INTRODUCTION TO HIV AND AIDS.

HIV is the shortened form for Human Immunodeficiency Virus. It is a virus, such as the virus
that causes the flu or cold. A virus is a minute particle that lives as a parasite in plants,
animals, and bacteria. It consists of an inside (core) made of a substance known as nucleic acid
and an outside (sheath) made of protein.
Viruses can only replicate within living cells and are not considered to be independent living
organisms. In order to make more viruses, a virus has to infect a cell. HIV mostly infects the
white blood cells of the body’s immune system. These cells are known as T-cells or CD4 cells.
Once inside the T-cell or CD4 cell, HIV starts producing millions of little viruses, which eventually
kill the cell and then go out to infect other cells. All of the drugs marketed to treat HIV work by
interfering with this process.

If one is infected with HIV, the body will try to fight the infection. It will make "antibodies", special
molecules that are supposed to fight HIV. When you get a blood test for HIV, the test looks for these
antibodies. If a person has them in the blood, it means that the person has HIV infection. People who
have the HIV antibodies are called "HIV Positive".

Infection with HIV does not necessarily mean that a person has AIDS. Some people who have
HIV infection may not develop any of the clinical illnesses that define the full-blown disease of
AIDS for ten years or more. Physicians prefer to use the term AIDS for cases where a person has
reached the final, life-threatening stage of HIV infection
AIDS is a shortened form for Acquired Immune Deficiency Syndrome. It is a condition caused
by HIV. This virus, as stated earlier, attacks the immune system, the body's "security force" that
fights off infections. When the immune system breaks down, this protection is lost and can lead
to the development of many serious, often deadly infections and cancers. These are called
"opportunistic infections (OIs)" because they take advantage of the body's weakened
defenses. You have heard it said that someone "died of AIDS." This is not entirely accurate,
since it is the opportunistic infections that cause death. AIDS is the condition that lets the OIs
take hold.
There are some specific criteria for determining when a person living with HIV progresses to
AIDS. One thing they look at is T-cell counts: if a person falls below 200 T4 cells, then they have
officially progressed to AIDS. Another thing they look for are OIs: if an HIV+ individual is
diagnosed with an opportunistic infection the list of over two dozen possible HIV-related OIs,
then they are diagnosed with AIDS.

VIRUSES.
A virus is an infectious agent that is found in virtually all life forms, including humans, animals,
plants, fungi, and bacteria. Viruses consist of two major parts- an outer protective coat called a
capsid which is made of protein; and an inside which consists of genetic material. The genetic
material is either of two substances with rather long names. These names have been
abbreviated as DNA and RNA. DNA stands for deoxyribonucleic acid while RNA stands for
ribonucleic acid. It is also worth noting that the capsid may or may not have an outer envelope
made of fat.
Viruses are between 20 and 100 times smaller than bacteria and hence are too small to be seen
by the light microscope. Viruses vary in size from the largest poxviruses of about 450
nanometre in length to the smallest polioviruses of about 30 nanometres. (Note: 1 nanometre
is a billionth of a metre) Viruses are not considered free-living, since they cannot reproduce
outside of a living cell; they have evolved to transmit their genetic information from one cell to
another for the purpose of replication. Viruses often damage or kill the cells that they infect,
causing disease in infected organisms. A few viruses stimulate cells to grow uncontrollably and
produce cancers.

TYPES OF HIV.
There are two types of this virus: HIV-1, which is the primary cause of AIDS worldwide, and HIV-
2 [ HIV 2 progresses much slower with low transmission and infectious rates], found mostly in
West Africa. On its surface, HIV carries a protein structure that recognizes and binds only with
a specific structure found on the outer surface of certain cells. HIV attacks any cell that has this
binding structure. However, white blood cells of the immune system known as T cells, which
orchestrate a wide variety of disease-fighting mechanisms, are especially vulnerable to HIV
attack. Particularly vulnerable are certain T cells known as CD4 cells. When HIV infects a CD4
cell, it commandeers the genetic tools within the cell to manufacture new HIV virus. The newly
formed HIV virus then leaves the cell, destroying the CD4 cell in the process. No existing
medical treatment can completely eradicate HIV from the body once it has integrated into
human cells.

