Friday, January 30, 2009

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.

Wednesday, January 28, 2009

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.

Physical

  • Persistent generalized lymphadenopathy: During the examination, the nodes are generally discrete and freely mobile.
  • Oral lesions
    • Thrush manifests as a white exudate, often with an erythematous mucosa. Thrush is observed most commonly on the soft palate. Early lesions can also be found along the gingival border. The diagnosis is made by direct examination of a scraping for pseudohyphal elements, which are characteristic of Candida species (typically Candida albicans). Severe cases can involve the esophagus, with resultant dysphagia or odynophagia.
    • Oral hairy leukoplakia manifests as filamentous white lesions, generally along the lateral borders of the tongue.
    • HSV causes lesions. Oral and genital lesions are most common, but perianal and periungual lesions are also observed. Herpetic lesions resemble a cluster of vesicles on an erythematous base.
    • Reactivation of herpes zoster (shingles) is characterized by varicella-zoster virus (VZV) lesions that may extend over several dermatomes. Widespread cutaneous dissemination may occur, but visceral involvement has not been reported.
    • Aphthous ulcers are shallow and painful and usually affect the posterior oropharynx.
  • Hematologic
    • Anemia may be present, and the physical examination may reveal pallor.
    • For thrombocytopenia, as in other forms of thrombocytopenia, bleeding is rare, unless the platelet count falls to less than 10,000/µL. If this occurs, bleeding gums, extremity petechiae, and easy bruising are common presenting features.
  • Neurologic
    • With aseptic meningitis, patients may experience headache, photophobia, and frank encephalitis. Cranial nerve involvement may be observed. Cranial nerve VII is affected predominantly; sometimes, nerves V and/or VIII are also affected.
    • Acute inflammatory demyelinating polyneuropathy findings include weakness, areflexia, and minimal sensory changes.
    • With mononeuritis multiplex, patients develop multifocal asymmetric cranial or peripheral nerve lesions, including facial or laryngeal palsy, wristdrop or footdrop, and other neuropathic symptoms. Early in the course of HIV infection, mononeuritis multiplex is usually limited to a single nerve or a few nerves and resolves spontaneously without treatment.

History

The clinical manifestations observed for acute HIV infection are numerous, and multiple systems can be affected. The discussion below outlines the historical course and physical findings of the conditions observed in acute HIV infection. Oral lesions, including thrush, hairy leukoplakia, and aphthous ulcers, are particularly common during this stage of HIV infection.

  • Persistent generalized lymphadenopathy: Patients have a history of enlarged lymph nodes (>1 cm) involving 2 or more extrainguinal sites for more than 3 months without an obvious cause.
  • Oral lesions
    • Thrush may be present.
    • Patients may have oral hairy leukoplakia.
    • Herpes simplex virus (HSV) lesions may be present and can be painful.
    • Reactivation of herpes zoster (shingles) occurs in patients infected with HIV, with a relapse rate of approximately 20%.
    • Aphthous ulcers are shallow and painful and typically affect the posterior oropharynx.
  • Hematologic
    • Anemia may be present, and patients usually present with fatigue and malaise.
    • Thrombocytopenia may also be an early consequence of HIV infection, but typically it is not symptomatic. Bleeding of the gums, extremity petechiae, and easy bruising are common presenting features in patients with clinically significant thrombocytopenia.
  • Neurologic manifestations: These result in significant morbidity for patients infected with HIV.
    • These manifestations may be either primary (ie, due to HIV infection) or secondary (ie, due to opportunistic infections, neoplasms, or other conditions [peripheral]).
    • Opportunistic infections and neoplasms include toxoplasmosis, cryptococcosis, cytomegalovirus (CMV) infection, human T-cell leukemia virus type I infection, M tuberculosis infection, syphilis, progressive multifocal leukoencephalopathy, and primary CNS lymphoma. Secondary processes typically occur when CD4 cell counts are less than 200/µL.
    • Neurologic conditions that can occur during the acute HIV infection phase include aseptic meningitis, peripheral neuropathies (eg, mononeuritis multiplex, Guillain-Barré–like syndrome), and myopathy.
    • Aseptic meningitis can be observed in all but the very late stages of HIV infection. Patients may experience headache, photophobia, and frank encephalitis. Aseptic meningitis due to HIV infection usually resolves spontaneously within 2-4 weeks. Signs and symptoms may persist long-term in some patients.
    • Peripheral neuropathies are common in patients infected with HIV. They occur at all stages of illness and take various forms, as follows:
      • Acute inflammatory demyelinating polyneuropathy: Patients commonly present with progressive weakness, areflexia, and minimal sensory changes.
      • Mononeuritis multiplex: This is a necrotizing arteritis of peripheral nerves. Patients develop multifocal asymmetric cranial or peripheral nerve lesions, including facial or laryngeal palsy, wristdrop or footdrop, and other neuropathic symptoms.
      • Myopathy: This may range in severity from an asymptomatic creatine kinase elevation to a subacute syndrome characterized by proximal muscle weakness and myalgia.

