aids
Acquired immunodeficiency syndrome (AIDS) is the final and most serious stage of the disease caused by the human immunodeficiency virus. Symptoms begin when an HIV-positive person presents a CD4-cell (also called T cell, a type of immune cell) count below 200. AIDS happens concurrently with numerous opportunistic infections and tumors that are normally associated with the HIV infection.
The most common neurological complications of AIDS involve opportunistic infections of the brain such as progressive multifocal leucoencephalopathy (PML) and meningitis, other opportunistic infections such as herpes zoster (shingles), peripheral neuropathy, depression, and AIDS-related dementia.
Description:
AIDS was first recognized in 1981 and has since become a major worldwide pandemic. Abundant evidence indicates that the human immunodeficiency virus (HIV), discovered in 1983, causes AIDS. By leading to the destruction and/or functional impairment of immune cells, notably CD4+ T cells, HIV progressively destroys the body’s ability to fight infections and to resist certain cancer formation.
Before the HIV infection became widespread in the human population, AIDS-like syndromes occurred extremely rarely, and almost exclusively in individuals with known causes of immune suppression, such as those receiving chemotherapy or those with underlying cancers. A marked increase in unusual infections and tumors characteristic of severe immune suppression was first recognized in the early 1980s in homosexual men who had been otherwise healthy and had no recognized cause for immune suppression. An infectious cause of AIDS was suggested by geographic clustering of cases, a sexual link among cases, mother-to-infant transmission, and transmission by blood transfusion.
Isolation of the HIV from patients with AIDS strongly suggested that this virus was the cause of AIDS. Since the early 1980s, HIV and AIDS have been repeatedly associated; the appearance of HIV in the blood supply has preceded or coincided with the occurrence of AIDS cases in every country and region where AIDS has been noted. Individuals of all ages from many risk groups, including homosexual men, infants born to HIV-infechers, heterosexual women and men, hemophiliacs, recipients of blood and blood products, health care workers and others occupationally exposed to HIV-tainted blood, and injection drug users have all developed AIDS with only one common denominator: HIV.
HIV destroys CD4+ T cells, which are crucial to the normal function of the human immune system. In fact, depletion of CD4+ T cells in HIV-infected individuals is an extremely powerful predictor of the development of AIDS. Studies of thousands of individuals have revealed that most HIV-infected people carry the virus for years before enough damage is done to the immune system for AIDS to develop; however, with time, a near-perfect correlation has been found between infection and the subsequent development of AIDS.
Treatment:
Since the early 1990s, several drugs to fight both the HIV infection and its associated infections and cancers have become available, including:
* Reverse transcriptase inhibitors: They interrupt the virus from making copies of itself. These drugs are AZT (zidovudine [Retrovir]), ddC (zalcitabine [Hivid], dideoxyinosine), d4T (stavudine [Zerit]), and 3TC (lamivudine [Epivir]).
* Nonnucleoside reverse transcriptase inhibitors (NNRTIS): These medications are used in combination with other drugs to help keep the virus from multiplying. Examples of NNRTIS are delavirdine (Rescriptor) and nevirapine (Viramune).
* Protease inhibitors: These medications interrupt virus replication at a later step in its lifecycle. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase), and nelfinavir (Viracept). Using both classes of drugs reduces the chances of developing resistance in the virus.
* Fusion inhibitors: This is the newest class of anti-HIV drugs. The first drug of this class (enfuvirtide [Fuzeon]) has recently been approved in the United States. Fusion inhibitors block HIV from entering the human immune cell.
* A combination of several drugs called highly active antiretroviral therapy (HAART): This treatment is not a cure. The virus still persists in various body sites such as in the lymph glands.
The antiretroviral drugs do not cure people of the HIV infection or AIDS. They stop viral replication and delay the development of AIDS. However, they may also have side effects that can be severe. These include decrease of red or white blood cells, inflammation of the pancreas, and painful nerve damage. Other complications are enlarged or fatty liver, which may result in liver failure and death.
Recovery and rehabilitation:
As there is no cure for AIDS, the focus is on maintaining optimum health, activity, and quality of life rather than on complete recovery.
Occupational therapy can have a crucial role in assisting people living with HIV/AIDS to reengage with life, particularly through vocational rehabilitation programs. Occupational therapy can provide the patient with a series of learning experiences that will enable the individual to make appropriate vocational choices.
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