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AIDS: Causes, incidence, and risk factors

AIDS Definition

Important facts about the spread of the disease:

  • AIDS is the sixth leading cause of death among people from 25 to 44 years in the United States, after being number one on 1995.
  • The World Health Organization estimates that more than 25 million people worldwide have died of this infection since the outbreak began.
  • In 2008, there were approximately 33,4 million people worldwide living with HIV / AIDS, including 2,1 million children under 15.
AIDS

A AIDS (Acquired Immunodeficiency Syndrome) is the final (but reversible) stage of HIV disease that causes severe damage to the immune system.

Causes, incidence and risk factors

Sarkoma's sarcoma
Sarkoma's sarcoma
Photo: ADAM

The human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a range of infections and various types of cancer that are life threatening.

Common bacteria, fungi, parasites and viruses that normally do not cause serious illness in people with a healthy immune system can lead to life-threatening illness in people with AIDS.

HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-ejaculatory fluid, which is the fluid that comes out before ejaculation), vaginal lubrication and in breast milk. However, in general, only blood, semen, vaginal secretions, and breast milk transmit the infection to others.

The virus can be transmitted:

  • Through sexual contact - including oral, vaginal and anal sex
  • By blood - via blood transfusions (currently extremely rare in the United States) or by sharing needles
  • From mother to child - a pregnant woman can transmit the virus to her unborn child circulationshared blood pressure or a nursing woman can transmit the virus to the baby through milk

Other forms of virus spread are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

HIV

HIV

HIV infection is NOT transmitted by:

  • Casual contact how to hug
  • Mosquitoes
  • Participation in sports
  • Touch objects previously touched by a virus-infected person

Syndrome and blood or organ donation:

  • AIDS is NOT transmitted to a person who DONATES blood or organs. People who donate organs to transplants They are never in direct contact with those who receive them. Similarly, a person who donates blood does not contact the person receiving it. In all these procedures, needles are used and sterile instruments are used.
  • However, HIV can be transmitted to a person who receives blood or organs from an infected donor. To reduce the risk, blood banks and organ donation programs examine donors, blood and tissues thoroughly.

People most at risk of contracting HIV are:

  • Users of drugs needles sharing needles
  • Babies born to mothers with HIV who did not receive HIV treatment during pregnancy
  • People who have unprotected sex, especially those with high-risk behavior, who are HIV positive or who have AIDS
  • Persons who have received blood transfusions or coagulants between 1977 and 1985 (before exams virus became standard practice)
  • Sex partners of people who engage in high-risk activities (such as injecting drug use or anal sex).

Symptoms

AIDS begins with HIV infection. Infected persons may not have symptoms of HIV for 10 years or more, but may still transmit the infection to others during this time without symptoms of the disease. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops.

Acute HIV infection progresses over time (usually from a few weeks to months) to an asymptomatic infection (without symptoms) and then to an early symptomatic HIV infection. It later progresses to Acquired Immunodeficiency Syndrome (advanced HIV infection with CD4 T-cell count below 200 cells / mm3).

Almost all people infected with HIV, if left untreated, develop the disease itself. There is a small group of patients who develop AIDS very slowly or who never develop it. These patients are called nonprogressors and may have a genetic difference that prevents the virus from damaging their immune system.

Symptoms are mainly the result of infections that usually do not develop in individuals with healthy immune systems. They are called opportunistic infections.

People with AIDS have had their immune systems attacked by HIV and are very susceptible to these opportunistic infections.

Common symptoms are:

  • Chills
  • Fevers
  • Sweat (especially at night)
  • Swollen lymph glands
  • Weakness
  • Weight loss

Note: Initial HIV infection may not produce symptoms. Some people, however, have flu-like symptoms such as fever, rash, pain sore throat and swollen lymph nodes, usually from 2 to 4 weeks after contracting the virus. Some people with HIV infection remain symptom-free for years between exposure to the virus and the development of the syndrome.

Exams and tests

The following is a list of the disease-related infections and cancers that people with the disease may have as their CD4 count decreases. Previously, AIDS was defined as having an HIV infection and contracting one of these additional diseases. Today, according to the Centers for Disease Control and Prevention, a person can be diagnosed as ill if they have a CD4 cell count below 200 cells / mm.3even if you don't have an opportunistic infection.

AIDS can also be diagnosed if a person develops one of the opportunistic infections and cancers that occur most often in people infected with HIV. These infections are uncommon in people with a healthy immune system.

CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells."

Many other diseases and their symptoms may develop beyond those listed here.

