Human immunodeficiency virus infection and acquired immune deficiency syndrome ( HIV/AIDS ) is the spectrum of conditions caused by human immunodeficiency virus infection (HIV). After initial infection, a person may not see any symptoms or may experience a short period of illness such as influenza. Usually, this is followed by long periods without symptoms. As the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people who have a functioning immune system. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unwanted weight loss.
HIV is spread primarily by unprotected sex (including anal and oral sex), contaminated blood transfusion, hypodermic needles, and from mother to child during pregnancy, labor, or breastfeeding. Some body fluids, such as saliva and tears, do not transmit HIV. Preventive methods include safe sex, needle exchange programs, treating those who are infected, and male circumcision. Infectious diseases can often be prevented by providing antiretroviral drugs to mothers and children. There is no cure or vaccine; However, antiretroviral treatment can slow the course of the disease and can lead to an almost normal life expectancy. Treatment is recommended as soon as the diagnosis is made. Without treatment, the mean survival time after infection was 11 years.
By 2016, about 36.7 million people are living with HIV and that results in 1 million deaths. There are 300,000 fewer new HIV cases by 2016 than in 2015. Most of those infected live in sub-Saharan Africa. Since AIDS was identified in the early 1980s to 2017, the disease has caused about 35 million deaths worldwide. HIV/AIDS is considered a pandemic - an epidemic of disease that is present in large areas and is actively spreading. HIV is believed to have originated in middle-west Africa during the late 19th or early 20th century. AIDS was first recognized by the US Centers for Disease Control and Prevention (CDC) in 1981 and its cause - HIV infection - was identified early in the decade.
HIV/AIDS has a major impact on society, both as a disease and as a source of discrimination. The disease also has a large economic impact. There are many misconceptions about HIV/AIDS such as the belief that it can be transmitted by ordinary non-sexual contact. This disease has been the subject of much controversy involving religion including the position of the Catholic Church not to support condom use as a precaution. It has attracted international medical and political attention as well as large-scale funding since it was identified in the 1980s.
Video HIV/AIDS
Signs and symptoms
There are three major stages of HIV infection: acute infection, clinical latency, and AIDS.
Acute infection
The initial period after HIV contraction is called acute HIV, primary HIV or acute retroviral syndrome. Many people develop diseases such as influenza or diseases such as mononucleosis 2-4 weeks after exposure while others have no significant symptoms. Symptoms occur in 40-90% of cases and most commonly include fever, large soft lymph nodes, throat inflammation, rash, headache, fatigue, and/or mouth and genital ulcers. The rash, which occurs in 20-50% of cases, presents itself on the stem and is maculopapular, classically. Some people also develop opportunistic infections at this stage. Gastrointestinal symptoms, such as vomiting or diarrhea may occur. Neurological symptoms of peripheral neuropathy or Guillain-Barrà © à © syndrome also occur. The duration of symptoms varies, but usually one or two weeks.
Because of their nonspecific character, these symptoms are not often recognized as a sign of HIV infection. Even cases that can be seen by a family doctor or hospital are often misdiagnosed as one of many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in people with unexplained fevers who may have risk factors for infection.
Clinical latency
The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. Without treatment, the second stage of a history of natural HIV infection can last from about three years to over 20 years (on average, about eight years). While there are usually some or no symptoms at first, near the end of this stage many people have fever, weight loss, digestive problems and muscle aches. Between 50 and 70% of people also develop persistent generalized lymphadenopathy, characterized by unclear and painless enlargement of more than one group of lymph nodes (other than the crotch) for more than three to six months.
Although the vast majority of people infected with HIV-1 had a detectable viral load and without treatment eventually developed into AIDS, a fraction (about 5%) maintained high levels of CD4 T (T helper) cells. cells) without antiretroviral therapy for more than 5 years. These people are classified as "long-term" HIV controllers or nonprogressors (LTNPs). The other group consisted of those who maintained low or undetectable viral loads without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 people infected.
Acquired immunodeficiency syndrome
Acquired immunodeficiency syndrome (AIDS) is defined in terms of CD4 count T below 200 cells per Ã, μL or occurrence of certain diseases associated with HIV infection. In the absence of special treatment, about half of people infected with HIV develop AIDS in ten years. The most common initial conditions reminiscent of AIDS are pneumocystis pneumonia (40%), cachexia in the form of the HIV wasting syndrome (20%), and esophageal candidiasis. Other common signs include recurrent respiratory infections.
Opportunistic infections can be caused by bacteria, viruses, fungi, and parasites that are normally controlled by the immune system. Which infection occurs depends partly on what organisms are common in that person's environment. This infection can affect almost every organ system.
People with AIDS have an increased risk of developing various cancers caused by viruses, including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer. Kaposi's sarcoma is the most common cancer in 10 to 20% of people with HIV. The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is an early sign of AIDS in 3 to 4%. Both of these cancers are associated with human herpes virus 8 (HHV-8). Cervical cancer is more common in those with AIDS because of its association with human papillomavirus (HPV). Conjunctival cancer (from the lining that covers the inside of the eyelids and the whites of the eyes) is also more common in those with HIV.
In addition, people with AIDS often have systemic symptoms such as prolonged fever, sweating (especially at night), swollen lymph nodes, chills, weakness, and unwanted weight loss. Diarrhea is another common symptom, which is present in about 90% of people with AIDS. They can also be affected by a variety of psychiatric and neurologic symptoms independent of opportunistic infections and cancer.
