AIDS - What Symptoms Are Present In The Later Stage Of Infection?

As the HIV virus continues to multiply in the host's body it destroys the person's immunity completely and makes him prone to attacks by not only very serious debilitating diseases, but very mild infections as well.

The count of the helper T cells (CD4 lymphocytes), which are typically in the range of 600 to 1,000, drop below 200 after which the person begins to show other serious signs of the disease. With the person's immunity system completely damaged, he becomes easily susceptible to opportunistic infections and may frequently experience the more serious symptoms of AIDS such as the following:

1. Severe fatigue

2. Soaking night sweats and high fever is very common among HIV positive patients.

3. Frequent episodes of chronic diarrhea

4. Shortness of breath is very commonly experienced by HIV positive patients.

5. Swelling and hardening of lymph nodes which persists for more than three months

6. Excessive weight loss which is not deliberately achieved through increased physical exercises or through dieting

7. Severe persistent headache

8. The presence of a slightly purple or faded growth over the skin or inside the mouth is very common among HIV positive patients.

9. HIV positive children's growth is poor, usually characterized by poor weight gain, trouble in walking, and slow mental development. Such children are also very susceptible to infections such as those relating to the ear, nose and throat like ear infection (otitis media), pneumonia or tonsillitis. They are also easily prone to more bruising and bleeding than their healthy and normal counterparts.

10. Apart from these physiological symptoms, it is also very common to find certain mental and behavioral disorders such as personality changes, deterioration of cognitive abilities of a person and degenerated memory in HIV positive patients.

Alarming Facts!

Exposure to the HIV virus cannot be determined accurately by individuals; because as people do so many things, meet a lot of people, and live a fast-paced life, the brain gets loaded with too much information that small details, such as having a one-night stand over a couple of beers, might be forgotten. Moreover, there are no symptoms of AIDS that are evident at the onset of the infection.

There is no way for a person to know whether one has AIDS or not than to go to the nearest hospital or testing center and get tested for AIDS. This is due to the fact that one characteristic of the AIDS virus which is the Human Immunodeficiency Virus (HIV) has a latency period. This means that the virus stays dormant for weeks. This is also the reason why it takes at least 12 weeks for the AIDS test to show whether it is negative or positive. As such, symptoms of AIDS are not clearly manifested until such time that HIV has fully taken over the immune system.

If HIV infection produces no signs and symptoms this is referred to as asymptomatic infection. But most number of people experience symptoms similar to that of a flu accompanied by fever and rashes, swollen lymph nodes and sore throat two weeks after exposure. All these have been considered as symptoms of AIDS in its early stage. Apparently, all of these symptoms are the results of the weakening of the immune system as the human immunodeficiency virus continues to ravage a person's protective system. After these series of symptoms which is collectively known as the acute retro viral syndrome, latency period begins; this is the second stage. The virus lays dormant for a period of time. No symptom or illness is seen and the person may even appear healthy even if tests show positive for HIV.

The Centers for Disease Control and Prevention defines the person as having an AIDS T-cell count of less than 200, wherein the normal count is between 600-1,500 T-cells; and manifesting at least 1 of the 21 AIDS defining infections characterized as opportunistic.

Symptoms of AIDS appear in 5 ways: as pulmonary infections, gastrointestinal infections, neurological and psychiatric episodes, tumors and malignancies and other opportunistic infections. Symptoms of AIDS become apparent and more pronounced during the late stages of the disease.

Prevention is clearly better than cure as the old maxim goes. True, there is still no cure for AIDS but people can always help those inflicted with the disease make their condition bearable; and for those who are free of the virus, it is better to take precautions especially in the area of sexual practices. Sexual promiscuity should be avoided. Drug dependents should stay away from drugs and start getting clean; and people in need of blood products should only go to accredited and licensed blood banks and similar establishments.

If you are not certain whether you have AIDS or not you may gather information through reading various materials, talking to friends and family or doctors who are experts in the study of venereal disease; but the best way to make sure if you have symptoms of AIDS is to have an AIDS test.

The Symptoms of AIDS

Acquired immune deficiency syndrome is known as AIDS and represents the part of infections and symptoms resulting from the harm to the human immune system caused by the human immunodeficiency virus (HIV). This structure constantly decreases the value of the immune system and leaves individuals in position to become infected with tumors and infections. HIV is spread through direct contact of a mucous membrane or the blood circulation with a physical fluid containing HIV, such as blood, seminal fluid, presentational fluid, vaginal fluid and mother's milk.

The symptoms of AIDS are found as a result of infected immune system. Viruses, bacterias, parasites or fungi are the main reason for causing conditions that develop AIDS and are usually controlled by the elements of the immune system that HIV damages.

The symptoms of AIDS can be found in almost every part and every organ of the human body. In the early stage when first infected with AIDS, there is a good possibility of not having any signs and symptoms of infection, but there is a chance of flu-like condition two to four weeks after becoming infected. Some of the early symptoms include: pyroxene (fever), headache, rash, swollen lymph glands and sore throat (pharyngitis). Even if the person does not have these symptoms, he can transmit the virus to the people surrounding him. The virus is reproducing in lymph nodes and gradually starts to break down the helper T cells which have the role of managing the complete immune system.

Ten or more years after the first AIDS infection, this virus becomes very critical and expands into the latest phase of infection when more serious symptoms can be found. The number of CD4 lymphocyte is less than 200 while normal count varies from 800 to 1,200. In this period the immune system of the person infected by the virus is much damaged, making it very sensitive to similar infections. The signs and symptoms of some of these infections may contain: headaches, weight reduction, chronic diarrhea, soaking night sweats, dry cough and difficulty in breathing, blurred and distorted vision, steady white spots or unusual lesions on the tongue or in the mouth, shaking chills or fever higher than 38 C for several weeks.

Aids and Mobile Phones

Being able to hear clearly makes all the difference in almost every situation in daily life. However, certain situations, such as talking on the phone, remain difficult to manage - even with the best digital hearing aids. But now, with huge advances in hearing aids, not just making them smaller and more lightweight but also making them compatible with mobile phones, TV's and even music listening devices.

A number of leading hearing aid manufacturers now support mobile phones and electronic devices such as Phonak's and Oticon hearing aids.

Oticon should prefer to recently launched the Connect Line series dollop to link the Oticon Epoch and Dual instruments to the delighted of electronic communication. This as a matter of fact is a massive breakthrough for all hearing mechanism wearers and provides to them not no more than amazing hearing and definiteness of sound but added convenience of being clever to use the mobile phone seamlessly with a hearing aid.

Listening to the TV has also become a total joy again for people who wear an Epoch or Oticon Dual as it will bring the sound directly into their ears. This not only helps to increase their own comprehension and enjoyment of the sound but also helps to minimize the frustrations that others often have to bear when the TV volume is too high.

The Oticon Connect Line solution allows the hearing instrument wearer to talk on the phone, watch TV and listen to music with total ease.

In a very similar way Phone's new digital hearing aid family: Exile Art, Versa, Certain and Audio Yes all have connectivity to mobile phones, TV's and other electronic devices.

It actually connects wireless via Blue tooth to televisions, telephones, MP3 players, computers and other audio sources with a simple touch of a button.

