The complications of HIV infection result mainly from a weakened immune system. The virus also infects the brain, causing degeneration, problems with thinking, or even dementia. This makes the person more vulnerable to certain types of conditions and infections (see Table 1). Treatment with ART can prevent, reverse, or mitigate the effects of HIV infection. Some patients on ART may be at risk for developing cholesterol or blood-sugar problems.
Because human immunodeficiency virus (HIV) infection is incurable, preventing HIV transmission is paramount. Exposure to HIV can occur by percutaneous, mucous membrane or non-intact skin exposure to infected blood or body fluids. It can also occur by sexual contact, trauma or needle sharing. Postexposure prophylaxis (PEP) is one method of preventing HIV transmission. PEP is the provision of antiretroviral therapy (ART) to HIV-negative persons exposed to infected materials. It should be emphasized that PEP should not replace standard infection control measures and behavioral practices that best prevent HIV exposure.
The typical course of an infection with HIV is illustrated in Fig. 11.21. However, it has become increasingly clear that the course of the disease can vary widely. Thus, although most people infected with HIV go on to develop AIDS and ultimately to die of opportunistic infection or cancer, this is not true of all individuals. A small percentage of people seroconvert, making antibodies against many HIV proteins, but do not seem to have progressive disease, in that their CD4 T-cell counts and other measures of immune competence are maintained. These long-term nonprogressors have unusually low levels of circulating virus and are being studied intensively to determine how they are able to control their HIV infection. A second group consists of seronegative people who have been highly exposed to HIV yet remain disease-free and virus-negative. Some of these people have specific cytotoxic lymphocytes and TH1 lymphocytes directed against infected cells, which confirms that they have been exposed to HIV or possibly noninfectious HIV antigens. It is not clear whether this immune response accounts for clearing the infection, but it is a focus of considerable interest for the development and design of vaccines, which we will discuss later. There is a small group of people who are resistant to HIV infection because they carry mutations in a cell-surface receptor that is used as a co-receptor for viral entry, as we will see below.
Even with anti-retroviral treatment, over the long term HIV-infected people may experience neurocognitive disorders, osteoporosis, neuropathy, cancers, nephropathy, and cardiovascular disease. Some conditions like lipodystrophy may be caused both by HIV and its treatment.
It is also important to foster wider availability of comprehensive services for people living with HIV and their partners through partnerships among health departments, community-based organizations, and health care and social service providers.
In the developed world, antiretroviral therapy has greatly improved prognosis and increased survival rates. Public education programs have raised awareness such that testing and prevention of infection are more common. Both of these approaches are difficult in countries with undereducated or underfunded populations.
Painful rash at the injection site and allergic (hypersensitivity) reactions (including rash, fever, chills, nausea, and low blood pressure), numbness and tingling in the hands and feet (peripheral neuropathy), insomnia, and loss of appetite
During this time, many scientists, researchers and government administrators were afraid to speak openly about condoms, needle exchange and L.G.B.T. issues for fear of reprisal and loss of funding. Community organizations became targets of anti-gay crusades, subjected to intense scrutiny, including exhaustive audits, by federal agencies. “It is no coincidence that new rates of H.I.V. infection among gay men, especially gay black men, began to spike sharply from 2000 on, because of an anti-science campaign that allowed for little or nothing to be done for a maligned community simply due to ideology and bigotry,” Millett said. “The hostile environment made funding effective H.I.V.-prevention programs, messages or research impossible for U.S. communities most impacted by H.I.V.”
^ Jump up to: a b Siegfried, Nandi; Irlam, James H.; Visser, Marianne E.; Rollins, Nigel N. (2012-03-14). “Micronutrient supplementation in pregnant women with HIV infection”. The Cochrane Database of Systematic Reviews (3): CD009755. doi:10.1002/14651858.CD009755. ISSN 1469-493X. PMID 22419344.
“Charlie does not have AIDS,” Huizenga said. “AIDS is a condition where the HIV virus markedly suppresses the immune and you are susceptible to rare, difficult cancers and infections. Charlie has none of those. He is healthy; he does not have AIDS.”
Currently, there is no licensed vaccine for HIV or AIDS. The most effective vaccine trial to date, RV 144, was published in 2009 and found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine. Further trials of the RV 144 vaccine are ongoing.
At the same time, it is important to recognise that reaching an undetectable viral load is determined by many factors, including treatment adherence, HIV resistance to certain anti-retroviral drugs, stigma, and inadequate health systems.
^ Jump up to: a b Gilbert, M. Thomas P.; Rambaut, Andrew; Wlasiuk, Gabriela; Spira, Thomas J.; Pitchenik, Arthur E.; Worobey, Michael (November 20, 2007). “The emergence of HIV/AIDS in the Americas and beyond” (PDF). PNAS. 104 (47): 18566–18570. Bibcode:2007PNAS..10418566G. doi:10.1073/pnas.0705329104. PMC 2141817 . PMID 17978186. Archived (PDF) from the original on September 24, 2015.
RNA testing (viral load test) detects HIV RNA in the blood. It is not commonly used for screening but can be helpful in detecting early HIV infection when a person is in the window period or if the screening tests are unclear.
