Friday, December 11, 2009

HOW DO YOU GET INFECTED WITH HIV?

HOW DO YOU GET INFECTED WITH HIV?

The Human Immunodeficiency Virus (HIV) is not spread easily. You can only get HIV if you get infected blood or sexual fluids into your system. You can’t get it from mosquito bites, coughing or sneezing, sharing household items, or swimming in the same pool as someone with HIV.

Some people talk about “shared body fluids” being risky for HIV, but no documented cases of HIV have been caused by sweat, saliva or tears. However, even small amounts of blood in your mouth might transmit HIV during kissing or oral sex. Blood can come from flossing your teeth, or from sores caused by gum disease, or by eating very hot or sharp, pointed food.

To infect someone, the virus has to get past the body’s defenses. These include skin and saliva. If your skin is not broken or cut, it protects you against infection from blood or sexual fluids. Saliva contains chemicals that can help kill HIV in your mouth.

If HIV-infected blood or sexual fluid gets inside your body, you can get infected. This can happen through an open sore or wound, during sexual activity, or if you share equipment to inject drugs.

HIV can also be spread from a mother to her child during pregnancy or delivery. This is called “vertical transmission.” A baby can also be infected by drinking an infected woman’s breast milk. Fact Sheet 611 has more information on pregnancy. Adults exposed to breast milk of an HIV-infected woman may also be exposed to HIV.

Monday, December 7, 2009

WHAT ABOUT DRUG RESISTANCE?

WHAT ABOUT DRUG RESISTANCE?

Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance.

Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance."

Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

HOW IS COMBIVIR TAKEN?

Combivir is taken by mouth as a tablet. The normal adult dose is one tablet, two times a day. Each tablet includes 300 milligrams (mg) of zidovudine (Retrovir) and 150 mg of lamivudine (Epivir).

Combivir can be taken with food, or between meals.

The dosage of lamivudine should be reduced for people who weigh less than 50 kilograms (110 pounds). People who weigh less than 110 pounds should normally not take Combivir.

Sunday, December 6, 2009

response to this threat and horror called AIDS

What do we in UFMCC say in response to this threat and horror called AIDS? In addition to keeping ourselves informed regarding the information from the Center for Disease Control, other research programs, the sensitivity and awareness of medical professionals in our respective areas, and the local and national AIDS support groups within our own communities, should we as a unique and spiritual body begin formulating an equally unique and spiritual response? I believe the answer is yes. As a people whose every action and decision must be guided by the Good News that God was present in Jesus Christ and continues that presence with us through the Holy Spirit, we must bring the same innovative and creative energy to this issue that we are attempting to bring to so many others with which we are faced.

I would like for the remainder of this article to be seen as nothing more than a beginning. The four points of departure which I shall discuss are, to me, crucial. However, they are in no way exhaustive. I invite other persons within UFMCC to revise and augment them. Seeing this, therefore, as the beginning of a process, I would like to suggest that we internalize and actualize at least the following four awarenesses in our response.

First, we must remain a sex-positive people.

AIDS VICTIM: “I should have known that God would punish me for having too much fun.”

One of the most tragic mistakes we could make would be to become a sex-negative people, even inadvertently. Both in language and attitude we must avoid any indication that AIDS is in any way a “plague” or “punishment” being visited upon us because of our sexuality. Instead, it is a time for an intense and personal evaluation, on the part of Gay males, of our sexual patterns, and caution and restraint in activities known to put one at increased risk.

Two thousand years of ignorance, fear, guilt, and shame regarding human sexuality (to say nothing of homosexuality) is just beginning to be reversed within Christian thought, writings and practice. I believe that the existence and witness of UGMCC has been an inextricable factor in this reversal. To abdicate that influence now, an influence I God has clearly called us to, would constitute sin on our parts.

Second, we must create spiritual support systems for victims, spouses, families and friends.

SPOUSE OF AIDS VICTIM: “Our friends were afraid to come to the hospital. Toward the end, they wouldn’t even come to the house. They didn’t even call but I think that was because they felt guilty.”

church, AIDS has also brought reconciliation

church, AIDS has also brought reconciliation between the sexes, a rift that has been especially deep between lesbians and gay men. Like other women, lesbians face economic disadvantages. But in the case of lesbians, their resulting anger at men is untempered by romantic involvement with the opposite sex. Most lesbian feminists feel it is a waste of energy to spend it in the traditional female role of helping men, their oppressors. However, that feeling doesn’t prevail in our church. When the topic of lesbians ministering to men with AIDS came up during a reception the women of our church held for Karen Ziegler, pastor of the Metropolitan Community Church in New York, Ziegler responded this way: “I don’t feel like I’m sacrificing — I receive energy by ministering to men with AIDS.” She told us how “some men I love very much — my friends David and Tim — began to die of AIDS. I had the experience of coming closer than I ever had come to a man before. David and then Tim opened a door to their souls in a way that I had never experienced before and my heart has been opened in a way it never was before, too. We’re all experiencing that transformation together.”

We have also connected with Congregation Shahar Zahav, a Reform synagogue with a lesbian and gay congregation, located a few blocks from our church. Together we sponsored a reading by award-winning lesbian poet Adrienne Rich. That evening Rich told us, “Lesbians and gay men have confronted mortality. We have mourned our friends and lovers together and we have stitched an extraordinary quilt of memory together . . . I think that the coming together of Jewish and Christian, lesbian and gay and straight congregants is an important part of this. I also think that the coming together those of us who are non-congregants with you is very important.”

Making this kind of connection — between Jew and Christian, female and male, gay and straight, black and white, parent and child — is what eschatological living is all about. With the end in sight, we do more to savor and value life, including the people we once viewed as hopelessly different from ourselves. As a church with AIDS, we try to embody eschatological living. AIDS is killing us at the same time that it heals us.

This must be the vision Steven Clover was talking about when he told us, “Heaven has as much to do with life before death as with life after death.”

And it must be the vision Rich meant to convey when she wrote the poem that has become a kind of creed for our church:

My heart is moved by all I cannot save: so much has been destroyed I have to cast my lot with those who age after age, perversely, with no extraordinary power, reconstitute the world.

This must be what Jesus meant when he said, “Behold, the kingdom of God is in the midst of you.”

Thursday, December 3, 2009

How is HIV Transmitted?

HIV enters the body through open cuts, sores, or breaks in the skin; through mucous membranes, such as those inside the anus or vagina; or through direct injection. There are several ways by which this can happen:
Sexual contact with an infected person. This is the primary focus of this lesson and is reviewed in greater detail in the following sections.
Sharing needles, syringes, or other injection equipment with someone who is infected.

Mother-to-child transmission. Babies born to HIV-positive women can be infected with the virus before or during birth, or through breastfeeding after birth. More information about HIV and pregnancy can be found in this lesson.

Transmission in health care settings. Healthcare professionals have been infected with HIV in the workplace, usually after being stuck with needles or sharp objects containing HIV-infected blood. As for HIV-positive healthcare providers infecting their patients, there have only been six documented cases, all involving the same HIV-positive dentist in the 1980s.

Transmission via donated blood or blood clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies, including in the United States.

Since the beginning of the HIV/AIDS epidemic, new or potentially unknown routes of transmission have been thoroughly investigated by state and local health departments, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). To date, no additional routes of transmission have been recorded, despite a national system designed to detect unusual cases.

Sunday, November 8, 2009

North America and Western Europe

North America and Western Europe


HIV spread in USA 1977-2006

In North America and Western Europe (as in the USA, see graphic) the HIV initially affected the homosexual population and injecting drug addicts. As long ago as the 1980s, the HIV epidemic was insidiously spreading from these key groups into the heterosexual population.

Nevertheless, the rate (percentage of HIV infections within a risk group) among homosexuals and injecting drug addicts is still 30 to 40 times higher than among heterosexuals.

In most western countries, new infections among homosexuals have increased strongly again in the last ten years. On the other hand, the number of new infections among injecting drug addicts fell sharply, e.g. in Switzerland from the most common transmission path at the start of the 90s to 4% of new infections in 2008.

