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Health
Tips from Cougars
HIV
WHAT
IS IT?
AIDS, or acquired immunodeficiency syndrome, is a disease that attacks
the immune system, your body's main defense against disease. AIDS
is caused by a virus known as HIV (or human immunodeficiency virus).
First reported in 1981, HIV infection is now a worldwide epidemic,
affecting 34 million. According to the Centers for Disease Control
and Prevention, 800,000 to 900,000 people in the United States are
infected with HIV, and another 40,000 contract the virus every year.
HIV travels from person to person through body fluids such as blood,
semen, vaginal fluids, and breast milk. It is most often spread
through sex or by sharing needles used to inject drugs into the
veins. An infected woman can also pass HIV to her child during birth
or breast-feeding. Blood transfusions given to patients before 1986
also spread HIV, but the risk now of getting the virus this way
is low-only 1 in 500,000. A person can't catch HIV through casual
contact such as hugs, kisses, or handshakes. When HIV first invades
the body, it causes minor damage to cells in your immune system.
You may not have symptoms, or you may have only a few symptoms at
first; these symptoms often go away for months or even years. During
all that time, though, HIV continues its assault. As the immune
system weakens, it can no longer fully protect the body from germs
and other invaders. When the damage reaches a certain point, the
HIV infection turns into AIDS, and life-threatening diseases such
as pneumonia or cancer may soon follow. There's no cure for AIDS,
but you can do a lot to prevent the disease in the first place.
And if you have tested positive for HIV, or even if you have full-blown
AIDS, you can do a lot to slow the progress of the disease and stay
healthy longer. New research and treatments also hold great promise:
They may soon make AIDS a chronic-not a fatal-disease.
WHAT IS HAPPENING?
Your immune system is the body's defender-it protects you against
invaders, such as the germs that cause infection. It also wards
off cancer by seeking out and destroying any abnormal cells. T helper
cells, a type of white blood cell that your body uses to fight disease,
are part of your immune system. These helper cells, also called
T cells, are vital: They find harmful agents, such as germs and
viruses, release chemicals to destroy them, and stimulate other
immune cells to help fight these invaders. When the HIV virus invades
the body, it locks on to two proteins, called a CD4 receptor and
CKR5, on the surface of a T helper cell. HIV then enters the cell.
The virus makes its own proteins, which in turn make new viruses.
These new viruses spill out from the cell, kill it, and invade other
T helper cells. As the T helper cells begin to die off, the immune
system becomes crippled, making it possible for a fatal infection
or cancer to take hold. Once this happens, or your T-helper-cell
count falls below 200 (one-fifth the level of a healthy person),
you have AIDS.
WHAT CAUSES IT?
Some factors that increase or lower your risk of becoming infected
with HIV and coming down with AIDS are beyond your control, but
most are things you can change. With a little caution, you can keep
yourself from being infected with HIV and getting AIDS in most situations.
THINGS YOU CAN'T CHANGE
Blood transfusions The risk is very slight, but you may still
catch the virus this way. New tests used since 1985 detect HIV in
donated blood. Before that, thousands of people who had surgery
or hemophilia (an illness in which a blood defect prevents clotting)
got HIV from infected blood.
Your genes Some people seem to be blessed with built-in defenses
against HIV. Thanks to their genes, the virus has a hard time invading
their cells. As a result, they can be HIV-positive for 10 years
or more without ever developing AIDS.
THINGS YOU CAN CHANGE
Sex habits Unprotected sex-sex without a condom-and having
sex with more than one partner increase your chance of getting AIDS.
Anal sex is especially risky. It can tear delicate tissue, leaving
small cuts that act like an open door for HIV.
Drug use One in five people with HIV got the infection by
using dirty needles to shoot illegal drugs directly into the veins.
The virus spreads from one person to another by bits of blood left
on used needles. Many drug users then pass the virus on to their
sexual partners.
Your job Health workers who treat AIDS patients are at greater
risk for getting HIV if they mistakenly "stick" themselves with
an infected needle. They may also catch the HIV virus if infected
fluids splash onto any moist tissue on their body, such as the eyes.