Transmission of HIV AND AIDS.

You don't actually "get" AIDS. You might get infected with HIV, and later you might develop
AIDS. You can get infected with HIV from anyone who is infected, even if they don't look sick,
and even if they haven't tested HIV-positive yet. The blood, vaginal fluid, semen, and breast
milk of people infected with HIV has enough of the virus in it to infect other people.
Most people get HIV by:
• Having sex with an infected person.
• Sharing a needle with someone who's infected.
• Being born when the mother is infected, or drinking the breast milk of an infected woman.
• Using unsterilised instruments in some traditional practices such as circumcision, tattooing,
manicure, pedicure, and using unsterilised clippers in barbing saloons.
Getting a transfusion of infected blood used to be a way people got AIDS, but now the blood
supply is screened very carefully and the risk is extremely low.
There are no documented cases of HIV being transmitted by tears or saliva, but it is possible to
be infected with HIV through oral sex or in rare cases through deep kissing, especially if you
have open sores in your mouth or bleeding gums.

CURE AND TREATMENT.

Currently, there is no cure for AIDS. There are drugs that can slow down the HIV virus, and
slow down the damage to your immune system. But there is no way to get all the HIV out of
your body. There are other drugs that you can take to prevent or to treat opportunistic
infections (OIs). In most cases, these drugs work very well. The newer, stronger anti-HIV drugs
have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to
treat.

LESSON SUMMARY.
• HIV is the shortened form for Human Immunodeficiency Virus.

• A virus is an infectious agent that is found in virtually all life forms consisting of two major parts- an
outer protective coat called a capsid which is made of protein; and an inside which consists of genetic
material- DNA or RNA.

• HIV mostly infects T-cells, also known as CD4+ cells, or T-helper cells. These cells are white blood cells
that turn the immune system on to fight disease. Once inside the cell, HIV starts producing millions of
little viruses, which eventually kill the cell and then go out to infect other cells.

• There are two types of this virus: HIV-1, which is the primary cause of AIDS worldwide, and HIV-2,
found mostly in West Africa.

• AIDS is a shortened form for Acquired Immune Deficiency Syndrome). It is a condition caused by HIV.

• Most people get the HIV virus by having sex with an infected person; sharing a needle or sharp
instruments with someone who's infected; and being born when the mother is infected, or drinking the
breast milk of an infected woman.

BRIEF HISTORY OF HIV AND AIDS.

• AIDS was first identified in 1981 among homosexual men and intravenous drug users in the
United States in New York and California.
• AIDS quickly developed into a worldwide epidemic, affecting virtually every nation. By 2003
over 40 million adults and 4 million children worldwide were living with HIV infection or AIDS.
• Some scientists have claimed that HIV originated around 1930 in rural areas of Central Africa,
where the virus may have been present for many years in isolated communities.
• Studies of stored blood from the United States suggest that HIV infection was well established
there by 1978. Many scientists from Africa have argued that HIV originated from North
America.
• In 1985 a new AIDS-causing virus was discovered in West Africa. Named HIV-2, the new virus
is closely related to the first HIV, but it appears to be less harmful to cells of the immune
systems and reproduces more slowly than HIV-1.
• In 1999 some scientists found that HIV spread from chimpanzees to humans on at least three
separate occasions in Central Africa, probably beginning in the 1940s or 1950s.
• The global HIV/AIDS epidemic killed more than 3 million people in 2003, and an estimated 5
million acquired the human immunodeficiency virus (HIV)—bringing to 40 million the number
of people living with the virus around the world.

HIV AND THE IMMUNE SYSTEM.