Friday, November 6, 2009

A congregant’s first AIDS-related counseling

A congregant’s first AIDS-related counseling often revolves around being tested for AIDS antibodies; a positive result means people can transmit the AIDS virus and may develop AIDS themselves. Just deciding to take the test is excruciating. Even those who imagined they were prepared to face a positive result are often devastated by feelings of grief, guilt and betrayal when the verdict is presented.

AIDS-related counseling also means providing home and hospital visitation, funerals, memorial services and bereavement support. An unforgettable example occurred in summer 1987 when one of us visited an AIDS hospice to take communion to a member, his parents visiting from the East Coast and a few close friends. The man, obviously near death, urged everyone to pray not just for him but for their own needs — a reversal of the angry response he expressed earlier in his illness. “I can see heaven,” he told them. “It’s a beautiful place, the place you’ve always wanted to go to, and anyone who wants to can go there.” The boundaries of heaven and earth seemed to shift that afternoon, so that they no longer corresponded to birth and death; it felt possible to reach into the skies and tug heaven into the present. Death became “a foretaste of the feast to come.”

The man died a few hours later. His mother spoke at his memorial service, with tears in her eyes: “He was the best son a mother could ever have.” But she and her husband dreaded going back to their home church, being reluctant to tell anyone in their United Methodist congregation that their son had died of AIDS. They didn’t think anyone there would understand.

Another set of parents, also United Methodists, asked one of us to come to their son’s hospital bedside to join them in prayer. There the mother asked, “Why are people so mean?” She was referring to unsympathetic church members back home. The next question was even harder: Was it OK to pray for their comatose son to die soon? The whole church is coming to see that physical death is not necessarily something to avoid; it can even mean healing.

MCC-SF also strives to educate people outside the gay and lesbian community about AIDS, through letter-writing campaigns, public presentations and workshops on AIDS, which have been given in a variety of settings, including the San Francisco AIDS Interfaith Conference, the United Methodist Consultation on AIDS Ministries, the Presbyterian Ministers Association, and Pacific School of Religion’s AIDS Awareness Week. In addition, MCC-SF members enrolled at Pacific School of Religion continually pressure the seminary to live up to its policy of fair treatment for students with AIDS. Joint activities with Double Rock Baptist Church have been educational, too. While we have confronted our racism, the Baptists have had to surmount unfounded fears about catching AIDS. One Double Rock usher described holding hands with gay people during prayer time as “the most growing I have ever done.”

Tuesday, November 3, 2009

How is HIV Transmitted? en español

How is HIV Transmitted?
en español

Introduction

Human immunodeficiency virus (HIV) was established as the cause of the acquired immunodeficiency syndrome (AIDS) in 1983. Ever since then, a lot of research has been conducted and a great deal of information has been generated regarding the ways HIV can be transmitted from one person to another.

The problem with much of the information about HIV transmission, especially on the Internet, is that it speaks in very general terms. All too often, advice from one site will directly contradict advice from another site as well. For example, some sources refer to oral sex as "risky," whereas others say it is "low risk" or "no risk." This can be very frustrating and it also leads to the spread of misinformation, and frequently a lot of unnecessary worry, about the transmission of HIV.

HIV infection—and HIV testing—is a medical issue. We have developed this lesson to provide straightforward and accurate information regarding HIV transmission. However, it is important to stress that this lesson—and other sources of HIV information on the Internet—should not be consulted as an alternative to medical care and testing. If you fear that you have been exposed to HIV—regardless of how low the perceived risk and no matter how much information you find on the Internet—you need to get in touch with your health care provider or an HIV testing center.

Sunday, November 1, 2009

WHAT IS VIRAL LOAD?

WHAT IS VIRAL LOAD?

The viral load test measures the amount of HIV virus in your blood. There are different techniques for doing this:

* The PCR (polymerase chain reaction) method uses an enzyme to multiply the HIV in the blood sample. Then a chemical reaction marks the virus. The markers are measured and used to calculate the amount of virus. Roche and Abbott produce this type of test.
* The bDNA (branched DNA) method combines a material that gives off light with the sample. This material connects with the HIV particles. The amount of light is measured and converted to a viral count. Bayer produces this test.
* The NASBA (nucleic acid sequence based amplification) method amplifies viral proteins to derive a count. It is manufactured by bioMerieux.

Different test methods often give different results for the same sample. Because the tests are different, you should stick with the same kind of test (PCR or bDNA) to measure your viral load over time.

Viral loads are usually reported as copies of HIV in one milliliter of blood. The tests count up to about 1 million copies, and are always being improved to be more sensitive. The first bDNA test measured down to 10,000 copies. The second generation could detect as few as 500 copies. Now there are ultra sensitive tests for research that can detect less than 5 copies.

The best viral load test result is “undetectable.” This does not mean that there is no virus in your blood; it just means that there is not enough for the test to find and count. With the first viral load tests, “undetectable” meant up to 9,999 copies! “Undetectable” depends on the sensitivity of the test used on your blood sample.

The first viral load tests all used frozen blood samples. Good results have been obtained using dried samples. This will reduce costs for freezers and shipping.

Wednesday, October 14, 2009

HIV transmission

HIV transmission

HIV can be transmitted through the blood (including menstrual blood), semen, breast milk, and vaginal fluids/secretions of infected persons. Transmission to another person can occur if those fluids enter the other person's body. HIV can be isolated from other bodily fluids, such as saliva, sweat, and tears, but the viral concentration is so low that the transmission risk is negligible. HIV cannot be transmitted from coughing or sneezing, sharing household items, or swimming in a pool with someone who is infected.

Transmission is affected by viral fitness (ability of the virus to replicate and cause disease), amount of exposure, and host resistance. There are three main ways in which HIV is transmitted.

Through unprotected anal or vaginal sex. The presence of another sexually transmitted infection (such as an active case of herpes or syphilis) heightens the risk of HIV transmission, as does unprotected sex with someone in the primary (acute) stage of HIV infection. HIV is unable to pass through quality latex or polyurethane condoms.

Through blood-to-blood contact. This mainly happens through the sharing of injecting equipment among drug users. The risk of transmission is high whenever needles and syringes are shared or re-used without proper sterilisation.

Very rarely, HIV infection results from an occupational accident amongst healthcare workers. Fortunately, follow-up studies have shown that 99.7% of all reported needlestick/cut exposures do not lead to HIV infection.

In countries where the blood supply is not screened, transmission occurs through the use of infected blood and blood products. In the past, infected blood products such as the Factor VIII used to treat haemophilia were responsible for causing many HIV infections.

Vertically, from an HIV-positive mother to her baby while pregnant, giving birth, or breastfeeding. In the absence of antiretroviral therapy, the average risk of transmission during pregnancy or delivery is in the region of 10 to 15%, although it will be higher if the mother has primary infection, a high viral load, or has developed AIDS. Breastfeeding carries a risk of transmission and should be avoided if alternatives to breastfeeding (including a safe water supply) are available and affordable.

Thursday, October 8, 2009

Brief History of HIV in the United States

Brief History of HIV in the United States


HIV was first identified in the United States in 1981 after a number of gay men started getting sick with a rare type of cancer. It took several years for scientists to develop a test for the virus, to understand how HIV was transmitted between humans, and to determine what people could do to protect themselves.

During the early 1980s, as many as 150,000 people became infected with HIV each year. By the early 1990s, this rate had dropped to about 40,000 each year, where it remains today

AIDS cases began to fall dramatically in 1996, when new drugs became available. Today, more people than ever before are living with HIV/AIDS. CDC estimates that about 1 million people in the United States are living with HIV or AIDS. About one quarter of these people do not know that they are infected: not knowing puts them and others at risk.

Wednesday, October 7, 2009

HIV

HIV


HIV stands for human immunodeficiency virus.

This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease.

For more information view CDC's questions and answers on "HIV Science".


Virusl

Anatomy of the AIDS Virus



Aids

AIDS stands for acquired immunodeficiency syndrome.

AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infections. When someone has one or more of these infections and a low number of T cells, he or she has AIDS.

For more information view CDC's questions and answers on "HIV Science".


