What is HIV and AIDS - Its Symptoms, treatment and prevention

Table of Contents

What are HIV and AIDS?

Introduction

The first reports of AIDS in the USA in 1981 among homosexual men and injecting drug users
By the end of 2001, over 2.7 million cumulative AIDS cases had been reported to the WHO
The developing world as a whole accounted for well over 80% of all AIDS cases
It is estimated that about 7.1 million people have HIV infection and AIDS in Asia and the Pacific and 90% of them live in India, Thailand and Myanmar.
HIV prevalence had reached 50% among sex workers, 33% in STD patients and 4.3% in pregnant women.
Most HIV transmission in Asia and Eastern Europe is due to the sharing of infected needles among injecting drug users
By the end of 2001, approximately 440,000 persons had HIV infection and AIDS, with a male: female ratio of 2.5:1( in North America and the Middle East)

The continent where the highest proportion of the population is infected with HIV is Africa.

Natural course

Acute infection with HIV may be accompanied by a transient non-specific illness similar to glandular fever; it includes fever, malaise, myalgia, lymphadenopathy, pharyngitis, and a rash
Physical examination may show no abnormality, but about one-third of patients have persistent, generalised lymphadenopathy (nodes of 1 cm or more in diameter in two or more non-contiguous extra-inguinal sites that cannot be explained by any other infection or condition).
The commonest sites of lymphadenopathy are the cervical and axillary lymph nodes

THE HIV LIFE CYCLE

Binding to the cell;

Fusing with the cell membrane;

Replicating itself with reverse transcription;

Releasing new viruses from the cell

MODES OF TRANSMISSION

Heterosexual intercourse accounts for more than 85% of cases of HIV infection in developing countries.
Early epidemiologic studies showed unprotected sexual intercourse with multiple partners or an infected partner and the presence of STDs or a history of STDs
Transmission of HIV-1 from mother to child vary from 13% to 48%.

(The immunologic status and viral load of the mother, maternal vitamin A deficiency, ingestion by the newborn at the time of delivery of the mother’s HIV-infected blood or amniotic fluid, and ingestion of infected breast milk.)

Blood products and contaminated equipment

BIOLOGIC FACTORS INCREASING THE PROBABILITY OF SEXUAL TRANSMISSION OF HIV

Confirmed:– Acute primary HIV infection Advanced clinical stage of HIV

Sexually transmitted diseases
Anal intercourse
Menstruation
HIV-1 versus HIV-2

AIDS

AIDS is defined as an illness characterised by one or more indicator diseases.

In the absence of another cause of immune deficiency and without laboratory evidence of HIV infection certain diseases when definitely diagnosed indicate AIDS.

Regardless of the presence of other causes of immune deficiency.

Diseases diagnostic of AIDS without laboratory evidence
of HIV

Candidiasis—oesophageal, pulmonary
Cryptococcosis—extrapulmonary
Cytomegalovirus disease—disseminated
Cryptosporidiosis—diarrhoea that persists for more than one month
Herpes simplex virus infection
Mucocutaneous ulceration that lasts more than one month
Pulmonary, oesophageal infection
Kaposi’s sarcoma—patient younger than 60 years
Mycobacterium avium—disseminated

Diseases diagnostic of AIDS if laboratory evidence of HIV exists

Recurrent or multiple bacterial infections—child aged under 13 years

Candidiasis—pulmonary,
Cervical carcinoma—invasive
Cryptococcosis—pulmonary
Cryptosporidiosis—with diarrhoea persisting for more than one month
Cytomegalovirus disease—not in liver, spleen, or nodes
HIV encephalopathy
Herpes simplex virus infection—mucocutaneous ulceration that lasts for more than one month or pulmonary, oesophageal infection
Histoplasmosis—disseminated
Recurrent pneumonia within a 12 month period

WHO’s AIDS definition for AIDS surveillance

For the purposes of AIDS surveillance, an adult or adolescent(older than 12 years of age) is considered to have AIDS if at least two of the following major signs are present in combination with at least one of the minor signs are not known to be caused by a condition unrelated to HIV infection.

