HIV AIDS natural history, complications, and prognosis: Difference between revisions

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__NOTOC__
{{AIDS}}
{{AIDS}}


{{CMG}}
{{CMG}}; {{AE}} {{Ammu}} ; {{AL}}


==Overview==
==Overview==
'''Acquired immune deficiency syndrome  ''' ('''AIDS''') is a [[syndrome|collection of symptoms and infections]] resulting from the specific damage to the [[immune system]] caused by the [[HIV|human immunodeficiency virus]] (HIV) in humans,<ref>{{cite web
There is currently no cure for HIV/[[AIDS]].  HIV infection leads to progressive decline in CD4+ T-lymphocyte count increasing the risk for opportunistic infections and malignancies. Despite having a variable rate of progression determined by specific host and viral factors, the median time from infection to the development of AIDS ranges from 8 to 10 years among untreated individuals.<ref name="pmid11144640">{{cite journal| author=Vergis EN, Mellors JW| title=Natural history of HIV-1 infection. | journal=Infect Dis Clin North Am | year= 2000 | volume= 14 | issue= 4 | pages= 809-25, v-vi | pmid=11144640 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11144640  }} </ref> With the advent of highly active antiretroviral therapy (HAART), both morbidity and mortality have dramatically decreased. Survival and the rate of CD4-count recovery is influenced by age, baseline CD4 cell count, baseline viral load and initial and sustained viral suppression.<ref name="aust">{{cite journal| author=Giles M, Workman C| title=Clinical manifestations and the natural history of HIV | journal=Australian Society for HIV Management | year= 2009 | pages= 125-32 | isbn=9781920773571 | url=http://www.ashm.org.au/images/Publications/Monographs/HIV_Management_Australasia/HIV-Management-Australia-2009.pdf  }} </ref>  In areas where HAART is widely available, the development of [[HAART]] as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to near normal (assuming full compliance to HAART).<ref>{{cite journal |journal= Int J Dermatol |date=2007 |volume=46 |issue=12 |pages=1219–28 |title= Current status of HIV infection: a review for non-HIV-treating physicians |author= Knoll B, Lassmann B, Temesgen Z |pmid=18173512 |doi=10.1111/j.1365-4632.2007.03520.x |pmid=18173512}}</ref> HIV infection makes individuals highly susceptible to severe opportunistic infections and neoplastic disease. Major complications of HIV/AIDS include ''[[Pneumocystis jirovecii]]'' pneumonia, disseminated [[Mycobacterium avium complex]] infection, [[Cryptococcus|cryptococcal meningitis]], [[cytomegalovirus]] retinitis, [[Kaposi sarcoma]], and [[primary CNS lymphoma]].
|url=http://www.niaid.nih.gov/Publications/hivaids/hivaids.htm
|title=The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome |publisher= NIAID
|accessdate=2008-03-10}}</ref> and similar viruses in other species ([[Simian immunodeficiency virus|SIV]], [[Feline immunodeficiency virus|FIV]], etc.)


