Overview Of Acquired Immune Deficiency Syndrome (AIDS)
Human immunodeficiency virus (HIV) causes the immune disorder known as acquired immune deficiency syndrome (AIDS). If left untreated, HIV will attack and weaken the person’s immune system until eventually they develop AIDS. Once the immune system is compromised, the person is prone to developing dangerous infections and various types of cancers. Currently there is no permanent cure for the HIV virus or AIDS.
Causes Of Acquired Immune Deficiency Syndrome (AIDS)
HIV spreads person-to-person through specific bodily fluids:
- Semen and preseminal fluid
- Blood
- Vaginal secretions
- Rectal secretions
- Breast milk
HIV can spread between people if these fluids come into contact with:
- The person’s bloodstream, typically through injections or transfusions
- Damaged tissue, such as cuts or scrapes
- Mucous membranes, such as the vagina, rectum, inside of the mouth, or penis
It is important to note that HIV does not spread through saliva, sweat, or urine.
In the United States, HIV most commonly spreads through:
- Needle sharing between several people
- Anal or vaginal sex without the use of a condom with someone who has HIV (and they are not taking medications to prevent or treat HIV, which are available and effective)
Less often, HIV can spread:
- From mother to child. During the course of the pregnancy, a fetus has exposure to the virus through shared blood circulation, or they may have exposure after birth while nursing. Testing and treatment of HIV is crucial for those who are pregnant and nursing, as proper care will reduce the number of infants becoming infected with HIV shortly before or after birth.
- Through contaminated needle sticks (or other sharp objects). This type of spread happens almost exclusively in health care workers.
HIV is NOT spread by:
- Handling or touching items after a person infected with HIV
- Pets or mosquitos
- Eating food prepared or handled by someone with HIV
- Engaging in sports or other recreational activities
- Casual contact, such as chaste kisses or hugs
Blood donation, organ donation, and HIV:
There is no risk of infection with HIV when donating blood or organs, as no contact occurs between donor and recipient, and all needles and instruments used are sterile and only used once.
Historically, it is not unheard of for HIV infection to happen when receiving blood or organs from infected donors. Screening was not yet being done at this time.
Today, though, there is virtually no risk of this ever occurring. Blood and organ donors receive vigorous screening for HIV and other blood-borne illnesses before they can donate. They also check the organs, blood, and tissues themselves, separate from the donor, just in case.
Risk factors for HIV infection can include:
- Engaging with an HIV positive sexual partner who does not take HIV medications.
- Sharing syringes or needles when using drugs.
- Unprotected anal or vaginal sex, with receptive anal sex as the riskiest of the options. Multiple partners can also increase risk of transmission. Correctly using condoms with each and every sexual encounter greatly helps lower the risk of HIV transmission.
- Active infection with a different sexually-transmitted disease (STD).
Symptoms Of Acquired Immune Deficiency Syndrome (AIDS)
The symptoms of acute HIV infection (the period of time when a person is first infected) can often appear similar to the flu or other viral infections.
These common symptoms typically include:
- Headache
- Swollen lymph nodes
- Widespread muscle pain and fever
- Diarrhea
- Sore throat
- Mouth sores, including thrush (a yeast infection)
- Night sweats
Notably, many early HIV infections are asymptomatic (no noticeable symptoms are present)
After the acute stage of HIV infection, the disease normally progresses to an asymptomatic stage, which can last 10 years or more. During this stage, many have no reason to suspect that they have an HIV infection, and can spread the virus to others unknowingly.
If not treated, almost all of those infected with HIV will develop AIDS eventually. Some will develop AIDS in only a few years after infection with HIV. Others could remain in the early stages for 10-20 years – doctors call these patients long-term non-progressors.
Those who have developed AIDS have had their immune systems severely damaged and compromised by HIV. Due to this, they are at a high risk for developing infections that are not common in those with properly functioning immune systems.
Medical professionals call these types of infections opportunistic infections. They can be caused by viruses, fungi, bacteria, or protozoa, and they can infect and damage any part of the body. Those with AIDS are also at a higher risk for developing certain varieties of cancers, notably various types of lymphomas and a specific skin cancer called Kaposi’s sarcoma.
When a person with AIDS experiences symptoms because of an infection, what particular symptoms they experience depends on what part of their body the infection is in. For example, infections of the lungs, which are common in AIDS patients, usually present with a cough, shortness of breath, and a fever. Another common infection type is intestinal infection, which involves vomiting, diarrhea, abdominal pain, or difficulties swallowing.
Other common and more non-specific symptoms include fever, weight loss, rashes, sweats, and swollen lymph nodes.
Exams & Tests
Diagnostic Testing
Testing is generally a 2-step process:
Screening test – There are several different types of tests available to screen for the presence of the HIV virus in a person. These include tests of the person’s blood or of other bodily fluids. These tests check for the presence of either HIV antigen, antibodies against the HIV virus, or both. Some screening tests produce results in thirty minutes or less.
Follow-up test – This test is also called a confirmatory test. It’s done after a positive screening test to be sure the positive was correct, and not a false result.
Home tests are also available to test for HIV if the patient doesn’t want to or cannot get to a clinic. If planning to use one, be absolutely sure that it is FDA approved and legitimate. Carefully follow the instructions on the test packaging to ensure that the results are as accurate as possible.
The Centers for Disease Control and Prevention (CDC) recommend that everyone who is at risk for HIV infection have a screening test for HIV done. They often recommend ages 15-65 test at least once. Those who engage in high risk behaviors (unprotected sex with multiple partners and intravenous drug use) should be tested regularly. Pregnant people should also have a screening test done, just in case.
Tests That Will Be Done After Diagnosis
Patients with AIDS typically have to have regular blood tests for checking on their CD4 cell count:
These tests are done because the CD4 T cells (also called T4 cells or “helper T cells”) are the particular blood cells that the HIV virus attacks and destroys. These cells are essential for the functioning of the immune system, and their absence is a very bad sign for the infected person.
In the process of the HIV virus damaging immune system cells, the CD4 count drops considerably. Normal CD4 counts range from 500 to 1,500 cells per mm3 of blood.
Patients normally develop symptoms at a CD4 count below 350. More serious problems and complications tend to happen when the CD4 count drops below 200. At that 200 marker, the patient has officially developed AIDS, instead of just an HIV infection.
Additional tests can include:
- A complete blood count, a urine test, and a blood chemistry test
- A pap smear to test for cervical cancer
- A resistance test to make sure that the HIV virus within the patient hasn’t mutated and acquired resistance to normal HIV treatment medications
- An HIV RNA level (or viral load test) to determine how much HIV virus is within the person’s blood
- A TB test
- Tests for other STDs that might also be infecting the patient
- An anal pap smear to test for anal cancer
Treatment Of Acquired Immune Deficiency Syndrome (AIDS)
HIV and AIDS are treated with medications that aim to stop the virus from multiplying. These medications are referred to as antiretroviral therapy (ART).
A few years ago, most people infected with HIV would only start ART after their CD4 counts dropped below a certain level, or they developed symptoms. Currently, however, ART is recommended for everyone infected with HIV, even if their CD4 count isn’t reduced from normal levels.
Regular blood tests are necessary to ensure that the virus level in the patient’s blood (also called the viral load) is kept suppressed to the lowest level possible. The ultimate goal of ART is to lower the HIV viral load in the person’s blood to a count so low that tests can’t even detect it. This state is referred to as an undetectable viral load.
HIV/AIDS symptoms and complications typically disappear entirely as the CD4 count goes up and the immune system recovers.
