Acquired immunodeficiency syndrome; Human immunodeficiency virus
Acquired immunodeficiency syndrome (AIDS) is a chronic and potentially fatal disease of the immune system. It is caused by the human immunodeficiency virus (HIV), which attacks a specific type of white blood cell known as T-lymphocytes. These cells are measured in the blood as the CD4 count. The lower a person's CD4 count, the weaker the person's immune system. As the immune system grows weaker, people with HIV and AIDS are more vulnerable to infections and cancers that the immune system would ordinarily fight off.
More than 50,000 new cases of HIV infection occur in the United States every year. A massive research effort has produced better treatments, resulting in longer survival and improved quality of life for those with access to treatments. However, there is still no vaccine or cure.
Symptoms of HIV vary. A flu-like syndrome occurs in 40 to 90% of those who contract HIV within the first 2 to 6 weeks, with a combination of symptoms such as:
- Sore throat
- Swollen lymph nodes
- Joint pain
- Muscle aches
- Mouth ulcers
- Nausea and vomiting
After infection with HIV, people may remain relatively symptom-free for years, or the disease may progress more rapidly. In this stage, the CD4 count is below 500/microliter. You may develop infections or chronic symptoms, including:
- Swollen lymph nodes
- Weight loss
- Cough and shortness of breath
- Low platelet count, which may manifest as easy bruising, bleeding gums, or nose bleeds
- Localized herpes or fungal infections
During the last stage of the disease, HIV infection may meet the official criteria for AIDS, which is the presence of an opportunistic infection (such as Pneumocystis carinii pneumonia, or PCP) or a CD4 count below 200/microliter. At this stage, symptoms may include:
- Pneumonia, including PCP
- Night sweats
- Persistent fatigue
- Extreme weight loss, exacerbated by diarrhea. More than 90% of HIV patients worldwide experience diarrhea, although that number is lower in the developed world.
- Meningitis and other brain infections
- Fungal infections
- Malignancies, such as lymphoma, cervical cancer, and Kaposi sarcoma, which affects the skin, oral mucosa, and may spread to the lungs. It can occur in earlier stages of HIV, as well.
What Causes It?
HIV infection causes AIDS. HIV is spread primarily through sexual contact, and also through blood-to-blood contact, needle sharing among intravenous drug users, and, in pregnant women, from mother to child. Worldwide, about 80% of HIV transmission occurs through sexual contact. Blood transfusions and blood products caused many infections in the early years of the epidemic, but screening procedures have nearly eliminated this risk in the United States and other developed countries. A mother can spread the virus to a newborn during delivery and through breastfeeding, although drug therapy available in the developed world can greatly reduce the risk to infants.
Risk factors include:
- Having unprotected sex and having more than one partner, whether you are heterosexual or homosexual
- Having another sexually transmitted disease
- Using intravenous drugs and sharing needles
What to Expect at Your Doctor's Office
If your doctor suspects HIV infection, you may receive a "rapid test," which can provide results in 20 minutes. If the test is positive, your doctor will order a blood test to detect antibodies against the virus. If that test is also positive, the doctor will order a CD4 count (see above) and a viral load (an indication of the amount of virus present). This information, along with your symptoms, helps the doctor see what stage the disease is in and determine the best course of treatment, including the appropriate tests and medications. For example, if you are experiencing shortness of breath, your doctor will order a chest x-ray, particularly if your CD4 count is low. Some symptoms and tests may require evaluation in the hospital.
HIV tests may not be accurate immediately after you are infected. It can take up to 12 weeks for your body to develop antibodies against the virus. If you suspect you have been infected and your test is negative, you may need to be retested after a short time to confirm the result.
If you do test positive for HIV, you will be asked to tell your sexual partners immediately so they can also be tested.
