Disclaimer: Clinical information is provided for educational purposes and not as a medical or professional service. Persons who are not medical professionals should have clinical information reviewed and interpreted or applied only by appropriate health professionals.
- How easily is HIV spread from male to female via
sexual intercourse? Transmission of HIV via sexual intercourse
is a number that has been defined better for the male to female (or male to
male) route than for female to male. The accepted rate for transmission via
vaginal or anal intercourse (unprotected sex) is about 1 in 8 to 1 in 10.
The only study of female to male (or, presumably male receptive partner to
male insertive partner) transmission was a retrospective study, which means
that they derived the number by tracing records and sexual histories backwards
in patients (men) who were known to have had exposure to HIV infected women.
The rate is felt to be about 1/10 to 1/15 the rate of male to female, or 1/80
to 1/50 range. This number is difficult to verify, since there is a known
increase risk of transmission if one of the partners has ulcers (often 2 to
syphilis or herpes type II) on his genitalia, which is a common occurrence
in areas of high heterosexual HIV such as Africa and SE Asia. The risk is
about 2 fold if a patient has nonulcerative STDs (gonorrhea, chlamydia). It
should be noted that 43% of new HIV transmission in the U.S. is heterosexual.
- High-risk behaviors? Other risky (while less risky than
intercourse, they still have a potential for HIV transmission) include unprotected
oral sex (esp. with exchange of ejaculate or if a woman is having her menstrual
flow). Even "safe" activities, such as mutual masterbation, should
be performed using common sense (for example: don't expose an open cut on
your hand to another person's blood or sexual fluids). Finally, selling sex
for drugs is a high-risk sexual activity.
- Is there effective treatment for early HIV disease? Yes.
The newer guidelines for HIV therapy recommend aggressive multi-drug regimens
for acute or early (known to be less than one year) infections. Many also
would advocate resistance testing of the patient's virus at this time, to
help guide effective anti-retroviral medicine choices. Studies seem to support
the benefit of decreasing viral load (leaving a lower "set point",
so to speak, for the chronic Carriage State of HIV disease). It is important
that the patient understands the risk and benefits of therapy, and that they
be made aware of the fact that non-compliance with medicines can lead to the
rapid development or resistance, making it even harder to treat the virus.
- How can HIV transmission be prevented?
- Don't share needles if you are an IV drug user.
- Use protection for sexual actvities. Condoms (male or female) along
with a water based lubricant are very helpful (though not 100% successful).
Dental dams are useful for oral-vaginal sex.
- If pregnant, get HIV testing, thereby helping to prevent peri-natal
transmission.
- Clinical Course? The clinical course
varies. Some patients, especially those without good prophylactic care and
follow up, become sick and die within 5 or 6 years. Others remain healthy
and disease free for greater than 10 or 15 years (This despite the fact that
they harbor a virus that can destroy their immune system!). Many untreated
patients will develop opportunistic infections (OIs) as their CD4 cells decrease.
This progression to OI has been drastically slowed by the use of anti-HIV
medications, as successful therapy tends to suppress HIV viral replication,
allowing for CD4 cells to remain at higher (or normal) levels. It is unknown
how long patients can remain healthy by taking those medicines, but thousands
are in their second decade of anti-retroviral therapy. If a patient's CD4
count gets low, then, they become at risk for OIs. Some patients who are very
compliant with their medicines will still have increased or high levels of
viral replication, and their CD4 counts tend to decrease – leading to
complicating OIs.
- Is HIV fatal? HIV has not been proven
to be eradicated from patients with currently available medicines. Many patients
who develop actual AIDS will die from OIs. Many other HIV patients have remained
relatively healthy, yet, have died from unrelated illnesses (heart disease,
auto accidents, diabetes) just like HIV uninfected people. It is not known
to be "curable", but, it is not the "almost certain death"
that it was before current therapies became available.
- What are some common conditions associated with
HIV? There are HIV-related conditions and OIs related to AIDS - which
is the syndrome associated with HIV. Many HIV "conditions" involve either
a modest increase in the incidence of certain cancers (lymphomas), occasional
fungal infections, and, a slight increase in "common" infections, such as
pneumonia. HIV patients may have some conditions as a result of the medicines
used to prevent them from developing AIDS. Those conditions vary by the medicines
they take, and include glucose metabolism issues, lipodystrophy/ fat redistribution
issues, lactic acidosis, and other drug-related events.
As for OIs associated with lower CD4 cells (usually at less than 200, often
referred to as AIDS-defining illnesses), (start old answer, as it is still
valid ) common conditions include:
(Add this new discussion at the end) "weight loss, fatigue, low testosterone
levels and neuropathy can also be seen as the disease progresses, especially
if viral replication remains high or counts become low. Interestingly, Kaposi's
sarcoma, cryptococcal meningitis and toxoplasmosis have all decreased significantly
since the use of aggressive anti-retroviral therapy (HAART) combination regimens,
including combinations of NRTI, NNRTI and PI agents."
Disclaimer: Clinical information is provided for educational purposes and not as a medical or professional service. Persons who are not medical professionals should have clinical information reviewed and interpreted or applied only by appropriate health professionals.