Know About HIV/AIDS

What is HIV?

HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (Acquired Immunodeficiency Syndrome), a health condition in which a person is affected by a series of diseases because of poor immunity. HIV by itself is not an illness and does not instantly lead to AIDS. An HIV infected person can lead a healthy life for several years before s/he develops AIDS.

What is AIDS?

As the name, Acquired Immunodeficiency Syndrome indicates, AIDS is a health condition that results from the deficiency in the body's immunity following HIV infection. HIV attacks the human body by breaking down its immune system that is meant to fight diseases. Over a period of time, the immune system weakens and the body loses its natural ability to fight diseases. At this stage, various diseases affect the infected person.

Human Immunodeficiency Virus

TRANSMISSION

A person can get infected with HIV through the following routes:

Unprotected sex:

If a person engages in sexual intercourse with an infected person without using a condom, s/he can get infected. The sexual act can be both vaginal and anal.

Sharing of needles:

If a person shares the needle or syringe used by/on an infected person, either for injecting drugs or drawing blood or for any other purpose involving piercing, s/he can get infected. Instruments used for piercing and tattooing also carry a small risk of infection.

Unsafe blood:

A person can get the infection, if he/she is given transfusion of infected blood.

Improperly sterilized hospital tools:

If surgical devices like syringes and scalpels, or even certain instruments, used on an infected person, are used on another person without proper sterilization, they can transmit the infection.

Parent to Child:

An HIV positive mother can transmit the virus to child during pregnancy or birth. Breast milk can also act as a transmission-medium.

Theoretically oral sex without condom (on men) or barriers like dental dam, vaginal dams or plastic wrap (on women) can also transmit the infection.

SYMPTOMS

What are the early symptoms of HIV infection?

Many people do not develop any symptoms when they first become infected with HIV. Some people, however, get a flu-like illness within three to six weeks after exposure to the virus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness, nausea, diarrhoea and enlarged lymph nodes (organs of the immune system that can be felt in the neck, armpits and groin). These symptoms usually disappear within a week to a month and are often mistaken for another viral infection.

During this period, the quantity of the virus in the body will be high and it spreads to different parts, particularly the lymphoid tissue. At this stage, the infected person is more likely to pass on the infection to others. The viral quantity then drops as the body's immune system launches an orchestrated fight.

More persistent or severe symptoms may not surface for several years, even a decade or more, after HIV first enters the body in adults, or within two years in children born with the virus. This period of "asymptomatic" infection varies from individual to individual. Some people may begin to have symptoms as soon as a few months, while others may be symptom-free for more than 10 years. However, during the "asymptomatic" period, the virus will be actively multiplying, infecting, and killing cells of the immune system.

What Happens Inside the Body?

Once HIV enters the human body t, it attaches itself to a White Blood Cell (WBC) called CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there is an infection, CD4 cells lead the infection-fighting army of the body to protect it from falling sick. Damage of these cells, hence can affect a person's disease-fighting capability and general health.

After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.

Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.

But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.

Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.

The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition.

What are the later symptoms of HIV/AIDS?

• Lack of energy

• Weight loss

• Frequent fevers and sweats

• A thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeast infection and sometimes accompanied by a sore throat

• Severe or recurring vaginal yeast infections

• Chronic pelvic inflammatory disease or severe and frequent infections like herpes zoster

• Periods of extreme and unexplained fatigue that may be combined with headaches, lightheadedness, and/or dizziness

• Rapid loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting

• Bruising more easily than normal

• Long-lasting bouts of daihorea 

• Swelling or hardening of glands located in the throat, armpit, or groin

• Periods of continued, deep, dry coughing

• Increasing shortness of breath

• The appearance of discolored or purplish growths on the skin or inside the mouth

• Unexplained bleeding from growths on the skin, from mucous membranes, or from any opening in the body

• Recurring or unusual skin rashes

• Severe numbness or pain in the hands or feet, the loss of muscle control and reflex, paralysis or loss of muscular  strength

• An altered state of consciousness, personality change, or mental deterioration

• Children may grow slowly or fall sick frequently. HIV positive persons are also found to be more vulnerable to some    cancers.

