1www.drjayeshpatidar.blogspot.comHIV /AIDSWhat is HIV/AIDS?HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (AcquiredImmunodeficiency Syndrome), a health condition in which a person is affected by a seriesof diseases because of poor immunity. HIV by itself is not an illness and does not instantlylead to AIDS. An HIV-infected person can lead a healthy life for several years beforehe/she develops AIDS.TransmissionA person can get infected with HIV through the following routesUnprotected sex, Sharing of needles, Unsafe blood, Improperly sterilized hospital tools andMother to Child.DiagnosisIn the early stages of infection, HIV often causes no symptoms and the infection can bediagnosed only by testing a persons blood. Two tests are available to diagnose HIVinfection - one that looks for the presence of antibodies produced by the body in responseto HIV and the other that looks for the virus itself.SymptomsMany people do not develop any symptoms when they first become infected with HIV.Some people, however, get a flu-like illness within three to six weeks after exposure to thevirus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness,nausea, diarrhea and enlarged lymph nodes (organs of the immune system that can be feltin the neck, armpits and groin).TreatmentTill today, there is no conclusive treatment to eliminate HIV from the body; however,timely treatment of opportunistic infections can keep one healthy for many years. The
2www.drjayeshpatidar.blogspot.comcommonly available treatment for AIDS is the treatment against opportunistic infections.Life after HIVThe experience of infected people during the last two decades has shown that HIV is notthe "end of the world" and that there is good quality life for several more years. Takingcare of ones health, keeping in mind ones vulnerability to diseases, and a positive attitudehave been found to be very useful.PreventionBecause there is no effective vaccine and no cure for HIV, the only way to protect oneselfis prevention. People should either avoid having sex with multiple partners or use latexcondoms, during oral, anal, or vaginal sex. Only condoms made of latex should be used,and whenever necessary only water-based lubricants should be used. People who areallergic to latex can use polyurethane condoms.Safe Sex GuideNo risk or very low risk - No reported cases due to these behaviors - Masturbation - mutualmasturbation, Touching - massage, Erotic massage - body rubbing, Kissing, Oral sex on aman with a condom, Oral sex on a woman with a dental dam, Glyde dam, plastic wrap, orcut-open condom, Not sharing drug injecting, body piercing instruments, needles, syringes,Using properly sterilized hospital tools.Blood SafetyThe Human Immunodeficiency Virus (HIV), which causes AIDS, is easily transmittedthrough blood transfusions. In fact, the chances that someone who has received atransfusion with HIV blood will himself or herself become infected are estimated to beover 90 percent.Frequently Asked QuestionsHIV stands for Human Immunodeficiency Virus. As the name suggests it only causesdisease in humans, which leads to the depletion of white blood cells leading to lowering ofimmunity. Once the virus enters the body it lies dormant for many years and hence is
3www.drjayeshpatidar.blogspot.comknown as a slow virus. Most other viruses for example, those causing measles, mumps,chicken pox, etc., manifest the disease in 14-21 days after it enters the body. Hence theincubation period is short (2-3 weeks) whereas in HIV infection it is very long and runsinto years.What is HIV?HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (AcquiredImmunodeficiency Syndrome), a health condition in which a person is affected by a seriesof diseases because of poor immunity. HIV by itself is not an illness and does not instantlylead to AIDS. An HIV infected person can lead a healthy life for several years before s/hedevelops AIDS.What is AIDS?As the name, Acquired Immunodeficiency Syndrome indicates, AIDS is a health conditionthat results from the deficiency in the bodys immunity following HIV infection. HIVattacks the human body by breaking down its immune system that is meant to fightdiseases. Over a period of time, the immune system weakens and the body loses its naturalability to fight diseases. At this stage, various diseases affect the infected person.Human ImmunodeficiencyVirusTRANSMISSION FrançaisA person can get infected with HIV through the following routes:Unprotected sex:
4www.drjayeshpatidar.blogspot.comIf a person engages in sexual intercourse with an infected person withoutusing a condom, s/he can get infected. The sexual act can be both vaginal andanal.Sharing of needles:If a person shares the needle or syringe used by/on an infected person, eitherfor injecting drugs or drawing blood or for any other purpose involvingpiercing, s/he can get infected. Instruments used for piercing and tattooingalso carry a small risk of infection.Unsafe blood:A person can get the infection, if he/she is given transfusion of infected blood.Improperly sterilised hospital tools:If surgical devices like syringes and scalpels, or even certain instruments, usedon an infected person, are used on another person without proper sterilization,they can transmit the infection.Parent to Child:An HIV positive mother can transmit the virus to child during pregnancy orbirth. Breast milk can also act as a transmission-medium.Theoretically oral sex without condom (on men) or barriers like dental dam,vaginal dams or plastic wrap (on women) can also transmit the infection.How is HIV diagnosed?
