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What is AIDS?
How common is AIDS?
How is AIDS transmitted?
What should you do to prevent getting and spreading AIDS?
What are the symptoms of AIDS?
References

What is AIDS?
AIDS (Acquired Immuno-Deficiency Syndrome) is an infection caused by Human Immunodeficiency Virus (HIV). The virus exists in two distinct forms, HIV-1 and HIV-2. HIV-1 causes AIDS in the United States, Europe and Central Africa, while HIV-2 is common in West Africa.

Specific tests for available to detect both HIV-1 and HIV-2.

HIV is a retrovirus belonging to the group Lentiviridae

The AIDS virus uses special mechanisms to attack the immune system and the central nervous system (brain and spinal cord). AIDS patients thus suffer from severe immunodeficiency and have a variety of central nervous system disorders.

This virus cannot be transmitted by casual personal contact in the house, workplace or school. The modes of transmission of this virus are discussed below.

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How common is AIDS?
India AIDS cases detected in India up to 29th February 1996. 1

Males               -           1881
Females            -           631
Total                -           2512

World By 1987, 70-80 per cent of adult hemophiliacs in Europe and USA had become seropositive for HIV1.

HIV infection or AIDS is a global health problem and affects virtually every country in the world. As on January 1997, according to WHO reports, the total number of people having AIDS is approximately 22 million, out of these 1 million are children. The global projection by the year 2000 is about 40 to 100 million cases.

Children – It is estimated that in 1996, of 1.5 million people who died of AIDS globally, 350,000 (23%) were children below 15 years of age. About 400,000 children became infected with HIV during the same period. Of the 23 million people worldwide living with HIV, 8,30,000 (3.6%) are children.2

Asia (including  India)

As on Nov 1996 (WHO) the total number cases were 53,974.

How is AIDS transmitted?

As explained above, AIDS cannot be transmitted by casual personal contact. The only modes of transmission of HIV are:

Sexual Transmission
Sexual Transmission is clearly the most important mode of transmission of AIDS infection and accounts for 75 percent of cases of AIDS globally.

AIDS could be transmitted by both heterosexual and homosexual transmission.

Heterosexual transmission is the dominant mode of transmission of AIDS infection in India, Asia and Africa. Females are commonly infected this way, as sexual partners of HIV positive male intravenous drug abuses

Homosexual transmission of AIDS is another mode of sexual transmission and occurs when a male has anal intercourse with another male. As this virus is carried in the semen, if one male is already having AIDS, the second male contacts this disease. This mode of transmission is more common in Europe and United States as compared to Asia and Africa.

Parental transmission or transmission via needles and blood products

Intravenous (IV) drug abusers
These comprise an important group in the chain of transmission of HIV. Drug abusers usually inject a variety of substances into the blood and often use or share the same needle. If any one of the drug abusers has HIV, this virus is transmitted to all those who use the same syringe and needle. Also as the drug abusers get infected and they pass this infection to their spouse. Thus a male drug abuser who has AIDS can infect his wife, she in turn infects the children born after she has contracted AIDS. Thus the whole family could be involved, if either the husband or wife abuses drugs. The children born before the wife is infected will not develop AIDS by mother to child transmission; only those children born after the wife’s infection acquire HIV from their mother. This is discussed in detail below (mother to infant transmission).

Transmission of AIDS by transfusion of blood or blood products
This occurs when infected HIV positive blood is transfused into a normal patient. Many blood products in common use today such as platelet concentrates, factor VIII concentrate, etc. also can transmit the virus. Therefore it is important to screen all blood for presence of HIV before transfusion is given. All blood banks now implement various methods to prevent HIV transmission by this route, including:

  • Screening of all blood and donated plasma for antibody to HIV
  • Heat treatment of clotting factor concentrate
  • Screening of donors for history of drug abuse, sexual contacts and blood transfusions. All donors should undergo HIV testing
  • All blood given for donation should be HIV free and carry such labels. Blood not carrying such labels of being HIV negative should be rejected.
  • Sharing of transfusion needles sets should never be done and once blood is transfused the transfusion set and needle should be destroyed.

Mother to infant transmission

This is the most common cause of pediatric AIDS (AIDS in children). An infected mother who is HIV positive can transmit HIV to the offspring by three methods:

  • When the fetus is in the uterus through placenta
  • During delivery as the fetus comes out in the birth canal
  • After birth via breast milk.

Accidental transmission

Accidental needle injuries: This happens for instance in a pathology lab when a sample drawn from an AIDS patient accidentally punctures the skin of a health worker carrying it. The chance of getting AIDS (seroconversion) in such a case is very low and is around 0.3 percent.

Doctor to a patient: Although the chances of transmitting AIDS to a patient from an infected physician are extremely low, it can occur if the instruments used not sterile and are infected with AIDS virus. It has been reported (1990, CDC, USA) that a Dentist in Florida passed HIV infection to five of the patients on whom he performed invasive dental procedures. Thus, strict asepsis observed during operative procedures could go a long way in preventing this extremely rare form of transmission.

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What should you do to prevent getting and spreading AIDS?
  • Do not have a sexual intercourse with a person whose HIV status is unknown. Do not have sex with a stranger. Remember it is dangerous to have sex with prostitutes, as many of them may be HIV positive.
     
