What is an Acquired Immune Deficiency Syndrome?

March 22 23:25 2019 Print This Article

Popularly Known As AIDS

It is defined as a condition in which there is an involvement of the immune system. It is caused by the human immune deficiency virus which is referred as HIV. It decreases the effectiveness of immune system and makes the individuals susceptible to the infections and tumors. The infections are mainly opportunistic. The virus is mainly transmitted by the direct contact of mucous membrane. It may also be transmitted through the blood stream or may also involve the body fluid. It consists of blood, semen, vaginal and pre seminal fluid along with the breast milk. The mode of transmission can be anal, oral or vaginal sex. It may also occur due o the blood transfusion.

The contaminated needles along with the exchange between mother and baby may lead to the transmission. It is mainly pandemic in nature. There are more than 33 million people who suffer from this disorder according to a report in the year 2007. It killed around 2 million people including many children. Most of the death occurred in the Africa region and lead to the retarding economic growth. There were few genetic researches which showed that this disorder originated from Africa during the 19th and 20th century. It was first recognized by the Centre for Disease Control in the U.S in the year 1981. The course of the disease can be slowed down by its treatment. There is no cure for this disorder. There is an anti retro viral treatment which can decrease the mortality and morbidity of HIV infection. These medicines are expensive and the access to these drugs is not available in all countries. So, the emphasis must be on the prevention of this disorder. One should promote needle exchange and the safe sex programme so that the spread of virus can be controlled.

What are the signs and symptoms of Acquired Immune Deficiency Syndrome?

The symptoms include the conditions which do not normally develop in the effective immune system.

1. Mostly, these are infections which are caused by the bacteria, virus, fungi and few parasites. These are controlled by the immune system. But HIV damages it. The people who have this disorder suffer from opportunistic infections. They affect each and every organ system. The people who suffer from this disorder can develop few cancers like Kaposi sarcoma and cervical cancer. The cancers of the immune system are also known as lymphoma.

2. The people with this disorder also suffer from fever, sweat, swollen glands and weakness along with the loss of weight. The sweats occur during the night. The opportunistic infections caused by this disorder vary according to the area where the patient lives. There are pulmonary infections which are also known as the pneumocystis pneumonia. It is also known as the PCP. It is not common among the healthy people. They are immune competent people. It is quite common in the people which suffer from AIDS. This is caused by the other species of pneumocystis. It was the most common cause of death among the western countries. But after the effective diagnosis and treatment the conditions changed.

3. In the developing countries the first indication of this disorder is the untested individuals. But it does not occur until the CD4 count becomes less than 200 cells per ul of blood. The other unique infection associated with this disorder is tuberculosis. It can be transmitted to the normal individuals through the respiratory route. If identified it cannot be treated easily. It can occur in the early stages of the AIDS and can be treated with the help of drugs. It is associated with the multi drug resistance and it is a serious problem.

4. The major world health problem is the association of tuberculosis with the HIV. This is stated by the world health organization. In the year 2007 around 456 000 deaths due to the TB cases were HIV positive. The use of directly observed therapy has decreased its incidence and this has been also attributed by the other improved practices. In the case of early HIV infection the TB represents a pulmonary disease. In the case of late HIV infection the TB represents an extra pulmonary disease.

5. The symptoms are collective and are not concentrated on a particular site and affect the bone marrow, bone, urinary and gastro intestinal infection. There also occur regional lymph nodes and the involvement of central nervous system. The gastro intestinal infections involve the esophagitis and which denotes to the inflammation of lower end of esophagus. It may occur due to the fungi or mycobacteria in the patients which suffer from HIV. This disorder may also lead to the unexplained diarrhea which may occur due to the multiple reasons. It includes the bacterial and parasitic infections.

6. There are few opportunistic infections along with the presence of virus. The viruses are of multiple types. The diarrhea is also a side effect of many drugs which are used to treat HIV. It may also come along with the HIV infection. The antibiotics may also cause diarrhea. In the later stages of HIV infection the changes in the intestinal tract can lead to the diarrhea. This is an important segment of HIV wasting. There occurs neuro logical and psychiatric involvement. There is an infection of the brain by the organism or they are affected directly due to the illness.

7. There is a disease known as the Toxoplasmosis which occurs due to single cell parasite. It infects the brain and is known as the toxoplasma gondii. It causes the toxoplasma encephalitis. It may also affect the other organs like eyes and lungs. There is an infection in the covering of membrane of brain which is known as the meninx and causes cryptococcal meningitis. It may also be caused by the fungi and is known as the crypto coccus neoformans. It may lead to fever, head ache, dizziness and vomiting. It can also develop seizures and confusion in the later cases. It can be lethal also.

