Developing AIDS requires that the person acquire HIV infection. Risks for acquiring HIV infection include behaviors that result in contact with infected blood or sexual secretions, which pose the main risk of HIV transmission. These behaviors include sexual intercourse and injection drug use. The presence of sores in the genital area, like those caused by herpes, makes it easier for the virus to pass from person to person during intercourse. HIV also has been spread to health care workers through accidental sticks with needles contaminated with blood from HIV-infected people, or when broken skin has come into contact with infected blood or secretions. Blood products used for transfusions or injections also may spread infection, although this has become extremely rare (less than one in 2 million transfusions in the U.S.) due to testing of blood donors and blood supplies for HIV. Finally, infants may acquire HIV from an infected mother either while they are in the womb, during birth, or by breastfeeding after birth.
Without treatment, risk of progression to AIDS is about 1 to 2%/yr in the first 2 to 3 yr of infection and about 5 to 6%/yr thereafter. Eventually, AIDS almost invariably develops in untreated patients.
Jump up ^ Zhu T, Wang N, Carr A, Nam DS, Moor-Jankowski R, Cooper DA, Ho DD (1996). “Genetic characterization of human immunodeficiency virus type 1 in blood and genital secretions: evidence for viral compartmentalization and selection during sexual transmission”. Journal of Virology. 70 (5): 3098–107. PMC 190172 . PMID 8627789.
From a legal, ethical, and moral standpoint, they should warn any prospective sexual partner of their HIV positive status. They should not exchange body fluids during sexual activity and must use whatever preventative measures (such as a latex condom) will afford the partner the most protection.
simian-human immunodeficiency virus a chimeric, engineered virus with the envelope of human immunodeficiency virus and the cytoplasm and nucleus of simian immunodeficiency virus; it is used in animal models because it is a better mimic of HIV than SIV is.
“Despite multiple risk factors for HIV acquisition perception of risk was low in over 50% of adolescents and young women from Malawi at highest risk, documenting a major gap requiring mechanistic study.”–Dr. William Blattner, JAIDS Co-Editor-in-Chief
Practising safer sex – use condoms and water based lubricants for penetrative sex. These reduce the risk of getting HIV, as well as other sexually transmitted infections (STIs). Having any STI increases the risk of getting HIV infection.
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 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.
In the United States, guidelines for using antiviral therapy have been developed and are updated on a regular basis by an expert panel assembled by the DHHS, the IAS-USA panel, and others. The DHHS guidelines are available at https://aidsinfo.nih.gov/. The most recent IAS-USA guidelines were published in the Journal of the American Medical Association (JAMA) in the summer of 2016.
^ Jump up to: a b editor, Julio Aliberti, (2011). Control of Innate and Adaptive Immune Responses During Infectious Diseases. New York, NY: Springer Verlag. p. 145. ISBN 978-1-4614-0483-5. Archived from the original on September 24, 2015.
Cultural factors (e.g., stigma, fear, discrimination, and homophobia) might contribute to longer diagnosis delays in some populations (12). Asians accounted for the highest percentage of persons living with undiagnosed HIV infection compared with all other race/ethnicity groups (13). Although blacks were more likely than whites to report testing in the past 12 months across all groups at risk, the median diagnosis delay was 1 year longer for blacks (median = 3.3 years) than for whites (median = 2.2 years). The testing results might reflect national efforts to improve access to testing among blacks, and black MSM in particular, through prevention programs and media campaigns. In 2007, CDC launched the Expanded Testing Initiative (https://www.cdc.gov/hiv/policies/eti.html) to facilitate HIV diagnosis and linkage to care among blacks and continues to support high levels of testing. CDC’s MSM Testing Initiative (https://www.researchgate.net/publication/287201580) scaled up HIV testing and linkage-to-care activities among black and Hispanic or Latino MSM in 11 cities. In addition, CDC implemented Testing Makes Us Stronger (https://www.cdc.gov/actagainstaids/campaigns/tmus), a public education campaign to increase testing among black MSM, from 2011 to 2015.
Teaching young people about AIDS is an enormously popular idea. Since the late 1980s, Gallup Polls have revealed that over 90 percent of respondents think public schools should do so. Agreement ends there, however. In the 1990s, more angry debate focused on AIDS education than on any issue facing schools since court-ordered busing in the 1970s. The core question of the debate is simple: What is the best way to equip students to protect themselves from this fatal disease? The answers may be miles apart. For one side, “equipping” means advocating the only sure means of protection, sexual and drug abstinence. For the other, it means supporting abstinence along with knowledge of sexual practices, the use of clean drug needles, and the use of prophylactics (condoms), which are distributed in some schools. Between these positions lie a great many issues of disagreement that have bitterly divided school districts, provoked lawsuits, and cost high-ranking Washington, D.C., officials their jobs.
