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It's my understanding that fevers are an immune system response to infection. Like the body's cells can take more heat than most viruses or bacteria.
So if that's the case then can you even get a fever if you have a non-functioning immune system due to AIDS?
With AIDS, the whole immune system is not non-functional. The condition results in a severe drop in CD4+ T-cells, which is what primarily predisposes AIDS patients to secondary infections.
Fever can be an immune response to infection, but it is not directly affected by the loss of CD4+ T-cells. Rather, fever occurs due to a complex cascade of events triggered by pyrogens, which causes a release of prostaglandin E2 (PGE2). In the hypothalamus, PGE2 signals a systemic response for the body to generate heat. More on the pathophysiology of fever can be read here.
AIDS patients still produce PGE2 in response to pyrogens (such as compounds produced by bacteria). Therefore, AIDS patients can certainly get fevers. In fact, AIDS patients may be more likely to get fevers because they may produce more PGE2.
The 4 Most Common Fungal Infections in People With HIV
Latesha Elopre, MD, is a board-certified internist specializing in HIV. She is an assistant professor of infectious diseases at the University of Alabama at Birmingham.
Fungal infections are common in people living with HIV and can present at different stages of the disease, from the earliest acute phase to later stage AIDS-defining conditions. Four of the most common fungal illness are known as candidiasis, cryptococcosis, histoplasmosis, and coccidiomycosis.
How Do Symptoms of HIV and AIDS Differ?
There's a big difference between the symptoms of HIV and the symptoms of advanced HIV disease, also known as AIDS.
During the first few weeks of having HIV, in the phase of recent HIV infection, the immune system tries to mount a defense. It's similar to the defense that occurs if the immune system detects influenza, mononucleosis, or rubella. This immune response can cause some people to have symptoms that usually go away within a few weeks. Others may not notice that anything is even wrong.
If a person develops any initial symptoms of HIV infection, once they fade, they usually experience a long period of time in which there are no symptoms at all. Many years can go by—a decade or more, in fact—without a person feeling or showing any sign that they're living with HIV.
But without treatment, HIV will slowly and surely damage the immune system (the body's natural defense system against infections). This eventually makes people vulnerable to a wide range of health problems.
The symptoms of advanced HIV disease (AIDS, short for acquired immune deficiency syndrome) are in fact the symptoms of other infections and diseases that the weakened immune system has been unable to keep under control. As such, the list of possible symptoms of AIDS is highly varied. They are not symptoms of HIV itself.
We'll get to a list of symptoms that can be associated with HIV and AIDS in a little bit, but first, an important disclaimer: These symptoms do not—we repeat, do not!—apply to everyone.
Get the full picture of all things HIV here.
Pet Guidelines For People Living With HIV/AIDS
(Clinical Infectious Diseases 1995 21(Suppl 1):S1-11)
"When obtaining a new pet, HIV-infected patients should avoid animals less than six months of age, especially those with diarrhea. Because the hygienic and sanitary conditions in pet breeding facilities, pet stores and animal shelters are highly variable, the patient should exercise caution when obtaining a pet from these sources. Stray animals should be avoided. Animals less than six months of age, especially those with diarrhea, should be examined by a veterinarian for Cryptosporidium, Salmonella and Campylobacter.
Those who elect to obtain a cat should adopt or purchase an animal that is less than one year of age and in good health to reduce the risk of cryptosporidiosis, bartonella infection, salmonellosis and campylobacteriosis.
HIV-infected persons who wish to assume the small risk of acquiring a puppy or kitten less than six months of age should request that their veterinarian examine the animal's stool for Cryptosporidium before they have contact with the animal.
Gloves should be worn during the cleaning of aquariums to reduce the risk of infection with Mycobacterium marinum. Contact with exotic pets, such as non-human primates, should be avoided."
Ascarids are worms. Toxocara canis most common to dogs, Toxocara cati (T. mystax) to cats and Toxascaris leonina to both cats and dogs. Eggs of T. canis are passed in the feces and larva develop to the infective stage within the egg. Eggs are extremely resistant to adverse conditions. Extremes of heat or cold and many usual cleaning agents/disinfectants will not effectively kill the eggs. Infection can occur from contact with dog feces, dirt, earthworms, mice, etc. Expulsion of the worm in infected cats can be through the feces or vomitus. Rodent ingestion is a common mode of transmission to the cat. Infection in humans by T. canis is usually termed visceral larva migrans (VLM). Transmission to humans is usually by ingestion of infective eggs from soil contaminated with dog or cat feces or by directly handling of the feces. Dogs should be kept away from feces found on the street. Cats or dogs suspected of having worms should be treated by a veterinarian immediately and care should be taken to avoid direct contact with both feces and vomitus.
