What Is HIV/AIDS

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=82 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="05bfd523.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Cape Fear Regional Bureau For Community Action, Inc.</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="Cape Fear Regional Bureau For Community "><U><B>home</B></U></A></div> <div> <A HREF="id61.htm" TARGET="_top" TITLE="Frequently Asked Questions"><U><B><IMG SRC="04e0e0e0.png" border=0 width="14" height="14" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A><B>  </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14"><B>    </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14"><B>  </B><A HREF="id64.htm" TARGET="_top" TITLE="What Are Opportunistic Infections"><U><B><IMG SRC="04f0e0e0.png" border=0 width="14" height="14" ALT="next" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A></div> <div> <A HREF="http://www.capefearregionalbureauforcommunityactioninc.org/mf.htm" TARGET="_top" TITLE="http://www.capefearregionalbureauforcomm"><U><B>Click Here For Site Map</B></U></A></div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" bgproperties="fixed" background="23fd2993.jpg"> <div>  <img src="HTMLobj-318/aniGif.gif" border="0" align="bottom" width="40" height="76">  </div> <div> <B>AIDS RIBBON</B></div> </td> <td valign="top" height=398 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I><B>What Is HIV/AIDS</B></I></div> <DIV ALIGN="LEFT"></DIV> <div> <B>Acquired Immunodeficiency Syndrome</B><B> <A NAME="hivaids"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>Acquired immunodeficiency syndrome, more conveniently known as "</B><A HREF="id44_top_of_page.htm" TARGET="_top" TITLE="HIV Antibody Testing"><U><B>AIDS</B></U></A><B>," has resulted in the greatest public health concern since the tuberculosis epidemics of the early 1900's. Viral infection with the Human Immunodeficiency Virus (HIV) is the causative factor in the development of AIDS. In the vast majority of cases, HIV results in the irreversible destruction of the victim's immune system by destroying specialized white blood cells, known as T4 helper lymphocytes. Without these cells, the immune system function is greatly compromised and subject to infection with bacteria and other microbes not normally pathogenic in the healthy adult.</B></div> <bR> <div> <B>An important distinction must be made between those who are infected with the HIV virus, and those who demonstrate the signs and symptoms of AIDS. All patients with AIDS are HIV positive, but not all HIV positive patients have AIDS. People who are HIV positive can be asymptotic (and transmit the virus), whereas people with AIDS exhibit the signs and symptoms of the disease.</B></div> <bR> <div> <B>Most experts agree, it is hard to estimate the actual number of HIV infected individuals. This is due to the presence of asymptotic (not yet exhibiting the symptoms of AIDS) carriers. In the last decade, approximately 280,000 individuals have become infected with HIV. Since it's first case reports of AIDS in June 1981, state and local health departments had reported to the </B><A HREF="http://www.cdc.gov/" TARGET="_top" TITLE="http://www.cdc.gov/"><U><B>CDC (Center for Disease Control)</B></U></A><B> 179,136 AIDS cases among persons of all ages in the United States. Reports of the rate of HIV infection in inner city emergency rooms range from 4.2 to 8.9 percent.</B></div> <bR> <div> <B>In North and South America combined, there are estimates that up to 2 million people are currently infected with the HIV virus in North and South America combined. The World Health Organization estimates that 810 million adults and 1 million children worldwide are infected with the AIDS virus. By the year 2000, 40 million persons may be infected with the virus. More than 90% of these persons will likely reside in the developing countries of Africa, South and Southeast Asia, Latin America, and the Caribbean. Based on 1989 data, AIDS is the number four cause of death in males age 15-54.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* MODES OF TRANSMISSION *</B></div> <bR> <div> <B>Although HIV virus has been detected in blood, semen, saliva, tears, breast milk, and female genital secretions the major mode of transmission appears to be sexual. Oral transmission is possible, particularly with oral-genital contact in the presence of skin lesions, cuts, or sores. Transmission through kissing, or via oral contact with infected tears or other infected secretions continues to be unusually rare. Anal and penile-vaginal sex are the common modes of HIV transmission. Other modes of transmission include transplacental (infected mother to fetus), blood transfusion, organ transplant (recipient), and via infected needlestick (drug abuse or accidental exposure).