* STD Tests
* Serology for STDs (HIV, Hepatitis B and Syphilis)
* Vaginal and Urethral exudate (gonorrhea, Ureaplasma, Chlamys and Trichomonas)
* HIV Testing
* Evidence of Human Papillomavirus
AIDS (acquired immunodeficiency syndrome) is the final and most serious stage of HIV infection, which causes severe damage to the immune system.
According to the Centers for Disease Control and Prevention, AIDS begins when a person with HIV infection has a CD4 cell count (a type of immune cell also called “T cells” or “helper T”) below 200. It is also defined by numerous opportunistic infections and cancers that occur in the presence of HIV infection.
Alternative Names
Acquired Immunodeficiency Syndrome
Causes, incidence and risk factors
AIDS (acquired immunodeficiency syndrome) is the fifth leading cause of death for people between 25 and 44 years of age in the United States. About 25 million people worldwide have died from this infection since the beginning of the epidemic and 40.3 million people are currently living with HIV / AIDS globally.
The human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of potentially fatal infections and cancers.
Common bacteria, yeast, parasites, parasites and viruses that ordinarily do not cause serious disease in people with normally functioning immune system can cause fatal illnesses in people with AIDS.
HIV has been found in saliva, tears, nervous system tissue, cerebrospinal fluid, blood, semen (including pre-seminal fluid), vaginal fluid and breast milk. However, only through blood, semen, vaginal secretions and breast milk presents the contagion to other people.
The transmission of the virus occurs:
1. Through sexual contact, including oral, vaginal or anal sex.
2. Via blood transfusions (now extremely rare in the U.S.) or needle sharing.
3. From mother to child. A pregnant woman can transmit the virus to her fetus through the sharing of blood circulation or a nursing mother can transmit it to your baby through milk.
Other methods of transmission rare and include accidental needle injury, artificial insemination with donated semen, and through organ transplants.
HIV infection is not spread by casual contact such as hugging, by touching items previously touched by someone infected with the virus, during participation in sports or by mosquitoes.
It is transmitted to a person who DONATES blood or organs. Those who donate organs do not come in direct contact with those who receive it. Similarly, someone who donates blood is not in contact with the recipient. In all these procedures are used sterile needles and instruments.
However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. This is why blood banks and organ donation programs are closely screened donors, blood and tissues.
Among those in the group at greatest risk include:
* Those who have unprotected sex
* Sexual partners of people who participate in high risk activities (such as anal sex)
* Intravenous drug users who share needles
* Children born to mothers with HIV who did not receive HIV therapy during pregnancy
* Persons who received blood transfusions or blood products between 1977 and 1985 (before the establishment of standard evaluations to find the virus in the blood).
AIDS begins with HIV infection. It is possible that people infected with HIV have no symptoms for 10 years or longer, but they can transmit the infection to others during this asymptomatic period. Meanwhile, if the infection is not detected and treatment, the immune system gradually weakens, and AIDS develops ..
Acute HIV infection progresses over time to asymptomatic HIV infection and then to early symptomatic HIV infection. Later, it progresses to AIDS (defined as very advanced HIV infection with T-cell count below 200).
Most individuals infected with HIV will develop AIDS without treatment. There is a small group of patients who develop AIDS very slowly or never at all. These individuals are called patients without disease progression, and many seem to have a genetic difference that prevents the virus to attach to certain immune receptors.
Symptoms
The symptoms of AIDS are primarily the result of infections that are not normally develop in individuals with healthy immune systems. These are called opportunistic infections.
HIV exhausts the immune system of patients with AIDS, which are very susceptible to these opportunistic infections. Common symptoms include fever, sweats (particularly at night), swollen glands, chills, weakness and weight loss.
It may refer to the signs and tests section below for a list of common opportunistic infections and major symptoms associated with them.
Note: Initial infection with HIV may be asymptomatic. However, most people do experience flu-like symptoms with fever, rash, sore throat and swollen lymph nodes, usually two weeks after contracting the virus. Some people with HIV infection remain without symptoms for years between the time of exposure and the development of AIDS.
