HIV-TRePS is an innovative and important

HIV-TRePS is an innovative and important tool to improve the health of people living with HIV, and the BC Centre for Excellence in HIV/AIDS (BC-CfE) is proud to contribute to its development,” commented Dr. Julio Montaner, Past President of the International AIDS Society and Director of the BC-CfE, based in Vancouver, Canada. “These promising results are the first to be published from a clinical evaluation of such a system. I would encourage people to try the system and enter follow-up data and evaluations to help the RDI to continue to refine and improve the system.”

Selecting and changing treatments for patients with HIV and AIDS in order to keep the virus suppressed is complex and challenging. There are approximately 25 HIV drugs available, from which physicians normally choose a combination of three or more to suppress the virus. However, mutations occurring in the viral genetic code can cause resistance to the drugs used against it. The physician then has to select a new combination of drugs to overcome this resistant strain.

The computational models within HIV-TRePS, called “Random Forests,” base their predictions on a range of more than 80 different variables including mutations in the viral genetic code, the drugs used to treat the patient in the past, CD4 cell counts (a type of white blood cell that is attacked by HIV) and the amount of virus in the bloodstream. The models estimate the probability of each combination of drugs reducing the amount of virus to below the limit of detection in the blood (50 copies HIV RNA/ml) based on what the system has ‘learnt’ during its training with thousands of real clinical cases. The system’s overall accuracy during development and testing was approximately 80%.

“We are very pleased to see the results of these studies published,” said Dr Brendan Larder, Scientific Chair of the HIV Resistance Response Database Initiative (RDI). “It is gratifying to see evidence that the years of technical development have resulted in a system that is likely to produce clinical benefits and that physicians are keen to use.”

The RDI is already working on a version of HIV-TRePS for use in resource-limited settings where there are fewer treatment options and health care workers do not have access to all the information that this initial system requires. The RDI’s approach could also have potential benefit in other diseases, most obviously where drug resistance can be a problem such as Hepatitis.

The RDI is an independent, not-for-profit research group set-up in 2002 with the mission to improve the clinical management of HIV infection through the application of bioinformatics to HIV drug resistance and treatment outcome data. Over the eight years since its inception, the RDI has worked with many of the leading clinicians and scientists in the world to develop the world’s largest database of HIV drug resistance and treatment outcome data, containing information from approximately 70,000 patients in more than 15 countries.

Note: HIV-TRePS is an experimental system intended for research use only. The predictions of the system are not intended to replace professional medical care and attention by a qualified medical practitioner and consequently the RDI does not accept any responsibility for the selection of drugs, the patient's response to treatment or differences between the predictions and patients’ responses.

RDI’s system for predicting how HIV and AIDS patients

Two multinational clinical studies indicate that the RDI’s system for predicting how HIV and AIDS patients will respond to different drugs could be a useful tool with potential clinical and economic benefits. The studies, published in the January issue of AIDS Patient Care and STDs, involved highly experienced physicians in the USA, Canada and Italy who used the system to help them select the optimum combination of HIV drugs for patients whose therapy was failing.

The HIV Treatment Response Prediction System (HIV-TRePS) harnesses the power of complex computer models that have been trained with data from thousands of patients around the world. In these studies, physicians entered their patient’s data and their selection of the next combination of HIV drugs, via the Internet. A prototype version of HIV-TRePS predicted how the patient would respond to hundreds of alternative combinations of HIV drugs. Within seconds, the physician received a report listing the drug combinations that the models predicted were most likely to work. Having reviewed the report, the physicians recorded their final treatment decision and completed an online evaluation.

The results demonstrated that use of the system was associated with a change of treatment decision in one-third of cases to combinations with fewer drugs overall, which were predicted to result in better virological responses. Evaluations indicated that the physicians found the system to be easy and useful. Based on these findings, use of the system could potentially improve patient outcomes and reduce the overall number – and therefore cost – of drugs used. An improved version of HIV-TRePS is now available free of charge over the Internet (via the RDI web site) as an experimental tool.

At least over 1000 HIV/AIDS patients

At least over 1000 HIV/AIDS patients in The Gambia are currently on anti-retroviral therapy according to the regional AIDS coordinator in the West Coast region, who said it was important to keep tab on the figures.

Mr. Kebba Jome who made this revelation shortly after a partnership forum on HIV/AIDs organised by the KMC and BCC at the Paradise Suite hotel, revealed that currently over 1,600 people with advanced HIV infection are receiving anti-retroviral therapy.

According to him, the secretariat and its partners have established a twenty-four health facility offering prevention of mother to child transmission services with over 90, 000 pregnant women completing the counselling and testing process.

Mr. Jome stressed that there are a total of nine health facilitators capable of providing advanced intervention for disease prevention and medical treatment for people living with HIV and appropriate laboratory facilities providing all essential tests for anti-retroviral therapy. According to the coordinator over 3,000 orphans and vulnerable children are receiving free basic external support and over 5, 000 people living with HIV are being provided with care and support services.

Mr. Jome said that the partnership forum was part of activities by the municipality’s AIDS committee to mark World AIDS Day, observed worldwide every December 1st.

The theme for the last commemoration was “Universal Access and Human Rights”.

According to him in 2003, the World Health Organisation launched an ambitious target of reaching three million people in low and middle income countries with anti-retroviral drugs by 2005. He said it was not intended as a final objective, but as a stepping stone to universal access to ARVs.

Mr. Jome said although the target was not attained until 2007, it was seen by some as succeeding in a number of ways as the treatment rose from covering 400, 000 people in December 2003 to 1.3 million in December 2005.

“Considering the relative success of the target, the international community set another target in 2006 aimed at universal access to HIV treatment, prevention and care by 2010.

The 2010 target is also part of it MDG 6 which includes halting and reversing the spread of HIV/AIDS by 2015’ he indicated

According to him, most countries including The Gambia are expanding coverage of their national treatment by setting themselves a goal of providing antiretroviral therapy to 80 percent of those in need. He added that although this target is yet to be met by many countries, the goal of universal access to HIV treatment remains an important one for low and middle income countries around the world.

Mr. Jome clarified that universal access broadly defined “does not necessarily mean 100 percent coverage of all services but can been seen as a desire to ensure high level access to the most effective interventions that are supposed to be equitable, accessible, affordable, comprehensive and sustainable”.

fighting HIV, malaria and tuberculosis donated by the Global Fund.

Kenya is under investigation for corruption and fraudulent use of money meant for fighting HIV, malaria and tuberculosis donated by the Global Fund.

According to the Fund, a procedural audit in August provided sufficient indications that there is theft, abuse and misappropriation of its money.

The country will also be investigated for rampant diversion of malaria drugs meant for public hospitals into the local and regional markets.

A recent report by the Fund’s Office of the Inspector General says Kenya is among 10 other countries whose routine audits last year justified formal investigations.

According to its charter, the Fund carries out formal investigations when it identifies potential fraud, abuse, misappropriation, corruption and mismanagement.

The Inspector General’s Office also says it has identified instances of organised thefts of anti-malarial drugs in several countries in Africa.

“We believe that a significant percentage of all Global Fund-financed anti-malarial drugs (and most likely other drugs) have been, and are continuously being, diverted,” says the Global Fund report

“Several identified instances, of organised thefts of anti-malarial drugs in several different countries in Africa including Kenya have been brought to our attention,” the fund states.

A study published in a December issue of the journal Research and Reports in Tropical Medicine estimated that 38 per cent of first line malaria drugs — artemisinin-based combination therapy — sold in Nairobi are taken from government supplies.

