Wanita secara Alami Lebih Lemah terhadap HIV

Tempat Bersembunyi Virus Penyebab AIDS-HIV telah Diketahui

Communication Facts: Special Populations: Pediatric HIV/AIDS – 2008 Edition

Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). This virus is passed from one person to another through blood-to-blood and sexual contact. Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. Most of the individuals with HIV infection will develop AIDS as a result. As HIV attacks the central nervous system, individuals who are HIV-positive frequently experience speech, language, and hearing difficulties (1).

General Demographics

As of 2005, there were 984,155 cases of AIDS in the United States that have been reported to the Centers for Disease Control and Prevention. Of these, 9,112 were children under age 13 (2).

Of the AIDS cases reported as of 2005, 39% were among Whites, 40% were among Blacks or African Americans, 16% were among Hispanics or Latinos, and fewer than 1% were among Asian and/or Pacific Islanders, American Indians, and Alaska Natives (2).

Etiology of Pediatric HIV/AIDS

Studies have indicated that 70% of HIV-infected women are sexually active and 25%-30% of HIV-infected women receiving medical care in North America express desires to have children (3).

The advent of potent antiretroviral therapy coupled with advances in the understanding and treating of HIV infection has improved the life expectancy of women with HIV infection. Similarily, the use of antiretroviral drugs during pregnancy has resulted in a dramatic reduction in mother-to-child transmission of HIV (3).

Almost all HIV-infected children acquire the virus from their mothers before or during birth, a process called perinatal transmission (4).

Considerable progress has been made in understanding the natural course of HIV infection in children. Infected children differ from infected adults in several ways: rapid disease progression, higher viral loads, and recurrent invasive bacterial infections are among the characteristics (5).

Regardless of how HIV is acquired, earlier age of onset typically causes more severe results. These consequences may affect cognitive, behavioral, and motor development (6).

Communication Manifestations of Pediatric HIV/AIDS

Oral lesions are common in women and children with HIV/AIDS and may decrease the overall quality of life in these patients because of pain, dry mouth, and difficulty in eating. Oral lesions such as candidiasis, oral hairy leukoplakia, herpetic ulcers, and Kaposi’s sarcoma are often among the first symptoms of HIV infection (7).

Since HIV crosses the blood-brain barrier and impacts all aspects of an infected person’s life, speech-language and hearing professionals need to be members of the interdisciplinary teams that assess and manage patients living with HIV (8).

Hearing

The otolaryngological literature is replete with reports of AIDS/HIV-related infections and disorders, including otitis media, conductive and sensorineural hearing loss, recurrent bacterial infections and cholesteatoma (9-12).

The effects of a hearing loss of any kind can have far-reaching consequences on communication in the pediatric AIDS population (13).

There has been a higher reported incidence of nasopharyngeal polyps and subcutaneous cysts in patients with HIV. Nasopharyngeal masses can occlude the Eustachain tube and block ventilation which can contribute to the development of chronic otitis media (9).

Speech/Language/Voice

Among the communication problems observed in those infected with HIV are speech, language, cognition and swallowing (14).

Children with HIV have critical speech and language issues because the virus manifests itself primarily in the developing central nervous system, sometimes causing speech, motor control, and language disabilities (12).

Elective mutism, hysterical aphonia, and pragmatic language disorders or delay appear to be unique manifestations in children with HIV (9).

Language deficits are a major characteristic of neurobehavioral dysfunction in pediatric HIV disease. Impairments that develop during the second year of life seem especially severe. A decline in language skills may coincide with or precede other losses in cognitive ability (12).

Thorough and regular assessment of the linguistic functioning of long term survivors of pediatric HIV disease is essential if optimal speech and language therapy management strategies are to be devised (15).

References

No author. (1999, August). AIDS patients often have hearing and speech problems. AIDS Alert, 14 (8): suppl 1-2.

Centers for Disease Control and Prevention. (2007, June 28). Basic statistics. .

Aaron, E.Z. & Criniti, S.M. (2007, August-September). Preconception health care for HIV-infected women. Topics in HIV Medicine, 15 (4):137-41.

Oxtoby, M.J. (1991). Perinatally acquired HIV infection. In P.A. Pizzo and C.M. Wilfert (Eds.), Pediatric AIDS: The challenge of HIV infection in infants, children, and adolescents (pp.3-21). Baltimore: Williams and Wilkins.

Saloojee, H. & Violari, A. (2001, September 22). HIV infection in children. British Medical Journal, 323: 670-674.

Armstrong, F.D., Sejdel, J.F., & Swaks, T.P. (1993). Pediatric HIV infection: A neuropsychological and educational challenge. Journal of Learning Disabilities, 26 (2): 92-103.

Gennaro, S., Naidoo, S. & Berthold, P. (2008, January-February). Oral health & HIV/AIDS. The American Journal of Maternal Child Nursing, 33 (1):50-7.

McNeilly, L.G. (2005, July-August). HIV and communication. Journal of Communication Disorders, 38 (4):303-10.

Zuniga, J. (1999, April). Communication disorders and HIV disease. Journal of the International Association of Physicians in AIDS Care, 5 (4): 16-23.

Scott, G.S. & Layton, T.L. (1997, July). Epidemiologic principles in studies of infectious disease outcomes: Pediatric HIV as a model. Journal of Communication Disorders, 30:303-322.

Layton, T.L., & Davis-McFarland, E. (2000). Pediatric human immunodeficiency virus and acquired immunodeficiency syndrome: An overview. Seminars in Speech and Language, 21 (1): 7-17.

Retzlaff, C. (1999, December). Speech and language pathology and pediatric HIV. Journal of the International Association of Physicians in AIDS Care, 5 (12): 60-62.

Scott, G.S., & Layton, T. (2000). Human immunodeficiency virus (HIV) infection in children. In T. Layton, E. Crais, & L. Watson (Eds.), Handbook of Early Language Impairments in Children: Nature (pp.317-353). Albany: Delmar Publishers.

