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Tests and examinations for the detection of the HIV virus
Routine HIV testing
Of about 1.1 million Americans currently living with HIV infection, 21 percent don’t know they’re infected.
People who have recently been infected with HIV often have few or no symptoms. Nevertheless, they are extremely contagious and do not know that they can transmit the virus to others.The United States Centers for Disease Control (CDC) recommends HIV testing to adults, adolescents, and pregnant women during regular medical checkups.
Regular screening for HIV allows doctors to identify the people who don’t know they are infected with HIV.
The doctor should advise on the need to avoid high-risk behavior, should educate about safe sexual intercourse practices, and inform about how to start antiretroviral therapy.
HIV testing can also be done anonymously if a person is concerned about their privacy.
Types of HIV testing
The doctor tests a blood sample for HIV-specific human antibodies (proteins that fight the disease).
The two main HIV antibody tests are ELISA and Western Blot.
However, these antibody tests could not detect HIV antibodies in patients who have recently been infected with HIV (within 3 months of exposure to the virus).
In such situations, doctors can perform a blood test for the presence of HIV genetic material.
HIV test in newborns
The Centers for Disease Control in the United States recommends that all pregnant women get an HIV test before or during childbirth.
Knowing that the mother is seropositive, doctors can avoid mother-to-child transmission of HIV through antiretroviral therapy, both in the HIV-infected mother and in the newborn.
However, it is difficult to determine whether a newborn is infected whose mother is seropositive because the children carry HIV antibodies from their mothers for several months.
Today, doctors can perform an HIV test on children aged 3 to 15 months.
Scientists are currently evaluating various blood tests to determine tests suitable for children under 3 months of age.
Therapies and medications for AIDS and HIV
There is no cure for AIDS and HIV, but you can take a combination of several medications to keep the virus under control.
Each class of HIV drugs blocks the virus in different ways.
It is best to combine at least three drugs from two different classes to avoid the formation of strains that are resistant to individual drugs.
The classes of HIV drugs include:
Non-nucleoside reverse transcriptase inhibitors (NNRTI). The NNRTI incapacitate a protein required for HIV self-replication.
Examples include efavirenz (Sustiva® syrup, capsules or tablets), etravirine (Intelence® tablets) and nevirapine (Viramune® syrup or tablets).
Nucleoside reverse transcriptase inhibitors (NRTIs).
The NRTI cause a blockade of the transcription of viral RNA into DNA; basically, the nitrogen bases are replaced during transcription, so the DNA produced is incomplete and cannot produce new viruses.
Examples include abacavir (Ziagen) and the combinations of the drugs KIVEXA (lamivudine + abacavir), TRUVADA (tenofovir + emtricitabine), TRIZIVIR (Retrovir + Epivir + Ziagen) and COMBIVIR (Retrovir + Epivir).
Protease inhibitors (PIs)
A protease is an enzyme that breaks the long chains of proteins and enzymes into shorter fragments.
The HIV virus causes the production of a very long RNA thread that contains the information to produce various proteins.
The protease enzyme breaks down the entire original strand into many pieces that are required to create a single protein. But to accomplish this, the strand must be separated at an exact point.
Inhibition of protease blocks the maturation and replication of the virus.
Examples of drugs that inhibit protease include atazanavir (Reyataz), ritonavir (Norvir), amprenavir (Agenerase), saquinavir (Invirase), or nelfinavir (Viracept).
Input or fusion inhibitors
These drugs prevent the penetration of the HIV virus into the CD4 cells, an example is enfuvirtide (Fuzeon).
Integrase inhibitors
Raltegravir (Isentress) works by deactivating an enzyme called integrase. This is a protein that HIV uses to introduce genetic material into CD4 cells.
When should treatment be initiated?
Current guidelines indicate that treatment must be initiated if:
- Severe symptoms occur
- The number of CD4 lymphocytes is less than 500
- A pregnancy exists
- You have kidney disease caused by HIV
- The patient is treated for hepatitis B.
Treatment can be difficult.
The HIV treatment regimens may consist
of taking several tablets daily for life over certain periods of time. Side effects may include:
- Nausea, vomiting or diarrhoea
- Abnormal tachycardia
- Shortness
- Rashes
- Osteoporosis
- Bone necrosis, especially on the hip
- Associated diseases.
Some health problems that are part of the natural aging process may be more difficult to treat in people with AIDS or HIV.
Some medications commonly used for age-related diseases, cardiovascular diseases, metabolic disorders and bones may interact with HIV medications.
There are also known interactions between HIV medications and:
- Oral contraceptives and female hormones
- Drugs for tuberculosis treatment
- Drugs for the treatment of hepatitis C.
Response to treatment
Response to treatment is measured by viral load and CD4 lymphocyte count.
Viral load should be measured at baseline and every three to four months during therapy.
The number of CD4 should be measured every three to six months.
Therapy for HIV should reduce the viral load until it is no longer detectable.
This does not mean that HIV has disappeared.
It simply means that the test is not sensitive enough to detect the virus.
Possible transmission of HIV to other people is possible, even if the viral load is not detectable.
Alternative medicine
People infected with HIV sometimes try to boost the immune system through supplements or counteract the side effects of HIV medications.
Dietary supplements that may be useful:
Fish oil
Some HIV medications can lead to elevated cholesterol.
Studies suggest that fish oil supplements may help lower levels.
Whey proteins
Whey is a by-product of cheese.
Previous data show that whey proteins may help some people with HIV gain weight.
Whey proteins decrease diarrhea and increase the number of CD4.
Prognosis and life expectancy
The average time it takes for HIV infection to develop AIDS is 10–11 years in people who do not take antiretroviral drugs.
People with a high viral load may develop AIDS before (within 5 years of infection).
Once an HIV infection has progressed to AIDS, there is an increased risk of death, which varies significantly from person to person.
For example, some people with AIDS died shortly after diagnosis, while others lived 12 years or more.
Since the most effective drugs have only been available since 1996, we still do not know how long people with HIV infection who receive appropriate therapy will live.
The drugs have extended average life expectancy and many individuals with HIV can live for decades with proper treatment.
The number of people with a normal life expectancy increases if therapy is carried out correctly.
The drugs help to re-strengthen the immune system and fight infections to prevent cancer.
In some cases, the virus becomes resistant to the available drugs and symptoms of AIDS may develop.
If you have an HIV infection, it is better to start therapy before the immune system is weakened.
Since the powerful antiretroviral drugs became available in the United States, the number of hospitalizations and deaths from AIDS has fallen dramatically.
Prevention
Currently, there is no vaccine to prevent HIV infection and there is no curative treatment for HIV/AIDS. To reduce the risk of contracting HIV infection or transmitting the virus to others, the following recommendations should be followed:
- Regularly take an HIV test
- Practicing abstinence
- Being faithful to your spouse or sexual partner
- Using condoms made of latex or polyurethane
- Do not share hypodermic needles.
