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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
HIV Infection and AIDS
What are HIV and AIDS?
HIV is the abbreviation used for the human immunodeficiency
virus. HIV is the virus that causes AIDS (acquired
immunodeficiency syndrome), a life-threatening disease.
HIV attacks the body's immune system. Normally, the immune
system produces white blood cells and antibodies that fight
viruses and bacteria. The infection-fighting cells are
called T-cell lymphocytes. Months to years after a person
is infected with HIV, this virus destroys the T-cells. When
the T-cells are destroyed, the immune system can no longer
defend the body against diseases and cancers.
When the immune system is weakened, various infections
called opportunistic infections develop. They are called
opportunistic because they take advantage of the weakened
immune system. These infections would not normally cause
severe or fatal health problems. However, when you have
AIDS, the opportunistic infections eventually cause death
because your body can no longer defend itself against them.
AIDS is the condition of the body being overwhelmed by
opportunistic infections or tumors.
How does it occur?
The AIDS virus is not spread through the air, in food, or by
casual social contact such as shaking hands or hugging. It
is passed on only when the blood, sexual secretions, or
breast milk of an infected person enter another person's
body. Spread of the virus can occur during such activities
as:
- unprotected sexual activity
- sharing IV needles
- being born to or breast-fed by an HIV-infected mother
- blood transfusions (now rare in the US because of current
screening tests).
The following groups have the highest risk for HIV infection
and possible development of AIDS:
- sexually active homosexual men
- bisexual men and their partners
- IV drug users and their sexual partners
- people who share needles (for IV drug use, tattooing, or
piercing)
- heterosexuals with more than one sexual partner
- people given transfusions of blood or blood products in
countries where the blood is not rigorously tested
- immigrants from areas with many cases of AIDS (such as
Haiti and east central Africa)
- people who have sex with anyone in the above groups
- people who have sex with an HIV-infected partner
- babies born to mothers who are HIV infected.
What are the symptoms?
The symptoms of HIV infection and AIDS are usually the
symptoms of the diseases that attack the body because of a
weakened immune system:
- fever that lasts from a few days to longer than a month
- prolonged swelling of the lymph nodes
- sore throat
- long-lasting or multiple viral skin problems, such as
herpes sores or plantar warts
- repeated, severe yeast infections in your mouth or vagina
despite treatment
- chronic muscle and joint pain
- diarrhea, especially if it lasts longer than a month
- headache
- nausea and vomiting
- enlarged spleen and liver
- loss of appetite or weight, especially loss of more than
10% of body weight.
The opportunistic diseases that most frequently affect
someone with AIDS include Kaposi's sarcoma, Pneumocystis
carinii pneumonia (PCP), tuberculosis, meningitis, and
herpes simplex infections.
How is it diagnosed?
The ELISA test is the first blood test done to see if you
are infected with HIV. If this test is positive, another
more specific blood test, usually the Western blot test, is
done to confirm the results.
Once you have confirmed positive HIV test results, you must
have a thorough medical exam. Your health care provider
will ask about your medical history and symptoms and will
examine you.
The complete medical history and physical exam includes
discussing your history of sexual practices and sexually
transmitted diseases. Your health care provider will also
ask about any history of drug abuse.
You will have some lab tests. Comparisons of the results of
your initial physical exam and lab tests with later results
can help your health care provider evaluate symptoms you may
develop in the future. It can also help your provider know
how well your medicines are working.
You will be tested for certain infections, such as
tuberculosis (TB), syphilis, and hepatitis B. These
infections can worsen rapidly when you have HIV. They also
pose a serious risk to others.
HIV-positive women should have a Pap smear according to the
schedule recommended by their health care provider (usually
every 6 to 12 months).
How is it treated?
Your treatment will depend on if it is known when you became
infected with HIV and whether you have symptoms. Your
treatment will include:
- lab tests to see how well your immune system is working,
to measure the amount of HIV in your blood, and to screen
for infections or other medical problems
- antiviral medicines, such as with the drugs zidovudine
(also called ZDV or AZT), didanosine (ddI), lamivudine
(3TC), and other protease inhibitors
- regular dental exams because people who are HIV positive
often have mouth problems, including gum disease
- preventive treatment for such diseases as:
- Pneumocystis carinii pneumonia (PCP)
- tuberculosis
- toxoplasmosis (be sure to avoid raw meat and cat
litter boxes)
- tetanus
- hepatitis B
- pneumococcal infections
- influenza (by getting flu shots)
- treatments for other opportunistic infections and tumors
as they develop.
