HIV and AIDS

"HIV/AIDS accompanies poverty, is spread by poverty and produces poverty in its turn, ” says the United Nations Population Fund in its paper on AIDS. The worst affected countries are in Africa, Asia, the Caribbean and Eastern Europe.
The UNAIDS report projects that, in the absence of drastically expanded prevention and treatment efforts, 68 million people will die because of AIDS in the 45 most affected countries between 2000 and 2020, more than five times the 13 million deaths of the previous two decades of the epidemic in those countries.
AIDS spreads because of risk behaviours rather than risk “factors”. Awareness can lead to an avoidance of these behaviours.
Despite the absence of preventive vaccine/medication and cure, there is an improvement in the quality of life for the AIDS patient. Yet, the stigma associated with AIDS prevents the patient from benefiting from the best care available.
This section attempts at raising awareness on HIV infection and AIDS. This section hopes to fight the stigma people with HIV face and provides tips on coping with the disease. You can also view Dr Sunithi Solomon’s views on AIDS and management.
Source: The material for this section is sourced from YRGCare,India.
HIV stands for Human immunodeficiency Virus.
It only causes disease in humans. It’s presence in the bloodstream leads to the depletion of white blood cells leading to lowering of immunity.
The incubation period:
Once the virus enters the body it lies dormant for many years and hence is known as a slow virus. Most other viruses, for example, those causing measles, mumps, chicken pox etc., manifest the disease in 14-21 days after they enter the body. In HIV the incubation period is very long and runs into years.
HIV and the Immune System
Once HIV enters the body, it gets attached to a type of white blood cell called the lymphocyte (which is the T cell in the human body's protection against infections). The RNA (genetic material) of the virus then gets converted to DNA (genetic material) by an enzyme that the virus produces. This viral DNA then gets incorporated in to the DNA of the human cell (T lymphocyte) and remains there for the lifetime of that cell. This infected cell now becomes a virus factory producing more viruses (HIV), which bud out of the cell, attack new T lymphocytes, and destroy them. Over a period of years, the T cell count of the infected person drops to a critical level and the individual develops many opportunistic infections and hence is then said to have AIDS.
HIV Outside the Body
The Human Immunodeficiency Virus is fragile.
Once the virus is outside the body in a dry form, it dies immediately.
Even in a wet state, it does not live long when exposed to heat, detergents, or disinfectants.
When stored in blood banks at 4^.C it can live for about 3 weeks (or longer) or till the white cell disintegrates.
In a frozen state it can survive for years.
HIV and AIDS – The Relation and the Difference
A person living with HIV (medically known as an HIV positive person) is one who has virus in his/her body. Such a person remains infected and is presumed infective for the rest of his/her life. However, she/he will appear to be perfectly normal and healthy and asymptomatic for many years. An asymptomatic HIV infected person does not have Acquired Immunodeficiency Syndrome (AIDS).
But when an HIV positive person's T lymphocytes (which are responsible for the immunity) count falls to 200 or less, she/he starts developing symptoms, for example, cough, fever, diarrhoea, skin lesions, etc.
These are due to opportunistic infections (so called because they develop when the body’s immunity becomes deficient) like TB, thrush, pneumonia, Cryptococcal meningitis, etc.
All persons with AIDS are infected with HIV, but not all persons with HIV infection have AIDS. AIDS is only the end stage of this infection.
The Progress from HIV to AIDS
A few weeks after the virus enters the body, some people have flu like symptoms such as fever, body ache, and headache (every infected person may not experience these same symptoms). These symptoms disappear after a while and then there is a long phase of 3 years to 12 years, which is asymptomatic. After that, when the immune system starts failing AIDS sets in.
The rate of progress depends on the mode of the HIV transmission and the lifestyle of the HIV positive person. Majority of persons who are infected through blood transfusion develop symptoms on an average from 3 years to 5 years. With the other modes of transmission when the quantum of the virus is low, the person can remain healthy for 8 to 12 years or longer.

Mental Health and Illness

About 450 million people suffer from mental and behavioural disorders worldwide, reports the World Health Organisation. In many parts of the world socio economic conditions have a negative impact to mental health: poverty, illiteracy, war, violence discrimination on various aspects are all detrimental factors. Awareness that some behaviours and symptoms are signs of illnesses, is lacking. There is a stigma to voicing mental problems and seeking help.
Mental Illness covers a wide spectrum where the boundaries between “normal” and “abnormal” are not very sharply defined. Illnesses can be classified in different ways. Some broad categories are:

• Organic, where there are structural/physiological abnormalities in the brain or nerves, leading to illness
• Functional where there are no structural abnormalities identifiable
• Neurosis - severe forms of normal experiences
• Psychosis – severe distortion of perception of reality.

Illnesses are also grouped as:

• Mood disorders
• Anxiety disorders.
• Substance-related disorders.
• Schizophrenia related disorders
• Dementia and Memory Related Disorders
• Developmental disorders
• Personality disorders.

While it is difficult to define what is normal when a behaviour interferes with your ability to cope with life on a daily basis, then it is better to seek help.

