- AIDS: description
- AIDS: symptoms
- AIDS: causes and risk factors
- AIDS: HIV transmission
- AIDS: examinations and diagnosis
- AIDS: HIV test
- AIDS: treatment
- AIDS: disease course and prognosis
AIDS (acquired immune deficiency syndrome) is the final stage of infection with HIV (HIV). The pathogen is mainly transmitted by unprotected intercourse and contaminated drug cutlery. It weakens the immune system, making patients more susceptible to other diseases. Medicines prolong the life expectancy of people with AIDS. But healing is not possible. Read here answers to all important questions about: What is AIDS, what is HIV? What symptoms occur, what treatment options are available and what is the prognosis for AIDS?
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. Z21B23B22B24
Causes and risk factors
AIDS: HIV transmission
Examinations and diagnosis
AIDS: HIV test
Disease course and prognosis
The abbreviation AIDS stands for "acquired immune deficiency syndrome". The German translation of the English term is acquired immunodeficiency syndrome. AIDS is acquired because it is caused by the infection with the HI virus (HIV). The disease is referred to as a syndrome because of various signs of disease that occur simultaneously and are related. One then speaks of a symptom complex.
What is HIV?
HIV stands for "human immunodeficiency virus", translated: human immunodeficiency virus. HIV and AIDS are often used as synonyms in everyday life. That is wrong. HIV infection leads to AIDS only at an advanced stage.
Also not right is the term HIV virus, since the word virus is already contained in HIV (correctly, so it is called HI virus). In addition, some people use the term "AIDS virus" for the pathogen. Again, this word is medically incorrect.
The first AIDS cases were documented in 1981. In 1983 and 1986, the two HI viruses 1 and 2 were identified as AIDS pathogens. It is believed that the HI virus is originally derived from a monkey virus. This so-called "simian immunodeficiency virus" (SIV) affects Old World monkeys such as chimpanzees and gorillas in Africa. It is believed that the source of HIV / AIDS in the consumption of infected chimpanzee meat is at the beginning of the 20th century.
HIV / AIDS: distribution
There are two types of HIV, HIV-1 and -2. In addition, there are several subtypes that are labeled with letters. HIV-1 is responsible for the global AIDS pandemic. A pandemic refers to the frequent occurrence of a disease in the same period, but in different places. About 85 percent of people infected with HIV-1 live in Africa and Southeast Asia. In contrast, HIV-2 is only found in West Africa.
Based on the subtypes, the path of the spread of the disease can be estimated. Subtype B is most prevalent in industrialized countries such as North America, Europe and Australia. It is assumed that the AIDS epidemic of the 1980s is the starting point for this spread. Subtypes C and E occur mainly in Asia. It is possible that they originally came from southern and central Africa.
According to World Health Organization (WHO) estimates, by the end of 2009, 33.3 million people worldwide were infected with the HI virus. 2.6 million of them had newly infected in 2009. About 95 percent of all infected people live in developing countries. In addition, it is estimated that by 2009, 30 million people around the world have already died from AIDS, including 1.8 million in 2009. At the time of diagnosis, on average, patients are in their mid-30s. About two years after becoming HIV-infected, approximately six percent of the patients have AIDS.
The Robert Koch Institute (RKI) has made the following estimates for AIDS at the end of 2010: At the end of 2010, around 70,000 people were infected with the HIV virus in Germany. About 65 percent of them are homosexual men, 12 percent of them from countries with a high rate of AIDS and 5 percent use drugs intravenously (so they inject drugs). Countries with a high AIDS rate are those in which more than one percent of adults are infected with the HIV virus. These are mainly countries in Southeast Asia, the Caribbean and the sub-Saharan region (sub-Saharan Africa). About 18 percent of those living in Germany have heterosexual intercourse with people from the other three named HIV risk groups.
Experts estimate that in Germany every year 3,000 people become infected with the HIV virus and 550 die of AIDS.
Read all about the signs of AIDS in the article HIV Symptoms.
AIDS: causes and risk factors
The cause of AIDS is the infection with the HI virus. It belongs to the family of retroviruses because it has a special enzyme (the reverse transcriptase), which is extremely important for its survival and reproduction. The HI virus consists of genetic information (RNA), packed in a protein capsule (capsid) and enveloped by a membrane. It is about 80 to 100 nanometers (millionths of a millimeter) in size.
