Notable progress has been made to the extent that it could be said that the end of the AIDS epidemic is in sight. In many parts of Africa the prevalence appears to be getting stable. This means that the number of people dying from the disease is roughly equal to the number of new cases. However, whilst new HIV infections have dropped by 38% globally since 2001, 2.1 million people were newly infected in 2013. There are also 22 million people who are not accessing life-saving treatment. Access to AIDS services are still patchy due to such issues as geography, gender and socio-economic factors.
*PEP is optional and should be based on an individualized decision by the exposed person and the treating If PEP is offered and taken and the source is later determined to be HIV-negative, PEP should be stopped.
In Africa antiretroviral treatment coverage has increased significantly. This has partly been due to the Treatment 2015 initiative which aims to ensure that the world reaches its 2015 HIV treatment target of 15 million. In sub-Saharan Africa:
Acronym for acquired immune deficiency (or immunodeficiency) syndrome; disorder of the immune system characterized by opportunistic diseases, including candidiasis, Pneumocystis jiroveci and others. Caused by the human immunodeficiency virus, which is transmitted in body fluids (notably breast milk, blood, and semen) through sexual contact, sharing of contaminated needles (by injecting drug abusers), accidental needle sticks, and contact with contaminated blood.
Jump up ^ Daecke J, Fackler OT, Dittmar MT, Kräusslich HG (2005). “Involvement of clathrin-mediated endocytosis in human immunodeficiency virus type 1 entry”. Journal of Virology. 79 (3): 1581–1594. doi:10.1128/jvi.79.3.1581-1594.2005. PMC 544101 . PMID 15650184.
Simonetti FR, Dewar R, Maldarelli F. Diagnosis of human immunodeficiency virus infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 122.
State Legislation and the Courts To stem transmission of HIV, states have adopted several legal measures. Two states attempted to head off the virus at the pass: Illinois and Louisiana at one point required HIV blood testing as a prerequisite to getting a marriage license. Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states. Several states have taken a less stringent approach, requiring only that applicants for a marriage license must be informed of the availability—and advisability—of HIV tests. More commonly, states criminalize sexual behavior that can spread AIDS. Michigan law makes it a felony for an HIV or AIDS-infected person to engage in sex without first informing a partner of the infection. Florida law provides for the prosecution of any HIV-positive person committing prostitution, and it permits rape victims to demand that their attackers undergo testing. Indiana imposes penalties on persons who recklessly or knowingly donate blood or semen with the knowledge that they are HIV-infected.
Use of PEP is determined by risk of infection; guidelines recommend antiretroviral therapy with ≥ 3 antiretroviral drugs. The drugs should be carefully selected to minimize adverse effects and provide a convenient dosing schedule and thus encourage PEP completion. Preferred regimens include combination of 2 NRTIs and the addition of one or more drugs (eg, 2 NRTIs plus an integrase inhibitor, a PI, or an NNRTI); drugs are given for 28 days. Nevirapine is avoided because of the rare possibility of severe hepatitis. Although evidence is not conclusive, ZDV alone probably reduces risk of transmission after needlestick injuries by about 80%. For detailed recommendations, see the CDC’s Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016.
Risk of acquiring HIV infection by entry siteEntry siteRisk virus reaches entry siteRisk virus entersRisk inoculatedConjuntivaModerateModerateVery lowOral mucosaModerateModerateLowNasal mucosaLowLowVery lowLower respiratoryVery lowVery lowVery lowAnusVery highVery highVery highSkin, intactVery lowVery lowVery lowSkin, brokenLowHighHighSexual:VaginaPenisUlcers (STD)LowHighHighLowLowHighMediumLowVery highBlood:ProductsShared needles Accidental needleHighHighLowHighHighHighHigh Very High LowTraumatic woundModestHighHighPerinatalHighHighHigh
About 97 percent of people develop detectable HIV antibodies within 21 to 84 days after infection. Some may take longer. A nucleic acid test can detect the virus in the blood as early as seven to 28 days after infection. This test is expensive and rarely given unless you’re at particularly high risk or already have symptoms of HIV.
