What is AIDS? 
AIDS (Acquired Immuno-Deficiency
Syndrome) is an infection caused by Human Immunodeficiency Virus (HIV).
The virus exists in two distinct forms, HIV-1 and HIV-2. HIV-1 causes
AIDS in the United States, Europe and Central Africa, while HIV-2 is
common in West Africa.
Specific tests for
available to detect both HIV-1 and HIV-2.
HIV is a retrovirus
belonging to the group Lentiviridae
The AIDS virus uses
special mechanisms to attack the immune system and the central nervous
system (brain and spinal cord). AIDS patients thus suffer from severe
immunodeficiency and have a variety of central nervous system disorders.
This virus cannot be
transmitted by casual personal contact in the house, workplace or
school. The modes of transmission of this virus are discussed below.
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How common is AIDS?
India
AIDS cases detected in
India up to 29th February 1996. 1
Males
- 1881
Females
- 631
Total
- 2512
World
By 1987, 70-80 per cent
of adult hemophiliacs in Europe and USA had become seropositive for HIV1.
HIV infection or AIDS is
a global health problem and affects virtually every country in the
world. As on January 1997, according to WHO reports, the total number of
people having AIDS is approximately 22 million, out of these 1 million
are children. The global projection by the year 2000 is about 40 to 100
million cases.
Children – It is
estimated that in 1996, of 1.5 million people who died of AIDS globally,
350,000 (23%) were children below 15 years of age. About 400,000
children became infected with HIV during the same period. Of the 23
million people worldwide living with HIV, 8,30,000 (3.6%) are children.2
Asia
(including India)
As on Nov 1996 (WHO) the
total number cases were 53,974.
How is AIDS transmitted?
As explained above, AIDS
cannot be transmitted by casual personal contact. The only modes of
transmission of HIV are:
Sexual Transmission
Sexual Transmission is
clearly the most important mode of transmission of AIDS infection and
accounts for 75 percent of cases of AIDS globally.
AIDS could be transmitted
by both heterosexual and homosexual transmission.
Heterosexual
transmission is the dominant mode of transmission of AIDS infection
in India, Asia and Africa. Females are commonly infected this way, as
sexual partners of HIV positive male intravenous drug abuses
Homosexual
transmission of AIDS is another mode of sexual transmission and
occurs when a male has anal intercourse with another male. As this virus
is carried in the semen, if one male is already having AIDS, the second
male contacts this disease. This mode of transmission is more common in
Europe and United States as compared to Asia and Africa.
Parental transmission or
transmission via needles and blood products
Intravenous (IV) drug
abusers
These comprise an
important group in the chain of transmission of HIV. Drug abusers
usually inject a variety of substances into the blood and often use or
share the same needle. If any one of the drug abusers has HIV, this
virus is transmitted to all those who use the same syringe and needle.
Also as the drug abusers get infected and they pass this infection to
their spouse. Thus a male drug abuser who has AIDS can infect his wife,
she in turn infects the children born after she has contracted AIDS.
Thus the whole family could be involved, if either the husband or wife
abuses drugs. The children born before the wife is infected will not
develop AIDS by mother to child transmission; only those children born
after the wife’s infection acquire HIV from their mother. This is
discussed in detail below (mother to infant transmission).
Transmission of AIDS by
transfusion of blood or blood products
This occurs when infected
HIV positive blood is transfused into a normal patient. Many blood
products in common use today such as platelet concentrates, factor VIII
concentrate, etc. also can transmit the virus. Therefore it is important
to screen all blood for presence of HIV before transfusion is given. All
blood banks now implement various methods to prevent HIV transmission by
this route, including:
- Screening of all blood
and donated plasma for antibody to HIV
- Heat treatment of
clotting factor concentrate
- Screening of donors
for history of drug abuse, sexual contacts and blood transfusions.
All donors should undergo HIV testing
- All blood given for
donation should be HIV free and carry such labels. Blood not
carrying such labels of being HIV negative should be rejected.
- Sharing of transfusion
needles sets should never be done and once blood is transfused the
transfusion set and needle should be destroyed.
Mother to infant
transmission
This is the most common
cause of pediatric AIDS (AIDS in children). An infected mother who is
HIV positive can transmit HIV to the offspring by three methods:
- When the fetus is in
the uterus through placenta
- During delivery as the
fetus comes out in the birth canal
- After birth via breast
milk.
Accidental transmission
Accidental needle
injuries: This happens for instance in a pathology lab when a sample
drawn from an AIDS patient accidentally punctures the skin of a health
worker carrying it. The chance of getting AIDS (seroconversion) in such
a case is very low and is around 0.3 percent.
Doctor to a patient:
Although the chances of transmitting AIDS to a patient from an infected
physician are extremely low, it can occur if the instruments used not
sterile and are infected with AIDS virus. It has been reported (1990,
CDC, USA) that a Dentist in Florida passed HIV infection to five of the
patients on whom he performed invasive dental procedures. Thus, strict
asepsis observed during operative procedures could go a long way in
preventing this extremely rare form of transmission.
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What should you do to
prevent getting and spreading AIDS?
- Do not have a sexual
intercourse with a person whose HIV status is unknown. Do not have
sex with a stranger. Remember it is dangerous to have sex with
prostitutes, as many of them may be HIV positive.