5www.drjayeshpatidar.blogspot.comIn the early stages of infection, HIV often causes no symptoms and theinfection can be diagnosed only by testing a persons blood. Two tests areavailable to diagnose HIV infection - one that looks for the presence ofantibodies produced by the body in response to HIV and the other thatlooks for the virus itself.Antibodies are proteins produced by the body whenever a disease threatens it. When thebody is infected with HIV, it produces antibodies specific to HIV. The first test, calledELISA (Enzyme Linked Immunosorbent Assay), looks for such antibodies in blood.If antibodies are present, the test gives a positive result. A positive test has to be confirmedby another test called Western Blot or Immunoflouroscent Assay (IFA). All positive testsby ELISA need not be accurate and hence Western Blot and repeated tests are necessary toconfirm a persons HIV status. A person infected with HIV is termed HIV- positive orseropositive.As ELISA requires specialized equipment, blood samples need to be sent to a laboratoryand the result will be available only after several days or weeks. To cut short this waitingperiod, RAPID TESTS , that give results in 5 to 30 minutes, are increasingly being usedthe world over. The accuracy of rapid tests is stated to be as good as that of ELISA.Though rapid tests are more expensive, researchers have found them to be more costeffective in terms of the number of people covered and the time the tests take.The HIV- antibodies generally do not reach detectable levels in the blood till about threemonths after infection. This period, from the time of infection till the blood is testedpositive for antibodies, is called the Window Period . Some times, the antibodies mighttake even six months to show up. Even if the tests are negative, during the Window Period,the amount of virus is very high in an infected person. Hence, if a person is newly infected,the risk of transmission is higher.If a person is highly likely to be infected with HIV and yet both the tests are negative, adoctor may suggest a repetition of the tests after three months or six months when theantibodies are more likely to have developed.
6www.drjayeshpatidar.blogspot.comThe second test is called PCR (Polymerase Chain Reaction), which looks for HIV itself inthe blood. This test, which recognizes the presence of the virus genetic material in theblood, can detect the virus within a few days of infection.There are also tests like Radio Immuno Precipitation Assay (RIPA) , a confirmatory bloodtest that may be used when antibody levels are difficult to detect or when Western Blot testresults are uncertain. Other available tests are Rapid Latex Agglutination Assay , asimplified, inexpensive blood test that may prove useful in medically disadvantaged areaswhere there is a high prevalence of HIV infection, and p24 Antigen Capture Assay .Are there any steps to be followed before and after the blood tests?The process of getting tested for HIV can generate a variety of intense emotional reactionssuch as fear, anger and denial. Therefore, psychological counselling is essential to prepareindividuals undergoing testing for the possible consequences. This is called Pre-TestCounseling and is unavoidable for anybody preparing to take a test.If the test result is positive, it should not be disclosed without another round of counseling.This Post-Test Counseling is more crucial because of the enormous stress and themultitude of emotions that the infected person could undergo on learning his/her HIVstatus. A positive test has been linked to increased suicide ideas and attempts andemotional trauma, both at the time of knowing the positive result and also at the emergenceof AIDS-defining symptoms.As there is still considerable stigma and discrimination attached to HIV/AIDS, the decisionwhether to test or not itself should be preceded by considerable introspection andassessment of the possible outcome. The person to take test should be aware of theemotional trauma and the possible consequences a positive test could bring about. Forthese reasonse, pre-test counseling is very crucial. With the help of the counselor, theperson taking the test should assess his/her personal setting and prepare himself/herself forthe probable consequences.
7www.drjayeshpatidar.blogspot.comOn the other hand, one should also be aware of the positive advantages of learning onesHIV status. If the test turns out to be positive, one can have early access to treatment, takecare of ones health better and plan the future. Early realization of the health condition canbe very useful in a large number of cases. The counselor could help the infected individualwin back his/her confidence and learn how to live a healthy and responsible life. Theindividuals should also be prepared how to deal with their relatives, friends, colleagues,classmates etc. If the test is negative, the person should be advised preventive methods.What are the early symptoms of HIV infection?Many people do not develop any symptoms when they first become infected with HIV.Some people, however, get a flu-like illness within three to six weeks after exposure to thevirus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness,nausea, diarrhoea and enlarged lymph nodes (organs of the immune system that can be feltin the neck, armpits and groin). These symptoms usually disappear within a week to amonth and are often mistaken for another viral infection.During this period, the quantity of the virus in the body will be high and it spreads todifferent parts, particularly the lymphoid tissue. At this stage, the infected person is morelikely to pass on the infection to others. The viral quantity then drops as the bodys immunesystem launches an orchestrated fight.More persistent or severe symptoms may not surface for several years, even a decade ormore, after HIV first enters the body in adults, or within two years in children born withthe virus. This period of "asymptomatic" infection varies from individual to individual.Some people may begin to have symptoms as soon as a few months, while others may besymptom-free for more than 10 years. However, during the "asymptomatic" period, thevirus will be actively multiplying, infecting, and killing cells of the immune system.What Happens Inside the Body?Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called
