AIDS Update 2011

Contents

About the Authoriii

A Quarter Century of AIDS and Counting:: A Humanitarian Crisisx

AIDS UPDATE 2011xx

Prefacexxii

Introduction:: Histories of Global Pandemics, AIDS, Its Place in History, Overview of HIV/AIDS, International AIDS Conferences and Means of Remembering-the AIDS Quilt, Candlelight Memorial, and World AIDS Day1

Three Words Echo around the World:: AIDS Crisis Worsens!1

History of Global Pandemics and Epidemics1

Fear, Ignorance, and Condemnation:: Who Is to Blame?2

Imagine a World without AIDS2

Overview of HIV/AIDS4

AIDS:: A Unique Disease5

AIDS:: A Cause of Death5

Another Anniversary6

Other Anniversaries6

International AIDS Conferences6

Means of Remembering7

The 27th Candlelight Memorial8

Walking to Change the Course of the HIV/AIDS Epidemic-United States8

Bicycle Riding to Change the Course of the HIV/AIDS Epidemic-United States10

World AIDS Day:: An International Day of Coordinated Action:: A Time to Recharge and Reconnect10

The Future11

National AIDS Hotlines12

Useful Internet Addresses13

1 AIDS:: Defining the Disease and Finding Its Cause15

The New Millennium15

AIDS:: A Disease or a Syndrome?16

First Reaction to AIDS:: Denial17

What Causes AIDS?18

The Centers for Disease Control and Prevention Reports20

Discovery of What Causes AIDS21

Defining the Illness:: AIDS and Surveillance22

Summary24

Review Questions25

2 What Causes AIDS:: Origin of the AIDS Virus26

The Cause of AIDS:: The Human Immunodeficiency Virus (HIV)26

HIV Does Not Cause AIDS:: Dissidents and Their Cults:: A Minority Point of View26

News Flash 2010-Leading HIV/AIDS Dissident Cleared of Misconduct Following Complaints Made After He and Others Published a 2009 Paper Arguing That There Is As Yet No Proof That HIV Causes AIDS32

Dissidents (AIDS Doest Exist or HIV Isnt the Cause)32

Summary of the HIV/AIDS Dissidents Viewpoints33

Evidence That HIV Causes AIDS33

Origin of HIV:: The AIDS Virus35

Summary on the Origin of HIV42

Summary43

Review Questions43

3 Biological Characteristics of HIV44

Viruses Need a Host Cell in Order to Replicate44

Viruses Are Parasites44

Viruses Specific to Cell Type45

How Do Human T4 or CD4+ Lymphocytes Relate to HIV Infection and AIDS?46

Description of HIV; How It Attaches to a Host Cell and Buds Out of the Cell47

HIV Fitness48

The HIV Life Cycle49

Understanding How HIV Works49

How HIV Escapes the Infected Cell50

Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins58

Summary61

Review Questions61

4 Anti-HIV Therapy62

Better Drugs, BEtter Technologies, and Lingering Problems63

Anti-HIV Therapy63

The Good News About ART64

Antiretroviral Therapy (ART) Drugs with FDA Approval67

The HIV Medicine Chest:: ART Drugs Receiving FDA Approval67

FDA-Approved Nucleoside/Non-Nucleoside Analog Reverse Transcriptase Inhibitors, Protease Inhibitors, Integrase Inhibitors, Entry Inhibitors, and Maturation Inhibitors71

Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors71

FDA-Approved Protease Inhibitors73

Entry Inhibitors and Problems75

Integrase Inhibitors76

Development and Selection of HIV Drug-Resistant Mutants76

Development of HIV Drug Resistance to Protease Inhibitors77

How Combination Drug Therapy Can Reduce the Chance of HIV Drug Resistance79

Viral Load:: Its Relationship to HIV Disease and AIDS86

Medical Complications Associated with Anti-HIV Drug Therapies (ART)87

Update 201094

Summary94

Disclaimer95

Some AIDS Therapy Information Hotlines96

Review Questions96

5 The Immunology of HIV Disease/AIDS98

The Immune System98

Human Lymphocytes:: T Cells and B Cells101

Why CD4+ Cells Are Important in HIV Infection-What It Means104

The CD4+ Cell Count-Why It Matters104

Antibodies and HIV Disease109

Cellular MicroRNAs Contribute to HIV Latency in Resting Primary CD4+ T Cells112

Immune System Dysfunction113

Original Antigenic Sin113

The Search for Additional Receptors (Coreceptors) to CD4:: Fusin or CXCKR-4 (R-4)116

