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AIDS (more information)

Overview

AIDS is a life threatening sexually transmitted disease caused by HIV or the Human Immunodeficiency Virus. AIDS stands for Acquired Immune Deficiency Syndrome:

• Acquired means that you are infected
• Immune Deficiency means that your body's immune system can no longer fight off germs and illness that it would be able to fight if you weren't infected with AIDS
• Syndrome means the health problems that are a part of the AIDS disease

You cannot have AIDS unless you are HIV positive. Many people think that being HIV-positive is the same as having AIDS because HIV and AIDS are usually referred to together (HIV/AIDS), but there is a difference. There are a lot of people who have HIV but live healthy lives without getting sick for years and do not have AIDS. But in some HIV-positive people, overtime HIV weakens your immune system's ability to fight off infection. HIV develops into AIDS when your immune system has been severely weakened. A weakened immune system means that your body cannot fight bacteria, germs and viruses that would not make you ill if you didn't have HIV. According to the Centers for Disease Control and Prevention, since 1992 about half of the people with HIV developed AIDS within 10 years after becoming infected with HIV. The time between HIV infection and the development of AIDS varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors.

How AIDS affects the body

WEAKENED IMMUNE SYSTEM: Many people with HIV may stay healthy for 10-15 years before they start to become ill or show signs of AIDS, but during this time HIV is weakening the immune system. Doctors measure how much damage has been done to the immune system by counting how many CD4 T cells. CD4 T cells are a special type of white blood cells found in your blood that attack and destroy infection. The fewer CD4 T cells you have in your blood the weaker your immune system. Healthy people have between 500 and 1,500 CD4 T cells in a milliliter of blood. But, if you have less than 200 CD4 T cells in a milliliter of blood, you have AIDS. For more information on CD4 T cells and T-cells tests please consult the following website:http://aids.org/factSheets/412-t-cell-test.html

When learning about AIDS and how it affects the body it is important to keep in mind that AIDS affects each person differently. Some people die soon after getting infected with HIV, while others live fairly normal lives for many years, even after they have been diagnosed with AIDS.

Causes of AIDS

You cannot have AIDS unless you are HIV-positive and have a CD4 T cell count of less than 200. HIV is most commonly contracted through having unprotected sex with someone who has HIV, sharing a needle (drugs) with someone who has HIV, or when a baby is born to a mother who has HIV. HIV can enter the body through a vein (e.g., injection drug use), the anus, the vagina, the penis, the mouth, eyes or inside of the nose, or cuts and sores. You cannot contract HIV through casual contact such as handshakes or kisses on the cheek.

The only way to be sure that you have AIDS or HIV is to be tested by your doctor. For a listing of testing facilities in Maryland from the National HIV Testing Resources please consult this site http://www.hivtest.org/subindex.cfm?FuseAction=getLocations.

Risk Factors

People at high risk for HIV and AIDS:

• Share drug needles or syringes
• Have sexual contact with an infected person without using a condom
• Have sexual contact with someone whose HIV status is unknown
• Have a sexually transmitted disease (STD) such as syphilis, genital herpes, Chlamydia or gonorrhea. These STDs may make you more susceptible to HIV during sex with infected partners

Minorities, especially African Americans and Hispanics, are more likely to have HIV or AIDS than whites. In the 1980s when HIV and AIDS were first discovered it was considered to be a disease mainly affecting gay white males, but now, according to the National Institutes of Health, African Americans and Hispanics regardless of sexual orientation make up more than half of the cases of AIDS reported in 2001. Below are some important statistics from the Centers for Disease Control and Prevention on African American and Hispanic males and the high prevalence of AIDS in these communities (http://www.cdc.gov/hiv/pubs/Facts/afam.htm):

