HIV works by attacking the immune system, including what is known as CD4+ cells, the very cells that are designed to fight off/prevent infection. AIDS stands for acquired immunodeficiency syndrome. AIDS is diagnosed when an HIV infected person becomes sick with another life threatening infection, often termed an immune defining illness. AIDS can be distinguished from virtually every other disease by the fact that it has no constant specific symptoms. 

It is important to understand that HIV does not always become AIDS. In fact, with new medications and more research supporting natural methods of balancing and strengthening the immune system, AIDS is a much less common outcome of HIV infection than it was 30 years ago. The terms chronic HIV infection or HIV disease are now being used to refer to those who have been living in relatively good health with HIV for many years. There are still others that argue, that although HIV may be present due to an extremely compromised immune system, HIV and AIDS do not have a proven cause and effect relationship. As much as we think we know, there seems to be much more to learn about these complicated diseases.  

Transmission
HIV, now much better understood than it was in the 80's, is transmitted when enough HIV from the blood of an HIV positive individual gets into an HIV negative individual. This CANNOT happen through casual contact, such as shaking hands, sneezing or touching a doorknob or toilet seat. HIV is only transmitted when there is an exchange of bodily fluids with a high concentration of the virus. Basically this can only happen via 5 different methods: blood, semen, vaginal fluid, anal fluid and breast milk. Infection can occur during sexual intercourse, during childbirth and breastfeeding and through the use of needles (ie; sharing needles) or needle stick injuries.

Our mucous membranes are the soft, wet linings of our mouth, nose, genitals and anus and they are meant, similar to the skin, to defend our bodies on a cellular level against germs. Mucous membranes are not the perfect barrier, however, and again similar to skin, small breaks and thinning in these membranes can create entry points into the inside of our bodies for viruses and germs to get in. Already having another sexually transmitted disease, such as herpes, gonorrhea or syphilis can make it easier to transmit, or be infected by HIV.

Things you should know.
Both HIV negative AND HIV positive individuals can be infected with HIV, meaning that HIV positive individuals need to practice safe sex, not only for the safety of their partner, but for their own safety, as well. These individuals can be re-infected, which can further damage their immune system or create a 'super virus' that is resistant to many of the current HIV medications.

Testing
In order to be diagnosed with HIV, you must have a blood test, specifically testing for HIV antibodies. Even with the most up to date testing methods, there is still a window period, in which an HIV test may come back negative even though you have HIV, depending on how much/little time has passed since expected date of transmission. Talk to you doctor or the individual testing you about the window period for the test being used. You may require another test a few weeks to a month later to ensure the result is accurate.

HIV and Our Immune System
What are CD4+ cells? One of the most important and hard working elements of our immune system is our white blood cells. Different types of white blood cells form teams, each with individual tasks ensuring the upkeep of our immune system. They are able to recognize and destroy intruding germs, as well as search for sneaky infections that may be hiding within our very own cells, again destroying these cells to prevent spread. CD4+ cells are sometimes referred to as the generals of the body's defensive army. They are designed to recognize infection and coordinate other elements of the immune system to provide an effective and organized response. Unfortunately, CD4+ cells are also one of HIV's main targets. The virus attacks and destroys these cells, or programs our own body/cells to destroy its own cells, leaving your immune system weak and disorganized, unable to defend against subsequent infection.

In terms of monitoring your health, the two numbers that are most pertinent to an HIV positive individual are CD4+ and viral load. Initially an HIV positive individual will have the means to replace the lost CD4+ cells, but as the HIV continues to replicate and your overall immune system weakens, the CD4+ cell count will fall. Measuring your CD 4 cell count is a way to do a general assessment/measure the overall strength of one's immune system. A normal CD4 count is generally between 500 and 1,500 cells per cubic millimetre. There are a number of 'normal' variations and the count will fluctuate depending on how active your immune system is when the test is taken. For this reason, if one count seems well out of the norm., it is worth repeating. Values between 200 and 500 cells/mm3 indicate that your immune system is weakening and that you may becoming more vulnerable to infection. A CD4+ cell count of 200 or less means that your immune system has been severely compromised and you are at a much higher risk of developing life threatening infections. These infections include pneumocystis pneumonia (PCP), cytomegalovirus (CMV), mycobacterium avium complex (MAC) or toxoplasma, a parasitic infection. These infections are known as AIDS defining illnesses, because their development is basis for diagnosing AIDS, as long as the individual test positive for HIV antibodies.