Electron microscope image of HIV, seen as small spheres on the surface of white blood cells



Source: ©Centers for Disease Control and Prevention (CDC) [basics#hiv]
Last updated: 03/08/2008

Fact Sheet Categories

Fact Sheet Categories

To see a list of fact sheets in each category, click on the category name.






100
Background Information
120Laboratory Tests
150Preventing HIV Infection
200Living with HIV
400Medications to Fight HIV
410Nukes: Nucleoside Analog Reverse Transcriptase Inhibitors
430Non-Nukes or NNRTIs: Non-Nucleoside Reverse Transcriptase Inhibitors
440Protease Inhibitors
460Attachment and Fusion Inhibitors
470Other Drugs to Fight HIV
480Strengthening the Immune System
500Opportunistic Infections and Related Diseases, and Their Treatment
530Drugs to Treat Opportunistic Infections
550Side Effects and Their Treatment
600Patient Populations
650HIV and Related Diseases
670Hepatitis C
700Alternative and Complementary Therapies
800Nutrition
900Internet Bookmarks for AIDS
1000Index of Fact Sheets

WHAT IS LAMIVUDINE?

WHAT IS LAMIVUDINE?

Lamivudine (Epivir®), is a drug used as part of antiretroviral therapy (ART). It is manufactured by GlaxoSmithKline. Generic versions made by Ranbaxy and Aurobindo Pharma were approved in 2005 for sale outside the US. Lamivudine is also known as 3TC.

Lamivudine is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes.

WHO SHOULD TAKE LAMIVUDINE?

Lamivudine was approved as an antiretroviral drug (ARV) for people with HIV infection. It has been studied in adults and children over 3 months old.

There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART.

If you take lamivudine with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.

A different formulation of lamivudine has been approved for people with hepatitis B. Some people with HIV had their hepatitis B get worse after they stopped taking lamivudine. Get tested for hepatitis B before you start taking lamivudine to treat HIV. If you have hepatitis B and stop taking lamivudine, your health care provider should carefully monitor your liver function for several months.

Sunday, September 13, 2009

Over the Counter Choices:

Over the Counter Choices:

There are no over the counter products recommended for the treatment of HIV infection. There are products that can be used to treat some of the symptoms of HIV infection and to manage some of the side effects of HIV drug therapy. There are also products available for nutrition, safe sex, skin care, hair loss, wasting syndrome - maintaining body mass and building muscle, immune system enhancement, liver cleansing, nausea & vomiting, constipation, sexual performance, wound healing, diabetes and lipodystrophy.

Prescription Choices:

The standard for therapy in treatment of HIV disease is now combination therapy that targets 2 different enzymes. Treatments that consist of 2 to 4 drugs have halted viral replication, preserved immune function, and decreased the likelihood of developing drug-resistant mutations. Evaluation of viral load is the accepted method for judging the effectiveness of drug therapy. The drugs used in the treatment of HIV disease are nucleoside analog reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors.

There are many other prescription medications available for the treatment of AIDS related infections. These medications fall into many different classes like antivirals, antineoplastics, antifungals, immune modulators, antibacterials, appetite stimulants, antimicrobials, and antiprotozoals. These medications are often taken with the other medications to treat HIV disease.

Wednesday, September 9, 2009

Clinical stages of HIV infection

Clinical stages of HIV infection


The American health authority CDC (Center for Disease Control and Prevention) defines 3 clinical stages of the disease and 3 immunological categories. According to the CDC definition HIV can only be diagnosed with a confirmed HIV positive test.

Stage A covers both the acute HIV illness and the subsequent clinical latency.The acute HIV illness arises 3-6 weeks after infection for 50-70% with flu type symptoms: fever, skin eruptions, throat inflammation, muscular pains, lymph node swelling, headache, and nausea.
During clinical latency there are no further complaints although some people have continuous Lymphadenopathie in the shoulders, back or neck. The clinical latency can last for many years.

Stage B consists of disease symptoms prior to stage C (AIDS), which further weakens the immune system. Usually these symptoms accompany a general worsening of health. In addition to long lasting (a month plus) symptoms such as fever, night sweats and weight loss, many other infections such as candida infections of the mouth and throat or viral illnesses like belt rose occur.

Stage C is the final phase of the HIV infection, the actual AIDS illness. It is the collapse of the immune system. The pattern of the AIDS illness is unmistakable although individual symptoms may vary. Diverse infections and cancers are common, as are fungal infections of the esophagus and special forms of pneumonia (Pneumocystis carinii Pneumonia), also common are virus illnesses (i.e. retinal inflammation CMV-Retinitis), parasite infection (i.e. Toxoplasmosis that causes brain abscesses), rare cancer forms (e.g. Kaposisarkom, Lymphdrüsensarkom, brain tumors) as well as neurological illnesses (among other things HIV dementia) and strong weight loss (Wasting syndrome).

stades of HIV

The defense system defends against the HIV infection (blue curve). But the HIVs (red curve) attack, infiltrate, and destroy them. During the first weeks the human defense system wins the first battle (decrease of the viruses), but eventually the HIVs overwhelm the immune system and the infected person dies. The concentration of the CD4+ helper cells is a good indicator of the condition of the human defense system, and is used nowadays as a measure of HIV infections.

Sunday, September 6, 2009

HOW DOES RESISTANCE DEVELOP?

HOW DOES RESISTANCE DEVELOP?

HIV usually becomes resistant when it is not totally controlled by drugs someone is taking. However, more people are getting infected with HIV that is already resistant to one or more ARVs.

The more that HIV multiplies, the more mutations show up. These mutations happen by accident. The virus doesn’t "figure out" which mutations will resist medications.

Just one mutation can make HIV resistant to some drugs. This is true for 3TC (Epivir) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, HIV has to go through a series of mutations to develop resistance to other drugs, including most protease inhibitors.

The best way to prevent resistance is to control HIV by taking strong ARVs. If you miss doses of your medications, HIV will multiply more easily. More mutations will occur. Some of them could cause resistance.

If you have to stop taking any ARV, talk to your health care provider. You may have to stop some drugs sooner than others. If you stop taking drugs while the virus is under control, you should be able to use them again.

TYPES OF RESISTANCE

There are three types of resistance:

  • Clinical resistance: HIV multiplies rapidly in your body even though you’re taking ARVs.
  • Phenotypic resistance: HIV multiplies in a test tube when ARVs are added.
  • Genotypic resistance: The genetic code of HIV has mutations that are linked to drug resistance.

Clinical resistance shows up as a higher viral load, lower CD4 count, or opportunistic infections (see Fact Sheet 500). Laboratory tests can measure phenotypic and genotypic resistance.

PHENOTYPIC TESTING

A sample of HIV is grown in the laboratory. A dose of one ARV is added. The growth rate of the HIV is compared to the rate of wild type virus. If the sample grows more than normal, it is resistant to the medication.

Phenotypic resistance is reported as "fold" resistance. If the test sample grows twenty times as much as normal, it has "20-fold resistance".

Phenotypic tests cost about $800. It used to take over a month to get the results. New phenotypic tests are somewhat quicker.

GENOTYPIC TESTING

The genetic code of the sample virus is compared to the wild type. The code is a long chain of molecules called nucleotides. Each group of three nucleotides, called a "codon", defines a particular amino acid used to build a new virus.

Mutations are described by a combination of letters and numbers, for example K103N. The first letter (K) is the code for the amino acid in the wild type virus. The number (103) identifies the position of the codon. The second letter (N) is the code for the "changed" amino acid in the mutant sample.

Genotypic testing costs about $250. Results come back in about two weeks.

VIRTUAL PHENOTYPE

This test is really a method of interpreting genotypic test results. First, genotypic testing is done on the sample. Phenotypic test results for other virus samples with a similar genotypic pattern are taken from a database. These matched samples tell you how the virus is likely to behave. The virtual phenotype is faster and less expensive than a phenotypic test.

CROSS-RESISTANCE

Sometimes a mutant version of HIV is resistant to more than one drug. When this happens, the drugs are called "cross-resistant". For example, most HIV that is resistant to nevirapine (Viramune) is also resistant to efavirenz (Sustiva). This means that nevirapine and efavirenz are cross-resistant.