The World Health Organization and United States recommends antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. Once treatment is begun it is recommended that it is continued without breaks or “holidays”. Many people are diagnosed only after treatment ideally should have begun. The desired outcome of treatment is a long term plasma HIV-RNA count below 50 copies/mL. Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate. Inadequate control is deemed to be greater than 400 copies/mL. Based on these criteria treatment is effective in more than 95% of people during the first year.
HIV/Aids is caused by the Human Immunodeficiency Virus (HIV). HIV is mainly transmitted through sexual intercourse, but can also be passed down from mother to child, acquired via blood transfusion with infected blood, or other methods. Once a person is infected, the virus remains in the body for life. There is no cure for HIV/Aids, but there are drugs that help control the virus, enabling people with symptoms of HIV to live full and healthy lives. There are also various methods to help prevent the spread of the disease.
Jump up ^ “Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America”. Department of Health and Human Services. February 2, 2007.
Jump up ^ Kouri, Vivian; Khouri, Ricardo; Alemán, Yoan; Abrahantes, Yeissel; Vercauteren, Jurgen; Pineda-Peña, Andrea-Clemencia; Theys, Kristof; Megens, Sarah; Moutschen, Michel; Pfeifer, Nico; Van Weyenbergh, Johan; Pérez, Ana B; Pérez, Jorge; Pérez, Lissette; Van Laethem, Kristel; Vandamme, Anne-Mieke (28 January 2015). “CRF19_cpx is an Evolutionary fit HIV-1 Variant Strongly Associated With Rapid Progression to AIDS in Cuba”. EBioMedicine. 2 (3): 244–254. doi:10.1016/j.ebiom.2015.01.015. Retrieved 17 Feb 2015.
Advances in Treatment Though the search for an AIDS vaccine has consumed many researchers, by 2003 no breakthroughs had appeared. However, other researchers have concentrated on ways of controlling AIDS through drug treatment regimens that require individuals to consume many different types of medications at the same time. These anti-AIDS “cocktails” undergo constant study and modification as researchers learn more about the working of HIV. The medications are from a family of drugs called protease inhibitors.
Wernicke’s syndrome; Wernicke-Korsakoff syndrome; Wernicke’s encephalopathy brainstem ischaemia causing nystagmus and other ocular effects, tremors and ataxia, mental confusion, hypothermia and hypotension; more common in chronic alcoholics
The appropriate use of combination antiretroviral therapies and prophylaxis for opportunistic infections dramatically improves survival and greatly decreases the risk of secondary opportunistic infections. [83, 84, 85] The risk of AIDS-associated lymphoma is not altered by antiviral therapy and, as such, has grown in prevalence among overall AIDS-defining conditions.
Sturdevant was devastated. Sometimes when he closes his eyes, he said, he still sees the smiling, fit and slender 27-year-old. “I felt like I had failed,” he said, choking up. “I kept thinking, He was going to get better, so how could this happen?” He took a breath, looking uncharacteristically tired, his eyes focused on a point off in the distance. “Listen, I know I can’t be there night and day for everyone. But at this point now, I feel like I can’t lose another young man to this disease.”
By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.
Because live-virus vaccines are potentially dangerous for patients with severe immunosuppression, expert opinion should be sought when dealing with patients at risk of primary varicella; recommendations vary (see Human Immunodeficiency Virus (HIV) Infection in Infants and Children : Vaccination and Considerations for Use of Live Vaccines in Children With HIV Infection).
People with AIDS may develop symptoms of pneumonia due to Pneumocystis jiroveci, which is rarely seen in people with normal immune systems. They also are more likely to get pneumonia due to common bacteria. Globally, tuberculosis is one of the most common infections associated with AIDS. In addition, people with AIDS may develop seizures, weakness, or mental changes due to toxoplasmosis, a parasite that infects the brain. Neurological signs also may be due to meningitis caused by the fungus Cryptococcus. Complaints of painful swallowing may be caused by a yeast infection of the esophagus called candidiasis. Because these infections take advantage of the weakened immune system, they are called “opportunistic infections.”
Jump up ^ Wilson, David P; Law, Matthew G; Grulich, Andrew E; Cooper, David A; Kaldor, John M (2008). “Relation between HIV viral load and infectiousness: A model-based analysis”. The Lancet. 372 (9635): 314–20. doi:10.1016/S0140-6736(08)61115-0. PMID 18657710. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]