AIDS prevention is possible through awareness and adequate measures. You can treat AIDS by responding to AIDS symptoms in time. Read more at Meri Sehat.

AIDS

Humza Khizer

Overview

Acquired immune deficiency syndrome (AIDS) is a transmissible disease of the immune system. The human immunodeficiency virus (HIV) causes it. AIDS is the final stage of HIV infection and the phase where cancers and fatal infections start.

On June 5th, 1981, CDC published a report about lung infection, Pneumocystis carinii pneumonia, in five homosexuals in Los Angeles<a href="#">[1]</a>. The expert review of the cases exclaimed that the disease was acquired through sexual contact, and had an association with immune dysfunction. It was due to exposure to some factor, predisposing the affected individuals to opportunistic infections.&nbsp;

Moreover, the following year, CDC published reports of outbreaks of Kaposi&rsquo;s Sarcoma, which is rare cancer in homosexuals in New York and San Francisco. The reports also noted that the cancers had been accompanied by opportunistic infections, for example, P. carinii pneumonia in many instances. Hence, the researchers determined that the infections were manifestations of an acquired immunodeficiency syndrome.&nbsp;

&nbsp;

The researchers initially referred it to as a syndrome in homosexuals and called it gay-related immune deficiency (GRID) due to its limitation (1982). However, due to advancements in research, we now know that AIDS has also been linked to contaminated needles (often due to sharing of contaminated hypodermic needles in drug abusers), and transfusion of contaminated blood and blood products. We also know that AIDS is not limited to homosexuals, but can also be spread via heterosexual intercourse, e.g., AIDS has been observed in women with male sexual partners. In Pakistan, the most common cause of transmission of AIDS is heterosexual intercourse, contaminated blood, and blood procedures<a href="#accordion">[2]</a>. 
&nbsp;

Signs And Symptoms

The symptoms of AIDS are due to the deterioration of the immune system. Furthermore, there is a decline in the CD4+ T cells, which are the key infection fighters of the immune system. When HIV enters the body, it immediately begins to destroy these immunity-providing cells. Some of the common symptoms of AIDS include the following: 
&nbsp;

<ul>
	<li>Diarrhoea that lasts more than one week</li>
	<li>Dry cough</li>
	<li>Depression, neurological disorders, amnesia (memory loss)</li>
	<li><a href="https://merisehat.pk/disease/pneumonia">Pneumonia</a></li>
	<li>Unexplained fatigue</li>
	<li>Rapid weight loss</li>
	<li>Recurrent fever or intense night sweats</li>
	<li>Red, brown, pink, and purple blotches over the surface or under the skin, inside the mouth, nose, or eyelids</li>
	<li>The lymph glands in the armpits, groin, and neck are swollen</li>
	<li>The tongue, mouth, and throat have white spots or unusual blemishes 
	&nbsp;</li>
</ul>

<h5>Association Of Infections With AIDS</h5>

People with AIDS have a weak <a href="https://www.merisehat.pk/article/how-an-over-prescription-of-antibiotics-affects-your-immune-system?_gl=1*139oiwl*_ga*MjQ0MTYxMjc0LjE2NjE4MzYwODE.*_ga_HQNJ3DQ2N7*MTY4NTM0Nzk5MS4zMjAuMS4xNjg1MzUxNjYyLjYwLjAuMA..">immune system</a>, which makes them prone to infections. For example, opportunistic infections<a href="#accordion">[3]</a>.