CCKR-5 (R-5) Receptor116

Emergence of HIV Strains That Vary in Their Lethal Abilities117

In Search of Genetic Resistance to HIV Infection119

T4 Cell Depletion and Immune Suppression120

Impact of T4 Cell Depletion121

Role of Monocytes and Macrophages in HIV Infection122

Where Do T4 or CD4+ Cells Become HIV Infected?123

Summary126

Review Questions127

6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS128

What Is an Opportunistic Disease?128

The Prevalence of Opportunistic Diseases129

Opportunistic Infections in HIV-Infected People130

TB:: The Leading Cause of Death among HIV-Positive People Worldwide141

Cancer or Malignancy in HIV/AIDS Patients141

Disclaimer146

Summary147

Review Questions147

7 A Profile of Biological Indicators for HIV Disease and Progression to AIDS148

What Is Known and What Is Missing from Our Understanding of HIV/AIDS148

HIV Disease Defined149

Stages of HIV Disease (without Drug Therapy)153

HIV Disease without Symptoms, with Symptoms, and AIDS158

Production of HIV-Specific Antibodies159

Prognostic Biological Markers Related to AIDS Progression163

HIV Infection of the Central Nervous System (CNS)166

Neuropathies (Nerve Tissue Damage) in HIV Disease/AIDS Patients167

Pediatric Clinical Signs and Symptoms168

Summary168

Review Questions168

8 Epidemiology and Transmission of the Human Immunodeficiency Virus170

Epidemic/Epidemiology171

We Must Stop HIV Transmission Now!173

Epidemiology of HIV Infection173

Transmission of Two Strains of HIV (HIV-1/HIV-2)176

Is HIV Transmitted by Insects?176

HIV Transmission176

HIV Transmission in Family/Household Settings177

Noncasual Transmission177

Gay Men Putting Themselves at High Risk for HIV Infection187

The Biological Factor193

Injection-Drug Users and HIV Transmission199

United States:: Heterosexual Injection-Drug Use (IDU)199

Injection-Drug Use and HIV Infections in Other Countries202

Other Means of HIV Transmission206

Influence of Sexually Transmitted Diseases (STDs) on HIV Transmission and Vice-Versa207

Pediatric Transmission214

Conclusion215

National AIDS Resources<216/p>

Summary216

Challenge Your Assumptions about the HIV Infected217

Review Questions217

9 Preventing the Transmission of HIV219

The AIDS Generation:: I Knew Everything about It, and I Still Got It!220

Prevention, Not Treatment, Is the Least Expensive and Most Effective Way to Reduce the Spread of HIV/AIDS221

Global Prevention222

Antiretroviral Drugs Have an Impact on Prevention, But We Cant Treat Our Way Out of This Pandemic223

Advancing HIV Prevention:: New Strategies for a Changing Epidemic228

Preventing the Transmission of HIV229

Sexual Risk Taking Depends on Sexual Activity232

New Rules to an Old Game:: Promoting Safer Sex-Nobody Has a Body to Die For!235

The Male Condom238

The Female Condom or Femidom (Vaginal Pouch)241

An Alternative to Condoms:: Vaginal Microbicides (MI-CRO-BA-CIDES) and Circumcision245

Update 2010-The CAPRISA 004 Study Results246

Circumcision and the Prevention of HIV Trransmission246

Injection-Drug Use (IDU) and HIV Transmission:: The Twin Epidemics247

HIV Prevention for Injection-Drug Users248

Prevention of Blood and Blood Product HIV Transmission251

Infection Control Procedures252

Sexual Partner Notification:: Disclosure253

The U.S. Federal Government Has Now Adopted Partner Notification as Its Cornerstone in Its Effort to Help Control the Spread of HIV254

The First Human Vaccine:: The Impact of Vaccines on Infectious Diseases258

HIV Vaccine Development and Its Role in Prevention258

How These Two Neutralizing Antibodies Work260

Types of Experimental HIV Vaccines262

DNA Vaccine264

Problems in the Search for HIV Vaccine264

September 2009-News Broke That a Partially Effective HIV Vaccine Was Found!265

Summary266

Review Questions268

10 Prevalence of HIV Infections, AIDS Cases, and Deaths among Select Groups in the United States and in Other Countries269