So the idea is that with the latest advances in hearing solutions, anyone suffering from hearing loss needn't be left behind, in fact some may say they have an advantage.

Hearing aids that connect to mobile phones, TV's and other devices are a thing of the future and represent an amazing step forward for all wearers.

Hear speech more clearly, the TV directly into your ears, pick up the phone at the touch of a button and talk hands free, even listen to your favorite music. And the best thing is you can do this all at once, with a simple click to tell your hearing device what you wish to engage.

Bone Conduction Hearing Aids

Reactionary hearing aids survive a remove sounds from exterior the ear, and then amplify this lucid and play it back to the inner ear. There are hearing aids known as bone conduction hearing aids, these travail very differently to the old-fashioned hearing aids. The bone conduction hearing aids pile up sounds from the worst world, however these hearing aids pass on the signal to an oscillator, degree than playing the complain back to the inner ear. This oscillator vibrates against the skull, the inner ear is masterful to pick up the vibrations and spell out them as sound. Customary hearing aids are much more shit than the bone conduction hearing aids. Nonetheless bone conduction hearing aids are designed for people that are unfit to use the traditional forms of hearing aid. If the ear canal is blocked like in Atresia, then a semi-annual hearing aid is next to unsuccessful, a bone conduction hearing aid on the other hand is much more usable.

If you induce ear infections or eczema then you may be not able to wear conventional hearing aids, and so power need to look at using bone conduction hearing aids. If your ear canal is restricted, or narrower than customary then a bone conduction hearing aid may be required. Bone conduction aids are superlatively suitable for children, and they are also exceptional for people that suffer from provisional hearing loss. Less than 1% of hearing aid wearers use bone conduction hearing aids, and so they can be trying to track down. If you insufficiency one be sure to discuss it with your audiologist. Bone conduction hearing aids are not able to perfectly reproduce pronounce, the sound is somewhat correspond to to the telephone.

Also the sound generated by bone conduction hearing aids is only mono, it isn't stereo. The wearer of the hearing aid is unable to tell where the sound I actually coming from due to this.

A bone conduction hearing aid uses a headband to hold everything in place, they are occasionally uncomfortable because for them to be effective the headband must be kept tight.

When these hearing aids were new they were designed to be installed into glasses. At the time it was not common to have your lenses thinned, so it was possible to place a small device into the thick frames of the glasses, so the vibrations will be felt.

The latest bone conduction hearing aids use surgery to implant a device. This works directly onto the bone, and so is less irritating for the user. The device also needs less power to operate, and there is less distortion as a result of this.

If you are suffering from permanent hearing loss as a last resort you may want to try one of these implanted bone conduction hearing aids as a last resort.

Women: The New Face of AIDS

While total HIV diagnoses in the U.S. dropped from an all-time high of 150,000 cases annually in the mid-80s to 40,000 cases today, women's numbers have gone in reverse. In 1992, American women accounted for 14% of people living with AIDS; today that number has jumped to nearly 25%.

Globally, the numbers are pandemic. More adult women are living with HIV/AIDS than ever before, nearly 50% of infected people worldwide. In countries throughout the world, women are the fastest-growing population of new HIV infections, and in some places women have surpassed men. In sub-Saharan Africa, for every 10 men living with HIV, there are 14 women living with the virus.

In 2004, 78% of new HIV infections among women were the result of heterosexual contact.
And promiscuity? A recent large-scale study out of London of 59 countries found that there is no link between promiscuity and sexually transmitted diseases. Women are getting AIDS because of economic and social inequalities. Most women who contract HIV worldwide are in monogamous relationships, victimized by partners who have unprotected sex with prostitutes and then bring the disease back home, where a woman is unaware or unable to negotiate condom use. It's not promiscuity, but rather a lack of education and resources that increases the rate of HIV infection.

At home, African-American women are suffering the consequences of poverty, inadequate health care, discrimination, and unsafe sex. African-American women are 20-times more likely to contract HIV than white women, accounting for 67% of new diagnoses; white women account for 15%. Yet black women constitute 13% of the population as a whole, while white women make up 66%.

So why are women at such high risk? The answer is part biological, in that women are twice as likely as men to contract HIV during vaginal intercourse, but mostly sociological.

Hearing Aids

A hearing aid makes sounds louder (amplifies). While hearing aids may amplify some types of sounds more than others, at this time they cannot be made or programmed to amplify only one type of sound, such as a voice. Hearing aids do not restore normal hearing, but they may help people with hearing loss function and communicate more easily.

If you think you have a hearing problem and are thinking about getting a hearing aid, see your doctor. If your doctor thinks you may need a hearing aid, another type of specialist (audiologist) can help determine what type of hearing aid will work best for you. The audiologist will pick a hearing aid based on the type and how much hearing loss you have and other factors. He or she can help you learn how to get the most out of your hearing aid. In general, it usually is better to wear hearing aids in both ears, even if the hearing loss in the ears is not equal.

You also need to consider cost. Hearing aids can be expensive, and they are not always covered by insurance. Be sure to ask about a return policy, in case you are not satisfied with the hearing aid, and any warranties.

Hearing aids differ in how they look, their size, where they are placed in the ear, and how much they can amplify sounds.

All hearing aids consist of:

* A microphone, to pick up sound.
* An amplifier, to make the sound louder.
* A speaker, to deliver the sound into the ear.
* Batteries, to power the hearing aid.

The size of a hearing aid is not a good indicator of its sound quality.

There are three major types of hearing aids:

* Analog adjustable hearing aids are made based on your hearing tests. They amplify both speech and other sounds in the same amount. Your doctor has some flexibility in adjusting them to fit your hearing, and you generally control loudness. These are the least expensive type of hearing aids.
* Analog programmable hearing aids contain a computer chip that your doctor can program to take into account your hearing loss and how you respond to louder sounds. They can be programmed for different hearing environments, such as a one-on-one conversation or a dinner party in a restaurant. You change hearing programs by using a remote control.
* Digital programmable hearing aids can analyze the hearing environment and adjust to the sound. They allow more flexibility in programming than analog hearing aids. They are the most advanced and the most expensive type of hearing aid.

You can wear hearing aids behind the ear, in the outer ear, or in the ear canal. Most newer models fit in the ear or ear canal.

* All parts of a behind-the-ear (BTE) hearing aid are found in a case that fits behind the ear. The case is connected to a plastic ear mold that fits inside the outer ear. BTE hearing aids are used for all degrees of hearing loss, especially very severe hearing loss. They may be better for children because of safety and growth reasons. Poorly fitting BTE ear molds or a buildup of earwax may cause a whistling sound (feedback).
* All parts of an in-the-ear (ITE) hearing aid are found in a case that fits in the outer part of the ear. It can be used by people with mild to severe hearing loss. ITE hearing aids can be used with other hearing devices, such as a telecoil that improves hearing during phone calls. ITE hearing aids can be damaged by earwax and fluid draining from the ear, and their small size may be difficult for some people to handle. Children do not usually use them because the case must be replaced as the child grows.
* All parts of an in-the-canal (ITC) hearing aid are found in a case that fits partly or completely into the ear canal. ITC hearing aids are used by people with mild to moderate hearing loss. They are made to fit the shape and the size of your ear canal. They can be damaged by earwax and fluid draining from the ear, and their small size may be difficult for some people to handle. They are not recommended for children.