The researchers had wanted the Global Fund to take action to stave off the loss of donors’ money.

In July Medical Services minister Anyang’ Nyong’o said such cartels were known to be in operation and would be crushed.

“We are awaiting information to ascertain how drugs meant for Kenya are found in Uganda. We shall chase them until they enter ant-holes,” Prof Nyong’o said.

Initial investigations by the Global Fund indicate these drugs to be “following a trans-continental trafficking route, overland and possibly by sea.”

The action against Kenya comes amid months of proxy wars in the Internet anonymously telling of corruption in HIV donor programmes in Kenya.

Branson Man Sentenced for Infecting Woman with H.I.V.

• 
  

• • 
    
  • 
    
  • 
    
  • 
    

• • 
    

Forsyth, MO — The Taney County prosecutor says Jeffery Scott Trumbo, 42, of Branson pleaded guilty on Thursday, January 13 to the class a felony of recklessly infecting another with H.I.V. By a plea agreement entered between Trumbo and the state, Trumbo was sentenced by Taney County Circuit Court Judge Mark Orr to 10 years in the Missouri Department of Corrections. The judge denied probation.

In August of 2010, a woman reported to the Taney County Sheriff’s Office that Jeffery Scott Trumbo had previously infected her with H. I.V. The woman explained that she and Trumbo had been in a long-term relationship, however, after separating, Trumbo informed the woman that he was H.I.V. Positive. The woman sought medical attention and confirmed that Trumbo had, in fact, infected her with H.I.V.

“Hopefully the Taney County community feels safer knowing that its local law enforcement, including the Taney County prosecutor’s office, understands that our community does not tolerate this sort of behavior,” Taney County Prosecutor Jeffrey Merrell said. “This is a crime that has tragic consequences for its victim and this community. Although it is rare that we see this sort of crime, let there be no mistake that we all take it very seriously.”

A two-tiered health care system that only allows "innocent" people with HIV to be treated?

A two-tiered health care system that only allows "innocent" people with HIV to be treated? That seems to be the sentiment of Representative Larry Brown of North Carolina, who states that the state shouldn't have to pay for treatment for anyone who acquired the disease because of their "perverted lifestyles."

Via Winston-Salem Journal:

State Rep. Larry Brown said during a discussion of his legislative goals for the year that the government should not spend money to treat adults with HIV or AIDS who "caused it by the way they live."

Brown, R-Forsyth, made the comments when asked by the Winston-Salem Journal to talk about his goals for the N.C. General Assembly session set to begin this month.

He began by discussing his support for a constitutional amendment limiting marriage to a union between one man and one woman, which would forestall any efforts to allow same-sex marriage.

He went on to say he thinks the government shouldn't spend money to treat HIV among people "living in perverted lifestyles."

"I'm not opposed to helping a child born with HIV or something, but I don't condone spending taxpayers' money to help people living in perverted lifestyles," said Brown, who ran unopposed in the November election to win a fourth term.

Brown wouldn't say Tuesday what he considers perverted, but did say that adults who get HIV through sexual behavior or drugs would be among those who should not be treated at government expense.

Brown’s discussion regarding HIV

Brown’s discussion regarding HIV and the gay community came at a sensitive time, in the wake of so many LGBTQ suicides. As an elected official, he has a responsibility to his citizens. Frankly, he is failing them. Equating HIV to the gay community is not only ignorant, it's dangerous.

Katherine Foster, the president of AIDS Care Service in Winston-Salem, called Brown's remarks "fiscally and socially irresponsible." She said the remarks highlight "his ignorance on this major public-health issue."

"What Representative Brown can't seem to get through his mind is that HIV disease … affects individuals regardless of age, race and sexual orientation," Foster said. "Without funding for HIV, the disease is at risk for reaching pandemic levels, just as it has in countries that do not provide government funding for HIV-AIDS."

It serves Americans well to be informed about our elected officials, inform others, speak up, and actually vote. Brown is a dangerous example of what can happen if we don’t. Beyond the HIV epidemic health risks, how can our LGBT youth move beyond self-hatred when our elected officials are connecting homosexuality to choice, HIV, health care, drug abuse and ultimately insulting the small part their identity that has finally shown some clarity?

That the government should not spend money to treat adults with HIV or AIDS

That the government should not spend money to treat adults with HIV or AIDS who "caused it by the way they live."

Not surprisingly, he began the discussion by saying he would support a constitutional amendment limiting marriage to a union between one man and one woman, clearly preventing any efforts to allow same-sex marriage.

Brown drew criticism in October for an e-mail he sent to other state Republican legislators in which he used disparaging language about gays. After the announcement of a legislative leadership award given to then-House Speaker Joe Hackney, Brown sent his e-mail to House Minority Leader Paul Stam saying: "I hope all the queers are thrilled to see him. I am sure there will be a couple legislative fruitloops there in the audience."

Without explaining his connection between gay marriage rights and HIV government spending, he continued, "I'm not opposed to helping a child born with HIV or something, but I don't condone spending taxpayers' money to help people living in perverted lifestyles," said Brown, elected in November to his fourth term.

When pressed by reporters, Brown wouldn't comment about what he considers "perverted." While it might be fortuitous that readers were spared his bit of ignorance, he did say that "adults who get HIV through sexual behavior or drugs would be among those who should not be treated at government expense."

Joe Solmonese, president of the Human Rights Campaign, called Brown's comments "ill-informed," "hateful," and "extremely dangerous." He added, "hysterical, judgmental and inaccurate statements like Brown’s create an environment that prevents many from getting tested and seeking treatment, thereby furthering the spread of HIV and AIDS. Larry Brown’s conduct reflects poorly on his constituents and other elected officials. The people of North Carolina deserve better."

The small silver lining in all of this falls to other North Carolina Republicans, who avoid his comments completely. Their unwillingness to even address Brown’s statement is an admission of transgression.

House Rep. Dale Folwell declined to discuss Brown's remarks about HIV. "I don't have any comment on that," said Folwell, who is slated to be the new speaker pro tem when the House convenes Jan. 26. "I just work on the things that I work on, and that takes all I have."

Rep. Bill McGee, a Republican who represents the 75th District in Forsyth County, said, "People who are sick need care. While I may not agree with the lifestyles which contribute to the sickness taking place, if a person is sick and has no recourse or any way to get help other than being on some program, then perhaps we will have to do that," McGee said.

While it seems unlikely Brown will be able to pass any legislation based on "lifestyle" choice, his comments are worth reporting because of their potential. Too many false assumptions were made connecting all of the dots.

Of course, we cannot dictate health care based on lifestyle, but deeper than the health care issue, Brown (and perhaps Rep. McGee) deserves to be pressed about the idea of choice. Homosexuality isn’t a "lifestyle choice" and ignoring that comment further propels rhetoric into the minds of young people grappling with issues of identity, especially in North Carolina, a state that has historically been very conservative.

Editorial: AIDS aid - Money for medicine helps control both HIV and costs

Editorial: AIDS aid - Money for medicine helps control both HIV and costs

>

<

>

<

[+] click to enlarge

It's cruel. It's ignorant. It's self-defeating. It isn't even cost-effective. In Cumberland County, which is tied with Guilford for the distinction of ranking fourth in the number of deaths from HIV and AIDS, it would cause suffering for no defensible reason.

If you think any of that will elicit a retraction from state Rep. Larry Brown of Kernersville, good luck to you.

Brown, who last year referred to gays as "queers" and "fruitloops" in an e-mail circulated within the hallowed halls of the people's House, wants to withhold public money from adults with the disease. He says they're welcome to find insurance on their own, but should get no subsidies because their lifestyles are "degenerate."