DIAGNOSIS

How is HIV diagnosed?

In the early stages of infection, HIV often causes no symptoms and the infection can be diagnosed only by testing a person's blood. Two tests are available to diagnose HIV infection - one that looks for the presence of antibodies produced by the body in    response to HIV and the other that looks for the virus itself.
Antibodies are proteins produced by the body whenever a disease threatens it. When the body is infected with HIV, it produces antibodies specific to HIV. The first test, called ELISA (Enzyme Linked Immunosorbent Assay), looks for such antibodies in blood.

If antibodies are present, the test gives a positive result. A positive test has to be confirmed by another test called Western Blot or Immunoflouroscent Assay (IFA). All positive tests by ELISA need not be accurate and hence Western Blot and repeated tests are necessary to confirm a person's HIV status. A person infected with HIV is termed HIV- positive or seropositive.

As ELISA requires specialized equipment, blood samples need to be sent to a laboratory and the result will be available only after several days or weeks. To cut short this waiting period, RAPID TESTS , that give results in 5 to 30 minutes, are increasingly being used the world over. The accuracy of rapid tests is stated to be as good as that of ELISA. Though rapid tests are more expensive, researchers have found them to be more cost effective in terms of the number of people covered and the time the tests take.

The HIV- antibodies generally do not reach detectable levels in the blood till about three months after infection. This period, from the time of infection till the blood is tested positive for antibodies, is called the Window Period . Some times, the antibodies might take even six months to show up. Even if the tests are negative, during the Window Period, the amount of virus is very high in an infected person. Hence, if a person is newly infected, the risk of transmission is higher.If a person is highly likely to be infected with HIV and yet both the tests are negative, a doctor may suggest a repetition of the tests after three months or six months when the antibodies are more likely to have developed.

The second test is called PCR (Polymerase Chain Reaction), which looks for HIV itself in the blood. This test, which recognizes the presence of the virus' genetic material in the blood, can detect the virus within a few days of infection.

There are also tests like Radio Immuno Precipitation Assay (RIPA) , a confirmatory blood test that may be used when antibody levels are difficult to detect or when Western Blot test results are uncertain. Other available tests are Rapid Latex Agglutination Assay , a simplified, inexpensive blood test that may prove useful in medically disadvantaged areas where there is a high prevalence of HIV infection, and p24 Antigen Capture Assay .

Are there any steps to be followed before and after the blood tests?

The process of getting tested for HIV can generate a variety of intense emotional reactions such as fear, anger and denial. Therefore, psychological counseling is essential to prepare individuals undergoing testing for the possible consequences. This is called Pre-Test Counseling and is unavoidable for anybody preparing to take a test.

If the test result is positive, it should not be disclosed without another round of counseling. This Post-Test Counseling is more crucial because of the enormous stress and the multitude of emotions that the infected person could undergo on learning his/her HIV status. A positive test has been linked to increased suicide ideas and attempts and emotional trauma, both at the time of knowing the positive result and also at the emergence of AIDS-defining symptoms.

As there is still considerable stigma and discrimination attached to HIV/AIDS, the decision whether to test or not itself should be preceded by considerable introspection and assessment of the possible outcome. The person to take test should be aware of the emotional trauma and the possible consequences a positive test could bring about. For these reasons, pre-test counseling is very crucial. With the help of the counselor, the person taking the test should assess his/her personal setting and prepare himself/herself for the probable consequences.

On the other hand, one should also be aware of the positive advantages of learning one's HIV status. If the test turns out to be positive, one can have early access to treatment, take care of one's health better and plan the future. Early realization of the health condition can be very useful in a large number of cases. The counselor could help the infected individual win back his/her confidence and learn how to live a healthy and responsible life. The individuals should also be prepared how to deal with their relatives, friends, colleagues, classmates etc. If the test is negative, the person should be advised preventive methods.

