Acquired immunodeficiency syndrome (AIDS) is a chronic and potentially fatal disease of the immune system caused by the human immunodeficiency virus (HIV), which attacks a specific type of white blood cells known as T-lymphocytes. These cells are measured in the blood as the CD4 count. The lower the CD4 count, the weaker the immune system. As the immune system grows weaker, people with HIV and AIDS are susceptible to infections and cancers that the immune system would ordinarily fight off. About 31 million adults and 2.5 million children worldwide are infected with HIV. A massive research effort has produced better treatments, resulting in longer survival and improved quality of life for those with access to the treatments. But there is still no vaccine or cure.

Symptoms of infection with HIV can vary. Often a flu-like syndrome occurs in 50 - 80% of those who contract HIV within the first 2 - 6 weeks, including a combination of the following symptoms:

• Fever
• Sore throat
• Swollen lymph nodes
• Joint pain
• Muscle aches
• Rash
• Mouth ulcers
• Nausea
• Diarrhea
• Headache

After infection with HIV, you may remain relatively symptom-free for years, or the disease may progress more rapidly. In this stage, the CD4 count is below 500/microliter. You may develop infections or chronic symptoms, including:

• Swollen lymph nodes
• Diarrhea
• Weight loss
• Fever
• Cough and shortness of breath
• Low platelet count, which may manifest as easy bruising, bleeding gums, or nose bleeds

During the last stage of the disease, HIV infection may meet the official criteria for AIDS, which is the presence of an opportunistic infection (such as Pneumocystis carinii pneumonia, or PCP) or a CD4 count below 200/microliter. At this stage, symptoms may include:

• Pneumonia, including PCP
• Tuberculosis
• Night sweats
• Persistent fatigue
• Extreme weight loss and wasting, exacerbated by diarrhea. Up to 90% of HIV patients worldwide experience diarrhea
• Meningitis and other brain infections
• Fungal infections
• Syphilis
• Malignancies such as lymphoma, cervical cancer, and Kaposi's sarcoma (affects the skin and oral mucosa and may spread to the lungs. Kaposi's sarcoma can actually occur in earlier stages of HIV as well)

HIV infection causes AIDS. HIV is spread primarily through sexual contact, and also through blood-to-blood contact, needle sharing among intravenous drug users, and, in pregnant women, from mother to child. About 75% of HIV transmission occurs through sexual contact. Blood transfusions and blood products caused many infections in the early years of the epidemic, but screening procedures have nearly eliminated this risk in the United States and other developed countries. A mother can spread the virus to a newborn during delivery and through breastfeeding, although drug therapy available in the developed world can greatly reduce the risk to infants.

Risk factors include:

• Having unprotected sex (without using a condom) and having more than one partner, whether you are heterosexual or homosexual
• Having another sexually transmitted disease
• Using intravenous drugs and sharing needles

If your health care provider suspects HIV infection, you may receive a "rapid test," which can provider results in 20 minutes. If the test is positive, your health care provider will order a blood test to detect antibodies against the virus. If this test is positive, the doctor will order a CD4 count (see above) and a viral load (an indication of the amount of virus present). This information, along with your symptoms, helps the doctor see what stage the disease is in and determine the best course of treatment for you, including the appropriate tests and medications. For example, if you are experiencing shortness of breath, your doctor will order a chest x-ray, particularly if your CD4 count is low. Some symptoms and tests may require evaluation in the hospital.

HIV tests may not be accurate immediately after you are infected, because it can take up to 12 weeks for your body to develop antibodies against the virus. If you suspect you have been infected and your test is negative, you may need to be retested after a short time to confirm the result.

If you do test positive for HIV, you will be asked to tell your sexual partners immediately so they can also be tested.

Many valuable medications can slow the progression of HIV infection to full-blown AIDS. Generally, a combination of these medicines, including a type called protease inhibitors, is used. In addition, antibiotics and other therapies are used to prevent or treat specific complications. It is important to have your care directed by a doctor who specializes in HIV. Your health care provider will know the most effective treatment for you, including the most current medical regimen, what alternative treatments are safe, and which combinations may be harmful. If you are using any alternative therapies to complement your medical regimen, be sure to share this information with your doctor.

Drug Therapies

A combination of drugs is used to treat HIV very aggressively, with the aim of reducing the amount of virus in your blood to very low or undetectable levels and to suppress symptoms for as long as possible.