Pathophysiology


Acute HIV infection affects the lymphatic system, skin, gastrointestinal system, genitourinary system, bone marrow, and neurological system. Clinical findings observed in acute HIV infection include the following:

  • Lymphatics - Persistent generalized lymphatic
  • Oral lesions
    • Thrush
    • Oral hairy leukocyte
    • Pharyngitis
    • Herpes simplex virus
    • Reactivation herpes zoster (shingles)
  • Dermatological - Rash
  • Hematologic
    • Anemia
    • Thrombotic
  • Neurological
    • Primary (IE, due to HIV infection)
    • Secondary due to opportunistic infections: These usually occur when CD4 cell counts are less than 200/µL.
      • Toxoplasmosis
      • Cryptococcosis
      • Cytomegalovirus infection
      • Mycobacterium tuberculosis infection
      • Syphilis
      • Human T-cell leukemia virus type I infection
    • Secondary due to neoplasms: These usually occur when CD4 cell counts are less than 200/µL.
      • Progressive multifocal leukoencephalopathy
      • Primary CNS lymphoma
    • Secondary due to other causes
      • Aseptic meningitis
      • Peripheral neuropathies (eg, mononeuritis multiplex, Guillain-Barré–like syndrome)
      • Myopathy

Mortality/Morbidity

Acute HIV infection comprises a range of diseases. Morbidity varies depending on the condition. By definition, no mortality is associated with acute HIV infection.

Race

No racial predilection is documented for patients with acute HIV infection.

Sex

Both sexes are affected with the constellation of symptoms that define the syndrome of acute HIV infection.

Age

This condition can affect patients of any age.

Background


The clinical effects of infection with human immunodeficiency virus (HIV) are diverse, ranging from an acute syndrome associated with primary infection to a prolonged asymptomatic state to advanced disease. Experts regard HIV disease as beginning at the time of primary infection and progressing through numerous stages. For most patients, active virus replication and progressive immunologic impairment occur throughout the course of HIV infection, even during the clinically latent stage. HIV disease can be divided empirically based on the degree of immunodeficiency into early stage (ie, CD4 T-cell count >500/µL), intermediate stage (ie, CD4 cell count 200-500/µL), and advanced stage (ie, CD4 cell count <200/µl).

The stage of HIV infection when CD4 cell counts are greater than 200/µL has been given a variety of names, including pre–acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Note that these 2 terms are being used less frequently.

The time from initial infection to clinical disease is highly variable, with a median time of approximately 10 years. HIV disease with active virus replication usually progresses during this asymptomatic period, and the rate of disease progression correlates directly with HIV RNA levels. Patients with high levels of HIV RNA progress to symptomatic disease faster than patients with low levels of HIV RNA.

In many patients, opportunistic diseases may be the first manifestations of HIV infection. Some patients who are otherwise asymptomatic develop persistent generalized lymphadenopathy (PGL) during this time. With few exceptions, CD4 cell counts decline progressively during this asymptomatic period at an average rate of approximately 50/µL/y. Patients with early symptomatic HIV infection have CD4 cell counts greater than 200/µL. When the CD4 cell count falls to less than approximately 200/µL, the resulting state of immunodeficiency places patients at high risk for opportunistic infections and neoplasms, thus, clinically apparent disease.

