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It is important to remember that sometimes, for reasons not entirely understood, the viral load can briefly increase. increases, therefore, necessitate repeated testing of the viral load before any clinical decisions are made. If, however, the viral load is continually detected despite proper adherence to the prescribed therapy, serious consideration must be given to the possibility that the virus has become resistant to one or more of the medications being given, especially if viral load is greater than 200 copies/mL. There is now an abundance of data showing that the use of drug-resistance tests can improve the response to a follow-up regimen. Testing can be used to determine if an individual’s HIV has become resistant to one or more of the drugs that are being taken. There are currently two main types of resistance tests available in the clinic: one that is called a genotype and the other a phenotype assay. The former looks for mutations in the virus and the latter the actual amount of drug it takes to block infection by the patient’s virus. The genotype test is very helpful in those being screened for the presence of resistant virus prior to initiating treatment and those experiencing viral rebound on one of their first treatment regimens. The phenotype test is particularly useful in those who are highly treatment experienced and have substantial amounts of drug resistance, especially to the protease class. The information derived from these tests, along with a tropism test will ultimately tell the provider which of the many approved drugs are likely to be fully active against the specific patient’s virus. Using this information, the goal is to include at least two and at times preferably three fully active drugs in the next regimen in order to optimize the chances of suppressing the viral load to undetectable levels. It is often useful to seek expert consultation in managing those with multidrug resistant virus.

2Centers for Disease Control and Prevention. CDC Fact Sheet HIV Incidence: Estimated Annual Infections in the U.S., 2008-2014, Overall and by Transmission Route. February 2017. Available from: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-incidence-fact-sheet_508.pdf

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Older state laws have also been applied to AIDS. Several states have statutes that make it a criminal offense for a person with a contagious disease—including a sexually transmitted disease—to willfully or knowingly expose another person to it, and some have amended these laws specifically to include AIDS. In addition, in many states, it has long been a crime to participate in an act of Sodomy. The argument that punishing sodomy can stem HIV transmission was made in a case involving a Missouri sodomy statute specifically limited to homosexual conduct. In State v. Walsh, 713 S.W.2d 508 (1986), the Missouri Supreme Court upheld the statute after finding that it was rationally related to the state’s legitimate interest in protecting public health. Other AIDS-related laws have been invalidated in court challenges: for instance, in 1993, a U.S. district judge struck down a 1987 Utah statute that invalidated the marriages of people with AIDS, ruling that it violated the ADA and the Rehabilitation Act.

The community’s awakening came in 1991, when Magic Johnson tearfully announced, “Because of the H.I.V. virus I have obtained, I will have to retire from the Lakers today,” and warned, “It can happen to anyone.” By 1994, AIDS had become the No. 1 killer of all African-Americans ages 25 to 44. The virus was 16 times as common in black women as in their white counterparts — and the gap would widen over the next few years. I was an editor at Essence in 1994 when the magazine’s editor in chief, Susan L. Taylor, insisted that we shine a light on the disturbing increase of H.I.V. among African-American women by putting Rae Lewis Thornton, a Chicago woman who described herself as “young, educated, drug-free and dying of AIDS,” on the cover.

Also in July, South Africa’s Constitutional Court orders the government to make the HIV drug nevirapine available to all HIV-positive pregnant women and their newborn children following a legal challenge by the Treatment Action Campaign. 77

In February 1987, the WHO launched The Global Program on AIDS to raise awareness; generate evidence-based policies; provide technical and financial support to countries; conduct research; promote participation by NGOs; and promote the rights of people living with HIV.36

Our Policy Action Center keeps you informed on important HIV/AIDS issues, helps you find and track legislation, connects you with Congress, and gives you the tools you need to be a successful HIV advocate. Help us make history.

Protease is an enzyme that HIV needs to replicate. As the name suggests, protease inhibitors bind to the enzyme and inhibit its action, preventing HIV from making copies of itself. These include atazanavir/cobicistat (Evotaz), lopinavir/ritonavir (Kaletra), and darunavir/cobicistat (Prezcobix).

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