Pneumonia

What is pneumonia?

Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people,pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital.

You can get pneumonia in your daily life, such as at school or work. This is called community-associated pneumonia. You can also get it when you are in a hospital or nursing home. This is called healthcare-associated pneumonia. It may be more severe because you already are ill. This topic focuses on pneumonia you get in your daily life.

What causes pneumonia?

Germs called bacteria or viruses usually cause pneumonia.

Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia.

What are the symptoms?

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

• Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.
• Fever.
• Fast breathing and feeling short of breath.
• Shaking and "teeth-chattering" chills. You may have this only one time or many times.
• Chest pain that often feels worse when you cough or breathe in.
• Fast heartbeat.
• Feeling very tired or feeling very weak.
• Nausea and vomiting.
• Diarrhea.

When you have mild symptoms, your doctor may call this "walking pneumonia."

Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion ordelirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad.

How is pneumonia diagnosed?

Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.

Influenza (flu)

Influenza (flu) is a viral upper respiratory illness that comes on suddenly, causing a person to feel very sick with symptoms such as fever, body aches, headache, fatigue, loss of appetite, and a dry cough or sore, dry throat. Home treatment to reduce discomfort is usually all that is needed.

In some cases, the flu can lead to complications, such as bacterial pneumonia. People who are at high risk for complications include young children up to 5 years of age, adults age 65 and older, and all those who have certain health conditions, such as chronic heart or lung problems or immune system disorders.

Yearly immunization with the inactivated flu vaccine (flu shot) or the nasal spray vaccine (FluMist) helps reduce the risk of getting the flu and makes symptoms less severe for people who do get the flu.

Pneumonia

Pneumonia is an inflammation of the lungs most often caused by infection with bacteria or a virus. Pneumonia can make it hard to breathe because the lungs have to work harder to get enough oxygen into the bloodstream.

Symptoms of pneumonia caused by bacteria often begin suddenly and may follow an upper respiratory infection, such as influenza (flu) or a cold. Common symptoms include fever, a cough that often produces colored mucus (sputum) from the lungs, and rapid, often shallow breathing.

Older adults may have different, fewer, or milder symptoms. The major sign of pneumonia in older adults may be a change in how well they think (confusion or delirium) or a worsening of a lung disease they already have.

Symptoms of pneumonia not caused by bacteria (nonbacterial) include fever, cough, and shortness of breath, and there may be little mucus production.

Antibiotics are used to treat pneumonia caused by bacteria.

What is DNA?

DNA, or deoxyribonucleic acid, is the hereditary material in humans and almost all other organisms. Nearly every cell in a person’s body has the same DNA. Most DNA is located in the cell nucleus (where it is called nuclear DNA), but a small amount of DNA can also be found in the mitochondria (where it is calledmitochondrial DNA or mtDNA).

The information in DNA is stored as a code made up of four chemical bases: adenine (A), guanine (G), cytosine (C), and thymine (T). Human DNA consists of about 3 billion bases, and more than 99 percent of those bases are the same in all people. The order, or sequence, of these bases determines the information available for building and maintaining an organism, similar to the way in which letters of the alphabet appear in a certain order to form words and sentences.

DNA bases pair up with each other, A with T and C with G, to form units called base pairs. Each base is also attached to a sugar molecule and a phosphate molecule. Together, a base, sugar, and phosphate are called a nucleotide. Nucleotides are arranged in two long strands that form a spiral called a double helix. The structure of the double helix is somewhat like a ladder, with the base pairs forming the ladder’s rungs and the sugar and phosphate molecules forming the vertical sidepieces of the ladder.

An important property of DNA is that it can replicate, or make copies of itself. Each strand of DNA in the double helix can serve as a pattern for duplicating the sequence of bases. This is critical when cells divide because each new cell needs to have an exact copy of the DNA present in the old cell.

DNA is a double helix formed by base pairs attached to a sugar-phosphate backbone.

For more information about DNA:

The National Human Genome Research Institute fact sheet Deoxyribonucleic Acid (DNA) provides an introduction to this molecule.

Information about the genetic code and the structure of the DNA double helix is available from GeneEd.

For additional information about the structure of DNA, please refer to the chapter called What Is AGenome? in the NCBI Science Primer. Scroll down to the heading “The Physical Structure of the Human Genome.”

The New Genetics, a publication of the National Institute of General Medical Sciences, discusses the structure of DNA and how it was discovered

What Is Syphilis? What Causes Syphilis?

Syphilis is one type of sexually transmitted disease. Syphilis is the result of a bacterial infection of the genital tract by the bacterium Treponema pallidum. Syphilis is passed from one person to another during direct sexual contact with a syphilis lesion that involves vaginal, oral, or anal sex. Syphilis can also be passed from an infected mother to her baby during pregnancy and result in stillbirth or serious birth defects. 

