AIDS
Everyone’s Problem
Everyone’s Problem
The National AIDS Control Programme under NACO developed a national public health programme in HIV/AIDS prevention and control, and the phase-1 of the programme was implemented between 1992 and 1999. The second phase of the programme which extends from 1999 to 2004, shifts its focus to changing behaviour through intervention for high risk groups. It also aims at protecting human rights by encouraging voluntary counseling and testing and discouraging mandatory testing.
Anybody can be infected with HIV, and hence, creating awareness, both among the infected and the healthy people, about how it spreads and how the disease can be prevented is very important.
Fatal Virus
The human immunodeficiency virus HIV has been responsible for the new epidemic that emerged world wide in the last two decades. HIV, which is about one sixteen thousandth the size of a head of a pin, has devastated human civilization perhaps like no other microbe has.
Structure
The HIV has an envelop and a core which contains RNA and three enzymes-reverse transcriptase, protease and integrase. The outer covers are made of proteins and glycoproteins. On the envelop are knob-projections made of glycoproteins.
Two types of HIV have been identified so far. While HIV-1 is found worldwide, HIV-2 is mostly found in West Africa and now in some Asian countries.
Infection
The HIV virus causes a weakness of the immune system. It attacks the helper T- lymphocytes which are a fundamental part of our immune system. The virus almost fully specializes on these white blood cells since these have CD4 molecules on the surface to which the AIDS virus binds.
Te virus also binds to a coreceptor on the cell surface. There are some other cells in the body like the macrophages and some cells in the skin and lymph nodes which have CD4 receptors. The HIV binds to these cells as well, remain there and emerge later.
Once the virus binds to the host T cell, there is no stopping it. The viral membrane fuses with the T cell membrane enabling the viral RNA to enter the cell. The enzyme reverse transcriptase converts this genetic material into DNA, which then joins with the DNA of the host cell with the help of Integrase, a HIV enzyme. All this happens within half a day after infection. This DNA is used to make several viral RNA to form new viruses. These migrate to the membrane of the host cell and through a process called budding leave the host and go on to infect other cells.
The HIV destroys helper T-lymphocytes and as a result the CD4 cell count drops from the normal 800-1,000 cells per cubic millimeter of blood to 400-600 cells. About three weeks into the infection, the person shows symptoms like fever, enlarged lymph nodes and muscle pain. But these symptoms recede as the body’s immune system tries to fight the virus. Antibodies are produced to fight HIV in the blood.
By six months, the viral level reaches a constant and on this depends the rate of progress of the disease.
What is AIDS?
A person can transmit the virus even when he/she seems apparently healthy and shows no symptoms. Many infected persons may not show symptoms for years. But over a period of time the immune system weakens. The T-cell count falls, and a person is said to have AIDS when the count is below 200 per cubic millimeter of blood.
This makes it easier for infections to set in. AIDS is the final stage of the HIV infection. In some persons it can take up to 10 years after the initials infection for the disease to set in.
How HIV Spreads
HIV does not live long outside the body, so it can spread only when a person comes in direct contact with the body fluids of an infected person. HIV spreads through blood, semen, vaginal secretions and breast milk. It does not spread through saliva, tears, sweat or urine; these fluids contain very little HIV.
Exposure-the act of coming into contact with an infected person through high-risk behaviour- can be of two types. Direct exposure is when the contact is between the uninfected person and an infected person. A exposed to all those persons his/her partner has had sexual relationship with.
Modes of transmission
Sexual Contact: This is the most common form of HIV transmission. Risk of contracting the infection is high when infected blood, semen or vaginal secretion comes in contact with the blood or mucous membrane of the healthy person. Though vaginal contact is risky and the most common form of transmission of infection, anal intercourse is riskier because the rectum, when penetrated, tears more easily than the vagina, making close contact with body fluids possible.
Blood transfusion: Since HIV can be transmitted through transfusion of infected blood, testing for HIV is mandatory when one donates blood. Moreover, in India the collection of blood from professional donors has been banned. Donating blood is safe as long as the equipment used is sterile. Intravenous drug users can contract the infection by sharing needles with in infected person. Tattooing and body piercing with infected instruments can be risky.
Mother to child: An infected woman can spread the virus to her baby during pregnancy, childbirth or lactation. There are 13-40 per cent chances of transmission of HIV from mother to child. With increasing infection among antenatal women, paediatric AIDS is poised to be come a major health problem.
During pregnancy the maternal blood does not enter the placenta. But during childbirth, labour contractions cause tears in the placenta and the foetus’ blood comes in contact with the mother’s. The foetus also comes into contact with the mother’s genital secretions. There have been cases where the HIV was found in the foetus and the amniotic fluid. An infected mother can also transmit the virus through breast milk.