But the risk is low: Less than .03 percent of health workers who
are exposed to HIV become infected. Other workers who may come into
contact with people's body fluids include police and firefighters.
But the chance of getting HIV through these types of work is small.
Having a STD HIV is more likely to enter through small sores
on the vagina or penis if you have a sexually transmitted disease
that hasn't been cured or is "active."
WHAT YOU CAN DO FOR YOURSELF
You can keep from getting HIV by making smart choices about sex,
drugs, and other lifestyle matters. If you already have HIV or AIDS,
getting treatment and building up your immune system will keep you
as healthy as possible. You should see your doctor regularly.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor will track your body's fight against HIV with blood
tests to count T cells and with checkups. If your T-cell levels
fall below 350-or if the virus has already made many copies of itself-your
doctor will prescribe drugs to destroy the virus or slow down its
growth. Your doctor can also help treat and prevent some of the
infections that may accompany AIDS, such as pneumonia and candida
(yeast infections). A number of drugs have been developed during
the last few years to fight HIV and AIDS. For instance, strong drugs
called protease inhibitors hold back an enzyme on the virus and
keep it from making copies of itself. Drugs known as reverse transcriptase
inhibitors work in the same way, but they target a different enzyme.
When these or other drugs are combined into a "cocktail," they can
often drive HIV down to very low levels-so low that a doctor can
no longer find any viruses in a patient's blood. However, HIV never
completely goes away. If a person stops taking the medicines, the
virus may come out of hiding and renew its attack on the immune
system. HIV changes to adapt to its surroundings, so your drugs
may lose their power over time. For this reason your doctor may
sometimes change your medicines, always testing along the way to
see what works. Protease inhibitors and other medicines are expensive.
Many also have serious side effects, such as constant nausea, stomach
pain, headaches, and fatigue. Some people find relief from side
effects with other drugs or treatments such as acupuncture and herbs.
Ask your doctor what will help you.
SOME WORDS YOU MAY HEAR AIDS
dementia complex: symptom of AIDS that occurs in the late
stages of the disease when HIV infects the brain. Patients can no
longer remember, focus, or make judgments.
Antibody: protein produced by the immune system to fight
something that invades the body, such as viruses or bacteria.
Antigen: toxins, bacteria, or viruses (among other things)
that trigger the response of the immune system.
Antiviral: treatment that slow or stops a virus from spreading
through the body. Baseline blood work: patient's first blood test
that shows how many of the body's immune system cells (antibodies)
are fighting HIV. All other blood tests are measured against this.
B cells or B lymphocytes: white blood cells from the bone
marrow that produce antibodies, which fight invaders such as HIV
in the body.
CD4 cells (also called T cells, T4 cells, T helper cells):
cells that control and stimulate the body's immune response to an
invader, such as pneumonia. HIV attacks these "helper" cells.
Kaposi's sarcoma: cancer that affects 20 percent of people
with AIDS, marked by purple, brown, or reddish sores on the skin
or in the mouth.
Opportunistic infection: illness that preys on sick people
with weak immune systems.
Pneumocystis carinii pneumonia (PCP): once-rare lung infection.
One of the leading causes of death in people who have AIDS.
LATEST DEVELOPMENTS
The search for a vaccine Could AIDS someday go the way of
smallpox and polio? Researchers around the world are looking for
an AIDS vaccine that could put an end to the epidemic and save millions
of lives. The National Institutes of Health alone is testing more
than 25 different vaccines on healthy human volunteers. One vaccine
contains proteins from HIV attached to harmless Salmonella bacteria.
In theory, the HIV proteins could spur the immune system to produce
antibodies to fight the virus. The antibodies could then make a
person immune to HIV. So far, none of these vaccines has been proven
to prevent HIV or AIDS. But with so many lives at stake, scientists
won't give up the search.