Medication can slow the progression of HIV infection to full blown AIDS. Doctors typically prescribe treatment when the CD4 count falls to a certain level. Generally, physicians use a combination of these medicines, including a type called protease inhibitors. In addition, antibiotics and other therapies are used to prevent or treat specific complications. It is important that a doctor who specializes in HIV direct your care. Your doctor will know the most effective treatment for you, including the most current medical regimen, what alternative treatments are safe, and which combinations may be harmful. Tell your doctor if you are using any alternative therapies to complement your medical regimen.
Doctors use combination of drugs to treat HIV very aggressively, with the aim of reducing the amount of virus in your blood to very low or undetectable levels, and to suppress symptoms for as long as possible.
Antiretroviral drugs help slow the progression of HIV by inhibiting the reproduction of the virus in your blood. It is important to keep a steady dose of antiretroviral drugs in your body to prevent the virus from developing resistance to the drugs. Antiretroviral medications include:
- Protease inhibitors (PIs). PIs stop an HIV enzyme from replicating. This class of drugs includes saquinavir (Invirase), nelfinavir (Viracept), ritonavir (Norvir), tipranavir (Aptivus), indinavir (Crixivan), amprenavir (Agenerase), and atazanavir (Reyataz). For people who have not responded to treatment, doctors may prescribe another medicine, darunavir (Prezista), in combination with other drugs. Ritonavir and lopinavir (Kaletra) is among the most prescribed combination. Protease inhibitors are considered the most powerful HIV drugs and often interact with other medications, so your doctor must monitor them carefully.
- Nucleoside analogue reverse transcriptase inhibitors (NRTIs). Also stop a particular HIV enzyme from replicating. These drugs were among the first to be developed and include zidovudine or azidodeoxythymidine (Retrovir or AZT), lamivudine (Epivir), didanosine (Videx), abacavir (Ziagen), stavudine (Zerit), and zalcitabine (Hivid). Emtricitabine (Emtriva) is a newer drug in this class and is taken with at least two other HIV medications. Combinations of several other drugs are also available. All have side effects that your doctor must monitor.
- Nucleotide reverse transcriptase inhibitors (NtRTIs). Work similarly to NRTIs but act more quickly. So far there is only one drug in this class, tenofovir (Viread), which seems to be effective in people who develop resistance to NRTIs.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs). Stop the virus from making DNA, so it cannot replicate itself. There are 3 drugs in this class: nevirapine (Viramune), efavirenz (Sustiva), and delavirdine (Rescriptor). They are often used if people cannot tolerate the side effects of protease inhibitors, want to delay protease inhibitor therapy, or if they have taken protease inhibitors but did not experience a drop in levels of the virus. Many of these drugs are cross resistant, meaning that if you develop resistance to one drug in this class it is likely you will be resistant to all.
- Fusion inhibitors. Prevent the HIV membrane from fusing with the membrane of healthy cells in your body. Enfuvirtide (Fuzeon) is often used in combination with other drugs in people who have become resistant to other medications. It must be administered by injection.
- Combination drug therapies also exist. Epzicom is a combination of abacavir (Ziagen) and lamivudine (Epivir). Truvada is a combination of tenofovir (Viread) and emtricitabine (Emtriva).
In addition, doctors treat any opportunistic infections with the appropriate medications, or in some cases they give medications to prevent infections from occurring (prophylaxis).
Complementary and Alternative Therapies
Many people with HIV turn to complementary and alternative therapies to reduce symptoms of the virus, lessen side effects from medications, improve overall health and well being, and gain a sense of empowerment by being actively involved in their own care.
Doctors use different therapies to:
- Inhibit the virus
- Treat symptoms of the virus or side effects of medication
- Treat or prevent opportunistic infections
- Improve function of the immune system
Since the major impact of HIV is that it leaves patients vulnerable to opportunistic infections, making adjustments to enhance your overall health through minimizing stress, getting regular exercise, building a social support network, and having a spiritual practice can significantly boost immune function. In fact, these actions are some of the most powerful tools a person has to impact the course of the disease. Other changes, such as improving oral and general hygiene and limiting exposure to environmental pollutants, can also bolster your health and vitality. These small steps can add up to a longer and healthier life for many people.