The human body contains microorganisms that live in a symbiotic state. In simple words, these organisms don&rsquo;t cause opportunistic infections i.e. they aren&rsquo;t fatal in healthy individuals. However, they do cause infections in immunocompromised individuals.&nbsp;

The immune system deteriorates when the CD4+ T cells decline. These cells are the key fighters of infections. When HIV enters the body, it attacks and destroys these cells. 
&nbsp;

The symptoms of opportunistic infections that are common with AIDS include the following: 
&nbsp;

<ul>
	<li>Coma</li>
	<li>Shortness of breath and coughing</li>
	<li>Difficulty swallowing accompanied by pain</li>
	<li>Severe fatigue</li>
	<li>Fever&nbsp;</li>
	<li>Confusion and forgetfulness</li>
	<li>Nausea, vomiting, and abdominal cramps&nbsp;</li>
	<li>Lack of coordination and seizure</li>
	<li>Severe and persistent diarrhea</li>
	<li><a href="https://merisehat.pk/disease/migraines-73">Severe headaches</a></li>
	<li>Loss of vision</li>
	<li><a href="https://merisehat.pk/disease/obesity">Weight loss</a> 
	&nbsp;</li>
</ul>

Opportunistic infections that are associated with AIDS cause severe illness. However, some can be prevented.

HIV is responsible for the effect on the macrophages present in the blood. The virus was investigated in non-human primates, and transmission between African apes and humans was seen.&nbsp; 
&nbsp;

<h5>How To Differentiate Between HIV And AIDS?&nbsp;</h5>

HIV is the virus that causes AIDS. It destroys the immunity of the body to a point, where it is unable to fend off diseases on its own. The virus is a retrovirus, and its genetic material is RNA.&nbsp;&nbsp;

The steps of HIV infection are listed below:&nbsp; 
&nbsp;

<ul>
	<li>Upon infection, the virus&rsquo;s RNA enters the host cell i.e. CD4.&nbsp;</li>
	<li>Inside the cell, reverse transcription is employed to convert HIV RNA to HIV DNA.</li>
	<li>This HIV DNA is then integrated into the genome of the host, where it multiplies exponentially i.e. creating more copies of the virus.</li>
	<li>These copies cause an infection when they reach the bloodstream.</li>
	<li>The same happens in the T lymphocytes, with HIV decreasing the immunity of the body.</li>
	<li>Even minor infections do not get treated because the system is immunocompromised.</li>
	<li>Other than significant weight loss, bouts of fever and diarrhea are also observed. 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of AIDS is based on its definition by the US Centers for Disease Control and Prevention (CDC), which is as follows:&nbsp;

&nbsp;

<ul>
	<li>The CD4+ T cells are less than 200 per cubic millimeter of blood (normal levels = 1000 CD4+ T cells).&nbsp;CD4+ T cells are white blood cells and they play an important role in the immune system of the body. These cells are destroyed by HIV. However, the cells are being infected by HIV even when an individual does not feel sick or experience any symptoms of HIV.&nbsp;</li>
	<li>CD4+ T cells account for less than 14% of the lymphocytes, which is a type of white blood cell. 
	&nbsp;</li>
</ul>

<h4>Tests For HIV And AIDS</h4>

The most common method of diagnosing HIV is through blood tests. These tests look for viral antibodies that are present in those who are infected. Moreover, people who have been exposed to the virus should immediately get tested. 
&nbsp;

Early testing is very crucial for HIV. If anyone tests positive for the virus, their doctor prescribes them a treatment plan to fight against HIV, in addition to warding off the complications. Furthermore, early testing can also alert you, which can allow you to avoid spreading the virus to others, which is termed high-risk behavior.

It can take six weeks to six months for the development of antibodies against the virus. In addition, follow-up tests may be required. Your doctor will ask you about your medical history, symptoms, and risk factors. They will also perform a physical examination.

&nbsp;

<h5>Primary Tests For Diagnosis Of HIV And AIDS</h5>

<h5>&nbsp;</h5>

<h5>ELISA Test</h5>

ELISA (Enzyme-Linked Immunosorbent Assay) is used for the detection of HIV infection. If a person&rsquo;s ELISA test is positive, it is followed by a Western blot test to confirm the diagnosis. However, if your ELISA test is negative, but you think you are HIV positive, you should get yourself tested every three months because the antibodies are not produced right after infection. You may test negative during a window of some weeks to some months after being infected. Although your test may be negative in this window, the level of the virus may be high, putting you at risk of transmission.

