HIV AIDS natural history, complications, and prognosis: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Blood]] to [[blood]] [[transmission]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Blood]] to [[blood]] [[transmission]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Transfusion]] with [[HIV]] infected [[blood]]<br> Direct contact with [[HIV]] infected [[blood]]. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Transfusion]] with [[HIV]] infected [[blood]] <br> Direct contact with [[HIV]] infected [[blood]]. | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Sexual [[contact]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Sexual [[contact]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Unprotected sexual intecourse<br> Direct contact with [[HIV]] infected body fluids such as [[semen]], vaginal and cervical secretions. | | style="padding: 5px 5px; background: #F5F5F5;" |Unprotected sexual intecourse <br> Direct contact with [[HIV]] infected body fluids such as [[semen]], vaginal and cervical secretions. | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Drug use | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Drug use | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Injection of drugs with needles or syringes contaminated with [[HIV]] | | style="padding: 5px 5px; background: #F5F5F5;" |Injection of drugs with needles or syringes contaminated with [[HIV]] | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Perinatal transmission (MTCT) | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | During pregnancy , labor, delivery or breastfeeding, mother who are HIV positive can transmit the infection to their infants | ||
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Revision as of 20:01, 6 October 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Currently there is no cure for AIDS but taking treatment dramatically increased the amount of time people with HIV remain alive. Research continues in the areas of drug treatments and vaccine development. Unfortunately, HIV medications are not always available in the developing world, where the bulk of cases now occur. Opportunistic infections and other coinfections that might be common in HIV-infected persons, such as sexually transmitted infections, can also have adverse effects on the natural history of HIV infection.
Natural history
- Antibodies are produced in the people infected with HIV by 4-6 weeks, but sometimes may take upto 3 months to develop. WIndow period is the period between the time of infection to the time when antibody test is positive. But these antibodies does not indicate protection against the disease. The process of producing antibodies is called as seroconversion. Some people manifest symptoms during seroconversion that are similar to glandular illness including swollen lymph nodes, fever, rash and pain in the joints.
- The antibodies or antigens associated with HIV are found in the urine, whole blood and saliva.
- Sero positiive individuals are those with positive blood test for HIV.
- Sero negative individuals are those with a negative HIV blood test.
Asymptomatic HIV infection
- A person who has no symptoms but is infected with HIV infection is asymptomatic . But they are infectious as they are seropositive. The asymptomatic phase is highly variable from person to person ranging from a few months to more than 15 year after primary infection.
- Asymptomatic phase is shorter in children who get infected with HIV during pregnancy, labor, delivery and breastfeeding through MTCT . A few get ill within the first week of life while most of them develop symptoms by 2 years or older.
Symptomatic HIV infection
- Symptomatic patients develop physical signs and complain of symptoms.
- CD4 count decreases and immune system weakens during this phase.
- The type of the virus and the host characteristics like general health , nutrition and immune status determine the HIV progression.
Progression
- Almost all patients who are seropositive develop HIV related diseases and end stage of HIV infection, AIDS. Opportunistic infections arise when the CD4 count is very low. HIV infection weakens the immune system of the person and hence germs which normally doesnt cause a illness in a healthy individual manifest disease in an immunocompromised individual as opporunistic infections.
- HIV co infection with AIDS is a good example of this condition.
- As the CD4 count gradually decreases, opportunistic infections can affect the lung, eyes, brain and other organs with organisms like pneumocystic carini(PCP), cryptosporidiosis, histoplasmosis and other viral , parasitic and fungal infections.
- Some types of cancer like Kaposi sarcoma caused by herpes virus 8 (HHV 8 ) can also occur as opporttunistic infection.
- The treatment and prophylaxis with anti retro viral therapy and also treatment of opportunistic infections helps to preserve CD4 cells, reduce viral load and prolong the tie of progression of symptomatic phase to AIDS.
Benefits of staging the system
- Easy to evaluate for new treatments
- Define prognosis and guide patient counselling
- Frame work for management and follow up
- Contribute to the quality of the care of individuals who are HIV infected.
HIV transmission routes
Route of transmission | Description |
---|---|
Blood to blood transmission | Transfusion with HIV infected blood Direct contact with HIV infected blood. |
Sexual contact | Unprotected sexual intecourse Direct contact with HIV infected body fluids such as semen, vaginal and cervical secretions. |
Drug use | Injection of drugs with needles or syringes contaminated with HIV |
Perinatal transmission (MTCT) | During pregnancy , labor, delivery or breastfeeding, mother who are HIV positive can transmit the infection to their infants |
Complications
HIV infection weakens patients immune system, making them highly susceptible to variety of infections and certain types of cancers.
