Guttmacher Institute. An overview of minors’ consent law. State Policies in Brief. New York (NY): GI; 2013. Available at: http://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf. Retrieved November 4, 2013. ⇦
Human immunodeficiency virus (HIV) associated cholangiopathy has been described in children.95 As in adults, the biliary abnormalities include irregularities of contour and caliber of the intrahepatic and extrahepatic ducts and papillary stenosis. The changes may result from concomitant infection with opportunistic organisms such as cytomegalovirus and Cryptosporidium parvum.
There is less information on the effectiveness of PEP for people exposed via sexual activity or intravenous drug use — however, if you believe you have been exposed, you should discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. All rape victims should be offered PEP and should consider its potential risks and benefits in their particular case.
The United States struggled to cope with AIDS from the early 1980s until the late 1990s, when new drug therapies started to extend the length and quality of life for many people with AIDS. Since the beginning, AIDS and its resulting epidemic in the United States have raised a great number of legal issues, which are made all the more difficult by the nature of the disease. AIDS is a unique killer, but some of its aspects are not: epidemics have been seen before; other sexually transmitted diseases have been fatal. AIDS is different because it was discovered in—and in the United States still predominantly afflicts—unpopular social groups: gay men and drug users. This fact has had a strong impact on the shaping of AIDS law. Law is often shaped by politics, and AIDS is a highly politicized disease. The challenge in facing an epidemic that endangers everyone is complicated by the stigma attached to the people most likely to be killed by it.
Jump up ^ Chen J, Powell D, Hu WS (2006). “High frequency of genetic recombination is a common feature of primate lentivirus replication”. Journal of Virology. 80 (19): 9651–8. doi:10.1128/JVI.00936-06. PMC 1617242 . PMID 16973569.
The only way to know if you have HIV is to take an HIV test. Most tests looks for signs of HIV in your blood. A small sample of blood is taken from your arm. The blood is sent to a lab and tested for HIV. There are other tests available that check for HIV in the urine and oral fluid. The urine test is not very sensitive. There are currently two FDA-approved oral fluid tests. They are OraSure and OraQuick Advance.
This Committee Opinion was developed with the assistance of the HIV Expert Work Group. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
For HIV treatment to be effective in reducing HIV incidence, infections need to be diagnosed as quickly as possible. This requires increasing HIV testing coverage and frequency. CDC recommends testing all persons aged 13–64 years at least once as a routine part of medical care and more frequent testing (at least annually) for persons at high risk for HIV infection (7). A large proportion (84%) of HIV sexually transmitted from MSM and heterosexual persons is transmitted by MSM (1). Some sexually active MSM might benefit from more frequent testing (e.g., every 3 to 6 months) (18). Testing according to CDC guidelines is critical to diagnosing HIV infection, so that anyone who receives a diagnosis of HIV infection can start antiretroviral treatment. Overall, prior year testing increased among groups at high risk over time. However, 29% of MSM (in 2014), 42% of persons who inject drugs (in 2015), and 59% of heterosexual persons at increased risk (in 2016) did not report testing in the past 12 months. In addition, it is important to note that these data are from persons residing in large metropolitan statistical areas in the United States. Studies have found that persons residing in rural areas are less likely to report prior HIV testing, including in the past 12 months, compared with their urban counterparts, and that persons living in rural areas are more likely to have HIV infection diagnosed at a late stage (19,20). Barriers to implementing routine testing include lack of time, competing priorities, and concerns about reimbursement on the health care provider’s part and stigma and lack of perceived risk on the client’s part (21). Lack of perceived risk was also one of the main reasons cited by MSM in NHBS for not testing in the past 12 months.
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.
There are many potential side effects associated with antiviral therapies. The most common ones for each class of drug are summarized in readily available product information. Some specific toxicities are summarized by class below.
ART extends the average life expectancy, and many people with HIV can expect to live for decades with proper treatment. An increasing number have a normal life expectancy if they adhere carefully to medication regimens. Medications help the immune system recover and fight infections and prevent cancers from occurring. If ART is not taken regularly and doses are missed, the virus may become resistant, and the manifestations of AIDS may develop.
Most AIDS patients require complex long-term treatment with medications for infectious diseases. This treatment is often complicated by the development of resistance in the disease organisms. AIDS-related malignancies in the central nervous system are usually treated with radiation therapy. Cancers elsewhere in the body are treated with chemotherapy.
Risk of infection is about 0.3% (1:300) after a typical percutaneous exposure and about 0.09% (1:1100) after mucous membrane exposure. These risks vary, reflecting the amount of HIV transferred to the person with the injury; the amount of HIV transferred is affected by multiple factors, including viral load of the source and type of needle (eg, hollow or solid). However, these factors are no longer taken into account in PEP recommendations.
The incidence of AIDS by date of diagnosis (assuming an almost constant population at risk) has roughly doubled every half-year since the second half of 1979 (Table 1). An average of one to two cases are now diagnosed every day. Although the overall case-mortality rate for the current total of 593 is 41%, the rate exceeds 60% for cases diagnosed over a year ago.