AIDS: the course of the infection
For example, if the HI virus reaches the mucous membrane of another person through sperm (ejaculate), it is absorbed by certain cells. These so-called Langerhans cells belong to the immune system and migrate with the virus into the surrounding lymph nodes. There, they present the virus to other immune cells, the so-called T helper cells (CD4-positive cells), causing them to be attacked by the AIDS pathogen. Via the infected T helper cells, the HI virus spreads throughout the body with the bloodstream or the lymph and attacks other lymphatic organs (such as the spleen, bone marrow) as well as the central nervous system (CNS).
The viruses also force the T helper cells to produce new viruses, destroying them in this way. In addition, infected T helper cells are recognized and killed by other immune cells. For example, about one billion new viruses are formed every day and about as many CD4 cells are lost. Since CD4 cells, as regulators of the immune system, play a key role in the body's own defense system, the immune system gradually collapses due to its demise. This immunodeficiency can lead to other infectious diseases and tumors leading to death.
AIDS: HIV transmission
How the HI virus is transmitted is described in the article HIV transmission.
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11 important facts about AIDS
Even if one hears less about it than before, AIDS is far from being defeated. Because the enemy is tiny and incredibly changeable: the "Human Immunodeficiency Virus", HIV for short, captures immune cells and harnesses them for its own purposes. This weakens the immune system and makes the body susceptible to disease. Therefore the name AIDS, which stands for German for "Acquired Immune Deficiency Syndrome". The most important facts for you at a glance.
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AIDS is young
AIDS has not accompanied people for so long. In 1981, the disease was first described. Originally, HIV was found mainly in developing countries, but made its triumphal march around the world from there. According to the World Health Organization (WHO), about 36.9 million people were infected with HIV at the end of 2014 - 80,000 of them in Germany. But: still around 95 percent of infected people live in Third World countries.
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HIV comes from monkeys
Experts are pretty sure today that HIV originally came from monkeys. Similar viruses have been found in chimpanzees and gorillas. Comparisons of the genetic material of the pathogens show that the jump to humans took place at the beginning of the 20th century. HIV may then be spread through the intravenous treatment of tropical diseases - because by the 1930s to the 1950s, today's standards of hygiene were not yet in place.
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AIDS is deadly
Even though the life expectancy of a person living with HIV or AIDS is much higher today than it was just a few years ago, AIDS still demands a high toll, especially in developing countries. In 2014, WHO estimates, 1.2 million people worldwide died of the virus. According to Robert Koch Institute (RKI) were among them 480 Germans. In many cases, it is pneumonia or tuberculosis that cause death due to the weakened immune system of AIDS patients.
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HIV is transmitted during sex
HI viruses are transmitted via blood or infectious bodily fluids, including semen, vaginal secretions and the fluid film of the intestinal mucosa. As a result, HIV infections occur mainly via unprotected sexual contact. Small injuries in the skin can then cause the virus to invade. The following applies: the higher the viral load in the body fluid, the more likely it is to get involved.
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Breastfeeding is dangerous, saliva is not
HIV is not only spread through sex. In some cases, people have been infected with blood (such as blood products, syringes). Likewise, mothers with HIV can infect their children at birth and breastfeeding. What many do not know: HIV is not spread when kissing or sneezing. By intact skin, the virus can not penetrate into the body anyway. Social coexistence with an HIV-infected person therefore carries no risk of infection.
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HIV is often misunderstood at first
In most cases, two to three weeks after infection, the first symptoms are relatively mild. They are usually misinterpreted as a flu infection, with fever, swollen lymph nodes, dysphagia and sometimes diarrhea. After that, the viruses behave inconspicuously - this phase can take months or even years. According to the RKI, only around 50 percent of those affected show symptoms of AIDS disease ten years after initial infection.
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HIV slumbers in the body for a long time
The HI viruses infest in the body especially the so-called helper cells, which are part of the body's immune system, and destroys them. Helper cells coordinate the use of the immune system. The less of them there, the worse diseases are warded off -AIDS often makes itself creeping noticeable. The first symptoms are unremarkable. The affected people feel initially unwell, the mucous membranes change and there are indigestion.