It is not possible to have a poorer grip on reality.

Never mind cruelty. Begin with a couple of tired, false assumptions: (1) all adults with HIV or AIDS are homosexuals; and (2) punishing people with illness or death for their perceived moral shortcomings is a proper exercise of civil government power.

Self-defeating? False economy? For many, losing insurance is tantamount to losing the medicine that controls the disease. And as Troy Williams, chairman of the Cumberland County HIV Task Force, noted, these patients will head for the emergency room, where Rep. Brown's $14 million saving would quickly be wiped out.

Gay-baiting plainly is part of Brown's repertoire, so expect no help there. But those of a more humane inclination, as well as taxpayers who can see where their own interests lie, should demand that Brown's colleagues keep him on a short leash

then told her he was HIV-positive

A Toronto woman is alleging an Edmonton man whom she met on an Internet dating website had sex with her against her will and then told her he was HIV-positive.

Testifying Monday at the aggravated sexual assault trial of Patient Simpenzwe, 44, in Edmonton’s Court of Queen’s Bench, the 39-year-old woman said she came to Edmonton to meet him after he told her in e-mails and phone calls that he wanted a long-term relationship.

She told jurors she went to Simpenzwe’s home after he flew her out in February 2008 and said he quickly tried to get her to have sex with him that night.

However, she testified she told him she wanted them to go to a clinic first to make sure they were disease-free and said he “just smiled and said OK.”

The next evening, she said he fell asleep while they were watching a movie and she decided to have a bath. Then, while naked and checking the water temperature, she said he came behind her and sexually assaulted her.

The woman told the jury she struggled and he grabbed her and carried her into his bedroom where he had unprotected sex with her against her will.

Afterwards, she testified he told her that he was HIV positive and had been infected by his wife. She said she pushed him off, got up and dressed and called police.

Court then heard a recording of a 911 call in which the woman is sobbing and asking for help. Simpenzwe then gets on the line and tells police he had used a condom.

Under cross examination, the woman denied suggestions that she and Simpenzwe had consensual sex and that he had informed her of his HIV-positive status.

“Never, never, never,” she said, looking like she was close to tears.

She also denied suggestions that Simpenzwe had worn a condom during the sex.

Jurors were told they will hear medical evidence during the five-day-long trial about how the AIDS virus is transmitted, as well as evidence regarding conflicting statements made by Simpenzwe to police.

For the millions of South African HIV-

For the millions of South African HIV-positive patients taking antiretroviral (ARV) drugs, a new threat has developed; to be robbed of their life-prolonging medicine by gangs using the drug to lace marijuana, creating a highly-addictive drug by the name “whoonga”.

Whoonga can be any mixture of cheap substances, including rat poison, used in an attempt to enhance the high from smoking marijuana.

Users of the drug strongly believe that using ARVs, such as Efavirenz, or Stocrin, boosts hallucinogenic effects, while police says that doing so has very little real effect.

Vish Naidoo, national police agency spokesman, said “It is a relatively new drug that began to surface a few months ago and fortunately for now, is confined to a few areas.”

As a result, among efforts to make ARVs more widely available to the nearly six million South Africans living with HIV, authorities are now also faced with the problem of eradicating the illegal trade in these drugs, involving increased security surrounding ARV supplies, as well as informing patients of the risk of theft.

Victims of whoonga criminals mostly stay silent, as reporting a theft would consequently expose them as HIV positive.

People with HIV get free bus passes

People with HIV get free bus passes

MADURAI/DINDIGUL: Free bus passes to persons living with HIV were handed over to beneficiaries in Madurai and Dindigul districts by the respective Collectors. People living with HIV, who are receiving free anti-retroviral therapy (ART), had good reason to celebrate Pongal as they received the passes which would enable them to travel to the ART centres free of cost, officials said.

While distributing the passes, Madurai Collector C. Kamaraj said that helping people living with HIV to access various government schemes was a priority. “As part of the antyodaya anna yojana scheme, over 169 families living with HIV are being provided 35 kgs of rice and a total of 77 young widows living with HIV have been provided with widow pension. Resource mobilisation is also being done for 250 children living with HIV in Madurai and as on December 2010, a total of 3,800 people are receiving free ART.

Dindigul

Collector M. Vallalar said that a total of 1,711 persons living with HIV in the district would shortly get the passes. He was handing over passes to a group of persons in the first phase at a function organised by the Department of Health Services and Tamil Nadu Aids Control Society held at Anti-Retroviral Therapy Centre (ART). Joint Director Health Services T. Jayabal said ART medicines were distributed to persons with HIV at PHCs at Vadamadurai and Ammayanaickanur and taluk hospitals at Palani, Batlagundu and Vedasandur.

On the other hand, ranking the medical risks of HIV

On the other hand, ranking the medical risks of HIV and hepatitis C in transplants as disincentives to high-risk donor use were not significant predictors of a change in practice overall, but did predict avoiding the use of high-risk donors. The odds ratios were 8.29 for HIV risk and 5.70 for hepatitis C risk, and both were significant at P<0.05.

Among physicians who changed practice, the researchers argued, most changes could be classified as "defensive medicine."

That finding is "worrisome," they noted, because high-risk donors contribute 8.6% of recovered organs and offer "significant survival benefit" despite a small risk of transmitting infectious disease.

The researchers cautioned that the data were self-reported, so it is possible that surgeons either over- or underreported changes to their practice following the 2007 event. It's also possible that those who responded to the survey differ from those who did not respond, they noted, although survey respondents represented 89.1% of U.S. transplant volume.

Finally, they cautioned that the survey took place after the 2007 case, so that recall bias is possible.

UNODC gives $660,000 to fund drug, HIV/AIDS programmes

UNODC gives $660,000 to fund drug, HIV/AIDS programmes

HA NOI — The United Nations Office on Drugs and Crime (UNODC) has given $660,000 to Viet Nam to fund two new projects.

One project will help the Vietnamese government carry out its crime prevention and drug control mission. The other will sort out barriers to health care and treatment facing people with HIV/AIDS.

The UNODC Viet Nam Country Manager Zhuldyz Akisheva said yesterday that her organisation would encourage drug users and people with HIV/ AIDS to support the Government's long-term strategies to combat these issues.

Among the top priorities this year, the UNODC will focus on helping Viet Nam deal with illicit trafficking, criminal justice, drug use reduction and HIV/AIDS prevention.

At yesterday's meeting between the UNODC and the Ministry of Public Security, Deputy Director General of the Criminal Investigating General Police Department Major General Vu Hung Vuong reiterated Viet Nam's commitment to fighting drug use.

"Viet Nam has achieved visible results in drugs and crime prevention, such as increasing awareness about the dangers of drugs, building a more formal legal system and reducing opium cultivation areas in Viet Nam," said Vuong.

The National Committee for AIDS, Drugs and Prostitutes Prevention's latest statistics show that authorities have handled 122,500 cases with nearly 200,000 drug criminals involved. They have seized nearly 1,900kg of heroin, 2,500kg of opium, 15,000kg of marijuana and 800,000 narcotics pills. The area under opium cultivation saw dramatic reductions: 428ha in 2000 became 30ha in 2009.

Including these two new projects, the UNODC has funded Viet Nam a total of 12 drug and crime prevention projects worth US$9.5 million. — VNS

After a rare, high-profile case of HIV

After a rare, high-profile case of HIV transmission through organ transplant, nearly a third of surgeons changed their practice, researchers reported.

