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In General:
HIV / Aids is the abbreviation used for the human immunodeficiency virus. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease.
HIV / Aids attacks the body's immune system. Normally, the immune system produces white blood cells and antibodies that attack viruses and bacteria. The infection-fighting cells are called T-cell lymphocytes. Months to years after a person is infected with HIV, the virus destroys the T-cell lymphocytes.
When the T-cell lymphocytes are destroyed, the immune system can no longer defend the body against diseases and tumors. Various infections called opportunistic infections develop that take advantage of the body's weakened immune system. These infections would not normally cause severe or fatal health problems. However, when you have AIDS, the opportunistic infections eventually cause death because your body can no longer defend itself against them. AIDS is the condition of the body being overwhelmed by opportunistic infections and/or tumors.
Leading Causes/Other Factors:
The AIDS virus is NOT spread through the air, in food, or by casual social contact such as shaking hands or hugging. It is passed on only when the blood or body fluids of an infected person mix with someone else's body fluids. This mixing can occur during activities such as unprotected sexual activity, sharing IV needles, birth to an HIV-infected mother, and blood transfusions.
The following groups have the highest risk for HIV infection and possible development of AIDS: homosexual
men with more than one sexual partner, bisexual men and their partners, intravenous drug users and their sexual partners, people who share needles (for IV drug use, tattooing, or piercing), heterosexuals with more than one sexual partner. People who were given transfusions of blood or blood products, especially people given emergency transfusions of unscreened blood and people given transfusions in countries where the blood is not rigorously screened are also at high risk. Immigrants from areas with many cases of AIDS (such as Haiti and east central Africa), people who have sex with anyone in the above groups, people who have sex with an HIV-infected partner, and infants born to mothers who are HIV infected may also develop HIV and AIDS.
Symptoms:
The symptoms of HIV infection and AIDS are usually the symptoms of the diseases that attack the body because of a weakened immune system. These include fever that lasts from a few days to longer than a month with no other disease present and no other obvious cause, prolonged periods of chills and sweats, and chronic or long-lasting fatigue for which other causes have been ruled out. Loss of appetite or weight, especially loss of more than 10% of body weight, with no other disease or condition present, chronic muscle and joint pain for no known reason, unexplained, long-lasting sore throat, and unexplained, prolonged swelling of the lymph nodes may also be symptoms. Diarrhea, especially if it lasts longer than a month and no other disease is present, repeated, severe yeast infections in your mouth or vagina despite proper treatment, and a certain kind of sores or changes in the skin (herpes) that last more than 4 weeks are also symptoms of HIV.
The opportunistic diseases that most frequently affect someone with AIDS include Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), tuberculosis, meningitis, and herpes simplex infections.
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Over the Counter Choices:
There are no over the counter products recommended for the treatment of HIV infection. There are products that can be used to treat some of the symptoms of HIV infection and to manage some of the side effects of HIV drug therapy. There are also products available for nutrition, safe sex, skin care, hair loss, wasting syndrome - maintaining body mass and building muscle, immune system enhancement, liver cleansing, nausea & vomiting, constipation, sexual performance, wound healing, diabetes and lipodystrophy.
Prescription Choices:
The standard for therapy in treatment of HIV disease is now combination therapy that targets 2 different enzymes. Treatments that consist of 2 to 4 drugs have halted viral replication, preserved immune function, and decreased the likelihood of developing drug-resistant mutations. Evaluation of viral load is the accepted method for judging the effectiveness of drug therapy. The drugs used in the treatment of HIV disease are nucleoside analog reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors.
There are many other prescription medications available for the treatment of AIDS related infections. These medications fall into many different classes like antivirals, antineoplastics, antifungals, immune modulators, antibacterials, appetite stimulants, antimicrobials, and antiprotozoals. These medications are often taken with the other medications to treat HIV disease.
Other Treatments:
The ELISA test is the first blood test done to see if you are infected with HIV. If this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the results.
Once you have confirmed positive HIV test results, you must have a thorough medical exam. Your health care professional will ask about your medical history and symptoms, if any, and will examine you.
The complete medical history and physical exam includes discussing your history of sexual practices and sexually transmitted diseases and any history of drug abuse.
