Many people do not develop any symptoms when they first become infected with HIV. Some people, however, get a flu-like illness within three to six weeks after exposure to the virus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness, nausea, diarrhoea and enlarged lymph nodes (organs of the immune system that can be felt in the neck, armpits and groin). These symptoms usually disappear within a week to a month and are often mistaken for another viral infection.
During this period, the quantity of the virus in the body will be high and it spreads to different parts, particularly the lymphoid tissue. At this stage, the infected person is more likely to pass on the infection to others. The viral quantity then drops as the body's immune system launches an orchestrated fight.
More persistent or severe symptoms may not surface for several years, even a decade or more, after HIV first enters the body in adults, or within two years in children born with the virus. This period of "asymptomatic" infection varies from individual to individual. Some people may begin to have symptoms as soon as a few months, while others may be symptom-free for more than 10 years. However, during the "asymptomatic" period, the virus will be actively multiplying, infecting, and killing cells of the immune system.
Sunday, August 31, 2008
What Happens Inside the Body?
Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there is an infection, CD4 cells lead the infection-fighting army of the body to protect it from falling sick. Damage of these cells, hence can affect a person's disease-fighting capability and general health.
After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.
Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.
But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.
Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.
The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition
After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.
Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.
But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.
Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.
The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition
Friday, August 29, 2008
What are the later symptoms of HIV/AIDS?
- Lack of energy
- Weight loss
- Frequent fevers and sweats
- A thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeast infection and sometimes accompanied by a sore throat
- Severe or recurring vaginal yeast infections
- Chronic pelvic inflammatory disease or severe and frequent infections like herpes zoster
- Periods of extreme and unexplained fatigue that may be combined with headaches, lightheadedness, and/or dizziness
- Rapid loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting
- Bruising more easily than normal
- Long-lasting bouts of diarrhoea
- Swelling or hardening of glands located in the throat, armpit, or groin
- Periods of continued, deep, dry coughing
- Increasing shortness of breath
- The appearance of discoloured or purplish growths on the skin or inside the mouth
- Unexplained bleeding from growths on the skin, from mucous membranes, or from any opening in the body
- Recurring or unusual skin rashes
- Severe numbness or pain in the hands or feet, the loss of muscle control and reflex, paralysis or loss of muscular strength
- An altered state of consciousness, personality change, or mental deterioration
- Children may grow slowly or fall sick frequently. HIV positive persons are also found to be more vulnerable to some cancers.
Thursday, August 28, 2008
Is there treatment against HIV and AIDS?
Till today, there is no conclusive treatment to eliminate HIV from the body; however, timely treatment of opportunistic infections can keep one healthy for many years. The commonly available treatment for AIDS is the treatment against opportunistic infections. Normally standard treatment regimens, used against such infections in non-HIV patients, also work well with the HIV-positive persons. If properly treated, almost all the opportunistic infections can be contained.
However, during the last decade, researchers have developed powerful drugs that check the replication of the virus at various levels. Called Antiretroviral drugs, they are available in three classes and under various brands. Taken in combinations (called cocktail or combination therapy) under specialised medical advice, these drugs drastically reduce the viral load in blood. However, they do not permanently cure one of HIV. This line of treatment, called HAART (Highly Active Antiretroviral Therapy) has resulted in a huge reduction or AIDS-related deaths. Though many positive persons and caregivers have welcomed these drugs, others have experienced serious side effects. They are also very expensive and are out of reach for a majority of the infected people. But of late, the prices have been steeply falling.
The three classes of drugs are:
1.Nucleoside analogue Reverse Transcriptase Inhibitors (NRTIs). NRTIs were the first antiretroviral drugs to be developed. They inhibit the replication of HIV in the early stage by inhibiting an enzyme (which is necessary for viral replication) called Reverse Transcriptase. The drugs include Zidovudine (Retrovir, AZT), Lamivudine (Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid, ddC), Stavudine (Zerit, d4T) and Abacavir (Ziagen).
The major reported side effect of Zidovudine is bone marrow suppression, which causes a decrease in the number of red and white blood cells. The drugs ddI, ddC and d4T can damage peripheral nerves (peripheral neuropathy), leading to tingling and burning in the hands and feet. Treatment with ddI can also cause pancreatitis, and ddC may cause mouth ulcers. Approximately 5 percent of people treated with Abacavir experience hypersensitivity reactions such as a rash along with fever, fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactions can also occur without a rash. In either case, symptoms usually appear within the first 6 weeks of treatment and generally disappear when the drug is discontinued. If a person had a hypersensitivity reaction to Abacavir, he/she should avoid taking the drug again.
2.Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These drugs bind directly to the enzyme, Reverse Transcriptase. There are three NNRTIs currently approved for clinical use: Nevirapine (Viramune), Delavirdine (Rescriptor) and Efavirenz (Sustiva). A major side effect of all NNRTIS is a rash. In addition, people taking Efavirenz may have side effects such as abnormal dreams, sleeplessness, dizziness and difficulty concentrating.
3.Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in the body to become structurally disorganized and noninfectious. Among these drugs are Saquinavir (Fortovase), Ritonavir (Norvir), Indinavir (Crixivan), Nelfinavir (Viracept), Amprenavir (Agenerase) and Lopinavir (Kaletra).
