AIDS is only caused by HIV
HIV infection and AIDS
AIDS (Acquired Immune Deficiency Syndrome): Through the HIV (Human immunodeficiency virus, HI virus) caused, so far incurable infectious disease with predominantly infection of the immune cells. The increasing weakness of the immune system leads to more and more frequent and more severe infections, also from otherwise harmless pathogens. In Germany around 2,500 people are infected each year (in Austria less than 500), mainly through (unprotected) sexual intercourse. Worldwide, around 6,000 AIDS deaths are counted every day; in poor regions, especially in Africa, AIDS is now the most common cause of death for those under 50 years of age (figures as of the end of 2007).
- Mostly no complaints for years (despite being contagious)
- Possibly short-term “flu-like” symptoms shortly after the infection
- Only after years slowly increasing complaints, initially v. a. Fungal infections (mainly of the mouth, throat and genitals), fever and prolonged diarrhea.
The acquired immune deficiency disease AIDS, which was first described in the early 1980s, is caused by an infection with the HI virus. In principle, the virus is excreted with all body fluids, but above all with blood, semen, vaginal secretions and breast milk (main routes of transmission below). The virus penetrates the body through the smallest of skin and mucous membrane injuries and primarily destroys defense cells that carry the CD4 molecule on their surface. These include in particular the T helper cells, a subgroup of T lymphocytes that activate other immune cells.
The viruses multiply vigorously soon after infection, but most infected people often do not notice anything for a long time. In this phase one speaks of HIV infection. Only about half of those infected have short-term symptoms 1–6 weeks after infection that are similar to those of flu, strep throat or glandular fever (acute HIV infection).
The first thing the person affected usually notices is the prolonged swelling of the lymph nodes. This is followed by uncharacteristic symptoms such as general weakness, repeated fever or frequent and prolonged diarrhea. After all, there are more and more serious infections. Since the defense against tumor cells is also impaired, tumors occur more frequently, especially malignant lymphomas and Kaposi's sarcomas, which usually show up as red-brown spots and lumps on the skin and mucous membranes. Many sick people lose weight more and more (Wasting syndrome). Last but not least, HIV can also affect the brain. Only when such typical diseases are present, one speaks of AIDS.
Particular infections. As a result of the severe immune deficiency, AIDS patients can “attack” infectious agents that pose no threat to those with healthy immune defenses. One of the AIDS-defining infections is pneumonia caused by Pneumocystis jiroveci (formerly Pneumocystis carnii), a common protozoan that belongs to the fungi. Encephalitis caused by Toxoplasma and the most severe cytomegaly diseases with involvement of the eyes and the brain are also characteristic of AIDS.
Main routes of transmission of the Toxoplasmosis infection are cat feces (litter box!) and raw meat. People with a healthy immune system usually do not notice the infection. If, however, an HIV-positive person becomes infected, symptoms can range up to dangerous meningitis and encephalitis, depending on the immune system. Toxoplasmosis infection is also dangerous during pregnancy: for the unborn child, in which the parasitic unicellular organisms primarily damage the eye and brain.
It is similar with the Cytomegaly infection (CMV infection). Only in the case of a weak immune system can there be severe inflammation of the lungs and liver, as well as rejection reactions after transplants. The most severe courses with involvement of the eyes and the brain are especially at risk for AIDS sufferers. In cytomegaly, too, a fresh infection in the pregnant woman puts the unborn child at risk: there is a particular risk of permanent visual, hearing and brain damage.
That's what the doctor does
From 3 weeks to 3 months after the infection, the organism forms antibodies against the HI virus, and all common antibodies are detected if they are detected AIDS tests based. This also explains why, after a possibly "dangerous" contact, safety is only possible after a quarter of a year. A search test (ELISA test) is carried out to detect an HIV infection, followed by a confirmation test in the event of a positive result. Direct detection of viral genome is possible, but is only carried out for special questions.
There are a number of them in industrialized countries today antiretroviral drugs available that keep the HI virus in check for many years but have not yet been able to eradicate it. The treatment, its controls and its management are highly complex and change faster than a book can be printed, let alone reworked. The very latest can be found at www.hiv.net, for example.
One of the main routes of transmission of the HIV virus is sexual contact. Accordingly, one of the most important precautionary options is the condom, which also protects against hepatitis B and C as well as the “classic” sexually transmitted diseases.
The second main route of transmission is blood. 1,500–2,000 blood patients in Germany, for example, became infected with HIV in the 1980s through blood products such as blood transfusions. The risk from blood products in this country is now minimal, in poorer countries it is still real (which is why you should take disposable syringes with you when traveling to such countries, for example).
Where you don't get infected with HIV
Most people now know that door handles, light switches, shaking hands, hugs and public swimming pools pose no danger. When asked about the common use of cutlery, crockery, linen and toilets, many laypeople already feel less secure. Here, too, there is definitely no risk of infection. And if your neighbor on the S-Bahn coughs and sneezes, you might catch the flu, but not AIDS.
An infection is excluded even with skin contact with the body fluids "theoretically containing virus", saliva, sweat and tears. Whether drops of sweat in the sauna or fitness studio or tears in kindergarten - jumping to the side in panic or reaching for a disinfectant are superfluous. And whether you like friendship kisses on the cheek or not is a matter of opinion - they are not a question of AIDS protection. Kisses on the closed mouth are also safe. From this point on, however, it slowly becomes dangerous: Although first (!) Transmission through French kissing is secured, doctors and self-help groups advise against it with an HIV-infected partner, as small injuries in the mouth can never be ruled out.
- www.hiv.net - Private website with commercial support, which is primarily aimed at medical professionals, but also provides information on HIV infection and AIDS that is understandable for laypeople, including with a complete textbook updated annually and new information on AIDS medication every month.
- www.aidshilfe.de - website of the Deutsche AIDS-Hilfe e. V., Berlin: Extensive, with reliable information and brochures to order (materials section) and to download (search term download).
AuthorsDr. med. Nicole Menche, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:46
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