8www.drjayeshpatidar.blogspot.comCD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever thereis an infection, CD4 cells lead the infection-fighting army of the body to protect it fromfalling sick. Damage of these cells, hence can affect a persons disease-fighting capabilityand general health.After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNAthen gets attached to the DNA of the host cell and thus becomes part of the cells geneticmaterial. It is a virtual takeover of the cell. Using the cells division mechanism, the virusnow replicates and churns out hundreds of thousands of its own copies. These cells thenenter the blood stream, get attached to other CD4 cells and continue replicating. As aresult, the number of the virus in the blood rises and that of the CD4 cells declines.Because of this process, immediately after infection, the viral load of an infected individualwill be very high and the number of CD4, low. But, after a while, the bodys immunesystem responds vigorously by producing more and more CD4 cells to fight the virus.Much of the virus gets removed from the blood. To fight the fast-replicating virus, as manyas a billion CD4 cells are produced every day, but the virus too increases on a similarscale. The battle between the virus and the CD4 cells continues even as the infected personremains symptom-free.But after a few years, which can last up to a decade or even more, when the number of thevirus in the body rises to very high levels, the bodys immune mechanism finds it difficultto carry on with the battle. The balance shifts in favour of the virus and the person becomesmore susceptible to various infections. These infections are called Opportunistic Infectionsbecause they swarm the body using the opportunity of its low immunity. At this stage, thenumber of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virusin the blood, will be very high at this stage.Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of thecommon opportunistic infections that affect HIV positive persons are: Mycobacteriumavium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (allcaused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Humanpapillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused byvirus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii
9www.drjayeshpatidar.blogspot.compneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positivepersons are also prone to cancers like Kaposis sarcoma and lymphoma.The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has enteredthe later stage of HIV infection and has started developing AIDS. The progression of HIVpositive persons into the AIDS stage is highly individual. Some people can reach the AIDSstage in about five years, while some remain disease free for more than a decade.Measurement of the viral load and the CD4 count helps a doctor in assessing an infectedpersons health condition.What are the later symptoms of HIV/AIDS?Lack of energyWeight lossFrequent fevers and sweatsA thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeastinfection and sometimes accompanied by a sore throatSevere or recurring vaginal yeast infectionsChronic pelvic inflammatory disease or severe and frequent infections like herpeszosterPeriods of extreme and unexplained fatigue that may be combined with headaches,lightheadedness, and/or dizzinessRapid loss of more than 10 pounds of weight that is not due to increased physicalexercise or dietingBruising more easily than normalLong-lasting bouts of diarrhoeaSwelling or hardening of glands located in the throat, armpit, or groinPeriods of continued, deep, dry coughingIncreasing shortness of breathThe appearance of discoloured or purplish growths on the skin or inside the mouthUnexplained bleeding from growths on the skin, from mucous membranes, or fromany opening in the body
10www.drjayeshpatidar.blogspot.comRecurring or unusual skin rashesSevere numbness or pain in the hands or feet, the loss of muscle control and reflex,paralysis or loss of muscular strengthAn altered state of consciousness, personality change, or mental deteriorationChildren may grow slowly or fall sick frequently. HIV positive persons are alsofound to be more vulnerable to some cancers.Is there treatment against HIV and AIDS?Till today, there is no conclusive treatment to eliminate HIV from the body; however,timely treatment of opportunistic infections can keep one healthy for many years. Thecommonly available treatment for AIDS is the treatment against opportunistic infections.Normally standard treatment regimens, used against such infections in non-HIV patients,also work well with the HIV-positive persons. If properly treated, almost all theopportunistic infections can be contained.However, during the last decade, researchers have developed powerful drugs that check thereplication of the virus at various levels. Called Antiretroviral drugs, they are available inthree classes and under various brands. Taken in combinations (called cocktail orcombination therapy) under specialised medical advice, these drugs drastically reduce theviral load in blood. However, they do not permanently cure one of HIV. This line oftreatment, called HAART (Highly Active Antiretroviral Therapy) has resulted in a hugereduction or AIDS-related deaths. Though many positive persons and caregivers havewelcomed these drugs, others have experienced serious side effects. They are also veryexpensive and are out of reach for a majority of the infected people. But of late, the priceshave been steeply falling.The three classes of drugs are:1. Nucleoside analogue Reverse Transcriptase Inhibitors (NRTIs). NRTIs were the
