All you need to know about AIDS.
Know your ailment well, so you can manage it better!!
Here we come with AIDS today!
HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome) and can be transmitted during sexual intercourse, syringe sharing, or during pregnancy, childbirth, or breastfeeding on a perinatal basis. HIV / AIDS has been one of humanity’s deadliest and most persistent epidemics since the first AIDS cases were identified in 1981. The HIV pandemic persists, while extraordinary progress has been made in the fight against new HIV cases and AIDS deaths.
By killing CD4 + T cells, a type of white blood cell that is essential to fighting off infection, HIV attacks the immune system. The death of these cells will leave people with untreated HIV susceptible to infections and complications that are life-threatening. Effective anti-HIV drugs today allow people with HIV to lead long, stable lives. These regular drugs, called antiretroviral therapy (ART), will reduce the amount of virus in the blood to a level so low that it is undetectable by normal tests when administered as prescribed. The virus can not be sexually transmitted by people with HIV who maintain a permanently undetectable viral load by taking everyday ART, a term known as Undetectable = Untransmittable, or U = U. Numerous methods of preventing the acquisition of HIV are available for those who are HIV-negative, including pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and voluntary adult medical male circumcision.
The virus joins several different cells after entering the body, integrates its genes into the human DNA, and hijacks the cell to create the HIV virus. Most notably, HIV targets cells named CD4 or T-helper cells (T cells) of the body’s immune system. The infection kills these cells. By producing new T cells or attempting to contain the virus, the body attempts to keep up, but ultimately the HIV wins out and gradually kills the capacity of the body to combat infections and certain cancers. The structure of the virus has been extensively studied, and this ongoing study has helped scientists create new HIV / AIDS therapies. While all HIV viruses are identical, drug-resistant viruses are produced by minor variations or mutations in the genetic material of the virus. In various viral subtypes, greater variations in the viral genes are observed. The predominant subtype which causes HIV / AIDS is currently HIV-1. Another type of HIV, HIV-2, occurs almost exclusively in West Africa but has sometimes caused outbreaks elsewhere related to travel.
GLOBAL HIV STATISTICS
- 25.4 million [24.5 million–25.6 million] people were accessing antiretroviral therapy in 2019.
- 38.0 million [31.6 million–44.5 million] people globally were living with HIV in 2019.
- 1.7 million [1.2 million–2.2 million] people became newly infected with HIV in 2019.
- 690 000 [500 000–970 000] people died from AIDS-related illnesses in 2019.
- 75.7 million [55.9 million–100 million] people have become infected with HIV since the start of the epidemic.
- 32.7 million [24.8 million–42.2 million] people have died from AIDS-related illnesses since the start of the epidemic.
People living with HIV
- In 2019, there were 38.0 million [31.6 million–44.5 million] people living with HIV.
- 36.2 million [30.2 million–42.5 million] adults.
- 1.8 million [1.3 million–2.2 million] children (0–14 years).
- 81% [68–95%] of all people living with HIV knew their HIV status.
- About 7.1 million people did not know that they were living with HIV.
People living with HIV accessing antiretroviral therapy
- As of the end of 2019, 25.4 million [24.5 million–25.6 million] people were accessing antiretroviral therapy, up from 6.4 million [5.9 million–6.4 million] in 2009.
- In 2019, 67% [54–79%] of all people living with HIV were accessing treatment.
- 68% [54–80%] of adults aged 15 years and older living with HIV had access to treatment, as did 53% [36–64%] of children aged 0–14 years.
- 73% [60–86%] of female adults aged 15 years and older had access to treatment; however, just 61% [48–74%] of male adults aged 15 years and older had access.
- 85% [63–100%] of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2019.
New HIV infections
- New HIV infections have been reduced by 40% since the peak in 1998.
- In 2019, around 1.7 million [1.2 million–2.2 million] people were newly infected with HIV, compared to 2.8 million [2.0 million–3.7 million] people in 1998.
