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HIV and AIDS Pathophysiology and Management Comparison

Introduction

More and more are being discovered about diseases that have been a nightmare to scientists, but researchers are yet to discover vaccines for some diseases. Cures for some diseases have also remained equally elusive. “HIV, an acronym for Human Immunodeficiency Virus, and AIDS, which stands for Acquired Immune Deficiency Syndrome, are undoubtedly the defining public health crisis of our time” (Simon, Ho, and Karim, 2006, p. 1).

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Scientists have succeeded in understanding various aspects of the conditions, but they have unfortunately not discovered a cure or a vaccine for the same. Meanwhile, AIDS remains responsible for millions of deaths the world over. AIDS substantially affects the productive capacity of countries and hence affects their economic growth. AIDS is a great public health concern that can never be wished away until a solution on how to manage it or cure it is found. This paper is an investigation of the similarities and differences between the AIDS condition and HIV infection.

Pathophysiology

Studies indicate that HIV is effective in counteracting the intrinsic, innate, and adapted immunity of humans. “Despite its modest genome size, less than 10 kb, and its few genes, HIV excels in taking advantage of cellular pathways while neutralizing and hiding from the different components of the immune system” (Simon, Ho, and Karim, 2006, p. 1). Early after a person is infected with HIV, the viral enters cells and does not cause immediate havoc in the cells. However, the entry of the virus into cells can cause changes within the cell resulting in viral replication.

Studies have also shown that, after a breach of the mucosal barrier by HIV, there is a window period during which the activities of viruses in the host’s body can be potentially controlled by the defense system of the host. “The important co-receptors of HIV infection are two chemokine receptors – CCR5 and CXCR4. Independently of the transmission route, most new infections are established by viral variants that rely on CCR5 usage. CXCR4-tropic viruses generally appear in late stages of infection and have been associated with increased pathogenicity and disease progression” (Simon, Ho, and Karim, 2006, p. 1).

The pathophysiology of HIV is therefore similar to that of AIDS since HIV is the precursor and cause of AIDS. It is however important to note that viral activities in an AIDS victim are more wasting to his/her cells than viral activities in HIV-infected people (Simon, Ho, and Karim, 2006).

Clinical manifestations

A person infected with HIV normally has no symptoms immediately after infection, which is before the HIV infection leads to the development of the AIDS condition. Symptoms normally appear in HIV-infected persons after a couple of years. During this time, the patient has HIV infection, but he/she does not have the AIDS condition. When the AIDS condition develops, two to fifteen years after the patient is infected with HIV, the “CD4-T cell count is less than 200” (HIV/AIDS, n.d., p. 1).

An exception to this is when a patient experiences acute HIV infection shortly after he/she is exposed to the HIV. In this case, the patient experiences symptoms similar to those experienced by AIDS patients after about four weeks after exposure to HIV. These symptoms include malaise, fever, weight loss, fatigue, joint pain, rash, diarrhea, ulcers in the mouth, muscle pain, and sore throat (HIV/AIDS, n.d.). It is however important to note that these symptoms do not occur at once. Some of the symptoms may not occur at all.

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Once the CD4 count of a patient goes beyond 200, a patient is declared to have developed AIDS. This condition is characterized by severe weight loss, diarrhea, and opportunistic infections. Some more symptoms that are experienced at this stage are nausea, malaise, fatigue, dry cough, shortness of breath, fever, and lymphadenopathy (HIV/AIDS, n.d.). Opportunistic infections experienced at this stage include candidiasis, hepatitis C, B and A, herpes simplex, herpes zoster, tuberculosis, etcetera. AIDS victims may also present with psychiatric issues. Stress is a common phenomenon in AIDS victims, and the illness is likely to depress the victim.

The psychiatric problems and stress are sometimes magnified by the use of antiretroviral drugs that are given to AIDS patients (HIV/AIDS, n.d.). Stress occurs in both HIV patients and AIDS patients but psychiatric problems are specific to AIDS patients. Additional symptoms associated with the AIDS condition include night sweats, lethargy, anorexia, and sometimes oral hairy leukoplakia (HIV/AIDS, n.d.)s. The last symptom normally occurs in patients that are co-infected with the EBV. That is, the patient has both Epstein-Barr virus and HIV. Patients with the AIDS condition are also vulnerable to developing lymphomas and Kaposi’s sarcoma. The latter is a cancerous condition that is identified by purple nodules and patches on the skin.

Medical management

The best medical management option for HIV infection is antiretroviral therapy. It achieves prolonged suppression of the virus and therefore reduces mortality of HIV-infected individuals. It is however important to note that the drugs that are currently available in the market “do not eradicate HIV infection and lifelong treatment might be needed” (Simon, Ho, and Karim, 2006, p. 1). Three or more types of drugs may be combined during therapy to ensure that the objective of reduced morbidity and mortality is achieved. Virtually, all HIV-infected individuals respond well to one or more of the twenty-one drugs approved by the FDA (Food and Drug Administration).