Hitting HIV hard-and early In the fall of 2000, Harvard researchers
announced that early treatment with a strong drug cocktail seems
to boost the body's own defenses against HIV. Patients in a study
took a mix of three or four drugs as soon as their infections were
found. Before long, their bodies produced large numbers of T cells
that target HIV. The researchers think that this kind of response
from the immune system might someday let some patients stop taking
medicines.
TO PREVENT HIV OR AIDS
Practice safe sex Don't have unprotected sex, especially
with more than one partner.
Don't share needles or inject drugs If you share needles
you open yourself up to HIV. Get treatment if you have a drug habit.
Addictions cause great physical and emotional problems, as well
as putting you at risk for HIV. If you must inject drugs, use a
new, clean needle each time. If that is impossible for you, be sure
to clean your needle with bleach every time you use it.
Avoid contact with other people's blood If you're a health
worker, protect yourself by using gloves and a mask when treating
patients. Change gloves between patients, and throw them away after
each use. Take care when injecting medicines. If you know you will
need a blood transfusion for surgery, you can often donate your
own beforehand or ask HIV-free friends or family members to donate.
Watch out for menstrual blood-a prime carrier of the HIV virus.
Use extra precautions when your partner is menstruating. A condom
is always a good idea.
Get tested regularly if you are sexually active. If you are
at high risk for HIV or your partner is infected, get tested right
away. The sooner you know you're HIV-positive, the sooner you can
begin treatment. That will help delay the onset of AIDS. If your
test is negative, get retested once again in three to six months;
antibodies that your body makes to fight the virus may take that
long to develop. If you engage in high-risk behavior-such as injecting
drugs or having unprotected sex-you should be tested every 6 to
12 months.
Study
Assesses HIV Risks: Blood Levels of Virus Are Key
A
study of heterosexual couples in Africa concludes that the chance
of contracting the AIDS virus from a single sexual encounter with
an infected person is one in 588. This risk is calculated for people
who do not use condoms and who have sex regularly with one infected
partner. Earlier estimates from North America and Europe vary but
generally have placed the risk at about one in 1,000 for heterosexuals.
In this study, researchers followed 174 sexually monogamous couples
in Rakai, Uganda, in which one partner had HIV and the other did
not. They were given condoms but usually did not use them. Typically
the couples had sex nine or 10 times a month and, over time, 38
people became infected. Earlier data from the same research team
showed that the risk of people transmitting HIV is slight if the
amount of virus in their bloodstream is low. Those findings have
encouraged the belief that the wide use of AIDS drug combinations,
which makes virus levels fall dramatically, will slow the spread
of the disease. The latest figures were presented by Dr. Ronald
Gray of Johns Hopkins University at the Eighth Annual Retrovirus
Conference in Chicago, which concluded Thursday.
Among the findings:
>>Infected teenagers are three times more likely than people
over 40 to spread HIV to others during each sexual encounter. This
difference cannot be explained by the fact that young people are
more sexually active.
>>The risk that an HIV-infected woman will transmit the virus
to an uninfected man is one in 454. For an infected man to an uninfected
woman, it is one in 769. This difference is not large enough to
be statistically meaningful, and many have assumed that HIV spreads
more readily from men to women than vice versa.
>>The risk of spread depends greatly on how much virus people
carry. In those whose level of virus is less than 1,700 copies per
milliliter of blood, the risk is one in 10,000. When levels are
higher than 38,500, the risk is one in 294.
>> The risk of transmission appears to be the same for different
subtypes of virus. Some have speculated that AIDS is much more prevalent
in Africa because a different variety of the virus dominates there.
None of the circumcised men in the study contracted HIV. Some experts
have raised the possibility of promoting circumcision as a way to
control the epidemic. Whether the transmission risk is the same
among couples outside Africa is unclear, especially since virus
levels may be higher in Africa, where so few infected people get
treated. But, Dr. Helene Gayle, AIDS chief at the U.S. Centers for
Disease Control and Prevention, said the data offers a general estimate
of this risk.
How long does it take for HIV to cause AIDS?
