• HIV/AIDS


    AIDS (acquired immune deficiency syndrome) is the final and most serious stage of HIV disease, which causes severe damage to the immune system.

    Symptoms

    The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called opportunistic infections.

    People with AIDS have had their immune system depleted by HIV and are very susceptible to these opportunistic infections. Common symptoms are fevers, sweats (particularly at night), swollen lymph glands, chills, weakness, and weight loss.

    See the signs and tests section below for a list of common opportunistic infections and major symptoms associated with them.

    Note: Initial infection with HIV may produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 weeks after contracting the virus. Some people with HIV infection remain without symptoms for years between the time they are exposed to the virus and when they develop AIDS.

    Treatment

    There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life of those who have already developed symptoms.

    Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed highly active antiretroviral therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream, as measured by the viral load (how much virus is found in the blood). Preventing the virus from replicating can help the immune system recover from the HIV infection and improve T-cell counts.

    HAART is not a cure for HIV, and people on HAART with suppressed levels of HIV can still transmit the virus to others through sex or sharing of needles. But HAART has been enormously effective for the past 10 years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mcl), life can be significantly prolonged and improved.

    However, HIV may become resistant to HAART in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether a particular HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each individual, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and prior to starting therapy.

    When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for the treatment of drug-resistant HIV.

    Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise (a general sick feeling), and fat accumulation on the back (“buffalo hump”) and abdomen. When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of fat and glucose in the blood.

    Any doctor prescribing HAART should carefully watch the patient for possible side effects associated with the combination of medications the patient takes. In addition, routine blood tests measuring CD4 counts and HIV viral load (a blood test that measures how much virus is in the blood) should be taken every 3 – 6 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the HIV amount of virus in the blood to an undetectable level.

    Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF or Neupogen) are sometimes used to treat anemia and low white blood cell counts associated with AIDS.

    Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

    Causes

    AIDS is the fifth leading cause of death among people aged 25 – 44 in the United States, down from number one in 1995. About 25 million people worldwide have died from this infection since the start of the epidemic, and in 2006, there were approximately 40 million people around the world living with HIV/AIDS.

    Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

    Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.

    HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out prior to ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk generally transmit infection to others.

    The virus can be transmitted:

    Through sexual contact — including oral, vaginal, and anal sex

    Through blood — via blood transfusions (now extremely rare in the US) or needle sharing

    From mother to child — a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk

    Other transmission methods are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

    HIV infection is not spread by casual contact such as hugging, by touching items previously touched by a person infected with the virus, during participation in sports, or by mosquitoes.

    It is NOT transmitted to a person who DONATES blood or organs. Those who donate organs are never in direct contact with those who receive them. Likewise, a person who donates blood is not in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.

    However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

    People at highest risk for getting HIV include:

    Injection drug users who share needles

    Infants born to mothers with HIV who didn’t receive HIV therapy during pregnancy

    People engaging in unprotected sex

    People who received blood transfusions or clotting products between 1977 and 1985 (prior to when screening for the virus became standard practice)

    Sexual partners of those who participate in high-risk activities (such as injuection drug use or anal sex)

    AIDS begins with HIV infection. People infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. Meanwhile, if the infection is not detected and treated, the immune system gradually weakens, and AIDS develops.

    Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ).

    Almost all people infected with HIV, if not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from damaging their immune system.

    Tests & diagnosis

    The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these additional diseases. Today, according to the Centers for Disease Control and Prevention, a person may also be diagnosed as having AIDS if they have a CD4 cell count below 200, even if they don’t have an opportunistic infection.

    AIDS may also be diagnosed if a person develops one of the opportunistic infections and cancers that occur more commonly in people with HIV infection. These infections are unusual in people with a healthy immune system.

    CD4 cells are a type of immune cell. They are also called “T cells” or “helper cells.”

    Many other illnesses and corresponding symptoms may develop in addition to those listed here.

