laboratory tests are used to monitor HIV

Two blood tests are routinely used to monitor HIV-infected people. One of these tests, which counts the number of CD4 cells, assesses the status of the immune system. The other test, which determines the so-called viral load, directly measures the amount of virus in the blood.
In individuals not infected with HIV, the CD4 count in the blood is normally above 400 cells per mm³ of blood. People generally do not become at risk for HIV-specific complications until their CD4 cells are fewer than 200 cells per mm³. At this level of CD4 cells, the immune system does not function adequately and is considered severely suppressed. A declining number of CD4 cells means that HIV disease is advancing. Thus, a low CD4 cell count signals that the person is at risk for one of the many opportunistic infections that occur in individuals who are immunosuppressed. In addition, the actual CD4 cell count indicates which specific therapies should be initiated to prevent those infections.

future for preventing HIV transmission

Early advances in preventing HIV transmission resulted from educational programs describing how transmission occurs and providing barrier protection for those exposed to genital secretions and new needles or bleach to those exposed to blood by sharing needles. Despite these efforts, new infection in both the developed and developing worlds has continued at high rates.
Historically, the greatest success in preventing viral transmission has resulted from the development of preventative vaccines. Unfortunately, decades of research to develop an HIV vaccine has led to little hope for success. In 2007, a major setback in this area occurred when the STEP study investigating a promising vaccine candidate was prematurely stopped due to the lack of evidence that it produced any protection from HIV infection. In contrast, a glimmer of hope did emerge with the report in 2009 of the results of the RV 144 Thai HIV vaccine trial which demonstrated borderline effectiveness in the more than 16,000 recipients. While this vaccine demonstrated only limited evidence of protection, research is under way to further explore what can be learned for future vaccine development from this modest success.

symptoms and signs of HIV

The time from HIV infection to the development of AIDS varies. Rarely, some individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy the time for progression from initial infection to AIDS is approximately eight to10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.
Within weeks of infection, many people will develop the varied symptoms of primary or acute infection which typically have been described as a "mononucleosis" or "influenza" like illness but can range from minimal fever, aches, and pains to very severe symptoms. The most common symptoms of primary HIV infection are

• fever,
• aching muscles and joints,
• sore throat,
• and swollen glands

key principles in managing HIV infection

First of all, there is no evidence that people infected with HIV can be cured by the currently available therapies. In fact, individuals who are treated for years and are repeatedly found to have no virus in their blood experience a prompt rebound in the number of viral particles when therapy is discontinued. Consequently, the decision to start therapy must balance the risk versus the benefits of treatment. The risks of therapy include the short- and long-term side effects of the drugs, described in subsequent sections, as well as the possibility that the virus will become resistant to the therapy which can limit options for future treatment.

How is HIV spread

HIV is present to variable degrees in the blood and genital secretions of virtually all individuals infected with HIV, regardless of whether or not they have symptoms. The spread of HIV can occur when these secretions come in contact with tissues such as those lining the vagina, anal area, mouth, eyes (the mucus membranes), or with a break in the skin, such as from a cut or puncture by a needle. The most common ways in which HIV is spreading throughout the world include sexual contact, sharing needles, and by transmission from infected mothers to their newborns during pregnancy, labor (the delivery process), or breastfeeding. (See the section below on treatment during pregnancy for a discussion on reducing the risk of transmission to the newborn.).
Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex. The best way to avoid sexual transmission is abstinence from sex until it is certain that both partners in a monogamous relationship are not HIV-infected. Because the HIV antibody test can take months to turn positive after infection occurs, both partners would need to test negative for at least 12 and up to 24 weeks after their last potential exposure to HIV. If abstinence is out of the question, the next best method is the use of latex barriers. This involves placing a condom on the penis as soon as an erection is achieved in order to avoid exposure to pre-ejaculatory and ejaculatory fluids that contain infectious HIV. For oral sex, condoms should be used for fellatio (oral contact with the penis) and latex barriers (dental dams) for cunnilingus (oral contact with the vaginal area). A dental dam is any piece of latex that prevents vaginal secretions from coming in direct contact with the mouth. Although such dams occasionally can be purchased, they are most often created by cutting a square piece of latex from a condom.

