AIDS gets a lot of press.

Most of us know that it affects the immune

system, and that the name is short for Acquired Immune Deficiency
Syndrome. Most of us probably also know that the immune system helps
protect us from infection. But how many of us know what the immune
system actually is, or how it works?

The fact is, the immune system is no one thing. You can't pinpoint any
specific part of the body and say "That's the immune system." It is so
complex, that no body of science yet fully understands exactly how it all
works. So let's go through the key points of what we do know, in order to
gain a better understanding of this strange condition called AIDS.

The biggest organ of your immune system is your skin. Does that surprise
you? Remember that the microbes that cause infection, whether they are
bacteria, viruses or fungi, are all invisible to the human eye. So although
we are surrounded by millions of them every day, we can't see them.
Your skin helps prevent all those microbes from gaining access to your
body. Think of it as fortress walls with electric fencing – that's the
immune function of your skin. Your mucous membranes also form part of
this fortress that keeps the microbes out.

Of course, no fortress is impenetrable. You may have a cut on your skin,

or a wound. And of course, there are doorways into your body through
your nose and mouth. Fortunately, these have little burglar alarms that
alert the immune system when an intruder tries to make an uninvited
entry.

The immune system, of course, has to be very smart. It has to know

which cells belong to the body, and which don't. It does this by looking for
little markers called antigens. Think of antigens as being little uniforms.
All the cells in your body wear the same uniform, even though they may
have different functions. Microbes coming into the body have their own
uniforms, which are usually very different. Maybe they're even dressed in
civvies, who knows.

Guard cells patrol the body all the time. There are small, quick-footed,
lightly armed guards called microphages ("little eaters") which patrol the
bloodstream. There are also bigger, slower, better-armed guards called
macrophages ("big eaters") which hang around the spleen and lymph
nodes, waiting to be called. They also patrol the body tissues.

Microphages are cells with powerful digestive enzymes and antibacterial

substances. When a microphage sees a foreign uniform, it rushes over
with a baton, bangs the microbe over the head and then gobbles it up to
get rid of it. They are always first at the scene of the crime, and call for
reinforcements from more powerful immune cells. It's quite possible that
the microbes may be more powerful than the microphages, in which case
it's the microphage that gets shot before it can wield the baton. The
macrophages arrive afterwards, to collect the evidence and destroy any
microbes that may have escaped the microphage guards.

Both microphages and macrophages come from the bone marrow. But the
bone marrow also makes stem cells, which move to different parts of the
body. These include other important immune organs like the thymus
gland, spleen, lymph nodes, tonsils, appendix and Peyer's patches in the
intestinal wall. Once settled into the organ, the stem cells produce white
blood cells called lymphocytes.

Cells produce more cells by dividing into two cells. The daughter cells
divide again, and so the process continues. The stem cells that go into the
thymus gland divide very quickly, to produce a large number of daughter
cells, most of which don't survive. Those that do, then leave the thymus
gland and travel between the other immune organs at will. But they never
return to the thymus.

These particular cells, formed in the thymus gland, are called T-

lymphocytes or T-cells. And they learn special skills in the thymus gland
which are very useful in fighting off foreign microbes.

When a T-cell reaches the scene of a crime, three things can happen. The
foreign microbe can either inactivate or kill the T-cell. If it kills all the T-
cells, the body can't see the foreign uniform any more and the microbe
can go where it likes.

The T-cells can also start dividing. This means there are more cells that
recognise the foreign uniform, which in turn means that if any more of
these uniforms try and get into the body, the body can respond quicker
and better.

The third thing the T-cell can do is release cytokines. This is a bit like
casting a magic spell which makes the macrophages in the area stronger
and more powerful, so that they can hit the microbes faster and have
more chance of devouring them.

T-cells make up about 70% of the lymphocytes in the body. The rest are
B-lymphocytes, which never go to the thymus gland. They don't travel as
easily as T-cells, and they have different skills, including the ability to
make antibodies which inactivate foreign particles.

HIV targets mainly the T-cells, specifically those which have a special
receptor called a CD4 receptor. The virus attaches onto that receptor so
that it can take over the inside of the cell. So we have a virus which looks
– and acts like – a CD4 T-cell.

During the first stage of infection with HIV, the virus will kill a number of
T-cells as it infects them. The immune system will react to the infection,
and the body will display all the symptoms of an immune response such
as fever, headache, tender lymph nodes, and generally feeling unwell.

However, once the B-cells have formed antibodies, the spread of infection
stabilises. The symptoms disappear, and nothing seems to happen for a
few months to several years.

But think what happens in the meantime. The virus has not been
destroyed, just stabilised. There are antibodies, but not enough. The virus
can continue to spread, although at a much slower rate.

Now think what happens when a microbe breaches the skin and enters
the bloodstream. The immune systems sends the T-cells to fight the new
microbe. But some of these T-cells are infected with HIV. They've lost
their magic spells, and can either die from a microbe attack, or start
dividing to make more T-cells. Except that they start making more virus-
infected T-cells, which will eventually succumb to the virus. As more and
more T-cells die, the body is less able to recognise foreign uniforms.

As time passes, the number of CD4 T-cells slowly drops, and the amount
of virus slowly increases until a critical level is reached. Then the number
of CD4 T-cells plummets, and the amount of virus in the bloodstream
shoots up. Without the T-cells, the immune system becomes virtually
useless. The foreign uniforms can march in unchallenged. Even an army
of 98 lb. weaklings can come in and create havoc. These diseases –
caused by everyday, normally harmless microbes – are the ones that
usually define the beginning of AIDS.