Antiretroviral drugs help slow the progression of HIV by inhibiting the reproduction of the virus in your blood. It's important to keep a steady dose of antiretroviral drugs in your body to prevent the virus from developing resistance to the drugs. Antiretroviral medications include:

• Protease inhibitors (PIs) stop an HIV enzyme from replicating. This class of drugs includes saquinavir (Invirase), nelfinavir (Viracept), ritonavir (Norvir), tipranavir (Aptivus), indinavir (Crixivan), amprenavir (Agenerase), and atazanavir (Reyataz). Another medicine, darunavir (Prezista), is used in combination with other drugs for people who have not responded to treatment. A combination of ritonavir and lopinavir (Kaletra) is among the most prescribed protease inhibitors. Protease inhibitors are considered the most powerful of HIV drugs and often interact with other medications, so they must be monitored carefully.
• Nucleoside analogue reverse transcriptase inhibitors (NRTIs) also stop a particular HIV enzyme from replicating. These drugs were among the first to be developed and include zidovudine or azidodeoxythymidine (Retrovir or AZT), lamivudine (Epivir), didanosine (Videx), abacavir (Ziagen), stavudine (Zerit), and zalcitabine (Hivid). Emtricitabine (Emtriva) is a newer drug in this class and is taken with at least two other HIV medications. Combinations of several other drugs are also available. All have side effects that must be monitored by your doctor.
• Nucleotide reverse transcriptase inhibitors (NtRTIs) work similarly to NRTIs but act more quickly. So far there is only one drug in this class, tenofovir (Viread), which seems to be effective in people who develop resistance to NRTIs.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) stop the virus from making DNA, so that it can't replicate itself. There are three drugs in this class: nevirapine (Viramune), efavirenz (Sustiva), and delavirdine (Rescriptor). They are often used if people cannot tolerate the side effects of protease inhibitors, want to delay protease inhibitor therapy, or if they have taken protease inhibitors but did not experience a drop in levels of the virus. Many of these drugs are cross-resistant, meaning that if you develop resistance to one drug in this class it's likely you will be resistant to all.
• Fusion inhibitors prevent the HIV membrane from fusing with the membrane of healthy cells in your body. Enfuvirtide (Fuzeon) is often used in combination with other drugs in people who have become resistant to other medications. It must be administered by injection.
• Combination drug therapies also exist. Epzicom is a combination of abacavir (Ziagen) and lamivudine (Epivir). Truvada is a combination of tenofovir (Viread) and emtricitabine (Emtriva).

In addition, any opportunistic infections are treated with the appropriate medications, or in some cases medications are given to prevent the infections from occurring (prophylaxis).

Complementary and Alternative Therapies

Many people with HIV turn to complementary and alternative therapies to reduce symptoms of the virus, lessen side effects from medications, improve overall health and well-being, and for a sense of empowerment by being actively involved in their own care.

Different therapies are used to:

• Inhibit the virus
• Treat symptoms of the virus or side effects of medication
• Treat or prevent opportunistic infections
• Improve function of the immune system

Since the major impact of HIV is that it leaves patients vulnerable to opportunistic infections, making adjustments to ensure your overall health through improving stress reduction, exercise, and building a social support network can significantly boost immune function. In fact, these actions are some of the most powerful tools a person has to impact the course of the disease. Other changes, such as improving oral and general hygiene and limiting exposure to environmental pollutants, can also bolster your health and vitality. These small steps can add up to a longer and healthier life for many people.

However, HIV should never be treated with alternative therapies alone. It is extremely important that you share information on your use of complementary and alternative therapies with your doctor, so that your doctor can help you determine what is safe and appropriate.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins, calcium, and iron, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Use quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, as part of a balanced program aimed at gaining muscle and preventing weight loss that can sometimes be a side effect of therapy. Try to eat fewer red meats and more lean meats, such as chicken and fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week. Talk to your health care provider about how much exercise you can tolerate.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tbs. oil, one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources but not substitutes for supplementation.
• Whey protein, 10 - 20 grams daily mixed in favorite beverage, when needed as a protein supplement for support of immunity and weight gain or creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting. Talk with your health care provider.
• N-acetyl cysteine, 200 - 800 mg daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some probiotic supplements need refrigeration for best results - check labels carefully.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support. Some doctors will use higher doses in HIV and AIDS therapies. Check with your health care provider.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
• Melatonin, 2 - 5 mg 1 hour before bedtime, for sleep and immune protection. Ask your health care provider about potential drug interactions with the use of melatonin.
• Dehydroepiandrosterone (DHEA), 200 - 500 mg per day, for hormonal balance. DHEA is a hormone that is often low in people with HIV. One study found that DHEA supplements improved minor depression with no serious side effects. Because DHEA is a hormone, you should not take it without your doctor's supervision.

Weight loss can be a serious problem for people with HIV. This symptom may begin early in the course of the disease and can increase the risk for developing opportunistic infections. Weight loss is exacerbated by other common symptoms of HIV and AIDS, including lesions in the mouth and esophagus, diarrhea, and poor appetite. Over the last several years, weight loss has become less of a problem due to the new protease inhibitors used for treating HIV. Reduction of muscle mass, though, remains a significant concern. Working with a registered dietitian to develop a meal plan to prevent weight loss and muscle breakdown is extremely helpful. Resistance training (lifting weights) can also protect against muscle breakdown and increase lean body mass.

