AIDS

The AIDS is an involvement of the immune system due to infection by a virus, HIV.

Immunosuppression leads to possible infection by microorganisms that under normal conditions would not produce any pathology, called opportunistic pathogens. This phase, which generally coincides with CD4 lymphocyte levels below 200 / mm3, is called AIDS. The most frequent opportunistic infections are caused by:

• Bacteria: Tuberculosis , Syphilis …
• Viruses: Cytomegalovirus, Herpes simplex, Varicella -zoster …
• Protozoa: Pneumonia due to “Pneumosystis carinii”, “Toxoplasmosis”, “Leishmaniasis”, chronic diarrhea due to “Cryptosporidium” or “Isospora” …
  Fungi: Candidiasis …

Why is it produced?

AIDS is caused by a human retrovirus called HIV. There are two types, HIV-1 and HIV-2, although the most common in the world is HIV-1. HIV-2 is more closely related to viruses that cause immunodeficiencies in monkeys.

HIV contains as genetic material an RNA and proteins, which are what allow its reproduction. Among them, the most important, because most HIV treatments affect them, are: reverse transcriptase and protease.

Once the virus enters the body, it specifically binds to a type of receptor present on the cells of the immune system, mainly CD4 lymphocytes, and penetrates them. At this time, the infection can remain latent, that is, without producing any type of symptoms, as long as the virus does not replicate. Once it begins to multiply, it needs and uses the lymphocyte’s genetic machinery. In this way it destroys it and a large number of new viruses, called virions, escape abroad, which will spread the infection to other cells. As the virus continues to infect cells, the immune defense capacity of the infected individual decreases, until it almost disappears in the last stages of the patient’s life.

AIDS symptoms

HIV disease is usually asymptomatic. Some patients suffer an acute picture at the beginning of the disease (3-6 weeks after infection) consisting of low-grade fever and general malaise, although the most normal thing is that the patient remains asymptomatic for years.

During this period, it is not uncommon, however, to find low-grade fever, recurrent canker sores, continuous weight loss and no apparent cause; and the sensation of pain when swallowing, the latter usually due to mild fungal infections (Candida albicans).

The patient with HIV infection can also present neurological alterations, of which the most frequent is encephalopathy. Another pathology caused by the HIV virus is the appearance of certain tumors, the most frequent being Kaposi’s Sarcoma .

How is it diagnosed?

The diagnosis of the disease can only be definitively established by laboratory methods.

These types of tests are carried out with a blood test of the patient and can be classified according to what they intend to see in:

• Direct: if they detect the presence of the virus.
• Indirect: if what they observe is the body’s response to infection (antibodies) in the patient’s blood.

The diagnosis is usually determined after successive tests: usually one of less specificity at the beginning (Screening test) and, later, one of greater specificity (Confirmation test). The fact of having to repeat the tests is due to the fact that sometimes, when the first one is carried out, the virus is still not detectable in the individual’s blood and therefore false negatives are obtained in some patients who have the disease.

Screening tests: The most widely used method is EIA and ELISA.
Confirmation tests: The most used methods are Western-Blot, IFI. and the RIPA.

In clinical practice, the following is usually done: when the individual has had a recent contact with the disease, a 1st test is done and it is repeated after six months. On many occasions, the diagnosis is delayed until the appearance of symptoms related to opportunistic infections, since the virus infection, until that moment, does not produce symptoms.

AIDS treatment

The HIV treatment approach should be aimed, on the one hand, at reducing the amount of virus in the individual and, on the other, at preventing or treating alterations or infections that may occur in the body due to the presence of HIV.

There are two types of drugs in the treatment of HIV:

• Reverse transcriptase inhibitors: Zidovudine (AZT), Didanosine (DDI), Stavudine (D4T), Lamivudine (3TC), Zalcitabine (DDC), Nevirapine and Efavirenz.
• Protease Inhibitors: Indinavir, Ritonavir, Saquinavir, and Nelfinavir.

At first, only Zidovudine was used to treat the disease. Subsequently, drugs were combined to prevent the appearance of resistance by the virus. Currently, combination therapy (combination of several drugs) is used. Typically 3 drugs (2 reverse transcriptase inhibitors and 1 protease inhibitor) or 4 drugs (2 reverse transcriptase inhibitors and 2 protease inhibitors) are used. The main causes of treatment change are ineffectiveness or the appearance of significant side effects for the patient. In this case, usually one drug is changed for another from the same group.

It is very important that the patient realizes that the treatment is chronic and complex, but that clinical experience has shown that in people who comply correctly, the virus is greatly reduced in the body and that the defenses are increased , thereby reducing the risk of infection by opportunistic pathogens.

Whenever a person starts antiretroviral treatment, they must be correctly informed of how to do it (it varies depending on the drug) and the possible side effects that it can cause. During the follow-up, it is important to control the possible treatments for other pathologies that the patient may suffer throughout his life, to avoid possible interactions and failures in therapy.

Finally, to say that treatment is very important for the life of the patient with this disease and that, as far as possible, it must be complied with, since the virus, in the long run, can generate resistance that would force a change in therapy And, what is more important, if we allow the virus to continue to develop, it will produce opportunistic infections that are one of the most important causes of death from this pathology.

Avoiding contracting AIDS

HIV has three ways of transmission.

Direct contact with blood

To prevent the spread of the virus through blood, precautions should be taken, especially in the group of health workers and in those who have contact with human blood (research, cleaning service). The use of gloves and the proper disposal of syringes in the containers arranged for it can prevent contagion of this and many other diseases that are transmitted by blood.

In the case of injecting drug users, the syringes used should not be shared, and it is preferable to use single-use ones.

Transmission through sexual intercourse

It was very common for a long period of time, due to the ignorance of the disease by the population. Currently, it is rare that there are people who are unaware of this transmission route due to the large number of advertising campaigns that have been carried out in this regard.

Prevention lies in the use of condoms and avoiding risky sexual practices as much as possible.

Transmission during childbirth

It is also a cause of HIV infection. There are hospital treatments to try to prevent contagion. After delivery, the relevant tests will be carried out on the newborn of an infected mother, to determine if he has acquired the virus. If so, treatment will begin. It should be remembered, however, that a large number of children born with antibodies to HIV become negative over time, since they have not acquired the virus, but only the antibodies produced by the mother.

Breastfeeding is contraindicated if the mother is infected with HIV.