AIDS
Item
- Title
- AIDS
- extracted text
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A BRITISH MEDICAL ASSOCIATION PUBLICATION
AIDS
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JSkiF1 Britons
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AIDS
Dr C A Carne
•
JAIC,0 PUBLISHING HOUSE
Bombay • Delhi • Bangalore
Hyderabad • Calcutta • Madras
Contents
Introduction_______ _
_________ 3
Origin and spread
__ 10
High risk groups
17
Symptoms and disease
__ 23
Anti-HIV test
28
Controlling the spread
Treatment of AIDS and HIV infection __ 31
36
How to get help
“Safer sex” guidelines
No risk
Solo masturbation
Massage away from
the genital area
Low risk
Mutual masturbation
Dry kissing
Body rubbing
Medium risk
Wet kissing
Fellatio (“sucking")
Urination (“watersports”)
external only
Anilingus (“rimming”)
ie oral-anal sex
High risk
Anal and vaginal
intercourse (may be
safe if a condom is used)
Fisting (insertion of hand
or fist into the rectum)
Sharing sex toys and needles
Any sex act which draws blood
Remember the risk increases with multiple partners
Introduction
It is therefore not possible, strictly speaking, to
catch AIDS. It is possible, however, to catch the virus
which may eventually cause AIDS. The time between
infected with the virus but do not have AIDS often
generalised lymphadenopathy) (see pl7). This con
dition is considerably less serious than AIDS and is
Although the full natural history of HIV
often AIDS patients suffer from opportunistic infec-
tumour called Kaposi’s sarcoma (see p20).
Origin and
spread
The following month a report appeared of 20 homo^een .diagnosed ^as having the rare skin tumour^
before that.
tions, Kaposi’s sarcoma had previously been .seen only
transplants.
AIDS. The early studies found that the homosexuals
Haitians
Second type of HIV found
Recently, a second type of HIV, called HIV-2 has been
strictly speaking, be called HIV-1.
High risk groups
In the UK and USA most people with AIDS have
HIV by sharing needles and syringes contaminated
In the UK the spread of the disease among intra
venous drug abusers has been slow initially in most
areas. Nevertheless there are now a substantial
spread with increasing rapidity.
Both here and in the USA a large number of haemophi-
mophilia is a bleeding disorder caused by a deficiency
of the clotting agent called Factor VIII. It is an inher-
for us to be self-sufficient in these preparations, they
Many batches of imported Factor VIII have been con-
bodies and other measures are being taken to ensure
the safety of Factor VIII preparations.
Recipients of blood transfusions
derivecTfrom just a few^lood donors. As only a tiny
proportion of blood donors have been infected the
chances of receiving contaminated blood were ex-
made up of the heterosexual partner
utt th I ui '
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u I I til It
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while at work - 10 from accidents with dirty needles
infection as a result of casual household
the available evidence indicates that the virus
Symptoms and
disease
generalised lymphadenopathy (or PGL). Most HIV-
AIDS-related complex
Some HIV-infected people who do not have AIDS
to AIDS than others infected with HIV. The virus can
of HIV-infected people. People with AIDS may suffer
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expectancy (15 months) is- slightly better than that of
Far less commonly, AIDS patients may d®v®loP. a
lymphoma. This is a disease which affects a lot of
to be infected with HIV then the disorder is considered
to be related to AIDS. AIDS patients te"d to do worse
How HIV infection may progress to AIDS
Anti-HIV test
When a person is infected with HIV this stimulates the
Widely used
If a person is told that they are antibody positive it has
:
imnUmHnnt fnr their lives. It is therefore
method^available) to make absolutely sure before
ive is the risk of developing AIDS—at lea
ledge that one’is anti-HIV positive is especially stressC..1 T—«rthi= nnnertaintv. Manv neonle who have
c of developing AIDS
An anti-HIV positive person has to regard himself or
ARE YOU
THINKING OF
TAKING OUT
LIFE INSURANCE
ORA
MORTGAGE?