Mathew, M. & Bhat, J. (2007, November). Voice disorders in HIV-infected individuals: a preliminary study. International Journal of STD & AIDS, 18 (11):732-5.

Hodson, A., Mok, J., & Dean, E. (2001). Speech and language functioning in paediatric HIV disease. International Journal of Language and Communication Disorders, 36 (suppl.): 173-178.

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Mothers receiving HAART less likely to transmit HIV virus to their newborns through breastfeeding

Risk of postnatal transmission can be reduced with HAART in HIV-positive mothers

WHO issues new HIV/AIDS treatment guidelines

Penderita HIV di Indonesia meningkat semakin pesat. Bahkan ditengarai di Indonesia termasuk dengan laju pertumbuhan penderita kasus HIV AIDS yang tercepat di Asia. Dalam setahun diperkirakan terjadi 1 juta kasus baru HIV di Indonesia. Tragisnya 92% di antaranya adalah usia produktif termasuk anak dan remaja. Sampai bulan September 2009 DEPKES telah melaporkan jumlah penderita AIDS pada anak dibawah 15 tahun telah mencapai 464 anak.
Penderita HIV/AIDS pada bayi dan anak kian meningkat pesat. Bertambahnya prevalensi ini diduga mudahnya jalur penularan: selama kehamilan, persalinan atau selama menyusui. Odha yang tidak mendapat terapi ARV berisiko 15 – 45 persen anaknya tertular. Angka tersebut bisa ditekan dengan penggunaan ARV selama kehamilan, metode persalinan operasi sectio cesarean dan pemberian makanan pengganti ASI pada bayi baru lahir. Sementara diketahui bahwa risiko penularan HIV lewat ASI mencapai 5 – 20 persen.

HIV dan AIDS
Infeksi HIV (Human Immunodeficiency Virus) adalah infeksi virus yang secara progresif menghancurkan sel-sel darah putih dan menyebabkan AIDS (Acquired Immunodeficiency Syndrome). AIDS adalah penyakit fatal yang merupakan stadium lanjut dari infeksi HIV. Infeksi oleh HIV biasanya berakibat pada kerusakan sistem kekebalan tubuh secara progresif, menyebabkan terjadinya infeksi oportunistik di berbagai bagian tubuh tertentu.
Jalur penularan yang relatif mudah tidak sebanding dengan pengobatannya. Pada awal kelahiran, diagnosa HIV sangat sulit ditegakkan lantaran si bayi terpapar dengan antibodi dari ibu hingga berusia 18 bulan. “HIV pada anak muncul dengan gejala dan tanda yang sangat bervariasi. Kebanyakan si anak mengalami malnutrisi, dan imunosupresi berat
Gejala umum yang sering terjadi pada anak adalah diare berkepanjangan, sering mengalami infeksi atau demam lama, tumbuh jamur di mulut, badan semakin kurus dan berat badan terus turun. Serta gangguan sistem dan fungsi organ tubuh lainnya yang berlangsung kronis atau lama. Secara primer HIV dan AIDS terjadi pada dewasa muda, tapi jumlah anak-anak dan remaja yang terkena semakin bertambah jumlahnya.

Mengancam anak di seluruh dunia termasuk Indonesia
Infeksi HIV dan AIDS pertama kali dilaporkan di Amerika pada tahun 1981 pada orang dewasa homoseksual, sedangkan pada anak tahun 1983. Enam tahun kemudian (1989), AIDS sudah merupakan penyakit yang mengancam kesehatan anak di Amerika. Di seluruh dunia, AIDS menyebabkan kematian pada lebih dari 8,000 orang setiap hari saat ini, yang berarti 1 orang setiap 10 detik. Karena itu infeksi HIV dianggap sebagai penyebab kematian tertinggi akibat satu jenis agen infeksius.
Sejak dimulainya epidemi HIV, AIDS telah mematikan lebih dari 25 juta orang; lebih dari 14 juta anak kehilangan salah satu atau kedua orang tuanya akibat AIDS. Setiap tahun diperkirakan 3 juta orang meninggal karena AIDS; 500,000 diantaranya adalah anak di bawah umur 15 tahun. Setiap tahun pula terjadi infeksi baru pada 5 juta orang terutama di negara terbelakang dan berkembang; 700,000 diantaranya terjadi pada anak-anak. Dengan angka transmisi sebesar ini maka dari 37.8 juta orang pengidap infeksi HIV/AIDS pada tahun 2005, terdapat 2.1 juta anak-anak di bawah 15 tahun.

AIDS pada anak pertama kali dilaporkan pada tahun 1983 di Amerika Serikat. Sejak itu laporan jumlah AIDS pada anak di Amerika makin lama makin meningkat. Kasus infeksi HIV terbanyak pada orang dewasa maupun anak-anak tertinggi di dunia adalah di Afrika terutama negara-negara Afrika Sub-Sahara.
Di Asia Tenggara Thailand yang pertama kali melaporkan AIDS pada anak tahun 1988. Meskipun saat ini tingkat prevalens HIV masih tergolong rendah di Asia Tenggara, tetapi pertumbuhan prevalensnya saat ini paling tinggi sedunia. Penyebabnya adalah jumlah populasi yang besar, kemiskinan, ketidaksetaraan gender, dan stigmatisasi sosial. Negara dengan tingkat infeksi tertinggi adalah India, Thailand, Myanmar dan Indonesia. Umumnya infeksi di Asia Tenggara disebarkan melalui hubungan seksual heteroseksual yang tidak aman. Pemakaian jarum suntik tidak steril pada pencandu narkoba suntik menambah cepatnya penyebaran infeksi HIV. Sekitar setengah dari pengguna narkoba suntik di Nepal, Myanmar, Thailand, Indonesia dan Distrik Manipur dan Nagaland di India sudah terinfeksi HIV.
Kasus AIDS di Indonesia setiap tahunnya terus menunjukkan kecenderungan meningkat. Menurut laporan yang dikeluarkan Depkes hingga bula September 2009 jumlahnya mencapai 18442 kasus, 73,2 persen di antaranya dialami laki-laki dan 26,8% perempuan. Dalam waktu yang sama tersebut juga dilaporkan sudah 464 anak Indonesia berusia di bawah 15 tahun yang positif terinfeksi AIDS. Sebagian besar terinfeksi karena lahir dari ibu yang positif HIV. Hal inipun mungkin jumlahnya akan lebih besar lagi karena semua kasus belum tentu dilaporkan.
Kumulatif Kasus AIDS Menurut Golongan Umur
Golongan Umur AIDS AIDS/IDU
<1 170 0
1 – 4 194 0
5 – 14 107 7
15 – 19 551 128
20 – 29 9142 4806
30 – 39 5503 2032
40 – 49 1606 262
49 – 59 455 45
>60 94 8
Tak Diketahui 620 210