8. There is a term ADC which is referred to the AIDS dementia complex. It is a metabolic encephalopathy and is stimulated by the immune activation of HIV infected brain. It involves the macrophages and microglia. These cells are infected by the HIV and secrete many neuro toxins which are of host and viral origin. After many years of HIV infection there occurs much neurological impairment which is also manifested by the other abnormalities like behavioral and cognitive. They are in association with the low CD4 cell count and have a high plasma viral load.

9. There is a condition known as the PML which is referred to the progressive muti focal leukeo encephalophathy which is a de myelinating disease. In this there is a gradual destruction of the myelin sheath which covers the axons of nerve cells. It impairs the transmission of nerve impulses. It is caused by the JC virus. It occurs in the 70 percent of the population in latent form. It causes the disease when the immune system is very weak. It spreads very fast and may lead to the death of the individual. Its prevalence in the western countries is more as compared to the developing countries. In India it is 1 to 2 percent. The difference in the prevalence is due to the different HIV types in India.

10. There is a mania related to this disorder which is seen in the AIDS patients in their later stages. There is more irritability and cognitive impairment. The euphoria is less than the bipolar disorder. Its course is chronic and it is not commonly associated with the multi drug therapy.

11. There are certain tumors and malignancies which are associated with this disorder. This is mainly feasible due to the co infection with the oncogenic DNA virus. It includes the EBV that is epsteinn barr virus and Kaposi sarcoma associated herpes virus. It is also known as the KSHV. There is a human papilloma virus also. The Kaposi sarcoma is the most common tumor associated with this disorder. It occurs mainly in the young homo sexual man. It occurred in the year 1981 as a signal of the first epidemic sign of AIDS. It is caused by the gamma herpes virus which is known as the Kaposi sarcoma associated herpes virus. It is also known as the KSHV. There are purple nodules present on the skin. It may also involve the mouth, gastro intestinal tract and lungs. There is a high grade B cell lymphoma which is known as the Burkitts lymphoma. The burkitt like lymphoma and diffuse large B cell lymphoma are along with the primary central nervous system lymphoma are present in the HIV patients. These cancers over shadow the poor prognosis. There is an Epstein barr virus or the Kaposi sarcoma associated herpes virus which is also known as the KSHV. It causes the different types of lymphoma. In this disorder lymphoma occurs in the extra nodal sites like the gastro intestinal tract. The Kaposi sarcoma associated herpes virus. It is also known as the KSHV along with the B cell lymphoma confirms the diagnosis of AIDS. There is an invasive cervical cancer in the HIV infected women which defines the AIDS. It occurs due to the human pappiloma virus which is referred as HPV.

12. The HIV infected patients are at increased risk of other tumors. It includes the Hodgkins disease, anal along with the head and neck cancer. There is a hepato cellular carcinoma. A few of them are caused by the viruses. The incidence of certain cancers remains the same in cases like breast and colon cancer. The cancers may also occur due to the presence of certain carcinogens like the smoke of cigarette. Some people live for years with subtle immune defects. In the cases were HAART is extensively used to treat the AIDS. The incidence of this disorder related malignancies has decreased. The malignant cancers have become the most common cause of death among the HIV infected patients. In recent times the death rate has been increased due to the presence of non AIDS defining cancers.

13. There are other infections which are associated with the AIDS. It includes the non specific symptoms like the weight loss and fever which is of low grade type. It includes the opportunistic infections like the mycobacterium and cyto megalo virus. It is also known as the CMV and can lead to the colitis, retinitis and blindness. The other most common infection is the penicillosis which is caused by the penicillium marneffei. It is mainly endemic and occurs in the people living in the south East Asia. The infection which is not traced in the HIV patients is the parvo virus B 19. It can lead to the anemia and is difficult to distinguish from the effects of anti retro viral drugs which are used in the treatment of this disorder.

What are the causes of Acquired Immune Deficiency Syndrome?

1.There are many causes of this disorder and includes mainly the low CD4 cell count. This disorder leads to the severe acceleration of infection. It is a retrovirus which affects the main organs of immune system. It affects the macrophages and dendritic cells. It destroys the CD4 cells directly or indirectly. After destroying the CD 4 cells there number becomes less than 200 per micro litre of the blood. It leads to the loss of cellular immunity.

