AIDS Update 2011

Contents

About the Author iii

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

AIDS UPDATE 2011 xx

Preface xxii

Introduction: Histories of Global Pandemics, AIDS, Its Place in History, Overview of HIV/AIDS, International AIDS Conferences and Means of Remembering-the AIDS Quilt, Candlelight Memorial, and World AIDS Day 1

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

History of Global Pandemics and Epidemics 1

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

Imagine a World without AIDS 2

Overview of HIV/AIDS 4

AIDS: A Unique Disease 5

AIDS: A Cause of Death 5

Another Anniversary 6

Other Anniversaries 6

International AIDS Conferences 6

Means of Remembering 7

The 27th Candlelight Memorial 8

Walking to Change the Course of the HIV/AIDS Epidemic-United States 8

Bicycle Riding to Change the Course of the HIV/AIDS Epidemic-United States 10

World AIDS Day: An International Day of Coordinated Action: A Time to Recharge and Reconnect 10

The Future 11

National AIDS Hotlines 12

Useful Internet Addresses 13

1 AIDS: Defining the Disease and Finding Its Cause 15

The New Millennium 15

AIDS: A Disease or a Syndrome? 16

First Reaction to AIDS: Denial 17

What Causes AIDS? 18

The Centers for Disease Control and Prevention Reports 20

Discovery of What Causes AIDS 21

Defining the Illness: AIDS and Surveillance 22

Summary 24

Review Questions 25

2 What Causes AIDS: Origin of the AIDS Virus 26

The Cause of AIDS: The Human Immunodeficiency Virus (HIV) 26

HIV Does Not Cause AIDS: Dissidents and Their Cults: A Minority Point of View 26

News Flash 2010-Leading HIV/AIDS Dissident Cleared of Misconduct Following Complaints Made After He and Others Published a 2009 Paper Arguing That There Is "As Yet No Proof That HIV Causes AIDS" 32

Dissidents (AIDS Does't Exist or HIV Isn't the Cause) 32

Summary of the HIV/AIDS Dissidents' Viewpoints 33

Evidence That HIV Causes AIDS 33

Origin of HIV: The AIDS Virus 35

Summary on the Origin of HIV 42

Summary 43

Review Questions 43

3 Biological Characteristics of HIV 44

Viruses Need a Host Cell in Order to Replicate 44

Viruses Are Parasites 44

Viruses Specific to Cell Type 45

How Do Human T4 or CD4+ Lymphocytes Relate to HIV Infection and AIDS? 46

Description of HIV; How It Attaches to a Host Cell and Buds Out of the Cell 47

HIV Fitness 48

The HIV Life Cycle 49

Understanding How HIV Works 49

How HIV Escapes the Infected Cell 50

Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins 58

Summary 61

Review Questions 61

4 Anti-HIV Therapy 62

Better Drugs, BEtter Technologies, and Lingering Problems 63

Anti-HIV Therapy 63

The Good News About ART 64

Antiretroviral Therapy (ART) Drugs with FDA Approval 67

The HIV Medicine Chest: ART Drugs Receiving FDA Approval 67

FDA-Approved Nucleoside/Non-Nucleoside Analog Reverse Transcriptase Inhibitors, Protease Inhibitors, Integrase Inhibitors, Entry Inhibitors, and Maturation Inhibitors 71

Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors 71

FDA-Approved Protease Inhibitors 73

Entry Inhibitors and Problems 75

Integrase Inhibitors 76

Development and Selection of HIV Drug-Resistant Mutants 76

Development of HIV Drug Resistance to Protease Inhibitors 77

How Combination Drug Therapy Can Reduce the Chance of HIV Drug Resistance 79

Viral Load: Its Relationship to HIV Disease and AIDS 86

Medical Complications Associated with Anti-HIV Drug Therapies (ART) 87

Update 2010 94

Summary 94

Disclaimer 95

Some AIDS Therapy Information Hotlines 96

Review Questions 96

5 The Immunology of HIV Disease/AIDS 98

The Immune System 98

Human Lymphocytes: T Cells and B Cells 101

Why CD4+ Cells Are Important in HIV Infection-What It Means 104

The CD4+ Cell Count-Why It Matters 104

Antibodies and HIV Disease 109

Cellular MicroRNAs Contribute to HIV Latency in Resting Primary CD4+ T Cells 112

Immune System Dysfunction 113

Original Antigenic Sin 113

The Search for Additional Receptors (Coreceptors) to CD4: Fusin or CXCKR-4 (R-4) 116