Cross-resistance is important when you change medications. You need to choose new drugs that are not cross-resistant to drugs you’ve already taken.

We do not totally understand cross-resistance. However, many drugs are at least partly cross-resistant. As HIV develops more mutations, it gets harder to control. Take every dose of your ARVs according to instructions. This reduces the risk of resistance and cross-resistance. It saves the most options for changing medications in the future.

PROBLEMS WITH RESISTANCE TESTING

Resistance tests are not available everywhere. They are expensive. However, they are becoming more common, faster and cheaper.

The tests aren’t good at detecting "minority" mutations (less than 20% of the virus population.) Also, they work better when the viral load is higher. If your viral load is very low, the tests might not work. Tests usually cannot be run if the patient’s viral load is less than 500 to 1,000 copies per ml.

Test results can be difficult to understand. Drugs that should work according to the tests sometimes don’t work, and vice versa. Sometimes genotypic and phenotypic tests give conflicting results for the same patient. Some mutations can "reverse" or reduce resistance to some medications.

Recent research suggests that a genotypic resistance test should be done for every patient before they start taking ARVs. This saves money by avoiding putting someone on ARVs that will not work for them.

Monday, August 24, 2009

Diagnosis and Treatment for Acute HIV

Diagnosis and Treatment for Acute HIV

As has been mentioned already, primary HIV infection cannot be identified only on the basis of acute HIV symptoms. Moreover, the early HIV symptoms in men and women may not be exhibited by all HIV infected individuals. HIV infection can be identified only with the help of proper diagnostic procedures. However, HIV antibody test may come negative during the primary infection stage, as the immune system usually requires about two months to produce the antibodies against the virus. But, HIV RNA test or 'viral load' test shows a positive result for acute HIV infection. Whether acute HIV infection should be treated immediately with antiretroviral medications, or one should wait until immune system exhibits the signs of damage is still controversial. Therefore, individuals going through the acute HIV infection need to talk to their physician and evaluate the various pros and cons of early treatment.

The early diagnosis of acute HIV infection is of utmost importance to prevent the spread of the virus. However, it is not so easy to detect acute HIV infection, as the symptoms are not very specific and they resemble the symptoms of many other health condition. So, people who think that they are at an increased risk of contracting the virus can get tested for acute HIV infection on observing the above mentioned acute HIV symptoms. This will help to detect the condition and prevent the transmission of the virus to healthy individuals.

Wednesday, August 19, 2009

What is your risk of HIV infection?

What is your risk of HIV infection? Certain conditions, circumstances, and behaviors can increase your risk of HIV infection. There are conditions and behaviors that make it easier for HIV to be transmitted from person to person. Without taking the proper precautions or being aware of high risk behavior, your risk of HIV can increase. Some of the more common ways your risk of HIV infection increases include:
  • Being Coinfected With Syphilis
    People with syphilis may have open sores on their genitals that provide a route for HIV to enter the body when engaging in unprotected sex.

    A Guide to Syphilis

  • Your Sexual Partner is in the Acute Stages of HIV Infection
    The acute phase of HIV infection is characterized by very high HIV activity and very high viral loads. Having unprotected sex with someone in the acute stage of HIV increases the exposure to activily replicating HIV, in turn increasing the risk of HIV transmission.

    What is Acute HIV?

  • Either Partner Has a Weakened Immune System
    The body's immune system protects us from illness, infection, and disease. Anytime that protection is weakened, the body is at increased risk of illnesses and infections, including HIV. If either partner in a sexual relationship has a weakened immune system, that person becomes more at risk for HIV.

    Understand the Immune Response

  • When Either Partner has an Open Wound
    Open wounds provide a portal of entry for HIV. In other words, any open wound or break in the skin can allow HIV to enter the body

  • The Presence of a Large Quantity HIV Infected Blood
    Large quantities of HIV infected blood exposes the body to an increase number of active HIV, making HIV infection easier. These large quantities of infected blood can occur during sex due to mechanical trauma of the sexual structures or during delivery of an HIV+ mom's newborn baby. Sharing syringes and needles can also expose people to large quantities of HIV infected blood.

Sunday, August 9, 2009

On the day before World AIDS Day 2009,

On the day before World AIDS Day 2009, the World Health Organization (WHO)released its new HIV treatment guidelines. Included in the new HIV treatment guidelines are:
  • CD4 thresholds for starting medication regimens;
  • preferred medications when building an HIV regimen;
  • ways to further reduce the risk of HIV transmission from mother to child;
  • and HIV treatment guidelines for taking medications while breastfeeding.
Here is a summary of the latest HIV treatment guidelines.

Start HIV Treatment at Higher CD4 Counts

HIV treatment should be started on all people with a CD4 count less than or equal to 350 regardless of the presence or absence of symptoms. In comparison, in 2006 WHO recommended treatment when the CD4 count fell below 200. Since then data accumulated from clinical trials and clinical research have shown that starting HIV medications earlier, when CD4 counts are higher, reduces illness and progression of HIV to AIDS.

Phase Out Older Medications

The WHO HIV treatment guidelines recommended phasing out the use of older HIV medications that have been found to have long term side effects. Medications such as Zerit (stavudine) are to be phased out of initial regimens because of toxic side effects like lactic acidosis. In developing nations where medications are hard to come by, Zidovudine (AZT) and Viread (tenofovir) are more affordable recommendations to replace Zerit. Keep in mind that while their toxic profile may be less, they are not without risk; for example Viread has been linked to toxic kidney side effects in some people. In the Western World, it is recommended that the newest medications be used because of their low side effect profiles.

Saturday, August 8, 2009

Conclusions and recommendations

Conclusions and recommendations
A meeting held on 15–17 September 2008 in Geneva brought together participants from the World Health Organization
(WHO) and its United Nations (UN) partners along with representatives from 26 countries to discuss the role that the
health sector can and should play in addressing prevention, treatment and care of HIV and other STIs among MSM,
transgender people and their sexual partners. The following key principles were agreed on at the meeting:
• Adopting a rights-based approach guarantees the human rights of MSM and transgender people, and will
ensure that they and their male and female sexual partners have the right to information and commodities that
enable them to protect themselves against HIV and other STIs, protection from discrimination and criminalization,
as well as information on where to seek appropriate care for these infections.
• Knowing the epidemic and the response to it means knowing where infections are occurring, who is at risk or
vulnerable and who is infected. It also means understanding the local, social and structural determinants of risk.
• The HIV and STI epidemics among MSM and transgender people cannot be addressed by the health sector
alone. It requires partnerships and engagement both across sectors (particularly with the legal and education
sectors) and, crucially, with the MSM and transgender communities.

Replication and Mutation of HIV

Replication and Mutation of HIV


HIV allows itself to be "eaten" by the defense cells and this way it gets into the defense cells of the human body. At the same time the virus brings along the enzyme "reverse transcriptase" which transforms the genetic material of the virus itself (RNA) into the human genetic material (DNA). The genetic material of the virus is then built into the one of the host cell, where it can lie dormant for many years.

When replicating, the virus tricks the defense cells in the same way. If the defense cell receives a command to replicate (for example to kill HIV or other viruses or bacteria), this triggers the replication of HIV. While replicating, the virus uses the host cell for its own purposes, exploiting its nutrients. Thousands of HIVs are immediately formed, destroying the defense cells. The new HIVs in turn attack other defense cells.

HIV-Vermehrungszyklus in einer Helferzelle

HIV is assimilated into the host cell (helper cell):

  1. HIV docks with the CD4 receptor of the helper cell.
  2. HIV smuggles in its genetic material (RNA).
  3. Reverse transcriptase of the helper cell converts the RNA into DNA.
  4. Integrase integrates the viral DNA into the DNA of the cell nucleus of the host cell.
The replication of HIV:
  1. HIV-DNA is converted into RNA.
  2. Protease builds up new HIV (sprouting).
  3. HIV detaches itself from the host cell (budding).

