Dr William Brian McNaull. — Photo courtesy of Family Medical Practice

By Dr William Brian McNaull*

What is AIDS?

AIDS is the most advanced stage of HIV infection. Once HIV infection develops into AIDS, infections and cancer pose a greater risk.

Without treatment, HIV infection is likely to develop into AIDS as the immune system gradually wears down. However, advances in ART mean than an ever-decreasing number of people progress to this stage.

By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.

There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.

Primary infection (Acute HIV)

Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include: fever, headache, muscle pain, sore throat, rash and swollen lymph glands

These symptoms can be so mild that you might not even notice them.

The transition from HIV to AIDS

HIV destroys CD4 T cells — white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes. You can have an HIV infection for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication.

AIDS presentation

Thanks to better antiviral treatments, most people with HIV in the West today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years.

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers.

The signs and symptoms of some of these infections may include:

• Soaking night sweats
• Recurring fever
• Chronic diarrhea
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Persistent, unexplained fatigue
• Weight loss
• Skin rashes or bumps

How HIV spreads

To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways:

• By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body.
• From blood transfusions. In the West this risk is extremely small.
• By sharing needles.
• During pregnancy or delivery or through breast-feeding. (Vaginal secretions, breast milk). HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies.

NB. You can't become infected with HIV through ordinary contact.

Complications of Aids

A. Infections common to AIDS

• Tuberculosis (TB). TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS.
• Cytomegalovirus. A healthy immune system inactivates the virus but it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.
• Candidiasis. Widespread candidiasis is a common HIV-related infection.
•    Coccidioidomycosis: Fungal
•    Histoplasmosis: Fungal lung infection
•    Cryptococcal meningitis.
• Toxoplasmosis. Infected cats pass the parasites in their stools. Seizures occur when it spreads to the brain.
• Cryptosporidiosis. Leads to severe, chronic diarrhea in people with AIDS.

B. Cancers common to AIDS

• Kaposi's sarcoma. A tumor of the blood vessel walls, only common in HIV-positive individuals.
• Lymphoma. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

C. Additional Complications

• Neurological complications. Such as confusion, forgetfulness, depression, anxiety and difficulty walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and reduced mental functioning.
• Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine.

Prevention

There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection.

To help prevent the spread of HIV:

• Use a new condom every time you have sex.
• Consider preexposure prophylaxis (PrEP). New combination drugs can reduce the risk of sexually transmitted HIV infection in people at high risk.
• These daily drugs can be prescribed for HIV prevention but only if you don't already have HIV infection. You will still need to practice safe sex.
• Tell your sexual partners if you have HIV. 
• Use a clean, sterile needle.
• If you're pregnant, get medical care right away.
• Consider male circumcision. — Family Medical Practice

* Living in Hà Nội since 2006, Dr Brian is presently Medical Director of Family Medical Practice Hà Nội. Graduated in the UK, he has practiced medicine principally in Canada (1981-2005) until coming to Việt Nam. Post graduate medical training includes Cambridge University (Chronic Disease Epidemiology and Biostatistics), University College London (Tropical and Infectious disease) and University of Toronto Hospitals (Hospital for Sick Children – Hematology and Bone Marrow Transplant) and Mt Sinai Hospital (Hepatology – Clinical trials experimental liver/virology unit 1997-2006). He has conducted medical research, worked and lectured in various countries on infectious disease topics, epidemiology and liver disease (Canada, Việt Nam, Cambodia, Philippines). He is also weekly co-host of Radio the Voice of Việt Nam’s (VOV5) ‘Doctor at Home’.

For more advice on any medical topics, visit Family Medical Practice (FMP) Hà Nội at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748. Email: hanoi@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh City location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền St, Dist 2. Tel: (028) 38227848. Email: hcmc@vietnammedicalpractice.com

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh St, Hải Châu Dist, Đà Nẵng. Tel: (0236) 3582 699. Email: danang@vietnammedicalpractice.com