HIV/AIDS Lecture Notes

HIV vs. AIDS

• HIV (Human Immunodeficiency Virus) is the virus that initiates the infection.

  • It's a retrovirus.
  • It attacks T cells (CD4 cells), replicates within them, and destroys them.

• AIDS (Acquired Immunodeficiency Syndrome) is the advanced stage of HIV infection.

  • A person is diagnosed with AIDS when they have an opportunistic infection (e.g., Pneumocystis pneumonia, Kaposi sarcoma) and their T cell count falls below 200.
  • Even if T cell counts increase with treatment, the AIDS diagnosis remains.

Treatment and Management

• Early treatment is crucial and can prevent progression to AIDS.

  • Treatment involves antiretroviral medications that can help maintain a normal life.
  • Previous treatment protocols were delayed until T cell counts dropped significantly due to limited treatment options.

• Kaposi Sarcoma:

  • A rare cancer that became prevalent in early AIDS cases.

• Opportunistic Infections:

  • Infections that take advantage of a weakened immune system.

Origin and Theories

• The generally accepted theory is that HIV originated from animal-to-human transmission.

• Although conspiracy theories exist, there is no proof that HIV was manufactured or the result of a lab mutation.

• Some labs do research on virus mutations, though the purpose is debated.

HIV and CD4 Counts

• HIV attacks CD4 cells (T cells).

• Upon diagnosis, monitoring CD4 count and viral load is essential.

• Low CD4 count and high viral load indicate a longer duration of infection.

Viral Load

• Viral load measures the number of HIV copies in the blood.

• The goal of treatment is to suppress the viral load to undetectable levels.

• As viral load decreases, T cell counts should increase.

Historical Context

• In the early days of the AIDS epidemic, treatments were limited, and patients often presented with severe symptoms.

• The stigma associated with HIV/AIDS affected various groups, including drug users, the LGBTQ+ community, and different racial groups.

Prevention Education

• HIV prevention education is essential but faces challenges, including reluctance to discuss sex.

• Some schools face restrictions that limit HIV education to abstinence-only approaches, preventing comprehensive discussions about prevention methods like condoms.

Safer Sex Practices

• Being Honest with Partners: Essential to communicate and be honest with partner(s).

• Condoms and PrEP Protect, But Have Limitations: Condoms and PrEP do not protect against all STDs or pregnancy.

  • PrEP can give a false sense of security, leading to risky behavior and increased STD transmission.

Transmission and Risk Factors

• Sexual transmission through semen and vaginal secretions is a significant route.

• Other transmission routes include blood and body fluids, shared needles among IV drug users.

Societal Impact

• The AIDS epidemic initially led to fear and abandonment, but later, significant support emerged from friends, families, and celebrities.

Treatment Advances

• Treatment advances in the 1990s introduced protease inhibitors and non-nucleoside reverse transcriptase inhibitors.

• These drugs block HIV from attaching to T cells or from replicating within them.

• Current treatments have simplified to one pill a day, a stark contrast to the multiple medications required in the past.

Risk Factors

• Gestational complications, extended labor, and breastfeeding increase the risk of transmission from mother to child.

• HIV-infected mothers are advised not to breastfeed.

• C-sections are recommended in some cases to lower transmission risk.

• Infants born to HIV-positive mothers may carry HIV antibodies for 15-18 months but can later convert.

Viral Load and T Cell Count

• Undetectable viral load (e.g., less than 50 copies) is a desirable outcome of treatment.

• Factors such as individual immune responses can influence the course of HIV infection.

• Non-progressors have immune systems that naturally resist HIV attachment.

• Elite controllers are a rare group (about 1% of the population) who can control HIV without medication.

AIDS-related Complications

• AIDS is diagnosed when the T cell count drops below 200 and opportunistic infections occur.

• Kaposi Sarcoma (KS) can manifest rapidly, with tumors appearing all over the body.

Early Symptoms and Testing

• Early HIV infection may be asymptomatic or present with mild cold or flu-like symptoms.

• Regular testing is recommended for sexually active individuals or those with concerns.

• Testing frequency depends on risk factors and partners.

Patient Interactions

• Avoid shaming patients and provide support and testing.

• Baseline testing is essential for individuals concerned about exposure.

*Seronegative means the HIV test came back nonreactive.

Opportunistic Infections

• Common opportunistic infections include Pneumocystis pneumonia, Kaposi sarcoma, and herpes.

• Tuberculosis (TB) is a significant concern for individuals with HIV/AIDS.

• New HIV diagnoses should include testing for all STDs and hepatitis.

Alternative Therapies

• Somepatients may experience pituitary issues.

• Growth hormone (GH) may be used to correct this.

Adherence to Medications and Palliative Care

• Adherence to HIV medications is critical. Newer medications may be in the form of a shot that can be taken every two months.

• Palliative care includes exercise, careful use of herbs and supplements, and addressing social isolation.

• Insulin resistance and fungal infections are common in long-term HIV.

*HIV support groups can help with feeling isolated.

Complex Cases

• Advanced AIDS cases may require salvage therapy to manage multiple complications.

Cognitive Issues

• Related cognitive issues include AIDS dementia complex or CMV.

Cytomegalovirus (CMV)

• One of the biggest sources of CMV is in the home in catboxes

Interventions

*Female Condoms: Female condoms didn't take off because of their thickness and plastic texture.

Risk Reduction

• Chemsex: There is a bad tendency in society towards chemsex.

• Club and Atlanta: Issues with clubs and Atlanta contribute to a rise in STDs.