HIV
HIV is a retrovirus that infects the immune system. It is a preventable disease. It can be managed with treatment and become a managed chronic medical condition. While there is no cure or vaccine for HIV antiretroviral therapy can postpone the development of the disease and if started before advanced disease, can extend the life expectancy of a person with HIV to a near normal state.
An HIV positive patient under treatment can live a normal life and die with the virus and not because of it. Treatment of HIV positive patients patients with HIV is a lifelong regimen of medication to keep the virus under check with the viral load being zero. Without treatment, it can lead to a variety of conditions such as acquired immunodeficiency syndrome.
Treatment must be started as soon as possible following diagnosis. A person with HIV but an undetectable viral load through long-term treatment in fact poses no risk for HIV sexual transmission. International mobilization by UNAIDS and communities has interpreted that as Undetectable Untransmittable. Without treatment, the illness would interfere with the body’s immune system and could over time progress on to AIDS sometimes taking many years.
After primary infection an individual can be unaware of any symptoms or can develop a brief course of influenza like illness. Throughout this period the person can be unaware of having HIV but they will be contagious. The phase is typically followed by a prolonged incubation period when there are no symptoms. Finally the HIV infection makes one susceptible to developing other infections such as tuberculosis and other opportunistic infections and neoplasms that are rare in people with normal immune status.
Late stage is also often marked by undesirable loss of body weight. Without treatment the person with HIV can survive for 11 years. Early diagnosis can determine if treatment should be begun to stop this path and prevent others from being infected.
Signs of acute HIV infection
The initial phase following becoming infected with HIV is called acute HIV primary HIV or acute retroviral syndrome. The majority of individuals acquire an illness like glandular fever or influenza mononucleosis 2 4 weeks after exposure but some have no significant symptoms. Symptoms occur in 40 90% of patients and include fever, large tender lymph nodes inflammation of the throat rash headache fatigue and/or sores in the mouth and genitalia.
The rash which occurs in 20–50% of patients is maculopapular typically and occurs on the trunk. Fever, lymphadenopathy, anemia, and neutropenia are frequent. Certain individuals also develop opportunistic infections at this time. Gastrointestinal manifestations in the form of diarrhea or vomiting occur. Peripheral neuropathy or Guillain Barré syndrome neurologic signs also occur. The duration of symptoms varies but is usually one or two weeks.
These symptoms are not commonly regarded as symptoms of HIV infection. General practitioners or hospitals can misdiagnose a disease as one of the many common infectious diseases with the same symptoms. Someone who has an unexplained fever and may have just recently had contact with HIV should have a test to see if they are infected.
Clinical latency
Clinical latency asymptomatic HIV or chronic HIV then comes after the primary symptoms. In case of no treatment, the second phase of natural history of HIV infection varies from as low as three years to more than 20 years on average approximately eight years. Though usually little or no symptoms initially towards the end of this phase many of them go through fever weight loss gastrointestinal issues and body pains. 50% to 70% of individuals also go through prolonged generalized lymphadenopathy with painless lymph node swelling of two or more sets except in the groin area for longer than three to six months.
While most HIV 1 infected persons carry a measurable viral load and if untreated will eventually develop AIDS, there is a minority of around 5% of persons who have extremely elevated CD4+ T cell T helper cells both on and off antiretroviral therapy for over five years. Such persons are referred to as HIV controllers or long term nonprogressors. Another category is of individuals with a low or undetectable viral load when they are not on antiretroviral therapy. They are approximately 1 in 300 infected individuals.
AIDS
Severe AIDS symptoms
Acquired immunodeficiency syndrome is a condition of HIV infection with a CD4+ T cell level less than 200 cells per μL, or the occurrence of some AIDS-defining diseases along with HIV infection. Without therapy approximately half of HIV-infected patients develop AIDS within ten years. The most frequent early warning signs to monitor in the diagnosis of AIDS are pneumocystis pneumonia, HIV wasting syndrome, and esophageal candidiasis. Other frequent symptoms are recurrent respiratory infections.
