[Guideline] Marrazzo JM, del Rio C, Holtgrave DR, et al, for the International Antiviral Society-USA Panel. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312(4):390-409. [Medline]. [Full Text].
The Island Coast AIDS Network (ICAN) was founded in 1987 and incorporated as a not for profit corporation in 1989. Its mission is “To stop the spread of HIV/AIDS and assist individuals infected and affected in Southwest Florida.” As a community based AIDS service organization, ICAN provides a wide variety of services to its clients as well as the general public.
AIDS is an acquired immunodeficiency syndrome defined by a severe depletion of T cells and over 20 conventional degenerative and neoplastic diseases. In the U.S. and Europe, AIDS correlates to 95% with risk factors, such as about 8 years of promiscuous male homosexuality, intravenous drug use, or hemophilia. Since AIDS also correlates with antibody to a retrovirus, confirmed in about 40% of American cases, it has been hypothesized that this virus causes AIDS by killing T cells. Consequently, the virus was termed human immunodeficiency virus (HIV), and antibody to HIV became part of the definition of AIDS. The hypothesis that HIV causes AIDS is examined in terms of Koch’s postulates and epidemiological, biochemical, genetic, and evolutionary conditions of viral pathology. HIV does not fulfill Koch’s postulates: (i) free virus is not detectable in most cases of AIDS; (ii) virus can only be isolated by reactivating virus in vitro from a few latently infected lymphocytes among millions of uninfected ones; (iii) pure HIV does not cause AIDS upon experimental infection of chimpanzees or accidental infection of healthy humans. Further, HIV violates classical conditions of viral pathology. (i) Epidemiological surveys indicate that the annual incidence of AIDS among antibody-positive persons varies from nearly 0 to over 10%, depending critically on nonviral risk factors. (ii) HIV is expressed in less than or equal to 1 of every 10(4) T cells it supposedly kills in AIDS, whereas about 5% of all T cells are regenerated during the 2 days it takes the virus to infect a cell. (iii) If HIV were the cause of AIDS, it would be the first virus to cause a disease only after the onset of antiviral immunity, as detected by a positive “AIDS test.” (iv) AIDS follows the onset of antiviral immunity only after long and unpredictable asymptomatic intervals averaging 8 years, although HIV replicates within 1 to 2 days and induces immunity within 1 to 2 months. (v) HIV supposedly causes AIDS by killing T cells, although retroviruses can only replicate in viable cells. In fact, infected T cells grown in culture continue to divide. (vi) HIV is isogenic with all other retroviruses and does not express a late, AIDS-specific gene. (vii) If HIV were to cause AIDS, it would have a paradoxical, country-specific pathology, causing over 90% Pneumocystis pneumonia and Kaposi sarcoma in the U.S. but over 90% slim disease, fever, and diarrhea in Africa.(viii) It is highly improbable that within the last few years two viruses (HIV-1 and HIV-2) that are only 40% sequence-related would have evolved that could both cause the newly defined syndrome AIDS. Also, viruses are improbable that kill their only natural host with efficiencies of 50-100%, as is claimed for HIVs. It is concluded that HIV is not sufficient for AIDS and that it may not even be necessary for AIDS because its activity is just as low in symptomatic carriers as in asymptomatic carriers. The correlation between antibody to HIV and AIDS does not prove causation, because otherwise indistinguishable diseases are now set apart only on the basis of this antibody. I propose that AIDS is not a contagious syndrome caused by one conventional virus or microbe. No such virus or microbe would require almost a decade to cause primary disease, nor could it cause the diverse collection of AIDS diseases. Neither would its host range be as selective as that of AIDS, nor could it survive if it were as inefficiently transmitted as AIDS. Since AIDS is defined by new combinations of conventional diseases, it may be caused by new combinations of conventional pathogens, including acute viral or microbial infections and chronic drug use and malnutrition. The long and unpredictable intervals between infection with HIV and AIDS would then reflect the thresholds for these pathogenic factors to cause AIDS diseases, instead of an unlikely mechanism of HIV pathogenesis.
There is little evidence that HIV can be transferred by casual exposure, as might occur in a household setting. For example, unless there are open sores or blood in the mouth, kissing is generally considered not to be a risk factor for transmitting HIV. This is because saliva, in contrast to genital secretions, has been shown to contain very little HIV. Still, theoretical risks are associated with the sharing of toothbrushes and shaving razors because they can cause bleeding, and blood can contain large amounts of HIV. Consequently, these items should not be shared with infected people. Similarly, without sexual exposure or direct contact with blood, there is little if any risk of HIV contagion in the workplace or classroom.