According to Medilexicon's medical dictionary:

Syphilis is an acute and chronic infectious disease caused by the bacterium Treponema pallidum and transmitted by direct contact, usually through sexual intercourse. After an incubation period of 12-30 days, the first symptom is a chancre, followed by slight fever and other constitutional symptoms (primary syphilis), followed by a skin eruption of various appearances with mucous patches and generalized lymphadenopathy (secondary syphilis), and subsequently by the formation of gummas, cellular infiltration, and functional abnormalities usually resulting from cardiovascular and central nervous system lesions (tertiary syphilis).

Any person that engages in sexual activity can contract and pass on syphilis. This includes heterosexual, homosexual and bisexual men and women. The more sexual partners a person has, the greater the risk of catching syphilis. Syphilis also increases the risk of HIV infection, which causes AIDS. About 12 million new cases of syphilis occur every year. More than 90% of them are in developing nations where congenital syphilis remains a leading cause of stillbirths and newborn deaths. In North America and Western Europe, syphilis is disproportionately common and rising among men who have sex with men and among persons who use cocaine or other illicit drugs. 

The name "syphilis" was coined by Hieronymus Fracastorius (Girolamo Fracastoro). Fracastorius on the temperature of wines, the rise of the Nile, poetry, the mind, and the soul; he was an astronomer, geographer, botanist, mathematician, philosopher and, last but not least in the present context, a physician. 

In 1530 he published the poem "Syphilis sive morbus gallicus" (Syphilis or the French Disease) in which the name of the disease first appeared. Perhaps more importantly, Fracastorius went on in 1546 to write "On Contagion" ("De contagione et contagiosis morbis et curatione"), the first known discussion of the phenomenon of contagious infection: a landmark in the history of infectious disease. 

What are the symptoms of Syphilis?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. 

After becoming infected with syphilis, there is an incubation period between of 9 to 90 days (the average being around 21 days) before the first signs and symptoms of the disease appear. Each stage of syphilis has characteristic signs and symptoms but any particular sign or symptom may or may not be present.

Some people with syphilis don't have any signs of infection. In other people, the signs may be very mild. They might not even know they have it. But even if the signs of infection go away on their own, the germs are still alive. They can cause serious health problems many years later. 

The first (primary) stage involves the formation of the chancre. At this stage, syphilis is highly contagious. The primary stage can last one to five weeks. The disease can be transmitted from any contact with one of the ulcers, which are teeming with spirochetes. If the ulcer is outside of the vagina or on the scrotum, the use of condoms may not help in preventing transmission. Likewise, if the ulcer is in the mouth, merely kissing the infected individual can spread syphilis. Even without treatment, the early infection resolves on its own in most women. 

In men, the first sign of syphilis may be a sore on the penis. In women, the first sign may be a sore around or inside the vagina. One might not even notice the sore, because syphilis sores don't hurt. The sores go away after three to six weeks. 

Twenty five percent of cases will proceed to the secondary stage of syphilis, which lasts four to six weeks. This phase can include hair loss; a sore throat; white patches in the nose, mouth, and vagina; fever; headaches; and a skin rash. There can be lesions on the genitals that look like genital warts, but are caused by spirochetes rather than the wart virus. These wart-like lesions, as well as the skin rash, are highly contagious. The rash can occur on the palms of the hands, and the infection can be transmitted by casual contact. 

If syphilis is not treated early, it spreads from the sore into the bloodstream. When syphilis gets into blood, it can cause many problems. The most common sign is a rash. The rash may show up, often on the palms of the hands or the soles of the feet, from two weeks to two months after the sore appeared. Other signs of syphilis include fever, sore throat and swollen lymph glands. 

The third (tertiary) stage is the final stage of the disease involves the brain and heart, and is usually no longer contagious. At this point, however, the infection can cause extensive damage to the internal organs and the brain, and can lead to death.

After many years, people with syphilis who don't get treatment may begin to have problems in their brain and spinal cord. Syphilis may damage the heart and other organs, too.

What are the causes of Syphilis?

Syphilis is almost always passed through sexual contact. It also can be passed from an infected mother to her baby during pregnancy. 

Syphilis is caused by bacteria called Treponema pallidum. The bacteria can enter the body if you have close contact with an infected sore, normally during vaginal, anal or oral sex or by sharing sex toys. 

It may also be possible to catch syphilis if one is an injecting drug user and shares a needle with somebody who is infected. 

Pregnant women can pass the condition on to their unborn babies, which can cause stillbirth or death of the baby shortly after labor. 

