HIV Infection and AIDS

What are HIV and AIDS?

HIV is the abbreviation used for the human immunodeficiency virus. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease.

HIV attacks the body's immune system. The infection-fighting cells of the immune system are a type of white blood cell called CD4 cells or T-helper cells. Months to years after a person is infected with HIV, the virus begins to destroy the CD4 cells. When the CD4 cells are destroyed, the immune system can no longer defend the body against infections and cancers.

HIV infection becomes AIDS when so many of the CD4 cells are destroyed that you lose your ability to fight off serious infections or tumors. Various infections called opportunistic infections develop. They are called opportunistic because they take advantage of the weakened immune system. These infections would not normally cause severe or fatal health problems. However, when you have AIDS, the infections and tumors are serious and can be fatal.

How does it occur?

HIV is not spread through the air, in food, or by casual social contact such as shaking hands or hugging. The virus is passed on only when blood or sexual secretions, such as semen, enter another person's body. HIV can also be spread to babies by the breast milk of an infected mother. Spread of the virus can occur during such activities as:

• unprotected sexual activity
• sharing IV needles
• being born to or breast-fed by an HIV-infected mother
• blood transfusions (now rare in the US because of current screening tests).

The following groups have the highest risk for HIV infection and the development of AIDS:

• sexually active homosexual men
• bisexual men and their male and female partners
• IV drug users and their sexual partners
• people who share needles (for IV drug use, tattooing, or piercing)
• heterosexual men and women with more than one sexual partner
• people given transfusions of blood or blood products in countries where the blood is not rigorously tested
• immigrants from areas with many cases of AIDS (such as Haiti and east central Africa)
• people who have sex with an HIV-infected partner or with anyone in the above groups if they do not always use a latex or polyurethane condom
• babies born to or breast-fed by HIV-infected mothers.

Even though gay and bisexual men are at highest risk for HIV infection, the number of HIV and AIDS cases among women is rising. In 2004 25% of all new HIV/AIDS cases diagnosed were women. Women of color are most likely to be infected with HIV/AIDS. In 2004 (the most recent year for which data are available), HIV infection was

• the leading cause of death for black women (including African American women) aged 25 to 34 years
• the 4th leading cause of death for Hispanic women aged 35 to 44 years.

The only diseases causing more deaths of women were cancer and heart disease.

What are the symptoms?

The symptoms of HIV infection and AIDS are usually the symptoms of the diseases that attack the body because of a weakened immune system:

• fever that lasts from a few days to longer than a month
• loss of appetite or weight, especially loss of more than 10% of body weight
• nausea and vomiting
• tiredness
• prolonged swelling of the lymph nodes
• sore throat
• long-lasting or multiple viral skin problems, such as herpes sores or plantar warts
• repeated, severe yeast infections in your mouth or vagina despite treatment
• chronic muscle and joint pain
• diarrhea, especially if it lasts longer than a month
• headache
• blurry vision or other problems with vision.

The serious opportunistic diseases that most often affect someone with AIDS include a type of cancer called Kaposi's sarcoma and these infections: Pneumocystis carinii pneumonia (PCP), tuberculosis, meningitis, and herpes simplex infections.

How is it diagnosed?

Testing to see if you are infected with HIV is done in 2 steps. The first test is a screening test. If it is negative, you don't have HIV and do not need more tests. If the screening test is positive, you will need a second, different test to confirm the positive screening test.

Usually the first test, the ELISA test, is a blood test. Some hospitals and facilities may instead do a test of fluid obtained from your mouth by swabbing your gums or holding the swab between your cheek and the gums for a few minutes. If the first test result is positive, another more specific blood test, usually the Western blot test, is done to confirm the results.

Once you have confirmed positive HIV test results, you must have a thorough medical exam. Your healthcare provider will ask about your medical history and symptoms and will examine you.

The medical history and physical exam includes discussing your history of sexual practices and sexually transmitted diseases. Your healthcare provider will also ask about any history of drug abuse.

You will have some lab tests. Comparing the results of the physical exam and these first lab tests with results weeks or months from now can help your healthcare provider diagnose new symptoms you may have in the future. It can also help your provider know how well your medicines are working.

You will be tested for certain infections, such as tuberculosis (TB), syphilis, and hepatitis B. These infections can worsen rapidly when you have HIV. They also pose a serious risk to others.

HIV-positive women should have a Pap test according to the schedule recommended by their healthcare provider (usually every 6 to 12 months). The Pap test can detect viral infections of the cervix. It's especially important for HIV-positive women to have regular Pap tests because the virus that causes cervical cancer can spread and cause problems much more quickly in women who are infected with HIV.

How is it treated?