    Common with CD4 count below 350 cells/mcl:

    Herpes simplex virus — causes ulcers/small blisters in the mouth or genitals, happens more frequently and usually much more severely in an HIV-infected person than in someone without HIV infection

    Tuberculosis — infection by the tuberculosis bacteria that mostly affects the lungs, but can affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system (brain and spinal cord)

    Oral or vaginal thrush — yeast infection of the mouth or vagina

    Herpes zoster (shingles) — ulcers/small blisters over a patch of skin, caused by reactivation of the varicella zoster virus

    Non-Hodgkin’s lymphoma — cancer of the lymph nodes

    Kaposi’s sarcoma — cancer of the skin, lungs, and bowel, associated with a herpes virus (HHV-8). Can happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is more common in men than in women

    Common with CD4 count below 200 cells/mcl:

    Pneumocystis carinii pneumonia, “PCP pneumonia,” now called Pneumocystis jiroveci pneumonia

    Candida esophagitis — painful yeast infection of the esophagus

    Bacillary angiomatosis — skin lesions caused by a bacteria called Bartonella, which may be acquired from cat scratches

    Common with CD4 count below 100 cells/mcl:

    Cryptococcal meningitis — fungal infection of the lining of the brain

    AIDS dementia — worsening and slowing of mental function, caused by HIV itself

    Toxoplasma encephalitis — infection of the brain by a parasite, called Toxoplasma gondi, which is frequently found in cat feces; causes lesions (sores) in the brain

    Progressive multifocal leukoencephalopathy — a viral disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions

    Wasting syndrome — extreme weight loss and loss of appetite, caused by HIV itself

    Cryptosporidium diarrhea — Extreme diarrhea caused by one of the parasites that affect the gastrointestinal tract

    Common with CD4 count below 50/mcl:

    Mycobacterium avium — a blood infection by a bacterium related to tuberculosis

    Cytomegalovirus infection — a viral infection that can affect almost any organ system, especially the large bowel and the eyes

    In addition to the CD4 count, a test called HIV RNA level (or viral load) may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in immunocompromised women. Anal Pap smears to detect potential cancers may also be important in both HIV infected men and women.

    Prognosis

    Right now, there is no cure for AIDS. It is always fatal if no treatment is provided. In the US, most patients survive many years after diagnosis because of the availability of HAART. HAART has dramatically increased the amount of time people with HIV remain alive.

    Research continues in the areas of drug treatments and vaccine development. Unfortunately, HIV medications are not always available in the developing world, where the bulk of the epidemic is raging.

    Prevention•

    Safe sex (condom usage) reduces the chance of acquiring or spreading HIV, and other sexually transmitted diseases.

    • Do not use injected drugs. If IV drugs are used, do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones for free. These programs can also provide referrals to addiction treatment.

    • Avoid contact with another person’s blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.

    • Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. An infected person should tell any prospective sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use whatever preventive measures (such as condoms) will give the partner the most protection.

    • HIV-positive women who wish to become pregnant should seek counseling about the risk to unborn children, and medical advances that may help prevent the fetus from becoming infected. Use of certain medications can dramatically reduce the chances that the baby will become infected during pregnancy.

    • Mothers who are HIV-positive should not breast feed their babies.

    • Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

    The riskiest sexual behavior is unprotected receptive anal intercourse — the least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period carries low risk of transmission.

    HIV-positive patients who are taking anti-retroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to the infant less than 1% of the time, compared with about 20% of the time if medications are not used.

    The US blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood. In 2000, according to the American Red Cross, the risk of infection with HIV through a blood transfusion or blood products was 1 in 2,135,000 in the United States.

    If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and has been used to treat health care workers injured by needlesticks, to prevent transmission.

    There is less information available about how effective PEP is for people exposed to HIV through sexual activity or IV drug use. However, if you believe you have been exposed, you should discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been raped should be offered PEP and should consider its potential risks and benefits.

    Complications

    When a person is infected with HIV, the virus slowly begins to destroy that person’s immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow or halt the destruction of the immune system.

    Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.

    When to contact a doctor

    Call for an appointment with your health care provider if you have any of the risk factors for HIV infection, or if you develop symptoms of AIDS. By law, AIDS testing must be kept confidential. Your health care provider will review results of your testing with you.