11www.drjayeshpatidar.blogspot.comfirst antiretroviral drugs to be developed. They inhibit the replication of HIV in theearly stage by inhibiting an enzyme (which is necessary for viral replication) calledReverse Transcriptase. The drugs include Zidovudine (Retrovir, AZT), Lamivudine(Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid, ddC), Stavudine (Zerit,d4T) and Abacavir (Ziagen).The major reported side effect of Zidovudine is bone marrow suppression, whichcauses a decrease in the number of red and white blood cells. The drugs ddI, ddCand d4T can damage peripheral nerves (peripheral neuropathy), leading to tinglingand burning in the hands and feet. Treatment with ddI can also cause pancreatitis,and ddC may cause mouth ulcers. Approximately 5 percent of people treated withAbacavir experience hypersensitivity reactions such as a rash along with fever,fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactionscan also occur without a rash. In either case, symptoms usually appear within thefirst 6 weeks of treatment and generally disappear when the drug is discontinued. Ifa person had a hypersensitivity reaction to Abacavir, he/she should avoid taking thedrug again.2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These drugs binddirectly to the enzyme, Reverse Transcriptase. There are three NNRTIs currentlyapproved for clinical use: Nevirapine (Viramune), Delavirdine (Rescriptor) andEfavirenz (Sustiva). A major side effect of all NNRTIS is a rash. In addition,people taking Efavirenz may have side effects such as abnormal dreams,sleeplessness, dizziness and difficulty concentrating.3. Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its lifecycle by interfering with an enzyme known as HIV protease. This causes HIVparticles in the body to become structurally disorganized and noninfectious. Amongthese drugs are Saquinavir (Fortovase), Ritonavir (Norvir), Indinavir (Crixivan),Nelfinavir (Viracept), Amprenavir (Agenerase) and Lopinavir (Kaletra).The most common side effects of PIs include nausea, diarrhoea and other digestive tractproblems. They can also cause a significant number of side effects when they interact withcertain other medications. That is because all PIs, to one degree or another, affect an
12www.drjayeshpatidar.blogspot.comenzyme system in the liver that is responsible for metabolising a large number of drugs.Newer side effects have also appeared with the continuing and widespread use of ProteaseInhibitors. These include elevated triglyceride levels and problems with sugar metabolismthat may sometimes progress to diabetes.There may also be abnormalities in the way fat is metabolised and deposited in the body.Some people lose much of their total body fat while others gain excess fat on the backbetween their shoulders (buffalo hump) or in the stomach (protease paunch). Right now, noone knows exactly why these abnormalities occur. In fact, it is not even certain whetherthese problems are a direct result of treatment with protease inhibitors or due to some othercause that has yet to be identified. Similar metabolic abnormalities have occurred in peopleon antiretroviral therapy that does not include PIs. Although these body changes can bedistressing, the possibility they may occur should not stop one from obtaining treatment forHIV/AIDS.In simple combination therapy, some physicians prescribe a combination of RTIs. But inHAART, which in fact has made a dramatic change in AIDS treatment, a combination ofRTIs and PIs is prescribed.People respond differently to treatment and maintaining the drug schedule is extremelyimportant. Indiscriminate treatment results in drug resistance and resurgence of the viralload. Therefore it should be taken only under expert medical advice.What about vaccines?More than a dozen HIV vaccines are currently being tested. As of now, there is no vaccineto prevent HIV infection.What is Parent to Child Transmission?Babies born to mothers infected with HIV may or may not be infected with the virus, butall carry their mothers antibodies to HIV for several months after birth. If these babies lacksymptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot bemade until after 15 months of age. By then, the babies are unlikely to still carry theirmothers antibodies and will have produced their own, if they are infected. Newtechnologies to detect HIV itself are being used to more accurately determine HIVinfection in infants between ages 3 months and 15 months. A number of blood tests arebeing evaluated to determine if they can diagnose HIV infection in babies younger than 3months.
13www.drjayeshpatidar.blogspot.comLIFE AFTER HIV FrançaisThe experience of infected people during the last two decades has shown that HIV is notthe "end of the world" and that there is good quality life for several more years. Takingcare of ones health, keeping in mind ones vulnerability to diseases, and a positive attitudehave been found to be very useful. New drugs and vaccine efforts also offer considerablehope to infected and affected individuals and their families. Several NGOs/CBOs,government organisations, public and private institutions offer ongoing support to peoplein need.What should one do if found HIV positive?Consult a clinician experienced in treating HIV/AIDS.Protect your sex partner(s) from HIV by following safe-sex guidelines.Inform sex partner(s) who may also be infected.Do not share needles.Get psychological support from a counsellor and/or join a support group for peoplewith HIV.Get information and social and legal support from AIDS service organisations.Dont share your HIV status with people who do not need to know. Only tell peopleyou can count on for support. Think about whom do you want to share your HIVstatus with.Maintain a strong immune system with a healthy lifestyle and regular medicalexaminations.Consider using antiretroviral therapies that may slow the progress of the infectionin consultation with a qualified physician.PREVENTION Français
