Key populations are groups who are at increased risk of HIV irrespective of epidemic type or local context. They include: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and their clients, and transgender people.
^ Jump up to: a b Kallings LO (2008). “The first postmodern pandemic: 25 years of HIV/AIDS”. Journal of Internal Medicine. 263 (3): 218–43. doi:10.1111/j.1365-2796.2007.01910.x. PMID 18205765.(subscription required)
^ Jump up to: a b c d Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach (PDF). World Health Organization. 2010. pp. 19–20. ISBN 978-92-4-159976-4. Archived (PDF) from the original on July 9, 2012.
For each of these diseases, genomic interventions are being conducted in all over the world. In the Health Professionals Resources section, one can find examples of best practices in genomics applications to these common diseases.
Beginning in the late ’90s, the United States government funneled billions of federal dollars into abstinence-until-marriage programs here and abroad. In place of effective sex education, these programs often discouraged condom use while teaching abstinence as the only way to prevent the spread of AIDS — even as well-regarded research established that this kind of sex education does not lower the risk of contracting H.I.V. and other sexually transmitted diseases.
June Gipson, president and chief executive of My Brother’s Keeper, the Jackson nonprofit Cedric Sturdevant works for, believes that the repeal of the Affordable Care Act wouldn’t have an immediate catastrophic effect in her state — but only because things are already so dire. Like most of the South, Mississippi refused Medicaid expansion, and nearly half of its citizens who are living with H.I.V. rely on the Ryan White H.I.V./AIDS Program to stay alive. Named for an Indiana teenager who contracted H.I.V. through a blood transfusion in the ’80s, this federal program provides funding for H.I.V. treatment and care for those who have no other way to finance their medication. If the A.C.A. is repealed, Gipson said, “it just means that the entire country becomes Mississippi.”
^ Jump up to: a b Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA (2002). “HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?”. AIDS. 16 (4): 597–632. doi:10.1097/00002030-200203080-00011. PMID 11873003.
Dutch HIV-ziekte, humaan immunodeficiëntievirusinfectie, niet-gespecificeerd, HIV-infectie NAO, humaan immunodeficiëntievirussyndroom, HIV-ziekte; aandoening (als gevolg), HIV-ziekte; infectie, Humaan Immunodeficiëntievirus; ziekte, aandoening; HIV-ziekte (als gevolg van HIV-ziekte), aandoening; als gevolg van HIV-ziekte, immunodeficiëntievirus-ziekte; humaan, infectie; HIV-ziekte als oorzaak, Niet gespecificeerd ziekte door Humaan Immunodeficiëntievirus [HIV], HIV-infectie, HIV-infecties, HTLV-III-LAV-infectie, HTLV-III-infectie, Infecties, HIV-
The World Health Organization first proposed a definition for AIDS in 1986. Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007. The WHO system uses the following categories:
The source is qualified by whether is known or unknown. If the source is unknown (eg, a needle on the street or in a sharps disposal container), risk should be assessed based on the circumstances of the exposure (eg, whether the exposure occurred in an area where injection drug use is prevalent, whether a needle discarded in a drug-treatment facility was used). If the source is known but HIV status is not, the source is assessed for HIV risk factors, and prophylaxis is considered (see Table: Postexposure Prophylaxis Recommendations).
A 2011 trial has confirmed that if an HIV-positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. The WHO recommendation to initiate ART in all people living with HIV will contribute significantly to reducing HIV transmission.
In Seattle, a group headed by Hans-Peter Kiem and Keith Jerome is taking a more futuristic approach. Using an enzyme called Zinc Finger Nuclease, they are genetically altering blood and marrow stem cells so as to disable CCR5, the doorway for infection in T cells. Researchers will modify the stem cells outside the body, so that when the cells are returned some portion of the T cells in the bloodstream will be resistant to H.I.V. infection. Over time, they hope, those cells will propagate, and the patient will slowly build an immune system that is resistant to the virus. Those patients might still have a small reservoir of H.I.V., but their bodies would be able to regulate the infection.