Penyebab dan penularan pada anak
Penularan infeksi HIV dari Ibu ke Anak merupakan penyebab utama infeksi HIV pada anak usia di bawah 15 tahun. Sejak HIV menjadi pandemic di dunia, diperkirakan 5,1 juta anak di dunia terinfeksi HIV. Hampir sebagian besar penderita tersebut tertular melalui penularan dari ibu ke anak.
Wanita sering tertular infeksi HIV melalui hubungan heterosexual dengan pasangan yang terinfeksi atau melalui penggunaan obat-obatan, Meningkatnya infeksi HIV pada anak adalah karena akibat penularan selama perinatal (periode kehamilan, selama dan setelah persalinan). Lebih dari 90% AIDS pada anak yang dilaporkan tahun 1994 terjadi karena transmisi dari ibu hamil ke anak.. Penularan terhadap bayi bisa terjadi selama kehamilan, persalinan atau postnatal melalui ASI. Angka kejadian penularan dari ibu ke anak diperkirakan sekitar 20% – 30%. Resiko penularan di negara berkembang sekitar 21% – 43%, lebih tinggi dibandingkan resiko penularan di negara maju sekitar 14%-26%. Penularan dapat tejadi saat kehamilan, intrapartum, dan pasca persalinan. Resiko infeksi penularan terbanyak terjadi saat persalinan sebesar 18%, di dalam kandungan 6% dan pasca persalinan sebesar 4%.
Penularan di dalam kandungan didiagnosis jika pemeriksaan virologis negatif dalam 48 jam pertama setelah kelahiran, selanjutnya tes minggu pertama menjadi positif dan bayi tidak menyusui Ibu. Selama persalinan bayi dapat tertular darah atau cairan vagina yang mengandung HIV melalui paparan virus yang tertelan pada jalan lahir. Pada ibu yang terinfeksi HIV, ditemukan virus pada cairan vagina 21%, cairan aspirasi lambung pada bayi yang dilahirkan. Besarnya paparan pada jalan lahir sangat dipengaruhi dengan adanya kadar HIV pada cairan vagina ibu, cara persalinan, ulkus serviks atau vagina, perlukaan dinding vagina, infeksi cairan ketuban, ketuban pecah dini, persalinan prematur, penggunaan elektrode pada kepala janin, penggunaan vakum atau forsep, episiotomi dan rendahnya kadar CD4 pada ibu.
Penularan HIV melalui ASI diketahui merupakan faktor penting penularan paska persalinan dan meningkatkan resiko tranmisi dua kali lipat. ASI diketahui banyak mengandung HIV dalam jumlah cukup banyak. Konsentrasi sel yang terinfeksi HIV pada ibu yang menderita HIV adalah 1 per 104 sel, partikel virus ini dapat ditemukan pada componen sel dan non sel ASI. Berbagai faktor yang dapat mempengaruhi resiko tranmisi HIV melalui ASI antara lain mastitis atau luka di puting, luka di mulut bayi, prematuritas dan fungsi kekebalan tubuh bayi. Penelitian yang telah dilakukan menyebutkan resiko tranmissi HIV melalui ASI diperkirakan adalah 3,2 per 100 anak pertahun. Keadaan penyakit ibu juga menjadi pertimbangan karena Ibu yang terinfeksi HIV mempunyai resiko kematian yang lebih tinggi dari yang tidak menyusui. WHO, Unicef dan UNAIDS mengeluarkan rekomendasi untuk menghindari Air Susu Ibu yang terkena HIV jika alternatif susu lainnya tersedia dan aman.
Pencegahan
Cara paling efisien dan efektif untuk menanggulangi infeksi HIV pada anak secara universal adalah dengan mengurangi penularan dari ibu ke anaknya (mother-to-child transmission (MTCT). Upaya pencegahan transmisi HIV pada anak menurut WHO dilakukan melalui 4 strategi, yaitu mencegah penularan HIV pada wanita usia subur, mencegah kehamilan yang tidak direncanakan pada wanita HIV, mencegah penularan HIV dari ibu HIV hamil ke anak yang akan dilahirkannya dan memberikan dukungan, layanan dan perawatan berkesinambungan bagi pengidap HIV. Pemberian obat Anti Retroviral (ARV) untuk anak dan bayi yang terinfeksi karenanya menjadi satu jalan untuk menanggulangi pandemi HIV pada anak di samping upaya untuk mencegah penularan infeksi HIV pada anak dan bayi.
Orangtua atau ibu dari bayi yang terpapar HIV harus menyadari masalah yang dihadapi anaknya sejak awal. Penentuan diagnosis HIV yang akan dihadapi penderita sangat berpengaruh pada orang tua dan keluarga. Ibu penderita harus diberikan informasi yang jelas tentang seringnya evaluasi pemeriksaan, kesulitan diagnosis awal infeksi HIV pada bayi, manfaat pemeriksaan untuk menentukan status infeksi bayi. Pemberian ARV dalam mengurangi resiko penularan, modifikasi dalam rekomendasi imunisasi, rekomendasi untuk tidak memberi ASI dan kewaspadaan untuk mencegah penyebaran penyakit. Sangatlah penting sebagai pencegahan.
Peningkatan kasus HIV memungkinkan terjadi peningkatan keterlibatan dokter khususnya dokter spesialis kandungan dan dokter anak dan tenaga medis lainnya dalam perawatan bayi yang terpapar HIV. Masyarakat khususnya yang beresiko terinfeksi HIV hendaknya juga turut aktif dalam pencegahan penularan HIV pada bayi yang akan dilahirkan. Skrening atau pemeriksan awal HIV pada Ibu hamil yang beresiko harus sudah menjadi tindakan rutin. Resiko dan potensi pada anak untuk terinfeksi HIV semakin meningkat pesat.
Untuk mencegah dalam kondisi yang lebih mangkawatirkan, maka pencegahan harus terus dilakukan. Momentum hari AIDS sedunia tanggal 1 Desember hendaknya jangan hanya dijadikan sekedar slogan. Mulai saat ini semua lapisan masyarakat tanpa terkecuali harus sadar bahwa ancaman AIDS sangat besar untuk generasi penerus bangsa ini. Kepedulian kita semua adalah dengan mengurangi kehidupan seks bebas, menghindari narkoba dan perilaku negatif lainnya adalah tindakan yang harus dikampanyekan terus menerus. Jangan sampai dosa dan perbuatan buruk orang tua menjadi beban kehidupan anak Indonesia di kemudian hari.

