HIV/AIDS

HIV/AIDS: Overview

AIDS – acquired immunodeficiency syndrome – was first reported in the United States in 1981 and has since become a major worldwide epidemic.  When the first AIDS cases were recognized, few would have thought that so many years would pass without a cure being discovered.  There still remains speculation as to the causative agent; although the controversy continues, AIDS is commonly thought to be caused by the human immunodeficiency virus (HIV).  By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers.

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Incidence; Causes and Development

By 2001, more than 750,000 cases of AIDS had been reported in the United States and as many as 1,000,000 Americans were thought to be infected with HIV – an invection rate of about 0.4%.  Growing most rapidly among minority populations, it is a leading killer of African-American males.  The rates of infection are very high in some southern African countries, with the situation in Botswana being described as shocking – by 2001 some 36% of the adult population was infected.  South Africa came second in that region with a 20% rate.

HIV is spread most commonly by having unprotected sex with an infected partner, contact with infected blood or being born to an HIV-infected mother.  Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies.  HIV also can also be spread to babies through the breast milk of infected mothers.

Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.  HIV is not spread by biting insects such as mosquitoes or bedbugs.  Scientists also have found no evidence that HIV is spread through sweat, tears, urine, or feces.

Signs and Symptoms

Many people do not have any symptoms when they first become infected with HIV.  Some people, however, have a flu-like illness within a month or two of being exposed to the virus.  This illness may include fever, headache, tiredness or enlarged lymph nodes.  These symptoms are often mistaken for those of another viral infection.  During this period, people are very infectious and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not surface for years after infection in adults, or for two years in children born with HIV infection.  This period of "asymptomatic" infection is highly individual.  Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is multiplying, infecting, and killing cells of the immune system, especially T4 cells (CD4+).  At the beginning of its life in the human body, the virus disables or destroys these cells without causing symptoms.

The term AIDS applies to the most advanced stages of HIV infection.  The Center for Disease Control defines AIDS as all HIV-infected people who have fewer than 200 T4 cells per cubic millimeter of blood.  Healthy adults usually have 1,000 or more.  In addition, the definition includes over 20 clinical conditions that affect people with advanced HIV disease.  Most of these conditions are opportunistic infections that generally do not affect healthy people.  Amongst people with AIDS, these infections are often severe and sometimes fatal because the immune system is so damaged by the virus that it can no longer fully resist.

Children with AIDS may get the same opportunistic infections as adults.  In addition, they also have severe forms of the bacterial infections that all children may get, such as conjunctivitis (pink eye), ear infections or tonsillitis.

During the course of HIV infection, most people experience a gradual decline in the number of T4 cells, although some may have abrupt and dramatic drops in their T4 cell counts.  A person with a T4 cell count above 200 may experience some of the early symptoms of HIV disease, while others may have no symptoms even though their T4 cell count is below 200.

Early symptoms include headache, night sweats, weight loss, fatigue, swollen lymph glands, fever, heavily coated white tongue, diarrhea, and lung infections.

The most common clinical presentations in the high-risk groups or ARC patients include: chronic generalized lymphadenopathy, splenomegaly, fever, fatigue, malaise, night sweats, weight loss, anorexia, oral candidiasis, recurrent herpes infections, and diarrhea.  Also, a mononucleosis-like syndrome can occur, characterized by prolonged fever, rigors, myalgias, arthralgias, rash, abdominal cramps, and diarrhea, and this is associated with seroconversion for the HIV antibody.

Diagnosis and Tests

Because early HIV infection often causes no symptoms, a doctor usually diagnoses it by testing a person's blood for the presence of antibodies to HIV.  HIV antibodies generally do not reach detectable levels in the blood for one to three months following infection.