- Since 2010, new HIV infections have declined by 23%, from 2.1 million [1.6 million–2.9 million] to 1.7 million [1.2 million–2.2 million] in 2019.
- Since 2010, new HIV infections among children have declined by 52%, from 310 000 [200 000–500 000] in 2010 to 150 000 [94 000–240 000] in 2019.
- AIDS-related deaths have been reduced by 60% since the peak in 2004.
- In 2019, around 690 000 [500 000–970 000] people died from AIDS-related illnesses worldwide, compared to 1.7 million [1.2 million–2.4 million] people in 2004 and 1.1 million [830 000 –1.6 million] people in 2010.
- AIDS-related mortality has declined by 39% since 2010.
HIV and COVID-19
- A new analysis by UNAIDS has revealed the potential impacts that the COVID-19 pandemic could have in low- and middle-income countries around the world on supplies of the generic antiretroviral medicines used to treat HIV.
- The lockdowns and border closures imposed to stop COVID-19 are impacting both the production of medicines and their distribution, potentially leading to increases in their cost and to supply issues.
- It has been estimated that the final cost of exported antiretroviral medicines from India could be between 10% and 25% higher than normal prices.
- Recent modeling has estimated that a six-month complete disruption in HIV treatment could lead to more than 500 000 [471 000–673 000] additional deaths from AIDS-related illnesses.
- If services to prevent mother-to-child transmission of HIV were similarly halted for six months, the estimated increases in new child HIV infections would be 162% in Malawi, 139% in Uganda, 106% in Zimbabwe and 83% in Mozambique.
- Every week, around 5500 young women aged 15–24 years become infected with HIV.
- In sub-Saharan Africa, five in six new infections among adolescents aged 15–19 years are among girls. Young women aged 15–24 years are twice as likely to be living with HIV than men.
- More than one third (35%) of women around the world have experienced physical and/or sexual violence by an intimate partner or sexual violence by a non-partner at some time in their lives.
- In some regions, women who have experienced physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced such violence.
- Women and girls accounted for about 48% of all new HIV infections in 2019. In sub-Saharan Africa, women and girls accounted for 59% of all new HIV infections.
- In 2019, 81% [68–95%] of people living with HIV knew their HIV status.
- Among people who knew their status, 82% [66–97%] were accessing treatment.
- And among people accessing treatment, 88% [71–100%] were virally suppressed.
- Of all people living with HIV, 81% [68–95%] knew their status, 67% [54–79%] were accessing treatment and 59% [49–69%] were virally suppressed in 2019.
- Key populations and their sexual partners account for:
- 62% of new HIV infections globally.
- 99% of new HIV infections in eastern Europe and central Asia.
- 97% of new HIV infections in the Middle East and North Africa.
- 96% of new HIV infections in western and central Europe and North America.
- 98% of new HIV infections in Asia and the Pacific.
- 77% of new HIV infections in Latin America.
- 69% of new HIV infections in western and central Africa.
- 60% of new HIV infections in the Caribbean.
- 28% of new HIV infections in eastern and southern Africa.
The risk of acquiring HIV is:
- 26 times higher among gay men and other men who have sex with men.
- 29 times higher among people who inject drugs.
- 30 times higher for sex workers.
- 13 times higher for transgender people.
- TB remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths.
- In 2018, an estimated 10.0 million [9.0 million–11.1 million] people developed TB disease, approximately 9% of whom were living with HIV.
- People living with HIV with no TB symptoms need TB preventive therapy, which lessens the risk of developing TB and reduces TB/HIV death rates by around 40%.
- 1.8 million people living with HIV across 65 countries started preventive treatment for TB in 2018.
- It is estimated that 44% of people living with HIV and TB are unaware of their coinfection and are therefore not receiving care.
- At the end of 2019, US$ 18.6 billion (constant 2016 dollars) was available for the AIDS response in low- and middle-income countries, almost US$ 1.3 billion less than in 2017.
