🦠 AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME)
📖 What is AIDS?
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV). 🦠 The late stage of the condition leaves individuals prone to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to slow the virus's progression, there is no known cure. 💊❌
Acquired immune deficiency syndrome—AIDS—is a very different high-mortality chronic illness from the others we have discussed till now, in at least three ways: 3️⃣
- First, AIDS is a new disease and was virtually unknown before 1980. 📅
- Second, it is an infectious disease that is caused by a virus (HIV) and is spread through the shared contact of blood and semen. 💉
- Third, AIDS is a worldwide epidemic, 🌍 its annual mortality statistics are skyrocketing, 📈 many millions of people are already infected with the virus, and the large majority of these people will probably die as a result of AIDS. Most of these people are heterosexuals who do not use drugs but live in developing countries with high rates of unsafe sex. 🚫
🌍 Origin and Prevalence of AIDS
Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century; 🌍 it is now a pandemic, with an estimated 38.6 million people now living with the disease worldwide. As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981, 💀 making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, 😢 of which more than 570,000 were children. 👶
🔬 Transmission and Risk Factors
The three main transmission routes of HIV are: 3️⃣
1️⃣ Sexual Contact 💑
Sexual activity that exposes each person's body fluids to the others is one of the leading causes of transmission across the world. 🌍 Exposure is more likely if the genital area has wounds or inflammation from a sexually transmitted disease. 🚨
2️⃣ Exposure to Infected Body Fluids 💉
This transmission route is particularly relevant to intravenous drug users and recipients of blood transfusions and blood products. 💉 Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with not only HIV, but also hepatitis B and hepatitis C. 🩸 Needle sharing is the cause of one third of all new HIV-infections and 50% of hepatitis C infections in North America, China, and Eastern Europe. 📊
The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. ✅ However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products." ⚠️
3️⃣ Mother-to-Child Transmission (MTCT) 👶
The transmission of the virus from the mother to the child can occur "in-utero" during the last weeks of pregnancy and at childbirth. 🤰 In the absence of treatment, the transmission rate between the mother to the child during pregnancy, labor and delivery is 25%. 📊
A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). 📈 Breastfeeding increases the risk of transmission by 10–15%. 🍼 This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding. ⏳
❓ What is the Difference between HIV and AIDS?
Having been exposed to HIV does not mean that the person is suffering from AIDS. 🚫 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS). AIDS is the most severe manifestation of infection with HIV. 🦠
HIV primarily infects vital components of the human immune system such as CD4+ T cells (a subset of T cells), 🧬 macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. 🛡️ When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, 🩸 cellular immunity is lost, leading to the condition known as AIDS. 💔
Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified on the basis of the amount of CD4+ T cells in the blood and the presence of certain infections. 📊
⏳ Progression from HIV Infection to AIDS
The median time of progression from HIV infection to AIDS is nine to ten years, ⏰ and the median survival time after developing AIDS is only 9.2 months. ⚰️
🎯 Factors That Affect the Rate of Progression:
Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function. 🛡️ Older people have weaker immune systems, 👴 and therefore have a greater risk of rapid disease progression than younger people. 👶 Poor access to health care 🏥 and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression. The infected person's genetic inheritance also plays an important role 🧬 and some people are resistant to certain strains of HIV. ✅
🔬 Diagnosis
In the beginning, the Centers for Disease Control and Prevention (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, 📝 and the disease after which the discoverers of HIV originally named the virus. In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per microliter of blood. 🩸
🦠 Infection and its Stages
Following exposure to the virus, HIV enters the bloodstream and begins to take up residence in the cells; this is when HIV infection occurs. 💉 People with HIV are considered to be infectious (able to transmit HIV to others) immediately after infection with the virus. ⚠️
Also, a person does not need to have symptoms or look sick to have HIV. 😷 In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if you are infected is by taking an HIV test. 🧪
1️⃣ Primary Infection (or Acute Infection)
Primary HIV infection is the first stage of HIV disease, typically lasting only a week or two, when the virus first establishes itself in the body. 🕐
Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms during this stage. 🤧 These symptoms, which usually last no more than several days, might include fevers, 🤒 chills, 🥶 night sweats, 💦 and rashes. Afterward, the infected person returns to feeling and looking completely well. ✅
2️⃣ The Asymptomatic Stage
After the acute stage of HIV infection, people infected with HIV continue to look and feel completely well for long periods, usually for many years. 😊 During this time, the only indication that you are infected with HIV is that you will test positive on standard (antibody) HIV tests 🧪 and you may have swollen lymph glands. 🔍
This means that the person looks and feels healthy but can infect other people through unprotected sex or through needle sharing—especially if he/she has not been tested and does not know that he/she is infected. ⚠️
Even though an infected person may appear perfectly healthy, 😊 HIV is still very active and is continuing to weaken the immune system during this stage. In some individuals, the virus appears to slowly damage the immune system over a number of years. ⏳ In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. 📈 This damage can be seen in blood tests before any actual symptoms are experienced. 🩸
3️⃣ Early- and Medium-Stage HIV Symptomatic Disease
When the immune system is compromised by HIV infection, many people begin to experience some mild HIV disease symptoms, such as skin rashes, 🦠 fatigue, 😴 night sweats, 💦 slight weight loss, ⚖️ mouth ulcers, 😮 and fungal skin and nail infections. 🦶 Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one's prognosis varies greatly depending on a number of factors, it is generally believed that it takes five to seven years for the first mild symptoms to appear. ⏰ These symptoms mark the early and medium stages of HIV symptomatic disease.