Disposable hearing aids that you use for a short period of time are now available. They last for 30 to 60 days. They may be an option for those with mild to moderate hearing loss.


It may take from several weeks to months for you to get used to your hearing aid. You may find that:

* Your hearing aid makes all sounds louder, and you may hear sounds you have not heard for a long time. Your own voice probably will sound very loud, and background noises—such as rustling newspapers, clinking silverware, and other voices—may bother you. You will have to learn to filter out unwanted sounds.
* Your hearing changes as your situation changes. How your hearing aid works will be different when talking quietly to a friend or spouse, enjoying a family dinner, or attending a presentation with a large group of people. In each situation you will have to learn how to adjust your listening.
* Your hearing aid is uncomfortable. It will feel odd in your ear at first and may cause some pain and tenderness in the ear canal. Do not feel you have to wear it 24 hours a day.
Here are some general tips to help you adjust to your new hearing aid.

* Talk to your audiologist about how long to wear your hearing aid. When you first get it, your audiologist often will recommend that you wear it 2 to 3 times a day, for 30 to 60 minutes at a time. Gradually increase the time you wear it. Overloading yourself with new sounds may result in fatigue and discomfort.
* When you first get your hearing aid, try to talk to only one person at a time, in a quiet room. This helps you adjust to the louder sounds without distractions.
* Wear your hearing aid even if you are alone. This is a good time to get used to hearing and filtering out background noise.
* To get used to your own voice, read aloud to yourself. Your voice is louder because it is closer to the hearing aids microphone.
* Adjust your hearing aid when your environment changes. For example, in meetings, sit close to the speaker so that you will be able to see him or her. Try sitting in different parts of a room until you find the spot that is best for your hearing. Change the volume of your hearing aid when necessary.

Schizophrenia: Twice As Common As HIV/AIDS

Twice as many Americans live with schizophrenia than with HIV/AIDS, but a major report by the National Alliance on Mental Illness (NAMI) reveals most Americans are unfamiliar with the disease.

"Americans are not sure what to think about schizophrenia," said NAMI executive director Mike Fitzpatrick. "They know schizophrenia is a medical illness affecting the brain, but it is largely misunderstood. There are gaps in knowledge- and access to treatment. Misinformation, mis perceptions, and misunderstanding represent a public health crisis."
Approximately two million Americans live with schizophrenia. Two-thirds do not receive treatment, even though the disease can be managed successfully.

The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.

- 85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include "split" or multiple personalities (64%).

- 79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.

- Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2-3 times that of the general population.

- A vast majority believe that better medications (96%) and health insurance (82%) would be most helpful to improving their condition,

- Caregivers agree better medications are needed. Approximately 80% have difficulty getting services for loved ones, 63% have difficulty finding time for themselves, and 41% have provided care for more than 10 years.

"We know what to do to increase recovery, but it requires public support, which depends on public attitudes," Fitzpatrick said.

What is hearing aid?

A hearing aid makes sounds louder (amplifies). While hearing aids may amplify some types of sounds more than others, at this time they cannot be made or programmed to amplify only one type of sound, such as a voice. Hearing aids do not restore normal hearing, but they may help people with hearing lose function and communicate more easily.

What should I do if I think I need a hearing aid?

If you think you have a hearing problem and are thinking about getting a hearing aid, see your doctor. If your doctor thinks you may need a hearing aid, another type of specialist (audiologist) can help determine what type of hearing aid will work best for you. The audiologist will pick a hearing aid based on the type and how much hearing loss you have and other factors. He or she can help you learn how to get the most out of your hearing aid. In general, it usually is better to wear hearing aids in both ears, even if the hearing loss in the ears is not equal.

You also need to consider cost. Hearing aids can be expensive, and they are not always covered by insurance. Be sure to ask about a return policy, in case you are not satisfied with the hearing aid, and any warranties.

What are the different types of hearing aids?

Hearing aids differ in how they look, their size, where they are placed in the ear, and how much they can amplify sounds. All hearing aids consist of:

• A microphone, to pick up sound.
• An amplifier, to make the sound louder.
• A speaker, to deliver the sound into the ear.
• Batteries, to power the hearing aid.

What Happens Inside the Body?

Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there is an infection, CD4 cells lead the infection-fighting army of the body to protect it from falling sick. Damage of these cells, hence can affect a person's disease-fighting capability and general health.


After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.


Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.


But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.


Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.

The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition

How do some of the relevant rights apply?

To empower rights-holders to claim their rights, to protect human dignity and to prevent the transmission of HIV, the following rights should be protected so that people will come forward for HIV information, education and means of protection, and will be supported to avoid risky behaviour:

• Non-discrimination : protected against discrimination if seek help or are HIV+
• Right to privacy : protected against mandatory testing; HIV status kept confidential
• Right to liberty and freedom of movement : protected against imprisonment, segregation, or isolation in a special hospital ward
• Right to education/information : access to all HIV prevention education and information and sexual and reproductive health information and education
• Right to health : access to all health care prevention services, including for sexually transmitted infections, tuberculosis, voluntary counseling and testing, and to male and female condoms

Vulnerable populations

Depending on the legal and social situation and the nature of the epidemic in country, some groups may be more vulnerable to infection and impact because of their legal status or lack of human rights protection, e.g. women, children, minorities, indigenous people, poor people, migrant-workers, refugees, sex workers, people who use drugs, men having sex with men, and prisoners.

These groups should have equal access to HIV prevention information, education, and commodities, and to HIV care, support and anti-retroviral treatment; should not be subject to sexual violence or coercion, where applicable; and should be able to participate in the formulation and implementation of HIV and AIDS policies that affect them.

• Non-discrimination/equality before the law : same access as others to services
• Rights to education and health : same access to HIV prevention education and information, and health care services, including STI services and condoms
• Liberty , security of person and freedom from cruel, inhuman and degrading treatment : freedom from violence, including sexual violence, freedom from mandatory testing
• Right to participate in public life : participation in the formulation and implementation of HIV policy

For those living with HIV or otherwise affected by it, the following rights should be protected:

• Non-discrimination and equality before the law : right not to be mistreated on the basis of health status, i.e. HIV status
• Right to health : right not to be denied health care/treatment on the basis of HIV status
• Right to liberty and security of person : right not to be arrested and imprisoned on the basis of HIV status
• Right to marry and found a family , regardless of HIV status
• Right to education : right not to be thrown out of school on the basis of HIV status
• Right to work : right not to be fired on the basis of HIV status
• Right to social security, assistance and welfare : right not to be denied these benefits on the basis of HIV status
• Right to freedom of movement , regardless of HIV status
• Right to seek and enjoy asylum , regardless of HIV status

Human rights and HIV

The risk of HIV infection and its impact feeds on violations of human rights, including discrimination against women and marginalized groups such as sex workers, people who inject drugs and men who have sex with men. HIV also frequently begets human rights violations such as further discrimination and violence. Over the past decade the critical need for strengthening human rights to effectively respond to the epidemic and deal with its effects has become evermore clear. Protecting human rights and promoting public health are mutually reinforcing.

