Aids/HIV information, Symptoms, treatment

The stages of HIV infection

Each person’s experience of health and illness is different and everyone experiences HIV infection differently. It’s important to remember that the stages of HIV infection will be different from one person to another. Some people have been HIV positive for many years and haven’t developed an opportunistic infection. On Page 233, you’ll find a checklist of things you may want to monitor with your doctor and care givers, in order to prevent or treat infections.

Primary HIV infection

This refers to the time when you’re first infected with HIV. During this stage, which is also called acute infection, the virus multiplies rapidly. About two to four weeks after infection, you may feel ill, with flu-like symptoms such as fatigue, fever, sore throat, swollen lymph nodes, headache, loss of appetite, or skin rash. This may last for as long as a few weeks. Your T4 cell count may drop during this period, and the amount of virus in your blood may be very high. You might test negative for HIV antibodies at this stage, but you can still pass HIV on to someone else.

Seroconversion

The word “seroconversion” refers to your body responding to HIV by making antibodies. After you seroconvert, a blood test for the HIV antibody will come back positive. This stage usually happens one to three months after infection.

Asymptomatic HIV infection

 “Asymptomatic” means without symptoms. In this stage, which may last years, you may feel perfectly well. However, you may have swollen lymph nodes in two or more different areas (your neck and armpits, for example). This is called “persistent generalized lymphadenopathy,” and may last for months, or even years. Even if you have no physical signs of infection, your T4 cells decrease in number.   

Symptomatic HIV infection

 As your immune system is weakened by the virus, you may develop “constitutional,” or whole-body, symptoms of HIV infection. These can include swollen lymph nodes, night sweats, fever, diarrhea, weight loss, and tiredness. You may develop infections like thrush, persistent vaginal yeast infections, or oral hairy leukoplakia. 

AIDS

 AIDS stands for Acquired Immunodeficiency Syndrome. “Acquired” refers to the fact that the condition is not hereditary - you acquire (get) it at some point in your life. “Immunodeficiency” is a weakness in your immune system. “Syndrome” is a combination of symptoms and/or diseases. AIDS is not a disease. Rather, it is a syndrome associated with HIV infection, decreased numbers of T4 cells. 

Your immune system

Your immune system is a network of chemicals, cells, tissues, and organs found throughout your body. These work together to protect you from germs. Your immune system can tell the difference between what belongs in your body and what doesn’t belong. When something that doesn’t belong gets into your body, your immune system tries to destroy it in order to keep you healthy.

 Your body has many ways of protecting itself. The first is your skin, the largest organ of your body. Your skin acts as a shield, and sweat glands in it get rid of waste. The small hairs and fluids in your body openings also protect you. Nostrils have hair and mucus (snot) to keep out germs carried in the air. The saliva (spit) in your mouth contains enzymes that can destroy germs. Your eyes are protected by eyelashes, eyelids, and tears. Your vagina (cunt), urethra (the tube you pee through), anus (asshole), and bowels (guts) are lined with mucous membranes, which protect them 

Your lymphatic system

 Your lymphatic system is like a twin to your circulatory system. Your circulatory system is made up of your heart and the blood vessels called arteries, capillaries, and veins. Instead of blood, your lymphatic vessels carry a fluid called lymph. This clear fluid helps carry germs away from your body’s cells. The germs are filtered and often destroyed through tissue called lymph nodes. There are 500 to 1,000 lymph nodes scattered through your body. Clusters of lymph nodes are found in your armpits, neck, abdomen (belly), and groin (crotch). Sometimes when you have an infection you will notice “swollen glands,” which may be sore. These are your lymph nodes responding to the unwanted germs. 

The cells of your immune system

The cells of your immune system are called white blood cells, or leukocytes. They are created in your bone marrow. Marrow is the material that fills the hollow parts inside many of your bones. Your immune system cells move throughout your body in both your bloodstream and your lymphatic system. There are several kinds of immune system cells. The white blood cells that are the most important in HIV infection are called macrophages and lymphocytes.

Macrophages (sometimes called monocytes) respond to things that don’t belong in your body, like germs, by surrounding and eating them. Macrophages can also bring germs or pieces of germs to lymph nodes to “show” to lymphocytes.

Lymphocytes are cells that live in lymph nodes. Lymphocytes can travel through your body in either your bloodstream or your lymph fluid, but at any one time about 98 per cent of all the lymphocytes in your body are found in your lymph nodes.

There are two ways your immune system can respond when faced with an infection.

T lymphocytes (T cells) are the cells involved in the Th1 response. This type of response is also called cell-mediated immunity, because your T cells coordinate or mediate the response. T cells all look alike under a microscope but they can be divided into different groups according to what they do.

Some T cells are called T4 lymphocytes (T4 cells, or CD4+ cells). T4 cells release chemicals called cytokines, which “instruct” other cells to begin your immune system’s response to anything that doesn’t belong. These are the cells most commonly infected by HIV.

 Other T cells are called T8 lymphocytes (T8 cells, or CD8+ cells). T4 cells “instruct” T8 cells to perform their role in your immune system’s response to infection. Some T8 cells can destroy cells that are infected by germs. Once an infection is under control, other T8 cells cause the immune system to return to normal.

B lymphocytes (B cells) are mostly involved in the Th2 response. This type of response is also called humoral immunity, or the antibody immune response. B cells produce proteins called antibodies. Antibodies “stick” to germs and kill them before they get a chance to infect cells.

 The Th1 response is useful when fighting off many of the infections seen in AIDS. After you become infected with HIV, your immune system’s ability to make a Th1 response generally weakens over time.

Introduction

Nutrition may be a cofactor in HIV progression.

1)  Poor nutritional status and infection affect the immune system and interact with each other.

2) Development of opportunistic infection and malignancies.

 Malnutrition is a very serious problem in AIDS, since the timing of death is directly related to the degree of body mass depletion and is independent of the underlying cause of wasting.When wasting of lean body mass approaches 55% of normal, death is imminent. This occurs independently of the reason for weight loss.“Slim Disease” - Earliest cases in Uganda, in late 1970s, characterized by unexplained wasting.In AIDS, CACHEXIA is present. There is a loss in lean body mass. Superimposed on this may be starvation, a loss of body fat mass. 

Malnutrition Causes Infections

 Protein-calorie malnutrition (PCM) causes depression of cellular immunity with abnormal T cell and macrophage function. This could theoretically worsen the immunodeficiency of people with AIDS, making them more susceptible to infection and worsening existing infections. Virulence may be influenced by a host’s nutritional state. Malnutrition may contribute to life-threatening infectious disease.  

Infection Causes Malnutrition

1) Alters absorption and availability of nutrients

2) Alters hormone secretion, liver synthesis of acute-phase reactant proteins

3) Increases gluconeogenesis/lipogenesis

4)Most infections alter carbohydrate, lipid and protein metabolism, electrolyte balance, trace mineral/vitamin levels

 5) Fever increases caloric requirements. Each degree rise increases caloric needs by 7%.