Bartonella (formerly Rochalimaea) - "Cat Scratch Fever" Declawing is not usually suggested to avoid cat scratch fever. Rough play and situations where scratches are a possibility should be avoided. Wounds should be washed promptly. It is believed that the organism harbored in the oral cavity and, therefore, cats should not be allowed to lick open wounds or cuts. Rigid flea control should be maintained.
Campylobacter is a gram-negative enteric organism. In people living with AIDS this organism is usually associated with severe diarrhea, cramping, nausea and fever. The most common form of this pathogen is Campylobacter jejuni. The organism has been found in dogs, cats and birds. As with other enteric infections the most common mode of transmission is via the fecal-oral route, though person to person transmission is possible.
"In the general population, the most common cause of sporadic C. jejuni infections appears to be eating or handling raw or undercooked poultry. This source is likely to be the same for HIV-infected persons."
Proper hygiene practices should include avoiding contact with animal feces.
Chlamydial infections can be carried by all warm blooded animals and by birds. Positive identification in animals is difficult as test results are not reliable. Vaccinations are available but it should be kept in mind that there are many different strains of Chlamydia. Cats are subject to Chlamydia infection especially with respiratory symptoms, swollen/runny eyes and stuffed/runny nose.
Cryptococcus neoformans is an encapsulated yeast-like fungus. It has been most commonly isolated from pigeon droppings. Transmission to humans occurs by inhalation of airborne organisms. Proper hygiene practices should include daily changes in cage liners and wearing gloves when changing the cage bottom and cleaning the cage.
Cryptosporidium is an enteric coccidian protozoan. It is commonly found in the gastrointestinal tract of fish, birds, reptiles and mammals. Animals with an immune system suppressed by drug therapy and cats with feline leukemia for feline immunovirus are especially susceptible to the organism. Cryptosporidium is transmitted to humans by exposure to contaminated food or water, person to person contact and animal contact, though this latter is the least likely means of transmission. Proper hygiene should include a clean litter box (cats) and, whenever possible, avoiding direct contact with both dog and cat feces. Because gerbils and hamsters can be carriers of Cryptosporidium their cages should be frequently cleaned.
Giardia is a flagellate protozoan with Giardia lamblia being the most significant with respect to human infection. Giardiasis is one of the most common causes of diarrhea in people living with AIDS. Transmission of the organism most commonly occurs through the fecal-oral route by the ingestion of cysts. Cats, dogs and small rodents such as hamsters and gerbils may carry the disease. Although Giardia can also be transmitted through contaminated water supplies, proper hygiene for people with a compromised immune system who have pets should include avoiding contact with the animal's feces.
Mycobacterium Avium Complex Infection
MAC organisms are acid-fast bacilli with Mycobacterium avium and Mycobacterium intracellulare being of most concern to people with a compromised immune system. The most common form of transmission is through ingestion. Contrary to what the name may imply Mycobacterium avium birds are not usually involved in the transmission of this disease to people living with AIDS.
Psittacosis - Ornithosis
Harbored by birds, especially psittacines. The organism is an avian form of Chlamydia. Psittacosis is the usual term for the disease in birds of the family Psittacidae (parrots, parakeets, cockatoos, macaws, etc.) and ornithosis for birds of other avian families. The disease can also be carried by canaries, South American parrot species, lorikeets, rosellas, finches and rice birds. In man the disease is usually called psittacosis. The use of a face mask and disposable gloves when cleaning cages is strongly recommended.
Ringworm is really a fungal infection, not a worm. Infection causes raised ring-like patterns on the skin and invades the superficial layers of the skin. Transmission is through contact with spores which can live for months or by direct contact with an infected dog or cat. Newly acquired dogs or cats should not be introduced to a household with other animals until the new dog or cat is checked by a veterinarian. Most cases of ringworm respond well to topical antifungals in both humans and animals. Oral medications are also available. Care should be taken to wash hands after handling a potentially infected animal. Because shedding hair can carry the fungus, a thorough airing out of the house will help.
Salmonellae are gram-negative rods and belong to the family Enterobacteriaceae. The most common forms of Salmonellae isolated in people living with AIDS are Salmonella typhimurium and Salmonella enteritidis. The most common form of transmission is via the fecal-oral route through the ingestion of contaminated food (meats, especially pork) or water. Poultry and poultry products such as eggs have also been implicated. Cats, dogs, birds, reptiles and insects can carry the disease . pet turtles, especially. Proper hygiene practices should include avoiding contact with feces and hand washing after contact with possible vectors. Food products, especially poultry, should be well cleaned before cooking. Eggs should be cooked, not used raw as in Caesar salads.
