Introduction:
AIDS, which stands for acquired immunodeficiency syndrome. AIDS is a condition that results from infection with the human immunodeficiency virus (HIV), which attacks and destroys the immune system. In this presentation, I will cover the following aspects of AIDS:
Pathophysiology of AIDS
HIV is a retrovirus, which means it uses an enzyme called reverse transcriptase to insert its genetic material into the DNA of the host cell. HIV mainly infects CD4 T cells, which are a type of white blood cell that helps coordinate the immune response to infections and cancers. HIV also infects other cells, such as macrophages, dendritic cells, and monocytes, that play a role in immunity. HIV replicates inside these cells and produces new virus particles that can infect more cells. Over time, HIV depletes the number and function of CD4 T cells, leading to immunodeficiency. This means the body becomes vulnerable to opportunistic infections and cancers that normally do not affect healthy people. HIV also causes chronic inflammation and activation of the immune system, which can damage various organs and tissues. The progression of HIV infection to AIDS can take several years, depending on the viral strain, the host’s genetic factors, and the availability of treatment.
Causes of AIDS
AIDS is caused by infection with HIV, which can be transmitted through different routes. The most common modes of transmission are:
Unprotected sexual contact (vaginal, anal, or oral) with an HIV-positive person. The risk of transmission depends on the type of sexual act, the viral load of the partner, the presence of other sexually transmitted infections, and the use of condoms or pre-exposure prophylaxis (PrEP).
Exposure to contaminated blood or blood products, such as through transfusion, injection drug use, needle sharing, or occupational injury. The risk of transmission depends on the amount and type of blood exposure, the viral load of the source, and the use of post-exposure prophylaxis (PEP) or antiretroviral therapy (ART).
Mother-to-child transmission during pregnancy, delivery, or breastfeeding.
Types of AIDS
two types that cause AIDS: HIV-1 and HIV-2. HIV-1 is the most common and widespread type, and it has several subtypes and strains that differ in their geographic distribution, genetic diversity, and pathogenicity. HIV-2 is mainly found in West Africa and some parts of Europe and Asia, and it is less transmissible and less virulent than HIV-1.
Signs and symptoms of AIDS
The signs and symptoms of AIDS vary depending on the stage of infection and the type of opportunistic infection or cancer that develops. The stages of HIV infection are:
Acute HIV infection: This is the initial phase of infection, which occurs within 2 to 4 weeks after exposure to HIV. Some people may experience a flu-like illness, with fever, headache, rash, sore throat, swollen lymph nodes, and muscle and joint pain. Others may have no symptoms at all.
Clinical latency: This is the asymptomatic phase of infection, which can last for several years. The virus continues to replicate at a low level, and the CD4 T cell count gradually declines. Some people may have mild or intermittent symptoms, such as fatigue, weight loss, night sweats, oral thrush, or shingles.
AIDS: This is the advanced stage of infection, which occurs when the CD4 T cell count falls below 200 cells per microliter of blood, or when the person develops an AIDS-defining illness.
Diagnosis of AIDS
The diagnosis of AIDS is based on the following criteria:
A positive test for HIV infection, using either an antigen/antibody test, an antibody test, or a nucleic acid test. These tests can detect HIV in blood or saliva samples, and they have different window periods, which are the time from infection until a test can detect any change.
A CD4 T cell count below 200 cells per microliter of blood, or the presence of an AIDS-defining illness, such as Pneumocystis pneumonia, Kaposi’s sarcoma, or tuberculosis.
Differential diagnosis of AIDS
The differential diagnosis of AIDS includes other conditions that can cause immunodeficiency, such as:
Primary immunodeficiency disorders, such as severe combined immunodeficiency (SCID), common variable immunodeficiency (CVID), or DiGeorge syndrome.
Secondary immunodeficiency disorders
Q & A
1.Q: What does AIDS stand for?
A: Acquired Immune Deficiency Syndrome.
2.Q: What is AIDS caused by?
A: Human Immunodeficiency Virus (HIV) infection.
3.Q: How is HIV transmitted?
A: HIV can be transmitted through unprotected sexual contact, sharing needles, mother-to-child transmission during childbirth or breastfeeding, and by receiving infected blood or blood products.
4.Q: How is HIV not transmitted?
A: HIV cannot be transmitted by casual contact such as hugging, shaking hands, or sharing household items.
5.Q: What is the most common mode of HIV transmission worldwide?
A: Unprotected heterosexual intercourse.
6.Q: Which body fluids can transmit HIV?
A: Blood, semen, vaginal fluid, and breast milk.
7.Q: What is the window period for HIV testing?
A: The window period is the time between HIV infection and the time when the test can accurately detect the infection. Generally, it can range from a few weeks to several months.
8.Q: What are the common symptoms of HIV infection?
A: Common symptoms can include fever, fatigue, swollen lymph nodes, sore throat, rash, and muscle and joint pain.
9.Q: How can HIV be prevented?
A: HIV can be prevented through practicing safe sex, using condoms, getting tested regularly, avoiding sharing needles, and accessing pre-exposure prophylaxis (PrEP) for high-risk individuals.