But the most common change was to avoid the use of high-risk donors, rather than to institute better ways of detecting the virus before transplant, according to Dorry Segev, MD, PhD, and colleagues at the Johns Hopkins University School of Medicine.

The finding, from a survey of more than 400 transplant surgeons, suggests that fear of legal or regulatory consequences -- rather than patient safety -- was driving changes in practice, Segev and colleagues reported in the January issue of Archives of Surgery.

In 2007, transplants from a single high-risk donor transmitted both HIV and hepatitis C to four organ recipients, despite negative antibody tests before the procedures. The case made national headlines, Segev and colleagues noted, and sparked a debate about informed consent and testing for HIV.

One of the issues was the use of the antibody test for HIV and hepatitis C, which in the first weeks after infection -- 22 days for HIV and 82 for hepatitis C -- cannot detect the presence of the viruses.

After the discovery of the transmission, physicians retrospectively used nucleic acid testing -- which reduces the discovery window to nine and seven days for HIV and hepatitis C, respectively -- and confirmed the donor had been infected.

To see what effect the case had, Segev and colleagues surveyed transplant surgeons across the U.S. between Jan. 17, 2008, and April 15, 2008, getting responses from 422 surgeons in current practice.

Of those, they found, 297 reported using high-risk donors, but 31.6% changed practice after the 2007 event. Specifically:

• 41.7% of those who changed decreased use of high-risk donors.
• 34.5% increased the emphasis on informed consent.
• 16.7% increased use of nucleic acid testing.
• 6% implemented a formal policy.

Surgeons who did not change were in practice longer, the researchers found -- 13.9 years versus 10.7, which was significant at P=0.002. They were also less likely to rank being sued or facing hospital pressure as disincentives (both differences significant at P≤0.001), but both groups saw the medical risks of HIV and hepatitis C in transplants as high (greater than four on a five-point scale).

In multivariate analyses of the reasons for changing practice, the researchers found that ranking the fear of being sued or hospital pressure as important disincentives was associated with higher odds of changing practice. The odds ratios were 2.26 and 2.52, respectively, and both were significant at P<0.05.

CHICAGO — The rare transmission of HIV

CHICAGO — The rare transmission of HIV through transplanted organs to four Chicago-area patients made headlines in 2007.

A new study says it also caused some U.S. transplant surgeons to limit their use of organs from high-risk donors such as gay men.

The study's senior author says the response is based more on fear of lawsuits than on science.

Dr. Dorry Segev of Johns Hopkins University in Baltimore says the risk of death while waiting for a transplant is far higher for many patients than the risk associated with organs from high-risk donors.

The survey of 422 transplant surgeons found about a third made changes following the 2007 events. Of those, 42 percent decreased their use of high-risk donors.

1. Health highlights
   1. 

The findings appear in Monday's Archives of Surgery.

Panaji, Jan 16 (PTI) A HIV positive man

Panaji, Jan 16 (PTI) A HIV positive man chargesheeted forsexually abusing a 14-year old boy and infecting him with thedisease died today at Goa medical college and hospital,authorities stated.

John D''Souza was chargesheeted for sexually abusing theboy for three months in 2008.

Jail authorities confirmed that John, who was admitted tothe Goa Medical College and Hospital, died today.

Since he was in the judicial custody when he died, Subdivisional magistrate would enquire into his death.

The accused was arrested in November 2008 after thechild''s father complained to the police. It was alsosubsequently revealed that the boy was also carrying HIVvirus.

John was initially given bail by Goa Children''s court.

But the state filed an appeal in the High Court that quashedChildren''s Court order and asked the paedophile to appearbefore the investigating team.

He surrendered on November 25 and was put behind barspending trial.

Police were also probing whether John had sexually abusedother boys. PTI RPSABC

Conference on 'HIV/AIDS Research' in New Delhi

a

The National AIDS Control Organisation (NACO) in collaboration with UNAIDS is organising a National Conference on 'HIV/AIDS Research' at India Habitat Centre in New Delhi from January 19 to 21.

The event is aimed at extensive exchange of knowledge among the researchers, programme managers and policy makers to more effectively identify, plan/design and implement appropriate strategies for effective prevention and control of HIV epidemic in India.

The National Conference on HIV/AIDS Research has been conceived with the objective of providing evidences for programme planning and policy formulation, besides serving as a national platform for exchange of views, ideas and learnings for the researchers, programme managers and policy makers in India. The Conference also aims to integrate and link preventive and therapeutic research on HIV /AIDS with the national programme. The theme of Conference is "Towards Evidence-Policy linkages in HIV/AIDS Research in India."

A highly stimulating and interactive technical programme has been developed for the Conference. There will be four Thematic sessions, namely, Basic Sciences, Clinical & Biomedical, Socio-behavioural and Evaluation Studies. Each session will include a Panel Discussion to cull out recommendations for the National Programme from the findings of the presentations.

Symposia on important research areas and keynote address by eminent researchers have been incorporated in the programme. In addition to the rich technical programme, a variety of resource material will also be available to the participants at the exhibition stalls. The Conference will be preceded by a Continuing Education Workshop, "HIV/AIDS Researchers: Challenges & Perspectives" which will provide an opportunity for young researchers to familiarize with the emerging priority areas for research in the field of HIV/AIDS.

It is envisaged that this scientific gathering would lead to timely and appropriate National response to the HIV epidemic and planning for the next phase of National AIDS Control Programme.

estimates, 21% of Anglo American's workforce was HIV

estimates, 21% of Anglo American's workforce was HIV-positive in 2001. Specifically, Dr. Brink
was debating the merits of adding a potentially costly antiretroviral component to the existing
HIV/AIDS program. Looks at the economic impact of HIV/AIDS on the Anglo workforce;
examines the strategic, cost/benefit, and corporate social responsibility issues involved in offering
the antiretroviral drug program to workers; contrasts Anglo's programs with its key competitors;
and considers the financial, implementation, and political challenges involved in launching the
antiretroviral program.
■ Teaching Module: HIV/AIDS and Strategy, prepared by Dr. Mary Gentile
When the challenges of HIV/AIDS in developing countries are integrated into Management
Education, they are often addressed in Business & Society courses or Business Ethics courses.
However, this teaching module provides a set or readings for students as well as some
background readings for faculty that illustrate the importance and relevance of raising this topic
in core Strategy courses.
Many corporate challenges presented by HIV/AIDS – the integration of so-called “non-market”
forces into corporate strategy deliberations; pricing decisions; public policy positions (e.g., with
regard to Intellectual Property Rights, tax incentives, etc.); stakeholder relationships; reputation;
collective industry actions; and product development commitments – are key strategic challenges.
This collection of readings includes four case studies and nine additional readings.
ONGOING QUESTIONS:
■ What stimulus is needed to get programs with no or little class time on this topic to take
notice? What impediments exist?
■ Assuming new best practices for firms tackling AIDS develop in economically strategic
areas such as Brazil, China, and India, will these ideas transfer at all to economically
disadvantaged regions such as sub-Saharan Africa? Can academics aid in facilitating this
transfer, perhaps by disseminating generalized templates of best practice?
■ Hypothetically, what would happen if top-10 business recruiters expected MBA graduates
to have basic knowledge of the business strategy implications of AIDS? Alternatively,
what would happen if top-tier business schools emphasized AIDS as a stand-out feature
in their educational offerings?
RESOURCES:
BeyondGreyPinstripes.org – World’s biggest MBA database, including detailed records on 1,672 courses,
1,730 extracurriculars, and 216 research articles at 128 schools on six continents.
CasePlace.org – A free and practical on-line resource for up-to-date case studies, syllabi, and innovative
teaching materials on business and sustainability. Created for the educators who will shape our next
generation of business leaders!

