-IBIS-1.5.0-
tx
immune system
AIDS/HIV
diagnoses

definition and etiology

definition:
Acquired Immune Deficiency Syndrome: This disease attacks T-helper cells and impairs macrophage function leaving the patient open to opportunistic infections, such as pneumocystis pneumonia carinii, tuberculosis, cytomegalovirus (CMV), toxoplasmosis and cryptococcal meningitis.

etiology:
The human immunodeficiency virus, HIV, is closely associated with these conditions, though the exact mechanism of its action remains unclear. While some schools of thought propose the virus as the sole active agent, it remains distinctly possible that HIV may be one of several factors which need to come together to create active infection.

Body fluids, specifically blood, semen, vaginal secretions and other fluids contaminated with blood, possibly also mothers milk, are the most common medium of transmission. Transmission by other routes is possible but rare.

People most at risk:
homosexual males
IV drug users (sharing needles)
prostitutes
fetuses of infected mothers
hemophiliacs (less so since intensive blood screening and altered processing of F8)
sexual partners of members of high-risk groups

signs and symptoms

For the diagnosis of AIDS there are a number of criteria to be met which leads to a high degree of suspicion. If there is a documented HIV + test along with Candida infection of bronchi, trachea, lungs or esophagus, Cryptococcosis, Cryptosporidum infection with chronic intestinal symptoms, CMV disease (other than liver, spleen or nodes), chronic Herpes simplex or zoster, Kaposis sarcoma, various lymphomas, Mycobacterium infections, Pseumocystis carinii pneumonia, wasting syndrome due to HIV, Toxoplamnosis of the brain and systemic Salmonella to name a few.

Key symptoms:
may be asymptomatic for years
persistent fever
weight loss
persistent lymphadenopathy
fatigue and malaise
dry cough
shortness of breath
night sweats
personality changes
diarrhea
Kaposi's sarcoma

lab:
The following blood work is essential for a full evaluation of each HIV+ patient:
CBC with platelet count and ESR
Full fasting chemistry and lipid panel (triglycerides, HDL, LDL)
T/B/NK cell subsets (Immune panel that includes CD3, CD4, CD8, CD19 and CD56 subsets)
HIV RNA viral load
DHEA (serum)
Urinalysis with microscopic analysis (especially important in patients who are taking certain protease inhibitors)
Serum candida antibodies (IgA, IgG, IgM) and candida antigen when available
For women, a recent pap read by a thorough cytopathologist (i.e., in addition to the standard classification of cervical cells, the pathologist should look for and report koilocytotic changes as well as assessment of bacterial dysbiosis)

It is also recommended to do the following tests if the history indicates problems in the associated area:
Complete digestive stool analysis
Serum and antibody titres of co-factor viruses present in the history
Serum food allergy panels that evaluate the IgE and IgG reactivity against panels of common foods. This is especially helpful in evaluating chronic sinusitis.
Thyroid panel
Ferritin if anemia is present
Serum vitamin B-12 and folate
Toxoplasmosis IgG
Mycobacterium avian intracellular (MAI) blood culture if CD4 count is lower than 100 cells/ml
(Standish, L., et al. Bastyr University AIDS Research Center. November, 1997.)

lab findings:
positive HIV serology: HIV via first ELISA and then Western blot test (Note that high risk serum negative patients have had HIV isolated from their blood). CD4+ levels below 200/mm usually have serious consequences regarding opportunistic infections, CD4+ 200-499 are fair and above 500 is considered pretty good.
low T-cell count
inverted T-cell ratios
labs associated with infectious complications
progression monitored with T-cell ratios and WBC counts
viral load - serum (done by PCR)
immune differential
differentiate between Syphilis as well as CMV, EBV, etc.

course and prognosis

Opportunistic infections are the most common complication. These include pneumocystis pneumonia carinii, candida albicans, toxoplasmosis, cryptosporidiosis, cryptococcal meningitis, tuberculosis, Non-Hodgkins lymphoma, cytomegalovirus and mycobacterium infections. Kaposi's sarcoma is a later-stage complication which carries a poor prognosis. Women also experience increased susceptibility to recurrent vaginitis and cervical cancer (due to decreased resistance to human papiloma virus). Children are susceptible to all the complications demonstrated by adults, plus an increased risk of acute bacterial infection, such as otitis media, meningococcal meningitis, lobar pneumonia, etc.

The course and prognosis depend on the health of the infected person upon contracting the disease. The course is often long and painful both physically and emotionally. While the resulting infections are treatable, the disease itself has no cure as yet.

It is important to distinguish between HIV infection and AIDS in this regard. With appropriate lifestyle and dietary changes and comprehensive treatment regimens, many HIV sufferers are living relatively normal lives without progression to AIDS. Some AIDS sufferers have held their condition at bay, some now for many years, while other have quickly declined. However, recent research demonstrates significant gains for patients using comprehensive natural medicine protocols, as all or part of their treatment. Genetics also appears to play a role.

differential diagnosis

leukemias
Hodgkin's lymphoma
non-Hodgkin's lymphoma
CMV/EBV
Syphilis
chronic fatigue syndrome
depression
chronic low grade allergies
other immune disorders
TB
collagen-vascular diseases


footnotes

Standish, Leanna J., Ruhland, John F., DiDomenico, Beth, and Kjersten Gmeiner. HIV/AIDS: Naturopathic Medical Principles and Practice. Bastyr University AIDS Research Center. November, 1997.