^ Jump up to: a b Marx PA, Alcabes PG, Drucker E (2001). “Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa” (PDF). Philosophical Transactions of the Royal Society B. 356 (1410): 911–20. doi:10.1098/rstb.2001.0867. PMC 1088484 . PMID 11405938. Archived (PDF) from the original on September 17, 2013.
HIV seeks out and destroys CCR5 expressing CD4+ T cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4+ T cells in mucosal tissues remain particularly affected. Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase. Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease.
In the UK in 2012, 15 donors tested positive for HIV infection at screening. This represented 0.6 detected infections per 100,000 donations. These were mainly in men who probably acquired the infection via heterosexual transmission.
HIV-1 testing is initially done using an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV-1. Specimens with a non-reactive result from the initial ELISA are considered HIV-negative unless new exposure to an infected partner or partner of unknown HIV status has occurred. Specimens with a reactive ELISA result are retested in duplicate. If the result of either duplicate test is reactive, the specimen is reported as repeatedly reactive and undergoes confirmatory testing with a more specific supplemental test (e.g., a polymerase chain reaction (PCR), western blot or, less commonly, an immunofluorescence assay (IFA)). Only specimens that are repeatedly reactive by ELISA and positive by IFA or PCR or reactive by western blot are considered HIV-positive and indicative of HIV infection. Specimens that are repeatedly ELISA-reactive occasionally provide an indeterminate western blot result, which may be either an incomplete antibody response to HIV in an infected person or nonspecific reactions in an uninfected person.
^ Jump up to: a b c Chan DC, Fass D, Berger JM, Kim PS (1997). “Core structure of gp41 from the HIV envelope glycoprotein” (PDF). Cell. 89 (2): 263–73. doi:10.1016/S0092-8674(00)80205-6. PMID 9108481.
¶ The 2011 estimate of diagnosis delay is based on the same CD4 methodology used in this report, but CD4 model parameters were updated, and more CD4 data are available in recent years; therefore, results are not directly comparable.
Sexual intercourse when either partner has a genital herpes infection, syphilis, or another sexually transmitted disease (STD) that can cause sores or tears in the skin or inflammation of the genitals
Dutch HIV-ziekte, humaan immunodeficiëntievirusinfectie, niet-gespecificeerd, HIV-infectie NAO, humaan immunodeficiëntievirussyndroom, HIV-ziekte; aandoening (als gevolg), HIV-ziekte; infectie, Humaan Immunodeficiëntievirus; ziekte, aandoening; HIV-ziekte (als gevolg van HIV-ziekte), aandoening; als gevolg van HIV-ziekte, immunodeficiëntievirus-ziekte; humaan, infectie; HIV-ziekte als oorzaak, Niet gespecificeerd ziekte door Humaan Immunodeficiëntievirus [HIV], HIV-infectie, HIV-infecties, HTLV-III-LAV-infectie, HTLV-III-infectie, Infecties, HIV-
In patients with HIV infection, certain syndromes are common and may require different considerations (see Table: Common Manifestations of HIV Infection by Organ System). Some patients present with cancers (eg, Kaposi sarcoma, B-cell lymphomas) that occur more frequently, are unusually severe, or have unique features in patients with HIV infection (see Cancers Common in HIV-Infected Patients). In other patients, neurologic dysfunction may occur.
Andre F. Dailey, MSPH1; Brooke E. Hoots, PhD1; H. Irene Hall, PhD1; Ruiguang Song, PhD1; Demorah Hayes, MA1; Paul Fulton Jr.1; Joseph Prejean, PhD1; Angela L. Hernandez, MD1; Linda J. Koenig, PhD1; Linda A. Valleroy, PhD1 (View author affiliations)
The spread of HIV by exposure to infected blood usually results from sharing needles, as in those used for illicit drugs. HIV also can be spread by sharing needles for anabolic steroids to increase muscle, tattooing, and body piercing. To prevent the spread of HIV, as well as other diseases, including hepatitis, needles should never be shared. At the beginning of the HIV epidemic, many individuals acquired HIV infection from blood transfusions or blood products, such as those used for hemophiliacs. Currently, however, because blood is tested for both antibodies to HIV and the actual virus before transfusion, the risk of acquiring HIV from a blood transfusion in the United States is extremely small and is considered insignificant.
In patients with unmasked IRIS, the newly identified opportunistic infection is treated with antimicrobial drugs. Occasionally, when the symptoms are severe, corticosteroids are also used. Usually, when unmasked IRIS occurs, ART is continued. An exception is cryptococcal meningitis. Then ART is temporarily interrupted until the infection is controlled.
