Hives

(Urticaria)
Hives, also known as urticaria, affects about 20 percent of people at some time during their
lives. It can be triggered by many substances or situations and usually starts as an itchy
patch of skin that turns into swollen red welts. The itching may be mild to severe.
Scratching, alcoholic beverages, exercise and emotional stress may worsen the itching.

Hives Symptoms
Raised itchy bumps, either red or skin-colored

Blanching (when pressed, the center of a red hive turns white)

For more information on hives symptoms click here.

Hives Triggers
Some food (especially peanuts, eggs, nuts and shellfish)

Medications, such as antibiotics (especially penicillin and sulfa), aspirin and

ibuprofen

Insect stings or bites

Physical stimuli, such as pressure, cold, heat, exercise or sun exposure

Latex

Blood transfusions

Bacterial infections, including urinary tract infections and strep throat

 Viral infections, including the common cold, infectious mononucleosis and hepatitis

Pet dander

Pollen

Some plants, such as poison oak and poison ivy

Hives Management and Treatment

Avoid known triggers

See an allergist, who will try to look for triggers to your hives and may recommend
medications to prevent the hives or reduce the severity of symptoms. Whether the
treatment is available only by prescription or over the counter will depend on several
factors, including how uncomfortable the hives are making you.

For more information on hives management and treatment click here.

Symptoms
Symptoms can last anywhere from minutes to months - or even years.

While they resemble bug bites, hives (also known as urticaria) are different in several ways:

Hives can appear on any area of the body; they may change shape, move around,
disappear and reappear over short periods of time.

The bumps - red or skin-colored wheals with clear edges - usually appear suddenly
and go away just as quickly.

Pressing the center of a red hive makes it turn white - a process called blanching.

There are two types of hives - short-lived (acute) and long-term (chronic). Neither is typically
life-threatening, though any swelling in the throat or any other symptom that restricts
breathing requires immediate emergency care.
Chronic hives occur almost daily for more than six weeks and are typically itchy. Each hive
lasts less than 24 hours. They do not bruise nor leave any scar.

If your hives last more than a month or if they recur over time, see an allergist, who will take
a history and perform a thorough physical exam to determine the cause of your symptoms.
A skin test and challenge test may also be needed to identify triggers.

Therapies range from cool compresses to relieve itching to prescription antihistamines and
other drugs, such as anti-inflammatory medications and medications that may modify your
immune system.

Is It Hives or Angioedema?
Angioedema - swelling of tissue beneath the surface of the skin - can be mistaken for or
associated with hives. It can be caused by allergic reactions, medications or a hereditary
deficiency of some enzymes. The following symptoms may indicate angioedema:

Swelling in the eyes or mouth

Swelling of the hands, feet or throat

Difficulty breathing, stomach cramps or chemosis (swelling of the lining of the eyes)

An allergist can diagnose and treat both hives and angioedema.

Diagnosis
In some cases, the trigger is obvious - a person eats peanuts or shrimp, and then breaks
out within a short time. Other cases require detective work by both the patient and the
physician because there are many possible causes. In a few cases, the cause cannot be
identified.

A single episode of hives does not usually call for extensive testing. If a food allergy is
suspected, consider keeping track of what you eat. This will help you discover whether there
is a link between what youre eating and when you break out with hives.
Chronic hives should be evaluated by an allergist, who will ask about your and your familys
medical history, substances to which you are exposed at home and at work, exposure to
pets or other animals and any medications youve taken recently. If you have been keeping
a food diary, show it to your allergist.

Your allergist may want to conduct skin tests, blood tests and urine tests to identify the
cause of your hives. If a specific food is the suspected trigger, your allergist may do a skin-
prick test or a blood test to confirm the diagnosis; once the trigger is identified, youll likely
be advised to avoid that food and products made from it. In rare instances, the allergist may
recommend an oral food challenge - a carefully monitored test in which youll eat a
measured amount of the suspected trigger to see if hives develop. If a medication is
suspected as the trigger, your allergist can conduct similar tests, and a cautious drug
challenge - similar to an oral food challenge, but with medications - may also be needed to
confirm the diagnosis. Because of the possibility of anaphylaxis, a life-threatening allergic
reaction, these challenge tests should be done only under strict medical supervision, with
emergency medication and equipment at hand.

In cases where vasculitis may be the cause, your allergist may conduct a skin biopsy and
send it to a dermatopathologist to examine under a microscope.

The cause of chronic hives is often difficult to identify.

Management and Treatment

Researchers have identified many - but not all - of the factors that can cause hives. These
include food and other substances you take, such as medications. Some people develop
hives just by touching certain items. Some illnesses also cause hives. Here are a few of the
most common causes:

Some food (especially peanuts, eggs, nuts and shellfish)

Medications, such as antibiotics (especially penicillin and sulfa), aspirin and

ibuprofen

Insect stings or bites

 Physical stimuli such as pressure, cold, heat, exercise or sun exposure

Latex

Blood transfusions

Bacterial infections, including urinary tract infections and strep throat

Viral infections, including the common cold, infectious mononucleosis and hepatitis

Pet dander

Pollen

Some plants, such as poison oak and poison ivy

Antihistamines - available either over the counter or by prescription - are a frequently

recommended treatment for hives. They work by blocking the effect of histamine, a chemical
in the skin that can cause allergy symptoms, including welts. Low-sedating or nonsedating
antihistamines are preferred. They are effective and long-lasting (may be taken once a day)
and have few side effects. Your allergist may recommend a combination of two or three
antihistamines to treat your hives, along with cold compresses or anti-itch salves to ease the
symptoms.