“High rate of viral replication, low fidelity of reverse transcription, and the ability to recombine are the viral characteristics that lead to the diversity of HIV species in chronically infected individuals. This high genetic variability is the reason highly active antiretroviral therapy (HAART) was introduced” (Simon, Ho, and Karim, 2006, p. 1). In some cases, HIV-infected individuals do not respond well to drugs due to the aforementioned reasons. They are therefore put on HAART. This usually occurs in individuals who have had the HIV infection for a long time. Thus, one difference between medical management of HIV and that of AIDS is the fact that more individuals with the AIDS condition are on HAART than HIV-infected people who are put on HAART (Simon, Ho, and Karim, 2006).

There has been a debate on whether HAART should be started on asymptomatic patients or patients with the AIDS condition. Some studies have shown the benefits of starting HAART on HIV patients, but their recommendations are discouraged by the high toxicity, costs, and side effects of HIV drugs used in HAART. “Early depletion of gut CD4+ T lymphocytes, increasing viral diversity, and the poor regenerative abilities of key populations of the immune system provide an argument for beginning treatment as early as possible. The wide application of this principle is restricted by long-term drug toxicities that lead to a reduction of quality of life, and by treatment costs” (Simon, Ho, and Karim, 2006, p. 1).

Prognosis

HIV patients have a better prognosis than AIDS patients do. HIV patients being favored by antiretroviral therapy are likely to stay alive for more than fifteen years. However, several factors determine their survival. Some of these factors are the type of opportunistic infections that the patients have or catch in the course of the disease. For instance, a patient who develops pneumonia has a better prognosis than another patient who is co-infected with herpes or hepatitis.

This is because pneumonia is treatable while hepatitis and EBV are not treatable. There has been a tremendous improvement in the prognosis of HIV patients since therapy with antiretroviral started being successful in the early 1990s (Oppenheim, 2009). The better prognosis can also be attributed to the improved treatment and prevention of complications that occur in HIV patients. More than three-quarters of patients have battled HIV for more than ten years thanks to combination therapy and good management of HIV complications.

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There has been effective management of opportunistic infections that have led to a reduction in the mortalities resulting from the same. More and more deaths of people with HIV are being reported from other co-morbidities such as suicide, cancers not related to HIV, hepatitis, and renal failure (Oppenheim, 2009s). This is an indication of the success of therapy and management of opportunistic infections.

Of course, the prognosis of HIV-infected patients is determined by several factors such as the options of therapy remaining/available, development of complications, CD4 count, age, viral load, and the response of opportunistic infections to the patients’ therapy (Oppenheim, 2009).

A slightly different scenario occurs in patients with the AIDS condition. A good prognosis of more than five years of life is only possible if the patient has not been in therapy for a long time, and more therapy options are available for him/her. It is however important to note that the prognosis may not be possible if the patient responds poorly to the available therapy options (Oppenheim, 2009). Therefore, for an AIDS patient to have a better prognosis, he/she should benefit from therapy.

If this is the case, it is even possible for an AIDS patient to change his/her status from an AIDS patient to an HIV-infected patient. Generally, however, the prognosis of AIDS patients is from as few as six months of life to a couple of years. Like HIV prognosis, AIDS prognosis is affected by infections like hepatitis, EBV, cancers, and other opportunistic infections. A person who has hepatitis C, EBV, or hepatitis B and AIDS has a prognosis of approximately one year of life. Another person without these conditions who does not develop serious opportunistic infections has a prognosis of a couple of years of life (Oppenheim, 2009).

Conclusion

As evident in the discussion above, the AIDS condition and HIV infection are similar in some ways and different in many ways. Although many people consider the two as synonymous, several aspects of the two conditions are substantially different. For instance, a person with HIV may have no symptoms at all but an AIDS patient must experience some clinical manifestations proving that he/she has the disease. The pathology, prognosis, and medical management of the two are also quite different. It is however important to note that AIDS is more or less advanced HIV infection.

Reference List

HIV/AIDS: Clinical features. (n.d.). Web.

Oppenheim, S. (2009). Prognosis in HIV and AIDS. Web.

Simon, V., Ho, D., & Karim, Q. (2006). HIV/AIDS epidemiology, pathogenesis, Prevention and treatment. PMC. Web.

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StudyCorgi. (2022, July 23). HIV and AIDS Pathophysiology and Management Comparison. Retrieved from https://studycorgi.com/hiv-and-aids-pathophysiology-and-management-comparison/

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