Every minute of every day wars rage within our bodies. The combatants are too tiny to see. Some, like
the infamous virus that causes AIDS, or acquired immune deficiency syndrome, are so small
that 200 million would fit on the tip of a needle. Yet they employ tactics that can kill much
larger cells they swarm upon. Usually we never even notice the battles in the incessant wars
within us. We have evolved legions of defenders, specialised cells that silently rout the unseen
enemy. Sometimes these warriors mistake harmless invaders, such as pollen, for deadly foes,
and they mount an allergic reaction. Sometimes our defenders are caught unprepared, and we
develop a cold, the flu, or worse. Occasionally some of our own cells begin the mutinous
proliferation of cancer and manage to evade the surveillance of our body's defence forces. But
for every successful penetration of our defences, thousands of attempts are repelled. We sleep
securely, trusting the invisible vigilantes of our immune system.
The immune system of the human body is made up of group of cells, molecules, and organs
that act together to defend the body against foreign invaders that may cause disease. The
health of the body is dependent on the immune system’s ability to recognise and then repel or
destroy these invaders.
In humans the immune system consists of about a trillion (1012) cells called lymphocytes and
about 100 million trillion (1020) molecules called antibodies that are produced and secreted by
the lymphocytes. The special capability of the immune system is pattern recognition and its
assignment is to patrol the body and guard its identity.
White blood cells are the mainstay of the immune system. Some white blood cells, known as
macrophages, play a function in innate immunity by surrounding, ingesting, and destroying
invading bacteria and other foreign organisms. Lymphocytes are specialised white blood cells
whose function is to identify and destroy invading antigens. All lymphocytes begin as “stem
cells” in the bone marrow, the soft tissue that fills most bone cavities, but they mature in two
different places. Some lymphocytes mature in the bone marrow and are called B lymphocytes.
B lymphocytes, or B cells, make antibodies, which circulate through the blood and other body
fluids, binding to antigens and helping to destroy them. Other lymphocytes, called T
lymphocytes, or T cells, mature in the thymus, a small glandular organ located behind the
breastbone. Mature lymphocytes constantly travel through the blood to the lymphoid organs
and then back to the blood again. This recirculation ensures that the body is continuously
monitored for invading substances.

IMMUNE DEFICIENCY.
Deficiencies in immune function may be either inherited or acquired. Inherited immune
deficiencies usually reflect the failure of a gene important to the generation or function of
immune system components.
DiGeorge syndrome is an inherited immune disorder in which a person has no thymus and,
therefore, cannot produce mature T lymphocytes. People with this disorder can mount only
limited humoral immune responses, and their cell-mediated immune responses are severely
limited. [ B Cells are responsible for humoral immunity while Tcells are responsible for cell
mediated immunity]
The most extreme example of a hereditary immune deficiency is severe combined
immunodeficiency (SCID). Individuals with this disease completely lack both T and B
lymphocytes and thus have no adaptive immune responses. People with SCID must live in a
completely sterile environment, or else they will quickly die from infections.
Acquired immune deficiencies can be caused by infections and also other agents. For example,
radiation therapy and some kinds of drugs used in treating disease reduce lymphocyte
production, resulting in damaged immune function. People undergoing such therapies must be
carefully monitored for lowered immune function and susceptibility to infections.
Environmental and lifestyle factors, such as poor nutrition or stress, can also affect the
immune system’s general status.
An infectious agent resulting in fatal immune deficiency is the human immunodeficiency virus
(HIV). This virus causes acquired immunodeficiency syndrome (AIDS) by infecting and eventually
destroying helper T cells. Because helper T cells regulate all immune responses, their loss
results in an inability to make adaptive immune responses. This complete lack of immune
function makes individuals with AIDS highly susceptible to all infectious agents.

LIFE CYCLE OF HIV.

The body’s immune system is made up of white blood cells (otherwise known as lymphocytes). One type
of lymphocyte is called T-lymphocytes or T-cells with surface receptors known as CD4+. Let us now
examine the stages in the life cycle of HIV. Six stages will be described.

Step 1: Binding
HIV binds to a CD4+ surface receptor, it activates other proteins on the cell's surface, allowing
the HIV envelope to fuse to the outside of the cell.
Step 2: Reverse Transcription
The virus infects the cell- a process called "reverse transcription" takes place. At the end of the
process the cell makes a DNA copy of the virus's RNA. After the binding process, the inside of
the virus which contains the RNA and important enzymes is released into the host cell. A viral
enzyme called reverse transcriptase makes a DNA copy of the RNA. This new DNA is called
"proviral DNA."
Step 3: Integration
The HIV DNA is then carried to the cell's nucleus, where the cell's DNA is kept. Then, another
viral enzyme called integrase hides the proviral DNA into the cell's DNA. When the cell tries to
make new proteins, it can accidentally make new HIVs. Integration can be blocked by integrase
inhibitors, a new class of drugs that are in the earliest stage of research.
Step 4: Transcription
Once HIV's genetic material is inside the cell's nucleus, it directs the cell to produce new HIV. The
strands of viral DNA in the nucleus separate, and special enzymes create a complementary strand of
genetic material called messenger RNA or mRNA (instructions for making new HIV). Transcription can be
blocked by antisense antivirals or transcription inhibitors (TIs), new classes of drugs that are in the
earliest stage of research.

