Symptoms Within a few days or weeks of infection with HIV, some victims develop symptoms of primary HIV infection. These can include fever, fatigue, rashes, headache, swollen lymph nodes, body aches, night sweats, sore throat, nausea, and ulcers in the mouth. Because the symptoms of primary HIV infection are similar to those of many common viral illnesses, the condition often goes undiagnosed.
Because the immune system is weakened, people with HIV infection are highly susceptible to other infections, both common and uncommon. The infection most often seen among people with HIV is Pneumocystis pneumonia, a fungal infection. Kaposi’s sarcoma, a once-rare form of cancer, is common in HIV-infected men. Women with HIV infection often have frequent and difficult-to-treat vaginal yeast infections. Cases of tuberculosis are also increasingly being reported in people with HIV.
Diagnosis The most commonly used screening blood test for HIV is the HIV antibody test. This procedure consists of an initial screening called an ELISA test and a more specific confirmation test called the Western blot. These tests determine whether a person has antibodies to HIV circulating in the bloodstream, a sign that the virus is present in the body (see the box “Getting an HIV Test”).
If a person is diagnosed as HIV positive, the next step is to determine the current severity of the disease in order to plan appropriate treatment. The infection can be monitored by tracking the amount of virus in the body (the viral load) through a test that measures the amount of HIV RNA in a blood sample.
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A new diagnostic test that may help guide treatment decisions is called HIV Replication Capacity. This test shows how fast HIV from a patient’s blood sample can reproduce itself. It is a measure of viral fitness and may be helpful when used in conjunction with CD4 and viral load tests in predicting how quickly a given person may progress to more serious disease.
Being tested once is not enough. Periodic routine testing is the best way for anyone to find out if he or she has HIV. The frequency of testing depends on multiple factors. For example, the CDC recommends that men who have sex with men should be tested at least once a year. People who engage in high-risk behavior (such as unprotected anal sex) should be tested more often. Rather than testing only at-risk individuals, the CDC also recommends universal HIV testing as part of routine medical care for everyone age 13-64. The
HIV positive A diagnosis resulting from the TERMS presence of HIV antibodies in the bloodstream; also referred to as seropositive. chlamydia An STI transmitted by the bacterium Chlamydia trachomatis.
CDC hopes that routine HIV testing will increase the odds that people with HIV are diagnosed earlier.
Treatment Although there is no known cure for HIV infection, medications can significantly alter the course of the disease and extend life. The drop in the number of U.S. AIDS deaths that has occurred since 1996 is in large part due to the increasing use of combinations of new drugs.
The main types of antiviral drugs used against HIV/AIDS are reverse transcriptase inhibitors, protease inhibitors, in-tegrase inhibitors, and entry inhibitors. These drugs either block HIV from replicating itself or prevent it from infecting other cells. More than 30 drugs are now available to treat HIV, including two once-a-day tablets (containing three combined HIV medications). In addition to antiviral drugs, most patients with low CD4 T cell counts take a variety of antibiotics to help prevent opportunistic infections such as pneumonia, tuberculosis, and other bacterial and fungal infections.
The cost of treatment for HIV continues to be an area of major concern. Pharmaceutical companies, the World Bank, and the international community are working to lower drug costs and provide aid for developing regions. HIV treatment is also challenging because taking the combination drugs is complicated, and the drugs have short-term side effects that may cause people to stop taking them. The drugs can also have long-term side effects, including serious health problems. The National Institutes of Health has issued guidelines for HIV treatment that help patients and their doctors with decisions about treatment.
The best hope for stopping the spread of HIV worldwide rests with the development of a safe, effective, and inexpensive vaccine. The U.S. Food and Drug Administration has approved a drug tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) to be taken by people who do not have HIV but are at high risk for it. It is called a pre-exposure prophylaxis, meaning that it is a prevention method, intended to be used with other methods for reducing HIV risk. This approval comes after a study was conducted of adults who inject drugs in Bangkok. They took a daily dose of the TDF/FTC pill and were found to reduce their risk of acquiring HIV by about 49 percent.
Many different approaches to the development of an AIDS vaccine are currently under investigation, and human trials have begun on several vaccines. However, no vaccine is likely to be ready for widespread use within the next decade. Researchers are making more rapid progress in producing a microbicide that could be used to prevent HIV and other STIs. A microbicide in the form of a cream, gel, sponge, or suppository could function as a kind of chemical condom.
All STIs, including HIV, are preventable. Follow the guidelines given throughout this chapter and make responsible sexual choices, and you can greatly reduce your risk of exposure to STIs.
You should strongly consider being tested for HIV if any of the following apply to you or to any past or current sexual partner:
• You have had unprotected sex (vaginal, anal, or oral) with more than one partner or with a partner who was not in a mutually monogamous relationship with you.
• You have used or shared needles, syringes, or other paraphernalia for injecting drugs (including steroids).
• You received a transfusion of blood or blood products between 1978 and 1985.
• You have been diagnosed with an STI.
If you decide to get an HIV test, you can either visit a physician or health clinic or take a home test.