Several countries still have policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care. Examples include laws criminalizing consensual sex between men, prohibiting condom and needle access for prisoners, and using residency status to restrict access to prevention and treatment services. At the same time, laws and regulations protecting people with HIV from discrimination are not enacted, or fully implemented or enforced.

Reforming laws and policies that are based in deeply-rooted social attitudes and norms such as gender inequality requires multisectoral collaboration. Although not sufficient to change social attitudes, legislation is important for addressing acts of discrimination. Civil society, including organizations of people living with HIV, as well as other parts of society, including police and justice systems, have a critical role to play. International organizations and donors can also play a positive role in support of local and national actors.

The protection of human rights, both of those vulnerable to infection and those already infected, is not only right, but also produces positive public health results against HIV. In particular, it has also become increasingly clear that:

• National and local responses will not work without the full engagement and participation of those affected by HIV, particularly people living with HIV.
• The human rights of women, young people and children must be protected if they are to avoid infection and withstand the impact of HIV.
• The human rights of marginalized groups (sex workers, people who use drugs, men who have sex with men, prisoners) must also be respected and fulfilled for the response to HIV to be effective.
• Supportive frameworks of policy and law are essential to effective HIV responses.

UNAIDS works to help enable States to meet their human rights obligations, and to empower individuals and communities to claim their rights in the context of the HIV epidemic.

Human Rights and Universal Access: What have Governments committed themselves to?

To ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups; promoting access to HIV education and information; full protection of confidentiality and informed consent; intensifying efforts to ensure a wide range of prevention programmes, including information, education and communication, aimed at reducing risk-taking behaviours and encouraging responsible sexual behaviour, including abstinence and fidelity; expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; expanded access to voluntary and confidential counselling and testing; safe blood supplies; and early and effective treatment of sexually transmitted infections; developing strategies to combat stigma and social exclusion connected with the epidemic.

Living With HIV: How Children Are Making The Successful Transition Into Adulthood

Most of what we read and hear about HIV and AIDS is bad. It is a bleak landscape where good news is generally hard to find.

Let alone what is happening in sub-Saharan Africa and other parts of the world under siege from this virus, the UK too is grappling with increasing health challenges from the HIV/AIDS epidemic.

The National AIDS Trust says the UK will have 100,000 people living with HIV by 2010 and failure of investment in HIV prevention and education is putting thousands at risk.

But, tough as it is to contract HIV as an adult, how much thought is given to those who have the virus at birth? As a child living with HIV in Britain today, how do you face the challenge and stigma of being HIV positive through no fault or direct action of your own? And how do you move forward into adulthood carrying such a responsibility?

In the heart of London, there is a very special clinic which is helping HIV positive adolescents from all over the country move through this journey from childhood to adulthood. The clinic, at St Mary's Hospital in Padding ton, is simply known as the '900'. Its central focus is to manage the successful passage of HIV positive kids from childhood to adulthood through multidisciplinary care.

Children are typically expected to move from pediatric to adult health services between the ages of 16 and 18. This is traditionally acknowledged amongst health professionals as a complex time to turn children over to adult care, especially for those with chronic diseases such as cystic fibrosis, diabetes and heart problems, which used to have high mortality rates in childhood. For kids who are HIV positive, the 900 aims to make this transition as seamless and successful as possible, and it is a UK first in shaping a new approach to the treatment and management of HIV.

"There is widespread recognition that the transfer from pediatric to adult services has been very poorly managed in the past. Often when this transfer has occurred, the level of care has deteriorated. Now there is increasing evidence that shows a proper transition process with shared paediatric and adult appointments can really help," says Caroline Foster, a paediatrician specialising in adolescent HIV, who helps manage the 900 clinic.

St Mary's, part of the Imperial College Healthcare NHS Trust, runs the largest pediatric clinic for kids born with HIV in the UK. It currently treats around 250 children, many of whom come to the clinic from considerable distances with shared care established with district general hospitals, allowing both the sharing of clinical care, expertise and education.

The total number of children known to be living with HIV in the UK and Ireland is estimated at around 1,400 but it is London which has the largest numbers. The average age in the paediatric clinic is 10, and there are now up to 50 young people who are aged 16 and above.

Now that virtually every pregnant woman takes up the routine antenatal HIV test, and if found to be infected can then take up interventions to prevent her baby becoming infected, and children with HIV are surviving thanks to combination antiresonator therapy, the median age of children with HIV is going up, thus generating the increasing need for adolescent care and care as young adults, according to Foster.

"To fulfill their potential, these children now need both medical and psychosocial help. Thus, typical treatment will involve anti retro viral drugs to suppress the virus and also support with problems that tend to come in the teenage years, for example in relationships with friends and family members especially, as this is very much a family disease," she says.

Problems for young people with HIV range from having to live with a chronic disease, adhering to medication which may cause side effects such as lipodystrophy which can be unsightly, as well as psychosocial issues such as the death or ill health of family members and the complex issues of negotiating relationships and your first sexual experiences with HIV. There is also the ever present issue of disclosure, as HIV remains a stigmatizing disease, with at least one example of the bullying on Facebook of a young girl who chose to come out.

Whilst these problems cannot be underestimated, there is good news too and Foster is anxious to make the point. "Four of the young women in this clinic have now had their own babies who are HIV negative and this is great news, because teenagers need to adhere to their treatment to make this happen. I think now we can say that there is a wave of young people born with HIV who are surviving on treatment, transitioning, moving into adult services, getting through school to university and who are fully engaged in getting on with their lives."

One cannot underestimate the issues that young people born with HIV and living in the UK have to deal with. But these issues are relative. In Africa, without treatment, half of kids born HIV positive will be dead by their third birthday.

Dosing and drug formulations in children

The dose of antiretroviral drugs given to children is generally based on either weight or body surface area. As children’s bodies are constantly changing, drug doses need to be altered to make sure that a child is not given too much, or too little, of a drug. Health care workers also need to take into account that children under the age of six metabolite drugs faster than adults, so even after adjusting for body weight, they may need to be given higher quantities of ARVs to achieve the same effect that the drugs would have in adults. Information about specific drugs is often limited, and drug manufacturers and expert guidelines use a variety of ways to calculate doses of pediatric ARVs, so there is no uniform dosing system to follow.
Because of the complex nature of pediatric dosing, under- or over-dosing can be a serious risk. Dosing is further complicated by the variety of forms that ARVs may take when provided to children, all of which require different measurements. Infants who are too young to swallow tablets ideally need to be provided with these drugs in the form of syrups or powders, but these formulations are expensive and often impractical. Some syrups need to be refrigerated after opening, which requires a reliable electricity supply, and powders need to be mixed with water, which may be unfeasible in areas where clean drinking water is not regularly available. In addition, the unpleasant taste of syrups and powders can make it difficult for children to take their ARVs every day.
An encouraging development is the relatively recent availability of fixed-dose combination therapies (FDCs), which combine multiple ARVs into a single tablet, for children. Tablets consisting of lamivudine, stavudine and nevirapine have been supplied by the Clinton HIV/AIDS Initiative (CHAI), in conjunction with drug purchase facility, UNITAID, to children in 26 nations. In these countries CHAI’s monthly pediatric treatment formerly consisted of 12 bottles of liquid. For those children who can now access FDCs, only a small container of tablets is needed, making the therapy easier to store, transport and administer.
In areas where there is a lack of affordable pediatric ARV formulations, clinicians often have no choice but to divide adult fixed-dose combination drugs into measures appropriate for children. There is evidence that dividing tablets carries a risk of under- or over-dosing but equally, a significant 2006 study of eight countries concluded that the use of divided adult FDCs can achieve successful and satisfactory results in children. The World Health Organisation supports this practice in situations where no appropriate pediatric medications are available.