Jump up ^ Butsch, M.; Boris-Lawrie, K. (2002). “Destiny of Unspliced Retroviral RNA: Ribosome and/or Virion?”. Journal of Virology. 76 (7): 3089–94. doi:10.1128/JVI.76.7.3089-3094.2002. PMC 136024 . PMID 11884533.
In recommending the opt-out approach for prenatal HIV testing, ACOG encouraged Fellows to include counseling as a routine part of care but not as a prerequisite for, or barrier to, prenatal HIV testing (11). Similarly, the American Medical Association, in recommending that universal HIV testing of all pregnant women with patient notification of the right of refusal be a routine component of prenatal care, indicated that basic counseling on HIV prevention and treatment also should be provided to the patient, consistent with the principles of informed consent (16). Accordingly, if adopting this option, physicians should be prepared to provide both pretest and posttest counseling. Broad implementation of an opt-out strategy, however, will require changing laws in states that require detailed and specific counseling and consent before testing. Physicians should be aware of the laws in their states that affect HIV testing. The National HIV/ AIDS Clinicians’ Consultation Center at the University of California—San Francisco maintains an online compendium of state HIV testing laws that can be a useful resource (see http://www.ucsf.edu/hivcntr/).
Opt-out testing removes the requirement for pretest counseling and detailed, testing-related informed consent. Under the opt-out strategy, physicians must inform patients that routine blood work will include HIV testing and that they have the right to refuse this test. The goal of this strategy is to make HIV testing less cumbersome and more likely to be performed by incorporating it into the routine battery of tests (eg, the first-trimester prenatal panel or blood counts and cholesterol screening for annual examinations). In theory, if testing barriers are reduced, more physicians may offer testing, which may lead to the identification and treatment of more women who are infected with HIV and, if pregnant, to the prevention of mother-to-infant transmission of HIV. This testing strategy aims to balance competing ethical considerations. On the one hand, personal freedom (autonomy) is diminished. On the other hand, there are medical and social benefits for the woman and, if she is pregnant, her newborn from identifying HIV infection. Although many welcome the now widely endorsed opt-out testing policy for the potential benefits it confers, others have raised concerns about the possibility that the requirement for notification before testing will be ignored, particularly in today’s busy practice environment. Indeed, the opt-out strategy is an ethically acceptable testing strategy only if the patient is given the option to refuse testing. In the absence of that notification, this approach is merely mandatory testing in disguise. If opt-out testing is elected as a testing strategy, a clinician must notify the patient that HIV testing is to be performed. Refusal of testing should not have an adverse effect on the care the patient receives or lead to denial of health care. This guarantee of a right to refuse testing ensures that respect for a woman’s autonomy is not completely abridged in the quest to achieve a difficult-to-reach public health goal.
WHO recommends lifelong ART for all people living with HIV, regardless of their CD4 count clinical stage of disease, and this includes women who pregnant or breastfeeding. In 2016, 76% of the estimated 1.4 million pregnant women living with HIV globally received ARV treatments to prevent transmission to their children. A growing number of countries are achieving very low rates of MTCT and some (Armenia, Belarus, Cuba and Thailand) have been formally validated for elimination of MTCT of HIV as a public health problem. Several countries with a high burden of HIV infection are also progressing along the path to elimination.
TDF is generally well tolerated although there may be rare kidney damage and may have a greater impact on reducing bone density than other agents. Both of these problems appear to be attenuated with the new formulation of tenofovir called TAF.
Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects blacks or Hispanics. Anyone with this complication should be started on antiretroviral therapy.
AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.
Integrase strand transfer inhibitors (integrase inhibitors or integrases) stop HIV genes from becoming incorporated into the human cell’s DNA and are very well tolerated. Raltegravir (Isentress) was the first drug in this class. Elvitegravir is part of a fixed-dose combination (elvitegravir/cobicistat/tenofovir/emtricitabine) taken as one pill once daily, called Stribild. Dolutegravir (Tivicay) is also available in a once-daily combination pill with two NRTIs, abacavir and lamivudine, called Triumeq.
Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex. The best way to avoid sexual transmission is abstinence from sex until it is certain that both partners in a monogamous relationship are not HIV infected. Because the HIV antibody test can take weeks to turn positive after infection occurs, both partners would need to test negative for at least 12 and up to 24 weeks after their last potential exposure to HIV. If abstinence is out of the question, the next best method is the use of latex barriers. This involves placing a condom on the penis as soon as an erection is achieved in order to avoid exposure to pre-ejaculatory and ejaculatory fluids that contain infectious HIV. For oral sex, condoms should be used for fellatio (oral contact with the penis) and latex barriers (dental dams) for cunnilingus (oral contact with the vaginal area). A dental dam is any piece of latex that prevents vaginal secretions from coming in direct contact with the mouth. Although such dams occasionally can be purchased, they are most often created by cutting a square piece of latex from a condom. Recent data has convincingly demonstrated that once a person has virologic suppression in blood after least six months of treatment, their likelihood of transmitting HIV to an uninfected partner, even without condoms, is virtually zero if they continue treatment.
These are standard doses for average-sized adults, and dosing may vary depending upon the weight of a patient. Certain combinations of drugs in this class should generally be avoided, including d4T with ZDV or ddI, 3TC with FTC, and TDF with ddI.
Sheen’s third marriage, to actress Brooke Mueller, was also contentious. The two married in 2008 and divorced three years later, time that included arrest on suspicion of domestic abuse and rehab stints for both. A custody battle ensued after the divorce, but the two are getting along for now.
PIs block the action of an HIV enzyme called protease that allows HIV to produce infectious copies of itself within HIV-infected human cells. Thus, blocking protease prevents HIV in already-infected cells from producing HIV that can infect other, not yet infected cells.
Although the American research Robert Gallo at the National Institutes of Health (NIH) believed he was the first to find HIV, it is now generally accepted that the French physician Luc Montagnier (1932-) and his team at the Pasteur Institute discovered HIV in 1983-84.
Sturdevant moved his seat back, preparing for a long drive, and adjusted the radio to 107.5, the local R.&B. oldies station. Toni Braxton’s wail — “I wish you’d hold me in your arms like that Spanish guitar” — filled the car. He was headed to a small town 90 miles east of the city to visit Jordon, an H.I.V.-positive 24-year-old. When Sturdevant himself was at his lowest point, he said, “I looked something like this boy we’re going to see.”
Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. Rash, which can involve the skin and mucous membranes, appears and spreads quickly.
Approximately 75% of AIDS cases occured among homosexual or bisexual males (Table 3), among whom the reported prevalence of intravenous drug abuse was 12%. Among the 20% of known heterosexual cases (males and females), the prevalence of intravenous drug abuse was about 60%. Haitians residing in the United States constituted 6.1% of all cases (2), and 50% of the cases in which both homosexual activity and intravenous drug abuse were denied. Among the 14 AIDS cases involving males under 60 years old who were not homosexuals, intravenous drug abusers, or Haitians, two (14%) had hemophilia A.** (3)
In a too brightly lit wood-paneled back room, Sturdevant and the younger men set up a table, displaying brochures, condoms, lube and a few lollipops. Stevenson and Watson, both open, friendly and handsome, attracted a few guys to the table, but mainly ones who had already heard the protect-yourself-against-H.I.V. spiel. Stevenson pointed out that the crowd was sparse — maybe 50 men and a few transgender women — because so many Jackson residents were attending the annual state fair. “Anyway, it’s always hard to make contact in the club,” he said. “I prefer one on one. That way it’s not, ‘I’m trying to educate you’; we’re just talking and having fun. I tell them what I do, and they feel comfortable asking questions.”
Compliance with medications is important to provide the best outcome for mother and child. Even though a physician might highly recommend a medication regimen, the pregnant woman has a choice of whether or not to take the medicines. Studies have shown that compliance is improved when there is good communication between the woman and her doctor, with open discussions about the benefits and side effects of treatment. Compliance also is improved with better social support, including friends and relatives.
Improving access to quality health care for populations disproportionately affected by HIV, such as people of color and gay and bisexual men, is a fundamental public health strategy for HIV prevention. People getting care for HIV can receive:
^ Jump up to: a b c d e f Wyatt R, Sodroski J (1998). “The HIV-1 envelope glycoproteins: fusogens, antigens, and immunogens”. Science. 280 (5371): 1884–8. Bibcode:1998Sci…280.1884W. doi:10.1126/science.280.5371.1884. PMID 9632381.
^ Jump up to: a b Sharp, PM; Hahn, BH (September 2011). “Origins of HIV and the AIDS Pandemic”. Cold Spring Harbor perspectives in medicine. 1 (1): a006841. doi:10.1101/cshperspect.a006841. PMC 3234451 . PMID 22229120. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]