14www.drjayeshpatidar.blogspot.comBecause there is no effective vaccine and no cure for HIV, the only way to protectoneself is prevention.People should either abstain from having sex or use latex condoms, during oral,anal, or vaginal sex. Only condoms made of latex should be used, and whenevernecessary only water-based lubricants should be used. People who are allergic tolatex can use polyurethane condoms.Although some laboratory evidence shows that spermicides can kill HIV, there isno conclusive evidence if it can prevent transmission.The risk of HIV transmission from a pregnant woman to her baby is significantlyreduced if she takes AZT during pregnancy, labour and delivery, and her babytakes it for the first six weeks of life. Nevirapine is also found to be useful. But, oneshould seek expert medical assistance in such situations. Having a sexuallytransmitted disease (STD) can increase manifold a persons chances of getting HIVthrough sexual contact. So, it is necessary to treat STD as soon as you suspectinfectionSAFE SEX GUIDE FrançaisThe Risk Chart - Practise Safe SexNo risk or very low risk - No reported cases due to these behavioursMasturbation - mutual masturbationTouching - massage
15www.drjayeshpatidar.blogspot.comErotic massage - body rubbingKissingOral sex on a man with a condomOral sex on a woman with a dental dam, glyde dam, plastic wrap, or cut-opencondomNot sharing drug injecting, body piercing instruments, needles, syringesUsing properly sterilised hospital toolsLow risk - Rare reported cases due to these behavioursDeep kissingOral sexVaginal intercourse with a condom or female condom –Anal intercourse with a condom (Try not to get semen or blood into the mouth oron broken skin.)High risk - Hundreds of thousands of reported cases are associated with thefollowing.Vaginal intercourse without a condomAnal intercourse without a condomSharing needles, syringes and other body piercing instrumentsBLOOD SAFETY FrançaisThe Human Immunodeficiency Virus (HIV), which causes AIDS, is easily transmittedthrough blood transfusions. In fact, the chances that someone who has received atransfusion with HIV blood will himself or herself become infected are estimated to beover 90 percent.Blood transfusions will always carry certain risks, but HIV transmission through bloodtransfusion can virtually be prevented. One can do this by setting up and maintaining a safe
16www.drjayeshpatidar.blogspot.comblood supply and by using the blood appropriately. One should always ensure that theblood is screened for the presence of diseases causing viruses, bacteria, or othermicroorganisms, or for the presence of anti bodies produced against these agents.All donated blood must be screened for HIV, as well as for hepatitis B and syphilis (andhepatitis C where ever possible). In addition, both doctors and patients must be aware thatblood should be used only for necessary transfusion. While it is important to takenecessary precautions, we also must keep in mind that if each individual is to donate bloodonce a year voluntarily, the total requirement of blood worldwide would be met.TransfusionIs it safe to have blood transfusion?Blood transfusion saves millions of lives each year, but only if safe blood supply isguaranteed. Receiving transfused blood has increased the risk to being affected by HIV anda number of other infections. Diseases such as hepatitis B, hepatitis C and several SexuallyTRansmitetd Diseases (STDs) can also be transmitted through transfusion.Can I receive my own blood ?Your own blood is the safest blood for your transfusion needs. A transfusion, after all, is atransplant of sorts, but instead of a kidney or liver, blood is the tissue a patient receives.When transfused with your own blood, you are not exposed to infectious disease and youare the perfect match. Your doctor will also carefully consider the benefits and effects yourblood donations may have on you.How do I ensure that the blood is actually HIV free?The process of testing blood to see if it contains infectious agents capable of beingtransmitted to those who received the blood is known as screening. Majority of tests detectthe presence of anti bodies to HIV and not the virus itself. Although HIV tests are verysensitive, there is a window period. This is the period between the onset of infection withHIV and the appearance of detectable anti bodies to the virus. In the case of most sensitiveHIV tests the window period is about three weeks.
17www.drjayeshpatidar.blogspot.comVoluntary Donation of BloodWho can donate blood?Every healthy individual with no known infection /disease can donate blood. It should stillbe done after having screened yourself. The donor should be in good health and should befeeling well on the day they donate. He/she should weigh at least 110 lbs. (50 kg) or more,not on any prescribed medication that may affect the donor or recipient. There should be agap of at least 56 days between donations.How often can I donate blood?Donating blood over thrice a year is not recommended. Excessive donation results in bloodbecoming substandard, for instance lacking in iron. It can also affect the donors health.Where can I donate blood?One can donate blood at any licensed blood bank and blood donation camp.Why should I donate blood?The safest type of blood donor is the voluntary, unpaid donor. Such donor gives out ofaltruism, and is not under pressure to donate blood. On the whole, such donors are aremore likely to meet the criteria for low risk donors. And they are also more likely to bewilling to donate on a regular basis and at properly spaced intervals. This is important inmaintaining a sufficient stock of blood.How will it be used?Blood is often used as a replacement of the quantity given to an individual by a medicalpractitioner. In this system, families of people needing a transfusion are asked to donate thesame quantity as that given to their relative and this blood may be used directly, wherecompatible, or else put into the general pool.Is blood donation harmful?No, if it is at properly spaced intervals and is donated at licensed blood banks/camps it isnot harmful. Many donors have given blood over 50 times, up to four times a year, withoutany harm to their health. If you are healthy, you can give blood every 56 days.