Your treatment depends on if it is known when you became infected with HIV and whether you have symptoms. Your treatment may include:

• antiretroviral medicines, such as zidovudine (also called ZDV or AZT), didanosine (ddI), and lamivudine (3TC)
• protease inhibitors, such as indinavir (Crixivan), lopinavir/ritonavir (Kaletra), ritonavir (Norvir), saquinavir (Fortovase), and nelfinavir (Viracept)
• lab tests every few weeks to see how well your immune system is working, to measure the amount of HIV in your blood, and to screen for infections or other medical problems
• regular dental exams because people who are HIV positive often have mouth problems, including gum disease
• preventive treatment for such diseases as:
  • Pneumocystis carinii pneumonia (PCP)
  • tuberculosis
  • toxoplasmosis (be sure to avoid raw meat and cat litter boxes)
  • tetanus
  • hepatitis B
  • pneumococcal infections
  • influenza
• treatment for infections and tumors as they develop.

Your healthcare your provider may recommend starting treatment with antiretroviral drugs and possibly other medicines, depending on how low your CD4 cell count is and how high your viral load is. Your treatment will be monitored with testing, usually every 3 to 4 months. The CD4 cell count is a good way to know how well the immune system is working. Along with the CD4 count you will have a viral load test, which measures the amount of HIV in your blood. If the amount of virus is still increasing in spite of your treatment, your treatment medicines will usually need to be changed.

Antiretroviral medicines can slow the progress of the disease, but they are not a cure. Many new drug treatments and combinations are being prescribed or studied.

Vision problems are often an early sign of opportunistic infection in HIV-positive individuals. Tell your healthcare provider promptly about any eye symptoms, especially if you keep having blurry vision or an off-and-on loss of vision.

Getting care in an office or clinic that uses the case management concept of care is perhaps the most important aspect of your treatment. This approach emphasizes team care coordinated by a case manager. The case manager helps you communicate with all who are caring for you. Other advantages include:

• Up-to-date medical care will be available to you.
• Treatment of the medical and social aspects of your illness will be brought together.
• You will have help in finding resources (medical, social, financial).

How long do the effects last?

The full effects of AIDS may not appear until 5 to 10 years after you are first infected with HIV. Although AIDS is a fatal disease, life expectancy has increased as new treatments are developed. There are now many individuals with AIDS in the US who are leading productive lives 10 to 15 years after their diagnosis.

How can I take care of myself?

If you are in a high-risk group but have not tested positively for HIV, see your healthcare provider regularly. He or she will examine you for signs of HIV-associated infections and will recommend how often your blood should be tested for HIV infection.

If you are HIV positive:

• Discuss your treatment with your healthcare provider.
• See your provider on a regular schedule to keep up to date on new treatments.
• Contact a local AIDS support network. Your provider should be able to help you find one.

Call or see your healthcare provider if:

• You have new or persistent symptoms.
• You notice a change in body function that concerns you.
• You are having side effects from your medicine.

How can I help prevent HIV infection?

Practice safe sex to prevent becoming infected, or to prevent spreading the infection to others:

• Have just 1 sexual partner who is not sexually active with anyone else.
• Avoid exposure to blood, vaginal secretions, semen, and other sexual secretions during foreplay and intercourse. Carefully use latex or polyurethane condoms for every oral, vaginal, or anal sexual activity.
• Do not use a spermicide containing nonoxynol 9 and do not use condoms coated with this spermicide. Research has found that nonoxynol 9 can irritate the lining of the vagina and rectum. These irritated areas make it easier for the virus to enter the body.
• If you use a lubricant, use one that is water based. Do not use oil-based lubricants made with petroleum jelly, mineral oil, vegetable oil, or cold cream. They can damage the condom.

In addition:

• Ask any new sexual partner about his or her sexual and injection drug use history.
• If you have not been tested for HIV, get tested and ask sexual partners to be tested for HIV.
• Do not share needles for drug use, tattooing, or body piercing.

If you are HIV positive:

• Do not donate blood, plasma, or semen.
• Do not plan to donate organs, such as corneas. (If you were previously planning to donate organs, have that statement removed from your driver's license.)
• Tell your healthcare providers that you are HIV positive. Discuss any concerns you may have about confidentiality with your healthcare provider.
• To avoid passing HIV to a baby, women should talk to their healthcare providers before becoming pregnant.

If you are exposed to HIV:

If you have been exposed to HIV through sexual intercourse, sexual assault, injection drug use, or an accident, antiretroviral drugs may be used to prevent HIV infection. The treatment must be started no later than 72 hours after the exposure. The treatment lasts 28 days. This preventive treatment is not recommended for people who are often at risk of exposure to HIV, such as people who have HIV-infected sex partners and rarely use condoms, or injection drug users who often share equipment.

How can I keep up to date on treatments for HIV infection?

Researchers are learning more about HIV. As a result, recommended treatments change often. Keeping up with these changes can be difficult and frustrating. Ways you can seek up-to-date information and care are:

• Obtain healthcare from a case management model facility and follow the recommended appointment schedule.
• Contact the following organizations with specific questions or to find other resources:

  CDC-INFO
  Phone: 1-800-232-4636 (24 hours a day, 365 days a year)

  AIDSinfo
  Web site: http://aidsinfo.nih.gov
  Phone: 1-800-HIV-0440 (1-800-448-0440)

  CDC National Prevention Information Network
  Web site: http://www.cdcnpin.org
  Phone: 800-458-5231