Wednesday, 18 January 2012

HIV infection

HIV infection is a condition caused by the human immunodeficiency virus (HIV).

The condition gradually destroys the immune system, which makes it harder for

the body to fight infections.

This article provides a general overview. For more detailed information, see:

    AIDS

    Acute HIV infection

    Asymptomatic HIV infection

    Early symptomatic HIV infection


Causes, incidence, and risk factors

The human immunodeficiency virus (HIV) can be spread by the following:

    Through sexual contact -- including oral, vaginal, and anal sex

    Through blood -- through blood transfusions, accidental needlesticks, or

needle sharing

    From mother to child -- a pregnant woman can transmit the virus to her

fetus through their shared blood circulation, or a nursing mother can pass it

to her baby in her breast milk

People who become infected with HIV may have no symptoms for up to 10 years,

but they can still pass the infection to others. After being exposed to the

virus, it can take up to 3 months for the HIV ELISA blood test to change from

HIV negative to HIV positive.

HIV has spread throughout the U.S. The disease is more common in urban areas,

especially in inner cities.

See also: AIDS for a more complete description of how HIV is spread.

Symptoms

Symptoms related to HIV are usually due to a different infection in the body.

Some symptoms related to HIV infection include:

    Diarrhea

    Fatigue

    Fever

    Frequent vaginal yeast infections

    Headache

    Mouth sores, including yeast infection (thrush)

    Muscle stiffness or aching

    Rashes of different types, including seborrheic dermatitis

    Sore throat

    Swollen lymph glands

Note: Many people have no symptoms when they are diagnosed with HIV.

Signs and tests

The HIV ELISA and HIV Western blot tests detect antibodies to the HIV virus in

the blood. Both tests must be positive to confirm an HIV infection. Having

these antibodies means you are infected with HIV.

    If the test is negative (no antibodies found) and you have risk factors

for HIV infection, you should be retested in 3 months.

    If the HIV ELISA and HIV Western blot tests are positive, other blood

tests can be done to determine how much HIV is in your bloodstream.

A complete blood count (CBC) and white blood cell differential may also show

abnormalities.

A lower-than-normal CD4 cell count may be a sign that the virus is damaging

your immune system.

Treatment

Doctors often recommend drug therapy for patients who are committed to taking

all their medications and have a CD4 count below 500 cells/mm3 (indicating

their immune system is suppressed). Some people, including pregnant women and

people with kidney or neurological problems related to HIV, may need treatment

regardless of their CD4 count.

It is extremely important for people with HIV to take all doses of their

medications, otherwise the virus may become resistant to the drugs. Therapy

always involves a combination of antiviral drugs. Pregnant women with HIV

infection are treated to reduce the chance of transmitting HIV to their

babies.

People with HIV infection need to become educated about the disease and

treatment so that they can be active participants in making decisions with

their health care provider.

Support Groups
See: AIDS - support group

Expectations (prognosis)

HIV is a chronic medical condition that can be treated, but not yet cured.

There are effective ways to prevent complications and delay, but not always

prevent, progression to AIDS.

Almost all people infected with HIV will develop AIDS if not treated. However,

there is a small group of people who develop AIDS very slowly, or never at

all. These patients are called long-term nonprogressors.

Complications

    Cancers

    Chronic wasting (weight loss) from HIV infection

    HIV dementia

    HIV lipodystrophy

    Opportunistic infections

        Bacillary angiomatosis

        Candidiasis

        Cytomegalovirus infection

        Cryptococcal infection

        Cryptosporidium enterocolitis (or other protozoal infections)

        Mycobacterium avium complex (MAC) infection

        Pneumocystis jiroveci pneumonia (previously called Pneumocystis

carinii pneumonia or PCP)

        Salmonella infection in the bloodstream

        Toxoplasmosis

        Tuberculosis (in the lungs or spread throughout the body)

        Viral infection of the brain (progressive multifocal

leukoencephalopathy)

Calling your health care provider
Call your health care provider if you have had a possible or actual exposure

to AIDS or HIV infection.

Prevention

 Avoid injecting illicit drugs. If you use injected drugs, avoid sharing

needles or syringes. Always use new needles. (Boiling or cleaning them with

alcohol does not guarantee that they're sterile and safe.)

 Avoid oral, vaginal, or anal contact with semen from HIV-infected people.

 Avoid unprotected anal intercourse, since it causes small tears in the rectal

tissues, through which HIV in an infected partner's semen may enter directly

into the other partner's blood.

    If you have sex with people who use injected drugs, always use condoms.

    If you have sex with many people or with people who have multiple

partners, always use condoms.

    People with AIDS or who have had positive HIV antibody tests can pass the

disease on to others. They should not donate blood, plasma, body organs, or

sperm. They should not exchange genital fluids during sexual activity.

    Safer sex behaviors may reduce the risk of getting the infection. There is

still a slight risk of getting the infection even if you practice "safe sex"

by using condoms. Abstinence is the only sure way to prevent sexual

transmission of the virus.

    Use protection when having sexual contact with people you know or suspect

of being infected with HIV. Even better, use protection for ALL sexual

contact.

References

  1.)  Piot P. Human immunodeficiency virus infection and acquired

immunodeficiency syndrome: A global overview. In: Goldman L, Ausiello D, eds.

Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 407.
  2.)  Del Rio C, Curran JW. Epidemiology and prevention of acquired

immunodeficiency syndrome and human immunodeficiency virus infection. In:

Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious

Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap

118.
  3.)  Sterling TR, Chaisson RE. General clinical manifestations of human

immunodeficiency virus infection (including the acute retroviral syndrome and

oral, cutaenous, renal, ocular, metabolic, and cardiac diseases. In: Mandell

GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases.

7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 121.




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