Maps HIV/AIDS
Transmission
HIV is transmitted by three major routes: sexual contact, significant exposure to body fluids or infected tissues, and from mother to child during pregnancy, labor, or breast-feeding (known as vertical transmission). There is no risk of contracting HIV if exposed to dirt, nasal secretions, saliva, sputum, sweat, tears, urine, or vomiting unless it is contaminated with blood. It is also possible to be coinfected by more than one type of HIV - a condition known as HIV superinfection.
Sexual
The most common mode of HIV transmission is through sexual contact with an infected person. Globally, the most common mode of HIV transmission is through sexual contact between people of the opposite sex; However, the pattern of transmission varies among countries. In 2014, most of the HIV transmission in the United States occurs among men who have sex with men (83% of new HIV diagnoses among men aged 13 and older and 67% of new diagnoses). In the US, gay and bisexual men ages 13 to 24 account for about 92% of new HIV diagnoses among all men in their age group and 27% from new diagnoses among all gay and bisexual men. About 15% of gay and bisexual men have HIV while 28% of transgender women are positive in the US.
With regard to unprotected heterosexual contacts, the estimated risk of HIV transmission per sexual act appears four to ten times higher in low-income countries than in high-income countries. In low-income countries, the risk of female-to-male transmission is estimated at 0.38% per action, and male-to-female transmission by 0.30% per action; an equivalent estimate for high-income countries was 0.04% per action for female-to-male transmission, and 0.08% per action for male-to-female transmission. The risk of transmission from anal intercourse is very high, estimated at 1.4 to 1.7% per action in both heterosexual and homosexual contacts. While the risk of transmission from oral sex is relatively low, it still exists. The risk of receiving oral sex has been described as "almost zero"; However, some cases have been reported. Per-action risk is estimated at 0-0.04% for receptive oral relationships. In settings involving prostitution in low-income countries, the risk of female-to-male transmission has been estimated as 2.4% per action and male-to-female transmission as 0.05% per action.
The risk of transmission is increased by the presence of many sexually transmitted infections and genital ulcers. Genital ulcers seem to increase the risk by about fivefold. Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with a slightly increased risk of transmission.
Viral load of an infected person is an important risk factor in sexual and mother-to-child transmission. During the first 2.5 months of HIV infection, a person's transmission rate is twelve times higher as high viral load is associated with acute HIV. If the person is in the final stages of infection, the transmission rate is approximately eight times greater. HIV-positive people who have an undetectable viral load as a result of long-term treatment effectively have no risk of sexually transmitted HIV.
Commercial sex workers (including those using pornography) have an increased HIV level. Rough sex may be a factor associated with an increased risk of transmission. Sexual harassment is also believed to bring an increased risk of HIV transmission because condoms are rarely used, physical trauma to the vagina or rectum is possible, and there may be a greater risk of concomitant sexually transmitted infections.
Body fluid
The second most common mode of HIV transmission is through blood and blood products. Blood-borne transmission can be through the sharing of needles during intravenous drug use, needle injury, blood transfusion or contaminated blood products, or medical injections with non-sterile equipment. The risk of sharing needles during drug injection was between 0.63 and 2.4% per action, with an average of 0.8%. The risk of contracting HIV from needles from an HIV-infected person is estimated to be 0.3% (about 1 in 333) per action and the risk after exposure to mucous membranes to infected blood is 0.09% (about 1 in 1000) per action. In the United States injecting drug users make up 12% of all new HIV cases in 2009, and in some areas, more than 80% of people who inject drugs are HIV positive.
HIV is transmitted in about 93% of blood transfusions using infected blood. In developed countries, the risk of contracting HIV from blood transfusion is very low (less than one and a half million) where better donor selection and HIV screening are performed; for example, in the UK the risk is reported at one in five million and in the United States it is one in 1.5 million in 2008. In low-income countries, only half of transfusions can be screened appropriately (in 2008), and Estimated that up to 15% of HIV infections in this area come from infected blood transfusions and blood products, representing between 5% and 10% of global infections. Although rarely because of screening, it is possible to get HIV from organ and tissue transplants.
Unsafe medical injections play an important role in the spread of HIV in sub-Saharan Africa. In 2007, between 12 and 17% of infections in the region were associated with the use of medical syringe. The World Health Organization estimates the risk of transmission as a result of medical injections in Africa at 1.2%. Significant risks are also associated with invasive procedures, assisted delivery, and dental care in this area of ​​the world.
People who give or receive tattoos, piercings, and scarifications are theoretically at risk of infection but no confirmed cases have been documented. It is impossible for other mosquitoes or insects to transmit HIV.
Mother-to-child
HIV can be transmitted from mother to child during pregnancy, during childbirth, or through breast milk, resulting in infants also contracting HIV. This is the third most common way in which HIV is transmitted globally. Without treatment, the risk of transmission before or at birth is about 20% and in those who also breastfeed 35%. In 2008, vertical transmission accounted for about 90% of HIV cases in children. With the right treatment the risk of mother-to-child infection can be reduced to about 1%. Preventive care involves mothers taking antiretroviral drugs during pregnancy and childbirth, elective caesarean section, avoiding breastfeeding, and providing antiretroviral drugs to newborns. Antiretrovirals when taken by the mother or baby lower the risk of transmission in those who breastfeed. However, many of these steps are not available in developing countries. If blood contaminates the food during pre-chewing it can pose a risk of transmission.
