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| | [[Image:120px-Red_ribbon.png|right|thumbnail|120px|The Red Ribbon is the global symbol for solidarity with HIV positive and people living with AIDS. The Red Ribbon made its public debut when host [[Jeremy Irons]] wore it during the 1991 Tony Awards.[http://www.redribbon.net/red-ribbon-history.htm] ]] | | [[Image:120px-Red_ribbon.png|right|thumbnail|120px|The Red Ribbon is the global symbol for solidarity with HIV positive and people living with AIDS. The Red Ribbon made its public debut when host [[Jeremy Irons]] wore it during the 1991 Tony Awards.[http://www.redribbon.net/red-ribbon-history.htm] ]] |
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| − | '''AIDS''' is an acronym for '''Acquired Immunodeficiency Syndrome''' or '''Acquired Immune Deficiency Syndrome.''' It is a collection of symptoms and infections resulting from the depletion of the immune system caused by infection with the human immunodeficiency virus or '''[[HIV]]'''. | + | '''AIDS''' is an acronym for '''Acquired Immunodeficiency Syndrome'''. It is thought to have originated in [[sub-Saharan Africa]] during the twentieth century and is now a global pandemic. AIDS is a collection of symptoms and opportunistic infections resulting from the depletion of the immune system caused by infection with the human immunodeficiency virus or '''[[HIV]]'''. |
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| − | The virus that causes AIDS is transmitted through sexual relationships, by sharing contaminated needles, through [[blood transfusions]], mishandling contaminated blood as well as during [[pregnancy]], [[childbirth]] and [[breastfeeding]]. But, primarily HIV is transmitted through sexual relationships. Therefore, HIV/AIDS is both a medical and a moral concern. Effective prevention strategies must take into account both dimensions of the disease. | + | The virus that causes AIDS is transmitted through sexual relationships, by sharing contaminated needles, through [[blood transfusions]], mishandling contaminated blood as well as during [[pregnancy]], [[childbirth]] and [[breastfeeding]]. But, primarily HIV is transmitted through sexual relationships with an infected partner. Therefore, HIV/AIDS is both a medical and a moral concern. Effective prevention strategies need to take into account both dimensions of the disease. |
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| | + | ==Early symptoms== |
| | + | When first infected, most people will not have any symptoms. Within a month or two, a flu-like illness may appear, accompanied by fever, headache, tiredness, and/or enlarged lymph nodes. Usually these symptoms disappear within a week to a month, but during this period infected people are highly contagious. |
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| | + | HIV infections reduce the number of CD4 positive T (CD4+T) cells. These cells are our body’s main defense against infections and, without symptoms, HIV slowly destroys these T-cells. When the T-cell count falls below 200 cells per cubic millimeter of blood, an HIV infected person is said to have contracted AIDS. In a healthy adult the T-cell count is usually 1,000 or more. |
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| | + | Severe and persistent symptoms may not appear for more than 10 years. This “asymptomatic” period varies widely in duration between individuals. As complications begin to set in, the lymph nodes enlarge. This may last for more than three months and be accompanied with other symptoms including: loss of weight and energy, frequent fevers and sweats, persistent or frequent yeast infections, skin rashes, and short-term memory loss. (HIV Infection and AIDS: An Overview, 2005) |
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| − | ==Global pandemic== | + | ==AIDS symptoms== |
| − | AIDS is thought to have originated in [[sub-Saharan Africa]] during the twentieth century, it is now a global epidemic. The [[World Health Organization]] (WHO) estimated that, worldwide, between 2.8 and 3.5 million people with AIDS died in 2004. [http://www.unaids.org/wad2004/EPIupdate2004_html_en/epi04_00_en.htm] | + | In people living with AIDS (PLWA), the immune system is so ravaged by HIV, that the body can no longer defend itself. Bacteria, viruses, fungi, parasites and other opportunistic infections go almost unchecked. Common symptoms in PLWA include: |
| | + | *Coughing and shortness of breath |
| | + | *Seizures and lack of coordination |
| | + | *Mental confusion and forgetfulness |
| | + | *Persistent diarrhea |
| | + | *Fever |
| | + | *Vision loss |
| | + | *Nausea and vomiting |
| | + | *Weight loss and extreme fatigue |
| | + | *Severe headaches |
| | + | *Coma |
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| − | [[UNAIDS]] and the WHO estimated that between 36 and 44 million people around the world were living with HIV in December 2004 [http://www.unaids.org/wad2004/EPIupdate2004_html_en/Epi04_02_en.htm#P16_3133]. It was estimated that during 2004, between 4.3 and 6.4 million people were newly infected with HIV and between 2.8 and 3.5 million people with AIDS died. Sub-Saharan Africa remains by far the worst-affected region, with 23.4 million to 28.4 million people living with HIV at the end of 2004. Just under two thirds (64%) of all people living with HIV are in sub-Saharan Africa, as are more than three quarters (76%) of all women living with HIV. [http://www.unaids.org/wad2004/EPIupdate2004_html_en/Epi04_03_en.htm#P28_3962] South & South East Asia are second most affected with 15%. AIDS accounts for the deaths of 500,000 children.