Many of the initial problems encountered while CD4 cell counts remain greater than 200/µL are not sufficiently indicative of a defect in cell-mediated immunity to be considered AIDS-defining illnesses. Some of these problems appear to be direct effects of long-standing HIV infection. Equally important is the fact that the clinical findings at the stage of disease encompassed by early symptomatic HIV infection, while indicative of a decline in immune function, are generally less predictive of overall patient status than the data obtained from serial measurements of CD4 cell counts.

The importance of AIDS symptoms


In any important area, research can really help the cause. This is especially the case when it comes to epidemics like the AIDS virus. Without the research and the developments that come from that research, the AIDS and HIV pandemic would be much worse than it already is. Many people in the world have this virus. By last estimates, there are over thirty three million people in the world who currently have the disease. That is astronomical when it comes to a terrible and deadly disease such as this. In fact, more than two million people have died from the virus so far. With the help of proper research, scientists can hopefully gain enough information on AIDS to create a cure.

Scientists have already learned a lot about HIV and AIDS through their research. In the beginning, there were a lot of misconceptions about the virus. For instance, people though that only homosexual sex or drug use spread the virus. Through great research, they've learned that this is not true. Anyone can contract or spread the disease. It isn't limited to a certain kind of person. Now that this is known, more people can protect themselves. And the more people that do, the epidemic can subside.

Through the proper research, scientists and doctors have found a lot of great treatments that can help people with this virus. While they have yet to find a cure, these medications are still very helpful. They improve the quality of the lives of the people with the illness. It also makes it harder to contract the disease from people who take the medicine. Through further research, scientists hope that they will eventually find a cure. If they do, it will likely be given to people all over the world in the form of a vaccination. This information on AIDS will be very helpful in stopping the current pandemic.

Research also does a great job of increasing the education on the subject. Often, education is the reason why the illness is so widespread. If people don't know how to protect themselves, then they will likely contract the disease and give it to others. This is evidenced by the current AIDS epidemic in Africa. Since these nations are so poor, they cannot afford to educate their population on AIDS and how it can be contracted. That is why there are so many people there who are sick with the virus. There are organizations that are working on educating people in sub-Saharan Africa, though. They work to let people know about simple ways that they can avoid getting sick, such as the use of condoms. They also supply these condoms to people in hopes that they will use them and avoid giving AIDS to others.

Without the proper research, we wouldn't have known about how to avoid getting sick with the AIDS virus. We would likely have many more people in the world who are sick. This research has helped a lot of people and it has slowed down the spread of the virus. Still, the amount of people who have the disease grows every year. With more research and education, this can hopefully be reversed.

Now you can see the importance of proper research when it comes to AIDS and HIV. The research that has already been done has had a great and positive impact on the epidemic. Hopefully, further research will help find a cure and make less people sick with the disease. That is the main goal for scientists. To help the cause, donating money often goes to the research. This money also helps people who already have the disease.

Learn more about AIDS statistics


Since AIDS and HIV have become such a problem, more and more people get sick from it. If people want to avoid getting sick, they must first learn the facts about the virus. There is a lot to be known about this illness. The more that people know about it, the better the chance of lowering the amount of people that are sick with it.

AIDS is an epidemic. This means that it is a virus or disease that has spread and infected a wide number of people. It is also a pandemic. This means that it is an epidemic that is prevalent in a large portion of the world. In this case, AIDS and HIV can be found in nearly every country in the world. As a matter of fact, there are more than thirty three million people in the world that are currently afflicted with the virus. That is a staggering number when you realize that there are six billion people in the world. That means that .5% of the world is infected with AIDS, and that number continues to grow every year.

Although most countries have a population of people infected with HIV and AIDS, the continent of Africa has by far the most. This is especially the case in sub-Saharan Africa, which consists of all of the countries to the south of the Sahara desert. In fact, three quarters of the world's HIV sufferers come from Africa. There are many reasons why this area of the world has more people infected with the AIDS virus. For starters, many scientists believe that this is where the virus originally began. While they don't know for sure, they still believe this to be the case. There is also a lack of education and medical staff in these areas.