If a woman is not treated, two years of breast-feeding produces the risk of HIV/AIDS in her baby at around 17%. Treatment reduces this risk to 1 to 2% per year. Because of the increased risk of death without breastfeeding in many areas of the developing world, the World Health Organization recommends either: (1) mothers and infants treated with antiretroviral drugs when breastfeeding is continued (2) provision of safe formulas. Infection with HIV during pregnancy is also associated with miscarriage.
Virology
HIV is the cause of the spectrum of diseases known as HIV/AIDS. HIV is a retrovirus that mainly infects the components of the human immune system such as CD4 T cells, macrophages and dendritic cells. Directly and indirectly destroys CD4 T cells.
HIV is a member of the genus Lentivirus , part of the family Retroviridae . Lentiviruses share many of the morphological and biological characteristics. Many mammalian species are infected by lentiviruses, which are characteristically responsible for long-term illness with long incubation periods. Lentivirus is transmitted as a single, positive-taste, and wrapped RNA virus. After entering the target cell, the viral RNA genome is altered (transversely transcribed) into double-stranded DNA with viral-encoded reverse transcriptase transported along with the viral genome in the viral particles. The resulting viral DNA is then imported into the cell nucleus and integrated into cellular DNA by integrase and hosted co-factors that are virally coded. Once integrated, the virus can become latent, allowing viruses and host cells to avoid detection by the immune system. Alternatively, the virus can be transcribed, producing new RNA genomes and viral proteins that are packed and released from cells as new virus particles that initiate a new replication cycle.
HIV is now known to spread among CD4 T cells by two parallel routes: free-cell deployment and cell-to-cell spread, using a hybrid dispersal mechanism. In cell-free dissemination, shoot virus particles from infected T cells, insert blood/extracellular fluid and then infect other T cells after a possibility. HIV can also spread through direct transmission from one cell to another through the process of spreading cells to cells. The HIV hybrid dispersal mechanism contributes to ongoing viral replication of antiretroviral therapy.
Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is a virus that was originally discovered (and originally referred to as LAV or HTLV-III). It is more virulent, more infective, and is the cause of the majority of HIV infections globally. Lower HIV-2 infectivity compared to HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Due to its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.
Pathophysiology
Once the virus enters the body, there is a period of rapid viral replication, which causes the number of viruses in the peripheral blood. During primary infection, HIV levels can reach several million virus particles per milliliter of blood. This response is accompanied by a decrease in T-cell counts circulating T cells. Acute viremia is almost always associated with CD8 T-cell activation , which kills HIV-infected cells, and then with antibody production, or seroconversion. The CD8 T cell response is considered important in controlling viral levels, which peak and then decrease, as the number of CD4 T cells recovers. A good CD8 T cell response has been associated with slower progression of the disease and a better prognosis, although it does not remove the virus.
Ultimately, HIV causes AIDS by thinning CD4 T cells. It weakens the immune system and allows opportunistic infections. T cells are essential for the immune response and without them, the body can not fight off infection or kill cancer cells. The mechanism of CD4 cell count depletion differs in the acute and chronic phase. During the acute phase, HIV-induced cell lysis and killing of cells infected with cytotoxic T cells contribute to the depletion of CD4 T cells, although apoptosis may also be a factor. During the chronic phase, the consequences of general immune activation coupled with a gradual loss of the immune system's ability to produce new T cells appear to account for the slow decline in T
Although the symptoms of AIDS immune deficiency characteristics do not appear for years after a person is infected, most of the T cells T occur during the first weeks of infection, especially in the intestinal mucosa, the majority harbor of lymphocytes found in the body. The reason for the loss of preferential mucosal CD4 m4 cells is that most mucosal T cells T express the CCR5 protein that HIV uses as a receptor to gain access to cells, whereas only a small proportion of CD4 cells T in the blood stream doing so. The specific genetic changes that alter the CCR5 protein when present on both chromosomes are very effective at preventing HIV-1 infection.
HIV seeks and destroys CCR5 expressing CD4 T cells during acute infection. A strong immune response eventually controls the infection and initiates a clinical latent phase. CD4 T cells in mucosal tissue remain highly affected. Continuous HIV replication causes a generalized immune activation state to persist throughout the chronic phase. Immune activation, reflected by an increase in immune cell activation states and the release of proinflammatory cytokines, results from the activity of some HIV gene products and immune responses to ongoing HIV replication. It is also associated with impaired immune control systems from gastrointestinal mucosal barrier caused by decreased CD4 m4 T cells during the acute phase of the disease.
Diagnosis
HIV/AIDS is diagnosed through laboratory testing and then staged based on the presence of certain signs or symptoms. HIV Screening is recommended by the United States Prevention Task Force for all people aged 15 to 65 including all pregnant women. In addition, tests are recommended for those at high risk, including anyone who is diagnosed with a sexually transmitted disease. In many areas of the world, one-third of HIV operators only find them infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.
HIV testing
Most people infected with HIV develop specific antibodies (ie seroconverts) within three to twelve weeks after initial infection. Primary HIV diagnosis before seroconversion is performed by measuring HIV-RNA or p24 antigen. Positive results obtained by antibodies or PCR assays are confirmed either by different antibodies or by PCR.
An antibody test in children younger than 18 months is usually inaccurate due to the continued presence of maternal antibodies. So HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or through testing for p24 antigen. Most of the world does not have access to reliable PCR testing and many places wait until symptoms develop or children are mature enough for accurate antibody testing. In sub-Saharan Africa in 2007-2009, between 30 and 70% of the population knew their HIV status. In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested that represented a significant increase compared to previous years.