When the genetic material is transformed and copies of genetic material are made for the production of new viruses, more and more new HIV variants emerge due to "translation mistakes". These variants can differ in character from the original HIV, varying for example in infectivity and in the speed with which they lead to AIDS and to death. Several million virus variants have been observed to develop in just one person infected with HIV.

This mutability enables HIV to adapt to its surroundings, and this is the reason why HIV may quickly become resistant to drugs and why attempts to develop either a vaccine, or drugs that could cure a person already infected with HIV, have been, so far, unsuccessful.

Saturday, July 11, 2009

UNSAFE ACTIVITIES

UNSAFE ACTIVITIES

Unsafe sex has a high risk of spreading HIV. The greatest risk is when blood or sexual fluid touches the soft, moist areas (mucous membrane) inside the rectum, vagina, mouth, nose, or at the tip of the penis. These can be damaged easily, which gives HIV a way to get into the body.

Vaginal or rectal intercourse without protection is very unsafe. Sexual fluids enter the body, and wherever a man’s penis is inserted, it can cause small tears that make HIV infection more likely. The receptive partner is more likely to be infected, although HIV might be able to enter the penis, especially if it has contact with HIV-infected blood or vaginal fluids for a long time or if it has any open sores.

SAFER ACTIVITIES

Most sexual activity carries some risk of spreading HIV. To reduce the risk, make it more difficult for blood or sexual fluid to get into your body.

Be aware of your body and your partner’s. Cuts, sores, or bleeding gums increase the risk of spreading HIV. Rough physical activity also increases the risk. Even small injuries give HIV a way to get into the body.

Use a barrier to prevent contact with blood or sexual fluid. Remember that the body’s natural barrier is the skin. If you don’t have any cuts or sores, your skin will protect you against infection. However, in rare cases HIV can get into the body through healthy mucous membranes. The risk of infection is much higher if the membranes are damaged.

The most common artificial barrier is a condom for men. You can also use a female condom to protect the vagina or rectum during intercourse. Fact Sheet 153 has more information on condoms.

Lubricants can increase sexual stimulation. They also reduce the chance that condoms or other barriers will break. Oil-based lubricants like Vaseline, oils, or creams can damage condoms and other latex barriers. Be sure to use water-based lubricants.

Oral sex has some risk of transmitting HIV, especially if sexual fluids get in the mouth and if there are bleeding gums or sores in the mouth. Pieces of latex or plastic wrap over the vagina, or condoms over the penis, can be used as barriers during oral sex. Condoms without lubricants are best for oral sex. Most lubricants taste awful.

SAFE ACTIVITIES

Safe activities have no risk for spreading HIV. Abstinence (never having sex) is totally safe. Sex with just one partner is safe as long as neither one of you is infected and if neither one of you ever has sex or shares needles (see Fact Sheet 154) with anyone else.

Fantasy, masturbation, or hand jobs (where you keep your fluids to yourself), sexy talk, and non-sexual massage are also safe. These activities avoid contact with blood or sexual fluids, so there is no risk of transmitting HIV.

To be safe, assume that your sex partners are infected with HIV. You can’t tell if people are infected by how they look. They could be lying if they tell you they are not infected, especially if they want to have sex with you. Some people got HIV from their steady partners who were unfaithful “just once”.

Even people who got a negative test result might be infected. They might have been infected after they got tested, or they might have gotten the test too soon after they were exposed to HIV.

Thursday, July 9, 2009

Antiretroviral therapy (ART)

Antiretroviral therapy (ART)


The current therapy for HIV infection is called HAART (Highly Active AntiRetroviral Therapy) and consists of a combination of at least three different active ingredients. There are more than 20 different drugs in use.

A successful HAART suppresses the viral load (concentration of HIV in the blood) below the detection threshold and indirectly increases the number of T-helper cells. Due to these drugs, an HIV infection changes from a fatal illness into a chronic illness. This way it is possible to prevent the appearance of symptoms, and also to significantly reduce the risk of infection.

The drugs all prevent replication of HIV via various mechanisms, by interrupting the replication cycle. However, these drugs can only work over the long term, if they are taken daily, 365 days a year.

ART hinders the replication of HIV

Thanks to antiretroviral therapy (ART), people infected with HIV are living significantly longer and have a better quality of life. But ART cannot completely eliminate the HIV in a person and it is not a cure. The drugs must be taken for a lifetime, which is a heavy burden on the patient. As soon as the drugs are stopped, the viruses replicate again explosively. Sometimes the drugs are not tolerated or the HIVs are resistant to these drugs, which therefore do not work any longer. Despite ART, more than 100 people still die from Aids every year in Switzerlan

Wednesday, July 8, 2009

Course of HIV infection

Course of HIV infection


The course of untreated HIV infection can be divided into three phases: the acute HIV disease, then the latency phase and finally the disease of Aids, ending in death.

The acute HIV disease lasts a few weeks. This period is also known as the window of vulnerability, and it is characterized by an explosive replication of the HIV. During this phase, the HIVs invade the organs of the defense system and other bodily organs and establish themselves there.

The latency phase lasts on average 10 years, during which the virus concentration is relatively low.

In the Aids phase the defense system is completely destroyed, as the result of which death occurs after 1-2 years.

course of HIV infection

Weakening and destruction of the immune system

The defense system (immune system) has two main jobs: as well as combating outside invaders such as bacteria, viruses, fungi etc., which give rise to so-called infectious diseases, it also prevents cancer by tracking down and destroying the body's own damaged or degenerate cells.

It takes several years before the human immune system is defeated by the HIV infection. A veritable war goes on between the immune system and the viruses, with many battles. We know now that as early as a few days after infection (during the acute infection stage) several thousand million (!) new viruses are formed and at the same time thousands of millions of helper cells are destroyed. Hence, 2-3 weeks following infection, the acute HIV infection (= primo-infection) can appear, which subsides again after about 6 weeks, when the human immune system has gained the upper hand in the first battle. Even during the symptom-free latency period, the viruses replicate with extraordinary vigour. The human immune system kills as many HIV as are produced, maintaining equilibrium year upon year. When AIDS itself occurs, the immune system becomes exhausted and the quantity of virus steadily increases. The weakening of the immune system through HIV infection makes people increasingly vulnerable, especially to infectious diseases and cancer.

Friday, July 3, 2009

What is AIDS & HIV?".

What is AIDS & HIV?".
AIDS (acquired immune deficiency syndrome) is a condition caused by HIV. This virus attacks the immune system, the body's "security force" that fights off infections. When the immune system breaks down, you lose this protection and can develop many serious, often deadly infections and cancers. These are called "opportunistic infections" (OIs) because they take advantage of the body's weakened defenses.

In the U.S., the Centers for Disease Control (CDC) is responsible for collecting data on the number of people with AIDS. This is not the same thing as the number of people living with HIV. Remember, AIDS includes the words "immune deficiency". Since people can live with HIV an average of 10 years—without effective treatment—before their immune systems become seriously impaired, AIDS is really just an advanced stage of an HIV infection.

The CDC uses specific criteria for determining when a person living with HIV progresses to AIDS. One thing they look at is CD4 cell counts: if a person's CD4 count falls below 200, then they have officially progressed to AIDS. Another thing they look for are OIs: if an HIV-positive individual is diagnosed with an opportunistic infection that's included on the CDC's list of over two dozen possible HIV-related OIs, then they are diagnosed with AIDS.

Many OIs can be prevented and/or treated. In fact, a lot of the AIDS research you hear about has been done to find treatments or cures for specific OIs, and not just looking for drugs to stop HIV.

Sunday, June 28, 2009

sobering news about the widespread AIDS

We're always hearing sobering news about the widespread AIDS epidemic, but, until now, you've probably never "heard" about HIV quite like this.

Alexandra Pajak, a graduate student at the University of Georgia, has just created a whole new way of looking at the complexities of HIV by combining the biology of the disease with music.

