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What you need to know
about Hiv Aids (II)
Complications
HIV infection weakens your immune system, making you highly susceptible to a
large number of bacterial, viral, fungal and parasitic infections. You may
also be vulnerable to certain types of cancers. But treatment with
anti-retroviral drugs has markedly decreased the number of opportunistic
infections and cancers affecting people with HIV. It's now more likely these
infections will occur in people who have not had treatment.
Bacterial infections
Bacterial pneumonia. Worldwide, this is one of the most common opportunistic
infections occurring in people living with HIV/AIDS. Dozens of types of
bacteria can cause bacterial pneumonia, which may develop on its own or
after you've had an upper respiratory infection such as a cold or the flu.
Mycobacterium aviumcomplex (MAC). This infection is caused by a group of
bacteria referred to by a single name — MAC. The bacteria normally cause an
infection of the respiratory tract. But if you have advanced HIV infection
and your CD4 lymphocyte count is less than 50, you're more likely to develop
a systemic infection that can affect almost any internal organ, including
your bone marrow, liver or spleen. MAC causes nonspecific symptoms such as
fever, night sweats, weight loss, stomach pain and diarrhea.
Tuberculosis (TB). In resource-poor nations, TB is the most common
opportunistic infection associated with HIV and a leading cause of death
among people living with AIDS. Millions of people are currently infected
with both HIV and tuberculosis, and many experts consider the two diseases
twin epidemics. That's because HIV/AIDS and TB have a deadly symbiotic
relationship, in which each fuels the progress of the other. Having HIV
makes you more susceptible to TB and far more likely to progress from
dormant to active infection. At the same time, TB increases the rate at
which the AIDS virus replicates. What's more, TB often strikes people with
HIV years before other problems associated with HIV develop. One of the
first indications of HIV infection may be the sudden onset of TB — often in
a site outside the lungs. Currently, someone in the world develops TB every
second and 5,000 to 6,000 people die of the disease each day.
If you're HIV-positive, you should have a simple skin test for TB early in
your medical care. If the test is positive, you'll also need a chest X-ray
and other appropriate tests to make sure you don't have an active infection.
If your TB isn't active, there are treatments to prevent it from becoming
active in the future. TB is more worrisome than many other opportunistic
infections because it's highly contagious. You can get TB when someone with
the disease coughs or sneezes near you. The bacteria then spread through
your blood and lymph nodes to the rest of your body. TB most often affects
the lungs, but people with HIV are more likely to have infection at other
sites. Multidrug-resistant tuberculosis (MDR-TB), in which the disease
resists treatment with traditional antibiotics, is of particular concern to
people with HIV/AIDS. Ultimately, however, TB is of concern to everyone
because it can affect even people with healthy immune systems.
Salmonellosis.
You contract this bacterial infection from contaminated food or water.
Symptoms include severe diarrhea, fever, chills, abdominal pain and,
occasionally, vomiting. Although anyone exposed to salmonella bacteria can
become sick, salmonellosis is far more common in people who are
HIV-positive. You can reduce your risk by washing your hands carefully after
handling food and animals and by cooking meat and eggs thoroughly.
Bacillary angiomatosis. Rarely seen in people not infected with HIV, this
infection first appears as purplish to bright red patches on your skin. It
often resembles Kaposi's sarcoma, but it can cause disease in other parts of
your body, including your liver and spleen.
Viral infections
Cytomegalovirus (CMV). This common herpesvirus is transmitted in body fluids
such as saliva, blood, urine, semen and breast milk. More than half the
adult population has been infected. But a healthy immune system inactivates
the virus, and it remains dormant in your body. If your immune system
weakens, the virus resurfaces, causing damage to your eyes, digestive tract,
lungs or other organs. Most commonly, CMV causes infection and inflammation
of your retina (CMV retinitis). If not treated, CMV retinitis can lead to
blindness.
Viral hepatitis.
Viral hepatitis is a viral infection of the liver. Signs and symptoms
include yellowing of your skin and the whites of your eyes (jaundice),
fatigue, nausea, abdominal pain, loss of appetite and diarrhea. There are
several types of viral hepatitis, but the most common are hepatitis A, B and
C. Hepatitis B and C can lead to persistent or chronic infection and put you
at risk of long-term complications such as cirrhosis or liver cancer. If you
are HIV-positive and also have hepatitis, you may be more likely to develop
liver toxicity from your medications.
Herpes simplex virus (HSV).
HSV, which usually causes genital herpes, may be transmitted during
unprotected anal or vaginal sex. Initial symptoms include pain or irritated
skin in the genital area. Later, sores that ooze and bleed erupt on the
genitals, buttocks and anus. Although these sores eventually heal, the virus
periodically reappears, causing the same symptoms. If you have HIV, your
skin infection is likely to be more severe than it would be in people who
don't have HIV, and the sores may take longer to heal. Systemic symptoms may
also be more severe. Although the herpes virus isn't life-threatening in
adults, it may cause brain damage, blindness or death in infants infected
during delivery.