Since 1992, scientists have estimated that about half the people
with HIV develop AIDS within 10 years after becoming infected. This
time varies greatly from person to person and can depend on many
factors, including a person's health status and their health-related
behaviors. Today there are medical treatments that can slow down
the rate at which HIV weakens the immune system. There are other
treatments that can prevent or cure some of the illnesses associated
with AIDS, though the treatments do not cure AIDS itself. As with
other diseases, early detection offers more options for treatment
and preventative health care.
HIV and Its Transmission
Research has revealed a great deal of valuable medical, scientific,
and public health information about the human immunodeficiency virus
(HIV) and acquired immunodeficiency syndrome (AIDS). The ways in
which HIV can be transmitted have been clearly identified. Unfortunately,
false information or statements that are not supported by scientific
findings continue to be shared widely through the Internet or popular
press. Therefore, the Centers for Disease Control and Prevention
(CDC) has prepared this fact sheet to correct a few misperceptions
about HIV.
How HIV is Transmitted
HIV is spread by sexual contact with an infected person, by sharing
needles and/or syringes (primarily for drug injection) with someone
who is infected, or, less commonly (and now very rarely in countries
where blood is screened for HIV antibodies), through transfusions
of infected blood or blood clotting factors. Babies born to HIV-infected
women may become infected before or during birth or through breast-feeding
after birth. In the health care setting, workers have been infected
with HIV after being stuck with needles containing HIV-infected
blood or, less frequently, after infected blood gets into a worker’s
open cut or a mucous membrane (for example, the eyes or inside of
the nose). There has been only one instance of patients being infected
by a health care worker in the United States; this involved HIV
transmission from one infected dentist to six patients. Investigations
have been completed involving more than 22,000 patients of 63 HIV-infected
physicians, surgeons, and dentists, and no other cases of this type
of transmission have been identified in the United States. Some
people fear that HIV might be transmitted in other ways; however,
no scientific evidence to support any of these fears has been found.
If HIV were being transmitted through other routes (such as through
air, water, or insects), the pattern of reported AIDS cases would
be much different from what has been observed. For example, if mosquitoes
could transmit HIV infection, many more young children and preadolescents
would have been diagnosed with AIDS. All reported cases suggesting
new or potentially unknown routes of transmission are thoroughly
investigated by state and local health departments with the assistance,
guidance, and laboratory support from CDC. No additional routes
of transmission have been recorded, despite a national sentinel
system designed to detect just such an occurrence. The following
paragraphs specifically address some of the common misperceptions
about HIV transmission.
HIV in the Environment
Scientists and medical authorities agree that HIV does not survive
well in the environment, making the possibility of environmental
transmission remote. HIV is found in varying concentrations or amounts
in blood, semen, vaginal fluid, breast milk, saliva, and tears.
(See page 3, Saliva, Tears, and Sweat.) To obtain data on the survival
of HIV, laboratory studies have required the use of artificially
high concentrations of laboratory-grown virus. Although these unnatural
concentrations of HIV can be kept alive for days or even weeks under
precisely controlled and limited laboratory conditions, CDC studies
have shown that drying of even these high concentrations of HIV
reduces the amount of infectious virus by 90 to 99 percent within
several hours. Since the HIV concentrations used in laboratory studies
are much higher than those actually found in blood or other specimens,
drying of HIV-infected human blood or other body fluids reduces
the theoretical risk of environmental transmission to that which
has been observed--essentially zero. Incorrect interpretation of
conclusions drawn from laboratory studies have unnecessarily alarmed
some people. Results from laboratory studies should not be used
to assess specific personal risk of infection because (1) the amount
of virus studied is not found in human specimens or elsewhere in
nature, and (2) no one has been identified as infected with HIV
due to contact with an environmental surface. Additionally, HIV
is unable to reproduce outside its living host (unlike many bacteria
or fungi, which may do so under suitable conditions), except under
laboratory conditions, therefore, it does not spread or maintain
infectiousness outside its host.
