What is Acquired Immune Deficiency Syndrome (HIV and AIDS)?
The human immunodeficiency virus (HIV) can be passed on through sexual contact, blood transfusions, sharing needles, and from mother to baby during birth or breastfeeding. HIV progresses through several stages, including an initial virus transmission phase, acute seroconversion, recovery, inactive chronic infection, and finally, symptomatic HIV infection or AIDS. Here, we will focus on chronic HIV infection and the stage known as AIDS.
HIV is a type of virus known as a retrovirus, which targets specific cells in the immune system known as CD4 T lymphocytes. Over time, this virus destroys these cells, resulting in severe weakening of the immune system for the affected individual. When the CD4 cells level fall too low, the immune system can’t effectively fight off infections and diseases. AIDS is diagnosed when the CD4 count is less than 200, or the patient has an illness linked to AIDS. Treating AIDS involves managing these additional illnesses, reducing the amount of HIV in the body, and boosting the CD4 cell count through medication called antiretroviral therapy (ART).
Without treatment, most individuals diagnosed with HIV will progress to AIDS within ten years. However, if antiretroviral therapy is started after an AIDS diagnosis, the individual may live more than ten years, or even have an average lifespan. If someone diagnosed with AIDS doesn’t undergo ART, their life expectancy is typically less than two years.
What Causes Acquired Immune Deficiency Syndrome (HIV and AIDS)?
HIV is a type of virus known as a retrovirus, and it has two different subtypes: HIV-1 and HIV-2. The subtype called HIV-1 is the most common and is the main cause of AIDS all over the world. The other subtype, HIV-2, mainly shows up in Western Africa and is not as common.
Risk Factors and Frequency for Acquired Immune Deficiency Syndrome (HIV and AIDS)
HIV infection is a worldwide crisis, affecting millions across the globe. Since its discovery, around 40 million people have died from HIV, while more than 38 million people are currently living with the virus. Despite this, advancements in treatment have meant that the number of people living with HIV/AIDS has increased over the years, as they’re able to live longer. Efforts have been made in the fields of education, prevention and research to slow the spread and improve treatment. Because of these efforts, the number of new infections each year have been going down since the 1990s.
Despite progress in developed countries, the impact of HIV and AIDS varies greatly worldwide. For instance, it’s estimated that 25 million people in sub-Saharan Africa are living with HIV. Sadly, there’s currently no vaccine for HIV.
- HIV infection is a global crisis, with millions affected worldwide.
- Since its discovery, around 40 million people have died from HIV, and over 38 million people are currently living with the virus.
- Thanks to advances in treatment, people can live longer with HIV/AIDS, causing an increase in the number of those living with the condition.
- Efforts in education, prevention and research have helped reduce the number of new infections each year since the 1990s.
- Though some progress has been made in developed nations, the prevalence of HIV and AIDS varies greatly across the globe. For example, about 25 million people in sub-Saharan Africa live with HIV.
- Currently, there is no vaccine for HIV.
Signs and Symptoms of Acquired Immune Deficiency Syndrome (HIV and AIDS)
It’s important for healthcare providers to examine a patient’s detailed HIV history, which includes the time of diagnosis, potential complications, medication usage, and additional diseases they might have. Understanding a patient’s most recent CD4 count (a way to measure the health of their immune system) and viral load (the quantity of HIV in their blood) offers insight into the type of AIDS-related illnesses they may be experiencing. This is particularly helpful if the patient could not get regular medical checkups or access to antiretroviral therapy (ART), which can control HIV. Cooperation with the patient’s other healthcare providers also proves crucial in delivering optimal care.
While understanding a patient’s HIV history is crucial, it’s also important for healthcare providers to remember that patients taking ART can still have other, non-HIV-related health problems if their CD4 count is adequate. They should thoroughly examine the patient and consider potential diagnoses related to their main complaints and symptoms, while keeping in mind that these conditions might not necessarily be related to HIV or AIDS. Below, we’ll focus on conditions related to HIV or AIDS, divided by the body system affected:
Cardiovascular System:
- HIV and ART can contribute to heart disease. Symptoms might include chest pain, shortness of breath, or fatigue.
- The doctor should assess patients as they would for heart disease or valve disorders, looking for chest wall pain, signs of vein distension and swelling, and listening to the heart for any irregular sounds.
- Infections like tuberculosis could result in conditions like purulent pericarditis (infection in the heart’s outer lining) or cardiac tamponade (fluid accumulation in the heart)
Pulmonary System:
- HIV and AIDS can lead to several lung problem including respiratory infections, bronchitis, sarcoidosis, and lung cancer.
- Patients breathing patterns should be monitored for signs of respiratory distress. Listening to lung sounds may provide clues to diagnosing lung problems.
Oropharyngeal and Gastrointestinal System:
- Many gastrointestinal complaints may be related to opportunistic infections, malignancies, or side effects of ART. For example, HIV medication might cause pancreatitis, fatty liver, or liver toxicity.