Education does a great bit of help in relation to the AIDS in Africa. Without the right information, people don't know about the illness and how it can be contracted. They will then not protect themselves and others the way that they should. In Africa, few people use condoms. This is because they don't have much access to them, and they don't realize how important they are. Organizations are working to help teach people so that AIDS in Africa becomes much less of a problem.

There are also organizations that are sending units of medical professionals to Africa as well. These doctors and nurses are helping administer important treatments so that the chance of spreading AIDS and HIV is lessened. They also give condoms and other protection to people so that they hopefully will cease to spread the illness to others. This work is very important and is a large reason why the world population of AIDS sufferers isn't larger than it already is.

Some people don't realize how many children are infected with AIDS and HIV every year. Most know that this virus can be spread the sexual acts and through the transfer of blood. Less know about how this all affects babies. Often, children can get AIDS before they are ever born. This happens when the mother is infected with the virus. She can pass it along to her baby during pregnancy. It can also happen through childbirth. If you have AIDS, do not breast feed your baby. This is a big way that most children contract the illness. Instead, feed your new child with formula. This way, you can ensure that they stay healthy and happy.

With these AIDS statistics, you can be much more well-informed about the virus. With proper education and research, the epidemic should subside.

Treatments of HIV and AIDS


There is a lot of fear that goes along with AIDS and HIV. Since it first started to show up in the early 1980s, there has been a large amount of fear present with this epidemic. People are scared that they will get it, so they are already concerned about the various treatments. While there are plenty of scientists working to find a cure for HIV and AIDS, they haven't yet found one. Instead, medication for the illness is used as a treatment rather than a cure.

Before you worry too much about the treatment for AIDS and HIV, you must first learn about the actual virus. HIV stands for Human Immunodeficiency Virus while AIDS stands for Acquired Immune Deficiency Syndrome. Essentially, AIDS is an advanced version of HIV. There are many people who have HIV but do not have AIDS, but it can't go the other way around. If you have AIDS, then you have HIV as well.

This virus can be contracted several ways. You basically need to come into contact with certain fluids that are infected with the virus, including blood. This also applies to vaginal fluid, semen and pre-seminal fluid. For children, AIDS can be contracted through breast milk. If you have HIV and your child was born without it, you should avoid breastfeeding in order to save your child from this harmful virus.

In order to determine if you have HIV, you need to take a test. This test is administered by nurses or doctors in health clinics. They will take your blood and send it out for testing. It usually then takes a few days to a few weeks in order to find out the results. If you find out, through the use of these tests, that you are positive for the virus, you'll need to start treatment right away. With help from the treatment, HIV and AIDS symptoms can greatly diminish.

Highly active antiresonator therapy, known as HART for short, is the main way that AIDS and HIV is treated. These consist of several different drugs, commonly called a cocktail. It may take a while for your doctor to figure out what works for you. They will put you on different HAART medication combinations to see what works and what does not. Eventually, you will be taking the right amount and combination of medications that will keep you as healthy as possible.

While these medications and treatments don't cure AIDS and HIV, they do help. They can reduce the chance of your giving the virus to others. They also help you fend off any other illnesses that you could get sick with because of your hampered immune system. Your quality of life could drastically improve if you were on these medications.

Not only that, but you could live much longer on these medications. For example, if you don't go on the treatment when you have HIV, you will only live for nine to eleven more years after you were infected. If you are on the treatment, this lifespan will double. This makes a significant impact on your health and life when you are on the medications. Because of this, doctors and nurses will encourage you to do so.

If you do not have health insurance and are low on funds, you likely won't need to worrying about the cost of the medications. There are organizations and government programs out there that help people who need treatment for AIDS and HIV. Contact them once you find out that you are sick. Your doctor may even be able to help you contact the appropriate organization that can help you with this.

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, preseminal 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: pyrexia (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.

After a few years, the AIDS develops into the later stage. The person infected by AIDS can stay without any symptoms manifestation for more than nine years, but after this period the virus is very crucial and destroys the immune system. There is a good possibility of getting soft infections or showing infection effects such as: swollen lymph nodes, weight reduction, diarrhea, fever, cough and breath problems.

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.

