Jump up ^ Huang Y, Yu J, Lanzi A, Yao X, Andrews C, Tsai L, Gajjar M, Sun M, Seaman M, Padte N, Ho D (2016). “Engineered Bispecific Antibodies with Exquisite HIV-1-Neutralizing Activity”. Cell. 165 (7): 1621–1631. doi:10.1016/j.cell.2016.05.024. PMC 4972332 . PMID 27315479.
HIV RNA tests can confirm positive results of an antibody test or detect evidence of HIV infection when antibody test results are negative. HIV RNA tests often use techniques to produce many copies of an organism’s genetic material (called nucleic acid amplification). These tests can detect very small amounts of HIV RNA in blood and are very accurate.
The human immunodeficiency virus (HIV) is one of the most intriguing and challenging viruses to have existed. Evidence suggests that HIV first originated in Africa around 1920–30 as a result of cross-species infections of humans by simian (ape and monkey) viruses. The United States became aware of the disease that HIV causes, acquired immune deficiency syndrome (AIDS), in 1981, and the virus was first identified 2 years later. HIV infects helper CD4 T cells of the immune system, causing their gradual decline in numbers. Scientifically, HIV is an enigmatic challenge that is being deciphered, molecule by molecule, in the search for a vaccine or cure. Sociologically, HIV began as a disease that caused fear and stigma but is now no longer a death sentence, manageable for years with antiviral medications. However, around 1.5 million people worldwide die each year of HIV/AIDS, making it the sixth most-common cause of death in the world.
In 1999, the WHO announced that AIDS was the fourth biggest cause of death worldwide and number one killer in Africa. An estimated 33 million people were living with HIV and 14 million people had died from AIDS since the start of the epidemic.70
Epidemiologic studies have shown that the risk of HIV transmission from patient to health care professional is exceedingly low and is related to needle stick or intraoperative injury or to potentially infectious fluid that comes in contact with a mucous membrane (17). Most contacts between health care professionals and women who are infected with HIV occur, however, during routine obstetric and gynecologic care. Health care practitioners should observe standard precautions with all patients to minimize skin, mucous membrane, and percutaneous exposure to blood and body fluids to protect against a variety of pathogens, including HIV.
Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil.
^ Jump up to: a b Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA (2002). “HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?”. AIDS. 16 (4): 597–632. doi:10.1097/00002030-200203080-00011. PMID 11873003.
There are theoretical reasons why patients identified with HIV around the time they are first infected (primary, acute infection) may benefit from the immediate initiation of potent antiviral therapy. Preliminary evidence suggests that unique aspects of the body’s immune response to the virus may be preserved by this strategy. It is thought that treatment during the primary infection may be an opportunity to help the body’s natural defense system to work against HIV. Thus, patients may gain improved control of their infection while on therapy and perhaps even after therapy is stopped. At one time, the hope was that if therapy was started very early in the course of the infection, HIV could be eradicated. Most evidence today, however, suggests that this is not the case, although research will certainly continue in the coming years in this area. In addition, recent data demonstrated that a subset of those starting ART within the first weeks of infection were able to stop therapy after many years and maintain good viral control off treatment. While this response does not occur in the majority of similarly treated patients, the observations are intriguing and an area of ongoing research. Regardless, at least for now it is premature to think that early treatment may result in a cure, although other benefits may still exist, including avoiding the substantial damage to the immune system that occurs during the first weeks of infection. In addition, these individuals have very high levels of virus in their blood and genital secretions, and early treatment might reduce their risk of transmitting HIV to others. There also is evidence that those who develop such symptoms during the early days of infection may be at greater risk of disease progression than those who become infected with minimal or no symptoms. Due to the absence of definitive data, guidelines vary, but since it is now recommended that all patients initiate therapy at the time of diagnosis it is generally recommended that patients with primary infection be offered early therapy.
In 2009, a newly analyzed HIV sequence was reported to have greater similarity to a simian immunodeficiency virus recently discovered in wild gorillas (SIVgor) than to SIVs from chimpanzees (SIVcpz). The virus had been isolated from a Cameroonian woman residing in France who was diagnosed with HIV-1 infection in 2004. The scientists reporting this sequence placed it in a proposed Group P “pending the identification of further human cases”.
Song R, Hall HI, Green TA, Szwarcwald CL, Pantazis N. Using CD4 data to estimate HIV incidence, prevalence, and percent of undiagnosed infections in the United States. J Acquir Immune Defic Syndr 2017;74:3–9. CrossRef PubMed
This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick during this time. For people who aren’t taking medicine to treat HIV, this period can last a decade or longer, but some may progress through this phase faster. People who are taking medicine to treat HIV (ART) the right way, every day may be in this stage for several decades. It’s important to remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed (having a very low level of virus in their blood) are much less likely to transmit HIV than those who are not virally suppressed. At the end of this phase, a person’s viral load starts to go up and the CD4 cell count begins to go down. As this happens, the person may begin to have symptoms as the virus levels increase in the body, and the person moves into Stage 3.
Trends continue toward simplifying drug regimens to improve adherence and decrease side effects. In addition, the availability of multiple new drugs in new classes has made it possible to suppress viral load to undetectable levels even in many of the most treatment-experienced patients. Moreover, many are virologically suppressed taking a single well-tolerated pill per day. As noted in the section on new therapies in development, another major advance could emerge with the availability of every one to two month injections of long-acting therapies. With great success in treatment, the field has increasingly considered strategies that may someday allow patients to control viral replication without the use of antiretrovirals. This could be in the form of a true cure with complete eradication of HIV from the body or a functional cure where the virus persists but is unable to replicated, a situation analogous to what happens when patients are on effective antiretroviral therapy. Research is in the very earliest stages with regard to development of strategies for viral eradication. Studies to control viral replication in the absence of antiretroviral therapy are actively being pursued, although thus far with limited success. One strategy has been to use immune-based therapies to boost the natural immune response to HIV and allow for complete or partial control. Another area of research is to purge infected cells, so-called “latent reservoir,” with various agents to facilitate eradication from the body. While research in these areas is under way, it has met with limited success.
