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AIDS / HIV Causes, Symptoms and Treatment

The HIV or HIV , is a type of virus that can cause a disease called AIDS(acquired immunodeficiency syndrome). HIV infection affects the immune system, which are the body’s natural defenses against the disease. If left untreated, serious illness can occur. Normally innocuous infections, such as influenza or bronchitis, can get worse, become very difficult to treat or even cause death. In addition, the risk of cancer is also increased.

What sets HIV apart from other viruses is that it reaches the immune system by taking control of CD4 T cells. The latter role is to coordinate the immune response when a virus occurs. When HIV uses CD4 cells to spread, it damages and destroys them. In so doing, HIV undermines the immune system from within, which has the role of fighting it (see diagram).

Transmission

HIV is transmitted through body fluids: blood , sperm , vaginal secretions and breast milk . These body fluids only transmit HIV if they come into contact with an area that allows it to enter the body, a mucous membrane. Healthy skin is impervious to HIV.

Most often, the virus is contracted during unprotected sexual activity or in the past by the exchange of needles among injecting drug users. The risk of transmission through kissing with saliva exchange is zero.

In most industrialized countries, sex-to-male intercourse is the most important route of HIV transmission. However, heterosexual transmission has increased significantly since the beginning of the epidemic.

HIV cannot be transmitted in the following ways  :
It cannot be contracted by shaking hands, sweat or tears. It is not carried by insects. It is not contracted on toilet seats, swimming in public swimming pools, sharing food or using the linen, towels or telephone of an infected person.

The epidemic

  • In North America, the first signs of the epidemic emerged in the late 1970s. Men who have sex with men (MSM) were the first to be affected;
  • The HIV virus was isolated in 1983;
  • The first antiretroviral treatment , AZT, was discovered in 1987. Triple combination therapy , which was much more effective, became available in the mid-1990s, and increasingly powerful antiretroviral therapy (ART) suggests that an HIV-positive young adult who starts treatment quickly will be able to live to age 80 or older. With these treatments, we often arrive at an undetectable viral load, even if the virus is still not eradicated from the body.
  • Around 35 million people around the world are living with HIV today. Two-thirds of them live in sub- Saharan Africa.
  • In North America, 1.3 million people are living with HIV in Western and Central Europe, 840 000, and in Sub-Saharan Africa 22.9 million.
  • In France, 150 000 people live with HIV so 50 000 are not followed and therefore not treated.
  • The number of people with HIV is increasing worldwide, with 2.5 million new infections per year and 1.5 million deaths. This is due to the considerable improvement in the effectiveness of the treatments.
  • Approximately 7,000 HIV-positive discoveries in France (2012 figures) , nearly half of them among men who have sex with men (MSM), and 3,000 AIDS deaths in the year.
  • In Canada, 71,300 people were living with HIV in 2011. There are an estimated 3175 new infections in 2011. However, this underestimates the actual number of cases as it is estimated that 25% of Canadians living with HIV are unaware of it.

HIV-AIDS, a sickness better and better

We know today that a well-groomed HIV-positive person presents an extremely low risk of transmitting HIV during sex, under certain conditions:
– The treatment is taken regularly,
– It causes an undetectable viral load (or viral load under the threshold of 50 copies / ml in the plasma for more than 6 months and at the last most recent test),
– The measurement of the viral load is done regularly, at least every 3 or 4 months

– Both partners do not have a sexually transmitted infection.

No treatment is currently a cure for AIDS or eliminates HIV from the body, even when it becomes undetectable by tests. This does not mean that the virus is eradicated from the body. That said, with the right treatments, an HIV-positive person can now live a long time. HIV infection has become a chronic disease. HIV-positive people, however, remain susceptible to HIV transmission throughout their lives, especially if they are not well treated.

Untreated, HIV infection causes AIDS and eventually leads to death . With HIV infection becoming better and better, some at-risk populations are slowing down their prevention efforts.

Evolution of infection to AIDS

  • sty stage – primary infection . In the weeks following infection, about one-third of those affected have symptoms similar to influenza or mononucleosis: fever, headache, sore throat, redness on the skin, fatigue, muscle aches, etc. . These symptoms disappear on their own, even without treatment.
  • th stage – asymptomatic infection . The virus can live in the body for many years without causing symptoms. The person may feel that they are not sick, but is likely to transmit HIV. The seroconversion  – when an HIV-negative person (no antibodies in the blood) becomes HIV positive(presence of antibodies in the blood) – occurs during this phase, 1 to 3 months after infection.
  • 3  Phase Phase AIDS (acquired immunodeficiency syndrome) or symptomatic infections . If left untreated, the person experiences one or more symptoms of HIV infection (fatigue, diarrhea, swollen glands, weight loss, night sweats, fever, etc.).
  • th stage –  If the number of immune cells (CD4 T cells) becomes is very low and the body can no longer fight against infections or other diseases, diagnosis of AIDS is made. The symptoms of the infection become more apparent and constant. In addition, opportunistic infections can cause significant health problems. Opportunistic infections are infections that are usually not serious, but become so in people with very weak immune defenses. Opportunistic diseases include candidiasis, pneumonia, tuberculosis, herpes infections, and cancers (including lymphoma and Kaposi’s sarcoma ).

