Clinical Management
HIV / AIDS

If left untreated HIV is a true death sentence, it will eventually over tax the
immune system and develop into AIDS.

HIV Progression

There is a distinct and well documented progression of HIV infection. In HIV’s infancy, being diagnosed with the infection meant a terminal diagnosis. Today, that is no longer true, however; if left untreated HIV is a true death sentence, it will eventually over tax the immune system and develop into AIDS. Since the discovery of what would later be known as AIDS in June of 1981, billions of dollars have been spent on research, combative drugs and therapies and prevention. These advances have dramatically reduced the morbidity and mortality of those infected and has prolonged the life of many. As with any disease early detection is key.

Within the first few weeks of HIV infection, most people but, not all, will experience either flu like symptoms (fever, chills, aches, and tiredness) or mononucleosis symptoms (fatigue, sore throat, fever, swollen lymph nodes in neck and armpits, swollen tonsils, headache, skin rash and soft, swollen spleen). These symptoms may last up to 2 weeks.

This is Acute Retroviral Syndrome (ARS) and is simply the workings of the immune system. The immune system is under attack and will do it’s best to fight back; however, large amounts of HIV are being produced. Immune cells called CD4 are duplicating but are destroyed during the process causing a dramatic drop in the CD4 count. It is at this stage of development that HIV is highly present in the blood, offering a higher risk of transmission. Eventually the immune system will balance the amount of HIV down to a stable level and CD4 count will begin to increase, unfortunately it may never return to pre infection levels. After this episode of symptoms have dissipated, there may be no other symptoms for years before clear clinical symptoms develop, which typically show up as HIV related opportunistic infections or cancer. The frequency and severity of these diseases are dependent on the degree of immune system dysfunction.

Clinical latency (inactivity or dormancy) is sometimes called asymptomatic HIV infection or chronic infection. At this stage, the reproduction of HIV is at extremely low levels but is still present and active. Ideally this is the stage that those infected want to stay in.

As mentioned, since HIV/AIDS inception, there has been a tremendous amount of funding for research and medical treatments are advancing, though a cure has not been found scientist are hopeful. Today there are treatments to control HIV.

Today there are treatments to control HIV. Guidelines used in the United States recommend the use of Antiretroviral Therapy (ART) upon diagnosis. ART is typically a combination of three or more antiretroviral medicines (cocktail) used to combat HIV and is more effective than monotherapy. This combination of drugs slows the rate of reproduction of HIV in the body and the goal is to dramatically reduce the viral load (amount of virus in body) to a level where it can no longer be detected in blood test. Though the goal is to reduce the virus to an undetectable amount in the blood; a person with HIV still can transmit HIV, as it may still be present in genital fluids. Viral load tests only measures HIV in the blood.

(ART) Antiretroviral Therapy is prolonging the lives of many HIV infected persons, allowing them to live with a sense of normalcy and expectancy further it is also lowering their ability to infect others.

Obviously for these drugs to offer hope to the afflicted they must be taken and taken properly. Though ART may be complex, they are becoming easier to manage. Once the regimen is started it should be lifelong and aggressive with the goal of viral suppression. Successful suppression does not translate into a cure but allows for immune reconstitution. Ongoing education, counseling, adherence to treatment, and prevention of transmission are key to the commitment.

Even people that are not involved with ART (remember approximately 13% of the 1.2 million infected are unaware of their infection) can live in this stage for 10 years however some may progress faster as there is nothing to prohibit HIV production. Approaching the middle or end of this stage, viral loads began to rise and CD4 cell count diminishes. As the immune system weakens and is unable to protect the body, HIV symptoms are more pronounced.

  • Dry, flaky skin

  • Persistent fatigue

  • Fever that comes and goes

  • Diarrhea that lasts more than one week

  • Night Sweats

  • Swollen lymph nodes in armpits, groin or neck

  • White spots on tongue

  • Headache

  • Persistent cough

Common Symptoms of HIV:

When the immune system becomes severely damaged and vulnerable to opportunistic infections (OI), affliction has reached the final stage – AIDS. Healthy individuals have a normal CD4 count between 500 and 1600 cells, per cubic millimeter of blood (500-1600 cells/mn3). A diagnosis of AIDS occurs when the CD4 count falls below 200 cells/mn3. A diagnosis of AIDS regardless of CD4 count may occur if one or more OI have developed. The typical survival rate of those that have progressed to this stage is 3 years, life expectancy drops to 1 year when OI are present.

The following factors can curtail
the progression of HIV:

  • Taking ART as soon as possible

  • Consistent ART and HIV care

  • Eating healthy foods

  • Regular exercise

  • No smoking

  • Reduce stress level

  • Healthy lifestyle choices

  • Genetic background

  • Good health prior to infection

Testing for HIV & AIDS

Since the first case was reported in June of 1981, more than 1.8 million people in the United States have been infected with HIV. Tragically, over 675,000 have died. Testing is key for treatment initiation and prevention. The Center for Disease Control (CDC) recommends all people between the ages of 13-64 submit to routine testing. HIV testing is used to determine if a person is infected with the virus; however, at this time the tests are unable to forecast how long the person has been infected. A person’s knowledge of their HIV status is imperative for personal safety and the safety of others.

Nucleic Acid Test /NAT-Is the most expensive and detects infection sooner than the other 2 types. It detects the actual virus and involves drawing blood from a vein. NAT detects infection and viral load. This test is not routinely used unless elevated risk, possible exposure, or early symptoms are present.

Antigen/Antibody Test – Looks for HIV antibodies and antigens. When HIV is present an antigen called p24 is produced, even before antibodies develop. The tests are for lab usage and are quite common in the U.S. It involves drawing blood from a vein. Rapid antigen/antibody tests are done with a finger prick.

HIV ANTIBODY TEST – Looks only for antibodies to HIV in blood, or oral fluids. Antibody tests that use blood drawn from a vein detect HIV sooner after infection than tests done with blood from a finger prick or oral fluid. Most rapid tests are antibody tests. The only approved HIV self-test is the antibody test.

There are several types of HIV tests, and their uses vary.

The time span for results varies. Results from NAT and Antigen/Antibody (blood drawn from veins) may take several days, with Rapid Antibody Screening Test (finger prick/oral fluid) results within 30 minutes or less. The time is the same for Rapid Antigen/Antibody test. The Oral Fluid Antibody self-test provides results within 20 minutes.

Currently, there is no HIV Test to detect HIV immediately after exposure/infection. A Nucleic Acid Test can detect infection 10 to 33 days after exposure. With an Antigen/Antibody test using blood drawn from a vein, HIV can be detected 18 to 45 days after exposure. Blood drawn from finger pricking may take longer to detect -18 to 90 days after exposure. In general, antibody tests that use blood drawn from a vein can detect infection sooner than tests using blood from finger pricking or oral fluid.

Clinical Management
HIV / AIDS

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