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HIV-infected: easy target for pathogens
Finally, the number of helper cells decreases so much that the body can no longer defend itself properly against intruders. Infections that are harmless to other people are more likely to have fatal complications in people with AIDS. Particularly feared are tuberculosis and pneumonia.
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HIV is treatable, not curable
Science is intensively researching a cure for HIV. So far, the life of those affected with medication can only be prolonged. The sooner the disease is recognized and treated, the better. Therapy also reduces the risk of infection for others by reducing the number of HI viruses in the blood. In many developing countries, infected people have poor access to medicines or are too expensive.
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HIV test gives security
Information about a possible infection is an HIV test, which can be done at the doctor. It is examined whether already detect viruses or virus component. Who is tested negative six weeks after the suspected infection time, most likely not infected. Overall, there are still too few people to test. The WHO estimates that around half of those infected do not know about their condition.
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Safe sex protects against HIV
"Give AIDS no chance - protect condoms," the advertising slogan of the Federal Center for Health Education brings it to the point. Condoms are the most important remedy in the fight against HIV. Safer sex, however, also means that during intercourse, sperm, vaginal fluid, intestinal secretions or blood do not enter the body of the partner. Researchers are also working on the development of a vaccine against HIV, but that is still a dream of the future.
AIDS: examinations and diagnosis
If you are worried that you have been infected with the HI virus, consult your family doctor. He can then refer you to an AIDS specialist, such as an internist with experience in infectious diseases. First, your doctor will ask you in detail about your medical history (anamnesis). He will ask you the following questions:
- Did you have unprotected sex?
- Do you inject yourself with drugs?
- Do you have a medical profession?
- Were you in Southeast Asia or sub-Saharan and had physical contact with locals there?
- Have you had flu-like symptoms in the last few weeks?
Subsequently, your doctor will examine you. He pays attention to a possible rash and scans your lymph nodes after enlargement.
In order to confirm or rule out an infection with the HI virus, you will be given blood for an HIV test.
Read more about the investigations
- blood collection
- blood test
AIDS: HIV test
Information on this topic can be found in the article HIV Test.
In recent years, HIV research has come to new conclusions and pointed the way to new drugs against HIV. Life expectancy and quality of patients can be improved with the preparations, even if their use is associated with side effects. An HIV cure is not possible with medication.
HIV & AIDS: medicines
The HIV therapy must be tailored to each patient individually. Among other things, the exact virus type is decisive. This means that in the laboratory, the HI virus is examined for certain peculiarities in order to then be able to select suitable drugs. The preparations must be taken regularly and permanently. Only then will AIDS therapy be successful.
The medical HIV therapy aims to
- to relieve the symptoms
- to prevent the transition to a higher stage of disease,
- to rebuild a stable immune system
- to prevent a harmful permanent activation of the immune system and
- to reduce the infectiousness, ie the possibility of contagion of others.
HIV patients receive a highly active antiretroviral therapy, in short: HAART, consisting of a customized combination of different drugs. There are currently more than 20 different medicines that are used in the treatment of AIDS. It is important to combine at least three remedies in order to prevent the resistance of the HI virus from developing. The following medications are available:
- Reverse Transcriptase Inhibitors (RTI): They prevent the HI virus from multiplying by inhibiting the necessary enzyme "reverse transcriptase". Active substance examples: lamivudine, tenofovir, emtricitabine, efavirenz.
- Protease Inhibitors (PI): They prevent virus multiplication by inhibiting the recomposition of virus particles. One of these agents is atazanavir.
- Integrase Inhibitors (INI): They prevent the virus from inserting its genetic information into the human genome of the host cell so that the cell can then produce new viruses. A representative of INI is Raltegravir.
- Fusion inhibitors (FI): They prevent the virus from infiltrating a human cell. These include, for example, enfuvirtide.
Researchers are continually adapting available medicines to improve the treatment of HIV. However, the disease is not curable with any of the active ingredients, as none of them can kill all viruses. Reasons include the fact that the virus hides in the cells of the patient and that some organs such as the central nervous system for drugs are not easily accessible.
AIDS treatment: criteria for therapy
When and to what extent HAART is initiated must be decided on a case by case basis for each patient. The decisive factors are, for example, the current symptoms and the possible side effects of HIV treatment. However, there are broad guidelines as to when generally a HAART is advisable - namely, when an HIV patient suffers from symptoms of category B or C, that is, when AIDS has broken out, or when the patient is suffering from diseases related to AIDS become.
Laboratory criteria are also included in the therapy decision, for example the number of remaining T helper cells (CD4 cells): If their value is below 350 cells per microliter (μl) of blood, drug therapy is often initiated.
AIDS treatment: checkups
To determine the success of HAART, the patient is bled every two to four months. It is examined for the number of HI viruses (viral load) and T helper cells. At the latest six months after initiation of therapy, the viral load should be less than 50 per milliliter (ml) of blood. If it is higher, it may be necessary to try another combination of drugs.
AIDS: living with HIV
Drug treatment is the basis of AIDS therapy. In addition, as a patient you can do even more for your health:
- Find a doctor who is an AIDS specialist and whom you find sympathetic. You will be treated by him for a long time.
- Follow the instructions of your doctor. Take your medication according to the schedule. If you can not tolerate the preparations, do not just stop them, ask your doctor for advice.
- Get vaccinated against diseases that additionally weaken you or that are more severe because of HIV infection, such as influenza (influenza vaccine) or pneumonia (pneumococcal vaccine).
- Do not smoke and do not take drugs. That would further weaken your body.
- Eat lots of fruits and vegetables as well as whole grains. This will strengthen your immune system. If you have problems with the gastrointestinal tract, talk to a nutritionist.
- Avoid foods that may contain pathogens. These include unpasteurised dairy products, raw eggs, oysters, raw fish and raw meat. Wash raw fruits and vegetables thoroughly before eating!
- Move regularly. Not only does this make your body fitter, it also helps prevent some of the depression that is common in HIV-infected individuals.
- Sleep well enough - this strengthens your immune system.
- Be careful with pets. Always wash your hands after petting animals and wear gloves when cleaning the litter box or rodent shed (to protect against toxoplasmosis).
- Relax regularly. Any type of relaxation like Progressive Muscle Relaxation or Autogenic Training is good for your immune system.
- Wash your hands regularly. This is especially important when preparing or eating meals.
- Find an AIDS Counseling Center to find out more about living with HIV, help and self-help.
AIDS: disease course and prognosis
The course of HIV is divided into different stages:
- Acute infection: from the sixth day after the infection up to six weeks as a feverish infection.
- Inconspicuous persistence: For years, the infection may remain asymptomatic.
- Lymphadenopathy: Swollen lymph nodes lasting several months.
- AIDS related complex (ARC): Patients suffer from diseases that are due to a weakened immune system.
- AIDS: AIDS-defining diseases such as pneumonia or tuberculosis occur (sometimes only decades after infection with HIV).
The individual stages of HIV can be very diverse individually. In all patients, however, it comes to the weakening and destruction of the cellular immune system.
With the current treatment options, the life expectancy of HIV-positive people in Germany is about the same as that of healthy people. However, this only applies to younger people who are otherwise healthy and begin therapy around the age of 25. Patients with other conditions such as hepatitis B or C, the elderly or drug addicts have a limited life expectancy.In other countries with poorer health care, the survival of people with AIDS is significantly reduced.
Medical personnel can become infected with the AIDS pathogen in the care of HIV-infected and AIDS patients, for example in the case of stab wounds and contact with virus-containing body fluids (such as blood). For these cases, there is a post-exposure prophylaxis (PEP): The affected person receives over four weeks of HIV medication to reduce the likelihood of infection. Often, a triple combination of the active ingredients raltegravir, tenofovir and emtricitabine is prescribed, but other combinations may be used. The PEP should be started within 24 hours of possible infection, preferably within two hours.
Not only medical staff have the opportunity to get a PEP. If you are worried that you have been infected with the HI virus, for example, through a torn condom, consult a doctor and discuss with him the possibility or the need for a PEP and its possible side effects. An HIV test is performed at the time of first taking the medication and after six weeks, three months and six months.
There is no HIV vaccine yet. The most important protective measure against HIV and AIDS So, it's about avoiding infection (for example, by using condoms during sex).
These laboratory values are important