Common with CD4 count below 350 cells / mm3:

  • Virus herpes simplex - causes ulcers / small blisters in the mouth or genitals, happens more often and usually more severely in people infected with HIV than in people without HIV infection
  • TB - infection with the tuberculosis bacteria that affects the lungs but can affect other organs such as the intestines, the lining of the heart or the lungs, brain or lining of the central nervous system (brain and spinal cord)
  • Candidiasis oral or vaginal - yeast infection in the mouth or vagina
  • Herpes zoster (shingles) - ulcers / small blisters on a skin plate caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox (chicken pox)
  • Non-Hodgkin's Lymphoma - cancer lymph nodes
  • Kaposi's sarcoma - Herpesvirus-associated skin, lung and intestine cancer (HHV-8). It can happen with any CD4 count, but is more likely at low CD4 levels and more common in men than in women.

Common with CD4 count below 200 cells / mm3:

  • Pneumonia by  Pneumocystis carinii, “PPC pneumonia”, now called pneumoniaPneumocystis jirovecicaused by a fungus
  • Candidiasis esophageal disease - painful fungal infection of the esophagus
  • Bacillary angiomatosis - skin lesions caused by a bacterium called Bartonella, that can be acquired by cat scratches

Common with CD4 count below 100 cells / mm3:

  • Meningitis cryptococcal - brain membrane fungal infection
  • Insanity by HIV - deterioration of mental function caused by HIV itself
  • Toxoplasma encephalitis - infection of the brain by a parasite called a Toxoplasma gondii, which is often found in cat feces; causes brain damage
  • Progressive multifocal leukoencephalopathy - a disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions.
  • Wasting Syndrome - Extreme Weight Loss and Appetite Caused by HIV
  • Diarrhoea by Cryptosporidium - extreme diarrhea caused by one of the parasites affecting the gastrointestinal tract

Common with CD4 count below 50 / mm3:

  • Mycobacterium avium - a blood infection caused by a bacterium related toTB
  • Cytomegalovirus infection - a viral infection that can affect almost any organ system, especially the large intestine and the eyes

In addition to CD4 counting, an exam called HIV RNA level (or viral load) can be used to monitor patients. The basic laboratory exams and the test of Pap smear Cervical cancer is important for monitoring HIV infection due to the increased risk of cervical cancer in women with compromised immune systems. Anal Pap smears for detecting potential cancer may also be important for infected men and women, but their value has not been proven.

Treatment

There is currently no cure for AIDS. However, there are a number of treatments available that can help keep symptoms under control and improve the quality of life of people who have already developed symptoms.

Antiretroviral therapy suppresses HIV replication in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been found to be very effective in reducing the number of HIV particles in the bloodstream. This is measured by viral load (amount of virus found in the blood). Preventing virus replication can increase T-cell counts and help the immune system recover from HIV infection.

HAART is not a cure for HIV, but it has been very effective in the last 12 years. People on HAART with low HIV levels can still transmit the virus through sex or sharing needles. There is good evidence that if HIV levels remain low and CD4 counts remain high (above 200 cells / mm3), life can be extended and significantly improved.

However, HIV can become resistant to HAART, especially in patients who do not take their medications daily at the indicated times. Genetic testing is available to determine if an HIV strain is resistant to a specific drug. This information can be helpful in determining the best drug combination for each person and adjusting the drug regimen if it begins to fail. These tests should be performed each time a treatment strategy begins to fail and before treatment begins.

When HIV becomes resistant to HAART, other drug combinations should be used to try to suppress the resistant strain of HIV. There are a number of new drugs on the market to treat resistant HIV.

Treatment with HAART has complications. HAART is a combination of different medicines, each with its own side effects.

Some common side effects are:

  • Fat concentration in the back (“giba”) and abdomen
  • General malaise
  • Headache
  • Nausea
  • Weakness

When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of fat and glucose (sugar) in the blood.

Any physician prescribing HAART should observe the patient closely to detect possible side effects. In addition, routine blood tests measuring CD4 count and bloodHIV viral load should be done every 3 months. The goal is to get the CD4 count as close to normal as possible and reduce the amount of HIV virus in the blood to a level where it cannot be detected.

Other antiretroviral drugs are being investigated. In addition, growth factors that stimulate cell growth, such as erythropoietin (Epogen) and filgrastim (G-CSF or Neupogen) are sometimes used to treat anemia and the low AIDS-associated leukocyte count.

Medicines are also used to prevent opportunistic infections (such as pneumonia).Pneumocystis jiroveci) if the CD4 count is low enough. This keeps patients with AIDS healthier for longer periods. Opportunistic infections are treated when they occur.

Support Groups

Often, joining support groups where members share experiences and problems can help ease the emotional stress of devastating illness.

Evolution (prognosis)

There is currently no cure for AIDS. It is always fatal when there is no treatment. In the United States, most patients survive for many years after diagnosis due to HAART availability. HAART has dramatically increased the survival time of people with HIV.

Research on drug treatments and vaccine development continues. However, HIV drugs are not always available in developing countries, where the epidemic is most devastating.

Complications

When a person becomes infected with HIV, the virus slowly begins to destroy the person's immune system. The speed of this process differs in each individual. Treatment with HAART may help reduce or stop the destruction of the immune system.