- Have sex with your
wife or your husband and do not change partners
- Do not abuse drugs. Do
not share needles if you are a drug abuser; contact a de-addiction
center if you want to stop using drugs.
- Use condoms if you
want to have sex. This decreases the chances of AIDS, and other
sexually transmitted diseases. Safe sex is the best way to protect
yourself from AIDS.
- If you are a drug
abuser and you are HIV positive, do not have sex with your spouse,
as he or she would also contract the disease. Remember AIDS is a
fatal disease and the best way to control this disease is to prevent
it.
- If you are mother who
is HIV positive, consult your doctor on the issue of having babies.
Your baby can have AIDS and consult your doctor on prevention. Aids
id a difficult disease to cure.
- Never use blood for
transfusion unless HIV status is not clear; use only HIV-1 and HIV-2
negative blood for transfusion.
- Never share
transfusion sets for blood transfusion; destroy all transfusion sets
or needles once they have been used. This is important in hospitals,
nursing homes and private clinics.
- Destroy all needles
once they have been used (for injections, to collect samples or used
for blood transfusion). Insist that the needles be destroyed in
needle crushers in hospitals and nursing homes. (and see to it that
they are done!)
- Health professionals:
- Always wear gloves
when you are handling HIV infected blood
- Destroy needles,
transfusion sets, slides, and HIV infected bottles. It is best
to burn or incinerate infected products.
- Maintain strict
aseptic standards during operative procedures.
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What are the symptoms of
AIDS?
HIV primarily infects a
particular cell called the CD4+ T cell. As the infection becomes more
widespread in the body, the number of these cells decreases.
Doctors commonly use the level of remaining CD4+ cells (called the CD4+
T cell count) to assess the extent of disease. The symptoms of AIDS also
roughly follow this count and staging is done accordingly.
- Early Stage:
CD4+T cell count more than 500/ml (500 cells per micro litre of
blood).
- Intermediate stage:
CD4+T cell count more than 200 and less than 500/ml of blood
- Advanced stage: CD4+T
cell count less than 200/ml
Symptoms in the early
stage or acute HIV syndrome
3 to 6 weeks after the
primary infection with HIV (primary infection refers to the process of
getting infected with HIV – an unprotected sexual intercourse,
transfusion with HIV positive blood or use of infected needle by a drug
abuser), the following symptoms may appear: -
- Fever
- Weight loss
- Loss of appetite
- Headache
- Malaise and lethargy
- Nausea and/or vomiting
- Pain in the eyes or
behind them
- Diarrhea
- Pain in the joints (athralgias)
- Pain in the muscles (myalgias)
- Pharyngitis or sore
throat
- Meningitis:
inflammation of the coverings of the brain
- Encephalitis:
inflammation of the brain itself
- Skin rashes
- Ulcers around the
mouth, anus and in vagina
Intermediate stage:
(Early symptomatic Disease)
After the early phase,
the patient enters a latency period for as long as 10 years during which
there are no clinical symptoms. Still HIV virus would infect more and
more cells in the body and rapidly increasing in number. Average CD4+ T
cell count falls by about 50 cells per year.
- Generalized
lymphadenopathy: Lymph nodes throughout the body enlarge: some
may become larger than 1 cm and be visible at sites like the neck,
groin, armpit, etc.
- Thrush: White
colored raised patches appear inside the mouth on the palate. This
is actually due to infection with Candida, a fungus and
denotes immunodeficiency.
- Reactivation of
Herpes Zoster infection or shingles: The chicken pox virus (Varicella-Zoster
virus) commonly affects people during their childhood, and then lies
dormant in their bodies for many years after the chickenpox is ‘cured.’
The virus emerges again when the patient’s immunity falls as in
AIDS and painful pustules appear on one side of the body on the
abdomen, inner part of the thigh or around the eyes.
- Thrombocytopenia:
A decrease in the count of blood platelets to around 50,000/ml is
the clinical definition of thrombocytopenia. Platelets are necessary
for the clotting of blood, and as their level falls beyond
10,000/ml; the patient may bleed from the gums, bruise easily, or
suffer life-threatening internal bleeding.
- Aphthous ulcers or
ulcers around the mouth on the lips
- Condyloma acuminata
or genital warts.
Advanced stage
As the defense mechanisms
of the body fall even further many bacteria and other microbes seize the
opportunity to set up infections in the patient whose immunity (ability
to figure infection) is falling.
Various organs may be
affected by AIDS:
|
Brain
TB,
syphilis infections
Cancer: lymphoma, Kaposi’s sarcoma
AIDS Dementia Complex
Abscess by Toxoplasma gondii or Cryptococcus
neoformans
Meningitis by Cryptococcus neoformans
|
Lungs
Pneumonia
due to Pneumocystis carnii, Tuberculosis, Cryptococcus
neoformans or Cytomegalovirus (CMV)
|
|
Muscles
Myopathy
|
Spinal
Cord
Myelopathy
|
|
Eye
Retinitis by
CMV
|
Heart
Toxoplasma infection
|
|
Digestive
System
Diarrhea by sospora
belli and Cyptosporidium
Esophagitis due to CMV
|
Ear
Otitis media
due to Pneumocystis carnii
|
|
Genitals
Ulcers by
Herpes Simplex Virus (HSV)
Syphilis due to Treponema pallidum
|
|
References
- ICMR Bulletin, 1997;
27(12):
117
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