- Around 57% of the total resources for HIV in low- and middle-income countries in 2019 were from domestic sources.
- UNAIDS estimates that US$ 26.2 billion (constant 2016 dollars) will be required for the AIDS response in 2020.
A virus causes HIV. During pregnancy, childbirth, or breast-feeding, it may spread by sexual contact or blood, or from mother to infant.
Why is HIV turning into AIDS?
HIV kills CD4 T cells, which are white blood cells that play a significant role in helping the body combat illness. The less you have CD4 T cells, the poorer your immune system becomes.
You may have an HIV infection for years until it turns into AIDS, with little to no signs. When the CD4 T cell count drops below 200 or you have an AIDS-defining complication, such as a severe infection or cancer, AIDS is diagnosed.
How HIV propagates
Infected blood, semen, or vaginal secretions must penetrate the body to become infected with HIV. In many cases, this can happen:
By making intercourse. If you have vaginal, anal, or oral sex with an infected partner whose blood, semen, or vaginal secretions have penetrated your body, you may become infected. During sexual intercourse, the virus will enter your body through mouth sores or small tears that often form in the rectum or vagina.
By getting needles exchanged. You are at high risk for HIV and other infectious diseases, such as hepatitis, by exchanging infected IV drug paraphernalia (needles and syringes).
From transfusions of blood. The virus can be transmitted via blood transfusions in some instances. The blood supply for HIV antibodies is now tested by American hospitals and blood banks, so this risk is very limited.
During or by breast-feeding during pregnancy or childbirth. Mothers who are infected will pass the virus on to their kids. Mothers who are HIV-positive and receive care during pregnancy for infection will substantially reduce their child’s risk.
How HIV won’t spread?
Via ordinary touch, you can not become infected with HIV. That means you can’t catch HIV or AIDS with someone who has the infection by hugging, kissing, dancing, or shaking hands.
The air, water, or insect bites do not transmit HIV.
- In three steps, HIV infection occurs. It gets worse over time without treatment and ultimately overpowers the immune system. Your symptoms will depend on your stage of growth.
First Stage: Acute HIV Infection Symptoms:
When they have been infected with HIV, most people do not know right away. But within 2 to 6 weeks after they have acquired the infection, they may have symptoms. This is when the immune system of your body puts a fight in place. It’s called primary HIV infection or acute retroviral syndrome.
The symptoms are close to those of other infectious diseases and are often compared with those of the flu. Usually, they stay for a week or two and then go down. Early HIV symptoms include:
- Muscles aching
- Soreness of throat
- Swollen lymph ganglions
- A red rash, usually on your torso, that doesn’t itch
- A fever
If you have symptoms like these, and in the past 2 to 6 weeks, you might have come into touch with someone with HIV, go to a doctor and ask for an HIV test. Get checked if you don’t have symptoms yet still think that you might have come into contact with the virus.
For two reasons, early testing is critical. First, HIV levels in your blood and bodily fluids are very high at this time. This renders it extremely contagious. Second, it may help improve your immune system and relieve your symptoms by beginning treatment as soon as possible.
A combination of medicines (called HIV medicines, antiretroviral therapy, or ART) can help combat HIV, maintain a healthy immune system, and prevent the spread of the virus. Your HIV infection probably won’t get worse if you take these drugs and have good habits.
Second Stage: Clinical Latency Symptoms:
The flu-like symptoms will go away after the immune system loses the battle with HIV. But inside your body, there’s a lot going on. This is what doctors call the asymptomatic phase of chronic infection with HIV.
Cells called CD4 T cells in your body coordinate the reaction of your immune system. Untreated HIV can kill CD4 cells at this stage and destroy your immune system. With blood tests, the doctor will verify how many of these cells you have. The number of CD4 cells will decrease without treatment, and you’ll be more likely to get other infections.
Many individuals may not have signs that they can see or experience. You do not know you are infected and are willing to pass on HIV to others.
