HIV AND AIDS-SYMPTOMS

Many people with HIV do not know they are infected. In the United States, it is likely that 20% of HIV-positive individuals are unaware of their infection.

• Many people do not develop symptoms after they first get infected with HIV. Others have a history of a flu-like illness within several days to weeks after exposure to the virus. Early HIV symptoms also include fever, headache, tiredness, and enlarged lymph nodes in the neck. These symptoms usually disappear on their own within a few weeks. After that, the person feels normal and has no symptoms. This asymptomatic phase often lasts for years.
• The progression of disease varies widely among individuals. This state may last from a few months to more than 10 years.
• During this period, the virus continues to multiply actively and infects and kills the cells of the immune system.
• The virus destroys the cells that are the primary infection fighters, a type of white blood cell called CD4 cells.
• Even though the person has no symptoms, he or she is contagious and can pass HIV to others through the routes listed above.

AIDS is the later stage of HIV infection, when the body begins losing its ability to fight infections. Once the CD4 cell count falls low enough, an infected person is said to have AIDS. Sometimes, the diagnosis of AIDS is made because the person has unusual infections or cancers that show how weak the immune system is.

• The infections that happen with AIDS are called opportunistic infections because they take advantage of the opportunity to infect a weakened host. The infections include (but are not limited to)
• pneumonia caused by Pneumocystis, which causes wheezing;
• brain infection with toxoplasmosis which can cause trouble thinking or symptoms that mimic a stroke;
• widespread infection with a bacteria called MAC (mycobacterium avium complex) which can cause fever and weight loss;
• yeast infection of the swallowing tube (esophagus) which causes pain with swallowing;
• widespread diseases with certain fungi like histoplasmosis, which can cause fever, cough, anemia, and other problems.
• A weakened immune system can also lead to other unusual conditions:
• lymphoma in (a form of cancer of the lymphoid tissue) in the brain, which can cause fever and trouble thinking;
• a cancer of the soft tissues called Kaposi's sarcoma, which causes brown, reddish, or purple spots that develop on the skin or in the mouth

HIV/AIDS Diagnosis

HIV infection is commonly diagnosed by blood tests. There are three main types of tests that are commonly used: (1) HIV antibody tests, (2) RNA tests, and (3) a combination test that detects both antibodies and a piece of the virus called the p24 protein. In addition, a blood test known as a Western blot is used to confirm the diagnosis.
No test is perfect. Tests may be falsely positive or falsely negative. For example, it can take some time for the immune system to produce enough antibodies for the antibody test to turn positive. This time period is commonly referred to as the "testing window period" and may last six weeks to three months following infection. Therefore, if the initial antibody test is negative, a repeat test should be performed three months later. Early testing is crucial, because early treatment for HIV helps people avoid or minimize complications. Furthermore, high-risk behaviors can be avoided, thus preventing the spread of the virus to others.
Testing for HIV is usually a two-step process. First, an inexpensive screening test is done. If that test is positive, a second test (Western blot) is done to confirm the result. Antibody tests are the most common initial screening test used. There are different types of antibody screening tests available:

• Most commonly, blood is drawn for an enzyme immunoassay (EIA). The test is usually run in a local laboratory, so results can take one to three days to come back.
• Other tests can detect antibodies in body fluids other than blood such as saliva, urine, and vaginal secretions. Some of these are designed to be rapid tests that produce results in approximately 20 minutes. These tests have accuracy rates similar to traditional blood tests.
• HIV home-testing kits are available at many local drug stores. Blood is obtained by a finger prick and blotted on a filter strip. Other test kits use saliva or urine. The filter strip is mailed in a protective envelope to a laboratory to be tested. Results are returned by mail in one to two weeks.
• All positive antibody screening tests must be confirmed with a follow-up blood test called the Western blot to make a positive diagnosis. If the antibody test and the Western blot are both positive, the likelihood of a person being HIV infected is >99%. Sometimes, the Western blot is "indeterminate," meaning that it is neither positive nor negative. In these cases, the tests are usually repeated at a later date. In addition, an RNA test for the virus might be done.

Other tests, such as those that look for virus RNA and the combination test, are not commonly used for screening.

HIV/AIDS Treatment

HIV/AIDS Medications

Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are called highly active antiretroviral therapy (HAART) and have substantially reduced HIV-related complications and deaths. However, medications do not cure HIV/AIDS. In one case, a patient treated for cancer apparently was cured of HIV through use of a stem cell transplant, but this "stem cell cure" is not recommended for HIV due to the high risk of mortality and uncertain chance of success. Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three drugs is recommended to suppress the virus from replicating and boost the immune system. The following are the different classes of medications used in treatment.

• Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. The following are examples:
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). These include medications such as zidovudine (AZT/Retrovir), didanosine (ddI/Videx), zalcitabine (ddC/Hivid), stavudine (d4T/Zerit), lamivudine (3TC/Epivir), abacavir (ABC/Ziagen), emtricitabine (FTC/Emtriva), and tenofovir (Viread).
• Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune), delavirdine (Rescriptor), and etravirine (Intelence). Rilpivirine (Edurant), the newest member of this class of drugs, was approved by the U.S. FDA in May of 2011.
• Two complete HIV treatment regimens that combine two NRTIs and one NNRTI in one pill taken once a day are available for convenience.
• Atripla: a combination of efavirenz, emtricitabine, and tenofovir. Atripla was approved for use by the FDA in 2006.
• Complera: a combination of rilpivirine, emtricitabine, and tenofovir. This combination pill was approved in August 2011 by the FDA as another first-line treatment for HIV infection in patients who need to start therapy.
• Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase), fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir (Aptivus), and nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications.
• Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin. Another drug called maraviroc (Selzentry) binds to a protein on the surface of the human cell and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs.
• Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This is a newer class of drugs recently approved to help treat those who have developed resistance to the other medications. Raltegravir (Isentress) was the first drug in this class approved by the FDA in 2007.

Antiretroviral viral drugs stop viral replication and delay the development of AIDS. However, they also have side effects that can be severe. They include decreased levels of red or white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol level, diabetes, abnormal body-fat distribution, and painful nerve damage. An expert in infectious diseases should be consulted if the patient needs concomitant treatment for diseases such as cancer or hepatitis C.

• Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss anti-HIV medications is crucial.

Source:emedicinehealth website.