HIV

Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain immune cells called CD4+ lymphocytes, which weakens the body’s defenses against infections and cancers and can cause acquired immunodeficiency syndrome (AIDS). AIDS is the most advanced form of HIV infection. Left untreated, it is likely that 95% (or more) of people infected with HIV will develop AIDS. HIV infections are caused by one of two viruses, HIV-1 or HIV-2. HIV-2 remains limited to West Africa but HIV-1 has caused a worldwide epidemic. According to the CDC, it’s estimated that about 1.2 million people in the United States were living with HIV at the end of 2012. Of those people, about 13%, did not know they were infected.

CAUSES, INCIDENCE AND RISK FACTORS

A person can become infected with the HIV virus through contact with certain body fluids from a person who is already infected with HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. (Mucous membranes are found inside the rectum, vagina, penis, and mouth).These body fluids include:

• Blood
• Semen
• Pre-seminal fluid
• Vaginal fluids
• Rectal fluids
• Breast milk

HIV transmission is possible at any stage of HIV infection-even if the HIV-infected person has no symptoms, and it is possible to be exposed and not infected.

In the United States, HIV is spread mainly by:

• Having unprotected sex with someone who has HIV. (Anal sex is the highest-risk sexual behavior. Vaginal sex is the second-highest-risk sexual behavior).
• Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV.

Less commonly, HIV may be spread:

• From mother to child during pregnancy, birth, or breastfeeding.
• By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.

HIV cannot survive for very long outside of the body and cannot be transmitted through routine activities such as using a toilet seat, sharing food utensils or drinking glasses, shaking hands, or through kissing (except as listed above). It also is not spread through animals or insect bites, only from person to person.

PREVENTION

To protect yourself from HIV infection:

• Get tested and know your partner’s HIV status BEFORE having sex.
• Abstain from sex or have less risky sex.
• Limit your number of sexual partners. More partners=more risk.
• Use a condom correctly every time you have sex.
• Get tested and treated for STDs. Insist that your partners get tested and treated too.
• Don’t inject drugs. If you do, use only sterile drug injection equipment and water and never share your equipment with others.
• If you don’t have HIV but are at high risk (for example, your partner has HIV), Pre-exposure prophylaxis (PrEP) is an option. PrEP involves taking a specific HIV medicine every day. PrEP should always be combined with other prevention options, such as condoms.

SYMPTOMS

In the first stages of HIV infection, most people will have very few, if any, symptoms. Within a month or two after infection, they may experience a flu-like illness, including

• Fever
• Headache
• Tiredness
• Enlarged lymph nodes in the neck and groin area

These symptoms usually last up to a month and may be mistaken for another viral infection, like the flu. However, during this period people are highly infectious. Some people with HIV may have more severe symptoms or symptoms that last longer, while others may have no symptoms for 12 years or more.

Later symptoms (due to extreme weakening of the immune system).

• Rapid weight loss
• Recurring fever or profuse night sweats
• Extreme and unexplained tiredness
• Prolonged swelling of the lymph glands in the armpits, groin, or neck
• Diarrhea that lasts for more than a week
• Sores of the mouth, anus, or genitals
• Pneumonia
• Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
• Memory loss, depression, and other neurologic disorders.

Each of these symptoms can be related to other illnesses. The only way to find out if you are infected with HIV is to get tested. Infected people can remain well for more than a decade.

DIAGNOSIS AND TESTS

Blood tests can show whether a person is infected with HIV, but not how long a person has been infected or if the person has AIDS. Some tests are used for HIV screening and others for follow-up testing if a screening test result is positive.

HIV screening tests

• The HIV antibody test is the most common HIV screening test. The test checks for HIV antibodies (proteins that the body produces in response to HIV infection) in blood, urine, or fluids from the mouth.
• The HIV antigen/antibody test can detect both HIV antigen (a part of the virus) and HIV antibodies in blood. An antigen/antibody test can detect HIV infection before an HIV antibody test.

Follow-up HIV tests (used to confirm a positive initial screening)

• Antibody differentiation test, which distinguishes HIV-1 from HIV-2
• HIV-1 nucleic acid test, which looks directly for HIV
• Western blot or indirect immunofluorescence assay, which detect antibodies

If HIV infection is diagnosed, blood tests should be done regularly to measure the CD4 count (the immune cell destroyed by the virus) and viral load (how much virus is in the blood). If the CD4 count is low, complications of HIV infection are more likely to develop. These two measurements help doctors determine when and how to start treatment, and whether other drugs may be needed to prevent complicating infections. With successful treatment, the viral load falls to very low levels within weeks, and the CD4 count can recover.

AIDS is diagnosed when the CD4 count falls below a certain level, or when extreme wasting (weight loss) or certain serious opportunistic infections or cancers develop.

TREATMENT

HIV drugs (antiretroviral drugs, sometimes called ART-anti-retroviral therapy), can stop HIV from reproducing, strengthen the immune system, and thus make people less susceptible to infection, but the drugs cannot, with rare exceptions, eliminate HIV. It persists in an inactive form even with treatment. The drugs are grouped into classes based on how they act against HIV:

• Reverse transcriptase inhibitors prevent HIV reverse transcriptase from converting HIV RNA into DNA. There are three types of these drugs: nucleoside, nucleotide, and non-nucleoside.
• Protease inhibitors prevent protease from activating certain proteins inside newly produced viruses. The result is immature, defective HIV that does not infect new cells.
• Entry (fusion) inhibitors prevent HIV from entering cells
• Integrase inhibitors prevent HIV DNA from being integrated into human DNA.

These drugs can dramatically reduce the amount of virus in the blood and are frequently used in combination with each other (CART-combination anti-retroviral therapy). Combinations are more powerful than single drugs in reducing the viral load, and help prevent the development of drug resistance. The regimens can be complicated, have side effects and some of the drugs are prone to interacting with other medicines.

Failure to take medicines correctly can result in HIV becoming resistant to treatment. Therefore, sticking to the treatment plan is essential. Our team will give you the tools you need to manage your medications and look out for problems and side effects, giving you the best chance for success.

Secondary and opportunistic infections that occur as a consequence of a weakened immune system may also require treatment.

SUPPORT GROUPS and INFORMATION LINKS

https://aidsinfo.nih.gov/drugs

http://www.merckmanuals.com/home/infections/human-immunodeficiency-virus-(hiv)-infection/human-immunodeficiency-virus-(hiv)-infection

http://www.cdc.gov/hiv/

Resource Guide

EXPECTATIONS/PROGNOSIS

If HIV infection is not treated, AIDS usually develops. However, with effective treatment, nearly normal life can continue, and the risk of illness and death decreases. HIV infection does not usually directly cause death. Instead, HIV infection leads to opportunistic infections, cancers, and other disorders, which then lead to death. Right now, there is no cure, but intensive research to find one continues.

DRUG INFORMATION

Drug information for this condition is made available by Factor One Source Pharmacy upon request by emailing contact@fosrx.com directly, or by submitting an inquiry through our Contact Page.