However, HIV should never be treated with alternative therapies alone. It is extremely important that you inform your doctor about any complementary and alternative therapies you are considering. Your doctor can help you determine what is safe and appropriate. Some herbs and/or nutrients can interfere with HIV/AIDS medications and new information on herb/drug interactions, both beneficial and detrimental, are being uncovered all the time. It is vital that you work with a knowledgeable provider to determine the proper nutrition and supplement program for your health.
Nutrition and Supplements
These nutritional tips may help reduce symptoms:
- Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your doctor may want to test you for food allergies.
- Eat foods high in B-vitamins, calcium, and iron, such as almonds, beans, whole grains (if no allergy), dark, leafy greens (such as spinach and kale), and sea vegetables.
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
- Avoid refined foods, such as white breads, pastas, and especially sugar.
- Use quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, as part of a balanced program aimed at gaining muscle and preventing weight loss that can sometimes be a side effect of therapy. Try to focus on eating more lean meats, such as chicken and fish, tofu (soy, if no allergy), or beans for protein.
- Use healthy oils in foods, such as olive or coconut oil.
- Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid coffee and other stimulants, alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, 5 days a week. Talk to your doctor about how much exercise you need.
You may address nutritional deficiencies with the following supplements:
- A daily multivitamin containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, and selenium. The HIV drug Agenerase already contains large amounts of Vitamin E, so speak to your doctor before taking supplements that contain vitamin E.
- Omega-3 fatty acids, such as fish oil, to help reduce inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources but not substitutes for supplementation. Omega-3 supplements can increase the blood-thinning effect of certain medications, such as warfarin (Coumadin) and aspirin; speak with your doctor.
- Whey protein, mixed in your favorite beverage, when needed as a protein supplement for support of immunity and weight gain or creatine, 5 to 7 grams daily, when needed for muscle weakness and wasting. Creatine can interact with some medications that treat kidney disease. Talk with your doctor.
- N-acetyl cysteine, for antioxidant effects.
- Probiotic supplement (containing Lactobacillus acidophilus among other strains), when needed for maintenance of gastrointestinal and immune health. Some probiotic supplements need refrigeration for best results. Check labels carefully. People who are severely immune compromised may not be able to take probiotics; speak with your doctor.
- Coenzyme Q10 (CoQ10), for antioxidant and immune activity. CoQ10 may interact with some chemotherapy medications and blood pressure medications, and may lower the effectiveness of blood-thinning medications, such as warfarin (Coumadin).
- Vitamin C, 1 to 3 times daily, as an antioxidant and for immune support. Some doctors will use higher doses in HIV and AIDS therapies. Check with your doctor.
- L-glutamine, for support of gastrointestinal health and immunity. High doses of glutamine may cause manic symptoms in people with a history of psychiatric illness. It may also interact with certain medications. Speak with your doctor.
- Melatonin, 1 hour before bedtime, for sleep and immune protection. Ask your doctor about potential drug interactions with the use of melatonin, particularly psychiatric medications.
- Dehydroepiandrosterone (DHEA), for hormonal balance. DHEA is a hormone that is often low in people with HIV. One study found that DHEA supplements improved minor depression with no serious side effects. Because DHEA is a hormone, you should not take it without your doctor's supervision. You and your doctor can determine proper dosages after testing blood or saliva levels of DHEA in your body.
Weight loss can be a serious problem for people with HIV. This symptom may begin early in the course of the disease and can increase the risk for developing opportunistic infections. Weight loss is exacerbated by other common symptoms of HIV and AIDS, including lesions in the mouth and esophagus, diarrhea, and poor appetite. Over the last several years, weight loss has become less of a problem due to the new protease inhibitors used for treating HIV. Reduction of muscle mass, though, remains a significant concern. Working with a registered dietitian to develop a meal plan to prevent weight loss and muscle breakdown is extremely helpful. Resistance training (lifting weights) can also protect against muscle breakdown and increase lean body mass.