18www.drjayeshpatidar.blogspot.comCan you get HIV by donating blood?It is safe to give blood. You cannot contract any diseases through blood donation if theneedle and other clinic materials used to take blood are new, sterile and used only once. Ifyou are donating at licensed banks, these safety conditions will be definitely adhered to.The materials used are disposed after one use.Rational UseWhen?Doctors and other medical staff should be educated to avoid prescribing inappropriatetransfusion. Blood substitutes should be used only when it is appropriate. Simplealternatives to blood, such as crystalloids or colloids, will not transmit infection and can beobtained at a fraction of the cost of whole blood.One of the reasons, which makes blood supply unsafe is shortage. This shortage can beaddressed to a great extent by transfusing blood components instead of whole blood.Wherever whole blood is not needed, the appropriate component should be used.The underlying reasons for blood transfusion should be addressed. A condition for whichblood transfusions are often given is chronic anemia, which results from the lack of redblood cells that carry oxygen to the tissues. Chronic anemia can be caused by malnutrition,slow loss of blood and infection such as malaria. If the root cause of chronic anemia isattacked, we can manage the condition. Another condition where blood is often needed ischildbirth-related emergencies. By taking proper care of women before and duringdelivery, we can decrease the need for transfusion.Avoid unnecessary transfusionTransfusion is not always necessary or appropriate. Avoid using single-unit transfusions.Transfusion increases the risk of transmitting HIV, especially in places where there is noadequate screening of blood. Apart from that, it creates an unavoidable shortage in bloodsupply. This encourages professional donors to become more active, reducing the safety ofthe supply.LinksJeevan Blood Bank and Research CentreWebsite of the Chennai-based voluntary blood bank. Has information and services, tailored
19www.drjayeshpatidar.blogspot.comto Indian needs and conditions. Also has a discussion forum.Blood Safety in the age of AIDSHIV/AIDS - FREQUENTLY ASKED QUESTIONSQuestion: What is HIV and how does it differ from other viruses which infect humanbeings?Answer: HIV stands for Human Immunodeficiency Virus. As the name suggests it onlycauses disease in humans, which leads to the depletion of white blood cells leading tolowering of immunity. Once the virus enters the body it lies dormant for many years andhence is known as a slow virus. Most other viruses for example, those causing measles,mumps, chicken pox, etc., manifest the disease in 14-21 days after it enters the body.Hence the incubation period is short (2-3 weeks) whereas in HIV infection it is very longand runs into years.Question: How does HIV attack the immune system?Answer: Once HIV enters the body, it gets attached to a type of white blood cell called Tlymphocyte (which is the T cell in the human bodys protection against infections). TheRNA (genetic material) of the virus then gets converted to DNA (genetic material) by anenzyme that the virus produces. This viral DNA then gets incorporated into the DNA of thehuman cell (T lymphocyte), and remains there for the lifetime of that cell. This infectedcell now becomes a virus factory producing more viruses (HIV) which bud out of the cell,attack new T lymphocytes, and destroy them. Over a period of years, the T cell count ofthe infected person drops to a critical level and the individual develops many opportunistic
20www.drjayeshpatidar.blogspot.cominfection and hence is then said to have AIDS.Question: What is the difference between a person infected with HIV and one whohas AIDS?Answer: A person living with HIV (medically known as an HIV positive person) is onewho has virus in his/her body. Such a person, remains infected and is presumed infectivefor the rest of his/her life. However, s/he will appear to be perfectly normal and healthyand asymptomatic for many years. An asymptomatic HIV infected person does not haveAcquired Immunodeficiency Syndrome (AIDS). But when an HIV positive persons Tlymphocytes (which are responsible for the immunity) count falls to 200 or less, s/he startsdeveloping symptoms for eg. cough, fever, diarrhoea, skin lesions, etc. They are due toopportunistic infections (so called because they develop when the bodys immunitybecomes deficient) like TB, Thrush, Pneumonia, Cryptococcal meningitis, etc. All personswith AIDS are infected with HIV, but not all persons with HIV infection have AIDS.AIDS is only the end stage of this infection.topQuestion: How is HIV transmitted?Answer: Anyone can become infected with HIV. It is transmitted only through unprotectedpenetrative sex (vaginal, anal, oral) with an infected partner, transfusion of infected bloodand blood products, contaminat ed needles and syringes, and from an infected mother toher baby before, during delivery or through breast milk.
21www.drjayeshpatidar.blogspot.comBut since the sexual route accounts for almost 80 percent of infections, the prevalence ismuch higher in the sexually active age group of 15 years to 40 years. It is not who you areor where you are, but what you do that puts you at this risk of acquiring the HIV infectionand eventually developing AIDS. Therefore, there are no "risk groups" but only "riskbehaviours".Question: How is HIV not transmitted?Answer: HIV cannot spread by casual contact such as touching, holding hands, body contactin crowded public places, shaking hands, working or playing together, sharing food, vesselsand clothes, eating food cooked by an infected person, light kissing, mosquito and otherinsect bites, swimming pools, and toilets.Question: Do mosquitoes transmit HIV?Answer: There is no evidence to show that mosquitoes transmit HIV. Epidemiologically,the incidence of HIV infection is the highest among the sexually active group of 15 yearsto 40 years. However, mosquitoes bite persons of all age groups and if they were a meansof spreading HIV, the incidence of infection would be uniformly high and among all agegroups. HIV does not survive or replicate inside the intestine of the mosquito, which isanother reason to believe that mosquitoes cannot spread the HIV infection.Question: Can HIV spread through kissing?Answer: Kissing such as on the cheek or lightly on the lips carries no risk of transmittingHIV. In deep kissing there is a small risk because the saliva of an infected person containsfew virus particles which by itself is not sufficient to cause the infection. But there couldbe bleeding gums or ulcers in the mouth and exchange of infected saliva mixed with bloodduring kissing could transmit the HIV.
