The human immunodeficiency virus (HIV) which causes acquired immune deficiency syndrome (AIDS) has brought about a global epidemic of massive proportions. HIV is a retrovirus and also the term often applied to the infection before the deterioration of the immune system to produce a full-blown picture of AIDS.
Ruiz L, van Lunzen J, Arno A, et al. Protease inhibitor-containing regimens compared with nucleoside analogues alone in the suppression of persistent HIV-1 replication in lymphoid tissue. AIDS. 1999 Jan 14. 13(1):F1-8. [Medline].
Jump up ^ Murray ED, Buttner N, Price BH (2012). “Depression and Psychosis in Neurological Practice”. In Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Bradley’s Neurology in Clinical Practice: Expert Consult – Online and Print, 6e (Bradley, Neurology in Clinical Practice e-dition 2v Set). 1 (6th ed.). Philadelphia, PA: Elsevier/Saunders. p. 101. ISBN 1-4377-0434-4.
HIV testing should be voluntary and the right to decline testing should be recognized. Mandatory or coerced testing by a health care provider, authority, or by a partner or family member is not acceptable as it undermines good public health practice and infringes on human rights.
The proviral reservoir, as measured by DNA polymerase chain reaction (PCR), seems to be incredibly stable. Although it does decline with aggressive antiviral therapy, the half-life is such that eradication is not a viable expectation.
Opportunistic infections may be caused by bacteria, viruses, fungi, and parasites that are normally controlled by the immune system. Which infections occur depends partly on what organisms are common in the person’s environment. These infections may affect nearly every organ system.
The development of rapid HIV tests is another mechanism to support HIV testing and management. Until recently, HIV testing was performed using the repeatedly reactive enzyme immunoassay followed by confirmatory Western blot or immunofluorescence assay. Although this test is very accurate, the results are not available for 24–48 hours after testing. In contrast, a rapid HIV test is a screening test with results that are available quickly, ideally within an hour. Rapid tests include point-of-care tests performed outside a laboratory (eg, an oral swab testing done in an outpatient setting) as well as testing performed in a laboratory. The tests currently approved by the U.S. Food and Drug Administration range in specificity from 93% to 100% with a sensitivity of 98.6–100% (11). The use of rapid HIV tests may provide test results to patients in a timelier manner and may reduce challenges related to loss to follow-up. Although a positive rapid test result is preliminary and must be confirmed with additional testing, a negative rapid test result does not require any additional testing. Therefore, rapid testing may be a feasible and acceptable approach for an HIV screening program in an obstetric–gynecologic practice (12).
Voluntary testing with counseling is the strategy most consistent with respect for patient autonomy. Under option, physicians provide both pretest and posttest counseling. Some physicians may perform such counseling themselves, whereas others may prefer to refer the patient for counseling and testing. (Such specialized HIV counseling was more widely available in previous years but has become less available as more health care professionals have become more comfortable treating patients with HIV and as the opt-out approach to testing—an approach that places less emphasis on pretest counseling—has become more common.) In addition to medical information, such counseling could include information regarding potential uses of test information and legal requirements pertaining to the release of information. Patients should be told what information will be communicated and to whom and the possible implications of reporting the information. This approach to testing maintains HIV’s status as being in a class by itself (sui generis), even as many ethicists have acknowledged the end to the exceptionalism that marked this disease in the early years of the epidemic (5).
The best combination of drugs for HIV are those that effectively suppress viral replication in the blood and also are well tolerated and simple to take so that people can take the medications consistently without missing doses.
Hematologic disorders (eg, cytopenias, lymphomas, cancers) are common and may be usefully evaluated with bone marrow aspiration and biopsy. This procedure can also help diagnose disseminated infections with MAC, M. tuberculosis, Cryptococcus, Histoplasma, human parvovirus B19, P. jirovecii, and Leishmania. Most patients have normocellular or hypercellular marrow despite peripheral cytopenia, reflecting peripheral destruction. Iron stores are usually normal or increased, reflecting anemia of chronic disease (an iron-reutilization defect). Mild to moderate plasmacytosis, lymphoid aggregates, increased numbers of histiocytes, and dysplastic changes in hematopoietic cells are common.
Sex is an old battleground in public education. Liberals and conservatives argued over it in the decade following the sexual revolution of the 1960s, initially over whether sexual issues should be discussed in schools. After all, earlier generations who went to public schools learned mainly about reproductive organs. As new classes began appearing in the late 1970s, children learned about the sexual choices people make. If liberals appeared to win the “sex ed.” debate, growing social problems helped: rises in teen pregnancies and sexually transmitted diseases secured a place for more explicit school health classes. The much greater threat of AIDS pushed state legislatures into action. By the mid-1990s, AIDS prevention classes had been mandated in at least 34 states and recommended in 14. But the appearance of even more explicit teaching has reinvigorated the sex ed. debate.
The nation also saw tremendous progress in the fight against HIV under former President Barack Obama, whose National HIV & AIDS Strategy explicitly called attention to gay and bisexual men and transgender women for the first time. President Obama also signed the Affordable Care Act into law, which, among other things, prohibited insurance companies from denying people health insurance on the basis of a pre-existing condition like HIV and expanded Medicaid coverage to include many low-income people living with HIV.
It appears that macrophage-tropic isolates of HIV are preferentially transmitted by sexual contact as they are the dominant viral phenotype found in newly infected individuals. Virus is disseminated from an initial reservoir of infected dendritic cells and macrophages and there is evidence for an important role for mucosal lymphoid tissue in this process. Mucosal epithelia, which are constantly exposed to foreign antigens, provide a milieu of immune system activity in which HIV replication occurs readily. Infection of CD4 T cells via CCR5 occurs early in the course of infection and continues to occur, with activated CD4 T cells accounting for the major production of HIV throughout infection. Late in infection, in approximately 50% of cases, the viral phenotype switches to a T-lymphocyte-tropic type that utilizes CXCR4 co-receptors, and this is followed by a rapid decline in CD4 T-cell count and progression to AIDS. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]