HIV/AIDS*The information on this website is not intended to diagnose, treat, cure or prevent any disease.
What is HIV/AIDS?
Acquired immunodeficiency syndrome (AIDS) is condition caused by the human immunodeficiency virus (HIV). It is primarily a sexually-transmitted disease, however direct blood-to-blood contact can also transmit the HIV virus, as happens through sharing of needles among IV drug users. The condition can result in severe impairment of the immune-system, making the infected individual susceptible to broad array of infectious conditions which are normally not considered life-threatening or severe.
HIV/AIDS is a relatively recent disease; it is only believed to have arisen in people sometime during the last 60 to 70 years. The first cases originated in sub-Saharan Africa, where the virus is believed to have mutated from the simian immunodeficiency virus (SIV) and infected people who slaughtered and consumed chimpanzees and mangabeys for food. It is possible that local, self-limiting infections have occurred for much longer than the disease has been recognized, but due to the development travel and development of sub-Saharan Africa, the disease was able to spread globally and become a pandemic.
Although the disease is now a pandemic (a global disease), sub-Saharan Africa is the most severely affected by the disease. Over 36 million people are infected, with the majority of those in Africa. The disease causes approximately 1 million deaths a year, and has killed approximately 35 million people around the world since its recognition in the early part of the 1980s.
In developed nations, the disease continues to spread, however better access to healthcare and anti-viral medications has limited its impact on society. It continues to carry a psychological stigma, however, and discrimination against those who are infected continues to this day.
The symptoms of HIV infection can be subtle, initially. The first signs are usually a vague, ranging from asymptomatic to a flu-like illness lasting from 7 to 14 days. Symptoms during early infection may include:
- Swollen/painful lymph nodes
- Sore throat
- Sores on mucocutaneous junctions (mouth and genitals)
- Muscle weakness
It is not uncommon for HIV to go undiagnosed during the early stages, unless a history of high-risk behaviors flags an astute clinician to screen for the disease. Usually following the early infection, the disease goes dormant from anywhere between 3 and 20 years. When the dormant or latent period ends, new symptoms arise again with vague signs including:
- Weight loss
- Chronic gastrointestinal issues
- Widespread lymph node enlargement which persists for months
The final stages of the disease, if undetected and uncontrolled, may progress to AIDS. Once AIDS is reached, a type of white blood cell called CD4+ T cells decrease dramatically. These cells are important for normal immune function, and their absence predisposes people to many “opportunistic” infections, including a type of pneumonia caused by a fungus called Pneumocystis, infections of the esophagus with the yeast Candida, and frequent respiratory infections. People with AIDS are also likely to develop a particular type of cancer called Kaposi’s sarcoma, but are also at increased risk of other cancers as well including lymphoma. These cancers are all associated with viral infections. People with uncontrolled AIDS also experience progressive weight loss, continued GI signs, fevers, and some develop neurologic or psychiatric disorders.
The diagnosis of HIV infection is made through screening or the virus based on symptomatology or a history of high-risk behavior (especially IV drug use) or a significant time spent in sub-Saharan Africa combined with an active sexual history. Diagnosis can be made in two different ways:
- Serology: testing for antibodies which develop between 1 to 3 months following infection
- PCR: Testing for viral proteins. This can be done before the development of antibodies.
Home test kits now exist which are available over the counter. This has made the test much more accessible and easier for people to test themselves in the privacy of their own homes. Although the test kits are sensitive, a positive home test kit should be followed up with an additional test through a medical clinic to confirm the diagnosis.
A positive test for HIV warrants additional testing to help stage the disease and determine what the best therapeutic options are. There are different variants of the HIV virus with differing susceptibilities to anti-viral drugs. Additional tests after a confirmatory diagnosis include:
- CD4+ T Cell Count: These cells are targeted by the virus. The disease is not considered to have progressed to AIDS until these cells drop below a specific threshold.
- Virus Typing: This test can determine which strain of HIV you are infected with and what drugs should be used to treat it.
- Viral Load: This test determines the burden of virus in your blood. Higher viral loads are predictive of a worse prognosis.
- Opportunistic Infectious Disease Testing: These tests will help determined if you have other diseases which become of greater concern in people with HIV/AIDS
- Tuberculosis: Skin testing and chest x-rays may be considered
- Other sexually transmitted diseases
- Hepatitis Virus Infection
- Urinary Tract Infections
There is no known cure for HIV/AIDS, however there are people who are genetically resistant to the disease and may never require medications. Typically, the virus is treated with combinations of anti-viral drugs which can effectively suppress it for years. In the developed world where people have access to healthcare and medication, HIV is often no longer a life-limiting disease.
Pharmaceuticals and Medical Procedures:
- Integrase Inhibitors: These drugs block the ability of HIV to hijack CD4+ T Cells.
- Protease Inhibitors: HIV uses an enzyme called protease in order to replicate. These drugs block the function of these key proteins to keep viral loads low and minimize ongoing infection of cells in the body.
- Reverse Transcriptase Inhibitors: Reverse transcriptase is another enzyme which is essential for HIV to replicate inside host cells. There are two categories of reverse transcriptase inhibitors:
- Non-nucleoside: These block the enzyme itself
- Nucleoside: These block the ultimate function of the enzyme by serving as decoy building blocks which are incorporated into the viral genome during replication. This results in a non-functional virus or causes the replication process to abort.
- Fusion Inhibitors: These drugs block the entry of the virus into CD4+ T cells.
- Antimicrobial Medications: These may be needed to help combat the secondary infections which occur in HIV/AIDS.
