Sunday, July 09, 2006

HIV prevention is a very big topic now a days, especially in areas around the world. Before I get into the prevention, I must talk about the measures taken by NGO and government authorities. Nearly 25 years after the first report of a handful of cases of a nameless deadly disease among gay men in New York and Los Angeles, there are still over 1 million persons living with HIV in the United States. About one-fourth of those with HIV have not yet been diagnosed and are unaware of their infection. The “new” syndrome discovered 25 years ago has become one of the deadliest epidemics in human history, killing more than 25 million people around the world, including more than 500,000 Americans. In the last decade, major advances in prevention and treatment for HIV/AIDS have prolonged and improved the lives of many, but despite extremely beneficial advances, the epidemic is far from over. An estimated 40,000 Americans still become infected with HIV every year, and many of these are young persons under the age of 25. African American men and women are among the hardest hit populations in the U.S. In 2004, they accounted for half of all new HIV diagnoses in this country and more than a third of AIDS deaths to date. African American men who have sex with men (MSM) are especially hard hit. Recent data show significant declines in HIV diagnoses in nearly every group of African Americans except black MSM. Women also remain a particularly vulnerable population, accounting for 29% of all HIV diagnoses in 2004.

The inescapable truth is that, to defeat HIV and AIDS, we need to reduce the number of people who become infected in the first place. Twenty-five years since the onset of the epidemic, prevention is still the only “cure” we have for HIV/AIDS. A comprehensive approach must be used to prevent the further spread of HIV and AIDS. Comprehensive HIV prevention strategies include monitoring the epidemic to target prevention and care activities, researching the effectiveness of prevention methods, diffusing proven effective interventions, funding the implementation and evaluation of prevention efforts in high-risk communities, encouraging early diagnosis of HIV infection, and fostering linkages between prevention and treatment programs. Many governmental and non-governmental organizations at all levels collaborate to implement, evaluate, disseminate, and further develop and strengthen effective HIV prevention efforts nationwide.

Friday, June 30, 2006

Thanks to the internet

I would like to thank the major companies to provide this blog and internet services at my area. I would like to thank everyone who visited my blog in search for more information. I will research this topic in depth for the coming months because i have to write a report in it. Please come back to view more information and leave questions in form of a comment for anything. Thanks once again to wikipedia and my local library and ofcourse to you guys who make my blog a live spot on the net.
Treatment of HIV and AIDS

There is currently no vaccine against HIV or AIDS, the only known methods of prevention are based on avoiding exposure to the virus or, failing that, on antiviral treatment directly after a highly significant exposure. Also, not a single case has been documented in which systemic HIV infection has been cured and even on the theoretical level, no plausible way of eradicating HIV infection has so far been found. Treatment for HIV can suppress viral replication to a degree sufficient to apparently stop disease progression, but success is critically dependent on the patients ability to keep perfect adherence to their drug schedule, which many people will fail to achieve. Also, modern combination therapy has been around for merely ten years, so it is not presently known whether treatment failure or inacceptable long-term side effects can be avoided in the majority even of perfectly compliant patients over a time-span of potentially many decades. However, it is known that without major medical and scientific breakthroughs, HIV will not have any problem surviving combination therapy for said decades. Still, in western countries, most patients survive many years following diagnosis because of the availability of the highly active antiretroviral therapy (HAART).[21] In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2 months.[7] HAART dramatically increases the time from diagnosis to death, and treatment research continues.
Current optimal HAART options consist of combinations (or "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 or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This treatment is frequently referred to as HAART (highly-active anti-retroviral therapy).[70] 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.[71][72]
Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.[73] In developed countries where HAART is available, doctors assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.[74]
There are several concerns about antiretroviral regimens, as side effects of these antiretrovirals have caused problems such as lipodystrophy, dyslipidaemia, insulin resistance, an increase in cardiovascular risks and birth defects.[75][76] Regimens can be complicated, requiring patients to take several pills at various times during the day, although treatment regimens have been greatly simplified in recent years. If patients miss doses, drug resistance can develop contributing to the rise of viral escape.[77][78] Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS. Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance.
A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of getting infected. In addition, AIDS patients should receive vaccination against Streptococcus pneumoniae and should receive yearly vaccination against influenza virus. Patients with substantial immunosuppression are generally advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.
Various forms of alternative medicine have been used to try to treat symptoms or to try to affect the course of the disease itself, although none are a substitute for conventional treatment.[79] In the first decade of the epidemic when no useful conventional treatment was available, a large number of people with AIDS experimented with alternative therapies. The definition of "alternative therapies" in AIDS has changed since that time. Then, the phrase often referred to community-driven treatments, untested by government or pharmaceutical company research, that some hoped would directly suppress the virus or stimulate immunity against it. These kinds of approaches have become less common over time as the benefits of AIDS drugs have become more apparent.
Examples of alternative medicine that people hoped would improve their symptoms or their quality of life include massage, herbal and flower remedies and acupuncture;[79] when used with conventional treatment, many now refer to these as "complementary" approaches. None of these treatments has been proven in controlled trials to have any effect in treating HIV or AIDS directly.[80] However, some may improve feelings of well-being in people who believe in their value. Additionally, people with AIDS, like people with other illnesses such as cancer, sometimes use marijuana to treat pain, combat nausea and stimulate appetite.
Major pulmonary illnesses