Severe episodes of urticaria may require temporary treatment with prednisone, a similar
corticosteroid medication or an immune modulator, which can reduce the severity of the
symptoms.

If your reaction involves swelling of your tongue or lips, or you have trouble breathing, your
allergist may prescribe an epinephrine(adrenaline) auto-injector for you to keep on hand at
all times. These can be early symptoms of anaphylaxis, a potentially fatal allergic reaction
that impairs breathing and can send the body into shock. The only treatment for anaphylaxis
is epinephrine. If you develop hives and your injector is not nearby - or if using the auto-
injector doesnt cause the symptoms to immediately improve - go to an emergency room
immediately. You should also go to the emergency room after using an auto-injector.
If the cause of hives can be identified, the best treatment is to avoid the trigger or eliminate
it:

Foods: Dont eat foods that have been identified to cause your symptoms.

Rubbing or scratching: Avoid harsh soaps. Frequent baths may reduce itching and
scratching beneficial because itching and scratching can make the hives feel
worse.

Constant pressure: Avoid tight clothing. Pressure hives can be relieved by wearing
loose-fitting clothes.

Temperature: If you develop hives when exposed to cold, do not swim alone in cold
water and always carry an epinephrine auto-injector. Avoid exposure to cold air and
use a scarf around your nose and mouth in cold weather. If you must be out in the
cold, wear warm clothing.

Sun exposure: Wear protective clothing; apply sunblock.

Medications: Notify your physician or pharmacist immediately if you suspect that a

specific medication is causing your hives.

Chronic hives
Some cases of hives last for more than six weeks and can last months or years. This
condition is known as chronic hives.

If the cause cannot be identified, even after a detailed history and testing, the condition is
called chronic idiopathic urticaria. (Idiopathic means unknown.) About half these cases
are associated with some immune findings. Chronic hives may also be associated with
thyroid disease, other hormonal problems or, in very rare instances, cancer. Even this
condition usually dissipates over time.

Physical urticaria
In physical urticaria, the hives have a physical cause, such as exposure to heat, cold or
pressure.
 Common triggers include:

Rubbing or scratching (simple dermographism). This is the most frequent cause of

physical urticaria. Symptoms appear within a few minutes in the place that was
rubbed or scratched and typically last less than an hour.

Pressure or constriction. Delayed pressure urticaria can appear as red swelling six to
eight hours after pressure (belts or constrictive clothing, for example) has been
applied. Symptoms can also occur in parts of the body under constant pressure,
such as the soles of the feet.

Change in temperature. Cold urticaria is caused by exposure to low temperatures

followed by re-warming. This can be severe and life-threatening if there is a general
body cooling - for example, after a plunge into a swimming pool.

Higher body temperature. Cholinergic urticaria is due to an increase in body

temperature because of sweating, exercise, hot showers and/or anxiety.

Sun exposure. Solar urticaria may occur within a few minutes after exposure to the
sun.

Inflammation of the blood vessels, or vasculitis, can also cause hives. These hives are more
painful than itchy, may leave a bruise on the skin and often last more than a day.

Bronchial Asthma
Listen

IN THIS ARTICLE

Bronchial Asthma Triggers

Signs and Symptoms of Bronchial Asthma

Diagnosing Bronchial Asthma

Treating Bronchial Asthma

Ever hear the term "bronchial asthma" and wonder what it
means? When people talk about bronchial asthma, they are
really talking about asthma, a chronic inflammatory disease of
the airways that causes periodic "attacks"
of coughing, wheezing, shortness of breath, and chest
tightness.

According to the CDC, more than 25 million Americans,

including 6.8 million children under age 18, suffer
with asthma today.

Allergies are strongly linked to asthma and to other respiratory

diseases such as chronic sinusitis, middle ear infections,
and nasal polyps. Most interestingly, a recent analysis of
people with asthma showed that those who had both allergies
and asthma were much more likely to have nighttime
awakening due to asthma, miss work because of asthma, and
require more powerful medications to control their symptoms.

Asthma is associated with mast cells, eosinophils, and T

lymphocytes. Mast cells are the allergy-causing cells that
release chemicals likehistamine. Histamine is the substance
that causes nasal stuffiness and dripping in a cold or hay fever,
constriction of airways in asthma, and itchy areas in a skin
allergy. Eosinophils are a type of white blood cell associated
with allergic disease. T lymphocytes are also white blood
cellsassociated with allergy and inflammation.
 SLIDESHOW

A Visual Guide to Asthma

Start

These cells, along with other inflammatory cells, are involved

in the development of airway inflammation in asthma that
contributes to the airway hyperresponsiveness, airflow
limitation, respiratory symptoms, and chronic disease. In
certain individuals, the inflammation results in the feelings of
chest tightness and breathlessness that's felt often at night
(nocturnal asthma) or in the early morning hours. Others only
feel symptoms when they exercise (called exercise-induced
asthma). Because of the inflammation, the airway
hyperresponsiveness occurs as a result of specific triggers.
Bronchial Asthma Triggers

Bronchial asthma triggers may include:

 Smoking and secondhand smoke

Infections such as colds, flu, or pneumonia

Allergens such as food, pollen, mold, dust mites, and pet

dander

Exercise

Air pollution and toxins

Weather, especially extreme changes in temperature

Drugs (such as aspirin, NSAIDs, and beta-blockers)

Food additives (such as MSG)

Emotional stress and anxiety

Singing, laughing, or crying

Perfumes and fragrances

Acid reflux
Signs and Symptoms of Bronchial Asthma

With bronchial asthma, you may have one or more of the

following signs and symptoms:

Shortness of breath

Tightness of chest

Wheezing
 Excessive coughing or a cough that keeps you awake at
night
Diagnosing Bronchial Asthma

Because asthma symptoms don't always happen during your

doctor's appointment, it's important for you to describe your,
or your child's, asthma signs and symptoms to your health
care provider. You might also notice when the symptoms occur
such as during exercise, with a cold, or after smelling
smoke. Asthma tests may include:

SLIDESHOW

Is Inflammation Harming Your Health?