For months, Pajak carefully studied the different types of

Saturday, June 13, 2009

Thailand

Thailand

CDC Trial Sites in ThailandThe CDC trial in Thailand is examining the safety and efficacy of tenofovir. The study is being conducted in collaboration with the Bangkok Metropolitan Administration and the Thailand Ministry of Public Health and has enrolled 2,400 HIV-negative intravenous drug users (IDUs) — male and female — at 17 drug treatment clinics in Bangkok. Participants are recruited at the drug treatment clinics, at community outreach sites, and through a peer referral program.

Botswana

CDC Trial Sites in BotswanaThe Botswana study is examining the behavioral and clinical safety of tenofovir plus emtricitabine and adherence to the regimen. This trial began as a safety and efficacy trial, but key challenges — including lower than anticipated HIV incidence and retention rates in the trial population — meant that the trial would be unable to determine efficacy. However, the study will still examine critical questions related to safety and adherence that will help guide potential implementation of PrEP, should efficacy be demonstrated in other trials.

The trial is being conducted in collaboration with the Botswana government and enrolled 1,200 HIV-negative heterosexual men and women, ages 18 to 39, in the nation’s two largest cities, Gaborone and Francistown. Participants were recruited through a number of venues, including HIV voluntary counseling and testing centers, sexually transmitted disease (STD) and family planning clinics, youth organizations, and community events.

Tuesday, June 9, 2009

H o w t o u s e t h i s t o o l

H o w t o u s e
t h i s t o o l
Use the fl owchart under differentiated strategies
to estimate the scope of actions for the education
sector in the fi eld of HIV and AIDS in the country
where you work.
Critically review the table with issues that put
children at a disadvantage and compare this
with your own context.
Use the issues under three dimensions for mainstreaming
as a framework for support.
Use the list of critical elements for effectiveness
when you are providing feedback to partners
and to sectors/governments on proposals for interventions,
or when you are planning, reviewing or
evaluating programmes.

Monday, June 8, 2009

Africa

Africa


Africa south of the Sahara is the worst-affected, with 2/3 of all living HIV infected persons. In 2008, 91% of all children there were living with HIV and there were 14 million orphaned children, whose parents had died of Aids. It is estimated that in Sub-Saharan Africa, one in 20 people (5%) carry HIV.

In 2008, South Africa, with 5.7 million, was the country with the highest number of HIV-infected people in the world. The situation is even more dramatic in some small countries, which have the highest number of HIV-infected people in percentage terms: Swaziland 26%, Botswana 24%, Lesotho 23%.

Global

Global


HIV global epidemic

During the 70s and 80s, the HIV epidemic propagated from Africa via Haiti and the USA to every country in the world. HIV infection is primarily transmitted by sexual means.

number of people living with HIV

number of people newly infected with HIV

Worldwide, the number of those living with HIV infection continues to rise, although more slowly. However, the number of those newly infected was steadily sinking from 1996 (3.5 million) to 2008 (2.3 million). This may be due to more frequent treatment with antiretroviral drugs (ART). In 2008, in poor countries every third HIV-infected person (4 million) received antiretroviral therapy, which is ten times more than in 2003.

HIV global epidemic - summary 2008

Friday, May 8, 2009

Diagnosis of HIV infection

Diagnosis of HIV infection


HIV can't be diagnosed through a medical examination or via disease symptoms. Diagnosis is only possible on the detection of the HIV virus or antibodies in body fluids (e.g. blood). Normally the presence of antibodies is tested.

The diagnostic window:
It takes some weeks before sufficient quantities of antibodies exist in the blood for the test. This period from infection to proof of infection is called the diagnostic window. The period varies from person to person and is dependent on several factors (transmission path, quantity of transferred viruses, immune system etc.).

The diagnostic window can be reduced by an average of 3 weeks with the use of an antigen (virus) test or a combination of antigen and antibody tests. For most people the time taken between infection and diagnosis is 3 months but it may take 6 months before it is possible.

diagnostic window

HIV infection and anti-body reaction
The green curve shows the concentration of the antibodies against the HIVs in the blood. The red line shows the virus concentration (antigen) in the HIV infected blood. HIV can diagnosed at the earliest after two weeks and the antibodies at the earliest 3 weeks later.

Wednesday, May 6, 2009

What's the difference between anonymous & confidential testing?

What's the difference between anonymous & confidential testing?

With anonymous testing, you don't have to give your name to anyone. With confidential testing, you supply your name during the testing process, but the healthcare system and government health agencies are required by law to keep your testing information confidential – they can't let it become public information.

In the United States, your medical records are confidential. They're protected by the Privacy Act, which was passed into law in 1974. Generally speaking, only your doctor or the facility where you have your test done have access to your medical records. However, laws vary from state to state with regard to their being required to report when someone tests positive. For instance, if you live in a state where reporting of communicable diseases is required, your doctor must report your positive test result – which will likely include your name – to the state and federal governments.

Anyone who is concerned about anonymity or disclosure should contact their local health department or any AIDS service organization hotline to find out what the law is in their area and where anonymous testing is available.

A home test, or going to an anonymous testing site – which are available through departments of health in all the states – are good ways of getting tested anonymously, which means that your name does not need to be used in order to have the test. You will have a conversation with a counselor, but your identity will still be protected.

Tuesday, May 5, 2009

Aren't there two different kinds of HIV?

Aren't there two different kinds of HIV? How do I know what I should be tested for?

The two known types of HIV are HIV-1 and HIV-2. In the United States and Europe, the overwhelming majority of HIV cases involve HIV-1. HIV-2 infections are predominantly found in West African nations. The first case of HIV-2 was discovered in the United States in 1987. Since then only 79 people with HIV-2 infections have been identified in the United States. While the CDC does not recommend routine screening for HIV-2, when someone tests for HIV-1 using ELISA/Western blot tests, there is a 60% to 90% chance that HIV-2 will be detected if it is present.

Not every test will automatically include testing for HIV-2. Anyone who thinks there's a possibility they have been exposed to HIV-2 and/or any of HIV's more rare subtypes should mention this when being tested. Among those for whom HIV-2 testing is indicated are those with sex partners from a country where HIV-2 is prevalent or people with an illness that indicate underlying HIV infection, such as an opportunistic infection, but whose HIV-1 test result was negative

Sunday, May 3, 2009

The HIV Life Cycle en español

The HIV Life Cycle
en español


Introduction

In order for viruses to reproduce, they must infect a cell. Viruses are not technically alive: they are sort of like a brain with no body. In order to make new viruses, they must hi-jack a cell, and use it to make new viruses. Just as your body is constantly making new skin cells, or new blood cells, each cell often makes new proteins in order to stay alive and to reproduce itself. Viruses hide their own DNA in the DNA of the cell, and then, when the cell tries to make new proteins, it accidentally makes new viruses as well. HIV mostly infects cells in the immune system.

Infection: Several different kinds of cells have proteins on their surface that are called CD4 receptors. HIV searches for cells that have CD4 surface receptors, because this particular protein enables the virus to bind to the cell. Although HIV infects a variety of cells, its main target is the T4-lymphocyte (also called the "T-helper cell"), a kind of white blood cell that has lots of CD4 receptors. The T4-cell is responsible for warning your immune system that there are invaders in the system.

Replication: Once HIV binds to a cell, it hides HIV DNA inside the cell's DNA: this turns the cell into a sort of HIV factory.
HIV - AIDS virus
representation of HIV

Monday, April 20, 2009

Health care workers and Aids

Health care workers and Aids

All health care workers - be that medical doctors, nursing staff or other support personnel - run the risk of being infected, and because of their unique employment environment should even be more careful and should demand that correct protocol be followed and maintained at all times.
health care providers, aids, professionals, doctors, dentists, nurses, protocol, infected, needle, sharps on this page

* Exposure to the HIV virus
* Needle stick injury
* Some simple guidelines

Exposure to the HIV virus

Should a health care worker be exposed to the HIV virus, post exposure prophylaxis (PEP) drugs should be taken within 3 hours or no later than 24 - 48 hours after the incident.

Depending on the circumstances a 2 or 3 drug regimen is normally followed for a four week period.

This also applies to percutaneous exposure (needle stick injury) as well as mucocutaneous exposure (transmission by means of mucous membrane and/or skin) - although the transmission danger is less through mucocutaneous exposure.