- HIV patients might also have co-infections with hepatitis B or C. Those with HIV/AIDS could suffer from herpes simplex infection, Candida esophagitis (throat yeast infection), or Cryptosporidium diarrhea.
- Common symptoms can range from pain, to nausea, vomiting, diarrhea, constipation, blood in the stool, or urinary symptoms.
Central Nervous System:
- Problems could range from meningitis (inflammation of the membranes around the brain and spinal cord), demyelinating lesions (damage to the protective covering of nerve fibers), or tumors caused by a weakened immune system.
- People might experience headaches, altered mental status, focal weakness, or seizures.
Oncologic Problems and Hematologic System:
- HIV patients might experience anemia, low platelet counts, or low white blood cell counts. A person may report unusual bruising or bleeding.
- The most common cancer in advanced HIV cases is lymphoma. Other potential cancers include primary central nervous system lymphoma, linked to Epstein-Barr virus infection.
Dermatologic System:
- HIV infection might present a rash, oral ulcers, or other skin infections.
- The most common skin condition related to AIDS is Kaposi’s sarcoma, a cancer that causes patches or nodules on the skin.
Testing for Acquired Immune Deficiency Syndrome (HIV and AIDS)
Testing for HIV infection includes a screening test and another test to confirm the disease. These tests check for specific antibodies or antigens. If a person has been newly diagnosed with HIV or is being examined for a sudden medical problem, they should have a complete blood count to check for conditions like leukopenia, anemia, or thrombocytopenia.
Checking the viral loads and CD4 counts could be helpful in managing HIV patients, however, the results may not always be readily available. From a complete blood count, the health professional can get an idea of the patient’s CD4 count. If the white blood cells and lymphocyte counts are normal, then the CD4 count is likely normal. If the total lymphocyte count is less than 950 cells/mm3, the patient may have a CD4 count of less than 200 cells/µL; this is low enough to weaken the immune system and raises the chance of opportunistic infection.
Further testing may be needed based on the patient’s symptoms. For instance, if a heart problem is suspected, an EKG and testing for cardiac biomarkers are useful. Ultrasound or echocardiography can also help in cases of suspected acute valvular disease, pericarditis, or cardiac tamponade.
Chest x-rays can be used for heart-related conditions or for suspected lung infections. If a chest x-ray doesn’t show any obvious lung issues but there’s still a concern for lung dysfunction, further testing with a chest CT scan may be necessary. Using an arterial blood test can help determine if steroids are required for someone with Pneumocystis pneumonia (PCP). Before starting antibiotics, blood cultures should be performed. Other tests like sputum cultures or serum and urine bacterial antigen testing can identify the cause of a lung infection. If tuberculosis (TB) is suspected, testing should be done. In-depth testing with advanced imaging like a CT scan might be necessary, especially in patients with AIDS where symptoms might not be clear. Patients suspected of having tuberculosis should be isolated, even before confirmatory testing results are back.
A comprehensive metabolic profile is helpful to understand baseline kidney and liver function or abnormalities due to medication or acute medical conditions. Patients with lower CD4 counts or AIDS are more likely to have acute problems related to the liver and gallbladder like pancreatitis and acalculous cholecystitis. Tests such as transaminases, bilirubin, and lipase can help in evaluating these conditions. Imaging like abdominal CT or ultrasound may be needed based on the patient’s symptoms. In certain cases, a procedure to examine the digestive tract may be necessary. AIDS patients are also more likely to have various diarrheal diseases. Tests for parasites, bacteria, and toxins should be done in patients with weak immunity presenting with diarrhea.
When checking for neurological issues in an HIV or AIDS patient, professionals should consider performing a head CT scan and a lumbar puncture with CSF analysis in patients presenting symptoms like altered mental state or focal neurological complaints. Cryptococcal meningitis may present subtle symptoms, and antigen testing should be considered in patients with altered mental status.
Treatment Options for Acquired Immune Deficiency Syndrome (HIV and AIDS)
HIV treatment typically involves the use of antiretroviral therapy (ART) which keeps the virus under control and ensures a healthy immune system. These treatments are lifelong and they need to take into consideration a wide variety of drugs. Some of the infections and conditions that a person living with HIV may face require similar treatments as if they didn’t have the virus. In this discussion, the focus will be on how to prevent and manage illnesses that may arise due to HIV or severe immune suppression, also known as AIDS.
The standard healthcare approach to bacterial pneumonia includes typical and atypical antibiotic treatments. When a condition known as Pneumocystis pneumonia is diagnosed, the first line of treatment is a drug combination known as trimethoprim-sulfamethoxazole for a total of 21 days. In severe cases, corticosteroids can be deployed.
When treating tuberculosis, drug resistance and the patient’s immunity levels need to be taken into account. Tuberculosis treatment in severely immunosuppressed patients necessitates consultation with a disease expert. A specific bacteria called Mycobacterium avium complex, which appears when the patient’s immune system is severely suppressed, is dealt with a multiple drug treatment.
