[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.
Much of the new AIDS research builds on the Silicianos’ foundational discovery of H.I.V.’s hidden reservoirs. So does their own work. Using potent chemicals, they have been able to draw H.I.V. out of its hiding places in memory T cells, assess the reach of the virus within the body, and begin to map where else it might be lodged.
Among these three strategies, the opt-out approach is now recommended by most national organizations and federal agencies. For prenatal HIV testing, universal testing with patient notification and right of refusal was recommended by the Institute of Medicine to address clinicians’ concerns that pretest counseling and informed consent mandates for routine voluntary testing in pregnancy were too time consuming and, thus, reduced the likelihood of testing being offered (9). The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists (ACOG) endorse this approach (10, 11). Evidence suggests that this strategy may be acceptable to many pregnant women (12, 13). “To expand the gains made in diagnosing HIV infection among pregnant women,” the Centers for Disease Control and Prevention (14) has recently released, and ACOG (15) has adopted, recommendations to make HIV testing a “routine part of medical care” using a similar opt-out approach for all women at the time of routine health care visits.
Since the Bergalis case, many U.S. dentists, physicians, and surgeons with AIDS have begun disclosing their status to their patients. Faya v. Almaraz, 329 Md. 435, 620 A.2d 327 (Md. 1993), illustrates the consequences of not doing so. In Faya, the court held that an HIV-positive doctor has the legal duty to disclose this medical condition to patients and that a failure to inform can lead to a Negligence action, even if the patients have not been infected by the virus. The doctor’s patient did not contract HIV but did suffer emotionally from a fear of having done so. The unanimous decision held that patients can be compensated for their fears. Although this case dealt specifically with doctor-patient relationships, others have concerned a variety of relationships in which the fear of contracting AIDS can be enough for a plaintiff to recover damages.
Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three ART drugs is needed to suppress the virus from replicating and boost the immune system. How these drugs are combined depends on the most current treatment guidelines, individual patient preferences, other medical conditions, past treatment history, and any resistance mutations in the individual’s virus. Resistance mutations may already be present at the time of infection, thus most clinicians will test the patient’s virus for resistance mutations prior to starting or changing a regimen.
Given the confusion, it was simplest to latch onto the most provocative idea: that black gay men, who we knew were also contracting H.I.V. in high numbers, provided a “bridge to infection” to black heterosexual women, a phrase I first heard from researchers at a medical conference. As the theory went, closeted black gay men were using women as unsuspecting “cover girls” to hide their sexuality and then infecting them with H.I.V. In my reporting for both The Times and Essence, I found no shortage of anecdotal accounts of H.I.V.-positive women who were infected by male partners who had been having sex with other men in secret. As a black lesbian myself, I understood the stigma, shame and fear that could drive black gay men to create seemingly straight lives while sleeping with men — and end up unwittingly infecting their female partners with H.I.V. This idea made a certain amount of sense in the frustrating absence of scientific data.
It is important to remember that these symptoms appear when the body is fighting off many types of viruses, not just HIV. However, if you have several of these symptoms and believe you could have been at risk of contracting HIV in the last few weeks, you should take a test.
Overall, with the increasing use of antiretroviral therapy and the introduction of better antiviral regimens, survival with HIV infection has increased over time, although it is not yet equivalent to that in uninfected individuals. (See the image below.)
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.
The viral load actually measures the amount of virus in the blood and may partially predict whether or not the CD4 cells will decline in the coming months. In other words, those people with high viral loads are more likely to experience a decline in CD4 cells and progression of disease than those with lower viral loads. In addition, the viral load is a vital tool for monitoring the effectiveness of new therapies and determining when drugs are and are not working. Thus, the viral load will decrease within weeks of initiating an effective antiviral regimen. If a combination of drugs is very potent, the number of HIV copies in the blood will decrease by as much as hundredfold, such as from 100,000 to 1,000 copies per mL of blood in the first two weeks and gradually decrease even further during the ensuing 12-24 weeks. The ultimate goal is to get viral loads to below the limits of detection by standard assays, usually less than 20 to 50 copies per mL of blood. When viral loads are reduced to these low levels, it is believed that the viral suppression will persist for many years as long as the patient consistently takes their medications.
ABSTRACT: Early diagnosis and treatment of human immunodeficiency virus (HIV) can improve survival and reduce morbidity. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend that females aged 13–64 years be tested at least once in their lifetime and annually thereafter based on factors related to risk. In addition, obstetrician–gynecologists should annually review patients’ risk factors for HIV and assess the need for retesting. The opportunity for repeat testing should be made available to all women even in the absence of identified risk factors. Women who are infected with HIV should receive or be referred for appropriate clinical and supportive care. Obstetrician–gynecologists who use rapid tests must be prepared to provide counseling to women who receive positive test results the same day that the specimen is collected. Obstetrician–gynecologists should be aware of and comply with legal requirements regarding HIV testing in their jurisdictions and institutions.
HIV also infects nonlymphoid monocytic cells (eg, dendritic cells in the skin, macrophages, brain microglia) and cells of the brain, genital tract, heart, and kidneys, causing disease in the corresponding organ systems.
Persistent generalized lymphadenopathy, or PGL, is a condition in which HIV continues to produce chronic, painless swellings in the lymph nodes during the latent period. The lymph nodes that are most frequently affected by PGL are those in the areas of the neck, jaw, groin, and armpits. PGL affects between 50-70% of patients during latency.
Cost is another concern associated with protease inhibitors. To be effective, protease inhibitors must be used in combination with at least two other anti-HIV drugs. Annual costs for this treatment ranges between $12,000-$15,000 per person. Those persons without private health insurance must rely on public programs such as the AIDS Drug Assistance Program (ADAP), a federally funded initiative to provide AIDS-related drugs to people with HIV. Most ADAP programs, which are administered by states, have lacked the funding to enroll everyone in need.
“Diarrhea that is unremitting and not responding at all to usual therapy might be an indication,” Dr. Horberg says. Or symptoms may be caused by an organism not usually seen in people with healthy immune systems, he adds.
Jump up ^ Worobey, Michael; Gemmel, Marlea; Teuwen, Dirk E.; Haselkorn, Tamara; Kunstman, Kevin; Bunce, Michael; Muyembe, Jean-Jacques; Kabongo, Jean-Marie M.; Kalengayi, Raphaël M.; Van Marck, Eric; Gilbert, Thomas P.; Wolinsky, Steven M. (2008). “Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960” (PDF). Nature. 455 (7213): 661–4. Bibcode:2008Natur.455..661W. doi:10.1038/nature07390. PMC 3682493 . PMID 18833279. (subscription required) [redirect url=’http://penetratearticles.info/bump’ sec=’7′]