HIV AND AIDS NOTES

Human Immunodeficiency Virus (HIV)

HIV stands for human immunodeficiency virus. If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).
Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life. No safe and effective cure for HIV currently exists, but scientists are working hard to find one, and remain hopeful.
HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, if left untreated, HIV can destroy so many of these cells that the body can’t fight off infections and disease. However, with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy or ART. It involves taking a combination of HIV medicines (called an HIV regimen) every day. Today, a person who diagnosed with HIV before the disease is far advanced and who gets and stays on ART can live a nearly normal life span.
The only way to know for sure if you have HIV is to get tested. Testing is relatively simple. You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them, too. You can also get an FDA-approved home HIV testing kit (the Home Access HIV-1 Test System or the OraQuick In-Home HIV Test) from a drugstore.

Acquired Immunodeficiency Syndrome (AIDS)

AIDS stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection, and not everyone who has HIV advances to this stage.
AIDS is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be diagnosed with AIDS if you develop one or more opportunistic infections, regardless of your CD4 count.
Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. People with AIDS need medical treatment to prevent death.

Where Did HIV Come From?

Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Studies show that HIV may have jumped from apes to humans as far back as the late 1800s. Over decades, the virus slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid- to late 1970s.

Symptoms, Diagnosis, Prevention and Treatment

Symptoms

• Most people who have become recently infected with HIV will not have any symptoms. They may, however, have a flu-like illness within a month or two after exposure to the virus, with fever, headache, tiredness, and enlarged lymph nodes (glands of the immune system easily felt in the neck and groin). These symptoms usually disappear within a week to a month and are often mistaken for those of other viral infections. During this period, people are very infectious, and HIV is present in large quantities in blood, semen, and vaginal fluids.
• More severe HIV symptoms—such as profound and unexplained fatigue, rapid weight loss, frequent fevers, or profuse night sweats—may not appear for 10 years or more after HIV first enters the body in adults, or within two years in children born with HIV infection.

Diagnosis

• Your health-care provider can diagnose HIV by testing blood for the presence of antibodies (disease-fighting proteins) to HIV. It may take HIV antibodies as long as six months after infection to be produced in quantities large enough to show up in standard blood tests. For that reason, make sure to talk to your health-care provider about follow-up testing.

Prevention

• Because there is no cure or vaccine to prevent HIV, the only way people can prevent infection from the virus is to avoid high-risk behaviors putting them at risk of infection, such as having unprotected sex or sharing needles.
• NIAID urges everyone ages 13 to 64 to get tested for HIV as part of their routine health care. Catching HIV in its early stages can make a lifesaving difference.

Treatment

NIAID and other researchers have developed drugs to fight both HIV infection and its associated infections and cancers. In combination with early detection through HIV testing, available HIV therapies can greatly extend years and quality of life, and have resulted in a dramatic decrease in AIDS deaths in the U.S. 

Stages of HIV Infection

How Does HIV Progress In Your Body?

Without treatment, HIV advances in stages, overwhelming your immune system and getting worse over time. The three stages of HIV infection are: (1) acute HIV infection, (2) clinical latency, and (3) AIDS (acquired immunodeficiency syndrome).
However, there’s good news: by using HIV medicines (called antiretroviral therapy or ART) consistently, you can prevent HIV from progressing to AIDS. ART helps control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others.
These are the three stages of HIV infection:

Acute HIV Infection Stage

Within 2-4 weeks after HIV infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection.
During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 count to replicate and destroys them in the process. Because of this, your CD4 cells can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.
During the acute HIV infection stage, you are at high risk of transmitting HIV to your sexual or drug using partners because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission.

Clinical Latency Stage

After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)
During the clinical latency stage, the HIV virus continues to reproduce at very low levels, although it is still active. If you take ART, you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster.
People in this symptom-free stage are still able to transmit HIV to others, even if they are on ART, although ART greatly reduces the risk of transmission.
If you have HIV and you are not on ART, then eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.
Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. However, if you are taking ART and maintain a low viral load, then you may enjoy a near normal life span. You will most likely never progress to AIDS.

Factors Affecting Disease Progression

People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful diet, exercise, and not smoke.

Time Between HIV Infection and AIDS

Factors that may shorten the time between HIV and AIDS:

• Older age
• HIV subtype
• Co-infection with other viruses (like tuberculosis or hepatitis C)
• Poor nutrition
• Severe stress
• Your genetic background

Factors that may delay the time between HIV and AIDS:

• Taking antiretroviral therapy consistently
• Staying in regular HIV care
• Closely adhering to your doctor’s recommendations
• Eating healthful foods
• Taking care of yourself
• Your genetic background

By making healthy choices, you have some control over the progression of HIV infection.

