HIV and the Risk of Opportunistic Infections

To date, there is no known cure for human immunodeficiency virus (HIV), which is a disease that attacks the lymphocytes, the components responsible for fighting off infection. Contracting HIV can open your body to diseases which can be readily fought off if you have a healthy immune system. Recovery takes longer and some don’t even recover at all, that is why you should make HIV testing a part of your annual check-up.

HIV in Singapore
The number of reported cases of HIV in Singapore has been constant at 480 annually since 2008, according to the reports from the Ministry of Health. About 93% of these cases are composed of male patients, with sexual intercourse as the leading mode of transmission of the virus. Nearly half of the cases were detected through HIV testing, but unfortunately, those cases were already at the later stages of the infection. The good news, however, is that more HIV cases are reported recently through voluntary anonymous HIV test.

MOH encourages individuals who are at high risk for infection to volunteer for HIV screening, regardless of the use of contraceptives during sexual encounters. High risk individuals include not just sex workers, but those who are also sexually active or have more than one partner. An early diagnosis can help slow down the progress of HIV to acquired immune deficiency syndrome (AIDS) and can stop the infected individual from spreading HIV.

How HIV Works
The immune system works as the first line of defense against infections through the white blood cells or lymphocytes, which are composed of T cells and B cells. When HIV enters the body, it primarily attacks the T cells. The T cells have two important tasks to protect the body from diseases. First, they travel to the macrophages and bind with peptide antigens in those cells to kill phagocytized microbes. Second, the T cells help the B cells (thus the term “T helper cells”) respond to antigens by binding to the cell and releasing cytokines.

When HIV enters the body, it specifically attaches to the T helper cells, or what some doctors call CD4 cells, and controls its DNA replication. Remember that HIV cannot reproduce by itself, so it makes multiple copies inside the T-cells so it can spread throughout the body. The process is called the HIV life cycle, which has seven stages composed of binding, fusion, reverse transcription, integration, replication, assembly, and budding.

There is no way to detect the infection as soon as you have contracted the disease. Most HIV testing can detect anomalies only after 2 or 3 weeks from the time you suspect you have been infected. To determine if you are infected, there are three types of HIV screening available at clinics and hospitals throughout Singapore, such as antibody tests, nucleic acid test, and fourth generation test. You can also perform an anonymous HIV test using an HIV test kit at home or visit in Singapore to book an appointment.

HIV and Opportunistic Infections
When a significant number of T-cells have been destroyed by the virus, your immune system suffers because you are unable to ward off even the most common infections. Even harmless colds can become fatal and recovery takes longer than usual. To effectively fight off diseases, your CD4 cell count should be between 500 to 1,000 cells/mm3. If it drops to 350 cells/mm3, you should talk to your health care provider about medications and boosters.

HIV patients with CD4 cell count below 500 cells/mm3 can acquire other diseases called opportunistic infections (OIs), while those with CD4 cell count below 200 cells/mm3 are the most vulnerable and also indicates that the HIV has already progressed to the last stage called AIDS. The OIs are so named because they take advantage of the body’s weakened immune system.

OIs can either be systemic, which affects the whole body, or localized, which affects only one part of the body. The most common OIs that affect HIV/AIDS patients are the following:

• Pneumocystis Infections can be fatal for and is also the leading cause of death of HIV patients even if it can be treated with antibiotics. Symptoms include fever, coughing, and breathing difficulties. The odds of survival are greater if treatment and care are given early.

• Candidiasis often manifests when a patient has a CD4 cell count of less than 500 cells/mm3. This can cause white patches to appear in the mouth, but can be treated with antifungal medication.

• Cryptococcosis affects the most severe HIV cases, especially those with CD4 cell count of less than 100 cells/mm3. This disease, which is one of the causes of pneumonia, is caused by a fungus that can be inhaled through the soil and transmitted to other people.

• Herpes Simplex Virus has 8 types and is common among sexually-active people, although most forms do not cause major health problems. If an HIV patient has a latent herpes virus, the condition can be reactivated and cause cold sores or ulcers to appear on moist parts of the body. The lungs and esophagus also become susceptible to infections when the herpes virus becomes active through HIV.

• Kaposi’s Sarcoma is a cancer caused by human herpes virus 8 that affects the capillaries. The capillaries grow abnormally and can be fatal if the sarcoma affects the intestines, lungs, and lymph nodes.

• Recurrent Pneumonia has many causes including viruses, bacteria, and fungi. It affects both lungs and can cause fever, breathing difficulties, coughing, and chills. HIV patients are usually given vaccines against this infection because it can be fatal.

• Tuberculosis is caused by the Mycobacterium tuberculosis bacteria that infects the lungs. Most HIV patients, however, are unaware that the bacteria also affect the lymph nodes, larynx, brain, bones, and kidneys.

• Wasting Syndrome is characterized by the loss of more than 10% of the body weight due to the loss of fat and muscle mass. It can happen within 30 days if there is recurring fever and diarrhea.

29 Dec 2017