Positive Living Association (PLA)
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WHAT IS HIV/AIDS?

HIV: HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes*. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

AIDS: Acquired Immunodeficiency Syndrome.
Acquired - means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV)
Immunodeficiency - means that the disease is characterized by a weakening of the immune system.
Syndrome - refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person's immune system.

When someone effected by the virus there might not be any symptomps for years.If the virus transferred by sexual ways it can be 8-10 years without any symptoms. If its with blood transmission then it will be 5months-2 years till the symptoms accquired.As soon as the person gets the virus he or she can transferred the virus the others.When the symptoms acquires if you dont start to treatment immediatly there will be opportunistic infections and also cancer and at the end all these infections causes AIDS and it causes death.

How Is the Virus Transmitted?
HIV lives in blood and other body fluids that contain blood or white blood cells. People have gotten HIV through:

  • unprotected sexual intercourse with an HIV-infected person. This includes vaginal or anal intercourse, and oral sex on a man or woman without a condom or other barrier. Intercourse while a woman is having her period, or during outbreaks of genital sores or lesions (caused by herpes and other sexually transmitted diseases) can increase the risk of HIV transmission.
  • sharing drug injection equipment (needles and/or works); or being accidentally stuck by needles or sharp objects contaminated with infected blood.
  • infected blood used in transfusions, and infected blood products used in the treatment of certain diseases and disorders
  • pregnancy, childbirth, and/or breastfeeding, where the virus is passed from mother to child.
  • transplanted organs from infected donors.
  • HIV and AIDS are not transmitted through casual contact (that is, where no blood or body fluids are involved). HIV is what gets passed from person to person. People don't "catch AIDS"; they "become infected with HIV."

What Does an "HIV-Positive" Test Result Mean?
A positive test result means your body has been infected by the human immunodeficiency virus-and that you are capable of transmitting it to others. The test did not look for the actual virus itself, but found evidence of it in your blood. There's no way to tell from this result who gave you the virus, how long you've had it, or when it will begin to affect your health.
At this time, doctors don't know of any way to rid the body of HIV. There is no cure. Once you've been infected, you have it for life.

Where Can I get tested for HIV?
You can get tested for Hiv in almost all state hospitals and also University Hospitals. Also there s many custom hospitals and labs are doing the ELISA test.

According the programme between Turkish Republic and Global Aids Fund in Izmir, Istanbul, Ankara and Trabzon there is volunteer HIV/AIDS Consultancy and Test Center is making the tests for free.

In these 14 centers, there will be psychologist, doctor, social service expert and nurses will be working volunteer for Hivers. These consultants will be informed the public about Hiv, answer their questions and will make quick Hiv test if the person willing to be.

The Center's information is below:

AIDS İLE MÜCADELE DERNEĞİ
Mustafa Kemal Sahil Bulvarı No: 425 Güzelyalı İZMİR
(0232) 243 60 70

ATATÜRK EĞİTİM VE ARAŞTIRMA HASTANESİ
Alsancak Semt Polikliniği Dr. Behçet Uz Çocuk Hastanesi Karşısı Montrö Alsancak İZMİR
(0232) 484 12 30 /223

TEPECİK EĞİTİM VE ARAŞTIRMA HASTANESİ
Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği Gaziler Cad. No:468 35120 Yenişehir İZMİR
(0232) 469 69 69 /1717

DIŞKAPI YILDIRIM BEYAZID EĞİTİM VE ARAŞTIRMA HASTANESİ
Etlik polikliniği Kasalar ANKARA
(0312) 326 00 10 /301-302

NUMUNE EĞİTİM VE ARAŞTIRMA HASTANESİ
SEMT POLİKLİNİĞİ
ENFEKSİYON HASTALIKLARI KLİNİK MİKROBİYOLOJİ KLİNİĞİ

Libya Cad. Çaldıran Sok. No:22 Kolej ANKARA
(0312) 434 22 09 /1301-1302

ANKARA EĞİTİM VE ARAŞTIRMA HASTANESİ
Plevne Cad. No:15 Cebeci ANKARA
(0312) 595 35 13 / 595 35 01-02-03

HASEKİ EĞİTİM VE ARAŞTIRMA HASTANESİ
E Blok Enfeksiyon Hastalıkları Kliniği Millet Cad. Aksaray İSTANBUL
(0212) 529 44 00 /1210-1208