22www.drjayeshpatidar.blogspot.comQuestion: How long can the virus live outside the human body?Answer: The Human Immunodeficiency Virus is fragile. Once the virus is outside the bodyin a dry form, it dies immediately. Even in a wet state, it does not live long when exposedto heat, detergents, or disinfectants. When stored in blood banks at 4°C, it can live forabout 3 weeks (or longer), or till the white cell disintegrates, but in a frozen state it cansurvive for years.Question: Can I get the HIV infection if I donate blood?Answer: No. This is not possible as all materials used for collecting blood are sterile. Infact, persons who are healthy should come forward for voluntary blood donation.Question: What is the risk of getting HIV by going to a dentist?Answer: The risk of getting HIV from a dentist is low. However, there have been strayreports linking the infection with dentists. Wherever there is invasive procedures of skin ormucous membrane, universal precautions should be practiced.Question: Is the breast milk of an HIV positive woman infective?Answer: HIV is known to be present in the breast milk of an infected woman. Hence, thereis a possibility of acquiring the infection via breast milk. However, in a country like Indiawhere infant mortality is very high, the advantages of breast feeding (prevention of otherinfections) outweigh the risk of HIV infection through breast milk. Formula feeding shouldbe advocated on individual cases only after proper counselling.Question: How would one know if a baby born to an HIV positive woman has theHIV infection?Answer: Most children born to HIV positive mothers carry HIV antibodies from themother in their blood. These take about fifteen months to disappear. Only after that will an
23www.drjayeshpatidar.blogspot.comHIV antibody test show whether the baby is, in fact, infected with the HIV, or not. In lessdeveloped countries, the chance of a baby born to an HIV infected mother being infected isabout 40 percent. But today there are antiretroviral drugs available which can be given tothe pregnant woman and babies to prevent the infection in the babies. As an alternative topregnancy, women living with HIV could also be counselled to adopt a baby.Question: How long does it take for an HIV infected person to develop symptoms?Answer: This depends on the mode of the HIV transmission and the lifestyle of the HIVpositive person. Majority of persons who are infected through blood transfusion developsymptoms on an average from 3 years to 5 years. With the other modes of transmissionwhen the quantum of the virus is low, the person can remain healthy for 8 to 12 years orlonger. If an HIV positive person improves his/her quality of life by adopting safer sexmethods, has good nutrition, regular exercise, regular medical management, emotionalsupport, does yoga and meditation, avoids stress and regularly treats other illnesses,continues to be active, and has an optimistic outlook, s/he is likely to live longerQuestion: How does an HIV positive person progress to AIDS?Answer: A few weeks after the virus enters the body, some people have flu-like symptomssuch as fever, body ache, and headache, (every infected person may not experience these).These symptoms disappear after a while, and then there is a long phase of 3 years to 12years which is asymptomatic. After that, when the immune system starts failing, AIDS setsin.The major and minor signs classified by World Health Organisation are:Major SignsWeight loss greater than 10% of body weight.Fever for longer than one month, intermittent or continous.Chronic diarrhoea for longer than one month, intermittent or constant.
24www.drjayeshpatidar.blogspot.comMinor SignsPersistent cough for longer than one month.General itchy dermatitis (skin irritation).Recurrent herpes zoster (shingles).Oropharyngeal candidasis (fungus infection in the mouth/throat).Chronic progressive and disseminated herpes simplex infection.Generalised lymphadenopathy (swelling of lymp glands).If a person has two major and two minor signs he is diagnosed as having AIDS. It isimportant to note that these symptoms are fairly common in various non-AIDS conditionsalso.Question: How would I know if any of the people I meet everyday is HIV infected?Answer: You cannot. Individuals may identify their HIV status only by doing an HIV test.Question: Is there any treatment for HIV/AIDS?Answer: Almost all opportunistic infections a person with AIDS develops can be treatedwith appropriate drugs. Eg. TB, thrush, diarrhoea, pneumonia can all be treated. They canalso be prevented by drugs - chemoprophylaxis. When it comes to treatment of HIV itself,there are many antiretroviral drugs available. These should be given in combinations of 2or 3 drugs for lifetime of the patient. These drugs are expensive, have side effects and needto be monitored using laboratory tests which are very expensive.Question: What is safe sex?Answer: Sexual activity which completely eliminates the risk of infection is safe sex. For eg.1. any sexual activity between two uninfected people is safe. 2. any sexual activity whichdoes not involve the entry of body fluids such as blood, semen, vaginal fluids, or othercontaminated material into the body is safeQuestion: What is safer sex?