diagnosis of HIV

n 1985, a blood test became available that measures antibodies to HIV that are the body's immune response to the HIV. The test used most commonly for diagnosing infection with HIV is referred to as an ELISA. If the ELISA finds HIV antibodies, the results must be confirmed, typically by a test called a Western blot. HIV antibody tests remain the best method for diagnosing HIV infection. Recently, tests have become available to look for these same antibodies in saliva, some providing results within one to 20 minutes of testing. Antibodies to HIV typically develop within several weeks of infection. During this interval, patients have virus in their body but will test negative by the standard antibody test, the so called "window period." In this setting, the diagnosis can be made if a test is used that actually detects the presence of virus in the blood rather than the antibodies, such as tests for HIV RNA or p24 antigen. Recently, a new test has been approved that measures both HIV antibodies and p24 antigen, shrinking the duration of the window period from infection to diagnosis. There also are many testing centers around the country that are routinely screening blood samples that are HIV-antibody negative for HIV RNA. Although the tests for detecting HIV infection continue to improve, they still require that people volunteer for testing. It is estimated that approximately 20% of those infected with HIV in the United States are unaware of their infection because they have never been tested. In order to decrease the number that are unaware of their HIV infection status, in 2006, the Centers for Disease Control and Prevention recommended that all people between the ages of 13 and 64 years be provided HIV testing whenever they encounter the health-care system for any reason. In addition, resources are available to facilitate people finding local HIV testing centers

What is the history of HIV, and when was HIV discovered

The history of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) dates back to 1981, when homosexual men with symptoms of a disease that now are considered typical of AIDS were first described in Los Angeles and New York. The men had an unusual type of lung infection (pneumonia) called Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia (PCP) and rare skin tumors called Kaposi's sarcomas. The patients were noted to have a severe reduction in a type of cell in the blood (CD4 cells) that is an important part of the immune system. These cells, often referred to as T cells, help the body fight infections. Shortly thereafter, this disease was recognized throughout the United States, Western Europe, and Africa. In 1983, researchers in the United States and France described the virus that causes AIDS, now known as HIV, belonging to the group of viruses called retroviruses. While HIV infection is required to develop AIDS, the actual definition of AIDS is the development of a low CD4 cell count (<200 cells/mm³) or any one of a long list of complications of HIV infection ranging from a variety of so-called "opportunistic infections," cancers, neurologic symptoms, and wasting syndromes.

Folic Acid

Folic acid is a B vitamin. It helps the body make healthy new cells. Everyone needs folic acid. For women who may get pregnant, it is really important. When a woman has enough folic acid in her body before and during pregnancy, it can prevent major birth defects of her baby's brain or spine.
Foods with folic acid in them include leafy green vegetables, fruits, dried beans, peas and nuts. Enriched breads, cereals and other grain products also contain folic acid. If you don't get enough folic acid from the foods you eat, you can also take it as a dietary supplement.

Insect Bites and Stings

 Most insect bites are harmless, though they feel unpleasant. Bee, wasp, and hornet stings and fire ant bites usually hurt. Mosquito, flea and mite bites usually itch. Insects can also transmit diseases, such as yellow fever and malaria. These diseases mainly are a risk for travelers outside the United States.
To prevent insect bites and their complications

• Don't bother insects
• Use insect repellant
• Wear protective clothing
• Be careful when you eat outside because food attracts insects
• If you know you have severe allergic reactions to insect bites, carry an emergency epinephrine kit

Finger Injuries and Disorders

You use your fingers and thumbs to do everything from grasping objects to playing musical instruments to typing on a keyboard. When there is something wrong with them, it can make life difficult. Common problems include

