Illness may not occur for months or years after untreated HIV infection. Without treatment, most adults will develop severe disease within 10 years of infection. Treatment of HIV with drug therapy has become much more effective in the past few years, prolonging life and increasing quality of life in people with HIV.
Gordon’s longevity, and the dozens of drugs he has taken to stay alive, exemplifies the experience of millions of infected AIDS patients. His state-of-the-art treatment costs almost a hundred thousand dollars a year. Although it’s covered by his insurance and by the State of California, he calls it “a ransom: your money or your life.” For Deeks, the question is “Can the world find the resources to build a system to deliver, on a daily basis, antiretroviral drugs to some thirty-five million people, many in very poor regions?” He is doubtful, which is why he is focussed on helping to find a cure. “Our philosophy is that in order to cure H.I.V., we need to know where and why it persists,” he said.
Many HIV-positive people are unaware that they are infected with the virus. For example, in 2001 less than 1% of the sexually active urban population in Africa had been tested, and this proportion is even lower in rural populations. Furthermore, in 2001 only 0.5% of pregnant women attending urban health facilities were counselled, tested or receive their test results. Again, this proportion is even lower in rural health facilities. Since donors may therefore be unaware of their infection, donor blood and blood products used in medicine and medical research are routinely screened for HIV.
Costs vary according to where you live and type of insurance coverage. Some pharmaceutical companies have assistance programs to lower the cost. Average wholesale prices of commonly used antiretroviral drugs range from $54 to $4,097 a month.
Alimonti JB, Kimani J, Matu L, et al. Characterization of CD8 T-cell responses in HIV-1-exposed seronegative commercial sex workers from Nairobi, Kenya. Immunol Cell Biol. 2006 Oct. 84(5):482-5. [Medline].
The entire HIV genome consists of nine genes flanked by long terminal repeat sequences (LTRs), which are required for the integration of the provirus into the host cell DNA and contain binding sites for gene regulatory proteins that control the expression of the viral genes. Like other retroviruses, HIV has three major genes—gag, pol, and env. The gag gene encodes the structural proteins of the viral core, pol encodes the enzymes involved in viral replication and integration, and env encodes the viral envelope glycoproteins. The gag and pol mRNAs are translated to give polyproteins—long polypeptide chains that are then cleaved by the viral protease (also encoded by pol) into individual functional proteins. The product of the env gene, gp160, has to be cleaved by a host cell protease into gp120 and gp41, which are then assembled as trimers into the viral envelope. As shown in Fig. 11.24, HIV has six other, smaller, genes encoding proteins that affect viral replication and infectivity in various ways. We will discuss the function of two of these—Tat and Rev—in the following section.
^ Jump up to: a b Jolly C, Kashefi K, Hollinshead M, Sattentau QJ (2004). “HIV-1 cell to cell transfer across an Env-induced, actin-dependent synapse”. Journal of Experimental Medicine. 199 (2): 283–293. doi:10.1084/jem.20030648. PMC 2211771 . PMID 14734528.
Once a person has been infected with HIV he or she remains infected for life and is able to transmit the virus to others. The risk of transmitting the infection to another person is dependent on the level of virus in body fluids of the infected person.
Exposure to contaminated blood. Risk of HIV transmission among intravenous drug users increases with the frequency and duration of intravenous use, frequency of needle sharing, number of people sharing a needle, and the rate of HIV infection in the local population. In 2006, about 19% of men with AIDS and 25% of women with AIDS contracted the disease through sharing needles during intravenous drug injection. With the introduction of new blood product screening in the mid-1980s, HIV transmission through blood transfusions became rare in the developed world. However, contaminated blood is still a significant source of infection in the developing world.
Teaching young people about AIDS is an enormously popular idea. Since the late 1980s, Gallup Polls have revealed that over 90 percent of respondents think public schools should do so. Agreement ends there, however. In the 1990s, more angry debate focused on AIDS education than on any issue facing schools since court-ordered busing in the 1970s. The core question of the debate is simple: What is the best way to equip students to protect themselves from this fatal disease? The answers may be miles apart. For one side, “equipping” means advocating the only sure means of protection, sexual and drug abstinence. For the other, it means supporting abstinence along with knowledge of sexual practices, the use of clean drug needles, and the use of prophylactics (condoms), which are distributed in some schools. Between these positions lie a great many issues of disagreement that have bitterly divided school districts, provoked lawsuits, and cost high-ranking Washington, D.C., officials their jobs.
