However, with effective treatment, the HIV RNA level decreases to undetectable levels, CD4 counts increase dramatically, and people can continue to lead productive, active lives. The risk of illness and death decreases but remains higher than that of people who are of similar age and who are not infected with HIV. However, if people cannot tolerate or take drugs consistently, HIV infection and immune deficiency progresses, causing serious symptoms and complications.
In individuals not infected with HIV, the CD4 count in the blood is normally above 400 cells per mm3 of blood. People generally do not become at risk for HIV-specific complications until their CD4 cells are fewer than 200 cells per mm3. At this level of CD4 cells, the immune system does not function adequately and is considered severely suppressed. A declining number of CD4 cells means that HIV disease is advancing. Thus, a low CD4 cell count signals that the person is at risk for one of the many opportunistic infections that occur in individuals who are immunosuppressed. In addition, the actual CD4 cell count indicates which specific therapies should be initiated to prevent those infections.
Because of the inaccurate results, the FDA has not approved any of the home-use HIV tests which allow people to interpret their tests in a few minutes at home. There is however a Home Access test approved which can be found at most drugstores. In this test blood from a finger prick is placed on a card and sent to a licensed lab. Consumers are given an identification number to use when phoning for results and have the opportunity to speak with a counselor if desired.
Merely having HIV does not mean a person has AIDS. AIDS is an advanced stage of HIV infection and requires that the person have evidence of a damaged immune system. That evidence comes from at least one of the following:
HIV-1 is the most common and pathogenic strain of the virus. Scientists divide HIV-1 into a major group (Group M) and two or more minor groups, namely Group N, O and possibly a group P. Each group is believed to represent an independent transmission of SIV into humans (but subtypes within a group are not). A total of 39 ORFs are found in all six possible reading frames (RFs) of HIV-1 complete genome sequence, but only a few of them are functional.
The first available drug in this class was RAL, which is very potent at suppressing HIV in all patients who have never been on this drug or others in the class. It was initially approved for treatment-experienced patients with drug-resistant virus. It is also now approved for those starting therapy for the first time. The approved dose of RAL is 400 mg twice daily with a recently approved new formulation that can be given to those starting therapy for the first time or stably suppressed on RAL twice daily that can be given as two 600 mg tablets once daily. As noted above, a second drug in this class, EVG, is approved for use as first-line therapy as part of the fixed-dose combination pill of TDF/FTC/COBI/EVG and more recently TAF/FTC/COBI/EVG as a stand-alone drug for use in treatment-experienced patients combining it with a ritonavir-boosted PI. This drug is well tolerated and given as one pill per day, but unlike RAL it does need to be taken with food and it has interactions with other drugs since it must be used with RTV or COBI, so it must be used with caution in those on multiple medications. Another InSTI, DTG is currently recommended for those starting therapy for the first time with either TDF/FTC or ABC/3TC and is available as a fixed-dose combination of ABC/3TC/DTG that can be given as a single pill per day. This drug has a limited number of drug-drug interactions and is generally well tolerated with resistance rarely emerging in those experience virologic failure. Another InSTI in advanced stages of development is called bictegravir (BIC) that has few drug-drug interactions, is potent, well-tolerated, and can be given with or without food. It is expected to be approved as a single-tablet regimen as BIC/FTC/TAF.
The election of Barack Obama brought renewed attention to the domestic epidemic and loosened the conservative grip on the federal government’s prevention and research agenda. At the first post-Bush national H.I.V.-prevention conference in 2009, Christopher Bates, then the director of H.I.V./AIDS policy for Health and Human Services and interim executive director of the Presidential Advisory Council on H.I.V./AIDS, kicked off the event in Atlanta by jumping onstage with duct tape on his mouth, ripping it off and shouting, “Finally, I can speak!” On World AIDS Day in 2011, Obama directly addressed the H.I.V. crisis among gay black men in a speech at George Washington University: “When new infections among young black gay men increase by nearly 50 percent in three years, we need to do more to show them that their lives matter.”
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 ^ Levy JA, Kaminsky LS, Morrow WJW, Steimer K, Luciw P, Dina D, Hoxie J, Oshiro L (1985). “Infection by the retrovirus associated with the acquired immunodeficiency syndrome”. Annals of Internal Medicine. 103: 694–699. doi:10.7326/0003-4819-103-5-694.