• AIDS is the leading cause of death among African-American men ages 35 to 44.
• AIDS is among the top three causes of death for African-American men ages 25 to 54. In 2001, the AIDS rates among African Americans were nine times the rates reported among whites.
• Cumulatively, males account for the largest proportion (81%) of AIDS cases reported among Hispanics in the United States. Sixty percent of Hispanics reported with AIDS in 2000 were born in the U.S.; of those, 42% were born in Puerto Rico. (note: Puerto Rico is a US territory and is considered a part of the US.)
• Although African Americans make up only about 12% of the U.S. population, they accounted for half of the new HIV infections reported in the United States in 2001.
• In 2001CDC data suggested that the leading cause of HIV infection among African-American men who have sex with men (MSM), followed by injection drug use and heterosexual contact.
• From the beginning of the epidemic through December 2000, 114,019 Hispanic men have been reported with AIDS in the United States. Of these cases, men who have sex with men (MSM) represent 42%, injection drug users (IDUs) account for 35%, and 6% of cases were due to heterosexual contact. About 7% of cases were among Hispanic men who both had sex with men and injected drugs. Among men born in Puerto Rico, however, injection drug use accounts for a significantly higher proportion of cases than male-male sex

For an excellent brochure on how HIV and AIDS affect the African American community please link to http://www.cdc.gov/hiv/pubs/facts/afam.pdf.

SYMPTOMS

It is important to note that there are no classic symptoms of AIDS. AIDS is a disease that weakens the immune system and as a result your body is more susceptible to other types of infections from germs, viruses and bacteria in the environment. Most people who have AIDS get sick from the germs, viruses and bacteria that their bodies cannot fight off (opportunistic infections), not by illnesses directly caused by AIDS.

OPPORTUNISTIC INFECTIONS: The infections you get as a result of a weakened immune system are called opportunistic infections. In your body are many germs which your immune systems can fight, but when AIDS weakens your immune system these germs can cause serious health problems which can be life threatening. Some symptoms of opportunistic infections common in people with AIDS are:

• Coughing and shortness of breath
• Severe headaches
• Seizures and lack of coordination
• Difficult or painful swallowing
• Confusion and forgetfulness
• Severe and persistent diarrhea
• Vision loss
• Fever
• Weight loss and extreme fatigue
• Coma
• Vomiting, abdominal cramps and nausea

The most common opportunistic infections are:

• Candidiasis (Thrush) is a fungal infection of the mouth, throat, or vagina, which looks like a white film coating.
• Cytomegalovirus (CMV) is a viral infection that causes an eye disease that can lead to blindness.
• Herpes simplex viruses can cause oral herpes (cold sores) or genital herpes. These are fairly common infections, but if you have HIV or AIDS, the outbreaks can be much more frequent and more severe.
• Mycobacterium avium complex (MAC or MAI) is a bacterial infection that can cause recurring fevers, general sick feelings, problems with digestion, and serious weight loss.
• Pneumocystis carinii pneumonia (PCP) is a lung infection that can cause a fatal pneumonia.
• Toxoplasmosis (Toxo) is an infection of the brain.
• Tuberculosis (TB) is a bacterial infection that attacks the lungs.
• KS (Kaposi's sarcoma) is a skin cancer.

For a more complete listing of opportunistic infections and their symptoms take a look at http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm.

CANCERS: People with AIDS are more likely to develop certain cancers, especially cancers of the skin and immune system called lymphomas. Cancers are more intense and harder to treat in patients with AIDS. One very common type of cancer is Kaposi's Sarcoma which causes tumors in the tissues just below the skin's surface. The tumors underneath create lesions which look like purple or brown spots and eventually spread throughout the whole body, where they can be especially fatal in the lungs.

Prevention/Planning Ahead

To prevent AIDS you have to protect yourself from getting HIV. Since there is no vaccine to prevent HIV infection, the only way to protect yourself is to modify your behaviors. Some ways to prevent infection of HIV are:

• not having sex at all
• have sex only in a long term monogamous relationship where both you and your partner have been tested and found uninfected.
• use latex condoms EVERYTIME you have sex whether it's oral, anal or vaginal sex. When condoms are used correctly they can prevent transmission of HIV/AIDS, but remember that condoms do not protect against all sexually transmitted diseases like Human Papilloma Virus which causes herpes and warts. For more information on safe condom use please consult this website http://www.cdc.gov/hiv/pubs/facts/condoms.htm.

