Contents

About the Author iii

A Quarter Century of AIDS and Counting:: A Humanitarian Crisis ix

AIDS UPDATE 2009 xvi

Preface xviii

Introduction:: Histories of Global

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

History of Global Pandemics and Epidemics 1

Fear, Ignorance and Condemnation::

Imagine a World Without AIDS 2

Overview of HIV/AIDS 4

AIDS:: A Unique Disease 5

AIDS:: A Cause of Death 5

Another Anniversary 6

A New Anniversary 6

International AIDS Conferences 6

Means of Remembering 7

The 25th Candlelight Memorial 9

Walking to Change the Course of the HIV/AIDS Epidemic United States 10

Bicycle Riding to Change the Course of the HIV/AIDS Epidemic United States 12

World AIDS Day:: An International Day of Coordinated Action:: A Time to Recharge and Reconnect 12

The World Health and UNAIDS Organizations 14

The Future 14

National AIDS Hotlines 16

Useful Internet Addresses 16

1 AIDS:: Defining the Disease and Finding Its Cause 19

The New Millennium 19

AIDS:: A Disease or a Syndrome? 20

First Reaction to AIDS:: Denial 21

What Causes AIDS? 22

How Does HIV Cause AIDS? 23

The Centers for Disease Control and Prevention Reports 25

Discovery of the AIDS Virus 25

Defining the Illness:: AIDS Surveillance 27

Summary 29

Review Questions 29

2 What Causes AIDS:: Origin of the AIDS Virus 30

The Cause of AIDS:: The Human Immunodeficiency Virus (HIV) 30

Evidence That HIV Causes AIDS 35

Origin of HIV:: The AIDS Virus 37

Summary on the Origin of HIV 43

Summary 44

Review Questions 44

3 Biological Characteristics of the AIDS Virus 46

Viruses Need a Host Cell in Order to Reproduce 46

Viruses Are Parasites 46

Viruses Specific to Cell Type 47

Retroviruses 47

Description of HIV; How It Attaches to a Host Cell and Buds Out of the Cell 47

Human Immunodeficiency Virus (HIV):: Its Life Cycle 50

The HIV Life Cycle 50

How HIV Escapes the Infected Cell 52

Basic Genetic Structure of Retroviral Genomes 54

Genetic Revolution 59

Formation of Genetic Recombination in HIV 59

Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins 60

Summary 63

Review Questions 63

4 Anti-HIV Therapy 65

Anti-HIV Therapy 66

HIV Eradication Update 2008 67

Antiretroviral Therapy (ART) Drugs with FDA Approval 67

The HIV Medicine Chest:: ART Drugs Receiving FDA Approval 69

FDA-Approved Nucleoside/Non-Nucleoside Analog Reverse Transcriptase Inhibitors and Protease Inhibitors 71

Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors 74

FDA-Approved Protease Inhibitors 74

Protease Inhibitors 74

Entry Inhibitors and Problems 76

Integrase Inhibitors 77

Development and Selection of HIV Drug-Resistant Mutants 78

Development of HIV Drug Resistance to Protease Inhibitors 78

How Combination Drug Therapy Can Reduce the Chance of HIV Drug Resistance 82

HIV Treatment Regimen Failure 83

Viral Load:: Its Relationship to HIV Disease and AIDS 88

Medical Complications Associated with Anti-HIV Drug Therapies (ART) 88

The Smart Trial Was Cancelled onJanuary 11, 2006 97

Novel Drugs 97

Disclaimer 97

Summary 99

Some AIDS Therapy Information Hotlines 100

Review Questions 101

5 The Immunology of HIV Disease/AIDS 103

The Immune System 103

Human Lymphocytes:: T Cells and B Cells 105

Antibodies and HIV Disease 113

Cellular Micro-RNAs Contribute to HIV Latency in Resting Primary CD4+ T Cells 115

Immune System Dysfunction 115

Original Antigenic Sin 117

The Search for Additional Receptors (Coreceptors) to CD4:: FUSIN or CXCKR-4 (R-4) 118

CCKR-5 (R-5) Receptor 118

Emergence of HIV Strains That Vary in Their Lethal Abilities 119

In Search of Genetic Resistance to HIV Infection 119

T4 Cell Depletion and Immune Suppression 122

Impact of T4 Cell Depletion 122

Role of Monocytes and Macrophages in HIV Infection 123

Where Do T4 or CD4+ Cells Become HIV Infected? 124

Summary 127

Review Questions 127

6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS 128

What Is an Opportunistic Disease? 128

The Prevalence of Opportunistic Diseases 129

Opportunistic Infections in HIV-Infected People 129

TB and HIV 140

Cancer or Malignancy in HIV/AIDS Patients 140

Disclaimer 145

Summary 145

Review Questions 145

7 A Profile of Biological Indicators for HIV Disease and Progression to AIDS 146

HIV Disease Defined 146

Stages of HIV Disease (Without Drug Therapy) 150

HIV Disease Without Symptoms, with Symptoms, and AIDS 156

Production of HIV-Specific Antibodies 157

Prognostic Biological Markers Related to AIDS Progression 161

HIV Infection of the Central Nervous System (CNS) 167

Neuropathies in HIV Disease/AIDS Patients 168

Pediatric Clinical Signs and Symptoms 169

Summary 170

Review Questions 171

8 Epidemiology and Transmissionof the Human Immunodeficiency Virus 172

We Must Stop HIV Transmission Now! 174

Epidemiology of HIV Infection 174

Transmission of Two Strains of HIV (HIV-1/HIV-2) 175

Is HIV Transmitted by Insects? 175

HIV Transmission 176

HIV Transmission in Family/Household Settings 178

Noncasual Transmission 178

Gay Men Putting Themselves at High Risk for HIV Infection 189

Problem 194

Injection-Drug Users and HIV Transmission 198

United States:: HeterosexualInjection-Drug Use (idU) 202

Cesarean Section 215

Conclusion 216

National AIDS Resources 216

Summary 217

Challenge Your Assumptions about the HIV Infected 217

Review Questions 217

9 Preventing the Transmission of HIV 219

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 Stop the Spread of HIV/AIDS 220

