Political attitudes toward AIDS have gone through dramatically different phases. In the early 1980s, it was dubbed the gay disease and as such was easy for lawmakers to ignore. No one hurried to fund research into a disease that seemed to be killing only members of a historically unpopular group. When it was not being ignored, some groups dismissed AIDS as a problem that homosexuals deserved, perhaps brought on them by divine intervention. Discriminatory action matched this talk as gay men lost jobs, housing, and medical care. AIDS activists complained bitterly about the failure of most U.S. citizens to be concerned. Public opinion only began to shift in the late 1980s, largely through awareness of highly publicized cases. As soon as AIDS had a familiar or more mainstream face, it became harder to ignore; when it became clear that heterosexuals were also contracting the disease, the epidemic acquired higher priority.
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One of the greatest advances in the management of HIV infection has been in pregnant women. Prior to antiviral therapy, the risk of HIV transmission from an infected mother to her newborn was approximately 25%-35%. The first major advance in this area came with studies giving ZDV after the first trimester of pregnancy, then intravenously during the delivery process, and then after delivery to the newborn for six weeks. This treatment showed a reduction in the risk of transmission to less than 10%. There is strong data that women who have viral suppression during pregnancy have very low risk of transmitting HIV to their baby. Current recommendations are to advise HIV-infected pregnant women regarding both the unknown side effects of antiviral therapy on the fetus and the promising clinical experience with potent therapy in preventing transmission. In the final analysis, however, pregnant women with HIV should be treated essentially the same as nonpregnant women with HIV. Exceptions would be during the first trimester, where therapy remains controversial, and avoiding certain drugs that may cause greater concern for fetal toxicity, such as EFV.
There are currently six major classes of antiretroviral medications: (1) nucleoside reverse transcriptase inhibitors (NRTIs), (2) non-nucleoside reverse transcriptase inhibitors (NNRTIs), (3) protease inhibitors (PIs), (4) fusion (entry) inhibitors, (5) integrase inhibitors, and (6) CCR5 antagonists. These drugs are used in different combinations according to the needs of the patient and depending on whether the virus has become resistant to a specific drug or class of drugs. Treatment regimens usually consist of three to four medications at the same time. Combination treatment is essential because using only one class of medication by itself allows the virus to become resistant to the medication. There are now available pills that contain multiple drugs in a single pill, making it possible for many people to be treated with a single pill per day.
Personal risks to the individual whose confidence is breached, such as serious implications for the patient’s relationship with family and friends, the threat of discrimination in employment and housing, intimate partner violence, and the impact on family members
Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/µL is a very effective way to prevent HIV infection of their partner (a strategy known as as prevention, or TASP). TASP is associated with a 10 to 20 fold reduction in transmission risk. Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. It may also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years.
Jump up ^ Beyrer, C; Baral, SD; van Griensven, F; Goodreau, SM; Chariyalertsak, S; Wirtz, AL; Brookmeyer, R (Jul 28, 2012). “Global epidemiology of HIV infection in men who have sex with men”. Lancet. 380 (9839): 367–77. doi:10.1016/S0140-6736(12)60821-6. PMID 22819660.
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.
Nonetheless, the results mark a clear watershed in the treatment of acquired immune deficiency syndrome, since the available drug therapies have gone almost overnight from the unspectacular to the possibly significant.
The normal CD4 count is about 750/μL, and immunity is minimally affected if the count is > 350/μL. If the count drops below about 200/μL, loss of cell-mediated immunity allows a variety of opportunistic pathogens to reactivate from latent states and cause clinical disease.
1. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren J, et al: CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 30;355 (22):2283–96, 2006.
The first cases of the acquired immune deficiency syndrome (AIDS) were reported in 1981 but it is now clear that cases of the disease had been occurring unrecognized for at least 4 years before its identification. The disease is characterized by a susceptibility to infection with opportunistic pathogens or by the occurrence of an aggressive form of Kaposi’s sarcoma or B-cell lymphoma, accompanied by a profound decrease in the number of CD4 T cells. As it seemed to be spread by contact with body fluids, it was early suspected to be caused by a new virus, and by 1983 the agent now known to be responsible for AIDS, called the human immunodeficiency virus (HIV), was isolated and identified. It is now clear there are at least two types of HIV—HIV-1 and HIV-2—which are closely related to each other. HIV-2 is endemic in West Africa and is now spreading in India. Most AIDS worldwide, however, is caused by the more virulent HIV-1. Both viruses appear to have spread to humans from other primate species and the best evidence from sequence relationships suggests that HIV-1 has passed to humans on at least three independent occasions from the chimpanzee, Pan troglodytes, and HIV-2 from the sooty mangabey, Cercocebus atys.
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]
[Guideline] World Health Organization. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach: 2003 revision. World Health Organization, Geneva 2004. Available at http://www.who.int/hiv/pub/prev_care/en/arvrevision2003en.pdf. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]