AIDS

Alternative Names

Acquired immune deficiency syndrome

Causes

AIDS is the sixth leading cause of death among people ages 25 - 44 in the United States, down from number one in 1995. Millions of people around the world are living with HIV/AIDS, including many children under age 15.

Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.

HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been shown to transmit infection to others.

The virus can be spread (transmitted):

• Through sexual contact -- including oral, vaginal, and anal sex
• Through blood -- via blood transfusions (now extremely rare in the U.S.) or needle sharing
• From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk

Other methods of spreading the virus are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

HIV infection is NOT spread by:

• Casual contact such as hugging
• Mosquitoes
• Participation in sports
• Touching items that were touched by a person infected with the virus

AIDS and blood or organ donation:

• AIDS is NOT transmitted to a person who DONATES blood or organs. People who donate organs are never in direct contact with people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.
• However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

People at highest risk for getting HIV include:

• Injection drug users who share needles
• Infants born to mothers with HIV who didn't receive HIV therapy during pregnancy
• People engaging in unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS
• People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice)
• Sexual partners of those who participate in high-risk activities (such as injection drug use or anal sex)

Back to TopSymptoms

AIDS begins with HIV infection. People who are infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops.

Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ).

Almost all people infected with HIV, if they are not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system.

The symptoms of AIDS are mainly the result of infections that do not normally develop in people with a healthy immune system. These are called opportunistic infections.

People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are:

• Chills
• Fever
• Rash
• Sweats (particularly at night)
• Swollen lymph glands
• Weakness
• Weight loss

Note: At first, infection with HIV may produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 - 4 weeks after contracting the virus. This is called the acute retroviral syndrome. Some people with HIV infection stay symptom-free for years between the time when they are exposed to the virus and when they develop AIDS.

Back to TopExams and Tests

CD4 cells are a type of T cell. T cells are cells of the immune system. They are also called "helper cells."

The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these other diseases. Today, according to the Centers for Disease Control and Prevention, a person may also be diagnosed with AIDS if they are HIV-positive and have a CD4 cell count below 200 cells/mm3, even if they don't have an opportunistic infection.

AIDS may also be diagnosed if a person develops one of the opportunistic infections and cancers that occur more commonly in people with HIV infection. These infections are unusual in people with a healthy immune system.

Many other illnesses and their symptoms may develop, in addition to those listed here.

The following illnesses are common with a CD4 count below 350 cells/mm3:

• Herpes simplex virus -- causes ulcers/small blisters in the mouth or genitals, happens more often and usually much more severely in an HIV-infected person than in someone without HIV infection
• Herpes zoster (shingles) -- ulcers/small blisters over a patch of skin, caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox
• Kaposi's sarcoma -- cancer of the skin, lungs, and bowel due to a herpes virus (HHV-8). It can happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is much more common in men than in women.
• Non-Hodgkin's lymphoma -- cancer of the lymph nodes
• Oral or vaginal thrush -- yeast (typically Candida albicans ) infection of the mouth or vagina
• Tuberculosis -- infection by tuberculosis bacteria mostly affects the lungs, but can also affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system (brain and spinal cord)

Common with CD4 count below 200 cells/mm3:

• Bacillary angiomatosis -- skin sores caused by a bacteria calledBartonella, which may be caused by cat scratches
• Candida esophagitis -- painful yeast infection of the tube through which food travels, called the esophagus
• Pneumocystis jiroveci pneumonia , "PCP pneumonia," previously called Pneumocystis carinii pneumonia, caused by a fungus

Common with CD4 count below 100 cells/mm3:

• AIDS dementia -- worsening and slowing of mental function, caused by HIV
• Cryptococcal meningitis -- fungal infection of the lining of the brain
• Cryptosporidium diarrhea -- extreme diarrhea caused by a parasite that affects the gastrointestinal tract
• Progressive multifocal leukoencephalopathy -- a disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions
• Toxoplasma encephalitis -- infection of the brain by a parasite, called Toxoplasma gondii , which is often found in cat feces; causes lesions (sores) in the brain
• Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV itself

Common with CD4 count below 50/mm3:

• Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes
• Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis

In addition to the CD4 count, a test called HIV RNA level (or viral load) may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in women with a compromised immune system. Anal Pap smears to detect potential cancers may also be important in both HIV-infected men and women.

Back to TopTreatment

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality and length of life for those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much free virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.

HAART is not a cure for HIV, but it has been very effective for the past 12 years. People on HAART with suppressed levels of HIV can still transmit the virus to others through sex or by sharing needles. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved.

However, HIV may become resistant to one combination of HAART, especially in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether an HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each person, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and before starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for treating drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are:

• Collection of fat on the back ("buffalo hump") and abdomen
• Diarrhea
• General sick feeling (malaise)
• Headache
• Nausea
• Weakness

When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of cholesterol and glucose (sugar) in the blood.