Classification
Two major clinical staging systems are used to classify HIV and HIV-related diseases for surveillance purposes: WHO's disease determination system for HIV infection and disease, and the CDC classification system for HIV infection. The CDC classification system is more frequently adopted in developed countries. Because the WHO staging system does not require laboratory tests, it is appropriate with the limited resource conditions encountered in developing countries, where it can also be used to help guide clinical management. Regardless of their differences, both systems allow comparison for statistical purposes.
The World Health Organization first proposed the definition for AIDS in 1986. Since then, the WHO classification has been updated and expanded several times, with the latest version published in 2007. The WHO system uses the following categories:
- Primary HIV infection: May be asymptomatic or associated with acute retroviral syndrome.
- Stage I: HIV infection is asymptomatic with CD4 cell count (also known as CD4 count) greater than 500 per microliter (Ã,Âμl or cubic mm) of blood. May include generalized lymph node enlargement.
- Stage II: Mild symptoms that may include mild mucocutaneous manifestations and recurrent upper respiratory tract infections. CD4 cell count less than 500/Âμl. Stage III: Further possible symptoms include unexplained chronic diarrhea for more than a month, severe bacterial infections including pulmonary tuberculosis, and a CD4 count of less than 350/Âμl.
- Stage IV or AIDS: severe symptoms including brain toxoplasmosis, esophageal candidiasis, trachea, bronchial or lung and Kaposi's sarcoma. CD4 cell count less than 200/Âμl.
The United States Centers for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008 and 2014. This system classifies HIV infection based on CD4 cell count and clinical symptoms, and describes infection in five groups. In those over the age of six it is:
- Stage 0: the time between HIV negative or indefinite testing followed by less than 180 days with a positive test
- Stage 1: CD4 count> = 500 cells/Ã,Âμl and no AIDS-defining condition
- Stage 2: CD4 counts 200 to 500 cells/Ã,Âμl and no AIDS-defining condition
- Stage 3: CD4 count <= 200 cells/Ã,Âμl or AIDS-defining condition
- Unknown: if the information available is not sufficient to create one of the above classifications
For surveillance purposes, the diagnosis of AIDS persists even if, after treatment, the number of CD4 cells rises to above 200 per ÂμL of blood or other AIDS-defining illnesses cured.
Prevention
Sexual contact
Consistent condom use reduces the risk of HIV transmission by about 80% in the long term. When condoms are used consistently by couples in which one person is infected, the HIV infection rate is less than 1% per year. There is some evidence to suggest that female condoms can provide an equivalent level of protection. Application of tenofovir-containing vaginal gel (inhibitor reverse transcriptase) immediately before sex appears to reduce infection rates by about 40% among African women. In contrast, the use of nonoxynol-9 spermicides may increase the risk of transmission because of the tendency to cause irritation of the vagina and rectum.
Circumcision in Sub-Saharan Africa "reduced the acquisition of HIV by heterosexual men between 38% and 66% over 24 months". Because of this research, both the World Health Organization and UNAIDS recommended male circumcision in 2007 as a method to prevent the transmission of HIV from women to men in areas with high HIV levels. However, whether it protects against contagious male-female contagion, and whether it is beneficial in developed countries and among men who have sex with unspecified men. The International Antiviral Society, however, recommends it to all sexually active heterosexual men and that it is spoken of as an option with men who have sex with men. Some experts fear that a lower perception of susceptibility among circumcised men may lead to more sexual risk-taking behavior, thus negating the prevention effect.
Programs encouraging sexual abstinence did not seem to affect the subsequent risk of HIV. Evidence of the benefits of peer education is equally bad. Comprehensive sex education provided at school can reduce high-risk behavior. A small minority of young people continue to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risks for HIV infection. Voluntary counseling and testing people for HIV do not affect risky behavior in those who test negative but increase condom use in those tested positive. It is not known whether treating other sexually transmitted infections is effective in preventing HIV.
Pre-exposure
Antiretroviral treatment among people with HIV with a CD4 cell count <550 cells/ÂμL is a very effective way to prevent HIV infection from partners (a strategy known as preventive treatment, or TASP). TASP is associated with a 10 to 20-fold reduction in the risk of transmission. Pre-exposure prophylaxis (PrEP) with daily doses of tenofovir drugs, with or without emtricitabine, is effective in a number of groups including men who have sex with men, HIV-positive couples and young heterosexuals in Africa. It may also be effective in intravenous drug users with a study finding a reduced risk of 0.7-0.4 per 100 persons per year.
Universal precautions in health care settings are believed to be effective in reducing HIV risk. Intravenous drug use is an important risk factor and harm reduction strategies such as needle exchange programs and opioid substitution therapy appear to be effective in reducing this risk.
Post-exposure
A series of ARVs administered within 48 to 72 hours after exposure to HIV-positive blood or genital secretions is referred to as post-exposure prophylaxis (PEP). The use of single agent zidovudine reduces the risk of HIV infection fivefold after a syringe injury. In 2013, the recommended preventive regimen in the United States consists of three drugs - tenofovir, emtricitabine and raltegravir - as this can reduce the risk further.
PEP treatment is recommended after a sexual assault when the offender is known to be HIV positive, but controversial when their HIV status is unknown. The duration of treatment is usually four weeks and is often associated with adverse effects - where zidovudine is used, about 70% of cases produce side effects such as nausea (24%), fatigue (22%), emotional stress (13%) and headache (9%).