Toxoplasmosis gandii is a ubiquitous, obligate, intracellular protozoan. The definitive host for T. gondii is the cat. The cat is the only animal that passes oocysts in their feces. The oocysts are not infective until they sporulate. This occurs 1-5 days after they are excreted in the feces. Infected cats will usually shed the T. gondii organism for only a short period of time. Once the organism is no longer in the feces, the feces is not a potential source of infection to you from T. gondii. Under some circumstances, however, an infected cat may begin passing the organism, again, in the feces. Severe stress can contribute to a second shedding.
Cats can become infected with T. gondii:
- if they are allowed outdoors and rummage in soil contaminated with the organism,
- by contact with a cat that is already infected with the organism,
- if they are allowed to hunt mice or other rodents,
- if they are fed raw or undercooked human food,
- if the queen was infected and passed the organism transplacentaly to the litter.
Once tested negative for T. gondii a housebound cat for whom (a)-(d) above do not pertain cannot develop the disease.
It is strongly suggested, especially in the case of cats that have not been tested for T. gondii by a veterinarian, that the following measures be observed:
- use litterbox liners,
- change the litterbox (liner and litter) every day,
- have someone change the litter box for you, if possible, or use gloves,
- dispose of the gloves when done or wash them,
- a mask may be worn if you desire,
- wash your hands when done.
Do not squeeze the air out of the twist-tied liner containing the litter it will blow clay dust into the air.
The unconditional love and affection provided by a companion animal is a strong and positive therapeutic for people living with HIV/AIDS. By observing a few simple guidelines for general cleanliness the possibility of disease transmission is significantly reduced. People living with HIV/AIDS who are planning to adopt or buy a companion animal must also act responsibly by planning ahead before the adoption/purchase is made to ensure that all aspects of the animal's health, maintenance and future are taken into account. POWARS can assist with this, but it would be an act of irresponsibility to assume that we will do it all or to assume that we will take over complete responsibility for the animal.
We strongly urge anyone considering adoption or purchase to talk with us first. Ensuring the general well being of a companion animal or a companion animal to be means:
- adopting or purchasing only so long as doing so does not exceed yours and our combined ability to maintain a healthy and happy animal
- attending to the annual vaccinations and rabies vaccinations necessary for both cats and dogs
- spaying or neutering all cats and dogs as early as is possible
- registering all animals with the appropriate authority.
Ensuring the general well being of the companion person or companion person-to-be means acting responsibly, not out of self-indulgence and following the general guidelines for people and pets as described in this brochure.
Pet Guidelines for People Living With HIV/AIDS is prepared and edited by POWARS with the participation of: Jane Bicks, D.V.M., Tom DeVincentis, D.V.M., Steve Kohn, Executive Director. POWARS, once located in New York City was dissolved in late 1998.
This brochure is intended to present information to people with HIV/AIDS and concerned friends. It is not to be regarded as providing medical advice. Please consult with your own health care provider(s) for medical advice related to your particular situation. Additional information concerning zoonoses can also be obtained from your veterinarian.
Even with treatment, HIV causes long-lasting inflammation. This raises your chances of other illnesses. You could have heart, liver, bone, or kidney disease. You could also get diabetes or cancer. The important thing is to follow your treatment and keep your appointments.
The advanced stage of HIV infection is AIDS. You might have night sweats, long-lasting fever, and diarrhea that lasts more than a week. You could be tired all the time and have unexplained weight loss. Purple or brown spots on your skin, depression, and memory loss are also possible. The best way to avoid AIDS is to start your HIV treatment early, take HIV medicine as prescribed, and follow your doctor’s advice.
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UCSF Health: “HIV Signs and Symptoms.”
National Institute of Child Health and Human Development: “What are the symptoms of HIV/AIDS?”
AVERT: “Symptoms and Stages of HIV Infection.”
UpToDate: “Patient education: Symptoms of HIV infection (Beyond the Basics).”
HIV.gov: “How Can You Tell If You Have HIV?” “Other Health Conditions Associated with HIV.”
U.S. Department of Veterans Affairs: “Herpes zoster (shingles).”
This tool does not provide medical advice. See additional information.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Is There a Cure for AIDS?
Though there are two cases of people who have been cured, there is currently no safe cure for HIV (see Fact Sheet 485). There is no way to "clear" HIV from the body. Antiretroviral therapy (ART, see Fact Sheet 403) can slow down the HIV virus, and slow down or reverse the damage to your immune system. Most people stay healthy if they stay adherent to ART.