Step 5: Translation
The mRNA carries instructions for making new viral proteins from the nucleus to a kind of
workshop in the cell. Each section of the mRNA corresponds to a protein building block for
making a part of HIV. As each mRNA strand is processed, a corresponding string of proteins is
made. This process continues until the mRNA strand has been transformed or "translated" into
new viral proteins needed to make a new virus.
Step 6: Viral Assembly.
Finally, a new virus is assembled. Long strings of proteins are cut up by a viral enzyme called
protease into smaller proteins. These proteins serve a variety of functions; some become
structural elements of new HIV, while others become enzymes, such as reverse transcriptase.
Once the new viral particles are assembled, they bud off the host cell, and create a new virus.
This virus is then able to infect new cells. Each infected cell can produce a lot of new viruses.
SUMMARY.
Step 1: Binding HIV binds to a CD4+ surface receptor, it activates other proteins on the cell's surface,
allowing the HIV envelope to fuse to the outside of the cell.

Step 2: Reverse Transcription The infected cell makes a DNA copy of the virus's RNA.
Step 3: Integration A viral enzyme called integrase hides the proviral DNA into the cell's DNA. Then,
when the cell tries to make new proteins, it accidentally make new HIVs.

Step 4: Transcription Once HIV's genetic material is inside the cell's nucleus, it directs the cell to produce
new HIV. The strands of viral DNA in the nucleus separate, and special enzymes create a complementary
strand of genetic material called messenger RNA or mRNA (instructions for making new HIV).

Step 5: Translation The mRNA carries instructions for making new viral proteins from the nucleus to a
kind of workshop in the cell. As each mRNA strand is processed, a corresponding string of proteins is
made. This process continues until the mRNA strand has been transformed or "translated" into new viral
proteins needed to make a new virus.

Step 6: Viral Assembly Finally, a new virus is assembled. Once the new viral particles are assembled, they
bud off the host cell, and create a new virus. This virus is then able to infect new cells. Each infected cell
can produce a lot of new viruses.

TRANSMISSION OF HIV.
HIV is passed on in the sexual fluids or blood of an infected person. This usually happens by
either having sexual intercourse with an infected person or by sharing needles or sharp objects
that had come in contact with the blood of an infected person. People can also become
infected by being born to a mother who has HIV. A very small number of people become
infected by having medical treatment using infected blood transfusions.
Sex with an infected person
HIV transmission occurs most commonly during intimate sexual contact with an infected
person, including genital, anal, and oral sex. The virus is present in the infected person’s semen
or vaginal fluids. During sexual intercourse, the virus gains access to the bloodstream of the
uninfected person by passing through openings in the mucous membrane—the protective
tissue layer that lines the mouth, vagina, and rectum—and through breaks in the skin of the
penis. In some parts of the world especially the United States and Canada, HIV is most
commonly transmitted during sex between homosexual men, but the incidence of HIV
transmission between heterosexual men and women has rapidly increased. In most other parts
of the world, HIV is most commonly transmitted through heterosexual sex.
Contact with infected blood
Someone can get infected with HIV when transfused with infected blood. Also, infected blood
occurs when people who use heroin or other injected drugs, share hypodermic needles or
syringes contaminated with infected blood. Sharing of contaminated needles among
intravenous drug users is the primary cause of HIV infection in many countries. Less frequently,
HIV infection results when health professionals accidentally stick themselves with needles or
other sharp objects containing HIV-infected blood or expose an open cut to contaminated
blood. To combat this, government regulations have required that all donated blood and body
tissues be screened for the presence of HIV before being used in medical procedures. As a
result of these regulations, HIV transmission caused by contaminated blood transfusion or
organ donations have reduced. However, the problem continues to concern health officials in
sub-Saharan Africa. Less than half of the 46 nations in this region have blood-screening policies.
By some estimates only 25 percent of blood transfusions are screened for the presence of HIV.
The World Health Organisation (WHO) had hoped to establish blood safety programs in more than 80
percent of sub Saharan countries by 2003.