Start
 Spirometry: A lung function test to measure breathing
capacity and how well you breathe. You will breathe into a
device called a spirometer.

Peak Expiratory Flow (PEF): Using a device called a peak

flow meter, you forcefully exhale into the tube to measure
the force of air you can expend out of your lungs. Peak
flow monitoring can allow you to monitor how well your
asthma is doing at home.

Chest X-ray: Your doctor may do a chest X-ray to rule out

any other diseases that may be causing similar
symptoms.
Treating Bronchial Asthma

Once diagnosed, your health care provider will recommend

asthma medication (which can include asthma inhalers and
pills) and lifestyle changes to treat and prevent asthma
attacks. For example, long-acting anti-inflammatory asthma
inhalers are often necessary to treat the inflammation
associated with asthma. These inhalers deliver low doses of
steroids to the lungs with minimal side effects if used properly.
The fast-acting or "rescue" bronchodilator inhaler works
immediately on opening airways during an asthma attack.

If you have bronchial asthma, make sure your health care

provider shows you how to use the inhalers properly. Be sure
to keep your rescue inhaler with you in case of an asthma
attack or asthma emergency. While there is no asthma cure
yet, there are excellent asthma medications that can help
with preventing asthma symptoms. Asthma support groups
are also available to help you better cope with your asthma

Severe Asthma Attacks

An acute, severe asthma attackthat doesn't respond to usual

use of inhaled bronchodilatorsand is associated with symptoms
of potential respiratory failure is called status asthmaticus. This
is life-threatening and requires immediate medical attention. It
is important to be aware of these severe asthma attacks and
prevent them with early intervention.

What Are The Symptoms of a Severe Asthma

Attack?
The symptoms of a severe asthma attack may include:

Persistent shortness of breath

The inability to speak in full sentences

Breathlessness even while lying down

Chest that feels closed

Bluish tint to your lips

Agitation, confusion, or an inability to concentrate

Hunched shoulders and strained abdominal and neck

muscles

A need to sit or stand up to breathe more easily

These are signs of an impending respiratory system failure and
require immediate medical attention.

You may not have more wheezing and coughing with a severe
asthma attack. In fact, the presence
of wheezing or coughing is not a reliable standard for judging
the severity of an asthma attack. Very severe asthma attacks
may affect airways so much that the lack of air in and out of
yourlungs does not cause a wheezing sound or coughing.

Are There Warning Signs of a Severe Asthma

Attack?
A severe asthma attack can sometimes occur with few warning
signs. It can happen quickly and progress rapidly to severe
breathing difficulties and a lack of oxygen.

Does Wheezing Indicate a Severe Asthma

Attack?
Wheezing does not necessarily indicate asthma. Wheezing can
also be a sign of other health conditions, such as respiratory
infection, heart failure, and other serious problems.

What Causes a Severe Asthma Attack?

Whereas the causes of an acute, severe asthma attack are
unknown, those people who have them may have a history of
infrequent health care, which may result in poor treatment of
asthma.

Some research shows that people who are at risk for a severe
asthma attack have poor control of allergens or asthma
triggers in the home and/or workplace. These people may also
infrequently use their peak flow meter and inhaled
corticosteroids. Inhaled steroids are potent anti-inflammatory
drugs that are highly effective in
reducing inflammationassociated with asthma.

To prevent a severe asthma attack, it is important to monitor

your lungfunction using a peak flow meter regularly and take
your asthma medication as recommended by your health
care provider.

How Is a Severe Asthma Attack Diagnosed?

To diagnose a severe asthma attack as actual status
asthmaticus, your doctor will notice physical findings such as
your consciousness, fatigue, and the use of accessory muscles
of breathing. Your doctor will notice your respiration rate,
wheezing during both inhalation and exhalation, and
your pulse rate. Some other tests may include peak expiratory
flow and oxygen saturation, among others. Other physical
symptoms will be noticed with the chest, mouth, pharynx, and
upper airway.

How Is a Severe Asthma Attack Treated?

A severe asthma attack may not respond quickly to routine
treatment with asthma inhalers. Continuous use of an asthma
nebulizer and injections of drugs such as epinephrine and
corticosteroids for asthma are often necessary to stop the
asthma attack. Other therapies may
include terbutaline injections, magnesium sulfate (induces
smooth muscle relaxation of the airways).

During a severe asthma attack that does not respond to

asthma drugs, a mechanical ventilator may be needed to assist
the lungs and respiratory muscles. A facemask is applied or a
breathing tube is inserted in the nose or mouth for this asthma
treatment. These breathing aids are temporary and are
removed once the attack has subsided and the lungs have
recovered sufficiently to resume the work of breathing on their
own. A short hospital stay in an intensive care unit may be
necessary with a severe asthma attack.

To avoid hospitalization with a severe asthma attack, it is

imperative to begin immediate early treatment at the first sign
of symptoms either at home or in your doctor's office. If you
have asthma, it's also important to see your doctor frequently
to monitor your lung function and to assess your asthma
medications. Also, using your peak flow meter several times
daily can help you monitor your breathing, so you can start
treatment immediately if you notice a lower reading, even if
you feel fine.