==Prognosis==
==Natural History==
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.<ref>{{cite paper |title= Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis |author= Zwahlen M, Egger M |url=http://data.unaids.org/pub/Periodical/2006/zwahlen_unaids_hq_05_422204_2007_en.pdf |format=PDF |date=2006 |accessdate=2008-03-19 |version= UNAIDS Obligation HQ/05/422204}}</ref> In areas where it is widely available, the development of [[HAART]] as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to about 20 years.<ref>{{cite journal |journal= Int J Dermatol |date=2007 |volume=46 |issue=12 |pages=1219–28 |title= Current status of HIV infection: a review for non-HIV-treating physicians |author= Knoll B, Lassmann B, Temesgen Z |pmid=18173512 |doi=10.1111/j.1365-4632.2007.03520.x |pmid=18173512}}</ref>
In the early days of the HIV epidemic, knowledge about the natural history of HIV accrued rapidly. However, the widespread use of effective antiretroviral therapy (ART) brought a shift in focus of the research community away from studies of natural history to those of treated infection.<ref name="pmid23698562">{{cite journal| author=Sabin CA, Lundgren JD| title=The natural history of HIV infection. | journal=Curr Opin HIV AIDS | year= 2013 | volume= 8 | issue= 4 | pages= 311-7 | pmid=23698562 | doi=10.1097/COH.0b013e328361fa66 | pmc=PMC4196796 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23698562  }} </ref> HIV infection leads to progressive decline in CD4+ T-lymphocyte count increasing the risk for opportunistic infections and malignancies. Despite having a variable rate of progression determined by specific host and viral factors, the median time from infection to the development of AIDS ranges from 8 to 10 years among untreated individuals.<ref name="pmid11144640">{{cite journal| author=Vergis EN, Mellors JW| title=Natural history of HIV-1 infection. | journal=Infect Dis Clin North Am | year= 2000 | volume= 14 | issue= 4 | pages= 809-25, v-vi | pmid=11144640 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11144640  }} </ref> With the advent of highly active antiretroviral therapy (HAART), both morbidity and mortality have dramatically decreased. Survival and the rate of CD4-count recovery is influenced by age, baseline CD4 cell count, baseline viral load and initial and sustained viral suppression.<ref name="aust">{{cite journal| author=Giles M, Workman C| title=Clinical manifestations and the natural history of HIV | journal=Australian Society for HIV Management | year= 2009 | pages= 125-32 | isbn=9781920773571 | url=http://www.ashm.org.au/images/Publications/Monographs/HIV_Management_Australasia/HIV-Management-Australia-2009.pdf  }} </ref>  


===Economic impact===
===Disease Progression===
[[Image:Life expectancy in some Southern African countries 1958 to 2003.jpg|left|295px|thumb|Changes in life expectancy in some hard-hit African countries.
[[File:HIV_natural_history.png|thumb|700px|center|Natural history of untreated HIV - By Sigve - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=15383502]]
{{legend-line|red solid 2px|Botswana}}{{legend-line|darkgreen solid 2px|Zimbabwe}}{{legend-line|blue solid 2px|Kenya}}{{legend-line|black solid 2px|South Africa}}{{legend-line|grey solid 2px|Uganda}}]]
====Acute HIV syndrome====
Approximately half of patients that acquire HIV develop a mononucleosis-like syndrome within 3-6 weeks during which the viral titers are very elevated. Common symptoms include [[acute]] but brief and nonspecific [[influenza]]-like [[retroviral syndrome]] that can include [[fever]], [[malaise]], [[lymphadenopathy]], [[pharyngitis]], [[arthritis]], or [[skin rash]].<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref> This causes a rapid drop in CD4 T-Cell count as these cells are the primary host for viral replication. Within several weeks patients mount a strong immune response to the virus that causes a drop in the viral titers. However, this response is not adequate to completely suppress viral replication. Although viremia may become undetectable, replication persists in the lymphoid organs. Although a significant number of patients do not have an acute HIV syndrome, these processes do occur albeit without symptoms.<ref name="pmid8093551">{{cite journal| author=Pantaleo G, Graziosi C, Fauci AS| title=New concepts in the immunopathogenesis of human immunodeficiency virus infection. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 5 | pages= 327-35 | pmid=8093551 | doi=10.1056/NEJM199302043280508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8093551  }} </ref>


HIV and AIDS retard economic growth by destroying human capital.<ref name=Bell-et-al-2003/>
====Clinical Latency====
Without proper [[nutrition]], health care and medicine that is available in developed countries, large numbers of people are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.<ref name=Greener>{{cite book
This period is sometimes called asymptomatic HIV infection or chronic HIV infection. After the initial phase, the majority of patients with HIV develop a clinical latency period that lasts several years. During this period, all patients have a progressive decline in immune status and gradual depletion of CD4 T-cells. This period does not represent a true microbiological or pathological latency, but rather defines a time period without clinically manifest disease. People who are on highly active antiretroviral therapy (HAART) may live with clinical latency for several decades.<ref name="pmid8093551">{{cite journal| author=Pantaleo G, Graziosi C, Fauci AS| title=New concepts in the immunopathogenesis of human immunodeficiency virus infection. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 5 | pages= 327-35 | pmid=8093551 | doi=10.1056/NEJM199302043280508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8093551 }} </ref>
| author =Greener R
| year = 2002
| title = State of The Art: AIDS and Economics
| chapter = AIDS and macroeconomic impact
| editor = S, Forsyth (ed.)
| pages = 49&ndash;55
| publisher = IAEN
  }}</ref>