    HIV Diagnosis Rate Down By A Third In The U.S. Over Last Decade, Experts Rejoice
    July 19, 2014 – The rate of HIV infections diagnosed in the United States each year fell by one-third over the past decade, a government study finds. Experts celebrated it as hopeful news that the AIDS epidemic may be slowing in the U.S.
    Researcher Charged In Major HIV Vaccine Fraud Case
    June 25, 2014 – Responding to a major case of research misconduct, federal prosecutors have taken the rare step of filing charges against a scientist after he admitted falsifying data that led to millions in grants and hopes of a breakthrough in AIDS vaccine research.
    Nearly 70 Percent Of New Yorkers Don’t Use Condoms
    June 5, 2014 – A whopping 68.2 percent of residents polled said they did not wear a condom the last time they had sex, according to some numbers just released by the Department of Health’s Community Health Survey.
    New Mobile HIV Testing Vans Directed Towards Black Gay And Bisexual Men
    An eye-catching new mobile health screening van launched on February 28 is carrying out its mission of encouraging black gay and bisexual men throughout the city to get tested for HIV.
    Experts Say HIV Prevention Drug Shows Big Promise During Testing
    Exciting research suggests that a shot every one to three months may someday give an alternative to the daily pills that some people take now to cut their risk of getting HIV.
    Major Grant Awarded To Black Gay HIV Study
    The University of Pittsburgh Graduate School of Public Health announced this week that it was awarded a $3.2 million grant to study the reasons why black gay men are disproportionately affected by HIV and AIDS, Pittsburgh City Paper reports.
    Only 1 in 3 HIV-Infected Black Americans Gets Effective Treatment: Study
    Even though drugs that can keep HIV at bay are available, only about one in three black Americans with the AIDS-causing virus have their infection under control, U.S. health officials said Thursday.
    President Obama Pledges $100 Million To Find HIV/AIDS Cure
    President Barack Obama announced a new initiative at the National Institutes of Health in pursuit of a cure for HIV, saying his administration is redirecting $100 million into the project to find a new generation of therapies.
    Vaccine Cures HIV-Like Virus In Monkeys, Potential Human Trials In The Works
    Researchers have achieved a potential major breakthrough in the treatment of HIV after successfully curing monkeys of the equivalent of the virus.
    New Research Offers Insight Into How HIV Infects Cells
    Scientists from the United States and China have obtained a high-resolution image of the structure of a cell-surface receptor through which most strains of HIV enter human immune cells.
    HIV And AIDS Among African American Youth
    African American youth continue to be one of the groups most severely affected by HIV infection in the United States. In fact, black youth represent half of all new HIV infections among young people aged 13 to 29.
    Doctors Cure An HIV-Positive Baby: What It Means For The Fight Against AIDS
    Worldwide, about 1,000 babies are born with HIV each day. There’s new reason to be hopeful about their future. On Sunday night, medical researchers reported that a girl born HIV-positive has been “functionally cured.
    Rate Of New HIV Infections Drops For First Time Among Black Women: CDC Says
    For the first time, the rate of new HIV infections among black American women declined between 2008 and 2010, according to a report released Wednesday by the U.S. Centers for Disease Control and Prevention.
    New Guidelines Push For Most In U.S. To Get At Least 1 HIV Test
    HIV testing could become as common as cholesterol check-ups. New screening guidelines proposed by an independent panel insist Americans ages 15 to 64 should get an HIV test at least once—not just people considered at high risk for the virus.
    If Multiple Sex Partners Is Your Choice, Then Be Safe And Healthy
    There are reasons a woman may want to have more than one partner at a time with whom she’s sexually intimate. There are some perfectly sound and healthy reasons; monogamy (especially for singles) is not for everyone.
    Faces Of HIV: Four Powerful Stories Of Hope And Strength
    Through insightful interviews, captivating portraits and poignant journal writing, the Faces of HIV project examines the effects of stigmas, the personal relationships and care issues associated with being HIV positive.
    Growing Proof That HIV & Aids Can Be Cured
    Aids researchers believe the time may have come to think the unthinkable: a growing body of expert opinion believes a cure for HIV infection is no longer a scientific impossibility but a realistic goal that scientists could reach in the very near future.
    Mysterious Disease Leaves Patients With AIDS-like Symptoms, But Not HIV
    Researchers have identified a mysterious new disease that has left scores of people in Asia and some in the United States with AIDS-like symptoms even though they are not infected with HIV.
    Heterosexuals Should Receive HIV Prevention Pill Too, Health Officials Say