HIV patients with mental health problems live just as long, says Australian study

HIV-positive individuals with mental health disorders survive just as long as HIV-positive people with good mental health, according to an Australian study published in the May edition of HIV Medicine. The investigators established, however, that patients with mental health problems took more antiretroviral drugs and spent more time in hospital than patients without mental health difficulties. Appropriate use of antiretroviral therapy could, they suggest, not only improve the health of patients with both HIV and mental health problems, but also reduce their use of healthcare resources.

Mental health disorders are common in people with HIV. Investigators from Melbourne, Australia, wished to determine the prevalence and impact of mental disorders in their clinic population between 1984 and 2000. They hypothesised that individuals with mental health problems would have a worse outcome, with poorer treatment outcome, reduced response to antiretroviral therapy, and increased mortality when compared to patients with no recorded mental health disorders.

The investigators performed a retrospective analysis including all 2,981 patients who received care for HIV at the Alfred Hospital. They cross-referenced this population with the VPCR database of mental health patients and found that 525 individuals matched.

Substance abuse was the most common psychiatric disorder seen in these individuals (17%), followed by affective disorders (9%) and personality disorders (2%). In 47% of cases, the cause of the mental health problem was unknown.

In a third of individuals, the mental health disorder pre-dated diagnosis with HIV. The investigators also observed that there were some slight differences in the demographics of patients recorded on the VPCR database and those of Alfred Hospital cohort. In particular, VPCR patients were less likely to be gay (58% versus 70%) and more likely to report injecting drug use as their HIV risk activity (24% versus 7%).

The investigators noted that 31% of individuals with mental health disorders received treatment with potent antiretroviral therapy after 1996 compared to 26% of individuals with no recorded mental health problems. They also noted that patients on the VPCR database used more antiretroviral drugs (median 6.4) than individuals with good mental health (median 5.5) and hypothesise that this was due to adherence problems or the capacity for some anti-HIV drugs, such as efavirenz (Sustiva) to exacerbate pre-existing mental health difficulties.

A third of individuals with mental health problems were hospitalised compared to 23% of patients with no recorded mental health disorders. The investigators also noted that there were differences in the reasons for hospitalisation between the two groups of patients, with patients with mental health problems more likely to be hospitalised because of infections (29% versus 20%), for non-infectious conditions such as liver problems (28% versus 19%) and for mental health reasons (18% versus 8%). Factors independently associated with an increased risk of hospitalisation were mental health problems (p < 0 .001), a prior AIDS-defining illness (p < 0.001) and receiving HIV treatment prior to 1986 (p = 0.001).

The investigators then looked to see if there was any relationship between a recorded mental health disorder and an increased risk of death. They found no difference in survival between patients in the general Alfred Hospital cohort and those on the VPCR database.

“Patients with psychiatric disorders are able to benefit from highly active antiretroviral therapy”, write the investigators. However, they note that their study was limited by its retrospective design. They conclude, “enhancing awareness and improving treatment in those with both HIV and mental health disorders may potentially improve quality of life for these patients but may also reduce unnecessary health care usage.”

Development of novel treatments for hepatitis C

Hepatitis C virus (HCV) infection is a major and growing global health problem, affecting about 170 million people worldwide, and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Currently, treatment is restricted to interferon alfa and ribavirin, which leads to a successful outcome in only about 50% of individuals.

New effective treatments with tolerable side-effect profiles are needed urgently, but development has been hindered by an inability to culture HCV and a scarcity of animal models. Herein, we review progress in HCV biology, including cell culture and new animal models, and the contribution of this work to our understanding of the virus' life-cycle and pathogenesis and development of specifically targeted antiviral treatment. We also discuss changes in our understanding of HCV epidemiology, clinical manifestations, and diagnostics.

Risk factors

Anyone can get tuberculosis, but certain factors increase your risk of the disease. These factors include:

• Lowered immunity. A healthy immune system can often successfully fight TB bacteria, but your body can't mount an effective defense if your resistance is low. A number of factors can weaken your immune system. Having a disease that suppresses immunity, such as HIV/AIDS, diabetes, end-stage kidney disease, certain cancers or the lung disease silicosis, can reduce your body's ability to protect itself. Your risk is also higher if you take corticosteroids, certain arthritis medications, chemotherapy drugs or other drugs that suppress the immune system.
• Close contact with someone with infectious TB. In general, you must spend an extended period of time with someone with untreated, active TB to become infected yourself. You're more likely to catch the disease from a family member, roommate, friend or close co-worker.
• Country of origin. People from regions with high rates of TB — especially sub-Saharan Africa, India, China, the islands of Southeast Asia and Micronesia, and parts of the former Soviet Union — are more likely to develop TB. In the United States, more than half the people with TB were born in a different country. Among these, the most common countries of origin were Mexico, the Philippines, India and Vietnam.
• Age. Older adults are at greater risk of TB because normal aging or illness may weaken their immune systems. They're also more likely to live in nursing homes, where outbreaks of TB can occur.
• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to TB.
• Malnutrition. A poor diet or one too low in calories puts you at greater risk of TB.
• Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of TB. That's because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of TB infection.
• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand washing greatly reduce your risk.
• International travel. As people migrate and travel widely, they may expose others or be exposed to TB bacteria.

Causes of tuberculosis

Tuberculosis is caused by an organism called Mycobacterium tuberculosis. The bacteria spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings. Rarely, a pregnant woman with active TB may pass the bacteria to her unborn child.

Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from a family member or close co-worker than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.

TB infection vs. active TB
If you breathe TB bacteria into your lungs, one of four things might happen:

• You don't become infected with TB. Your immune system immediately destroys the germs and clears them from your body.
• You develop latent TB infection. The germs settle in your lungs and begin to multiply. Within several weeks, however, your immune system successfully "walls off" the bacteria in your lungs, much like a scab forming over a wound. The bacteria may remain within these walls for years — alive, but in a dormant state. In this case, you're considered to have TB infection and you'll test positive on a TB skin test. But you won't have symptoms and won't transmit the disease to others.

• You develop active TB. If your immune defenses fail, TB bacteria begin to exploit your immune system cells for their own survival. The bacteria move into the airways in your lungs, causing large air spaces (cavities) to form. Filled with oxygen — which the bacteria need to survive — the air spaces make an ideal breeding ground for the bacteria. The bacteria may then spread from the cavities to the rest of your lungs as well as to other parts of your body.

