The human immunodeficiency virus (HIV)

 

The history of HIV and AIDS is a short one, and the origins of HIV are disputed; yet since it was first reported just over thirty years ago, it has become one of the leading causes of death worldwide. With time, as research, investment and commitment into understanding HIV increased, treatment methods evolved and the outcome of people living with HIV improved around the world.

Covered in this section are detailed year-by-year accounts, including different country responses to preventing, testing and treating HIV.

Moving through our ‘AIDS History Topics’ you will be guided through the history of AIDS from the 1970s up to 1986, AIDS and HIV in the 1990s, to HIV and AIDS in the new millennium; enabling you to learn how the response to HIV and AIDS has changed over time.

In the early years of the epidemic, AIDS was unknown and misunderstood, feared, untreatable and often fatal. Years down the line, a virus named HIV was discovered and linked to AIDS. That was the turning point in AIDS history.

HIV history then took a sharp turn with the development of highly-effective antiretroviral drugs which meant that, with access to treatment, people could lead healthy lives with HIV.

Key historical moments in the history of HIV and the history of AIDS can be explored through the HIV and AIDS timeline page, such as the various advances in HIV treatment over the years; the impact and evolution of legislation; and HIV activism, among other epidemic defining events.

What Is HIV/AIDS?

You may have heard about HIV and AIDS, but many people don't know the basic facts about them.

HIV causes AIDS. HIV stands for human immunodeficiency virus. It breaks down the immune system — our body's protection against disease. HIV causes people to become sick with infections that normally wouldn't affect them.

AIDS is short for acquired immune deficiency syndrome. It is the most advanced stage of HIV disease.

In the United States, more than 980,000 cases of AIDS have been reported to the government. About 40,000 women and men in the United States get HIV each year.

What Are the Symptoms of HIV?

Some people develop HIV symptoms shortly after being infected. But it usually takes more than 10 years.

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection

The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include: Fever, Muscle soreness, Rash, Headache, Sore throat, Mouth or genital ulcers, Swollen lymph glands, mainly on the neck, Joint pain, Night sweats, Diarrhea

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the blood stream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection.

Clinical latent infection

In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, as free virus and in infected white blood cells.

Clinical latent infection typically lasts eight to 10 years. A few people stay in this stage even longer, but others progress to more-severe disease much sooner.

Early symptomatic HIV infection

As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as: Fever, Fatigue, Swollen lymph nodes — often one of the first signs of HIV infection, Diarrhea, Weight loss, Cough and shortness of breath

Progression to AIDS

If you receive no treatment for your HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections — diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include: Soaking night sweats, Shaking chills or fever higher than 100 F (38 C) for several weeks, Cough and shortness of breath, Chronic diarrhea, Persistent white spots or unusual lesions on your tongue or in your mouth, Headaches, Persistent, unexplained fatigue, Blurred and distorted vision, Weight loss, Skin rashes or bumps, When to see a doctor

If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible!

Causes

Scientists believe a virus similar to HIV first occurred in some populations of chimps and monkeys in Africa, where they're hunted for food. Contact with an infected monkey's blood during butchering or cooking may have allowed the virus to cross into humans and become HIV.

How does HIV become AIDS?

HIV destroys CD4 cells — a specific type of white blood cell that plays a large role in helping your body fight disease. Your immune system weakens as more CD4 cells are killed. You can have an HIV infection for years before it progresses to AIDS.

People infected with HIV progress to AIDS when their CD4 count falls below 200 or they experience an AIDS-defining complication, such as: Pneumocystis pneumonia, Cytomegalovirus, Tuberculosis, Toxoplasmosis, Cryptosporidiosis

How Is HIV Spread?

People have lots of questions about the ways you can get HIV. HIV is transmitted in blood, semen, vaginal fluids, and breast milk. The most common ways HIV is spread are by

  •  having vaginal or anal intercourse without a condom with someone who has HIV/AIDS
  • sharing needles or syringes with someone who has HIV/AIDS
  • being deeply punctured with a needle or surgical instrument contaminated with HIV
  •  getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores
  •  Babies born to women with HIV/AIDS can get HIV from their mothers during birth or from breastfeeding.