DERİ VE TENASÜL HASTALIKLARI HASTANESİ
Kennedy Cad. No:52 Cankurtaran Eminönü İSTANBUL
(0212) 517 74 51

OKMEYDANI EĞİTİM VE ARAŞTIRMA HASTANESİ
Enfeksiyon Hastalıkları ve Klinik Mik. Kliniği Darülaceze Cad. Şişli İSTANBUL
(0212) 221 77 77 /1368-1369

BEŞİKTAŞ BELEDİYESİ SAĞLIK İŞLERİ MÜDÜRLÜĞÜ
Çırağan Cad. No:77 Beşiktaş İSTANBUL
(0 212) 261 21 15

ŞİŞLİ BELEDİYESİ SAĞLIK İŞLERİ MÜDÜRLÜĞÜ
Abide-i Hürriyet Cad. Mezarlık Çıkmazı No:2 Şişli İSTANBUL
(0212) 234 48 31 /117-234 03 66

DR. L. KIRDAR KARTAL EĞİTİM VE ARAŞTIRMA HASTANESİ
Enfeksiyon Hastalıkları Kliniği E-5 Karayolu Kartal İSTANBUL
(0216) 441 39 00 /1163-1821-1850

HAYDARPAŞA NUMUNE EĞİTİM VE ARAŞTIRMA HASTANESİ
Enfeksiyon Hastalıkları Kliniği Tıbbiye Cad. Üsküdar İSTANBUL
(0216) 414 45 02 /1906


NUMUNE EĞİTİM VE ARAŞTIRMA HASTANESİ
İnönü Mah. Maraş Cad.
TRABZON
(0462) 230 23 01

To make blood donation is so dangerous just to get an Hiv/Aids test. Because in incubation period of disease even if the blood has the virus the tests may result negative but still the virus will be transferred the other person's body by blood. In our country we have these kind of examples. If you are suspicious about Hiv, you have to see an Hiv specialist immeadiatly and He/or she will give you the right tests and at the end of the tests you can find out the correct result.

Do I have to give my name for get tested?
You don't have to give your name or any other information about your id to any hospital or any labs. Ministry of Health also have a report about this.

Can I get tested at home?
There is a test only for Hiv in the pharmacies. However there might be serious results if you get tested without consulting. Because the results of the test is not 0 safe. For example, fake positive tests can cause psychological damages which is the person might think have hiv. Other example might be fake negative result. In this way the patient can passé the virus the others without knowing he or she has the virus. That's why home tested is not offered by the experts.

How often should I get tested for Hiv and what is the test's content?
The current HIV tests detect the presence of HIV antibody. HIV antibody is your body's response to the presence of HIV virus. In most persons it takes a few weeks to develop antibodies that are detectable by current tests. 95% of people develop antibodies within 3 months after being infected. It is recommended that people take a second test in 6 months, because 99% of those infected will develop antibodies within 6 months. A positive test is positive no matter when the test was. A negative test becomes more and more a true and accurate result the longer after the possible exposure.
After you get the positive result you need to have another test the name called Western Blood. This test is a confirmation test. If it comes positive that mean is the person have the hiv. If it comes negative you should repeat the test in every per 3 months.

Does everyone knows if it comes positive?
AIDS, a disease that you have to inform the Ministry of Health. This is necessary for statistics and to watch of the increase of disease. Your name is not following up in that notice. Just the beginning letters of your name, surname and the year of birth. Other than that nobody should know about your situation except your doctor and the staff. All the expenses of treatment is paid by any insurance company. The ones who hasn't got any insurance can use green card opportunity.

What kind of Doctor should I have to see?
HIV treatment is a very complex treatment so your doctor should be an expert about HIV and AIDS treatment. Your doctor need to be someone that you could feel comfortable to work with. This is important for you to ask any question that you have freely. Moreover there are several centers that you can get any information about hiv treatment in Turkey.
Before you start your treatment your doctor should take your history about the disease. Also physical examination and blood tests needs to be done. These tests includes full blood counting, viral load test and cd4 t cell count. Also other tests needs to be done for the other opportunistic infections ( syphilis , tuberculosis skin test, toxopla ma and for the woman gynecologic pop smear tests). Viral load and cd4 T cell counting tests needs to be done before you start to Hiv treatment.