Dr Widodo Judarwanto SpA
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US health officials are considering whether to promote routine circumcision for all baby boys born in the country as a way to reduce the spread of HIV; a topic that is giving rise to considerable debate in anticipation of the Centers for Disease Control and Prevention’s official draft recommendations on the subject that are due out at the end of the year.

The New York Times reported online yesterday, in an article that will appear in today’s print edition, that experts are also considering whether circumcision should also be offered to adult heterosexual men whose sexual behaviour puts them at higher risk of infection.

The reasons behind the consideration stem from several studies in support of male circumcision as a way to reduce HIV spread.

Trials in Africa, where there are several countries with severe AIDS and HIV epidemics, have shown that male circumcision reduced HIV infection risk by 50 per cent in heterosexual men who were at high risk of infection from women with HIV.

And earlier this year, an Australian study suggested that the inner foreskin has the largest concentration of Langerhans’ cells, which are the initial cellular targets in the sexual transmission of HIV. The researchers suggested that removing the skin surface which is most susceptible to the virus would reduce the risk of contracting HIV.

However, there is also a strong opinion that large scale male circumcision will not make a big difference in the US where the group at highest risk is men who have sex with men, and there is no evidence that circumcision prevents the spread of HIV among this group.

Another reason that the measure might have less impact in the US is because health officials there suggest that nearly 80 per cent of adult American males are already circumcised, although this is likely to go down in the future because there is less routine circumcision of newborns nowadays, reports the New York Times.

Another argument that is being put against the idea of promoting male circumcision in newborn boys is that it subjects them to a medical procedure of questionable health value without their permission.

However, the CDC HIV/AIDS Division’s chief epidemiologist, Dr Peter Kilmarx said every potential step that could prevent the spread of HIV should be seriously considered. He said there is a significant HIV epidemic in the US and every opportunity to add another “tool in the toolbox” should be examined.

“What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks,” he told the New York Times.

However, he did acknowledge that the situation in Africa was different to the US and the effect of male circumcision was likely to be less dramatic both because the disease was not so prevalent in the US and because the routes of infections were also different. Another consideration was the difference in health care infrastructures.

Circumcision will be a discussion topic at the CDC’s National HIV Prevention Conference which takes place this week in Atlanta and is expected to be attended by thousands of HIV health professionals.

Intact America, a group that is against the idea of routine circumcision for newborns is holding a protest in the city to coincide with the conference.

They will be arguing that the facts show that circumcision only reduces the risk of HIV infection, it does not eliminate it, and circumcised men still have to wear condoms.

source : sciencedaily.com

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email : judarwanto@gmail.com

curriculum vitae

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U.S. health officials “are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of HIV,” the New York Times reports. The topic will be discussed this week at the CDC’s National HIV Prevention Conference in Atlanta. “Experts are also considering whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection,” according to the Times. Experts acknowledge that routine circumcision “would be unlikely to have a drastic impact” as it did in African countries because “the procedure does not seem to protect those at greatest risk here, men who have sex with men.” In addition, most U.S. adult males are already circumcised, the article states. “Critics say [circumcision] subjects baby boys to medically unnecessary surgery without their consent,” the Times reports.

Peter Kilmarx, chief of epidemiology for the CDC’s division of HIV/AIDs prevention, said, “We have a significant HIV epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic.” CDC is expected to release a formal draft of the proposed recommendations by the end of the year

source : sciencedaily.com

Supported by

FIGHT AGAINST  AIDS, SAVE  INDONESIAN CHILDREN

YUDHASMARA FOUNDATION

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE :62 (021) 70081995 – 5703646

Email : judarwanto@gmail.com

http://childrenhivaids.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com,

Copyright © 2009,  FIGHT AGAINST  AIDS, SAVE  INDONESIAN CHILDREN  Information Education Network. All rights reserved.

Basics

Human immunodeficiency virus (HIV) suppresses the immune system’s ability to fight infection and disease. HIV was first identified in the early 1980s when doctors and public health officials began to notice clusters of previously unusual infections. The virus targets white blood cells in the immune system known as helper T cells (or CD4 cells), thus impairing the body’s ability to fight infections. People infected with the HIV virus will gradually develop lower levels of CD4 cells and higher levels of HIV virus in their blood. CD4 cell levels are an important marker of HIV disease severity. The introduction and use of drug regimens to combat HIV infection has meant that many HIV-infected people with access to these drugs have a much-increased life expectancy than ever before.