The increased mortality in this region will result in a smaller skilled population and labor force.<ref name=Greener /> This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.<ref name=Greener /> By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.<ref name=Greener />
====Clinically Apparent Disease (AIDS)====
The eventual outcome of most HIV infections is gradual immune system deterioration resulting in AIDS. Clinically apparent disease is classically diagnosed following an AIDS-defining illness i.e. an opportunistic infection or neoplasm that demonstrates a significant compromise of the immune system. Another diagnostic sign, although not strictly clinical, is the decline of CD4 T-cell count below 200 cells/mm<sup>3</sup>. Without treatment, individuals diagnosed with AIDS may survive approximately 1-3 years.<ref name="pmid8093551">{{cite journal| author=Pantaleo G, Graziosi C, Fauci AS| title=New concepts in the immunopathogenesis of human immunodeficiency virus infection. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 5 | pages= 327-35 | pmid=8093551 | doi=10.1056/NEJM199302043280508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8093551  }} </ref>


On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.<ref name=WBank>{{
===Distinct Patterns of Progression===
''The natural course of untreated HIV infection varies widely. The past decade has seen considerable interest in the identification of subgroups of HIV-positive persons who exhibit distinct patterns of disease progression:''<ref name="pmid23698562">{{cite journal| author=Sabin CA, Lundgren JD| title=The natural history of HIV infection. | journal=Curr Opin HIV AIDS | year= 2013 | volume= 8 | issue= 4 | pages= 311-7 | pmid=23698562 | doi=10.1097/COH.0b013e328361fa66 | pmc=PMC4196796 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23698562  }} </ref>


  cite journal |
*'''Long-term nonprogressors (LTNP)''' are individuals who remain asymptomatic for a prolonged period of time off ART with a high CD4 cell count. Although it is widely reported that 1–5% of the HIV-positive population are LTNP, these estimates are complicated by the fact that there is no standardized definition of a LTNP, and thus definitions used (and the way in which they are applied, particularly in the presence of varying follow-up and irregularly measured CD4 cell counts) differ widely. LTNP status can be lost, and thus the reported prevalence of LTNP within a study will depend on the required period of follow-up. Predictors of loss of LTNP status are a high baseline HIV DNA level and a more rapid increase in HIV DNA over the first year of follow-up, suggesting the presence of ongoing (but low-grade) viral replication. Indeed, HIV RNA levels in plasma increased by 0.04 log10 copies/ml per year over the first 8 years after diagnosis. As such, it is likely that virtually all HIV-positive persons will eventually experience disease progression if left untreated.<ref name="pmid23698562">{{cite journal| author=Sabin CA, Lundgren JD| title=The natural history of HIV infection. | journal=Curr Opin HIV AIDS | year= 2013 | volume= 8 | issue= 4 | pages= 311-7 | pmid=23698562 | doi=10.1097/COH.0b013e328361fa66 | pmc=PMC4196796 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23698562  }} </ref>
author=Over M |
title=The macroeconomic impact of AIDS in Sub-Saharan Africa, Population and Human Resources Department |
journal=The World Bank | year=1992


}}</ref>
*'''Elite controllers''' or '''viral controllers''' are individuals who are able to suppress HIV replication to such an extent that viral load levels remain undetectable in the absence of ART. As with LTNP, several studies have attempted to identify factors associated with elite controller status. Loss of naive CD4 T cells seems to be a universal feature of elite controllers, despite the ability of such individuals to maintain undetectable viral loads. However, CD4 naive lymphocytes from elite controllers tend to be less susceptible to HIV infection than such lymphocytes from progressors or uninfected individuals. This specific feature was linked with upregulation of a cellular kinase (p21). HIV-specific CD4 activation is a hallmark of viral control but, many other host factors have been linked with this phenotype, including cellular restriction factors such as APOBEC, tetherin, and SAMHD1. In addition, several viral factors may also play a role, including deletions or mutations with the viral genes that may have an impact on the ability of the virus to replicate. <ref name="pmid23698562">{{cite journal| author=Sabin CA, Lundgren JD| title=The natural history of HIV infection. | journal=Curr Opin HIV AIDS | year= 2013 | volume= 8 | issue= 4 | pages= 311-7 | pmid=23698562 | doi=10.1097/COH.0b013e328361fa66 | pmc=PMC4196796 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23698562  }} </ref>