Other drugs can prevent or treat opportunistic infections (OIs). ART has also reduced the rates of most OIs. A few OIs, however, are still very difficult to treat. See Fact Sheet 500 for more information on opportunistic infections.
Why Should I Get Tested?
If you are worried because you think you may have been exposed to HIV, get tested. Then, if you learn you are HIV-negative, you can stop worrying. You can also consider taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). PrEP means taking an HIV drug before being exposed to HIV, to prevent yourself from getting it, similar to taking birth control pills to prevent pregnancy. PEP means taking HIV drugs for about a month immediately after possible exposure to HIV, to prevent HIV acquisition.
If you test HIV+, there are effective medications to help you stay healthy. These medications are also part of HIV prevention. When a person living with HIV is taking HIV drugs and their viral load (amount of HIV in their blood) has reached undetectable levels (not enough HIV in their bloodstream for a test to measure) for more than six months, that person cannot sexually transmit HIV to a partner who is HIV-negative.
But you cannot get the health care and treatment you need if you do not know your HIV status (whether you are living with HIV or are HIV-negative). If you don't know your status, you could also pass HIV to others without knowing it.
For women who plan to become pregnant, testing is especially important. If a woman is living with HIV, medical care and certain HIV drugs taken during pregnancy can lower the chance of passing HIV to her baby. For more information, see our fact sheet on Pregnancy and HIV.
In the US, you can go to your primary care doctor and request a test or to the National HIV, STD and Hepatitis Testing website or the HIV.gov website to find a testing location near you. You can also call the CDC’s information line at 800-232-4636 or call your state’s HIV/AIDS hotline (numbers listed here). For more on getting tested for HIV — types of tests, how they work, and where to get them — see our fact sheet on HIV Testing.
People with HIV Can Give the Gift of Life by Becoming Organ Donors – A Q&A with HIV Transplantation Experts
Organ donation saves lives. Tragically, many patients are waiting for a life-saving transplant, and there are not enough people registering as organ donors. As a result, 20 people die each day waiting for a transplant—including people living with HIV, who are more likely than HIV-negative people to develop end-stage kidney and liver disease. The HOPE Act of 2013 allows for research into organ transplantation from one person with HIV to another, ultimately benefitting all people waiting for transplants by increasing the number of people eligible to become organ donors.
To learn more about how researchers are leveraging this legislation, NIAID Now spoke to two HIV transplantation experts. Beverly Alston-Smith, M.D., serves as the chief of the Complication and Co-infections Research Branch in NIAID’s Division of AIDS, and Jonah Odim, M.D., Ph.D., is chief of the Clinical Transplantation Section in NIAID’s Division of Allergy, Immunology and Transplantation. Both experts oversee organ transplantation studies among people with HIV.
Q: How does the HOPE Act of 2013 change research into organ transplantation for people living with HIV?
JO: The HOPE Act of 2013 was an important milestone in HIV and solid organ transplantation research. This legislation permits transplant teams with an approved research protocol to transplant kidneys and livers from donors with HIV to appropriate candidates with well-controlled HIV and end-stage organ failure. For a person living with HIV who needs a transplant, this means they may not wait as long for a transplant if an organ from a donor with HIV is available. It also means that people with HIV may now sign up to become organ donors and potentially give the gift of life when they pass away.
Q: At the height of the AIDS crisis, people with HIV were not considered good candidates for organ transplantation, and federal law prohibited HIV-exposed organs from being transplanted to anyone in any circumstance. What has changed since then to make the HOPE Act possible?
BAS: The old policies were implemented before HIV could be effectively treated and when organ transplantation itself was not as safe and effective as it is today. Back then, doctors feared people with HIV would not survive an organ transplant because of a weakened immune system. Today, HIV is a chronic condition managed by highly effective medications. People with HIV are living longer and reaching advanced ages where end-stage organ failure is more common. In fact, people with HIV are at a higher risk for kidney and liver disease than their HIV-negative peers because of co-infections like viral hepatitis and long-term damage to organs from HIV itself. On the other hand, because of effective treatment, more people with HIV do seem to have organs healthy enough to be donated to someone in need of one. Successful kidney transplants between people with HIV in other countries such as South Africa also have shown that this practice may be both safe and effective.
Q: The federal Organ Procurement and Transplantation Network (OPTN) estimates that every 10 minutes, someone is added to the national transplant waiting list, and many people die before a potentially life-saving organ becomes available—including many people with HIV. Can the HOPE Act help change this?
