Questions and Answers about HIV and AIDS

1. What is the difference between HIV and AIDS?

HIV (Human Immune Deficiency Virus) is a virus which you can get, mainly through unprotected (no condom) penetrative sex (where the penis is put into the vagina or anus). HIV can also be passed from a mother to her baby in the womb, during birth or by breast feeding. HIV invades, and eventually disables, the body's natural defense against disease (the immune system), leaving you vulnerable to various infections and diseases that could, eventually cause AIDS.

Acquired Immune Deficiency syndrome means:-

Acquired - Something that you picked up from outside your body

Immune - Your body's personal army to protect you from disease

Deficiency - Not enough fighting cells in your immune system

Syndrome - a group or collection of illnesses or diseases

Therefore, AIDS is a cluster of symptoms, caused by having HIV. You do not die from AIDS but from one of the diseases that AIDS allows to take hold in your body. As your immune system gets weaker, your body is less capable of fending off the illnesses that a healthy immune system can resist. ('Know AIDS', Metropolitan publication).

2. What are the different stages of HIV and when can treatment be started?

HIV infects cells in the immune system and the central nervous system. The main cell HIV infects is called a T helper lymphocyte. The T helper cell is a crucial cell in the immune system. It co-ordinates all other immune cells so any damage or loss of the T helper cell seriously affects the immune system.

HIV infects the T Helper cell because it has the protein CD4 on its surface. HIV needs to use CD4 to enter cells it infects. This is why the T helper cell is referred to as a CD4 lymphocyte. Once inside a T helper cell, HIV takes over the cell and the virus then replicates. In this process (which takes around a couple of days) the infected cell dies. New virus then seeks out new T helper cells to infect.

However, battling against this the immune system is rapidly killing HIV and HIV-infected cells, and replacing the T helper cells that have been lost.

HIV progression can generally be broken down into four distinct stages; primary infection, clinically asymptomatic stage, symptomatic HIV infection, and progression from HIV to AIDS.

Primary HIV Infection - Stage 1

This stage of infection lasts for a few weeks and is often accompanied by a short flu like illness which occurs just after infection. This flu like illness is sometimes referred to as sero-conversion illness. In up to about 20% of people the symptoms are serious enough to consult a doctor, but the diagnosis is frequently missed. Even if an HIV antibody test is done at this time, it may not yet be positive.

During this stage there is a large amount of HIV in the peripheral blood and the immune system begins to respond to the virus by producing HIV antibody and cytotoxic lymphocytes.

Clinically Asymptomatic Stage - Stage 2

This stage lasts for an average of ten years and as its name suggests, is free from any symptoms, although there may be swollen glands. The level of HIV in the peripheral blood drops to very low levels but people remain infectious and HIV antibodies are detectable in the blood.

Recent research has shown that HIV is not dormant during this stage, but is very active in the lymph nodes. Large amounts of T helper cells are infected and die and a large amount of virus is produced.

A new test is now available to measure the small amount of HIV that escapes the lymph nodes. This test which measures HIV RNA (HIV genetic material) is referred to as the viral load test, and it has an increasingly important role in the treatment of HIV infection.

Symptomatic HIV Infection - Stage 3

Over time the immune system loses the struggle to contain HIV. This is for three main reasons:

-The lymph nodes and tissues become damaged or 'burnt out' because of the years of activity;
- HIV mutates and becomes more pathogenic, in other words stronger and more varied, leading to more T helper cell destruction;
- The body fails to keep up with replacing the T helper cells that are lost.

As the immune system fails, so symptoms develop. Initially many of the symptoms are mild, but as the immune system deteriorates the symptoms worsen.

Where do opportunistic infections and cancers occur?

Symptomatic HIV infection is mainly caused by the emergence of opportunistic infections and cancers that normally the immune system would prevent. These can occur in almost all the body systems, but common examples are featured in the table below.
As the table below indicates, symptomatic HIV infection is often characterised by multi-system disease. Treatment for the specific infection or cancer is often carried out, but the underlying cause is the action of HIV as it erodes the immune system. Unless HIV itself can be slowed down the symptoms of immune suppression will continue to worsen.