How Does Status Asthmaticus Differ From an

Acute Asthma Attack?
An acute, or sudden, asthma attack is usually caused by an
exposure to allergens or an upper respiratory tract infection.
The severity of the asthma attack depends on how well your
underlying asthma is controlled (reflecting how well the
airway inflammation is being controlled). An acute asthma
attack is potentially life-threatening because it may continue
despite the use of your usual quick-relief medications (inhaled
bronchodilators). When the acute asthma attack is
unresponsive to treatment with an asthma inhaler (albuterol),
this may then be status asthmaticus, where you'd need
immediate medical attention and treatment.

Asthma attacks often do not stop on their own without asthma

treatment. If you ignore the early warning signs of an asthma
attack, you put yourself at risk of developing status
asthmaticus, which may require hospitalization for treatment.

If you have an asthma attack that does not respond to your

usual bronchodilator inhaler, this is considered to be a medical
emergency. These severe attacks require immediate
emergency care

HIV and AIDS

HIV is a virus which is most commonly passed on by sexual contact. HIV
attacks cells of the immune system. Untreated, the immune system
weakens so that the body cannot defend against various bacteria,
viruses and other germs. This is when AIDS (commonly now called late-
stage HIV infection) develops. However, early detection and treatment
with antiretroviral therapy (ART) means that people living with HIV can
lead active, healthy lives. However, they may have side-effects from the
treatment.

What are HIV and AIDS?

HIV stands for human immunodeficiency virus. This is a virus in the group of viruses called
retroviruses. HIV destroys cells in the body, called CD4 T cells. CD4 T cells are a type of white blood
cell (a lymphocyte). These are important cells involved in protecting the body against various
bacteria, viruses and other germs. HIV actually multiplies within CD4 cells. HIV cannot be destroyed
by white blood cells, as it keeps on changing its outer coat, so protecting itself.

AIDS stands for acquired immunodeficiency syndrome. This is a term which covers the range of
infections and illnesses which can result from a weakened immune system caused by HIV. Because
antiretroviral therapy (ART) has altered the way we think about the condition, the term late-stage HIV
is being increasingly used instead of AIDS.

Note: HIV and AIDS are not the same thing and people who get HIV infection do not automatically
develop AIDS. AIDS is unlikely to develop in people who have been treated in the early stages of
HIV infection. Even in people who do not receive treatment, there is usually a time lag of several
years between first being infected with HIV and then developing infections and other AIDS-related
problems. This is because it usually takes several years for the number of CD4 T cells to reduce to a
level where your immune system is weakened.

People with HIV can pass the virus on to others whether or not they have any symptoms.

How do you become infected with HIV?

Sexual transmission. This is the most common way to pass the virus on. In 2013, it
accounted for about 19 in 20 new confirmed cases in the UK. Semen, vaginal secretions and
blood from an infected person contain HIV. The virus can enter the body through the lining of
the vagina, vulva, penis, rectum or mouth during sex. Having vaginal or anal sex with an
infected person is the most common route. Oral sex carries a much lower risk. However, this
can increase if you have a condition affecting the defence barriers of the mouth, such as ulcers,
bleeding or damaged gums or a sore throat. You cannot be infected with HIV by coming into
contact with the saliva of an infected person (for example, through kissing or coming into
contact with spit). HIV is not passed on by coughing or sneezing.

Needle sharing. HIV (and other viruses such as hepatitis B and hepatitis C) can be passed
on by people who are dependent on injectable drugs and share needles, syringes and other
injecting equipment which is contaminated with infected blood. However, needle-exchange
services run by hospitals, clinics and drug dependency units and the more ready availability of
 medicines taken by mouth (such as methadone) have drastically reduced needle-sharing as a
source of infection.

Infected blood. In the past, quite a number of cases occurred from infected blood
transfusions and other blood products. This is now rare in the UK, as since 1985 all blood
products are checked for HIV before being used. It is still a significant problem in developing
countries.

Accidental needlestick injuries. There have been no cases of HIV infection from
needlestick injuries in a healthcare setting in the UK since 1999. HIV infection from a
needlestick injury outside of a healthcare setting has never been recorded anywhere in the
world.

From mother to child. HIV can be passed to an unborn child from an HIV-positive mother.
However, with appropriate treatment the risk of transmission of HIV from mother to baby can be
reduced to less than 1 in 100. This means that, with appropriate treatment, the vast majority of
babies born to HIV-positive mothers will not have HIV. Achieving this depends on detecting HIV
before pregnancy, or, in early pregnancy, when antiretroviral medicines can be taken by the
mother. Having a caesarean section to deliver the baby reduces the risk even further. HIV can
occasionally be passed to babies through breast milk during breast-feeding. If formula milk is
available, mothers with HIV are encouraged not to breast-feed.

Note: to become infected with HIV, some infected blood, semen or vaginal secretions would have to
get into your body. You can not catch HIV from ordinary contact with someone with HIV, such as
hugging, shaking hands or touching, or from sharing food, towels, utensils, swimming pools or
telephones.

How common is HIV?

The number of new people diagnosed with HIV in the UK peaked at 8,000 in 2006 and dropped to
6,000 in 2013. The total number of people living with HIV in the UK in 2013 was 107,800. Of these,
about 6 in 10 resulted from men having sex with men and about 4 in 10 were due to heterosexual
sex. A heterosexual person is attracted to people of the opposite sex. HIV infection is much more
common in many other countries in the world.
How does HIV cause problems in the body?
Once HIV is in your body the virus attaches to and gets into the CD4 T cells. The virus then uses the
genetic code inside the cell (the DNA) to make copies of itself (replicate). As new virus particles
break out of a CD4 T cell, the cell dies. The new virus particles then attach and enter new CD4 T
cells and so the process continues. Millions of new virus particles are made in CD4 T cells each day
and millions of CD4 T cells die each day.