Any doctor prescribing HAART should carefully watch the patient for possible side effects. In addition, blood tests measuring CD4 counts and HIV viral load should be taken every 3 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the amount of HIV virus in the blood to a level where it cannot be detected.

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen, Procrit, and Recomon) and filgrastim (G-CSF or Neupogen) are sometimes used to treat AIDS-associated anemia and low white blood cell counts.

Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

Back to TopSupport Groups

Joining support groups where members share common experiences and problems can often help the emotional stress of devastating illnesses. See AIDS - support group.

Back to TopOutlook (Prognosis)

Right now, there is no cure for AIDS. It is always fatal without treatment. In the U.S., most patients survive many years after diagnosis because of the availability of HAART. HAART has dramatically increased the amount of time people with HIV remain alive.

Research on drug treatments and vaccine development continues. However, HIV medications are not always available in the developing world, where most of the epidemic is raging.

Back to TopPossible Complications

When a person is infected with HIV, the virus slowly begins to destroy that person's immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow or halt the destruction of the immune system.

Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.

Back to TopWhen to Contact a Medical Professional

Call for an appointment with your health care provider if you have any of the risk factors for HIV infection, or if you develop symptoms of AIDS. By law, the results of HIV testing must be kept confidential. Your health care provider will review results of your testing with you.

Back to TopPrevention

See: Safe sex to learn how to reduce the chance of catching or spreading HIV and other sexually transmitted illnesses (STIs)

Tips for preventing HIV/AIDS:

• Do not use illicit drugs and do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones. These programs can also provide referrals for addiction treatment.
• Avoid contact with another person's blood. You may need to wear protective clothing, masks, and goggles when caring for people who are injured.
• Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use preventive measures (such as condoms) to reduce the rate of transmission.
• HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn child, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy.
• The Public Health Service recommends that HIV-infected women in the United States avoid breastfeeding to prevent transmitting HIV to their infants through breast milk.

Safer sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there is a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

The riskiest sexual behavior is receiving unprotected anal intercourse. The least risky sexual behavior is receiving oral sex. There is some risk of HIV transmission when performing oral sex on a man, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period has a low risk of transmission.

HIV-positive patients who are taking antiretroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with 13% to 40% of the time if medications are not used.

The U.S. blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.

If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and it has been used to prevent transmission in health care workers injured by needlesticks.

There is less information available about how effective PEP is for people exposed to HIV through sexual activity or injection drug use, but it appears to be effective. If you believe you have been exposed, discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been sexually assaulted should consider the potential risks and benefits of PEP.

Back to TopReferences

Quinn TC. Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome. In: Goldman L, Schafer AI,eds. Cecil Medicine . 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap392.

 Sterling TR, Chaisson RE. General clinical manifestations of human immunodeficiency virus infection (including the acute retroviral syndrome and oral, cutaneous, renal, ocular, metabolic, and cardiac diseases). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 121.

Surprising Health Benefits of Sex

Sexual Health

When you're in the mood, it's a sure bet that the last thing on your mind is boosting your immune system or maintaining a healthy weight. Yet good sex offers those health benefits and more. That's a surprise to many people, says Joy Davidson, PhD, a New York psychologist and sex therapist. "Of course, sex is everywhere in the media," she says. "But the idea that we are vital, sexual creatures is still looked at in some cases with disgust or in other cases a bit of embarrassment. So to really take a look at how our sexuality adds to our life and enhances our life and our health, both physical and psychological, is eye-opening for many people."
Sex does a body good in a number of ways, according to Davidson and other experts. The benefits aren't just anecdotal or hearsay -- each of these health benefits of sex is backed by scientific scrutiny.

Sex Relieves Stress

A big health benefit of sex is lower blood pressure and overall stress reduction, according to researchers from Scotland who reported their findings in the journal Biological Psychology. They studied 24 women and 22 men who kept records of their sexual activity. Then the researchers subjected them to stressful situations -- such as speaking in public and doing verbal arithmetic -- and noted their blood pressure response to stress. Those who had intercourse had better responses to stress than those who engaged in other sexual behaviors or abstained.

Sex Lowers Blood Pressure

Another study published in Biological Psychology found that frequent intercourse was associated with lower diastolic blood pressure (the lower, or second, number in a blood pressure reading). This study focused on people living with their sex partner.
Still further research found a link between partner hugs and lower blood pressure in women.
Elevated blood pressure is a risk factor for coronary artery disease, heart attack, kidney disease, and stroke

Sex Boosts Immunity

Good sexual health may mean better physical health. Having sex once or twice a week has been linked with higher levels of an antibody called immunoglobulin A or IgA, which can protect you from getting colds and other infections. Scientists at Wilkes University in Wilkes-Barre, Pa., took samples of saliva, which contain IgA, from 112 college students who reported the frequency of sex they had.
Those in the "frequent" group -- once or twice a week -- had higher levels of IgA than those in the other three groups -- who reported being abstinent, having sex less than once a week, or having it very often, three or more times weekly.