Mother-to-child
Programs to prevent vertical transmission of HIV (from mother to child) can reduce transmission rates by 92-99%. This primarily involves the use of a combination of antiviral drugs during pregnancy and after birth in infants and potentially includes bottle feeding rather than breastfeeding. If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, the mother should avoid breastfeeding her baby; However exclusive breastfeeding is recommended during the first months of life if this does not happen. If exclusive breastfeeding is performed, provision of extended antiretroviral prophylaxis for infants reduces the risk of transmission. In 2015, Cuba became the world's first country to combat mother-to-child transmission of HIV.
Vaccinations
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 of transmission risk by about 30%, stimulating some hope in the research community to develop a truly effective vaccine. Further trials of the RV 144 vaccine are ongoing.
Treatment
There are currently no effective HIV drugs or vaccines. Treatment consists of very slow antiretroviral therapy (ART) that slows the progression of the disease. In 2010 more than 6.6 million people took them in low- and middle-income countries. Treatment also includes preventive and active treatment of opportunistic infections.
The choice of current ART is a combination (or "cocktail") consisting of at least three drugs that belong to at least two types, or "classes," of antiretroviral drugs. Initially treatment is usually a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two NRTIs (NRTIs). Typical NRTIs include: AZT or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). A combination of agents including protease inhibitors (PIs) is used if the above regimen loses effectiveness.
The World Health Organization and the United States recommend antiretroviral drugs to people of all ages including pregnant women immediately after diagnosis without regard to CD4 cell count. Once the treatment begins it is recommended that it be continued without a break or "vacation". Many people are diagnosed only after treatment should ideally begin. The desired treatment outcome is the long-term amount of plasma HIV-RNA below 50 Âμg/mL. Levels to determine if effective treatment is initially recommended after four weeks and once the rate drops below 50 checks/checks every three to six months is usually sufficient. Inadequate control is considered to be greater than 400 copies/mL. Based on these criteria effective treatment in more than 95% of people during the first year.
Treatment benefits include reduced risk of development to AIDS and reduced risk of death. In developing countries treatment also improves physical and mental health. With treatment there is a 70% decreased risk of contracting tuberculosis. Additional benefits include reduced risk of transmission of the disease to sexual partners and decreased mother-to-child transmission. The effectiveness of treatment depends on most adherence. Reasons for non-compliance include poor access to medical care, inadequate social support, mental illness and drug abuse. The complexity of treatment regimens (due to number of pills and frequency of dosing) and side effects may reduce adherence. Although cost is an important issue with some drugs, 47% of those who need them take it in low- and middle-income countries by 2010 and similar adherence rates in low-income and high-income countries.
Specific side effects associated with antiretroviral drugs used. Some of the relatively common side effects include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus, especially with protease inhibitors. Other common symptoms include diarrhea, and an increased risk of cardiovascular disease. Newer recommended treatments are associated with fewer side effects. Certain medications may be related to birth defects and therefore may not be suitable for women who wish to have children.
Treatment recommendations for children are somewhat different from adults. The World Health Organization recommends taking care of all children less than 5 years old; children over 5 are treated like adults. The United States Guidelines recommend taking care of all children younger than 12 months and all people with HIV viral loads greater than 100,000 copies/mL between one year and five years.
Opportunistic infections
Steps to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current diseases, treatment with antiretroviral drugs reduces the risk of developing additional opportunistic infections. Adolescents and adolescents living with HIV (even on anti-retroviral therapy) without evidence of active tuberculosis in settings with high TB ​​burden should receive isoniazid preventive therapy (IPT), a tuberculin skin test may be used to help decide whether IPT is needed. Vaccination against hepatitis A and B is recommended for all people at risk of HIV infection before they become infected; However, it may also be given after the infection. Trimethoprim/sulfamethoxazole prophylaxis between the ages of four and six weeks and stop breastfeeding in infants born to HIV positive mothers is recommended in resource-limited settings. It is also advisable to prevent PCP when a person's CD4 cell count is below 200 cells/uL and in those who have or have previously had PCP. People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and MAC. Precautionary precautions reduced the rate of infection by 50% between 1992 and 1997. Influenza vaccination and pneumococcal polysaccharide vaccine are often recommended in people with HIV/AIDS with some evidence of benefits.
Diet
The World Health Organization (WHO) has issued recommendations on the nutritional requirements of HIV/AIDS. A healthy diet is generally promoted. Micronutrient nutrient intake at the RDA level by HIV-infected adults recommended by WHO; Higher intake of vitamin A, zinc, and higher iron can produce adverse effects in HIV-positive adults, and is not recommended unless there is a documented deficiency. Dietary supplements for HIV-infected and malnourished or diet-deficient people can strengthen their immune system or help them recover from infection, but evidence showing overall benefit in morbidity or mortality is not consistent.
The evidence for supplementation with selenium is mixed with some evidence of tentative benefits. For pregnant and lactating women with HIV, multivitamin supplements improve outcomes for mothers and children. If pregnant or breast-feeding women are advised to take anti-retroviral drugs to prevent mother-to-child transmission of HIV, multivitamin supplements should not replace this treatment. There is some evidence that vitamin A supplementation in children with HIV infection reduces mortality and promotes growth.
Alternative medicine
In the US, about 60% of people with HIV use various forms of complementary or alternative medicine, although the effectiveness of most of these therapies has not been established. There is not enough evidence to support the use of herbal medicines. There is not enough evidence to recommend or support the use of medical marijuana to try to increase appetite or weight gain.