Scientists have now developed tests to measure the amount of CD4 T-

cells and the amount of virus in the body. When the T-cells get too low, or
the virus gets too high, they can adjust the HIV treatment to restore a
measure of law and order in the body. When pharmaceutical companies
test their new anti-HIV drugs, they measure the T-cells and amount of
virus in order to measure exactly how effective their drug is.

As a result of understanding the immune system better, people infected

with HIV are able to live longer, healthier, productive lives. New research
is leading scientists to consider the possibilities of cell transplants.
Perhaps one day, our understanding will grow to the point that we know
how to rebuild a defective immune system completely.
Vaginal sex
HIV is found in the sexual fluids of an infected person. For a man, this means the pre-come and semen fluids that
come out of the penis before and during sex. For a woman, it means HIV is in the vaginal fluids which are
produced by the vagina to keep it clean and to help make intercourse easier.

If a man with HIV has vaginal intercourse without a condom then HIV can pass into the woman's body through
the lining of the vagina, cervix and womb. The risk of HIV transmission is increased if the woman has a cut or
sore inside or around her vagina; this will make it easier for the virus to enter her bloodstream. Such a cut or sore
might not always be visible, and could be so small that the woman wouldn't know about it.

If a woman with HIV has sexual intercourse without a condom, HIV could get into the man's body through a sore
patch on his penis or by getting into his urethra (the tube that runs down the penis) or the inside of his foreskin (if
he has one).

Any contact with blood during sex increases the chance of infection. For example, there may be blood in the
vagina if intercourse occurs during a woman's period. Some sexually transmitted diseases – such as herpes and
gonorrhoea – can also raise the risk of HIV transmission.

Anal sex
Receptive anal intercourse (i.e. being the “bottom”) carries a higher risk of HIV transmission than receptive
vaginal intercourse. The lining of the anus is more delicate than the lining of the vagina, so is more likely to be
damaged during sex. Any contact with blood during sex increases the risk of infection.

If a man takes the insertive (“top”) position in anal sex with a man or woman who has HIV, then he too risks
becoming infected.

Oral sex
Oral sex with an infected partner carries a small risk of HIV infection. If a person gives oral sex (licking or sucking
the penis) to a man with HIV, then infected fluid could get into their mouth. If the person has bleeding gums or
tiny sores or ulcers somewhere in their mouth, there is a risk of HIV entering their bloodstream. The same is true
if infected sexual fluids from a woman get into the mouth of her partner.

There is also a small risk if a person with HIV gives oral sex when they have bleeding gums or a bleeding wound
in their mouth. Saliva does not pose a risk.

HIV infection through oral sex alone seems to be very rare, and there are things you can do to protect yourself.
For more information visit our Oral sex page.

Injecting drugs
Injecting drug users are a high-risk group for exposure to HIV. Sharing injecting equipment is a very efficient way
to transmit blood-borne viruses such as HIV and Hepatitis C. Sharing needles and “works” (syringes, spoons,
filters and blood-contaminated water) is thought to be three times more likely to transmit HIV than sexual
intercourse. Disinfecting equipment between each use can reduce the chance of transmission, but does not
eliminate it entirely. For more information, visit our injecting drugs, drug users and HIV page.

Mother to child transmission

An infected pregnant woman can pass HIV on to her unborn baby during pregnancy, labour and delivery. HIV
can also be transmitted through breastfeeding.
If a woman knows she is infected with HIV, there are drugs she can take to greatly reduce the chances of her
child becoming infected. For more information, go to our pages about HIV and pregnancy and mother-to-child
transmission of HIV.

Blood transfusions and blood products

Some people have been infected through a transfusion of infected blood. These days, in developed countries all
the blood used for transfusions is tested for HIV. In those countries where the blood is tested, HIV infection
through blood transfusions is now extremely rare. In some developing countries, testing systems are not so
efficient and transmission through blood transfusions continues to occur.

Blood products, such as those used by people with haemophilia, are now heat-treated to make them safe.

Infection in health-care settings

Hospitals and clinics should take precautions to prevent the spread of blood-borne infections. These measures
include using sterile surgical instruments, wearing gloves, and safely disposing of medical waste. In developed
countries, HIV transmission in health-care settings is extremely rare. However, cases continue to occur in less-
resourced areas where safety procedures are not so well implemented.

Health-care workers have on rare occasions become infected with HIV by being stuck with needles containing
HIV-infected blood. A few have also become infected by HIV-infected blood getting into the bloodstream through
an open cut, or splashing onto a mucous membrane (e.g. the eyes or the inside of the nose). There have been
only a very few documented instances of patients acquiring HIV from an infected health-care worker. We have
more information about healthcare workers and HIV infection.

Tattoos / piercing
Anything that potentially allows another person's blood to get into your bloodstream carries a risk. If the
equipment has not been sterilised before having a tattoo or piercing, there could be a significant risk of exposure
if the person before was HIV positive.

In most developed countries there are hygiene regulations governing tattoo and piercing parlours to ensure all
instruments used are sterile. If you are thinking of having a tattoo or piercing, ask staff at the shop what
procedures they take to avoid infection.