Major signs

Weight loss10% of body weight
Chronic diarrhoea for more than one month
Prolonged fever for more than one month (intermittent or constant)

Minor signs

A persistent cough for more than one month*
Generalised pruritic dermatitis
History of herpes zoster
Oropharyngeal candidiasis
Chronic progressive or disseminated herpes simplex infection
Generalised lymphadenopathy

Expanded WHO case definition for AIDS surveillance

For the purposes of AIDS surveillance, an adult or adolescent(older than 12 years of age) is considered to have AIDS if a test for HIV antibody gives a positive result and one or more of the following conditions are present:
10% body weight loss or cachexia, with diarrhoea or fever, or both, intermittent or constant, for at least one month, not known to be caused by a condition unrelated to HIV infection
Cryptococcal meningitis
Pulmonary or extrapulmonary tuberculosis
Kaposi’s sarcoma
Neurological impairment, which is sufficient to prevent independent daily activities, not known to be caused by a condition unrelated to HIV infection (for example, trauma or cerebrovascular accident)
Candidiasis of the oesophagus (which may be presumptively diagnosed based on the presence of oral candidiasis accompanied by dysphagia)
Clinically diagnosed life-threatening or recurrent episodes of pneumonia, with or without aetiological confirmation
Invasive cervical cancer

Common AIDS-defining diseases

Developed world

Pneumocystis pneumonia
Oesophageal candida
Non-Hodgkin’s lymphoma
Tuberculosis (pulmonary and extra pulmonary)

Developing world

Tuberculosis (pulmonary and extra pulmonary)
HIV wasting syndrome
Cerebral toxoplasmosis
Cryptococcus meningitis

Proposed WHO staging system for HIV infection and disease

Clinical stage 1: asymptomatic or persistent generalised lymphadenopathy, performance scale 1 (asymptomatic, normal activity)
Now Clinical stage 2: weight loss 10% of body weight, minor mucocutaneous manifestations, varicella zoster within the last five years, recurrent upper respiratory tract infections (bacterial sinusitis), performance scale 2 (symptomatic but normal activity)
Clinical stage 3: weight loss 10% of body weight, unexplained chronic diarrhoea for more than one month, unexplained chronic fever for more than one month, oral candidiasis, oral hairy leukoplakia, pulmonary tuberculosis within the past year, severe bacterial infections, performance scale 3 (bedridden 50% of day during the last month)

● And Clinical Stage 4: most other AIDS-defining diseases (but not pulmonary tuberculosis), performance scale 4 (bedridden 50% of day during the last month

Symptoms and Signs

Weight loss
Nausea
Sinusitis
AIDS dementia complex
Oral lesions
Candidal esophagitis
Biliary disease
Enterocolitis
Endocrinologic manifestations
Skin manifestations
Myelopathy

Treatment

Recommended first-line regimens

Zidovudine and lamivudine plus nevirapine or efavirenz
And Zidovudine and lamivudine plus abacavir
Zidovudine and lamivudine plus nelfinavir or low dose ritonavir

comprehensive care for people living with HIV and AIDS

Available, accessible voluntary counselling and testing services
Prevention and treatment of HIV-related illnesses
Good nutrition
Prevention and treatment of tuberculosis and other infections
Family planning
Prevention of further HIV transmission
Respect for human rights
Prevention and treatment of STIs
Reduction of the stigma associated with HIV and AIDS
Social, spiritual, psychological, and peer support
Provision of antiretrovirals
And Palliative care

Prevention and control

Surveillance
Counselling and health education
Screening of people and donated blood
Heat treatment of blood products
Strategies to reduce high-risk behaviour in targeted populations
Antiretroviral therapy to reduce mother to child transmission
Protection of healthcare staff
Treatment and control of STIs

CLARIFYING COMMON MISCONCEPTIONS
ABOUT HIV AND AIDS

Since HIV is a virus, nothing that two uninfected people do can result in transmission of HIV.
Although tiny amounts of virus and its antibody are detectable in urine and other body fluids of people with HIV, contact with tears, urine, and sweat from a person who is infected does not transmit HIV.
With treatment during pregnancy, the risk of mother-to-child HIV transmission can be decreased to less than 2%.
Worldwide, most HIV transmission is due to sex between men and women.
The medicines, although very effective in delaying the onset of AIDS and progression to severe disease, do not cure HIV.
HIV antibody testing can be done with saliva or urine samples.