As the disease progresses, some individuals may become quite ill even if they have not yet been diagnosed with AIDS, the late stage of HIV disease. 😷 Typical problems include chronic oral or vaginal thrush (a fungal rash or spots), 🦠 ongoing fevers, 🤒 persistent diarrhea, and significant weight loss. ⚖️📉
These symptoms are not necessarily specific to HIV or the development of AIDS. However, they should be of concern to people who have tested positive for HIV. ⚠️ Usually, symptoms occur when the virus has already caused considerable damage to the immune system. 🛡️💔
4️⃣ Late-Stage HIV Disease (AIDS)
When immune system damage is more severe, HIV positive individuals may experience opportunistic infections (called "opportunistic" because they are caused by organisms which do not ordinarily induce illness in people with normal immune systems, but take the opportunity to flourish in people with compromised immune systems). 🦠 Some of the most common opportunistic infections include Pneumocystis carinii pneumonia (PCP), 🫁 Mycobacterium avium complex (MAC) disease, cytomegalovirus (CMV), toxoplasmosis, and candidiasis. 🦠
💊 Treatment
There is currently no vaccine or cure for HIV or AIDS. 🚫 The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called post-exposure prophylaxis (PEP). ⚕️ PEP has a very demanding four-week schedule of dosage. It also has very unpleasant side effects including diarrhea, 🚽 malaise, nausea and fatigue. 😷
Current treatment for HIV infection consists of Highly Active Antiretroviral Therapy, or HAART. 💊 This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available. HAART allows the stabilization of the patient's symptoms and viremia, 📊 but it neither cures the patient of HIV, nor alleviates the symptoms, 🚫 and high levels of HIV return once treatment is stopped. ⚠️
😔 The Psychosocial Impact of AIDS
Every epidemic arouses fear—but when so little is known about the disease except that it is so deadly, 💀 people tend to react in extreme ways to protect themselves and the people they love. 😰
In 1983, a young man in San Francisco who was diagnosed with AIDS told his housemates of his condition. 🏠 Soon after, he arrived home one evening and found that the door lock had been changed. 🔒 He knocked, but no one answered. A few days later, he found that everything in his room had been thrown out—clothes, 👕 bed linens, toothbrush, 🪥 books, 📚 curtains, carpeting, and even the wallpaper. The American news media in the mid-1980s had frequent stories of AIDS patients being fired from their jobs, 💼❌ children with AIDS not being allowed to attend school, 🏫🚫 families with an AIDS patient being driven from their homes, 🏡😢 and health care workers refusing to treat AIDS patients. 🏥❌
Although stories like these have declined in the last two decades, AIDS still arouses fear and discrimination in many people in the United States and around the world. 🌍😰 Many people still believe that AIDS patients are being punished by God for their misbehavior, ⚖️ and in some developing nations, people with HIV continue to be shunned by neighbors and medical workers. 🚫
Because of the fears about AIDS, and because the disease is often associated with homosexuality 🏳️🌈 and drug abuse 💉 in industrialized countries, AIDS patients and their families—which includes lovers 💑—often feel stigmatized. One of the first questions they consider is, "Should I tell anyone—and if so, who?" 🤔 Many with HIV infections don't even tell their immediate family. 👨👩👧👦 They worry that family, friends, neighbors, and coworkers will reject them. 😔 This may lead to their being secretive and withdrawn, thereby cutting off the social support they will need as the disease progresses. 🚫🤝
The cycles of AIDS-related diseases can arouse feelings of hopelessness and helplessness. 😞 Depression may become very severe, especially among those patients who try to cope mainly with avoidance strategies, believe their illness is punishment for past wrong-doings, ⚖️ and have been rejected by people they care about. 💔 Preventing and treating emotional distress is important because depressed HIV patients subsequently show faster disease progression and shorter survival than those who are not depressed. 📉⏳