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!

Hearing that a person is HIV positive instantly makes us wary of him or her and unconsciously we may begin avoiding social interactions with them. However, HIV does not spread through the air or by water and hence there is no reason to ostracize HIV positive people. To understand how to prevent the transmission of HIV it is essential to first understand how the virus is transferred from one person to another. There are three ways in which this virus can be transmitted from an HIV positive person to another. These are:

Through blood
Through bodily fluids such as semen and vaginal or rectal fluids
From a mother to a child
Keeping this in mind, here are a few ways to prevent the transferring of HIV from one person to another:



Use only Disposable Syringes: Getting pricked by a needle that has been used on a HIV positive patient can increase your risk of suffering from the disease. Hence, insist on using a fresh needle for blood tests etc. Also ensure that the syringe and needle and destroyed after being used.
Registered Blood Banks: In case you need a blood transfusion, get blood only from registered blood banks. These blood banks need to run HIV screening tests before collecting blood and hence are guaranteed to have only HIV negative blood as opposed to local quacks.
Use a Condom: The only way to prevent the transference of HIV cells while having intercourse is by using a condom. This is essential not only for vaginal intercourse but for anal intercourse as well.
Get Tested: Today, an HIV screening test can be easily done and your results are guaranteed to be kept confidential. STDs can increase your risk of getting infected with HIV or spreading it to others. Get tested regularly for STDs and insist that your partners are checked for it as well. This is crucial if you have more than one sexual partner.
Limit the Number of Sexual Partners: The more number of people you have sex with, the higher your chance of getting infected with the virus and transmitting it to others. Remember, HIV has no overt symptoms that are visible to the naked eye.
HIV cannot be cured but it can be controlled through medication. Hence, if you suffer from this disease, follow the doctor's prescription religiously to prevent transmitting the virus to your partner. If you wish to discuss about any specific problem, you can consult a doctor.

HIV/AIDS - How To Prevent It?

According to the tenets of Ayurveda, HIV is primarily a disease involving low immunity which is considered the most vital sap of the body. Immunity is in charge of providing both mental and physical strengths required to cope up with the foreign bodies that cause unwanted changes in the human body. When the immune system gets disrupted, the individual becomes susceptible to a host of infections and disorders. There are incessant numbers of bacteria and viruses in the environment, and some of them are highly contagious which can easily cause an infection.

Ayurveda has numerous highly effective therapies to combat HIV exposure. There is a sector of Ayurveda specifically dedicated to boosting immunity and vitality in the body with the help of herbs, minerals, and practice of Ayurvedic techniques. The treatment first aims to detoxify the body and strengthen the immune system which improves the immune system with the help of certain "rasayanic" techniques.

How is HIV exposure treated through Ayurveda?
The first step of HIV exposure treatment through Ayurveda is having nourishing food and leading a positive life supported by well-meaning friends and relatives. The patient can also take part in some physical exercises which don't cause any strain to the fragile health condition. Engaging in comfortable yet fruitful activities can help in strengthening good tendencies and stimulating appetite as well.

Then the patient will have to take some Ayurvedic tonics along with rejuvenators that can boost immunity levels and eliminate the toxins from the body. This is particularly done through emesis, purgation, and enemas. The medications which are given at this stage are neither drastic nor very harsh for the body so that they can be digested without any difficulty.

In the third stage of treatment, appropriate medications will help in purifying the blood, and this is where the role of liver corrective measures come to the fore. The patient has to take preparations with medicated ghee and soups that can alleviate the signs and symptoms of HIV exposure. There is no scope of consuming spicy and oily junk foods as they can take a toll on the patient s liver. Medicated alcohol may have to be used to aid in the digestive procedure and removal of blockages in the flow of energy.

Participating in physical activities on a daily basis is important. In case the patient is too weak to exercise or even run, then steaming can be helpful. This is very crucial since it is believed in Ayurveda that heated blood can weaken and sometimes destroy the virus involved in HIV.

There are some herbal cum mineral compounds which are helpful for subsiding the conditions of HIV exposure. It is important to consult with an expert who can evaluate your condition and help in healing the signs and symptoms that you are suffering from.

HIV Exposure - How Ayurveda Can Help You Manage It?

HIV or Human Immunodeficiency Virus is a type of immune disorder which attacks the immune system of the body and slowly destroys it overtime. The HIV virus targets the immune system and makes the body susceptible to other diseases. HIV infection can progress to AIDS although it may take up to 10 or 12 years to fully go into the last stage.

Risks and Causes
HIV is a communicable disease which spreads through only the following methods

    It can spread from one person to another by means of unprotected sexual intercourse due to the exchange of bodily fluids.
    The virus spreads if you share drug needles with someone who is already contaminated with HIV virus. It can also occur due to improperly trained medical staff that may reuse syringes although this is very uncommon.
    The HIV virus transmits from the mother to the child during pregnancy through the placenta.
    Any exchange of blood in significant amounts such as blood transfusion from a contaminated patient will result in infection as well although this is very rare.

Any other form of contracting the disease such as through kissing or food is a untrue and only propagates due to ignorance.

Symptoms
The initial symptoms of HIV infection are noticed after a few weeks although it can take a few months to come up as well. The initial symptoms may include
1. Severe headache along with intense pain in the muscles and the joints of the body.
2. Frequent appearances of rashes
3. inflation of the lymph nodes
4. Itchy skin
5. Disorders which stay for sustained periods such as an upset stomach or a cold.

The early symptoms disappear within 2 to 3 weeks without any treatment. The later symptoms might appear after few years (sometimes up to or more than a decade), which will stay. This is usually the time HIV is diagnosed. The symptoms now may also include
1. severe muscle fatigue
2. severe loss in body weight,
3. High fever and recurrent instances of sweating at the night time.
HIV is suspected if the later symptoms tend to last for a long time without any other diagnosable cause.

Treatment
HIV can be treated by means of antiretroviral therapy which reduces the rate at which the virus multiplies. However, there is no cure for HIV as of yet.
Prevention
In order to prevent yourself from getting HIV, you should adopt the following precautionary measures:
1. You should use protection every time when engaging in sexual intercourse and if you are unsure of your partner s HIV status.
2. You should use new blades in barbershops for shaving purposes in order to prevent yourself from HIV as well
3. If you are diagnosed with HIV/AIDS while you are pregnant, to prevent spreading it to your unborn baby, you might immediately need undergo a medical check-up and follow the doctor s advice.
4. Ensure that disposable syringes are used whenever they are being use for medical tests or treatments.

HIV / AIDS - Things You Should Remember About It

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?


- 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

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