JC Virus DNA, PCR Tips

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.

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

If you are in an area which has a lot of mosquitoes, any fever that is not subsiding in a couple of days is a cause for concern as it can be due to dengue. It is one of the dreadful diseases doing the rounds in recent years and when someone complains of fever and joint pain, the first question we ask if they got checked for dengue. This is caused by a virus that is carried by an infected mosquito.

The blood is made up of 3 types of cells mainly that are in a liquid medium called the plasma. The red blood cells are the oxygen-carrying cells and the white blood cells fight infection and provide immunity. The third type are the platelets, they are smaller than the other two and help in blood clotting. With dengue fever, both the white blood cell count and the platelet count are decreased. Normal platelet count in the body ranges from 1.5 to 4 lacs and in patients with dengue; this can go down to as low as 20,000 to 40,000. This is because of the following:

• Dengue suppresses bone marrow, which is the platelet-producing area, leading to decreased platelet count.
• Blood cells affected by dengue virus damage platelets, leading to their drastic fall in numbers
• Antibodies produced in dengue also lead to massive destruction of platelets

Patient presents with nonspecific symptoms including a high fever that does not subside, vomiting, pain behind the eyes, headache, nausea, and severe muscular and joint pain. The eye pain and joint pain lead to the suspicion of dengue fever. Symptoms develop after 4 to 7 days after the bite. The fever lasts for about 5 to 7 days and is followed by a prolonged period of fatigue, joint pains, body pain, and rashes.

For the sake of confirming the diagnosis, the doctor will run some lab tests. These include testing for antibodies IgG and IgM, PCR testing to check the virus and a complete blood count. This will reveal the decrease in the white blood cells and the platelets to a significant degree. Whether or not a person requires platelet transfusion will be decided by the doctor based on the person’s age, immunity levels and severity of the disease.

There isn't a particular level below which a person would require platelet transfusion. In aged people and with people who have other chronic diseases, platelet transfusion may be required even if the blood count is about 50,000. The doctor will decide this based on the patient’s health. The right thing to do is to go for medical consultation and discuss your situation with the doctor and identify what needs to be done for your condition specifically.

What causes cervical Cancer?

Genital Human papilloma virus (HPV) is a very common virus in both men and women that can lead to the development of genital warts, abnormal cervical cells or cervical cancer.

This virus can cause normal cells on your cervix (Know more about Cervix Infection) to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found and treated by your doctor. It can take 10 to 15 years (or more) for cells to change from normal to abnormal, and then into cancer. Abnormal cells are sometimes called 'pre cancer ' because they are not normal, but they are not yet cancer.

You cannot see or feel HPV or these cell changes on your cervix. Screening tests help us to look for these changes or for abnormal cells (Learn more about sexually transmitted diseases)

How is HPV spread?

HPV is transmitted during genital skin to-skin sexual contact. This includes vaginal or anal sex and possibly oral sex.A person can get HPV even if years have passed since he or she had sex. They will never know it because HPV usually has no signs and symptoms.

In most cases, HPV goes away within two years, without causing any health problems. It is thought that the immune system  fights off HPV infection naturally

What screening tests exist for HPV- related diseases?

Cervical Cancer: Cervical cancer can be detected with routine Cervical cancer screening (Pap test) and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops.    Abnormal cells often become normal over time, but can sometimes turn into cancer. These cells can usually be treated, depending on their severity and on the woman's age, past medical history, and other test results.

An HPV DNA test, which can find certain HPV types on a woman's cervix, may also be used with a Pap test in certain cases (called co-testing). The HPV-DNA test is done to determine if you are infected with one of the high-risk types or if your doctor finds certain type of abnormal Pap test result.

Even women who were vaccinated when they were younger need regular cervical cancer screening because the vaccines do not protect against all cervical cancer strains.

Is there a treatment for HPV or related problems?

HPV vaccination could prevent most cancers and other diseases caused by HPV. There is no treatment for the virus itself, but there are treatments for the problems that HPV can cause:

Visible genital warts may remain the same, grow more in number, or go away on their own. The warts can be treated when they appear.

