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Acquired Immunodeficiency SyndromeAcquired immunodeficiency syndrome, more conveniently known as "AIDS," has resulted in the greatest public health concern since the tuberculosis epidemics of the early 1900's. Viral infection with the Human Immunodeficiency Virus (HIV) is the causative factor in the development of AIDS, thus results in irreversible destruction of the victim's immune system by destroying specialized white blood cells, known as T4 helper lymphocytes. Without these cells, the immune system function is greatly compromised. An important distinction must be made between those who are infected with the HIV virus, and those who demonstrate the signs and symptoms of AIDS. All patients with AIDS are HIV positive, but not all HIV positive patients have AIDS. People who are HIV positive can be asymptomatic, whereas people with AIDS exhibit the symptoms of the disease. Most experts agree, it is hard to estimate the actual number of HIV infected individuals. This is due to the presence of asymptomatic (not yet exhibiting the symptoms of AIDS) carriers. Since its first case reports of AIDS in June 1981, state and local health departments had reported to the CDC (Center for Disease Control) 179,136 AIDS cases among persons of all ages in the United States. Reports of the rate of HIV infection in inner city emergency rooms range from 4.2 to 8.9 percent. In North and South America combined, there are estimates that up to 2 million people are currently infected with the HIV virus in North and South America combined. The World Health Organization estimates that 8-10 million adults and 1 million children worldwide are infected with the AIDS virus. By the year 2000, 40 million persons may be infected with the virus. More than 90% of these persons will likely reside in the developing countries of Africa, South and Southeast Asia, Latin America, and the Caribbean. Based on 1989 data, AIDS is the number four cause of death in males age 15-54. The exact origin of AIDS is unknown, but it is suspected to have originated in Africa. A monkey population has been shown to be afflicted with a similar immunodeficiency syndrome. Transmission to the human population may have been through an infected bite or scratch. There is a substantial time lapse in the time at which a patient first produces a positive HIV antibody screening test and the time at which the patient first develops the symptoms of AIDS. In most cases, a patient will develop a positive HIV antibody test 3-6 months after exposure to the virus (closer to 3 months for those who contract the illness via blood transfusion or contaminated needle-stick). The incubation time of the virus is defined as the interval between actual infection (needle-stick, transfusion, or sexual contact) and the development of symptoms consistent with AIDS (see below). The mean incubation time is estimated at 8.23 years for adults, and 1.97 years for children under age 5. The mode of HIV infection seems to be a determining factor in the actual incubation time for the virus. The range of incubation contaminated needle-sticks and blood transfusion can be several months to several years, whereas homosexual contact may have incubation range of 1 year to over 10 years. Patients with AIDS suffer from secondary bacterial, viral, and fungal infections that would otherwise not occur in an individual with a healthy immune system. These are known as opportunistic infections. Examples include; pneumocystis pneumonia, oral thrush, toxoplasmosis, histoplasmosis, tuberculosis, and disseminated fungal infections (Candida). Some forms of cancer (Kaposis sarcoma) are also more commonly seen in the AIDS patient. It is important to identify certain groups with a high risk for contracting (and transmitting) this disease. HIGH RISK ACTIVITIES1. HOMOSEXUAL CONTACT IN MEN (large number of infected individuals) 2. INTRAVENOUS DRUG ABUSE (shared needles) 3. PROSTITUTION (likely related to intravenous drug use as this population has a higher incidence of needle abuse) 4. BLOOD AND BLOOD PRODUCT TRANSFUSIONS (highest risk in those who received transfusion prior to 1985, hemophiliacs and kidney dialysis patients most commonly infected) 5. ANAL INTERCOURSE (recipient at greatest risk) 6. UNKNOWN OR MULTIPLE SEX PARTNERS (promiscuity) Through intravenous drug abuse, prostitution, and, to some degree, blood transfusions, the HIV virus has spilled over into the heterosexual population and is spreading within this group. The vast majority of cases are still reported in homosexual males (60% of the total U.S. cases), IV drug abusers (22% of the total U.S. cases), and combinations of these two groups. AIDS cases from heterosexual contact alone appear to be roughly 5% of the total U.S. cases. PEOPLE WHO CARRY THE HIV VIRUS ARE INFECTIOUS AND DO NOT HAVE TO HAVE AIDS TO TRANSMIT THE DISEASEStudies in Africa have shown that the chance of transmitting AIDS from an infected female to a male in a single act of vaginal-penile intercourse is less than 0.2% . It must be pointed out that venereal diseases (gonorrhea syphilis, herpes, etc.) may facilitate the transfer of AIDS. The female to male infection rate jumps to 5-10% when the female (or male) has a genital ulcer (from one of he above venereal diseases). It is now known that the transmission of the virus from an infected male to a noninfected female has a greater rate of incidence than infection from infected females to males. This has been attributed to the relatively high concentration of the virus in semen and the susceptibility of the cells lining the