If you’re taking ART, you might stay for decades in this process. You can pass on the virus to other people, but if you take your medication, it’s extremely unlikely.
Third Stage: AIDS Symptoms:
The advanced stage of HIV infection is AIDS. Typically this is when the amount of your CD4 T-cell drops below 200 and your immune system is badly impaired. In individuals that have compromised immune systems, you may get an opportunistic infection, a disease that occurs more frequently and is worse. Some of these are often called ‘AIDS-defining diseases,’ such as Kaposi’s sarcoma (a type of skin cancer) and pneumocystis pneumonia (a lung disease).
If you didn’t know previously that you were infected with HIV after you have some of these symptoms, you might realize it:
- Feeling half of the time exhausted
- Swollen nodes of the lymph in your neck or groin
- Fever that has a period of more than 10 days
- Sweats at Night
- Loss of weight for no specific cause
- Purplish marks that don’t go away on your face
- Shortness of Respiration
- Long-lasting, severe diarrhea
- Infections of yeast in your mouth, throat, or vagina
People with AIDS who do not take drugs live for nearly three years or less if they have another infection. But in this process, HIV can still be treated. You will live for a long time if you start using HIV medications, stay on them, follow the advice of your doctor, and maintain good habits.
Anyone of any age, race, sex, or sexual orientation can be infected with HIV/AIDS. However, you’re at greatest risk of HIV/AIDS if you:
- Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is riskier than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners.
- Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body.
- Use IV drugs. People who use IV drugs often share needles and syringes. This exposes them to droplets of other people’s blood.
Popular HIV / AIDS infections
Pneumonia with Pneumocystis (PCP). Serious illness may cause this fungal infection. While current HIV / AIDS therapies have deteriorated dramatically in the U.S., In individuals infected with HIV, PCP is still the most common cause of pneumonia.
Candidiasis. Candidiasis is a common infection associated with HIV. It causes your mouth, tongue, esophagus or vagina to become inflamed and have a thick, white coating.
(TB) tuberculosis. TB is the most common opportunistic infection associated with HIV in resource-limited nations. For people with AIDS, it’s a leading cause of death.
Cytomegalovirus. In body fluids, such as saliva, blood, urine, semen, and breast milk, this common herpes virus is passed on. The virus is inactivated by a strong immune system and it stays inactive in your body. The virus resurfaces if your immune system weakens, causing damage to your eyes, digestive tract, lungs or other organs.
Cryptococcal Meningitis. Meningitis is an inflammation of the brain and spinal cord (meninges) covering the membranes and blood. A common central nervous system infection associated with HIV, caused by a fungus found in soil, is cryptococcal meningitis.
With toxoplasmosis. Toxoplasma gondii, a parasite transmitted mainly by cats, triggers this potentially deadly infection. The parasites migrate through the stools of infected cats, which may then spread to other animals and humans. Toxoplasmosis can cause heart disease, and as it spreads to the brain, seizures happen.
HIV / AIDS-Common Cancers.
With lymphoma. This cancer begins in the white cells of the blood. Painless swelling of the lymph nodes in your throat, armpit, or groin is the most prevalent early warning.
Sarcoma of Kaposi. Kaposi’s sarcoma, a tumor of the blood vessel walls, typically occurs on the skin and mouth as yellow, red, or purple lesions. The lesions may look dark brown or black in individuals with darker skin. The internal organs, including the digestive tract and the lungs, can also affect Kaposi’s sarcoma.
Syndrome from Wasting. Untreated HIV / AIDS, often followed by diarrhea, chronic fatigue, and fever, may trigger severe weight loss.
Complications from neurology. Neurological symptoms including fatigue, forgetfulness, depression, anxiety, and trouble walking may be caused by HIV. Neurocognitive disorders associated with HIV (HAND) can differ from mild symptoms of behavioral changes and diminished mental function to extreme dementia that causes fatigue and inability to function.