  • Have sex with your wife or your husband and do not change partners
     
  • Do not abuse drugs. Do not share needles if you are a drug abuser; contact a de-addiction center if you want to stop using drugs.
     
  • Use condoms if you want to have sex. This decreases the chances of AIDS, and other sexually transmitted diseases. Safe sex is the best way to protect yourself from AIDS.
     
  • If you are a drug abuser and you are HIV positive, do not have sex with your spouse, as he or she would also contract the disease. Remember AIDS is a fatal disease and the best way to control this disease is to prevent it.
     
  • If you are mother who is HIV positive, consult your doctor on the issue of having babies. Your baby can have AIDS and consult your doctor on prevention. Aids id a difficult disease to cure.
     
  • Never use blood for transfusion unless HIV status is not clear; use only HIV-1 and HIV-2 negative blood for transfusion.
     
  • Never share transfusion sets for blood transfusion; destroy all transfusion sets or needles once they have been used. This is important in hospitals, nursing homes and private clinics.
     
  • Destroy all needles once they have been used (for injections, to collect samples or used for blood transfusion). Insist that the needles be destroyed in needle crushers in hospitals and nursing homes. (and see to it that they are done!)
     
  • Health professionals:
    • Always wear gloves when you are handling HIV infected blood
    • Destroy needles, transfusion sets, slides, and HIV infected bottles. It is best to burn or incinerate infected products.
    • Maintain strict aseptic standards during operative procedures.

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What are the symptoms of AIDS? HIV primarily infects a particular cell called the CD4+ T cell. As the infection becomes more widespread in the body, the number of these cells decreases. Doctors commonly use the level of remaining CD4+ cells (called the CD4+ T cell count) to assess the extent of disease. The symptoms of AIDS also roughly follow this count and staging is done accordingly.

  • Early Stage: CD4+T cell count more than 500/ml (500 cells per micro litre of blood).
  • Intermediate stage: CD4+T cell count more than 200 and less than 500/ml of blood
  • Advanced stage: CD4+T cell count less than 200/ml

Symptoms in the early stage or acute HIV syndrome

3 to 6 weeks after the primary infection with HIV (primary infection refers to the process of getting infected with HIV – an unprotected sexual intercourse, transfusion with HIV positive blood or use of infected needle by a drug abuser), the following symptoms may appear: -

  • Fever
  • Weight loss
  • Loss of appetite
  • Headache
  • Malaise and lethargy
  • Nausea and/or vomiting
  • Pain in the eyes or behind them
  • Diarrhea
  • Pain in the joints (athralgias)
  • Pain in the muscles (myalgias)
  • Pharyngitis or sore throat
  • Meningitis: inflammation of the coverings of the brain
  • Encephalitis: inflammation of the brain itself
  • Skin rashes
  • Ulcers around the mouth, anus and in vagina

Intermediate stage: (Early symptomatic Disease)

After the early phase, the patient enters a latency period for as long as 10 years during which there are no clinical symptoms. Still HIV virus would infect more and more cells in the body and rapidly increasing in number. Average CD4+ T cell count falls by about 50 cells per year.

  • Generalized lymphadenopathy: Lymph nodes throughout the body enlarge: some may become larger than 1 cm and be visible at sites like the neck, groin, armpit, etc.
     
  • Thrush: White colored raised patches appear inside the mouth on the palate. This is actually due to infection with Candida, a fungus and denotes immunodeficiency.
     
  • Reactivation of Herpes Zoster infection or shingles: The chicken pox virus (Varicella-Zoster virus) commonly affects people during their childhood, and then lies dormant in their bodies for many years after the chickenpox is ‘cured.’ The virus emerges again when the patient’s immunity falls as in AIDS and painful pustules appear on one side of the body on the abdomen, inner part of the thigh or around the eyes.
     
  • Thrombocytopenia: A decrease in the count of blood platelets to around 50,000/ml is the clinical definition of thrombocytopenia. Platelets are necessary for the clotting of blood, and as their level falls beyond 10,000/ml; the patient may bleed from the gums, bruise easily, or suffer life-threatening internal bleeding.
     
  • Aphthous ulcers or ulcers around the mouth on the lips
     
  • Condyloma acuminata or genital warts.

Advanced stage
As the defense mechanisms of the body fall even further many bacteria and other microbes seize the opportunity to set up infections in the patient whose immunity (ability to figure infection) is falling.

Various organs may be affected by AIDS:
 

Brain

TB, syphilis infections
Cancer: lymphoma, Kaposi’s sarcoma
AIDS Dementia Complex
Abscess by Toxoplasma gondii or Cryptococcus neoformans
Meningitis by Cryptococcus neoformans

Lungs

Pneumonia due to Pneumocystis carnii, Tuberculosis, Cryptococcus neoformans or Cytomegalovirus (CMV)

 
Muscles

Myopathy

Spinal Cord Myelopathy

 

Eye

Retinitis by CMV

Heart

Toxoplasma infection

Digestive System Diarrhea by sospora
belli
and Cyptosporidium Esophagitis due to CMV

 

Ear Otitis media due to Pneumocystis carnii

Genitals

Ulcers by Herpes Simplex Virus (HSV)
Syphilis due to Treponema pallidum

References

>ICMR Bulletin, 1997; 27(12): 117                                 

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