Let's learn about AIDS-Defining Illnesses.

Do you remember, sometimes when we get sick unexpectedly, we wonder, "Where did this disease come from?" Especially when the body's immunity is low, diseases easily try to infiltrate the body. Today we are going to talk about several special diseases that can arise when we are infected with the virus called `HIV` (Human Immunodeficiency Virus) and the condition worsens a bit, that is, when some say it reaches the stage of AIDS. This is what doctors call `AIDS-Defining Illnesses (ADIs)`. These are like red lights, indicating that our immune system has become quite weak due to the `HIV` infection in our body.

What are these AIDS-defining illnesses (ADIs)?

Simply put, these `ADIs` are cancers and diseases that fall into the category of `Opportunistic Infections` that can occur when the `HIV` infection becomes severe, that is, when our body's immune system becomes very weak.

Do you know what "opportunistic infections" are? Imagine leaving all the doors and windows of your house open and there is no security. Then anyone can easily enter. That's how it is, when our body's immune system is weakened by `HIV`, even very small germs that normally cannot cause illness in a healthy person easily get an 'opportunity' to enter the body and cause major illnesses. That's what we call `opportunistic infections`. These germs can normally be found in our environment, but the immune system of a healthy person fights them off and controls them.

Doctors use the CD4 cell count and these ADIs to measure the severity of an HIV infection, that is, how far it has spread and how severe it is. These CD4 cells are a very important part of our immune system, like special police officers in our bodies. The HIV virus destroys these CD4 cells. So, if you are infected with HIV and have these ADIs, doctors call this the third stage of HIV infection, which is AIDS.

Sometimes, it is only when someone develops an `ADI` that they are diagnosed with `HIV`. However, it is important to remember that not everyone who has an `ADI` has `HIV`. While some `ADIs` are more common among people with `HIV` or those with weakened immune systems, many `ADIs` can also occur in healthy people without any underlying disease. Therefore, the best way to know for sure is to get a medical test.

What are the types of AIDS-defining illnesses (ADIs)?

There are different types of these `ADIs`. They mainly include infectious diseases (fungal, bacterial, parasitic, viral infections), some types of cancer, and some conditions related to the nervous system. Let's see what they are.

Fungal Infections

When your immune system is weakened, fungal infections can easily spread throughout your body. Some of these include:

• Pneumocystis pneumonia (PCP): This is a serious infection of the lungs.
• Candidiasis of the bronchi, esophagus, trachea, or lungs
• Coccidioidomycosis - disseminated/extrapulmonary
• Chronic intestinal cryptosporidiosis lasting more than a month
• Cryptococcosis - extrapulmonary
• Histoplasmosis - disseminated/extrapulmonary

Just think, when our immune system is strong, these fungi can't do much. But when our immune system is weakened by HIV, they start causing problems.

Bacterial Infections

Bacteria can also cause various infections. Some bacterial infections that are considered `ADIs` are:

• Tuberculosis (Mycobacterium tuberculosis) for people aged 6 and over: This is a disease that many people have heard of, and it can affect the lungs as well as other organs.
• Other Mycobacterium infections that have spread outside the lungs: Examples include Mycobacterium kansasii and Mycobacterium avium complex (MAC).
• Recurrent bacterial infections in children under 6 years of age.
• Recurrent nontyphoid Salmonella septicemia: In this, the Salmonella infection enters the bloodstream and spreads throughout the body.

Parasitic Infections

Parasites can also cause `ADIs`. Examples:

• Toxoplasmosis in the brain: However, this does not apply to babies under one month old.
• Chronic intestinal cystoisosporiasis lasting more than a month

Viral Infections

HIV is also a virus. Also, when the immune system is weakened, it is easier for other viruses to attack.

• Herpes simplex bronchitis, pneumonitis, or esophagitis: This also does not apply to babies under one month old.
• Herpes simplex ulcers that last more than a month
• Cytomegalovirus disease: In organs other than the liver, spleen, or lymph nodes (e.g., cytomegalovirus retinitis - affecting the eyes). This also does not apply to babies under one month old.
• Progressive multifocal leukoencephalopathy (PML): This is a rare but serious condition that affects the brain.

Cancers

When our T cells (CD4 cells are also a type of T cell) decrease, the risk of developing cancers caused by viruses or cancers that affect the immune system itself increases. Types of cancers considered ADIs in HIV-infected people:

• Kaposi sarcoma: A cancer that can occur in places like the skin, lymph nodes, and mouth.
• Burkitt lymphoma
• Invasive cervical cancer
• Immunoblastic lymphoma
• Primary lymphoma of the brain

Other Conditions

In addition to this, several other conditions are also known as `ADIs`:

• Recurrent pneumonia: For adults and children over 6 years of age. Pneumonia is an infection of the lungs caused by viruses, bacteria, or fungi.
• HIV encephalopathy: In this, the HIV virus affects brain function.
• HIV wasting syndrome: This causes the body to become thin and weak.

What are the most common AIDS-defining illnesses (ADIs)?

Not all of these occur in everyone. However, some of the more common `ADIs` are:

• Pneumocystis pneumonia (PCP)
• Kaposi sarcoma
• HIV wasting syndrome
• Esophageal candidiasis
• Mycobacterium avium complex (MAC) infections
• Tuberculosis

What are the symptoms of these diseases?

The symptoms of `ADIs` vary depending on the disease. However, most infections have several common features:

• Fever
• Headache
• Body pain, muscle pain
• Sore throat
• Difficulty breathing
• Skin rash
• Diarrhea
• Confusion or other mental changes

If you have one or more of these symptoms, especially if you know you have HIV, it is very important to see a doctor as soon as possible.