Parent-to-Child Transmission
HIV can be transmitted from an infected mother to her baby while the baby is still in the
woman’s uterus or, more commonly, during childbirth. The virus can also be transmitted
through the mother’s breast milk during breastfeeding. Mother-to-child transmission accounts
for 90 percent of all cases of AIDS in children. Mother-to child transmission is particularly
prevalent in Africa, where the number of women infected with HIV is ten times the rate found
in other regions. Studies conducted in several cities in southern Africa in 1998 indicate that up
to 45 percent of pregnant women in these cities carry HIV.
Misconceptions about HIV Transmission
The routes of HIV transmission are well documented by scientists, but health officials
continually grapple with the public’s unfounded fears concerning the potential for HIV
transmission by other means. HIV differs from other infectious viruses in that it dies quickly if
exposed to the environment. No evidence has linked HIV transmission to casual contact with an
infected person, such as a handshake, hugging, or kissing, or even sharing dishes or bathroom
facilities. Studies have been unable to identify HIV transmission from modes common to other
infectious diseases, such as an insect bite or inhaling virus-infected droplets from an infected
person’s sneeze or cough.
 SIGNS AND SYMPTOMS OF HIV & AIDS INFECTION.
Symptoms in Adults
In the period immediately after infection with HIV, no specific symptoms are noticeable.
However, within one to three weeks after infection, most people experience the following:
• flu-like symptoms, such as fever, sore throat, headache;
• skin rash;
• tender lymph nodes; and
• a vague feeling of discomfort.
These symptoms usually go away after a week or two. Often, if they occur at all, they are so
mild they are hardly noticeable, although for some people they are severe enough to warrant
calling a doctor. It is important to keep in mind that these symptoms are almost identical to
those of many other illnesses. That is why testing is so important.
The symptoms last one to four weeks. During this phase, known as acute retroviral syndrome
(early HIV symptoms), HIV reproduces rapidly in the blood. The virus circulates in the blood
throughout the body, particularly concentrating in organs of the lymphatic system (thymus,
spleen, bone marrow, lymphatic vessels). The normal immune defenses against viral infections
eventually activate to battle HIV in the body, reducing but not eliminating HIV in the blood.
Infected individuals typically enter a prolonged asymptomatic phase, a symptom-free period
that can last ten years or more. While persons who have HIV may remain in good health during
this period, HIV continues to replicate, progressively destroying the immune system. Often an
infected person remains unaware that he or she carries HIV and unknowingly transmits the
virus to others during this phase of the infection.
When HIV infection reduces the number of CD4 cells to around 200 per microlitre of blood, the
infected individual enters an early symptomatic phase that may last a few months to several
years.
HIV-infected persons in this stage may experience a variety of symptoms that are not life-
threatening but may be debilitating. These symptoms include:
• extensive weight loss and fatigue (wasting syndrome);
• periodic fever;
• recurring diarrhea;
• and thrush, a fungal mouth infection.
An early symptom of HIV infection in women is a recurring vaginal yeast infection. Unlike
earlier stages of the disease, in this early symptomatic phase the symptoms that develop are
severe enough to cause people to seek medical treatment. Many may first learn of their
infection in this phase. If CD4 cell levels drop below 200 cells per microlitre of blood, the late
symptomatic phase develops. This phase is characterised by the appearance of any of 26
opportunistic infections and rare cancers. The onset of these illnesses, sometimes referred to as
AIDS-defining complications, is one sign that an HIV-infected person has developed full-blown
AIDS. Without medical treatment, this stage may last from several months to years. The
cumulative effects of these illnesses usually cause death.
Symptoms in Children
HIV infection in children progresses more rapidly than in adults, most likely because the
immune system in children have not yet built up immunity to many infectious agents. The
disease is particularly aggressive in infants—more than half of infants born with an HIV
infection die before age two. Once a child is infected, the child’s undeveloped immune system
cannot prevent the virus from multiplying quickly in the blood.
This extensive virus burden speeds the progression of the disease. In contrast, when adults
become infected with HIV, their immune system generally fights the infection. Therefore, HIV
levels in adults remain lower for an extended period, delaying the progression of the disease.
Children develop many of the opportunistic infections that befall adults but also exhibit
symptoms not observed in older patients.
Among infants and children, HIV infection produces wasting syndrome and slows growth
(generally referred to as failure to thrive). HIV typically infects a child’s brain early in the course
of the disease, impairing intellectual development and coordination skills. While HIV can
infect the brains of adults, it usually does so toward the later stages of the disease and
produces different symptoms. Children show a susceptibility to more bacterial and viral
infections than adults. More than 20 percent of HIV-infected children develop serious, recurring
bacterial infections, including meningitis and pneumonia. Some children suffer from repeated
bouts of viral infections, such as chicken pox. Healthy children generally develop immunity to
these viral illnesses after an initial infection.
Wasting Syndrome and Weight Loss
Weight loss and wasting syndrome are two AIDS-related complications that, if not adequately
treated, can be life threatening. Even though anti-HIV therapies have helped reduce the risk of
weight loss and wasting syndrome, both problems still occur. As its name implies, weight loss
refers to a loss of body weight. Wasting syndrome refers to a loss of body mass or size, most
notably muscle mass (sometimes referred to as "lean body mass"). Very often, both occur at
the same time. However, this is not always the case. It is possible that someone who is losing
weight might not lose muscle mass. It is also possible that someone losing muscle mass might
not lose a lot of weight. For example, some HIV-positive people lose a lot of muscle. Yet they may
experience an increase in fat. This can cause weight to stay the same, even though muscle wasting is
going on. In people who do not have HIV, weight loss is not usually a serious problem. For example,
someone who goes on a diet will eventually lose weight. To make up for the lack of food being eaten,
the body will naturally burn fat – either in the blood or stored in cells – to help meet its energy needs. At
the same time, the body works to protect protein during periods of dieting or physical activity. Protein is
needed to build muscle, cells, and organs in the body. In other words, most people can afford to lose fat.
They cannot afford to lose protein.