</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* ORIGIN OF AIDS*</B></div> <bR> <div> <B>The exact origin of AIDS is unknown, but it is suspected to have originated in Africa. A monkey population has been shown to be afflicted with a similar immunodeficiency syndrome. Transmission to the human population may have been through an infected bite or scratch.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* HIV SEROCONVERSION *</B></div> <bR> <div> <B>In most cases, a patient will develop a positive HIV antibody test 3-6 months after exposure to the virus (sexual contact, blood transfusion, needlestick). This may be closer to 3 months for those who contract the illness via blood transfusion or contaminated needlestick, and slightly longer for those who are exposed to the virus via sexual contact. The development of a positive HIV test, or seroconversion, is usually accompanied by Iow-grade fever, malaise, and generalized lymph node swelling. For the most part, these symptoms are flu-like in nature. These symptoms will disappear, but the blood test for HIV remains positive for life. Prior to seroconversion, HIV infection cannot be diagnosed using routine laboratory testing. Furthermore, evidence suggests this group can still transmit HIV before they demonstrate a positive HIV test themselves!</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* INCUBATION TIME *</B></div> <bR> <div> <B>The incubation time of the virus is defined as the interval between actual infection (needlestick, transfusion, or sexual contact) and the development of symptoms consistent with AIDS (see below). During the incubation period of the virus the patient will undergo seroconversion (develop a positive HIV test) and eventually demonstrate signs and symptoms of AIDS. The mean incubation time is estimated at 8.23 years for adults, and 1.97 years for children under age 5.</B></div> <bR> <div> <B>The mode of HIV infection seems to be a determining factor in the actual incubation time for the virus. The range of incubation contaminated needle-sticks and blood transfusion can be several months to several years, whereas homosexual contact has an incubation range of 1 year to over 10 years.</B></div> <bR> <div> <B>A small group of individuals have been identified who contracted HIV between 1977 and 1980 and still have not progressed to clinical AIDS. From this data, it is possible there may be a subgroup of HIV infected individual's who are resistant to the development of AIDS. Further studies are pending to try to determine what factors are unique with regard to these individuals.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>*</B><A HREF="id64_oi.htm" TARGET="_top" TITLE="What Are Opportunistic Infections"><U><B>OPPORTUNISTIC INFECTION</B></U></A><B>S *</B></div> <bR> <div> <B>Patients with AIDS suffer from secondary bacterial, viral, and fungal infections that would otherwise not occur in an individual with a healthy immune system. These are known as opportunistic infections. Examples include; Pneumocystis pneumonia, oral thrush, esophagitis candida, toxoplasmosis, histoplasmosis, cytomegalovirus infection, tuberculosis, Cryptosporidium, atypical mycobacterial infection, tuberculosis, and disseminated fungal infections (candidiasis). Some forms of cancer (Kaposis sarcoma) are also more commonly seen in the AIDS patient.</B></div> <bR> <div> <B>It is important to identify certain groups with a high risk for contracting (and transmitting) this disease.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* HIGH RISK ACTIVITIES *</B></div> <bR> <div> <B>1.      HOMOSEXUAL CONTACT IN MEN (large number of infected individuals)</B></div> <bR> <div> <B>2.      INTRAVENOUS DRUG ABUSE (shared needles)</B></div> <bR> <div> <B>3.      PROSTITUTION (likely related to intravenous drug use as this population has a higher incidence of needle abuse)</B></div> <bR> <div> <B>4.      BLOOD AND BLOOD PRODUCT TRANSFUSIONS (highest risk in those who received transfusion prior to 1985, hemophiliacs and kidney dialysis patients most commonly infected)</B></div> <bR> <bR> <div> <B>5.     ANAL INTERCOURSE (recipient at greatest risk)</B></div> <bR> <div> <B>6.      UNKNOWN OR MULTIPLE SEX PARTNERS / UNSAFE SEX (promiscuity without using condoms)</B></div> <bR> <div> <B>Through intravenous drug abuse, prostitution, and, to some degree, blood transfusions, the HIV virus has spilled over into the heterosexual population and is spreading within this group. The vast majority of cases are still reported in homosexual males (60% of the total U.S. cases), IV drug abusers (22% of the total U.S. cases), and combinations of these two groups. AIDS cases from heterosexual contact alone appear to be roughly 5% of the total U.S. cases. In Africa, heterosexual transmission is the number one form of HIV transmission.