UNAIDS, WHO and the United Nations Development Programme have documented a correlation between the decreasing life expectancies and the lowering of gross national product in many African countries with prevalence rates of 10% or more. Indeed, since 1992 predictions that AIDS would slow economic growth in these countries have been published. The degree of impact depended on assumptions about the extent to which illness would be funded by savings and who would be infected.<ref name=WBank /> Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990&ndash;2025 were that the economic growth rates of these countries would be between 0.56 and 1.47% lower. The impact on gross domestic product (GDP) per capita was less conclusive. However, in 2000, the rate of growth of Africa's per capita GDP was in fact reduced by 0.7% per year from 1990&ndash;1997 with a further 0.3% per year lower in countries also affected by [[malaria]].<ref name=Bonnel>{{
==Complications==
HIV infection makes individuals highly susceptible to severe opportunistic infections and neoplastic disease. The following complications are classically observed among patients with significant immunocompromise and rarely manifest among patients with a CD4 count greater than 350 cells/mm<sup>3</sup>.
===1. Infections===
* ''[[Pneumocystis jirovecii]]'' pneumonia
* [[Tuberculosis]]
* Disseminated [[Mycobacterium avium complex]]
* [[Salmonellosis]] (Septicemia)
* [[Cytomegalovirus]] retinitis
* [[Candidiasis]]
* [[Cryptococcus|Cryptococcal meningitis]]
* Cerebral [[Toxoplasmosis]]
* Cryptococcal meningitis
* Disseminated [[Coccidiomycosis]]
* Disseminated [[Histoplasmosis]]
* [[Cryptosporidiosis]]
* Isosporiasis


cite journal |
===2. Cancers===
author=Bonnel R |
* [[Kaposi Sarcoma]]
title=HIV/AIDS and Economic Growth: A Global Perspective |
* [[AIDS-related lymphoma]]s
journal=S. A. J. Economics | year=2000 | pages=820&ndash;855 | volume=68 | issue=5 |
:*[[Non-Hodgkin's Lymphoma]]
:*[[Hodgkin's Lymphoma]]
:*[[Primary CNS Lymphoma]]
:*Burkitt's Lymphoma
:*Large B-cell Lymphoma
* Invasive [[cervical cancer]]
* Invasive [[anal cancer]]


}}</ref> The forecast now is that the growth of GDP for these countries will undergo a further reduction of between 0.5 and 2.6% per annum.<ref name=Greener /> However, these estimates may be an underestimate, as they do not look at the effects on output per capita.<ref name=Bell-et-al-2003>{{
===3. Other Complications===


cite paper
* [[HIV associated nephropathy]]
|author= Bell C, Devarajan S, Gersbach H |date=2003
* [[HIV induced pericarditis]]
|url=http://ssrn.com/abstract=636571
* HIV-associated wasting syndrome
| title=The long-run economic costs of AIDS: theory and an application to South Africa
* [[Aortitis]]
|accessdate= 2008-03-12
* [[AIDS dementia complex]]
|version= World Bank Policy Research Working Paper No. 3152
* Lymphoid interstitial pneumonia


}}</ref>
==Prognosis==
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.<ref>{{cite paper |title= Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis |author= Zwahlen M, Egger M |url=http://data.unaids.org/pub/Periodical/2006/zwahlen_unaids_hq_05_422204_2007_en.pdf |format=PDF |date=2006 |accessdate=2008-03-19 |version= UNAIDS Obligation HQ/05/422204}}</ref> In areas where it is widely available, the development of [[HAART]] as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to near normal (assuming full compliance to HAART).<ref>{{cite journal |journal= Int J Dermatol |date=2007 |volume=46 |issue=12 |pages=1219–28 |title= Current status of HIV infection: a review for non-HIV-treating physicians |author= Knoll B, Lassmann B, Temesgen Z |pmid=18173512 |doi=10.1111/j.1365-4632.2007.03520.x |pmid=18173512}}</ref>


