Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006 Sep. 43(1):27-34. [Medline].
Jump up ^ Nachega, JB; Marconi, VC; van Zyl, GU; Gardner, EM; Preiser, W; Hong, SY; Mills, EJ; Gross, R (April 2011). “HIV treatment adherence, drug resistance, virologic failure: evolving concepts”. Infectious disorders drug targets. 11 (2): 167–74. doi:10.2174/187152611795589663. PMID 21406048.
Rarely, HIV has been transmitted via transplantation of organs from HIV-seropositive donors. Infection has developed in recipients of kidney, liver, heart, pancreas, bone, and skin—all of which contain blood—but screening for HIV greatly reduces risk of transmission. HIV transmission is even more unlikely from transplantation of cornea, ethanol-treated and lyophilized bone, fresh-frozen bone without marrow, lyophilized tendon or fascia, or lyophilized and irradiated dura mater.
Some viruses do not produce rapid lysis of host cells, but rather remain latent for long periods in the host before the appearance of clinical symptoms. This carrier state can take any of several different forms. The term latency is used to denote the interval from infection to clinical manifestations. In the lentiviruses, it was formerly mistakenly believed that virus was inactive during this period. The true situation is that lentiviruses are rapidly replicating and spawning dozens of quasi-species until a particularly effective one overruns the ability of the host’s immune system to defeat it. Other viruses, however, such as the herpesviruses, actually enter a time known as “viral latency,” when little or no replication is taking place until further replication is initiated by a specific trigger. For many years all forms of latency were thought to be identical, but now it has been discovered that there are different types with basic and important distinctions.
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.
When HIV infection destroys CD4+ lymphocytes, it weakens the body’s immune system, which protects against many infections and cancers. This weakening is part of the reason that the body is unable to eliminate HIV infection once it has started. However, the immune system is able to mount some response. Within a month or two after infection, the body produces lymphocytes and antibodies that help lower the amount of HIV in the blood and keep the infection under control. For this reason, untreated HIV infection may cause no symptoms or only a few mild symptoms for an average of about 10 years (ranging from 2 to more than 15 years).
Walmsley S, Antela A, Clumeck N, et al. Dolutegravir (DTG; S/GSK1349572) + Abacavir/Lamivudine Once Daily Statistically Superior to Tenofovir/Emtricitabine/Efavirenz: 48-Week Results – SINGLE (ING114467). Abstract presented at: 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Sept 2012. Abstract H-556b:
Many say rejection feels most acute and painful from the institution that should offer sanctuary and support: the black church. Individual congregations, religious organizations and clerics have made strides in openness and acceptance, but in general the black church remains largely absent from and often hostile toward the L.G.B.T. community. An African-American pastor in Jackson, the Rev. Edward James of Bertha Chapel Missionary Baptist Church, became a cringe-worthy symbol of homophobia in December 2014 for his protest against same-sex marriage equality. News outlets and social-media accounts shared a photo of him in his clerical robe, holding a sign that read: “Marriage is one man and one woman. Anything else is a perversion,” next to a horse clad in a white wedding dress. “The church is someplace to go for release and spiritual comfort, but the church is actually fearful for me,” said Buckley, who, growing up, attended Baptist services with his grandmother in the delta. “Now I stay at home on Sunday. It’s too hard.”
June Gipson, president and chief executive of My Brother’s Keeper, the Jackson nonprofit Cedric Sturdevant works for, believes that the repeal of the Affordable Care Act wouldn’t have an immediate catastrophic effect in her state — but only because things are already so dire. Like most of the South, Mississippi refused Medicaid expansion, and nearly half of its citizens who are living with H.I.V. rely on the Ryan White H.I.V./AIDS Program to stay alive. Named for an Indiana teenager who contracted H.I.V. through a blood transfusion in the ’80s, this federal program provides funding for H.I.V. treatment and care for those who have no other way to finance their medication. If the A.C.A. is repealed, Gipson said, “it just means that the entire country becomes Mississippi.”
NNRTIs include NVP, DLV, EFV, ETR, and RPV. ETR was developed specifically to be an option for patients who have developed resistance to the earlier drugs in the class. NVP, DLV, EFV, and RPV are typically used with two NRTIs, and ETR is primarily being used as part of regimens for those with a history of different types of treatment to which they have developed resistance.
There are many potential side effects associated with antiviral therapies. The most common ones for each class of drug are summarized in readily available product information. Some specific toxicities are summarized by class below.
Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century. HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes troglodytes). The closest relative of HIV-2 is SIV(smm), a virus of the sooty mangabey (Cercocebus atys atys), an Old World monkey living in coastal West Africa (from southern Senegal to western Côte d’Ivoire). New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes. HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.
Health care workers are at risk on the job and should take special precautions. Some health care workers have become infected after being stuck with needles containing HIV-infected blood or less frequently, after infected blood comes into contact with an open cut or through splashes into the worker’s eyes or inside their nose.
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.
The United States struggled to cope with AIDS from the early 1980s until the late 1990s, when new drug therapies started to extend the length and quality of life for many people with AIDS. Since the beginning, AIDS and its resulting epidemic in the United States have raised a great number of legal issues, which are made all the more difficult by the nature of the disease. AIDS is a unique killer, but some of its aspects are not: epidemics have been seen before; other sexually transmitted diseases have been fatal. AIDS is different because it was discovered in—and in the United States still predominantly afflicts—unpopular social groups: gay men and drug users. This fact has had a strong impact on the shaping of AIDS law. Law is often shaped by politics, and AIDS is a highly politicized disease. The challenge in facing an epidemic that endangers everyone is complicated by the stigma attached to the people most likely to be killed by it.
There are different variants of HIV, and the cell types that they infect are determined to a large degree by which chemokine receptor they bind as co-receptor. The variants of HIV that are associated with primary infections use CCR5, which binds the CC chemokines RANTES, MIP-1α, and MIP-1β (see Chapter 2), as a co-receptor, and require only a low level of CD4 on the cells they infect. These variants of HIV infect dendritic cells, macrophages, and T cells in vivo. However, they are often described simply as ‘macrophage-tropic’ because they infect macrophage but not T-cell lines in vitro and the cell tropism of different HIV variants was originally defined by their ability to grow in different cell lines.
In general, most antiviral regimens for HIV disease contain a backbone of at least two NRTIs. The NRTIs include zidovudine (Retrovir, ZDV), stavudine (Zerit, d4T), didanosine (Videx, ddI), zalcitabine (HIVID, ddC), lamivudine (Epivir, 3TC), emtricitabine (Emtriva, FTC), abacavir (Ziagen, ABC), tenofovir disoproxil fumarate (Viread, TDF), and tenofovir alafenamide (Descovy, TAF). The latter drug is a new formulation of tenofovir that has become available as tenofovir alafenamide (TAF) as part of multiple fixed-dose combinations. This form of tenofovir has been shown to be equally effective as TDF but with less renal and bone toxicity. The NRTIs FTC and 3TC are highly related compounds and, although data is somewhat limited, most experts agree that they probably can be used interchangeably. That said, many combinations of NRTIs can be used together, with current guidelines generally recommending the fixed-dose combination of TDF with FTC (Truvada), or TAF with FTC (Descovy), both of which are also available as part of single tablet regimens. An alternative regimen uses the fixed-dose combination of ABC/3TC (Epzicom) alone or combined as a single tablet regimen with dolutegravir (Triumeq). ABC has been associated with severe allergic reactions in approximately 5% of patients. Recent studies have shown that a blood test can be performed to determine who is at risk for this reaction so that the drug can be avoided in these individuals and be used in others with greater confidence that there will not be such a reaction. In fact, when available, it is now the standard of care to perform this test prior to initiation of ABC. The main side effects associated with TDF are reduced kidney function and bone density.
For the next two months, Sturdevant and Dot kept a close eye on the young man, scolding, nagging and pleading with him to stay in treatment and to tell his family the truth so he would have someone to support him. On a Friday in March 2016, Sturdevant arranged to visit him and take medication to his house. But when he arrived, there was no answer. “I banged on the door, and then constantly called him all weekend,” Sturdevant said. “On Monday, they told me he had passed away.”
^ Jump up to: a b c Reid, SR (August 28, 2009). “Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review”. Harm reduction journal. 6: 24. doi:10.1186/1477-7517-6-24. PMC 2741434 . PMID 19715601.
Specific adverse events are related to the antiretroviral agent taken. Some relatively common adverse events include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus, especially with protease inhibitors. Other common symptoms include diarrhea, and an increased risk of cardiovascular disease. Newer recommended treatments are associated with fewer adverse effects. Certain medications may be associated with birth defects and therefore may be unsuitable for women hoping to have children.
The size of the proviral reservoir correlates to the steady-state viral load and is inversely correlated to the anti-HIV CD8+ T-cell responses. Aggressive early treatment of acute infection may lower the proviral load, but generally, treatment in newly infected (but postseroconversion) patients yields no long-term benefit.
