HIV/AIDS : Introduction

HIV/AIDS in India has now emerged as a serious Socio-economic and public health problem and have highest number of infected cases in the world surpassing Africa. Despite involvement and implementation of many interventions by International, Governmental and Non Governmental Organizations to prevent HIV/AIDS, there is nothing much done to combat the spread of the most dreaded disease. Indian Scenario: The first AIDS case in India was reported in May 1986 in Madras, South India. India is facing an accelerating threat from HIV , especially Andhra Pradesh already experiencing a cross over into the general population from high risk groups. In India there are 5.7 million people infected with HIV/AIDS.

How Does the AIDS Virus Function?

Introduction

According to the international AIDS charity Avert, more than 25 million people have died due to AIDS since 1981. The human immunodeficiency virus, which causes AIDS, slowly progresses into a destructive disease that destroys your immune system and leaves your body open to a host of different viruses and bacteria. According to Avert, there were an estimated 33 million people worldwide living with HIV/AIDS in 2007, but nearly 2 million of those will die each year.

Infection

HIV is transmitted through body fluids including blood, vaginal secretions, semen and breast milk. Most commonly, the virus enters your body through unprotected sex, but it can also be transmitted by the introduction of infected blood into your system, such as through sharing dirty injection needles or through the transfusion of infected blood (rare in developed countries, due to modern screening methods).
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The Process

Once HIV enters your body, the virus attacks the cells of your immune system, called Tcells. Since viruses do not have the necessary internal structure to multiply and reproduce on their own, they must hijack another cell and use its structures to reproduce. The virus does this by injecting a piece of viral DNA into the T-cell. The Tcell then goes through its regular stages of duplication, serving as an HIV factory and spreading the virus throughout your body before the cell ultimately dies.

How Does HIV Turn Into AIDS?

Definition

Human Immunodeficiency Virus (HIV) is a disease that attacks the immune system by attacking CD4+ lymphocytes. These lymphocytes allow your immune system to properly function, and when depleted by the virus, compromise your immune system. If your body has a CD4+ count below 200, you are susceptible to opportunistic infections, which over time, develops into Acquired Immune Deficiency Syndrome (AIDS). During the transition from HIV to AIDS, HIV destroys white blood cells, replicates the virus while weakening the immune system, and leaves the body vulnerable to infection.

Virus Replication and Cell Breakdown

When the host cell becomes active, it uses RNA polymerase (genetic material) to create copies of HIV and messenger RNA. According to Joseph S. Cervio, M.D., mRNA is used as a blueprint that makes chains of HIV protein in the body. The chains of HIV protein are cut into smaller proteins, and combines with the HIV's RNA material to make more of the virus. The virus detaches from the host cell and attaches to uninfected CD4 cells to destroy and replicate again. Mild symptoms of HIV can occur within 5 to 7 years after infection, and during this time your immune system is being severely weakened. As your viral load increases, your CD4+ cell count will decrease, signaling the final stage of HIV.

AIDS

When you are given an AIDS diagnosis due to a high viral load and low CD4 count, your physician will start you on highly active antiretroviral therapy (HAART), which is a strict regimen of extremely powerful medications to reduce viral load and raise CD4 levels. When your CD4+ cell count drops below 200 you will begin to develop opportunistic infections, which are infections that normally wouldn't occur in a person with a healthy immune system. Your immune system is detrimentally weakened and cannot fight off these opportunistic infections, which are a hallmark of the AIDS virus.

Common opportunistic infections (OI) are pneumocystis pneumonia (PCP), Kaposi's sarcoma (KS) and cytomegalovirus. PCP is a lung infection that leads to pneumonia, and KS is a skin cancer that causes lesions, also known as open sores. Cytomegalovirus is an eye infection that can distort vision by producing black spots, also known as floaters, that compromise your eyesight.

How Does a Man Get HIV?

Vaginal Sex

HIV is found in vaginal secretions, and a man who has unprotected vaginal sex with an HIV-positive woman is at risk of contracting HIV. Women are more commonly infected during unprotected vaginal intercourse, but this is not a risk-free behavior for men.

Anal Sex

A man who has unprotected anal sex with an HIV-positive man is also at risk of contracting HIV. According to the website Avert, both the insertive and receptive partners are at risk of infection from unprotected anal sex.
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Oral Sex

A man who performs oral sex on either an HIV-positive woman or man can contract HIV. This is less common than infection from unprotected vaginal or anal intercourse, but infection can occur in the event of a cut, abrasion or sore in the mouth.

Drug Use

Using shared equipment to inject drugs is a risky behavior for the contraction of HIV. Although not an injected drug, crack cocaine can cause burns and sores when the drug is heated. These sores are conduits for infection, according to Avert.

Prevention

Barriers (condoms, female condoms and dental dams) should be used correctly for vaginal, anal and oral sex. IV drug users should use sterile works and not shared needles to lower their risk for infection.

Testing

Men who believe they have been exposed to HIV should seek out testing at least one month after suspected infection; this is the average time it takes to develop a detectable level of antibodies to HIV. The CDC's National HIV and STD Testing Resources helps individuals locate testing centers based on a number of different criteria (see Resources below).

