FAQS

Definition of the disease

What is the disease?

AIDS (Acquired Immune Deficiency Syndrome) is caused by the (HIV) Human Immune Deficiency Virus, a retro-virus. Once a person is infected the virus can remain in the blood and tissue cells a very longtime.

How is it caused?

AIDS is caused by infection with HIV, a virus that belongs to a family known as 'human retroviruses. There appear to be at least two major types of the virus  – type HIV1 and type HIV2.

HIV1 has now spread worldwide and is the most common type in Africa. HIV2 discovered in 1986 is believed to be most prevalent in West Africa. Much less is known about HIV2, but it seems to cause a disease similar to HIV1, but it also seems to be less severe.

The HIV virus mainly affects the body’s immune system. The immune system is the body’s main defence against invading organisms such as viruses, bacteria, fungi as well as parasites, commonly referred to as a persons “resistance” to disease. Once inside the body, the virus infects and multiplies in immune cells, ultimately leading to the death of these cells. HI V mainly affects the white blood cells, a type of immune cells known as CD4 lymphocytes. Over time, the number of CD4 cells, as well as other immune cells in the body falls.

HIV by attacking and destroying white blood cells that are responsible for mounting an immune response to disease gradually weakens the body’s resistance to invasion by other microorganisms. The result of this is a state of   'Immunodeficiency'.

The victim gradually becomes more susceptible to “opportunistic infections”, such as pneumonias, tuberculosis, diarrhoea  and tumours.  These infections are caused by organisms that would not normally affect the body i.e. they are opportunistic.  In the end the victim succumbs to this onslaught and dies. AIDS is now regarded as the final stage of HIV infection, which is a long slow illness.

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Prevalence - Where is it found?

HIV/AIDS has now spread world wide, but the highest number of infected people are found in Sub-Saharan Africa, where 8.8% of all adults (15-49 years) are HIV positive.

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Transmission - How is it spread?

The virus is found in body fluids such as blood or semen. There have so far been only three main methods for the transmission of the virus by blood or semen from an infected person:-

i) Unprotected sexual intercourse  (both heterosexual and homosexual).

ii) HIV infected blood, contaminated blood products including needles, syringes, and organs used in transplants.

iii) Perinatal transmission from an infected mother to child during pregnancy.

In Africa 90% of infections are acquired through heterosexual contact. An estimated 5-8% are through blood products and the rest are children being infected by their mothers.

HIV is not spread by insect bites such as mosquitoes, ticks);
HIV is not spread by skin contact e.g. by exchanging handshakes or touch.
HIV is not spread by saliva, so you cannot get it by using a cup or plate used by an HIV positive person.

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What are the signs and symptoms?

Diagnosis

HIV infection is normally silent and can only be reliably diagnosed by blood tests. There are several different kinds of tests that work by detecting antibodies produced by the body as the initial immune response to infection by the virus.

HIV infection can be detected by various tests, of which two are commonly used:  

ELISA (Enzyme linked immuno-sorbent assay), a screening test. If a person tests positive, a confirmatory test is done.

Western blot – which is the confirmatory test.

Both these tests detect antibodies produced by the body in response to infection. Certain other tests detect the viral particles directly (for example, Polymerase chain reaction).

Blood tests to reveal the T- lymphocytes  count are also routinely performed.

CD4 counts serve as useful predictors of disease progression. Complications with infections usually begin when CD4 counts fall below 500 cells per milliliter of blood.

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The symptoms and signs of HIV infection are related to the patient's immune status at a given point of time, and thus vary with the duration and progression of the disease.

AIDS is the final stage of HIV and is diagnosed when a person has developed one of several opportunistic diseases associated with the virus as well as underlying immune problem (See the Table below)

With progression to AIDS, many opportunistic infections and some cancers occur and as a result many organs can be affected. Thus, symptoms and signs are varied and many.

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Respiratory infections affecting the lungs are common and can be caused by bacteria (pneumococci, haemophilus), viruses (cytomegalovirus) or fungi (pneumocystis carinii). It leads to fever, cough and shortness of breath.

Tuberculosis frequently occurs in conjunction with AIDS. IN HIV/AIDS patients it is particularly difficult to treat due to problems of drug resistance (organisms become resistant to the action of the drugs). The increase in HIV has been followed by a concurrent increase in TB all over the world. It presents with complaints of fever, weight loss and cough.

Neurological complications include infection of the brain (by toxoplasma, or cryptococcus) resulting in severe meningitis, which often proves fatal. They are characterised by fever, headache, seizures, altered mental state and specific neurological deficits.

Oral candidiasis or oral thrush (a fungal infection) causes lesions of the mouth cavity and lips with yellow or white patches on the tongue or cheek (inner) surface that are highly suggestive of AIDS. Oral ulcers are also very common.

Gastrointestinal symptoms usually are profuse and watery diarrhoea, which may not relent with routine treatment. It is usually caused by infection with an organism called cryptosporidium. Other infections include candidial oesophagitis, which leads to difficulty in swallowing of food.

A number of skin diseases are common in AIDS including ulcers and skin rashes. The most serious skin lesions, is a form of cancer known as Kaposi's sarcoma. This is the commonest cancer in AIDS, and often by the time it is discovered, it has spread throughout the body.