Simonetti FR, Dewar R, Maldarelli F. Diagnosis of human immunodeficiency virus infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 122.
There is little evidence that HIV can be transferred by casual exposure, as might occur in a household setting. For example, unless there are open sores or blood in the mouth, kissing is generally considered not to be a risk factor for transmitting HIV. This is because saliva, in contrast to genital secretions, has been shown to contain very little HIV. Still, theoretical risks are associated with the sharing of toothbrushes and shaving razors because they can cause bleeding, and blood can contain large amounts of HIV. Consequently, these items should not be shared with infected people. Similarly, without sexual exposure or direct contact with blood, there is little if any risk of HIV contagion in the workplace or classroom.
Not everyone who has HIV have AIDS. When people first get HIV, they can be healthy for years. A person is diagnosed as having AIDS when he or she gets specific types of illnesses or gets sick in certain ways due to their HIV. Once a person’s HIV progresses to (or turns into) AIDS, the person will continue to have AIDS for the rest of their life. While there are many treatments for HIV/AIDS, at this point there is no cure.
Chun TW, Engel D, Berrey MM, Shea T, Corey L, Fauci AS. Early establishment of a pool of latently infected, resting CD4(+) T cells during primary HIV-1 infection. Proc Natl Acad Sci U S A. 1998 Jul 21. 95(15):8869-73. [Medline].
A considerable amount of stigma has been attached to HIV infection, mostly because of the virus’s association with sexual acquisition and the inference of sexual promiscuity. Consequences of this stigma have included discrimination and reluctance to be tested for HIV infection. The stigma of HIV infection is also associated with a fear of acquiring a rapidly fatal infection from relatively casual contact.
Cahn P, Pozniak AL, Mingrone H, Shuldyakov A, Brites C, Andrade-Villanueva JF, et al. Dolutegravir versus raltegravir in antiretroviral-experienced, integrase-inhibitor-naive adults with HIV: week 48 results from the randomised, double-blind, non-inferiority SAILING study. Lancet. 2013 Jul 2. [Medline].
In light of the limited ability of counseling and testing to curb the spread of the HIV pandemic, many researchers have moved toward other biologic strategies for preventing HIV that not rely solely on people changing their behavior. It is in this area where there has been some success. During the last 10 years, there were several large studies showing that male circumcision along with behavioral counseling reduced the risk of heterosexual men acquiring HIV infection. This provides a novel prevention strategy for at-risk, HIV-uninfected heterosexual men. Another major advance on the prevention front came from the HPTN 052 study in which HIV-infected individuals with CD4 cells between 350 cells/mm3 and 550 cells/mm3 who had uninfected partners were randomly assigned to initiate antiviral therapy or wait until their CD4 cells declined to less than 250 cells/mm3 or they developed symptoms consistent with disease progression. All enrolled individuals were aggressively counseled about continued safe sex practices, provided condoms, and were monitored for sexual activities. The study ultimately showed that those treated early were more than 96% less likely to transmit to their partner than those who had antiviral treatment deferred. Subsequent cohort studies have shown that those who are virologically suppressed on antiretroviral therapy for at least six months have a very low risk of transmitting to uninfected partners, even when not using condoms. In fact, many groups have suggested that the risk in this setting of HIV transmission may be virtually zero based upon the existing data.
Jump up ^ Clevestig P, Maljkovic I, Casper C, Carlenor E, Lindgren S, Navér L, Bohlin AB, Fenyö EM, Leitner T, Ehrnst A (2005). “The X4 phenotype of HIV type 1 evolves from R5 in two children of mothers, carrying X4, and is not linked to transmission”. AIDS Research and Human Retroviruses. 21 (5): 371–8. doi:10.1089/aid.2005.21.371. PMID 15929699.
The source is qualified by whether it is known or unknown. If the source is unknown (eg, a needle on the street or in a sharps disposal container), risk should be assessed based on the circumstances of the exposure (eg, whether the exposure occurred in an area where injection drug use is prevalent, whether a needle discarded in a drug-treatment facility was used). If the source is known but HIV status is not, the source is assessed for HIV risk factors, and prophylaxis is considered (see Table: Postexposure Prophylaxis Recommendations).
