HUMAN IMMUNO DEFICIENCY VIRUS
( HIV ) infection and Acquired Immuno Deficiency Syndrome(AIDS)* :-
THE VIRUS: -
The causative agents are human immunodeficiency viruses (HIV) of strains HIV 1 and HIV 2. HIV belongs to retrovirus (double stranded RNA) family. Retroviruses possess the enzyme reverse transcriptase which allows viral RNA to be transcribed into DNA. The viral DNA when gets incorporated into the host cell genome, chronic infection begins. The basic structure of this icosahedral HIV (RNA-retrovirus) consists of a core protein (P-24) with glycoprotein (GP 120; GP 41) envelope. Of the various core antigens, P-24 is most widely used for investigation study. Antibodies to envelope proteins (GP 120) have got some protective role. The virus is destroyed by heating at 56°C for 30 minutes or by disinfectants with glutaraldehyde.
Incidence: The incidence is difficult to work out but the fact remains that the disease is spreading alarmingly fast both in the developed and developing countries and now has become a global problem.
In South and South East Asia, an estimated 4 million people (more than 50% of them are women and children) were with HIV. In most Asian countries, infection rates are less than 0.5 percent.
Predominent route of infection worldwide is heterosexual contact and vertical transmission.
MODE OF TRANSMISSION: -
- Sexual intercourse — Women are affected more than the men because in female, larger mucosal surface is exposed and semen contains high viral load. Transmission of virus from male to female is high. Transmission is both by heterosexual and homosexual contact.
- Intravenous drug abusers.
- Transfusion of contaminated blood or blood products.
- Use of contaminated needles, needlestick injuries.
Breastfeeding: Infected mothers may infect their children during breastfeeding through breast milk (10–20%). More so in presence of ulcers (cracked nipples).
However, many health promoting benefits of breastfeeding may outweigh the risk of HIV transmission particularly in the developing world. For the other high risk factors for AIDS.
Perinatal transmission: The vertical transmission to the neonates of the infected mothers is about 25–35%. The baby may be affected in utero (30%) through transplacental transfer, during delivery (70–75%) by contaminated secretions and blood of the birth canal.
IMMUNO PATHOGENESIS: -
The target for HIV is the CD 4 receptor molecule. Cells within the immune system that have this molecule are: CD 4 T lymphocytes (predominantly affected), monocytes, macrophages and other antigen presenting cells like fibroblasts, neurons, renal, hepatic, and intestinal cells.
Following infection, there is profound cellular immunodeficiency as the CD 4 are progressively depleted by cytopathic effects of HIV.
Primary infection 3 6 weeks → Acute syndrome 1 week to → 3 months' Immune response to HIV 1 ,2 weeks → Clinical latency (7–10 years).
Immunological markers that are used to determine the progression of the disease are:
y CD 4 T lymphocyte count—patients with count from 200–500 cells/mm3 are more likely to have HIV related symptoms and count < 200 cells/mm3 is taken into AIDS defining criteria.
Breastfeeding — Infected mothers may infect their children during breastfeeding through breast milk (10–20%). More so in presence of ulcers (cracked nipples).
However, many health promoting benefits of breastfeeding may outweigh the risk of HIV transmission particularly in the developing world. For the other high risk factors for AIDS (see Table 11.4).
Perinatal transmission—The vertical transmission to the neonates of the infected mothers is about 25–35%. The baby may be affected in utero (30%) through transplacental transfer, during delivery (70–75%) by contaminated secretions and blood of the birth canal.
HIV RELATED OTHER DISEASES:
COMMON SECONDARY INFECTIONS ARE: a typical tuberculosis, pneumonia (Pneumocystis carinii pneumonia), systemic candidiasis, and meningitis.
- Encephalitis, myelopathy and polyneuropathy are neurological manifestations.
- There is an increased incidence of high-grade lymphoid neoplasms, Kaposi sarcoma and non-Hodgkin’s lymphoma.
- Viral infections with herpes simplex, human papilloma virus (HPV) and cytomegalovirus (CMV) are common.
GYNECOLOGICAL SYMPTOMATOLOGY: -
- Infection of the genital tract is high due to progressive immunodeficient state
- Vaginitis due to recurrent candidiasis. There may be oral, esophogeal candidiasis also.
- Pelvic Inflammatory Diseases—with other STIs (gonorrhea, chlamydia, syphilis) are more likely.
- Neoplasms of the genital tract are increased
- Increased incidence of CIN and carcinoma of the cervix. Colposcopy and cervical cytology screening should be routinely done.
- Increased incidence of vulval intraepithelial neoplasia (VIN).
- Increased morbidity following gynecological surgery
- Increased risk of wound infection and chest infection, an intensive antibiotic therapy is needed.
- Menstrual abnormality: Menorrhagia, amenorrhea, or abnormal uterine bleeding may be due to associated weight loss, thrombocytopenia or opportunistic infections or neoplasms.
- Fertility is not generally affected.
- Pregnancy does not worsen the disease neither the disease affect pregnancy adversely.
HOMOEOPATHIC MANAGEMENT OF HIV: -
The medicines that can be thought of use are:-
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