Though blood transfusion is the most risky, the incidence of HIV through sex is high because sexual activity is the most common of these modes.
STD and HIV
Growing evidence from around the world indicates that incidence of HIV is higher if the person has sexually transmitted diseases (STD). a person with STD has greater risk of contracting HIV though sexual intercourse with an infected person than a healthy person because they may have open sores on their genitals and the infection can enter through these pores. India has a high incidence of STD in both rural and urban
You cannot get HIV infection
v From social kissing
(Closed mouth). Deep open mouthed kissing is not completely safe.
v From shaking hands with the infected person.
v From hugging.
v From sharing the same air with infected persons at public places as cinema, shopping complex, office or school.
v From clothes, beds or toilets.
v From sharing food or dishes.
v From caring for an AIDS patient, such as bathing them, feeding them or cleaning them.
v From mosquitoes, files or bedbugs. HIV cannot live and multiply in the mosquito.
v HIV cannot survive for long outside the human body. It dies when dried, exposed to heat and in contact with detergents.
Areas, IN Mumbai, HIV infection is 50 per cent among sex workers and 36 per cent among STD patients.
Sources of HIV infection in India
Heterosexual activity - 81.0%
Mother to child - 0.7%
Blood transfusions - 5.5%
Intravenous drug users - 5.2%
Others - 7.6%
Source: Combating HIV/AIDS in India 1999-2000, NACO
STD Control
Programme for control of STD in India has been in force since 1946. This programme went on till it was brought under NACO in 1992 with the spread of HIV/AIDS in the country and also because STD has a strong relation with AIDS.
Everyone needs to learn about AIDS/ HIV because the infection is spreading fast and is not restricted to prostitutes or their clients, or gays or drug users who share needles. Many people may be exposed to HIV infection unknowingly. Persons like housewives belonging to the non-high risk group have been found infected. However, people falling under the high risk behaviour category are more vulnerable; those who have multiple partners have a greater chance of contracting the infection.
Symptoms
People with infection start showing symptoms any time from 6 months to many years. Most people get a short illness soon after infection, but usually do not know this is HIV. An HIV test 3-6 months later will show that the person is HIV positive.
Then they may go on for years together without showing symptoms. But they get cold and fever occasionally. Once infected the person remains a carrier all his/her life.
Early symptoms include swollen glands in the neck, groin and armpits. The patient will have recurrent cold, cough, fever, headaches or diarrhoea. Weight loss, skin rashes, prolonged unexplained fatigue, mouth infections, chills, sweating at night, shortness of breath, specific opportunistic infections and tumors are other symptoms. Women develop persistent yeast infections and STDs.
The final stage of the infection is called AIDS when the patient shows at least two major symptoms and one minor symptom.
Major Symptoms
- Weight loss: The patient loses more than 10 per cent of body weight.
- Diarrhoea: The patient has persistent diarrhoea for more than one month.
- Fever: It continues for more than one month.
Minor Symptoms
- Cough for mote than one month
- Itching on the skin
- Skin rashes called shingles
- Herpes simplex
- Swollen glands
- Fungal infections of the mouth
Other additional symptoms are speech impairment, muscle atrophy, memory loss and decreasing intellectual ability, sluggish movements and anxiety. There can be swelling and stiffness of joints, bone pain, muscle atrophy and numbness. The HIV positive will also have problems with vision, such as blurred vision, double vision, light sensitivity, decreased vision and blind spots in vision. They may experience chest pain, pain in the sides, back and abdomen. There will be loss of appetite.
Besides the symptoms a person with AIDS will have a CD4 cell count below 200 cells per cubic millimeter of blood.
However, it is not possible to go by the CD4 count always so often opportunistic infections are they yardsticks. The ailments that affect HIV infected people are of two types-opportunistic infections and aggressive cancers.
Opportunistic illnesses
Candidiasis and Cryptococcas meningitis: Candidiasis is often the first sign of AIDS. Caused by the yeast Candida, usually present in the mouth, digestive tract, vagina and skin, the infection appears in the mouth as white patches. It can also infect the skin, digestive tract and vagina causing itching, redness, burning and discharge. It can also affect the penis.
This infection is usually treated by applying antifungal medication on the affected area. Eating a lot of garlic is said to be an effective remedy, since garlic has been found to be an anti fungal and anti-bacterial agent.
Cryptococcal meningitis is caused by fungus Cryptococcus neoformans. It lives in birds and is found in the soil and air, and infects people whose CD4 count has fallen below 200.
Gastrointestinal infections: Very common and prolonged among HIV positive people, it is mostly caused by protozoans. The infection reaches the body through unwashed or uncooked food, contaminated water and soiled hands. Symptoms include abdominal cramps, pain bloating, fever, weight loss and vomiting.
