AIDS Update 2010

Contents

About the Author iii

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

AIDS UPDATE 2010 xix

Preface xxi

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 Day 1

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

History of Global Pandemics and Epidemics 1

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

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

Other Anniversaries 6

International AIDS Conferences 6

Means of Remembering 7

The 26th 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 13

The Future 13

National AIDS Hotlines 15

Useful Internet Addresses 15

1 AIDS:: Defining the Disease and Finding Its Cause 18

The New Millennium 18

AIDS:: A Disease or a Syndrome? 19

First Reaction to AIDS:: Denial 20

What Causes AIDS? 20

How Do CD4+ Cells Relate to HIV Infection and AIDS? 22

The Centers for Disease Control and Prevention Reports 24

Discovery of the AIDS Virus 24

Defining the Illness:: AIDS and Surveillance 26

Summary 28

Review Questions 28

2 What Causes AIDS:: Origin of the AIDS Virus 29

The Cause of AIDS:: The Human Immunodeficiency Virus (HIV) 29

Dissidents (AIDS Doesnt Exist or HIV Isnt the Cause) 33

Evidence That HIV Causes AIDS 33

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 45

Viruses Need a Host Cell in Order to Reproduce 45

Viruses Are Parasites 45

Viruses Specific to Cell Type 46

Retroviruses 46

Description of HIV; How It Attaches to a Host Cell and Buds Out of the Cell 46

Human Immunodeficiency Virus (HIV):: Its Life Cycle 49

The HIV Life Cycle 49

How HIV Escapes the Infected Cell 53

Basic Genetic Structure of Retroviral Genomes 53

Genetic Revolution 58

Formation of Genetic Recombination in HIV 58

Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins 59

Summary 62

Review Questions 62

4 Anti-HIV Therapy 64

Exciting Times for Antiretroviral Therapy 65

Anti-HIV Therapy 65

HIV Eradication Update-Is a Cure Possible? 69

Antiretroviral Therapy (ART) Drugs with FDA Approval 69

The HIV Medicine Chest:: ART Drugs Receiving FDA Approval 72

FDA-Approved Nucleoside/Non-Nucleoside Analog Reverse Transcriptase Inhibitors and Protease Inhibitors 73

Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors 75

FDA-Approved Protease Inhibitors 75

Entry Inhibitors and Problems 78

Integrase Inhibitors 79

Development and Selection of HIV Drug-Resistant Mutants 80

Development of HIV Drug Resistance to Protease Inhibitors 81

How Combination Drug Therapy Can Reduce the Chance of HIV Drug Resistance 84

HIV Treatment Regimen Failure 86

Viral Load:: Its Relationship to HIV Disease and AIDS 91

Medical Complications Associated with Anti-HIV Drug Therapies (ART) 91

Update 2010 96

Novel Drugs 99

Summary 102

Disclaimer 104

Some AIDS Therapy Information Hotlines 105

Review Questions 105

5 The Immunology of HIV Disease/AIDS 107

The Immune System 107

Human Lymphocytes:: T Cells and B Cells 109

Why CD4+ Cells Are Important in HIV Infection-What It Means 114

The CD4+ Cell Count-Why It Matters 114

Antibodies and HIV Disease 118

Cellular Micro-RNAs Contribute to HIV Latency in Resting Primary CD4+ T Cells 120

Immune System Dysfunction 121

Original Antigenic Sin 121

The Search for Additional Receptors (Coreceptors) to CD4:: Fusin or CXCKR-4 (R-4) 124

