EBV DNA, PCR Tips

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

1. Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
2. Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
3. Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
4. Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
5. Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
6. Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one’s health.

Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

1. Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
2. Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
3. Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
4. Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
5. Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
6. Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one’s health.

Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. 

HIV/AIDS

Human immunodeficiency virus (HIV) has been conclusively known to be the causative agent for AIDS (Acquired Immune Deficiency Syndrome) which is a major killer disease of the modern times affecting almost 50 million people around the world.

The virus that causes ‘ Aids’ – HIV belongs to a family of viruses known as retroviruses. HIV looks like a rolled up porcupine. It contains two snakes like single strands of RNA along with reverse transcripts firmly wrapped up in a core, giving HIV its characteristic appearance.

On entering the white blood cells known as CD 4 cells, HIV produces its own DNA and sees to it that this gets inserted into the DNA of the host cell. The viral DNA has enough power and information to direct the destiny of the cell. It can force the cell to manufacture several new copies of HIV. However due to certain trigger and regulatory mechanisms, the viral DNA lies dormant in the host cell for several years before it begins to do the damage.

It has been known that CD4 lymphocytes are mainly affected by the HIV when these classes of lymphocytes are destroyed. It produces an immunological imbalance in the body and weakens the resistance to several opportunistic infections, consequently leading to death. The medicines available at present produce a decrease of the viral load, but as they are immunosuppresents they can produce a deterioration of the patients’ immunity.

People infected with HIV may take 7 – 10 years to develop AIDS.

Ayurveda Management

AID/HIV in Ayurveda may be considered as Ojakshaya, meaning the loss of Vital Energy or immunity. The symptoms, Signs and Causative factors (Nidan), and the Treatment aspect has been described in many Ayurvedic Treaties like Charak Samhita, Susrutha Samhita and Ashtanga Hrudaya, Bhavprakash, Vaidya Chintamani and Chakradatta etc.

Ojas is essence of our body. Ojas is otherwise explained as ‘Bala’ (strength or immunity) and ‘Dhatusara’. Ojas is of two types namely, ‘para ojas’ and ‘Apara ojas’. The ‘ojas’ of para(excellent) type is eight drops in quantity, is located within the heart and death occurs when this get depleted. The other type ‘Apara ojas’ is also known as ‘sleshmaka ojas’, the quantity of which is described as Ardha Anjali and distributed throughout the body. When this ojas is not affected the bodily functions will be normal.

In conditions like HIV/AIDS, where loss of ojas is a prominent feature, people are found to be susceptible to various other diseases or infections.

A miscarriage can have adverse effects on both physical and emotional health. The impact of one such event can last for a very long time and harm your social behavior and thus, relationships. It is important to understand that in most cases, it is no one's fault. A number of things can go wrong naturally during the development of the fetus and so, the feelings of guilt, shame and anger are best avoided.

Here are the common causes responsible for miscarriages:

1. Chromosomal defects: Chromosomal abnormalities are responsible for more than half of the miscarriages around the world. The development conditions like Turner syndrome, cystic fibrosis, Down syndrome etc. can be detected by the system and upon detection, the system often chooses to shut itself down leading to a miscarriage. If the cause of the miscarriage is identified as a chromosomal flaw, then a maternal and fetal specialist or a genetic counsellor can help solve the problem.
2. Diabetes: Pregnant women develop high levels of blood sugar even if they did not have diabetes mellitus in the past. This condition is known as Gestational diabetes mellitus. It occurs primarily due the changes in the regular hormonal cycles and secretion of pregnancy hormones and can result in a variety of complications, the most severe one being a miscarriage. A miscarriage may also be caused by a chronic diabetic condition.
3. Thyroid conditions: Both hypothyroidism (low production of thyroid hormones) and hyperthyroidism (high production of thyroid hormones) can be responsible for miscarriages. In case of hypothyroidism, the body produces more of the other hormones in order to make up for the deficiency and this interferes with the reproductive cycle. In case of hypothyroidism, the functionality of the estrogen hormone is compromised due to the over production of other hormones.
4. Separation of the sperm DNA: The sperm DNA is divided or separated due to a number of possible reasons like radiation therapy, chemotherapy, smoking, overexposure to heat etc. and it does not fertilize the egg properly i.e. the DNA is not delivered efficiently. The eggs can sometimes repair the damage in the DNA but this does not happen, a miscarriage is the likely outcome. The condition in males can be treated depending on the reason for the damage in the sperm.