| + | Many PLWA become debilitated and cannot hold a job or do work at home. However, a small number of people infected with HIV never develop AIDS. They are being studied by scientists to determine why, although they HIV, their infection has not progressed into AIDS. (HIV Infection and AIDS: An Overview, 2005) |
| − | | |
| − | {| {{prettytable}}
| |
| − | |- style="background: #efefef;"
| |
| − | ! scope="col" | World region
| |
| − | ! scope="col" | Estimated adult prevalence of HIV infection<br>(ages 15–49)
| |
| − | ! scope="col" | Estimated adult and child deaths<br>during [[2004]]
| |
| − | |-
| |
| − | ! scope="row" | [[Sub-Saharan Africa]]
| |
| − | | 6.9% to 8.3%
| |
| − | | 2.1 to 2.6 million
| |
| − | |-
| |
| − | ! scope="row" | [[Caribbean]]
| |
| − | | 1.5% to 4.1%
| |
| − | | 24,000 to 61,000
| |
| − | |-
| |
| − | ! scope="row" | [[Asia]]
| |
| − | | 0.3% to 0.6%
| |
| − | | 350,000 to 810,000
| |
| − | |-
| |
| − | ! scope="row" | [[Eastern Europe]] and [[Central Asia]]
| |
| − | | 0.5% to 1.2%
| |
| − | | 39,000 to 87,000
| |
| − | |-
| |
| − | ! scope="row" | [[Latin America]]
| |
| − | | 0.5% to 0.8% || 73,000 to 120,000
| |
| − | |-
| |
| − | ! scope="row" | [[Oceania]]
| |
| − | | 0.1% to 0.3%
| |
| − | | fewer than 1,700
| |
| − | |-
| |
| − | ! scope="row" | [[Middle East]] and [[North Africa]]
| |
| − | | 0.1% to 0.7%
| |
| − | | 12,000 to 72,000
| |
| − | |-
| |
| − | ! scope="row" | [[North America]], [[Western Europe|Western]] and [[Central Europe]]
| |
| − | | 0.3% to 0.6%
| |
| − | | 15,000 to 32,000
| |
| − | |}
| |
| − | Source: UNAIDS and the WHO 2004 estimates. The ranges define the boundaries within which the actual numbers lie, based on the best available information. [http://www.unaids.org/wad2004/EPIupdate2004_html_en/epi04_00_en.htm]
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| − | {{main|AIDS pandemic}}
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| | ==Prevention== | | ==Prevention== |
| | [[Image:R402a1t1.gif|frame|right|CDC 2005]] | | [[Image:R402a1t1.gif|frame|right|CDC 2005]] |
| − | As with all diseases, prevention is better than cure. This is all the more true for HIV/AIDS because although treatments for both AIDS and HIV exist, there is currently no known cure or vaccine. | + | As with all diseases, prevention is better than cure. This is all the more true for HIV/AIDS because, although treatments exist that will slow the progression from HIV to AIDS, there is currently no known cure or vaccine. |
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| − | Preventing HIV/AIDS requires a two pronged approach: strengthening moral values for the general population and targeting high risk groups (sex traffickers, drug uses and those likely to engage in non-marital sex) with barrier devices such as condoms.
| + | The most effective method for preventing HIV/AIDS requires a two pronged approach: strengthening moral values for the general population and targeting high risk groups (sex traffickers, drug uses and those likely to engage in non-marital sex) with barrier devices such as condoms. |
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| − | According to a recent report from the U.S. Agency for International Development [[USAID]], there is only one country in the world that has substantially turned back the HIV/AIDS pandemic.
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| | + | According to a recent report from the [[U.S. Agency for International Development]], there is only one country in the world that has substantially turned back the HIV/AIDS pandemic. |
| | :Uganda is the standout among countries that have effectively responded to HIV/AIDS under the guidance of national leadership in both the political and religious realms. Uganda has experienced the most significant decline in HIV prevalence of any country in the world. (Green, 2003) | | :Uganda is the standout among countries that have effectively responded to HIV/AIDS under the guidance of national leadership in both the political and religious realms. Uganda has experienced the most significant decline in HIV prevalence of any country in the world. (Green, 2003) |
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| − | Uganda’s model, developed indigenously, is called the ABC model. Here “A” stands for Abstinence, “B” for Be faithful, and “C” for Condoms (used correctly and consistently). Importantly, equal emphasis was not given to each component. Ugandans put the primary emphasis on “A” and “B,” all the while, condom distributed continued through the Ministry of Health, under a “Policy of Silent Promotion” (Dyer, 2003). | + | Uganda’s model, developed indigenously, is called the “ABC model.” Here “A” stands for Abstinence, “B” for Be faithful, and “C” for Condoms (used correctly and consistently). Importantly, equal emphasis was not given to each component. Ugandans put the primary emphasis on “A” and “B,” all the while, condom distributed continued through the Ministry of Health, under a “Policy of Silent Promotion” (Dyer, 2003). |
| | | | |
| − | In Uganda, it was important that the condom message be specifically targeted and not mass marketed. This allowed the faith-based communities to be fully engaged in HIV/AIDS prevention. Separating “A” and “B” from “C” had two other benefits: 1) it helped the condom message be “very effective” (Green, et al., 2005) in high-risk groups by defining a smaller target of people that could be more easily educated, trained and more effectively monitored, and 2) it did not undermine the message to the general population that human sexuality should be exclusively an act of marriage.