PREVENTION

• Because there is no effective vaccine and no cure for HIV, the only way to protect oneself is prevention.

• People should either abstain from having sex or use latex condoms, during oral, anal, or vaginal sex. Only condoms made of latex should be used, and whenever necessary only water-based lubricants should be used. People who are allergic to latex can use polyurethane condoms.

• Although some laboratory evidence shows that spermicidal can kill HIV, there is no conclusive evidence if it can prevent transmission.

• The risk of HIV transmission from a pregnant woman to her baby is significantly reduced if she takes AZT during pregnancy, labor and delivery, and her baby takes it for the first six weeks of life. Nevirapine is also found to be useful. But, one should seek expert medical assistance in such situations.

              Having a sexually transmitted disease (STD) can increase manifold a person's chances of getting HIV through sexual contact. So, it is necessary to treat STD as soon as you suspect infection.

SAFE SEX GUIDE

The Risk Chart - Practice Safe Sex

No risk or very low risk - No reported cases due to these behaviors

• Masturbation - mutual masturbation

• Touching - massage

• Erotic massage - body rubbing

• Kissing

• Oral sex on a man with a condom

• Oral sex on a woman with a dental dam, glide dam, plastic wrap, or cut-open condom

• Not sharing drug injecting, body piercing instruments, needles, syringes

• Using properly sterilized hospital tools

Low risk - Rare reported cases due to these behaviors

• Deep kissing

• Oral sex

• Vaginal intercourse with a condom or female condom 

• Anal intercourse with a condom (Try not to get semen or blood into the mouth or on broken skin.)

High risk - Hundreds of thousands of reported cases are associated with the following.

• Vaginal intercourse without a condom

• Anal intercourse without a condom

• Sharing needles, syringes and other body piercing instruments

TREATMENT

Is there treatment against HIV and AIDS?

Till today, there is no conclusive treatment to eliminate HIV from the body; however, timely treatment of opportunistic infections can keep one healthy for many years. The commonly available treatment for AIDS is the treatment against opportunistic infections. Normally standard treatment regimens, used against such infections in non-HIV patients, also work well with the HIV-positive persons. If properly treated, almost all the opportunistic infections can be contained.

However, during the last decade, researchers have developed powerful drugs that check the replication of the virus at various levels. Called Antiretroviral drugs, they are available in three classes and under various brands. Taken in combinations (called cocktail or combination therapy) under specialized medical advice, these drugs drastically reduce the viral load in blood. However, they do not permanently cure one of HIV. This line of treatment, called HAART (Highly Active Antiretroviral Therapy) has resulted in a huge reduction or AIDS-related deaths. Though many positive persons and caregivers have welcomed these drugs, others have experienced serious side effects. They are also very expensive and are out of reach for a majority of the infected people. But of late, the prices have been steeply falling.

The three classes of drugs are:

1.       Nucleoside analogue Reverse Transcriptase Inhibitors (NRTIs). NRTIs were the first antiretroviral drugs to be developed. They inhibit the replication of HIV in the early stage by inhibiting an enzyme (which is necessary for viral replication) called Reverse Transcriptase. The drugs include Zidovudine (Retrovir, AZT), Lamivudine (Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid, ddC), Stavudine (Zerit, d4T) and Abacavir (Ziagen).

The major reported side effect of Zidovudine is bone marrow suppression, which causes a decrease in the number of red and white blood cells. The drugs ddI, ddC and d4T can damage peripheral nerves (peripheral neuropathy), leading to tingling and burning in the hands and feet. Treatment with ddI can also cause pancreatitis, and ddC may cause mouth ulcers. Approximately 5 percent of people treated with Abacavir experience hypersensitivity reactions such as a rash along with fever, fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactions can also occur without a rash. In either case, symptoms usually appear within the first 6 weeks of treatment and generally disappear when the drug is discontinued. If a person had a hypersensitivity reaction to Abacavir, he/she should avoid taking the drug again.