^ Jump up to: a b c d e f Coutsoudis, A; Kwaan, L; Thomson, M (October 2010). “Prevention of vertical transmission of HIV-1 in resource-limited settings”. Expert review of anti-infective therapy. 8 (10): 1163–75. doi:10.1586/eri.10.94. PMID 20954881.
Detection of antibodies to HIV is sensitive and specific except during the first few weeks after infection. Currently, a 4th-generation combination immunoassay is recommended; it detects antibodies to both HIV-1 and HIV-2 as well as the p24 HIV antigen (p24 is a core protein of the virus). The laboratory version is probably preferred over the point-of-care one for diagnosing early infection, but both can be done quickly (within 30 min). If the test result is positive, an assay to differentiate HIV-1 and HIV-2 and an HIV RNA assay are done.
Jump up ^ Keele BF, Van Heuverswyn F, Li Y, Bailes E, Takehisa J, Santiago ML, Bibollet-Ruche F, Chen Y, Wain LV, Liegeois F, Loul S, Ngole EM, Bienvenue Y, Delaporte E, Brookfield JF, Sharp PM, Shaw GM, Peeters M, Hahn BH (Jul 28, 2006). “Chimpanzee reservoirs of pandemic and nonpandemic HIV-1”. Science. 313 (5786): 523–6. Bibcode:2006Sci…313..523K. doi:10.1126/science.1126531. PMC 2442710 . PMID 16728595.
However, through international efforts, as of 2016, an estimated 19.5 million people living with HIV were accessing antiretroviral therapy, dramatically reducing deaths and transmission in many countries.
In 2016, about 36.7 million people, including about 2.1 million children (< 15 yr), were living with HIV worldwide, according to the World Health Organization (WHO ). Almost half do not know they are infected. In 2016, about 1 million died, and 1.8 million were newly infected. Most new infections (95%) occur in the developing world; > 1/2 are in women. Since 2010, new infections among children have decreased by 47%, from about 300,000 to 160,000 (in 2016). In many sub-Saharan African countries, incidence is declining markedly from the very high rates of a decade before.
Jump up ^ Surveillance; riques, Risk Assessment Division = Le VIH et le sida au Canada: rapport de surveillance en date du 31 décembre 2009 / Division de la surveillance et de l’évaluation des (2010). HIV and AIDS in Canada : surveillance report to December 31, 2009 (PDF). Ottawa: Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Surveillance and Risk Assessment Division. ISBN 978-1-100-52141-1. Archived from the original (PDF) on January 19, 2012.
Jump up ^ Liu JP, Manheimer E, Yang M (2005). Liu, Jian Ping, ed. “Herbal medicines for treating HIV infection and AIDS”. Cochrane Database Syst Rev (3): CD003937. doi:10.1002/14651858.CD003937.pub2. PMID 16034917.
^ Jump up to: a b c d e f g h i Markowitz, edited by William N. Rom ; associate editor, Steven B. (2007). Environmental and occupational medicine (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 745. ISBN 978-0-7817-6299-1. Archived from the original on September 11, 2015.
Jump up ^ Lee, KY; Tsai, MS; Kuo, KC; Tsai, JC; Sun, HY; Cheng, AC; Chang, SY; Lee, CH; Hung, CC (2014). “Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy”. Human vaccines & immunotherapeutics. 10 (12): 3700–10. doi:10.4161/hv.32247. PMC 4514044 . PMID 25483681.
The majority of people on HIV treatment in countries like Australia will have long-term suppression of symptoms and a reduced viral load. Without HIV treatment people with HIV may develop AIDS and die from infections, cancers and other illnesses the immune system can no longer fight.
The basis of management is described in the separate article Human Immunideficiency Virus (HIV). There may be defining conditions such as Pneumocystis jirovecii pneumonia that will need treatment. Highly active antiretroviral therapy (HAART) has improved the prognosis enormously in terms of duration of survival but premature death is to be expected.
Nucleotide reverse transcriptase inhibitors (also called nucleoside analogues). These drugs work by interfering with the action of HIV reverse transcriptase inside infected cells, thus ending the virus’s replication process. These drugs include zidovudine (Retrovir), lamivudine (Epivir), and abacavir (Ziagen) and many others. They are often used in used in multi-drug combinations.
Improving access to quality health care for populations disproportionately affected by HIV, such as people of color and gay and bisexual men, is a fundamental public health strategy for HIV prevention. People getting care for HIV can receive:
The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Manifestations include the following:
People who are likely to come into contact with blood or other body fluids at their job should wear protective latex gloves, masks, and eye shields. These precautions apply to body fluids from all people, not just those from people with HIV, and are thus called universal precautions. Universal precautions are taken for two reasons:
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Gum disease is caused by plaque and may result in tooth loss without proper treatment. Symptoms and signs of gum disease (gingivitis or periodontal disease) include receding gums, bad breath and pocket formation between the teeth and gums. Treatment depends upon the stage of the gum disease, how you responded to earlier treatments, and your overall health. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]