The results of your physical and lab exams give your health care provider a baseline for comparison if you develop symptoms later. It is also necessary to screen for certain infections, such as tuberculosis (TB), syphilis, and hepatitis B, which may worsen rapidly or pose a serious risk to others. HIV-positive women should have a Pap smear according to the schedule recommended by their health care professional (usually every 6 to 12 months).
Your treatment will include lab tests that will determine how well your immune system is working, measure the amount of HIV present in your blood, and to screen for infections or other medical problems. Prescription medications may include antiviral treatment, such as with the drugs zidovudine (also called ZDV or AZT), didanosine
(ddI), lamivudine (3TC), and protease inhibitors. You should also schedule regular dental exams because people who are HIV positive have a high rate of mouth abnormalities, including gum disease. Preventive treatment for such diseases such as Pneumocystis carinii pneumonia (PCP), Tuberculosis, Toxoplasmosis (avoid raw meat and cat litter boxes), Tetanus, hepatitis B,
pneumococcus, flu, and treatments for opportunistic infections and tumors as they develop must also be addressed.
The CD4 lymphocyte cell count is an important lab test. CD4 cells are a type of white blood cell. They are the best indicator of how well the immune system of an HIV-positive person is functioning. If the first CD4 cell count is greater than 600 per microliter of blood, the test should be repeated every 6 months. When the count begins to decrease, more frequent counts will be necessary.
Another test, the viral load test, measures the amount of HIV in your blood. Levels above 10,000 viral copies per milliliter of blood are considered high and usually require prompt treatment.
Vision problems are often an early indicator of opportunistic infection in HIV-positive individuals. Tell your health care professional promptly about any eye symptoms, especially persistent blurry vision or partial loss of vision.
Getting care in an office or clinic that uses the case management concept of care is perhaps the most important aspect of your treatment. This approach emphasizes team care coordinated by a case manager. The case manager helps you communicate with all professionals who are providing your care. Other advantages include up-to-date medical care will be available to you, treatment of both medical and social aspects of your illness will be brought together, and you will have help in locating resources (medical, social, financial).
The full effects of AIDS may not appear until 5 to 10 years after you are first infected with the virus. Although AIDS is a fatal disease, life expectancy has increased as new treatments continue to be developed.
To take care of your self, you should ask any new sexual partner about his or her sexual history. Homosexual and bisexual men should be careful to practice safe sex, use condoms, and seek HIV testing.
If you are in a high-risk group but have not tested positively for HIV, see your health care professional regularly. He or she will examine you for signs of HIV-associated infections and may recommend testing your blood regularly to screen for HIV infection.
If you are HIV positive discuss your treatment with your health care professional. See your health care professional on a regular schedule to keep up to date on new treatments available, and call or see your health care professional when you have new or persistent symptoms or whenever you notice a change in body function that concerns you.
If you are HIV positive, you should practice safe sex, avoid sharing sexual secretions and blood in any way, ask sexual partners to be tested for the presence of HIV, and tell your health care professionals that you are HIV positive.
In addition: do not share needles for drug use, tattooing, or body piercing, try to avoid becoming pregnant, and do not donate blood, plasma, semen, or body parts.
Research continues to increase knowledge of the human immunodeficiency virus. As a result, recommended treatments for infection with the virus change often. Keeping up with these changes can be difficult and frustrating. Two ways you can seek up-to-date information and care are by obtaining health care from a case management model facility and following the recommended appointment schedule and by contacting the national or state AIDS Hotline with specific questions or to find other resources.
For more information on risk factors or HIV testing, contact your health care professional or the National AIDS Hotline at 1-800-342-AIDS (24 hours, 7 days a week). Hotline numbers are also available for Spanish-speaking persons at 1-800-344-7432 (8 a.m. to 2 a.m., EST, 7 days a week), and for the hearing impaired at TDD 1-800-243-7889 (10 a.m. to 10 p.m., EST, Monday through Friday). These hotlines are provided by the Centers for Disease Control and Prevention.
Developed by Phyllis G. Cooper, R.N., M.N., and Clinical Reference Systems.
Copyright 1999 Clinical Reference Systems.
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