^ Jump up to: a b Marx PA, Alcabes PG, Drucker E (2001). “Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa”. Philos Trans R Soc Lond B Biol Sci. 356 (1410): 911–20. doi:10.1098/rstb.2001.0867. PMC 1088484 . PMID 11405938.
WHO is a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS). Within UNAIDS, WHO leads activities on HIV treatment and care, HIV and tuberculosis co-infection, and jointly coordinates with UNICEF the work on the elimination of mother-to-child transmission of HIV.
Merely having HIV does not mean a person has AIDS. AIDS is an advanced stage of HIV infection and requires that the person have evidence of a damaged immune system. That evidence comes from at least one of the following:
In making decisions about patient care, health care professionals who are infected with HIV should adhere to the fundamental professional obligation to avoid harm to patients. Physicians who have reason to believe that they have been at significant risk of being infected should be tested voluntarily for HIV for the protection of their patients as well as for their own benefit. The physician as a patient is entitled to the same rights to privacy and confidentiality as any other patient.
Mills EJ, Bakanda C, Birungi J, Yaya S, Ford N. The prognostic value of baseline CD4 cell count beyond 6 months of antiretroviral therapy in HIV positive patients in Uganda. AIDS. 2012 Apr 21. [Medline].
Other drugs can prevent or treat opportunistic infections (OIs). In most cases, these drugs work very well. The newer, stronger ARVs have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat. See Fact Sheet 500 for more information on opportunistic infections.
HIV is passed from person to person through bodily fluids such as blood and semen. Once the virus enters your body, it attacks your immune system by destroying CD4 cells, which help keep you from getting sick.
For primary prophylaxis against some fungal infections (eg, esophageal candidiasis, cryptococcal meningitis or pneumonia), oral fluconazole 100 to 200 mg once/day or 400 mg weekly is successful but is infrequently used because the cost per infection prevented is high and diagnosis and treatment of these infections are usually successful.
HIV is probably directly responsible for a substantial loss of weight (AIDS wasting) in some people. Wasting in people with AIDS may also be caused by a series of infections or by an untreated, persistent digestive tract infection.
stage 3 atrophic phase, characterized by reduced/absent/intractable pain, irreversible atrophy of skin/subcutaneous tissues, flexion contractures of foot, advanced osteoporosis with a ‘ground-glass’ appearance on X-ray of affected bone
Plasma HIV RNA level (viral load) reflects HIV replication rates. The higher the set point (the relatively stable virus levels that occur after primary infection), the more quickly the CD4 count decreases and the greater the risk of opportunistic infection, even in patients without symptoms.
The RNA genome consists of at least seven structural landmarks (LTR, TAR, RRE, PE, SLIP, CRS, and INS), and nine genes (gag, pol, and env, tat, rev, nef, vif, vpr, vpu, and sometimes a tenth tev, which is a fusion of tat, env and rev), encoding 19 proteins. Three of these genes, gag, pol, and env, contain information needed to make the structural proteins for new virus particles. For example, env codes for a protein called gp160 that is cut in two by a cellular protease to form gp120 and gp41. The six remaining genes, tat, rev, nef, vif, vpr, and vpu (or vpx in the case of HIV-2), regulatory genes for proteins that control the ability of HIV to infect cells, produce new copies of virus (replicate), or cause disease.
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.
The most important way to stop HIV/AIDS is education. People can get HIV from the exchange of bodily fluids and from sharing needles. Children can also get HIV from their mothers (when they grow inside pregnant mothers and when they drink breast milk.) Sex is one way to get HIV. If people use condoms when they have sex, there is a much smaller chance of catching HIV.
The most important thing you can do is start antiretroviral treatment as soon as possible. And it’s important to follow up with your doctor regularly. By taking your medications exactly as prescribed, you can keep your viral count low and your immune system strong.
Medications that fight HIV are called antiretroviral medications. Different antiretroviral medications target the virus in different ways. When used in combination with each other, they are very effective at suppressing the virus. It is important to note that there is no cure for HIV. ART only suppresses reproduction of the virus and stops or delays the disease from progressing to AIDS. Most guidelines currently recommend that all HIV-infected people who are willing to take medications should have them initiated shortly after being diagnosed with the infection. This delays or prevents disease progression, improves overall health of an infected person, and makes it less likely that they will transmit the virus to their partners.
Medications are continued throughout pregnancy, labor, and delivery. Some medicines, such as zidovudine (also known as AZT), can be given intravenously during labor, particularly for those women who do not have good viral suppression at the time of delivery. Other medications are continued orally during labor to try to reduce the risk of transmission to the baby during delivery. If the quantity of virus in the mother’s blood (viral load) is more than 1,000 copies/mL near the time of delivery, scheduled cesarean delivery is done at 38 weeks gestation to reduce the risk of transmitting the virus during vaginal delivery. Women with HIV who otherwise meet criteria for starting antiretroviral therapy, per local guidelines or the patient’s preference, should continue taking ART after delivery for their own health. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]