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Signs And Symptoms Of HIV In Women

Early on, human immunodeficiency virus (HIV) causes flu-like symptoms, which are similar across sexes. HIV symptoms in women may differ after the initial infection and include changes in menstrual cycles and increased vaginal infections.

HIV is an infection that attacks cells in your immune system, known as CD4 cells. If untreated, HIV may progress to acquired immunodeficiency syndrome (AIDS), which increases the risk of severe infections.

Women may experience unique symptoms of HIV. Read on to learn about how HIV affects women, special considerations for women with HIV, and when to consult a healthcare provider.

Generally, people with HIV do not have symptoms right away. It may take 10 years or longer for people with HIV to notice symptoms or complications. HIV symptoms progress in stages: acute and chronic HIV. Chronic HIV may progress into AIDS if untreated. Acute HIV symptoms develop within two to four weeks after HIV exposure. During this stage, HIV quickly multiplies and spreads throughout the body. Within two to four weeks after exposure, about two-thirds of people with HIV have flu-like symptoms such as fever, chills, and fatigue. Those symptoms are your body's natural response to infection. Other acute HIV symptoms include: Mouth ulcers Muscle aches Night sweats Rash Sore throat Swollen lymph nodes Chronic HIV is also known as asymptomatic HIV infection. It's possible for people not to have any symptoms or feel sick. Severe HIV complications, such as a weak immune system, take years to develop. With chronic HIV, HIV continues to multiply but at lower levels. Chronic HIV can last about 10 years before progressing to AIDS if untreated. People with HIV develop AIDS if their CD4 counts fall below a certain level. AIDS increases the risk of opportunistic infections, those that happen more often or severely in people with weak immune systems than others. In addition to opportunistic infections, AIDS symptoms include: Anal, genital, or mouth sores Blotches on the skin Depression Diarrhea Memory loss or other neurological problems Pneumonia Rapid unintentional weight loss Reoccuring fevers Swollen lymph nodes On average, people with AIDS survive for three years without treatment. However, people with AIDS who receive antiretroviral therapy (HAART) can live for more than 10 years after onset. Several HIV-related health changes during chronic HIV infection are specific to women. It's possible not to experience any complications for quite some time. Still, they can eventually develop. Bone Loss People with HIV, especially women with HIV, experience faster bone loss than others without HIV. Generally, women tend to lose bone faster than men because of the hormonal changes after menopause. Having HIV can affect women's bone loss more so than usual. Early Menopause Menopause happens when you do not have a menstrual period for at least 12 months. In the United States, the average age for menopause is 52. People with HIV tend to enter menopause earlier than that. You may notice various changes, including the onset of hot flashes, during the time leading up to menopause. A hot flash causes sudden heat in the upper part or all of your body. The sensation can last anywhere from 30 seconds to 10 minutes and can happen at varying frequencies. Typically, people with HIV have more severe hot flashes than those without the virus. Menstrual Cycle Changes You may notice changes to your menstrual cycle if you have HIV. For example, people with HIV might miss their periods. They might also have lighter or heavier bleeding than before having HIV. People with HIV are more likely to have severe premenstrual syndrome (PMS) symptoms than others, such as: Backache Bloating or a gassy feeling Changes in appetite Constipation Cramps Diarrhea Headache Irritability Sleeping too little or too much Swollen or tender breasts In the United States, about 2% of transgender people make up new HIV diagnoses. Social and medical factors may affect symptoms in transgender women with HIV. Transgender women may face several obstacles in receiving proper healthcare compared to people with different gender identities. For example, transgender women may experience discrimination in healthcare settings, such as being called by the incorrect name or pronouns. Some evidence suggests that transgender women with HIV may have concerns over interactions between HIV medicines and gender-affirming treatments. Research has found that transgender women may develop more severe bone loss and have a higher risk of heart disease than others with HIV. As a result, transgender women with HIV are less likely to take HIV medicine than others. Recognizing those obstacles and taking steps to reduce them may help improve outcomes among transgender women with HIV. For example, experts advise healthcare providers to consider gender-affirming healthcare history (e.G., past hormone use or surgery) and adjust HIV medicines accordingly. HIV attacks and weakens the immune system. As a result, women with HIV have a higher risk than others of developing health conditions, such as: Cervical cancer: This cancer begins in the cervix, or the lowermost part of the uterus. Certain strains of human papillomavirus (HPV) are among the most common causes of cervical cancer. Women with HIV are more likely to have HPV than others. People with low CD4 counts are more likely to have abnormal cells in their cervix that may develop into cancer. Flu: People with low CD4 counts or those not taking HIV medicine