- Antifungal medications: Opportunistic yeast infections are a major issue for people who have progressed to AIDS.
- Dietary Modifications: Healthy, well-balanced diets are important for overall health in HIV/AIDS. It is important to adhere to recommend daily allowances of certain micronutrients like zinc. Over-supplementation of zinc can have negative consequences during HIV infection. Incorporating whey protein in the diet can also help maintain body weight and muscle mass in HIV patients.
- Mind-Body Therapies: HIV/AIDS can carry a large psychological burden on those infected. Daily practice of activities designed to promote psychological well-being and promote relaxation are important. These practices include:
- Acupuncture: Another great way to relieve pain and reduce stress and anxiety.
- Massage: This can help relieve neurologic pain that sometimes is present in HIV infections.
- Hypnosis: This can be especially helpful for people who may have substance abuse disorders and are trying to halt their dependence.
- Yoga: Meditative exercise that promotes wellness, muscle strength, and relaxation.
- Tai Chi: This is gentle exercise that is similar to yoga in that it can be very meditative.
- Medical Marijuana: This can help increase appetite and may be a way to maintain or gain body weight.
- Biofield Therapies: These involve manipulation of energy fields around the body to promote healing and wellness.
- Electromagnetic Therapy: Electrical or magnetic fields can be applied to the body to help promote a healthy immune system and healing of tissues.
- Aroma Therapy: This can help promote a sense of calmness, relaxation, and wellness.
- Mold Binders: Products like cholestyramine and apple pectin can help remove toxic mold from the body. Mold exposure may further suppress the immune system, drive inflammation, and make HIV/AIDS harder to control. Time these supplements to not coincide with prescription medications, as they may decrease absorption.
- Stem Cells: Stem cells may one day be used to generate completely new white blood cells for people with HIV. If the infected cells can be completely eradicated and then replaced, this may be a path to a cure in some people.
- Fish Oil: Fish oil is great for minimizing inflammation in the body, lower cholesterol, and promoting general wellness.
- Selenium: There is some evidence to suggest that selenium may be helpful in slowing progression of HIV.
- Milk Thistle: This is a liver-supportive supplement. Many people with HIV are at increased risk of liver damage due to infections.
- Acetyl-L-Carnitine: This amino acid appears to be helpful in reduce neurologic pain
- Supplements to avoid or use with caution: These are supplements which are known to interact with anti-retroviral medications used in the treatment of HIV/AIDS. If you are currently taking prescription medications, you should consult with your doctor before beginning these medications:
- St. John’s Wort
- Vitamin A
- African Potato
As terrible a disease as HIV can be, it is fortunately a preventable disease in most cases. The most common routes of infection are sexual transmission and transmission through IV drug use. It goes without saying that IV drug use should be avoided. For those who have addiction issues, seek out needle exchange programs which are increasingly available. These provide clean, sterile needles and will safely dispose of used needles. These have been one of the most effective approaches to limiting the spread of HIV in developed countries.
For casual sexual encounters, condoms should be employed. It is important to note that sexual transmission can occur through anal or vaginal penetration; both homosexual and heterosexual transmission is entirely possible. If you are uncertain of your partner’s sexual history, or if you solicit the services of sex-industry workers, condoms should always be used.
For pregnant mothers, anti-retroviral drugs have made it possible to give birth to a child who does not become infected with the disease. It is no longer a guaranteed outcome that HIV will be transmitted.
For those who are infected with HIV, regular check-ups with a doctor are extremely important to monitor viral loads and CD4+ T cell counts. Being diligent about taking medications may mean that you will never experience progression to AIDS, and may be able to live a normal or near-normal life. Being responsible about your condition is important as well. Although there can be a stigma about the condition, avoid putting others at risk by communicating with sexual partners prior to intercourse.
Continue to promote your own wellness by eating a healthy diet and exercising regularly. This will promote general wellness and help you continue to combat the other challenges to your immune system.
AIDS is a specific progression of HIV infection. The HIV virus is a “retrovirus” which means that it is made from RNA and has an atypical replication strategy. The nature of retroviruses makes them highly susceptible to mutation, and therefore very adept at becoming resistant to drugs very quickly. The virus initiates its infection by replicating inside CD4+ T cells, a specific type of white blood cell. Over time, these cells die or become so dysfunctional they are unable to contribute to the immune response. In the absence of these cells, the immune system is unable to function appropriately, and normally benign organisms which live all around us can easily infect the body. Unusual cancers, which are also typically sensed and eliminated by the immune system, also begin to arise.
Opportunistic infections and certain cancers are hallmark features of AIDS. Fungal infections of the esophagus and respiratory tract (candidiasis and pneumocystis) are frequently implicated in people who have progressed to AIDS. Toxoplasmosis (a protozoal infection which infects many people but is generally latent and dose not cause overt disease) can become a devastating infection for people with AIDS. It can affect many different systems in the body and be difficult to eliminate without the aid of a functioning immune system. Tuberculosis is another bacterium which can easily become a persistent infection unable to be cleared.
Over time, most people who progress to AIDS eventually succumb to either these opportunistic infections or some type of cancer. Frequently, lymphoma is the eventual cause of death in AIDS.
For those who have well-managed HIV, AIDS may never be an issue. Continuing to take anti-retroviral medications as prescribed will typically keep the immune system healthy and functioning. People on anti-retroviral drugs frequently have undetectable viral loads and may not even be capable of transmitting the virus.
Clinics for Management of HIV/AIDS