How do I understand that I ve got infected? What are the symptoms of HIV?
Most of early HIV is without symptoms, but some people can get a flu-like illness with fever, fatigue, sore throat, rash, swollen glands and general weakness. Some say it's like the worst flu of their life. But many people have no symptoms, so if someone has been exposed, the most important thing is to get tested.

The symptoms of HIV and AIDS vary, depending on the phase of infection. When first infected with HIV, you may have no symptoms at all, although it's more common to develop a brief flu-like illness two to six weeks after becoming infected. But because the signs and symptoms of an initial infection — which may include fever, headache, sore throat, swollen lymph glands and rash — are similar to those of other diseases, you might not realize you've been infected with HIV.

Even if you don't have symptoms, you're still able to transmit the virus to others. Once the virus enters your body, your own immune system also comes under attack. The virus multiplies in your lymph nodes and slowly begins to destroy your helper T cells (CD4 lymphocytes) — the white blood cells that coordinate your entire immune system.

You may remain symptom-free for eight or nine years or more. But as the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:

  • Swollen lymph nodes - often one of the first signs of HIV infection
  • Diarrhea
  • Weight loss
  • Fever
  • Cough and shortness of breath

During the last phase of HIV - which occurs approximately 10 or more years after the initial infection - more serious symptoms may begin to appear, and the infection may then meet the official definition of AIDS. In 1993, the Centers for Disease Control and Prevention (CDC) redefined AIDS to mean the presence of HIV infection as shown by a positive HIV-antibody test plus at least one of the following:

  • The development of an opportunistic infection - an infection that occurs when your immune system is impaired - such as Pneumocystis carinii pneumonia (PCP)
  • A CD4 lymphocyte count of 200 or less - a normal count ranges from 600 to 1,000

By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections. The signs and symptoms of some of these infections may include:

  • Soaking night sweats
  • Shaking chills or fever higher than 100 F for several weeks
  • Dry cough and shortness of breath
  • Chronic diarrhea
  • Persistent white spots or unusual lesions on your tongue or in your mouth
  • Headaches
  • Blurred and distorted vision
  • Weight loss

You may also begin to experience signs and symptoms of later stage HIV infection itself, such as:

  • Persistent, unexplained fatigue
  • Soaking night sweats
  • Shaking chills or fever higher than 100 F for several weeks
  • Swelling of lymph nodes for more than three months
  • Chronic diarrhea
  • Persistent headaches

If you're infected with HIV, you're also more likely to develop certain cancers, especially Kaposi's sarcoma, cervical cancer and lymphoma, although improved treatments have reduced the risk of these illnesses.

Symptoms of HIV in children
Children who are HIV-positive often fail to gain weight or grow normally. As the disease progresses, they may have difficulty walking or delayed mental development. In addition to being susceptible to the same opportunistic infections that adults are, children may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis.

Transmission Of HIV

  • Exchanging blood, semen, and vaginal secretions through vaginal, oral, or anal intercourse with someone who has HIV. During vaginal intercourse, the risk of becoming infected is higher for women than men, because HIV is more easily transmitted from man to woman.
  • Sharing needles or syringes used for injecting drugs, medicine, tattooing, or ear piercing with someone who has HIV.
  • Being born to a mother who has the virus. (HIV can be passed to a fetus through the umbilical cord while it is still inside the mother, through contact with vaginal fluids and blood during birth or through breast milk.)

You can't get it from:

  • Touching, talking to, or sharing a home with a person who is HIV infected or has AIDS.
  • Sharing utensils, such as forks and spoons, used by someone with HIV infection or AIDS.
  • Using swimming pools, hot tubs, drinking fountains, toilet seats, doorknobs, gym equipment, or telephones used by people with HIV infection or
  • AIDS.
  • Having someone with HIV or AIDS hug, kiss, spit, sneeze, cough, breathe, sweat, or cry on you.
  • Being bitten by mosquitoes.
  • Donating blood in countries like the U.S. where a new needle is used for every donor. You do not come into contact with anyone else's blood. In the U.S., donated blood is always screened for HIV so the risk of infection from a blood transfusion is very, very low.

Maybe you have heard the term HIV-positive. It means that an antibody test has shown that someone has been infected with HIV. It does not necessarily mean that a person has AIDS right now.