Abnormal cervical cells (found on a Pap test) often become normal over time, but they can sometimes turn into cancer. If they remain abnormal, these cells can usually be treated to prevent cervical cancer from developing. This may depend on the severity of the cell changes, the woman's age , past medical history, and other test results. It is critical to follow up with testing and treatment, as recommended by a doctor.

Post detection of ovarian cancer the doctors , depending on your cancer stage can recommend the treatment more- surgery, medical treatment, radiation therapy or chemotherapy.

If you are in an area which has a lot of mosquitoes, any fever that is not subsiding in a couple of days is a cause for concern as it can be due to dengue. It is one of the dreadful diseases doing the rounds in the recent years and when someone complains of fever and joint pain, the first question we ask if they got checked for dengue. This is caused by a virus that is carried by an infected mosquito.

The blood is made up of 3 types of cells mainly that are in a liquid medium called the plasma. The red blood cells are the oxygen-carrying cells and the white blood cells fight infection and provide immunity. The third type are the platelets, they are smaller than the other two and help in blood clotting. With dengue fever, both the white blood cell count and the platelet count are decreased. Normal platelet count in the body ranges from 1.5 to 4 lacs and in patients with dengue; this can go down to as low as 20,000 to 40,000. This is because of the following:

• Dengue suppresses bone marrow, which is the platelet-producing area, leading to decreased platelet count.
• Blood cells affected by dengue virus damage platelets, leading to their drastic fall in numbers
• Antibodies produced in dengue also lead to massive destruction of platelets

Patient presents with nonspecific symptoms including a high fever that does not subside, vomiting, pain behind the eyes, headache, nausea, and severe muscular and joint pain. The eye pain and the joint pain lead to the suspicion of the dengue fever. Symptoms develop after 4 to 7 days after the bite. The fever lasts for about 5 to 7 days and is followed by a prolonged period of fatigue, joint pains, body pain, and rashes.

For the sake of confirming the diagnosis, the doctor will run some lab tests. These include testing for antibodies IgG and IgM, PCR testing to check the virus and a complete blood count. This will reveal the decrease in the white blood cells and the platelets to a significant degree. Whether or not a person requires platelet transfusion will be decided by the doctor based on the person’s age, immunity levels and severity of the disease.

There isn't a particular level below which a person would require platelet transfusion. In aged people and with people who have other chronic diseases, platelet transfusion may be required even if the blood count is about 50,000. The doctor will decide this based on the patient’s health. The right thing to do is to go for a medical consultation and discuss your situation with the doctor and identify what needs to be done for your condition specifically. In case you have a concern or query you can always consult an expert & get answers to your questions!

Liver disorders are very common. Gastroenterologists trained in liver diseases are known as Hepatologists.Symptoms of liver disease include jaundice, vomitting of blood(Hemetemesis), bleeding in the motions(also known as Melena or hematochezia),altered sensorium known as Hepatic encephalopathy(HE), Renal failure also known as Hepatorenal syndrome(HRS), Breathlessness (due to Hepatopulmonary syndrome and portopulmonary hypertension).

Let’s understand the liver disease point by point: 

1. Hepatitis B: Hepatitis B is a virus which is usually acquired in four ways. Unprotected sexual intercourse with the infected partner, from infected to the child, infected needles, infected blood. It takes many years for the hepatitis B virus to cause liver damage. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When liver is more then 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. Treatment depends on virus count which is calculated by HBV DNA PCR and other lab parameters. Once the treatment starts monitoring of viral count is done to document the effectiveness of the treatment. All the family members and sexual partners must get HbsAg screening done to detect early silent infection. All those who test negative, Hepatitis vaccination should be done, by three injections which provide them with 100% protection against the HBV infection.