  If you have active TB, you're likely to feel sick. Even if you don't feel sick, you can still infect others. Without treatment, many people with active TB die. Those who survive may develop long-term symptoms, such as chest pain and a cough with bloody sputum, or they may recover and go into remission.

• You develop active TB years after the initial infection. After you've had latent TB for years, the walled-off bacteria may suddenly begin multiplying again, causing active TB, also known as reactivation TB. It's not always clear what triggers this reactivation, but it most commonly happens after your immune system becomes weakened. Your resistance may be lower because of aging, drug or alcohol abuse, malnutrition, chemotherapy, prolonged use of prescription medications such as corticosteroids or TNF inhibitors, and diseases such as HIV/AIDS.

Only about one in 10 people who have TB infection goes on to develop active TB. The risk is greatest in the first two years after infection and is much higher if you have HIV infection.

Tuberculosis

Symptoms

Although your body may harbor the bacteria that cause tuberculosis, your immune system often can prevent you from becoming sick. For this reason, doctors make a distinction between:

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious.
• Active TB. This condition makes you sick and can spread to others.

Signs and symptoms of active TB include:

• Unexplained weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite

Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:

• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

When to see a doctor
See your doctor if you have a fever, unexplained weight loss, night sweats and a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause. TB can be diagnosed by your primary care doctor or by a doctor who specializes in lung diseases (pulmonologist) or by an infectious disease specialist. If you don't have a doctor, your local public health department can help.

HIV testing results

Can you test negative for HIV and still have HIV?
Yes. If you were only recently exposed to the HIV virus, you could test negative and still have HIV (false-negative), particularly with the standard antibody tests. Unfortunately, you may also be at greatest risk of spreading the virus during this time.

If you test negative for HIV during standard antibody HIV testing and it's been less than three months since the suspected exposure, consider retesting. The best time for retesting is three months or more after the possible exposure.

Instead of waiting to be retested with an antibody test, you may also have the option of getting one of the few less commonly done tests that can identify HIV infection earlier, before antibodies can be detected.

What if you test positive for HIV?
Although there's no cure for HIV/AIDS, treatment has come a long way in the past few decades, offering extended and improved quality of life for many. Early treatment can help you stay well and delay the onset of AIDS. Inform any partners about a positive diagnosis, because they will need to be evaluated and possibly treated, as well.

Discuss further testing and treatment with your doctor. Your doctor will use PCR tests to measure the amount of the virus in your blood, which can help predict the probable progression of your disease. People with higher viral loads generally don't do as well as those with lower viral loads. Viral load tests are also used to decide when to start and when to change your treatment.

A healthy lifestyle can also help you stay well:

• Avoid smoking, using illicit drugs and drinking too much alcohol. These can weaken your immune system.
• Get tested for tuberculosis (TB) and STDs. You may have TB or STDs and not know it. These may cause serious illness if not treated.
• Use condoms. Abstaining from sex is the most effective way to avoid transmitting HIV to others or to getting other STDs that may harm your health. But if you decide to have sex, use condoms. Condoms are very effective at preventing HIV and other STD transmission, though they aren't 100 percent effective.

What can you expect during HIV testing?

Traditional HIV testing

The enzyme-linked immunosorbent assay (ELISA) test looks for antibodies to the virus in a sample of your blood drawn from a vein. If this test is positive — meaning you have antibodies to HIV — the same test is repeated. If the repeat test is also positive for HIV antibodies, you need a confirming blood test called the Western blot test, which checks for the presence of HIV proteins. The Western blot test is important because you may have non-HIV antibodies that cause a false-positive result on the ELISA test. Combining the two types of tests helps ensure that results are accurate, and you receive a diagnosis of HIV only if all three tests are positive.

It can take up to two weeks to get the results of the ELISA and Western blot tests.

Rapid HIV testing
Several rapid tests offer highly accurate information within as little as 20 minutes. These tests also look for antibodies to the virus using a sample of your blood, drawn from a vein or a finger prick, or fluids collected on a treated pad that's rubbed on your upper and lower gums. The oral test is almost as sensitive as the blood test and eliminates the need for drawing blood. A positive reaction on a rapid test requires a confirming blood test. And because the tests are relatively new and were originally approved for use only in certified laboratories, they may not be available everywhere.

Home HIV testing
Currently, the Food and Drug Administration (FDA) has approved only one HIV test for home use. The Home Access HIV-1 Test System, marketed by Home Access Health, is as accurate as traditional HIV tests, and all positive results are automatically retested.

For this test, you mail in a drop of your blood, then call a toll-free number to receive your results in three to seven business days. This approach ensures your privacy and anonymity — you're identified only by a code number that comes with your kit. The greatest disadvantage is that you're not offered the counseling that you typically receive in a clinic or doctor's office, although you're given referrals to medical and social services.

Early detection HIV testing
Some tests can detect HIV infection earlier, before antibodies are detectable in standard HIV testing. These tests may cost more than standard HIV testing and may not be as widely available. You will also still need standard antibody testing later, to confirm results, because false-positives and false-negatives are possible. Tests that can help identify early HIV infection include:

• PCR or RNA tests. Polymerase chain reaction (PCR) tests involve evaluating a blood sample for genetic material — RNA or DNA — produced by the HIV virus infection. These tests measure the amount of virus present in your blood (viral load) and are most useful for monitoring your condition after you've already been diagnosed with HIV. The tests may return a false-negative result if infection with HIV occurred too recently, such as fewer than five days ago.
• p24 antigen tests. This test can identify an HIV protein — p24 — in your blood from about one week to up to three or four weeks after infection with HIV. Once antibodies begin to form, they bind to the p24 protein, making p24 undetectable. By that time, standard antibody tests may be able to detect the antibodies.

HIV testing: What tests and when to get tested

You may be thinking about getting tested for HIV for any number of reasons. Perhaps you've been exposed to someone's blood or had unprotected sex. Or maybe you just want to make sure. If you're considering HIV testing, you might be feeling some anxiety about it. Knowing what to expect from HIV testing and what types of tests are available can help.

If you do have HIV, the sooner you find out, the better. Early medical treatment and a healthy lifestyle may delay the onset of AIDS — a chronic, life-threatening condition caused by HIV.

Who needs HIV testing, and how often?

If you think you may have HIV — get tested. The Centers for Disease Control and Prevention (CDC) encourages voluntary HIV testing as a routine part of medical care if you are:

• An adolescent or adult between the ages of 13 to 64
• Pregnant, because if you're infected with HIV there are ways to reduce the chance you'll pass it along to your baby

Yearly testing is recommended if you're at high risk of infection. Consider HIV testing yearly and before having sex with a new partner if you:

• Have had unprotected vaginal, oral or anal sex with more than one sexual partner or with an anonymous partner since your last screening
• Are a man who has sex with men
• Use IV drugs
• Have been diagnosed with tuberculosis or a sexually transmitted disease (STD) such as hepatitis or syphilis
• Have had unprotected sex with someone who falls into any of the above categories

How do you prepare for HIV testing?

No special preparations are necessary for HIV testing. You may need to call your doctor to schedule an appointment. Some public health clinics may allow you to simply walk in for HIV testing.

How is HIV testing done?