People with HIV may not know or show that they carry the virus for up to 15 years and possibly longer. They may look, act, and feel healthy, but can still infect others with HIV through unsafe sex and sharing needles.

You can protect yourself from HIV infection by not having sex or using drugs. You can lower your risk of exposure to HIV by making smart decisions. If you choose to have sexual intercourse, you can protect yourself by using latex condoms. Of course, condoms are also a safe, effective, and inexpensive form of birth control, so you can protect yourself from unwanted pregnancy at the same time. They also protect you from sexually transmitted infections (STIs).

100% Risk Free

Of course, the surest way to avoid the virus is to choose not to have sexual intercourse - vaginal, oral, or anal - and not to do drugs. Using any drugs at all, including alcohol, is risky. Drugs cloud your judgment and may lead you to make unsafe choices.

Safer Sex

There are lots of physical ways to share love and sexual feelings with your partner that are safe, such as:

  • Hugging.
  • Holding hands.
  • Touching.

Low Risk Sex

If you do have sex, it is important to protect yourself and your partner by:

  • Getting tested for HIV and insisting your partner does the same.
  • Using a latex condom every single time you have vaginal, oral, or anal intercourse.
  • Using a barrier, such as a latex dental dam, a cut-open condom or plastic wrap, for oral sex.

What About Kissing?

There are no reported cases of people getting HIV from deep kissing. It might be risky, however, to kiss someone if there is a chance for blood contact—if the HIV infected person has an open cut or sore in the mouth or on the gums. It would be even more risky if both people had bleeding cuts or sores. So, use common sense - wait until any sores or cuts have healed before kissing.

Unsafe Activities

It is never a good idea to:

  • Have vaginal, oral, or anal sex without using a latex condom.
  • Have oral sex without a latex barrier.
  • Share needles, syringes, or any kind of sharp object for cutting, tattooing, or piercing.

Remember, preventing HIV takes action and communication. Talk to your partner about HIV and safer sex practices. Love and passion don't protect you. Just knowing and trusting your partner isn't enough. Use a male or female condom or latex barrier for every act of vaginal, oral, or anal intercourse or remain abstinent. Respect yourself enough to protect yourself!

Is there a connection between HIV and other STD(Sexually Transmitted Diseases)?

Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person is also infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid all STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

  • Engaging in behaviors that do not involve vaginal or anal intercourse or oral sex
  • Having sex with only one uninfected partner
  • Using latex condoms every time you have sex

HOW DOES DRUG USE RELATE TO HIV?

Drug use is a major factor in the spread of HIV infection. Shared equipment for using drugs can carry HIV and hepatitis, and drug use is linked with unsafe sexual activity.

Drug and alcohol use can also be dangerous for people who are taking anti-HIV medications. Drug users are less likely to take all of their medications, and street drugs may have dangerous interactions with HIV medications.


INJECTION AND INFECTION

HIV infection spreads easily when people share equipment to use drugs. Sharing equipment also spreads hepatitis B, hepatitis C, and other serious diseases.

Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone's bloodstream.

Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be enough to infect another user.

To reduce the risk of HIV and hepatitis infection, never share any equipment used with drugs, and keep washing your hands. Carefully clean your cookers and the site you will use for injection.

A recent study showed that HIV can survive in a used syringe for at least 4 weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between users. If possible, re-use your own syringe. It still should be cleaned because bacteria can grow in it.

The most effective way to clean a syringe is to use water first, then bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because hot water can make the blood form clots. To kill most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning does not always kill HIV or hepatitis. Always use a new syringe if possible.

MOTHER TO CHILD TRANSMISSION

The number of children reported with AIDS due to perinatal HIV transmission in the United States peaked at 954 in 1992 and declined 95% to 48 in 2004, largely because of the effectiveness of ensuring that pregnant women are encouraged to be tested for HIV and, for those who are infected, to receive treatments that can significantly reduce the risk of transmitting HIV to a newborn. The CDC reports that perinatal transmission rates can be reduced to less than 2% if women are aware that they are infected with HIV and take appropriate treatments to prevent transmission.

Perinatal HIV transmission continues to occur mostly among women who lack prenatal care or who are not offered voluntary HIV counseling and testing during pregnancy. Many of the perinatal HIV infections each year can be attributed to the lack of timely HIV testing and treatment of pregnant women.