| + | The Vatican and other religious groups oppose the use of condoms. Having a dual approach to HIV/AIDS prevention allowed both the faith-based organizations and the medical community to work towards a common goal. This made it possible for the faith-based communities to be fully engaged in HIV/AIDS prevention without violating their theologies. Religions groups focused on “A” and “B” while health care professionals focused on “C.” Both benefited from this specialization. |
| | | | |
| − | The Vatican and other religious groups oppose the use of condoms. Having a dual approach to HIV/AIDS prevention allowed both the faith-based organizations and the medical professionals to work towards a common goal. Religious communities have vast networks that reach into the most rural areas, they can be powerful agents for behavioral and social change, they have the resources to mobilize large numbers of volunteers, and the have experience in health care and education. Their full participating in HIV/AIDS prevention was essential in Uganda’s success.
| + | Religious communities have vast networks that reach into the most rural areas, they can be powerful agents for behavioral and social change, they have resources to mobilize large numbers of volunteers, and they have experience in health care and education. Their full participating in HIV/AIDS prevention was essential in Uganda’s success. |
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| − | Uganda’s model has been well documented and heavily scrutinized. In a generalized heterosexual population HIV prevalence declined nearly 70 percent since the early 1990s. Importantly, it was accompanied with a 60 percent reduction in casual sex. The decline of HIV prevalence in 15- to 19-year-olds was 75 percent and was seen as a key to Uganda’s success. The annual cost was $1 per person aged 15 and above. If this ABC program been implemented throughout sub-Saharan Africa by 1996, it is estimated that there would be 6 million fewer persons infected with HIV and 4 million fewer children would have been orphaned (Green, et al., 2005).
| + | It was important that the condom message be specifically targeted and not mass marketed. Separating “A” and “B” from “C” helped the condom message be “very effective” (Green, et al., 2005) in high-risk groups. By having a well-defined small target, condom use could be more effectively monitored, including the needed education and training. Importantly, this small focus did not undermine the message to the general population that human sexuality should be an exclusive act of marriage. |
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| − | ===HIV blood screening===
| + | Uganda’s model has been heavily scrutinized and well documented. In a generalized heterosexual population HIV prevalence declined nearly 70 percent since the early 1990s. Importantly, it was accompanied with a 60 percent reduction in casual sex. The decline of HIV prevalence in 15- to 19-year-olds was 75 percent and was seen as a key to Uganda’s success. The annual cost was $1 per person aged 15 and above. If this ABC program been implemented throughout sub-Saharan Africa by 1996, it is estimated that there would be 6 million fewer persons infected with HIV and 4 million fewer children would have been orphaned (Green, et al., 2005). |
| − | In where improved donor selection and antibody tests have been introduced, the risk of transmitting [[HIV]] infection to [[blood transfusion]] recipients has been effectively eliminated. According to the [[WHO]], the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products." [http://www.who.int/inf-pr-2000/en/pr2000-25.html]
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| − | ===Medical procedures=== | + | ==Treatment== |
| − | Medical workers who follow [[universal precautions]] or body substance isolation such as wearing latex gloves when giving injections and washing the hands frequently can help prevent infection of HIV. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV infected person though is thought to be about 1 in 150 ([[AIDS#Prevention|see table above]]). [[Post-exposure prophylaxis]] with anti-HIV drugs can further reduce that small risk. [http://en.wikipedia.org/w/index.php?title=Special:Booksources&isbn=076370086X]
| + | There is currently no cure or vaccine for HIV or AIDS. |
| − | | |
| − | Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections. [http://tokyo.usembassy.gov/e/p/tp-20030804b1.html]. Because of this, the United Nations General Assembly, supported by universal medical opinion on the matter, has urged the nations of the world to implement universal precautions to prevent HIV transmission in health care settings [http://www.africaaction.org/docs03/safe0304.htm].
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| − | | |
| − | Universal precaution gets its name from the idea that precautions are to be used every single time, and not merely when the healthcare worker thinks that a patient might be high-risk for a transmissable disease.