2. Hepatitis C: Hepatitis C is a virus which is acquired by injection drug abuse and infected needles and blood. Transmission by unprotected sexual intercourse is possible but chances are very low. Hepatitis C virus damages the liver slowly and takes years before clinical symptoms of liver failure appear. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When the liver is more than 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. All hepatitis C virus infected patients must be treated irrespective of virus count. Baseline virus count by HCV RNA  is done to measure the effectiveness of the treatment. HCV Genotype is done for patients with cirrhosis. Vaccination is not available for hepatitis C but newer medicines(Direct acting antivirals DAA) for Hepatitis C can cure it with more than 95% certainty.

3. Acute viral Hepatitis: Sudden infection in the liver can be due to multiple causes but commonly is due to Hepatitis A and Hepatitis E, which are caused due to eating or drinking contaminated food and water. Rarely Hepatitis B and Hepatitis C can cause Acute hepatitis including Acute liver failure. Acute hepatitis presents with Jaundice, loss of appetite, generalised fatigue, vomiting and abdominal pain.  Patients are usually treated on an outpatient basis but if they have severe vomiting, abdominal pain or altered sensorium, they are admitted for inpatient care and monitoring. Drugs or complementary and alternative medicines (CAM) such as herbal or bodybuilding protein supplements which contain steroids and heavy metals can cause acute hepatitis.

4. Liver transplant: Removing the damaged liver and to put a new liver in the patients is called Liver transplant. Liver transplant is major surgery and costs around 20 to 30 Lacs. Indications of liver transplant are an acute liver failure due to hepatitis viruses such as hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E, decompensated cirrhosis due to any cause including chronic hepatitis B and C, Drug-induced liver failure such antitubercular drugs(ATT). The donor for liver transplant is either a close relative (Living donor liver transplant LDLT) or a brain dead donor (deceased donor liver transplant DDLT).

5. Chronic liver disease or Cirrhosis: It is the end result of slow damage to the liver, where many liver cells are damaged and replaced by fibrosis. Apart from viruses such as Hepatitis B and Hepatitis C, Alcohol is one of the most common causes of cirrhosis.

Drinking alcohol for years together causes irreversible liver damage causing cirrhosis. Alcohol can cause acute severe hepatitis, acute liver failure and chronic liver disease.  Patients with suspected heavy alcohol drink must-visit Hepatologist (Liver doctor ) for proper diagnosis of stage of liver damage and deaddiction programme. USG Abdomen, blood tests, endoscopy and Fibroscan is usually done to know the liver health.

Fatty liver is also known as non-alcohol fatty liver disease(NAFLD) is a lifestyle disorder due to lack of exercise, high fat diet, obesity and due to drugs. Fatty liver causes silent liver damage and if not recognised in time can cause irreversible liver damage and cirrhosis. The evaluation includes Liver function tests, Ultrasound abdomen, Fibroscan. Treatment includes daily moderate-intensity aerobic exercise, drinking coffee and a low-fat diet. Few medicines are available which help in the reversal of fatty liver.

HIV infection is the causative factor of the acquired immune deficiency syndrome (AIDS). Worldwide research is being conducted and treatment strategies are being formulated to combat this fatal disease. Fighting HIV is not an easy task, since the disease cannot be completely reversed. However, worldwide use of anti-retroviral therapy has helped in controlling the spread and transmission of disease. Use of medications, regular screening and close contact with caregivers and physicians is necessary for proper management of the disease. Despite, available treatment options, a difficult obstacle that arises before or during the treatment is drug resistance.

Drugs are aimed at targeting the disease-causing pathogens like bacteria and viruses. These pathogens, over a period of time, develop the ability to acquire resistance against the targeted drugs. The pathogens continue multiplying despite the presence of the drug in the system. In today’s scenario, the potent drug combination of anti-retroviral therapy (ARV) has been successful in remarkably reducing HIV-related mortality. However, an increased emergence of resistance to the drug therapy is concerning.

