HIV/AIDS

HIV/AIDS

What is HIV/AIDS?

HIV/AIDS is the one sexually transmitted infection (STI) that frightens people most because it is life-threatening and so far we have no cure. HIV stands for Human Immunodeficiency (m U NO dah fish hun see) Virus. Infection with HIV usually leads to AIDS (Acquired Immune Deficiency Syndrome).

AIDS is not a disease, but the name given to a complex group of illnesses that happen because of a crippled immune system. The diagnosis of AIDS is made by a doctor and based on a definition set up by the US Centers for Disease Control and Prevention (CDC). Infection with HIV can leave a person unprotected from certain types of cancer and various infections that are either not found or are mild in persons with normal immune systems.

These types of infections are known as opportunistic (AW purr tune IS tic) infections and will be addressed later in this article. Sometimes, HIV directly attacks the nervous system and brain causing depression, disorientation, dementia, and other neurological (nur ah LA gee cul) problems.

Individuals may be infected with HIV for a long time before they develop any noticeable symptoms of the disease. They can still transmit HIV to someone else. The time between infection with HIV and diagnosis with AIDS tends to belong but varies from person to person. The average is about 8-11 years.

AIDS has killed 22 million people since it appeared 20 years ago. There are 5 million new infections every year – 15,000 per day. Poor countries have been hit especially hard with 95% of the new infections. Worldwide, 42 million people living with HIV/AIDS. In Africa, 1 of every 4 adults is infected with HIV, 1 out of 2 in some countries. Fifty-five hundred die daily. A state of emergency and national disaster has been declared in some countries. One of every 250 Americans is living with HIV/AIDS.

How is HIV transmitted?

HIV must be passed directly from certain body fluids of an infected person into the body of an uninfected person. It’s usually spread by sexual contact with an infected person or by sharing needles and/or syringes with someone who is infected. Anal or vaginal sex can pass HIV from an infected person to a sexual partner.

But also oral sex with a man or woman can transmit HIV since blood, semen/cum (or pre-cum), or vaginal fluids are involved in the transmission of the virus. When any of those fluids from an HIV-infected person enters the bloodstream of another person, through breaks in the skin or through the mucous membrane (like the mouth or the penis/vagina), there is a definite possibility of transmission.

The risk of acquiring HIV is greatly increased if a person is infected with HepC or HCV (Hepatitis C Virus). A person in a high-risk group (people who practice unsafe sex, intravenous drug users, etc.) is always gambling with the chance of getting HepC infection which is easily transmitted through the same ways (by body fluids generally) as HIV (which is much more fragile than HepC).

Today HIV only rarely is transmitted through transfusions of infected blood or blood clotting factors, since most countries screen blood products for HIV antibodies. Babies born to HIV-infected mothers may become infected before or during birth or through breastfeeding after birth.

Health care workers have been infected with HIV after accidental sticks with needles containing HIV-infected blood or, less often, after infected blood gets into a worker’s open cut or a mucous membrane (like eyes or in the nose). There has been only one known instance of patients being infected by a health care worker in the US – a dentist infected 6 patients.

HIV is a very fragile virus that is not transmitted through the air nor by shaking hands or hugging. To be clear on how HIV is transmitted, it is important to understand which body fluids contain enough HIV to be a transmission threat. Blood, semen, and vaginal fluids of an HIV-infected person are the only fluids that can transmit HIV to another person (in a non-medical setting).

A small amount of HIV in body fluid does not mean HIV can be transmitted by that body fluid. For instance, HIV has been found in saliva and tears in very low amounts in some people with AIDS. Contact with saliva or tears has never resulted in known transmission of HIV.

CDC recommends against open-mouth or French kissing with a person known to be HIV-infected, even though the risk of getting HIV this way is very low, because of the possible exposure to blood in the infected person’s mouth. The one known case of HIV infection CDC blames open-mouth kissing was due to blood in the infected person’s mouth.

Although some fear that HIV might be transmitted in other ways, so far no scientific evidence has been found. If HIV were being transmitted through air, water, or insects the pattern of reported AIDS cases would be much different. For example, if mosquitoes could transmit HIV infection, many more children would have HIV. Any case that might be a new kind of transmission is completely investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC.

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in business involving food. CDC recommends that food-service workers known to be infected with HIV not be restricted from work unless they have infections or illnesses such as diarrhea or hepatitis A for which any food-service worker should be restricted.

Personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) have shown no evidence of transmission to a client or vice versa. Instruments used to penetrate the skin (tattooing, acupuncture, and piercing devices) or which may become contaminated with blood (like razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use by the same cleaning methods recommended for health care institutions.

CDC knows of no HIV transmission by tattooing or body piercing. One case of acupuncture transmitting HIV has been documented. Body piercing (NOT ear piercing) has greater medical complications than tattoos.

Healing of piercings generally will take weeks or months and the pierced skin could be torn, cut, or inflamed even after healing. In theory, the unhealed skin could come into contact with HIV-infected blood and transmit the virus. Or, HIV could be transmitted if instruments contaminated with HIV-infected blood are not properly cleaned between clients.

Public safety workers (police, paramedics) or others who might be involved in broken skin and/or blood should understand HIV risk. CDC has found one situation that appeared to be the blood-to-blood transmission of HIV by a human bite and there have been other reports in the medical literature that also seem to show HIV being transmitted by a bite.

It’s important to understand that severe tearing and damage with blood present were in each of these cases and that biting is not a common way of transmitting HIV. Usually, bites do not result in HIV infection.

Another rare HIV transmission is between family members who are caregiving a person living with AIDS in a household setting. These transmissions were from contact between skin or mucous membranes and infected blood. When caring for family members known to have HIV/AIDS, precautions are known in medical settings as “universal precautions” should be used. There are 5 basic steps for care-giving HIV prevention:

1. Latex gloves should be worn during contact with blood or body fluids (urine, feces, vomit) that could contain visible blood.
2. Cuts, sores, or breaks on both the caregiver’s and patient’s skin should be covered with bandages.
3. Hands or other body parts should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected correctly.
4. Practices that increase the likelihood of blood contacts, such as sharing of razors and toothbrushes, should be avoided.
5. Needles and other sharp instruments should be used only when medically necessary and handled as recommendations for healthcare settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers.)

How is HIV/AIDS diagnosed?

In 1982, CDC established a specific definition of AIDS, but this has been revised in 1987 when HIV was discovered, and also in 1993 to include more illnesses and severe suppression of the immune system. You can’t rely on symptoms to tell if someone is infected with HIV.

Many people don’t have any symptoms at all, and besides, HIV/AIDS symptoms are similar to many other illnesses like the flu. The initial flu-like symptoms referred to as acute retroviral infection or the seroconverting syndrome commonly lasts for a two-week period. The most common symptoms are fever, painful joints, fatigue, and rash.

The lymph nodes are significantly enlarged. However, the symptoms of immunodeficiency like yeast-like infections may also appear in the first period of infection. At that time the body starts to produce antibodies to fight HIV infection but in not sufficient amounts to detect them by test.

Nearly all persons infected with HIV will have antibodies the test can find in 3 months after becoming infected. In rare cases, antibodies may take up to 6 months or longer to show up. After remission of acute symptoms, a person is still an HIV carrier. Although this is a symptom-free period, the antibodies are detectable.

Many places offer to test for HIV infection. Common locations include test sites set up just for HIV testing, local health departments, doctor’s offices, hospitals, and even private testing companies. Blood donation should not be used for testing because if the donor’s infected blood has not yet developed antibodies s/he has a false sense of security and has passed on infected blood.

CDC’s National AIDS Hotline can look up free testing sites in the US. CDC recommends that the HIV test be taken where counseling is given before and after the test. Test counseling is important whether the results show HIV infection or not. You should ask who will know your test result and how it will be stored.

CDC states that over time most HIV-infected persons will eventually develop AIDS. Symptoms related to an AIDS diagnosis take many years to develop. Research has shown that there are things that HIV-infected people can do to stay healthy longer – taking good care of general health and treatment by an HIV/AIDS-knowledgeable doctor.

What is the treatment?

Research is being conducted all over the world to find effective drugs
1. to treat the illnesses that people with AIDS suffer
2. to boost the immune system in order to help delay the disease in people with HIV infection who are symptomatic or asymptomatic (without symptoms)
3. to prevent HIV infection.

Many Americans volunteer to take part in clinical drug trials. The Food and Drug Administration (FDA) requires strict testing programs to approve new drugs. It used to take 7-10 years to approve a drug, but since 1988 FDA reduced that time by half for drugs fighting life-threatening diseases. HIV/AIDS-knowledgeable doctors can help people living with HIV/AIDS decide which drugs (whether already approved or in a clinical trial) are best for them.