For years, HIV infected women who were pregnant had little choice in how they delivered their baby. C-section delivery was considered the safest option in an effort to prevent HIV transmission to the baby. Today, more and more HIV infected women are delivering vaginally. There are guidelines as to who should and shouldn't have a vaginal delivery. Keep in mind the following are just guidelines and your doctor's choice may vary.

C-section delivery is recommended if:

  • the viral load is unknown or is greater than 1000 copies/ml at 36 weeks of pregnancy
  • there as been no HIV medications taken during the pregnancy
  • there has been no prenatal care prior to 36 weeks of pregnancy
  • a c-section should be scheduled prior to the rupture of membranes ("water breaking")

Vaginal delivery can be done if:

  • there has been prenatal care throughout pregnancy
  • the viral load is less than 1000 copies/ml at 36 weeks of pregnancy
  • HIV medications have been taken during pregnancy

If you are pregnant and have HIV, make sure you are getting the proper prenatal care throughout your pregnancy and talk to your doctor to find out if vaginal delivery is an option for you.

Breast milk can contain HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is potentially a viable means of transmission to infants. Mothers infected with HIV should discuss the risk of HIV transmission to their baby via breast milk with their doctor.

WHAT IS THE DANGER FOR MEDICAL STAFF FOR GET INFECTED?

It is really a low risk for medical staff to get infected during their work. It gets even lower if they use the general precautions like wearing latex glows. The biggest risk for medical staff is to cut themselves with infected needle or scalpel. But even that is a real low risk. However if it happens somehow the infection risk is %1. Bottom line is there is no big risk for medical staff if they execute the basic rules.

WHAT CAN I DO TO STAY HEALTHY?

It is important to have a person or a place for you to get mentally support.Because it makes you not to feel alone and also it is a safe place to share emotions and informations. You can get this support from your family or your doctor also "Pozitif Destek Merkezi" can give you this support as well. In addition to this keep your nutrition balanced, stop smoking and drinking alcohol, stop drug using, sleeping well, work out and stay away from stress etc. are so important to make your immune system stronger.

Medically as soon as you find your doctor or a medical health care center first thing you should do is to check your immune system immediately. Most of the doctors have made the tests first and then they check your immune system. After that process they check for the other diseases which have the possibility of treat your health in the future. Like syphilis, tuberculosis, hepatitis B.

Your doctor either decides to start to treatment or s/he can take some precautions for the future opportunistic infections. Like vaccine (Hepatitis A and B, pneumonia, flu, and some others if that's necessary) , preventative medicines or therapeutic medicines. Besides your doctor will set a schedule for you for check your health condition regularly.

We're both positive. Do we need to use a condom?

Sexual contact between two HIV infected people most certainly requires a condom. Different strains or types of HIV can be passed between two HIV infected people, making treatment of the infection even more difficult. This transfer of one HIV strain to another HIV infected person is called reinfection

For instance, if person "A" has an HIV type that has been responsive to therapy and person "B" has an HIV type that hasn't, passing that type of HIV from "B" to "A" will make it harder to treat person "A", possibly making therapy ineffective in person "A" as well. Also keep in mind, condom use is also important in preventing the transmission of other sexually transmitted diseases.

What is drug resistance testing?

Drug resistance testing is an important tool in HIV therapy that can help physicians understand more about a person's virus and therapy options. There are two methods of drug resistance testing: phenotypic and genotypic.

Phenotypic testing
Phenotypic testing measures a person's HIV against each of the currently available antiviral drugs. This method detects drug sensitivity by directly exposing the virus to a drug. Once the virus is exposed to a specific drug, it is evaluated to determine how much of the drug is necessary to block viral activity. An individual's virus is resistant to a particular drug when more of the drug is required to block the virus.

Genotypic testing
Genotypic analysis determines the presence of genetic mutations in HIV that may be associated with drug resistance. By using genotypic analysis to evaluate the genetic makeup of someone's virus, the data can be compared to past trends in HIV treatment failure. Included in the knowledge about HIV are preestablished genetic mutation patterns that have been linked to drug resistance. If the genetic mutations in a person's virus match mutations assumed to signal resistance for a certain drug, then his or her virus is presumed to be resistant to that drug.
When used in combination with viral load and CD4 T cell count analyses, drug resistance testing can give physicians a more complete picture of a patient's health and therapy options. The use of drug resistance testing can help physicians determine which drugs may not work in a patient's therapy, allowing him or her to create a treatment plan that is more likely to suppress the virus for a longer period of time.

