The growth of AIDS in Africa and Asia has raised worries about global political and economic stability. Governments in these ravaged countries have not been able to afford the anti-viral drugs. In 2002 pharmaceutical companies agreed to sell these drugs to these countries as generic drugs, dropping the cost from $12,000 to $300 a year per patient; yet even at these prices many governments would be hard pressed to purchase them.
Jump up ^ Smith, Johanna A.; Daniel, René (Division of Infectious Diseases, Center for Human Virology, Thomas Jefferson University, Philadelphia) (2006). “Following the path of the virus: the exploitation of host DNA repair mechanisms by retroviruses”. ACS Chem Biol. 1 (4): 217–26. doi:10.1021/cb600131q. PMID 17163676.
Dealing with the potential consequences of bias and discrimination – job loss, homelessness, lack of healthcare insurance – often results in LGBTQ people engaging in behaviors that facilitate the spread of HIV. For example, in the face of persistent employment discrimination, many transgender women are left with few other options but to engage in survival sex work in order to meet their most basic needs. According to a 2015 survey of more than 27,000 transgender people, “The rate of HIV [diagnosis] was…five times higher among those who have participated in sex work at any point in their lifetime” than among those who have not.
Human immunodeficiency virus, or HIV, is the virus that causes AIDS. HIV/AIDS weakens a person’s ability to fight infections. It is contracted through unprotected sex or needle sharing. An HIV test confirms diagnosis. Medications may suppress the virus and delay the onset of AIDS.
Side effects associated with EFV are mostly dizziness, confusion, fatigue, and vivid dreams. These tend to be most prominent during the first weeks of therapy and then often decrease in severity. It is generally recommended that EFV be taken at bedtime so that the patient is asleep during the time dizziness and confusion may be most severe. It is also noteworthy that there may be an increased risk of depression associated with the use of this drug, and it should be used with caution in those with poorly managed depression. Rash and liver inflammation can occur with both EFV and DLV, and these drugs may also be linked to abnormalities of lipids in the blood.
In the developed world, antiretroviral therapy has greatly improved prognosis and increased survival rates. Public education programs have raised awareness such that testing and prevention of infection are more common. Both of these approaches are difficult in countries with undereducated or underfunded populations.
The production of infectious virus particles from an integrated HIV provirus is stimulated by a cellular transcription factor that is present in all activated T cells. Activation of CD4 T cells induces the transcription factor NFκB, which binds to promoters not only in the cellular DNA but also in the viral LTR, thereby initiating the transcription of viral RNA by the cellular RNA polymerase. This transcript is spliced in various ways to produce mRNAs for the viral proteins. The Gag and Gag-Pol proteins are translated from unspliced mRNA; Vif, Vpr, Vpu, and Env are translated from singly spliced viral mRNA; Tat, Rev, and Nef are translated from multiply spliced mRNA. At least two of the viral genes, tat and rev, encode proteins, Tat and Rev respectively, that promote viral replication in activated T cells. Tat is a potent transcriptional regulator, which functions as an elongation factor that enables the transcription of viral RNA by the RNA polymerase II complex. Tat contains two binding sites, contained in one domain, named the transactivation domain. The first of these allows Tat to bind to a host cellular protein, cyclin T1. This binding reaction promotes the binding of the Tat protein through the second binding site in its transactivation domain to an RNA sequence in the LTR of the virus known as the transcriptional activation region (TAR). The consequence of this interaction is to greatly enhance the rate of viral genome transcription, by causing the removal of negative elongation factors that block the transcriptional activity of RNA polymerase II. The expression of cyclin T1 is greatly increased in activated compared with quiescent T lymphocytes. This, in conjunction with the increased expression of NFκB in activated T cells, may explain the ability of HIV to lie dormant in resting T cells and replicate in activated T cells (Fig. 11.25).
Joint United Nations Programme on HIV/AIDS (UNAIDS) (2011). Global HIV/AIDS Response, Epidemic update and health sector progress towards universal access (PDF). Joint United Nations Programme on HIV/AIDS.
^ Jump up to: a b Sodora DL, Allan JS, Apetrei C, Brenchley JM, Douek DC, Else JG, Estes JD, Hahn BH, Hirsch VM, Kaur A, Kirchhoff F, Muller-Trutwin M, Pandrea I, Schmitz JE, Silvestri G (2009). “Toward an AIDS vaccine: lessons from natural simian immunodeficiency virus infections of African nonhuman primate hosts”. Nature Medicine. 15 (8): 861–865. doi:10.1038/nm.2013. PMC 2782707 . PMID 19661993.
Overall, with the increasing use of antiretroviral therapy and the introduction of better antiviral regimens, survival with HIV infection has increased over time, although it is not yet equivalent to that in uninfected individuals. (See the image below.)
Ideally, prior to initiating treatment, the viral load and the CD4 cell count should be checked and the viral load test then repeated after approximately four weeks of treatment. If the patient is beginning a regimen that includes two to three drugs for which the patient’s virus does not appear to be resistant, it is expected that the amount of virus should decrease by at least a hundredfold during this interval. The ultimate goal is for the viral load to decrease to undetectable levels which should occur by approximately 12-24 weeks. There are some individuals that despite taking all of their medications correctly will suppress their viral load to less than 200 copies/mL but not consistently undetectable levels. It is not completely known how to optimally manage this situation but many experts would continue to monitor on current therapy as long as viral load remains below 200 copies/mL. Those who are not having an appropriate response to therapy need to be questioned to make sure that they are taking their medications correctly, and if not, why. If the viral load is not going to undetectable levels and the patient is taking the medications correctly, then it is likely that there is a resistant virus to some of the medications. Drug-resistance testing then should be performed and the patient managed as described in the next section. Once the patient’s viral load is suppressed, they can often have viral load and CD4 cell counts performed less frequently (for example, every three to four months and in select cases every six months or possibly even less).