• Injuries that result in fractures, ruptured ligaments and dislocations
• Osteoarthritis - wear-and-tear arthritis, which can also cause deformity
• Tendinitis - irritation of the tendons
• Dupuytren's contracture - a hereditary thickening of the tough tissue that lies just below the skin of your palm, which causes the fingers to stiffen and bend
• Trigger finger - an irritation of the sheath that surrounds the flexor tendons, sometimes causing the tendon to catch and release like a trigger

Fibromyalgia

Fibromyalgia makes you feel tired and causes muscle pain and "tender points." Tender points are places on the neck, shoulders, back, hips, arms or legs that hurt when touched. People with fibromyalgia may have other symptoms, such as trouble sleeping, morning stiffness, headaches, and problems with thinking and memory, sometimes called "fibro fog."
No one knows what causes fibromyalgia. Anyone can get it, but it is most common in middle-aged women. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia. There is no cure for fibromyalgia, but medicines can help you manage your symptoms. Getting enough sleep and exercising may also help.

Uterine Fibroids

Uterine fibroids are the most common non-cancerous tumors in women of childbearing age. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. The cause of fibroids is unknown. Risk factors include being African-American or being overweight.
Many women with uterine fibroids have no symptoms. If you have symptoms, they may include

• Heavy or painful periods or bleeding between periods
• Feeling "full" in the lower abdomen
• Urinating often
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages or early labor

Most women with fibroids can get pregnant naturally. For those who cannot, infertility treatments may help. Treatment for uterine fibroids includes medicines that can slow or stop their growth, or surgery. If you have no symptoms, you may not even need treatment.

Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels and medicines you take may cause lumps, bumps and discharges.
If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.
Some common causes of breast changes are

• Fibrocystic breast condition - lumpiness, thickening and swelling, often associated with a woman's period
• Cysts - fluid-filled lumps
• Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
• Intraductal papillomas - growths similar to warts near the nipple
• Blocked or clogged milk ducts
• Milk production when a woman is not breastfeeding
• Injury

Prenatal Testing

Prenatal testing provides information about your baby’s health before he or she is born. Some routine tests during pregnancy also check on your health. At your fist prenatal visit, your healthcare provider will test for a number of things, including problems with your blood, signs of infections, and whether you are immune to rubella (German measles) and chickenpox.
Throughout your pregnancy, your healthcare provider may suggest a number of other tests, too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV. Other tests might be offered based on your:

• Age
• Personal or family health history
• Ethnic background
• Results of routine tests

Some tests are screening tests. They detect risks for or signs of possible health problems in you or your baby. Based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby.

Fetal Alcohol Syndrome

If you are pregnant and drink alcohol, so does your baby. This can hurt your baby's growth and cause life-long physical and behavioral problems. One of the most severe effects of drinking during pregnancy is fetal alcohol syndrome (FAS). FAS is a group of problems that can include

• Mental retardation
• Birth defects
• Abnormal facial features
• Growth problems
• Problems with the central nervous system
• Trouble remembering and/or learning
• Vision or hearing problems
• Behavior problems

FAS lasts for a lifetime. There is no cure. Special school services can help with learning problems. Routines and consistency at home may help with behavior problems. Women can prevent FAS and other problems related to alcohol use by not drinking when they are pregnant or might get pregnant.

Sexual Problems in Women

 There are many problems that can keep a woman from enjoying sex. They include

• Lack of sexual desire
• Inability to become aroused
• Lack of orgasm, or sexual climax
• Painful intercourse

These problems may have physical or psychological causes. Physical causes may include conditions like diabetes, heart disease, nerve disorders or hormone problems. Some drugs can also affect desire and function. Psychological causes may include work-related stress and anxiety. They may also include depression or concerns about marriage or relationship problems. For some women, the problem results from past sexual trauma.
Occasional problems with sexual function are common. If problems last more than a few months or cause distress for you or your partner, you should see your healthcare provider.

Female Infertility

Infertility is a term doctors use if a woman hasn’t been able to get pregnant after at least one year of trying. If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from physical problems, hormone problems, and lifestyle or environmental factors.
Most cases of infertility in women result from problems with producing eggs. One problem is premature ovarian failure, in which the ovaries stop functioning before natural menopause. In another, polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or may not release a healthy egg.
About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.
If you suspect you are infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technologies. Happily, two-thirds of couples treated for infertility are able to have babies.