According to NACO a person is said to have AIDS if he/she:
v Tests positive for HIV infection in two tests based on different antigens.
v Loses 10 per cent of body weight for no reason
v Has chronic diarrhoea for over a month
v Develops neurological impairment which restricts daily activity
v Has tuberculosis, Cadidiasis or Kaposi’s Sarcoma
Detection
It is difficult to diagnose HIV infection based only on symptoms because most of these symptoms are common to other health problems as well. So it is better to take a blood test to confirm HIV infection.
The blood of an HIV infected person has antibodies, which are produced as a reaction to other HIV infection. The presence of the antibodies I the blood indicates infection. The two major tests for diagnosing HIV infection. Enzyme Linked Immunosorbent Assay (ELISA) and the Western Blot analysis, work by looking for antibodies, rather than for the virus.
For the test, the blood is separated into blood cells and serum; the antibodies are present in the serum. Since the body takes time to make enough antibodies to show on the test, a test is accurate only if done after three months of the infection.
Procedure for testing HIV infection
The serum sample is first tested with one ELISA or Simple/Rapid assay. Reactive sample is retested using a different assay and then tested a third time. Serum found reactive in all the three tests is considered HIV positive.
If the serum is found reactive in the first two tests but non-reactive in the third, it is better to take another test after a minimum of two weeks. For confirmation the serum may be sent for a Western Blot analysis.
ELISA
There are direct, indirect, competitive, sandwich types of ELISA tests. First the serum is added to the HIV antigen. After allowing sufficient time for the serum to react with the antigen, it is washed. An enzyme that attaches to the anti-HIV antibodies then added followed by chemicals that react with the enzyme to give a colour. The serum sample is then washed. If it takes a colour, it means the serum is HIV positive. The colour indicates that the enzyme has attached to the antibodies present in the serum. A negative sample shows no colour. The enzyme in this case, in the absence of antibodies to attach to get washed away.
Treatment
Though there is no cure for AIDS at present, treatments are available to improve the quality of the life of the individuals. The patients can follow lifestyles that help them remain healthy and strong. If a person has HIV-related symptoms , he/she should see a doctor and get tested for HIV.
Treatment includes antiviral therapy, which suppresses the replication of the HIV infection in the body using three drugs known as cocktail therapy.
Opportunistic infections are treated as they occur. Preventive medications to avoid opportunistic infections such as Pneumocystis carinii pneumonia are also available.
Joining support groups of ten helps people overcome other symptoms like stress and anxiety associated with the illness.
However, the combination therapy offered for AIDS has been found to have serious side effects like nerve damage, accumulation of fat in the neck and abdomen and diabetes. In some people it has given rise to high levels of cholesterol and heart diseases as a consequence. Following a growing concern regarding the toxic effects of AIDS therapy, the US Federal Health Authority recently issued guidelines that treatment for AIDS should be delayed as long as possible for people without symptoms.
An alternative group of researchers believe that AIDS is the result of a suppressed immune system with antibiotics, drug abuse, nutritional stress and anal sex, which build up toxins in the body. Studies have shown that the damage caused to the immune system b the HIV virus can be reversed to a great extent if people change their habits, eat nutritious food and practice hygiene. Such people tend to live healthier and longer than other HIV infected people.
Take care of them
The infection does not spread if you are only taking care of the patient.
Treat symptoms through normal remedies. For instance treat cold with home remedies like steam inhalation and medicated tea and headache with paracetamol.
Honey or lemon could help get relief from sore throat. For diarrhoea, give salt/sugar solution or rice gruel to prevent dehydration.
Give paracetamol (as prescribed by the doctor) or other pain relievers for headache and body ache. Use soothing lotions like calamine for itching skin.
Yeast infection can be controlled by applying vinegar-water or gentian violet. Emphasise person hygiene and avoid antibiotics.
Encourage the person to eat small meals throughout the day to fight weight loss. Give them a high calorie and protein rich diet consisting of dals, groundnuts and cereals. Help the patients keep track of their life. Tell them to take rest and reduce stress.
Every small gesture makes a difference. Never blame the patient for the disease.
Eat well to say healthy
It is important to eat nutritious food, which gives vitamins, energy and the strength to fight the disease.
A person with HIV should see a doctor if he/she has diarrhoea, does not feel hungry or is losing weight.
To avoid infection from food, eat freshly cooked and keep drinking water in a clean and covered vessel. Boil the water if it is not safe. Before eating raw fruits or vegetables, wash them thoroughly. Do not eat food kept uncovered for long. Wash the dishes with soap or detergent.
Pay attention to hygiene
HIV positive should avoid going near people with cold, fever or other infections. Family members of an HIV positive person should make sure to get their infections treated quickly and to avoid passing it on.