Treatment

Currently there is no cure for AIDS although extensive research is being done to find a cure. There are, however, many drugs that can slow down the HIV virus, and therefore slow down the damage to your immune system. But there is no way to get all the HIV out of your body.

To prevent opportunistic infections associated with AIDS and the spread of the virus throughout the body you have to take strong anti-HIV drugs, called prophylaxis. The combination of drugs used to fight the progression of HIV/AIDS is known as antiviral therapy. It is important to note that the drugs used to treat HIV are often the same drugs used to treat AIDS since the main goal of treatment is to prevent the HIV virus from attacking healthy cells. There are 3 types or classes of antiretroviral drugs which each attack HIV in a different way:

1. The first class is called nucleoside reverse transcriptase inhibitors (RTs or NRTIs), which slow the spread of HIV and may delay the onset of opportunistic infections. These drugs prevent healthy T-cells from being infected.
2. The second class are called non-nucleoside reverse transcriptase inhibitors(NNRTIs) which are being used only in combination with NRTIs to prevent new cells from being infected. For more detailed information on NNRTIs please consult this site: http://www.atdn.org/simple/nnrtis.html.
3. The third class is called protease inhibitors. These drugs prevent the HIV virus from replicating itself and therefore preventing it from spreading to health cells.

Since HIV can become resistant to these drugs many times doctors prescribe a number of the drugs be taken together to reduce resistance. For example, a very well known drug combination called highly active antiretroviral therapy or HAART or is made when RT inhibitors and protease inhibitors are taken together. HAART may be used by both HIV and AIDS patients.

People with AIDS who have Kaposi's Sarcoma and other cancers may be treated with radiation, chemotherapy or injections of alpha interferon, which is a genetically engineered protein that exists naturally in the body.

There are also various drugs used especially to treat the opportunistic illnesses associated with AIDS as opposed to the antiviral drugs which combat the spread of HIV in the body. Please take a look at this site for more information on drugs made specifically for opportunistic infections http://www.aids.org/factSheets/500-opportunistic-infections.html.

For more complete information on approved antiviral drugs and treatment please take a look at http://aids.org/factSheets/410-antiviral-therapy.html and http://aids.org/factSheets/410-antiviral-therapy.html#anchor270774.

Alternative Treatment

For information on alternative treatments such as acupuncture, herbalism and traditional Native American medicine please consult http://www.aids.org/factSheets/700-alternatives.html, http://www.aids.org/factSheets/index.html and http://www.mcphu.edu/~AIDSinfo/alternative.html.

Glossary

White blood cells- Cells found in the blood that help protect the body from disease and infection.

For more information...

CDC National AIDS Hotline:
1-800-342-AIDS
Spanish: 1-800-344-SIDA
Deaf: 1-800-243-7889

Free HIV/AIDS treatment information:

AIDSinfo 1-800-448-0440

Project Inform 1-800-822-7422

Free Materials on HIV/AIDS:

1-800-458-5231

Information for Children on AIDS:
http://www.kidshealth.org/kid/talk/qa/aids.html

Helpful Brochure on AIDS Treatment:
http://aidsinfo.nih.gov/other/hivtr.pdf

References:

http://www.cdc.gov/nchstp/od/nchstp.html

http://www.cdc.gov/hiv

http://www.cdcnpin.org

http://www.cdc.gov/hiv/pubs/facts/hispanic.htm

http://www.niaid.nih.gov/factsheets/hivinf.htm

http://www.niaid.nih.gov/factsheets/hivinf.htm

http://www.aidsinfo.nih.gov/ed_resources/default.asp?REC_ID=28

http://familydoctor.org/healthfacts/165/index.html

http://www.niaid.nih.gov/factsheets/hivinf.htm

http://www.aids.org/factSheets/101-what-is-aids.html

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