Your health care provider will probably recommend starting
treatment with anti-virus drugs and anti-pneumonia drugs if
you are having symptoms of HIV infection. Even if you are
not having symptoms, your provider may recommend starting
treatment if:
- Your CD4+ T-cell count is below 350 cells per cubic
millimeter, or
- Your viral load is over 30,000 copies per milliliter (mL)
when using the branched DNA test, or more than 55,000
copies/mL when using the RT-PCR test.
The CD4 lymphocyte cell count is a good way to know how well
the immune system is working. (CD4 cells are a type of
white blood cell.) You should have this lab test every 4 to
6 months. When the count begins to decrease, you will need
to have the test more often.
The viral load test, measures the amount of HIV in your
blood.
Drugs such as AZT, ddI, and protease inhibitors are often
prescribed for people in both the early and late stages of
HIV infection. In most cases AZT is the first drug given.
Your health care provider may prescribe didanosine (ddI) or
dideoxycytidine (ddC) if you have side effects from AZT or
if your symptoms get worse in spite of AZT. You may start
treatment with 2 or more of these drugs, such as AZT and
lamivudine (3TC). These drugs may slow the onset of the
disease, but they are not a cure. Many new drug treatments
are being prescribed or studied.
Vision problems are often an early sign of opportunistic
infection in HIV-positive individuals. Tell your health
care provider promptly about any eye symptoms, especially if
you keep having blurry vision or a loss of vision.
Getting care in an office or clinic that uses the case
management concept of care is perhaps the most important
aspect of your treatment. This approach emphasizes team
care coordinated by a case manager. The case manager helps
you communicate with all who are caring for you. Other
advantages include:
- Up-to-date medical care will be available to you.
- Treatment of the medical and social aspects of your
illness will be brought together.
- You will have help in finding resources (medical, social,
financial).
How long do the effects last?
The full effects of AIDS may not appear until 5 to 10 years
after you are first infected with HIV. Although AIDS is a
fatal disease, life expectancy has increased as new
treatments are developed.
How can I take care of myself?
Ask any new sexual partner about his or her sexual history.
Be careful to practice safe sex, use condoms, and seek HIV
testing.
If you are in a high-risk group but have not tested
positively for HIV, see your doctor regularly. He or she
will examine you for signs of HIV-associated infections and
will recommend how often your blood should be tested for HIV
infection.
If you are HIV positive:
- Discuss your treatment with your health care provider.
- See your provider on a regular schedule to keep up to
date on new treatments.
- Contact a local AIDS support network. Your provider
should be able to help you find one.
Call or see your health care provider if:
- You have new or persistent symptoms.
- You notice a change in body function that concerns you.
- You are having side effects from your medicine.
How can I help prevent spreading the HIV virus?
If you are HIV positive, you should:
- Practice safe sex: Do not share sexual secretions and
blood in any way.
- Ask sexual partners to be tested for HIV.
- Tell your health care providers that you are HIV
positive.
In addition:
- Do not share needles for drug use, tattooing, or body
piercing.
- Do not donate blood, plasma, semen, or body parts.
To avoid passing HIV to a baby, women should talk to their
health care providers before becoming pregnant.
How can I keep up to date on treatments for HIV infection?
Researchers are learning more about HIV. As a result,
recommended treatments change often. Keeping up with these
changes can be difficult and frustrating. Two ways you can
seek up-to-date information and care are:
- Obtain health care from a case management model facility
and follow the recommended appointment schedule.
- Contact the AIDS Hotline with specific questions or to
find other resources.
The National AIDS Hotline: 1-800-342-AIDS
(1-800-342-2437), 24 hours, 7 days a week
TDD: 1-800-243-7889 (10 a.m. to 10 p.m., EST, Monday
through Friday
Spanish National AIDS hotline: 1-800-344-7432,
8 a.m. to 2 a.m., EST, 7 days a week
These hotlines are provided by the U.S. Centers for
Disease Control and Prevention.
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