Note . Research has shown that cardiovascular disease is more common in people with HIV because their body is subject to a higher degree of inflammation . Inflammation is known to contribute to the formation of plaques in the artery walls, which may impede blood circulation. In addition, cases of cognitive degeneration (eg, Alzheimer’s disease) related to HIV infection have also been reported.

The fact that HIV directly takes control of the immune system makes it particularly dangerous. To find out how the virus manages to enter and multiply in the immune cells called CD4 T cells, use our interactive diagram (at the top of the page).

The symptoms of AIDS (HIV)

sty phase or primary infection. The symptoms resemble those of influenza or mononucleosis and are present in about one in two cases. Primary infection can go unnoticed. At the time of onset, the person newly contracted HIV poses a particularly high risk of transmitting the virus, because the number of viruses present in the body (viral load) is particularly high. These symptoms persist for 1 week to 1 month, then disappear.

  • Fever;
  • Headache ;
  • Sore throat ;
  • Redness on the skin;
  • Tired ;
  • Muscle and joint pain.

2  phase or asymptomatic phase. The HIV-positive person has no symptoms, even though the virus attacks the immune system mute (no symptoms).

th phase or AIDS phase. The symptoms appear because the immune system is overwhelmed by the virus. Some symptoms become more frequent, persistent and sometimes chronic, for example:

  • Fever;
  • Night sweats ;
  • Significant weight loss;
  • Swelling of the ganglia;
  • Persistent diarrhea;
  • Skin infections;
  • Persistent dry cough;
  • Shortness of breath.

At this stage, opportunistic diseases appear. Due to the weakening of the immune system, various diseases can occur, particularly infectious diseases or cancers. We talk about opportunistic diseases. This phase occurs on average 10 years after the primary infection.

People at risk for HIV / AIDS 

  • People living in a country or from a country where HIV infection is widespread (for example, sub-Saharan Africa and the Caribbean);
  • Children born to an HIV-positive mother who has not been treated. The virus is likely to be transmitted during pregnancy or delivery, but also during breastfeeding;
  • People in jobs that expose to blood or other body fluids (health professionals, police officers, firefighters, etc.);
  • People who received a blood or blood product transfusion or organ transplant from 1979 to November 1985 (when the HIV test was developed).
  • People with unprotected sex with multiple partners.
  • Men having sex with men. It is a population in which the number of cases of HIV transmission increases while it tends to decrease in the rest of the population (INVS). The risk of contracting HIV is 200 times higher for these men than for men who have only heterosexual sex.

Risk factors

Here are the risk behaviors.

  • Have  unprotected sex  with someone who is infected with HIV. This includes vaginal or anal sex without condoms (condoms) and oral sex without condoms (condoms). People who have mouth ulcers (cold sores) or sexually transmitted infections such as gonorrhea, syphilis, genital herpes, etc., are more likely to contract or transmit HIV.
  • Having sex with  multiple partners , with a partner who has or has had multiple partners, or with a partner who consumes or has used   intravenous drugs and has practiced needle exchange.
  • Share syringes for  injecting drug users .
  • Get  tattooed  or ”  pierced  ” with equipment that is not for single use or non-sterile.

HIV / AIDS prevention

Screening measures
How is HIV diagnosed?

HIV testing can only be done with the consent of the person being tested. It must therefore be aware.

The HIV test is to detect the seropositivity, that is, the presence of anti-HIV antibodies in a blood sample. The reference method used is the combined ELISA test, performed from a blood test . This test is reliable as early as 6 weeks after taking a risk for HIV transmission. Because of the risk of false positives (positive result in the absence of HIV in 0.5% of cases), in case of a positive result this test must be completed by another test, the Western Blot.

There is also a rapid screening test or TROD (Rapid Diagnostic Orientation Test for HIV) , carried out in some anonymous and free testing centers or in associative sites in France and in medical practices, clinics and hospitals in Canada. The result of this test is reliable three months after taking a risk for HIV transmission. The result is obtained in 20 to 30 minutes. If this test is positive, it must be confirmed by a standard test performed in an analytical laboratory or an Anonymous and Free Screening Center (CDAG)

In case of a positive test, it is advisable to contact Sida Info Service at 0 800 840 800 (Anonymous and free) for support and explanations by trained professionals.

