Human Immunodeficiency Virus (HIV)

What is HIV?

The Human Immunodeficiency Virus (HIV) is a retrovirus that pass infection to humans when it is in touch with human tissue like mouth, eyes, vagina, anal area or cut in the skin. The infection progresses slowly where the virus will be present in the body at all stages. 

  • Statistics
  • Signs and Symptoms
  • Transmission and Prevention
  • Diagnosis
  • Treatment
  • Conclusion

hiv

Statistics

Since the outbreak of HIV, 70 million individuals have been affected by the HIV virus where statistics show that around 35 million people have died from AIDS (Acquired Immunodeficiency Syndrome). As of the end of the year 2011, 34 million people were reported as being infected with this virus. 

Signs and Symptoms

The time period from HIV infection to its progression to AIDS is not consistent. Scarcely, people infected with HIV  develop difficulties that will lead to AIDS within a period of 1 year. Moreover, some other individuals show no symptoms, asymptomatic, for a period of 20 years. The advancement of infection from HIV to AIDS, without antiviral therapy, is about 8-10 years. The time period that takes for an individual to develop AIDS, thus varies. The rationale behind this yet remains unknown and is an active area of research currently.

Many individuals will first experience the diverse symptoms of acute infection within a couple of weeks. The symptoms are generally like the symptoms of influenza which include mild fever, pain and aches that has the tendency to become very severe too. The most common symptoms of HIV infection that a person infected may experience are:-

  • Fever
  • Muscle and joint aches
  • Sore throat
  • Swollen lymph nodes in the neck.

 Nevertheless, the reason behind why only some individuals with HIV infection develop these symptoms remain unknown. Additionally, the link between these symptoms, which one may experience or not,  and the disease that will follow suit in the near future, remains unknown too. After the primary infection, the individuals with the infection will subsequently go through a “no-symptom” phase, commonly known as asymptomatic. When the patient is tested at this stage, although he or she might have symptoms of primary infection, antibody  testing will yield a negative result. This is during the first few weeks of infection. If the medical doctor suspects infection due to the symptoms the patient experiences and due to exposure to HIV that might have taken place recently, the doctor will order other tests. The medical doctor will order tests that will look for the virus of interest that will circulate the blood system. A viral load test or assay test (antibody/antigen combination test) that will recognise the HIV antigen will be ordered. 

Identification of primary infection in patients is of particular importance in order to give the best possible treatment for the patient at an early stage and also to avoid transmission of the virus to others. This is of high importance as the patient with primary infection will have very high levels of the HIV virus in their body making them extremely infectious. When the individual is in the aysmptomatic stage, he or she can find out if they are infected or not through tests. Generally, a test to detect HIV antibodies will be undertaken.

As mentioned previously, patients are subjected to an asymptomatic period that can last for years shortly after primary infection. At this phase, the immune system of the affected individual deteriorates due to the CD4 cells which will decline progressively. Thus, other mild symptoms of HIV manifests and may include fungal infections like vaginal or oral candidiasisthrush, fungal infection of nails, hairy leukoplakia, persistent rashes, fatigue, loss of weight and diarrhoea. When the individual experiences these symptoms, a test for HIV should be performed abruptly, if for some reason it has not been done.

As the immune system progressively deteriorates, the patient will experience more severe symptoms and complications of HIV which may include other serious infections, serious weight loss problems, malignancy and deterioration of mental function. Clinically, HIV is categorised into three: experiencing no symptoms, mild symptoms and severe symptoms.

Transmission and Prevention

Nearly all persons infected with HIV, even if they exhibit any symptoms or not, will have the HIV viruses  in inconsistent levels in their blood and genital discharges. HIV can be transmitted through contact of these discharges from infected persons with the tissues lining the orifices in the body (the vagina, anal area, mouth, eyes any cuts in the skin etc) of a non-infected person. There are many methods for the spread of HIV and the most frequent of these are through sexual interaction, sharing of needles, from an infected mother to her baby (at the time of pregnancy, delivery, or breastfeeding).

Sexual spread of HIV can be from men to women, women to men, men to men or women to women. This could be through vaginal, anal and oral sex. In order to protect one’s self from sexual transmission of HIV, it is advised that one abstains from any sexual contact with one’s spouse or partner until it is certain that they are HIV-uninfected. It is important that both the partners test themselves for HIV for a period of 12-24 weeks following their most recent possible disclosure to the virus. This should be done  as it can take up to several months for the virus to be detected through the HIV antibody tests. If one is unable to abstain from sexual interaction or intercourse one can seek protection by the use of latex barriers. The usage of condoms during sexual intercourse will act as a barrier and will not let any ejaculatory secretions from an infected person coming into contact with any of the orifices of his or her sexual partner.

The transmission of HIV through HIV contaminated blood is generally by means of  sharing needles during the use of prohibited drugs and or anabolic steroids which are used to enhance the development of muscles. Other methods of transmission include piercing body parts, tattoo arts etc. The transmission of this infectious virus and other ailments like hepatitis can be easily avoided by using sterilised needles or having one needle per individual. At the start of the HIV outbreak, several individuals infected were those who had transfusions or donations of blood or components of blood. For instance, blood and its constituents were used for haemophiliacs, that lead to HIV. This method of contracting the deadly virus is now very rare in the US as blood or other blood components are well tested and screened for antibodies to HIV and the HIV itself prior to any transfusion or donation.