10.Q: What is the purpose of World AIDS Day observed on December 1st?
A: World AIDS Day is observed on December 1st every year to raise awareness about HIV/AIDS and remember those who have lost their lives to the disease.
11.Q: When was the first World AIDS Day observed?
A: The first World AIDS Day was observed on December 1st, 1988.
12.Q: Which organization coordinates World AIDS Day activities globally?
A: The Joint United Nations Programmed on HIV/AIDS (UNAIDS) coordinates World AIDS Day activities globally.
13.Q: What is the theme for World AIDS Day 2021?
A: The theme for World AIDS Day 2021 is “End inequalities. End AIDS. End pandemics.”
14.Q: Why is it important to celebrate World AIDS Day?
A: It is important to celebrate World AIDS Day to raise awareness, combat stigma and discrimination, support those living with HIV, and encourage people to get tested and take preventive measures.
15.Q: How many people worldwide are living with HIV/AIDS?
A: Approximately 38 million people are living with HIV/AIDS worldwide.
16.Q: Which continent is most affected by HIV/AIDS?
A: Sub-Saharan Africa is the most affected region with the highest burden of HIV/AIDS.
17.Q: Is there a cure for HIV/AIDS?
A: Currently, there is no cure for HIV/AIDS, but antiretroviral therapy (ART) helps manage the infection and can significantly increase the lifespan of people living with HIV.
18.Q: What is the role of stigma in the HIV/AIDS epidemic?
A: Stigma and discrimination act as barriers to HIV prevention, testing, and engagement in care, making it challenging for those affected to seek treatment and support.
19.Q: Can HIV-positive individuals have children without transmitting the virus?
A: Yes, with proper medical advice and care, HIV-positive individuals can have children without transmitting the virus by following specific interventions such as HIV treatment, viral load suppression, and assisted reproductive technologies.
20.Q: How can communities contribute to the fight against HIV/AIDS?
A: Communities can contribute by promoting awareness, advocating for HIV prevention and care services, supporting those affected, and tackling stigma and discrimination.
Case studies!
– Case study 1: Ravi is a 35-year-old truck driver who travels across India. He has been married for 10 years and has two children. He also has occasional sex with female sex workers along his routes. He does not use condoms consistently. He has never been tested for HIV. One day, he develops a fever, cough, and weight loss. He visits a local clinic and is diagnosed with tuberculosis. He is also offered an HIV test, which comes back positive. He is shocked and scared. He does not know how to tell his wife and family. He is referred to an HIV care center for further treatment and counseling.
– Case study 2: Maria is a 25-year-old sex worker in Gurugram, Haryana. She has been working in the sex industry for five years. She has a regular boyfriend who does not know about her occupation. She uses condoms with her clients, but not with her boyfriend. She has been feeling tired and weak for the last few months. She also has recurrent vaginal infections and oral thrush. She visits a health center and is tested for HIV. She is positive. She is devastated and angry. She blames her boyfriend for infecting her. She does not want to take any medication or disclose her status to anyone. She is afraid of losing her income and her relationship. She is counseled by a peer educator and a doctor who explain the benefits of antiretroviral therapy and the importance of safe sex practices.
– Case study 3: James is a 45-year-old gay man living in London. He has been HIV positive for 15 years. He has been on antiretroviral therapy for 10 years and has a good viral suppression. He is healthy and happy. He has a stable partner who is also HIV positive. They have an open relationship and sometimes have sex with other men. They always use condoms with casual partners. James is involved in a local HIV support group and advocates for the rights of people living with HIV. He is optimistic about the future and hopes to see a cure for HIV in his lifetime.
– Case study 4: Grace is a 60-year-old widow living in Nairobi, Kenya. She lost her husband to AIDS 10 years ago. She has three children and six grandchildren. She works as a tailor and sells her products at the market. She is a respected member of her community and church. She has never been tested for HIV. She assumes she is negative because she has no symptoms. She has a new boyfriend who is 50 years old. He is a widower and has four children. He is a farmer and owns some land. He is kind and generous. He wants to marry Grace and take care of her. He does not use condoms with her. He says he trusts her and loves her. Grace is happy and feels young again. She does not know that her boyfriend is HIV positive and has not disclosed his status to her. He is afraid of losing her and being stigmatized. He is not on treatment and has a high viral load. He is unaware of the risk of transmitting HIV to Grace.
– Case study 5: Dominique is a 28-year-old professional basketball player in the United States. He is a star athlete and has a large fan base. He is married and has a daughter. He also has a secret life. He is bisexual and has sex with men and women outside his marriage. He does not use condoms consistently. He is addicted to drugs and alcohol. He has been feeling unwell for the last few weeks. He has night sweats, swollen glands, and diarrhea. He visits his team doctor and is tested for HIV. He is positive. He is shocked and confused. He does not know how he got infected or who he may have infected. He is worried about his career, his reputation, and his family. He is advised to start treatment and to disclose his status to his sexual partners. He is reluctant to do so. He is afraid of the consequences. He is also concerned about the public reaction and the media attention. He is not sure if he can cope with the situation.
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