In people with HIV, especially during periods of illness (e.g., MAC or tuberculosis), the energy demands
of the body increase. Turning fat into energy also requires a lot of work in the body. To help save
energy, the body may go after protein to fuel its energy needs. This is because protein is much easier to
convert into energy than fat. Also, protein is needed to help repair damaged organs and to replace
immune system cells lost during periods of illness.

Figuring out the underlying cause of weight loss is very important. In some cases, the cause of weight
loss or wasting is obvious, particularly when an opportunistic infection (OI) that is known to cause
weight loss has been diagnosed. Other times, weight loss or wasting can be a symptom of an underlying
OI that has not yet been diagnosed. Thus, weight loss that cannot be easily explained often requires that
doctors examine their HIV-positive patients carefully, especially if they are losing weight.

There are a number of treatment strategies that have been proven effective in terms of weight gain and,
in some cases, muscle growth and maintenance:

Diet Improvements: Diet improvement is crucial for virtually all HIVinfected individuals suffering from
mild to severe forms of weight loss. Forms of dietary improvement include nutritional counselling and
oral nutrition supplements. In terms of counselling, a registered dietitian can help identify weaknesses
in an existing diet and make suggestions regarding dietary needs and how best to tailor them to meet
individual tastes, schedules, and tolerances. Nutritional supplementation can also be extremely useful.

Treating Side Effects or General Symptoms of HIV: There are a number of treatments available to
control symptoms, including drug side effects that make eating undesirable. Drugs to control nausea and
vomiting (anti-emetics), diarrhea (anti-diarrheals), and decreased appetite (appetite stimulants) are
widely available.

Treating the Opportunistic Infection (OI): Treating an active opportunistic infection, especially one that
causes malabsorption, can halt and possibly reverse weight loss. Unfortunately, there are no effective
treatments for intestinal diseases such as cryptosporidiosis and microsporidiosis, however a number of
recent reports have suggested that anti-HIV drugs may be extremely helpful in terms of boosting the
immune response against these chronic infections and ultimately increasing weight. But, like appetite
stimulants, treatments for OIs associated with weight gain usually contribute to fat accumulation, not
muscle.