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| − | ===Intravenous drug use===
| + | The optimal treatment consists of a combination ("cocktail") consisting of at least three drugs belonging to at least two types, or "classes," of [[anti-retroviral]] agents. Typical regimens consist of two [[nucleoside analogue reverse transcriptase inhibitors]] (NRTIs) plus either a [[protease inhibitor (pharmacology)|protease inhibitor]] or a non nucleoside reverse transcriptase inhibitor (NNRTI). This treatment is frequently referred to as [[HAART]] (highly-active anti-retroviral therapy). [http://www.hab.hrsa.gov/tools/HIVpocketguide05/PktGARTtables.htm#ARTtable3] |
| − | HIV can be transmitted by the sharing of needles by users of intravenous drugs. Cumulative data from 1981 to 2001 has shown that 31% of people with AIDS in the United States are injection drug users [http://en.wikipedia.org/w/index.php?title=Special:Booksources&isbn=076370086X]. All AIDS-prevention organisations advise drug-users not to share needles and to use a new or properly sterilized needle for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from [[needle exchange]]s. In the United States and other western countries, clean needles are available free in some cities, at needle exchanges or [[safe injection site]]s.
| + | Anti-retroviral treatments, along with medications intended to prevent AIDS-related opportunistic infections, have played a part in delaying complications associated with AIDS, reducing the symptoms of HIV infection, and extending patients' life spans. Over the past decade the success of these treatments in prolonging and improving the quality of life for people with AIDS has improved dramatically. |
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| | ===Mother to child transmission=== | | ===Mother to child transmission=== |
| − | There is a 15–30% risk of transmission of HIV from mother to child during pregnancy, labour and delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding. | + | There is a 15–30% risk of transmission of HIV from mother to child during pregnancy, labor and delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding. |
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| | Studies have shown that antiretroviral drugs, cesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child. ([http://content.nejm.org/cgi/content/full/335/22/1621 Sperlin ''et al''., 1996]) | | Studies have shown that antiretroviral drugs, cesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child. ([http://content.nejm.org/cgi/content/full/335/22/1621 Sperlin ''et al''., 1996]) |
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| | When replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers are recommended to avoid breast feeding their infant. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible. [http://www.unaids.org/en/Resources/faq/faq_prevention.asp#20] | | When replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers are recommended to avoid breast feeding their infant. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible. [http://www.unaids.org/en/Resources/faq/faq_prevention.asp#20] |
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| − | ==Transmission and infection==
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| − | [[Image:300px-HIV-budding.jpg|right|thumbnail|300px|[[Scanning electron microscope|Scanning electron micrograph]] of HIV-1 budding from cultured [[lymphocyte]].]]
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| − | Patterns of HIV transmission vary in different parts of the world. In [[sub-Saharan Africa]], which accounts for an estimated 60% of new HIV infections worldwide, controversy rages over the respective contribution of medical procedures, heterosexual sex and the bush meat trade. In the United States, sex between men (35%) and needle sharing by intravenous drug users (15%) remain prominent sources of new HIV infections. [http://www.cdc.gov/hiv/stats/2003SurveillanceReport/table17.htm]
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| − | In January 2005, Anthony S. Fauci, M.D., director of [[NIAID]] said,
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| − | "Individual risk of acquiring HIV and experiencing rapid disease progression is not uniform within populations". [http://www2.niaid.nih.gov/newsroom/Releases/CCL3L1.htm NIH press release] Some epidemiological models suggest that over half of HIV transmission occurs in the weeks following primary HIV infection before antibodies to the virus are produced. [http://www.aegis.com/pubs/rita/2002/RI020102.html] [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7932084&dopt=Abstract] Investigators have shown that viral loads are highest in semen and blood in the weeks before antibodies develop and estimated that the likelihood of sexual transmission from a given man to a given woman would be increased about 20-fold during primary HIV infection as compared with the same couple having the same sex act 4 months later. [http://www.natap.org/2002/9retro/day27.htm] Most people who are infected typically suffer from days to weeks of fever with or without muscle and joint aches, fatigue, headache, sore throat, swollen glands and sometimes rash. This "acute retroviral syndrome" is rarely diagnosed because it is difficult to distinguish from other very common ailments.
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| − | {{main|WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents}}
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| − | The [[Centers for Disease Control]] (CDC) in the United States reported a cluster of [[HIV]] infections in 13 of 42 young women who reported sexual contact with the same HIV infected man in a rural county in upstate New York between February and September 1996 [http://jama.ama-assn.org/cgi/content/full/282/1/20]
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| − | The risk of oral sex has always been controversial. [http://www.phac-aspc.gc.ca/publicat/epiu-aepi/epi_update_may_04/13_e.html] Most of the early AIDS cases could be attributed to [[anal sex]] or [[vaginal sex]]. As the use of condoms became more widespread, there were reports of AIDS acquired by oral sex. [http://www.aegis.com/pubs/bala/2000/BA000301.html] Unprotected oral sex is widely understood to be less risky than unprotected vaginal sex, which in turn is less risky than unprotected anal sex.