The person infected by AIDS is more likely to develop certain cancers, but improved treatments have reduced the risk of these illnesses.

Symptoms


A doctor should be seen if any of the following symptoms persist for longer than two weeks:

  • painless swelling in the lymph nodes in the neck, underarm, or groin
  • fever
  • night sweats
  • tiredness
  • weight loss without dieting

If a patient has AIDS and symptoms of lymphoma, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, the doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.

In general, patients with AIDS-related lymphoma respond to treatment differently from patients with lymphoma who do not have AIDS. AIDS-related lymphoma usually grows faster and spreads outside the lymph nodes and to other parts of the body more often than lymphoma that is not related to AIDS. Because therapy can damage an already weak immune system even further, patients who have AIDS-related lymphoma are generally treated with lower doses of drugs than patients who do not have AIDS.

Wednesday, January 21, 2009

Intestinal Disorders


The churning action of the stomach breaks down food to help the absorption of nutrients in the small intestine. Malabsorption and diarrhea from intestinal problems are common in HIV and can result from both infectious and non-infectious causes.

Intestinal opportunistic infections are less frequent now than they were in the pre-HAART era, but people with advanced AIDS can develop Mycobacterium avium complex (MAC) or other bacterial infections of the small intestine. Cryptosporidium, a parasite which causes chronic diarrhea in people with AIDS, other parasites such as giardia and microsporidia, and some viruses can all infect the small intestine. Symptoms of small intestine infection often include upper abdominal cramping, bloating, and nausea, along with diarrhea. Stool and blood tests are necessary to check for infectious causes of diarrhea. When an infection can't be found, the diarrhea may be the result of small bowel bacterial overgrowth or HIV enteropathy -- the direct infection of the intestine with HIV. HIV enteropathy alters the lining of the small intestine, decreasing the area available to absorb nutrients. This condition may also affect drug absorption, although it's difficult to test the effects directly.

Infection in the large intestine has a distinct set of symptoms -- diarrhea with lower abdominal pain, defecating blood, or feeling the need to defecate but being unable to do so. The large intestine is a common site for infection with CMV, HSV, and bacteria like salmonella and shigella. Antibiotic therapy can alter the environment of the gut, allowing for overgrowth of the bacteria clostridium difficile in the large intestine, which causes diarrhea 3-4 times a day.

Stomach Disorders


Gastritis (inflammation of the stomach lining) is a common problem regardless of HIV status. Symptoms of gastritis include stomach pain, nausea, vomiting, decreased appetite, and, in severe cases, vomiting blood. Common causes of gastritis are non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, major health stress (patients who are sick enough to be in an Intensive Care Unit), heavy alcohol use, and infection with the bacteria H pylori. H pylori doesn't cause problems for most people who have it. And it is no more common in people with HIV than in those without HIV. But the presence of H pylori can negatively affect treatment success for people with HIV.

The breakdown of the stomach or intestinal lining causes an ulcer. Ulcers are extremely common - 10% of adults have an ulcer at some point in their lives -- and they cause dull or gnawing pain in the upper abdomen. Contrary to popular belief, ulcers occur more frequently in the small intestine than in the stomach, and they are more commonly caused by NSAIDs, excessive acid production, or H pylori infection than by stress or too much coffee. An upper endoscopy is performed to diagnose ulcers, often accompanied by specialized testing for H pylori.

HIV gastropathy, a condition caused by decreased stomach acid secretion, makes affected patients more susceptible to bacterial infections like salmonella and shigella. These bacteria would normally be destroyed by acidic stomach contents. HIV gastropathy also decreases absorption of medications that require an acidic environment, such as Nizoral (ketoconazole) and Sporanox (itraconazole), two commonly-used antifungal drugs. There is no specific test for HIV gastropathy at this time, but your healthcare provider may make certain medication adjustments if he or she suspects this condition, such as switching to other drugs that don't depend on acid for absorption.

Disorders of Esophagus


The GI tract is a long tube with one entrance (the mouth) and one exit (the anus), and problems can occur in any section on the way down. The esophagus is the part of the tube between the mouth and the stomach. The muscles of the esophagus contract and relax to propel food down. A muscular valve at the base of the esophagus closes off the stomach so that its acidic contents can't leak back up into the esophagus.