Living with HIV can be a daily struggle against

Living with HIV can be a daily struggle against acute depression, anxiety and fatigue turning daily life events into overwhelming challenges. Depression is twice as common in people living with HIV as it is in the general population.Stress, its accompanying poor mental/emotional health, and a sense of isolation from community are factors known to contribute to the progression of HIV infection. They compromise both quality and length of life.

Maintaining good health requires a vibrant balance between the physical, mental/emotional, social and spiritual aspects of our lives.

Our Solution: The Yoga of the Breath for People Living with HIV teaches techniques that significantly decrease the impact of stressors on the mind, body and spirit. They are simple to learn and practice, cost effective, both non-invasive and therapeutic, and they complement any existing medical regimen. They carry no side effects.

Skillful use of one's own breath re-educates the body, mind and emotions to interact in a manner that enhances health on all levels. Greater energy, an ability to feel good about yourself and your life, a peaceful mind during the day and restful sleep at night are only a breath away.

Program Details: This 8-day, 23 hour workshop provides techniques utilizing the breath the quiet the mind, eliminate stress, improve vitality and expand awareness. The cornerstone of the Yoga of Breath program is a breath technique called the Sudarshan Kriya. This simple, yet powerful technique utilizes specific rhythms of the breath to clarify the body & mind, improve cognitive function, strengthen the respiratory system, increase energy and stamina, enhance immune function, improve cardiovascular health and restore harmony to the entire system.

Sudarshan Kriya: This simple, yet powerful technique utilizes specific rhythms of the breath to clarify the bodya & mind, improve cognitive function, strenghten the respiratory system, increase energy and stamina, enhance immune function, improve cardiovascular health and restore harmony to the entire system.

Life Skills: We discuss practical tools for diffusing the impact of the daily stressors of life including the value of nutrition. All the techniques from the course are offered as a personal practice that can be done safely at home.

current about HIV/AIDS and bring their

University of Western Ontario, Operating Manager (Elective Course)
In this course, students “Use a case in Operating Manager Course that deals with AIDS in the
workplace. This case asks students to think of the differentiating characteristics of HIV/AIDS
compared to other human diseases, what management's responsibilities are in helping PWA’s
[Persons With AIDS] cope, and what specifically would they do in the position of the case decision
maker. The students are asked as well to read something current about HIV/AIDS and bring their
understanding to class. The class typically starts with an "up-date" on the status of HIV/AIDS from
a medical, social, economic, or political standpoint.”
■ McGill University, Managing Organizational Politics (Elective Course)
“When dealing with power "around" organizations, at the level of inter-organizational domains (a
broader concept than 'industry', as it incorporates all types of organizations, including NGOs and
regulatory bodies) one is talking about the social impact of business. In the second session, we
discuss business and politics: how firms and industry associations are actors in the political and social
system as well as in the economic system. During the session on 'domain transformation', the case
study we used addressed the success of AIDS treatment activists in getting the institutions of
commerce (i.e. pharmaceutical companies), government and science to reform their ways in a manner
that PWA’s [Persons With AIDS] found more socially responsible.”
For additional courses on related subjects, search 1,672 descriptions at Beyond Grey Pinstripes.
NOTABLE TEACHING MATERIALS:
Materials referenced are meant to represent the diversity of related teaching resources available
at Caseplace.org. All are offered for free download to registered faculty members.
■ Case Study: Volkswagen in the Global War Against HIV/AIDS (UN Global Compact Learning
Forum)
This case study shows how the VW group and its Brazilian and South African branches are
organizing themselves to fight HIV/AIDS throughout their workforces as well as they look for
ways to cooperate with national and regional communities in prevention and treatment of this
terrible disease.
■ Case Study: Anglo American (A) (Stanford University)
In 2001, Dr. Brian Brink, senior vice president of Anglo American, a massive South African
mining conglomerate, was debating how to confront the ravages that extremely high HIV/AIDS

the AIDS crisis in Africa

“One of the most important recent developments in business strategy is the realization that nonmarket
actors — governments, nongovernmental organizations (NGOs) and the court of public opinion —
can be as important as competitors, customers and suppliers in determining firm performance. In the
core strategy class, we study these problems in the context of the pharmaceutical industry’s response
tothe AIDS crisis in Africa and two main impacts. First, the availability of medications to combat
communicable diseases has tremendous consequences for public health and economic development in
all nations of the world. Second, the pharmaceutical industry’s response may be critical to its own
long-term prospects, as the AIDS pandemic continues to cause governments and NGOs to question
the virtues of systems for protecting intellectual property rights for human therapeutics.”
■ University of Vermont, Fundamentals of Legal Environment of Business (Core Course)
Of three social impact sessions in the course, one focuses upon “social, moral and ethical”
considerations related to the strategy of “pricing…AZT AIDS drugs.”University of Stellenbosch, Strategic HIV/AIDS Management (Elective Course, last offered 2004)
“The general aim of this course is to acquire a basic knowledge and understanding of HIV/AIDS as a
strategic business issue, and to enable students to take proactive steps to manage the risks effectively
in order to reduce the economic impact of the epidemic. At completion of the module, students will
be able to apply this knowledge and insights in generating a HIV/AIDS strategic plan for a particular
company.”
■ Emory University, Customer Behavior (Elective Course) d dddddddddddddddddddddddddd
“Students do a social marketing project. This project requires that the students come up with a
marketing campaign for a social marketing initiative or sensitive issue. The instructor positions the
subject by having students read a case about AIDS and the failure in curbing the spread of the disease,
and then the success of ad campaigns dealing with the promotion of condom use for the prevention of
AIDS. The key points for students to take away from this case and use in their subsequent projects are
to think about who they might offend, who might be opposed and how they can gain ‘buy-in’ from
these groups.”

Africa Centre for HIV/AIDS Management

Dr. Witold Henisz, Associate Professor at the Wharton School, the University of Pennsylvania
▪ Dr. Jan du Toit, Director of the Africa Centre for HIV/AIDS Management at the University of
Stellenbosch, South Africa
▪ Dr. Brenda Zimmerman, Director of both the Health Industry Management Program and the
HIV/AIDS Strategy Studies for MBA Students at the Schulich School of Business, York
University
▪ Celina Gorre, Technical Manager at the Global Business Coalition on HIV/AIDS
▪ Dr. Mary Gentile, Independent Consultant for the Aspen Institute
▪ Justin Goldbach, Fellow at the Aspen Institute Business and Society Program
▪ Amy Lawrence, Senior Program Manager at the Aspen Institute Business and Society Program
and Director of Caseplace.org
Of special note- and underscoring the importance of discussion amongst colleagues- are many
new teaching materials that came to light in this dialogue and weren’t previously known to some
other participants: a strategic simulation for students titled “The AIDS Crisis” recently conducted
by Booz Allen Hamilton; a new online class from Dr. du Toit; and a forthcoming case study on
DeBeers from Dr. Zimmerman

For many firms, HIV/AIDS

THE BOTTOM LINE:
■ For many firms, HIV/AIDS in the business realm is slowly changing from a philanthropic
issue to one of risk management.
■ Multi-sector teamwork is necessary to combat the disease’s effect in many nations. It is clear
that collaborative problem-solving is barely broached in relation to HIV/AIDS in most
business schools.
■ Opportunities for core course integration are numerous, including marketing, strategy,
operations/supply chain management, just to name a few. Yet, core coursework that
addresses HIV/AIDS in some way is quite rare.
1A FACULTY POINT OF VIEW:
The Aspen Institute Business and Society Program recently organized and facilitated a dialogue
on HIV/AIDS as it is being addressed in business school education. Participants examined the
topic from their unique expertise and perspectives, reflected on curriculum development and
student demand, engaged with the idea of collaboration between business and academia, and
much more.