HIV is not transmitted by simple casual contact such as kissing, sharing drinking glasses, or hugging.

Getting and Giving Blood

Some people are concerned about the risk of HIV when getting or giving blood. Hospitals, blood banks, and health care providers in the United States are extremely careful. Syringes and needles are only used once. And blood is always tested before it's banked. So, today, there is practically no risk of getting or spreading HIV by giving or receiving blood.

Tests and diagnosis

HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. Unfortunately, these types of HIV tests aren't accurate immediately after infection because it takes time for your body to develop these antibodies — usually up to 12 weeks. In rare cases, it can take up to six months for an HIV antibody test to become positive.

A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. This test can confirm a diagnosis within days of infection. An earlier diagnosis may prompt people to take extra precautions to prevent transmission of the virus to others. There is also increasing evidence that early treatment may be of benefit.

Tests to tailor treatment

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you have. These tests include:

  • CD4 count. CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.
  •  Viral load. This test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.
  • Drug resistance. This blood test determines whether the strain of HIV you have will be resistant to certain anti-HIV medications and the ones that may work better.

Tests for complications

Your doctor might also order lab tests to check for other infections or complications, including: Tuberculosis, Hepatitis, Toxoplasmosis, Sexually transmitted infections, Liver or kidney damage, Urinary tract infection

Treatments and drugs

There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
  •  Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
  •  Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
  •  Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
  •  Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.

When to start treatment

  • Current guidelines indicate that treatment should begin if:
  •  You have severe symptoms
  • Your CD4 count is under 500
  • You're pregnant
  •  You have HIV-related kidney disease
  •  You're being treated for hepatitis B

Treatment can be difficult

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include: Nausea, vomiting or diarrhea, Abnormal heartbeats, Shortness of breath, Skin rash, Weakened bones, Bone death, particularly in the hip joints

Co-diseases and co-treatments

Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions you're receiving medication for. There are also known interactions between anti-HIV drugs and:

  •  Contraceptives and hormones for women
  • Medications for the treatment of tuberculosis
  •  Drugs to treat hepatitis C

Treatment response

Your response to any treatment is measured by your viral load and CD4 counts. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.

Alternative medicine

People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs.

Supplements that may be helpful

Fish oil. Some anti-HIV drugs can cause increases in cholesterol levels. Studies indicate that fish oil supplements can help bring those numbers down.

Whey protein. Preliminary evidence indicates that whey protein, a cheese by-product, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 counts.

Supplements that may be dangerous

St. John's wort. Commonly used to combat depression, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than 50 percent.

Garlic supplements. Although garlic may help strengthen the immune system, it also interacts with several anti-HIV drugs — reducing their effectiveness by 50 percent. Occasionally eating garlic in food appears to be safe.

Prevention

There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body.

To help prevent the spread of HIV:

  •  Use a new condom every time you have sex. If you don't know the HIV status of your partner, use a new condom every time you have anal or vaginal sex. Women can use a female condom. Use only water-based lubricants. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a condom, dental dam — a piece of medical-grade latex — or plastic wrap.
  • Consider the drug Truvada. In July 2012, the Food and Drug Administration (FDA) approved the use of the drug Truvada to reduce the risk of sexually transmitted HIV infection in those who are at high risk. Truvada is also used as an HIV treatment along with other medications.

When used to help prevent HIV infection, Truvada is only appropriate if your doctor is certain you don't already have an HIV or hepatitis B infection. The drug must also be taken daily, exactly as prescribed. And it should only be used along with other prevention strategies such as condom use every time you have sex.

Truvada isn't for everyone. If you're interested in Truvada, talk with your doctor about the potential risks and benefits and whether it's right for you.

  •  Tell your sexual partners if you have HIV. It's important to tell anyone with whom you've had sex that you're HIV-positive. Your partners need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so that they don't infect others.
  • Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
  • If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby's risk by as much as two-thirds.
  • Consider male circumcision. There's evidence that male circumcision can help reduce a man's risk of acquiring HIV

Source: http://www.mayoclinic.org/

 

                     

 
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