Holistic treatments generally attempt to supplement regular treatments by improving the immune system. Some examples are vitamin C therapy, macrobiotics, acupuncture, homeopathy, and good nutrition. People with HIV/AIDS feel more in control of their disease by becoming aware and staying up to date on treatments.

There are many organizations that help with this ongoing process. HIV/AIDS support groups offer information about treatments, ways to deal with stress, and emotional support. Individual support is an important option for those not interested in groups, where groups aren’t available, or for those needing in-depth counseling and support.

Any condition that suppresses the immune system can increase the risk of developing an HIV-related illness. HIV-infected people should not place themselves at risk of other STDs or reinfection with HIV.

Reinfection or repeated infection with HIV can increase the amount of virus in the body and increase the chances of acquiring another strain of HIV. It’s thought that different combinations of different HIV strains are even harder for the immune system to fight. The healthier the lifestyle, the healthier the immune system. Focusing on physical health and emotional well-being is highly recommended for people living with HIV/AIDS.

How do I prevent HIV/AIDS?

Sexual transmission of HIV can be prevented by not having sex or having sex only with one uninfected person who only has sex with you. All other sexually active persons need to greatly reduce the risk of acquiring or transmitting sexually transmitted infections (STIs), including HIV infection, by the proper and consistent use of latex or polyurethane (a type of plastic) condoms when having vaginal, anal, or oral sex.

For condoms to provide maximum protection, they must be used consistently (every time) and correctly. Several studies show that latex condom breakage rates in the US are less than 2% of the time and even when condoms do break, 1 study found that over half the breaks happened before ejaculation (cumming). When condoms are used right every time, they have been shown to prevent pregnancy up to 98% of the time.

Many studies prove that a properly used latex condom gives excellent protection against and significantly reduces the chance of getting many STIs, including HIV. Women should use the “female condom” when a male condom cannot be used. The “female condom” is a shield sort of like a condom and a diaphragm. It’s inserted into the vagina and held in place by a flexible ring at each end.

Fluid barriers should be used during mouth to vagina or mouth to anus sex. Household plastic wrap, dental dams (square pieces of latex used by dentists), or cut-open and flattened latex condoms are possibilities. Household plastic wrap is larger, easy to find, and cheap. Latex gloves should be worn when inserting 1 or more fingers in the vagina or anus (finger fucking or fisting). These gloves can be found at most pharmacies.

Drug users who share needles or “works” (other drug equipment) are at high risk of infection with HIV and many other diseases. Users who can’t stop or can’t get help to stop, should not share needles or at least clean them before sharing.

CDC says that mixing liquid chlorine bleach and water (1 to 100) would kill most of the HIV, which means a capful of bleach in a glass of water could be used. The syringe should be flushed (completely filled and emptied) with the bleach water twice, then flushed with plain water twice. If bleach isn’t available, a 10-minute soak in alcohol is better than nothing.

Healthcare workers should always use blood and body fluid precautions for all patients to lower the risk of HIV transmission and other blood-borne diseases. These “universal precautions” include hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Details and training about this important protection should be available from an “infection control officer,” boss, or professional organization.

What are possible complications from HIV/AIDS?

HIV directly infects the nervous and immune systems. It directly infects the brain and nerve tissue. The first symptoms of AIDS usually involve the nervous system.

HIV may cause neurological problems including dementia with symptoms like dizziness and headaches, memory loss, loss of motor control, and difficulty with speech or seizures. So-called “opportunistic” infections and diseases take advantage of a weakened immune system. These infections would not happen in a healthy immune system, and therefore not be serious or life-threatening. The most common opportunistic infections and other AIDS-related illnesses are:

Nervous system:
• Central Nervous System Toxoplasmosis (tox o plaz MO sis) or Toxo infects the brain causing symptoms like fever, dizziness, headaches, and seizures. The one-cell parasite that causes Toxo is in soil, cat feces, or undercooked meat. Pregnant women are warned not to change cat litter boxes to avoid Toxo since their immune system is weakened by the pregnancy.
• Cytomegalovirus (SIGH toe meg low virus) or CMV is a member of the herpes family of viruses that can cause hepatitis, pneumonia, colitis, and blindness in people with HIV/AIDS.
• Cryptococcal meningitis (krip-ta-COCK-el men-in-JI-tis) usually affects the brain and spinal cord causing headaches, blurred vision, confusion, depression, agitation or inappropriate speech. It often re-occurs and can be fatal.