Renal illness. HIV-associated nephropathy (HIVAN) is an inflammation in your kidneys with small philters that extract excess fluid and waste from your blood and transfer it to your urine. It affects black or Hispanic individuals more frequently.
Hepatic illness. It is also a major complication of liver disease, especially in people who also have hepatitis B or hepatitis C.
By direct contact with those types of body fluids, you get HIV — blood, semen, pre-seminal fluid (also called pre-cum), vaginal fluids, rectal fluids, and breast milk. The biggest threats are having vaginal or anal sex with someone who has HIV without a condom or sharing needles. But other factors will improve the chances of getting it, too.
The CDC suggests that anyone between the ages of 13 and 64 in the United States gets screened for HIV at least once as a precaution. Furthermore, you should ask yourself the following questions, and you should get tested if you answer yes to any of them:
- Have you had unprotected sex with someone who has HIV or with someone you don’t know about their HIV status?
- Have you injected medications and exchanged needles or syringes with others (including hormones, steroids, and silicone)?
- Have you received an STD diagnosis?
- Have you been diagnosed with hepatitis or with tuberculosis ( TB)?
- Did you have sex with someone who would answer “yes” to all of the above questions?
- Have you been assaulted sexually?
Talk to your doctor about which HIV test is right for you. If any of these tests are negative, you may still need follow-up test weeks to months later to confirm the results
Blood tests usually diagnose HIV infection. HIV testing is typically a two-step procedure. A screening test is performed first. A second test (Western blot) is performed to validate the outcome if the test is positive.
Three types of screening tests that use a blood specimen are common:
- Antibody tests for HIV;
- A hybrid antibody/antigen test of the fourth generation that detects both antibodies and a piece of the virus called p24 antigen;
- (HIV RT PCR or viral load) RNA tests;
- In addition, it is important to validate the diagnosis with a blood test called a Western blot.
- Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens are substances on the HIV virus itself and are usually detectable — a positive test — in the blood within a few weeks after exposure to HIV.
Antibodies are produced by your immune system when it’s exposed to HIV. It can take weeks to months for antibodies to become detectable. The combination of antigen/antibody tests can take two to six weeks after exposure to become positive.
- Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take three to 12 weeks after you’re exposed to become positive.
- Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load). They also involve blood drawn from a vein. If you might have been exposed to HIV within the past few weeks, your doctor may recommend NAT. NAT will be the first test to become positive after exposure to HIV.
No test is flawless. Tests can be falsely positive or falsely adverse. It may take some time, for instance, for the immune system to generate enough antibodies to turn positive for the antibody test. This time period is usually referred to as the “window period” and can last between six weeks and three months after infection. The antigen/antibody test is most vulnerable and may be positive after infection within two weeks. A repeat test three months later should be conducted if the initial antibody test is negative or ambiguous.
In body fluids other than blood, such as saliva , urine, and vaginal secretions, other tests can detect antibodies. Some of these are intended to be quick HIV tests that produce outcomes in about 20 minutes. Similar to conventional blood tests, these tests have precision thresholds. OraQuick is an at-home test that detects HIV antibodies in oral fluid using an oral swab. Another fast HIV test that can detect HIV antibodies in blood or plasma is Clearview. At many local drugstores, HIV home-testing kits are available. A finger prick obtains blood and it is blotted on a philter strip. Saliva or urine is used in other test kits. The philter strip is mailed to a laboratory in a protective envelope to be checked. Results are returned within one to two weeks by mail.
In order to produce a definitive diagnosis, all positive HIV screening tests must be checked with a confirmatory blood test called the Western blot. The probability of a person becoming HIV infected is > 99 percent if the screening test and the Western blot are both positive. The Western blot is also “indeterminate,” which means it is neither positive nor negative. The experiments are typically repeated at a later date in these cases. Furthermore, an RNA test for the virus could be performed. The antibody/antigen screening test can decrease the “window time” and allow for earlier detection of HIV infections because the p24 antigen is present in the blood before the body forms antibodies.