Preventing diarrhea and ensuring that the body absorbs enough protein to maintain muscle strength has become a major goal of HIV/AIDS preventative care. One program for combating diarrhea includes using soluble fiber (not insoluble fiber, such as Metamucil and psyllium husks). For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed, and lessening bowel frequency. Good sources of soluble fiber include apple pectin, oat bran, and flax seed. Because diarrhea can be a potentially life-threatening situation, use soluble fiber therapy only under the strict supervision of a trained professional.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Fermented wheat germ extract, 1 packet dissolved in favorite beverage once daily, for immune effects. Ask your health care provider for more information about this supplement.
• Bitter Melon (Momordica charantia) standardized extract, 200 mg two to three times daily, for antiviral and immune support. Higher dosages may be needed in HIV and AIDs therapy. A health care provider can help with dosages.
• Maitake mushroom (Grifola frondosa) standardized extract (D-fraction), 600 mg twice daily, for immune and antiviral effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for immune and antiviral activity.

You may use herbs as supportive therapies, but never use them alone to treat HIV or AIDS. Tell all of your health care providers about any treatments, conventional or alternative, you are taking so they can monitor interactions and side effects, and provide the best care.

Herbs you should avoid until more studies are done include St. John's wort (Hypericum perforatum), which has a negative effect on indinavir and could lead to developing resistance to the drug. You should also aovid echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus). These two substances show conflicting evidence of enhancing immune function and strengthening replication of the HIV virus in test tubes.

Homeopathy

No specific scientific research supports the use of homeopathy for HIV or AIDS. A licensed, certified homeopathic doctor would evaluate you individually to assess the value of homeopathy for reduction of symptoms or side effects from medication as an adjunct to standard medical treatment.

Physical Medicine

Exercise is another way to help develop a general sense of well-being, improve mental attitude, decrease depression, diminish weight loss, and increase lean body mass. Resistance or weight training is particularly useful to increase strength and enhance lean body mass.

Acupuncture

People with HIV have used acupuncture to improve general well-being, alleviate symptoms such as fatigue, insomnia, and night sweats, and to minimize side effects from medications, such as nausea. Some people also find relief from peripheral neuropathy, caused occasionally by certain medications used for HIV, reporting less pain, increased strength, and improved sensation.

In China, acupuncture and moxibustion (a heat treatment performed by the acupuncturist over points where the needles are placed) are the standard treatments for HIV-related diarrhea.

Acupuncture can also be used to treat the neuropathic (nerve) pain associated with certain HIV medications. Inserting needles bilaterally in the hand and foot points known as Baaxie and Bafeng, respectively, can lessen neuropathic pain.

Massage

Massage can relieve chronic muscle tension and stress, which may help the immune system.

If you are HIV-positive and pregnant, taking certain antiretroviral medications will reduce the likelihood of you transmitting the virus to your baby. Your doctor will determine which medicine is best for you and safe for your baby. Depending on your own condition, you and your health care provider may decide to postpone treatment until after your first trimester to reduce the risk of birth defects. The drug efavirenz (Sustiva) should be avoided throughout pregnancy. If you are HIV-positive, you should not breastfeed because of the risk of transmission to your baby.

Faintuch J, Soeters PB, Osmo HG. Nutritional and metabolic abnormalities in pre-AIDS HIV infection. Nutrition. 2006;22(6):683-90.

Harris A, Bolus NE. HIV/AIDS: An update. Radiol Technol. 2008;79(3):243-52.

Hendricks MK, Eley B, Bourne LT. Colecraft E. HIV/AIDS: nutritional implications and impact on human development. Proc Nutr Soc. 2008;67(1):109-13.

Highleyman L. Nutrition and HIV. BETA. 2006;18(2):18-32.

Hoppe C, Andersen GS, Jacobsen S, et al. The use of whey or skimmed milk powder in fortified blended foods for vulnerable groups. J Nutr. 2008;138(1):145S-161S.

Joy T, Keogh HM, Hadigan C, et al. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS. 2007;21(12):1591-600.

Liu JP, Manheimer E, Yang M. Herbal medicines for treating HIV infection and AIDS. Cochrane Database Syst Rev. 2005;(3):CD003937.

Suttajit M. Advances in nutrition support for quality of life in HIV+/AIDS. Asia Pac J Clin Nutr. 2007;16 Suppl 1:318-22.

Tabi M, Vogel RL. Nutritional counselling: an intervention for HIV-positive patients. J Adv Nurs. 2006;54(6):676-82.

Yeh SS, Lovitt S, Schuster MW. Pharmacological treatment of geriatric cachexia: evidence and safety in perspective. J Am Med Dir Assoc. 2007;8(6):363-77.