Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

Most of us are affected by diseases, which spread through physical contact, but most of us do not consider it important to get them checked, due to which they turn into major ailments. Sexually transmitted diseases (stds) are infections, which are transmitted through any kind of sexual contact. The organism that causes the disease is transmitted from one person to the other during sex intercourse. Sometimes stds can be asymptomatic (no symptoms or signs)

Here are some stds that you should be informed about:

1. Gonorrhoea: genital infection caused by bacteria is called gonorrhoea, its symptoms include 

 Bloody vaginal discharge
 Painful urination
 Heavy period bleeding
 Anal itching

2. Chlamydia: bacterial infection in the genital tract is called chlamydia. Chlamydia is usually difficult to diagnose, its symptoms include

 Pain during urination
 Pain in lower abdomen
 Vaginal discharge
 Painful intercourse
 Bleeding between menstrual cycles

3. Syphilis: the bacterium treponema pallidum causes syphilis, its symptoms include

 Rashes
 Sores in the mouth, anus or vagina
 In later stages, it causes nerve and organ damage

4. Genital herpes: the herpes simplex virus (hsv) causes herpes. Signs and symptoms include-

 Small red bumps or ulcers in the anal, genital and other areas
 Itching or pain around the genital area, thighs and buttocks

5. Human papillomavirus (hpv) and genital warts: genital warts are caused by hpv. It infects the genital tract. Hpv has been linked to cervical cancer, its symptoms include

 Small swellings in the genital area
 Itching
 Bleeding during sex

6. Chancroid: chancroid is a bacterial infection. The bacterium haemophilus ducreyi causes chancroid, its symptoms include

 Development of red bumps on the skin folds covering the genitals
 Pain during urination
 Burning sensation during bowel movement

7. Ectoparasitic infections: ectoparasitic infections are caused by small parasitic bugs like mites or lice. The parasites usually affect the hair or skin. Scabies and crabs are common parasites that cause such infections. They both cause intense itching and visible rashes.

8. Human immunodeficiency virus (hiv) and acquired immunodeficiency syndrome (aids): the virus that causes aids is called hiv. It can spread through blood, vaginal fluids, semen and breast milk. Unprotected sex or sharing needles with an infected person is how the disease spreads. It includes symptoms, such as

 Slight fever
 Fatigue
 Muscle aches
 Weight loss.

Most Common STDs in Women


- hiv testing in pregnancy should be done early so as standard care can be taken for the pregnant women.


- this hiv testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with hiv-seronegative and also in pregnant women who are at a high risk of developing hiv infection.


- expedited hiv tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for hiv. The results of the test should be available in one hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.


- women who have not been able to be tested for hiv at the time of labor and delivery are suggested expedited screening for hiv. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental hiv tests are negative. In infants with positive hiv, prophylaxis should be discontinued and antiretroviral drug therapy should be started.


- in case of acute hiv infection during pregnancy, that is in the intrapartum period, or during breast feeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (dna, rna) are necessary for the diagnosis of the hiv infection.
- if the mother is hiv positive then this information must be documented in the infant's medical record and also communicated to the infants care provider.
The knowledge of an antenatal maternal hiv infection allows the:
- women with hiv infection to get the correct antiretroviral therapy along with prophylaxis for the infections which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
- when there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the hiv.
- the hiv infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the hiv.
- the hiv women should be counseled about the risk of breastfeeding.

Identification and Management of Perinatal HIV Treatment

HIV: QUICK FACTSIntroductionThe human immunodeficiency virus (HIV) is a subgroup of retrovirus (lentivirus) that causes HIV infection. After a period of time, this infection leads to what is called acquired immunodeficiency syndrome (AIDS).

Epidemiology

According to the Centers for Disease Control and Prevention (CDC), from 2010-2015, the estimated rate of HIV infection in all 50 US states decreased from 14.2 per 100,000 population in 2010 to 12.3 per 100,000 population in 2015. In 2015, 39,513 individuals were diagnosed with HIV infection. From 2010 to 2014, the annual number of new HIV infections decreased by 9%.

Virology HIV-1 and HIV-2 are retroviruses in the Retroviridae family, Lentivirus genus. They are enveloped, diploid, single-stranded RNA viruses with a DNA intermediate.Upon entry into the target cell, the viral RNA genome is converted into double-stranded DNA by an enzyme, reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded enzyme, integrase. HIV contains three retroviral genes, namely gag, pol, and env.

Gag gene: Encodes group-specific antigen; the inner structural proteins
Pol gene: Encodes polymerase; it also contains integrase and protease
Env gene: Encodes the viral envelope, the outer structural proteins responsible for cell-type specificity. Glycoprotein 120, the viral envelope protein, binds to the host CD4+molecule
Pathophysiology

HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells and leads to cellular immune deficiency. This results in the development of opportunistic infections and neoplastic processes.

Mode of Transmission
Sexual intercourse: Unprotected sexual intercourse; especially receptive anal intercourse and different sexual partnersContact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids infected with the virus.Spread from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid.

Signs and Symptoms There are 3 categories of infection 

Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions
Category B: HIV infection with symptoms that are directly attributable to HIV infection
Category C: HIV infection with AIDS-defining opportunistic infections
Investigation

A high-sensitivity enzyme-linked immunosorbent assay (ELISA) should be used for screening.