In addition to helping physicians select more effective therapies, there may be long-term benefits from using resistance testing to direct treatment decisions. These include avoiding the use of potentially ineffective drugs, and in turn, reducing the health risks associated with medication side effects and the amount of money wasted on purchasing unnecessary medications.In Turkey we have Genotypic testing.

Committing to a Regime

Taking HIV medications requires a large commitment on your part. There is no cure for HIV so once treatment is started, it needs to be continued for the rest of your life. Additionally, your medications need to be taken according to a strict timetable anywhere from one to three times a day. Some drugs need to be refrigerated while others have side effects.

Once you have started treatment, regular testing will still be necessary to make sure your viral load is decreasing while your CD4 count is increasing. If this does not happen, or if your viral load begins to increase after a period of effective treatment, it may indicate that your drug regime is failing or that your infection is starting to become resistant to treatment. Changing your drug regime may be necessary.

Treatment Side Effects

Like many other types of medications, HIV treatment often causes unwanted side effects in users. In general, the most common side effects include nausea, fatigue and diarrhea. However, some side effects may severely limit your daily activities, require hospitalization or even be life threatening, although this is rare.

Common side effects in those using nucleoside RT inhibitors include a decrease in red or white blood cells and possibly an inflamed pancreas or nerve damage. Protease inhibitors user often experience nausea, diarrhea as well as other gastrointestinal problems. The drug may also interact with other drugs causing an allergic reaction. Using Fuzeon has also been known to cause an allergic reaction as well pneumonia, low blood pressure, vomiting, fever or chills, rash and difficulties breathing.

Most people find that their body adjusts to the drugs after a period of time causing their side effects to subside. Those who don�t find any relief from their side effects may want to discuss the issue with their health care provider, especially if the side effects are so severe that they make it difficult for you to follow your drug regime. Changing your HIV treatment may help reduce the severity of your side effects and make it easier to take your medications. It is important to note, though, that repeated changes to your medication combinations can actually increase the likelihood that your body will develop a resistance.

While HIV treatments have come a long way over the years, they still leave much to be desired at least as far as side effects are concerned. Currently, researchers are looking for new ways of treating HIV and AIDS as well trying to create an HIV vaccine.

HOW DOES IMMUNE SYSTEM WORKS?

The immune system is composed of many interdependent cells and organs that protect the body from bacteria, parasites, fungi, viruses, and tumor cells. The immune system acts like an army that protects the body from invaders, and each of the different cells of the immune system performs a highly specialized and interrelated function in fighting off these invaders.

When bacteria, viruses, or other agents invade the body, they are recognized as foreign, which then signals the immune system to attack and destroy them. If the immune system does not act sufficiently in response to an invading agent, the result will be infection.

The interrelationships between cells in the immune system are complex and extremely intricate, and damage to one type of cell in the system compromises the entire system's ability to protect the body from infections and cancers.

How HIV affects the immune system HIV is a retrovirus, a type of virus that stores its genetic information on a single-stranded RNA molecule. After a retrovirus penetrates a cell, it creates a DNA version of its genes, and its DNA becomes part of the infected cell's DNA.

HIV infects one particular type of immune system cell, called CD4 cells (or T-cells). T-cells coordinate immune regulation and secrete specialized factors that activate other white blood cells to fight off infection. In healthy individuals, the number of CD4 cells normally ranges from 450 to 1,200 cells per microliter of blood (this measurement is known as the T-cell count).

When infected with HIV, a T-cell becomes an HIV-replicating cell. In other words, the virus binds with the cell, copies itself into the cell's DNA, and causes the cell to begin producing new HIV viruses. This process eventually causes the cell to die. As the number of T-cells decreases, the infected person's immune system becomes increasingly compromised. When a person's T-cell count (number of CD4 cells) drops to below 200 cells per microliter of blood, the person is considered to have AIDS.

An infected person's body tries to fight off HIV infection by aggressively manufacturing antibodies, which are tiny bits of protein designed to bond with HIV particles and neutralize them before they can infect more cells. (Most HIV tests actually detect the presence of these antibodies, not HIV itself.)

