Understanding HIV/AIDS- Part 2
Signs and symptoms of HIV/AIDS
Signs and symptoms of HIV/AIDS
The symptoms of HIV/AIDS depends on the individual and the stage of the disease. The following are the stages of HIV infection as well as the signs and symptoms.
Stage 1: Acute
At this stage, the virus may not be detected and the number of CD4 cells in a milliliter of blood is around 800, so most people may be asymptomatic, that is, they may not experience any signs and symptoms. If you experience any of the signs and symptoms, it does not necessarily mean that you have been infected with HIV, this is because other diseases may present with similar symptoms. However, if you think you may have been exposed to the virus, get an HIV test done.
Within a month of HIV infection, some people experience flu-like symptoms including;
Fever, Chills, Rash, Night sweats, Muscle aches, Sore throat, Fatigue
Swollen lymph nodes, and Mouth ulcers.
Stage 2: Chronic
At this stage, the viral load increases and the number of CD4 cells decreases below 400 cells/ ml of blood. People can stay at this stage for about 15years without HIV treatment. However if you take your medicine exactly as prescribed everyday, the viral load may be undetectable and your risk of transmitting the virus to others will be reduced but if your viral load is detectable, it is necessary to visit the healthcare centre regularly to check your viral load because you can transmit HIV to others at this stage even if you are not experiencing symptoms.
Stage 3: AIDS
This is the last stage of HIV infection. When you have HIV infection and you are not receiving treatment, the virus eventually weakens your immune system and then progress to the AIDS stage, making your body susceptible to opportunistic infections.
Symptoms of AIDS can include:
- Rapid weight loss
- Recurring fever or profuse night sweats
- Prolonged swelling of the lymph glands in the armpits, groin, or neck
- Diarrhoea that lasts for more than a week
- Sores of the mouth, anus, or genitals
- Pneumonia
- Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
- Memory loss, depression, and other neurologic disorders
Types of Drugs used in the Management of HIV/AIDS
The first antiretroviral to be produced was zidovudine, in 1987. This revolutionalised HIV management and paved way for an in-depth study of the life cycle of the HIV virus and subsequent development of other drugs. The following are some of the antiretroviral drug groups.
Nucleoside/nucleotide reverse transcriptase inhibitors. Eg. abacavir, lamivudine, zidovudine, emtricitabine.
Non-nucleoside reverse transcriptase inhibitors.eg. nevirapine,efavirenz,etravirine, doravirine.
Protease inhibitors.eg .ritonavir, lopinavir,atazanavir.
Integrase inhibitors.eg.dolutegravir, raltegravir.
Fusion inhibitors.eg.enfurvitide.
CCR5 antagonist.eg.Maraviroc.
p120 (glycoprotein 120) attachment inhibitor.eg.fostemsavir.
Post-attachment inhibitor or monoclonal antibody.eg.Ibalizumab-uiyk
Overview of HIV Drugs
The drugs used to manage HIV infection target important steps and processes involve in the infection process and the life cycle of the virus. These include :
Fusion of viral envelope with host cell membrane.
Release of viral enzymes and RNA into host cytoplasm.
Reverse transcription that is production of DNA from viral RNA.
Migration of viral DNA into host nucleus.
Integration of viral DNA into host DNA.
Production of HIV proteins and enzymes using host machinery and viral DNA.
Assembling and budding of new virions from host cell membrane.
Most drugs target portions of these processes that are specific to the virus in order to prevent them from having adverse effects on the host cell.
How HIV Drugs work
Some group of drugs such as fusion inhibitors, gp120 attachment inhibitors and CCR5 antagonists prevent the virus from gaining entry into a healthy cell in the first place.
CCR5 antagonists prevent the HIV virus from gaining entry into a healthy cell. This is achieved by blocking receptors (CCR5 receptors) on the surface of the cells which the HIV virus uses as the gateway into the cell.
Fusion inhibitors prevent fusion of the virus with the host cell membrane thereby denying the virus entry into the cell.
Protease inhibitors block the viral protease enzymes that are needed to produce mature virions upon budding from the host cell membrane.
Integrase inhibitors inhibit the viral enzyme integrase which is responsible for integration of the viral DNA into the host cell’s DNA.
Post-attachment inhibitor or monoclonal antibody drugs prevent infected host cells from fusing with other healthy cells and transmitting the virus to them.
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) are nucleotide and nucleoside analogues that inhibit reverse transcription and hence prevent the viral RNA from being incorporated into the host DNA. They do this by inhibiting the enzyme reverse transcriptase that converts the viral RNA to DNA before it can be integrated into the host DNA.
Non-nucleoside reverse transcriptase inhibitors(NNRTIs) bind to the enzyme reverse transcriptase and inhibit its action. Unlike nucleoside/nucleotide reverse transcriptase inhibitors, they are not nucleoside or nucleotide analogues. HIV-2 is naturally resistant to this group of drugs.
Diagnosis of HIV/AIDS
In order to reduce the occurrence of false positive results, a three test algorithm is now used in the diagnosis of HIV. This helps to to increase the number of true positives.
For every HIV exposed infant, a DNA PCR (polymerase chain reaction) is done at 6 weeks and repeated at 9 months if the 6 weeks test was negative. Finally a HIV RDT is done at 18 months to to make sure that the child is actually HIV negative. The test algorithm for the general population and antenatal clients is shown below.
Management of HIV/AIDS
Management of HIV/AIDS depends on the stage of the disease. The mainstay of HIV management is the ART(antiretroviral therapy) which is a combination of ARVs(antiretroviral drugs). Monotherapy is discouraged. A three drug therapy (highly active antiretroviral therapy, HAART) is used. This involves the combination of two NRTIs(nucleotide reverse transcriptase inhibitors) plus another ARV from any of the other remaining drug groups. Comprehensive management of HIV/AIDS should include ART, Screening for and Treatment of any comorbidities, Prophylaxis and Treatment of opportunistic infections and Long term monitoring.
ART- the goal of ART is to prevent weakening of the immune system to the point where opportunistic infections set in. ART also helps HIV infected persons to live longer and have fewer complications. The current preferred first line regimen for adults, adolescents and children (with weight more than 20kg) is a combination of tenofovir, lamivudine and dolutegravir. The alternative is a combination of tenofovir , lamivudine and efavirenz.
Screening for and Treatment of any comorbidities- HIV infected individuals should be screened for diabetes, hypertension and other cardiovascular diseases, hepatitis infection, tuberculosis and STIs such as gonorrhoea and chlamydia.
Prophylaxis and Treatment of opportunistic infections- septrin is given as prophylaxis for toxoplasmosis and Pneumocystis jirovecii which causes pneumocystis pneumonia. Parients should be screened for G6PD deficiency before initiation of septrin. Prophylaxis for fungal infections is not routinely necessary but when needed fluconazole can be given.
Long term monitoring- includes liver function tests, full blood count , lipid profile, kidney function tests. These should be done at least once in every 6months. The viral load and CD4 counts are also checked at the beginning of the therapy and periodically to monitor disease progression.
Ms. Seidu
Read more: https://www.who.int, https://www.ghanaids.gov.gh/, https://en.m.wikipedia.org/wiki/HIV/AIDS
Picture source: Google
These articles are very educative, both for health personnel's and the public. Please keep up the good work
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