To counter the virus destruction, the body continues to make new CD4 T cells each day. However,
over time, the virus usually wins and the the number of CD4 T cells gradually falls (usually over
several years). Once the level of CD4 T cells goes below a certain level, your immune system is
weakened. If your immune system is severely weakened by HIV infection, you are likely to develop
various opportunistic infections. These are infections caused by germs which are commonly around
us. You would not normally develop infections from these germs if you have a healthy immune
system. A low level of CD4 T cells also increases the risk of developing other conditions which the
immune system helps to prevent, such as certain cancers.

What are the symptoms of HIV and AIDS?

Primary infection with HIV
When you first become infected with HIV it is known as the primary infection. About 8 in 10 people
develop symptoms at this time. The three most common symptoms (sometimes known as the classic
triad) are sore throat, high temperature (fever) and a blotchy red rash. Other symptoms can include
feeling sick, diarrhoea, swollen glands, headache, tiredness and general aches and pains. The
symptoms can last up to three weeks and are often just thought of as flu or a mild viral illness.

After the primary infection

After any primary infection settles, you can remain without any symptoms for several years. Early
testing and treatment has revolutionised our concept of HIV infection which is now considered a
long-term disease (see 'What is the outlook (prognosis)?', below). Even without treatment, there are
often no symptoms for a long time (often up to ten years) and many people do not realise that they
are even infected. However, the virus continues to multiply, the number of CD4 T cells tends to
gradually fall and you can pass on the virus to others. During this time some people with HIV who
are otherwise well may develop persistent swollen lymph glands (persistent generalised
lymphadenopathy) or night sweats.
In time you may start to develop problems such as repeated mouth ulcers, repeated herpes or
shingles infections, or a skin condition called seborrhoeic dermatitis, caused by a yeast. Old
tuberculosis (TB) infection may reactivate in some cases even before AIDS develops, especially in
people in the developing world. Other symptoms of HIV that may occur before AIDS develops
include diarrhoea, skin rashes, tiredness and loss of weight.

Symptoms of AIDS
The term AIDS is used to describe the most advanced stages of HIV infection and is being overtaken
by the term late-stage HIV. People who are treated early in an HIV infection do not develop this
stage. AIDS is a general term which includes various diseases which can result from a very
weakened immune system. Typically, a person with AIDS has:

A very low level of CD4 T cells (around 200 cells per cubic millimetre of blood or below);
and/or

One or more opportunistic infections such as Pneumocystis jirovecii pneumonia, severe

thrush in the vagina or mouth, fungal infections, TB, Mycobacterium aviumcomplex,
toxoplasmosis, cytomegalovirus, etc. These infections can cause a range of symptoms
including sweats, fever, cough, diarrhoea, weight loss and generally feeling unwell.

In addition, people with AIDS have an increased risk of developing other conditions such as:

Certain cancers. Kaposi's sarcoma is a cancer which is usually only seen in people with
AIDS. There is also an increased risk of developing cancer of the neck of the womb (cervix)
and lymphoma.

An AIDS-related brain illness such as AIDS dementia (HIV encephalopathy).

A severe body wasting syndrome.

Many different symptoms can develop from the above conditions. Children with AIDS can develop
the same opportunistic infections and problems experienced by adults. In addition, they may also
develop severe common infections of childhood such as severe ear infections or severe tonsillitis.

What tests are done?

Decision aids

Doctors and patients can use Decision Aids together to help choose the best course of
action to take.

Compare the options

Most sexual health clinics offer a rapid blood test for HIV and can give results within thirty minutes.
Even if rapid testing is not available, the results are usually back within a week. Modern tests will
pick up the infection a month after first being infected (as opposed to three months with the older
tests). GPs can also arrange blood tests. The result will go on your health record but negative results
are no longer considered important by organisations such as insurance and loan companies. It is
recommended that all gay and bisexual men should be tested every year. They should be tested
more often if they:

Have anal sex without a condom.

Have multiple partners.

Have been diagnosed with another sexually transmitted infection.

Develop symptoms of primary or late-stage HIV.

It became legal to sell HIV home testing kits in the UK in April 2014. However, to date, none of the
available products have been awarded the CE (Conformit Europenne) mark indicating they are
safe for home use.

Assessing the extent of disease

If you are confirmed to have HIV, your doctor may do a blood test to check the amount of virus in
your blood (the viral load) and the number of CD4 T cells in your blood. These tests may be done
from time to time to assess how far the disease has progressed (and the response to treatment).

Tests to diagnose AIDS-related conditions

There is no test for AIDS but you may have a range of other tests to detect opportunistic infections or
other AIDS-related conditions. These will depend on the type of symptoms that you develop.
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What is the treatment for HIV infection?

Although there is still no cure for HIV, treatment is now effective at allowing people with HIV to live
their lives as normally as possible. Since the introduction of medicines to treat HIV, the death rates
from AIDS have reduced dramatically. With effective treatment, very few people go on to develop
AIDS.

It is not uncommon for people with HIV to feel low or even depressed, especially soon after the
diagnosis is made. If you have any feelings of depression then you should speak with your doctor.

Treatment to tackle the virus itself

HIV is now a treatable medical condition and most people with the virus remain fit and well on
treatment. Since the 1990s a number of medicines have been developed calledantiretroviral
medicines. Antiretroviral medicines work against HIV infection by slowing down the copying
(replication) of the virus in the body. Newer medicines are more effective than medicines used in the
past. There are several classes of these medicines which include:

Nucleoside reverse transcriptase inhibitors (NRTIs).

