HIV is present to variable degrees in the blood and genital secretions of virtually all untreated individuals infected with HIV, regardless of whether or not they have symptoms. The spread of HIV can occur when these secretions come in contact with tissues such as those lining the vagina, anal area, mouth, eyes (the mucus membranes), or with a break in the skin, such as from a cut or puncture by a needle. The most common ways in which HIV is spreading throughout the world include sexual contact, sharing needles, and by mother-to-child transmission during pregnancy, labor (the delivery process), or breastfeeding. (See the section below on treatment during pregnancy for a discussion on reducing the risk of transmission to the newborn.)
Jump up ^ Bobkov AF, Kazennova EV, Selimova LM, et al. (October 2004). “Temporal trends in the HIV-1 epidemic in Russia: predominance of subtype A”. J. Med. Virol. 74 (2): 191–6. doi:10.1002/jmv.20177. PMID 15332265.
In May 2007, the WHO and UNAIDS issued new guidance recommending “provider-initiated” HIV testing in healthcare settings. This aimed to widen knowledge of HIV status and greatly increase access to HIV treatment and prevention.83
Barre-Sinoussi F, Chermann JC, Rey F, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983 May 20. 220(4599):868-71. [Medline].
Pruss D, Bushman FD, Wolffe AP. Human immunodeficiency virus integrase directs integration to sites of severe DNA distortion within the nucleosome core. Proc Natl Acad Sci U S A. 1994 Jun 21. 91(13):5913-7. [Medline].
Jump up ^ Sharp PM, Bailes E, Chaudhuri RR, Rodenburg CM, Santiago MO, Hahn BH (2001). “The origins of acquired immune deficiency syndrome viruses: where and when?” (PDF). Philosophical Transactions of the Royal Society B. 356 (1410): 867–76. doi:10.1098/rstb.2001.0863. PMC 1088480 . PMID 11405934.
HIV infection is often diagnosed through rapid diagnostic tests (RDTs), which detect the presence or absence of HIV antibodies. Most often these tests provide same-day test results, which are essential for same day diagnosis and early treatment and care.
State Legislation and the Courts To stem transmission of HIV, states have adopted several legal measures. Two states attempted to head off the virus at the pass: Illinois and Louisiana at one point required HIV blood testing as a prerequisite to getting a marriage license. Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states. Several states have taken a less stringent approach, requiring only that applicants for a marriage license must be informed of the availability—and advisability—of HIV tests. More commonly, states criminalize sexual behavior that can spread AIDS. Michigan law makes it a felony for an HIV or AIDS-infected person to engage in sex without first informing a partner of the infection. Florida law provides for the prosecution of any HIV-positive person committing prostitution, and it permits rape victims to demand that their attackers undergo testing. Indiana imposes penalties on persons who recklessly or knowingly donate blood or semen with the knowledge that they are HIV-infected.
The profound immunosupression seen in AIDS is due to the depletion of T4 helper lymphocytes. HIV is present at a high level in the blood immediately after exposure. It then settles down to a certain low level set-point during the incubation period that lasts from 3-8 weeks. During the incubation perid, there is a massive turnover of CD4 cells as the CD4 cells killed by HIV are replaced rapidly and efficiently. The immune system eventually succumbs and AIDS is developed when killed CD4 cells can no longer be replaced, as witnessed by high HIV-RNA, HIV-Antigen and low CD4 counts.
HIV-2 is divided into groups A through E, with subtypes A and B being the most relevant to human infection. HIV-2, which is found primarily in western Africa, can cause AIDS, but it does so more slowly than HIV-1. There is some evidence that HIV-2 may have arisen from a form of SIV that infects African green monkeys.
Treatments with HAART have shown considerable progress since the first antiretroviral was approved for use by the FDA in 1987. Impressive improvements in life expectancy and quality of life have ensued. There are, however, still many problems. Although HAART is able to suppress the viral load in the plasma, it fails to eradicate it,and once HAART is initiated, treatment needs to be continued for life. The side-effects of long-term HAART include lipodystrophy, lactic acidosis, insulin resistance, and hyperlipidaemia.