2. There is an acute HIV infection which can spread to the clinical latent HIV infection. It may lead to the early symptoms in the HIV which leads to AIDS. They are differentiated on the basis of CD4 cell count. It may also indicate the infections. If there is no anti retro viral therapy the time of progression from HIV to AIDS is around 10 years and the time of survival is just 1 year. The rate of progression of disease is not static and it can vary from few weeks to two decades.

3. There are many factors which affect the progression of disease. It includes the factors which affect the body’s ability to defend against the HIV infection. It includes the infected person immunity. The old age people have weak immune system as compared to the young people. The poor access to the health care and the exisistence of infections like T.B may dispose the people to fast disease progression.

4. The genetic inheritance of the infected person is an important determinant of the resistant to certain strains of HIV. The people with the homozygous CCR5 are resistant to infection with few strains of HIV. This disorder is genetically variable and keeps on changing. It gives rise to different rates of clinical progression.

5. There is a sexual transmission which shows the contact between sexual secretions of one person with the rectal, genital and mucus membrane of the other. The unprotected receptive sexual acts are more risky as compared to the insertive sexual acts. The risk of transmitting HIV by the unprotected anal inter course is more than the vaginal or oral sex. The oral sex is not completely safe and can also lead to the HIV by insertive and receptive oral sex. An increase risk of HIV transmission occurs by the sexual assault. In this case no condoms are used and vagina or rectum suffers from the physical trauma. It facilitates the transmission of HIV.

6. There are certain STI which are known as the Sexually Transmitted Infections which increase the risk of HIV transmission. They disturb the normal epithelium by the formation of genital ulcers. There are a lot of HIV infected cells present in this area. These include the lymphocytes and macrophages. It occurs mainly in the semen and vagina. There were few studies which were done in the Africa, Europe and America which indicated that the presence of genital ulcers like caused by syphilis may increase the risk of AIDS by four times. The increase in risk is lesser in the cases of STI like Chlamydia, gonorrhea and trichomoniasis. They are mainly the accumulations of macrophages and lymphocytes.

7. The transmission of HIV depends on the infection of the index case. It also depends on the susceptibility of uninfected patients. During, the course of illness the infectivity remains variable. The un detectable viral load in the plasma does not indicate a low viral load in the seminal liquid or genital secretions. The increase in the level of HIV in the blood around 10 times increases the rate of transmission of AIDS by 80 percent.

8. The women are more susceptible to the HIV infection due to the hormonal changes. The microbial ecology of vagina and physiology are also important factor related to it. They lead to the high prevalence of sexually transmitted diseases.

9. The people who are infected with the single strain of HIV can still be infected later with the HIV by the more virulent strains. The infection cannot occur in the single counter. The increase in the rate of infections is linked to the overlapping long term sexual relationships. It allows the virus to spread quickly from one partner to the other. The infection rate can be lower if the person is mono gamous and has few occasional casual encounters. It is quite common in the hetero sexual males of Africa. There is a schistosomiasis which involves around 10 percent of the women and involves the vagina. It is quite common in the Africa.

10. The transmission route of virus is mainly the intra venous in case of drug users and in hemophiliacs. It also occurs in the person who receives the blood and blood products. The reusing of the needles and syringes are the major risk factor associated with this disorder. One third of the HIV infections in America, China and East Europe can lead to the HIV infections. The risk of infected with the HIV in a single prick is 1 in 10. The post exposure prophylaxis with the anti HIV drugs can reduce the risk of HIV. It also affects the people who receive and give tattoos. One must follow the precautions before using them but in the certain areas of the world like sub Saharan Africa and Asia these precautions are not followed. This may occur due to the improper training and shortage in the supply. The world health organization has estimated that the 3 percent of the HIV infections in the certain parts of Africa are transmitted by the un safe health care injections. As of this the United Nations General Assembly has urged the nations to follow precautions and prevent the transmission of HIV infection. In the developed countries the risk of transmitting HIV to blood transfusion is very low as in these countries there is a proper procedure of donor selection and HIV screening. Most of the population of the world has do not any access to the safe blood according to the world health organization. Nearly, 10 percent of the world population is infected by the transfusion of infected blood and blood products.

11. The transmission of virus can occur from the mother to child via pregnancy in utero or during the birth of child. If there is no treatment than the transmission rate between the mother and her child during the pregnancy is 25 percent but when the mother takes anti viral therapy the rate of transmission falls to nearly 1 percent. The risk of infection is affected by the viral load of mother at the birth. The higher is the viral load more is the risk associated with it. The risk is also increased by the breast feeding about 4 percent.