The possibility of contracting HIV through ordinary contact with infected individuals has shown to be very unlikely. Kissing too is usually regarded to be risk free, but the presence of open sores, cuts or blood in the mouth can lead to the contraction of HIV. Studies have shown that the content of HIV in saliva to be very low in comparison to genital discharges, this explains why kissing is usually regarded risk free. HIV can be found in large quantities in blood so it is always advisable to be cautious when sharing other objects that can cause cuts or bleeding; these include razors, shaving equipments, scissors, toothbrushes etc. Therefore one should refrain from sharing such objects with infected persons. Likewise, with no sexual contact or direct exposure to blood with an infected person, the danger of contracting the disease in a school or working environment is very unlikely.

Diagnosis

Back in the mid 1980s, a blood test was found that could detect the antibodies to HIV in the body. These antibodies become available as a result of the immune response that will be generated to a foreign particle, in this case the HIV virus. The test that is almost always used to detect and diagnose HIV infection is the ELISA. When ELISA shows a positive result for HIV antibodies, the results will be confirmed again using another test called the Western blot. These tests that utilise the antibodies produced by the immune system in response to HIV infection is the best test out there to detect the infection.

Currently, tests are becoming more advanced. The antibodies can now be detected in the saliva of the patient and test results can be given out within 20 minutes. FDA approved OraQuick home HIV antibody test is available which only requires saliva to test a patient for HIV infection. This has resulted in an increased number of people being tested for this infection.

The immune system triggers antibody production against the virus within a couple of weeks. As previously mentioned, during this period of primary infection, the antibody test will show negative results. This period is referred to as the window period. At this stage, diagnosis can be carried out if a test used detect the virus in the blood and not the antibodies is available. These tests can be for HIV RNA or p24 antigen. Lately, a new test has been developed and approved; this test can not only detect HIV antibodies but can also detect the p24 antigen. Therefore, the window period is considerably reduced as diagnosis can be made earlier. Furthermore, many testing centres are available in the country who perform routine check ups on blood samples that are HIV antibody negative for HIV RNA.

Despite the fact that the tests are constantly improving for HIV detection, it still needs volunteers who would come up for testing. It is reported that about 20% of the HIV virus infected individuals in the United States are ignorant of their condition as they have never been tested for it. Consequently, the Centre for Disease Control and Prevention urged the  general population to test for HIV when they are in need of the health care system for any medical condition. Individuals who are between 13-64 years only were urged to do so. Moreover, any information and other resources were made available to the public by their local centres for HIV testing.

Treatment

No cure is available for HIV infection or for AIDS. However, a number of medications are available which can be used in combination. The drugs are aimed to control the virus. Currently, 32 antiretroviral drugs, or ARVs, are available that are approved by the FDA for HIV infection. The drugs control and suppress the virus to undetectable levels. However, the drugs are not able to completely eradicate the virus out of the body. This suppression of the virus can make the patients live longer and healthier lives.

Treatment should commence when the patient has severe symptoms, the CD4 count is below 500, if the patient is pregnant, the patient has kidney disease related to HIV and when the patient is treated for hepatitis B. Treatment is not all that easy. The treatment plan prescribed for the patient will require him or her to take a variety of drugs at a specific time every day forever. Side effects to this treatment include abnormal pulse rate, nausea, vomiting, diarrhoea, skin rash, weak bones and death of bones which is commonly seen in hip joints.

How well a patient is responding to the administered treatment will be determined by the viral load and CD4 counts. Viral load is generally tested at the very beginning of treatment and every 3-4 months during treatment. On the other hand, CD4 counts will be checked and monitored every six months. The main aim of HIV treatment is to decrease the viral  load drastically to undetectable levels in the body. It is important to understand that the patient is still capable of transmitting the HIV virus to others although his or her levels are undetectable.

 Conclusion

The Human Immunodeficiency Virus (HIV) is a retrovirus that pass infection to humans when it is in touch with human tissue like mouth, eyes, vagina, anal area or cut in the skin. The infection progresses slowly where the virus will be present in the body at all stages. Since the outbreak of HIV, 70 million individuals have been affected by the HIV virus where statistics show that around 35 million people have died from AIDS.  The most common symptoms of HIV infection that a person infected may experience are fever, muscle and joint aches, sore throat and swollen lymph nodes in the neck. Currently, tests are becoming more advanced. The antibodies can now be detected in the saliva of the patient and test results can be given out within 20 minutes. No cure is available for HIV infection or for AIDS. However, a number of medications are available which can be used in combination. The drugs are aimed to control the virus.Side effects to this treatment include abnormal pulse rate, nausea, vomiting, diarrhoea, skin rash, weak bones and death of bones which is commonly seen in hip joints.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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The Team Manager Web Diseases

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