It is best practice to also retest all people initially diagnosed as HIV-positive before they enrol in care and/or treatment to rule out any potential testing or reporting error. Notably, once a person diagnosed with HIV and has started treatment they should not be retested.
There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, SIV is a weak virus, and it is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Furthermore, due to its relatively low person-to-person transmission rate, it can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa prior to the 20th century.
When CD4 T-cell numbers decline below a critical level, cell-mediated immunity is lost, and infections with a variety of opportunistic microbes appear (Fig. 11.29). Typically, resistance is lost early to oral Candida species and to Mycobacterium tuberculosis, which shows as an increased prevalence of thrush (oral candidiasis) and tuberculosis. Later, patients suffer from shingles, caused by the activation of latent herpes zoster, from EBV-induced B-cell lymphomas, and from Kaposi’s a tumor of endothelial cells that probably represents a response both to cytokines produced in the infection and to a novel herpes virus called HHV-8 that was identified in these lesions. Pneumonia caused by the fungus Pneumocystis carinii is common and often fatal. In the final stages of AIDS, infection with cytomegalovirus or Mycobacterium avium complex is more prominent. It is important to note that not all patients with AIDS get all these infections or tumors, and there are other tumors and infections that are less prominent but still significant. Rather, this is a list of the commonest opportunistic infections and tumors, most of which are normally controlled by robust CD4 T cell-mediated immunity that wanes as the CD4 T-cell counts drop toward zero (see Fig. 11.21).
Implications for Public Health Practice: Health care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.
However, with effective treatment, the HIV RNA level decreases to undetectable levels, CD4 counts increase dramatically, and people can continue to lead productive, active lives. The risk of illness and death decreases but remains higher than that of people who are of similar age and who are not infected with HIV. However, if people cannot tolerate or take drugs consistently, HIV infection and immune deficiency progresses, causing serious symptoms and complications.
First of all, there is no evidence that people infected with HIV can be cured by the currently available therapies, although research related to curing people of infection will be discussed later. In general, those who are treated for years and are repeatedly found to have no virus in their blood by standard viral load assays will experience a prompt rebound in the number of viral particles when therapy is discontinued. Consequently, the decision to start therapy must balance the risk versus the benefits of treatment. The risks of therapy include the short- and long-term side effects of the drugs, described in subsequent sections, as well as the possibility that the virus will become resistant to the therapy, which can limit options for future treatment. The risks of both of these problems are quite small with the treatment options currently available.
The idea of combining medications into a “cocktail” came in the mid-nineteen-nineties, mirroring the way oncologists treated cancer. Cancer cells, like H.I.V. particles, can mutate quickly enough to escape a single targeted drug. The treatment regimen—HAART, for highly active antiretroviral therapy—was put through clinical trials by prominent researchers such as David Ho, of the Aaron Diamond Institute, in New York. I gave the cocktail to one of my patients, David Sanford, and less than a month after beginning treatment his fever fell, his infections disappeared, his energy returned, and he started to gain weight. The H.I.V. in his bloodstream plummeted to an undetectable level, where it has remained. Later, in a Pulitzer Prize-winning article, Sanford wrote, “I am probably more likely to be hit by a truck than to die of AIDS.” That now holds true for a great majority of people with H.I.V. in the United States. In the past five years, not one of the dozens of H.I.V. patients I’ve cared for has died of the disease.
Survival rates have dramatically improved for those individuals using protease inhibitors, but other problems have also arisen. Some persons do not respond to these medications or the side effects from taking the drugs diminish the quality of life. Protease inhibitors, for many people, are intolerable because of nausea, diarrhea, vomiting, headache, kidney stones, and serious drug interactions with other medications. By 2003 researchers had found that serious side effects include increased risk of heart attack, abnormalities in fat distribution, an increased propensity toward diabetes, and abnormalities in cholesterol metabolism.
Untreated HIV destroys certain cells within the immune system (CD4+ or helper T cells) from the time of infection onwards, causing more and more damage. Eventually the damage to the immune system is so great the body can no longer stop some infections or cancers it normally fights successfully. Infections not usually seen in healthy people, called opportunistic infections, and certain unusual tumours such as Kaposi’s sarcoma, may occur. Women with untreated HIV infection are at increased risk of developing cervical cancer and both men and women are at increased risk of anal cancer. Untreated HIV can cause infection in the brain, which can lead to nervous system disorders or dementia in some people with HIV infection.
On the 15th Feb 2012, i lost a dear friend to the dreadful Illness called HIV. I strongly advise everyone, to use Protection when having Sex. Yes, my friend liked Men, and he has paid the price for his Sexual habit. He was only 34 years old, and very clever, but he didn’t think about taking precautions against HIV or AIDS. This information on this page by the MNT you are reading is very important to take in, and be guided by.
Mortality from HIV disease has not been among the 15 leading causes of death in the US since 1997. The age-adjusted death rate for HIV disease peaked in 1995 at 16.3 per 100,000 population, decreased 69.9% through 1998, then further decreased 30.2% from 1999 through 2007, to 3.7 per 100,000 population. In 2007, a total of 11,295 persons died from HIV disease. However, HIV disease has remained among the 5 leading causes of death for specific age groups for females, and in the black population. 
Usually, HIV infection does not directly cause death. Instead, HIV infection leads to a substantial loss of weight (wasting), opportunistic infections, cancers, and other disorders, which then lead to death. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]