Heartburn - a burning sensation behind the center of the ribcage - occurs when stomach contents travel back up the esophagus. If you experience heartburn, it usually happens thirty to sixty minutes after eating and is sometimes accompanied by a sour taste in the mouth. Heartburn can be prevented by waiting at least three hours after meals to lie down, by elevating the head of the bed or using extra pillows in bed, and by avoiding spicy or acidic foods. Other lifestyle changes to help prevent heartburn include maintaining a healthy weight and avoiding tight belts or pants.

Frequent heartburn is a side effect of some HIV medications. It may also be a sign of esophageal reflux disease, called GERD for short. GERD can damage the lining of the esophagus and lead to other complications. Frequent heartburn should be discussed with your health care provider, as inexpensive, over-the-counter treatments are available. Further testing by your provider, including looking down the esophagus with a camera (an upper endoscopy), may be necessary if the symptoms don't go away.

Another symptom related to the esophagus is pain when swallowing or difficulty swallowing. Those symptoms should raise a red flag, especially for people with low immune function (CD4 counts less than 200), as they may be signs of a yeast infection (esophageal candidiasis), cytomegalovirus (CMV), or herpes virus (HSV), each of which requires specific therapy. Left untreated, swallowing problems can have a significant negative impact on medication adherence, nutrition, and, of course, quality of life. Treating AIDS with highly active antiretroviral therapy (HAART) helps to cure esophageal infection and to prevent future infections.

Several medications -- some used to treat HIV and opportunistic infections as well as some used to treat other illnesses and conditions -- may cause direct injury to the lining of the esophagus if the pills get stuck in the esophagus as they travel down. They should always be taken with plenty of water while you're sitting up to make sure that the medications are appropriately washed down.


Tuesday, January 13, 2009

The infection caused by the human immunodeficiency virus (HIVE infection, AIDS)

The infection caused by immunodeficiency virus (HIVE). Another name - AIDS (acquired immunodeficiency syndrome). I have in recent years the spread of epidemic in the world, is caused by human immunodeficiency virus, found in saliva and mucous discharges of patients. This is a contagious disease, developed with the hit of the causative agent in the blood, most often transmitted sexually. HIVE infection occurs and when intravenous drugs, with transfusions of blood and its products because of the non-tool, especially needles.
Destroyed by boiling the causal agent of AIDS, ether, acetone, ethanol (20%), sophomoric sodium (0.2%). For the first time the disease was detected among homosexuals and drug addicts. He even called the first "gay disease." Pain predominantly male (9 of 10). Later it was also widely disseminated among the people, having indiscriminate sex. We prove the transmission of the virus from mother to child during pregnancy and childbirth.
Symptoms and over. First, the temperature rises to 38-40S, at any time of day, there is profuse sweating, sharply reduced physical activity. At the same time, you may experience liquid stools, loss of flesh, shortness of breath, inflammatory changes in skin, hair loss, increase in lymph nodes. This may take several years. Then the patients developed various associated infections, which rarely occur in people with normal immunity. They can affect the skin, lymph nodes, eyes, the various departments of gastrointestinal tract, lungs, central nervous system. At the skin while there are various rashes (spotty, nodular, bubble, etc.), often accompanied by itch's. The difficult period of these diseases is extremely limited due to the protective forces of the body. Most of the time in patients with AIDS, there is double the current pneumonia persisted. Often occurs candidness of the oral cavity, which is spreading, resulting in a vipers the esophagi and lungs. At the oral mucosa, genital organs and perineum bubble eruptions occur. Many affects the central nervous system, eyes. Often there diarrhea, taking a rather hard, with frequent watery stools (up to 15 liters a day). The majority of patients immediately after recovery from illness infection the other begins, there is a mix of various infections.
Approximately 40% of AIDS patients develop malignant tumors. Often diagnosed at a late stage or after the death of the patient. Approximately 1 / 3 found Kapok's sarcoma, which often affects not only the skin, and lymph nodes, mucous membranes and internal organs.
Quite often infected with the virus for several years, apart from increasing the neck, or axillaries cervical lymph nodes, there are no other symptoms with further classical painting.
Human immunodeficiency virus, and the war affect the people most active age.