Why do these AIDS-defining illnesses (ADIs) occur?

As we have already discussed, the virus `HIV` destroys the `T` cells (especially `CD4` cells) in our immune system. These `T` cells are what help us fight infections. So, when the number of these `T` cells decreases too much, our body cannot fight infections normally. Then, we can get sick from things that do not cause illness to a person with a healthy immune system. Also, this is a reason for the development of cancers related to the immune system or cancers caused by viruses.

Antiretroviral therapy (ART) is very effective in keeping our immune systems healthy. However, sometimes an ADI can develop even while taking ART. There are several possible causes:

• If you are unable to take your medication as prescribed and on time.
• If the medicine you take isn't working properly.
• You may have had an asymptomatic ADI before you started ART, and it may recur when your immune system is restored after you start ART (this is also called immune reconstitution inflammatory syndrome - IRIS).

How are AIDS-defining illnesses (ADIs) identified?

Your doctor will diagnose an ADI based on your symptoms. This may involve testing blood or other body fluids, and possibly doing a biopsy. They may also do imaging tests, such as an X-ray or CT scan, to look for changes in your lungs or other organs.

If you are not previously diagnosed with HIV, and only have an ADI, your doctor may test you for HIV and other possible causes of immune suppression.

What kind of tests are done?

Some tests the doctor may use:

• Blood tests
• Taking a sample from the nose (Nasal swab)
• Biopsy
• Sputum test: A sample of phlegm is taken from the lungs to check for infection.
• Stool test
• Chest X-ray
• CT scan
• Lumbar puncture/spinal tap
• HIV test

How are these diseases treated?

Treatment options depend on the type of disease you have and your specific situation. If you are not taking ART, your doctor may start ART as soon as possible or within two to four weeks of starting treatment for opportunistic infections.

If you have already been diagnosed with HIV and are taking ART, your doctor may do more tests to see how well your medication is working.

Treatments for specific ADIs may include:

• Antibiotics for bacterial infections
• Antifungals for fungal infections
• Antiparasitic drugs for parasitic infections
• Surgery, radiation, or chemotherapy for cancer

What happens if I have an AIDS-defining illness (ADI)?

Having an ADI increases the risk of dying from AIDS-related complications. However, the good news is that in recent years, the number of AIDS-related deaths has decreased significantly due to ART. Although it is estimated that about a quarter of people infected with HIV die from AIDS-related complications, with early initiation of ART, many people with HIV live healthy lives without developing AIDS.

Can AIDS-defining illnesses (ADIs) be prevented?

Yes, it definitely can!

ART can help keep the amount of virus in your blood (viral load) low. This increases your number of T cells (CD4 cells). This helps your immune system stay healthy and fight infections. It also helps fight the viruses that cause HIV-related cancers.

There are several other ways to reduce the risk of infection:

• Preventive medications: Your doctor may prescribe things like antibiotics or antifungal medications to reduce the risk of certain infections.
• Vaccination: Ask your doctor what vaccines you need to get and if there are any you should avoid.
• Screenings: Your doctor may recommend regular screenings for certain cancers and infectious diseases.
• Do not share drug injection equipment: When using prescription and non-prescription drugs, do not share needles, syringes, etc. with others.
• Good hygiene: Wash your hands often, especially before preparing food, before eating, and after using the bathroom. Do not share food, drinks, or personal items with others.
• Food safety: Avoid undercooked eggs, unpasteurized milk (including cheese and ice cream), and unpasteurized fruit juice. Wash or peel fruits and vegetables thoroughly before eating.
• Avoid using untreated water: Avoid getting water in your mouth when bathing in places like lakes and ponds, and avoid drinking untreated tap water. If you go to a place where you are unsure about the purity of the water, drink bottled water and use the same water for cooking.

When should I see a doctor?

If you have HIV, be sure to keep all your appointments with your doctor. Tell your doctor if you have new or worsening symptoms, or if you are having difficulty taking your ART. Find out what you can do to prevent infection and what to do if you have symptoms of infection.

When should you go to the Emergency Treatment Unit (ETU) ?

If you think you may have been exposed to HIV, or if you have any of these severe symptoms, go to the emergency room immediately:

• A fever of more than 103 degrees Fahrenheit (40 degrees Celsius).
• Difficulty breathing.
• Severe vomiting or diarrhea.
• Chest pain.
• Confusion or loss of consciousness.
• If a wound is hot, red, swollen, painful, or not healing.

What questions should I ask my doctor?

It may be helpful to ask your doctor questions like these:

• How do I take my medicine correctly?
• What do you do if you miss a medication appointment?
• What can I do to prevent infections?
• What symptoms should I look out for?
• When should I go to the emergency room?

Finally, take-home message

AIDS-defining illnesses (ADIs) are tests that help doctors determine how much the HIV virus has affected your body. When you have HIV, you are at higher risk of developing serious complications from any infection.

But, most importantly, taking antiretroviral therapy (ART) correctly and consistently can keep your immune system healthy and give your body the strength to fight infections. These medications have helped prevent AIDS and enable people with HIV to live as long as those without HIV.

Therefore, talk to your doctor about other precautions you can take to prevent serious illnesses. Don't worry, you can fight these conditions with the right knowledge and treatment.

` AIDS, HIV, AIDS diagnosis, opportunistic infections, immunity, CD4 cells, ART treatment