Health Talk

HIV/AIDS is an immune deficiency arising from HIV (Human Immunodeficiency Virus)  infection. When infected, HIV starts destroying immune cells until the body’s immune capability is so severely depleted that it can no longer protect the body. This stage is known as AIDS (Acquired Immune Deficiency Syndrome). Other infections known as opportunistic infections are able to attack the host and cause death. These potentially deadly opportunistic infections can be as mild as the seasonal flu (influenza) or more severe infections like TB (tuberculosis) or meningitis.

How does HIV/AIDS occur?

Pathophysiology of HIV Infection

HIV is a virus, which is a non-living protein shell containing nucleic acid (map for producing other proteins). The virus is transmitted by the blood (transfusions, sharing needles in IV drug users), semen (sexual intercourse) and breast milk (to the infant during breastfeeding). Once the virus enters a host, it travels in the blood stream and enters a specific type of immune cell known as the CD4 T-lymphocyte. The viral nucleic acid then ‘hijacks’ the immune cells protein manufacturing capability causing the immune cell to produce multiple copies of the virus. Thousands of new virus are produced within the immune cells and they exit the cell and enter the blood stream. The immune cell is destroyed once the virus exits.

Over months and years, this process is constantly repeated until the virus population is so high that the body’s immune cells cannot overcome the ‘invasion’. Gradually the CD4 T-cells are destroyed and any new CD4 immune cells are ‘met’ by a massive invading population of HIV within the blood. Ultimately the immune cells stand no chance of surviving the onslaught.

With the immune system severely weakened (immunocompromised or immune deficient) , other virus, bacteria, fungi and protozoa can invade the body with little resistance. These infections can continue affecting the body, destroying health body cells and secreting their toxins into the system unabated until the system cannot cope with the infection and death ensues.

What Causes HIV/AIDS?

Causes of HIV/AIDS

HIV infection is a result of the Human Immunodeficiency Virus entering the body, replicating and spreading within the system. AIDS is the stage at which the host is considered too severely immunocompromised (immune deficient) and at significant risk of death due to opportunistic infection. Being HIV positive (infected with HIV) does not mean you have AIDS as yet. Similarly, there is no exact time scale as to when you will reach the stage that can be considered as AIDS. In famine stricken countries, HIV infection progresses to AIDS in less than 2 years, sometimes within a year. In person living with HIV, leading a healthy life, exercising and eating appropriately, the onset of AIDS can be delayed by years, if not decades.

How is HIV/AIDS detected?

Tests for HIV/AIDS

HIV infection can be detected in two ways :

1. ELISA blood test which detects the presence of HIV antibodies in the blood. These antibodies are produced by the immune system to mobilize the immune cells. Usually these antibodies can be detected within 6 weeks to 3 months after infection, depending on the quality of the testing and related procedure.
2. Western Blot blood test is used to detect the HIV proteins in the blood and should be conducted to confirm a positive ELISA. Due to cost factors, certain health care facilities may not always opt to conduct a western blot test.
3. Rapid response tests are an on-site testing procedure utilizing just a few drops of blood (finger prick) to provide a result within 10 to 20 minutes. Rapid response finger prick blood tests are a convenient testing method for mobile clinics and low cost testing facilities and are fairly accurate.

How will you know if you are HIV positive?

Signs & Symptoms of HIV

HIV infection can be asymptomatic for years and initial signs and symptoms may be associated with other diseases and opportunistic infections. Therefore there is no definitive way of identifying HIV infection without considering a blood test. However some signs and symptoms exhibited by many HIV positive patients include :

• Weight loss
• Fatigue (severe tiredness)
• Recurrent mouth sores and fungal infections of the mouth
• Repeated bouts of the flu with a year (gastric flu,  seasonal flu and common colds)
• Swollen lymph nodes
• Fevers and night sweats
• Skin eruptions and rashes, especially widespread skin fungal infections.

These signs and symptoms are vague and may be associated with many diseases. Always consult with your doctor if you suspect HIV infection to ensure that proper blood tests are conducted to confirm diagnosis. If you have any of these signs and symptoms and a history of the risk factors below, HIV testing should be undertaken.

Risk Factors associated with HIV Infection

• Multiple sexual partners
• Unprotected sex (even once)
• A history of sexually transmitted disease(s)
• IV drug use
• Blood transfusions
• Consuming breast milk from an HIV positive woman

How is HIV/AIDS monitored?

Monitoring HIV Infection

If HIV positive, regular visits to your doctor is important in preventing any serious opportunistic infections or complications. The key is to identifying these conditions at an early stage and taking appropriate action. Your doctor will conduct a physical examination and blood tests to monitor the progression of the infection.

• CD4 count is an assessment of your immune status. This is usually measured by the number of cells per mm³ (millimeter cubed). In a healthy person who is not immunocompromised, the CD4 count varies between 1,000 and 1,500 cells/mm³.
• A CD4 T-cell count below 200 cells/mm³ is considered to be AIDS.
• AIDS may be diagnosed even with a  CD4 T-cell count higher than 200 cells/mm³ if there are any opportunistic infections or conditions considered to be AIDS defining illnesses.
• ART (antiretroviral therapy) is usually commenced at a level of 350 cells/mm³
• Viral load is a measure of the virus nucleic acid in the blood and measured by the copies per mL. It is an indication of the viral population within the host.
• Both CD4 count and viral load should be considered to monitor the progression of the HIV infection or AIDS and the response to ART.

Is HIV/AIDS Curable?

HIV Vaccine & Treatment

HIV/AIDS is not curable. However it can be effectively treated and appropriately managed to increase the lifespan and improve the quality of life compared to untreated cases. While HIV positive, healthy living and regular medical attention will ensure that your CD4 count is within acceptable levels. Any spikes in viral load can also be detected at an early stage and the necessary measures taken to prevent large drops in the CD4 T-cell count. Anti-retroviral therapy (ART) is the only known treatment for HIV/AIDS and appropriate ARV’s will be used at different stages of the condition.

Herbal concoctions and ‘natural immune boosters’ should be avoided as this may increase viral load or hamper the effect of ARV’s. In severe cases, a cocktail of ARV’s (HAART or highly aggressive anti-retroviral therapy) may be necessary to reduce the viral load. Chronic antibiotics or antifungals may be necessary in cases of low CD4 counts where life threatening bacterial or fungal infections are present. These are continued until the CD4 rises to a suitable level to control the infection.

Efforts are underway globally to develop an HIV vaccine in order to prevent new infections. HIV/AIDS awareness and education programs have proven to be ineffective in curbing the spread of the virus in HIV/AIDS hotspots like South Africa. However it is unlikely that any HIV vaccine will emerge for human use before 2012.

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