Hormonal Therapy: Treating metabolic disorders associated with wasting has been a large focus of
research over the past few years. In particular, results from clinical trials of anabolic therapies have
suggested that certain agents can increase and protect muscle mass in HIV-positive people with wasting
and weight loss.

Immune-Based and Anti-HIV Therapies: In terms of treating immune system disorders, promising
results have been seen using the drug thalidomide (Synovir), a drug that was once banned because of its
ability to cause birth defects in pregnant women taking the drug. Yet, the most promising therapy in
terms of stabilizing the immune system has been taking the anti-HIV drug combinations currently
recommended. By drastically reducing the amount of virus circulating in the body, anti-HIV therapy
allows the immune system to recover from the damage of HIV. In fact, a large number of studies have
demonstrated that people receiving anti-HIV therapy, especially those with wasting, gain a great deal of
weight while on therapy.

TESTING OF HIV
Testing is recommended for those who:

• have multiple sexual partners (2 or more sexual partners in the last 12 months)

• have received a blood transfusion recently in a place where blood is not screened before transfusion,
or if a sexual partner received a transfusion and later tested positive for HIV.

• are uncertain about their sexual partner's risk behaviours.

• are homosexuals

• have used street drugs by injection especially when sharing needles and/or other equipment.

• have a sexually transmitted disease (STD), including pelvic inflammatory disease (PID).

• are health care workers with direct exposure to blood on the job.

• want to make sure they are not infected with HIV before getting pregnant.

• are infected with tuberculosis

HIV Tests
Since HIV was first identified as the cause of AIDS in 1983, a variety of tests have been developed for
diagnosing HIV infection as well as determine how far the infection has progressed. Doctors determine
if HIV is present in the body by identifying HIV antibodies, specialized proteins created by the immune
system to destroy HIV. The presence of the antibodies indicates HIV infection because these antibodies
form in the body only when HIV is present. HIV antibodies form anywhere from five weeks to three
months after HIV infection occurs, depending upon the individual’s immune system. The antibodies are
produced continually throughout the course of the infection. There is a "window period" which is the
time it takes the body to produce antibodies after HIV infection has begun. For the vast majority of
those who will test positive, antibodies to HIV will develop within 4-6 weeks after exposure. Thus, to
receive a reliable test result, it is necessary to wait at least three months (13 weeks) after the last
possible exposure to the virus before being tested.

Getting tested before three months may result in an unclear result or a false negative. Some testing
centres may recommend testing again at six months. All but less than 1% of those who are going to
seroconvert will do so within three months (seroconversion is the development of detectable antibodies
to HIV in the blood as a result of infection.) It is extremely rare for seroconversion to take more than six
months to develop detectable antibodies.
The ELISA AND WESTERN BLOT TEST
The standard test for detecting HIV antibodies in the blood is the enzyme-linked immunosorbent assay
(ELISA). In this test, a blood sample is mixed with proteins from HIV. If the blood contains HIV
antibodies, they attach to the HIV proteins, producing a telltale colour change in the mixture. This test is
highly reliable when performed two to three months after infection with HIV. The test is less reliable
when used in the very early stage of HIV infection, before detectable levels of antibodies have had a
chance to form. Doctors routinely confirm a positive result from an ELISA test by using the Western
Blot test, which can detect lower levels of HIV antibodies. In this test a blood sample is applied to a
paper strip containing HIV proteins. If HIV antibodies are present in the blood, they bind to the HIV
proteins, producing a color change on the paper. The combination of the ELISA and the Western Blot
test is more than 99.9 percent accurate in detecting HIV infection within 12 weeks following exposure.

P24 Antigen Test: This test uses ELISA technology to look directly for key pieces of the HIV virus – the
p24 protein found on HIV's outer coat. This test can reduce the chance of a false-negative in standard
(antibody) ELISA testing if it is done too early (i.e., less than 13 weeks after exposure). The p24 antigen
test may be ordered if there is a very recent risky exposure to HIV, such as a healthcare work-related
incident. Blood banks also use it for screening donations. The test is valuable in detecting HIV infection
early in the window period after exposure, this test is only useful for a period of approximately three
weeks after exposure, before the production of antibodies begins. A p24 test result should be confirmed
by antibody testing once the window period has passed.