CCKR-5 (R-5) Receptor 116

Emergence of HIV Strains That Vary in Their Lethal Abilities 117

In Search of Genetic Resistance to HIV Infection 119

T4 Cell Depletion and Immune Suppression 120

Impact of T4 Cell Depletion 121

Role of Monocytes and Macrophages in HIV Infection 122

Where Do T4 or CD4+ Cells Become HIV Infected? 123

Summary 126

Review Questions 127

6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS 128

What Is an Opportunistic Disease? 128

The Prevalence of Opportunistic Diseases 129

Opportunistic Infections in HIV-Infected People 130

TB: The Leading Cause of Death among HIV-Positive People Worldwide 141

Cancer or Malignancy in HIV/AIDS Patients 141

Disclaimer 146

Summary 147

Review Questions 147

7 A Profile of Biological Indicators for HIV Disease and Progression to AIDS 148

What Is Known and What Is Missing from Our Understanding of HIV/AIDS 148

HIV Disease Defined 149

Stages of HIV Disease (without Drug Therapy) 153

HIV Disease without Symptoms, with Symptoms, and AIDS 158

Production of HIV-Specific Antibodies 159

Prognostic Biological Markers Related to AIDS Progression 163

HIV Infection of the Central Nervous System (CNS) 166

Neuropathies (Nerve Tissue Damage) in HIV Disease/AIDS Patients 167

Pediatric Clinical Signs and Symptoms 168

Summary 168

Review Questions 168

8 Epidemiology and Transmission of the Human Immunodeficiency Virus 170

Epidemic/Epidemiology 171

We Must Stop HIV Transmission Now! 173

Epidemiology of HIV Infection 173

Transmission of Two Strains of HIV (HIV-1/HIV-2) 176

Is HIV Transmitted by Insects? 176

HIV Transmission 176

HIV Transmission in Family/Household Settings 177

Noncasual Transmission 177

Gay Men Putting Themselves at High Risk for HIV Infection 187

The Biological Factor 193

Injection-Drug Users and HIV Transmission 199

United States: Heterosexual Injection-Drug Use (IDU) 199

Injection-Drug Use and HIV Infections in Other Countries 202

Other Means of HIV Transmission 206

Influence of Sexually Transmitted Diseases (STDs) on HIV Transmission and Vice-Versa 207

Pediatric Transmission 214

Conclusion 215

National AIDS Resources <216/p>

Summary 216

Challenge Your Assumptions about the HIV Infected 217

Review Questions 217

9 Preventing the Transmission of HIV 219

The AIDS Generation: "I Knew Everything about It, and I Still Got It!" 220

Prevention, Not Treatment, Is the Least Expensive and Most Effective Way to Reduce the Spread of HIV/AIDS 221

Global Prevention 222

Antiretroviral Drugs Have an Impact on Prevention, But We Can't Treat Our Way Out of This Pandemic 223

Advancing HIV Prevention: New Strategies for a Changing Epidemic 228

Preventing the Transmission of HIV 229

Sexual Risk Taking Depends on Sexual Activity 232

New Rules to an Old Game: Promoting Safer Sex-Nobody Has a Body to Die For! 235

The Male Condom 238

The Female Condom or Femidom (Vaginal Pouch) 241

An Alternative to Condoms: Vaginal Microbicides (MI-CRO-BA-CIDES) and Circumcision 245

Update 2010-The CAPRISA 004 Study Results 246

Circumcision and the Prevention of HIV Trransmission 246

Injection-Drug Use (IDU) and HIV Transmission: The Twin Epidemics 247

HIV Prevention for Injection-Drug Users 248

Prevention of Blood and Blood Product HIV Transmission 251

Infection Control Procedures 252

Sexual Partner Notification: Disclosure 253

The U.S. Federal Government Has Now Adopted Partner Notification as Its Cornerstone in Its Effort to Help Control the Spread of HIV 254

The First Human Vaccine: The Impact of Vaccines on Infectious Diseases 258

HIV Vaccine Development and Its Role in Prevention 258

How These Two Neutralizing Antibodies Work 260

Types of Experimental HIV Vaccines 262

DNA Vaccine 264

Problems in the Search for HIV Vaccine 264

September 2009-News Broke That a Partially Effective HIV Vaccine Was Found! 265

Summary 266

Review Questions 268

10 Prevalence of HIV Infections, AIDS Cases, and Deaths among Select Groups in the United States and in Other Countries 269