Prognosis
HIV/AIDS has become a chronic disease and not an acute deadly disease in many regions of the world. Prognosis varies between people, and CD4 cell count and viral load are useful for predicted outcomes. Without treatment, the mean survival time after HIV infection is estimated to be 9 to 11 years, depending on the subtype of HIV. After an AIDS diagnosis, if treatment is not available, survival is between 6 and 19 months. HAART and proper prevention of opportunistic infections reduce mortality by up to 80%, and increase life expectancy for a newly diagnosed young adult up to 20-50 years. This is between two-thirds and almost of the general population. If treatment begins late in infection, the prognosis is not good: for example, if treatment begins after an AIDS diagnosis, life expectancy is ~ 10-40 years. Half of infants born with HIV die before the age of two without treatment.
The main causes of death from HIV/AIDS are opportunistic infections and cancer, both of which are often the result of a progressive failure of the immune system. Cancer risk appears to increase after CD4 counts below 500/? L. The rate of progression of clinical disease varies greatly among individuals and has been shown to be influenced by a number of factors such as one's susceptibility and immune function; their access to health care, the presence of co-infection; and certain strains (or strains) of the virus involved.
Tuberculosis co-infection is one of the leading causes of illness and death in those with HIV/AIDS who are present in one-third of all people infected with HIV and cause 25% of HIV-related deaths. HIV is also one of the most important risk factors for tuberculosis. Hepatitis C is one of the most common co-infections in which every disease promotes another progression. The two most common cancers associated with HIV/AIDS are Kaposi's sarcoma and AIDS-related non-Hodgkin's lymphoma. Other more frequent cancers include anal cancer, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer.
Even with anti-retroviral treatment, in long-term HIV-infected individuals may experience neurocognitive disorders, osteoporosis, neuropathy, cancer, nephropathy, and cardiovascular disease. Some conditions such as lipodystrophy may be caused by HIV and its treatment.
Epidemiology
HIV/AIDS is a global pandemic. By 2016, about 36.7 million people have HIV worldwide with a new infection number this year of about 1.8 million. This figure fell from 3.1 million new infections in 2001. More than half of the infected population are women and 2.1 million children. It generates about 1 million deaths by 2016, down from a peak of 1.9 million in 2005.
Sub-Saharan Africa is the most affected region. In 2010, an estimated 68% (22.9 million) of all HIV cases and 66% of all deaths (1.2 million) occurred in the region. This means that about 5% of the adult population is infected and is believed to be responsible for 10% of all deaths in children. Here, unlike the other regions, women make up nearly 60% of cases. South Africa has the largest population of people with HIV in any country in the world with 5.9 million. Life expectancy has fallen in the worst affected countries due to HIV/AIDS; for example, in 2006 is expected to decline from 65 to 35 years in Botswana. Mother-to-child transmission, in 2013, in Botswana and South Africa has dropped to less than 5% with improvements in many other African countries due to better access to antiretroviral therapy.
South & amp; Southeast Asia is the second most affected; in 2010 the region contains about 4 million cases or 12% of all people living with HIV resulting in some 250,000 deaths. About 2.4 million of these cases are in India.
In 2008 in the United States about 1.2 million people were living with HIV, which resulted in about 17,500 deaths. The US Centers for Disease Control and Prevention estimates that by 2008 20% of infected Americans are unaware of their infection. By 2016 about 675,000 people have died of HIV/AIDS in the United States since the beginning of the HIV epidemic. In the UK by 2015 there are about 101,200 cases resulting in 594 deaths. In Canada in 2008 there were approximately 65,000 cases causing 53 deaths. Between the first recognition of AIDS in 1981 and 2009 it has caused nearly 30 million deaths. The lowest prevalence in the Middle East and North Africa at 0.1% or less, East Asia of 0.1% and Western and Central Europe of 0.2%. The worst affected European countries, in 2009 and 2012 estimates, are Russia, Ukraine, Latvia, Moldova, Portugal, and Belarus, in order to decrease prevalence.
History
Discovery
AIDS was first observed clinically in 1981 in the United States. Initial cases were a group of injecting drug users and homosexual men with no known cause of immune disorders showing symptoms of Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection known to occur in people with a strongly compromised immune system. Soon after, a number of unexpected homosexual men developed a previously rare skin cancer called Kaposi's sarcoma (KS). More cases of PCP and KS emerged, reminding the US Centers for Disease Control and Prevention (CDC) and the CDC taskforce set up to monitor outbreaks.
In the early days, the CDC did not have an official name for the disease, often referring to the disease associated with it, for example, lymphadenopathy, a disease after which the HIV discoverer was originally named the virus. They also used Kaposi's sarcoma and opportunistic infections, a name used by the task force in 1981. At one point, the CDC coined the term "4H disease," because the syndrome appears to affect the heroin, homosexual, hemophilia , and Haiti. In the general press, the term "GRID", meaning gay-related immune deficiency, has been created. However, after determining that AIDS was not isolated for the gay community, it was realized that the term GRID was misleading and the term AIDS was introduced at a meeting in July 1982. In September 1982 the CDC began referring to the disease as AIDS.
In 1983, two separate research groups led by Robert Gallo and Luc Montagnier stated that the new retroviruses might have infected people with AIDS, and published their findings in the same issue of the journal Science. Gallo claims that a virus whose group has been isolated from someone with AIDS is very similar to other human T-lymphotropic viruses (HTLVs) whose group was the first to isolate. The Gallo group calls their newly isolated HTLV-III virus. At the same time, the Montagnier group isolated the virus from someone who had swollen lymph nodes in the neck and physical weakness, two typical symptoms of AIDS. Contrary to reports from the Gallo group, Montagnier and his colleagues showed that the core protein of this virus is immunologically different from HTLV-I. The Montagnier group named the isolated virus-associated lymphadenopathy virus (LAV). Since both of these viruses were the same, in 1986, LAV and HTLV-III were renamed to HIV.
