What is HIV & AIDS? Causes, Symptoms & Treatment

What is HIV & AIDS? HIV infections/ AIDS is a disease of the human’s immune system caused by infection with Human Immunodeficiency Virus (Retrovirus)

It destroys the body’s defense mechanism or immune system against infection and threatens life. Sometimes, also called “Slim disease”. AIDS is a killer disease- no cure is known and no vaccine is available against it.

Magnitude of problem

AIDS is a worldwide epidemic and pandemic. It was 1st reported in 1981, USA. Since the beginning of the epidemic in 1981, the prevalence has increased exponentially with a doubling time of 6-12 months.

Table of Contents

Epidemiological Features

Agents

  • HIV (Retrovirus)
  • 2 types of HIV
  • HIV 1 (Common in the USA)
  • HIV 2 (common in developing countries)

      A) Sources of Infection

  • Body fluids like blood, semen, vaginal fluids, breast milk etc.

     B) Reservoir of infection

  • Once a person is infected, the virus remains in the body for lifelong
  • A person may be an asymptomatic carrier, about 50% people develop AIDS within 10 years after being infected with HIV

    C) Infectivity: lifelong  

Host

  1. Age: common in 20-49 years age groups as they are sexually active but may occur in any age group.
  2. Sex: affects both sexes equally, common in people with multiple partner and male homosexuals
  3. High-risk groups
  4. Male homosexuals
  5. Heterosexual partners (including sex workers)
  6. IV drug abusers
  7. Transfusion recipients of blood and blood products
  8. Hemophilia
  9. Clients of STI

Environmental factors

  1. Lack of knowledge regarding HIV/AIDS and its preventive measures

Mode of transmission

Note- virus cannot enter intact skin

Sexual Transmission

  1. HIV/AIDS is first and foremost an STI
  2. Any vaginal, and or oral sex can spread HIV
  3. Homosexual transmission is common in the US and heterosexual transmission is common in developing countries

Vertical transmission

  1. Transmitted to child via transplacental route in utero, during delivery or breastfeeding

Parenteral transmission

  1. Transfusion of contaminated blood
  2. IV drug abusers sharing the same syringe
  3. Skin piercing by contaminated instruments

Incubation period

  1. It can be up to 6 years or more, but it is not certain
  2. It takes 6 – 12 weeks after infection for Ab to rise to a detectable level, this is called the “window period”. During which the infected person may transmit infection despite being seronegative.

Clinical Manifestations

The clinical features of HIV infection have been classified into 4 broad categories:

  1. Initial infection
  2. Asymptomatic carrier state
  3. AIDS-Related Complex (ARS)
  4. AIDS
  • Initial Infection

HIV can pass through Blood-Brain Barrier and can destroy some brain cells causing HIV neurological disease e.g. dementia and seizures

  • Asymptomatic Carrier State

Host shows no symptoms but is a carrier and may infect others

  • AIDS-Related complex
  1. In this, the host has illness caused by damage to the immune system but without the opportunistic infections and cancer associated with AIDS
  2. Exhibits one or more of the following symptoms
  3. Unexplained diarrhea lasting longer than a month
  4. Fatigue
  5. Malaise
  6. Loss of >10% body weight
  7. Oral thrush
  8. Generalized lymphadenopathy
  9. Enlarged spleen
  • AIDS
  1. It is the end stage of the HIV
  2. It is characterized by life-threatening opportunistic infections and/or cancer
  • Major signs
  1. Weight loss (>10% body weight)
  2. Chronic diarrhea for >1month
  3. Prolonged fever for more than 1 month (intermittent or constant)
  • Minor Signs
  1. A persistent cough for more than 1 month
  2. Generalized pruritus dermatitis
  3. Repeated common infections (e.g. otitis, pharyngitis, pneumonitis etc.)
  4. Generalized lymphadenopathy
  5. Oropharyngeal candidiasis etc.

