Lingappa JR, Baeten JM, Wald A, Hughes JP, Thomas KK, Mujugira A, et al. Daily acyclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial. Lancet. 2010 Mar 6. 375(9717):824-33. [Medline]. [Full Text].
In light of the limited ability of counseling and testing to curb the spread of the HIV pandemic, many researchers have moved toward other biologic strategies for preventing HIV that do not rely solely on people changing their behavior. It is in this area where there has been some success. During the last 10 years, there were several large studies showing that male circumcision along with behavioral counseling reduced the risk of heterosexual men acquiring HIV infection. This provides a novel prevention strategy for at-risk, HIV-uninfected heterosexual men. Another major advance on the prevention front came from the HPTN 052 study in which HIV-infected individuals with CD4 cells between 350 cells/mm3 and 550 cells/mm3 who had uninfected partners were randomly assigned to initiate antiviral therapy or wait until their CD4 cells declined to less than 250 cells/mm3 or they developed symptoms consistent with disease progression. All enrolled individuals were aggressively counseled about continued safe sex practices, provided condoms, and were monitored for sexual activities. The study ultimately showed that those treated early were more than 96% less likely to transmit to their partner than those who had antiviral treatment deferred. Subsequent cohort studies have shown that those who are virologically suppressed on antiretroviral therapy for at least six months have a very low risk of transmitting to uninfected partners, even when not using condoms. In fact, many groups have suggested that the risk in this setting of HIV transmission may be virtually zero based upon the existing data.
HIV has been transmitted when organs (kidneys, livers, hearts, pancreases, bone, and skin) from infected donors were unknowingly used as transplants. HIV transmission is unlikely to occur when corneas or certain specially treated tissues (such as bone) are transplanted.
99. UNAIDS (2016) ‘UNAIDS announces 18.2 million people on antiretroviral therapy, but warns that 15–24 years of age is a highly dangerous time for young women’ (Accessed 24/01/2017), WHO (2016) ‘Global report on early warning indicators for HIV drug resistance’
The development of rapid HIV tests is another mechanism to support HIV testing and management. Until recently, HIV testing was performed using the repeatedly reactive enzyme immunoassay followed by confirmatory Western blot or immunofluorescence assay. Although this test is very accurate, the results are not available for 24–48 hours after testing. In contrast, a rapid HIV test is a screening test with results that are available quickly, ideally within an hour. Rapid tests include point-of-care tests performed outside a laboratory (eg, an oral swab testing done in an outpatient setting) as well as testing performed in a laboratory. The tests currently approved by the U.S. Food and Drug Administration range in specificity from 93% to 100% with a sensitivity of 98.6–100% (11). The use of rapid HIV tests may provide test results to patients in a timelier manner and may reduce challenges related to loss to follow-up. Although a positive rapid test result is preliminary and must be confirmed with additional testing, a negative rapid test result does not require any additional testing. Therefore, rapid testing may be a feasible and acceptable approach for an HIV screening program in an obstetric–gynecologic practice (12).
Sexual contact with an infected person, when the mucous membrane lining the mouth, vagina, penis, or rectum is exposed to body fluids such as semen or vaginal fluids that contain HIV, as occurs during unprotected sexual intercourse
Sheen’s third marriage, to actress Brooke Mueller, was also contentious. The two married in 2008 and divorced three years later, time that included Sheen’s arrest on suspicion of domestic abuse and rehab stints for both. A custody battle ensued after the divorce, but the two are getting along for now.
Oral PrEP of HIV is the daily use of ARV drugs by HIV-negative people to block the acquisition of HIV. More than 10 randomized controlled studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among a range of populations including serodiscordant heterosexual couples (where one partner is infected and the other is not), men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.
Acronym for acquired immune deficiency (or immunodeficiency) syndrome; disorder of the immune system characterized by opportunistic diseases, including candidiasis, Pneumocystis jiroveci pneumonia, oral hairy leukoplakia, herpes zoster, Kaposi sarcoma, toxoplasmosis, isosporiasis, cryptococcosis, non-Hodgkin lymphoma, and tuberculosis. The syndrome is caused by the human immunodeficiency virus (HIV-1, groups M and O, and HIV-2), which is transmitted in body fluids (notably breast milk, blood, and semen) through sexual contact, sharing of contaminated needles (by IV drug abusers), accidental needle sticks, contact with contaminated blood, or transfusion of contaminated blood or blood products. Hallmark of the immunodeficiency is depletion of T4+ or CD4+ helper/inducer lymphocytes, primarily the result of selective tropism of the virus for the lymphocytes.
HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk, resulting in the baby also contracting HIV. This is the third most common way in which HIV is transmitted globally. In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%. As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%. Preventive treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in those who do breastfeed. However, many of these measures are not available in the developing world. If blood contaminates food during pre-chewing it may pose a risk of transmission.
Voluntary testing with counseling is the strategy most consistent with respect for patient autonomy. Under this option, physicians provide both pretest and posttest counseling. Some physicians may perform such counseling themselves, whereas others may prefer to refer the patient for counseling and testing. (Such specialized HIV counseling was more widely available in previous years but has become less available as more health care professionals have become more comfortable treating patients with HIV and as the opt-out approach to testing—an approach that places less emphasis on pretest counseling—has become more common.) In addition to medical information, such counseling could include information regarding potential uses of test information and legal requirements pertaining to the release of information. Patients should be told what information will be communicated and to whom and the possible implications of reporting the information. This approach to testing maintains HIV’s status as being in a class by itself (sui generis), even as many ethicists have acknowledged the end to the exceptionalism that marked this disease in the early years of the epidemic (5).
The bias that black gay and bisexual men still face poisons the H.I.V. picture in Mississippi and throughout the South. In 2016, Gov. Phil Bryant of Mississippi signed HB 1523, the Protecting Freedom of Conscience From Government Discrimination Act, one of the country’s most sweeping and repressive anti-L.G.B.T. laws. Though currently blocked by federal court and under appeal, the legislation, if allowed to proceed, would allow churches, religious charities and private businesses to deny services in a broad variety of contexts to L.G.B.T. people.
HIV, or human immunodeficiency virus, attacks the immune system by destroying white blood cells, which are vital to fighting infection. Once enough of these cells have been destroyed and the person has another “opportunistic” infection like pneumonia or tuberculosis, the diagnosis moves to the final stage of the infection, called AIDS.
A poor CD4 count response is more likely if the CD4 count at initiation of treatment is low (especially if < 50/μL) and/or the HIV RNA level is high. However, marked improvement is likely even in patients with advanced immunosuppression. An increased CD4 count correlates with markedly decreased risk of opportunistic infections, other complications, and death. With immune restoration, patients, even those with complications that have no specific treatment (eg, HIV-induced cognitive dysfunction) or that were previously considered untreatable (eg, progressive multifocal leukoencephalopathy), may improve. Outcomes are also improved for patients with cancers (eg, lymphoma, Kaposi sarcoma) and most opportunistic infections. Sex with an infected partner without using a condom or other barrier protection can transmit HIV. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex. Anal intercourse, followed by vaginal intercourse, are the primary risk factors. Oral sex is less likely to transmit HIV, but studies have shown that it can transmit both HIV and other sexually transmitted diseases (STDs). ^ Jump up to: a b c Herek GM, Capitanio JP (1999). "AIDS Stigma and sexual prejudice" (PDF). American Behavioral Scientist. 42 (7): 1130–1147. doi:10.1177/0002764299042007006. Archived from the original (PDF) on April 9, 2006. Retrieved March 27, 2006. Jump up ^ Tolli, MV (May 28, 2012). "Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies". Health education research. 27 (5): 904–13. doi:10.1093/her/cys055. PMID 22641791. The impact of AIDS in southern Africa has been devastating. Some communities have been very hard hit with many deaths and economic hardship related to loss of the workforce of young adults. However, significant progress has been made in the last decade. South Africa has the largest antiviral roll-out programme in the world. Campaigns to reduce homophobia are encouraging MSM to declare their sexuality and come forward for testing and treatment. Innovative work with sex workers and injectable drug users, antiretroviral treatment of children, condom distribution programmes and mother-to-child transmission prevention services are all beginning to bear fruit. Life expectancy has increased by five years since the height of the epidemic.With a prevalence of 17.9% and a population of 6.1 million, South Africa has the largest HIV epidemic of any country. In neighbouring countries in southern Africa, the prevalance ranges from 10-15%. As of 2010, there are 8 known HIV-2 groups (A to H). Of these, only groups A and B are pandemic. Group A is found mainly in West Africa, but has also spread globally to Angola, Mozambique, Brazil, India, Europe, and the US. Despite the presence of HIV-2 