Mouth infections, common in HIV patients, can be treated with an antifungal medication called nystatin. In severe cases, it is advisable to use an azole, such as fluconazole, which also treats inflammation of the esophagus. Certain types of herpes and cytomegalovirus might require antiviral drugs such as acyclovir or ganciclovir.
There are several infections which can happen in the gastrointestinal tract and for these cases, antibiotics that target specific bacteria are advised. A typical set of antibiotics for such cases include metronidazole and ciprofloxacin. If the cause of the diarrhea is suspected to be a parasite known as Cryptosporidium, the preferred antibiotic is paromomycin.
When meningitis is suspected, common antibiotics and antiviral therapies are used while waiting for test results. In severe cases of HIV, cryptococcal meningitis is common and the recommended treatment includes the drugs amphotericin B and flucytosine at first, followed by fluconazole.
Cutaneous infections, or skin infections, caused by a dispersed fungal infection can be handled with systemic antifungals such as azoles. Kaposi’s sarcoma, a type of skin cancer common to HIV patients, can be treated with a variety of therapies including cryotherapy, radiation, or surgery, and possibly chemotherapy.
Preventive care is important to avert the onset of common infections. When immunity levels drop to low counts, using certain drugs as preventive measures can keep patients safe from potential infections.
To sum up, HIV treatment is multifaceted with focus on both controlling the virus through ART, managing symptoms, and preventing potential infections via prophylaxis.
What else can Acquired Immune Deficiency Syndrome (HIV and AIDS) be?
When a patient is known to have HIV and their CD4 count (a type of white blood cell that fights infection) is less than 200 cells per micro-liter, or they have a specific illness associated with AIDS, they are considered to have AIDS. These specific illnesses are strong indicators of a weakened immune system in someone with HIV. They include:
- TB that affects the lungs or is spread throughout the body
- Invasive cervical cancer
- Esophageal candidiasis (a yeast infection in the throat)
- Cryptococcosis (a fungal infection)
- Cryptosporidiosis (a parasitic infection)
- CMV retinitis (an infection in the eye) or infection outside of the liver, spleen, or lymph nodes
- HSV (Herpes Simplex Virus) that causes chronic ulcers, bronchitis, pneumonia, or esophagitis
- Kaposi’s sarcoma (a type of cancer that forms in the lining of blood and lymph vessels)
- A rash associated with HIV known as pruritic popular eruption
- Lymphoma – specifically Burkitt’s lymphoma or primary brain lymphoma
- Mycobacterium avium complex – an infection that is spread throughout the body or outside of the lungs
- PCP pneumonia (a type of pneumonia)
- Progressive multifocal leukoencephalopathy (a rare and usually fatal viral disease)
- Brain toxoplasmosis (a parasitic infection in the brain)
Other illnesses associated with AIDS include HSV encephalitis (an inflammation of the brain), HIV wasting syndrome (severe weight loss), disseminated histoplasmosis (a fungal infection), isosporiasis (a parasitic infection), recurrent salmonella septicemia (blood poisoning), and recurrent bacterial pneumonia.
What to expect with Acquired Immune Deficiency Syndrome (HIV and AIDS)
If HIV is left untreated, most patients will develop AIDS within a decade. There’s usually a symptom-free period of about eight years, but a rapid decline can follow once immune system (CD4) levels drop to around 200 cells per microliter. However, if antiretroviral treatment is started, even after an initial AIDS diagnosis, a patient can live for more than ten years. Without this therapy, those diagnosed with AIDS generally only survive about two years.
Recovery from Acquired Immune Deficiency Syndrome (HIV and AIDS)
People living with HIV/AIDS are often referred to therapy by their healthcare providers. Therapy is designed to help them manage ongoing muscle, nerve, and heart issues, which are common as the disease progresses. Therapy also aids in managing pain that is either caused or worsened by their condition. Moderate intensity aerobic and resistance exercises have been proven to be beneficial without negatively affecting the key markers of the disease—like the CD4+ cell count or viral load—and can help patients significantly improve their strength.
As the outlook for people with HIV/AIDS has improved, work-related challenges are frequently addressed in therapy as well. Therapies can be tailored to the physical demands of the patient’s job and the specific difficulties they are struggling with.
Preventing Acquired Immune Deficiency Syndrome (HIV and AIDS)
Patients need to understand how HIV is transmitted, how the virus is contracted, and how it can spread to others. It’s also crucial for them to be informed about the importance of the CD4 count level, which can tell us about the health of their immune system. They should also know how antiretroviral therapy (ART) helps keep their immunity in check, along with the side effects that might come with the medication.
Patient awareness should also include the potential risk of opportunistic infections, cancers, and associated diseases that might occur with long-term HIV infection, AIDS, and ART. It’s important to highlight that with the right medical care and treatment, many HIV patients can lead normal lives for many years after their diagnosis. This was not always the case in the past, making it really a significant progress in combatting this disease.