    Doctors should consider giving an AIDS prevention pill to women and heterosexual men who are at high risk for getting the virus, U.S. health officials said Thursday.
    New Data Strengthens View Of HIV Threat For Gay Black Men
    A study of black gay and bisexual men in six U.S. cities found HIV infection rates that were 50 percent higher than among their white counterparts, and rates were even higher for men under the age of 30 in the same community, researchers said….
    NAACP Develops HIV Manual For Black Churches
    Houston pastor Timothy W. Sloan has felt for years that he needed to talk about HIV and AIDS with his congregation. But he worried the 3,000 mostly African-American parishioners at St. Luke Missionary Baptist Church in Humble, Texas, could be offended and leave the church or curtail their giving.
    National Black HIV/AIDS Awareness Day
    February 7 marks the 12th annual National Black HIV/AIDS Awareness Day (NBHAAD), a national community mobilization initiative to boost HIV awareness and advance HIV prevention, testing, and treatment among blacks in the United States.
    Can Male Circumcision Stem The AIDS Epidemic In Africa?
    Adult male circumcision, in which the foreskin of the penis is surgically removed, has emerged as one of the more powerful reducers of infection risk. Some studies are finding that it decreases the odds that a heterosexual man will contract HIV by 57 percent or more.
    Vaccine Could Reduce HIV To Minor Infection
    HIV could be reduced to a “minor chronic infection” akin to herpes, scientists developing a new vaccine have claimed. Spanish researchers found that 22 of 24 healthy people (92 per cent) developed an immune response to HIV after being given their MVA-B vaccine.
    Annual HIV Infections In U.S. Relatively Stable, Alarming Increase Among Young, Black Gay And Bisexual Men
    ”More than 30 years into the HIV epidemic, about 50,000 people in this country still become infected each year. Not only do men who have sex with men continue to account for most new infections, young gay and bisexual men are the only group in which infections are increasing, and this increase is particularly concerning among young African American MSM….
    FDA Approves New HIV Treatment
    The U.S. Food and Drug Administration today approved Edurant (rilpivirine) in combination with other antiretroviral drugs for the treatment of HIV-1 infection in adults who have never taken HIV therapy…..
    Black Couples Benefit From Program To Curb Spread of HIV
    A couple-focused program cut risky sexual behaviors among black American couples in which one partner has HIV and the other is HIV-free, researchers report.
    Black And Hispanic Infants Much More Likely to Have HIV
    Rates of HIV infection in infants are significantly higher among blacks and Hispanics than whites, and preventive measures are needed to reduce the disparity, a new government report says.
    Burden Of HIV Highest For Blacks, CDC Reports
    Although blacks make up only 13.6 percent of the U.S. population, they account for 50.3 percent of all diagnosed cases of HIV, federal health officials reported Thursday.
    Black Americans And HIV/AIDS
    Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time. Blacks account for more new HIV infections, AIDS diagnoses, people estimated to be living with HIV disease, and HIV-related deaths than any other racial/ethnic group in the U.S.
    US Helps To Fight HIV/AIDS In Africa
    Two new agreements will further the Obama administration’s fight against HIV/AIDs in Africa. U.S. State Department officials have recently signed Partnership Frameworks with the governments of South Africa and Botswana under the U.S. President’s Emergency Plan for AIDS Relief or PEPFAR. These five-year joint strategic plans aim to promote a sustainable approach to combating HIV/AIDS in the partner countries through service delivery, policy reform and coordinated financial commitments.
    African Americans And Sexually Transmitted Diseases (CDC)
    Sexually transmitted diseases (STDs) pose a serious and widespread health threat in the United States. Though most STDs can be easily diagnosed and treated, many have no noticeable symptoms, and infected individuals may not seek testing or treatment. As a result, many infections go undetected. Without treatment, individuals with STDs are at risk of serious health problems, such as infertility.
    Higher HIV Risk In Black Gay Men Is Linked To Partner Choice
    Young black men who have sex with men get infected with HIV nearly five times more often than MSM from other races, even though they don’t have more unprotected sex. The discrepancy has long mystified public health experts, but a new study by investigators at Johns Hopkins and elsewhere now offers a possible explanation for it.
    Hepatitis C Virus Levels Higher In Black Injection Drug Users
    Among injection-drug users in the United States infected with hepatitis C, virus levels are highest among blacks…..
    Decisions About Condom Use Among Gay Couples Vary By Race
    Although black gay couples tend to practice safe sex more often, researchers from San Francisco State University found they don’t talk about it. However, white gay couples often do the opposite…..