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| − | Heterosexual transmission of HIV-1 depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. Each 10 fold increment of seminal HIV RNA is associated with an 81% increased rate of HIV transmission. [http://bmj.bmjjournals.com/cgi/content/full/324/7353/1586] During 2003 in the United States, 19% of new infections were attributed to heterosexual transmission [http://www.cdc.gov/hiv/stats/2003SurveillanceReport/table17.htm]
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| − | The argument about the exact incidence of HIV transmission per act of intercourse is academic. Infectivity depends critically on social, cultural, and political factors as well as the biological activity of the agent. Whether the epidemic grows or slows depends on infectivity plus two other variables: the duration of infectiousness and the average rate at which susceptible people change sexual partners. [http://bmj.bmjjournals.com/cgi/content/full/324/7353/1586]
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| − | === Genetic susceptibility ===
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| − | [[Image:300px-800px-HIV_Viron.png|right|thumbnail|300px|Diagram of an HIV viron]]
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| − | CDC has released findings that genes influence susceptibility to HIV infection and progression to AIDS. HIV enters cells through an interaction with both CD4 and a chemokine receptor of the 7 Tm family. They first reviewed the role of genes in encoding chemokine receptors (CCR5 and CCR2) and chemokines (SDF-1). While CCR5 has multiple variants in its coding region, the deletion of a 32-bp segment results in a nonfunctional receptor, thus preventing HIV entry; two copies of this gene provide strong protection against HIV infection, although the protection is not absolute. This gene is found in up to 20% of [[Europeans]] but is rare in [[Africans]] and [[Asians]]; researchers and scientists believe that HIV had a similar viral shell as the bacteria which caused the [[black plague]] (1347-1350), leading to the decimation of one-third of the European population, possibly explaining why the CCR5-32 receptor gene is more prevalent in Europeans than Africans and Asians. Multiple studies of HIV-infected persons have shown that presence of one copy of this gene delays progression to the condition of AIDS by about 2 years. And it is possible that a person with the CCR5-32 receptor gene will not develop AIDS, although they will still carry HIV.
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| − | {{main|HIV Disease Progression Rates}}
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| − | ===Oral sex===
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| − | While it is agreed that oral sex is a very much lower risk activity than vaginal and anal sex, it has been established that HIV can be transmitted through both insertive and receptive oral sex (Rothenberg et al., 1998). An insidious danger of this myth is that it results in increased practice of unprotected oral sex. Even if the risk of infection is very small from a single encounter, it increases with frequency of activity. The perpetuation of the "oral sex is safe" myth probably is driven by the fact that people typically find oral sex far less pleasurable with a condom or dental dam, and consequently [[cognitive bias]] inclines people to believe it is safe.
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| − | ==Diagnosis==
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| − | The majority of people infected with HIV, if not treated, develop signs of AIDS within 8-10 years. However, 1-2% of HIV-infected individuals retain functional immune systems, despite being infected with HIV for a number of years. These individuals are known as HIV longterm non-progressors.
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| − | The [[Centers for Disease Control]] has, since [[1993]], defined an AIDS diagnosis in adults and adolescents in the USA as when a person presents with HIV infection and either a CD4+ [[T cell]] count below 200/µL or one of 26 of [[AIDS defining clinical condition]]s. This is different for children. {{main|CDC Classification System for HIV Infection}}
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| − | In developing countries, AIDS in adults and adolescents is identified on the basis of certain infections, grouped by the '''W'''orld '''H'''ealth '''O'''rganization ([[WHO]]):
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| − | *Stage I HIV disease is [[asymptomatic]] and not categorized as AIDS
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| − | *Stage II (includes minor [[mucocutaneous]] manifestations and recurrent [[upper respiratory tract]] infections)
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| − | *Stage III (includes unexplained chronic [[diarrhoea]] for longer than a month, severe bacterial infections and [[pulmonary tuberculosis]]) or
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| − | *Stage IV (includes [[Toxoplasmosis]] of the brain, [[Candidiasis]] of the [[oesophagus]], [[trachea]], [[bronchi]] or [[lungs]] and [[Kaposi's Sarcoma]]) HIV disease are used as indicators of AIDS.
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| − | {{main|WHO Disease Staging System for HIV Infection and Disease}}
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| − | ==Treatment==
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| − | There is currently no cure or vaccine for [[HIV]] or AIDS. Current optimal treatment options consist of combinations ("cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of [[anti-retroviral]] agents. Typical regimens consist of two [[nucleoside analogue reverse transcriptase inhibitors]] (NRTIs) plus either a [[protease inhibitor (pharmacology)|protease inhibitor]] or a non nucleoside reverse transcriptase inhibitor (NNRTI). This treatment is frequently referred to as [[HAART]] (highly-active anti-retroviral therapy). [http://www.hab.hrsa.gov/tools/HIVpocketguide05/PktGARTtables.htm#ARTtable3] [[Anti-retroviral]] treatments, along with medications intended to prevent AIDS-related opportunistic infections, have played a part in delaying complications associated with AIDS, reducing the symptoms of HIV infection, and extending patients' life spans. Over the past decade the success of these treatments in prolonging and improving the quality of life for people with AIDS has improved dramatically. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12646794&query_hl=5], [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12957089&query_hl=9].
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| − | However, treatment guidelines are changing constantly. The [http://www.who.int/hiv/pub/prev_care/en/arvrevision2003en.pdf current guidelines for antiretroviral therapy] from the [[World Health Organization]] reflect the [[2003]] changes to the guidelines and recommend that in resource-limited settings (i.e., developing nations), HIV-infected adults and adolescents should start ARV therapy when HIV-infection has been confirmed and one of the following conditions is present:
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| − | * Clinically advanced HIV disease:
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| − | * WHO Stage IV HIV disease, irrespective of the CD4 cell count;
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| − | * WHO Stage III disease with consideration of using CD4 cell counts <350/µl to assist decision-making.