12. There are many mis conceptions associated with this disorder. The most common mis conception is that this disorder spreads by casual contact. The other misconception is that the sexual contact with the virgin can cure AIDS. The HIV can infect only he homo sexual man and drug users. There are other mis conceptions also which states that the anal contact between the gay man can lead to this disorder. There is a need for open discussion on the homo sexuality and HIV mainly in the schools. It will decrease the rate of AIDS.

What is the patho physiology of Acquired Immune Deficiency Syndrome?

It is very complex like all other syndromes. The HIV causes AIDS by depleting the CD 4 T helper cells. It weakens the immune system and allows the opportunistic infections to occur. The lymphocytes are essential to the immune response and if they are not present the body loses the ability to fight with infections. The mechanism of depleting the CD 4 T helper cells is different in the acute and chronic phases. In the acute phases the HIV causes lysis and killing of the infected cells by cyto toxic T cells. They are responsible for the depletion of CD 4 T helper cells. It may also occur due to the apoptosis. In the chronic phase, the generalized immune activation is combined with the loss of the ability of immune system to form new T cells which are responsible for the slow decline of CD 4 T cells. The symptoms of immune deficiency in this disorder take a year to occur and during the first weeks of infection there is depletion the CD 4 T helper cells. It takes place mainly in the mucosa of intestine which contains a lot of lymphocytes which are present in the body. The depletion of the mucosal CD 4 T helper cells is mainly due to the ability of the most of mucosal CD 4 T helper cells to express CCR 5 coreceptor. There is in ability of the most of blood CD 4 T helper cells to express CCR 5 coreceptor. The HIV seeks and destroys the CCR 5 coreceptor. It occurs during the acute infection. A vigorous immune response controls the infection and starts the clinical latent phase. The CD 4 T cells in the mucosal tissue deplete throughout the infection and few remain to clear off the life threatening situations. The continuous division of HIV causes a state of generalized immune activation. It persists through the chronic phase. The increased activation state of immune cells occurs due to the immune activation. There is a release of pro inflammatory cytokine which occurs due to the activity of many HIV gene products along with the immune response to the HIV replication. The other reason may be the breakdown of the immune surveillance system of mucosal barrier. It is caused due to the depletion of mucosal CD 4 T cells in the acute phase of disease. It results in the systemic exposure of the immune system to microbial components. These are present in the guts normal flora. A check is kept on them by the mucosal immune system. The proliferation and activation of the T cells gives fresh targets for the HIV infection. It occurs as a result of immune activation. The direct killing by the HIV cannot be held responsible for the depletion of CD 4 T cells. As very few CD 4 T cells are affected in the blood. The loss of CD 4 T cells occur mainly due to their susceptibility to apoptosis when the immune system remains active. The T cells are produced by the thymus and they replace the old ones. The regenerative capacity of the thymus is affected by the direct infection by the thymocytes of HIV. The minimal number of CD 4 T cells to maintain the sufficient immune response is lost. There are many cells which are affected by this disorder. The virus affects the lympho reticular system involving macrophages, monocytes, B lymphocytes and CD 4 T Helper cells. The endothelial cells are also involved. The central nervous system including the microglia, astrocytes, oligo dendrocytes and neurons are also involved. The virus causes cytopathic effects but how does it causes is not clear. It remains inactive in the cells for long periods. This effect is due to the CD 4 gp interaction. The main effect of this disorder is the suppression of T helper cells. It also leads to the lysis of these cells. The cell is killed till it becomes function less. The infected cell cannot produce enough antibodies. The immune system collapses leading to the complications of AIDS. It may lead to the infection and neoplasms. There is an infection of the cells of CNS which may lead to the aseptic meningitis, sub acute encephalitis, vascular myelopathy along with the peripheral neuropathy. It can lead to ADC in the later stages. The CD 4 gp interaction can occur in few viruses like hepatitis virus, cytomegalo virus and herpes simplex virus. These viruses can lead to the further cell damage which is known as the cytopathy.

What is the diagnosis of Acquired Immune Deficiency Syndrome?