Nucleotide reverse transcriptase inhibitors (NtRTIs).

Protease inhibitors (PIs).

 Non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Newer classes of medicines have recently been introduced which are integrase inhibitors, fusion
inhibitors and CCR5 antagonists. The medicines in each class work in different ways but all work to
stop the HIV from replicating itself. This method of treatment is called antiretroviral therapy (ART).
You may still occasionally see this referred to as highly active antiretroviral therapy (or HAART).

There is a growing body of evidence that taking ART reduces the risk of passing the HIV infection on
to others.

Taking three or more antiretroviral medicines at the same time, each attacking HIV at different points
in its cycle of replication, is more effective than one or two medicines alone. Taking a combination of
different medicines also reduces the risk that the virus will become resistant to any individual
medicine. In 2008 the first one pill a day treatment was launched. Each pill contains three different
medicines. This is popular, as it is convenient to take and has few side-effects.

The choice of medicines is considered and chosen for each individual patient. The treatment for HIV
can be complicated but the majority of people diagnosed with HIV now take ART in a combination
format just once or twice a day. A team of healthcare professionals is usually involved in looking after
you and giving you your treatment.

The aim of treatment is to reduce the viral load to low levels. In most people who are treated with
ART, the viral load reduces to very low levels and the number of CD4 T cells rises. This means your
immune system is no longer as weakened and you are not likely to develop opportunistic infections.
However, it is vital to take the medication regularly and exactly as prescribed to maintain success
and to help prevent the virus from becoming resistant to the medicines.

As with other powerful medicines, antiretroviral medicines can cause side-effects in some cases. In
addition, some of these medicines can react with other commonly used medications. It may be
necessary to change an initial combination of medicines to a different combination because of
problems with side-effects, reactions or resistance of the virus to an initial medicine. Therefore,
different people with HIV can often take different combinations of medicines. Common side-effects
include feeling sick (nausea), being sick (vomiting) and headaches.
 When is treatment with antiretroviral medicines started?
As a general rule, antiretroviral medicines are usually started if:

Your CD4 T cells fall below a certain level (around 350 cells per cubic millimetre of blood or
less) - even without symptoms. The exact level when treatment is started depends on various
factors which your doctor will discuss with you. These include any symptoms present and the
rate of decline of the CD4 T cells.

Opportunistic infections or other AIDS-related problems develop.

However, the treatment of HIV is a rapidly changing area of medicine. Trials are underway to assess
whether antiretroviral medicines should be started earlier in people who have no symptoms, even as
early as when first infected with HIV. The trials aim to show whether there are benefits from
treatment before symptoms develop, which outweigh the risk of side-effects from the medicines. You
are likely to have regular blood tests to monitor for side-effects whilst taking treatment.

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Treatment and prevention of infections

Wearing a condom when having sex is very important to protect against other sexually transmitted
infections, including herpes and hepatitis. People with HIV are usually vaccinated against hepatitis
A and hepatitis B, influenza and the pneumococcus (a common cause of pneumonia).

Opportunistic infections are usually treated with antibiotics, antifungals or anti-TB medicines,
obviously depending on which infection develops. Even if you have not developed an infection, once
the CD4 T cells fall to a low level, you will normally be advised to take a regular dose of one or more
antibiotics or other medicines to prevent certain opportunistic infections from developing.
 How can infection with HIV be prevented?
There is no vaccine to prevent HIV. Development of one is proving to be very difficult, as the HIV
virus is constantly mutating and changing. Therefore, the main way to prevent infection by HIV is to
avoid activities that put you at risk, such as sharing needles and having sex without a condom.

Some cases of HIV can be prevented in other ways - for example:

If you are an injecting drug user then do not share needles or other injecting equipment. If
available, use local needle exchange schemes.

If you think they have been exposed to HIV through sharing needles or sexual contact, you
should contact your GP or a sexual health clinic as soon as possible. If it is thought that there is
a high risk that you may pick up the infection, you will be offered a course of anti-HIV
medicines. These are most effective when taken as soon as possible after exposure and
certainly within 72 hours.

Healthcare workers should follow local guidelines to reduce the chance of needlestick injury.
If you do have an injury, see your occupational health specialist urgently. A course of anti-HIV
medicines started as soon as possible and no later than 72 hours after the injury may prevent
infection with HIV developing.

If you are pregnant and have HIV infection then you need special antenatal care to reduce
the risk of passing on the virus to your baby. HIV treatments can be taken during pregnancy. An
HIV test is offered to all pregnant women in the UK.

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What is the outlook (prognosis)?

People with HIV who are diagnosed in good time can expect to lead a near-normal lifespan. A study
to predict the life expectancy of men infected with HIV at 30 years of age in 2010 found that they
could expect to live to 75, based on access to current treatments. Those who are diagnosed late
(with a CD4 count below 350 - the point at which treatment should commence), are more likely to
have a poor prognosis. However, even when someone has been diagnosed with a low CD4 count,
treatment can effectively bring them back to a good level of health. Life expectancy also depends on
other factors such as smoking, alcohol intake and use of other medicines.

In short - for people who have access to modern medicines, the outlook has improved greatly in
recent years.

Leukemia
What Is Leukemia?
Leukemia is a cancer of the blood cells. There are several
broad categories of blood cells, including red blood cells
(RBCs), white blood cells (WBCs), and platelets. Generally,
leukemia refers to cancers of the WBCs.

