At the same time, it is important to recognise that reaching an undetectable viral load is determined by many factors, including treatment adherence, HIV resistance to certain anti-retroviral drugs, stigma, and inadequate health systems.
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.
Still, the questions that have been answered astonish AIDS scientists. At U.C.L.A. during the brutal first years, I never would have imagined that future patients would live into their eighties. A fatal disease has been tamed into a chronic condition. The next step is to find a cure. Scientists are innately cautious, and AIDS researchers have learned humility over the years. Science operates around a core of uncertainty, within which lie setbacks, but also hope. ♦
[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].
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11. 365(6):493-505. [Medline]. [Full Text].
Effective chemoprophylaxis is available for many opportunistic infections and reduces rates of disease due to P. jirovecii, Candida, Cryptococcus, and MAC. If therapy restores CD4 counts to above threshold values for > 3 mo, chemoprophylaxis can be stopped.
Keating SM, Golub ET, Nowicki M, et al. The effect of HIV infection and HAART on inflammatory biomarkers in a population-based cohort of women. AIDS. 2011 Sep 24. 25(15):1823-32. [Medline]. [Full Text].
Infection with the human immunodeficiency virus (HIV) is the cause of acquired immune deficiency syndrome (AIDS). This worldwide epidemic is now spreading at an alarming rate, especially through heterosexual contact in less-developed countries. HIV is an enveloped retrovirus that replicates in cells of the immune system. Viral entry requires the presence of CD4 and a particular chemokine receptor, and the viral cycle is dependent on transcription factors found in activated T cells. Infection with HIV causes a loss of CD4 T cells and an acute viremia that rapidly subsides as cytotoxic T-cell responses develop, but HIV infection is not eliminated by this immune response. HIV establishes a state of persistent infection in which the virus is continually replicating in newly infected cells. The current treatment consists of combinations of viral protease inhibitors together with nucleoside analogues and causes a rapid decrease in virus levels and a slower increase in CD4 T-cell counts. The main effect of HIV infection is the destruction of CD4 T cells, which occurs through the direct cytopathic effects of HIV infection and through killing by CD8 cytotoxic T cells. As the CD4 T-cell counts wane, the body becomes progressively more susceptible to opportunistic infection with intracellular microbes. Eventually, most HIV-infected individuals develop AIDS and die; however a small minority (3–7%), remain healthy for many years, with no apparent ill effects of infection. We hope to be able to learn from these individuals how infection with HIV can be controlled. The existence of such people and other people who have been naturally immunized against infection gives hope that it will be possible to develop effective vaccines against HIV.
AIDS was first recognized in the United States 1981 in homosexual men. Today is seen in both homosexual and heterosexual men and women. AIDS is the advanced form of infection with HIV virus. This virus may not cause recognizable symptoms for a long period after the initial exposure (latent period). As of early 2009, no vaccine was available to prevent HIV infection. Until such a vaccine is developed, all forms of HIV/AIDS therapy are focused on improving the quality and length of life for people who are infected by slowing or halting the replication of the virus and treating or preventing infections and cancers that often develop in people with AIDS.
The second phase of HIV infection, the asymptomatic period, lasts an average of 10 years. During that period the virus continues to replicate, and there is a slow decrease in the CD4 count (the number of helper T cells). When the CD4 count falls to about 200 cells per microlitre of blood (in an uninfected adult it is typically about 1,000 cells per microlitre), patients begin to experience opportunistic infections—i.e., infections that arise only in individuals with a defective immune system. That is AIDS, final stage of HIV infection. The most-common opportunistic infections are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium infection, herpes simplex infection, bacterial pneumonia, toxoplasmosis, and cytomegalovirus infection. In addition, patients can develop dementia and certain cancers, including Kaposi sarcoma and lymphomas. Death ultimately results from the relentless attack of opportunistic pathogens or from the body’s inability to fight off malignancies.
Jump up ^ Behrens, Anna-Janina; Vasiljevic, Snezana; Pritchard, Laura K; Harvey, David J; Andev, Rajinder S; Krumm, Stefanie A; Struwe, Weston B; Cupo, Albert; Kumar, Abhinav; Zitzmann, Nicole; Seabright, Gemma E; Kramer, Holger B; Spencer, Daniel I.R; Royle, Louise; Lee, Jeong Hyun; Klasse, Per J; Burton, Dennis R; Wilson, Ian A; Ward, Andrew B; Sanders, Rogier W; Moore, John P; Doores, Katie J; Crispin, Max (2016). “Composition and Antigenic Effects of Individual Glycan Sites of a Trimeric HIV-1 Envelope Glycoprotein”. Cell Reports. 14 (11): 2695–706. doi:10.1016/j.celrep.2016.02.058. PMC 4805854 . PMID 26972002.
During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies.
The primary mechanism for immunologic control of HIV appears to be CD8+ cytotoxic T-cells. T-cell responses are correlated with the steady-state viral load and hence, the rate of progression.  Cellular immunity is apparently responsible for some multiply-exposed, but uninfected individuals. [64, 65]
There is less evidence that treatment of HIV-2 infection slows progression, and certain antiretroviral medications (specifically the non-nucleoside–analogue reverse-transcriptase inhibitors) are not effective against HIV-2. The HIV-1 viral-load assays are much less reliable at quantifying HIV-2, if they work at all. HIV-2 viral load assays have been developed, but none has been approved by the US Food and Drug Administration except as blood donor–screening tools.
Human immunodeficiency virus (HIV) associated cholangiopathy has been described in children.95 As in adults, the biliary abnormalities include irregularities of contour and caliber of the intrahepatic and extrahepatic ducts and papillary stenosis. The changes may result from concomitant infection with opportunistic organisms such as cytomegalovirus and Cryptosporidium parvum.
In people with unmasked IRIS, doctors treat the newly identified opportunistic infection with antimicrobial drugs. Occasionally, when the symptoms are severe, corticosteroids are also used. Usually, when unmasked IRIS occurs, cART is continued. An exception is when a cryptococcal infection affects the brain. Then cART is temporarily interrupted until the infection is controlled.
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.
“The key to ending the AIDS epidemic requires people to have either therapeutic or preventive treatments, so repealing the A.C.A. means that any momentum we have is dead on arrival,” said Phill Wilson, chief executive and president of the Black AIDS Institute, a Los Angeles-based nonprofit. “For the most vulnerable, do we end up back in a time when people had only emergency care or no care and were literally dying on the streets? We don’t know yet, but we have to think about it.”
Jump up ^ Tolli, MV (May 28, 2012). “Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies”. Health education research. 27 (5): 904–13. doi:10.1093/her/cys055. PMID 22641791. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]