American Medical Association Family Medical Guide - American Medical Association [622]
The only sure way of preventing HIV infection is to avoid behaviors that put you at risk, such as having unprotected sex and sharing needles. There is no reliable way to know if someone is infected with HIV because many infected people have no symptoms for years. For this reason, you should use a latex condom each time you have sexual intercourse—vaginal, anal, or oral—unless you are in a monogamous relationship and you and your partner have both tested negative for HIV. Pregnant women who are infected with HIV can reduce the risk of spreading the infection to their babies by taking the drug zidovudine during pregnancy and labor. The infant must then be given zidovudine for the first 6 weeks of life.
Symptoms
Many people have no symptoms when they first become infected with HIV. Others experience a flulike illness that produces fever, headache, fatigue, and enlarged lymph glands about 4 to 8 weeks after becoming infected. The symptoms usually go away within a few weeks and the infected person often thinks that he or she has had the flu. During this time, affected people are extremely infectious because HIV is present in large amounts in blood and other body fluids.
In adults, additional symptoms may not appear for 10 years or more after exposure to the virus, although some people begin noticing symptoms within a few months or years. Children infected at birth usually show symptoms within 2 years. During this time, HIV is actively reproducing and destroying the helper T cells of the immune system.
As the immune system deteriorates, a wide range of symptoms begins to appear. The first sign may be swollen lymph glands that remain enlarged for more than 3 months. Other symptoms include lack of energy, weight loss, frequent fevers, profuse sweating, frequent yeast infections in the mouth or vagina, skin rashes, pelvic inflammatory disease (see page 871) that does not respond well to treatment, and short-term memory loss. Some people develop severe herpes infections (see page 482) or shingles (see page 936).
As the infection progresses, the level of helper T cells in the blood becomes very low, opportunistic infections begin to appear, and the diagnosis of full-blown AIDS is made. Signs of opportunistic infections that are common in people with AIDS include fever, shortness of breath, seizures, difficulty swallowing, confusion and forgetfulness, severe diarrhea, loss of vision, nausea, abdominal cramps, vomiting, extreme fatigue, severe headaches, and coma. Children with AIDS can develop the same opportunistic infections as adults or severe versions of common childhood bacterial infections such as tonsillitis or ear infections.
People with AIDS are especially susceptible to developing some cancers, usually those that are caused by viruses. For example, Kaposi’s sarcoma (a cancer of the tissue under the skin or mucous membranes lining the mouth, nose, and anus) and cervical cancer (see page 875) are unusually common in people who have AIDS. Cancers of the immune system, such as lymphoma (see page 625), are also common in people with AIDS.
Diagnosis
Doctors diagnose HIV infection by testing the blood for the presence of antibodies (infection-fighting proteins the body has produced in response to exposure to HIV). The antibodies usually do not reach detectable levels for 1 to 3 months after infection.
In general, a person who is infected with HIV is thought to have developed AIDS when his or her level of CD4-positive T cells falls below 200 cells per cubic millimeter (mm3) of blood. In addition, the person must have at least one opportunistic infection, such as Pneumocystis carinii pneumonia or Kaposi’s sarcoma, for a diagnosis of AIDS.
Treatment
In the initial years of the AIDS epidemic, no drugs were available to fight