Who should be tested?

– People who have been in a situation at risk of contracting the virus;
– People whose symptoms may be due to HIV infection (to be discussed with a doctor);
– All women before starting a pregnancy or from the beginning of the pregnancy in order to put in place a treatment avoiding transmission to the unborn child.
– People donating tissues, sperm, milk, and organ are routinely screened.
– People who are in a good relationship and want to stop using condoms, making sure that they are not HIV-positive.
– And everyone can get tested because 30-50% of people with HIV do not know. However, it is people who are at the origin of transmissions. So do not hesitate to ask for a screening if you have never done so.

When to take the test?

The best time for a reliable HIV test is 3 months after you think you have taken a risk of HIV exposure.

 

Basic preventive measures
For HIV-negative people who do not have HIV.

  • Use condoms (condoms) for all sexual intercourse regardless of the modality (vaginal, anal, and oral). Petroleum-based lubricants can damage condom rubber (condoms): use only water-based lubricants;
  • Do not exchange sex toys;
  • Do not share your toothbrush, razor, file or any other personal item that may be in contact with blood;
  • For injection drug users, do not share syringes or injection equipment.

For HIV-positive people

  • Use condoms (condoms) for each sex (oral, vaginal and anal). Thus, not only will HIV not be transmitted to the partner, but it will also prevent you from being exposed to HIV . Re-contracting HIV can aggravate the existing infection and accelerate progression to AIDS. Plus protecting yourself helps reduce the risk of getting a sexually transmitted infection(ITS). HIV-positive people have an increased risk of contracting sexually transmitted infections (STIs) and this can be more difficult to treat. Under certain circumstances, in case of zero viral load for a moment and closely followed by the examinations, in case of absence of STI (sexually transmitted infection) of you and your partner, and of taking regular treatment, the doctor can allow not to use a condom.
  • Do not share needles or devices associated with drugs;
  • Do not share your toothbrush, razor, lime, or any other personal item that may carry traces of blood;
  • Cover all wounds with a bandage;
  • Clean any area contaminated by your blood with bleach (1 part bleach to 9 parts water);
  • Do not give blood, organs or semen for artificial insemination;
  • If you are pregnant, you should receive immediate treatment that will prevent the child from being infected with HIV.
  • If your partner has been exposed to HIV, see a doctor as soon as possible, within 72 hours. Preventive treatment may be given (“post-exposure prophylaxis”).

Note . Researchers are working to develop a vaccine that would prevent HIV infection. However, the barriers are numerous and cannot be expected to be available until 2020. It is very difficult to find molecules that completely neutralize the virus at its site of entry. In addition, HIV often mutates, that is, its genes change and therefore the duration of action of the vaccine can be very limited.

That said, some researchers believe that research for the vaccine should not obscure the progress: knowing that with effective treatment resulting in undetectable viral load, HIV-positive people are almost no longer at risk of transmission … it would be enough to treat ALL HIV-positive people so that the epidemic goes out in about forty years. This means that rich countries must help the most affected countries to work together to eradicate this virus. It also implies that screening is better deployed to treat each HIV-positive person quickly and to let as few people as possible get through the cracks of screening.

Other measures to delay the onset of AIDS and prevent opportunistic diseases
  • To support the body and the immune system, it is recommended to have healthy lifestyle  : eat well, exercise, get enough rest, do not smoke, have a moderate consumption of alcohol etc. Emotional and spiritual support also helps to cope with stress. Since life expectancy with HIV has increased dramatically over the past 30 years, physicians are placing even greater emphasis on the importance of taking care of one’s health. To learn more, consult our fact sheet Strengthen your immune system .
  • Several vaccinations may be indicated, depending on the case (against pneumococci, influenza, tetanus, diphtheria, hepatitis A and B, etc.) Despite the immune depression and less effective, it is possible to vaccinate an HIV-positive person with a vaccine that does not contain a live infectious agent, that is, no bacteria or virus. Vaccines containing a virus or live bacteria with attenuated virulence are most often against indicated (eg chicken pox, tuberculosis, yellow fever, measles, mumps …) It is up to the doctor to determine useful and beneficial vaccines.
  • In order to avoid foodborne infections and intoxications, people living with HIV / AIDS should be particularly cautious and avoid certain raw foods (eggs, poultry, rare meat and tartar, fish and seafood) as well. than unpasteurized dairy products.
  • Great caution is also needed with pets or others, which can lead to serious opportunistic infections. Wash hands thoroughly after touching animals.