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| − | * WHO Stage I or II HIV disease with CD4 cell counts <200/µl
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| − | The US Department of Health and Human Services, the federal agency responsible for overseeing HIV/AIDS healthcare policies in the United States, have recently stated on [[April 7]], [[2005]] that:
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| − | * All patients with history of an AIDS-defining illness or severe symptoms of HIV infection regardless of CD4+ T cell count receive ART.
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| − | * Antiretroviral therapy is also recommended for asymptomatic patients with <200 CD4+ T cells/µl
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| − | * Asymptomatic patients with CD4+ T cell counts of 201–350 cells/µl should be offered treatment.
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| − | * For asymptomatic patients with CD4+ T cell of >350 cells/µl and plasma HIV RNA >100,000 copies/ml most experienced clinicians defer therapy but some clinicians may consider initiating treatment.
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| − | * Therapy should be deferred for patients with CD4+ T cell counts of >350 cells/µl and plasma HIV RNA <100,000 copies/mL.
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| − | The preferred initial regimens are either:
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| − | * efavirenz + lamivudine or emtricitabine + zidovudine or tenofovir; or
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| − | * lopinavir boosted with ritonavir + zidovudine + lamivudine or emtricitabine.
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| − | The DHHS also recommends that doctors should assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to begin treatment. [http://aidsinfo.nih.gov/other/cbrochure/english/cbrochure_en.html#03]
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| − | There are several concerns about antiretroviral regimens. The drugs can have serious side effects (Saitoh et al., 2005). Regimens can be complicated, requiring patients to take several pills at various times during the day. If patients miss doses, drug resistance can develop. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12617573&query_hl=1] Also, anti-retroviral drugs are costly, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.
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| − | Research to improve current treatments includes decreasing side effects of current drugs, simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance.
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| − | ===Alternative medicine===
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| − | Ever since AIDS entered the public consciousness, various forms of [[alternative medicine]] have been used to treat its symptoms. In the first decade of the epidemic when no useful conventional treatment was available, a large number of people with AIDS experimented with [[alternative medicine|alternative therapies]] (massage, herbal and flower remedies and [[acupuncture]]). Interest in these therapies has declined over the past decade as conventional treatments have improved. People with AIDS, like people with other illnesses such as [[cancer]], also sometimes use [[marijuana]] to treat pain, combat nausea and stimulate appetite.
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| − | ==Research==
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| − | ===Origin ===
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| − | The official date for the beginning of the AIDS epidemic is marked as [[June 18]], [[1981]], when the US Center for Disease Control and Prevention reported a cluster of [[Pneumocystis jiroveci pneumonia|''Pneumocystis carinii'' pneumonia]] (now classified as Pneumocystis jiroveci pneumonia) in five gay men in [[Los Angeles]] in the early [[1980s]]. [http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm] Originally dubbed GRID, or Gay-Related Immune Deficiency, health authorities soon realized that nearly half of the people identified with the syndrome were not gay. Reporter Randy Shilts discovered the name of an extremely sexually active man, [[Gaëtan Dugas]], who epidemiologists at the time suspected to be the first carrier of what was first called "gay-plague", but later research failed to track the epidemic to any individual carrier. [http://www.uic.edu/classes/osci/osci590/4_3Human%20Immunodeficiency%20Virus%20AIDS.htm] In 1982, the CDC introduced the term AIDS to describe the newly recognized syndrome.
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| − | Three of the earliest known instances of HIV infection are as follows:
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| − | #A plasma sample taken in 1959 from an adult male living in what is now the Democratic Republic of Congo.
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| − | #HIV found in tissue samples from an American teenager who died in St. Louis in 1969.
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| − | #HIV found in tissue samples from a Norwegian sailor who died around 1976.
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| − | Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted. HIV-1 is the source of the majority of HIV infections throughout the world, while HIV-2 is less easily transmitted and is largely confined to [[West Africa]]. [http://www.socgenmicrobiol.org.uk/JGVDirect/18253/18253ft.htm] Both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 is the [[Common Chimpanzee|Central Common Chimpanzee]] (''Pan troglodytes troglodytes''). The origin of HIV-2 has been established to be the [[Sooty Mangabey]], an Old World monkey of Guinea Bissau, Gabon, and Cameroon.
