Table of 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: Denning 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 Doesn’t Exist or HIV Isn’t 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 and Transmission 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 can’t 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

 

Canada’s Estimated HIV/AIDS Cases through 2009: Population 33,310,000

303

 

Mexico’s Estimated HIV/AIDS Cases through 2009: Population 110 Million

303

 

United Kingdom’s (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 Women’s 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 Won’t 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, Déjà 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