stimulate the development of Kaposi's sarcoma.

It's important to remember that AIDS is a medical diagnosis made by a doctor based on specific criteria. The only way to know for sure if you are infected is to be tested for HIV infection. Although the following may be warning signs of infection with HIV, NIAID says it's important to note that you cannot rely on symptoms to know whether or not you are infected with HIV and that many people who are infected with HIV do not have any symptoms at all for many years:

• rapid weight loss
• dry cough
• recurring fever or profuse night sweats
• profound and unexplained fatigue
• swollen lymph glands in the armpits, groin, or neck
• diarrhea that lasts for more than a week (Read about "Diarrhea")
• oral thrush - white spots or unusual blemishes on the tongue, in the mouth, or in the throat (Read about "Thrush")
• pneumonia (Read about "Pneumonia")
• red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids
• pelvic inflammatory disease in women that does not respond to treatment (Read about "Pelvic Inflammatory Disease")

Again, however, no one should assume they are infected if they have any of these symptoms, since all of these symptoms can be related to other illnesses. The only way to know for sure about HIV is to be tested.

Anyone who does seek testing should look for a place that also provides counseling about HIV and AIDS. Counselors can answer questions you might have about risky behavior and ways to protect yourself and others in the future. In addition, they can provide information about AIDS-related resources.

Treatment

The U.S. Centers for Disease Control and Prevention (CDC) says that the amount of time it takes for a person infected with the HIV virus to develop symptoms varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors. This is why accurate testing is so important if someone is concerned about AIDS. Especially now - with medical treatments that can slow down the rate at which HIV weakens the immune system, as well as other treatments that can prevent or cure some of the illnesses associated with AIDS - it's important to keep in mind the fact that, as with other diseases, early detection offers more options for treatment and preventative care.

CDC says that if someone does test positive for HIV, there are a number of important steps they can take to protect their health:

• see a doctor, even if there are no bothersome symptoms
• look for a doctor who has experience treating HIV
• have a tuberculosis or TB test done since undetected TB can cause serious problems (Read about "Tuberculosis")

Antiviral therapy means treating viral infections like HIV with drugs. Because HIV is a retrovirus, these drugs are sometimes called antiretroviral therapy. The U.S. Food and Drug Administration (FDA) has approved several different classes of drugs for treating HIV infection, including:

• nucleoside reverse transcriptase (RT) inhibitors, which interrupt an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections. (Infections that occur only in patients with weakened immune systems.)
• nucleotide reverse transcriptase inhibitors (NtRTIs) work to stop HIV from replicating itself in much the same manner as nucleoside reverse transcriptase (RT) inhibitors.
• non-nucleoside reverse transcriptase inhibitors (NNRTIs), which can be used in combination with other antiretroviral drugs.
• protease inhibitors, which interrupt virus replication at a later step in its life cycle
• fusion inhibitors, which interfere with the virus' ability to fuse with and enter the host cell
• integrase strand transfer inhibitors, designed to interfere with the enzyme that HIV-1 needs to multiply
• CCR5 antagonist, which can help block HIV from infecting cells

CDC says that HIV can become resistant to any of these drugs; therefore, a combination treatment is often needed to suppress the virus effectively. In addition, antiretroviral drugs have side effects, including anemia (Read about "Anemia"), nausea, vomiting, headache and fatigue that can be severe. Some, but not all medications for AIDS can lead to nerve damage called peripheral neuropathy. (Read about "Peripheral Neuropathy") Lipodystrophy may also develop. Lipodystrophy is a clinical condition characterized by a poor or uneven distribution of fat cells. This distribution causes large amounts of fat to be stored in inappropriate places, which can lead to lower belly obesity and a hump on the upper back. Lipodystrophy side effects also include diabetes and high levels of cholesterol and triglycerides. (Read about "Diabetes" "Cholesterol")

Highly active antiretroviral therapy (HAART) employs combinations of anti-HIV drugs to help suppress the virus in people with HIV/AIDS. The goal of HAART is to combine three or more drugs from one or more different classes of anti-HIV drugs to suppress HIV replication and prevent progression to AIDS and death. Two key classes include those that prevent the virus from copying itself, called reverse transcriptase (RT) inhibitors, and those that prevent the virus from becoming infectious, called protease inhibitors. RT inhibitors can be further broken down into nucleoside RT inhibitors, which halt HIV replication by making faulty DNA building blocks, and non-nucleoside inhibitors, which bind to the enzyme reverse transcriptase to prevent the virus from copying itself. The effectiveness of different drug combinations may diminish over time, however, and physicians often must implement new ones over the course of a person's treatment.

In addition to treatment, it's also important for someone with HIV to do all they can to strengthen their immune system, by avoiding cigarette, drug or alcohol use, and following as healthy a lifestyle as possible. All these issues, and any supplements or herbal products being taken, should be discussed with a doctor. The CDC says some herbal products have been shown to interfere with proven HIV/AIDS medications. (Read about "Herbal Precautions")

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