Global Prevention 221

Antiretroviral Drugs Having an Impact on Prevention, but We Cant Treat Our Way Out of This Pandemic 222

Advancing HIV Prevention:: New Strategies for a Changing Epidemic 224

Preventing the Transmission of HIV 226

Sexual Risk Taking Depends on Sexual Activity 229

New Rules to an Old Game:: Promoting Safer Sex Nobody Has a Body to Die for! 231

The Male Condom 234

The Female Condom or Femidom(Vaginal Pouch) 240

An Alternative to Condoms:: Vaginal Microbicides 242

Injection-Drug Use and HIV Transmission:: The Twin Epidemics 245

HIV Prevention for Injection-Drug Users 245

Lifting the Ban on the Use of Federal Funding to Support Needle Exchange Programs 247

Prevention of Blood and Blood Product HIV Transmission 248

Infection Control Procedures 249

Sexual Partner Notification:: Disclosure 250

The U.S. Federal Government Has Now Adopted Partner Notification as Its Cornerstone in Its Effort to Help Control the Spread of HIV 251

The First Human Vaccine:: The Impact of Vaccines on Infectious Diseases 254

HIV Vaccine Development and Its Role in Prevention 254

Types of Experimental HIV Vaccines 258

DNA Vaccine 258

Problems in the Search for HIV Vaccine 260

Summary 262

Review Questions 263

10 Prevalence of HIV Infections, AIDS Cases, and Deaths Among Select Groups in the United States and in Other Countries 264

A Word about HIV/AIDS Data 265

The Millennium:: Year 2009 270

Formula for Estimating HIV Infections 272

Behavioral Risk Groups and Statistical Evaluation 274

Estimates of AIDS Cases and HIV Infection 284

Newly Infected 286

Shape of the HIV Pandemic::United States 288

Shape of AIDS Pandemic::United States 288

Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States 290

Canada Estimated HIV/AIDS Cases through 2008:: Population 33,310,000 292

Global Prevalence and Impact of HIV/AIDS 294

Connected But Separate 296

WorkforceĐSouth Africa:: Some Examples 298

Education:: Teachers and StudentsĐ South Africa and Some Countries in Southern Africa 298

Other HIV/AIDS Time Bombs in Asia:: India, China, and Russia 299

Summary 303

Review Questions 303

11 Prevalence of HIV Infection and AIDS Cases Among Women and Children 305

AIDS Is Defining the Lives of Millions of Women 306

Female Vulnerability 306

Every Day a Tragedy 306

Triple Jeopardy 306

Annual International Womens Day March 8 307

Women:: AIDS and HIV Infections Worldwide 307

Women:: HIV-Positive and AIDS Cases United States 308

Childbearing Women 323

Internet 324

Pediatric HIV-Positive and AIDS Cases United States:: A Fight We Can Win! 324

Orphaned Children Due to HIV Infection and AIDS 325

The Phenomenon of AIDS Orphans 326

Summary 332

Review Questions 332

12 Prevalence of HIV Infection and AIDS Among Young Adults, Ages 13 to 24 334

Global HIV Infections in Young Adults 334

Addressing the AIDS Pandemic Among Young Adults 335

How Large Is the Young Adult Population in the United States? 336

HIV/AIDS Wont Affect Us! 337

Estimate of HIV-Infected and AIDS Cases Among Young Adults in the United States 338

Summary 346

Internet 346

Other Useful Sources 346

Review Questions 346

13 Testing for Human Immunodeficiency Virus 347

Determining the Presence of Antibody Produced When HIV Is Present 348

Requests for HIV Testing 348

Reasons for HIV Testing 349

Laboratory Methods for Detecting HIV 350

ELISA HIV Antibody Test 351

Western Blot Assay 358

New ELISA Antibody Testing and Viral Load Procedures Reveal Early versus Late HIV Infection 361

Rapid HIV Testing 363

FDA Approves Two Home HIV Antibody Test Kits 367

Some Screening and Confirmatory Tests for HIV 368

Deciding Who Should Get an Hiv Test and When 371

Why Is HIV Test Information Necessary? 372

Immigration into the United States 372

Testing, Competency, and Informed Consent 374

Summary 381

Review Questions 382

14 AIDS and Society:: Knowledge, Attitudes, and Behavior 383

HIV/AIDS Is a Story in Our Lifetime 384

The New Millennium and HIV/AIDS 385

HIV/AIDS Is an Unusual Social Disease 385

Discrimination vs. Compassion and Support 385

HIV/AIDS Is Here to Stay 386

AIDS 387

Blame Someone, DeJa Vu 387

Fear:: Panic and Hysteria Over the Spread of HIV/AIDS in the United States 388

Whom Is the General Public to Believe? 389

AIDS Education and Behavior:: Dissipating Fear with Education 394

The Character of Society 401

Dealing with Discrimination:: The Americans with Disabilities Act 406

Federal and Private Sector Financing:: Creation of an AIDS Industry 408

U.S. Government Believes HIV/AIDS Is a Threat to National Security 411

Global HIV/AIDS Funding for Underdeveloped Nations 412

Forms of U.S. Monetary Assistance for HIV/AIDS 418

Summary 423

Review Questions 424

Answers to Review Questions 425

Glossary 431

References 439

Index 461