Once HIV has progressed to AIDS, the immune system has become quite weakened. Opportunistic infections are infections that people with a normal immune system don't usually get. These infections occur in patients with AIDS because the immune system isn't able to fight them off. People with AIDS often suffer from debilitating weight loss, diarrhea, infections of the intestinal tract, brain, eyes, and other organs, such as the lungs resulting in pneumocystis carinii pneumonia (PCP), and cancers such as Kaposi's sarcoma and certain types of lymphomas. Several of the most common opportunistic infections and other complications of AIDS include:
- Thrush (an overgrowth of yeast)
- Pneumonia
- Invasive fungal infections (resulting in brain and/or lung infections)
- Toxoplasmosis infection
- Tuberculosis
- Viral brain infection
- Kaposi's sarcoma
- Lymphoma
- Cervical cancer
- Eye disease due to cytomegalovirus infection
- Intestinal infections, typically due to Shigella, Salmonella, and Campylobacter
- Severe weight loss
- Severe skin rashes
- Reactions to medications
- Psychiatric problems, including depression and dementia
- Diagnosing HIV
Your physician will ask about your symptoms, medical history, any risk factors, and perform a physical exam.
A blood test called an ELISA test is used to detect HIV infection. If an ELISA test is positive, the Western blot blood test is usually done to confirm the diagnosis. The ELISA test may be negative if you were infected with HIV recently. Many people (95%) will have a positive test within three months. Most people (99%) will have a positive test within six months. If an ELISA test is negative, but you think you may have HIV, you should be tested again in 1–3 months.
The CDC (Centers for Disease Control and Prevention) estimates that approximately 40,000 persons in the United States become infected with HIV each year. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV and about one-fourth have not yet been diagnosed and are unaware of their infection.
Treatment
Currently there are no available drugs that cure the HIV infection or AIDS. They can suppress the virus, even to undetectable levels, but are unable to completely eliminate HIV from the body. Hence, infected patients still need to take antiretroviral drugs.
The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections. Also approved is a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle.
FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV's ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules.
Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS.
Antiretroviral Therapy (HAART)
As HIV reproduces itself, different strains of the virus emerge, some that are resistant to antiretroviral drugs. Therefore, doctors recommend patients infected with HIV take a combination of antiretroviral drugs known as HAART. This strategy, which typically combines drugs from at least two different classes of antiretroviral drugs, has been shown to effectively suppress the virus when used properly. Developed by NIAID-supported researchers, HAART has revolutionalized how we treat people infected with HIV by successfully suppressing the virus and decreasing the rate of opportunistic infections.
Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.