Respiratory system:
• Pneumocystis Carinii Pneumonia (New-mow-SIS-tis Car-REE-knee-eye new-MOAN-yah) is also known as PCP. This is the most common opportunistic infection in people with AIDS. Newer treatments can fight PCP off, but it often returns.
• Tuberculosis (to BURR cue low sis) or TB is seen more and more often in people infected with HIV. It’s one of the few diseases connected with HIV that can be spread to others, although TB is treatable and preventable. CDC recommends that people living with HIV/AIDS, healthcare workers, and other HIV/AIDS caregivers be tested yearly for TB by the “Mantoux” (man-TOO) skin test.

Digestive system:
• MAI or MAC (Mycobacterium Avium Complex) is caused by a type of bacteria commonly found in the environment and is the leading cause of “wasting syndrome” with symptoms of fatigue, quick high fevers, severe night sweats, cramping, diarrhea, and weight loss.
• Candidiasis (kan duh DIE ah sis) is a yeast-like infection that can be in the mouth (thrush), throat, esophagus, or lungs. Frequent or difficult to cure vaginal yeast infections may sometimes be an early warning of HIV infection. However, most cases do NOT have HIV as the cause. There are many common causes that have absolutely nothing to do with HIV. FDA now requests makers of over-the-counter drugs for vaginal yeast infections to have a label pointing out that HIV and other serious medical conditions can damage the immune system and cause these infections.
• Hairy leukoplakia (lew ka PLAY key ah) is caused by 2 viruses and grows on the sides of the tongue like wet cotton or velvet. It’s sometimes confused with thrush, but can’t be scraped off the tongue like thrush can.
• Cryptosporidiosis (krip-TOE-spor-id-e-o-sis) is caused by a bug commonly found in farm animal intestines. Once transmitted to humans, it lives in the intestines causing terrible diarrhea that can last for weeks or months. It can cause malnutrition, significant weight loss, loss of body fluids, and death unless fluid and nutritional supplements are taken.

Other organ systems:
• Persistent lymphadenopathy (limp FAD n op ah thee) is long-lasting or recurring swelling of the lymph nodes (2-6 months or more) in at least 2 locations, not including the groin. Often the cause of the swelling and infection can’t be determined.
• Kaposi’s sarcoma (KAP-oh-see’s sar-COMB-uh) or KS is often incorrectly called skin cancer because of the blotches on the skin. It’s actually cancer on the wall of the blood vessels and mostly affects HIV-infected gay and bi men, for unknown reasons. CDC thinks it’s sexually transmitted. KS also may occur in the lungs.
• Recurrent infection with Herpes Simplex I and II (see another article on this website, LINK) can cause severe sores in an HIV infected person, not only in and around the mouth and genitals (as in those with healthy immune systems) but also on other parts of the body, lasting longer and spreading more easily than in healthy individuals.
• Varicella-Zoster virus or VZV affects the skin comparatively more often and more seriously than in healthy individuals. VZV causes chickenpox in children, after which it lies dormant in the nervous system and may appear in adulthood as Herpes Zoster or Shingles. Shingles usually affect the elderly who may be less able to fight off the disease or individuals with weak immune systems. It causes a painful rash on skin areas (innervated by the affected nerve) with blisters on the torso, neck, head (including eyes) or thigh.
• Anemia and low platelet cell count also frequently occur in AIDS, causing disorders of coagulation and bleeding.

Who should I contact?

If you find that you are infected with HIV, talk to an HIV-knowledgeable doctor about further tests to determine treatment and about the sexual partner(s) being tested for HIV. If you are in a mutually monogamous relationship (meaning you only have sex with one partner who only has sex with you) you must discuss safe(r) sex (ways to reduce but not eliminate the chance of transmitting the virus) and the need for testing.

If you have multiple sex partners you should be honest about your HIV infection and use safe(r) sex to avoid giving them HIV, reinfecting yourself, and/or getting an STD from them. If you or a sexual partner use injected drugs, get treatment, or learn how to avoid getting/giving bloodborne diseases by not sharing needles or proper cleaning of needles.

These discussions and new behaviors will undoubtedly be difficult, but this life-threatening virus requires emotional maturity as an important step in personal growth and relationship building. Many people with HIV find that once their shock and overwhelming emotions are stabilized, spiritual growth and happiness can make life extremely worthwhile.

Stay informed about new developments in HIV/AIDS through your HCV-knowledgeable doctor.

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