First Sign of HIV

Acute HIV Infection

Flu-like symptoms may occur two to four weeks after an individual contracts HIV. Symptoms of this illness include fever, fatigue, sore throat, headache and muscle aches, skin rash, and digestive troubles like nausea and diarrhea. These symptoms clear up on their own within a month.

Transmission

When considering a diagnosis of HIV, it is necessary to establish that a possible exposure has occurred. Adults contract HIV through unprotected vaginal, anal and oral sex with an infected person and by sharing hypodermic needles or crack pipes with an infected person.
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Considerations

The symptoms of acute HIV infection are not specific to HIV, meaning that other conditions cause these symptoms, and they alone are not enough to diagnose HIV. Similarly, an absence of these symptoms is not enough to rule out HIV, as not everyone develops symptoms of acute HIV infection.

Symptomatic HIV

Some people may not experience signs of HIV until third-stage HIV-disease, which follows the long asymptomatic stage (lasting an average of 10 years). Symptoms of this stage include a chronic flu-like illness along with night sweats, weight loss, fungal infections, as well as skin and breathing problems.

Last Stages of AIDS & HIV

Fourth-Stage HIV Disease

AIDS is the fourth and final stage of HIV disease. HIV disease weakens the immune system by targeting white blood cells called lymphocytes, specifically the CD4 T-cells. AIDS is diagnosed when these fall below 200 per cubic milliliter of blood, meaning that the immune system has become severely damaged. Treatment for HIV disease can be started before this, as long as the infection has already been detected and CD4 level testing can be done. The Department of Health and Human Services (DHHS) recommends that antiretroviral treatment be started when CD4 cells dip below 350 per cubic milliliter of blood. In countries where this CD4 testing is not available, the World Health Organization (WHO) recommends that treatment be begun during its description of clinical stage three of HIV disease (which is somewhat different than the definition of general third-stage HIV, also known as symptomatic HIV).

Effects

AIDS is a syndrome, which is a group of conditions. In the case of HIV disease, these are known as AIDS-defining illnesses, and they fall into four categories: opportunistic infections, wasting, malignancies (cancers) and neurological conditions. Opportunistic infections are bacterial, viral, fungal and protozoan infections that do not cause disease in people with healthy immune systems or which cause much more serious disease in immunocompromised people, i.e., people whose immune systems have lost the ability to fight off infection. These include thrush, toxoplasmosis, cytomegalovirus, Pneumocystis pneumonia and herpesviruses. Some opportunistic infections respond to antiretroviral treatment for HIV-disease, while others must be targeted more specifically. To learn more about opportunistic infections, see Resources. Wasting is a condition that causes the loss of 10% or more of body weight, according to AIDS.org. Both HIV disease and antiviral treatment for HIV disease can worsen wasting (through symptoms like nausea, loss of appetite and vomiting), but maintaining a healthy diet and exercising can help mitigate the effects of wasting. Some cancers are linked to advanced HIV disease; these include Kaposi's sarcoma and lymphomas. Kaposi's sarcoma is a skin cancer that produces purple lesions and is caused by an opportunistic infection with HHV-8, a herpes virus. Lymphomas are cancers of lymphocytes, cells targeted by HIV. Neurolgical conditions of AIDS include AIDS Dementia Complex (ADC). According to HIV InSite, ADC can affect cognition and motor skills as well as behavior, and a high death rate is associated with ADC.

End-of-Life Care

AIDS leads to terminal conditions, which means that end-of-life care is part of the management of advanced HIV disease. According to Avert.org, care provided at the end of life includes management of pain and other symptoms while providing support to the dying and their families.

Difference Between HIV & AIDS

Window Period

The first stage of HIV infection is also called the "window period." This is a period when the infected person may not be ill at all and may not test positive, but they will have a high viral load and be very infectious.

Seroconversion

Seroconversion is the second stage of HIV infection and is another period in which an infected person is highly infectious. It is during seroconversion that the body develops antibodies to HIV that can be detected on tests. Various symptoms of infection may appear as well, including fever, rash, fatigue and neurologic symptoms.
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Asymptomatic Period

The asymptomatic period is the stage of HIV infection in which a person may not show any symptoms nor have a major increase in viral load. This period may last up to ten years or longer, especially with medical treatment. HIV-positive patients in the asymptomatic period are still not considered to have AIDS.

Symptomatic Stages

Once the asymptomatic period ends, an HIV-positive individual will pass through earlystage and mid-stage symptomatic periods. Early-stage symptoms will include rashes, fatigue, weight loss, and other relatively common symptoms of disease. As the infection compromises more of the immune system, mid-stage symptoms such as significant weight loss, persistent cold sores, oral thrush and diarrhea will become much more common.

AIDS

AIDS is the final stage of HIV infection and is characterized by a CD4 or t-cell count of less than 200 and/or certain opportunistic infections. AIDS is considered to be a separate condition from HIV infection because it requires such specific criteria before it will be diagnosed.

Difference Between HIV and AIDS

HIV is a virus that replicates inside of certain immune cells. AIDS is a syndrome made up of several medical problems, including a low CD4 count and the presence of one or more opportunistic infections. One does not "catch" AIDS, they develop AIDS as a worsening of their HIV infection.