Hyperopia

Your cornea is the clear front part of your eye. It is like a window that controls and focuses the light coming into the eye. If your cornea has an irregular shape, the light does not focus properly. Everything looks blurry. This is a refractive error.
Four common refractive errors are

• Myopia, or nearsightedness - clear vision close up but blurry in the distance
• Hyperopia, or farsightedness - clear vision in the distance but blurry close up
• Presbyopia - inability to focus close up as a result of aging
• Astigmatism - focus problems caused by the cornea

Glasses or contact lenses can usually correct refractive errors. Laser eye surgery may also be a possibility.

Contraception

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways. These include

• Preventing sperm from getting to the eggs - condoms, diaphragms and intrauterine devices (IUDs) work this way
• Keeping the woman's ovaries from releasing eggs that could be fertilized - birth control pills work this way
• Sterilization, which permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant

Your choice of birth control should depend on several factors. These include your health, frequency of sexual activity, number of sexual partners and desire to have children in the future. Your health care provider can help you select the best form of birth control for you.

Kidney Diseases

Your kidneys are two bean-shaped organs, each about the size of your fists. They are located near the middle of your back, just below the rib cage. Inside each kidney about a million tiny structures called nephrons filter blood. They remove waste products and extra water, which become urine. The urine flows through tubes called ureters to your bladder, which stores the urine until you go to the bathroom.
Damage to the nephrons results in kidney disease. This damage may leave kidneys unable to remove wastes. Usually the damage occurs slowly over years. There are no obvious symptoms, so you don't know it is happening.
Many things can cause kidney disease. You are at risk if you have

• Diabetes
• High blood pressure
• A close family member with kidney disease

Your doctor can run tests to find out if you have kidney disease. If your kidneys fail completely, a kidney transplant or dialysis can replace the work your kidneys normally do.

Mosquitoes Inject Saliva, Not Blood

Because hepatitis B and hepatitis C are spread by contact with infected blood, it's very tempting to think of mosquitoes as flying hypodermic needles. However, the "needle" that mosquitoes feed with, called the proboscis, is actually a complex structure that has separate channels. When a mosquito bites, it injects saliva through one channel. The saliva functions as a lubricant to help the mosquito feed easier. The blood it sucks as a meal flows in a completely separate channel and only in one direction: toward the mosquito. So, it's biologically unlikely for infected blood to be spread to another person.

Why Mosquitoes Don't Spread Hepatitis

It's a beautiful day and you're outside enjoying the fresh air. You feel a small prick on your arm and notice that a mosquito is getting a free meal. Without realizing, you kill it with a quick slap of your hand, but notice a little blood on your arm where the mosquito was. Along with the nuisance of a mosquito bite, you might be worried about possible infections you can catch, including hepatitis.
It's intuitive to think that when a mosquito bites someone infected and then bites another person, the second person could be exposed to viral hepatitis. Fortunately, viral hepatitis isn't spread from mosquitoes.

Tylenol Cause Liver Damage

Tylenol, generically called acetaminophen, is a very popular and effective drug for pain relief and reducing fever. Because it's so well known (it's been available since the 1950s) and it's so common (it's widely combined with other medications), it's sometimes used carelessly which can lead to liver damage.

Is Tylenol Safe?

Yes, Tylenol is very safe when used as recommended. Many people with chronic hepatitis and other types of liver disease (who don't regularly drink alcohol) can safely take the recommended doses of Tylenol; however, you should definitely check with your physician before taking any medication if you have liver disease. For people with advanced cirrhosis (decompensated cirrhosis), Tylenol probably can't be used because of the serious existing liver damage. If you have serious liver disease, talk to your doctor about appropriate dosing and best alternatives for treatment of pain or fevers.

Why Is the Liver Affected by Tylenol?