HIV/AIDS INTRODUCTION

INTRODUCTION:
The statistics are still staggering: last year approximately 3.1 million deaths worldwide were
attributed to AIDS.1 With about 5 million new infections last year, the total global population of
people living with HIV/AIDS is estimated at 40 million.2 While two-thirds of those afflicted
reside in sub-Saharan Africa, infections continue to rise in each region of the globe.3 It’s not
surprising, then, that firms are eyeing fast-emerging economies such as Brazil, Russia, India and
China and noting the potential negative impact of this disease on their bottom line.
In addition to obvious issues of workplace productivity and morale, firms are increasingly
confronting valuation concerns in high-prevalence areas.4 Outside factors also play a role, with
the U.S. consumer demanding more substantial action from businesses on this issue: more than
two-thirds believe that companies should be actively fighting AIDS.5 Many firms are weighing
the question of internal program development and implementation versus reliance on public
health programs in their host countries. Yet while fifty percent of business leaders expect AIDS
to have an affect upon their firms’ operations within five years, less than ten percent have
actually taken the steps to conduct a quantitative HIV/AIDS risk assessment.6
It’s feasible, then, to think that the issue of HIV/AIDS and specifically its impact upon business
performance is soon to be an essential element of a comprehensive business education. While
some classes do exist that address AIDS in several disciplinary perspectives within business,
most are elective courses; the integration of AIDS-related matters into core coursework is
relatively unexplored. This issue of A Closer Look investigates how B-schools and their
curricula are presently tackling this issue.

HIV ATLAS provides its users

• A Social Media initiative that aims to Collect, Collate, Classify and Disseminate the information on HIV, TB & Malaria so that people living with HIV and the people working in the field can be on top of the information generating from more than 700 online and offline resources.
  
  HIV ATLAS provides its users a unique way to be on top of information ranging from common living to funding, jobs, events and much more absolutely free of charge. We encourage Employers to post their Job opportunities in our featured Jobs category to reach out to more than 40000 subscribers daily.
.

HIV ATLAS welcomes content contributions and strongly encourages all sector participants to actively share their advertisements.

You can contribute and engage by:

• Creating your profile
• Posting your classified advertisements
• Sharing information about Jobs, Events, Funding etc with us
• Sharing information about any online resource you want us to include
• Creating your resume for potential employers to have a look in.

Early symptomatic HIV

Early symptomatic HIV infection has signs and symptoms typical of HIV infection but not full-blown AIDS. The onset of symptoms signals the transition from asymptomatic HIV infection to HIV disease.

At this early stage of HIV infection, the person does not have signs or symptoms of AIDS such as opportunistic infections, certain cancers, or a CD4 count of less than 200.

Risk factors for HIV infection are:

• Being born to an HIV-positive mother
• Receiving a blood transfusion or blood components
• Injection drug use
• Sexual contact with an infected partner in which there is an exchange of semen or vaginal fluids

Symptoms

• Diarrhea that persists
• Excessive sweating or night sweats
• Fatigue that persists
• Fever that persists
• General feeling of discomfort, illness, or lack of well-being
• Herpes zoster infections (shingles) that keep coming back
• Joint pain
• Mouth disorders
  • Gingivitis
  • Oral hairy leukoplakia of the tongue, caused by a viral infection
  • Oral thrush ("yeast infection")
• Pain, loss of sensation, and inability to control muscles (peripheral neuropathy)
• Skin disorders
  • Fungal infection of the skin or nails
  • Molluscum contagiosum
  • Seborrheic dermatitis
• Swollen lymph glands
• Weight loss

Asymptomatic HIV infection

Asymptomatic HIV infection is a period of time, which varies in length from person to person, in which the immune system slowly deteriorates but there are no symptoms.

The length of this phase varies depending on how quickly the HIV virus is copying itself and the individual's genetic differences that affect the way his or her immune system handles the virus.

Some people can go 10 years or longer without symptoms, while others may have symptoms and worsening immune function within a few years after the original infection.

Symptoms

Asymptomatic HIV infection, by definition, does NOT have symptoms typically associated with HIV, such as:

• Fever
• Opportunistic infections (opportunistic means they occur because the weakened immune system provides the "opportunity" for infections to take hold. Serious opportunistic infections include Pneumocystis jirovecii pneumonia, cytomegalovirus, and Mycobacterium avium).
• Oral thrush (also an opportunistic infection, but not life-threatening and does not require a seriously weakened immune system to occur)
• Weight loss

Exams and Tests

The diagnosis of HIV infection is based on standard blood tests such as the HIV antibody test (ELISA). A Western blot confirms the diagnosis.

How well an HIV-infected person's immune system is functioning can be determined by measuring the level of certain white blood cells called CD4 lymphocytes (also known as helper T lymphocytes).

Treatment

When a person without symptoms should receive therapy remains controversial. People who are asymptomatic but who have CD4 lymphocyte counts of less than 200 should take treatment to suppress the HIV infection (called antiretroviral therapy). This therapy boosts the immune system and helps prevent opportunistic infections.

Most doctors also recommend antiretroviral therapy for some individuals with CD4 counts between 200 and 350, and perhaps for those with even higher CD4 counts (depending on the level of HIV in the person's blood). However, factors other than blood test results must be considered, such as patient readiness and ability to stick to the therapy regime, before prescribing antiretroviral therapy.

People with HIV infection need to be educated

People with HIV infection need to be educated about the disease and its treatment so they can be active partners in making decisions with their health care provider.

There is still controversy about whether aggressive early treatment of HIV infection with anti-HIV medications (also called antiretroviral medications) will slow the long term progression of disease. You should discuss this option with your health care provider.

Follow these healthy practices in the early stages of HIV infection:

• Avoid exposure to people with infectious illnesses.
• Avoid settings and situations that could lead to depression. Maintain positive social contacts, hobbies, interests, and pets.
• Eat a nutritious diet with enough calories.
• Get enough exercise, but don't wear yourself out.
• Keep stress to a minimum.
• Practice safer sex. The disease is highly transmissible, especially in the first months after infection.

Support Groups

You can often reduce the stress of illness by joining a support group where members share common experiences and problems. See AIDS - support group.

Outlook (Prognosis)

There is no cure for HIV infection or AIDS. However, appropriate treatment can dramatically improve the length and quality of life for persons infected with HIV, and can delay the onset of AIDS.

The treatments for conditions that occur with early symptomatic HIV disease vary in effectiveness. Some infections and diseases are easier than others to treat with medications.

Possible Complications

• AIDS (acquired immunodeficiency syndrome)
• Autoimmune diseases
• Cancers, typically Kaposi's sarcoma and lymphomas

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have had a possible or actual exposure to AIDS or HIV infection, or if you are at risk and have had symptoms like those of acute HIV infection.

Prevention

For a comprehensive discussion, see the prevention section in AIDS.

Safer sex behaviors may reduce the risk of getting the infection. There is still a risk of getting infected with HIV, even if you practice "safe sex," because condoms can break. Abstinence is the only sure way to prevent sexual transmission of the HIV virus.

Acute HIV infection

Acute HIV infection is caused by the human immunodeficiency virus (HIV), a virus that gradually destroys the immune system.