- System
- Examples of Infection / Cancer
- Respiratory system
- Pneumocystis Carinii Pneumonia (PCP)
- Tuberculosis (TB)
- Kaposi's Sarcoma (KS)
- Gastro-intestinal system
- Cryptosporidiosis
- Candida
- Cytomegolavirus (CMV)
- Isosporiasis
- Kaposi's Sarcoma
- Central/peripheral Nervous system
- HIV
- Cytomegolavirus
- Toxoplasmosis
- Cryptococcosis
- Non Hodgkin's lymphoma
- Varicella Zoster
- Herpes simplex
- Skin
- Herpes simplex
- Kaposi's sarcoma
- Varicella Zoster

Progression from HIV to AIDS - Stage 4

As the immune system becomes more and more damaged the illnesses that are present become more and more severe leading eventually to an AIDS diagnosis.

(Source: avert.org/hivstages:htm)

In South Africa, organizations, such as Medicines Sans Frontiers in Khayelitsha, have initiated projects to provide antiretroviral treatment to HIV positive individuals. Candidates can start treatment only when they have reached stage 4 or their CD4 count is below 200.

3. Why are women at higher risk for HIV?

The inside of a woman's vagina is a natural incubator for HIV and is a much larger area than a man's penis. Therefore, the risk of infection for a woman is much higher than a man. Also, women have been denied sexual rights in many cultures in our country. Many women are therefore disempowered and this is why they are afraid to make their partners wear condoms and practice safer sex. ('Know AIDS', Metropolitan publication).

4. Can 2 infected people have unprotected sex?

No, because there is the probability of re-infection or cross-infection. In other words, there are sub-strains of the virus and you can pass these to each other and worsen each other's health. An HIV+ person, can become re-infected with a different drug-resistant strain (type) of HIV, if he / she does not practice protected sex. ('Know AIDS', Metropolitan publication).

5. What are the symptoms of HIV?

There are many different symptoms that can indicate HIV infection. However, many of these symptoms are similar to other common illnesses. The most common symptoms are very similar to the early stages of flu or a cold but without the runny nose.

They include:-
- Fatigue (feeling tired)
- Slight fever that lasts for a few weeks
- Headaches
- Muscular pain
- Not wanting to eat normally
- Feeling sick or nauseous
- Swollen glands in the groin or under your arms or at the back of your neck
- Sometimes a rash that will not go away
- Sometimes a dry cough that is unrelated to smoking
- Woman also tend to have a persistent vaginal thrush that doesn't heal rapidly

If you have any of these symptoms and they continue for more than a few weeks, get to your doctor or clinic. Remember, early intervention is the key to living longer with HIV. ('Know AIDS', Metropolitan publication).

6. What diseases are associated with HIV?

AIDS is a whole bunch of illnesses that come about when your body has been infected with HIV and the body becomes overwhelmed. There are many illnesses associated with AIDS, some of the more common ones are listed below:

- Many forms of rare cancers
- Thrush (in the mouth, throat, stomach, vagina or anus)
- Blindness
- Wasting syndrome (rapid, ongoing weight loss)
- Dementia (memory loss or failure, hallucinations)
- Various lung problems (pneumonia, bronchitis, TB)

('Know AIDS', Metropolitan publication).

7. Why do some people live longer than others?

There is not one scientific reason. What is known, however, is that with some people it's genetic, while, with others, it's a will to live. Each person is different and some people have a strong immune system that helps keep the HIV under control, and they become what is called a long-term non-progressor. Researchers are studying these people to find out how they're able to keep the effects of HIV under control. Also, the people who have lived longer have made specific choices - sometimes unconsciously, which have ensured a longer life. These choices are all about reasons to live and seeing purpose and pleasure in their future. ('Know AIDS', Metropolitan publication).

8. Why are some infants born positive but later test negative?

When a child is born, it has the mother's immune system for the first 12 - 18 months of life. In that same period, the child's own immune system activates and this is when the child can go from HIV+ to HIV-. ('Know AIDS', Metropolitan publication).

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