Tylenol is quickly absorbed into the blood through the gastrointestinal tract. Once in the blood stream, it begins to relieve pain by increasing you're body's overall threshold to pain and it reduces fever by helping to get rid of excess heat. Ultimately, the blood filters through the liver where most of the drug is metabolized (broken down) and its components are excreted in the urine.

Diagnosing Autoimmune Hepatitis

Autoimmune hepatitis is diagnosed using blood tests and liver biopsy. The blood tests look for a variety of auto-antibodies, which are similar in ways to normal antibodies except they attack the body's own cells and tissues. For type 1, the most common circulating auto-antibodies are antinuclear antibodies (ANA). A more specific, but less prevalent auto-antibody (as compared to ANA) is the anti-smooth muscle antibody (ASMA). For type 2, the major auto-antibodies are called anti-liver-kidney microsomal-1 antibodies (ALKM-1 and ALC-1), but these are usually only found in children. Circulating levels of immunoglobulins are generally high in autoimmune hepatitis. A liver biopsy helps to confirm diagnosis and determine the degree of liver damage. Imaging tests, such as ultrasound or CT (computerized tomography) also may help detect the presence of cirrhosis, which can be caused by autoimmune hepatitis.

Autoimmune Hepatitis

Autoimmune hepatitis is chronic liver inflammation that's caused by the body's malfunctioning immune system. The same important process that identifies harmful invading bacteria and viruses and protects your body from them somehow becomes altered to attack and damage your liver cells. Why this begins isn't completely understood, but the leading theory is that it's triggered by some drug or infection in people who have inherited a trait that makes them more likely to develop an autoimmune disease. Autoimmune hepatitis, if untreated, can lead to cirrhosis and liver cancer.

Who's at Risk for Autoimmune Hepatitis?

About 70 percent of people with the disease are women, usually between the ages of 15 and 40. However, autoimmune hepatitis is an uncommon disease.

Living With Hepatitis

Perhaps your first reactions are disbelief and fear. While these are understandable responses to unpleasant news, hepatitis, even in its chronic form, is a treatable disease. With proper treatment and good lifestyle choices, it is possible to live a full and active life. For many people, the treatment goal in chronic hepatitis is to prevent the development of cirrhosis of the liver. Doctors do this by controlling the effects of hepatitis with medications. However, medicine is only one part of the therapy. Living with hepatitis involves some minor lifestyle changes. The good news is that these changes can be wonderfully beneficial to your entire body and mind, in addition to your liver. Let's start with the basics of nutrition.

What You Should Eat and Drink

The liver is a major organ of metabolism and is responsible for removing toxins in the body from the food we ingest. One of the safest dietary practices for someone with a diseased liver is to avoid additional toxins such as alcohol, alternative remedies that are unknown to science and all recreational drugs. It is important to realize that all these are processed as toxins by the liver and can be especially dangerous to one that is damaged. Even prescribed medications are of concern and doctors will probably require additional blood tests to monitor liver functions when these medications are required.

How Hepatitis C Spreads

Needlestick Injuries in Healthcare

Nurses and physicians, and other technicians who routinely use needles while providing medical care, are at risk for needlestick injuries. In fact, it's estimated that more than 600,000 needlestick injuries happen each year, with nurses being at most risk. An average of about 2 percent of needlestick injuries where there has been exposure to the virus will result in acute hepatitis C.

Blood Transfusion

In the past, blood transfusion was a common way hepatitis C was spread. People who had hemophilia or thalassemia (or some other disease requiring multiple transfusions) were especially at risk for exposure. However, now it is very rare because donated blood is tested for HCV antibodies and also HCV genetic material. Experts believe that your chances today of getting hepatitis C from a blood transfusion is about one in 2 million.

Mother-Infant Transmission

Since only about 4 percent of infants born to mothers with hepatitis C will be infected with the virus, this type of spread (known as vertical spread) is relatively uncommon. However, the risk nearly doubles if the mother is co-infected with HIV. Also, the chance of spreading HCV at birth is probably more likely if the mother has a higher viral load at the time of delivery.