The pattern of opportunistic infections in a geographic region reflects the pathogens that are common in that area. For example, persons with AIDS in the United States tend to present with commensal organisms such as Pneumocystis and Candida species, homosexual men are more likely to develop Kaposi sarcoma because of co-infection with HHV8, and tuberculosis is common in developing countries.
Detection of antibodies to HIV is sensitive and specific except during the first few weeks after infection. Currently, a 4th-generation combination immunoassay is recommended; it detects antibodies to both HIV-1 and HIV-2 as well as the p24 HIV antigen (p24 is a core protein of the virus). The laboratory version is probably preferred over the point-of-care one for diagnosing early infection, but both can be done quickly (within 30 min). If the test result is positive, an assay to differentiate HIV-1 and HIV-2 and an HIV RNA assay are done.
respiratory syncytial virus (RSV) any of a genus of single-stranded paramyxoviruses; the name is derived from the type of disease produced (respiratory infection) and the microscopic appearance of the viruses in cell cultures. RSV can cause a wide variety of respiratory disorders ranging from a mild cold to serious or even fatal disease of the lung in the very young and very old. It regularly produces an outbreak of infection each winter and virtually disappears in the summer months. The most severe infections in children are in the very young, especially those who are preterm, immunologically compromised, or suffering from a congenital heart defect or preexisting lung disorder. Adults at risk for infection include parents and others who are repeatedly exposed to young children, for example, pediatric nurses and day care attendants. The course of infection tends to be milder in adults than in children and about 15 per cent of affected adults have no symptoms. In the very elderly these infections may have the same degree of seriousness and clinical manifestations as in the very young.
Jump up ^ “Quick Reference Guide—Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations” (PDF). cdc.gov. New York State Department of Health. June 27, 2014. pp. 1–2. Retrieved April 13, 2017.
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.
With passage of the ADA in 1990, Congress gave broad protection to people with AIDS who work in the private sector. In general, the ADA is designed to increase access for disabled persons, and it also forbids discrimination in hiring or promotion in companies with fifteen or more employees. Specifically, employers may not discriminate if the person in question is otherwise qualified for the job. Moreover, they cannot use tests to screen out disabled persons, and they must provide reasonable accommodation for disabled workers. The ADA, which took effect in 1992, quickly emerged as the primary means for bringing AIDS-related discrimination lawsuits. From 1992 to 1993, more than 330 complaints were filed with the U.S. Equal Employment Opportunity Commission (EEOC), which investigates charges before they can be filed in court. Given the lag time needed for EEOC investigations, those cases started appearing before federal courts in 1994 and 1995.
Vaccines can test your immune system response in what is called an antibody test. Your doctor will give you a vaccine. Then they will test your blood for its response to the vaccine a few days or weeks later.
Diagnostic blood tests for AIDS are given to individuals in high-risk populations, pregnant women, health care and public service workers who have been exposed to HIV, those who have symptoms associated with AIDS, or others who fear they may have been exposed to the virus. The first blood test for AIDS was developed in 1985. Patients who are being tested for HIV infection are usually given an enzyme-linked immunosorbent assay (ELISA) test for the presence of HIV antibody in their blood. Positive ELISA results are then tested with a Western blot or immunofluorescence (IFA) assay for confirmation. The combination of the ELISA and Western blot tests is more than 99.9% accurate in detecting HIV infection within four to eight weeks following exposure. The polymerase chain reaction (PCR) test can be used to detect the presence of viral nucleic acids in the very small number of HIV patients who have false-negative results on the ELISA and Western blot tests. These tests are also used to detect viruses and bacteria other than HIV and AIDS.
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.
Moyer VA; US Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(1):51-60. PMID: 23698354 www.ncbi.nlm.nih.gov/pubmed/23698354.
Aaron Glatt, MD Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)
There are now six approved combination pills that allow for a full regimen to be taken as a single pill once per day, so called single tablet regiments. This includes the following NRTI plus third drug combinations:
Rapid test results usually will be available during the same clinical visit that the specimen (eg, blood or oral swab sample) is collected. Obstetrician–gynecologists who use these tests must be prepared to provide counseling to women who receive positive test results the same day that the specimen is collected. Women with positive test results should be counseled regarding the meaning of these preliminarily positive test results and the need for confirmatory testing (11). Obstetrician–gynecologists should develop collaborative care plans with health care professionals who can provide these counseling services on an emergent basis or train their own staff to handle the initial encounter and, thereafter, transition infected individuals to professionals who can serve as ongoing resources to them. Women whose confirmatory testing yields positive results and, therefore, are infected with HIV should receive or be referred for appropriate clinical and supportive care. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]