The diagnosis of AIDS is based mainly on the signs and symptoms. AIDS has been defined differently according to many epidemiological studies. The first definition was given by Bangui and later on it was modified by the world health organization. The clinic testing of the patients were not reliable method for the diagnosis of this disorder. As they are neither sensitive and nor specific. In the developing countries, the world health organization staged the system for HIV infection and disease. It depends on the clinical and laboratory data. In the developed countries a centre for disease control classification system is used. In the year 1990 the world health organization grouped the infections and conditions by introducing the staging system for the infected patients. This was updated in the year 2005. Many of these conditions are opportunistic infections and can be easily treated in the healthy people. In the stage I the HIV is asymptomatic and is not categorized as AIDS. In the stage II the HIV includes muco cutaneous manifestations and recurrent respiratory tract infections. In the stage III the HIV includes the chronic diarrhea which extends for more than a month. There are many bacterial infections and pulmonary tuberculosis associated with it. In the stage iv the HIV includes the toxoplasmosis of brain, candidiasis of the respiratory organs and Kaposi sarcoma. These are the indicators of AIDS. There are two main definitions of AIDS which are produced by the Centre for Disease Control and Prevention referred sd CDC. The older definition referred o the association with the AIDS like involvement of the lymph adenopathy. After this the discoverers of HIV named the virus. In the year 1993 CDC modified the definition of AIDS and included all the HIV positive people which had a CD 4 T cell count less than 200 per micro litre of blood or 14 percent of all the lymphocytes. The new AIDS definition has been used in the developed countries or the pre 1993 CDC definition. This is the most important component for the diagnosis of AIDS. After the treatment a CD 4 T cell count increases more than 200 per micro litre of blood. Most of the people are unaware of the fact that they are infected with the HIV. Nearly, 1 percent of the sexually active population is tested for this disorder and this percentage declines further in the rural areas. Less than 1 percent of the women are counseled in the urban health facilities. Again the percentage declines further in the rural areas. So, donor blood and blood products are used in the medicine after proper screening for HIV is done. The tests of HIV are done on the venous blood. There are many laboratories which use the fourth generation screening tests to identify the anti HIV antibodies like igG and igM. It also uses the HIV p 24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative indicates the HIV infection. The individuals whose first specimen indicates an evidence of infection will need a repeat test on a second blood sample. It confirms the results. There is a window period in between the initial infection and the development of antibodies which is not static. It takes around half a year to sero convert and test positive. The virus can be detected by the polymerized chain reaction which is referred as PCR. It is possible during the window period and the evidence suggests that the infection can be detected earlier than using the fourth generation testing system. The results obtained by the PCR are confirmed by the antibody tests. There are few HIV tests which are used routinely and are done in the cases of neonates and infants. The infants which are born to the HIV positive mother have no value due to the presence of maternal antibody to HIV in the blood of child.

What are the preventive methods of Acquired Immune Deficiency Syndrome?

There are different methods of prevention of this disorder.

1. The transmission route of virus is mainly the intra venous in case of drug users and in hemophiliacs. It also occurs in the person who receives the blood and blood products. The reusing of the needles and syringes are the major risk factor associated with this disorder.

2. The other main cause is the unprotected sex between different individuals. It occurs among the heterosexuals. There are only male or female condoms which can reduce the chances of infection with HIV. It also reduces the chances of infection with STDs. So, are the chances of becoming pregnant. The use of condom in the hetero sexual cases reduces the chance of infection with the HIV by 80 percent. The percentage can go higher if the condoms can be used properly. The male latex condom must be used in the combination with oil based lubricants. It is the single most effective technology which reduces the sexual transmission of HIV. It also reduces the chances of infection with STDs. Some manufacturers recommend that the oil base lubricants must not be used with the latex condoms. It includes the petroleum jelly, butter and lard. They have the ability to dissolve the latex and make the condoms porous. They can also be replaced by the water based lubricants. The oil based lubricants are mainly used with the poly urethane condoms. The male condom can be replaced by the female condom which is poly urethane type. It can be used in the presence of oil based lubricants. They are larger than the male condoms and have a ring shape opening and can be inserted into the vagina. The female condom is kept in the place with the help of inner ring. The ring must be squeezed before inserting. The availability of the female condom is low and the cost is high. There are few studies which are done on the female condoms and have shown that the female condoms increase the protected sexual acts as compared to the non usage of female condom. It is an important part of HIV preventive strategy. There are few more studies which have shown that the consistent use of condom in the infected partner can reduce the risk of HIV below 1 percent in the uninfected partner.

3. The preventive strategies are well developed and fully followed in the developed countries and in the developing countries they are not fully formed and developed. There are young sections of the people in America and Europe which follow high risk practices inspite of having a good knowledge about this disorder. They have higher chances of becoming HIV infected.

4. There are few randomized controlled trials which have shown that the risk of HIV infection can be lowered with the use of circumcision. It reduces the risk by 60 percent among hetero sexual men. This procedure must be actively followed in the countries which are affected by the HIV. It affects the practical, cultural and attitudinal issues.