Jump up ^ Chitnis A, Rawls D, Moore J (2000). “Origin of HIV type 1 in colonial French equatorial Africa?”. AIDS Research and Human Retroviruses. (1): 5–8. doi:10.1089/088922200309548. PMID 10628811.
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 referred 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.
Mandatory testing strategies are problematic because they abridge a woman’s autonomy. In addition, during pregnancy, the public health objective of this strategy, identification of women who are infected with HIV who will benefit from treatment, has been accomplished in certain populations by other ethically sound testing strategies noted previously (6). Some see mandatory testing as a more efficient way of achieving universal testing. Advocates support this strategy, believing it provides the greatest good for the greatest number and that the potential benefit to the woman and, if pregnant, her newborn justifies abridging a woman’s autonomy. However, because of the limits it places on autonomy, the Committee on Ethics believes that mandatory HIV screening without informing those screened and offering them the option of refusal is inappropriate. Mandatory prenatal testing is difficult to defend ethically and has few precedents in modern medicine, although HIV testing of newborns is now required in New York, Connecticut, and Illinois (There are provisions, however, that permit refusal in a few defined circumstances.) (7, 8). Importantly, mandatory testing may compromise the ability to form an effective physician–patient relationship at the very time when this relationship is critical to the success of treatment.
Wasting syndrome. Aggressive treatment approaches have reduced the number of cases of wasting syndrome, but it still affects many people with AIDS. It’s defined as a loss of at least 10 percent of body weight, often accompanied by diarrhea, chronic weakness and fever.
A generalized graph of the relationship between HIV copies (viral load) and CD4 counts over the average course of untreated HIV infection; any particular individual’s disease course may vary considerably.
Editorial Note: CDC defines a case of AIDS as a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease. Such diseases include KS, PCP, and serious OOI.((S)) Diagnoses are considered to fit the case definition only if based on sufficiently reliable methods (generally histology or culture). However, this case definition may not include the full spectrum of AIDS manifestations, which may range from absence of symptoms (despite laboratory evidence of immune deficiency) to non-specific symptoms (e.g., fever, weight loss, generalized, persistent lymphadenopathy) (4) to specific diseases that are insufficiently predictive of cellular immunodeficiency to be included in incidence monitoring (e.g., tuberculosis, oral candidiasis, herpes zoster) to malignant neoplasms that cause, as well as result from, immunodeficiency((P)) (5). Conversely, some patients who are considered AIDS cases on the basis of diseases only moderately predictive of cellular immunodeficiency may not actually be immunodeficient and may not be part of the current epidemic. Absence of a reliable, inexpensive, widely available test for AIDS, however, may make the working case definition the best currently available for incidence monitoring.
Jump up ^ Daecke J, Fackler OT, Dittmar MT, Kräusslich HG (2005). “Involvement of clathrin-mediated endocytosis in human immunodeficiency virus type 1 entry”. Journal of Virology. 79 (3): 1581–1594. doi:10.1128/jvi.79.3.1581-1594.2005. PMC 544101 . PMID 15650184.
Jump up ^ Thorley JA, McKeating JA, Rappoport JZ (2010). “Mechanis ms of viral entry: sneaking in the front door”. Protoplasma. 244 (1–4): 15–24. doi:10.1007/s00709-010-0152-6. PMC 3038234 . PMID 20446005.
Hecht FM, Wang L, Collier A, et al. A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection. J Infect Dis. 2006 Sep 15. 194(6):725-33. [Medline].
HIV infection takes different forms within different cells. As we have seen, more than 95% of the virus that can be detected in the plasma is derived from productively infected cells, which have a very short half-life of about 2 days. Productively infected CD4 lymphocytes are found in the T-cell areas of lymphoid tissue, and these are thought to succumb to infection in the course of being activated in an immune response. Latently infected memory CD4 cells that are activated in response to antigen presentation also produce virus. Such cells have a longer half-life of 2 to 3 weeks from the time that they are infected. Once activated, HIV can spread from these cells by rounds of replication in other activated CD4 T cells. In addition to the cells that are infected productively or latently, there is a further large population of cells infected by defective proviruses; such cells are not a source of infectious virus.
Being HIV-positive, or having HIV disease, is not the same as having AIDS. Many people are HIV-positive but don’t get sick for many years. As HIV disease continues, it slowly wears down the immune system. Viruses, parasites, fungi and bacteria that usually don’t cause any problems can make you very sick if your immune system is damaged. These are called “opportunistic infections.” See Fact Sheet 500 for an overview of opportunistic infections. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]