A Word about HIV/AIDS Data271

Year 2011273

Formula for Estimating HIV Infections276

Behavioral Risk Groups and Statistical Evaluation277

September 18:: Annual National HIV/AIDS Aging Awareness Day290

Estimates of AIDS Cases and HIV Infection291

Newly Infected292

Shape of the HIV Pandemic:: United States293

Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States298

Selected Nations/Countries Have Different Epidemics. Each Faces Its Own Reality298

Canadas Estimated HIV/AIDS Cases through 2009:: Population 33,310,000300

Mexicos Estimated HIV/AIDS Cases through 2009:: Population 110 Million300

United Kingdoms (UK) Estimated HIV/AIDS Data through 2009:: Population 61 Million301

Global Prevalence and Impact of HIV/AIDS304

Connected but Separate:: Each Country a Different Reality, Different Countries Similar Questions, but Different Answers, Different Epidemics<304/p>

Workforce-South Africa:: Some Examples307

Education:: Teachers and Students-South Africa and Some Countries in Southern Africa307

Other HIV/AIDS Time Bombs in Asia:: India, China, and Russia308

Summary312

Review Questions313

11 Prevalence of HIV Infection and AIDS Cases among Women and Children 314

HIV/AIDS Is Defining the Lives of Millions of Women315

Female Vulnerability to HIV316

Every Day a Tragedy316

Triple Jeopardy316

Annual International Womens Day-March 8316

Women:: AIDS and HIV Infections Worldwide317

Asia-Pacific Region, Over Five Million HIV Positive:: 2010318

Women:: HIV-Positive and AIDS Cases-United States320

Childbearing Women:: Worldwide331

Internet Resources332

Pediatric HIV-Positive and AIDS Cases-United States:: A Fight We Can Win!333

Orphaned Children Due to HIV Infection and AIDS334

The Phenomenon of AIDS Orphans336

Summary340

Review Questions341

12 Prevalence of HIV Infection and AIDS among Young Adults, Ages 13 to 24342

Global HIV Infections in Young Adults342

Addressing the AIDS Pandemic among Young Adults343

How Large Is the Young Adult Population in the United States?345

HIV/AIDS Wont Affect Us!347

Estimate of HIV-Infected and AIDS Cases among Young Adults in the United States, Globally347

Summary355

Internet355/p>

Other Useful Sources355

Review Questions355

13 Testing for Human Immunodeficiency Virus356

Determining the Presence of Antibody Produced When HIV Is Present358

Requests for HIV Testing358

Reasons for HIV Testing:: I Know, I Took the Test358

Laboratory Methods for Detecting HIV360

ELISA HIV Antibody Test361

Western Blot Assay367

New ELISA Antibody Testing and Viral Load Procedures Reveal Early Versus Late HIV Infection369

Rapid Result HIV Testing372

FDA Approves Home HIV Antibody Test Kit375

Some Screening and Confirmatory Antigen-Detection Tests for HIV375

Deciding Who Should Get an HIV Test and When376

Why Is HIV Test Information Necessary?378

Immigration and Travel Ban into the United States Is Lifted378

Testing, Privacy, Competency, and Informed Consent380

Summary387

Review Questions387

14 AIDS and Society:: Knowledge, Attitudes, and Behavior389

HIV/AIDS Is a Story in Our Lifetime390

The New Millennium and HIV/AIDS391

HIV/AIDS Is an Unusual Social Disease392

Discrimination vs. Compassion and Support392

HIV/AIDS Is Here to Stay392

AIDS Comes to the United States393

Blame Someone, DŽj^ Vu393

Fear:: Panic and Hysteria over the Spread of HIV/AIDS in the United States394

Whom Is the General Public to Believe?396

AIDS Education and Behavior:: Dissipating Fear with Education400

The Character of Society409

Dealing with Discrimination:: The Americans with Disabilities Act411

Federal and Private Sector Financing:: Creation of an AIDS Industry413

U.S. Government Believes HIV/AIDS Is a Threat to National Security414

Global HIV/AIDS Funding for Underdeveloped Nations419

Forms of U.S. Monetary Assistance for HIV/AIDS425

Summary431

Review Questions432

Answers to Review Questions434

Glossary442

References453

Index480