The RNA (viral load test) test detects RNA in the blood for HIV. It is not widely used for screening, but when a person is in the window time or if the screening tests are ambiguous, it may help detect early HIV infection.
There’s no treatment for HIV / AIDS now. Your body can not get rid of it once you have the infection. There are several drugs, however, that can control HIV and avoid complications. Antiretroviral therapy ( ART) is the name of these drugs. Everyone diagnosed with HIV, regardless of their stage of infection or complications, should get started on Painting.
Typically, ART is a mixture of three or more drugs from many different types of drugs. This technique has the best chance of reducing the amount of HIV in your blood. There are several options for ART that combine three HIV drugs, taken once daily, into one tablet.
Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:
- Account for individual drug resistance (viral genotype)
- Avoid creating new drug-resistant strains of HIV
- Maximize suppression of the virus in the blood
Two drugs from one class, plus a third drug from a second class, are typically used.
The classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant), and doravirine (Pifeltro).
- Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
- Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
- Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress), and dolutegravir (Tivicay).
- Entry or fusion inhibitors block HIV’s entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
Home Remedies and self-care:
It‘s important to take an active role in your own care, along with seeking medical attention. You will be able to remain safe longer with the following suggestions:
Eat foods that are balanced. Make sure you get ample nourishment. Fresh fruits and vegetables, whole grains, and lean protein help to keep you strong, provide you with more energy, and strengthen your immune system.
Stop raw eggs, poultry, and more. In people who are HIV infected, foodborne illnesses may be extremely serious. Cook your meat until it’s done right. Stop unpasteurized dairy products such as oysters, sushi or sashimi, raw eggs, and raw seafood.
Get the vaccines correct. These may avoid infections such as pneumonia and influenza that are common. Other vaccines may also be recommended by your doctor, including those for HPV, hepatitis A, and hepatitis B. Inactivated vaccines are normally healthy, but because of the compromised immune system, most vaccines with live viruses are not.
Pay attention to companion animals. In people who are HIV-positive, some animals may carry parasites that can cause infections. Cat feces can cause toxoplasmosis, salmonella can be carried by reptiles, and cryptococcus or histoplasmosis can be carried by birds. Since handling pets or emptying the litter box, wash your hands thoroughly.
HIV infected individuals often pursue dietary supplements that appear to improve the immune system or mitigate the side effects of anti-HIV medicines. There is no scientific evidence, however, that any dietary supplement enhances immunity, and several may interfere with other medicines that you are taking. To ensure there are no drug interactions, always consult with your doctor before taking any supplements or alternative therapies.
Supplements which could be useful
L-carnitine acetyl. In people with diabetes, researchers have used acetyl-L-carnitine to treat nerve pain, numbness, or weakness (neuropathy). It can also ease HIV-related neuropathy if you lack the drug.
Proteins in whey and some amino acids. Early evidence indicates that whey protein may help some people with HIV gain weight, a cheese by-product. Whey protein also seems to decrease diarrhea and increase the count of CD4 T cells. Weight gain can also be supported by the amino acids L-glutamine, L-arginine, and hydroxymethyl butyrate (HMB).
About probiotics. There is some evidence that the probiotic medicine Saccharomyces boulardii can help with diarrhea associated with HIV, but use it only as prescribed by your doctor. For treating diarrhea, bovine colostrum is also being examined.
Minerals and vitamins. If you have low levels, vitamins A, D, E, C, and B, as well as the minerals zinc, iron, and selenium, may be useful.
Supplements which may be hazardous
Wort from St. John’s. St. John’s Wort, a popular remedy for depression, can reduce the efficacy of many types of anti-HIV drugs by more than half.
Supplements of Garlic. While garlic itself may help improve the immune system, garlic supplements may interfere with and decrease their ability to function with some anti-HIV drugs. Eating garlic occasionally in food tends to be healthy.
Extract from red yeast rice. This is used by certain individuals to reduce cholesterol, but if you take a protease inhibitor or a statin, stop it.
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