Wikipedia:WikiProject AIDS/Sample

AIDS (acquired immune deficiency syndrome, also written Aids) was defined by the Centers for Disease Control in 1993 ^[1] as beginning when a person with HIV infection has either a CD4 cell count below 200 or one of numerous opportunistic infections, which are unusual in a person with a healthy immune system.

There is no cure for AIDS. There is good evidence that if the levels of HIV remain suppressed and the CD4 cell count remains greater than 200, then life and quality of life can be significantly prolonged and improved.

Discovery

AIDS was first reported as a cluster of Pneumocystis pneumonia in five gay male drug users in Los Angeles in 1981 ^[2] and called GRID (Gay Related Immune Deficency). Similar opportunisitic infections were reported in men with haemophilia, intravenous heroin users, and men from Haiti.

In April 1984, U.S. Health and Human Services Secretary Margaret Heckler announced at a press conference that an American scientist, Dr. Robert Gallo, had discovered the probable cause of AIDS: the retrovirus subsequently named HIV (human immunodeficiency virus).

In October 1985, a conference of public health officials including representatives of the Centers for Disease Control and World Health Organisation met in Bangui and defined AIDS in Africa as, "prolonged fevers for a month or more, weight loss of over 10% and prolonged diarrhoea".

Based on the Bangui definition the WHO's cumulative number of AIDS cases from 1980 through 1997 for all of Africa was 620,000. source Table 79 on page 146 of The Impact of HIV/AIDS on the Health Sector: National Survey of Health Personnel, Ambulatory and Hospitalised Patients and Health Facilities 2002. For comparison, the cumulative total of AIDS cases in the USA through 1997 was 641,087.

Symptoms

The first symptoms of AIDS are opportunistic infections, that do not normally develop in a person with a healthy immune system. People who has been exposed to HIV are encouraged to have an HIV test, so that the health of their immune system can be monitored and antiretroviral medication offered before their CD4 cell count is less than 200.

The time from infection with HIV to a diagnosis of AIDS varies. Individuals who have been living with HIV for at least 7 to 12 years and have stable CD4+ T cell counts of 600 or more cells per cubic millimeter of blood, no HIV-related diseases, and no previous antiretroviral medication are called long-term nonprogressors.

HIV infection

The acronym HIV has been used since 1986 for human immunodeficiency virus, a retrovirus that was first proposed as the cause of AIDS by Luc Montagnier of France, who named it LAV (lymphadenopathy associated virus) and Robert Gallo of the United States, who named it HTLV-III (human T lymphotropic virus type III).

Transmission of HIV

HIV is transmitted through penetrative (anal or vaginal) and oral sex, blood transfusion, the sharing of contamenated needles in health care settings or drug injection, and between mother and infant during pregnancy, childbirth and breastfeeding. UNAIDS transmison

WHO estimated in 2000, between 15% and 20% of new HIV infections worldwide were the result of blood transfusions, where the donors were not screened or inadequately screened for HIV.

There is no evidence that HIV can be transmitted through hugging, shaking hands or other simple physical contact where there was no bleeding involved - including contact with carrier's sweat. There is no evidence that HIV can be spread through vectors such as mosquitoes.

Treatment of HIV infection

HIV is a chronic medical condition that can be treated, but not yet cured. There are effective means of preventing complications and delaying, but not preventing, progression to Aids.

People with HIV infection need to receive education about the disease and treatment so that they can be active partners in decision making with their health care provider.

Treatment guidelines are changing constantly.

First came "hit hard, hit early", then came a more conservative approach with a starting point somewhere between 350 and 500 CD4+ T cells/mm3. The latest guidelines use 200 to 350 cells/mm3 as the range to consider starting HAART. The current guidelines have the most data to support them, still these are mostly retrospective studies and there are some studies that contradict them Brian Boyle, MD July 2002

Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance because of nonadherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions are critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. Panel on Clinical Practices for Treatment of HIV. September 2002

The 2004 guidelines from the World Health Organization and U.S. Department of Health and Human Services defer antiretroviral medications for a person with no symptoms who has a CD4 count above 350 and viral load under 100,000. ^[3]

The current guidelines for antiretroviral therapy from the World Health Organization reflect the 2004 changes to the guidleines to defer retroviral treatment in patients with no symptoms who have a CD4 count above 350 and viral load under 100,000.

I ask those who urge me to take medications to wait at least until I have regained enough strength to enable me to stand the effort and the risk. Michel de Montaigne 1533-1592

Footnotes

These footnotes use automatic footnote numbering

1. ^ 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults Centers for Disease Control. Morbidity and Mortality Weekly Report, Recommendations and Reports, December 18, 1992. See also analysis of this expanded definiton
2. ^ Centers for Disease Control. 1981. Pneumocystis pneumonia- Los Angeles. MMWR 30 (21):250­252.