5. The provision of cost free condoms to the poor people has been the most cost effective programme. It is 100 times more cost effective than circumcision. The perception of vulnerability is lower among the circumcised men and may lead to more sexual risk taking behavior. It negatives its preventive effect. Another randomized controlled trial showed that the circumcision does not increase the HIV risk behavior.

6. The exposure to body fluids can be decreased by the use of certain precautions by health care workers. It includes the use of gloves, masks, eye wares, gowns or aprons which does not allow the contaminated material to come into the contact with skin. It also protects the mucous membrane. The skin must be washed frequently and properly with the soap and water so that the chances of infection are decreased.

7. The sharp objects must be disposed off as early as possible. It includes the needles, scalpels and glass. It helps in the prevention of needle stick injuries with the contaminated items.

8. In the developed countries the most important method of transmission of HIV is intra venous use of drugs. One must follow the harm reduction strategies including the needle exchange programme. They decrease the infection due to the drug abuse.

9. The AIDS can be transmitted from the mother to child. It is applicable when the replacement feeding is acceptable and feasible. It must be safe and sustainable also. The HIV infected mother must not breast feed his child. If this is not feasible than the mother must breast feed the child for one month and it must be discontinued later on. The women may breast feed other children who are not their own.

10. The risk behavior can be altered with the use of health education. There are many studies which have shown that the impact of health education is effective in altering the behavior. The education cannot work alone and must be used in the combination with the high literacy rates and general cognitive ability.

What is the treatment of Acquired Immune Deficiency Syndrome?

There are many treatments available which can deal with this disorder.

1. In today time there is no vaccine available in the market to treat HIV. The only feasible method is to avoid the exposure to virus and the use of anti retroviral treatment. It must be done after the exposure and is known as post exposure prophylaxis also known as PEP. Its schedule is for a month and may lead to nausea, fatigue, malaise and diarrhea.

2. The current treatment for this disorder is the use of highly active anti retro viral therapy referred as HAART. It was introduced in the year 1996 and has provided an excellent result. It is mainly a protease inhibitor. In this therapy at least three drugs are used which are of two different types or classes. The normal regime consists of nucleoside analogue reverse transcriptase inhibitors which are referred as NARTIs. It is combined with a protease inhibitor and non nucleoside reverse transcriptase inhibitors which are referred as NNRTIs. The progression of HIV is more rapid in children as compared to the adults. The laboratory parameters are not indicative of the risk of this disorder. The treatment recommendations for children are more intensive as compared to the adults. In the developed countries where HAART is available the doctors can assess the viral load. The decrease in CD 4 T cell count and patient readiness are also important factor in deciding this condition. There are different goals set up by the HAART which includes the patient quality of life and decrease in the complications and HIV viremia below the limit of detection. It does not cure the HIV patient and nor does it prevent the return once treatment is stopped. The HAART must be given during the life time of the individual to protect him from AIDS. There are many HIV individuals who have improved from the general health and quality of life aspects. It has decreased the HIV associated morbidity and mortality. If there is no HAART the progress from HIV to AIDS takes a median time period of 9 to 10 years. The median survival time after developing AIDS is around 10 years. The HAART increases the survival time between 4 and 12 years. More than half of the patients which receives the HAART the optimal results are far less than the required and it occurs due to the use of medicines and its side effects. It may also occur due to the ineffective anti retro viral therapy and infection with a drug resistant strain of this disorder. The reasons people do not get benefit from the HAART are its non adherence and persistence. The reason for their behavior is not understood properly.

2. There are many psycho social causes such as poor and inadequate access to medical care and social supports. A drug abuse is also an important factor in it. The HAART regimen can be complex and is difficult to follow as the pills taken in this regimen are multiple.

3. There are many side effects associated with the HAART are and include the lipodystrophy, dyslipidaemia, diarrhea and insulin resistance. There is an increased risk of cardiovascular problems and birth defects. The anti retroviral drugs are expensive and most of the individuals in the world are not able to afford it. There is a vaccine which can stop the progression of this disease. As it is comparatively cheap and is affordable to most of the population. It is best suited in the developing countries and does not need daily treatments. But after so many years still the HIV 1 remains a difficult target for a vaccine.

4. There are many researches which have been done and shown that the current treatment decreases the side effects. The drug regimes must be simple and the adherence must be improved. It determines the best sequence of regimens so that the resistance of drug can be controlled.

5. There are many researches which have been done and shown that the opportunistic infections can be managed along with the HIV infection. The patients who are not infected by the hepatitis A and B viruses can become infected by the inability of vaccination against Hepatitis A and B. The patients in whom the immune system is compressed must receive the prophylactic therapy for PCP which refers to pneumocystis jiroveci pneumonia. There are many patients who benefit from the prophylactic therapy for toxoplasmosis and crypto coccus meningitis.