Each year about 5 million people contract AIDS worldwide, and 3 million die of it. Some 40-50 million are estimated to be living with the disease. The gender incidence is approximately equal. The highest prevalence is in some African countries, where as many as 25% of the adult population may test HIV positive; about 70% of the world’s infected population lives in sub-Saharan Africa. The first cases of AIDS were reported in the U.S. in June 1981. During the succeeding 2 decades an estimated 1.4 million people in this country were infected with HIV and 816,149 cases of AIDS and 467,910 deaths were reported to the U.S. Centers for Disease Control and Prevention (CDC). The numbers of new AIDS cases and deaths declined substantially after introduction of combination antiretroviral therapy in the late 1990s. The annual number of new cases of AIDS in the U.S. has remained stable at about 40,000, with 16,000 deaths since 1998. The number of people infected with HIV continues to increase, and of an estimated 1 million, one fourth are unaware that they are infected. In the U.S., AIDS is the leading cause of death among men 25-44 years old, and the fourth leading cause of death among women in the same age group. The development of effective antiretroviral agents (for example, reverse transcriptase inhibitors and protease inhibitors) and of quantitative plasma HIV RNA assays that can monitor progression of disease and response to treatment has shifted the goal of management in AIDS from prophylaxis and treatment of opportunistic infections to achievement of remission through suppressive therapy. Immune compromise is monitored by serial CD4 counts, viral replication by plasma HIV RNA assay (that is, plasma viral load, PVL). Indications for starting antiretroviral therapy are the appearance of symptoms of opportunistic infection, decline of the CD4 count below 350/mm3, or viral load exceeding 30,000 copies/mL. The CD4 count is considered a more sensitive predictor of disease progression than viral load. Empiric treatment may be begun early (within 6 months after conversion to HIV-positive status) in an effort to preserve immune function and mobilize the patient’s own defenses against the virus. But current guidelines advise deferring treatment as long as possible so as to limit induction of drug resistance. Protease inhibitors have been shown to be highly effective antiretroviral agents and standard treatment regimens combining 2 reverse transcriptase inhibitors with 1 protease inhibitor (“triple therapy”) have clearly demonstrated superiority over monotherapy. These drugs are expensive. Regimens are often complex, with varying requirements for fasting and timing of doses, and adverse effects and drug interactions are common. Protease inhibitors have been associated with elevation of cholesterol and triglycerides, insulin resistance, and disfiguring lipodystrophy. In one large study, more than one half of HIV-infected adults under treatment were found to be infected with strains of virus resistant to one or more antiretroviral drugs, and strains of HIV that are resistant to all available protease inhibitors have appeared. The rationale for current AIDS regimens is an effort to eradicate HIV infection by inhibiting spread of virus to new cells until all infected cells have died. However, actual cure seldom if ever occurs. A small number of resting CD4 memory cells in treated patients with undetectable plasma HIV RNA levels harbor HIV proviral DNA capable of replication, and these cells may survive for months or years. Macrophages and CNS neurons may serve as an anatomic sanctuary for HIV into which antretroviral drugs cannot penetrate in adequate concentration. When antiretroviral therapy is initiated early, CD4 helper cell counts rise, CD4 cell activity is preserved, and HIV RNA levels may remain undetectable for long periods. But in about 50% of patients with advanced disease, even multidrug regimens fail to suppress plasma viral RNA to undetectable levels. Many treatment failures result from poor compliance with multidrug regimens. Failure of one therapeutic regimen often precludes success with others because of the high degree of cross-resistance among antiretroviral drugs. After failure of an initial regimen, genotypic testing can be used to identify mutations in the HIV genome that confer resistance to one or more classes of HIV drugs. Many patients remain vulnerable to opportunistic infections despite restoration of CD4 counts to normal, probably because some subpopulations of T cells have been annihilated and cannot be recovered even after HIV has been suppressed. Moreover, even HIV-infected patients with undetectable viral loads must still be considered infectious. In a small set of those infected with HIV, impairment of immunity progresses to AIDS slowly or not at all. CD8 T-cells from such nonprogressors have been found to produce proteins called α-defensins. Evolving standards of treatment in HIV disease include aggressive prophylaxis in pregnancy and after accidental needle stick and sexual assault. Administration of antiretroviral agents to HIV-positive mothers before birth and during labor and delivery, and to newborns for the first 6 weeks of life, markedly decrease the risk of vertical transmission of HIV infection. The risk of HIV infection after occupational parenteral exposure to blood from an HIV-infected patient is approximately 0.3%. Postexposure prophylaxis with antiretroviral agents continued for 28 days have been shown to reduce the risk by 80%. The selection of agents depends on the source patient’s therapeutic history. Efforts to develop a vaccine against HIV have been hampered by the unique properties of the virus and the long incubation period of AIDS. Early in the 21st century, public health authorities sought to make HIV testing a routine part of medical care, to facilitate diagnosis outside formal clinical settings, to prevent new infections by educating people and their sexual partners, and to decrease perinatal HIV transmission through routine HIV testing of pregnant women and of infants whose mothers were not screened.
Compliance with medications is important to provide the best outcome for mother and child. Even though a physician might highly recommend a medication regimen, the pregnant woman has a choice of whether or not to take the medicines. Studies have shown that compliance is improved when there is good communication between the woman and her doctor, with open discussions about the benefits and side effects of treatment. Compliance also is improved with better social support, including friends and relatives.
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. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]