HIV and AIDS
   

HIV and AIDS
Also Listed As:  AIDS and HIV
 
Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Drug Therapies
Complementary and Alternative Therapies
Following Up
Special Considerations
Supporting Research

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:

  • Fever
  • Sore throat
  • Swollen lymph nodes
  • Joint pain
  • Muscle aches
  • Rash
  • Mouth ulcers
  • Nausea
  • Diarrhea
  • Headache

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
  • Shingles
  • 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)
  • Tuberculosis
  • 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
  • Syphilis
  • 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 well)

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.


Treatment Options

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.


Drug Therapies
  • 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 supplements
  • 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 acupuncture
  • 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 breathing exercises

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 helpful.


Nutrition

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 HIV.

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


Herbs

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 harm.

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.


Homeopathy

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.


Physical Medicine

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.


Acupuncture

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

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.


Following Up

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.


Special Considerations

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 your baby.

Resources

Bastyr University AIDS Research Center: www.bastyr.edu/research/projects/

AIDS.ORG: www.aids.org


Supporting Research

Allard JP et al. Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS. 1998;13:1653-1659.

Anastasi JK, Dawes NC, Li YM. Diarrhea and HIV: Western and Eastern perspectives. J Altern Comp Med. 1997;2:163-168.

Auerbach J, Oleson T, Solomon G. A behavioral medicine intervention as an adjunctive treatment for HIV-related illness. Psychology and Health. 1992;6:325-334.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:119-120, 134, 169-170.

Dubin J. HIV Infection and AIDS. Emergency Medicine Online. 1998. Accessed at www.emedicine.com/emerg/topic253.htm on February 13, 1999.

Dworkin BM. Selenium deficiency in HIV infection and the acquired immunodeficiency syndrome (AIDS). Chem Biol Interact. 1994;91:181-186.

Elion RA, Cohen C. Complementary medicine and HIV infection. Primary Care. 1997;4:905-919.

Ernst E. Complementary AIDS therapies: the good, the bad and the ugly [editorial]. Int J STD AIDS. 1997;5:281-285.

Fairfield KM, Eisenberg DM, Davis RB, Phillips RS. Patterns of use, expenditure and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch intern Med. 1998;158:2257-64.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998; 1110-1111, 1818-1840.

Fawzi WW, Mbise RL, Hertzmark E, et al. A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania. Pediatr Infect Dis J. 1999;18:127-133.

Galantino ML, Elseokoro ST, Findley TW, Condoluci D. Use of noninvasive electroacupuncture for the treatment of HIV-related peripheral neuropathy: a pilot study. J Altern Comp Med. 1999;5(2):135-142.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:626-627, 866-867, 903-904, 1138-1139, 1174-1175.

Hayashi K, Hayashi T, Kojima I. A natural sulfated polysaccharide, calcium spirulan, isolated from Spirulina platensis: in vitro and ex vivo evaluation of anti-herpes simplex virus and anti-human immunodeficiency virus activities. AIDS Res Hum Retroviruses. 1996;12:1463-1471.

Homsy J, Katabira E, Kabatesi D, et al. Evaluating herbal medicine for the management of Herpes zoster in human immunodeficiency virus-infected patients in Kampala, Uganda. J Altern Comp Med. 1999;5(6):553-565.

Kalvatchev Z, Walder R, Garzaro D. Anti-HIV activity of extracts from Calendula officinalis flowers. Biomed Pharmacotherapy. 1997;51(4):176-180.

Lissoni P, Vigore L, Rescaldani R, et al. Neuroimmunotherapy with low-dose subcutaneous interleukin-2 plus melatonin in AIDS patients with CD4 cell number below 200/mm3: a biological phase-II study. J Biol Regul Homeost Agents. 1995;9:155-158.

MacIntyre RC, Holzemer WL. Complementary and alternative medicine and HIV/AIDS. Part II: selected literature review. J Assoc Nurses AIDS Care. 1997;8(2):25-38.

Nerad JL, Gorbach SL, et al. Nutritional aspects of HIV infection. Infect Dis Clin North Am. 1994;8:499-515.

Noyer CM, Simon D, Borczuk A, Brandt LJ, Lee MJ, Nehra V. A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestintal permeability in patients with AIDS. Am J Gastroenterol. 1998;93:972-975.

Patarca R, Fletcher MA. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. Int J Neurosci. February 1996;84:205-217.

Piscitelli S, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John's wort [letter]. Lancet. 2000;355:547-548.

Remacha AF, Cadafalch J. Cobalamin deficiency in patients infected with the human immunodeficiency virus. Semin Hematol. 1999;36:75-87.

Rouben R, McDermott A, Weiss L, Suri J, Wood M, Block K, Gorbach S. Short-term progressive resistance training increases strength and lean body mass in adults infected with HIV. AIDS. 1999;2:231-239.

Shabert JK, Winslow C, Lacey JM, Wilmore DW. Glutamine antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Nutrition. 1999;11:860-864.

Weber R et al. Randomized, placebo-controlled trial of Chinese herb therapy for HIV infected individuals. J Acquir Immun Defic Syndr. 1999;1:56-64.

Wynia MK, Eisenberg DM, Wilson IB. Physician-patient communication about complementary and alternative medical therapies: a survey of physicians caring for patients with human immunodeficiency virus. J Altern Comp Med. 1999;5:447-456.


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, MD.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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