People with HIV infection should not have sex without condoms. This is to avoid contracting STDs and HIV reinfection. Dispose of the used condoms and menstrual pads carefully, sealed in a bag.
Wash hands with soap before eating and cooking and after going to the toilet. Bathe every day and brush teeth twice daily. Keep windows open to let fresh air in. When things are clean there are less germs.
HIV and children
In the next few years in India, tens of thousands of children will be born with HIV. Children with HIV in developing countries are at a greater risk because poor nutrition and widespread diseases make survival difficult.
Foetus in the womb and infants often get the infection from an infected mother. If the baby is infected there are chances that the mother also has the infection. Or if the mother tests HIV positive, the child should also be taken for a test.
Symptoms in children
Many babies with HIV show symptoms by the time they are six months old. If a child is continuously ill for apparently no reason, he/she should be taken to the doctor and tested for HIV. But the test does not work till the baby is 18 months old.
Children born with HIV usually develop AIDS by the time they are two years old, and die before they are five. Only a very small percentage survive till five. Since their immune system is still developing, children tend to contract infections quickly and succumb to it faster than adults. The common infection in children are bacterial, such as meningitis. Viral infections like chicken pox and measles keep recurring.
Children with HIV should have regular check ups. Infants should be breastfed as breast milk provides all necessary nutrients and builds their immune system.
Children should be given normal, healthy food and allowed to live as normal a life as possible. They can play with other children. Risk arises only when they get wounded and the blood falls on another child’s open wounds.
The signs are
v Low birth weight
v Persistent diarrhoea
v Slow growth
v Slow physical and mental development
v Persistent fever and cough
v Month infections
Living with HIV
According to the UNAIDS,by last year 36.1 million people around the world were living with the HIV, 16.4 million of them being women and 1.4 million children.
Protect yourself
Most people still do not have a complete picture of HIV/AIDS. In the absence of a cure, prevention continuous to be the most effective strategy in the control of AIDS. Only intensive communication efforts can raise awareness levels and bring about behavioural changes. STD services, condom programming and blood safety are the components of the programme adopted by NACO.
How to avoid AIDS
Use condoms.
Use disposable syringes and needles.
Avoid multi- partner sex.
Ensure the blood is HIV free before transfusion. If possible avoid taking blood donated by strangers; get blood from your family members or people known to you.
Get STDs treated.
Common Queries
Can blood transfusion transmit HIV?
Yes, Blood taken from an HIV positive person can infect the receiver. Make sure that the blood has been screened for HIV by a licensed blood bank.
What are blood products and how can one ensure that they are uninfected?
Blood products include red blood cells, platelets, plasma, albumin and immunoglobulin. If any of these is taken from an HIV positive person, the products may be infected. Always verify that the blood products have been screened for HIV.
Can one acquire HIV infection at a blood test?
Blood tests are usually done using sterile instruments. However, when you go for a blood test, check if the syringe and needle are sterile. You can ask for disposable syringes.
How do you know if the instruments are sterile?
Always ask the doctor or the nurse if the syringes are sterile before an injection or blood test.
Can one acquire the infection by donating blood?
No. Instruments used for blood donation are sterile. In fact, healthy people should come forward to donate blood.
Is menstrual blood infective?
Yes. Any blood which is infected with HIV can pass on the infection.
Is tattooing, ear piercing and shaving dangerous?
All this could be dangerous if the instruments are not sterile. So always insist on a fresh instrument. Ask the barber to use a fresh blade for shaving. Sharing razors holds some degree of risk if it has been used by an HIV infected person and has not been cleaned thoroughly. It is advisable not to share razors.
Do mosquitoes transmit HIV?
There is no evidence to indicate that mosquito bite can transmit the disease. The incidence of HIV is highest among the sexually active group of 15 to 40 years. If mosquito bite could transmit the virus, the infection should have been uniform among all age groups. The HIV virus cannot survive replicate inside a mosquito.
Can kissing transmit the infection?
Light kissing on the cheeks or on the lips carries no risk of transmitting HIV. Deep kissing can be risky because the saliva of the infected person contains the virus, though very few. Moreover, there could be bleeding gums or ulcers in the mouth and exchange of saliva mixed with infected blood could transmit the infection.
Does a checkup by the dentist hold any risk?
Even though the risk is very low, you can always ensure that the instruments have been sterilized before use.
For how long does the virus survive after a patient dies?
This depends on the temperature in which the body is kept. In cases where the body has been kept in cold storages, there have been reports of the virus surviving for more than a week. The dead body must be covered wit double layers of thick polythene sheets with bleach in between each layer.
Can complete blood transfusion cure the infection?
No, because the virus is present in tissues and organs like liver, brain and spleen, besides blood. So the virus cannot be completely eliminated from the body.