Amongst the various drug classes available in the ARV, no drug is resistance-proof. The drugs belonging to the same class have a similar mechanism of action against the virus. So resistance developed against a particular class of drug inevitably leads to resistance against all the other drugs belonging to that class. An individual with HIV infection may have one or more drug-resistant mutations, which makes the person less sensitive to one or more anti-retroviral drugs. When the replication of virus in the system is not suppressed fully, a resistance towards it develops.

Non-compliance of the ARV results in resistance. Resistant viruses can spread the infection and affect ARV therapy. Drug resistance is usually attributed to inadequate adherence to the regimen. But in some cases, strict adherence to the drug is seen, yet there is a presence of resistance due to poor absorption. This implies that since the drug is not getting adequately absorbed in the body, it is unable to prevent the replication thus leading to drug resistance.

Anti-retroviral treatment is aimed at limiting the replication of HIV in the body. Various drug classes target different steps of replication, which stops further replicating and infecting of the cells. The nucleo-capsid contains viral genome and three enzymes vital to HIV life cycle:

• Reverse transcriptase - Transcribes viral RNA genome into complementary deoxyribonucleic acid (DNA)
• Integrase - Facilitates incorporation of pro-viral DNA into host cell genome
• Protease - Cleaves viral polypeptide into individual functional enzymes

Drugs targeted on these steps are as follows

• Nucleoside and non-nucleoside reverse transcriptase inhibitors like Nevirapine and Efavirenz act on the reverse transcriptase enzyme.
• Integrase inhibitor Raltegravir acts on the Integrase enzyme.
• Protease inhibitors like Ritonavir, Indinavir, Saquinavir act on the Protease enzyme.
• Fusion inhibitor Enfuvirtide acts to prevent fusion of HIV with cell membranes.
• CCR5 inhibitor Maraviroc block the CCR5 co-receptor.
• A viral mutation occurring at any stage of this process can affect the efficacy of the drug therapy.

The emergence of drug resistance can be managed by evaluation of drug absorption and ensure strict adherence to the drug schedule. Genotype tests can be done to look for drug-resistant mutations in genes. Phenotype tests are done for measuring the ability of a virus in an individual to undergo replication in different drug concentrations. A successfully administered and effectively acted first-line drug treatment, preferably a 3-drug combination, reduces the chances of drug resistance in future.

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

If you are concerned about liver cancer, you should know that most people do not experience signs and symptoms of the cancer in the early stages. Liver cancer is a form of cancer which occurs in the cells of the liver. There are various types of cancer which can develop in the liver. Hepatocellular carcinoma (HCC) is the most common liver cancer which begins in the hepatocyte, which is the main liver cell.

Symptoms-

Usually there are no specific primary stage symptoms of liver cancer. Some symptoms which may develop include the following:

1. Unusual weight loss is observed

2. Loss of appetite and developing food aversion

3. Pain in the upper abdomen

4. Nausea followed by vomiting

5. General weakness with intense fatigue

6. Swelling in the abdomen

7. The skin may become yellow

8. White and chalky stools are likely

Causes-

In most cases, the causes of liver cancer cannot be clearly determined. In some cases, the cause is known, such as chronic infection with the hepatitis virus, which may lead to liver cancer. Liver cancer occurs when the liver cells undergo changes or mutations in their DNA structure. DNA mutations lead to changes in instructions of chemical processes taking place in the body. The cells may grow out of control and develop into a cancerous tumour.

Risk Factors-

There are several factors which enhance the risk of liver cancer. They are as follows:

1. Chronic infection with hepatitis B or hepatitis C increases the risk of liver cancer.

2. A progressive and irreversible condition known as cirrhosis leads to scar tissue formation in the liver, increasing the risk of liver cancer.

3. Certain inherited liver diseases such as Wilson’s disease and hemochromatosis also increase the chances of liver cancer.

4. People with diabetes are also at a greater risk of having liver cancer.

5. Non-alcoholic fatty liver disease (NAFLD), which is the accumulation of fat in the liver, also increases the chances of getting this condition.

6. Excessive alcohol consumption is another factor which causes irreversible damage to the liver and the chances of getting liver cancer get boosted.

