Questions & Answers about Multi-Drug Resistant HIV

HIV/AIDS

What is AIDS?

Acquired It is not innate, it is not self-germinating, and it is not based on a person’s status, personality, sexual orientation or economic class. It is a communicable (or transmissible) illness, and it is acquired through specific behaviors or processes. There is a specific causal agent, and it doesn’t discriminate—it can be acquired by anyone as a result of his/her behavior.

Immune It is a disease of the immune system, and it impacts how the immune system functions. The immune system is the body’s defense against illness and disease. Skin is our main external immune defense; internally, our main interior immune defense is our white blood cells. Our immune system:

1. Regulates: it maintains the body’s natural balance.
2. Defends: It fights off new invasive agents (antigens).
3. Rebounds: It helps the body recover from illness.

Deficiency Persons with AIDS have an immune deficiency. This means they lack sufficient immune response. Persons with AIDS may lack all three levels of immune response.

Syndrome AIDS is characterized by a syndrome. A syndrome is a group of illnesses or symptoms. AIDS, rather than being characterized by specific symptoms, is characterized by a syndrome of specific illnesses/diseases. These diseases are called Opportunistic Infections.

What is HIV?

• Human
• Immunodeficiency
• Virus

Human It is a human virus, it is transmitted from person to person, and it causes clinical disease and “full blown” AIDS only in humans. Animals do not give it to humans; humans do not give it to animals.

Immunodeficiency The virus causes immune deficiency in those it infects.

Virus The causal agent of AIDS is a virus. A virus is the smallest known disease causing agent—it is about 1/1000th the size of a blood cell. A virus is much smaller than bacteria and parasites. Viruses are the causal agents we know least about, and viruses also mutate very quickly.

“Necessary but not Sufficient”

Not everyone living with HIV will progress to AIDS. There is no causal agent known that causes disease in 100% of the people it infects. HIV is necessary—but not sufficient by itself—to cause progression to “full blown” AIDS.

Progression of the illness may take many years, and people usually live with HIV for years with no signs/symptoms of the disease.

It is inaccurate to refer to having HIV as definitely a death sentence.

Understanding HIV Cofactors

Cofactors are a complex combination of medical and behavioral variables that can influence the progression to disease in persons who have already acquired an infection with a causal agent. Cofactors which may influence HIV disease progression include:

• Nutrition Things we eat can be helpful, neutral or harmful to our bodies.
• Substance Use Alcohol, injection drug use, and nicotine cigarettes can have the effect of weakening our immune response.
• Rest/Fatigue Rest helps to rejuvenate our bodies. Lack of rest, or chronic fatigue can weaken our immune system.
• Stress Stress weakens our immune response and makes us more susceptible to illness and disease.
• History of other diseases STDs are believed to have a high interactive rate with HIV, particularly syphilis, herpes, and chlamydia.
• Genetics Genetics may speed the progression of HIV infections to AIDS, or may increase the odds of a person becoming infected with HIV upon exposure to the virus.

Any or all of these cofactors—along with others such as exercise, the environment where a person lives, an individual’s age, or their ability to access/afford the health care system—can influence a disease progression.

HIV Disease Continuum

Initial Infection occurs when the virus enters the blood stream and takes hold. This is often associated with mono-like symptoms. Once infected, a person is infected forever.

Asymptomatic HIV infection is when the person is infected, but shows no obvious signs or symptoms of the illness. HIV has a median asymptomatic (latency) phase of about 10 years.

Even prior to a diagnosis of AIDS, a person living with HIV may develop several kinds of generalized symptoms. These symptoms are not otherwise associated with other potential illnesses. These symptoms include:

• Persistent Generalized Lymphadenopathy (Swollen Lymph Glands)
• Nausea
• Night Sweats
• Weight Loss
• Headaches
• Fever
• Diarrhea
• Thrush (yeast infection)

AIDS is the end stage of HIV disease. This occurs when an individual is HIV+ and begins experiencing opportunistic infections associated with an AIDS diagnosis or when his/her CD4 white blood cell count drops below 200/mm³. (Individuals may progress to full-blown AIDS without having “generalized” symptomatic HIV symptoms.)

It should be noted that once someone has recieved an AIDS diagnosis, it remains with them for life. Even if they beat an opportunistic infection, their CD4 count goes back up over 200, and their viral load becomes undetectable, they are considered to have AIDS.

Opportunistic Infections

There are currently about 28 official opportunistic infections associated with AIDS, as defined by the Center for Disease Control. Some of the more common include:

Pneumocystis Carinii Pneumonia (PCP)
This parasitic infection affects the lungs and causes extreme difficulty breathing, disorientation, headaches, and chest pain. It can also spread and cause damage to other organs. There are treatments available to prevent and overcome PCP, and greater than 90% of people with AIDS recover from their first bout. Most people infected with the causal organism of PCP were infected as children.

Kaposi’s Sarcoma (KS)
This is a rare cancer of the blood vessels that produces bluish/brown lesions on the body. These lesions are hard and raised above the skin. Though they might be unsightly, they are not contagious. When these lesions are internal (e.g. in the spleen, lungs or heart) they can be fatal.

Cytomegalovirus (CMV)
This disease is usually sexually transmitted and is related to the herpes virus family. The most common problem associated with it is Retinitis, which can lead to blindness. This OI is usually seen in the later stage of AIDS.

Toxoplasmosis Encephalitis (Toxo)
This parasitic infection is found in soil, in the feces of animals that dig in soil, or under-cooked meat. One of the most common OIs to affect the central nervous system, Toxo causes infection in the brain (memory loss and motor control difficulties.) It is estimated that half of the US population is infected with the parasite.

Cryptosporidiosis (Crypto)
This is a parasitic infection of the intestines that causes mal-absorption and severe diarrhea. The disease is spread through contaminated water, fecal-oral contact, or eating contaminated raw foods. Unable to keep food down or stay adequately hydrated, this disease causes rapid weight loss in the people it infects.

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