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>PEOPLE WHO CARRY THE HIV VIRUS ARE INFECTIOUS AND DO NOT HAVE TO HAVE AIDS TO TRANSMIT THE DISEASE</B></div> <bR> <div> <B>Studies in Africa have shown that the chance of transmitting AIDS from an infected female to a male in a single act of vaginal-penile intercourse is less than 0.2%. It must be pointed out that venereal disease (gonorrhea syphilis, herpes, etc.) may facilitate the transfer of AIDS. The female to male infection rate jumps to 5-10% when the female (or male) has a genital ulcer (from one of the above venereal diseases). It is now known that the transmission of the virus from an infected male to a noninfected female has a greater rate of incidence than infection from infected females to males. This has been attributed to the relatively high concentration of the virus in semen and the susceptibility of the cells lining the vaginal walls. For this reason, the routine use of LATEX condoms (impenetrable) is essential.</B></div> <bR> <div> <B>Although AIDS has been identified with those who have received blood transfusions (in the past before adequate testing) the current risk of HIV virus transmission by blood transfusion, even in high-prevalence metropolitan areas, is extremely Iow. It has been estimated that the probability of a screened donor (negative test) would be a carrier of the HIV virus is 1 in 61,171 cases. In the state of Florida, one is more likely to be a victim of a lightning strike than acquiring the HIV virus through a tainted blood transfusion.</B></div> <bR> <div> <B>AIDS is expected to become one of the five leading causes of death among FEMALES of reproductive age in 1991. By the end of 1991 it will be the second leading cause of death among MEN 25-44 years of age. See U.S. mortality data in the HEALTH & DIET FILE.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> * AIDS AND THE HEALTH CARE WORKER *</B></div> <bR> <div> <B>One of the most emotionally charged issues in the AIDS epidemic has been the HIV risk to, and from, health care workers.</B></div> <bR> <div> <B>The risk of HIV transmission for a health care worker, after needlestick inoculation with HIV infected blood has been estimated to be 0.3% (3 out of 1,000 workers will become infected after a contaminated needlestick).</B></div> <bR> <div> <B>An investigation of HIV infections among patients in the practice of one Florida dentist with AIDS suggested that five patients, of the approximately 850 patients evaluated through June 1991, were infected with the HIV virus. In three other studies involving transmission of the HIV virus from infected health care workers, not a single case of transmission was identified. A precise estimate of the risk of HIV transmission from infected health care workers has yet to be determined through continued research in this area.</B></div> <bR> <div> <B>The Center for Disease Control (CDC) has estimated that several thousand individual health care workers have been diagnosed with AIDS. As of February 1993, 32 health care workers were regarded by the CDC as cases of "documented occupational transmission of HIV (contracted HIV infection from an infected patient)."</B></div> <bR> <div> <B>In summary, the risk of contracting AIDS from a health care worker appears to be extremely Iow (less than 10 total cases), although the risk of HIV infection for the health care worker appears to be substantially greater.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* THE SYMPTOMS OF AIDS *</B></div> <bR> <div> <B>Symptoms of AIDS can be quite varied. Swollen glands, weight loss, fevers, chills, headaches, excessive sweating, night sweats, unexplained fatigue, exertional cough, shortness of breath, skin lesions, mouth lesions, swollen gums, chronic diarrhea, speech impairment, memory loss, seizures, and persistent sore throat (fungal throat infection) are all seen. Symptoms will vary in accordance with the type of opportunistic infection (see above). Pneumocystis pneumonia is a common complication see in the AIDS patient.</B></div> <bR> <div> <B>HIV-Associated Conditions in Pediatric HIV Infection</B></div> <div> <B>1.      Failure to thrive</B></div> <bR> <div> <B>2.      Generalized lymphadenopathy 3. Hepatomegaly 4. Splenomegaly</B></div> <bR> <div> <B>3.      Persistent oral thrush</B></div> <bR> <div> <B>4.      Parotitis</B></div> <bR> <div> <B>5.      Recurrent or chronic diarrhea</B></div> <bR> <div> <B>6.      Encephalopathy</B></div> <bR> <div> <B>7.      Lymphoid interstitial pneumonitis</B></div> <bR> <div> <B>8.      Hepatitis</B></div> <bR> <div> <B>9.      Cardiomyopathy</B></div> <bR> <div> <B>10.      Nephropathy</B></div> <bR> <div> <B>11.      