Sex Counts As Exercise

"Sex is a great mode of exercise," says Patti Britton, PhD, a Los Angeles sexologist and president of the American Association of Sexuality Educators and Therapists. It takes work, from both a physical and psychological perspective, to do it well, she says.
The benefits of sex as a form of exercise are many - sex can improve your cardiovascular fitness, strength, flexibility, and balance, not to mention your emotional health.

Sex Burns Calories

Thirty minutes of sex burns 85 calories or more. It may not sound like much, but it adds up: 42 half-hour sessions will burn 3,570 calories, more than enough to lose a pound. The number of calories burned during sex is about the same as the number burned by walking at 2 miles per hour.
Doubling up on the 30 minute sessions, you could drop that pound in 21 hour-long sessions.

Sex Improves Cardiovascular Health

While some older folks may worry that the efforts expended during sex could cause a stroke, that's not so, according to researchers from England. In a study published in the Journal of Epidemiology and Community Health, scientists found that the frequency of sex was not associated with stroke in the 914 men they followed for 20 years.
And the heart health benefits of sex don't end there. The researchers also found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month.


Archives of Sexual Behavior.
That finding makes sense to Gina Ogden, PhD, a sex therapist and marriage and family therapist in Cambridge, Mass., although she finds that those who already have self-esteem say they sometimes have sex to feel even better. "One of the reasons people say they have sex is to feel good about themselves," she tells WebMD. "Great sex begins with self-esteem, and it raises it. If the sex is loving, connected, and what you want, it raises it."

Sex Strengthens Your Well-Being

Sex, like any activity that fosters a close and loving connection to your partner, not only raises self-esteem, but strengthens your overall sense of well-being. Studies have shown that people with strong social support networks (which includes lovers) are healthier and happier than their less-connected peers.

Sex Improves Intimacy

Having sex and orgasms increases levels of the hormone oxytocin, the so-called love hormone, which helps us bond and build trust. Researchers from the University of Pittsburgh and the University of North Carolina evaluated 59 premenopausal women before and after warm contact with their husbands and partners ending with hugs. They found that the more contact, the higher the oxytocin levels.
"Oxytocin allows us to feel the urge to nurture and to bond," Britton says.
Higher oxytocin has also been linked with a feeling of generosity. So if you're feeling suddenly more generous toward your partner than usual, credit the love hormone.

Sex Reduces Pain

As the hormone oxytocin surges, endorphins increase, and pain declines. So if your headache, arthritis pain, or PMS symptoms seem to improve after sex, you can thank those higher oxytocin levels.

Oxytocin – The Love Hormone

A study published in the Bulletin of Experimental Biology and Medicine examined the response of the “love hormone” oxytocin on pain perception in an experiment with 48 volunteers. Study participants inhaled oxytocin vapor and then had their fingers pricked. Those who had inhaled oxytocin lowered their pain threshold by more than half.

Sex Reduces Prostate Cancer Risk

Frequent ejaculations, especially in 20-something men, may reduce the risk of prostate cancer later in life, Australian researchers reported in the British Journal of Urology International. When they followed men diagnosed with prostate cancer and those without, they found no association of prostate cancer with the number of sexual partners as the men reached their 30s, 40s, and 50s.
But they found men who had five or more ejaculations weekly while in their 20s reduced their risk of getting prostate cancer later by a third.
Another study, reported in the Journal of the American Medical Association, found that frequent ejaculations, 21 or more a month, were linked to lower prostate cancer risk in older men, as well, compared with less frequent ejaculations of four to seven monthly.

Sex Strengthens Pelvic Floor Muscles

For women, doing a few pelvic floor muscle exercises known as Kegel exercises during sex offers a couple of benefits. You will enjoy more pleasure, and you'll also strengthen the area and help to minimize the risk of incontinence later in life.
To do a basic Kegel exercise, tighten the muscles of your pelvic floor, as if you're trying to stop the flow of urine. Count to three, then release.

Additional Benefits of Kegel Exercises

Kegel exercises have a number of proven health benefits in addition to making sex more enjoyable. The strengthening of the pelvic floor muscles can help prevent prolapse (a slipping out of position) of the vagina, uterus, and bladder. Pelvic floor muscles may be weakened later in life as a result of childbearing, being overweight, and aging. Kegel exercises help offset the consequences of weakened pelvic floor muscles.

Sex Helps You Sleep Better

The oxytocin released during orgasm also promotes sleep, according to research.
And getting enough sleep has been linked with a host of other good things, such as maintaining a healthy weight and blood pressure. Something to think about, especially if you've been wondering why your guy can be active one minute and snoring the next.

Sex As Physical Exercise Also Promotes Sleep

The physical exercise component of sex can also help you relax and sleep better, in addition to the hormonal effects. People who get regular exercise tend to sleep better and have more restful sleep. Moreover, as we have seen in the earlier part of this slideshow, sex is a great way to get some exercise.

Summary

Take note that sex is good for you in ways you may never have imagined and that the health benefits extend well beyond the bedroom.