Diagnosis

  1. ELISA: it a screening test
  2. Western Blot: confirmatory test
  3. P24 antigen: indicator of active viral replication
  4. CD4 T-cell antigen: monitoring immune status
  5. HIV viral load: detection of actively dividing virus marker of disease progression

Complication

System

  • Central Nervous System  
  1. AIDS – dementia complex
  2. Toxoplasmosis
  3. Primary CNS lymphoma
  4. CMV retinitis
  • Gastrointestinal system
  1. Esophagitis
  2. Colitis
  • Hepatobiliary system
  1. Biliary tract infection
  • Renal system
  1. Focal segmental glomerulosclerosis
  • Respiratory system
  1. Pneumonia
  2. Tuberculosis
  • Skin
  1. Kaposi’s sarcoma
  2. Bacillary angiomatosis

Treatment

  • Zidovudine is in longest use. It decreases the frequency of opportunistic infection and contributes to an increase in the survival time, progresses lifespan
  • Dideoxyinosine (DDI)  and Dideoxycytidine (DDC):  studies have shown that the combination of this two drugs with Zidovudine delays the emergence of resistance and clinical deterioration as well as reduce the incidence of adverse reactions

Prevention

  • Promotion
  1. Health education using different media like radio, television etc.
  2. AIDS: How AIDS is caused, how it spreads and doesn’t spread, etc
  3. Safe sex practices: sexually active population should adopt safe sex practices, use of condoms with spermicide
  4. Needles and syringes: separate syringe should be used. Drug addicts should avoid sharing syringe and needles. They should seek treatment for their addiction.
  • Examination and rehabilitation of sex workers:

Sex workers are periodically examined for AIDS and other STIs and treated promptly. If possible, the one who are forced into sex works must be rehabilitated by helping them to go back to their home, or by giving them training in some craft and helping them to find a job.

  • Control of STIs and drug abuse

STI patients and drug addicts are at high risk for acquiring AIDS. Therefore, attempts are made to detect them, treat them and motivate them to practice safe sex and to use sterile syringes and needles.

  • Housing for migrant laborers

Those who have migrated in search of jobs and found work in towns must be provided houses. A better approach is to motivate their employers to build a house for them.

Specific protection

  • Protection against sexual transmission
  1. Safe sex practices
  2. Practice abstinence before marriage and fidelity after marriage
  3. Mutual monogamy
  4. Avoiding sex with multiple partners
  5. Banning of pornographic movies and literature
  6. Marriage counseling
  • Protection against parenteral transmission
  1. Screening of donated blood
  2. HIV testing for organs to be transplanted
  3. Avoiding use of same injections
  4. Use of sterile needles/ syringes for any skin piercing
  5. Strict aseptic technique in handling any specimen in lab/ward by health workers

Universal precaution

  • Workplace control
  1. Hand washing
  2. Personal Protective Equipment
  3. Medical examination of health workers
  4. Immunization against Hepatitis B
  5. Safe disposal of hospital and dangerous wastes
  6. Education about HIV/AIDS spread and precautions to be taken to avoid them
  • Environmental disinfection

Surface and materials including toys used by child patients are disinfected with a bleach solution.

  • Engineering control
  1. Medical institutions and laboratories are well ventilated
  2. To reduce oozing of blood during surgical treatment, laser scalpel is used
  3. Local exhaust ventilation is provided in the form of laboratory fume hoods
  • Testing and counseling
  1. Testing – ELISA test for early detection
  2. Counselling on decisions regarding treatment, help to cope up with the stress, assist in planning the future course of action on miscarriage, pregnancy, breastfeeding, care of child etc.
  • Protection against vertical transmission
  1. Administration of antiretroviral therapy (ART)
  2. Modify midwifery practices to minimize the risk of vertical transmission. E.g. avoidance of rupture of membrane, episiotomy, oral suction of newborn infant etc.

Note:

HIV cannot spread through

  1. Shaking hands and hugging
  2. Sharing equipment
  3. Using same utensils
  4. Sharing toilets

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