|HIV and AIDS
|Also Listed As:
|| AIDS and
Acquired immunodeficiency syndrome, or AIDS, is a worldwide health problem.
AIDS is caused by the human immunodeficiency virus (HIV), which attacks a
specific type of white blood cells known as T-lymphocytes. It is measured in the
blood as the CD4 count, which is a marker on the T cells; the lower the CD4
count, the weaker the immune system. About 20 million people throughout the
world—heterosexuals and homosexuals
alike—are infected with HIV; in 1997, 35% of HIV
infections occurred in heterosexuals. A massive research effort has produced
better treatments, resulting in longer survival and improved quality of life for
those with access to the treatments. But there is still no vaccine or cure. The
only real defense against AIDS is prevention.
|Signs and Symptoms|
Primary or initial infection: generally, a flu-like syndrome that occurs in
50 to 80% of those who contract HIV within 2 to 6 weeks, including a combination
of the following symptoms:
- Sore throat
- Swollen lymph nodes
- Joint pain
- Muscle aches
- Mouth ulcers
Early HIV infection: generally occurs when the CD4 count is below
500/microliter; sometimes called pre-AIDS or AIDS-related complex (ARC); there
is a long latency phase (median time of 10 years) between the initial
contraction of HIV and early infection.
- Swollen lymph nodes throughout the body
- Lesions on the tongue or mouth, which may represent a fungal infection
called Candida or one called Hairy Leukoplakia
- Low platelet count, which may manifest as easy bruising, bleeding
gums, or nose bleeds
- Herpes lesions of the mouth or genitals
- Skin infection
- Genital warts
Advanced stage HIV, often called AIDS: generally occurs when the CD4 count is
below 200/microliter and is usually marked by the development of opportunistic
infections (those that occur with a weakened immune system).
- Pneumonia, including Pneumocystis carinii (PCP)
- Extreme weight loss and wasting; exacerbated by diarrhea which can be
experienced in up to 90% of HIV patients worldwide
- Meningitis and other brain infections
- Fungal infections
- Malignancies such as lymphoma, cervical cancer, and Kaposi's sarcoma
(KS) (affects the skin and oral mucosa and may spread to the lungs; KS can
actually occur in earlier stages of HIV as
|What Causes It?|
Infection by the human immunodeficiency virus (HIV) causes AIDS. Seventy
percent of HIV transmission occurs through sexual contact. Intravenous drug
users transmit HIV by sharing needles. 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. In addition, a mother can spread the virus to a newborn
during delivery and through breast feeding.
|What to Expect at Your Provider's Office|
If your healthcare provider suspects HIV infection, he or she will order a
blood test to detect antibodies against the virus. If this test is 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
assess the advancement of the HIV disease process and assists your doctor in
determining the best course of treatment for you, including the appropriate
tests and medications. For example, if you are experiencing shortness of breath,
a chest X ray will likely be ordered, particularly if your CD4 count is low.
Stool studies may be requested if you have diarrhea and, if you have any
neurological symptoms, your provider may recommend an imaging study of your
brain and/or analysis of the spinal fluid. Some symptoms and tests may require
evaluation in the hospital.
There are valuable medications that slow the progression of HIV infection to
full-blown AIDS; generally, a combination of these medicines, including a type
called protease inhibitors, is used. In addition, antibiotics and other
therapies are used to prevent or treat specific complications. It is important
to have your care directed by a doctor who specializes in HIV; he or she 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. If you are using any alternative therapies to complement your medical
regimen, be sure to share this information with your doctor.
- Antiretrovirals (e.g., zidovudine, lamivudine, efavirenz, ritonavir,
indinavir) - help slow the progression of HIV; must be
taken as directed to avoid development of viral strains that no longer respond
to the medication
- Prophylaxis - medicines used to prevent
opportunistic infections; started when the CD4 count drops to a certain number
(e.g., CD4 < 200/microliter, medication to prevent PCP is begun)
- Treatment - appropriate treatment depends on
the particular opportunistic infection or symptoms and should be determined by
your HIV specialist
|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 for a sense of empowerment by being actively
involved in their own care. In fact, surveys show that:
- 52 to 68% of those with HIV take vitamins, herbs, or
- 64% do aerobic exercise, while 33% do other forms of exercise such as
yoga or strength training
- 22 to 54% obtain bodywork such as massage, energy healing, or
- 38 to 56% use prayer or other forms of spiritual practice
- 42% attend group support
- 33 to 46% practice meditation or other forms of relaxation such as
It is extremely important that you share information on your use of
complementary and alternative therapies with your doctor, so that he or she can
help you determine what is safe and appropriate. While only 26% of medical
doctors ask about these practices, 63% admit that they do want to know if their
HIV-positive patients are using such alternatives and believe that they are
Weight loss has historically been 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.