HIV infection progresses through these stages: viral transmission, primary infection, seroconversion, clinical latent period with or without persistent generalized lymphadenopathy, early symptomatic disease, AIDS and advanced HIV infection.

• Viral transmission. This involves the introduction of the HIV virus from an already-infected person to someone who was not previously infected.
• Primary infection. This is the stage in which HIV first enters the body and begins reproducing itself. Primary infection may be accompanied by the sudden onset of flulike symptoms such as fever, joint pain, swollen lymph nodes, sore throat, mouth sores, nausea, diarrhea, and headache. Some people experience no symptoms at all. Symptoms generally occur two to four weeks after viral transmission occurs.
• Seroconversion. Seroconversion means that the virus will show up on blood tests. Most people exposed to HIV will seroconvert within four to 10 weeks, although it can take up to 6 months for some people.
• Asymptomatic disease. During this stage, which typically lasts from two to 10 years, HIV becomes established in the body, but does not cause symptoms. The number of CD4 cells in the blood begins a gradual decline, starting from around 1,000 cells per milliliter (mL) of blood to around 500 cells per mL.
• Symptomatic disease. When the CD4 count drops to between 200 and 500 cells per mL, patients may develop symptoms such as swollen glands, fatigue, unexplained weight loss, and fever. Infections that rarely occur in people with healthy immune systems also begin to appear.
• AIDS. AIDS isn’t a single disease, but rather a group of symptoms or illnesses that occur together. AIDS has been defined by the U.S. Centers for Disease Control and Prevention (CDC) as occurring in a person who: 

   

  • Has a laboratory-documented HIV infection
  • Has a CD4 count less than 200 cells per mL of blood
  • Has had one or more infections or types of cancer that do not occur regularly in the general population.These infections include Candida (a yeast infection) of the esophagus or lungs, disseminated tuberculosis, PCP pneumonia, several bouts of bacterial pneumonia, and extrapulmonary coccidiomycosis and histoplasmosis. The types of cancer include invasive cervical cancer, Kaposi’s sarcoma, and certain types of lymphoma. People without HIV develop cervical cancer and lymphoma, but anyone known to be infected with HIV who then develops one of these conditions is considered to have AIDS.

   

   

• Advanced AIDS. Anyone who has AIDS with a CD4 count less than 50 cells per mL has advanced AIDS. Survival at this stage is generally only 12 -18 months in people not taking medications to treat AIDS.

While the majority of people who contract HIV will ultimately develop AIDS, the time between initial HIV infection and the development of AIDS varies widely. Historically, most HIV-positive people develop AIDS within 10 to 11 years after infection; however, some people have lived with HIV for 15 years or more without symptoms. There currently is no cure for AIDS, though scientists are trying to develop a vaccine to prevent its spread. Highly active antiretroviral therapy (HAART), available in the developed world since 1996, has greatly prolonged the life expectancy of people living with AIDS who have access to this treatment.

Causes

HIV is spread primarily via contact with bodily fluids such as blood, semen, and vaginal secretions. HIV can also be spread from an infected mother to her fetus and via transplantation of infected organs. HIV cannot survive outside of the body for very long, and can only be transmitted through contact in which bodily fluids are exchanged. The primary means of HIV sexual transmission is through vaginal or anal intercourse, but HIV can also be transmitted through oral sex. HIV does not appear to be transmitted through kissing.

In the early years of the epidemic before effective tests for the virus were available, many people contracted HIV through blood transfusions, or from using blood-clotting factors, such as Factor VIII, used in hemophilia. Today, the risk of getting HIV from the blood supply is very small, particularly in the developed world in which donated blood undergoes rigorous testing. Blood-borne transmission of HIV occurs most commonly among people who share intravenous needles when using illicit drugs. HIV can spread via organ transplant, but rigorous testing of organ donors and the organ supply has greatly reduced the likelihood of this occurrence.

HIV can be passed from a mother to her child during pregnancy or childbirth, and after birth through breast milk. Viral transmission to the child may occur in the uterus. The risk of transmission is enhanced if there is a prolonged period of time between the rupture of a mother’s membranes and the time of delivery. In addition, breast milk contains relatively high levels of HIV, and transmission of the virus from mother to child through breast-feeding has been well-documented. This route of transmission is especially problematic in developing countries where HIV-infected mothers may not have access to affordable, sterile, nutritious infant formula.

There are no documented cases in which HIV was transmitted through ordinary social contact. HIV transmission is not known to have occurred through touching, kissing, hugging, shaking hands, sharing food, being bitten by an insect, sitting on an infected toilet seat, or working or playing with an infected person.

Symptoms

During primary HIV infection you may have no symptoms, or may experience a short, flulike illness [Table 1]. Symptoms of a primary HIV infection, if present, include sore throat, fever, nausea and vomiting, diarrhea, fatigue, swollen glands, muscle aches, headaches, and joint pain. Occasionally, the virus causes meningitis (inflammation of the lining of the nerves and brain) or encephalitis (inflammation of the brain). The symptoms of the initial infection clear up without treatment within a few weeks, and there may be no additional symptoms for 10 years or more.

After the primary infection, infected persons will enter an asymptomatic phase. During the asymptomatic phase of HIV infection, the virus becomes established in the body, and a person’s CD4 count will decrease. An infected person at this stage will not, however, experience any symptoms for several years.

When HIV symptoms recur, many different parts of the body may be affected. The most common persistent symptom of HIV infection is often enlarged or sore glands (lymph nodes) in the neck, armpit, and groin. Other symptoms include fatigue, chills, fever, night sweats, skin rash, persistent headache, unexplained weight loss lasting at least one month, diarrhea for several weeks or more, a persistent dry cough, a white coating on the tongue (thrush), [Figure 1] or persistent vaginal yeast infections.

Figure 1. Oral Thrush

A white coating on the tongue (oral thrush) is a common sign of HIV infection.