Causes

Primary or acute HIV infection occurs 2 - 4 weeks after infection with the human immunodeficiency virus (HIV). The virus is spread by:

• Sexual contact
• Contaminated blood transfusions and blood products
• Injection drug use with contaminated needles and syringes
• Passing through the placenta from an infected, pregnant mother to the unborn baby
• Breastfeeding (rarely)

After someone is infected with HIV, blood tests can detect antibodies to the virus, even if they never had any symptoms of their infection. This is called HIV seroconversion (converting from HIV negative to HIV positive by blood testing), and usually occurs within 3 months of exposure, but on rare occasions can by delayed up to a year after infection.

Following the initial infection, there may be no further evidence of illness for the next 10 years. This stage is called asymptomatic HIV infection.

Acute HIV infection can, but does not always, progress to early symptomatic HIV infection and to advanced HIV disease (AIDS). However, the vast majority of patients do ultimately progress to AIDS. To date there are a small number of people who have tested positive for HIV, but later no longer test positive and have no signs of disease. Although this is relatively rare, it provides evidence that the human body may be capable of removing the disease. These people are being carefully watched and studied.

HIV has spread throughout the world. Higher numbers of people with the disease are found in large metropolitan centers, inner cities, and among certain populations with high-risk behaviors.

spreading HIV, and other sexually transmitted diseases

Prevention

1. See the article on safe sex to learn how to reduce the chance of acquiring or spreading HIV, and other sexually transmitted diseases.
2. Do not use illicit drugs and do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones. These programs can also provide referrals for addiction treatment.
3. Avoid contact with another person's blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.
4. Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use whatever preventive measures (such as condoms) will give their partner the most protection.
5. HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn children, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy.
6. The Public Health Service recommends that HIV-infected women in the United States avoid breast-feeding to prevent transmitting HIV to their infants through breast milk.
7. Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

The riskiest sexual behavior is unprotected receptive anal intercourse. The least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period has a low risk of transmission.

HIV-positive patients who are taking antiretroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with about 20% of the time if medications are not used.

The U.S. blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.

If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and it has been used to prevent transmission in health care workers injured by needlesticks.

There is less information available about how effective PEP is for people exposed to HIV through sexual activity or injection drug use. However, if you believe you have been exposed, discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been raped should be offered PEP and should consider its potential risks and benefits.

Right now, there is no cure for AIDS.

Right now, there is no cure for AIDS. It is always fatal without treatment. In the U.S., most patients survive many years after diagnosis because of the availability of HAART. HAART has dramatically increased the amount of time people with HIV remain alive.

Research on drug treatments and vaccine development continues. However, HIV medications are not always available in the developing world, where most of the epidemic is raging.

Possible Complications

When a person is infected with HIV, the virus slowly begins to destroy that person's immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow or halt the destruction of the immune system.

Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have any of the risk factors for HIV infection, or if you develop symptoms of AIDS. By law, AIDS testing must be kept confidential. Your health care provider will review results of your testing with you.

There is no cure for AIDS at this time

Treatment

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.

HAART is not a cure for HIV, but it has been very effective for the past 12 years. People on HAART with suppressed levels of HIV can still transmit the virus to others through sex or by sharing needles. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm³), life can be significantly prolonged and improved.

However, HIV may become resistant to HAART, especially in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether an HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each person, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and before starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for treating drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are:

• Collection of fat on the back ("buffalo hump") and abdomen
• General sick feeling (malaise)
• Headache
• Nausea
• Weakness

When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of fat and glucose (sugar) in the blood.

Any doctor prescribing HAART should carefully watch the patient for possible side effects. In addition, routine blood tests measuring CD4 counts and HIV viral load should be taken every 3 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the amount of HIV virus in the blood to a level where it cannot be detected.

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF or Neupogen) are sometimes used to treat anemia and low white blood cell counts associated with AIDS.

Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

The following is a list of AIDS-related infections

Exams and Tests

The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these additional diseases. Today, according to the Centers for Disease Control and Prevention, a person may also be diagnosed as having AIDS if they have a CD4 cell count below 200 cells/mm³, even if they don't have an opportunistic infection.

AIDS may also be diagnosed if a person develops one of the opportunistic infections and cancers that occur more commonly in people with HIV infection. These infections are unusual in people with a healthy immune system.

CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells."

Many other illnesses and their symptoms may develop, in addition to those listed here.

Common with CD4 count below 350 cells/mm³:

• Herpes simplex virus -- causes ulcers/small blisters in the mouth or genitals, happens more frequently and usually much more severely in an HIV-infected person than in someone without HIV infection
• Tuberculosis -- infection by tuberculosis bacteria that mostly affects the lungs, but can affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system (brain and spinal cord)
• Oral or vaginal thrush -- yeast infection of the mouth or vagina
• Herpes zoster (shingles) -- ulcers/small blisters over a patch of skin, caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox
• Non-Hodgkin's lymphoma -- cancer of the lymph nodes
• Kaposi's sarcoma -- cancer of the skin, lungs, and bowel associated with a herpes virus (HHV-8). It can happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is more common in men than in women.

Common with CD4 count below 200 cells/mm³:

• Pneumocystis carinii pneumonia, "PCP pneumonia," now called Pneumocystis jiroveci pneumonia, caused by a fungus
• Candida esophagitis -- painful yeast infection of the esophagus
• Bacillary angiomatosis -- skin lesions caused by a bacteria called Bartonella, which may be acquired from cat scratches

Common with CD4 count below 100 cells/mm³:

• Cryptococcal meningitis -- fungal infection of the lining of the brain
• AIDS dementia -- worsening and slowing of mental function, caused by HIV itself
• Toxoplasma encephalitis -- infection of the brain by a parasite, called Toxoplasma gondii, which is frequently found in cat feces; causes lesions (sores) in the brain
• Progressive multifocal leukoencephalopathy -- a disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions
• Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV itself
• Cryptosporidium diarrhea -- Extreme diarrhea caused by one of the parasites that affect the gastrointestinal tract

Common with CD4 count below 50/mm³:

• Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis
• Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes

In addition to the CD4 count, a test called HIV RNA level (or viral load) may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in women with a compromised immune system. Anal Pap smears to detect potential cancers may also be important in both HIV-infected men and women, but their value is not proven.

AIDS begins with HIV infection

Symptoms

AIDS begins with HIV infection. People infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops.

Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm³ ).

Almost all people infected with HIV, if not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from damaging their immune system.

The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called opportunistic infections.

People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are:

• Chills
• Fevers
• Sweats (particularly at night)
• Swollen lymph glands
• Weakness
• Weight loss

Note: Initial infection with HIV may produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 - 4 weeks after contracting the virus. Some people with HIV infection stay symptom-free for years between the time they are exposed to the virus and when they develop AIDS.

Symptoms

Symptoms related to HIV are usually

AIDS

Important facts about the spread of AIDS include:

• AIDS is the sixth leading cause of death among people ages 25 - 44 in the United States, down from number one in 1995.
• The World Health Organization estimates that more than 25 million people worldwide have died from this infection since the start of the epidemic
• In 2008, there were approximately 33.4 million people around the world living with HIV/AIDS, including 2.1 million children under age 15.

Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.

HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk generally transmit infection to others.