WBCs are a vital part of your immune system. They protect

your body from invasion by bacteria, viruses, and fungi, as
well as from abnormal cells and other foreign substances. In
leukemia, the WBCs dont function like normal WBCs. They
can also divide too quickly and eventually crowd out normal
cells.
WBCs are mostly produced in the bone marrow, but certain
types of WBCs are also made in the lymph nodes, spleen, and
thymus gland. Once formed, WBCs circulate throughout your
body in your blood and lymph, concentrating in the lymph
nodes and spleen.

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Part 2 of 7

The Types of Leukemia

The onset of leukemia can be acute (sudden onset) or chronic

(slow onset). In acute leukemia, cancer cells multiply quickly.
In chronic leukemia, the disease progresses slowly and early
symptoms may be very mild.

Leukemia is also classified according to the type of cell.

Leukemia involving myeloid cells is called myelogenous
leukemia. Myeloid cells are immature blood cells that would
normally become granulocytes or monocytes. Leukemia
involving lymphocytes is called lymphocytic leukemia. There
are four main types of leukemia:

Acute Myelogenous Leukemia (AML)

Acute myelogenous leukemia (AML) can occur in children and
adults. According to National Cancer Institute (NCI), about
21,000 new cases of AML are diagnosed annually in the
United States. This is the most common form of leukemia.
Acute Lymphocytic Leukemia (ALL)
Acute lymphocytic leukemia (ALL) occurs mostly in children.
About 6,000new cases of ALL are diagnosed annually.
Chronic Myelogenous Leukemia (CML)
Chronic myelogenous leukemia (CML) affects mostly adults.
About 7,000new cases of CML are diagnosed annually.
Chronic Lymphocytic Leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is most likely to affect
people over the age of 55. Its very rarely seen in children.
About 15,000 new cases of CLL are diagnosed annually.
Hairy cell leukemia is a very rare subtype of CLL. Its name
comes from the appearance of the cancerous lymphocytes
under a microscope.

Part 3 of 7

Risk Factors for Leukemia

 The causes of leukemia are not known. However, several
factors have been identified which may increase your risk.
These include:

a family history of leukemia

smoking, which increases your risk of developing AML
genetic disorders such as Down syndrome
blood disorders, such as myelodysplastic syndrome,
which sometimes called preleukemia
previous treatment for cancer with chemotherapy or
radiation
exposure to high levels of radiation
exposure to chemicals such as benzene
Part 4 of 7

What Are the Symptoms of

Leukemia?

The symptoms of leukemia include:

excessive sweating, especially at night (called night

sweats)
fatigue and weakness that dont go away with rest
 unintentional weight loss
bone pain and tenderness
painless, swollen lymph nodes (especially in the neck
and armpits)
enlargement of the liver or spleen
red spots on the skin, called petechiae
bleeding and bruising easily
fever or chills
frequent infections
Leukemia can also cause symptoms in organs that have been
infiltrated or affected by the cancer cells. For example, if the
cancer spreads to the central nervous system, it can cause
headaches, nausea and vomiting, confusion, loss of muscle
control, and seizures.

Leukemia can also spread to other parts of your body,

including:

the lungs
gastrointestinal tract
heart
kidneys
testes
Part 5 of 7

Diagnosing Leukemia
Leukemia may be suspected if you have certain risk factors,
or concerning symptoms. Your doctor will begin with a
complete history and physical examination, but leukemia
cant be fully diagnosed by physical exam. Instead, doctors
will use blood tests, biopsies, and imaging studies to
diagnose you.

Tests
There are a number of different tests that can be used to
diagnose leukemia. A complete blood count determines the
numbers of RBCs, WBCs, and platelets in the blood. Looking
at your blood under a microscope can also determine if the
cells have an abnormal appearance.

Tissue biopsies can be taken from the bone marrow or lymph

nodes to look for evidence of leukemia. These small samples
can identify the type of leukemia and its growth rate. Biopsies
of other organs such as the liver and spleen can show if the
cancer has spread.
Staging
 Once leukemia is diagnosed, it will be staged. Staging helps
your doctor determine your prognosis. AML and ALL are
staged based on how cancer cells look under the microscope
and the type of cell involved. ALL and CLL are staged based
on the WBC count at the time of diagnosis. The presence of
immature white blood cells, or myeloblasts, in the blood and
bone marrow is also used to stage AML and CML.

Assessing the Progression

A number of other tests can be run to assess the progression
of the disease, including:

Flow cytometry examines the DNA of the cancer cells

and determines their growth rate.
Liver function tests show whether leukemia cells are
affecting or invading the liver.
Lumbar puncture is performed by inserting a thin needle
between the vertebrae of your lower back. This allows your
doctor to collect spinal fluid and determine if cancer has
spread to the central nervous system.
Imaging studies, such as X-rays, ultrasounds, and CT
scans, help doctors look for any damage to other organs
thats caused by the leukemia.
Part 6 of 7

Treating Leukemia
 Leukemia is usually treated by a hematologist-oncologist.
These are doctors who specialize in blood disorders and
cancer. The treatment depends on the type and stage of the
cancer. Some forms of leukemia grow slowly and dont need
immediate treatment. However, treatment for leukemia
usually involves one or more of the following:
Chemotherapy uses drugs to kill leukemia cells.
Depending on the type of leukemia, you may take either a
single drug or a combination of different drugs.
Radiation therapy uses high-energy radiation to damage
leukemia cells and inhibit their growth. Radiation can be
applied to a specific area or to your entire body.
Stem cell transplantation replaces diseased bone
marrow with healthy bone marrow, either your own
(autologous transplantation) or from a donor (allologous
transplantation). This procedure is also called a bone marrow
transplant.
Biological or immune therapy uses treatments that help
your immune system recognize and attack cancer cells.
Targeted therapy uses medications that take advantage
of vulnerabilities in cancer cells. For example, imatinib
(Gleevec) is a targeted drug that is commonly used against
CML.
Part 7 of 7

Long-Term Outlook

The long-term outlook and prognosis for people who have

leukemia depends on the type of the cancer they have and
their stage at diagnosis. The sooner leukemia is diagnosed
and the faster its treated, the better the chance of recovery.
Some factors, like older age, past history of blood disorders,
and chromosome mutations, can negatively affect your
prognosis.