Scientists have found that the AIDS virus can hide in cells of human

Scientists have found that the human immunodeficiency virus ( HIVE), causes the acquired immunodeficiency syndrome (AIDS), can hide in human cells, so that the natural protective mechanisms do not notice. The statement was made by Dr. Kathleen Collins (Kathleen Collins) from the University of Michigan (University of Michigan), USA. She worked with the report on the 162 the meeting of the general microbiology (Society for General Microbiology), taking place this week at the International Conference Center (International Conference Center) in Edinburgh, UK.
Usually, the immune system reacts to the emergence of the virus (egg influenza virus), the formulation of special cells that can cope with the virus. But in the case of HIVE immune response can be formed all human life, because it evaded the virus from immune cells, making them feel part of the normal cells. Hide helps protein Neff, explains Dr. Collins. He is introduced to the part of the immune system, which is responsible for the identification of viruses and bacteria. U.S. Scientists have developed drugs that can block this action of protein Neff.
Incidentally, during the same session of the general microbiology hear the report that the AIDS virus emerged as a result of evolution. The nearest relatives of the virus, SIVA (simian immunodeficiency virus, immunodeficiency virus monkeys) living in monkeys, do not destroy the work of the immune system of their hosts. More active and destructive force of HIVE obliged all the same protein Neff.
AIDS made its presence felt recently, only 26 years ago. Journal of Mortality and Morbidity Weekly Report (departmental publication of the American Center for disease control) 5 June, 1981 published an article about a strange outbreak of pneumonia in Los Angels, USA. During 7 months, five men have been victims of a microscopic fungus Pneumatics caring, which often occurs in the human lung, but usually behaves quietly and may cause disease only in people with suppressed immunity. In addition, all patients were found cytomegalovirus, has also tended to quickly neutralized the immune system. It was clear that the five with severe immune disorders could not accidentally come together. It turned out that all the victims were members of one sex communes. Therefore, in the introductory part of the article Dr. Jim Curran suggested that the depression of immunity due to any infection, possibly transmitted through sexual contact. Since the world first learned about AIDS.

A protein "lock" the AIDS virus in human cells


American biologists discovered a protein that prevents new particles of human immunodeficiency virus (HIVE) to withdraw from the infected cells, thus preventing virus reproduction.
The study, published in the journal Nature Medicine, believe their discovery will help to create new ways to fight HIVE.
The human immunodeficiency virus that causes AIDS and other viruses, is the intracellular parasites and can not reproduce without the participation of different ways of living cell.Virus "cheat" system cells, forcing them to make viral proteins instead of their own.
Infected cells works as a kind of factory for production of viral particles - proving that at the final stage of development must reach out through the membrane infected cells.
Scientists had previously been known that most human cells contain a factor that regulates the output of viral particles, but still a factor that has not been identified.
Biologists from the Emory University Medical School (Georgia), Vanderbilt University and the Mayo Clinic have found that HIVE particle "locks" in the cell protein CAME (calcium-modulating chillingly lag ans).
This protein works in the latter stages of the life cycle of the virus, keeping Verizon in the membrane of cells. However, HIVE and developed a means of defense against CAME - viral protein Up. When Up is absent, the virus particles can not be separated from the membrane.
When researchers in the laboratory "removed" from the human cell protein CAME, they found that Up was no longer required to exit the virus particles from the cell. When the researchers introduced CAME in cells, which under normal circumstances do not prevent the entry of HIVE particles, Verizon stayed on the surface of cells.
"This study is important because experience shows that CAME - is innate defense mechanism against HIVE", - said one of the authors, Professor Paul Spinier (Paul Spearman) from Emory University.