Origins
Both HIV-1 and HIV-2 are believed to originate from non-human primates in central-West Africa and transferred to humans in the early 20th century. HIV-1 appears to originate in southern Cameroon through the evolution of SIV (cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 down from endemic SIVcpz in the subspecies of the Pan troglodytes troglodytes chimpanzee ). The closest relatives of HIV-2 are SIV (smm), virus from mangabey soot ( Cercocebus atys atys ), Old World monkeys living on the West African coast (from Senegal south to west CÃÆ'Â'te d'Ivoire ). The New World Monkey is like an owl monkey that is resistant to HIV-1 infection, probably due to the genomics of the two viral resistance genes. HIV-1 is thought to have skipped the species barrier at least on three separate occasions, resulting in three groups of viruses, M, N, and O.
There is evidence that humans who participate in wildlife meat activities, either as hunters or as sellers of wildlife meat, usually earn SIV. However, SIV is a weak virus that is usually suppressed by the human immune system within weeks of infection. It is estimated that multiple virus transmissions from individual to individual are required to allow sufficient time to mutate into HIV. Moreover, due to the relatively low rates of person-to-person transmission, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, thought to have been absent in Africa before the 20th century.
Specifically proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout the community, depending on the time proposed for crossing animals to humans. Genetic studies of viruses indicate that the most common ancestor of the HIV-1 group M dates back to around 1910. These dating advocates linked the HIV epidemic with the emergence of colonialism and the growth of major African colonial cities, leading to social change. , including higher rates of sexual intercourse, prostitution spread, and high frequency of genital ulcer disease (such as syphilis) in newborn colonial cities. While the rate of HIV transmission during sex is low under normal circumstances, they increase a lot if one partner has sexually transmitted infections that cause genital ulcers. The early 1900s colonial cities were notorious for the high prevalence of prostitution and genital ulcers, to the extent that, by 1928, as many as 45% of East Kinshasa female population was considered to be prostitutes, and, in 1933, about 15% of all residents of the same city suffer from syphilis.
An alternative view states that unsafe medical practices in Africa after World War II, such as the re-use of unsterilized sterile needles during mass vaccinations, antibiotic treatment campaigns and anti-malarials, are early vectors that allow viruses to adapt to humans and spread.
The earliest well-documented HIV cases in humans date from 1959 in Congo. The earliest retrospectively described cases of AIDS are believed to have started in Norway in 1966. In July 1960, after Congolese independence, the United Nations recruited experts and technicians from all over the world to help fill the administrative vacuum left by Belgium, which left no elite Africa to run the country. In 1962, the Haitians became the second largest group of educated experts (out of 48 recruited national groups), totaling about 4,500 in the country. Dr. Jacques PÃÆ' Â © pin, the Quebec author of The Origins of AIDS, states that Haiti is one of the entry points of HIV to the United States and one of them may have brought HIV back across the Atlantic in the 1960s. Although the virus may have been present in the United States since 1966, most infections outside of sub-Saharan Africa (including the US) can be traced back to an unknown individual who became infected with HIV in Haiti and then bring the infection to the United States around in 1969. This epidemic then spread rapidly among high-risk groups (initially, sexually indecent men who have sex with men). In 1978, HIV-1 prevalence among homosexual men of New York City and San Francisco residents was estimated at 5%, indicating that several thousand people in the country had been infected.
Society and culture
Stigma
AIDS stigma exists worldwide in a variety of ways, including isolation, rejection, discrimination and avoidance of HIV-infected persons; mandatory HIV testing without prior consent or confidentiality protection; violence against people infected with HIV or persons deemed infected with HIV; and quarantine people infected with HIV. Violence associated with stigma or fear of violence prevents many people from seeking HIV testing, returns for their results, or gets treatment, possibly turning what could be a chronic illness that can be managed to death and perpetuate the spread of HIV.
AIDS stigma has been subdivided into the following three categories:
- Instrumental AIDS stigma - a reflection of fears and fears that may be associated with deadly and contagious diseases.
- Symbolic AIDS Stigma - the use of HIV/AIDS to express attitudes toward social groups or lifestyles deemed to be related to disease.
- Stigma Courtesy AIDS - stigmatization of people related to HIV/AIDS or HIV-positive people.
Often, AIDS stigma is expressed along with one or more other stigma, especially related to homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.
In many developed countries, there is a link between AIDS and homosexuality or bisexuality, and this relationship is correlated with higher levels of sexual prejudice, such as anti-homosexual/bisexual attitudes. There is also a perceived relationship between AIDS and all male sexual behavior, including sex between uninfected men. However, the dominant mode of worldwide spread for HIV remains a heterosexual transmission.
In 2003, as part of the marriage and population reform legislation as a whole, it became legal for people with AIDS to marry in China.
In 2013, the US National Medical Library developed a traveling exhibition entitled, "Surviving and Growing: AIDS, Politics, and Culture", covering medical research, US government responses, and personal stories of people with AIDS, caregivers and activists.
Economic impact
HIV/AIDS affects the economy of both individuals and countries. Gross domestic product of the most affected countries has declined due to lack of human capital. Without proper nutrition, health care and medicine, many people die of AIDS-related complications. They not only can not work, but will also require significant medical care. It is estimated that in 2007 there were 12 million AIDS orphans. Many are cared for by elderly grandparents.