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| − | {{main|AIDS origin}}
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| − | ===Circumcision===
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| − | Current research is clarifying the relationship between male circumcision and HIV in differing social and cultural contexts. UNAIDS believes that it is premature to recommend male circumcsion services as part of HIV prevention programmes. [http://www.who.int/mediacentre/news/releases/2005/pr32/en/]
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| − | South African medical experts are concerned that the repeated use of unsterilised blades in the ritual circumcision of adolescent boys may be spreading HIV. [http://allafrica.com/stories/200507070803.html]
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| − | ===Vaccine research===
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| − | {{main|HIV vaccine}}
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| − | As there is no known cure for [[AIDS]], the search for a [[vaccine]] against the [[etiology|etiological]] agent, [[HIV]], has become part of the struggle against the disease. Only a vaccine will be able to halt the pandemic. This would possibly cost less, thus being affordable for developing countries, and would not require daily treatments. However, after over 20 years of research, HIV remains a difficult target for a vaccine and there is still no vaccine available; a June 2005 study estimates that $682 million is spent on AIDS vaccine research annually [http://www.iavi.org/viewfile.cfm?fid=30892].
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| − | ===Alternative theories===
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| − | {{main|AIDS reappraisal}}
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| − | A minority of scientists and activists question the connection between HIV and AIDS, or the existence of HIV, or the validity of current testing methods. These claims are met with resistance by, and often evoke frustration and hostility from, most of the scientific community, who accuse the dissidents of ignoring evidence in favor of HIV's role in AIDS, and irresponsibly posing a dangerous threat to [[public health]] by their continued activities. Dissidents assert that the current mainstream approach to AIDS, based on HIV causation, has resulted in inaccurate diagnoses, psychological terror, toxic treatments, and a squandering of public funds. The debate and controversy regarding this issue from the early [[1980s]] to the present has provoked heated emotions and passions from both sides.
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| − | References:
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| − | *Dyer, Emilie. (2003). And Banana Trees Provided the Shade. Kampala, Uganda: Ugandan AIDS Commission.
| + | {{main|AIDS pandemic}} |
| − | *Green, Edward C. (2003). Faith-Based Organizations: Contributions to HIV Prevention. Washington, DC: U.S. Agency for International Development, The Synergy Project.
| + | |
| − | *Green, Edward C., Rand L. Stoneburner, Daniel Low-Beer, Norman Hearst and Sanny Chen. (2005). Evidence That Demands Action: Comparing Risk Avoidance and Risk Reduction Strategies for HIV Prevention. Austin, TX: The Medical Institute.
| + | ==References== |
| | + | |
| | + | Dyer, Emilie. (2003). And Banana Trees Provided the Shade. Kampala, Uganda: Ugandan AIDS Commission. |
| | + | Green, Edward C. (2003). Faith-Based Organizations: Contributions to HIV Prevention. Washington, DC: U.S. Agency for International Development, The Synergy Project. |
| | + | Green, Edward C., Rand L. Stoneburner, Daniel Low-Beer, Norman Hearst and Sanny Chen. (2005). Evidence That Demands Action: Comparing Risk Avoidance and Risk Reduction Strategies for HIV Prevention. Austin, TX: The Medical Institute. |
| | + | HIV Infection and AIDS: An Overview. (2005, March). Washington, DC: Courtesy: National Institute of Allergy and Infectious Diseases. Retrieved Jan. 24, 2006, from http://www.niaid.nih.gov/factsheets/hivinf.htm. |
The Red Ribbon is the global symbol for solidarity with HIV positive and people living with AIDS. The Red Ribbon made its public debut when host Jeremy Irons wore it during the 1991 Tony Awards.
[1]AIDS is an acronym for Acquired Immunodeficiency Syndrome. It is thought to have originated in sub-Saharan Africa during the twentieth century and is now a global pandemic. AIDS is a collection of symptoms and opportunistic infections resulting from the depletion of the immune system caused by infection with the human immunodeficiency virus or HIV.
The virus that causes AIDS is transmitted through sexual relationships, by sharing contaminated needles, through blood transfusions, mishandling contaminated blood as well as during pregnancy, childbirth and breastfeeding. But, primarily HIV is transmitted through sexual relationships with an infected partner. Therefore, HIV/AIDS is both a medical and a moral concern. Effective prevention strategies need to take into account both dimensions of the disease.
Early symptoms
When first infected, most people will not have any symptoms. Within a month or two, a flu-like illness may appear, accompanied by fever, headache, tiredness, and/or enlarged lymph nodes. Usually these symptoms disappear within a week to a month, but during this period infected people are highly contagious.
HIV infections reduce the number of CD4 positive T (CD4+T) cells. These cells are our body’s main defense against infections and, without symptoms, HIV slowly destroys these T-cells. When the T-cell count falls below 200 cells per cubic millimeter of blood, an HIV infected person is said to have contracted AIDS. In a healthy adult the T-cell count is usually 1,000 or more.