Preventing diarrhea and ensuring the body absorbs enough protein to maintain muscle strength has become a major goal of HIV/AIDS care. One program for combating diarrhea includes using soluble fiber (not insoluble fiber, such as Metamucil and psyllium husks). For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed and lessening bowel frequency. Good sources of soluble fiber include apple pectin, oat bran, and flax seed. Because diarrhea can be life threatening, use soluble fiber therapy only under the strict supervision of a trained professional.
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting any treatment. Work with a knowledgeable health care provider to establish a supplement regimen and make sure you have an up-to-date list of any supplements you are taking. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.
- Green tea (Camellia sinensis) standardized extract. For antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb. In one study, a component of green tea called epigallocatechin gallate (EGCG) inhibited HIV infectivity.
- Fermented wheat germ extract, for immune effects. Ask your health care provider for more information about this supplement.
- Bitter Melon (Momordica charantia). For antiviral and immune support. Higher dosages may be needed in HIV and AIDs therapy. A health care provider can help with dosages.
- Maitake mushroom (Grifola frondosa). For immune and antiviral effects. You may also take a tincture of this mushroom extract. Maitake may lower blood sugar, so take extra care if you already take blood sugar-lowering medications.
- Cat's claw (Uncaria tomentosa) standardized extract. For immune and antiviral activity. Cat's claw may be inappropriate for some people with leukemia or certain autoimmune disorders. It may also interact with some medications. Speak with your doctor.
You may use herbs as supportive therapies, but never use them alone to treat HIV or AIDS. Tell all of your providers about any treatments, conventional or alternative, you are taking so they can monitor interactions and side effects, and provide the best care. Always work with a complementary and alternative (CAM) practitioner who is knowledgeable in HIV care. HIV medicine is changing continually and practitioners need to stay current on the latest medication and herb/drug/nutrient interactions.
You should stop taking St. John's wort (Hypericum perforatum), which has a negative effect on indinavir and could lead to developing resistance to the drug. You should also avoid echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus). Both show conflicting evidence of enhancing immune function and strengthening replication of the HIV virus in test tubes. Garlic may also interfere with certain HIV medications.
No specific scientific research supports the use of homeopathy for HIV or AIDS. A licensed, certified homeopathic doctor would evaluate you individually to assess the value of homeopathy for reduction of symptoms or side effects from medication as an adjunct to standard medical treatment.
Exercise is another way to develop a general sense of well being, improve mental attitude, decrease depression, diminish weight loss, and increase lean body mass. Resistance or weight training is particularly useful to increase strength and enhance lean body mass.
People with HIV may use acupuncture to improve general well being, alleviate symptoms such as fatigue, insomnia, and night sweats, and to minimize side effects from medications, such as nausea and diarrhea. Some people also find relief from peripheral neuropathy, caused occasionally by certain medications used for HIV, reporting less pain, increased strength, and improved sensation.
In China, acupuncture and moxibustion (a heat treatment performed by the acupuncturist over points where the needles are placed) are the standard treatments for HIV-related diarrhea.
Health care professionals may also use acupuncture to treat the neuropathic (nerve) pain associated with certain HIV medications. Inserting needles bilaterally in the hand and foot points known as Baaxie and Bafeng, respectively, can lessen neuropathic pain.
Massage can relieve chronic muscle tension and stress, which may help the immune system.
If you are HIV positive and pregnant, taking certain antiretroviral medications will reduce the likelihood of you transmitting the virus to your baby. Your doctor will determine which medicine is best for you and safe for your baby. Depending on your own condition, you and your doctor may decide to postpone treatment until after your first trimester to reduce the risk of birth defects. The drug efavirenz (Sustiva) should be avoided throughout pregnancy. If you are HIV-positive, you should not breastfeed because of the risk of transmission to your baby.
Studies show that people who are HIV positive have increased arterial inflammation compared to non-infected people with the same risk factors.
Preliminary research suggests that spirituality and a positive outlook can help slow disease progression and improve quality of life.
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