globally, Group B is mainly confined to West Africa. Despite its relative confinement, HIV-2 should be considered in all patients exhibiting symptoms of HIV that not only come from West Africa, but also anyone who has had any body fluid transfer with a person from West Africa (i.e. needle sharing, sexual contact, etc.). In viruses that have membranes, membrane-bound viral proteins are synthesized by the host cell and move, like host cell membrane proteins, to the cell surface. When these proteins assemble to form the capsid, part of the host cell membrane is pinched off to form the envelope of the virion. A Pakistani technician takes samples in a laboratory alongside a ribbon promoting World Aids Day in Islamabad on November 30, 2013. Researchers in the United States believe there may finally be an HIV vaccine within 10 years. In the United States, 1.2 million people aged 13 years or older were estimated to have HIV infection in 2012. About 12.8% of them do not know they have HIV infection. About 50,000 new cases are estimated to occur each year in the United States. Most new infections occur in gay and bisexual men, and black men and black women are disproportionately affected (see also HIV in the United States: At A Glance). ^ Jump up to: a b Chou R, Huffman LH, Fu R, Smits AK, Korthuis PT (July 2005). "Screening for HIV: a review of the evidence for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 143 (1): 55–73. doi:10.7326/0003-4819-143-1-200507050-00010. PMID 15998755. Opt-out testing removes the requirement for pretest counseling and detailed, testing-related informed consent. Under the opt-out strategy, physicians must inform patients that routine blood work will include HIV testing and that they have the right to refuse this test. The goal of this strategy is to make HIV testing less cumbersome and more likely to be performed by incorporating it into the routine battery of tests (eg, the first-trimester prenatal panel or blood counts and cholesterol screening for annual examinations). In theory, if testing barriers are reduced, more physicians may offer testing, which may lead to the identification and treatment of more women who are infected with HIV and, if pregnant, to the prevention of mother-to-infant transmission of HIV. This testing strategy aims to balance competing ethical considerations. On the one hand, personal freedom (autonomy) is diminished. On the other hand, there are medical and social benefits for the woman and, if she is pregnant, her newborn from identifying HIV infection. Although many welcome the now widely endorsed opt-out testing policy for the potential benefits it confers, others have raised concerns about the possibility that the requirement for notification before testing will be ignored, particularly in today's busy practice environment. Indeed, the opt-out strategy is an ethically acceptable testing strategy only if the patient is given the option to refuse testing. In the absence of that notification, this approach is merely mandatory testing in disguise. If opt-out testing is elected as a testing strategy, a clinician must notify the patient that HIV testing is to be performed. Refusal of testing should not have an adverse effect on the care the patient receives or lead to denial of health care. This guarantee of a right to refuse testing ensures that respect for a woman's autonomy is not completely abridged in the quest to achieve a difficult-to-reach public health goal. Medications that fight HIV are called antiretroviral medications. Different antiretroviral medications target the virus in different ways. When used in combination with each other, they are very effective at suppressing the virus. It is important to note that there is no cure for HIV. ART only suppresses reproduction of the virus and stops or delays the disease from progressing to AIDS. Most guidelines currently recommend that all HIV-infected people who are willing to take medications should have them initiated shortly after diagnosed with the infection. This delays or prevents disease progression, improves overall health of an infected person, and makes it less likely that they will transmit the virus to their partners. By the end of 1990, over 307,000 AIDS cases had been officially reported with the actual number estimated to be closer to a million. Between 8-10 million people were thought to be living with HIV worldwide.50 As the center of the epidemic has moved from New York and San Francisco to the smaller cities in the South, and from gay white men of means to poorer people of color, L.G.B.T. advocacy and fund-raising has shifted to marriage equality. In 2013, H.I.V. activists persuaded 35 L.G.B.T. leaders to sign a statement and create a video imploring the greater gay community to recommit to the AIDS struggle. The message: “We need you to come back.” But of $168 million in H.I.V./AIDS philanthropic dollars spent in the United States in 2015, $31 million was disbursed to the South, just 19 percent of total H.I.V. philanthropy in the United States; only $26 million directly targeted African-Americans, and just $16 million went directly to gay and bisexual men, according to the organization Funders Concerned About AIDS. This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. [redirect url='http://penetratearticles.info/bump' sec='7']