Saturday, April 11, 2009

HIV Immune Responses are Random

HIV Immune Responses are Random
New research shows the body's defenses against HIV are random rather than genetically determined, which may be why it's so difficult to develop an AIDS vaccine. The UCLA AIDS Institute study shows the immune systems in two HIV-positive identical twins responded to the infection in different ways.

In 1983, male twins were infected with HIV shortly after their births in Los Angeles by blood transfusions from the same donor at the same time. The twins have been exposed to the same environmental factors, yet their T-cell receptors reacted differently in each twin. Researchers say this shows the body's defense response is random and unpredictable.

"These boys are as similar as two humans can be, yet we see differences in how they fight the virus," says Paul Krogstad, Ph.D., study researcher and professor of pediatrics and pharmacology. "That's one more thing that makes it difficult to develop a vaccine for everyone."

UCLA researchers say the study results have broader implications and could apply to other viruses, such as hepatitis C and herpes viruses.

Wednesday, April 8, 2009

© World Health Organization 2009

© World Health Organization 2009
All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health
Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;
e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for
sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22
791 4806; e-mail: permissions@who.int).
The designations employed and the presentation of the material in this publication do not imply the expression of
any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines
on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed
or recommended by the World Health Organization in preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital
letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained
in this publication. However, the published material is being distributed without warranty of any kind, either
expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no
event shall the World Health Organization be liable for damages arising from its use.

Monday, April 6, 2009

Where can I get tested?

Where can I get tested?

You can arrange for testing through your doctor or healthcare provider or public health department. Other places where you may be able to get tested are at your local community health center, family planning clinic, STD clinic, or hospital. For those who prefer anonymity, any FDA-approved home testing kit is accurate and reliable.

It's important for you to be aware that counseling is an important part of HIV testing. It may be done face-to-face with a doctor, at a testing site with a counselor, or over the phone with a counselor working for a home-collection testing kit company. These conversations play a valuable role in informing anyone who's tested negative about maintaining their negative status and advising those who test positive about their health care.

When it comes to HIV testing, the old cliché, "knowledge is power," still holds true. Knowing your accurate HIV status, whether negative or positive, puts you in the best position to protect your health.

Every state has its own HIV Hotline where information can be obtained about where to get tested, including anonymously, in those states in which anonymous testing is available.

In the following states, only confidential but not anonymous testing is available: Alabama, Idaho, Iowa, Mississippi, Nevada, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee and Wyoming.

In all other states both anonymous and confidential testing is available.

Some useful phone numbers:

CDC National STD and AIDS Hotlines for testing referral information:

  • 1-800-342-2437 (English)
  • 1-800-344-7432 (Spanish)

Thursday, March 26, 2009

· Scale up early infant diagnosis


· Scale up early infant diagnosis


Detection of HIV infection in infants is crucial so that antiretroviral therapy can be started as quickly as possible. However, it is currently very difficult to test HIV in children under 18 months due to the persistence of maternal antibodies that are present for the first 18 months of the child’s life. Currently, the only way to test children under 18 months is to use a polymerase chain reaction (PCR) machine, which is a complex DNA-based diagnostic tool.

The PCR machine is expensive, requires trained परसोंnnel and advanced laboratory infrastructures – all factors that make it difficult for national programmes to use. Additionally the machines often only exist at the centralised laboratory level which means that tests carried out in rural areas need to be sent to a central structure, and the results sent back again, a process which can take between one to three months, during which time there is the risk of losing the patient to follow up. What is needed is a test that allows the mother to be informed about her baby’s HIV status within a day.

But until a more practical long term solution is found, relying on PCR remains the only option for diagnosing children under 18 months, and as such, every effort should be made by donors and implementers to ensure that it is available and used.

· Treatment – painfully slow progress


Today there remains, despite some progress, a wide gap between the range of treatment options available for adults and those for children. Of the 22 drugs approved by the U.S. Food and Drug Administration and available for adults, six do not have paediatric indications, and seven do not exist in paediatric formulations.

Drug companies were very slow to design treatments specifically formulated for children. The first paediatric fixed-dose combination (an FDC simplifies treatment by combining several drugs in one pill) to be approved by the World Health Organization (WHO), appeared six years after the adult ones. Currently there are only seven paediatric FDCs that have been quality assured by WHO or the USFDA (US Food and Drug Administration) compared with 60 for adults

Many more drugs for children could potentially exist but it is taking a painfully long time for these drugs to be studied for use on children. This process needs to be accelerated – at the moment there are simply not enough treatment options for children. If a child should develop resistance to a class of antiretrovirals there are not enough alternative medicines available, even though these drugs exist for adults.

Additionally, what is urgently needed is a good treatment for young children co-infected with tuberculosis (TB), the most common opportunistic infection in HIV. For example, efavirenz – an antiretroviral that has been registered in the U.S. since 1998 – still has no safety or efficacy data for its use in children under three. Efavirenz is particularly needed for children with HIV/AIDS who are co-infected with TB because it does not interact with TB drugs. However, until the drug is tested on children we are not able to use it.

· Not adapted to real life conditions


Of the limited number of antiretrovirals to treat HIV that do exist for children, many of them are ill-adapted to the context where the majority of HIV infected children live. Some of them are syrups that come with logistical constraints as they are heavy or require refrigeration, others are powders that need to be mixed with clean water, all factors that make them harder to use in remote settings. Other formulations have an unpleasant taste making it harder to dispense to children. When producing paediatric drugs more thought needs to be given to where those drugs will be used, and by whom.


Ensuring that children with HIV/AIDS are no longer neglected requires:


· Boosting diagnosis: more effort and funds to be placed on diagnosing children under 18 months so that treatment can be started as soon as possible
· Improving treatment: governments and other actors to start treating more paediatric HIV patients
· Accelerating drug studies for paediatric treatments: children need more treatment options to be available sooner
· Putting the constraints that exist in remote settings at the centre of the development of paediatric HIV formulations

Saturday, March 14, 2009

Kids Feel...

Kids Feel...

Kids feel isolated

Children whose loved one is infected often feel "different".
Many say they cannot tell others, even professionals, that a loved one has HIV/AIDS.
They usually carry this secret alone.

Kids feel angry

Kids FightingAffected kids often say they are angry that HIV/AIDS has come into their families.
They are also upset by the negative comments others make about HIV/AIDS.
At times kids act out this anger through risky behaviour, like skipping school, experimenting with drugs and alcohol, and stealing.

Kids feel worried

Kids worry about what will happen to their loved ones who are infected.
They wonder "what will happen to them and me in the future?".

Kids feel loss

Grief and loss are are familiar to these kids.
Change is something they cope regularly.
Some have had a loved one die

Wednesday, March 11, 2009

HIV Infection and AIDS

HIV Infection and AIDS

HIV infection and AIDS both are correlated to each other. Before going to discuss about both these terms it would be better to understand the conception of HIV and AIDS. HIV stands for Human Deficiency Virus. It is a kind of virus that attacks on immune system. It exists in the CD4 cells. CD4 cells are soldier cells that resist the diseases and infections and thus keep the body protected from these invaders. However, CD4 cells can not recognize the existence of the virus as it hides in these cells. It develops gradually and replicates itself in order to damage the immune system. Once it develops completely, it takes over the immune system and destroys it completely. At the end a person becomes a victim of AIDS. Moreover when a person leads to this stage opportunistic infections attack on the immune system. They take the advantage of weakened or destroyed immune system.

On the other hand the word AIDS represents as Acquired immune deficiency syndrome. It is the advanced stage of HIV infection. When a person develops this stage he/she cannot go back to the primary stage that is known as HIV infection though he/she seems better. There are certain stages of HIV infection as a person develops these stages he/she reaches near to AIDS that is the last stage of HIV infection.

Let us see how HIV and AIDS are correlated

In order to see the correlation of these terms it would be better to see that how HIV infection turns into the AIDS. For that we will have to study the symptoms of HIV infection that once developed leads to AIDS. The symptoms of HIV can be randomly classified into two groups. The first one is early symptoms that appear when a person gets infected with HIV. The other is common symptoms that take eight to ten years to be seen.