CCKR-5 (R-5) Receptor 124

Emergence of HIV Strains That Vary in Their Lethal Abilities 124

In Search of Genetic Resistance to HIV Infection 125

T4 Cell Depletion and Immune Suppression 127

Impact of T4 Cell Depletion 129

Role of Monocytes and Macrophages in HIV Infection 129

Where Do T4 or CD4+ Cells Become HIV Infected? 130

Summary 133

Review Questions 133

6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS 134

What Is an Opportunistic Disease? 134

The Prevalence of Opportunistic Diseases 135

Opportunistic Infections in HIV-Infected People 135

TB:: The Leading Cause of Death among HIV-Positive People Worldwide 146

Cancer or Malignancy in HIV/AIDS Patients 146

Disclaimer 151

Summary 151

Review Questions 151

7 A Profile of Biological Indicators for HIV Disease and Progression to AIDS 152

What Is Known and What Is Missing from Our Understanding of HIV/AIDS 152

HIV Disease Defined 153

Stages of HIV Disease (without Drug Therapy) 157

HIV Disease without Symptoms, with Symptoms, and AIDS 162

Production of HIV-Specific Antibodies 163

Prognostic Biological Markers Related to AIDS Progression 165

HIV Infection of the Central Nervous System (CNS) 174

Neuropathies in HIV Disease/AIDS Patients 175

Pediatric Clinical Signs and Symptoms 175

Summary 177

Review Questions 177

8 Epidemiology andTransmission of the Human Immunodeficiency Virus 178

We Must Stop HIV Transmission Now! 180

Epidemiology of HIV Infection 180

Transmission of Two Strains of HIV (HIV-1/HIV-2) 181

Is HIV Transmitted by Insects? 181

HIV Transmission 183

HIV Transmission in Family/Household Settings 184

Noncasual Transmission 184

Gay Men Putting Themselves at High Risk for HIV Infection 194

Problem 200

Injection-Drug Users and HIV Transmission 206

United States:: Heterosexual Injection-Drug Use (IDU) 206

Injection-Drug Use and HIV Infections in Other Countries 209

Other Means of HIV Transmission 215

Influence of Sexually Transmitted Diseases on HIV Transmission and Vice-Versa 215

Pediatric Transmission 221

Conclusion 224

National AIDS Resources 224

Summary 225

Challenge Your Assumptions about the HIV Infected 225

Review Questions 225

9 Preventing the Transmission of HIV 227

The AIDS Generation:: I Knew Everything about It, and I Still Got It! 228

Prevention, Not Treatment, Is the Least Expensive and Most Effective Way to Stop the Spread of HIV/AIDS 228

Global Prevention 229

Antiretroviral Drugs Having an Impact on Prevention, but We Cant Treat Our Way out of This Pandemic 230

Advancing HIV Prevention:: New Strategies for a Changing Epidemic 234

Preventing the Transmission of HIV 236

Sexual Risk Taking Depends on Sexual Activity 239

New Rules to an Old Game:: Promoting Safer Sex-Nobody Has a Body to Die For! 241

The Male Condom 244

The Female Condom or Femidom (Vaginal Pouch) 250

An Alternative to Condoms:: Vaginal Microbicides (MI-CRO-BA-CIDES) 254

Injection-Drug Use (IDU) and HIV Transmission:: The Twin Epidemics 254

HIV Prevention for Injection-Drug Users 255

Lifting the Ban on the Use of Federal Funding to Support Needle Exchange Programs 257

Prevention of Blood and Blood Product HIV Transmission 258

Infection Control Procedures 258

Sexual Partner Notification:: Disclosure 260

The U.S. Federal Government Has Now Adopted Partner Notification as Its Cornerstone in Its Effort to Help Control the Spread of HIV 261

The First Human Vaccine:: The Impact of Vaccines on Infectious Diseases 264

HIV Vaccine Development and Its Role in Prevention 264

Types of Experimental HIV Vaccines 268

DNA Vaccine 270

Problems in the Search for HIV Vaccine 270

Update 2009, September-Breaking News:: HIV Vaccine Is Safe, Partly Effective 271

Summary 272

Review Questions 273

10 Prevalence of HIV Infections, AIDS Cases, and Deaths among Select Groups in the United States and in Other Countries 274

A Word about HIV/AIDS Data 275

The Millennium:: Year 2010 279

Formula for Estimating HIV Infections 282

Behavioral Risk Groups and Statistical Evaluation 282

September 18:: Annual National HIV/AIDS Aging Awareness Day 293

Estimates of AIDS Cases and HIV Infection 294

Newly Infected 295

Shape of the HIV Pandemic:: United States 295

Shape of AIDS Pandemic:: United States 300

Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States 302

Different Nations/Countries Have Different Epidemics. Each Faces Its Own Reality 302