Returning to work after starting treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. Unemployment in people with HIV/AIDS is also associated with suicidal ideation, memory problems, and social isolation; work increases self-esteem, sense of dignity, self-confidence, and quality of life. The 2015 Cochrane Review finds low-quality evidence that ART helps people with HIV/AIDS work more, and increases the likelihood that someone with HIV/AIDS will be hired.
By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing available resources to public spending such as education and health services that are not related to AIDS thereby increasing pressure for the country's finances and slower economic growth. This leads to slower growth of the tax base, a reinforced effect if there is ever-increasing spending to treat the sick, training (to replace sick workers), paying ill and taking care of AIDS orphans. This is especially true if a sharp increase in adult deaths shifts responsibility and blames families for the care of these orphans.
At the household level, AIDS causes income loss and increased spending on health care. A study at CÃÆ'Â'te d'Ivoire showed that households with people with HIV/AIDS spend twice as much on medical expenses as compared to other households. These additional expenses also leave less income to spend on education and personal or other family investments.
Religion and AIDS
Religious and AIDS topics have become highly controversial in the past twenty years, especially as some religious authorities openly declare their refusal of condom use. The religious approach to preventing the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global AIDS Crisis argues that cultural change is necessary including a re-emphasis on loyalty in marriage and sexual abstinence beyond that.
Some religious organizations claim that prayer can cure HIV/AIDS. In 2011, the BBC reported that several churches in London claimed that prayer would cure AIDS, and the Hackney-based Center for Sexual and HIV Studies reported that some people stopped using their medication, sometimes on the advice of their pastor. , causing a number of deaths. Synagogue Church Of All Nations advertises "anointing water" to promote God's healing, even though the group refuses to advise people to stop taking medicine.
Media depictions
One of the first cases of AIDS was American Rock Hudson, a married and divorced gay actor early on, who died on October 2, 1985 after announcing that he had the virus on July 25 that year.. He has been diagnosed during 1984. A famous British AIDS victim of the year was Nicholas Eden, a gay politician and son of prime minister Anthony Eden. On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, the lead singer of Queen's band, who died of AIDS-related illnesses only showed a diagnosis the previous day. However, he had been diagnosed as HIV positive in 1987. One of the first high-profile heterosexual cases of the virus was Arthur Ashe, an American. She was diagnosed as HIV positive on August 31, 1988, after contracting the virus from a blood transfusion during cardiac surgery in the early 1980s. Further examination within 24 hours after initial diagnosis showed that Ashe had AIDS, but she did not publicly tell her about her diagnosis until April 1992. She died as a result on February 6, 1993 at the age of 49.
Therese's photograph of gay activist David Kirby, as he lay dying of AIDS while surrounded by the family, was taken in April 1990. LIFE magazine said the photograph became one of the "most strongly identified images of HIV/Epidemic AIDS. "The photo was featured in LIFE magazine, a winner of World Press Photo, and gained a worldwide reputation after being used in the United Colors of Benetton advertising campaign in 1992. In 1996, Johnson Aziga, Uganda Infants born in Canada are diagnosed with HIV, but then have unprotected sex with 11 women without revealing the diagnosis. In 2003, seven people contracted HIV, and two died of AIDS-related complications. Aziga was convicted of first-degree murder and sentenced to life imprisonment.
Disaster transmission
Crime of HIV transmission is a deliberate or reckless infection of a person with human immunodeficiency virus (HIV). Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure. Others may sue defendants under the laws imposed before the HIV pandemic.
Misconceptions
There are many misconceptions about HIV and AIDS. Three of the most common is that AIDS can spread through casual contact, that sexual intercourse with virgins will cure AIDS, and that HIV can only infect gay men and drug users. In 2014, some people in the UK mistakenly think that someone could be infected with HIV by kissing (16%), sharing glasses (5%), spitting (16%), public toilets (4%), and coughing or sneezing (5%). Another misconception is that any anal act between two uninfected gay men can lead to HIV infection, and that open discussion about HIV and homosexuality in schools will lead to an increase in AIDS rates.
A small group of people continue to debate the relationship between HIV and AIDS, the presence of HIV itself, or the validity of HIV testing and treatment methods. These claims, known as AIDS rejection, have been examined and rejected by the scientific community. However, they have a significant political impact, particularly in South Africa, where the official government embrace of the Aids refusal (1999-2005) is responsible for an ineffective response to the country's AIDS epidemic, and has been blamed for hundreds of thousands of people who could have been avoided. death and HIV infection.
Some discredited conspiracy theories have suggested that HIV was created by scientists, either by accident or by accident. INFEKTION operation is the operation of Soviet active steps worldwide to spread the claim that the United States has created HIV/AIDS. Surveys show that a large number of believers - and continue to believe - in such claims.
Research
The HIV/AIDS study covers all medical research that tries to prevent, treat or cure HIV/AIDS along with fundamental research on the nature of HIV as an infectious agent and AIDS as a disease caused by HIV.
Many governments and research institutions participate in HIV/AIDS research. The study included behavioral health interventions such as sex education, and drug development, such as microbicide research for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include pre-exposure prophylaxis, post-exposure prophylaxis, and circumcision and HIV.
References
External links
- HIV/AIDS in Curlie (based on DMOZ)
- UNAIDS - UN Joint Program on HIV/AIDS.
- AIDSinfo - Information on HIV/AIDS treatment, prevention and research, US Department of Health and Human Services.
Source of the article : Wikipedia
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