&nbsp;

<h5>Home Tests</h5>

The saliva home test that has been approved by the US Food and Drug Administration is called Home Access Express Test and is sold in pharmacies.

&nbsp;

<h5>Saliva Test</h5>

Saliva is obtained from inside your cheek by using a cotton pad. The pad is placed in a vial and given to the lab for testing. The results are usually available after three days. Furthermore, the positive tests should be confirmed with a blood test.

&nbsp;

<h5>Viral Load Test</h5>

The Viral Load Test measures the quantity of HIV in the blood. It is generally used for monitoring the progress of treatment, and to detect HIV infections in their early stages. Three technologies are used for the measurement of HIV infection in the blood.&nbsp; 
&nbsp;

<ol>
	<li>Reverse transcription-polymerase chain reaction (RT-PCR)</li>
	<li>Branched DNA (bDNA)</li>
	<li>Nucleic acid sequence-based amplification assay (NASBA) 
	&nbsp;</li>
</ol>

Furthermore, the basic principle of these tests is the same. HIV is detected through DNA sequences that bind to the ones in the virus specifically. It is necessary to note that the results vary between the tests. 
&nbsp;

<h5>Western Blot</h5>

Western Blot confirms the positive results of ELISA and is a very sensitive blood test.

&nbsp;

Treatment

There is no definitive cure for HIV, but the treatments listed below can increase life expectancy. 
&nbsp;

<h5>Emergency HIV Drugs</h5>

If you think that you have been infected or exposed to the virus, post-exposure prophylaxis medicine can stop you from becoming infected.&nbsp;

PEP should be started within seventy-two hours of exposure for effectiveness. However, it is only recommended for high-risk exposure, particularly in positive partners. PEP involves getting HIV treatment every day, for one month. However, it can cause side effects. 
&nbsp;

<h5>Antiretroviral Drugs</h5>

Antiretroviral drugs are used for the treatment of HIV, which stop the virus from replicating in the body. It allows the immune system to repair on its own without any further damage. Moreover, a combination of drugs is used because HIV can adapt and become resistant very quickly.&nbsp;

Some of the HIV treatments are combined in a single pill, which is called a fixed-dose combination. Although, they are more costly.

Most people, who have recently been diagnosed with HIV, take between one to four pills per day.

&nbsp;

HIV medications are different for everyone and the combination varies from person to person. Hence, the medicines you take are personalized. The viral load of the blood is measured to check how well your body is responding to the treatment. Once it cannot be measured, it means it is undetectable. People taking HIV treatment usually reach an undetectable viral load within six months 
&nbsp;

Key Points

<ul>
	<li>Acquired immunodeficiency syndrome is an advanced stage of HIV infection.</li>
	<li>Human immunodeficiency virus is the virus responsible for causing AIDS.</li>
	<li>There are two main types of HIV, HIV-1 and HIV-2, and both can cause AIDS.</li>
	<li>The CD4+ T Lymphocytes count is less than 200 cubic millimeters of blood in infected individuals.</li>
	<li>Currently, there is no definitive cure. However, antiretroviral drugs are the mainstay of treatment&nbsp;and can help increase life expectancy.&nbsp;</li>
	<li>AIDS is a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned authorities immediately.&nbsp;&nbsp;</li>
</ul>

&nbsp;

[1] Centers for Disease Control and Prevention (CDC, 1996. Pneumocystis pneumonia--Los Angeles. 1981. MMWR. Morbidity and mortality weekly report, 45(34), pp.729-733.

[2] Ilyas, M., Asad, S., Ali, L., Shah, M., Badar, S., Sarwar, M.T. and Sumrin, A., 2011. A situational analysis of HIV and AIDS in Pakistan. Virology journal, 8(1), pp.1-3.

[3] National Institutes of Health, 2020. HIV and opportunistic infections, coinfections, and conditions.

[4] Tasaka, S., 2015. Pneumocystis pneumonia in human immunodeficiency virus–infected adults and adolescents: current concepts and future directions. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 9, pp.CCRPM-S23324.

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