JO: That is absolutely the goal. Both people with and without HIV are on organ waiting lists. Because of the HOPE Act, people living with HIV can now also accept organs from donors with HIV who were previously excluded from the organ donor pool. This also means people without HIV may then move up on the list for an HIV-negative organ if people with HIV receive organs from this new alternative source—thereby shortening waiting times for people regardless of HIV status.
Q: Why do organ transplants between people with HIV need to occur under a research protocol?
BAS: All new medical procedures need to be rigorously tested for safety and efficacy before they are widely implemented, and this is no exception. Since the enactment of the HOPE Act, many transplant centers in the United States are assessing transplant- and HIV-related outcomes after transplantation between people with HIV to establish safety and efficacy for recipients over the long term.
Q: In 2017 and 2018, NIH launched the HOPE in Action studies. What are they, and what do these large-scale trials hope to accomplish?
JO: While there are many ongoing small pilot studies since enactment of the Act, the HOPE in Action Multicenter Kidney Study and the HOPE in Action Multicenter Liver Study are the largest safety and efficacy clinical trials underway, to date, in the United States. As their names imply, these studies are putting the intent and motivation behind the HOPE Act into clinical practice under the oversight of an Internal Review Board, or IRB, and NIH-sponsored clinical research. This oversight gives research participants robust protection as we aim to answer these scientific questions.
The Kidney Study is evaluating the clinical outcomes of 160 transplants of kidneys into people living with HIV and end-stage kidney disease. Each kidney will come from a deceased donor half of them will come from donors with HIV and the other half from donors without HIV for comparison. In the Liver Study, 80 transplants will occur, in which half of the livers will originate from donors with HIV and half from HIV-negative deceased donors for comparison. Both study teams are chaired by investigators at Johns Hopkins University. Researchers will follow all recipients for up to four years to monitor the success of the transplant, and the health and quality of life of participants. In addition, the researchers hope to gain further insight and understanding of HIV strains, antiretroviral therapy, and immunosuppression in the unique context of solid organ transplantation. The results from these studies will determine the safety and efficacy of this practice and may hopefully expand this approach to transplantation centers throughout the country as standard of care.
Q: Will the HOPE in Action studies evaluate interventions beyond assessing the safety and efficacy of transplants of HIV-positive kidneys and livers into people with HIV?
BAS: Yes! This large study will provide a wealth of information on transplants between people with HIV and transplantation science in general. HOPE in Action participants are also eligible to enroll in a study evaluating the use of the antiretroviral drug maraviroc to prevent organ rejection, a finding that may translate to HIV-negative people undergoing organ transplants.
Q: If you are a healthy person with HIV, can you donate your organs to participants in HOPE in Action or similar studies?
JO: The bottom line is that anyone can sign up to become an organ donor regardless of health conditions and HIV status. Ultimately, representatives from a local Organ Procurement Organization (OPO), the transplant hospital teams, and recipients on the waiting list determine whether potential organs, as they become available, are suitable for transplantation in willing and appropriately consented recipients. In fact, all organs from deceased and living donors are routinely screened for HIV, as well as other infections and cancers. So, if you are living with HIV and want your organs to be eligible for donation to others with HIV when you pass away, sign up to become an organ donor.
In a landmark case this March, surgeons at Johns Hopkins University successfully transplanted a kidney from a living donor with well-controlled HIV into a recipient also living with well-controlled HIV. This procedure was performed under a specialized clinical protocol. (Read a related blog post from HIV.gov.)
Q: If you are a person with HIV in need of an organ transplant, how can you enroll in HOPE in Action?
What Are Vaccines?
Vaccines protect your body from diseases such as human papillomavirus (HPV), flu, and polio. They are given by needle injection (a shot), by mouth, or sprayed into the nose. The process of getting a vaccine is called immunization.
Vaccines help your immune system fight infections faster and more effectively. When you get a vaccine, it sparks an immune response, helping your body fight off and remember the germ so it can attack it if the germ ever invades again. And since vaccines are made of very small amounts of weak or dead germs, they won’t make you sick.
Vaccines often provide long-lasting immunity to serious diseases without the risk of serious illness. Learn more about how vaccines work.
Types of Mosquito-Borne Diseases
While mosquitoes pose no threat of HIV transmission, there are other types of diseases associated with mosquito bites. Among them:
Mosquitoes are known to carry many classes of infectious diseases, including viruses and parasites.
Mosquitoes are estimated to transmit disease to more than 700 million people each year, resulting in millions of resulting deaths. These disease outbreaks are most commonly seen in Africa, Asia, Central America, and South America, where disease prevalence, temperate climates, and lack of mosquito control provide greater opportunity for the spread of mosquito-borne diseases.