Households
Although HIV has been transmitted between family members in a household
setting, this type of transmission is very rare. These transmissions
are believed to have resulted from contact between skin or mucous
membranes and infected blood. To prevent even such rare occurrences,
precautions, as described in previously published guidelines, should
be taken in all setting "including the home" to prevent exposures
to the blood of persons who are HIV infected, at risk for HIV infection,
or whose infection and risk status are unknown. For example,
>> Gloves should be worn during contact with blood or other
body fluids that could possibly contain visible blood, such as urine,
feces, or vomit.
>> Cuts, sores, or breaks on both the care giver’s and patient’s
exposed skin should be covered with bandages.
>> Hands and other parts of the body should be washed immediately
after contact with blood or other body fluids, and surfaces soiled
with blood should be disinfected appropriately.
>> Practices that increase the likelihood of blood contact,
such as sharing of razors and toothbrushes, should be avoided.
>> Needles and other sharp instruments should be used only
when medically necessary and handled according to recommendations
for health-care settings. (Do not put caps back on needles by hand
or remove needles from syringes. Dispose of needles in puncture-proof
containers
Preventing Infections During Travel
In the United States or abroad? For business or pleasure? When you
travel, you risk coming into contact with germs you might not find
at home. Many of these germs can make you very sick.
For people with special health needs, travel can be risky to their
health. If you have human immunodeficiency virus (HIV)-the virus
that causes AIDS-you should have all the facts. Travel, especially
to developing countries, can increase your risk of getting opportunistic
infections. (They are called "opportunistic" because a person may
get the infection when their weakened immune system gives it the
opportunity to develop.) The best thing you can do when you travel
is to know the medical risks and to take steps to protect yourself.
Before You Travel
>> Talk to your doctor or an expert in travel medicine about
health risks in the area you plan to visit. They can tell you how
to keep yourself healthy when you travel to places where certain
illnesses are a problem. They also can tell you about places that
might not be safe for you to visit. Ask them if they know of doctors
who treat people with HIV in the region you plan to visit.
Plan in advance for problems that might come up.
>> Traveler’s diarrhea is a common problem. Carry a 3- to
7-day supply of medicine (antibiotics) to treat it. A common drug
for traveler’s diarrhea is ciprofloxacin (SIP-ro-flocks-uh-sin).
If you are pregnant, your doctor may suggest you take TMP- SMX (trimethoprim-sulfamethoxazole
[try- METH-o-prim - sul-fa-meth-OX-uh-sole]) instead.
>> Insect-borne diseases are also a major problem in many
areas. Take a good supply of an insect repellent that contains 30
percent or less "Deet" with you. Plan to sleep under a mosquito
net, preferably one treated with permethrin, in places where there
is malaria or dengue [DEN-gay] fever. Unless you need to go there,
avoid areas where yellow fever is found.
>> Ask your doctor if you need to take medicine or get special
vaccinations before you travel. He or she will know which vaccines
are safe for you. Your doctor will also know the best ways to protect
you from such things as malaria, typhoid fever, and hepatitis. Make
sure all your routine vaccinations are up to date. This is very
important for HIV-infected children who are traveling.
>> If you are leaving the United States, make sure you know
if the countries you plan to visit have special health rules for
visitors. These rules can include vaccinations that may not be safe
for HIV-infected people to take. Your doctor or local health department
can help you with this.
>> If you have medical insurance, check to see what it covers
when you are away from home. Many insurance plans have limited benefits
outside the United States. Very few plans cover the cost of flying
you back to the United States if you become very sick. Make sure
your paperwork is in order, and take along proof of insurance when
you travel.
When You Travel
Food and water in developing countries may not be as clean as they
are at home. These items might contain bacteria, viruses, or parasites
that could make you sick.
>> Do not eat raw fruit and vegetables that you do not peel
yourself, raw or undercooked seafood or meat, unpasteurized dairy
products, or anything from a street vendor. Also, do not drink tap
water, drinks made with tap water, or with ice made from tap water,
or unpasteurized milk.