tion of the penis into the vagina, mouth or anal canal k
method oZcontraception and if she does become preg
nant she needs to consider seriously whether she wants
the pregnancy terminated. An antibody-positive per
son is also asked to inform his dentist so that necessary
safety precautions can be taken. Any doctor looking
Tell as few people as possible
tions about AIDS. Some people have been sacked from
rejection may feel so humiliated and dejected that it is
There are therefore some disadvantages in finding out
that one is anti-HIV positive. The major advantage in
taking the antibody test is that it enables one to make
important questions in life. Most people who take the
test want to establish whether or not they are infec
tious so that they can ensure that they don’t infect
other people. Many people also want to take definite
steps towards a healthier lifestyle if they are antibody
if these indicate a high risk of progression to AIDS in
Controlling the
spread
shFPpreh
Testing blood and blood products
trpatpd to kill any virus present. Unfortunately many
[reate° .
Z. infected before beat treatment was
testing of blood donors has similarly protected blood
transfusion recipients from the risk of acquiring HIV.
Intravenous drug abusers, bisexual mem and haemonhiliacs are the main groups who may spread HIV to
heterosexuals outside the recognised high risk groups.
Isolation will not work
Occasionally onT^ars people
sw^g
measures such as locking up all AIDS patients in an
attempt to control the spread of HIV. Apart from the
inhumanity of this suggestion it does not make practi
cal sense. Patients with AIDS account for only a small
proportion of HIV infected people and it is inconceiv50 000 HIV infected people in the UK and over one
million in the. USA. These suggestions are no doubt
made partly because of prejudice against some of the
high risk groups and partly because of misconceptions
about the ways in which HIV is spread.
Treatment of
AIDS and HIV
infection
about their past lifestyle and may be greatly troubled
f-show improvement, about one third stay the same, and
( the remainder continue to deteriorate. Unfortunately,
I even in those patients who show some improvement’
the effect is only temporary and .interferon generally
: makes the patient feel unwell with flu-like symptoms
1 at least when starting treatment.
| Kaposi’s sarcoma may also be treated with antiI cancer drugs known as cytotoxic drugs. These drugs
| may give the undesirable side effect of depressing the
bone marrow’s production of white cells. They can
t therefore only be used in low doses and their use needs
I to be closely monitored with blood tests. Because of the
risk of side effects from cytotoxic drugs and interferon
many doctors and patients will jointly decide that no
treatment should be given unless the disease is inter
fering with the quality of life. Often the only treatment
currently given is very low dose radiotherapy to
exposed lesions such as those on the face so that their
} appearance is disguised. This is known as cosmetic
In the absence of effective drug treatment for AIDS
I many patients will receive forms of treatment often
referred to as "alternative medicine”, frequently with
the full support of their "conventional” doctor. These
I approaches to treatment include hypnotherapy, acu
puncture, herbalism, and homeopathy. While no re
search trials have been done to assess the effectiveness
I ot these methods their use is often associated with an
increased sense of well being and a positive approach
wo T different avenues are be>ng followed by research
reverse transcriptase inhibitors. Reverse transcriptase
is an enzyme - that is, a kind of protein - which enables
the genetic information carried by the virus to be
transferred into the substance called DNA, which car’
"Reverse transcriptase is vital to the spread of the
virus within the body. By inhibiting this enzyme it
should be possible to prevent the virus spreading to
infect more cells in the immune system. One reverse
transcriptase inhibitor, zidovudine, has now been
licensed for use. It can prolong life expectancy in AIDS
patients who have had opportunistic infections but
seems less useful in those with Kaposi’s sarcoma alone.
It is also helpful in patients with ARC in delaying or
possibly preventing progression to AIDS, and has also
been shown to at least partially reverse the neurologi
cal damage done by the virus.
Current trials are examining whether zidovudine is
of benefit to all HIV antibody positive people in dimi
nishing the risk of progressing to AIDS. Other trials
are looking at whether zidovudine should be combined
to that of the patient. Identical twins are the best, but
even then success has only been short lived. This
approach has therefore been superceded by the deve-
ntoSdotethi?itr°teCt itSelf against an organismJn
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