A miscarriage can have adverse effects on both physical and emotional health. The impact of one such event can last for a very long time and harm your social behavior and thus, relationships. It is important to understand that in most cases, it is no one's fault. A number of things can go wrong naturally during the development of the fetus and so, the feelings of guilt, shame and anger are best avoided. Here are the common causes responsible for miscarriages:

1. Chromosomal defects: Chromosomal abnormalities are responsible for more than half of the miscarriages around the world. The development conditions like Turner syndrome, cystic fibrosis, Down syndrome etc. can be detected by the system and upon detection, the system often chooses to shut itself down leading to a miscarriage. If the cause of the miscarriage is identified as a chromosomal flaw, then a maternal and fetal specialist or a genetic counsellor can help solve the problem.
2. Diabetes: Pregnant women develop high levels of blood sugar even if they did not have diabetes mellitus in the past. This condition is known as Gestational diabetes mellitus. It occurs primarily due the changes in the regular hormonal cycles and secretion of pregnancy hormones and can result in a variety of complications, the most severe one being a miscarriage. A miscarriage may also be caused by a chronic diabetic condition.
3. Thyroid conditions: Both hypothyroidism (low production of thyroid hormones) and hyperthyroidism (high production of thyroid hormones) can be responsible for miscarriages. In case of hypothyroidism, the body produces more of the other hormones in order to make up for the deficiency and this interferes with the reproductive cycle. In case of hypothyroidism, the functionality of the estrogen hormone is compromised due to the over production of other hormones.
4. Separation of the sperm DNA: The sperm DNA is divided or separated due to a number of possible reasons like radiation therapy, chemotherapy, smoking, overexposure to heat etc. and it does not fertilize the egg properly i.e. the DNA is not delivered efficiently. The eggs can sometimes repair the damage in the DNA but this does not happen, a miscarriage is the likely outcome. The condition in males can be treated depending on the reason for the damage in the sperm.

A miscarriage can have adverse effects on both physical and emotional health. The impact of one such event can last for a very long time and harm your social behavior and thus, relationships. It is important to understand that in most cases, it is no one's fault. A number of things can go wrong naturally during the development of the fetus and so, the feelings of guilt, shame and anger are best avoided.

Here are the common causes responsible for miscarriages:

1. Chromosomal defects: Chromosomal abnormalities are responsible for more than half of the miscarriages around the world. The development conditions like Turner syndrome, cystic fibrosis, Down syndrome etc. can be detected by the system and upon detection, the system often chooses to shut itself down leading to a miscarriage. If the cause of the miscarriage is identified as a chromosomal flaw, then a maternal and fetal specialist or a genetic counselor can help solve the problem.
2. Diabetes: Pregnant women develop high levels of blood sugar even if they did not have diabetes mellitus in the past. This condition is known as Gestational diabetes mellitus. It occurs primarily due the changes in the regular hormonal cycles and secretion of pregnancy hormones and can result in a variety of complications, the most severe one being a miscarriage. A miscarriage may also be caused by a chronic diabetic condition.
3. Thyroid conditions: Both hypothyroidism (low production of thyroid hormones) and hyperthyroidism (high production of thyroid hormones) can be responsible for miscarriages. In case of hypothyroidism, the body produces more of the other hormones in order to make up for the deficiency and this interferes with the reproductive cycle. In case of hypothyroidism, the functionality of the estrogen hormone is compromised due to the over production of other hormones.
4. Separation of the sperm DNA: he sperm DNA is divided or separated due to a number of possible reasons like radiation therapy, chemotherapy, smoking, overexposure to heat etc. and it does not fertilize the egg properly i.e. the DNA is not delivered efficiently. The eggs can sometimes repair the damage in the DNA but this does not happen, a miscarriage is the likely outcome. The condition in males can be treated depending on the reason for the damage in the sperm.

In case you have a concern or query you can always consult an expert & get answers to your questions!

A miscarriage can have adverse effects on both physical and emotional health. The impact of one such event can last for a very long time and harm your social behavior and thus, relationships. It is important to understand that in most cases, it is no one's fault. A number of things can go wrong naturally during the development of the fetus and so, the feelings of guilt, shame and anger are best avoided. Here are the common causes responsible for miscarriages:

1. Chromosomal defects: Chromosomal abnormalities are responsible for more than half of the miscarriages around the world. The development conditions like Turner syndrome, cystic fibrosis, Down syndrome etc. can be detected by the system and upon detection, the system often chooses to shut itself down leading to a miscarriage. If the cause of the miscarriage is identified as a chromosomal flaw, then a maternal and fetal specialist or a genetic counsellor can help solve the problem.
2. Diabetes: Pregnant women develop high levels of blood sugar even if they did not have diabetes mellitus in the past. This condition is known as Gestational diabetes mellitus. It occurs primarily due the changes in the regular hormonal cycles and secretion of pregnancy hormones and can result in a variety of complications, the most severe one being a miscarriage. A miscarriage may also be caused by a chronic diabetic condition.
3. Thyroid conditions: Both hypothyroidism (low production of thyroid hormones) and hyperthyroidism (high production of thyroid hormones) can be responsible for miscarriages. In case of hypothyroidism, the body produces more of the other hormones in order to make up for the deficiency and this interferes with the reproductive cycle. In case of hypothyroidism, the functionality of the estrogen hormone is compromised due to the over production of other hormones.
4. Separation of the sperm DNA: The sperm DNA is divided or separated due to a number of possible reasons like radiation therapy, chemotherapy, smoking, overexposure to heat etc. and it does not fertilize the egg properly i.e. the DNA is not delivered efficiently. The eggs can sometimes repair the damage in the DNA but this does not happen, a miscarriage is the likely outcome. The condition in males can be treated depending on the reason for the damage in the sperm.

The 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.