It is particularly difficult for the immune system to fight off HIV infection for a number of reasons, including the following:

  • HIV attacks the immune system itself, weakening its ability to fight back.
  • HIV replicates in large quantities that are more than the compromised immune system can handle.
  • HIV has the ability to mutate (change itself) very quickly, making it more difficult for the body to fight the infection.

WHAT IS CD4 ( T Cell) CELL?

A type of white blood cell that is of key importance to the immune system and is at the core of adaptive immunity, the system that tailors the body's immune response to specific pathogens. The T cells are like soldiers who search out and destroy the targeted invaders.
Immature T cells (termed T-stem cells) migrate to the thymus gland in the neck, where they mature and differentiate into various types of mature T cells and become active in the immune system in response to a hormone called thymosin and other factors. T-cells that are potentially activated against the body's own tissues are normally killed or changed ("down-regulated") during this maturational process.
There are several different types of mature T cells. Not all of their functions are known. T cells can produce substances called cytokines such as the interleukins which further stimulate the immune response. T-cell activation is measured as a way to assess the health of patients with HIV/AIDS and less frequently in other disorders.

VIRAL LOAD TEST

How is it used?
The viral load test provides important information that is used in conjunction with the CD4 cell count:

  • to monitor the status of HIV disease,
  • to guide recommendations for therapy, and
  • to predict the future course of HIV.

Evidence shows that keeping the viral load levels as low as possible for as long as possible decreases the complications of HIV disease and prolongs life.

Public health guidelines state that treatment should be considered for asymptomatic HIV-infected people who have viral loads higher than 30,000 copies per milliliter of blood using a test known as a branched DNA test, or more than 55,000 copies using an RT-PCR test.

There are several methods for testing viral load; results are not interchangeable so it is important that the same method be used each time.

When is it ordered?
A viral load test is ordered when a patient is first diagnosed with HIV. The test result functions as a baseline measurement that shows how actively the virus is reproducing and whether treatment is immediately necessary.

If and when therapy is started, your doctor should order a viral load test and a CD4 count about two to eight weeks after you start a treatment to evaluate whether therapy is being effective. To monitor long-term therapy, your doctor will order viral load tests and CD4 counts about every three to six months.

What does the test result mean?
Viral load tests are reported as the number of HIV copies in a milliliter of blood. If the viral load measurement is high, it indicates that HIV is reproducing and that the disease will likely progress faster than if the viral load is low. A high viral load can be anywhere from 5,000 to 10,000 copies and can range as high as one million or more.

A low viral load is usually between 200 to 500 copies, depending on the type of test used. This result indicates that HIV is not actively reproducing and that the risk of disease progression is low.

A viral load result that reads "undetectable" does not mean that you are cured. It may mean that the level of HIV virus in your blood is below the threshold needed for detection by this test. Other tests that are ultra-sensitive and that can measure as few as 20 to 40 copies in a milliliter of blood can be performed to make sure.

If you are not taking your medication as your physician has directed, your viral load will not drop as significantly as if you take your medication on time.

Change in viral load is also a very important measurement. A rising count indicates an infection that is getting worse, while a falling count indicates improvement and suppression of the HIV infection.

A non-infected person should have no circulating HIV virus in his or her blood and, therefore, a negative or undetectable viral load.

IS THERE A CURE?

At this time, there is no cure for HIV. But there are things you can do.

Since this is the current reality, it is important that those people who are not infected with HIV stay negative and those living with HIV/AIDS stay healthy.

For people infected with HIV, drug development has helped to change the face of the disease. Whereas HIV infection once implied certain death, drug therapy has helped to prolong and improve the quality of life for many individuals.

HIV is a retrovirus, so drugs that target the virus are called antiretroviral (ARV) drugs. There are many different types of ARVs, but they all work by slowing the growth or inhibiting the replication of the virus. Although these drugs do not kill the virus, they effectively reduce the levels of HIV in the blood.

In choosing to begin drug therapy to treat HIV, it is important to discuss your options with a doctor. The doctor will perform blood tests to determine your viral load (how much HIV is in your blood) and your T cell (CD4+) levels (how strong your immune system is). Knowing these test results and the symptoms you have experienced will allow the two of you to decide when to begin treatment and which therapies to use.