Other diseases that occur in AIDS commonly are those involving the muscles (and leading to wasting), the nerves (leading to weakness and sensory loss), and of various other organs. Infections of the genitals by fungi (vaginal candidiasis) also occur.

AIDS Dementia Complex (ADC) is a condition wherein confusion altered mental function and cognitive impairment, motor and speech defects are seen, this tends to be seen in the most advanced cases.

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How does the disease progress?

Initially those infected with the HIV do not develop any signs and symptoms but as the viral load in the body increases and the white blood cells get destroyed, AIDS and its accompanying infections sets in.

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Based on studies done the range of incubations is from 2 months to 10 years. Current estimates for the progression from HIV to AIDS are

1 year               -           1% of those infected develop symptoms

5 years             -           20-25%  “                      “

10 years            -           50%  “                           “

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What is the prognosis?

Once a person gets infected with HIV, the infection persists for life and almost invariably leads to AIDS. Most patients will eventually die of the complications of AIDS.

What is the treatment?

There is no known cure for HIV. A number of drug cocktails and a range of treatments have been developed that slow down the development of AIDS by reducing the virus load and rebuilding the immune system.  These drugs are extremely expensive.

The treatment consists of numerous different drugs, and the patients have to stick to a rigid regime. The treatment is aimed at decreasing the number viral load using anti-retroviral drugs such as AZT or Protease Inhibitors. In some cases, the virus has been reduced to undetectable levels. It is usually started when the CD4 counts fall below 500 cells. These drugs often have powerful side effects, such as anaemia, and not everyone responds to them.

The treatment is life long and cannot be broken, for fear of the virus developing resistance to the drugs. However recently there has been a growing problem of resistance developing to even new drugs, despite patients sticking to the regime as prescribed. Newer drugs have only moderately improved the outlook for treated patients.

Treatment of opportunistic infections: depending upon the infection, different drugs active against bacteria, viruses and fungi are used.

Prompt or prophylactic (pre-emptive treatment) against opportunistic infections.

Agents that stimulate blood production.

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What precautions are needed?

Practicing safe sex methods will prevent further spread of the disease.

Once diagnosed with HIV infection, the victim should avoid exchange of body fluids with others to stop spread of the disease.

Women infected with HIV should avoid getting pregnant as the infection may be transmitted to the infant. Likewise, breast-feeding is discouraged.

People infected with HIV, or those at high-risk, should not donate blood, body organs, or semen (to sperm banks).

The HIV sufferer should take great care with their health. Prophylactic (pre-emptive) treatment of infections and vaccination is helpful in preventing many infections. If they do get ill. Prompt and aggressive treatment of the infection will prevent more complications setting in.

Live vaccines should be avoided in AIDS.

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How will the disease affect the patient’s life?

The psychological and social implications of a positive HIV test are just as devastating as and perhaps more immediate than the physical effects of the disease itself.

Due to a combination of weight loss, malabsorption and anorexia (loss of appetite), there is a progressive loss of muscle mass and strength. This contributes to the poor health of the patients who already are affected by several infections. It also leads to negative effects on work and lifestyle.

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What people need to know?

A sympathetic attitude towards the patient is necessary.

Education and awareness of the disease helps in removing common misbeliefs and false notions.

Holding hands, sharing plates and spoons, kissing, and using bedclothes do not result in transmission of HIV.

Personal care must be taken to avoid contact with the patient's body fluids, especially if any ulcers or cuts or bruises are present on the either the patient skin or the attendants skin.

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What other treatment is required?

The patient should take great care with their health, by following healthy nutritious diet. A normal social life is encouraged, but the patients should avoid situations that would put the body under great stress.

Patients are advised to avoid contact with persons with tuberculosis and infectious illnesses such as chicken pox ( a childhood disease) which can prove devastating to an HIV positive person.

Drug resistance and toxicity lead to various complications. Monitoring for the efficacy of treatment and for onset of any complications should be done periodically.

Support and counseling of the patient to help cope with emotional problems that often follow diagnosis of the disease.

Can one recover from HIV infection?

HIV infection is always ultimately fatal.

Drug treatment, apart from being expensive and complicated, merely delays an inevitable death.

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How do you prevent the disease?

At the moment the only way the spread of HIV can be prevented, by proper preventive measures. These are mainly behavioural changes such as:-

Practicing safe sex. This requires the use of condoms during sexual activity and is strongly recommended in high-risk groups. Some important points about the use of condoms are:-

They have to be used during every act of sex.

Avoiding promiscuous sex, especially with multiple sex partners, is to be avoided.

Blood should always be screened for HIV prior to transfusions.

Medical and paramedical staff should follow universal body-fluid protection.

Avoiding sharing of needles, razors, etc.

Vaccines: There has been extensive scientific research done to develop a vaccine for AIDS. A number of trials are being conducted around the world in humans, but the results are not expected for another 10 years.

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DRUGS & TREATMENT

AIDS UPDATES
2002
2001

Special Coverage: XIV International Conference on AIDS Barcelona, Spain, 7-12 July 2002