Opportunistic infections are produced by bacteria viruses fungi and parasites under the normal surveillance of the immune system. Based on what organisms are common in the persons environment. what infections develop is to some extent a matter of luck. They can affect almost every organ system.
AIDS if caught increases the risk of developing various cancers caused by viruses such as Kaposis sarcoma Burkitts lymphoma primary central nervous system lymphoma and cervical cancer. Kaposis sarcoma is the most frequent cancer that occurs in 10 to 20 of individuals with HIV infection.
Lymphoma responsible for the death of almost 16% of individuals with AIDS and the first symptom of AIDS in 3% to 4% of individuals is the second most prevalent cancer. Both of these cancers are linked with human herpesvirus . Cervical cancer is more common in AIDS patients due to its link with human papillomavirus. Conjunctival cancer of the covering layer of the inner eyelid surface and the white eye is also more prevalent in HIV patients.
HIV/AIDS is diagnosed by lab tests and later staged based on the presence or absence of particular signs or symptoms. HIV testing is recommended by the United States Preventive Services Task Force in all persons 15 years through 65 years including all pregnant women. It is also recommended to further test those who have a higher risk which includes every person who has been diagnosed with a sexually transmitted infection. In the majority of the world, a third of HIV carriers are only aware they carry the virus after they are well along in disease and AIDS or severe immunodeficiency has become plainly apparent.
HIV testing
Ora quick HIV test
Most of the people infected with HIV will have seroconverted antibodies three to twelve weeks after their first infection. Primary HIV is diagnosed before seroconversion by HIV RNA or p24 antigen testing. Confirmation of positive test results by antibody or PCR is either by an alternative antibody or by PCR.
Ab tests in children under the age of 18 months are generally not reliable since maternal antibodies remain in infants. Thus, HIV infection can only be diagnosed with PCR testing for HIV RNA or DNA or with p24 antigen testing. Most of the world is not accessible to valid PCR testing, and people in much of the world just wait until symptoms develop or the child is old enough for valid antibody testing. Between 2007 and 2009, 30% to 70% of the population were aware of their HIV status in sub-Saharan Africa. Men and women between 3.6% and 42% in sub-Saharan countries were tested in 2009. This was a tremendous improvement compared to other years.
Classifications
There are two large clinical staging systems that are utilized to stage HIV and HIV-related illness for surveillance the WHO disease staging system for HIV disease and infection and the CDC’s system for classifying HIV infection. The CDC’s system is utilized more extensively in developed countries. Since the WHOs staging system excludes laboratory tests, it is in itself very appropriate for the low resource environment typical of the Third World where it can be utilized to help steer clinical management. Although varying in each other they both allow comparability for analysis at a statistical level.
Sexual contact
Condom usage regularly reduces transmission of HIV approximately by 80% in the long run. When condoms are used consistently by a pair where one is infected the rate of HIV infection is less than 1% per annum. There is some evidence to suggest that female condoms could be just as effective. Application of a vaginal gel containing tenofovir a reverse transcriptase inhibitor at the point of intercourse seems to reduce rates of infection by approximately 40% in African women. On the other hand, use of the spermicide nonoxynol 9 can increase the risk for transmission due to its tendency to irritate the vagina and rectum.
HIV and pregnancy
Interventions to avoid vertical HIV transmission from mothers to children can lower transmission rates.This is mostly done by taking a combination of antiviral drugs during pregnancy and post-birth in the child and possibly by bottle feeding instead of breastfeeding. If replacement feeding is affordable feasible safe and acceptable mothers should avoid breastfeeding their children but exclusive breastfeeding should be employed during the first months of life if otherwise. Exclusive breastfeeding if applied lowers the risk of transmission by giving the infant prolonged antiretroviral prophylaxis. In 2015 Cuba became the world’s first country to eliminate mother to child transmission of HIV.
There is no authorized HIV or AIDS vaccine. RV 144 best vaccine trial yet was reported in 2009. it evidenced a partial transmission risk reduction of about 30 providing some cause for optimism within the research world to create a genuine vaccine.