In its late stages (AIDS), HIV infection may spread to the central nervous system, causing dementia and other neurological disorders. In some people infected with HIV, the virus causes a cluster of symptoms known as AIDS dementia complex, or HIV encephalopathy. Symptoms of this complex include impaired ability to concentrate, increased forgetfulness, difficulty reading, or increased difficulty performing complex tasks. In addition, the complex may also include behavioral changes such as apathy, and motor difficulties such as unsteady gait, poor balance, and tremors. Late stages may also be characterized by bowel or bladder incontinence.

Multiple infections and cancer may develop as the immune system weakens [Table 2]. In addition, people with HIV may develop Kaposi’s sarcoma [Figure 2], a rare cancer of the blood vessels that manifests as bluish-red nodules on the surface of the skin.

Figure 2. AIDS-related Kaposi’s Sarcoma.

Kaposi’s sarcoma (shown) is a rare cancer of the blood vessels that is associated with HIV. It manifests as bluish-red oval-shaped patches that may eventually become thickened. Lesions may appear singly or in clusters. Men who have sex with men (MSM) and contract HIV are far more likely to get Kaposi’s sarcoma than other people infected with HIV.

Risk Factors

Engaging in unsafe sexual practices increases your risk of contracting HIV. Unsafe sexual practices include having sex with an HIV-infected person without using latex condoms, having multiple sex partners, and having sex with someone in a high-risk group. High-risk groups include men who have sex with men (MSM), people of either sex who have multiple sex partners, and intravenous drug users.

Sharing needles for intravenous drug use increases your risk of contracting HIV. HIV is more common among intravenous drug users than among the general population. Sharing needles or intravenous drugs puts you at serious risk of exposure to and infection with HIV. Sharing needles also increases the risk of transmitting other blood-borne pathogens such as hepatitis B and hepatitis C.

Needlesticks from an HIV-positive source constitute a risk for healthcare workers and others whose jobs bring them in contact with blood or other bodily fluids: 3 in 1,000 needlesticks from an HIV-positive source will result in HIV infection.

The HIV virus can be transmitted through the blood supply and through blood treatments, such as Factor VIII, that are derived from pooled blood products. In the early stage of the HIV epidemic, a number of people became infected with the virus through blood transfusions, and nearly 90% of boys and men with hemophilia A contracted the virus. Blood clotting factors, such as Factor VIII, are now made via recombinant genetic technology, and no longer rely on blood products from donors, eliminating the risk of HIV spread. In the developed world, the blood supply is checked thoroughly and the risk of HIV transmission in incredibly small.

An infected mother can spread HIV to her developing fetus. Taking HIV medication to prevent transmission of the virus during pregnancy, delivery and after birth has greatly diminished the risk of spreading the infection in this manner. An infected mother can also pass along the virus in her breast milk.

HIV can be spread through organ donation, from an infected donor to an uninfected recipient. Organ donors and organs now undergo extensive testing to avoid this unfortunate situation.

Diagnosis

If you are concerned that you may have been exposed to HIV, a simple blood test can determine if you have been infected. The standard HIV blood test is designed to detect antibodies to the HIV virus in your blood. At least 95% of people will develop antibodies to HIV within six months of infection. A test performed too soon after infection may give a false-negative result.

The most commonly used blood test is called an ELISA (enzyme-linked immunosorbent assay). The test is very sensitive, but occasionally it will give a false-positive result. Whenever an ELISA test comes back positive, a second more specific test known as a Western blot is performed to confirm the results. Both ELISA and Western blot tests require that you give blood during a first visit, and then return to get the results from your doctor one to two weeks later.

Rapid screening tests have also been developed that provide results in 15 to 30 minutes, and require only a single office visit. A drawback to rapid testing, however, is that positive results will not be confirmed with a Western blot. Consequently, the rate of false positives is higher for rapid screening tests than for standard (ELISA plus Western blot) testing.

Home collection kits for HIV testing are also available. There are many different tests available; however, only the Home Access Express HIV-1 Test System (a product of the Home Access Health Corporation) has been approved by the FDA. To perform this test, a person pricks a finger and blots the blood onto a piece of paper. The sample is then mailed to a lab, and the results are provided over the phone several days later. In clinical studies, this test was able to identify 100% of known positive samples, and 99.5% of HIV-1 negative samples.

If your blood test is positive, your doctor will take a medial history to help determine the health of your immune system. When you first seek treatment for HIV, your doctor will take a medical history to identify factors that may affect the progression of your disease. The medical history will help your doctor to determine the overall health of your immune system, and thus will inform important treatment decisions. The average time for untreated HIV disease to progress from infection to development of AIDS is 10 to 11 years, so if you were infected soon before your positive test, you are unlikely to develop symptoms in the near future.

You doctor will ask you questions to identify:

• Symptoms related to HIV infection

• Current medications you are taking and any allergies to medications

• Past history of tuberculosis, hepatitis, or sexually transmitted diseases

• Previous treatment with antiretroviral drugs

• Previous immunizations

• History of substance abuse

Your doctor will perform a comprehensive physical examination. The most common symptoms of HIV infection your doctor will look for include weight loss, a white coating on your tongue that indicates a yeast infection (candidiasis or thrush), and signs of other infections that wouldn’t normally occur in people with healthy immune systems.

Your doctor will order additional blood tests to determine the health of your immune system and estimate the stage of your HIV infection. One test is designed to determine the number of CD4 cells in the blood, and the second is a test for HIV viral load. These tests help to stage the infection, determine when to begin or change antiretroviral therapy, and to monitor how well a particular drug or drug combination is working. The lower the viral load, the lower the risk of disease progression.

Both CD4 counts and viral load testing will generally be done every three to four months after diagnosis to monitor the progression of the disease.