2.        Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These drugs bind directly to the enzyme, Reverse Transcriptase. There are three NNRTIs currently approved for clinical use: Nevirapine (Viramune), Delavirdine (Rescriptor) and Efavirenz (Sustiva). A major side effect of all NNRTIS is a rash. In addition, people taking Efavirenz may have side effects such as abnormal dreams, sleeplessness, dizziness and difficulty concentrating.

3.   Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in the body to become structurally disorganized and noninfectious. Among these drugs are Saquinavir (Fortovase), Ritonavir (Norvir), Indinavir (Crixivan), Nelfinavir (Viracept), Amprenavir (Agenerase) and Lopinavir (Kaletra).

The most common side effects of PIs include nausea, diarrhoea and other digestive tract problems. They can also cause a significant number of side effects when they interact with certain other medications. That is because all PIs, to one degree or another, affect an enzyme system in the liver that is responsible for metabolising a large number of drugs. Newer side effects have also appeared with the continuing and widespread use of Protease Inhibitors. These include elevated triglyceride levels and problems with sugar metabolism that may sometimes progress to diabetes.

There may also be abnormalities in the way fat is metabolised and deposited in the body. Some people lose much of their total body fat while others gain excess fat on the back between their shoulders (buffalo hump) or in the stomach (protease paunch). Right now, no one knows exactly why these abnormalities occur. In fact, it is not even certain whether these problems are a direct result of treatment with protease inhibitors or due to some other cause that has yet to be identified. Similar metabolic abnormalities have occurred in people on antiretroviral therapy that does not include PIs. Although these body changes can be distressing, the possibility they may occur should not stop one from obtaining treatment for HIV/AIDS.

In simple combination therapy, some physicians prescribe a combination of RTIs. But in HAART, which in fact has made a dramatic change in AIDS treatment, a combination of RTIs and PIs is prescribed.

People respond differently to treatment and maintaining the drug schedule is extremely important. Indiscriminate treatment results in drug resistance and resurgence of the viral load. Therefore it should be taken only under expert medical advice.

What about vaccines?

More than a dozen HIV vaccines are currently being tested. As of now, there is no vaccine to prevent HIV infection.

What is Parent to Child Transmission?

Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months after birth. If these babies lack symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be made until after 15 months of age. By then, the babies are unlikely to still carry their mothers' antibodies and will have produced their own, if they are infected. New technologies to detect HIV itself are being used to more accurately determine HIV infection in infants between ages 3 months and 15 months. A number of blood tests are being evaluated to determine if they can diagnose HIV infection in babies younger than 3 months.

LIFE AFTER HIV

The experience of infected people during the last two decades has shown that HIV is not the "end of the world" and that there is good quality life for several more years. Taking care of one's health, keeping in mind one's vulnerability to diseases, and a positive attitude have been found to be very useful. New drugs and vaccine efforts also offer considerable hope to infected and affected individuals and their families. Several NGOs/CBOs, government organizations, public and private institutions offer ongoing support to people in need.

What should one do if found HIV positive?

• Consult a clinician experienced in treating HIV/AIDS.

• Protect your sex partner(s) from HIV by following safe-sex guidelines.

• Inform sex partner(s) who may also be infected.

• Do not share needles.

• Get psychological support from a counsellor and/or join a support group for people with HIV.

• Get information and social and legal support from AIDS service organisations.

• Don't share your HIV status with people who do not need to know. Only tell people you can count on for support. Think about whom do you want to share your HIV status with.

• Maintain a strong immune system with a healthy lifestyle and regular medical examinations.

Consider using antiretroviral therapies that may slow the progress of the infection in consultation with a qualified physician.

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