Health care professionals who fail to provide care to women who are infected with HIV because of personal practice preferences violate professional ethical standards. The public appropriately expects that health care practitioners will not discriminate based on diagnosis, provided that the patient’s care falls within their scope of practice. Physicians should demonstrate integrity, compassion, honesty, and empathy. Failure to provide health care to a woman solely because she is infected with HIV violates these fundamental characteristics. As with any other patient, it is acceptable, however, to refer women who are infected with HIV for care that the physician is not competent to provide or if care elsewhere would be more convenient or associated with decreased financial burden to the patient.
Over the past 3 decades the world has witnessed the evolution of the HIV pandemic. The impact of this infection continues to devastate much of Africa and many other poor communities throughout the world. The immunosuppression and immune dysregulation that typifies this disease is triggered by the human immunodeficiency virus (HIV), of which there are two subtypes: HIV-1 and HIV-2. HIV-1 has been responsible for the majority of infections worldwide, whilst HIV-2 causes a milder disease and has affected predominantly those in West Africa.
Cure of HIV infection has not been thought possible, and thus lifelong drug treatment is considered necessary. Patients living with HIV infection should be urged to take their antiretroviral drugs consistently. An instance of a possible cure was widely reported in an infant with transient eradication of replication-competent HIV after about 15 mo of antiretroviral therapy. However, HIV replication subsequently resumed. In a large international clinical trial, risk of opportunistic infection or death from any cause, particularly from premature coronary artery disease, cerebrovascular events, or liver and kidney disorders, was significantly higher when antiretroviral therapy was taken episodically (guided by the CD4 count) than when it was taken continuously (1).
These sub-epidemics each follow their own pattern, although there is some degree of interdependence. Early on, nearly all cases of HIV infection detected in the Western Hemisphere were in homosexual men, but the spread of the disease to female partners of bisexual men with HIV infection gave rise to an increased rate among heterosexual persons.
The ward occupies the sixth floor of an Art Deco building on the north side of campus. I found Deeks in his office, wearing a flannel shirt and New Balance sneakers. He explained his concerns about the drug cocktail. “Antiretroviral drugs are designed to block H.I.V. replication, and they do that quite well,” he said. But they don’t enable many patients to recover fully. The immune system improves enough to prevent AIDS, but, because the virus persists, the immune system must mount a continuous low-level response. That creates chronic inflammation, which injures tissues.
When people get HIV and don’t receive treatment, they will typically progress through three stages of disease. Medicine to treat HIV, known as antiretroviral therapy (ART), helps people at all stages of the disease if taken the right way, every day. Treatment can slow or prevent progression from one stage to the next. It can also dramatically reduce the chance of transmitting HIV to someone else.
The human immunodeficiency virus (HIV) was identified in 1983, 2 years after the first five cases of the acquired immunodeficiency syndrome (AIDS) were reported by the Centers for Disease Control and Prevention (CDC). The ensuing years witnessed rapid advances in the prevention and management of HIV/AIDS and dramatic shifts in its epidemiology. In developed countries, the availability of effective antiretroviral therapy reduced perinatal transmission to 1–3%; prolonged survival; increased resistance to 15% of circulating strains; and introduced a set of common side effects called body-fat abnormalities. In developing countries, however, less than 20% of those needing antiretroviral therapy receive it and interventions to reduce behavioral risk have had limited impact. As a result, the developing world accounts for 95% of AIDS-related deaths and new HIV infections.
PHE receives information on HIV infections from several sources. The major sources of information are reports from clinicians and laboratories of newly diagnosed infections, an annual survey of all patients seen for HIV-related treatment or care and a family of unlinked anonymous surveys which tests blood samples taken for other investigations, after they have been irreversibly unlinked from any patient identifiers. All reporting methods are confidential and avoid the use of names.
Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men — 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010 Sep 24. 59(37):1201-7. [Medline].
The human immunodeficiency virus-1 envelope protein gp120 was shown to induce apoptosis in hippocampal neurons, thus perhaps causing directly the acquired immunodeficiency syndrome dementia syndrome (for references, see Meucci et al., 1998). However, in the presence of either ABCD-1 or ABCD-3, human immunodeficiency virus-1 gp120-induced neuronal death was considerably slowed (Meucci et al., 1998).
Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [Medline].