HIV is usually diagnosed by testing your blood or oral mucus for the presence of antibodies to the virus. Unfortunately, these HIV tests aren't accurate immediately after infection because it takes time for your body to produce antibodies — usually two to eight weeks. In rare cases, it can take up to six months for HIV antibodies to develop and for these types of HIV tests to be accurate. However, the majority of tests are considered to be accurate within three months. A few early detection tests also exist, but they may be more costly and less widely available.

Risk factor

Anyone of any age, race, sex or sexual orientation can be infected with HIV, but you're at greatest risk of HIV/AIDS if you:

• Have unprotected sex with multiple partners. You're at risk whether you're heterosexual, homosexual or bisexual. Unprotected sex means having sex without using a new latex or polyurethane condom every time.
• Have unprotected sex with someone who is HIV-positive.
• Have another sexually transmitted disease, such as syphilis, herpes, chlamydia, gonorrhea or bacterial vaginosis.
• Share needles during intravenous drug use.
• Received a blood transfusion or blood products before 1985.
• Have fewer copies of a gene called CCL3L1 that helps fight HIV infection.

Newborns or nursing infants whose mothers tested positive for HIV but did not receive treatment also are at high risk.

How HIV is transmeted

You can become infected with HIV in several ways, including:

• Sexual transmission. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. You can also become infected from shared sexual devices if they're not washed or covered with a condom. The virus is present in the semen or vaginal secretions of someone who's infected and enters your body through small tears that can develop in the vagina or rectum during sexual activity. If you already have another sexually transmitted disease, you're at much greater risk of contracting HIV. Contrary to what researchers once believed, women who use the spermicide nonoxynol 9 also may be at increased risk. This spermicide irritates the lining of the vagina and may cause tears that allow the virus into the body.
• Transmission through infected blood. In some cases, the virus may be transmitted through blood and blood products that you receive in blood transfusions. Since 1985, American hospitals and blood banks have screened the blood supply for HIV antibodies. This blood testing, along with improvements in donor screening and recruitment practices, has substantially reduced the risk of acquiring HIV through a transfusion.
• Transmission through needle sharing. HIV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis. Your risk is greater if you inject drugs frequently and also engage in high-risk sexual behavior. Avoiding the use of injected drugs is the most reliable way to prevent infection. If that isn't an option, you can reduce your risk by participating in a needle exchange program that allows you to trade used needles and syringes for sterile ones.
• Transmission through accidental needle sticks. Transmission of the virus between HIV-positive people and health care workers through needle sticks is low. Experts put the risk at far less than 1 percent.
• Transmission from mother to child. Each year, nearly 600,000 infants are infected with HIV, either during pregnancy or delivery or through breast-feeding. But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced. In the United States, most pregnant women are pre-screened for HIV, and anti-retroviral drugs are readily available. Not so in developing nations, where women seldom know their HIV status, and treatment is often limited or nonexistent. When medications aren't available, Caesarean section is sometimes recommended instead of vaginal delivery. Other options, such as vaginal disinfection, haven't proved effective.
• Other methods of transmission. In rare cases, the virus may be transmitted through organ or tissue transplants or unsterilized dental or surgical equipment.

Symptoms of HIV in children

Children who are HIV-positive may experience:

• Difficulty gaining weight
• Difficulty growing normally
• Problems walking
• Delayed mental development
• Severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis

When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, seek medical counseling as soon as possible. Questions to consider include:

• Why should you get tested? The idea of being tested for HIV infection may be frightening. But testing itself doesn't make you HIV-positive or HIV-negative, and it's important not only for your own health but also to prevent transmission of the virus to others. If you engage in a high-risk behavior such as unprotected sex or sharing needles during intravenous drug use, get tested for HIV at least annually.
• What if you're pregnant? If you're pregnant, you may want to get tested even if you think you're not at risk. If you are HIV-positive, treatment with anti-retroviral drugs during your pregnancy can greatly reduce the chances you'll pass the infection to your baby.
• Where can you get tested? You can be tested by your doctor or at a hospital, the public health department, a Planned Parenthood clinic or other public clinics. Many clinics don't charge for HIV tests. Be sure to choose a place in which you feel comfortable and that offers counseling before and after testing. Don't let concern about what people may think stop you from being tested. For a referral, or to make an appointment for an HIV test at a Planned Parenthood clinic near you, call 800-230-PLAN (800-230-7526). You can also contact your local or state health department.
• Will your results be private? All states and U.S. territories report positive HIV and AIDS test results to state public health officials to help track the spread of the disease. Most states use name reporting, but the results are released only to the health department and not to anyone else — including the federal government, employers, insurance companies and family members — without your permission. In addition, legal provisions ensure the highest degree of confidentiality with regard to name-based HIV data. If you are concerned about having your name reported, many states offer anonymous testing centers. If you do test positive and seek treatment, however, you will likely have to provide your name to your doctor.

Drug treatments

As medical understanding about how the virus invades the body and multiplies within cells has increased, drugs to inhibit its growth and slow its spread have been developed. Drug treatment for HIV/AIDS is complicated and expensive, but highly effective in slowing the replication (reproduction) of the virus and preventing or reducing some effects of the disease.

Drugs to treat HIV/AIDS use at least three strategies:

1. interfering with Hive's reproduction of its genetic material (these drugs are classified as nucleotide or nucleotide anti-retrovirus)
2. interfering with the enzymes HIV needs to take over certain body cells (these are called protease inhibitors)
3. interfering with Hive's ability to pack its genetic material into viral code — that is, the genetic "script" HIV needs to be able to reproduce itself (these are called non-nucleotide reverse transcription inhibitors )

Because these drugs work in different ways, doctors generally prescribe a "combination cocktail" of these drugs that are taken every day. This regimen is known as HEART treatment (HEART stands for highly active antiretroviral therapy). Doctors may also prescribe drugs to prevent certain opportunistic infections — for example, some antibiotics can help prevent PCP, especially in kids.

Although a number of medicines are available to treat HIV infection and slow the onset of AIDS, unless they are taken and administered properly on a round-the-clock schedule, the virus can quickly become resistant to that particular mix of medications. HIV is very adaptable and finds ways to outsmart medical treatments that are not followed properly. This means that if prescribed medicines are not taken at the correct times every day, they will soon fail to keep HIV from reproducing and taking over the body. When that happens, a new regimen will need to be established with different drugs. And if this new mix of medicines is not taken correctly, the virus will likely become resistant to it as well and eventually the person will run out of treatment options.

Aside from the difficulty of getting young children to take their medication on a timed schedule, the medications present other problems. Some have unpleasant side effects, such as a bad flavor, whereas others are only available in pill form, which may be difficult for kids to swallow. Parents who need to give their child these medications should ask the doctor or pharmacist for suggestions on making them easier to take. Many pharmacies now offer flavoring that can be added to bad-tasting medicines, or your doctor may recommend mixing pills with applesauce or pudding.

Because the number of drugs described above is still limited, doctors are concerned that if children fail to take their medicines as prescribed (even missing just a few doses), the virus could eventually develop resistance to existing HIV drugs — making treatment difficult or impossible. It is then doubly important that kids take their medications as directed. One of the most important home treatment messages for any parent or caregiver that the child should take all medications consistently, at the time the prescription indicates. This can be difficult — but many HIV/AIDS family support groups and experienced medical providers can help families with practical suggestions to help them be successful with the many day-to-day challenges they face.