A study published in November 1999 supports the use of certain supplements
for those with HIV, particularly for help in maintaining body weight. In a
well-designed study comparing the use of a daily supplement regimen that
included the amino acid glutamine (40 g per day), vitamin C (800 mg), vitamin E
(500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetylcysteine
(2400 mg) to placebo, people who took the supplements gained significantly more
weight after 12 weeks than those who took the placebo.
The antioxidant vitamins C and E may reduce cell damage and viral load; this
was suggested by a study published in September 1998, although it was not
definitively proven. If true, it would support the fact that many people with
HIV seem to have lower levels of , such as vitamins C and E, in their blood than
those without HIV. Related to vitamin C, grapefruit juice may enhance the
absorption of protease inhibitors. The antioxidant selenium (100 to 400 mcg per
day) and a vitamin B complex (75 to 100 mg per day) may also be useful because
of the physical stress of HIV. Cobalamin (vitamin B12) levels are
occasionally low with HIV, in which case your doctor may prescribe monthly
injections of vitamin B12. Low levels of vitamin A are also
particularly severe among children infected with HIV. Some studies suggest that
vitamin A supplements may reduce the risk of death in children infected with
Amounts generally used in the case of HIV are:
Vitamin C 1000 mg per day
Vitamin E 400 to 800 IU per day
Selenium 100 to 400 mcg per day
Vitamin B complex 75 to 100 mg per day
In a study in Uganda, 154 patients with HIV who received individualized
herbal treatments for shingles—a skin infection caused
by herpes zoster and characterized by extreme pain and sensitivity on the
surface of the skin, together with blisters in the location of the
pain—improved more quickly than 55 patients who
received standard treatment with the drug acyclovir. In other words, both groups
got better, but the group receiving the individualized herbal remedies
experienced reduced pain and resolution of the blisters more quickly than the
group receiving acyclovir, the medication usually used to treat shingles.
In one study of 13 patients with human immunodeficiency virus (HIV) who
refused to take conventional treatments, a dosage of 20 mg cat's claw per day
for up to 5 months significantly increased white blood cell counts (the
infection-fighting cells in the body that HIV destroys).
Although the use of herbs is standard in , and despite some promising
test-tube and animal studies, human research in the United States of traditional
Chinese medicinal herbs to help reduce levels of circulating HIV in the
bloodstream have been inconclusive, showing no definitive help but no obvious
Test-tube studies of , an herb frequently used for , suggest that it may also
be helpful against HIV. St. John's wort given to people with the virus, however,
led to such intolerable side effects in one study that very few people were
willing to complete the study. In addition, recent information from an article
published in February 2000 shows that St. John's wort may lower levels of
indinavir, a medication known as a protease inhibitor used to treat HIV.
Test-tube studies of other herbs in the treatment of HIV, including licorice
root, Calendulus officinalis flowers, and ginseng, have yielded some
interesting results. Ginseng has also shown some possible benefits in human
studies. More research is necessary, however, before drawing definitive
conclusions about these herbal remedies for HIV. Please see the individual
monographs about these herbs for additional information.
In addition, and astragalus, two substances touted to enhance immune function
in people with HIV, should not be used because they may actually enhance
replication of the HIV virus.
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 help 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 have used acupuncture to improve general well being,
alleviate symptoms such as fatigue, insomnia, , and night sweats, and to
minimize side effects from medications.
A small study published in 1999 showed that acupuncture used for people with
peripheral neuropathy, caused occasionally by certain medications used for HIV,
improved nerve function for all of the
participants—each individual reported feeling less
pain, increased strength, and improved sensation, confirmed by measurable
improvement in nerve function.
As mentioned earlier, diarrhea can be a major problem for people with HIV
throughout the world. 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.
Massage may enhance the immune system and decrease anxiety, as demonstrated
in a study of newborns specifically. Other forms of stress reduction have shown
improved CD4 counts in additional populations.
Frequent follow up with your doctor who specializes in HIV is very important;
he or she will determine the frequency of those visits which may vary depending
on the stage of your disease.
If you are HIV-positive and pregnant, taking certain antiretroviral
medications will reduce the likelihood of 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 healthcare provider may
decide to postpone treatment until after your first trimester to reduce the risk
of birth defects. Efavirenz should be avoided throughout pregnancy. If you are
HIV positive, you should not breastfeed because of the risk of transmission to
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|Review Date: August 1999|
|Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Dahlia Hirsch, MD,
Center for Holistic Healing, BelAir, MD; Eric Wellons, MD, Department of
Surgery, Union Memorial Hospital, Baltimore, MD; Leonard Wisneski, MD, FACP,
George Washington University, Rockville,
Copyright © 2004 A.D.A.M., Inc
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