HIV/AIDS
Subjects covered on HIV/AIDS
- The HI Virus (CD4 count, Viral load)
- How serious is it – in the World, Africa, South Africa?
- The Phases of the Virus
- Treatment
- Anti-retroviral Treatment
- Nutrition
AIDS – Acquired Immune Deficiency Syndrome.
HIV – the Human Immunodeficiency (HI) Virus, the virus that causes AIDS. A person that has been infected by the virus is regarded as HIV Positive.
The HI Virus - Back to the top
The virus enters and destroys important cells which control and support the body’s immune system and makes it so weak that it is unable to protect the body from serious and common infections.
After entering the body the HI Virus attaches to the CD4 cells. After attachment and entry into the CD4 cells the HIV destroys the cell.
CD4 cells are a type of white blood cells (T helper cells or CD4 lymphocytes). These cells play an important role in keeping a person’s immune system healthy. It protects the body from invasion by certain bacteria, viruses, fungi and parasites. It also clears away a number of cancer cells.
The CD4 count is the laboratory test often used to estimate the level of immune deficiency in HIV infected individuals by counting the CD4 cells. The CD4 count for a person not infected with the virus is approximately 1000 cells/ mm2. When it lowers to approximately 200 cells /mm2 a person starts to use Anti Retroviral (ARV) medicine. At this stage the person will suffer from major symptoms and opportunistic diseases like skin rashes, shingles, weight loss, diarrhea etc.
After a long period of infection, sometimes up to seven years (or longer), large numbers of virus particles are produced which destroy many immune cells and that leads to immune deficiency. When a person is immune deficient, the body finds it difficult to defend itself against many infections and even some cancers.
It is important to know the number of HI viruses in the blood in order to treat the infected person effectively. This number is known as the HI viral load. It is important to keep the viral load as low as possible and to keep the CD4 cell count as high as possible. Viral loads can vary between “undetectable” levels to values higher than 2 to 3 million ‘copies’ /mm2 of blood.
The viral load is the best indicator of the speed of the development of immune-deficiency and AIDS. The higher the viral load, the more likely that immune-deficiency will develop sooner. People with higher viral loads are also more likely to spread HIV via sex, pregnancy and breast feeding.
How serious is it? - Back to the top
World figures:
A United Nations report states that, by the end of 2004, approximately 40 million people were HIV positive. More than 25 million of these people are living in Africa south of the Sahara.
Africa:
An interesting study was produced by UNAIDS Three Scenarios for AIDS in Africa by 2025. One possible outcome is that "AIDS will kill 80 million Africans by 2025."
South Africa:
The most recent study (published 30 November 2005) of the HSRC/Nelson Mandela Foundation found that 10.8% (0.76% in 1990) of the people older than 2 years, that is about 5 million, are HIV positive. Most of them are in the age group 25-29 while 13.3% are women and 8.2% men. Most of them live in KZN, then Mpumalanga and Free State. The Western Cape has the lowest HIV prevalence. The HIV prevalence of the population is African 13.3%, Coloured 1.9%, Indian 1.6% and White 0.6%.
This has a tremendous impact on the SA population:
The Phases of the Virus - Back to the top
1. Early infection:
In the first 3-6 months after acquiring the HIV infection there may be a short (1-2 weeks) sero-conversion illness which causes fever, tiredness, rash, sore throat, muscle and joint pains and some swelling of the lymph glands.
2. Latent or ‘silent’ infection – asymptomatic phase:
In the first few years after HIV infection the HIV antibody test may be the only sign of HIV infection. Therefore the patient remains well and does not experience any negative symptoms. During this phase the CD4 count is between 500 and 800 cells/ mm2. Even though the infection is ‘silent’ during this phase, the virus is active in the body and the person is able to spread the virus.
3. Minor symptomatic phase:
After about three to seven years the following signs might appear:
During this phase the CD4 count is between 350 and 500 cells/ mm2.
4. The symptomatic phase:
The viral load increases and the immune system deteriorates. At this stage the patient suffers, amongst other conditions, from Oral or vaginal thrush, Shingles (herpes infection), Skin rashes, Persistent diarrhea and Weight loss.
During this phase the CD4 count is between 150 and 350 cells/ mm2.
5. The severe symptomatic phase (AIDS)
During this phase the CD4 count is below 200 cells/ mm2. AIDS is characterized by a high viral load and severe immune-deficiency. Therefore severe opportunistic infections, some cancers and HIV-related organ damage develops.
AIDS patients suffer from some of the following conditions:
DEATH USUALLY OCCURS SIX MONTHS TO THREE YEARS AFTER REACHING THE AIDS PHASE.
When the therapy is available an HIV infected person can benefit well from Anti-Retroviral Therapy (ART). If not available or affordable effective nutrition can also benefit an infected person and provide him/her with a decent quality of life for quite some time. ART sometimes have side effects and proper nutrition with ART can be of great benefit to an HIV+ patient.
Anti-Retroviral Therapy - Back to the top
The ultimate purpose of ART is to reduce (suppress) the HIV viral load as much as possible for as long as possible. A combination of two or three different anti-retroviral drugs seems to produce the best results and reduce the possibility of viral resistance.
Some experts suggest that ART should be initiated in
1. all patients with symptomatic HIV infection, regardless of the CD4 count and viral load;
2. all patients with CD4 cell counts below 350 cells/ mm2 and
3. all patients with a high viral load (above 30 000 copies/ml) – irrespective of the CD4 cell count.
Starting to take anti-retroviral therapy is serious business:
It is important to know that ART cannot cure HIV/AIDS. No cure is available as yet. The treatment of HIV+ persons is aimed at strengthening the immune system in order to keep people as healthy as possible. The emphasis is also on keeping the viral load as low as possible and on treating opportunistic diseases.
While ART is extremely expensive and most HIV+ persons cannot afford it, proper nutrition is a much more affordable alternative that can contribute to a fairly high quality of life in spite of being infected.
Research studies indicate that increasing the intake of certain vitamins, minerals and essential fatty acids can boost the immune system and help the body to fight against HIV/AIDS, thus prolonging life. Patients must also keep in mind that most of the anti-AIDS drugs deplete one or more vitamins and/or minerals in the body.
In a recent article in the New England Journal of Medicine (351;1 July 1, 2004) the results are published of a two-year trial in Tanzania involving 1078 HIV+ pregnant women. The researchers found that “In addition to enhancing immunity, multivitamins may also reduce HIV replication, as indicated by a significant reduction in viral load.” They reported that women using multivitamins were “significantly less likely to progress to [Aids] or die of Aids-related diseases. …they were also less at risk for rashes, inflammation and fatigue.” The conclusion of the study is:
“Multivitamin supplements delay the progression of HIV disease and provide effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women.”
Dr Leon Regensberg, Clinical Director of Aid for Aids, SA’s biggest managed treatment programme, commented in the Sunday Times (04-07-2004): “We had the view all along that micronutrients do have value but we have been waiting for scientific evidence to back this up.”
In South Africa numerous HIV+ patients have benefited and are benefiting from the use of Sterolandia 50. Click here to see why.
Read more about Nutrition:
> Aids: Can diet help?
> HIV/Aids and Nutrition
> Aids and Supplements
An extremely useful and easy to understand source for anybody affected by HIV/AIDS is the book by Alta van Dyk, HIVAIDS Care & Counselling. A Multidisciplinary Approach. Pearson Education, South Africa, 2001.