The virus can be spread (transmitted):

• Through sexual contact -- including oral, vaginal, and anal sex
• Through blood -- via blood transfusions (now extremely rare in the U.S.) or needle sharing
• From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk

Other methods of spreading the virus are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

HIV infection is NOT spread by:

• Casual contact such as hugging
• Mosquitoes
• Participation in sports
• Touching items previously touched by a person infected with the virus

AIDS and blood or organ donation:

• AIDS is NOT transmitted to a person who DONATES blood or organs. Those who donate organs are never in direct contact with those who receive them. Likewise, a person who donates blood is not in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.
• However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

People at highest risk for getting HIV include:

• Injection drug users who share needles
• Infants born to mothers with HIV who didn't receive HIV therapy during pregnancy
• People engaging in unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS
• People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice)
• Sexual partners of those who participate in high-risk activities (such as injection drug use or anal sex)

Human Immunodeficiency Virus (HIV)

Overview

Human Immunodeficiency Virus (HIV) presents a complex knot for scientists to unravel। After initial contact and attachment to a cell of the immune system (e।g. lymphocytes, monocytes), there is a cascade of intracellular events. The endproduct of these events is the production of massive numbers of new viral particles, death of the infected cells, and ultimate devastation of the immune system. However, the knot IS becoming unraveled. These pages attempt to simplify HIV infection at the cellular level. The following diagram shows a number of steps from initial attachment of a viral particle to a lymphocyte through budding of new viruses from that cell.

Causes

The human immunodeficiency virus (HIV) can be spread by the following:

• Through sexual contact -- including oral, vaginal, and anal sex
• Through blood -- via blood transfusions (now very rare in the U.S.) or needle sharing
• From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can pass it to her baby in her breast milk

People who become infected with HIV may have no symptoms for up to 10 years, but they can still pass the infection to others. After being exposed to the virus, it usually takes about 3 months for the HIV ELISA blood test to change from HIV negative to HIV positive.

HIV has spread throughout the U.S. The disease is more common in urban areas, especially in inner cities.

See also: AIDS for a more complete description of how AIDS is spread.

Pressures on AIDS Funding

Pressures on AIDS Funding

Armed with improved data, UNAIDS has substantially reduced its estimate of 2010 spending requirements to deliver country targets for universal access. Nevertheless, its figure of $25.1 billion remains formidable and must contend with a perfect storm of resistance.

There are already signs that the global economic recession will disrupt government budgets and donor resources for AIDS programmes. The wider squeeze on development aid will almost certainly bring to a head long-simmering grievances that AIDS funding has been disproportionate.

Many poor countries invest more in AIDS programmes than in the rest of their health services combined. The two million annual deaths caused by AIDS-related illness compare with ten million through hunger, five million due to unsafe water and one million from malaria.

The most recent plans published by PEPFAR and the Global Fund acknowledge that the narrow "vertical" world of AIDS-related intervention must shift towards "horizontal" development support for general public health facilities. Such moves will recognise the significance of HIV and AIDS in crucial MDG agendas such as food security and maternal mortality.

AIDS funding estimates may themselves be affected by new guidelines published by the World Health Organization which recommend that ART should commence much earlier. They advise a CD4 threshold of 350 rather than 200 in developing countries, estimating that this might add up to 5 million people to the treatment backlog.

A final pressure point is the inherent exponential profile of future demand for antiretroviral treatment. Growth will be driven by the goal of universal access, the continuing high rate of new infections and the longer life expectancy of patients.

The human consequences of any interruption to antiretroviral treatment add great complexity to economic considerations. A patient may develop resistance to the drugs if unable to sustain 95% adherence to the prescription, creating the need for more expensive second line treatments. This knowledge influences governments to prioritise treatment at the expense of prevention programmes, rekindling the embers of the epidemic.

Treatment of AIDS

Treatment of AIDS

On average a patient with the HIV virus can live a normal life for 10-11 years without treatment. A cocktail of drugs known as antiretroviral therapy (ART) should commence when the strength of the immune system (known as the CD4 count) falls to a defined threshold.

The virus is not eliminated by ART but the risk of onset of Acquired Immune Deficiency Syndrome (marked by the establishment of one of a range of serious illnesses associated with immune deficiency) is reduced by about 80% giving the prospect of a reasonably normal lifespan.

Such is the position for people living with HIV in rich countries. In poor countries the patient may be unaware that he or she is HIV positive, there may be no available test for the CD4 count, there may be no government funds to pay for the treatment and health workers may lack skills to prescribe and monitor antiretrovirals. The CD4 threshold may be set lower than in rich countries exposing the patient to greater risk.

Other obstacles include the complexities of tuberculosis, often dormant in people living with HIV but liable to be activated by the virus. Circumstances of poverty and malnutrition conspire against the discipline of lifelong uninterrupted observance of the prescription. Drop-out rates of 62% after just 2 years have been reported in a UNAIDS survey of 13 developing countries.

Annie Kaseketi Mwaba, an HIV positive pastor in Zambia © Centre for Development and Population Activities

By the end of 2008, 4.0 million people living with HIV were receiving treatment in low and middle income countries out of 9.5 million in need. Although far behind the 2010 target for universal treatment, this figure has increased tenfold in just five years. Sub-Saharan Africa has kept pace such that its 48% treatment rate exceeds the global average. Nearly all poor countries now offer free testing for HIV at public heath centres.

Prospects for continued rapid progress are very sensitive to the price of antiretroviral drugs. This is a constant source of tension between the humanitarian anxiety to save lives and the return on capital sought by multinational pharmaceutical companies armed with 20 year patent protection.

Although World Trade Organisation (WTO) rules permit the least developed countries (LDCs) to acquire or manufacture low cost generics until 2016, middle income countries such as India, Thailand and Brazil depend on less concrete concessions in WTO rules for health emergencies. Painful lessons about equitable distribution of drugs may prove invaluable if the daunting problems associated with finding a vaccine for HIV are eventually overcome.

Prevention of HIV

Prevention of HIV

Box for anonymous questions at Diemo School, Kisumo, Kenya © Peter Armstrong

The human immunodeficiency virus, first identified in California in 1983, is transmitted by bodily fluids exchanged in sexual relations, or by contaminated blood, or through mother-to-child transmission. Despite years of creative educational initiatives costing billions of dollars, supported by many exemplary acts of political leadership, the MDG Progress Report for 2009 states that “only about 31 per cent of young men and 19 per cent of young women (aged 15-24) in developing countries have a thorough and accurate understanding of HIV.” The target for these indicators is a hopelessly impossible 95% by 2010.

Concerns about the sluggish pattern of behaviour change encouraged the World Health Organisation (WHO) to add male circumcision to its list of approved preventative measures. Research shows that the risk of infection is reduced by 60% for circumcised men. This makes no difference to the risks for women and great efforts are going into the development of HIV-resistant microbicide gels.

As results continue to lag expectations, critics question whether national strategies pay insufficient attention to the profile of new infections which varies in every country. This is particularly so in those Asian countries where the epidemic is “concentrated” within high risk groups. Many governments find it politically unappealing to direct funding into these communities.

In sub-Saharan Africa where the epidemic has become “generalised” amongst heterosexuals, it is possible that a very different form of denial is at play. The preferred behavioural code adopted in AIDS programmes is the ABC concept of Abstinence, Be faithful and use Condoms, each principle having priority over the next but not to an unrealistic extent. Many argue that this sidesteps the deeper cause which is cultural tolerance of multiple and concurrent partners for men.

President Zuma of South Africa stands at the crossroads of this debate. In decisively rejecting the disastrous policies of his predecessor, Thabo Mbeki, he has performed valuable service to his country, home to the world's largest number of people living with HIV. But Zuma’s personal lifestyle of multiple female partners, however grounded in Zulu culture, is an inappropriate role model for young Africans yearning for a new generation free of AIDS.