Asthma

Introduction 
Asthma is a disease of the airways. It is characterised by increased sensitivity of the airways to a number of stimuli-producing spasm of airways; it is also caused by constriction. This ailment causes a pronounced narrowing of the airways, which may be relieved either spontaneously or after treatment. Asthma can occur at all ages. However in 50% of the cases it occurs before the age of ten. Asthma may be triggered by exposure to specific allergens and/or external stimuli, in which case it is classified as allergic asthma. Cases of asthma where there is no specific allergen or stimuli implicated, are called idiosyncratic asthma. Asthmatics may have a strong personal or family history of allergies. Asthma is thought to affect close to 3% of the population in most countries. Asthma is an episodic disease that alternates with long periods of normalcy.

Cause and Pathogenesis 
Extrinsic or allergic asthma is triggered by a variety of allergens such as dust, smoke, pet dander, chemicals, and certain foodstuffs. Underlying respiratory infections, emotional stress, and fatigue can also act as triggers. Viral infections of the respiratory tract may provoke severe asthma. A number of drugs such as aspirin and beta blockers also act as causes. Quite often more than one factor may be responsible for triggering an episode. The exact mechanism by which the increased reactivity of the airway begins is not clear but the progress of the ailment in its subsequent stages has been well studied. The inflammatory reaction that occurs is mediated by certain cells such as the eosinophils, mast cells, and lymphocytes, as well as by certain chemical mediators such as Prostaglandins and Leukotrienes.The inflammation that occurs leads to an exudation of inflammatory material and leads to narrowing and blockage of the airway, producing the typical symptoms of the disease. Air also gets trapped within the airways producing a hyper-inflated chest. The severity of the obstruction is not uniform and different parts of the airway may be affected in varying degrees.

Symptoms and Signs 
The three typical symptoms of asthma are:

• Breathlessness (dyspnoea)
• Cough
• Wheezing

Usually all three symptoms may be evident during an acute attack. The accessory muscles of respiration may be active. The presence of a pulsus paradoxus (a type of pulse) and the presence of significant activity of the accessory muscles of respiration, indicate that the episode is severe. The patients may complain of a feeling of tightness in the chest - often at the start of an episode. During an episode the patient may lean forward and breathe long and hard. In severe cases the wheeze may appear to reduce and the patient may become cyanosed with severe fatigue and narrow, shallow respirations. A silent chest in a severe episode of asthma is often an ominous sign. Severe cases may lead to status asthmaticus (a form of treated but uncontrolled severe asthma) and eventually respiratory failure.

Investigations and Diagnosis 
A typical feature of an asthma attack is its reversibility. Administering a bronchodilator and estimating the improvement in the patient's expiratory volume during the first second of expiration (FEV1), is a simple and effective method of diagnosis. During an acute attack, an examination of the arterial blood gases would indicate the severity of the episode. A chest X-Ray may be necessary to indicate a hyperventilated chest. It also helps differentiate from other causes of breathlessness such as cardiac failure. The sputum could be thick and viscous and may indicate eosinophils and what are called Charcot-Leyden crystals. The effectiveness of therapy is monitored by assessing the PEFR (Peak Expiratory Flow Rate). Estimation of blood and sputum eosinophil counts (elevated), and raised levels of serum Immunoglobin-E, are often useful supportive evidence but are not specific. A Pulmonary Function Testing may indicate an obstructive pattern of airway disease.

Treatment and Prognosis 
A variety of drugs are used in the treatment of asthma. These include the Beta-agonists, the Methylxanthines, and Corticosteroids. Drugs such as Salbutamol, Terbutaline and Salmetrol (long acting) belong to the group of adrenergic stimulants; while Theophylline and its various salts belong to the family of Methylxanthines. Anticholinergic drugs are also useful in treating acute episodes but are not used as often. Steroids reduce the inflammation within the airways in asthma and are highly effective. The drugs may be administered either by inhalation, orally, or by injections. Treatment has to continue until the episode has completely resolved; after that many patients may require a small dose of bronchodilator, usually administered by an inhaler for a prolonged period.
Mast cell stabilizing agents such as Cromolyn Sodium and Nedocromil sodium help restrict the degranulation of mast cells, and prevent the release of the mediators of inflammation. Thus they are more useful when given as prophylactics rather than during the acute episode. Oxygen may need to be given during severe attacks; severe attacks may warrant antibiotics. Desensitization or immunotherapy with extracts of the suspected allergens, has been tried and may become widely acceptable in the future. The prognosis of asthma remains good with as many as 60%-80% of those who have the disease being able to lead normal lives without any significant disruptions. But between 10%-20% of patients continue to have severe attacks throughout their lives. Fortunately asthma is not a progressive disease. The mortality rate among asthma patients is low though it has been on the rise of late.

Prevention 
Asthma can be prevented by avoiding known triggers or allergens. Educating the patient, and regular follow-up are also known to improve the prognosis. Immunotherapy and treatment with Sodium Cromoglycate may be useful in some cases.