A Word about HIV/AIDS Data 271

Year 2011 273

Formula for Estimating HIV Infections 276

Behavioral Risk Groups and Statistical Evaluation 277

September 18: Annual National HIV/AIDS Aging Awareness Day 290

Estimates of AIDS Cases and HIV Infection 291

Newly Infected 292

Shape of the HIV Pandemic: United States 293

Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States 298

Selected Nations/Countries Have Different Epidemics. Each Faces Its Own Reality 298

Canada's Estimated HIV/AIDS Cases through 2009: Population 33,310,000 300

Mexico's Estimated HIV/AIDS Cases through 2009: Population 110 Million 300

United Kingdom's (UK) Estimated HIV/AIDS Data through 2009: Population 61 Million 301

Global Prevalence and Impact of HIV/AIDS 304

Connected but Separate: Each Country a Different Reality, Different Countries Similar Questions, but Different Answers, Different Epidemics <304/p>

Workforce-South Africa: Some Examples 307

Education: Teachers and Students-South Africa and Some Countries in Southern Africa 307

Other HIV/AIDS Time Bombs in Asia: India, China, and Russia 308

Summary 312

Review Questions 313

11 Prevalence of HIV Infection and AIDS Cases among Women and Children 314

HIV/AIDS Is Defining the Lives of Millions of Women 315

Female Vulnerability to HIV 316

Every Day a Tragedy 316

Triple Jeopardy 316

Annual International Women's Day-March 8 316

Women: AIDS and HIV Infections Worldwide 317

Asia-Pacific Region, Over Five Million HIV Positive: 2010 318

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

Childbearing Women: Worldwide 331

Internet Resources 332

Pediatric HIV-Positive and AIDS Cases-United States: A Fight We Can Win! 333

Orphaned Children Due to HIV Infection and AIDS 334

The Phenomenon of AIDS Orphans 336

Summary 340

Review Questions 341

12 Prevalence of HIV Infection and AIDS among Young Adults, Ages 13 to 24 342

Global HIV Infections in Young Adults 342

Addressing the AIDS Pandemic among Young Adults 343

How Large Is the Young Adult Population in the United States? 345

HIV/AIDS Won't Affect Us! 347

Estimate of HIV-Infected and AIDS Cases among Young Adults in the United States, Globally 347

Summary 355

Internet 355/p>

Other Useful Sources 355

Review Questions 355

13 Testing for Human Immunodeficiency Virus 356

Determining the Presence of Antibody Produced When HIV Is Present 358

Requests for HIV Testing 358

Reasons for HIV Testing: I Know, I Took the Test 358

Laboratory Methods for Detecting HIV 360

ELISA HIV Antibody Test 361

Western Blot Assay 367

New ELISA Antibody Testing and Viral Load Procedures Reveal Early Versus Late HIV Infection 369

Rapid Result HIV Testing 372

FDA Approves Home HIV Antibody Test Kit 375

Some Screening and Confirmatory Antigen-Detection Tests for HIV 375

Deciding Who Should Get an HIV Test and When 376

Why Is HIV Test Information Necessary? 378

Immigration and Travel Ban into the United States Is Lifted 378

Testing, Privacy, Competency, and Informed Consent 380

Summary 387

Review Questions 387

14 AIDS and Society: Knowledge, Attitudes, and Behavior 389

HIV/AIDS Is a Story in Our Lifetime 390

The New Millennium and HIV/AIDS 391

HIV/AIDS Is an Unusual Social Disease 392

Discrimination vs. Compassion and Support 392

HIV/AIDS Is Here to Stay 392

AIDS Comes to the United States 393

Blame Someone, DŽjˆ Vu 393

Fear: Panic and Hysteria over the Spread of HIV/AIDS in the United States 394

Whom Is the General Public to Believe? 396

AIDS Education and Behavior: Dissipating Fear with Education 400

The Character of Society 409

Dealing with Discrimination: The Americans with Disabilities Act 411

Federal and Private Sector Financing: Creation of an AIDS Industry 413

U.S. Government Believes HIV/AIDS Is a Threat to National Security 414

Global HIV/AIDS Funding for Underdeveloped Nations 419

Forms of U.S. Monetary Assistance for HIV/AIDS 425

Summary 431

Review Questions 432

Answers to Review Questions 434

Glossary 442

References 453

Index 480