Viral Load Test

Viral load testing measures the amount of new virus being produced and released into the
bloodstream. Several studies have shown that higher levels of viral load are associated with more rapid
disease progression and a greater risk of death. Lower levels are associated with stability and reduced
risk of progression, infection, or death. Ideally, an HIV infected person should have no detectable level
of virus, which means that the level of virus activity is too low to be measured. Currently available tests
measure down as low as 200 to 500 copies of virus, the lowest amount presently measurable. This is
associated with the best possible clinical outcome. Higher levels, ranging from several hundred upwards
of millions of copies of virus, are associated with higher rates of disease progression. In short, the higher
the number, the more rapid the rate of disease progression. The viral load test gives a more accurate
picture of the rate of disease progression. There are two commonly available tests for measuring viral
load. One is called "quantitative PCR" (or "Q-PCR"), the other "branched DNA" (or "b-DNA"). Though
there are small differences between the two tests, they are for practical purposes one and the same.

CD4+ Testing
For many years, testing the number of CD4+ cells was the most common way to measure the effects of
HIV disease. Low numbers of these cells (below 200) accurately predicts the risk of major infections.
The meaning of test results in between this critical level of 200 and the normal level of 1000 is unclear.
Physicians once typically started treatment for people when the CD4+ was below 500, but this was
always an arbitrary number simply selected from clinical trials. By itself, this number does not tell us
enough about the state of disease. It only shows that the level of CD4+ cells is below normal, to varying
degrees. Getting the full picture of HIV disease requires additional tests, especially the Viral Load Test.
CD4+ Cell Ranges
High Range: In general, a CD4+ count above 500 suggests no immediate danger, even though it may
represent a loss of half the normal CD4+ cell count (1000). The 500 level is sometimes cited as the
bottom of the "normal" range, but this can be misleading. While an occasional drop to 500 may be
normal, a steady or falling count of 500 or even 600 is not normal and indicates suppressed immunity.
At the very least, dietary counselling, nutritional supplements, CD4+ cell monitoring, and periodic use of
other tests are recommended in this range, whether or not treatments are used.

Medium Range: CD4+ counts in this range indicate significant decline of the immune system. However,
serious symptoms are uncommon in this range. Some researchers believe this is the optimum time to
begin treatment, especially if the viral load test also indicates significant viral activity.

Low Range: CD4+ counts below 300 indicate the greatest risk of infections and according to the 1993
definition of AIDS, a CD4+ count of 200 or less constitutes an AIDS diagnosis. A person with counts
below 300 CD4+ may remain stable for many years, especially with careful health management. While
some people have warning signs in the form of symptoms before major infections occur, this is not
always the case.

How Testing is Done

Rapid Testing: A blood sample is obtained through finger stick and analyzed using the ELISA test. The
results are usually available within ten to sixty minutes. If the result is positive, a follow-up test is
required, usually by drawing blood and sending the sample to a laboratory for Western blot testing. If
the result is negative, there is no need for additional testing and the result can be considered conclusive.
Convenient and faster, this method is often used in healthcare settings, particularly where urgency is an
issue such as with someone who is pregnant or about to give birth. Because it provides a result so
quickly, this is an increasingly popular method for testing.

Oral Fluid Test: A device is used to collect oral (mouth) fluid (i.e. saliva). Oral fluids can contain
antibodies to HIV, which can be detected using the ELISA and Western blot tests. Typically, it takes one
to two weeks to get a result. Because it is so easy and comfortable to accomplish, this test is often used
in clinics, doctors' offices, hospitals, and school-based and university health centres.

Urine-Based Test: A urine sample, collected in a cup, is used for the ELISA/Western blot tests. The
results of this non-invasive and nontechnical method can be obtained typically in one to two weeks. It is
commonly used in community-based and outreach settings, adolescent, school and university-based
settings. Anyone with a positive urine result must have a confirmatory test.