In some individuals treatment may not be commenced as recommended and disease progression may occur. The length of time that people with untreated HIV infection may live without symptoms varies widely. Some people experience rapid development of symptoms or disease due to their HIV infection, whereas others may remain free of any symptoms for years.
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. Rockville (MD): Department of Health and Human Services; 2012. Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. Retrieved December 12, 2013. ⇦
Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. ACOG Committee Opinion No. 304. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;104:1119–24.
Risk of transmission increases in the presence of many sexually transmitted infections and genital ulcers. Genital ulcers appear to increase the risk approximately fivefold. Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.
HIV is one of a group of viruses known as retroviruses. After getting into the body, the virus enters many different cells, incorporates its genes into the human DNA, and hijacks the cell to produce HIV virus. Most importantly, HIV attacks cells of the body’s immune system called CD4 or T-helper cells (T cells). These cells are destroyed by the infection. The body tries to keep up by making new T cells or trying to contain the virus, but eventually the HIV wins out and progressively destroys the body’s ability to fight infections and certain cancers. The virus structure has been studied extensively, and this ongoing research has helped scientists develop new treatments for HIV/AIDS. Although all HIV viruses are similar, small variations or mutations in the genetic material of the virus create drug-resistant viruses. Larger variations in the viral genes are found in different viral subtypes. Currently, HIV-1 is the predominant subtype that causes HIV/AIDS. HIV-2, another form of HIV, occurs almost exclusively in West Africa.
After an hour they folded up the table and stuffed the condoms and brochures back into a gym bag, dropped it next to Sturdevant, who was sipping a syrupy cocktail from a can, and headed out to the dance floor. A remix of Rihanna’s “Where Have You Been” came on, so loud the walls shook. Like everyone else, Stevenson and Watson, who are dance coaches and choreographers, had perfected their moves from watching YouTube videos of the Prancing J-Settes. Stevenson bent and thrust, at once explosive, angular and precise. Watson’s face was still as a stone; as he snapped his neck to the side, his waist-length dreadlocks whipped around his head. After a few songs, the music ended as the club prepared for a 1 a.m. drag show. Stevenson, sweaty and breathless, melted into a conversation with other dancers.
When HIV becomes resistant to HAART, salvage therapy is required to try to suppress the resistant strain of HIV. Different combinations of medications are tried to attempt to reduce viral load. This is often not successful, unfortunately, and the patient will usually develop AIDS and its complications.
“Are you taking your medicine?” Sturdevant asked. For many young men, the H.I.V. diagnosis and the illness are so overwhelming that maintaining a new and unfamiliar regimen of medication can be difficult. Jordon looked down. “Not as often as I should.” When he saw Sturdevant’s glare, he continued, sounding like a little boy. “I hate taking medicine; I hate it. I have to take six pills, now seven, eight, plus a shot —”
complex regional pain syndrome, type 2; CRPS 2; causalgia; sympathetic pain syndrome persistent and severe skin paraesthesia/burning sensations; caused by trauma to peripheral sensory nerve fibres; symptoms, progress and treatment are similar to that of CRPS 1
CDC recommends routine testing for HIV infection for persons aged 13–64 years in health care settings and testing at least annually for persons at high risk for HIV infection (7). Yet, according to National HIV Behavioral Surveillance (NHBS), one third of gay, bisexual, and other men who have sex with men (MSM) have not been tested in the past year, with even lower percentages of recent testing reported among other population segments at high risk for HIV infection.
People with AIDS or who have had positive HIV antibody tests may pass the disease on to others. They should not donate blood, plasma, body organs, or sperm. They should not exchange body fluids during sexual activity.