In most states, it is perfectly legal to discriminate against someone on the basis of their sexual orientation or their gender identity in one or more aspects of their life, including employment, housing, and public accommodations. Explicit non-discrimination protections based on sexual orientation or gender identity do not exist at the federal level either.
Despite significant efforts, there is no effective vaccine against HIV. The only way to prevent infection by the virus is to avoid behaviors that put one at risk, such as sharing needles or having unprotected sex. Unprotected sex means sex without a barrier such as a condom. Because condoms break, even they are not perfect protection. Many people infected with HIV don’t have any symptoms and appear healthy. There is no way to know with certainty whether a sexual partner is infected. Here are some prevention strategies:
Jump up ^ National Institute of Health (June 17, 1998). “Crystal structure of key HIV protein reveals new prevention, treatment targets” (Press release). Archived from the original on February 19, 2006. Retrieved September 14, 2006.
(Pathology) acquired immune (or immuno-)deficiency syndrome: a condition, caused by a virus, in which certain white blood cells (lymphocytes) are destroyed, resulting in loss of the body’s ability to protect itself against disease. AIDS is transmitted by sexual intercourse, through infected blood and blood products, and through the placenta
HIV/AIDS research includes all medical research that attempts to prevent, treat, or cure HIV/AIDS, as well as fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.
Regardless of the cause for the disruption, a loss of thymic replacements in the face of an induced state of immune activation and T-cell loss seems to be a key component of the mechanism by which HIV narrows the T-cell repertoire and progresses to AIDS. [51, 52, 53]
A poor CD4 count response is more likely if the CD4 count at initiation of treatment is low (especially if < 50/μL) and/or the HIV RNA level is high. However, marked improvement is likely even in patients with advanced immunosuppression. An increased CD4 count correlates with markedly decreased risk of opportunistic infections, other complications, and death. With immune restoration, patients, even those with complications that have no specific treatment (eg, HIV-induced cognitive dysfunction) or that were previously considered untreatable (eg, progressive multifocal leukoencephalopathy), may improve. Outcomes are also improved for patients with cancers (eg, lymphoma, Kaposi sarcoma) and most opportunistic infections. Jump up ^ Wiysonge, Charles Shey; Kongnyuy, Eugene J; Shey, Muki; Muula, Adamson S; Navti, Osric B; Akl, Elie A; Lo, Ying-Ru (June 15, 2011). Wiysonge, Charles Shey, ed. "Male circumcision for prevention of homosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd (6): CD007496. doi:10.1002/14651858.CD007496.pub2. PMID 21678366. Many opportunistic infections that complicate HIV are reactivations of latent infections. Thus, epidemiologic factors that determine the prevalence of latent infections also influence risk of specific opportunistic infections. In many developing countries, prevalence of latent TB and toxoplasmosis in the general population is higher than that in developed countries. Dramatic increases in reactivated TB and toxoplasmic encephalitis have followed the epidemic of HIV-induced immunosuppression in these countries. Similarly in the US, incidence of coccidioidomycosis, common in the Southwest, and histoplasmosis, common in the Midwest, has increased because of HIV infection. In the United States, the rate of HIV infection is highest in blacks (44.3 cases per 100,000 population). The prevalence is also high among Hispanic persons (16.4 per 100,000 population).  These increased rates are due to socioeconomic factors rather than genetic predisposition. There are currently nine approved PIs that all have distinct toxicities. The most common side effects associated with these drugs are nausea and diarrhea, which occur more often with some PIs than others. For example, diarrhea is more common with NFV than other PIs but can occur with any and all drugs in this class. Many of the drugs in this class also increase blood lipid levels, some more than others with ATV and DRV appearing to have less effect on lipids than other drugs in the class. Other unique toxicities associated with various PIs are kidney stones, kidney damage, and increases in blood bilirubin levels and potentially jaundice with IDV and ATV. Some of these drugs also have been associated with elevations in blood sugar levels and bleeding in hemophiliacs. Finally, little is known regarding the role these drugs may play in the development of lipodystrophy. There is also some data suggesting that LPV/RTV and DRV may be associated with an increased risk of cardiovascular events. HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. Although there is no HIV vaccine, HIV infections are entirely preventable through safe behaviour. Everyone has a responsibility to help prevent transmission of HIV and to take care of themselves and others. This means: [redirect url='http://penetratearticles.info/bump' sec='7']