Viral load is a measure of how much HIV is in your blood. It measures the number of copies of HIV in a millilitre of blood. With this test it is most helpful to look at a trend over time. If the patient is un-medicated and not using natural alternatives to medication/following a healthy lifestyle, the overall trend for viral load will increase as the virus continues to replicate. For medicated individuals, this test is a measure of how responsive the virus is to the treatment, and should show a general trend of decline. Don't be discouraged if your results come back 'undetectable'. This is a good thing, actually, what every treatment strives for. A viral load less than 50 copies per ml will not show up on the test and will show a result of undetectable. This means the virus is making significantly fewer copies.

Treatment
It is important to know that there are different genotypes of HIV. The specific genotype will indicate which drugs the virus is sensitive to and which ones it is resistant to. If viral load is unaffected by anti-HIV drugs, or is initially affected but rebounds, it is likely that your doctor will do a genotype test and consider changing your current medication.

It is always an individuals own decision as to what of course of treatment, if any, they choose to follow. The point at which the HIV infection poses more risk than the treatment will vary from person to person. I encourage you take an interest in the drug options and possible side effects, become knowledgeable in terms of all your options and openly discuss them with your doctor, voicing any concerns and being aware that the final choice is yours. Talk to a Naturopath or alternative healthcare practitioner to get a few different options and find a compromise that you feel most comfortable with. If you have serious symptoms or illness, if your CD4+ count gets very low (usually under 500), or if you are pregnant, treatment is highly encouraged and tends to be more aggressive. There are generally 5 different classes of drugs available to choose from: Entry inhibitors or fusion inhibitors prevent HIV from getting inside the cell. 'Nukes' and 'non-Nukes' both act to prevent the HIV infection from converting its RNA into DNA (before it can replicate) by inhibiting a molecule called reverse transcriptase. Integrase inhibitors interfere with an enzyme called integrase, which inserts HIV's viral DNA into our own DNA. And lastly, protease inhibitors, which slow or prevent HIV from cutting long chains of HIV to increase replication. The combination of all of these therapies is termed HAART (Highly active anti-retroviral therapy).

Symptoms
There are a number of side effects associated with the HIV virus itself, as well as with most HIV medication. Herbs, vitamins, nutritional supplements and homeopathic remedies can do wonders to decrease these side effects safely and effectively. Nutrition itself is also vitally important to ensure you are getting the nutrients and caloric intake you need to stay strong and maintain energy. Some of the more common side effects include digestive problems, such as nausea, vomiting, diarrhea and loss of appetite. Metabolic disorders are common, including fat redistribution, cardiovascular problems, and insulin resistance/diabetes. Bone weakness, liver dysfunction and skin and muscle complaints have also been reported. For some, the mental/emotional side effects are the most troublesome. Again, it is so important to talk to your doctor or other healthcare professional about what is going on and ask for help when its needed.

What about Natural options?
In terms of diet and nutrition, it truly is the foundation for any natural based therapy. Certain vitamins and minerals are essential to immune system function. Many individuals who are HIV positive or diagnosed with AIDS have been found to be deficient in vitamins A, B6, B12, folate, selenium and zinc. Eating a diet high in whole foods, vegetables and fruits, fresh and organic, whenever possible is a great way to ensure adequate intake of many essential vitamins and minerals, as well as antioxidants. Avoid processed foods and refined carbohydrates as much as possible. Focus on omega 3 fatty acids, found in fish/fish oils and some plant oils. Ensure you are getting a minimum of 15 % of your caloric needs from protein, this will help to prevent weight loss and maintain energy levels. Try to eliminate sugar, caffeine and alcohol, which can all act to depress the immune system.

The following supplements have been used in the treatment of HIV positive individuals - as immune support and/or to combat common and often debilitating side effects associated with the medication or the disease itself.