Medical treatments for AIDS / HIV

Warning ! HIV-positive people should at all time take precautions to avoid transmitting HIV. We know that this is the case because people who disseminate HIV in the population are essentially those who do not know their HIV status, hence the importance of screening.

None of these treatments cure the disease , but thanks to them, the majority of people with HIV can live very long. In addition, the side effects of drugs are less troublesome than before.

The treatments against HIV / AIDS have two main components: the immediate treatment with antiretroviral therapy (ART) and the opportunistic diseases.

Antiretroviral treatment (ART)

HIV is usually treated with highly active antiretroviral therapy (HIV being a retrovirus), a potent combination of at least 3 drugs . These antiretrovirals slow the progression of HIV by attacking the virus to minimize the viral load , which is the number of viruses (HIV) in the blood.
The price of this ART has fallen considerably, reaching 139 to 172 dollars per year per person in 2013, or even less for countries purchasing large quantities. This allows less wealthy countries to better treat their HIV-positive inhabitants. However, this price is that of treatments called front-line treatments. In case of resistance to treatment, there are second-line treatments that are much more expensive and often difficult for everyone to access, particularly in countries without a public or private health insurance system.

There are several  classes of antiretroviral drugs , and several slightly different molecules in each of them.

  • Nucleoside reverse transcriptase inhibitors  (NRTIs) (AZT or zidovudine) are part of this class of drugs, or abacavir, d4T or stavudine, ddI or didanosine, 3TC or lamivudine
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs); for example, nevirapine, delavirdine and efavirenz, rilpivirine, etravirine.
  • Protease inhibitors ( PIs); such as saquinavir, atazanavir, arunavir, lopinavir-ritonavir, nelfinavir, ritonavir, tipranavir.
  • Inhibitors of entry and fusion . Used later in the disease, when the patient has already taken several other drugs; for example, enfuvirtide or T20.
  • Inhibitors of integrase . Used later in the disease, when the patient has already taken several other drugs. dolutegravir, raltegravir.
  • CCR5 receptor inhibitors, such as maraviroc.

The treatment is adapted to each person and it is a combination of several drugs. The goal of the treatment is to obtain in 6 months an undetectable viral load.

Most people are treated with a combination of three drugs, and there are several possible choices depending on the effectiveness, immediate or long-term tolerance, the living conditions of each …

To be effective, the treatment must be followed to the letter, that is to say that you must take the tablets every day at the times prescribed by the doctor , and therefore be ready to adapt his lifestyle. Many of these medications are now available in a single daily dose. The adherence is extremely important because it also prevents the emergence of drug resistance (if the dosage of a drug drop in the body, it increases the risk that the virus changes or mutates to “survive”).

In addition, we must find the best possible balance between the effectiveness of the treatment and the maintenance of a good quality of life. The side effects of drugs can be important: fatigue, headache, loss of appetite, rash, diarrhea, etc.

The unique tablets have emerged (eg Atripla, Eviplera or Stribild combining 4 molecules). Instead of taking 3 or 4 antiretroviral drugs, for example, they are combined into a single tablet, taken once a day.

Note . Researchers are working to create “therapeutic vaccines” that would help the immune system fight infection and this research is advancing as clinical trials are underway. The goal of these vaccines will be to boost the immunity of HIV-positive people to help their bodies fight HIV and opportunistic diseases.

Prevention and treatment of AIDS-related opportunistic diseases

When one is HIV-positive, it is necessary to undergo regular examinations to detect certain diseases at their early stage. You also need to receive certain vaccines and take medication to prevent frequent infections in people with HIV / AIDS. If an opportunistic infection occurs, the doctor may recommend continuing treatment even after healing to prevent recurrence.

In case of cancer, chemotherapy or radiotherapy is used.

Other

Deficiencies of vitamins and minerals are more common in people with HIV. Some medicines can cut appetite, and fighting the virus requires more energy and nutrients. According to scientific studies, these deficiencies may accelerate the progression of infection to AIDS. This effect was especially noticed in a disadvantaged environment. Many health professionals believe that taking a multivitamin and mineral supplement daily can benefit people with HIV, especially if the diet is deficient.

All people infected with HIV should be monitored for their sex hormone levels. In case of deficiency, hormone replacement therapy can be undertaken. In men, for example, hormone therapy can help maintain muscle mass or restore libido.

Some people take marijuana ( Cannabis sativa ) to stimulate their appetite . Indeed, in Canada and the United States, Dronabinol (Prescription Synthetic THC) is approved to stimulate appetite for anorexia in people with AIDS. This medicine is obtained by prescription.

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