Saturday, March 7, 2009

In the US the CDC launched a series of 13 bold and frank AIDS

1994 History

In the US the CDC launched a series of 13 bold and frank AIDS advertisements breaking away from their previous low-key approach. The advertisements focused on the use of condoms, which were rarely seen or even mentioned on American television.

"One of the television ads, entitled Automatic, features a condom making its way from the top drawer of a dresser across the room and into bed with a couple about to make love. The voice-over says, 'it would be nice if latex condoms were automatics. But since they're not using them should be. Simply because a latex condom, used consistently and correctly, will prevent the spread of HIV.'"34

In the UK, the Department of Health vetoed an AIDS campaign promoting safer sex and condoms, developed at a cost of £2 million, on the grounds that it was too explicit.35 The campaign was developed by the Health Education Authority (a government funded body), who later in the year were banned by the Department of Health from distributing the book, "Your Pocket Guide to Sex".36

In February the film maker Derek Jarman died of AIDS. He wrote in the preface of his autobiography:

"On 22nd of December 1986, finding I was body positive, I set myself a target: I would disclose my secret and survive Margaret Thatcher. I did. Now I have my sights on the millennium and a world where we are equal before the law."37

Randy Shilts, author of the book 'And the band played on' also died in February.38

In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in the film Philadelphia.39

Official statistics for Brazil, with a population of about 154 million, indicated that some 46,000 cases of AIDS had been recorded, but estimates put the actual number at anywhere between 450,000 and 3 million cases. Two thirds of the known cases were in Sao Paulo state where AIDS was the leading cause of death of women aged 20-35.40

In France, on 7th April all the television networks, public and private, broadcast 'Tous contre le Sida' ('All against AIDS'), a special 4-hour AIDS programme. The aim was to heighten awareness about HIV/AIDS and to raise money.41 The estimated audience for the program was 33 million. Some 32,000 cases of AIDS had been recorded in France, with 15 deaths each day, and an estimated 150,000 people were thought to be infected. 42

During the summer, the AIDS Prevention Agency in Brussels, in collaboration with the European Union, launched a campaign whose central image was 'the flying condom'. This was intended to serve as a visual reminder to young travellers of the risks of HIV infection. The logo was displayed in airports, railway stations, popular holiday destinations and other places young people visited during the summer.43

A large European study on mother-to-child transmission showed that Caesarean section halved the rate of HIV transmission.44

Research indicated that Thailand had reduced its rate of HIV transmission. This was largely due to action by the government, which had distributed condoms to brothels and insisted that they were used consistently; establishments that failed to comply were threatened with closure. Condom use in commercial sex had risen from 14% in 1989 to 94% in 1993.45

By July 1994 the number of AIDS cases reported to the WHO was 985,119. The WHO estimated that the total number of AIDS cases globally had risen by 60% in the past year from an estimated 2.5 million in July 1993 to 4 million in July 1994.46 It was estimated that worldwide there were three men infected for every two women, and that by the year 2000 the number of new infections among women would be equal to that among men.47

At the end of July, the UN Economic and Social Council approved the establishment of a new "joint and cosponsored UN programme on HIV/AIDS" to replace the WHO's Global Programme on AIDS. The separate AIDS programmes of the UNDP, World Bank, UN Population Fund, UNICEF and UNESCO would have headquarters with the WHO in Geneva, starting in 1996.48 Later in the year it was announced that Dr. Peter Piot, the head of the research and intervention programme within the Global Programme on AIDS, would be the head of the new UN program.49

A study, ACTG 076, showed that AZT reduced by two thirds the risk of HIV transmission from infected mothers to their babies.50 Somepeople believed that ACTG076 was:

“the most stunning and important result in clinical acquired immunodeficiency syndrome research to date.”51

And according to Dr Harold Jaffe of the CDC:

“It is the first indication that mother-to-child transmission of HIV can be at least decreased, if not prevented. And it will provide a real impetus for identifying more HIV-infected women during pregnancies so that they could consider the benefit of AZT treatment for themselves and their children.”The New York Times -52

In early August 1994, the Tenth International Conference on AIDS was held in Yokohama, Japan. It was the first of the International Conferences to be held in Asia. No major breakthroughs emerged, and it was announced that in future the international conference would be held every two years.53

Meanwhile in the Russian Federation, deputies in the Russian Parliament, the Duma, voted at the end of October to adopt a law making HIV tests compulsory for all foreign residents, tourists, businessmen and even members of official delegations.54

India by this time had around 1.6 million people living with HIV, up by 60% since 1993. Local and state governments were accused of underusing and misusing HIV prevention funds.55

On 11th November AIDS killed the 22-year old Pedro Zamora. He had become famous when he appeared on MTV's 'Real World' documentary about the real lives of a group of young room mates.56

In December, President Clinton asked Joycelyn Elders to resign from the post of US Surgeon General, following her suggestion during a World AIDS Day conference that school children should, amongst other things, be taught about masturbation. Gay activists defended the Surgeon General and criticised the president's record on AIDS. Fears were expressed that the president's action would discourage other government leaders from speaking frankly about AIDS.

WHAT ARE THE SIDE EFFECTS?

WHAT ARE THE SIDE EFFECTS?

When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of Combivir are the same as with zidovudine (Retrovir) and lamivudine (Epivir). They include headache, upset stomach, and fatigue. See Fact Sheet 551 for more information on fatigue.

The most serious side effects of zidovudine are anemia, granulocytopenia, and myopathy. Very few people have these side effects. If they occur, your health care provider will probably have you stop using Combivir. See Fact Sheet 411 on zidovudine for more information on these side effects.

Anemia is a shortage of red blood cells caused by damage to bone marrow. Fact Sheet 552 has more information on anemia.

Granulocytopenia is a shortage of white blood cells caused by damage to bone marrow.

Myopathy is muscle pain and weakness. There is no specific treatment for myopathy.

HOW DOES COMBIVIR REACT WITH OTHER DRUGS?

Combivir can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.

Combivir should not be taken with with stavudine (Zerit®, d4T). Also, lamivudine and emtricitabine (FTC) are very similar and should not be taken together.

Blood levels of lamivudine may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs.

Zidovudine’s side effects may be worse if you are taking several other drugs.

Methadone may increase blood levels of zidovudine. If you take combivir and methadone, watch for zidovudine side effects.

Friday, March 6, 2009

What is a window period?

What is a window period?

The ‘window period’ is a term used to describe the period of time between HIV infection and the production of antibodies. During this time, an antibody test may give a ‘false negative’ result, which means the test will be negative, even though a person is infected with HIV. To avoid false negative results, antibody tests are recommended three months after potential exposure to HIV infection.

A negative test at three months will almost always mean a person is not infected with HIV. If an individual’s test is still negative at six months, and they have not been at risk of HIV infection in the meantime, it means they are not infected with HIV.

It is very important to note that if a person is infected with HIV, they can still transmit the virus to others during the window period.

How accurate are antibody tests?

Antibody tests are extremely accurate when it comes to detecting the presence of HIV antibodies. ELISA tests are very sensitive and so will detect very small amounts of HIV antibody. This high level of sensitivity however, means that their specificity (ability to distinguish HIV antibodies from other antibodies) is slightly lowered. There is therefore a very small chance that a result could come back as ‘false positive’.

A false positive result means that although a person may not be infected with HIV, their antibody test may come back positive. All positive test results are followed up with a confirmatory test, such as:

  • A Western blot assay – One of the oldest but most accurate confirmatory antibody tests. It is complex to administer and may produce indeterminate results if a person has a transitory infection with another virus.
  • An indirect immunofluorescence assay – Like the Western blot, but it uses a microscope to detect HIV antibodies.
  • A line immunoassay - Commonly used in Europe. Reduces the chance of sample contamination and is as accurate as the Western Blot.
  • A second ELISA – In resource-poor settings with relatively high prevalence, a second ELISA test may be used to confirm a diagnosis. The second test will usually be a different commercial brand and will use a different method of detection to the first.

When two tests are combined, the chance of getting an inaccurate result is less than 0.1%.