7. Exposure to aflatoxins, which are poisons produced by molds growing on poorly stored crops, make you more likely to get liver cancer.

Several tests and procedures are carried out for the diagnosis of liver cancer. These include blood tests for diagnosing liver function problems, and imaging tests such as ultrasound, CT scan and MRI scan.

HIV infection is the causative factor of the acquired immune deficiency syndrome (AIDS). Worldwide research is being conducted and treatment strategies are being formulated to combat this fatal disease. Fighting HIV is not an easy task since the disease cannot be completely reversed.

However, worldwide use of anti-retroviral therapy has helped in controlling the spread and transmission of disease. Use of medications, regular screening and close contact with caregivers and physicians is necessary for proper management of the disease. Despite, available treatment options, a difficult obstacle that arises before or during the treatment is drug resistance.

Drugs are aimed at targeting the disease-causing pathogens like bacteria and viruses. These pathogens, over a period of time, develop the ability to acquire resistance against the targeted drugs. The pathogens continue multiplying despite the presence of the drug in the system. In today’s scenario, the potent drug combination of anti-retroviral therapy (ARV) has been successful in remarkably reducing HIV-related mortality. However, an increased emergence of resistance to drug therapy is concerning.

Amongst the various drug classes available in the ARV, no drug is resistance-proof. The drugs belonging to the same class have a similar mechanism of action against the virus. So resistance developed against a particular class of drug inevitably leads to resistance against all the other drugs belonging to that class. An individual with HIV infection may have one or more drug-resistant mutations, which makes the person less sensitive to one or more anti-retroviral drugs. When the replication of virus in the system is not suppressed fully, a resistance towards it develops.

Non-compliance of the ARV results in resistance. Resistant viruses can spread the infection and affect ARV therapy. Drug resistance is usually attributed to inadequate adherence to the regimen. But in some cases, strict adherence to the drug is seen, yet there is a presence of resistance due to poor absorption. This implies that since the drug is not getting adequately absorbed in the body, it is unable to prevent the replication thus leading to drug resistance.

Anti-retroviral treatment is aimed at limiting the replication of HIV in the body. Various drug classes target different steps of replication, which stops further replicating and infecting of the cells. The nucleo-capsid contains viral genome and three enzymes vital to HIV life cycle:

• Reverse transcriptase - Transcribes viral RNA genome into complementary deoxyribonucleic acid (DNA)
• Integrase - Facilitates incorporation of pro-viral DNA into host cell genome
• Protease - Cleaves viral polypeptide into individual functional enzymes

Drugs targeted on these steps are as follows

• Nucleoside and non-nucleoside reverse transcriptase inhibitors like Nevirapine and Efavirenz act on the reverse transcriptase enzyme.
• Integrase inhibitor Raltegravir acts on the Integrase enzyme.
• Protease inhibitors like Ritonavir, Indinavir, Saquinavir act on the Protease enzyme.
• Fusion inhibitor Enfuvirtide acts to prevent fusion of HIV with cell membranes.
• CCR5 inhibitor Maraviroc block the CCR5 co-receptor.
• A viral mutation occurring at any stage of this process can affect the efficacy of the drug therapy.

The emergence of drug resistance can be managed by evaluation of drug absorption and ensure strict adherence to the drug schedule. Genotype tests can be done to look for drug-resistant mutations in genes. Phenotype tests are done for measuring the ability of a virus in an individual to undergo replication in different drug concentrations. A successfully administered and effectively acted first-line drug treatment, preferably a 3-drug combination, reduces the chances of drug resistance in future.

Swine flu is a respiratory infection caused by a virus which usually infects pigs. The virus is highly contagious and can survive in the environment for days. It is not unusual for people to get the infection. Swine flu is transmitted from person to person by inhalation or ingestion of droplets containing virus from people sneezing or coughing; it is not transmitted by eating cooked pork products. The symptoms of swine flu are similar to those of common flu-like fever, sore throat, cough, body aches, headache, chills and fatigue.