Exams and Tests
The following is a list of infections and AIDS-related cancers that people with this disease may get as their CD4 count decreases. Past, having AIDS was defined as having HIV infection and getting one of these additional diseases, but now additionally defined as having a CD4 count below 200, even without the presence of an opportunistic infection. It may have many other illnesses and corresponding symptoms besides those listed here.
Common with CD4 count below 350 cells / ml:
* Herpes simplex virus: cause ulcers or blisters in the mouth or genitals, occurring more frequently and severely in a patient infected with HIV before infection.
* Tuberculosis: infection with the tuberculosis bacteria that mostly affects the lungs but can affect other organs such as the intestines, the lining of the heart or lungs, brain or the lining of the central nervous system.
* Oral thrush or vaginal yeast infection in the mouth or genitals.
* Herpes zoster (shingles): ulcers / vesicles on an isolated patch of skin caused by the varicella-zoster virus.
* Non-Hodgkin lymphoma: cancer of the lymph nodes.
* Kaposi’s sarcoma: skin cancer, lung and bowel, associated with a herpes virus (HHV-8). This condition may occur with any CD4 count, but most likely at lower CD4 counts, and is more common in men than in women.
CD4 count below 200 cells / ml:
* Pneumocystis carinii pneumonia PCP pneumonia now called jiroveci pneumonia.
* Esophagitis Candida esophageal painful infection caused by yeast.
* Bacillary angiomatosis: cutaneous lesions caused by bacteria called Bartonella, which is usually acquired from cat scratches.
CD4 count below 100 cells / ml:
* Cryptococcal Meningitis: infection of the lining of the brain by a yeast.
* AIDS dementia: impairment and decreased mental function caused by HIV itself.
* Toxoplasmosis encephalitis: infection of the brain caused by a parasite commonly found in cat feces and causes discrete lesions in the brain.
* Progressive multifocal leukoencephalopathy: a viral disease of the brain caused by a virus (called the JC virus) that causes a rapid decline in cognitive and motor functions.
* Wasting syndrome: anorexia and extreme weight loss caused by HIV.
* Cryptosporidium Diarrhea: Extreme diarrhea caused by one of several related parasites
CD4 count below 50 cells / ml:
* Mycobacterium avium: a blood infection caused by a bacterium related to tuberculosis.
* Cytomegalovirus infection: a viral infection that can affect almost any organ system, especially the large intestine and eyes.
In addition to the CD4 count, the HIV RNA load and basic testing laboratory, regular Pap smears are important for monitoring HIV infection, due to an increased risk of cervical cancer in immunocompromised patients. Anal Pap smears to detect potential cancers may also be important for both men and women infected with HIV.
Treatment
Until now, there is no cure for AIDS. However, several treatments are available that can slow the progression of the disease for many years and improve the quality of life of those people who have developed symptoms.
Antiretroviral therapy inhibits the replication of HIV in the body. A combination of several antiretroviral drugs known as Highly Active Antiretroviral Therapy (HAART, by its acronym in English) has been very effective in reducing the number of HIV particles in the bloodstream (measured with a test called viral load), which may help the immune system to recover from HIV infection and improve T-cell counts
Although this is not a cure for HIV and that people treated with HAART with reduced levels of HIV can still transmit the virus to others through sex or sharing needles, this treatment has been greatly cash during the past 10 years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200) can be significantly prolonged and improved the life of the person. However, HIV can become resistant to HAART in patients not taking their medications on schedule every day. Currently, there is availability of genetic testing to determine whether a particular strain is resistant to a particular drug. These tests can be useful in determining the best combination of drugs and adjust the system if it starts to fail. These tests should be performed to any course of treatment failure and before starting therapy.
When HIV becomes resistant to HAART, requires a treatment of last resort to try to suppress the resistant strain of HIV. Use different combinations of drugs to try to reduce the viral load and a variety of new drugs have come on the market for treatment of drug resistant HIV.
HAART is not without complications, since it is a combination of different medications, each has its own profile of side effects. Some of these common effects include nausea, headache, weakness, malaise, and fat accumulation in the back and abdomen ( “buffalo hump”). When using these medications long term may increase the risk of heart attack, affecting the metabolism of fats, especially through increased lipid and glucose levels.