HOW HIV IS TRANSMITTED?

HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker's open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States.

Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence.

The following paragraphs specifically address some of the common misperceptions about HIV transmission.

HIV in the Environment

Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears.

To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limited laboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed--essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have unnecessarily alarmed some people.

Results from laboratory studies should not be used to assess specific personal risk of infection because (1) the amount of virus studied is not found in human specimens or elsewhere in nature, and (2) no one has been identified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, therefore, it does not spread or maintain infectiousness outside its host.

Households

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as described in previously published guidelines, should be taken in all settings "including the home" to prevent exposures to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown. For example,

  • Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit.
  • Cuts, sores, or breaks on both the care giver's and patient's exposed skin should be covered with bandages.
  • Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately.
  • Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided.
  • Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers out of the reach of children and visitors.)

Businesses and Other Settings

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments (see information on survival of HIV in the environment). Food-service workers known to be infected with HIV need not be restricted from work unless they have other infections or illnesses (such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, should be restricted. CDC recommends that all food-service workers follow recommended standards and practices of good personal hygiene and food sanitation.

In 1985, CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from a personal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.

CDC knows of no instances of HIV transmission through tattooing or body piercing, although hepatitis B virus has been transmitted during some of these practices. One case of HIV transmission from acupuncture has been documented. Body piercing (other than ear piercing) is relatively new in the United States, and the medical complications for body piercing appear to be greater than for tattoos. Healing of piercings generally will take weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person's blood or other infectious body fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.

Kissing

Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to contact with blood during open-mouth kissing.

Biting

In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.

Saliva, Tears, and Sweat

HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Insects

From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person's or animal's blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces.

There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors serve to explain why this is so--first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest this blood meal.

Effectiveness of Condoms

Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA). Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection.

There are many different types and brands of condoms available--however, only latex or polyurethane condoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores and are therefore not recommended for disease prevention (they are documented to be effective for contraception). Women may wish to consider using the female condom when a male condom cannot be used.

For condoms to provide maximum protection, they must be used consistently (every time) and correctly. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.

When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection.

How Long Does Hiv Live Outside The Body?

HIV does not survive well outside the body. In artificially high concentrations produced in the lab, HIV drying that occurs outside of the body reduces the number of infectious viral particles by 99 percent in just a few hours. Since the concentration of HIV in blood or other bodily fluids is much lower, HIV drying outside the body virtually eliminates all infectious HIV particles therefore making the risk of HIV infection from blood or bodily fluids outside the body essentially zero.

Keep in mind that while HIV infection from infectious bodily fluids outside the body is essentially zero, other diseases like hepatitis B and C can and do occur. Therefore, any blood or bodily fluid outside the body should be considered a health risk and cleaned up using universal precautions and cleaning fluids that are known to kill viruses on contact.

How Can I clean my skin from Hiv virus?

  • Prevent injuries, such as cuts and scrapes.
  • Keep the skin clean and dry by washing daily with mild soap and water. Dry your skin very well.
  • Rub lotion on the skin to prevent dryness and chapping.
  • In the case of injuries, the wound needs to be cleaned and apply ticture of iodine or betadine.

Do I Have To Tell My Dentist About My Hiv Status?

It is your dentist's obligation to use universal precautions. S/he must have take care of all the patients like they might have any infection. You might not know that you have Hiv.

What is the Information of HIV/AIDS Centers?

TAPV (Türkiye Aile Planlama Vakfı) Kadın Sağlığı Bilgi Hattı (212) 257 06 46
TAPV (Türkiye Aile Planlama Vakfı) Okey Cinsel Bilgi Hattı 444 65 39
ASAD (Aile Cinsel Sağlığı Araştırma Derneği) Cinsel Sağ. Dayanışma Hattı (212) 282 01 01
Eczacılar Birliği Cinsel Sağ. Eğitim ve Day. Mer. (312) 409 81 19
TAPD (Türkiye Aile Planlama Derneği) CYBH Bilgi Hattı (312) 435 20 47- 48
Hacettepe AIDS Tedavi ve Araştırma Merkezi Hatam AIDS Tedavi Merkezi (312) 310 80 47
Eczacılar Birliği Cinsel Sağ. Eğitim ve Dayanışma Merkezi (312) 409 81 19





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