It is extremely rare for syphilis to be spread through blood transfusions as almost all blood transfusions are routinely screened for syphilis.

Diagnosing Syphilis

A blood test can tell for sure if a person has syphilis. Sometimes other tests can show how far the syphilis has spread. For example, a doctor may want to look at spinal fluid to see if the syphilis bacteria have spread to the nervous system. 

Syphilis has several clinical manifestations, making laboratory testing a very important aspect of diagnosis. In North America, many unsuspected cases are discovered by laboratory testing. The etiological agent, Treponema pallidum, cannot be cultured, and there is no single optimal alternative test. 

Serological testing is the most frequently used approach in the laboratory diagnosis of syphilis.

What are the treatment options for Syphilis?

Primary and secondary syphilis can be successfully treated with a single dose of penicillin, which is given as an injection into the buttocks. If allergic, one will be prescribed anotherantibiotic alternative in tablet form. 

Later stages of the disease need to be treated with three penicillin injections, which are given at weekly intervals. 

Some of the antibiotics used to treat syphilis can adversely affect methods of contraception that contain the hormones oestrogen and progestogen, such as the combined pill or contraceptive patch. Tell a doctor or nurse if using these methods of contraception so they can advise on additional contraceptive methods to protect from pregnancy.

Preventing Syphilis

Prevention measures include seeking regular medical care throughout a lifetime. Regular medical care allows a health care professional to best evaluate a person's individual risks of catching syphilis and regularly test for the disease. These measures greatly increase the chances of catching and curing syphilis in its earliest stage before serious complications occur. 

Other preventive measures include abstaining from sexual activity or having sex only within a mutually monogamous relationship in which neither partner is infected with syphilis or another sexually transmitted disease. Latex condoms also provide some protection when used properly.

What Is Gonorrhea? What Causes Gonorrhea?

Gonorrhea (from Late Latin gonorrhoia where gonos means "seed" and rhoe means "flow") is a sexually transmitted bacterial infection that tends to attack the mucous membranes of the body. It is the second most common sexually transmitted diseasein the U.S.; the first being Chlamydia. The bacteria reside in the warm and moist body cavities of both men and women and are highly contagious. Gonorrhea is the most common cause of female infertility and is also known as "the clap" or "the drip". Only a fraction of women infected with the disease show any symptoms, leaving them unaware of their condition. If left untreated, gonorrhea patients can develop pelvic inflammatory disease or PID (women), or aninflammation of the epididymis, prostate gland, or urethral structure (men), all of which are far more difficult to treat.

What causes gonorrhea?

Gonorrhea is caused by the growth and proliferation of the bacteria Neisseria gonorrhoeae. The disease can survive in the eye, rectum, mouth, penis, throat, or vagina. This means that it can be transmitted through any variety of sexual contact. 
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Once infected, a person runs a high risk of spreading the bacteria to other parts of their body. For instance, someone with gonorrhea may rub his or her eye, inadvertently spreading the infection and elongating the treatment period. The infection can also be spread from mothers to babies during childbirth.

Who is at risk of getting gonorrhea?

Any sexually active person can become infected with gonorrhea. Rates of infection are highest among teenagers and young adults between the ages of 15 and 29. Those who have been diagnosed with and treated for gonorrhea in the past have no resistance to the bacteria.

What are the symptoms of gonorrhea?

Symptoms of gonorrhea, usually appearing between two and ten days after exposure, can take up to 30 days to occur and are sometimes so mild they are mistaken for something else. Most women with gonorrhea show no symptoms. In men, the symptoms include:

• Yellow, green, or white discharge from the penis
• Testicular swelling and/or pain
• Burning during urination

Women may experience:

• Yellow, green, or white vaginal discharge
• Pain or burning during urination
• Pain in the pelvic region
• Conjunctivitis (pink-eye)
• Irregular bleeding (between periods)
• Vulvitis (swelling of the vulva)
• Spotting after intercourse

The infection, if spread to the rectum, can cause anal itching, anal discharge, and painful bowel movements. Gonorrhea, as a result of oral sex, can also occur in the throat, characterized by burning sensations and swollen glands. Many women with gonorrhea interpret the symptoms as those of a yeast infection due to the vaginal discharge.

How is gonorrhea diagnosed?

If you suspect that you have gonorrhea, a professional health care worker can take a sample of discharge from the urethra (men) or cervix (women) and use it to conduct laboratory tests. Throat and anal cultures may also be taken if any symptoms suggest a spreading infection. Due to the large amount of cases in which the two occur together, the samples will be tested for both gonorrhea and Chlamydia in a laboratory. It often takes a few days for the test results to be reported. A urine test can also be done that checks for the presence of the bacteria responsible for gonorrhea.

How is gonorrhea treated?