Management

Start with antiretroviral therapy (ART) in all HIV-infected adults ready to start therapy. 
CD4 count is no longer a criterion for starting the therapy.
Use of nucleoside reverse transcriptase inhibitors and protease inhibitors.
For refractory cases, during the failing treatment regimen and before switching therapy, use rapid confirmation, perform resistance testing and reevaluate.

HIV - Quick Facts Need To Know!

Sexually Transmitted Diseases (STDs) are the infections that spread primarily from unprotected sexual intercourse or any kind of sexual contact. Men, like women, are equally prone to contracting STDs on having unprotected sexual intercourse; anal, vaginal or oral. Having multiple sex partners just increases the risks of it. So, you need to consult a specialist sexologist if anything these sort of things happening to you:

Common STD Symptoms in Men

Blisters on or around penis 

Spots, bumps or lesions on the penis 

Discharge (clear, white, or yellow) 

Oozing from the tip of the penis (thick or thin) 

Painful urination 

Painful ejaculation 

Itching on the tip of the penis 

Rash on the penis, testicles, or groin

Here is a list of STDs for men

Chlamydia- Chlamydia is a type of bacterial STD transmitted during oral, anal or vaginal sex with an already infected person. Some of the symptoms of Chlamydia in men are swollen testicles, penile discharge or pain while urinating.

Gonorrhea- This is another bacterial infection, majorly affecting the urethra, anus or the throat and primarily spreads through vaginal, oral or anal sex with someone already suffering from it. The symptoms are quite similar to those of Chlamydia.

Hepatitis B- Hepatitis B Virus (HBV) is the cause of the disease Hepatitis B and can cause severe inflammation of the liver. It spreads from one person to the other on coming into contact with the bodily fluids or blood of the person affected. Few signs of Hepatitis B include jaundice, vomiting, nausea, body aches, mild fever, lethargy and appetite loss.

Herpes (Simplex) - It is a viral infection caused by the herpes simplex virus (HSV) and generally tends to develop on or near to the mouth and the genitals. Primarily, herpes spreads through direct contact with the genitals or mouth of a person already diagnosed with the same.

Syphilis- Another bacterial Sexually Transmitted Disease, unprotected oral, vaginal and anal sex are the primary carriers of this disease. It is considered to be one of the most serious STDs because the risks of contracting HIV (Human Immunodeficiency Virus) get magnified once infected with Syphilis.

Human Papillomavirus (HPV) - In men, HPV is capable of causing cancers in the throat, anus or the penis. It is either passed on through skin-to-skin or unprotected sexual contact with an infected partner.

Preventing STDs

Many people can be infected with an STD without experiencing any visible symptoms. This means that practicing safe sex is crucial if you want to prevent STD infection.

The only way to completely prevent an STD is abstinence from any type of sexual contact or contact with open sores and bodily fluids of an infected person. But there are other ways to prevent STDs too.

Condoms during intercourse and dental dams or barriers during oral sex are proven effective when used correctly. Refraining from sex with multiple partners and instead opting for a monogamous sexual relationship can also help to prevent STDs. To understand it better and get treated you can always consult a sexologist.

Common STDs in Men

People who suffer from human immunodeficiency virus, commonly known as'hiv, are known as hiv positive people. The virus is the agent of aids that is currently incurable. Hiv is known to alter the human immune system and makes people much more susceptible and vulnerable to diseases and infections. 

Body fluids such as semen, blood, breast milk, vaginal fluids etc. Of an infected individual contains the virus, which can be passed from one person to another during blood-to-blood and/or sexual contact. Hiv positive women may even pass on this virus to their children during pregnancy, delivery or by breast feeding them. Hiv is also transmitted during oral, anal or vaginal sex, by contaminated hypodermic needles and by blood transfusion. 

Mentioned below are a few issues that a hiv positive woman have to face apart from discrimination and stigma, fear of infecting their children or partners, violence and abandonment. 

1. Menstrual disorders: changes in menstrual cycles are frequently reported by hiv infected women. However, menstrual dysfunctions are due to varied reasons that aren't directly related to the disease. Although most of the hiv positive women suffer from amenorrhea i. E. The unusual absence of periods, it is not just due to hiv but also because of weight loss or immunosuppression. 
 
2. Contraception: it is very important that the contraception a hiv positive woman chooses not only acts as birth control, but also to prevent the transmission of sexually transmitted diseases and hiv. Although condoms do not provide exceptional pregnancy prevention, they are excellent at preventing transmission of the hiv virus. Permanent sterilization is usually the most chosen contraceptive method for hiv serodiscordant couples.

3. Surgical complications: hiv positive women are at a higher risk of undergoing gynecologic surgery. This is because they are more vulnerable to pelvic infectious disease that requires surgical intervention. There is also a greater risk of developing vulvar cancer in hiv positive women. 

4. Fertility: there has been an increase in the number of seropositive women contemplating pregnancy and childbirth. Most couples resort to assisted reproduction to lower the risk of horizontal hiv transmission. Studies show that undergoing hiv treatment and having an undetectable viral load is helpful in preventing the transmission of hiv. It is important to consult a medical expert if you are unable to get pregnant after at least 6 months of trying. Fertility problems are more common in hiv positive women than hiv negative women.

Issues for HIV Positive Women

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