Because the recommended population for HIV testing includes adolescents, it also is important to have practices in place to assist young patients. This includes a process of discussing safe-sex practices, risk factors, and behavior that may lead to HIV exposure. Currently, some states allow minors to access HIV testing in a confidential fashion without disclosing testing or results to a parent or guardian (9, 10). However, there are others that require some degree of notification or consent from a parent before testing. It is important for Fellows to be aware of the local policies in place and to fulfill the legal and ethical obligations their adolescent patients who seek HIV testing as part of their reproductive health care. The Guttmacher Institute maintains an updated list of minors’ consent state policies (www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf).
AIDS is usually marked by a very low number of CD4+ lymphocytes, followed by a rise in the frequency of opportunistic infections and cancers. Doctors monitor the number and proportion of CD4+ lymphocytes in the patient’s blood in order to assess the progression of the disease and the effectiveness of different medications. About 10% of infected individuals never progress to this overt stage of the disease.
By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state’s finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.
Newborn babies of HIV-positive mothers may also receive medication. Studies have found that giving a mother antiretroviral medications during pregnancy, labor, and delivery can reduce the chance of transmission of HIV to the baby to less than 2 percent.
Humoral: Antibodies to HIV are usually measurable within a few weeks after primary infection; however, antibodies cannot fully control HIV infection because mutated forms of HIV that are not controlled by the patient’s current anti-HIV antibodies are generated.
Some religious organizations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths. The Synagogue Church Of All Nations advertised an “anointing water” to promote God’s healing, although the group denies advising people to stop taking medication.
Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was initially discovered and termed both LAV (Lymphadenopathy Associated Virus) and HTLV-III (Human T cell Lymphotropic Virus III). HIV-1 is more virulent and more infective than HIV-2, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 compared to HIV-1 implies that fewer of those exposed to HIV-2 will be infected per exposure. Due to its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.
Sturdevant drove on another 15 minutes to pick up Marq (a shortened version of his name to protect his privacy), a teenager who was still reeling from the H.I.V. diagnosis he received the previous spring. As they headed to and from a doctor’s appointment and a meeting with a counselor, Sturdevant, slow-talking and patient, with eyes that disappear into his cheekbones when he smiles and a snowy beard, gently grilled him, reminding him to stay on his meds. The teenager slumped in the back seat, half listening, half checking his texts. He looked up briefly when Sturdevant told him, “You’ve come a long way. I’m proud of you.” But Marq barely said goodbye as he jumped out of the car in front of a convenience store on an avenue scattered with a pawnshop, a liquor store and several Baptist churches, and he all but admitted he was planning to spend the afternoon smoking weed and looking at Instagram. “Knucklehead,” Sturdevant whispered, as the teenager slammed the door. Pulling off his favorite Dallas Cowboys baseball cap and running a hand over his bald head, Sturdevant added softly, “Breaks my heart.”
The PrEP Heroes campaign aims to increase awareness of drugs that prevent HIV from establishing itself if a person is exposed. “Being a part of the PrEP Hero campaign was important because it was an opportunity to show diversity in communities where HIV and LGBT intersect,” Franco De Marco said.
HIV continues to be a major public health crisis both in the United States and around the world. While major scientific advances have made it easier than ever to prevent and treat HIV, there remains no vaccine or cure, and tens of thousands of people continue to contract HIV every year. Insufficient funding for public health programs, ideological opposition to common sense prevention policies, and societal barriers like stigma and discrimination, have made it especially difficult for us to turn the tide against the epidemic. Together, HRC and the HRC Foundation are committed to working with our friends, partners, members, and supporters to end the dual epidemics of HIV and HIV-related stigma.
Non-nucleoside reverse transcriptase inhibitors. This class of drugs binds to an enzyme that is necessary for the HIV virus to reproduce. Examples of drugs in this class are viramune, delavirdine (Rescriptor), and efavirenz (Sustiva) and others.
Some medicines used to treat HIV or other infections can cause a rash. It usually appears within a week or two of starting on a new medication. Sometimes the rash will clear up on its own. If it doesn’t, you may need to switch medicines.
The stage of symptomatic infection, in which the body’s immune (or defense) system has been suppressed and complications have developed, is called the acquired immunodeficiency syndrome (AIDS). The symptoms are caused by the complications of AIDS, which include one or more unusual infections or cancers, severe loss of weight, and intellectual deterioration (called dementia). [redirect url=’http://penetratearticles.info/bump’ sec=’7′]