Dr Masroor Ahmad Wani
World AIDS day is held on December 1, each year. It raises awareness across the world and in the community about the issue surrounding HIV and AIDS. It is a day for the people to show their support for the people living with HIV and to commemorate people who have died due to the AIDS.
No one can deny the importance of sex education in an era of AIDS. The days of panic and historical attacks over uttering the word sex have gone. There is a gradual awakening and young people especially feel the need to get correct information on matters pertaining to sexuality. Every year AIDS day is being celebrated in every part of world to raise this issue and to give awareness in common mass so that people may be aware about this black disease. I have also tried to write this article pertaining to the subject.
What is HIV?
HIV means Human Immunodeficiency Virus. HIV is the virus that causes AIDS. While many viruses can be controlled by the immune system, HIV destroys certain blood corpuscles called T4 cells which are part of body’s defense system .The body is then open to attack from infections or cancers that it would otherwise be able to resist. These are called opportunistic infections.
What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the most advanced stage of HIV infection. It is a serious illness that slowly attacks and destroys the body’s defense mechanism making it vulnerable to infections and cancers which normally do not affect healthy persons.
HIV causes AIDS by attacking the immune system-the CD4 cells (T-cells). When the immune system loses too many CD4 cells, you are less able to fight off infection and can develop serious problem, often deadly, infections. These are called opportunists infections because they take advantage of the body’s weakened defenses.
When someone dies of AIDS, it is usually opportunistic infections or other long-term effects of HIV infection that cause death. AIDS refers to the body’s immune-compromised state that can no longer stop opportunists infections from developing and becoming so deadly.
Causes and symptoms
AIDS is the fifth leading cause of death among people aged 25-44 especially in America, down from number one in 1995. About 25 million people worldwide have died from this infection since the start of the epidemic, and in 2006, there were approximately 40 million people around the world living with HIV/AIDS. In India HIV positive and AIDS patients are not in less quantity and this black disease is pinching a lot.
Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections like pneumonia, tuberculosis, diarrhea, fever and cancers. Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.
HIV was found in blood and saliva, vaginal fluid, and breast milk. How over blood, semen, vaginal secretions, and breast milk generally transmits infection to others.
The virus can be transmitted:
* Through sexual contact — including oral, vaginal, and anal sex
* Through blood — via blood transfusions or needle sharing
* From mother to child — a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk
Other transmission methods are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.
HIV infection is not spread by casual contact such as hugging, by touching items previously touched by a person infected with the virus, during participation in sports, or by mosquitoes bite.
It is not transmitted to a person who donates blood or organs. Those who donate organs are never in direct contact with those who receive them. Likewise, a person who donates blood is not the cause of primary AIDS is infection with the HIV virus, transmitted via infected blood or body fluids. Methods of transmission of the virus include unprotected coitus, especially anal coitus; occupational needle stick or body fluid splash, which has an estimated transmission rate of less than 0.3%; sharing of needles in drug abuse; and receiving contaminated blood products.
Opportunistic infections occur in individuals whose CD4 count is less than 200 cells/mm3 and those not taking preventative drugs.
Symptoms of AIDS include:
* cough and shortness of breath
* difficult or painful swallowing
* confusion and forgetfulness
* severe and persistent diarrhea
* fever
* vision loss
* nausea, abdominal cramps, and vomiting
* weight loss and extreme fatigue
* severe headaches with neck stiffness
Diagnosis
In the early stages of infection, HIV often causes no symptoms and the infection can be diagnosed only by testing a person’s blood. Two tests are available to diagnose HIV infection, one that looks for the presence of antibodies produced by the body in response to HIV and the other that looks for the virus itself. Antibodies are proteins produced by the body whenever a disease threatens it. When the body is infected with HIV, it produces antibodies specific to HIV. The first test, called ELISA (enzyme-linked immunosorbent assay), looks for such antibodies in the blood.
A positive ELISA has to be confirmed by another test called western blot or immunofluorescent assay (IFA). All positive tests by ELISA are not accurate and hence, western blot and repeated tests are necessary to confirm a person’s HIV status. A person infected with HIV is termed HIV positive.
Rapid tests that give results in five to 30 minutes are increasingly being used worldwide. The accuracy of rapid tests is stated to be as good as that of ELISA. Though rapid tests are more expensive, researchers have found them to be more cost effective in terms of the number of people covered and the time the tests take.
The HIV antibodies generally do not reach detectable levels in the blood until about three months after infection. This period, from the time of infection until the blood is tested positive for antibodies, is called the window period. Sometimes, the antibodies might take up to six months to be detected. Even if the tests are negative, during the window period the amount of virus is very high in an infected person. If a person is newly infected, therefore, the risk of transmission is higher.
Another test for HIV is called polymerase chain reaction (PCR), which looks for HIV itself in the blood. This test, which recognizes the presence of the virus’ genetic material in the blood, can detect the virus within a few days of infection. There are also tests like radio immune precipitation assay (RIPA), a confirmatory blood test that may be used when antibody levels are difficult to detect or when western blot test results are uncertain. These tests are available free of cost in our valley at SKIMS, SMHS, FPI Branch Srinagar and at some other places.
Treatment
Since the early 1990s, several drugs to fight both the HIV infection and its associated infections and cancers have become available, including:
The antiretroviral drugs do not cure people of the HIV infection or AIDS. They stop viral replication and delay the development of AIDS. However, they may also have side effects that can be severe. These include decrease of red or white blood cells, inflammation of the pancreas, and painful nerve damage. Other complications are enlarged or fatty liver, which may result in liver failure and death.
Recovery and rehabilitation
As there is no cure for AIDS, the focus is on maintaining optimum health, activity, and quality of life rather than on complete recovery.
Occupational therapy can have a crucial role in assisting people living with HIV/AIDS to reengage with life, particularly through vocational rehabilitation programs. Occupational therapy can provide the patient with a series of learning experiences that will enable the individual to make appropriate vocational choices.
Clinical trials
There are many ongoing clinical trials for AIDS. “HIV Vaccine Designed for HIV Infected Adults Taking Anti-HIV Drugs,” “When to Start Anti-HIV Drugs in Patients with Opportunistic Infections,” and “Outcomes of Anti-HIV Therapy during Early HIV Infection” is some trials that are currently recruiting patients at various institutes. Updated information on these and other trials for the study and treatment of AIDS can be found at these Institutes.
(The author is consultant sexual medicine)
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