25www.drjayeshpatidar.blogspot.comAnswer: Safer sex is a way of adapting your sex life to minimize the risk of giving orgetting the HIV infection. It includes those sexual practices which reduce the risk ofacquiring or transmitting HIV during sexual activity. Sex can be made safer by using acondom consistently or by practicing non-penetrative sex.Question: What can I do to protect myself against getting the HIV infection?Answer: There is a lot you can do to keep yourself protected from getting the HIVinfection:- Learn the facts about HIV and AIDS.- Assess your own risk behaviours (unsafe sex, sharing needles, etc.)- Postpone, as much as possible, sex until marriage, or else practice safe or safer sex.- Do not feel shy to talk about your doubts and fears. Get these clarified.- Verify that any blood product you receive has been screened for HIV.- Verify that any needles/ syringes or invasive equipment being used on you is sterile.- If you are going for procedures such as tattooing, ear piercing, or acupuncture, verify thatthe equipment to be used on you is sterile.- Avoid alcohol and drugs as they affect your judgement, and can induce you to take risksyou would not otherwise take, like having unsafe sex, sharing needles, or driving rashly.- Do not let peer pressure force you into unsafe activities.Question: What is the role of HIV/AIDS awareness programmes in preventing thespread of HIV/AIDS?Answer: The objective of AIDS awareness programmes is to create awareness about theproblem, to give accurate and reliable information about HIV/AIDS, to clear existingmyths and misconceptions, and to provide practical skills that can be implemented at theindividuals level so as to lead to behaviour change that minimize the risk of HIV infection.Question: How safe are condoms in the prevention of HIV infection?
26www.drjayeshpatidar.blogspot.comAnswer: Condoms make sex safer when used properly but they are not 100 percent safe.Safety factors to check on when buying and using condoms are,- Expiry date of the condom - do not use one which has expired.- Storage - condoms should be kept away from the heat (for example, from car glovecompartments, direct sunlight), and pressure (for example, sitting on a wallet containingcondoms).- Making sure that sharp objects do not tear a condom during use.- Making sure that the air is expelled from the teat of the condom while wearing, so as toprevent it from bursting during intercourse.Question: Does the use of a condom reduce sexual pleasure?Answer: Condoms do not reduce sexual pleasure, as sexual pleasure is a perceivedpleasure. Psychologically, some people perceive a loss of pleasure when using a condom.Whereas, ribbed condoms, for example, are known to increase sexual pleasure.Question: Do contraceptives like Today, diaphragm, and the pill protect a womanfrom getting the HIV infection?Answer: No, they do not. These contraceptives only prevent a woman from gettingpregnant but do not prevent the potentially infected semen from coming into contact withthe lining of the vagina or cervix. If the HIV or organisms causing STD are present in thesemen, they can still get into a womans body and infect her.topQuestion: What are the different tests to detect HIV?Answer: There are a number of tests to detect the HIV. Blood tests are done to look forspecific antibodies produced by the HIV. These include,Screening tests: ELISA (Enzyme Linked Immunosorbent Assay - the most commonlyfollowed procedure). Spot test or Rapid Test These may give false positive results andhence should be confirmed.
27www.drjayeshpatidar.blogspot.comConfirmatory Tests: Western Blot, the most commonly used procedure. There are othertests that are done to detect the virus or its protein or genetic material. These are however,expensive, complicated or may take long and hence, are used only for research andacademic purposes.Question: Why are consent and confidentiality important during voluntary testing?Answer: HIV positive persons are discriminated against by family, friends, neighbours,colleagues, employers, and the society in general. Unless an individual is assuredconfidentiality, s/he will not come forward for testing for fear of such discrimination andstigma. Testing for HIV without consent violates human rights and should not be done.Only consented testing with pre- and post-test counselling should be encouraged.Question: How can I know the HIV status of the person I am going to marry?Answer: Marriages are based on mutual trust. It is important that any concerns about HIVare communicated to the prospective spouse in a sensitive and sensible manner. The HIVstatus of a person cannot be determined without a HIV test. A fully informed voluntaryconsent is a pre-requisite before a HIV test can be performed on someone. Please beprepared to likewise undergo a test should your prospective spouse so requests. In somestates of USA, HIV and VDRL testing are mandated by law as pre-requisite to marriageregistration. In India, there is no such law.Question: Should premarital HIV testing be done?Answer: This cannot be made mandatory as it would undermine confidentiality as a pre-requisite for testing. But if individuals request consented voluntary testing, it should beencouraged. Unfortunately in India, given the lack of code of conduct in reporting testresults, it may be possible to "purchase" a negative result.
28www.drjayeshpatidar.blogspot.comQuestion: What is ‘window period’?Answer: The common test for HIV is screening blood for antibodies. The antibodies take 2to 24 weeks to appear in blood. This is known as the ‘window period.’ During this period,an infected individual is infective, but the HIV tests for antibodies are negative. Hence, tobe sure, the test should be repeated again 6 months after the last contact or exposure toHIV.