Because gonorrhea is a bacterial infection, it can be treated with antibiotics. Antibiotics for the infection can be taken orally or via injection. It is important that the patient does not engage in sexual interactions until he/she has finished all of the prescribed treatment. Feeling better does not always mean that the infection is gone. Medical professionals will advise that any infected person notify everyone with whom they have had relations with in the past month about the infection.

How can gonorrhea be prevented?

Using a condom every time you have sex reduces your chance of contracting gonorrhea. Bacterial infections such as gonorrhea are more common among the promiscuous. If you have even the slightest inclination that you or your partner may be infected with gonorrhea, abstain from sex until consulting with a medical professional. 

What Is Tuberculosis? What Causes Tuberculosis?

Tuberculosis (TB) is an infectious disease that is caused by a bacterium calledMycobacterium tuberculosis. TB primarily affects the lungs, but it can also affect organs in the central nervous system, lymphatic system, and circulatory system among others. The disease was called "consumption" in the past because of the way it would consume from within anyone who became infected.

According to Medilexicon`s medical dictionary, tuberculosis is "A specific disease caused by infection withMycobacterium tuberculosis, the tubercle bacillus, which can affect almost any tissue or organ of the body, the most common site of the disease being the lungs."

When a person becomes infected with tuberculosis, the bacteria in the lungs multiply and cause pneumonia along with chest pain, coughing up blood, and a prolonged cough. In addition, lymph nodes near the heart and lungs become enlarged. As the TB tries to spread to other parts of the body, it is often interrupted by the body's immune system. The immune system forms scar tissue or fibrosis around the TB bacteria, and this helps fight the infection and prevents the disease from spreading throughout the body and to other people. If the body's immune system is unable to fight TB or if the bacteria breaks through the scar tissue, the disease returns to an active state with pneumonia and damage to kidneys, bones, and the meninges that line the spinal cord and brain. 

TB is generally classified as being either latent or active. Latent TB occurs when the bacteria are present in the body, but this state is inactive and presents no symptoms. Latent TB is also not contagious. Active TB is contagious and is the condition that can make you sick with symptoms. 

TB is a major cause of illness and death worldwide, especially in Africa and Asia. Each year the disease kills almost 2 million people. The disease is also prevalent among people with HIV/AIDS.

What causes tuberculosis?

Tuberculosis is ultimately caused by the Mycobacterium tuberculosis that is spread from person to person through airborne particles. It is not guaranteed, though, that you will become infected with TB if you inhale the infected particles. Some people have strong enough immune systems that quickly destroy the bacteria once they enter the body. Others will develop latent TB infection and will carry the bacteria but will not be contagious and will not present symptoms. Still others will become immediately sick and will also be contagious.

What are the symptoms of tuberculosis?

Most people who become infected with the bacteria that cause tuberculosis actually do not present symptoms of the disease. However, when symptoms are present, they include unexplained weight loss, tiredness, fatigue, shortness of breath, fever, night sweats, chills, and a loss of appetite. Symptoms specific to the lungs include coughing that lasts for 3 or more weeks, coughing up blood, chest pain, and pain with breathing or coughing.

How is tuberculosis diagnosed?

Tuberculosis diagnosis usually occurs after a combination of skin, blood, and imaging tests. 

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.

A little talk about Tuberculosis

• Tuberculosis (TB) is an infection, primarily in the lungs (a pneumonia), caused by bacteria calledMycobacterium tuberculosis. It is spread usually from person to person by breathing infected air during close contact.
• TB can remain in an inactive (dormant) state for years without causing symptoms or spreading to other people.
• When the immune system of a patient with dormant TB is weakened, the TB can become active (reactivate) and cause infection in the lungs or other parts of the body.
• The risk factors for acquiring TB include close-contact situations, alcohol and IV drug abuse, and certain diseases (for example, diabetes, cancer, and HIV) and occupations (for example, health-care workers).
• The most common symptoms and signs of TB are fatigue, fever, weight loss, coughing, and night sweats.
• The diagnosis of TB involves skin tests, chest X-rays, sputum analysis (smear and culture), and PCRtests to detect the genetic material of the causative bacteria.
• Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active.
• Active TB is treated, usually successfully, with INH in combination with one or more of several drugs, including rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide, and streptomycin.
• Drug-resistant TB is a serious, as yet unsolved, public-health problem, especially in Southeast Asia, the countries of the former Soviet Union, Africa, and in prison populations. Poor patient compliance, lack of detection of resistant strains, and unavailable therapy are key reasons for the development of drug-resistant TB.
• The occurrence of HIV has been responsible for an increased frequency of tuberculosis. Control of HIV in the future, however, should substantially decrease the frequency of TB.