Prevention and Screening

The risk of contracting HIV can be reduced through sexual abstinence or by engaging in safer sexual practices. HIV is most commonly transmitted through exchange of bodily fluids during intercourse or other types of sexual behaviors. Abstinence is the only way to completely eliminate the risk of contracting HIV through sexual encounters. Engaging in safer sexual practices, however, is a more realistic way for people to reduce their risk of contracting HIV.

Latex and polyurethane condoms provide an impenetrable barrier to HIV, and when used with every sexual encounter, provide effective prevention against infection. Condoms should only be used before their expiration date, and when no obvious signs of defects or damage are visible.

The U.S. government’s Centers for Disease Control and Prevention recommend the following:

• Use a new condom with each act of intercourse.
• Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
• Put the condom on after the penis is erect and before any genital contact with your partner.
• Ensure that no air is trapped in the tip of the condom.
• Ensure adequate lubrication during intercourse, possibly requiring use of lubricants such as KY Jelly or glycerine. Never use oil-based lubricant such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
• Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.

Having a monogamous sexual relationship with an uninfected partner can dramatically reduce your risk of contracting HIV. The primary risk in these cases, however, is that one or both of the partners may not be completely truthful about having sex outside the relationship with people who could be infected with HIV.

Partners considering a monogamous relationship can be tested to confirm their HIV status, but they should remember that the HIV antibody test may miss infections that occurred six months or less before the test was performed.

Avoiding high-risk sexual practices such as anal intercourse can reduce the risk of HIV transmission. Unprotected anal intercourse is considered to carry the highest sexual risk of HIV transmission. Microscopic cuts or abrasions that occur in both partners during anal intercourse allow the virus to get directly into the bloodstream. Unprotected vaginal intercourse is also considered to carry a relatively high risk of HIV transmission.

Use safer-sex precautions if you engage in oral sex. While it was commonly thought that unprotected oral sex posed a lower risk for HIV transmission than did unprotected vaginal or anal intercourse, a recent study of 122 people with a primary HIV infection revealed that 6% of that group had been infected through oral sex. This study refutes the previous notion of unprotected oral sex as “safe,” and underscores the importance of consistently engaging in safer sex practices.

Intravenous drug users can reduce their risk of contracting HIV by not reusing or sharing needles. Half of all new HIV infections in the U.S. are estimated to occur among people who inject illegal drugs. Because many of these infections could be prevented if drug users did not use contaminated needles or syringes, needle exchange programs have been set up in more than 80 cities in 38 states in the U.S. The details vary, but the programs generally distribute clean needles and syringes, safely dispose of used ones, and offer referrals for drug treatment and counseling.

The risk of passing HIV from a mother to her child during pregnancy or birth can be reduced through drug treatment [Table 3]. In 1994, a pivotal clinical trial demonstrated that a three-part drug regimen of zidovudine (AZT) could reduce the risk of HIV transmission from the mother to her child by 70%.

Since 1994, however, several new drugs have been developed. Current treatment recommendations for adults and adolescents include using combination therapy, which has proved to be more effective than AZT alone. While this new combination therapy would be most effective for treating a pregnant woman, its effectiveness for preventing transmission to the child remain unclear. Taking these factors into account, The U.S. Public Health Service Task Force currently recommends that physicians offering combination therapy as an option to HIV-infected pregnant women fully inform them of its potential benefits and risks. The Task Force further recommends that pregnant women consider delaying therapy until 10 to 12 weeks into pregnancy, because early pregnancy is the period in which the fetus is most susceptible to drug-induced birth defects.

Adapted from the U.S. Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States, Feb. 25, 2000.

Using formula rather than breast milk can reduce the risk that an infant will contract HIV from breast milk. HIV can be passed from a mother to her child through breast milk. As many as 40% of pediatric HIV infections in developing countries are thought to be caused by breast milk, the risk increasing the longer the child is breastfed. In the U.S. and other industrialized countries, national health authorities recommend that HIV-positive women not breastfeed their infants to reduce the risk of virus transmission.

AZT treatment directly after a known exposure may stop HIV infection from developing. Healthcare workers exposed to HIV-contaminated blood through needlesticks have long been treated with AZT to prevent an HIV infection from becoming established. This treatment is known as postexposure prophylaxis, or PEP.  Most forms involve using one or more drugs within 72 hours of a possible exposure, continuing for a period of 4 weeks.

Preliminary evidence shows that PEP is also effective after sexual or drug-related exposure to HIV. In a recent San Francisco study, 400 participants were given PEP after known HIV exposures. None of those treated had developed an HIV infection after 6 months.

Treatment

HIV treatment has been revolutionized since 1996 with the development of protease inhibitors, a type of highly active antiretroviral therapy (HAART). Prior to 1996, only AZT was available, and it only slightly prolonged life. Since the newer types of medication that effectively fight the virus for many years have become available, life expectancy for people with HIV has soared. The newer drugs are taken in combination to best fight the virus. Newer versions of the drugs may require only 1 or 2 combination pills/day. People taking HAART require frequent monitoring and blood draws, and must do their best to take their medication as prescribed without missing a single dose. Most doctors start patients with HIV infection on HAART when their CD4 is about 300-350 cells per mL; this approach does vary, however. Choosing the best combination pill (s) for you is complex and should be individualized. If you have HIV, you should talk to your doctor about available options. People with HIV who develop opportunistic infections require proper treatment. It is important for you to discuss any unusual symptoms that might require care with your doctor.

Urgent Care

In severe cases late in the course of the disease, people living with HIV may need urgent care for respiratory failure or severe neurological complications. Urgent care is most commonly required in the later stages of HIV disease when the immune system becomes so weakened that infections are difficult to keep under control. Acute respiratory failure accounts for between 50% and 75% of HIV-related intensive care admissions, and often involves the use of mechanical respirators. A patient experiencing respiratory failure may go to the emergency room initially, but in many cases will end up in an intensive care unit for a prolonged period of time.

Late-stage HIV infection can cause deterioration in neurological function, and may result in lethargy, coma, seizures, and respiratory failure. Many patients who are admitted for neurological symptoms require mechanical ventilation; many die from profound coma.