1. Infections common to HIV/AIDS
- Tuberculosis (TB).
- Salmonellosis.
- Cytomegalovirus (CMV).
- Candidiasis.
- Cryptococcal meningitis.
- Toxoplasmosis.
- Cryptosporidiosis.
2. Cancers common to HIV/AIDS
AIDS-associated Kaposi sarcoma presents with cutaneous lesions that begin as one or several red to purple-red macules, rapidly progressing to papules, nodules, and plaques, with a predilection for the head, neck, trunk, and mucous membranes.[1]
AIDS-associated Kaposi sarcoma simulated the greatest interest as one of the first illnesses associated with AIDS. Different from the classic form of Kaposi sarcoma, Tumors usually appear on the head, back, neck, muscular palate and the area of the gingiva.
In more advanced cases, they can be found in the stomach and intestines, the lymph nodes, and the lungs. KS-AIDS was first described in 1981 by three separate groups, most notably by Robert A. Schwartz and his collaborators at the University of Arizona.[2][3][4]
To read more about AIDS-related Lymphome, click here.
3. Other complications
- A. Wasting syndrome
- B. Aortic dissection
- C. Aortitis
- C. Neurological complications
Although HIV doesn't appear to invade the neuron, it can still cause neurological symptoms such as:
- Confusion
- Forgetfulness
- Depression
- Anxiety
One of the most common neurological complications in AIDS patient is AIDS dementia complex, to read more about it, click here
- D. Stigma associated with AIDS
AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.[5] Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.[6] AIDS stigma has been further divided into the following three categories:
- 1. Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.[7]
- 2. Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.[7]
- 3. Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.[8]
Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, and intravenous drug use.
In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.[9] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.[7]
- D. Death
The strongest risk factor for excess mortality are[10]:
- Viral load more than 400 copies/mL.
- CD4 count less than 200 cells/mL.
- Cytomegalovirus retinitis.
Prognosis
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.[11] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to about 20 years.[12]
Related Chapters
References
- ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ↑ Schwartz, Robert A. (1994). "Kaposi's sarcoma presenting in a homosexual man — a new and striking phenomenon". Ariz Med. 38 (12): 902–4. Unknown parameter
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(help) - ↑ Hausen, Harald Zur (2006). "Rhadinoviruses". Infections Causing Human Cancer. Weinheim: Wiley-VCH.
|access-date=
requires|url=
(help) - ↑ Drabell, Fredrick G (2006). "Kaposi's Sarcoma and Renal Diseases". New Topics in Cancer Research. New York: Nova Biomedical Books.
|access-date=
requires|url=
(help) - ↑ "The impact of AIDS on people and societies" (PDF). 2006 Report on the global AIDS epidemic (PDF)
|format=
requires|url=
(help). UNAIDS. 2006. Retrieved 2006-06-14. - ↑ Ogden J, Nyblade L (2005). "Common at its core: HIV-related stigma across contexts" (PDF). International Center for Research on Women. Retrieved 2007-02-15.
- ↑ 7.0 7.1 7.2 Herek GM, Capitanio JP (1999). "AIDS Stigma and sexual prejudice" (PDF). American Behavioral Scientist. 42 (7): 1130–1147. doi:10.1177/0002764299042007006. Retrieved 2006-03-27.
- ↑ Snyder M, Omoto AM, Crain AL (1999). "Punished for their good deeds: stigmatization for AIDS volunteers". American Behavioral Scientist. 42 (7): 1175&ndash, 1192. doi:10.1177/0002764299042007009.
- ↑ Herek GM, Capitanio JP, Widaman KF (2002). "HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999" (PDF). Am J Public Health. 92 (3): 371–7. PMID 11867313. Retrieved 2008-03-10.
- ↑ Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C (2010). "Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors". Clin. Infect. Dis. 51 (8): 947–56. doi:10.1086/656415. PMC 2943970. PMID 20825306. Retrieved 2012-03-19. Unknown parameter
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ignored (help) - ↑ Template:Cite paper
- ↑ Knoll B, Lassmann B, Temesgen Z (2007). "Current status of HIV infection: a review for non-HIV-treating physicians". Int J Dermatol. 46 (12): 1219–28. doi:10.1111/j.1365-4632.2007.03520.x. PMID 18173512.
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