People exposed to the virus should get an HIV test as soon as they are likely to develop antibodies to the virus i.e. within 6 weeks to 12 months after possible exposure to the virus.  By detecting it early, people with HIV infection can discuss with their doctor when they should start treatment to help their immune systems combat HIV and help prevent the emergence of opportunistic infections.  Early testing also alerts HIV-infected people to avoid high-risk behaviors that could spread the virus to others.

Health care providers diagnose HIV infection by using two different types of antibody tests, ELISA and Western Blot.  If a person is highly likely to be infected with HIV and yet both tests are negative, the doctor may request additional tests.  The person also may be told to repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.

Polymerase chain reaction (PCR) testing is more expensive and labor-intensive but can detect the virus even in someone only recently infected.  Urine testing for HIV antibodies is not as sensitive or specific as blood testing but may be used for someone who does not want blood drawn.

Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months.  If these babies lack symptoms, a doctor cannot make a definitive diagnosis of HIV infection using standard antibody tests until after 15 months of age.  By then, babies are unlikely to still carry their mothers' antibodies and will have produced their own, if they are infected.  Health care experts are using new technologies to detect HIV itself to more accurately determine HIV infection in infants between ages 3 months.

Treatment and Prevention

To effectively deal with the confusion about AIDS, the diagnosis and it's treatment requires personal involvement.  It really is important that everyone facing AIDS must educate themselves carefully in order to be prepared for the challenges and comfortable with the decisions that will need to be made.  While many alternative therapies have turned out to be less effective than initially thought, there is much that can be done to enhance immune function and keep the infection in check.

Signs, symptoms & indicators of HIV/AIDS:

Lab Values - Cells

Symptoms - Bowel Movements

Symptoms - Food - General

Symptoms - Glandular

(Frequent/multiple) swollen cervical nodes

Swollen, firm and possibly tender lymph nodes lasting longer than three months are a symptom of AIDS.

Symptoms - Metabolic

Resolved atypical recent/current atypical headaches

Some people get a flu-like illness within a month or two after first getting HIV.  The flu-like symptoms often go away within a week, and include fever, headache, fatigue (being a lot more tired than usual, and all the time), swollen lymph nodes (glands in the neck and groin).

Symptoms - Nails

Black/brown fingernails

Black nails are sometimes seen in people infected with AIDS.

Symptoms - Nervous

Conditions that suggest HIV/AIDS:

Dental

Digestion

General

Excessive Fatigue

Fatigue can be one of the most debilitating symptoms experienced by people with HIV disease, as well as one of the most under-reported and under-recognized aspects.  The rate of fatigue increases as the disease progresses and women are more likely to experience fatigue than men.  HIV-positive men with CD4 cell counts below 500 cells/ml experienced more fatigue than men with CD4 cell counts above 500.  However, studies so far have not found a consistent correlation between viral load and fatigue.  The fatigue may be due to anemia, depression, the HIV virus, secondary infections, hormone deficiency (testosterone, adrenal exhaustion), malnutrition, poor sleep quality or quantity, inactivity, or drug side-effects.

Immunity

Immune System Imbalance (TH2 Dominance)

In HIV progression to AIDS, there is a shift from Th1 (cellular immunity) to the less effective Th2 (humoral immunity).

Infections

Valley Fever (Coccidioidomycosis)

The depressed cellular immunity seen in HIV infection increases the risk of coccidioidomycosis.  Individuals with AIDS are at high risk not only for pulmonary coccidioidomycosis but for the disseminated form and cutaneous form of the disease.

Leukoplakia

HIV or AIDS patients are especially likely to develop hairy leukoplakia.  Although modern drugs have reduced its incidence, as many as 25% of HIV-positive people still develop hairy leukoplakia.  It can be one of the first signs of HIV infection.

Shingles (Herpes Zoster)

Some people with AIDS develop frequent and severe shingles; shingles is 9 times more likely to develop in those infected with HIV.

Canker Sores (Aphthous Ulcers)

Any condition that attacks or suppresses the body's immune system can cause you to develop mouth ulcers.