Friday, January 9, 2009

Infections


Cytomegalovirus (CMV)
This virus family herpetologist. It can be located not only in those infected with HIVE. But a person with a healthy immune system, it either does not cause any inflammation (of symptoms) or manifest as a mild cold. CMV can be transmitted through semen, cervical secret urine. He very easily transmitted through sexual contact. People with immunodeficiency virus that can cause liver injury (hepatitis), lungs (pneumonia), gastrointestinal tract (colitis), the eye (retinues, often resulting in complete or substantial loss of vision). Because CMV is transmitted through semen and cervical secret and urine, HIVE-positive people must use a condom during any sexual contact penetrating to prevent contamination of this virus.
Not a small role in the prevention of CMV plays a compliance standard of hygiene, including the timely thorough handshaking.
Hairy leukemia
This defeat cover fabric of language, as reflected stuck wite thin hairs (similar to the raw cotton). Called Epstein-Bar virus. Leukemia does not endanger the lives of HIVE-infected, but reduces the quality of life, so how can create discomfort when eating. It is not contagious and often goes by itself .. Look-alike may be confused with candidiasis, but unlike him, leukemia does not extend further language.
Herpes simplex I and herpes simplex II
This family of viruses herpes. Manifested in the form of small bubbles in the vicinity of the mouth ( "cold") (herpes simplex I) or the anus and / or genitals (herpes simplex II). Those and other manifestations are usually held in 10-15 days, but could be renewed. It may be infected by both viruses at once. People with impaired immune systems of most do not pass, and spread on the skin to other parts of the body. The lesions are sometimes accompanied by severe itch, which poses a considerable inconvenience.
Lymph nodes
This is a long time not passing the increase in lymph nodes. Its cause is not a specific infectious agent (this is not a contagious disease). Usually, when the body is struggling with an infection the size of lymph nodes increased some what, particularly in the worst-hit areas of the body. Increased state of lymph nodes may persist up to several weeks.
In the case of HIVE infection, increasing the lymph nodes is observed through 2-6 months after infection, and remains a very long time, because the body can not "win" the infection and is in a position to fight. Sometimes lymph nodes reach a significant size, so that they can be seen.

Opportunistic infections


Opportunistic infections and diseases develop only on the background of the affected in a weakened immune system. If the immune system is working properly, the infection and the disease or do not develop or appear to not dangerous to the life form.
Against the backdrop of the defeat the immune system of HIVE can develop opportunistic infections following:
Candida
It is very common disease caused by a fungus Candida Albanians. It can infect mucous tissue throat, anus, vagina, digestive tract, but most often seen in the mouth. In the worst option mouth into the throat and further into the lungs. May grow at a reception of antibiotics, when the violation healthy flora of the human body. There is a belong raid on the mucous tissues. There is strong pain, but can create difficulties when eating.
Often occurs and vaginal candidates. Sometimes it develops in the early stages of HIVE infection, but most cases are not linked to HIVE infection. Pregnancy, diabetes, hormonal disorders, severe stress, some oral contraceptives, and strong antibiotics can lead to the emergence and development of vaginal candidates.
Cryptically meningitis
The defeat of the brain caused by Cryptograms informant. It can be found in meningitis and, rarely, in the blood. More often than not, there are the external manifestations of the disease the following: headache, visual impairment (blurred picture "), a state of constant confusion, depression, speech impediments. According to statistics, the disease affected 10% of AIDS patients.
Circumscription's
Called a parasite circumscription parvenu. Until 1976, there have been no deaths caused by a parasite that. Infection occurs if the company gets something, which had earlier contact with the faces of contaminated human or animal. Also, contamination can occur when you do not use boiled water or food, did not pass the required heat treatment. In this case, the organism into the parasite eggs. Quite often, circumscription parvenu enters the mouth through dirty hands.
After about 2-10 days after infection symptoms of infection. It can be watery diarrhea, headache, skin irritation, weak catarrh about the phenomenon. When there is severe diarrhea dehydration. In humans with normal immune systems, these symptoms are often themselves through 7-10 days. For people with immunodeficiency infection with circumscription parvenu can lead to serious violations, including threats to life.
HIVE-positive people should avoid any contact with the faces of humans and animals (generally not recommended to take home, or playing with cats or tanks under a month, or with animals suffering from diarrhea), be sure to wash your hands after using the toilet, working in the garden and other contact with the ground, meeting with many people. It also should be excluded oral-anally practice sec . Particular attention should be given water and products: water must boil immediately before use, to try to avoid any food, more than 2-W hours without being sealed packaging and are not held enough heat treatment.