vaginal walls. For this reason, the routine use of LATEX condoms (impenetrable) is essential. Although AIDS has been identified with those who have received blood transfusions (in the past before adequate testing) the current risk of HIV virus transmission by blood transfusion, even in high-prevalence metropolitan areas, is extremely low. It has been estimated that the probability of a screened donor (negative test) would be a carrier of the HIV virus is 1 in 61,171 cases. In the state of Florida, one is more likely to be a victim of a lightning strike than acquiring the HIV virus through a tainted blood transfusion. AIDS is expected to become one of the five leading causes of death among FEMALES of reproductive age in 1991. By the end of 1991 it will be the second leading cause of death among MEN 25-44 years of age. AIDS AND THE HEALTH CARE WORKEROne of the most emotionally charged issues in the AIDS epidemic has been the HIV risk to, and from, health care workers. The risk of HIV transmission for a health care worker, after needlestick inoculation with HIV infected blood has been estimated to be 0.3% (3 out of 100 workers will become infected after a contaminated needlestick). An investigation of HIV infections among patients in the practice of one Florida dentist with AIDS suggested that five patients, of the approximately 850 patients evaluated through June 1991, were infected with the HIV virus. In three other studies involving transmission of the HIV virus from infected health care workers, not a single case of transmission was identified. A precise estimate of the risk of HIV transmission from infected health care workers has yet to be determined through continued research in this area. The Center for Disease Control (CDC) has estimated that several thousand individual health care workers have been diagnosed with AIDS. As of February 1993, 32 health care workers were regarded by the CDC as cases of "documented occupational transmission of HIV (contracted HIV infection from an infected patient)." In summary, the risk of contracting AIDS from a health care worker appears to be extremely low (less than 10 total cases), although the risk of HIV infection for the health care worker appears to be substantially greater. THE SYMPTOMS OF AIDSSymptoms of AIDS can be quite varied. Swollen glands, weight loss, fevers, exertional cough, skin lesions, chronic diarrhea, and persistent sore throat (fungal throat infection) are all seen. Symptoms will vary in accordance with the type of opportunistic infection. Pneumocystis pneumonia is a common complication see in the AIDS patient. Evaluation will include history to identify potential high risk groups. Physical examination may exhibit skin lesions or the fungal throat infection that typifies this disease. The blood test for HIV will be more definitive although false positives still occur. Further testing may be necessary. This test result remains confidential in most states. Most patients will also have a CBC, electrolyte profile, urinalysis, and chest x-ray performed as part of their general evaluation. Home diagnostic test kits for HIV infection are likely to be marketed to the general public by the year 2000. THE TREATMENT OF AIDSTreatment of AIDS and HIV infection is aimed at individual treatment of the bacterial and fungal infections that occur in the AIDS patient. Medications are used which seem to slow down the progression of the HIV carrier state to clinical AIDS. New medications such as "AZT" (Zidovudine) have been reported to decrease the progression of this disease. A relatively new medication currently in clinical trials in the United States is didanosine (Videx). This is an anti-viral agent, also referred to as "ddI" that inhibits the replication of the HIV virus (responsible for AIDS). The effectiveness of this medication is still being evaluated. An important part of the treatment of AIDS and asymptomatic HIV infection is a nutritious diet. A cure or an effective vaccine remains in the future. New rapid tests for the AIDS virus are being developed and may eventually be marketed to the public. Politics and public opinion are quite influential in this area. Prevention of viral transmission remains an important factor in controlling this serious epidemic. TIPS ON PREVENTION1. Condom (latex only) use is the current recommendation unless between monogamous sexual partners (both negative for disease). 2. Do not share personal utensils (razors, toothbrush, etc) that could result in viral inoculation through breaks in the skin. 3. Avoid casual sexual relationships, multiple partners, sexual relations with partners of unknown sexual background, and those from high risk groups (see above). 4. Do not share insertive (sex) objects as they may transfer the virus through small breaks in the skin. 5. Avoid anal kissing, oral-genital sex (particularly in the presence of oral or genital sores), and anal intercourse. As a rule avoid any contact with blood, semen, urine, or feces. 6. Women should not douche immediately after intercourse because this can compromise the body's natural immunity. 7. Petroleum based lubricants (vaginal) can trap germs and viruses. Use water based lubricants. 8. The use of spermacidal agents (with condoms) may provide additional protection from the AIDS virus. 9. Health care workers need to avoid any contact with potentially infected fluids (blood, semen, urine, or feces) by always wearing gloves (and a mask) during medical procedures. Hope this article will provide you information about acquired immunodeficiency syndrome. |
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