Since the immune system is severely affected, the person has AIDS and is susceptible to infections and cancers that most healthy adults would not have. However, antiretroviral treatment can still be very effective, even at this stage of the disease.

Calling the doctor

Make an appointment with your doctor if you have any of the risk factors for HIV infection or if you develop symptoms of the disease. By law, the AIDS screening must be confidential. Your doctor will review the test results with you.

Photo: ADAM
Primary HIV infection

Prevention

  1. See the safer sex article to learn how to reduce the likelihood of acquiring or transmitting HIV and other sexually transmitted diseases.
  2. Do not use illicit drugs or share needles or syringes. Many communities now have needle exchange programs where you can get rid of used syringes and get new sterile syringes. These programs also offer referrals for addiction treatment.
  3. Avoid contact with someone else's blood. Clothing, masks and goggles may be appropriate to treat injured persons.
  4. Anyone who has a positive HIV test can transmit the disease and should not donate blood, plasma, organs or sperm. Infected persons should tell any sexual partner that they are HIV positive. They should not exchange fluids during sexual activity and should use all precautionary measures (such as condoms) to give their partner maximum protection.
  5. HIV-positive women who want to become pregnant should seek advice on risk to the fetus and methods to prevent the baby from becoming infected. Use of certain medications dramatically reduces the likelihood that your baby will become infected during pregnancy.
  6. The US Public Health Service recommends that HIV-infected women avoid breastfeeding to prevent HIV from being transmitted to their babies through breast milk.
  7. Safe sex practices, such as the use of latex condoms, are highly effective in preventing the transmission of HIV. However, there is a risk of getting the infection even with the use of condoms. Abstinence is the only safe way to prevent sexual transmission of HIV.

STDs and ecological niches

The riskiest sexual behavior is unprotected receptive anal sex. The least risky sexual behavior is to receive oral sex. Practicing oral sex in a man is associated with some risk of HIV transmission, but is less risky than unprotected vaginal intercourse.

Transmission from woman to man is much less likely than transmission from man to woman. Practicing oral sex in a woman who is not on her menstrual period has a low risk of transmission.

HIV-positive patients taking antiretroviral drugs are less likely to transmit the virus. For example, pregnant women who are undergoing effective treatment at birth and who have undetectable viral load levels transmit HIV to their babies less than 1% of the time, compared with about 20% of the time when medications are not given. used.

The US blood supply is one of the safest in the world. Virtually all people infected with HIV from blood transfusions received these transfusions before 1985, the year when HIV test in all donated blood.

If you think you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that immediate treatment with antiviral drugs may reduce the likelihood that you will become infected. This is called post-exposure prophylaxis (PEP) and has been used to prevent transmission to needle-injured healthcare workers.

Little information is available on the effectiveness of PEP for people exposed to HIV through sexual activity or injecting drug use. However, if you think you have been exposed, discuss the possibility with an informed specialist (consult your local AIDS organization for the latest information) as soon as possible. Any rape victim should have access to PEP and consider its potential risks and benefits.

Taking up references

Piot P. Human immunodeficiency virus infection and acquired immunodeficiency syndrome: A global overview. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 407.

Del Rio C, Curran JW. Epidemiology and prevention of acquired immunodeficiency syndrome and human immunodeficiency virus infection. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009: chap 118.

Sterling TR, Chaisson RE. General clinical manifestations of human immunodeficiency virus infection (including acute retroviral syndrome and oral, cutaneous, renal, ocular, metabolic, and cardiac diseases). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009: chap 121.

Updated 9 / 6 / 2011 by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, ADAM, Inc.

All diseases

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The information provided here may not be used during any medical emergency or for the diagnosis or treatment of disease. A licensed physician should be consulted for the diagnosis or treatment of all diseases. Call 192 in case of medical emergencies. Links to other sites are provided for information only and do not constitute an endorsement of them. 1997- 2011 ADAM, Inc.

Soropositive Editor's Note.Org: Although Superinteressante magazine has put on its cover, in bold letters the headline that makes me consider it a brown magazine, “Anyway the cure for AIDS”, this cure is not so close and in a few days I will put here a picture of all my monthly medicine dosage.

MAs give something around 15 tablets a day plus two injections. This disease does have treatment, but it requires spartan discipline where an error can result in calamity and a calamity resulting in death! Do not be silly, if you are going to have a sexual relationship, even if it is with someone very beautiful and who "does not look", remember. Who sees man, doesn't see AIDS.

If you need to talk and couldn't find me or Beto Volpe, this is a much more balanced option, Beto, you can also send your message. Maybe I can take a while. I check the messages at noon, shortly after, in fact, at 20:00.
It's getting harder and harder for me, this whole thing, to type.
And I end up needing an interval between one paragraph and another.

But be sure of one thing I learned:

Time and patience solve just about everything!
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