According to the NCI, the overall mortality rate for leukemia

has been falling about 1 percent each year for the past
decade. From 2005 to 2011, the five-year survival rate for
leukemia patients was 58.5 percent. However, its important
to note that this figure includes people of all ages and with all
forms of leukemia. Its not predictive of the outcome for any
one person. Work with your medical team to treat leukemia,
and remember that each persons situation is different.
What is systemic lupus
erythematosus?
The immune system normally fights off dangerous infections
and bacteria to keep the body healthy. An autoimmune
disease occurs when the immune system attacks the body
because it confuses it for something foreign. There are many
autoimmune diseases, including systemic lupus
erythematosus (SLE).

The term lupus has been used to identify a number of

immune diseases that have similar clinical presentations and
laboratory features, but SLE is the most common type of
lupus. People are often referring to SLE when they say lupus.

SLE is a chronic disease that can have phases of worsening

symptoms that alternate with periods of mild symptoms.
Most people with SLE are able to live a normal life with
treatment.

According to the Lupus Foundation of America, at least 1.5

million Americans are living with diagnosed lupus. The
foundation believes that the number of people who actually
have the condition is much higher and that many cases go
undiagnosed.
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Part 3 of 8

Recognizing potential symptoms

of SLE

Symptoms can vary and can change over time. Common

symptoms include:

severe fatigue
joint pain
joint swelling
headaches
a rash on the cheeks and nose, which is called a
butterfly rash
 hair loss
anemia
blood-clotting problems
fingers turning white or blue and tingling when cold,
which is known as Raynauds phenomenon
Other symptoms depend on the part of the body the disease
is attacking, such as the digestive tract, the heart, or the
skin.

Lupus symptoms are also symptoms of many other diseases,

which makes diagnosis tricky. If you have any of these
symptoms, see your doctor. Your doctor can run tests to
gather the information needed to make an accurate
diagnosis.

Part 4 of 8

Causes of SLE

The exact cause of SLE isnt known, but several factors have
been associated with the disease.

Genetics
 The disease isnt linked to a certain gene, but people with
lupus often have family members with other autoimmune
conditions.

Environment
Environmental triggers can include:

ultraviolet rays
certain medications
viruses
physical or emotional stress
trauma
Sex and hormones
SLE affects women more than men. Women also may
experience more severe symptoms during pregnancy and
with their menstrual periods. Both of these observations have
led some medical professionals to believe that the female
hormone estrogen may play a role in causing SLE. However,
more research is still needed to prove this theory.

Part 5 of 8

How is SLE diagnosed?

 Your doctor will do a physical exam to check for typical signs
and symptoms of lupus, including:

sun sensitivity rashes, such as a malar or butterfly rash

mucous membrane ulcers, which may occur in the
mouth or nose
arthritis, which is swelling or tenderness of the small
joints of the hands, feet, knees, and wrists
hair loss
hair thinning
signs of cardiac or lung involvement, such as murmurs,
rubs, or irregular heartbeats
No one single test is diagnostic for SLE, but screenings that
can help your doctor come to an informed diagnosis include:

blood tests, such as antibody tests and a complete blood

count
a urinalysis
a chest X-ray
Your doctor might refer you to a rheumatologist, which is a
doctor who specializes in treating joint and soft tissue
disorders and autoimmune diseases.
 Part 6 of 8

Treatment for SLE

No cure for SLE exists. The goal of treatment is to ease

symptoms. Treatment can vary depending on how severe
your symptoms are and which parts of your body SLE affects.
The treatments may include:

anti-inflammatory medications for joint pain and stiffness

steroid creams for rashes
corticosteroids to minimize the immune response
antimalarial drugs for skin and joint problems
disease modifying drugs or targeted immune system
agents for more severe cases
Talk with your doctor about your diet and lifestyle habits. Your
doctor might recommend eating or avoiding certain foods
and minimizing stress to reduce the likelihood of triggering
symptoms. You might need to have screenings for
osteoporosis since steroids can thin your bones. Your doctor
may also recommend preventive care, such as immunizations
that are safe for people with autoimmune diseases and
cardiac screenings,
 Part 7 of 8

Long-term complications of SLE

Over time, SLE can damage or cause complications in

systems throughout your body. Possible complications may
include:

blood clots and inflammation of blood vessels or

vasculitis
inflammation of the heart, or pericarditis
a heart attack
a stroke
memory changes
behavioral changes
seizures
inflammation of lung tissue and the lining of the lung, or
pleuritis
kidney inflammation
decreased kidney function
kidney failure
SLE can have serious negative effects on your body during
pregnancy. It can lead to pregnancy complications and even
miscarriage. Talk with your doctor about ways to reduce the
risk of complications.

Part 8 of 8

What is the outlook for people

with SLE?

SLE affects people differently. Treatments are most effective

when you start them soon after symptoms develop and when
your doctor tailors them to you. Its important that you make
an appointment with your doctor if you develop any
symptoms that concern you.

Living with a chronic condition can be difficult. Talk to your

doctor about support groups in your area. Working with a
trained counselor or support group can help you reduce
stress, maintain positive mental health, and manage your
illness.