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UNDERSTANDING THE AIDS VIRUS
Will I live to see tomorrow? Is there a hope for the future? These are probably the most commonly asked questions among AIDS patients today. This paper delves into the heart of the AIDS topic by giving a detailed definition of the virus, risk factors associated with transmission, and the best treatment methods studied by the Centers for Disease Control, the National Institutes of Health, and other research organizations.
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AIDS. The word alone strikes fear into every sexually active individual. Why is this? The reason is that everyone can relate to the consequential symptoms of the disease, but not everyone knows the real meaning of AIDS. AIDS is an acronym for “Acquired Immunodeficiency Syndrome.” The Centers for Disease Control defines AIDS as the presence of at least one of several opportunistic diseases, along with infection by the human immunodeficiency virus (HIV). An opportunistic disease is described as a disease that has an opportunity to occur because the immune system has been weakened. Examples of opportunistic diseases would be Pneumocystis carinii pneumonia, Kaposi’s sarcoma, or toxoplasmosis. The combination of such diseases, plus HIV, deplete the complex natural defense system protecting the body from infection by viruses and microorganisms. The definition of AIDS has also been expanded to include a CD4+ T cell count less than 200 cells per cubic millimeter (mm3) of blood.
AIDS is characterized by the progressive loss of the CD4+ helper cell, a type of white blood cell that helps the body fight off certain infections. This cell is also known as the T, T-helper, and T4 cells. The CD4+ cells are white blood cells that stimulate B lymphocytes to produce antibodies, lead to a severe reduction of functions of the body’s immune system (immunosuppression), neurological complications, and opportunistic infections that rarely occur in persons with intact immune function. Although the precise causes leading to the destruction of the immune system have not been fully discovered, the detailed studies of epidemiology, virology, and immunology support the conclusion the HIV is the underlying cause of AIDS; hence HIV invades and destroys the CD4 cells.
Primary HIV infection is often associated with as abrupt decline of CD4 cells in the peripheral blood. The decrease in circulating CD4 cells during primary infection is probably due to two factors: 1) depletion by HIV, and 2) to redirect cells to the lymphoid tissue and other organs. The median period between the infection of HIV and the onset of clinically apparent disease is approximately 10 years in western countries, according to prospective studies of homosexual men. This period also applies to HIV-infected blood transfusion recipients, injection drug users, and adult hemophiliacs.
In 1981, clinical investigators in New York and California observed among young, previously healthy, homosexual men a strange clustering of cases of rare diseases, notably Kaposi’s sarcoma (KS) and opportunistic infections such as Pneumocystis carinii pneumonia (PCP), as well as cases of unexplained, persistent lymphadenopathy. It soon became evident that these men had a common immunologic deficit- the impairment in cell mediated immunity, resulting from a significant loss of CD4 cells. The widespread development of KS and PCP in young people with no previous history of disease was
unusual. After detailed studies and searches of autopsy records, medical history books, and tumor recordings, results showed that KS and PCP had only occurred at very low levels in the United States previously.
KS, Kaposi’s sarcoma, is a skin neoplasm that affected older men, cancer, or transplant patients undergoing immunosuppressive therapy. Before AIDS became a big issue, the only reports of KS in the United States were 0.02 to 0.06 per 100,000 population. In addition, the disease was generally found in certain parts of Africa among younger individuals. By 1984, men in San Francisco were found 2,000 times more likely to develop KS! By 1994, at least a whopping 36,693 patients with AIDS had been reported. This shows how fast the spread of the disease takes place.
PCP, Pneumocystis carinii pneumonia, a lung infection caused by a pathogen, was extremely rare before 1981. Taken from a survey in 1967, only 107 cases had been reported and documented in medical literature. In that same year, the Centers for Disease Control became the sole supplier in the US of pentmidinne isthionate- the only recommended PCP therapy at that time. The CDC began collecting data on each PCP case diagnosed and treated. In 1981 alone, 42 requests for the drug were received for patient treatment. As an example of how fast this disease was spread, note the following: the CDC had reported 127,626 individuals with AIDS in the US with a definite diagnosis of PCP! Now that’s fast!
There are most definitely certain risk factors associated with AIDS. The most common risk behavior in acquiring AIDS is through sexual intercourse. Today, ninety percent of new infections occur in the developing world. Widespread poverty seems to stimulate the disease. Poor and disadvantaged groups tend to be at higher risk for AIDS that others because they have less access to AIDS info through the media and other channels. In addition, they may not be able to afford the treatment of sexually transmitted diseases or buy condoms from the store. In general, it is easier for the poor to contract this disease because they have no education about the risks and causes of the disease.
