Diagnosis and Treatment for Acute HIV

Diagnosis and Treatment for Acute HIV

As has been mentioned already, primary HIV infection cannot be identified only on the basis of acute HIV symptoms. Moreover, the early HIV symptoms in men and women may not be exhibited by all HIV infected individuals. HIV infection can be identified only with the help of proper diagnostic procedures. However, HIV antibody test may come negative during the primary infection stage, as the immune system usually requires about two months to produce the antibodies against the virus. But, HIV RNA test or 'viral load' test shows a positive result for acute HIV infection. Whether acute HIV infection should be treated immediately with antiretroviral medications, or one should wait until immune system exhibits the signs of damage is still controversial. Therefore, individuals going through the acute HIV infection need to talk to their physician and evaluate the various pros and cons of early treatment.

The early diagnosis of acute HIV infection is of utmost importance to prevent the spread of the virus. However, it is not so easy to detect acute HIV infection, as the symptoms are not very specific and they resemble the symptoms of many other health condition. So, people who think that they are at an increased risk of contracting the virus can get tested for acute HIV infection on observing the above mentioned acute HIV symptoms. This will help to detect the condition and prevent the transmission of the virus to healthy individuals.

What is your risk of HIV infection?

What is your risk of HIV infection? Certain conditions, circumstances, and behaviors can increase your risk of HIV infection. There are conditions and behaviors that make it easier for HIV to be transmitted from person to person. Without taking the proper precautions or being aware of high risk behavior, your risk of HIV can increase. Some of the more common ways your risk of HIV infection increases include:

• Being Coinfected With Syphilis
  People with syphilis may have open sores on their genitals that provide a route for HIV to enter the body when engaging in unprotected sex.

  A Guide to Syphilis

• Your Sexual Partner is in the Acute Stages of HIV Infection
  The acute phase of HIV infection is characterized by very high HIV activity and very high viral loads. Having unprotected sex with someone in the acute stage of HIV increases the exposure to activily replicating HIV, in turn increasing the risk of HIV transmission.

  What is Acute HIV?

• Either Partner Has a Weakened Immune System
  The body's immune system protects us from illness, infection, and disease. Anytime that protection is weakened, the body is at increased risk of illnesses and infections, including HIV. If either partner in a sexual relationship has a weakened immune system, that person becomes more at risk for HIV.

  Understand the Immune Response

• When Either Partner has an Open Wound
  Open wounds provide a portal of entry for HIV. In other words, any open wound or break in the skin can allow HIV to enter the body

• The Presence of a Large Quantity HIV Infected Blood
  Large quantities of HIV infected blood exposes the body to an increase number of active HIV, making HIV infection easier. These large quantities of infected blood can occur during sex due to mechanical trauma of the sexual structures or during delivery of an HIV+ mom's newborn baby. Sharing syringes and needles can also expose people to large quantities of HIV infected blood.

On the day before World AIDS Day 2009,

On the day before World AIDS Day 2009, the World Health Organization (WHO)released its new HIV treatment guidelines. Included in the new HIV treatment guidelines are:

• CD4 thresholds for starting medication regimens;
• preferred medications when building an HIV regimen;
• ways to further reduce the risk of HIV transmission from mother to child;
• and HIV treatment guidelines for taking medications while breastfeeding.

Here is a summary of the latest HIV treatment guidelines.

Start HIV Treatment at Higher CD4 Counts

HIV treatment should be started on all people with a CD4 count less than or equal to 350 regardless of the presence or absence of symptoms. In comparison, in 2006 WHO recommended treatment when the CD4 count fell below 200. Since then data accumulated from clinical trials and clinical research have shown that starting HIV medications earlier, when CD4 counts are higher, reduces illness and progression of HIV to AIDS.

Phase Out Older Medications

The WHO HIV treatment guidelines recommended phasing out the use of older HIV medications that have been found to have long term side effects. Medications such as Zerit (stavudine) are to be phased out of initial regimens because of toxic side effects like lactic acidosis. In developing nations where medications are hard to come by, Zidovudine (AZT) and Viread (tenofovir) are more affordable recommendations to replace Zerit. Keep in mind that while their toxic profile may be less, they are not without risk; for example Viread has been linked to toxic kidney side effects in some people. In the Western World, it is recommended that the newest medications be used because of their low side effect profiles.

Conclusions and recommendations

Conclusions and recommendations
A meeting held on 15–17 September 2008 in Geneva brought together participants from the World Health Organization
(WHO) and its United Nations (UN) partners along with representatives from 26 countries to discuss the role that the
health sector can and should play in addressing prevention, treatment and care of HIV and other STIs among MSM,
transgender people and their sexual partners. The following key principles were agreed on at the meeting:
• Adopting a rights-based approach guarantees the human rights of MSM and transgender people, and will
ensure that they and their male and female sexual partners have the right to information and commodities that
enable them to protect themselves against HIV and other STIs, protection from discrimination and criminalization,
as well as information on where to seek appropriate care for these infections.
• Knowing the epidemic and the response to it means knowing where infections are occurring, who is at risk or
vulnerable and who is infected. It also means understanding the local, social and structural determinants of risk.
• The HIV and STI epidemics among MSM and transgender people cannot be addressed by the health sector
alone. It requires partnerships and engagement both across sectors (particularly with the legal and education
sectors) and, crucially, with the MSM and transgender communities.

Replication and Mutation of HIV

HIV allows itself to be "eaten" by the defense cells and this way it gets into the defense cells of the human body. At the same time the virus brings along the enzyme "reverse transcriptase" which transforms the genetic material of the virus itself (RNA) into the human genetic material (DNA). The genetic material of the virus is then built into the one of the host cell, where it can lie dormant for many years.

When replicating, the virus tricks the defense cells in the same way. If the defense cell receives a command to replicate (for example to kill HIV or other viruses or bacteria), this triggers the replication of HIV. While replicating, the virus uses the host cell for its own purposes, exploiting its nutrients. Thousands of HIVs are immediately formed, destroying the defense cells. The new HIVs in turn attack other defense cells.



HIV is assimilated into the host cell (helper cell):

1. HIV docks with the CD4 receptor of the helper cell.
2. HIV smuggles in its genetic material (RNA).
3. Reverse transcriptase of the helper cell converts the RNA into DNA.
4. Integrase integrates the viral DNA into the DNA of the cell nucleus of the host cell.

The replication of HIV:

5. HIV-DNA is converted into RNA.
6. Protease builds up new HIV (sprouting).
7. HIV detaches itself from the host cell (budding).

When the genetic material is transformed and copies of genetic material are made for the production of new viruses, more and more new HIV variants emerge due to "translation mistakes". These variants can differ in character from the original HIV, varying for example in infectivity and in the speed with which they lead to AIDS and to death. Several million virus variants have been observed to develop in just one person infected with HIV.

This mutability enables HIV to adapt to its surroundings, and this is the reason why HIV may quickly become resistant to drugs and why attempts to develop either a vaccine, or drugs that could cure a person already infected with HIV, have been, so far, unsuccessful.