6. There are many researches which have been done and shown that the abzyme can destroy the protein gp 120 CD4 binding site. The protein is common in all the forms of HIV and is the attachment point for B lymphocytes. It affects the immune system.

7. In Berlin, there was leukemia patient who was suffering from HIV for more than 10 years. He was 42 year old and he underwent transplant of bone marrow. The cells used in the bone marrow were unusual variants of CCR5 which refers to cell surface receptor. This variant make cells from people who are born with it and are resistant to some strains of infection of HIV. After 12 months of bone marrow transplantation and non usage of the anti retro viral drugs HIV was not detected in the blood of patient. There are certain alternative medicines available to treat this disorder. In US alone 60 percent of the patients use alternative medicines.

8. There is a widespread use of CAM by people living with HIV and the effectiveness of therapy has not been established. There are many researches which have been done and shown that there is insufficient evidence of the use of herbal medicines in the treatment of HIV. The acupuncture provides a relief which is symptomatic but cannot treat the AIDS condition.

9. In the HIV individuals the mortality and morbidity remains almost unaffected by the dietary intake which is adequate and the multi vitamins cannot change the scenario either. There are many researches which have been done and a study in the Tanzania has shown that the compromised pregnant and lactating women showed a good response to the multi vitamin supplementation given to the mother and children. According to the world health organization the dietary intake of nutrients at RDA levels is recommended in the HIV patients. The vitamin A supplement given to children reduces the mortality and increases the growth.

10. The HIV viral burden can also be decreased by the daily doses of selenium along with the improvement in CD 4 T cell count. It can act as an alternative therapy to anti viral treatments but cannot be used alone to decrease the mortality and morbidity.

What is the prognosis of Acquired Immune Deficiency Syndrome?

If there is no treatment provided than the net median survival time after developing AIDS is around 10 years. It depends on the HIV sub type. The median survival rate after developing AIDS is around 6 to 19 months. The HAART act as an effective therapy for HIV patient and it reduces the death rate of disease by 80 percent. It raised the life expectancy by 20 years of HIV infected patient. There are new treatments available in the market and the HIV develops resistance to treatments. The estimate survival time changes continuously. If there is no anti retro viral therapy it may lead to the death of individual in a year.

Most of the patients die from opportunistic infections or with the malignancies which are related to the immune system. The clinical disease rate progression changes in between the different individuals. It is affected by many factors like the susceptibility of host and immune function. The other important functions can be health care and co functions. When the anti retro viral treatment is used over the long term it may lead to the osteoporosis, neuro cognitive disorders, cancers, and neuropathy and cardio vascular diseases. These could be the side effects or the conditions arising from the results or the related complications. The main cause of AIDS morbidity is the tuberculosis co infection.

What is the history of Acquired Immune Deficiency Syndrome?

It includes the date when the AIDS was first reported on June 5 1981. The US centre for disease control recorded multiple PCP. They were found in the homo sexual men in US. The CDC did not have any official name for this disorder and referred it by the way in which the disease was associated with it. The discoverers of HIV originally named virus after the lymph adenopathy. They also describe the disorder as Kaposi sarcoma and opportunistic infection. The task force was set according to these names in the year 1981. It was also known as the GRID which referred to the gay related immune deficiency. It was also referred as 4H by CDC. It stood for homo sexuality, haitains, hemophiliacs and heroin users. The AIDS was not isolated to the single community so the term GRID was abolished. The term AIDS was introduced in the year 1982. It was properly defined in the year 1982. There were many theories regarding it and there was a controversial theory which suggested that the AIDS was started in the year 1950 in Congo. This theory is known as the OPV AIDS hypothesis. A research was done in the polio vaccine. This scenario is not supported by the available evidence. A new study has suggested that the HIV moved from Africa to Haiti and then entered the US in the year 1969.

What is the epidemiology of Acquired Immune Deficiency Syndrome?

This disorder is mainly pandemic. It has multiples subtypes. The main factors in the transmission of this disorder are the sexual and vertical transmission involving the mother and child. It can also occur through the breast milk. With the improvement in the anti retro viral treatment and care the AIDS involved 2 million lives in the year 2007. There were 33000 children below the age of 15 which were involved. In the year 2007, globally there were 33 million people who were suffering from this disorder. It included two and a half million children. In the year 2007, globally there were new 2.5 million people who were suffering from this disorder. It included four hundred and twenty thousand children. The worst affected region in the world is Sub Saharan Africa. In the year 2007, 68 percent of the people living with the AIDS and three fourth of the deaths along with the 1.7 million new infections which raised the total number of people upto 22 million. There were 11.5 million orphans of AIDS which reside in this region. Most of the people living with the HIV in Sub Saharan Africa were women.