Another group at high risk for AIDS is women. Today, women account for forty-two percent of people living with HIV/AIDS. Women are also becoming infected at younger ages than men are. Women tend to marry older men who have had more sexual partners and experience, and they are associated with a lower social economic and social status than men are. Biologically, the risk of HIV infection during unprotected vaginal intercourse is two to four times higher for women than men. The reason is that women have a bigger surface area of mucosa exposed to their partner’s sexual secretions during intercourse. Semen also contains a higher concentration of HIV than vaginal secretions, and it can stay in the vagina hours after intercourse.
Although anyone who is sexually active is at risk of exposure to the AIDS, the gay and bisexual community has been most affected by the disease. Sexual activities
among the gay community can be found all over the world, but little data is available on this subject matter for sufficient coverage. AIDS is transmitted through the exchange of certain body fluids. The bottom line is, any type of sexual activity without adequate protection (condoms) or with multiple partners can put individuals at a dangerously high risk of contracting HIV/AIDS.
Another form of risk behavior would be the use of sharing infected drug needles. The use of infected drug needles and polluted needles are risks that certainly can not be
avoided, and this is a very common method of contraction. Some countries and cities have places to go to obtain clean needles and to get rid of used ones. Although some evidence suggests that injection drug use can cause certain immunologic abnormalities, such as reduction of CD4 cells, this has been shown rare in HIV-seronegative injection drug users in the absence of other immunosuppressive conditions. Blood transfusions have been known to transmit HIV during earlier years, but more precautions have been taken since then to ensure all needles are sterile in an effort to reduce all possibilities of transmission.
Treatments for HIV/AIDS vary from lab studies and blood analysis, symptom observation, to the more common drug therapy. Lab studies and blood analysis shows indications of illness well before the illness becomes apparent, but it is more difficult to act on test results because the patient often feels fine; hence, patients who feel healthy are less motivated to begin treatment. Symptom observation is based on the evidence presented by active interventions and disease processes. In HIV, this means watching out for such things as thrush, pneumocystis, and Kaposi’s sarcoma legions.
Federal healthcare guidelines now call for including a potent protease inhibitor as part of combination treatments to fight HIV/AIDS. By taking the protease inhibitors such as CRIXVAN, AZT (zidovudine), and 3TC, this can help lower the amount of HIV in your body (called “viral load”) and raise your CD4 (T) cell count. Although the drugs are not a cure for HIV or AIDS, they can help reduce the chance of illnesses and death associated with HIV. Recent year-long study conducted by the National Institutes of Health studied over 1,000 patients and confirmed results from another study. A combination of these drugs have been shown to have reduced the frequency and severity of opportunistic infections, improved body weight, and increased counts of CD4 cells in the peripheral blood. Further studies show that drug therapy has extended patient’s life expectancy by at least 21 months after initiation.
Because HIV/AIDS is a life and death matter, it is crucial to take a preventative approach once infected. After infection, individuals that have HIV/AIDS do not get better naturally or by waiting. There is no natural remission. The purpose of preventative treatment is to buy time and to slow progression of the disease while researchers seek better treatment methods. Taking a preventative approach makes it possible to:
? Use treatments at the stage that they are most effective,
? Head off serious optic infections and further damage they do to the immune system, and
? Slow the spread and replication of the virus.
Taking the preventative approach clearly offers hope to those infected with this devastating virus.
Research is rapidly progressing in the HIV/AIDS era. Molecular biologists are interested in the workings of cells and infectious organisms at the cellular level. The recent advances and breakthroughs in understanding the mechanisms that bring about programmed cell death may ultimately explain HIV and AIDS in detail. Currently, there are no tests that can offer a total picture of immune health. Some researchers believe that
as we manage HIV/AIDS as a chronic illness, testing will provide guidance about what treatments to use, when to use them, and how well they are working.
In conclusion, HIV and AIDS have been repeatedly linked in time, place, and population. Individuals as different as homosexuals, transfusion recipients, injection drug users, and heterosexuals have all developed AIDS with one common denominator: infection with HIV. We must remember that AIDS is fatal, and that there is no known cure. The most troubling view is that individuals will forget about the threat of AIDS and continue to engage in risky behavior, eternally adding to the global tragedy of this epidemic.