are more likely to have complications from the flu than others. One of the most common flu complications is pneumonia. Heart disease: This is a group of conditions that affect your heart. Heart disease occurs when fatty substances build up in your arteries that carry blood to your heart. Certain HIV medicines may increase heart disease risk. Eating a healthy diet, regularly exercising, and not smoking help prevent heart disease. Hepatitis: This is an infection of the liver. Experts advise people with HIV to receive vaccines that prevent hepatitis A and B and regular tests for hepatitis B and C. Kidney disease: HIV may infect your kidney cells. As a result, HIV—as well as some HIV medicines—may damage the filters, or nephrons, in your kidneys that produce urine and remove waste. Pneumocystis pneumonia (PCP): Normally, your body keeps a balance of "bad" and "good" germs in your body. One of those "bad" germs is Pneumocystis jirovecii, a fungus. That fungus may grow out of control in people with weak immune systems, like those with HIV. Sexually transmitted infections (STIs): These infections spread through sexual contact. Some people with HIV are at risk for certain STIs, like herpes and pelvic inflammatory disease (PID). STIs may cause more severe symptoms and be harder to treat in people with HIV than others. Vaginal yeast infections: These infections happen when a fungus, Candida albicans, overgrows in the vagina. Candida overgrowth may occur if you have an illness that weakens your immune system, such as HIV. Vaginal yeast infections that happen at least four times a year are most common among people with chronic HIV. Pregnant or breastfeeding people and those taking HIV medication may be at risk for potential complications.  Transmission to Children HIV can pass from mother to child during pregnancy, birth, and breastfeeding. Still, people with HIV can have healthy pregnancies. The risk of passing HIV to an infant is less than 1% if you take precautions. A healthcare provider will likely advise the following precautions: Getting tested for HIV if you are pregnant or trying to become pregnant: A healthcare provider may advise testing again during your third trimester if you are HIV-negative but at risk of contracting the virus. Taking pre-exposure prophylaxis (PrEP): This medicine can help prevent HIV if you test negative for the virus but are at risk of contracting it. Using HIV medicine: This helps keep HIV at undetectable levels in your body. You may be able to deliver vaginally if your HIV levels are low. HIV medicine also prevents the virus from spreading through breast milk.  Pregnant people with HIV—and their children once they are born—need to take HIV medicine to reduce the risk of transmission. HIV Medicine Complications People with HIV can take antiretroviral therapy (ART) to bring and keep HIV at undetectable levels. ART allows people to live with few complications and minimal risk of passing HIV to others. Generally, women taking ART may have different—sometimes more severe—side effects from HIV medicines. Certain HIV medicines may cause nausea, rashes, and vomiting at higher rates in women than others. Some HIV medicines can interact with hormonal birth control and increase the risk of unintended pregnancy. You can use any form of birth control if you have HIV. Still, you might need a secondary form of protection if you typically use hormonal methods like implants, pills, or shots. Talk with a healthcare provider about the best birth control option if you take ART. Consult a healthcare provider or go to a clinic to receive a blood test if you suspect that you have had exposure to HIV and have flu-like symptoms. Any number of illnesses may cause those early symptoms and do not necessarily mean you have HIV. Still, the only way to know for sure is a blood test. Some people with HIV never develop early symptoms. A blood test is essential if you think you have had exposure to HIV and do not have flu-like systems.   Early diagnosis is vital for HIV. The sooner you receive a blood test and diagnosis, the sooner you can start treatment to bring and keep HIV at undetectable levels. Staying in close contact with healthcare providers is essential. HIV puts you at an increased risk of complications from infections. Talk to a healthcare provider about what to do if there is a change in your health, such as if you get the flu. Practicing safer sex, sometimes called "safe sex," can help prevent spreading STIs. The only way to completely prevent the spreading of STIs is to abstain from all forms of sex. However, ways to have safer sex include: Using a barrier, such as condoms, internal condoms, dental dams, and/or latex or nitrile gloves when you have any form of sex, including when using sex toys Getting regular STI testing Washing your hands before and after touching your or your partner's genitals Washing sex toys with soap and water before and after use—you can also use condoms on sex toys Using alcohol or other substances responsibly—drinking or getting high can lower your decision-making ability and could lead to forgetting to use barriers, using condoms incorrectly, or not practicing good hygiene Women with HIV may notice early menopause, menstrual cycle changes, and more frequent vaginal infections than average. HIV may impact bone loss and cervical cancer risk.  Consult a healthcare provider if you think you have had exposure to HIV. A blood test is the only way to know if you have HIV. The sooner you know you have HIV, the sooner you can begin treatment to bring and keep HIV at undetectable levels.