Lab Values

Metabolic

Sexually-Transmitted Diseases

Herpes Simplex Type II

AIDS has been associated with frequent and severe genital herpes infections.

Herpes Simplex Type II

AIDS has been associated with frequent and severe genital herpes infections.

Skin-Hair-Nails

Night Sweats

The most common clinical presentations in the high-risk groups or ARC patients includes night sweats.  If HIV has progressed to an advanced stage, night sweats become a severe problem.

Symptoms - Reproductive - STDs

Counter-indicators

Tumors, Malignant

Non-Hodgkin's Lymphoma

People with HIV have a weakened immune system and, as a result, are more likely to develop certain cancers.  Non-Hodgkin's Lymphomas are the second-most common type of malignancy after Kaposi's Sarcoma in HIV patients.

Kaposi's Sarcoma

People with HIV/AIDS are particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma, cervical cancer or cancers of the immune system known as lymphomas.

Risk factors for HIV/AIDS:

Medical Procedures

Personal Background

Latin / Hispanic ethnicity

According to the U.S.  Centers for Disease Control and Prevention (CDC), AIDS affects nearly seven times more African Americans than whites.  [CDC HIV/AIDS Surveillance Report, Vol. 12, 2000]

Symptoms - Immune System

Symptoms - Reproductive - General

Symptoms - Reproductive - STDs

Counter-indicators
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HIV/AIDS suggests the following may be present:

Hormones

Low Male Testosterone Level

An estimated 45% of men with untreated AIDS and 25% of asymptomatic, untreated HIV-infected men experience low testosterone levels.  Both men and women may be negatively affected by testosterone deficiency.

Infections

Herpes Simplex Type I

Some AIDS sufferers develop frequent oral herpes infections.

Sexually-Transmitted Diseases

Herpes Simplex Type II

About 80% of people with HIV are also infected with genital herpes.  Those infected with both HIV and HSV are likely to have more frequent, serious and long-lasting outbreaks of herpes.

Tumors, Malignant

Cervical Cancer

HIV-infected women are more likely to acquire human papillomavirus (HPV), including the high-risk subtypes 16 and 18 that can lead to cervical dysplasia and cervical cancer.  HIV-infected women also have increased persistence of HPV.

Uro-Genital

Vaginitis/Vaginal Infection

Scientists are finding that the status of vaginal flora may significantly affect both the amount and the survival of HIV virus inside the female genital tract.  Abnormal vaginal flora – i.e. infection with candida or bacterial vaginosis – corresponded with increased amounts of HIV virus in the cervico-vaginal secretions of women who were HIV-positive.  The HIV infection rate among women with bacterial vaginosis is twice as high as it is in those with healthy vaginal flora.  Understanding these dynamics can "help shape preventative strategies aimed at reducing both heterosexual and the mother-to-child transmission of HIV", the researchers observed.  [BJOG 2001;108: pp.634-641]

HIV/AIDS can lead to:

Dental

Digestion

Hormones

Low Adrenal Function / Adrenal Insufficiency

In general, diagnosis and treatment endocrine issues in HIV patients is no different from non-HIV patients.  However, HIV can cause reactive changes in pituitary and adrenal function, as can many HIV medications.

Immunity

Immune System Imbalance (TH2 Dominance)

In HIV progression to AIDS, there is a shift from Th1 (cellular immunity) to the less effective Th2 (humoral immunity).

Lab Values

Metabolic

Tumors, Malignant

Kaposi's Sarcoma

People with HIV/AIDS are particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma, cervical cancer or cancers of the immune system known as lymphomas.

Recommendations for HIV/AIDS:

Action

Amino Acid / Protein

Glutamine

Individuals with muscle-wasting and immune-system related illnesses (such as cancer or AIDS) who may be incapable of manufacturing their own supply of glutamine, may benefit from glutamine supplements taken along with other amino acids.

