Although all NRTIs can be associated with lactic acidosis (a serious condition in which lactic acid accumulates in the blood), it may occur more often with some drugs, such as d4T. Although this complication of treatment is rare, it can be severe and life-threatening. Early symptoms of lactic acidosis are nausea, fatigue, and sometimes shortness of breath. Lactic acidosis needs to be watched for and, if suspected, requires that therapy be discontinued until symptoms and laboratory test abnormalities resolve.
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.
Taking an antiretroviral drug beforebeing exposed to HIV can reduce the risk of HIV infection. Such preventive treatment is called preexposure prophylaxis (PrEP). However, PrEP is expensive and is effective only if people take the drug every day. Thus, PrEP is recommended only for people who have a very high risk of becoming infected, such as people who have a partner who is infected with HIV.
State Legislation and the Courts To stem transmission of HIV, states have adopted several legal measures. Two states attempted to head off the virus at the pass: Illinois and Louisiana at one point required HIV blood testing as a prerequisite to getting a marriage license. Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states. Several states have taken a less stringent approach, requiring only that applicants for a marriage license must be informed of the availability—and advisability—of HIV tests. More commonly, states criminalize sexual behavior that can spread AIDS. Michigan law makes it a felony for an HIV or AIDS-infected person to engage in sex without first informing a partner of the infection. Florida law provides for the prosecution of any HIV-positive person committing prostitution, and it permits rape victims to demand that their attackers undergo testing. Indiana imposes penalties on persons who recklessly or knowingly donate blood or semen with the knowledge that they are HIV-infected.
Without treatment, HIV is likely to advance to AIDS. At that point, the immune system is too weak to fight off life-threatening disease and infection. Untreated, life expectancy with AIDS is about three years.
Currently, there is no vaccine or cure for HIV, but treatments have evolved which are much more effective and better tolerated; they can improve patients’ general health and quality of life considerably, in as little as one pill per day.
Macrophages. Tissue macrophages are one of the target cells for HIV. These macrophages harbour the virus and are known to be the source of viral proteins. However, the infected macrophages are shown to lose their ability to ingest and kill foreign microbes and present antigen to T cells. This could have a major contribution in overall immune dysfunction caused by HIV infection.
Over time, the receptor usage shifts to chemokine-related receptor (CXCR4) and other related receptors found on CD4+ T cells. These virus strains are more likely to cause cell fusion (syncytia formation). This trend is far from absolute but does correlate in many people with disease progression. 
Kaposi’s sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not infected with HIV, but common in HIV-positive people. It usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi’s sarcoma can also affect the internal organs, including the digestive tract and lungs.
HIV-1 causes most HIV infections worldwide, but HIV-2 causes a substantial proportion of infections in parts of West Africa. In some areas of West Africa, both viruses are prevalent and may coinfect patients. HIV-2 appears to be less virulent than HIV-1.
Most individuals infected with HIV will progress to AIDS if not treated. However, there is a tiny subset of patients who develop AIDS very slowly, or never at all. These patients are called non-progressors.
Jump up ^ Sallam, Malik; Şahin, Gülşen Özkaya; Ingman, Mikael; Widell, Anders; Esbjörnsson, Joakim; Medstrand, Patrik (July 2017). “Genetic characterization of human immunodeficiency virus type 1 transmission in the Middle East and North Africa”. Heliyon. 3 (7): e00352. doi:10.1016/j.heliyon.2017.e00352. ISSN 2405-8440. PMID 28725873. 16 July 2017.
Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. The reason for the preferential loss of mucosal CD4+ T cells is that the majority of mucosal CD4+ T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the cells, whereas only a small fraction of CD4+ T cells in the bloodstream do so. A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV-1 infection.
The appropriate use of combination antiretroviral therapies and prophylaxis for opportunistic infections dramatically improves survival and greatly decreases the risk of secondary opportunistic infections. [83, 84, 85] The risk of AIDS-associated lymphoma is not altered by antiviral therapy and, as such, has grown in prevalence among overall AIDS-defining conditions.
These drugs prevent HIV from replicating in cells and dramatically reduce the amount of HIV in the blood over a few days to weeks. If replication is sufficiently slowed, the destruction of CD4+ lymphocytes by HIV is decreased and the CD4 count begins to increase. As a result, much of the damage to the immune system caused by HIV can be reversed. Doctors can detect this reversal by measuring the CD4 count, which begins to return toward normal levels over weeks to months. The CD4 count continues to increase for several years but at a slower rate.
Antenatal testing and the availability of drugs to reduce mother-to-child transmission has resulted in a mother-to-child transmission rate of just 1%. In 2011, the number of infections resulting from mother-to-child transmission was 95. Increasing numbers of HIV-positive women are becoming pregnant and choosing not to have terminations. It is thought this is due to the increasing availability of drugs to prevent mother-to-child transmission.
Jump up ^ Choopanya, Kachit; Martin, Michael; Suntharasamai, Pravan; Sangkum, Udomsak; Mock, Philip A; Leethochawalit, Manoj; Chiamwongpaet, Sithisat; Kitisin, Praphan; Natrujirote, Pitinan; Kittimunkong, Somyot; Chuachoowong, Rutt; Gvetadze, Roman J; McNicholl, Janet M; Paxton, Lynn A; Curlin, Marcel E; Hendrix, Craig W; Vanichseni, Suphak (June 1, 2013). “Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial”. The Lancet. 381 (9883): 2083–2090. doi:10.1016/S0140-6736(13)61127-7. PMID 23769234.
Jump up ^ Centers for Disease Control (CDC) (August 1987). “Recommendations for prevention of HIV transmission in health-care settings”. MMWR. 36 (Suppl 2): 1S–18S. PMID 3112554. Archived from the original on July 9, 2017.
There are more than 25 medications in six drug classes approved to treat HIV. The U.S. Department of Health and Human Services (HHS) recommends a starting regimen of three HIV medicines from at least two drug classes.
^ Jump up to: a b Sodora DL, Allan JS, Apetrei C, Brenchley JM, Douek DC, Else JG, Estes JD, Hahn BH, Hirsch VM, Kaur A, Kirchhoff F, Muller-Trutwin M, Pandrea I, Schmitz JE, Silvestri G (2009). “Toward an AIDS vaccine: lessons from natural simian immunodeficiency virus infections of African nonhuman primate hosts”. Nature Medicine. 15 (8): 861–865. doi:10.1038/nm.2013. PMC 2782707 . PMID 19661993.
Masia M, Padilla S, Alvarez D, et al. Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy. AIDS. 2013 Jan 14. 27(2):181-9. [Medline]. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]