Once the virus has infected a T cell, HIV copies its RNA into a double-stranded DNA copy by means of the viral enzyme reverse transcriptase; that process is called reverse transcription, because it violates the usual way in which genetic information is transcribed. Because reverse transcriptase lacks the “proofreading” function that most DNA-synthesizing enzymes have, many mutations arise as the virus replicates, further hindering the ability of the immune system to combat the virus. Those mutations allow the virus to evolve very rapidly, approximately one million times faster than the human genome evolves. That rapid evolution allows the virus to escape from antiviral immune responses and antiretroviral drugs. The next step in the virus life cycle is the integration of the viral genome into the host cell DNA. Integration occurs at essentially any accessible site in the host genome and results in the permanent acquisition of viral genes by the host cell. Under appropriate conditions those genes are transcribed into viral RNA molecules. Some viral RNA molecules are incorporated into new virus particles, whereas others are used as messenger RNA for the production of new viral proteins. Viral proteins assemble at the plasma membrane together with the genomic viral RNA to form a virus particle that buds from the surface of the infected cell, taking with it some of the host cell membrane that serves as the viral envelope. Embedded in that envelope are the gp120/gp41 complexes that allow attachment of the helper T cells in the next round of infection. Most infected cells die quickly (in about one day). The number of helper T cells that are lost through direct infection or other mechanisms exceeds the number of new cells produced by the immune system, eventually resulting in a decline in the number of helper T cells. Physicians follow the course of the disease by determining the number of helper T cells (CD4+ cells) in the blood. That measurement, called the CD4 count, provides a good indication of the status of the immune system. Physicians also measure the amount of virus in the bloodstream—i.e., the viral load—which provides an indication of how fast the virus is replicating and destroying helper T cells.
HIV infection does not immediately cause AIDS, and the issues of how it does, and whether all HIV-infected patients will progress to overt disease, remain controversial. Nevertheless, accumulating evidence clearly implicates the growth of the virus in CD4 T cells, and the immune response to it, as the central keys to the puzzle of AIDS. HIV is a worldwide pandemic and, although great strides are being made in understanding the pathogenesis and epidemiology of the disease, the number of infected people around the world continues to grow at an alarming rate, presaging the death of many people from AIDS for many years to come. Estimates from the World Health Organization are that 16.3 million people have died from AIDS since the beginning of the epidemic and that there are currently around 34.3 million people alive with HIV infection (Fig. 11.19), of whom the majority are living in sub-Saharan Africa, where approximately 7% of young adults are infected. In some countries within this region, such as Zimbabwe and Botswana, over 25% of adults are infected. (AIDS in Mother and Child, in Case Studies in Immunology, see Preface for details)
Stage IV (also known as AIDS): The immune system is now severely damaged and the symptoms become even more severe. The person is now severely wasted, has severe recurrent bacterial infections, develops cancers such as Kaposi sarcoma, and other infections like Pneumocystis carinii pneumonia (PCP), toxoplasmosis and HIV encephalopathy.
Greg Millett, a senior scientist for the C.D.C. for 14 years and a senior policy adviser for the Obama administration’s White House Office of National AIDS Policy, put it more candidly. “During the Bush years, the administration dropped all pretense that they cared about AIDS in this country,” said Millett, who is now the vice president and director of public policy at amfAR, the Foundation for AIDS Research. “The White House said H.I.V. is only a problem in sub-Saharan Africa, and that message filtered down to the public. Though the Bush administration did wonderful work in combating H.I.V. globally, the havoc that it wreaked on the domestic epidemic has been long-lasting.”
A person gets HIV when an infected person’s body fluids (blood, semen, fluids from the vagina or breast milk) enter his or her bloodstream. The virus can enter the blood through linings in the mouth, anus, or sex organs (the penis and vagina), or through broken skin. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]