Botanical

Garlic

In one study, 10 patients with AIDS who were given 5 to 10gm per day of an aged garlic extract later had increased levels of natural killer cells, a higher helper:suppressor ratio, and reduced infection rates.

Marijuana

Marijuana is being used to moderate wasting syndrome in AIDS patients.  [Grinspoon, L., and Bakaler, J.B.  "Marijuana as Medicine." Journal of the American Medical Association 1995; 273(23): pp1875-76.]

MGN-3

During the normal progression of this disease, NK cell activity begins to drop along with that of other immune cells.  T4 levels routinely decrease at a rate of about 15% per year.  Dr Ghoneum, who has been researching MGN-3 since 1993, reports that T4 levels can be maintained in almost every case of AIDS he has tested, and oftentimes they will even begin to increase.  Although the number of patients studied has been limited, all of the patients who have taken MGN-3 reported a noticeable difference in their well-being, and have continued to use the product.  Most felt that MGN-3 was instrumental in helping them stabilize their disease.

Mistletoe

A German study examined the use of Iscador, a mistletoe extract, in 40 HIV-positive patients with less than 200 T4 cells/ml.  Patients injected themselves subcutaneously with 0.01mg to 10mg of Iscador twice per week for eighteen weeks.  The only toxicities were transient fever on the day of injection and soreness at the injection site.  The researchers of this small, unblinded and unreviewed study reported that 28 of the 36 patients (77%) had increases in T4 levels of greater than 20%.  Iscador should only be administered under the supervision of a doctor familiar with its use.  [Gorter R, et al.  Abstract PO-B28-2167.  IX International Conference on AIDS.  Berlin.  June 1993]

Bladderwrack

Alginic acid has been shown to inhibit HIV in the test tube.  [Béress A, Wassermann O, Bruhn T, et al.  A new procedure for the isolation of anti-HIV compounds (polysaccharides and polyphenols) from the marine alga Fucus vesiculosus.  J Nat Prod 1993;56: pp478-88.] However, this effect has not been studied in humans.

Chemical

BHT (Butylated Hydroxytoluene)

BHT is a potent inactivator of lipid-enveloped viruses.  The viral envelope structure is physically disturbed by BHT, thereby interfering with viral adsorption to host cells.  Since the virus generally believed responsible for AIDS contains a lipid envelope, BHT warrants investigation as a potential antiviral agent against the AIDS virus.  Published scientific evidence strongly suggests that BHT might help in treating AIDS or ARC and that any risks can be kept small.  No one expects BHT to be a cure, but if it can help in the management of AIDS and/or CMV, it would have value now until better treatments become available.

Diet

Sugar Avoidance / Reduction

Sugar and corn syrup found in many desserts impair the engulfing power of white blood cells.  The worst offenders are found in canned soda, candy bars, pastry and other processed desserts.  Even sugars found in fruit juice, when consumed quickly, will have a depressive effect on immune cells.

Coconut

Lauric acid from coconut oil, coconut milk and fresh or cooked coconut meat, at 24gm daily for adults, may be an effective aid in the destruction of lipid-enveloped viruses such as HIV, HHV-6 (strains A and B), EBV, CMV and herpes.  This treatment may be used continuously as viral resistance or immune system adaption is not expected to develop.

Not recommended
Therapeutic Fasting

Extended fasting should be avoided in AIDS patients, who tend to be malnourished already.

Drug

Conventional Drug Avoidance

Prednisone must be used cautiously by HIV-positive individuals because it is immunosuppressive and can increase the risk of getting opportunistic infections.

Hormone

Melatonin

Melatonin slows HIV replication in cell cultures.

Lab Tests/Rule-Outs

Test for Hormones

Several studies have shown that testosterone levels are generally lower and that testosterone administration alleviates fatigue and depression in men with HIV/AIDS.  In one study, 80% of men reported significant improvements in their energy levels.  [General Hospital Psychiatry, July 1998]

Oxygen / Oxidative Therapies

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