Self Care

Good nutrition is critical for people living with HIV. Chronic infection with HIV increases a person’s metabolism, requiring a high intake of calories just to maintain existing weight. At the same time, many people living with the virus lose their appetite, or experience illnesses that can cause diarrhea or reduce the ability of the intestines to absorb nutrients. Most physicians recommend high-protein, low-fat, nutrient-rich diets with fresh fruits, vegetables, and whole grains. Small, frequent, regular meals are easier to digest than less frequent, larger meals.

Physical exercise can improve the health of people living with HIV. Several studies suggest that exercise may improve the health of the immune system by raising CD4 counts and reducing the number of opportunistic infections. If you have symptomatic HIV disease or are recovering from an HIV-related illness, check with your physician before starting a new exercise program.

Drug Therapy

Your doctor is the best source of information on the drug treatment choices available to you.

Other Therapies

Maintaining good mental health is important for people living with HIV. Depression, anxiety, and stress are common among HIV-positive people. Signs of depression occur in an estimated 20% to 40% of people living with the virus, which is of particular concern because people who are depressed often stop taking their medication.

If you are experiencing signs of depression (e.g., fatigue, loss of appetite, loss of interest in your work or leisure activities), your doctor or counselor may be able to help. In addition, depressed people should not take efavirenz, as it has been associated with a risk of suicide.

Treatment for substance abuse can improve the health of people living with HIV. Putting an end to alcohol, cocaine, heroin, and other drug abuse can both improve overall health and strengthen the immune system. If you smoke cigarettes, quitting can improve stamina, restore lung function over time, and reduce the risk of certain infections associated with HIV. Quitting can also reduce the risk of smoking-related illnesses such as emphysema and lung cancer.

If you are diagnosed with HIV, talk to your doctor about the vaccinations you should receive to help prevent infectious diseases. Current recommendations include vaccination against pnuemonia, hepatitis B, and yearly flu shot. If your CD4 count drops below 200 cells per mL, your doctor will prescribe medication that can help prevent opportunistic infections. Subsequently, if your CD4 count falls below 100, your doctor will prescribe additional drugs to help prevent infections for which you are susceptible. Intravenous drug users who simultaneously take HIV medication have a risk of adverse drug interactions that can put them at risk for suicide. Therefore, substance abuse treatment is especially important for HIV-positive individuals.

Alternative Medicine

Acupuncture, herbal remedies, spiritual approaches, homeopathy, and non-FDA-approved drugs are sometimes used by people with HIV. Because HIV infection is a disease for which conventional medicine has no cure, many people with the virus seek out alternative treatments. Although some remarkable examples of success have been reported, few alternative therapies have been studied in rigorously controlled clinical trials.

Special Circumstances

Children with HIV have special needs. The fundamental goals of HIV treatment are the same for children as for adults, but the treatment plan must be customized for each child’s developmental stage and immune status.

The rate at which children metabolize drugs changes as they grow and their organs mature. Therefore, a physician must closely monitor how the metabolism of the drugs changes in the child over time, and modify therapy accordingly.

Children, and especially infants, have less developed immune systems than do adults, putting them at a greater risk for rapid disease development. In addition, blood tests that measure the progression of the disease are not very accurate for infants. Despite the adverse events and unknown long-term effects, however, early aggressive therapy is recommended for infants.

Infants cannot swallow the pills that are sometimes the only available form for a given HIV medication. Very young children also have problems taking their drugs, as the drugs often taste unpleasant, or must be taken in pill form. Therefore, doctors must be vigilant when treating children with HIV.

Older adults are often an invisible at-risk population for HIV infection. More than 10% of new AIDS cases in the U.S. each year occur in people over the age of 50; however, few screening or prevention programs are targeted to older adults. As a result, most older adults infected with the virus are first diagnosed at later stages of the disease.

It is important for people over the age of 50 to continue to protect themselves from HIV infection. Even though pregnancy is no longer a concern after menopause, condom use is important because it can reduce the risk of contracting the virus or other sexually transmitted diseases.

Prognosis

Most people infected with HIV will go on to develop AIDS, but new drug treatments can slow the progression. An estimated 95% to 100% of people infected with HIV will go on to develop AIDS, but the time from infection to late-stage disease varies widely. Before the availability of effective treatments, a person with HIV had a 1% to 2% chance of developing AIDS within the first few years of infection, increasing by 5% each year thereafter. By 10 to 11 years postinfection, most people with HIV had already developed AIDS. The availability of effective drugs and drug combinations may improve this outlook.

Prevention of and treatment for infections has increased the lifespan of people with AIDS. In the early stages of the epidemic, most people died within two years of developing AIDS. Most often they died because of resulting infections, and not because of the virus itself. Aggressive prevention, treatment, and suppression of infections has improved both the quality and quantity of life of people living with AIDS. Today, HIV infection is a chronic disease, and although not curable, is treatable.

Ongoing research may lead to effective vaccines and more effective treatments. Scientific research has already had a dramatic impact on the lives of people living with HIV. For example, since the introduction of protease inhibitors (one type of HAART) in 1996, the number of deaths and AIDS-related hospitalizations has declined significantly. In 1997 alone, 44% fewer people with AIDS died than in 1996. Ongoing research into the molecular biology of HIV infection holds the promise of more effective treatments and the potential for effective vaccines to either prevent or treat HIV infection.

Follow-up

During the asymptomatic phase of HIV, your physician will want to see you several times a year to monitor the progression of your disease. Every 3 to 4 months, your physician will want to perform a physical exam and laboratory tests to monitor the progression of your disease. Follow-up will be more frequent when starting or changing drug therapies. Laboratory testing will generally include CD4 counts and HIV RNA viral load testing, as well as standard blood tests to determine the health of your liver, kidneys, and other organs.

During symptomatic HIV disease, follow-up will depend on your particular symptoms, infections, and stage of disease

source : pdrhealth.com

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