Any doctor prescribing HAART should carefully follow up on the patient for the possible effects associated with the combination of drugs administered. In addition, every 3 to 4 months, should have routine blood tests to measure CD4 counts and HIV viral load (a test that measures how much virus is in the blood). The aim is to achieve a CD4 count as close to normal as possible and reduce levels of HIV viral load to undetectable.
Other antiviral drugs are in the stage of research and many new drugs are in development. In addition, growth factors that stimulate cell growth, such as Epogen (erythropoietin) and G-CSF, used sometimes to treat anemia and low white blood cell counts associated with AIDS.
Medications are also used to prevent opportunistic infections (such as Pneumocystis carinii pneumonia) if the CD4 count is very low. This keeps AIDS patients healthier for longer periods of time. These opportunistic infections are treated to the extent that they manifest.
Expectations (prognosis)
Currently, there is no cure for AIDS is always fatal if treatment is not provided any. In the United States, most patients survive many years after diagnosis due to the availability of HAART. HAART has dramatically increased the time between diagnosis and death, and research continues in the areas of drug treatments and vaccine development. Unfortunately, medications for HIV infection are not always available in developing countries, where the magnitude of the epidemic is raging, due to socioeconomic reasons.
Complications
When a patient is infected with HIV, the virus slowly begins to destroy your immune system, but the speed of this process varies from person to person. Treatment with HAART can help slow and even halt the destruction of the immune system.
Once the immune system is severely damaged and it is said that the patient has developed AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at this stage of the disease.
Calling your health care
Call your doctor if there are risk factors for HIV infection or if symptoms of AIDS. By law, AIDS testing and results are confidential and may only be reviewed by the doctor in the presence of the patient.
Prevention
1. See the article on safe sex to learn how to reduce the chances of getting or spreading HIV and other sexually transmitted diseases.
2. Try not to inject drugs and, if they do not share needles or syringes. Today, many communities have needle exchange programs where used syringes can be discarded and can be obtained free sterile new needles. These programs can also provide referrals to addiction treatment.
3. Avoid contact with the blood of someone else when you know their status in relation to HIV. It may be appropriate to use protective clothing, masks and goggles when caring for people who are injured.
4. Anyone with positive results in the test for HIV can pass the disease to others and should not donate blood, plasma, organs or semen. An infected person should tell any prospective sexual partner about their HIV status, should not exchange body fluids during sexual activity and should use whatever preventive measures (such as condoms) will give greater protection to the couple.
5. HIV-positive women who wish to become pregnant should seek counseling about the risks to the baby and medical advances that can help prevent the fetus from becoming infected with the virus. Use of certain medications can dramatically reduce the chances of the baby becoming infected during pregnancy.
6. Women who are HIV positive should not breastfeed their babies.
7. The practice of “safe sex” such as latex condoms are highly effective in preventing HIV transmission. HOWEVER, the risk of acquiring the infection continues even with the use of condoms. Abstinence is the only sure method of preventing the sexual transmission of HIV.
The high-risk sexual behavior is unprotected anal receptive contact and lower risk of oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but is less risky than unprotected vaginal intercourse. HIV transmission from women to men is much less likely than male to female transmission. Performing oral sex on a woman who has her period presents a low risk of transmission.
HIV-positive patients who are taking antiretroviral drugs are less likely to transmit the virus. For example, a pregnant woman who is undergoing treatment at delivery with undetectable viral loads transmit HIV to her baby in less than 1% of the time, compared with about 20% if you are not using drugs.
The blood supply in the United States is among the safest in the world. Almost all people infected with HIV through blood transfusions received those transfusions before 1985, the year when HIV testing began for all donated blood. At present, the risk of HIV infection in the United States through a blood transfusion or blood products is extremely low, even in geographic areas with high HIV prevalence.
If you believe 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 the person is infected. This is called post-exposure prophylaxis (PEP) and has been used to treat health care workers injured by needle sticks to prevent the transmission end.
There is little information about the effectiveness of PEP for people exposed through sexual activity or intravenous drug use. However, if you believe you have been exposed, should discuss the possibility with a knowledgeable specialist (check local AIDS organizations to get the latest information) as soon as possible. All victims of rape should be offered PEP and should consider the risks and potential benefits in your particular case.
Consultation Venereology
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