There are different variants of HIV, and the cell types that they infect are determined to a large degree by which chemokine receptor they bind as co-receptor. The variants of HIV that are associated with primary infections use CCR5, which binds the CC chemokines RANTES, MIP-1α, and MIP-1β (see Chapter 2), as a co-receptor, and require only a low level of CD4 on the cells they infect. These variants of HIV infect dendritic cells, macrophages, and T cells in vivo. However, they are often described simply as ‘macrophage-tropic’ because they infect macrophage but not T-cell lines in vitro and the cell tropism of different HIV variants was originally defined by their ability to grow in different cell lines.
Immunodeficiency disorders are either congenital or acquired. A congenital, or primary, disorder is one you were born with. Acquired, or secondary, disorders you get later in life. Acquired disorders are more common than congenital disorders.
The viral load of an infected person is an important risk factor in both sexual and mother-to-child transmission. During the first 2.5 months of an HIV infection a person’s infectiousness is twelve times higher due to this high viral load. If the person is in the late stages of infection, rates of transmission are approximately eightfold greater. An HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually.
AIDS is currently defined as an illness characterised by the development of one or more AIDS-indicating conditions. It is diagnosed in people infected with HIV when they develop certain opportunistic infections or malignancies for the first time. The following list relates to diagnosis in adults. Congenital HIV and Childhood AIDS has its own separate article.
There are some people who do not want people to know about condoms or clean needles. They believe that if people know about condoms and have condoms they will have more sex. They believe that if people have clean needles they will use illegal drugs more. Many of these people think this because of their religion. For example, the Catholic church does not want people to have or use condoms. They do not want people to have condoms because they do not think people should have sex unless they are married. They also think that married people should not use condoms, because they believe that if people have sex, they should be prepared to accept a possible pregnancy.
Analysis of reported AIDS cases shows that 51% had Pneumocystis carinii pneumonia (PCP) without Kaposi’s sarcoma (KS) (with or without other “opportunistic” infections (OOI) predictive of cellular immunodeficiency); 30% had KS without PCP (with or without OOI); 7% had both PCP and KS (with or without OOI); and 12% had OOI with neither PCP nor KS. The overall mortality rate for cases of PCP without KS (47%) was more than twice that for cases of KS without PCP (21%), while the rate for cases of both PCP and KS (68%) was more than three times as great. The mortality rate for OOI with neither KS nor PCP was 48%.
Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H.I.V. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of H.I.V., at 28.8 percent of the population. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation — and all other nations.
If the source’s virus is known or suspected to be resistant to≥ 1 drug, an expert in antiretroviral therapy and HIV transmission should be consulted. clinicians should not delay PEP pending expert consultation or drug susceptibility testing. Also, clinicians should provide immediate evaluation and face-to-face counseling and not delay follow-up care.
^ Jump up to: a b Centers for Disease Control (CDC) (1982). “Opportunistic infections and Kaposi’s sarcoma among Haitians in the United States”. MMWR Morb Mortal Wkly Rep. 31 (26): 353–354; 360–361. PMID 6811853. Archived from the original on September 20, 2011. Retrieved August 31, 2011.
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]
Full blood count: This is a test to check on the levels of white blood cells, red blood cells, platelets and haemoglobins in your blood. This test needs to be done before and regularly after treatment to check for anaemia (reduced blood haemoglobin) and reduction of other blood cells.
If the CD4 count drops below 200 cells per microliter of blood, the antibiotic trimethoprim-sulfamethoxazole is given to prevent Pneumocystis jirovecii pneumonia. This antibiotic also prevents toxoplasmosis, which can damage the brain.
The second problem is our uncertainty over what form protective immunity to HIV might take. It is not known whether antibodies, cytotoxic T lymphocyte responses, or both are necessary to achieve protective immunity, and which epitopes might provide the targets of protective immunity. Third, if strong cytotoxic responses are necessary to provide protection against HIV, these might be difficult to develop and sustain through vaccination. Other effective viral vaccines rely on the use of live, attenuated viruses and there are concerns over the safety of pursuing this approach for HIV. Another possible approach is the use of DNA vaccination, a technique that we discuss in Section 14-25. Both of these approaches are being tested in animal models.
Jump up ^ Wilson, David P; Law, Matthew G; Grulich, Andrew E; Cooper, David A; Kaldor, John M (2008). “Relation between HIV viral load and infectiousness: A model-based analysis”. The Lancet. 372 (9635): 314–20. doi:10.1016/S0140-6736(08)61115-0. PMID 18657710.
General Health – it is crucial to take medication correctly and take steps to avoid illness. People living with HIV should seek to improve their general health by regularly exercising, eating healthfully, and not smoking.
If you do inject drugs, never share your needles or works. Use only sterile needles. You can get them at many pharmacies without a prescription, or from community needle-exchange programs. Use a new sterile needle and syringe each time you inject. Clean used needles with full-strength laundry bleach, making sure to get the bleach inside the needle, soak at least 30 seconds (sing the “happy birthday” song three times), and then flush out thoroughly with clean water. Use bleach only when you can’t get new needles. Needles and syringes aren’t designed to be cleaned and reused, but it is better than sharing uncleaned needles and works.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America [redirect url=’http://penetratearticles.info/bump’ sec=’7′]