Not everyone is diagnosed early. Some people are diagnosed with HIV and AIDS concurrently, meaning that they have been living with HIV for a long time and the virus has already done damage to their body by the time they find out they are infected. These individuals need to seek a healthcare provider immediately and be linked to care so that they can stay as healthy as possible, as long as possible. Use the HIV Testing and Services Locator to find an HIV provider near you.

		How long can a person live with HIV/AIDS? Jul 27, 1998 What is the longest time that someone has lived with the AIDS virus active in their body? does HIV always turn into AIDS? Is it possible for a person with AIDS or HIV to live a full long life? What is the average life span?
		Response from anonymous doctor Hi. Thank you for your question. At this time, we cannot say what is thenlongest amount of time a person can live with HIV. This is because there are some people who have been infected for many years (since the epidemic was first recognized in the early 1980s), and they are still alive today. Some of these patients have been found to have rare genetically defective strains of HIV that are not causing them any significant illness thus far. One recent study used mathematical modeling to predict that some HIV positive people (perhaps 10% or more) may live up to 25 years without getting AIDS. Because HIV has only been studied since the early 1980s, we cannot say at this time how accurate this mathematical model may be. Only time and experience will answer this question. Because treatments have improved so dramatically over the past few years, we cannot say how long the average person can now live with the disease. Since things are changing so quickly in regard to treatments, all we can say that people are living longer, but we don't yet know how long most will live. A person can potentially live for years, even with full-blown AIDS, but just how many years is highly variable from person to person. What we can say is that the vast majority of people infected with HIV will develop AIDS sometime during their life (an average of 10 years or more after infection), and with early intervention and treatment, they could potentially live with AIDS for many years more. The following are some of the many variables that can determine how long a person can live with HIV. 1) How well the person takes care of themselves medically. People who live a healthy lifestyle (diet, exercise, etc.) tend to live longer. People who have other medical problems, and/or those with a history of substance abuse, may not live as long. 2) How well the person takes care of themselves emotionally. People with a positive mental attitude tend to live longer than those with a pessimistic or negative mental attitude. 3) The virulence of the strain of HIV. Some strains of HIV may be more virulent than others. We have already found cases where a person was infected with a rare genetically defective strain of HIV, and that strain was not causing any significant illness (so far). 4) Drug resistant strains of HIV. People who have drug resistant strains of HIV may not live as long, if the drugs that are available are no longer effective. But if a person is responding well to their medications, they are expected to live longer. 5) The genetic make-up of the person. A few people have genetic mutations in their white blood cells (including mutations in the CCR-5 receptor and other receptors), that can slow down the progression of the disease. 6) Partial Immunity???? I have to put question marks after the word "immunity", since there is no definitive proof thus far that anybody has a true documented immunity to HIV. But, in persons who are living prolonged periods of time with HIV (and not developing AIDS), this possibility cannot be excluded. It is very hard to know what the longest amount of time is that one can live with HIV/AIDS. Often, it is difficult to predict exactly how long a person has been infected with the virus, since people progress from HIV to AIDS at different rates. Some people progress to AIDS very quickly, and others progress very slowly. But we do know that there are some infected individuals that can live for many years with the virus. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Prevention There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body. To help prevent the spread of HIV: Use a new condom every time you have sex. If you don't know the HIV status of your partner, use a new condom every time you have anal or vaginal sex. Women can use a female condom. Use only water-based lubricants. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a nonlubricated, cut-open condom or a dental dam — a piece of medical-grade latex. Consider the drug Truvada. Use of the combination drug emtricitabine-tenofovir (Truvada) can reduce the risk of sexually transmitted HIV infection in those who are at high risk. Truvada is also used as an HIV treatment along with other medications. When used to help prevent HIV infection, Truvada is only appropriate if your doctor is certain you don't already have an HIV infection. Your doctor should also test for hepatitis B infection. If you have hepatitis B, your doctor should test your kidney function before prescribing Truvada. Truvada must be taken daily, exactly as prescribed. Truvada should only be used along with other prevention strategies, such as condom use every time you have sex, as it doesn't protect against other sexually transmitted infections, and it can't provide complete protection against HIV transmission. If you're interested in Truvada, talk with your doctor about the potential risks and benefits of the drug. Tell your sexual partners if you have HIV. It's important to tell anyone with whom you've had sex that you're HIV-positive. Your partners need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so that they don't infect others. Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use. If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby's risk significantly. Consider male circumcision. There's evidence that male circumcision can help reduce a man's risk of acquiring HIV.