Pneumocystis jiroveci pneumonia (originally known as Pneumocystis carinii pneumonia, often-abbreviated PCP) is relatively rare in healthy, immunocompetent people but common among HIV-infected individuals. Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL.[25]
Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multi-drug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[26] Alternatively, symptoms may relate more to the site of extrapulmonary involvement.

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.[18] HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi sarcoma, cervical cancer and cancers of the immune system known as lymphomas.
Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.[19][20] After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy is estimated to be now more than 5 years,[21] but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year.[7] Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[22]
The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function[8][9][12] health care and co-infections,[7][22] as well as factors relating to the viral strain.[14][23][24] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.
HIV test

Approximately half of those infected with HIV do not know their HIV status until an AIDS diagnosis is made with an HIV test. Donor blood and blood products used in medicine and medical research are screened for HIV using such a test. Typical HIV tests, including the HIV enzyme immunoassay and the Western blot assay, detect HIV antibodies in serum, plasma, oral fluid, dried blood spot or urine of patients. However, the window period (the time between initial infection and the development of detectable antibodies against the infection) can vary. This is why it can take 6-12 months to seroconvert and test positive. Commercially available tests to detect other HIV antigens, HIV-RNA, and HIV-DNA in order to detect HIV infection prior to the development of detectable antibodies are available. For the diagnosis of HIV infection these assays are not specifically approved, but are nonetheless routinely used in developed countries
CDC classification system

"The Centers for Disease Control and Prevention (CDC) originally classified AIDS as GRID which stood for Gay Related Immune Disease. However, after determining that AIDS is not isolated to homosexual people the name was changed to the neutral AIDS. In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes.[17] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured."

"WHO Disease Staging System for HIV Infection and Disease was first produced in 1990 by the World Health Organisation [1] and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic HIV disease. Most of these conditions are opportunistic infections that can be easily treated in healthy people. The staging system is different for adults and adolescents and children.
Stage I: HIV disease is asymptomatic and not categorized as AIDS.
Stage II: include minor mucocutaneous manifestations and recurrent upper respiratory tract infections.
Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis.
Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are used as indicators of AIDS."
Diagnosis of HIV

"Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization (WHO) staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used."
Infection by HIV

"AIDS is the most severe manifestation of infection with HIV. HIV is a retrovirus that primarily infects vital components of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, cellular immunity is lost, leading to AIDS. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later, to AIDS, which is identified on the basis of the amount of CD4+ T cells in the blood and the presence of certain infections.
In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function. Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression. The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the CCR5-Δ32 mutation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression. The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time."
HIV in the world...

Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century;[4] it is now a pandemic, with an estimated 38.6 million people now living with the disease worldwide.[5] As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on December 1, 1981, making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4 - 3.3 million lives, of which more than 570,000 were children.[5] A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth by destroying human capital. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.[6] HIV/AIDS stigma is more severe than that associated with other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.
What is HIV

Acquired immunodeficiency syndrome or Acquired immune deficiency syndrome (AIDS or Aids) is a collection of symptoms and infections in humans resulting from the specific damage to the immune system caused by infection with the human immunodeficiency virus (HIV).[1] The late stage of the condition leaves individuals prone to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to slow the virus's progression, there is no known cure. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV.