In this essay we will discuss about:- 1. Introduction to HIV 2. Meaning of HIV 3. Clinical Features 4. Diagnosis 5. Treatment 6. Terminal Care.

Contents:

  1. Essay on the Introduction to HIV
  2. Essay on the Meaning of HIV
  3. Essay on the Clinical Features of HIV
  4. Essay on the Diagnosis of HIV
  5. Essay on the Treatment of HIV
  6. Essay on the Terminal Care of HIV

Essay # 1. Introduction to HIV:

The full term for the word AIDS is Acquired Immu­nodeficiency Syndrome. There is a relation between infection with the human immunodeficiency virus (HIV) and the development of AIDS. HIV infection is caused by the exchange of semen, vaginal secre­tions, milk or blood which is infected by virus.

The transmission for HIV occurs through anal or vagi­nal intercourse. The infection with HIV is higher with anal than with vaginal intercourse. Intrave­nous drug abusers (IVDA) are affected by HIV in­fection due to the practice of “needle sharing” which allows transmission of HIV infected blood from 01 individual to another.

Transmission of the virus is also caused by transfusion of infected blood or blood products (coagulation factors for hemo­philia). The disease specially occurs among homo­sexuals, contaminated bisexuals, promiscuous heterosexuals, drug abusers, babies from affected mother’s milk, people receiving blood transfusion. AIDS is a viral disease due to retrovirus, now called HIV.

Essay # 2. Meaning of HIV:

(a) HIV belongs to the subfamily of retroviruses. Retroviruses have an RNA genome and transcribe a DNA copy of the RNA genome after penetration of the host cell. The DNA is used as a template to tran­scribe new RNA viral copies—thus the term “retrovirus”.

(b) HIV has a core consisting of the RNA ge­nome and core protein surrounded by an envelope with high lipid content render­ing it sensitive to organic compounds.

(c) The virus gains entry to host cells by bind­ing to the CD4 receptor using the viral sur­face membrane glycoprotein 120. The CD4 receptor is present abundantly on T-helper lymphocytes. After the penetration of the host cell, the viral RNA is transcribed by the viral enzyme reverse transcriptase into a DNA copy which becomes incorporated into the host cell genomic DNA.

The viral DNA may then lie dormant within the cell or undergo replication resulting in tran­scription of RNA copies and translation to viral proteins causing new virus formation and assembly. Viruses then bud from the cell surface. New virus is then available to infect other cells and repeat the process.

(d) HIV is of two types—HIV-1 and HIV-2. HIV-1 is extremely antigenically variable and many different strains are found within a single patient. HIV-1 is responsible for disease in Western Europe, North America and Central Africa. HIV-2 causes clinical syndrome similar to HIV-1 infection and it is chiefly found in West Africa.

(e) HIV also infects cells in the central nerv­ous system (CNS) by the migration of HIV infected monocytes to the brain.

(f) The number of CD4 cells circulating in peripheral blood is gradually decreased during the course of HIV disease.

(g) HIV principally affects CD4 helper T- lymphocytes (TH cells) and even can in­fect and impair the function of many other cell types, mainly cells of the monocyte, dendritic cells and B-lymphocytes.

(h) HIV infection is confirmed by detecting the presence of antibodies to HIV in the patient’s serum. Such antibodies are de­tected by the current ELISA test which is simple and cheap and has the advantage of a very low false negative rate. All posi­tive results are normally confirmed by the more precise Western blot test.

Following infection, the detection of antibodies to HIV may not occur for three months and sometimes much longer. This indicates that serial testing may need to be per­formed on a patient following a high risk of exposure to HIV in order to definitely exclude infection. However, ELISA be­comes the routine screening test for the “same day” testing service.

(i) The drugs for regular clinical use are re­verse transcriptase inhibitors that inhibit the spread of infectious virus into uninfected cells but do not affect replica­tion of the HIV genome once it is inte­grated into the host cell.

The drugs in clini­cal use at the moment are zidovudine (AZT), didanosine (dideoxyinosine, DDI) and zalcitaline (de-deoxycytidine, DDC). Zidovudine is although generally recom­mended still it has got side-effects includ­ing nausea, vomiting, headaches, anemia, neutropenia, and occasionally leucopenia and thrombocytopenia. Macrocytosis also develops in most patients.

Essay # 3. Clinical Features of HIV:

(a) HIV infection is followed by seroconversion which coincides with a brief clinical illness for about two weeks after which HIV antibodies appear in the blood. Symptoms of this illness include fever, headache, malaise, macular popular rash, tender lymphadenopathy, encepha­litis. All individuals infected with HIV proceed to AIDS which is fatal.

(b) Some HIV infected patients develop per­sistent generalized lymphadenopathy (PGL) which expresses the presence of enlarged lymph nodes greater than 1 cm in diameter in two anatomically distinct sites for more than three months in the ab­sence of other detectable causes of lym­phadenopathy. Most of the patients are asymptomatic, although a few have fever and weight loss.

Essay # 4. Diagnosis of HIV:

(a) More attention is applied on the sugges­tive features in the presence of persistent fever, continuous loss of weight, oral can­didiasis, diarrhoea, and cough with thick ex­pectoration, leucopenia, anemia, lym­phadenopathy and thrombocytopenia.

(b) These above cases should be selected for ELISA test for HIV infection. Positive ELISA test should be confirmed by other tests like Western blot (WB) and Immun­ofluorescence test. Virus can also be con­firmed by electron microscopy.

Essay # 5. Treatment of HIV:

(a) The main theory today depends on the fol­lowing:

1. Direct effect on the virus or its en­zymes.

2. Immunodulation. It means boosting up of immune response of the patient by which the virus may be eliminated by interleukin-2 therapy and alpha and gamma interferon therapy.

(b) Several antiviral agents have also been tried without satisfactory results. No suc­cess has also been obtained with the trial of autologous bone marrow transplant, pal­liative radiotherapy, chemotherapy and vaccine.

(c) Drug therapy is also not effective for pre­vention, progression or spread of the dis­ease.

(d) Counselling is only the most important and valuable.

(e) Different Antiviral Treatment.

Aggressive and Conservative

Essay # 6. Terminal Care of HIV:

(a) Good support from a partner, family and friends can be of great help during this potentially distressing time.

(b) Effective attention is given to the control of anorexia, nausea, vomiting, dry mouth and diarrhoea.

(c) Dysphagia may be a problem and many medications can be given rectally.

(d) Intramuscular injections should be avoided.

(e) Syringe drivers for subcutaneous or intra­venous delivery of anti-emetics and opi­ates can be extremely useful.

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