Human papillomavirus (HPV).
This is one of the most common causes of sexually transmitted disease. Some
types of this virus cause common warts; others cause warts on the genitals.
If you're HIV-positive, you're especially susceptible to infection with HPV
and more prone to recurrent infections. HPV infection is especially serious
because it significantly increases a woman's risk of cervical cancer.
Infection with both HPV and HIV increases a woman's risk even further —
cervical cancer seems to occur more often and more aggressively in women who
are HIV-positive. In 2006, the Food and Drug Administration approved the
first vaccine to offer protection from the most dangerous types of HPV. The
vaccine is most effective when given to girls before they become sexually
active, but it also provides protection for sexually active women age 26 and
younger. If you are not a candidate for the vaccine, are HIV-positive or
have unprotected sex with more than one partner, you should have a Pap test
— a test that examines cells taken from the cervix — every year to check for
cervical cancer, HPV and other sexually transmitted diseases. Anyone who
engages in anal sex should be tested for anal cancer because HPV increases
the risk of this type of cancer in both men and women.
Progressive multifocal leukoencephalopathy (PML).
PML is an extremely serious brain infection caused by the human polyomavirus
JCV. Signs and symptoms vary and may include speech problems, weakness on
one side of the body, loss of vision in one eye or numbness in one arm or
leg. PML usually occurs only when your immune system has been severely
damaged.
Fungal infections
Candidiasis. Candidiasis is a common HIV-related infection. It causes
inflammation and a thick white coating on the mucous membranes of your
mouth, tongue (thrush), esophagus (Candida esophagitis) or vagina. Children
may have especially severe symptoms in the mouth or esophagus, which can
make eating painful and difficult. Cryptococcal meningitis.
Meningitis is an inflammation of the membranes and fluid surrounding your
brain and spinal cord (meninges). Cryptococcal meningitis, the most common
central nervous system infection associated with HIV, is caused by a fungus
that is present in soil. Symptoms include headache, high fever, a stiff neck
and sensitivity to light. Cryptococcal meningitis can be successfully
treated with antifungal medications, but early treatment is essential.
Meningitis is a serious disease that can cause severe complications or prove
fatal in a short period of time. Once you've had cryptococcal meningitis,
you'll need to be on long-term medication to prevent a recurrence.
Parasitic infections
Pneumocystis carinii pneumonia (PCP).
Although antiretroviral drugs have helped reduce the number of cases of PCP,
it remains one of the most common opportunistic infections affecting people
with AIDS in the United States. PCP attacks the lungs, making it difficult
to breathe. Symptoms include a cough that doesn't go away, fever and trouble
breathing. Toxoplasmosis.
This potentially deadly infection is caused by Toxoplasma gondii, a parasite
spread primarily by cats. Infected cats pass the parasites in their stools,
and the parasites may then spread to other animals. Humans generally
contract toxoplasmosis by touching their mouths with their hands after
changing cat litter or by eating raw or undercooked meat, especially pork,
lamb and venison. If you become infected with the parasites while pregnant,
you may pass the infection to your baby. Once you're infected, the parasites
can spread to every organ in your body, including your heart, eyes and
lungs. For many people with AIDS, toxoplasmosis leads to encephalitis, an
infection of the brain. Signs and symptoms may include disorientation,
seizures and difficulty walking or speaking. Cryptosporidiosis.
This infection is caused by an intestinal parasite that's commonly found in
animals. You contract cryptosporidiosis when you ingest contaminated food or
water. The parasite grows in your intestines and bile ducts, leading to
severe, chronic diarrhea in people with AIDS.
Cancers
Kaposi's sarcoma. Kaposi's sarcoma is a tumor of the blood vessel walls.
Although rare in people not infected with HIV, it's common in HIV-positive
people. Kaposi's sarcoma usually appears as pink, red or purple lesions on
the skin and mouth. In people with darker skin, the lesions may look dark
brown or black. Kaposi's sarcoma can also affect the internal organs,
including the digestive tract and lungs. Researchers are testing new
combinations of the chemotherapy drugs currently used to treat Kaposi's
sarcoma as well as new ways of delivering those medications. What's more, as
with most opportunistic infections associated with AIDS, the use of
anti-retrovirals has reduced the incidence of this cancer and has even
reduced the lesions in people already affected.
Non-Hodgkin's lymphoma.
This cancer originates in lymphocytes, a type of white blood cell.
Lymphocytes are concentrated in your bone marrow, lymph nodes, spleen,
digestive tract and skin. Although lymphomas can start in other organs, they
usually begin in your lymph nodes. The most common early sign is painless
swelling of the lymph nodes in your neck, armpit or groin.