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HIV/AIDS

HIV (human immunodeficiency virus) is a viral infection transmitted through the sexual route.  Intravenous needle sharing, infected blood transfusions and transmission from mother to child during birth and breastfeeding can also cause HIV infection. The symptoms become manifest two to four weeks after HIV infection.  Symptoms can also be delayed for as long as ten months. HIV causes acquired immunodeficiency syndrome (AIDS) and can cause complications.  Treatment of HIV / AIDS comprises antiretroviral drugs and lifestyle management. The patient may suffer from opportunistic infections, which are usually fatal. Hence control of infection in an HIV positive patient is a crucial part.

Types

HIV is classified into two different types:

  • HIV-1: HIV-1 is commonly found all around the world
  • HIV-2: HIV-2 is prevalent in Western Africa. It is uncommon elsewhere.
  • Stages

    The stages and progression of HIV infection is as following:

    Asymptomatic phase: HIV infection initial stages without any significant symptoms. However, changes in the immune system are noted. This phase can last up to 3 months. Primary infection to develop into HIV disease and immunosuppression takes many years.

    Primary infection: The patient replicates the HIV in his bloodstream and lymph nodes in this phase of the disease.

    Symptomatic stage: this is known as the late phase of HIV disease, also known as acquired immunodeficiency syndrome. The patient is at risk of developing opportunistic infections such as tuberculosis, candidiasis during this phase of infection.

    Symptoms

    Patients may remain asymptomatic initially after infection. Symptoms progress over two to three weeks after infection, the delay in symptoms for ten months has also been noted in many patients. Non-specific symptoms of HIV may occur during the Acute retroviral phase of the illness. Symptoms pointed out during this phase are as following-

  • Headache
  • Diarrhoea
  • Swollen lymph nodes
  • Fatigue
  • Skin rash
  • Night sweats
  • Sore throat
  • Joint pain
  • Muscle pain
  • The symptoms during chronic HIV infection symptoms of the following disease can be observed:

    Chronic HIV infection without AIDS

  • Vaginal candidiasis
  • Herpes zoster
  • Thrush
  • Cervical dysplasia
  • Bacillary angiomatosis
  • Cervical carcinoma in situ
  • Chronic HIV infection with AIDS
  • Candidiasis
  • Recurrent Pneumonia
  • Chronic ulcers
  • Herpes simplex
  • HIV related encephalopathy etc.
  • Risk Factors

    Following are the routes of acquiring HIV/AIDS infection:

  • Sexual transmission is a primary route of getting HIV infection
  • Blood transfusions from infected individuals
  • Needle sharing with an infected individual.
  • Transmission from an infected mother to child.
  • Prevention

    The following measures can prevent the spread of HIV infection:

  • Sharing needle should be avoided. Discard it after using it once.
  • Use a clean condom; discard the used condom.
  • A pregnant female with HIV infection should be treated.
  • It is essential to inform the sexual partner if the individual is HIV positive.
  • Diagnosis

    Screening test and confirmatory test are the mainstays for the diagnosis of HIV infection. A complete blood count is performed to assess thrombocytopenia, leukopenia or anaemia. CD4 cell count and viral load are also essential in the diagnosis of HIV infection. Differential diagnosis also plays a significant role in testing for HIV infection. For example, considering cardiovascular disorders, order cardiac biomarkers.

    In the case of acquired immunodeficiency syndrome, pneumonia is a significant complication. Planning of chest X-Ray may be valuable to detect pulmonary infiltrates. Arterial blood gases provide essential information about an HIV infected person. Tuberculosis testing should be done. Sputum cultures are necessary for detecting bacterial infections. Other diagnostic tests such as CT scan may be crucial if disseminated TB is a possible diagnosis, especially in patients with acquired immunodeficiency syndrome. Individual with AIDS and decreased cd4 cell counts are at risk for pancreatitis and cholecystitis. Industries diagnostic tests such as bilirubin, transaminase and light base are functional.