>> Food and drinks that are generally safe include steaming-hot
foods, fruits that you peel yourself, bottled (especially carbonated)
drinks, hot coffee or tea, beer, wine,and water that you bring to
a rolling boil for1 full minute. If you can’t boil your water, you
can filter and treat it with iodine or chlorine, but this will not
work as well as boiling.
>> Tuberculosis, or "TB," is very common worldwide, and can
be severe in people with HIV. Avoid hospitals and clinics where
coughing TB patients are treated. When back in the United States,
have your doctor test you for TB.
In many places, animals may roam more freely than they do in the
area where you live.
>> If you think animals have left droppings on beaches or
other areas, always wear shoes and protective clothing and sit on
a towel to avoid direct contact with the sand or soil.
>> Swimming can make you sick if you swallow water. You should
never swim in water that might contain even very small amounts of
sewage or animal waste. To make sure that you get the most fun from
your trip, protect your health (and the health of others) just as
you do at home.
>> Take all medications as prescribed by your doctor.
>> If your doctor has you on a special diet, stick with it.
>> Take the same precautions that you take at home to prevent
giving HIV to others.
IF YOU'RE INFECTED WITH HIV
Reduce stress As with any major illness, the stress of coping
puts pressure on your immune system. That makes it harder for it
to do its job. Try to reduce stress by reaching out for support
from family and friends. Join a support group for people with AIDS.
Talking to others who know what you're going through can help. Studies
show prolonged support can help fight off illness.
Take care of legal issues You'll want to decide how your
health care will be handled if you reach the end stages of the disease.
A living will sets out how much health care you want during this
time. A power of attorney gives someone you trust the power to make
health care and financial decisions for you if you can't.
If you're pregnant, talk to your doctor If you're pregnant
and infected with HIV, you'll need to take several steps to protect
your baby. Your doctor will likely give you drugs such as zidorudine
(Retrovir or AZT) to take during your pregnancy. These drugs can
help prevent the spread of the virus to unborn child. So far, they
haven't been found to cause serious side effects in the children.
Your doctor may also recommend that your baby be delivered by cesarean
section. A recent study of over 8,000 HIV-infected preganant women
found that babies delivered by c-section-before the women had gone
in to labor or their water had broken-were half as likely to become
infected with the virus than those who were delivered normally.
Finally, since HIV can be transmitted from mother to child during
breast feeding, you'll need bottle feed your baby.
HOW TO PRACTICE SAFE SEX
Besides not having sex, the chief way to prevent a sexually transmitted
disease (STD), including HIV, is to practice safe sex.
Here are some tips:
>> If you have more than one sex partner, or if you or your
partner may be infected, always use a condom during both vaginal
and anal sex. If you're also trying to prevent pregnancy, use a
spermicide such as nonoxynol-9 along with the condom.
>> Use latex condoms during vaginal, anal, and oral sex. Never
reuse a condom. A water-based lubricant (such as K-Y jelly or Replens)
will keep the condom from tearing. If you have oral sex with a woman,
you can split the condom lengthwise and put it between her body
and your mouth.
>> Get to know your partner. Talk about whether you've both
been checked for STDs, such as HIV, and which ones you've been tested
for.
EATING WELL
If you're infected with HIV, or if you have AIDS, you'll need to
take special care with what and how you eat.
If you're infected with HIV:
Don't undercook meats, fish, or poultry. You are at high risk of
getting sick from undercooked meat. To find out if your meat is
done, put a skewer or thin knife in the fleshy part. If it comes
out smoothly and the juice is clear, it's ready to eat.
If you have AIDS:
>> You're at risk of sudden weight loss-called wasting. Losing
lots of weight weakens your body's ability to fight off other illnesses.
>> Eat foods you like that are high in calories and fat. Work
on keeping the pounds on, not following a strict low-fat diet.
>> Don't overcook fruits and vegetables; many of their vitamins
are lost that way. Use the cooking water from fruits and vegetables
in soups or sauces.
>> Get lots of protein-try to eat at least 100 grams a day
and buy diverse foods. Enjoy comfort foods, and keep your refrigerator
stocked with them. When you crave food, even for a moment, give
in.
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