Severe and persistent symptoms may not appear for more than 10 years. This “asymptomatic” period varies widely in duration between individuals. As complications begin to set in, the lymph nodes enlarge. This may last for more than three months and be accompanied with other symptoms including: loss of weight and energy, frequent fevers and sweats, persistent or frequent yeast infections, skin rashes, and short-term memory loss. (HIV Infection and AIDS: An Overview, 2005)
AIDS symptoms
In people living with AIDS (PLWA), the immune system is so ravaged by HIV, that the body can no longer defend itself. Bacteria, viruses, fungi, parasites and other opportunistic infections go almost unchecked. Common symptoms in PLWA include:
- Coughing and shortness of breath
- Seizures and lack of coordination
- Mental confusion and forgetfulness
- Persistent diarrhea
- Fever
- Vision loss
- Nausea and vomiting
- Weight loss and extreme fatigue
- Severe headaches
- Coma
Many PLWA become debilitated and cannot hold a job or do work at home. However, a small number of people infected with HIV never develop AIDS. They are being studied by scientists to determine why, although they HIV, their infection has not progressed into AIDS. (HIV Infection and AIDS: An Overview, 2005)
Prevention
As with all diseases, prevention is better than cure. This is all the more true for HIV/AIDS because, although treatments exist that will slow the progression from HIV to AIDS, there is currently no known cure or vaccine.
The most effective method for preventing HIV/AIDS requires a two pronged approach: strengthening moral values for the general population and targeting high risk groups (sex traffickers, drug uses and those likely to engage in non-marital sex) with barrier devices such as condoms.
According to a recent report from the U.S. Agency for International Development, there is only one country in the world that has substantially turned back the HIV/AIDS pandemic.
- Uganda is the standout among countries that have effectively responded to HIV/AIDS under the guidance of national leadership in both the political and religious realms. Uganda has experienced the most significant decline in HIV prevalence of any country in the world. (Green, 2003)
Uganda’s model, developed indigenously, is called the “ABC model.” Here “A” stands for Abstinence, “B” for Be faithful, and “C” for Condoms (used correctly and consistently). Importantly, equal emphasis was not given to each component. Ugandans put the primary emphasis on “A” and “B,” all the while, condom distributed continued through the Ministry of Health, under a “Policy of Silent Promotion” (Dyer, 2003).
The Vatican and other religious groups oppose the use of condoms. Having a dual approach to HIV/AIDS prevention allowed both the faith-based organizations and the medical community to work towards a common goal. This made it possible for the faith-based communities to be fully engaged in HIV/AIDS prevention without violating their theologies. Religions groups focused on “A” and “B” while health care professionals focused on “C.” Both benefited from this specialization.
Religious communities have vast networks that reach into the most rural areas, they can be powerful agents for behavioral and social change, they have resources to mobilize large numbers of volunteers, and they have experience in health care and education. Their full participating in HIV/AIDS prevention was essential in Uganda’s success.
It was important that the condom message be specifically targeted and not mass marketed. Separating “A” and “B” from “C” helped the condom message be “very effective” (Green, et al., 2005) in high-risk groups. By having a well-defined small target, condom use could be more effectively monitored, including the needed education and training. Importantly, this small focus did not undermine the message to the general population that human sexuality should be an exclusive act of marriage.
Uganda’s model has been heavily scrutinized and well documented. In a generalized heterosexual population HIV prevalence declined nearly 70 percent since the early 1990s. Importantly, it was accompanied with a 60 percent reduction in casual sex. The decline of HIV prevalence in 15- to 19-year-olds was 75 percent and was seen as a key to Uganda’s success. The annual cost was $1 per person aged 15 and above. If this ABC program been implemented throughout sub-Saharan Africa by 1996, it is estimated that there would be 6 million fewer persons infected with HIV and 4 million fewer children would have been orphaned (Green, et al., 2005).
Treatment
There is currently no cure or vaccine for HIV or AIDS.
The optimal treatment consists of a combination ("cocktail") consisting of at least three drugs belonging to at least two types, or "classes," of anti-retroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) plus either a protease inhibitor or a non nucleoside reverse transcriptase inhibitor (NNRTI). This treatment is frequently referred to as HAART (highly-active anti-retroviral therapy). [2]
Anti-retroviral treatments, along with medications intended to prevent AIDS-related opportunistic infections, have played a part in delaying complications associated with AIDS, reducing the symptoms of HIV infection, and extending patients' life spans. Over the past decade the success of these treatments in prolonging and improving the quality of life for people with AIDS has improved dramatically.
Mother to child transmission
There is a 15–30% risk of transmission of HIV from mother to child during pregnancy, labor and delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding.
Studies have shown that antiretroviral drugs, cesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child. (Sperlin et al., 1996)
When replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers are recommended to avoid breast feeding their infant. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible. [3]
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References
Dyer, Emilie. (2003). And Banana Trees Provided the Shade. Kampala, Uganda: Ugandan AIDS Commission.
Green, Edward C. (2003). Faith-Based Organizations: Contributions to HIV Prevention. Washington, DC: U.S. Agency for International Development, The Synergy Project.
Green, Edward C., Rand L. Stoneburner, Daniel Low-Beer, Norman Hearst and Sanny Chen. (2005). Evidence That Demands Action: Comparing Risk Avoidance and Risk Reduction Strategies for HIV Prevention. Austin, TX: The Medical Institute.
HIV Infection and AIDS: An Overview. (2005, March). Washington, DC: Courtesy: National Institute of Allergy and Infectious Diseases. Retrieved Jan. 24, 2006, from http://www.niaid.nih.gov/factsheets/hivinf.htm.