    Esophagogastroduodenoscopy is essential in patients with dysphagia. Diarrhoea is a common symptom in patients with AIDS. In these patients testing for bacteria, parasite, and ova should be performed. In severe refractory cases, colonoscopy is essential. Neurological complaints of HIV and AIDS should be detected using CT scan, CSF analysis, and lumbar puncture.

    Treatment

    Antiretroviral drugs: Antiretroviral drugs are the mainstay of treatment in HIV infected patients. Nucleoside/ nucleoid reverse transcriptase inhibitors in many combinations available. Along with this, CCR5 inhibitors and protease inhibitors are also used in the treatment of HIV infected patience.

    Highly active antiretroviral therapy (HAART) is a vital part of HIV treatment.

  • Single tablet regimens of tenofovir disoproxil 245mg, Rilpivirine 25mg and Emtricitabine 200mg are used in a frequency of once daily. Associated side effects can be insomnia, flatulence, diarrhoea, nausea, vomiting, rash, weakness, fatigue, etc.
  • Elvitegravir 150mg/emtricitabine 200mg/cobicistat 150mg/tenofovir 245mg is given as once a day single tablet. Side effects such as fatigue, dizziness, flatulence, rash, sleepiness, and diarrhoea are associated with this drug.
  • Dolutegravir 50mg/abacavir 600mg/lamivudine 300mg is used as a single tablet daily. Side effects such as itching, depression, muscle pain running nose, indigestion, nausea, vomiting, fatigue loss of appetite can occur.
  • Nucleoside/ nucleotides reverse transcriptase inhibitors (NRTIs)
  • Abacavir in the dose of 300 MG tablet is given two times a day. Associated side effects can be abdominal pain, headache, tiredness, fever, nausea and vomiting.
  • Emtricitabine in the doze off of 200 mg capsule should be given once daily. Associated side effects can be diarrhoea, nausea, high creatinine kinase levels, headache, and dark skin.
  • Lamivudine tablet with a dose of 150 and 300 mg two times a day should be prescribed. Hair loss, nausea, vomiting, diarrhoea and joint pain are some Ill effects that can occur.
  • Zidovudine which comes in 100 and 250 mg capsules, should be given two times a day. Muscle pain, headache, nausea and vomiting, loss of appetite, fever, and fatigue are possible effects of the drug.
  • Tenofovir disoproxil 245 mg should be given once a day. Side effect such as rash, weakness, dizziness, headache for fatigue and stomach pain are associated with this drug.
  • Fixed-dose combinations of NRTI
  • Abacavir 600mg/Lamivudine 300mg once a day should be taken.
  • Abacavir 300mg/ Lamivudine 150mg/Zidovudine 300mg is another Fixed-dose combination used.
  • Emtricitabine 200mg/tenofovir disoproxil 245mg is available.
  • Lamivudine 150mg/Zidovudine 300mg once daily is another fixed-dose combination available to treat HIV.
  • Integrase inhibitors

    Dolutegravir 50mg once or twice a day, Raltegravir 400mg tablet twice a day should be taken.

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
  • Ultrafine 100/200mg tablets and Rilpivirine 25mg tablets are taken.Maraviroc 150mg and 300mg tablets twice a day.

    Protease Inhibitors

  • Atazanavir 150,200 and 300mg capsules once a day.
  • Darunavir 600 and 800 mg tablets once a day.
  • Lopinavir 20mg /ritonavir 50mg tablet twice a day.
  • Atazanavir 300mg/cobicistat 150mg taken once a day.
  • Lifestyle Management
  • Inform your sexual partners about your HIV status.
  • You must use clean needles for injecting drugs; dispose of them after use.
  • Circumcision reduces the risk of HIV infection.
  • Use of condoms containing a water-based lubricant that is more protective.
  • Pregnant women can take the treatment.
  • Prognosis And Complications

    Prognosis

    The progress of a patient suffering HIV with CD4 count greater than 500 lives a normal life compared to a person with a low CD4 level. Patients with AIDS who have untreated opportunistic infections have a low life expectancy.

    Complications

    A major complication to HIV is its progression to AIDS. It can be recognised when there is a low CD4 count with signs of opportunistic infections.