Many of the new medications that fight HIV infection are expensive. One of the major challenges facing individuals, families, communities, and nations is how to make these medications easily available to all that need them.

Diagnosing HIV Infections and AIDS

Every pregnant woman should be tested for HIV to have a better chance of preventing transmission to her unborn child.

If a woman knows she is HIV-infected and already has children, it is recommended that all of her children be tested for HIV. Even if she has older children and they seem healthy, they could still have an HIV infection if she was HIV-positive at the time they were born. A blood test is needed to know for sure.

However, when a new baby is born to an HIV-infected mother, there is no immediate way to know whether the baby is infected with the virus. This is because if the mother is infected, an ELISA test (which checks for HIV antibodies in the blood) will almost always be positive, too. Babies will have their HIV-infected mother's antibodies (which are passed to the baby through the placenta) even if they are not truly infected with HIV. These babies may remain HIV-antibody positive for up to 18 months after birth, even if they are not actually infected.

Infants who are not actually infected with the virus (but are born to HIV-positive mothers) will not make their own antibodies; the HIV antibodies that came from their mothers will gradually disappear from their blood before they reach 2 years of age. Any blood tests performed after this point will likely be HIV-negative. Infants who are infected with HIV from their mothers will begin to make their own HIV antibodies and will generally remain HIV-positive after 18 months of age.

The most accurate diagnosis of HIV infection in early infancy comes from tests that show the presence of the virus itself (not HIV antibodies) in the body. These tests include an HIV viral culture and PCR (polymerase chain reaction), a blood test that looks for the DNA of the virus.

Older children, teens, and adults are tested for HIV infection by an ELISA test to detect the presence of HIV antibodies in the blood. Antibodies are specific proteins that the body produces to fight infections; HIV-specific antibodies are produced in response to infection with HIV. Someone with antibodies against HIV is said to be HIV-positive. If the ELISA test is positive, it is always confirmed by another test called a Western blot. If both of these tests are positive, the patient is almost certainly infected with HIV.

How Common Are HIV and AIDS?

The first case of AIDS was reported in 1981, but the disease may have existed unrecognized for many years before that. HIV infection leading to AIDS has been a major cause of illness and death among children, teens, and young adults worldwide. AIDS has been the sixth leading cause of death in the United States among 15- to 24-year-olds since 1991.

In recent years, AIDS infection rates have been increasing rapidly among teens and young adults. Half of all new HIV infections in the United States occur in people who are under 25 years old; thousands of teens acquire new HIV infections each year. Most new HIV cases in younger people are transmitted through unprotected sex; one third of these cases are from injection drug usage via the sharing of dirty, blood-contaminated needles.

Among children, most cases of AIDS — and almost all new HIV infections — resulted from transmission of the HIV virus from the mother to her child during pregnancy, birth, or through breastfeeding.

Fortunately, medicines currently given to HIV-positive pregnant women have reduced mother-to-child HIV transmission tremendously in the United States. These drugs (discussed in detail in the Drug Treatments section of this article) are also used to slow or reduce some of the effects of the disease in people who are already infected. Unfortunately, these medicines have not been readily available worldwide, particularly in the poorer nations hardest hit by the epidemic. Providing access to these life-saving treatments has become an issue of global importance.

Causes

• Persistent generalized lymphadenopathy: This is often the earliest symptom of HIV infection after primary infection. Because of marked follicular hyperplasia in response to HIV infection, the lymph nodes have very high viral concentrations. Persistent generalized lymphadenopathy may be observed at any point in the spectrum of immune dysfunction and is not associated with an increased likelihood of developing AIDS.
• Oral lesions
  • Thrush: This can result from Candida infection and oral hairy leukoplakia, presumably due to Epstein-Barr virus (EBV) infection. It is usually indicative of fairly advanced immunologic decline, generally occurring in patients with CD4 cell counts of 200-500/µL.
  • HSV lesions: The finding of HSV lesions can also reflect deteriorating immune function in patients infected with HIV.
  • Reactivation of herpes zoster (shingles): Observed in 10-20% of patients infected with HIV infection, shingles indicate a modest decline in immune function and are often the first clinical indication of immunodeficiency.
  • Aphthous ulcers of the posterior oropharynx: These affect 10-20% of patients infected with HIV. Their etiology is unknown. These ulcers can be very painful and can cause dysphagia if left untreated.
• Hematologic
  • Anemia
    • All other causes of anemia should be excluded systematically before concluding that anemia is due to HIV infection.
    • With disease progression, patients infected with HIV develop a moderate-to-severe hypoproliferative anemia. The most common form of anemia observed in patients infected with HIV has the characteristics of anemia of chronic disease.
    • Anemia may be a complication of opportunistic infections and/or it may be due to marrow damage from the virus or from drug toxicity (eg, zidovudine, also known as azidothymidine [AZT]).
  • Thrombocytopenia
    • Thrombocytopenia may also be an early consequence of HIV infection. Approximately 3% of patients infected with HIV with CD4 cell counts greater than 400/µL have platelet counts of less than 150,000/µL. Of patients who have CD4 cell counts less than 400/µL, 10% also have platelet counts of less than 150,000/µL.
    • HIV-associated thrombocytopenia is rarely a serious clinical problem. In most cases, platelet counts remain greater than 50,000/µL and the condition can be treated conservatively.
    • Idiopathic thrombocytopenia observed in patients with HIV infection is very similar to the thrombocytopenia observed in patients with idiopathic thrombocytopenic purpura (ITP). Immune complexes containing anti-gp 120 antibodies and anti–anti-gp 120 antibodies have been found in the circulation and on the surface of platelets. Because these data point to an immunologic basis for the thrombocytopenia observed in patients infected with HIV, most of the treatments used are immune-based.
    • Another mechanism for HIV-induced thrombocytopenia is a direct effect of HIV on megakaryocytes, evidenced by a defect and subsequent decrease in platelet production.
    • In patients infected with HIV, thrombocytopenia has also been reported as a consequence of classic thrombotic thrombocytopenic purpura (TTP). This clinical syndrome, consisting of fever, thrombocytopenia, hemolytic anemia, and neurologic and renal dysfunction, is a rare complication of early HIV infection.
• Neurologic
  • Aseptic meningitis: This can be observed in all but the very late stages of HIV infection. This suggests that aseptic meningitis in the setting of HIV infection is an immune-mediated disease. Aseptic meningitis due to HIV infection usually resolves spontaneously within 2-4 weeks. Signs and symptoms may persist long-term in some patients.
  • Acute inflammatory demyelinating polyneuropathy: Through unknown mechanisms, HIV infection can mimic Guillain-Barré syndrome.
  • Mononeuritis multiplex: A necrotizing arteritis of peripheral nerves, this condition is another autoimmune peripheral neuropathy observed in patients infected with HIV.
  • Myopathy: AZT can cause myopathy; this is often reversible once the drug is discontinued. HIV infection can also cause myopathy by direct damage to the muscle cells. The exact mechanism has not yet been elucidated.