The prevalence of this disorder in the adult was 5 percent. It was in the year 2007. The single largest cause of mortality in the African region is the AIDS. South Africa has the highest population of AIDS patient. It is followed by the Nigeria and India. The second worst affected area is the south East Asia. In the year 2007, this region had 18 percent of all the cases of AIDS. It killed around 300, 000 people. Our country has around 2.5 million infections and the adult prevalence is 0.36 percent. The life expectancy has reduced in the worst affected countries and In the year 2006, it decreased from 65 to 35 years in Bostwana. In the US young African and American women are at a high risk of this infection. It is due to the lack of knowledge and their belief that they cannot be affected by the AIDS. They have a limited access to the health services and have a high risk of coming in contact with the high risk male sexual partners. AIDS is not uniformly distributed and the prevalence in the US is more as compared to the other countries. It is more common in the rural areas. It is also common in the southern states near the Mexico.

What is the relation of society and culture to the Acquired Immune Deficiency Syndrome?

This disorder is considered to be a stigma. It exists around the world in many ways like ostracism, rejection, discrimination and avoidance of the HIV infected people. There is a compulsory HIV testing without the prior consent. There is a protection of confidentiality. There is violence against the HIV infected people or which are perceived to be HIV infected. There is a quarantine of the HIV infected individuals. The stigma related violence prevents the people to seek HIV testing. They do not return for their results and apprehensive in receiving the treatment. It turned the manageable chronic illness to the death sentence and help in the spreading of AIDS. The stigma of this disorder has been divided into different parts. It includes the instrumental, symbolic and courtesy AIDS stigma. In the instrumental stigma there is a fear and apprehension. They are likely to be associated with the deadly and transmissible illness. In the symbolic stigma there is an expression of attitude towards the social groups or life styles which are associated with this disorder. In the courtesy stigma there is a stigmatization of people which are connected to this disorder.

The stigma of AIDS is expressed along with the combination of one or more stigmas. They are associated with the homo sexuality, bi sexuality, prostitution, promiscuity and the use of intra venous drugs. In the developed countries there is an association between the AIDS and sexuality. It can be homo sexuality or bi sexuality. It is correlated with the higher levels of sexual prejudice like the anti homo sexual attitudes. There is also an association between the AIDS and all male sexual behavior which includes sex between un infected men.

What is the economic impact of Acquired Immune Deficiency Syndrome?

This disorder affects the economic by acting on the human capital. It decreases the human capital and if the nutrition is not proper it can lead to the death of large number of people in the developed countries and it can be also due to the improper health care and medicine. Their work output becomes zero and they require a lot of medical care. It will result in the collapse of economies and societies of country in the future time. In the area where this disorder is quite common it has lead to the multiple orphans cared for by the grandparents. The increase death rate will decrease the small skilled population and hence the labor force. It mainly consists of young people and they do not have much knowledge and work experience. They decrease the productivity of the individual. The workers time to look after the sick people will be more and this leads to the decrease in productivity. The increase death rates have a negative impact on the human capital and investment. It may lead to the loss of income and death of the parents. It also exerts a negative impact on the taxes as it kills the young taxpaying population.

The resources needed for public expenditure will be reduced and increases the pressure on state finances by lowering the economic growth. The growth rate becomes slow and the results of the state finances will be badly affected as the money will be spend on the care of sick people. This gets more critical when the responsibility of the death rate moves from family to the government. At the house hold levels it decreases the income and increases the spending on health care facilities. So, the income spend on the education is reduced and is more towards health care and funeral spending. A study showed that the households with HIV infection spent twice as much on their health care as compared to the households.

What is the impact of religion and Acquired Immune Deficiency Syndrome?

Their impact is controversial. Its status has been the same during the last two decades as most of the religious groups do not allow the use of condoms which exerts such a negative impact in the prevention of this epidemic. There are other issues also like the participation of religious groups in global health care services. Its callobration with the secular organizations like UNAIDS and world health organizations. The connection between the HIV and AIDS is raised by many activists. They have questioned the current treatment methods and other related factors associated with this disorder. But these claims have been rejected by the medical sciences. They come on the internet and raise many political issues. In the South Africa, the former president Thabo Mbeki denied the existence of this epidemic and lead to the increased mortality rate of AIDS.

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