HIV infection takes different forms within different cells. As we have seen, more than 95% of the virus that can be detected in the plasma is derived from productively infected cells, which have a very short half-life of about 2 days. Productively infected CD4 lymphocytes are found in the T-cell areas of lymphoid tissue, and these are thought to succumb to infection in the course of being activated in an immune response. Latently infected memory CD4 cells that are activated in response to antigen presentation also produce virus. Such cells have a longer half-life of 2 to 3 weeks from the time that they are infected. Once activated, HIV can spread from these cells by rounds of replication in other activated CD4 T cells. In addition to the cells that are infected productively or latently, there is a further large population of cells infected by defective proviruses; such cells are not a source of infectious virus.
Jump up ^ Zhu T, Wang N, Carr A, Nam DS, Moor-Jankowski R, Cooper DA, Ho DD (1996). “Genetic characterization of human immunodeficiency virus type 1 in blood and genital secretions: evidence for viral compartmentalization and selection during sexual transmission”. Journal of Virology. 70 (5): 3098–107. PMC 190172 . PMID 8627789.
As mentioned above, with regards to GALT, HIV infection may be compartmentalized; specifically, areas of immune-privilege may occur such as in the testes and central nervous system where not only will there be differences in HIV pseudospecies but also different degrees of antiretroviral drug penetration. There is evidence that even with good peripheral control of HIV, the virus may still be detectable in the CSF and semen of some infected patients. [56, 57]
If a person has been exposed to the virus, it is crucial that they get tested as soon as possible. The earlier HIV is detected, the more likely the treatment will be successful. A home testing kit can be used as well.
This is an abstract of a report from the National Organization for Rare Disorders (NORD). A copy of the complete report can be downloaded free from the NORD website for registered users. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational therapies (if available), and references from medical literature. For a full-text version of this topic, go to www.rarediseases.org and click on Rare Disease Database under “Rare Disease Information”.
Jump up ^ Linden, JA (September 1, 2011). “Clinical practice. Care of the adult patient after sexual assault”. The New England Journal of Medicine. 365 (9): 834–41. doi:10.1056/NEJMcp1102869. PMID 21879901.
However, viruses are highly antigenic. Mechanisms of pathologic injury to cells include cell lysis; induction of cell proliferation (as in certain warts and molluscum contagiosum); formation of giant cells, syncytia, or intracellular inclusion bodies caused by the virus; and perhaps most importantly, symptoms caused by the host’s immune response, such as inflammation or the deposition of antigen-antibody complexes in tissues.
ART extends the average life expectancy, and many people with HIV can expect to live for decades with proper treatment. An increasing number have a normal life expectancy if they adhere carefully to medication regimens. Medications help the immune system recover and fight infections and prevent cancers from occurring. If ART is not taken regularly and doses are missed, the virus may become resistant, and the manifestations of AIDS may develop.
Jump up ^ Kolata, Gina (October 28, 1987). “Boy’s 1969 Death Suggests AIDS Invaded U.S. Several Times”. The New York Times. Archived from the original on February 11, 2009. Retrieved February 11, 2009.
The best time to start drug treatment is as soon as possible, even if people are not sick and their CD4 count is still above 500 (normal is 500 to 1,000). Doctors used to wait until the CD4 count was below 500 to start drug treatment. However, research has shown that people who are promptly treated with antiretroviral drugs are less likely to develop AIDS-related complications and to die of them.
^ Jump up to: a b c Montessori, V., Press, N., Harris, M., Akagi, L., Montaner, J. S. (2004). “Adverse effects of antiretroviral therapy for HIV infection”. CMAJ. 170 (2): 229–238. PMC 315530 . PMID 14734438.
A new (fourth-generation) ELISA test can test for both HIV antibodies and the p24 antigen simultaneously. Thus, people can find out as early as 14 days after being exposed to HIV whether they are infected. However, because this test is expensive and requires special equipment, it is not available at every facility.
The impact of AIDS in southern Africa has been devastating. Some communities have been very hard hit with many deaths and economic hardship related to loss of the workforce of young adults. However, significant progress has been made in the last decade. South Africa has the largest antiviral roll-out programme in the world. Campaigns to reduce homophobia are encouraging MSM to declare their sexuality and come forward for testing and treatment. Innovative work with sex workers and injectable drug users, antiretroviral treatment of children, condom distribution programmes and mother-to-child transmission prevention services are all beginning to bear fruit. Life expectancy has increased by five years since the height of the epidemic.With a prevalence of 17.9% and a population of 6.1 million, South Africa has the largest HIV epidemic of any country. In neighbouring countries in southern Africa, the prevalance ranges from 10-15%.
HIV infection negatively affects the ability to diagnose TB in both adults and children. Progression to disease may occur soon after infection by M. tuberculosis or latent infection may be reactivated. Further, response to treatment is often slower and outcome is worse than in HIV-uninfected patients. Therefore, in areas with a high prevalence of HIV infection in the general population (HIV prevalence > 1%) where TB and HIV infection are likely to coexist, HIV counselling and testing is indicated for all TB patients as part of their routine management.2,27 In areas with lower prevalence rates of HIV, counselling and testing is indicated for TB patients with symptoms and/or signs of HIV-related conditions and in those having a history suggestive of a high risk of exposure to HIV. A rapid test for HIV (a side room investigation) could be used as a screening test. Commercially available HIV ELISA tests are most commonly used as confirmatory tests, with HIV PCR as a confirmatory test in children less than 18 months of age.
In the United States, the face of the HIV/AIDS epidemic has changed dramatically. Adolescents and young adults less than 25 years of age now account for half the new HIV infections reported annually to the CDC and for most perinatally acquired infections. As a result, strategies to prevent new infection and manage the long-term effects of past infection have focused increasingly on the second and third decades of life.
One morning in the winter of 1981, my wife came home after her on-call shift at the U.C.L.A. Medical Center and told me about a baffling new case. Queenie was an eighteen-year-old prostitute, his hair dyed the color of brass. He had arrived at the emergency room with a high fever and a cough, and appeared to have a routine kind of pneumonia, readily treated with antibiotics. But the medical team retrieved a microbe from his lungs called Pneumocystis carinii. The microbe was known causing a rare fungal pneumonia that had been seen in severely malnourished children and in adults undergoing organ transplants or chemotherapy.
Most PIs are associated with important drug-drug interactions so they must be used with caution in patients on other medications. There are numerous resources available to patients on these medications to make sure that they do not adversely interact with other HIV or non HIV-related drugs.
Dyer WB, Geczy AF, Kent SJ, et al. Lymphoproliferative immune function in the Sydney Blood Bank Cohort, infected with natural nef/long terminal repeat mutants, and in other long-term survivors of transfusion-acquired HIV-1 infection. AIDS. 1997 Nov. 11(13):1565-74. [Medline]. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]