In September, the WHO launched new treatment guidelines recommending that all people living with HIV should receive antiretroviral treatment, regardless of their CD4 count, and as soon as possible after their diagnosis.96
Antiretroviral therapy should be initiated regardless of CD4 count in pregnant patients, patients with HIV-associated and those with hepatitis B virus (HBV) coinfection when treatment of HBV infection is indicated
Following decades of inadequate funding, our nation’s public health infrastructure lacks the resources it needs to respond aggressively to the HIV and AIDS epidemic. This arrangement has been devastating for members of the LGBTQ community, since the little funding that does exist for HIV prevention, treatment, and care has not been focused on or funded in the communities most impacted by HIV. The Ryan White Care Program, for instance, has been flat funded (i.e, remained the same) since its reauthorization in 2009 despite an increasing number of people living with HIV in the U.S. coming to rely on it for medical and social suport.
Siliciano told me about the first time he saw the latent virus emerge in the memory T cells of an H.I.V. patient on HAART. The patient was thought to be cured. “He had been biopsied in every imaginable place, and nobody could find any virus,” Siliciano said. Researchers took twenty tubes of the patient’s blood, isolated the T cells, and divided them into multiple wells. The specimen was then intermixed with cells from uninfected people. If the healthy T cells became infected, the virus would reproduce and be released. Detection of the virus would be signalled by a color change to blue. Siliciano remembers sitting at his desk, talking with a visitor, when a graduate student burst in: “The wells are turning blue!” He said, “It was a very strange moment, because it was a confirmation of this hypothesis—so it was exciting—but it was also a disaster. Everybody came to the same conclusion: that these cells persisted despite the antiretroviral therapy.”
Trends continue toward simplifying drug regimens to improve adherence and decrease side effects. In addition, the availability of multiple new drugs in new classes has made it possible to suppress viral load to undetectable levels even in many of the most treatment-experienced patients. Moreover, many are virologically suppressed taking a single well-tolerated pill per day. As noted in the section on new therapies in development, another major advance could emerge with the availability of every one to two month injections of long-acting therapies. With great success in treatment, the field has increasingly considered strategies that may someday allow patients to control viral replication without the use of antiretrovirals. This could be in the form of a true cure with complete eradication of HIV from the body or a functional cure where the virus persists but is unable to replicated, a situation analogous to what happens when patients are on effective antiretroviral therapy. Research is in the very earliest stages with regard to development of strategies for viral eradication. Studies to control viral replication in the absence of antiretroviral therapy are actively being pursued, although thus far with limited success. One strategy has been to use immune-based therapies to boost the natural immune response to HIV and allow for complete or partial control. Another area of research is to purge infected cells, so-called “latent reservoir,” with various agents to facilitate eradication from the body. While research in these areas is under way, it has met with limited success.
HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These special cells help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections and some other diseases. Opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS. Learn more about the stages of HIV and how to know whether you’re infected.
The α-chemokine SDF-1, a ligand for CXCR4, suppresses replication of T-tropic HIV-1 isolates. It does this by down-regulating the expression of CXCR4 on the surface of HIV target cells. M-tropic HIV-1 isolates that use only the CCR5 receptor are termed R5; those that use only CXCR4 are termed X4, and those that use both, X4R5. However, the use of co-receptor alone does not explain viral tropism, as not all R5 viruses are able to use CCR5 on macrophages for a productive infection and HIV can also infect a subtype of myeloid dendritic cells, which probably constitute a reservoir that maintains infection when CD4+ T cell numbers have declined to extremely low levels.
Cells infected with HIV must be activated for the virus to replicate. Activation of CD4 T cells induces the expression of the transcription factor NFκB, which binds to the proviral LTR and initiates the transcription of the HIV genome into RNA. (more…)
HIV attaches to and penetrates host T cells, then releases HIV RNA and enzymes into the host cell. HIV reverse transcriptase copies viral RNA as proviral DNA. Proviral DNA enters the host cell’s nucleus, and HIV integrase facilitates the proviral DNA’s integration into the host’s DNA. The host cell then produces HIV RNA and HIV proteins. HIV proteins are assembled into HIV virions and budded from the cell surface. HIV protease cleaves viral proteins, converting the immature virion to a mature, infectious virion. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]