Recurrent bacterial infections</B></div> <bR> <div> <B>12.      Opportunistic infections (e.g. herpes simplex, zoster, toxoplasmosis, histoplasmosis, parasitic disease)</B></div> <bR> <div> <B>13.      Malignancies (lymphoma)</B></div> <bR> <div> <B>Evaluation will include careful history to identify potential high risk groups or exposures. Physical examination may exhibit skin lesions (Kaposis sarcoma) or the fungal throat infection that typifies this disease. The blood test for HIV will be more definitive although false positives still occur (see HIV test in the TEST FILE). The HIV antibody blood test, or ELISA (enzyme-linked immunoabsorbent assay), is a reliable initial screening test, but positive tests will require confirmation with the more sensitive western blot test.</B></div> <bR> <div> <B>Other tests to diagnose AIDS include a CD4 lymphocyte count that is less than 200, an abnormal p24 antigen, and T lymphocyte (lymphocytes from the thymus gland) count that is abnormal. Most patients will also have a CBC, electrolyte profile, urinalysis, and chest x-ray performed as part of their general evaluation.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* THE TREATMENT OF AIDS *</B></div> <bR> <div> <B>Treatment of AIDS and HIV infection is aimed at individual treatment of the bacterial and fungal infections that occur in the AIDS patient. Medications are used which seem to slow down the progression of the HIV carrier state to clinical AIDS. New medications such as "AZT" (zidovudine) and zalcitabine have been reported to decrease the progression of this disease.</B></div> <bR> <div> <B>A relatively new medication currently in clinical trials in the United States is didanosine (Videx). This is an anti-viral agent, also referred to as "DDI" that inhibits the replication of the HIV virus (responsible for AIDS). The effectiveness of this medication is still being evaluated.</B></div> <bR> <div> <B>An important part of the treatment of AIDS and asymptomatic HIV infection is a nutritious diet. Anorexia and cachexia are a major problem in the patient with AIDS and can further diminish the patient's immune response to infection. A new medication known as megestrol has been used to stimulate weight gain (primarily fatty tissue). See nutrition and the immune system in the HEALTH & DIET FILE.</B></div> <bR> <div> <B>A cure or an effective vaccine remains in the future. Antigenic drift is the major problem in the development of an effective HIV vaccine. The HIV virus has a constantly varying outer coating, making a HIV vaccine useless and "out-of-date" by the time it is developed.</B></div> <bR> <div> <B>New rapid tests for the AIDS virus are being developed and may eventually be marketed to the public. Politics and public opinion are quite influential in this area. Prevention of viral transmission remains an important factor in controlling this serious epidemic.</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>* TIPS ON PREVENTION *</B></div> <bR> <div> <B>1.     Abstinence – abstain from sex until marriage and have only one</B></div> <div> <B>         sex partner for life.</B></div> <bR> <div> <B>2.      Condom (latex only) use is the current recommendation unless between monogamous sexual partners (both negative for disease).</B></div> <bR> <div> <B>3.      Do not share personal utensils (razors, toothbrush, etc.) that could result in viral inoculation through breaks in the skin.</B></div> <bR> <div> <B>4.      Avoid casual sexual relationships, multiple partners, sexual relations with partners of unknown sexual background, and those from high risk groups (see above).</B></div> <bR> <div> <B>5.      Do not share insertive (sex) objects as they may transfer the virus through small breaks in the skin. 5. Avoid anal kissing, oral-genital sex (particularly in the presence of oral or genital sores), and anal intercourse. As a rule avoid any contact with blood, semen, urine, or feces.</B></div> <bR> <div> <B>6.      Women should not douche immediately after intercourse because this can compromise the body's natural immunity.</B></div> <bR> <div> <B>7.      Petroleum based lubricants (vaginal) can trap germs and viruses. Use water based lubricants.</B></div> <bR> <div> <B>8.      The use of spermacidal agents (with condoms) may provide additional protection from the AIDS virus. Agents which contain nonoxynol 9 as the active ingredient have been shown to kill HIV.</B></div> <bR> <div> <B>9.      Some evidence has emerged that indicates males who are uncircumcised have a higher incidence of HIV infection.</B></div> <bR> <div> <B>10.    Health care workers need to avoid any contact with potentialy              infected fluids (blood, semen, urine, or feces) by always wearing gloves (and a mask) during medical procedures.</B></div> </td> </tr></table></body>