    AIDS usually occurs when the lymphocyte count is below a specific level, and one of the following infections is present:

  • Tuberculosis
  • Cytomegalovirus
  • Candidiasis
  • Lymphoma
  • References
  • Stat Pearls. Acquired Immunodeficiency Syndrome. [Internet] [Updated on Sept 8, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK537293/.
  • Stat Pearls. HIV disease current practice. [Internet] [Updated on Dec 30, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK534860/.
  • Infectious disease reports. Pathogenesis of HIV Infection. [Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC3892619/.
  • HHS Public Access. Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV.[Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC4130780/.
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    AIDS Wasting Syndrome

    AIDS wasting syndrome isn't a specific disease. Someone with AIDS is said to have it when they've lost at least 10% of their body weight, especially fat and muscle. They may have also had diarrhea for at least a month, or extreme weakness that's not related to an infection.

    We don't understand it well, but it doesn't happen as much as it used to, thanks to antiretroviral therapy (ART), the drugs that treat HIV. Still, it's a significant threat in AIDS patients. It makes opportunistic infections, dementia, and death more likely. Even a weight loss of 5% can raise your chances of trouble.

    Keep an eye on your weight and eat well, even when you're not hungry. Call your doctor if you lose weight suddenly, have severe diarrhea, or get an infection that affects your tummy and guts.

    Most important, stay on your HIV medication and keep up with your doctor visits.

    The top reason for wasting syndrome is not takingART medications, so don't miss a dose.

    You may simply not be eating enough to get the nutrients your body needs to do its best.

    When you have HIV, especially if you are not taking ART medications, you burn calories fast. This could be because your immune system is working hard, or it may be because HIV has affected the hormones that control your metabolism. Whatever the reason, you'll need more calories to keep up your weight. This can be a challenge because HIV can take away your appetite.

    Other things that may make you not want to eat and lead to weight loss:

  • Medication side effects like nausea, changes in taste, or mouth tingling
  • Symptoms of opportunistic infections, like a painful throat or stomach discomfort
  • Lack of energy
  • Depression
  • Sometimes, your body may not be absorbing the nutrients that you are getting. HIV can damage the lining of your intestines, or you may have an infection that could be interfering. Diarrhea is a side effect of some medicines.

    People with HIV tend to have high levels of cytokines. These trigger your body to make more fats and sugars, but fewer proteins, the building blocks for your muscles.

    Your doctor will want to assess the status of your HIV infection -- whether you are taking your ART, and what your HIV viral load and CD4 count are. If your virus is not controlled and you have a low CD4 count (AIDS), they will want to do tests for various opportunistic infections.

    Your doctor will also ask you questions about weight loss and other symptoms, your diet, the medications you're taking, and your recent moods.

    If your doctor wants to check the tissues in your body, you'll need a body composition test. Bioelectrical impedance analysis (BIA) is one example of this kind of test: While you're lying down, someone will measure how well a painless electrical signal travels through your body. You should have this testing done somewhere that has experience with AIDS wasting syndrome.

    You may also need tests to help your doctor find out if you have problems absorbing nutrients.

    Megestrol acetate (Megace) is an appetite stimulant. Some doctors don't recommend it though, because it can build body fat and slow the release of hormones from sex glands.

    Marijuana is legal for medical uses in some states. It can make you hungry, soothe nausea, and lessen pain. But it can cause breathing problems such as bronchitis.

    Dronabinol (Marinol), a man-made form of an active ingredient in marijuana, has similar effects as marijuana and may improve your mood and stabilize your weight. However, insurance companies often don't pay for it.

    Your doctor may adjust your ART drugs to avoid or ease diarrhea. And you should treat any opportunistic infections that affect your intestines.

    Diet changes can also prevent and relieve diarrhea. Limit fat, lactose (in dairy products), and insoluble fiber found mainly in whole grains and some vegetables. Eat more soluble fiber from oat bran, nuts, lentils and beans, and some fruits and veggies. Stay away from caffeine, alcohol, and high-sugar sweets.

    Nutritional supplements (like Advera and Ensure) may help if you're not getting enough nutrients.

    Somatropin (Serostim and other brand names), a human growth hormone, helps you gain weight and lean body mass. It's approved by Medicaid, but it's also expensive. And it causes high blood sugar levels and muscle and joint pain.

    Progressive resistance training can help you develop lean body mass. When you exercise, you can gradually increase weight, repetitions, or sets to make you stronger.

    Testosterone and anabolic steroids may help you build muscle, but because they're related to sex hormones, they can cause male infertility or irregular periods. They can also lower your good cholesterol (HDL).

    Thalidomide (Thalomid) can lower levels of cytokines. The down side is possible muscle weakness. You may also get tingling or burning in your arms or legs.






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