The most common side effects of PIs include nausea, diarrhoea and other digestive tract problems. They can also cause a significant number of side effects when they interact with certain other medications. That is because all PIs, to one degree or another, affect an enzyme system in the liver that is responsible for metabolising a large number of drugs. Newer side effects have also appeared with the continuing and widespread use of Protease Inhibitors. These include elevated triglyceride levels and problems with sugar metabolism that may sometimes progress to diabetes. There may also be abnormalities in the way fat is metabolised and deposited in the body. Some people lose much of their total body fat while others gain excess fat on the back between their shoulders (buffalo hump) or in the stomach (protease paunch). Right now, no one knows exactly why these abnormalities occur. In fact, it is not even certain whether these problems are a direct result of treatment with protease inhibitors or due to some other cause that has yet to be identified. Similar metabolic abnormalities have occurred in people on antiretroviral therapy that does not include PIs. Although these body changes can be distressing, the possibility they may occur should not stop one from obtaining treatment for HIV/AIDS. In simple combination therapy, some physicians prescribe a combination of RTIs. But in HAART, which in fact has made a dramatic change in AIDS treatment, a combination of RTIs and PIs is prescribed. People respond differently to treatment and maintaining the drug schedule is extremely important. Indiscriminate treatment results in drug resistance and resurgence of the viral load. Therefore it should be taken only under expert medical advice.
However, during the last decade, researchers have developed powerful drugs that check the replication of the virus at various levels. Called Antiretroviral drugs, they are available in three classes and under various brands. Taken in combinations (called cocktail or combination therapy) under specialised medical advice, these drugs drastically reduce the viral load in blood. However, they do not permanently cure one of HIV. This line of treatment, called HAART (Highly Active Antiretroviral Therapy) has resulted in a huge reduction or AIDS-related deaths. Though many positive persons and caregivers have welcomed these drugs, others have experienced serious side effects. They are also very expensive and are out of reach for a majority of the infected people. But of late, the prices have been steeply falling.
The three classes of drugs are:
1.Nucleoside analogue Reverse Transcriptase Inhibitors (NRTIs). NRTIs were the first antiretroviral drugs to be developed. They inhibit the replication of HIV in the early stage by inhibiting an enzyme (which is necessary for viral replication) called Reverse Transcriptase. The drugs include Zidovudine (Retrovir, AZT), Lamivudine (Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid, ddC), Stavudine (Zerit, d4T) and Abacavir (Ziagen).
The major reported side effect of Zidovudine is bone marrow suppression, which causes a decrease in the number of red and white blood cells. The drugs ddI, ddC and d4T can damage peripheral nerves (peripheral neuropathy), leading to tingling and burning in the hands and feet. Treatment with ddI can also cause pancreatitis, and ddC may cause mouth ulcers. Approximately 5 percent of people treated with Abacavir experience hypersensitivity reactions such as a rash along with fever, fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactions can also occur without a rash. In either case, symptoms usually appear within the first 6 weeks of treatment and generally disappear when the drug is discontinued. If a person had a hypersensitivity reaction to Abacavir, he/she should avoid taking the drug again.
2.Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These drugs bind directly to the enzyme, Reverse Transcriptase. There are three NNRTIs currently approved for clinical use: Nevirapine (Viramune), Delavirdine (Rescriptor) and Efavirenz (Sustiva). A major side effect of all NNRTIS is a rash. In addition, people taking Efavirenz may have side effects such as abnormal dreams, sleeplessness, dizziness and difficulty concentrating.
3.Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in the body to become structurally disorganized and noninfectious. Among these drugs are Saquinavir (Fortovase), Ritonavir (Norvir), Indinavir (Crixivan), Nelfinavir (Viracept), Amprenavir (Agenerase) and Lopinavir (Kaletra).
The most common side effects of PIs include nausea, diarrhoea and other digestive tract problems. They can also cause a significant number of side effects when they interact with certain other medications. That is because all PIs, to one degree or another, affect an enzyme system in the liver that is responsible for metabolising a large number of drugs. Newer side effects have also appeared with the continuing and widespread use of Protease Inhibitors. These include elevated triglyceride levels and problems with sugar metabolism that may sometimes progress to diabetes. There may also be abnormalities in the way fat is metabolised and deposited in the body. Some people lose much of their total body fat while others gain excess fat on the back between their shoulders (buffalo hump) or in the stomach (protease paunch). Right now, no one knows exactly why these abnormalities occur. In fact, it is not even certain whether these problems are a direct result of treatment with protease inhibitors or due to some other cause that has yet to be identified. Similar metabolic abnormalities have occurred in people on antiretroviral therapy that does not include PIs. Although these body changes can be distressing, the possibility they may occur should not stop one from obtaining treatment for HIV/AIDS. In simple combination therapy, some physicians prescribe a combination of RTIs. But in HAART, which in fact has made a dramatic change in AIDS treatment, a combination of RTIs and PIs is prescribed. People respond differently to treatment and maintaining the drug schedule is extremely important. Indiscriminate treatment results in drug resistance and resurgence of the viral load. Therefore it should be taken only under expert medical advice.
What should one do if found HIV positive?
- Consult a clinician experienced in treating HIV/AIDS.
- Protect your sex partner(s) from HIV by following safe-sex guidelines.
- Inform sex partner(s) who may also be infected.
- Do not share needles.
- Get psychological support from a counsellor and/or join a support group for people with HIV.
- Get information and social and legal support from AIDS service organisations.
- Don't share your HIV status with people who do not need to know. Only tell people you can count on for support. Think about whom do you want to share your HIV status with.
- Maintain a strong immune system with a healthy lifestyle and regular medical examinations.
- Consider using antiretroviral therapies that may slow the progress of the infection in consultation with a qualified physician.
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