Other complications
Wasting syndrome. Researchers identified wasting syndrome as a complication
of AIDS in the 1980s. Although current aggressive treatment regimens have
reduced the number of cases, wasting syndrome still affects many people with
AIDS. It is defined as a loss of at least 10 percent of body weight and is
often accompanied by diarrhea, chronic weakness and fever.
Neurological complications.
Although AIDS doesn't appear to infect the nerve cells, it can still cause
neurological symptoms such as confusion, forgetfulness, changes in behavior,
depression, anxiety and trouble walking. One of the most common neurological
complications is AIDS dementia complex, which leads to behavioral changes
and diminished mental functioning. It's best treated with aggressive
anti-retroviral medications.
Treatment
When HIV was first identified in the early 1980s, there were few drugs to
treat the virus and the opportunistic infections associated with it. Since
then, a number of medications have been developed to treat both HIV/AIDS and
opportunistic infections. For many people, including children, these
treatments have extended and improved the quality of life. Scientists at the
National Institutes of Health estimate that since 1989, anti-retroviral
medications have provided HIV-positive Americans with 3 million years of
extended life. But none of these drugs can cure HIV/AIDS, many have side
effects that can be severe, and most are expensive. What's more, after 20
years on AIDS drugs, some people — about 40,000 in the United States alone —
develop resistance to the drugs and no longer respond to treatment. The new
protease inhibitor darunavir is intended to help this group of people.
Treatment guidelines
A panel of leading AIDS specialists has developed recommendations for the
use of anti-retroviral medications in people with HIV. These recommendations
are based on the best information available at the time they were developed.
AIDSinfo, a program of the U.S. Department of Health and Human Services, has
a program in place to regularly refine and update the recommendations as
knowledge about HIV infection evolves.
According to current guidelines, treatment should focus on achieving the
maximum suppression of symptoms for as long as possible. This aggressive
approach is known as highly active antiretroviral therapy (HAART). The aim
of HAART is to reduce the amount of virus in your blood to very low, or even
nondetectable, levels, although this doesn't mean the virus is gone. This is
usually accomplished with a combination of three or more drugs.
But the treatment guidelines also emphasize the importance of quality of
life. Thus the goal of AIDS treatment is to find the strongest possible
regimen that is also simple and has the fewest side effects. If you have
HIV/AIDS, it's important that you take an active role in every treatment
decision. You and your doctor should discuss the risks and benefits of all
therapies so that you can make an informed decision about what will likely
be a complex and long-term treatment.
Antiretroviral drugs
Antiretroviral drugs inhibit the growth and replication of HIV at various
stages of its life cycle. Five classes of these drugs are available:
Nucleoside analogue reverse transcriptase inhibitors (NRTIs).
NRTIs were the first antiretroviral drugs to be developed. They inhibit the
replication of an HIV enzyme called reverse transcriptase. They include
zidovudine (Retrovir), lamivudine (Epivir) didanosine (Videx), zalcitabine
(Hivid), stavudine (Zerit) and abacavir (Ziagen). A newer drug,
emtricitabine (Emtriva), which must be used in combination with at least two
other AIDS medications, treats both HIV and hepatitis B.
The major side effect of zidovudine is bone marrow suppression, which causes
a decrease in the number of red and white blood cells. Approximately 5
percent of people treated with abacavir experience hypersensitivity
reactions such as a rash along with fever, fatigue, nausea, vomiting,
diarrhea and abdominal pain. Hypersensitivity reactions can also occur
without a rash. In either case, symptoms usually appear within the first six
weeks of treatment and generally disappear when the drug is discontinued. If
you've had a hypersensitivity reaction to abacavir, avoid taking the drug
again. Side effects of emtricitabine include nausea, vomiting, abdominal
pain, difficulty breathing and fatigue.
Protease inhibitors (PIs).
PIs interrupt HIV replication at a later stage in its life cycle by
interfering with an enzyme known as HIV protease. This causes HIV particles
in your body to become structurally disorganized and noninfectious. Among
these drugs are saquinavir (Invirase), ritonavir (Norvir), indinavir
(Crixivan), nelfinavir (Viracept), amprenavir (Agenerase), lopinavir,
atazanavir (Reyataz) and tipranavir (Aptivus). Darunavir (Prezista), a
protease inhibitor approved in 2006, is intended for people who haven't
responded to treatment with other drugs. Darunavir is used in conjunction
with ritonavir and other anti-HIV medications.
The most common side effects of protease inhibitors include nausea, diarrhea
and other digestive tract problems. PIs can also cause a significant number
of side effects when they interact with certain other medications you may be
taking. That's because all PIs, to one degree or another, affect an enzyme
system in your liver that is responsible for metabolizing a large number of
drugs. Newer side effects have also appeared with the continuing and
widespread use of protease inhibitors. These include elevated triglyceride
levels and problems with sugar metabolism that may sometimes progress to
diabetes.
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SUNDAY, DECEMBER 24 2006