Canadas Estimated HIV/AIDS Cases through 2009:: Population 33,310,000 303

Mexicos Estimated HIV/AIDS Cases through 2009:: Population 110 Million 303

United Kingdoms (UK) Estimated HIV/AIDS Cases through 2009:: Population 61 Million 303

Global Prevalence and Impact of HIV/AIDS (See Table 10-7) 305

Connected but Separate:: Each Country a Different Reality, Different Countries Similar Questions but Different Answers, Different Epidemics 307

Workforce-South Africa:: Some Examples 310

Education:: Teachers and Students-South Africa and Some Countries in Southern Africa 310

Other HIV/AIDS Time Bombs in Asia:: India, China, and Russia 311

Summary 315

Review Questions 316

11 Prevalence of HIV Infection and AIDS Cases among Women and Children 317

HIV/AIDS Is Defining the Lives of Millions of Women 318

Female Vulnerability 318

Every Day a Tragedy 318

Triple Jeopardy 318

Annual International Womens Day-March 8 319

Women:: AIDS and HIV Infections Worldwide 319

Asia-Pacific Region, Over 5 Million HIV Positive:: 2009 320

Women:: HIV-Positive and AIDS Cases-United States 320

Childbearing Women 335

Internet 336

Pediatric HIV-Positive and AIDS Cases-United States:: A Fight We Can Win! 336

Orphaned Children Due to HIV Infection and AIDS 337

The Phenomenon of AIDS Orphans 339

Summary 344

Review Questions 345

12 Prevalence of HIV Infection and AIDS among Young Adults, Ages 13 to 24 346

Global HIV Infections in Young Adults 346

Addressing the AIDS Pandemic among Young Adults 347

How Large Is the Young Adult Population in the United States? 349

HIV/AIDS Wont Affect Us! 350

Estimate of HIV-Infected and AIDS Cases among Young Adults in the United States, Globally 350

Summary 358

Internet 358

Other Useful Sources 358

Review Questions 358

13 Testing for Human Immunodeficiency Virus 359

Determining the Presence of Antibody Produced When HIV Is Present 360

Requests for HIV Testing 360

Reasons for HIV Testing 361

Laboratory Methods for Detecting HIV 362

ELISA HIV Antibody Test 363

Western Blot Assay 369

New ELISA Antibody Testing and Viral Load Procedures Reveal Early Versus Late HIV Infection 373

Rapid HIV Testing 375

FDA Approves Two Home HIV Antibody Test Kits 378

Some Screening and Confirmatory Tests for HIV 380

Deciding Who Should Get an HIV Test and When 382

Why Is HIV Test Information Necessary? 384

Immigration and Travel Ban into the United States Is Lifted 384

Testing, Privacy, Competency, and Informed Consent 385

Summary 393

Review Questions 394

14 AIDS and Society:: Knowledge, Attitudes, and Behavior 395

HIV/AIDS Is a Story in Our Lifetime 396

The New Millennium and HIV/AIDS 397

HIV/AIDS Is an Unusual Social Disease 397

Discrimination vs. Compassion and Support 397

HIV/AIDS Is Here to Stay 398

AIDS Comes to the United States 399

Blame Someone, DŽjˆ Vu 399

Fear:: Panic and Hysteria over the Spread of HIV/AIDS in the United States 400

Whom Is the General Public to Believe? 402

AIDS Education and Behavior::Dissipating Fear with Education 406

The Character of Society 413

Dealing with Discrimination:: The Americans with Disabilities Act 418

Federal and Private Sector Financing:: Creation of an AIDS Industry 420

U.S. Government Believes HIV/AIDS Is a Threat to National Security 424

Global HIV/AIDS Funding for Underdeveloped Nations 428

Forms of U.S. Monetary Assistance for HIV/AIDS 431

Summary 438

Review Questions 439

Answers to Review Questions 440

Glossary 446

References 454

Index 476