History marks the beginning of the American AIDS epidemic as June 5, 1981, when an issue of the C.D.C.’s Morbidity and Mortality Weekly Report — the authoritative voice of the agency — highlighted five cases of pneumocystis pneumonia (PCP) in previously healthy men in Los Angeles. Healthy people do not contract a disease like PCP, which had been largely confined until then to patients on medication to suppress their immune systems for an organ transplant or cancer patients on chemotherapy. Though not stated explicitly, the language of the report, by omitting race, implied that its “five young men, all active homosexuals,” were white, which they were. But there were two more documented cases, not mentioned in the notice, and these sixth and seventh cases were black — one of them a gay African-American, the other a heterosexual Haitian.
Rockstroh JK, DeJesus E, Lennox JL, et al. Durable efficacy and safety of raltegravir versus efavirenz when combined with tenofovir/emtricitabine in treatment-naive HIV-1-infected patients: final 5-year results from STARTMRK. J Acquir Immune Defic Syndr. 2013 May 1. 63(1):77-85. [Medline].
Cryptosporidiosis. This infection is caused by an intestinal parasite that’s commonly found in animals. You get it when you eat or drink contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.
HIV is a preventable disease. Effective HIV prevention interventions have been proven to reduce HIV transmission. People who get tested for HIV and learn that they are infected can make significant behavior changes to improve their health and reduce the risk of transmitting HIV to their sex or drug-using partners. Recent scientific advances have demonstrated that early initiation of antiretroviral therapy (ART) not only preserves the health of people living HIV but also reduces their risk of transmitting HIV to others by 93%.3
Despite the persistent anti-L.G.B.T. stigma and entrenched social and economic issues that cling to the South, Sturdevant feels a complicated, bone-deep tie to the people and the place. When he encourages his “sons” and “daughters” to take care of themselves and others, he is echoing the love and acceptance he received from his own large family. After years of hiding, when he came out to his mother in his 20s, she told him, “I love you regardless.” When his family eventually found out that he was sick, his mother and sister drove up to where he was living in Memphis, along with six carloads of aunts, uncles, nieces, nephews and cousins. They tried to serve him plates laden with down-home food that he was too ill to eat and did their best to love him back to health. In the hospital, he finally admitted to his mother he had AIDS. “She told me, ‘Boy, you gonna be all right; God got you,’ ” he recalls, tearing up. In the end, they took him home. He moved back to his mother’s house in Metcalfe, with somebody from the sprawling network of nearly 100 family members always close by, until he recovered. “They saved my life, and I’ll never forget that,” he said.
Copyright © December 2007 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to: Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400.
By 1984 researchers working in Africa had provided clear evidence for heterosexual transmission of the causative agent, HIV. The virus had been isolated the year before by a team of French researchers led by virologist Luc Montagnier. Montagnier and his colleagues identified the virus as a new type of human retrovirus, and they suspected that it was the cause of AIDS. But more-detailed characterization was needed to confirm the connection, so Montagnier sent samples to American virologist Robert C. Gallo, who had contributed to the discovery of the first known human retrovirus (human T-lymphotropic virus) several years earlier. Gallo helped establish that HIV caused AIDS, and he contributed to the subsequent development of a blood test for its detection. Montagnier initially called the new infectious agent lymphadenopathy-associated virus (LAV), but in 1986 the International Committee on Taxonomy of Viruses renamed it HIV. Montagnier and French virologist Françoise Barré-Sinoussi were awarded the 2008 Nobel Prize for Physiology or Medicine for their discovery of HIV; despite Gallo’s role in confirming HIV as the cause of AIDS, Montagnier and colleagues were the first to isolate the virus.
Other information on sexual risk reduction: The riskiest sexual behavior is unprotected receptive anal intercourse — the least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse.
In the United States, Europe, and Australia, HIV has been transmitted mainly through male homosexual contact and the sharing of needles among people who inject drugs, but transmission through heterosexual contact accounts for about one fourth of cases. HIV transmission in Africa, the Caribbean, and Asia occurs primarily between heterosexuals, and HIV infection occurs equally among men and women. In the United States, fewer than 25% of adults who have HIV infection are women. Before 1992, most American women with HIV were infected by injecting drugs with contaminated needles, but now most are infected through heterosexual contact.
^ Jump up to: a b Cheung, MC; Pantanowitz, L; Dezube, BJ (Jun–Jul 2005). “AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy”. The Oncologist. 10 (6): 412–26. doi:10.1634/theoncologist.10-6-412. PMID 15967835.
simian immunodeficiency virus (SIV) a lentivirus closely related to human immunodeficiency virus that causes inapparent infection in African green monkeys and a disease resembling acquired immunodeficiency syndrome in macaques and chimpanzees.
Sax PE, DeJesus E, Mills A, et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks. Lancet. 2012 Jun 30. 379(9835):2439-48. [Medline].
Regular blood tests are needed to make sure the virus level in the blood (viral load) is kept low, or suppressed. The goal of treatment is to lower the HIV virus in the blood to a level that is so low that the test can’t detect it. This is called an undetectable viral load. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]