Many governments in sub-Saharan Africa denied that there was a problem for years, and are only now starting to work towards solutions. Underfunding is a problem in all areas of HIV prevention when compared to even conservative estimates of the problems.
==References==
 
{{reflist|2}}
Recent research by the Overseas Development Institute (ODI) has suggested that the private sector has begun to recognize the impact of HIV/AIDS on the bottom line, both directly and indirectly. It is estimated that a company can generate an average return of US$3 for every US$1 invested in employee health due to a reduced absenteeism, better productivity and reduction in employee turnover.<ref>{{cite journal
  | author = Goetzel RZ, Ozminkowski RJ, Baase CM, Billotti GM
  | title = Estimating the return-on-investment from changes in employee health risks on the Dow Chemical Company’s health care costs
  | journal = Journal of Occupational and Environmental Medicine
  | volume = 47
  | year = 2005
  | pages = 759-68
  | pmid = 16093925}}</ref> Indirectly there are also important implications on the supply chain. Many multi-national corporations (MNCs) have therefore gotten involved in HIV/AIDS initiatives of three main types: a community-based partnerships, supply chain support, and sector-based initiatives.<ref name="odi">{{cite web |url=http://www.odi.org.uk/publications/briefing/bp_hiv_privatesector_nov07.pdf |format=PDF|title= AIDS and the private sector: The case of South Africa |accessyear=2007 |year=2007 |publisher=Overseas Development Institute}}</ref>
 
The launching of the world's first official HIV/AIDS Toolkit in Zimbabwe on October 3 2006 is a product of collaborative work between the International Federation of Red Cross and Red Crescent Societies, World Health Organization and the Southern Africa HIV/AIDS Information Dissemination Service. It is for the strengthening of people living with HIV/AIDS and nurses by minimal external support. The package, which is in form of eight modules focusing on basic facts about HIV and AIDS, was pre-tested in Zimbabwe in March 2006 to determine its adaptability. It disposes, among other things, categorized guidelines on clinical management, education and counseling of AIDS victims at community level.<ref name=xinhua>{{


cite web
[[Category:HIV/AIDS]]
| author=Mu Xuequan | publisher=xinhua | year= 2006
[[Category:Disease]]
| url=http://news.xinhuanet.com/english/2006-10/04/content_5167991.htm
[[Category:Immune system disorders]]
| title=Zimbabwe launches world's first AIDS training package
| accessdate = 2006-10-03


}}</ref>
[[category:viral diseases]]
 
[[Category:Pandemics]]
The Copenhagen Consensus is a project that seeks to establish priorities for advancing global welfare using methodologies based on the theory of welfare economics. The participants are all economists, with the focus of the project being a rational prioritization based on economic analysis. The project is based on the contention that, in spite of the billions of dollars spent on global challenges by the United Nations, the governments of wealthy nations, foundations, charities, and non-governmental organizations, the money spent on problems such as malnutrition and climate change is not sufficient to meet many internationally-agreed targets. The highest priority was assigned to implementing new measures to prevent the spread of HIV and AIDS. The economists estimated that an investment of $27&nbsp;billion could avert nearly 30&nbsp;million new infections by 2010.<ref name=Kaiserfunds>{{
[[Category:Sexually transmitted infections]]
 
[[Category:Syndromes]]
cite web
[[Category:Virology]]
| publisher=kaisernetwork.org | year= 2002
[[Category:AIDS origin hypotheses]]
| url=http://kaisernetwork.org/aids2002/syndication.asp?show=daily_report_1.html
[[Category:Medical disasters]]
| title=$27 Billion Boost for HIV Prevention Programs Could Avert Majority of Projected HIV Infections Worldwide
[[Category:Acronyms]]
| accessdate = 2008-03-10
[[Category:Immunodeficiency]]
 
[[Category:Microbiology]]
}}</ref>
{{WH}}
 
{{WS}}
===Stigma===
[[Image:Saigon AIDS Sign.jpg|thumb|250px|left|AIDS Awareness Sign. Ho Chi Minh City, Vietnam (August 2005).]]
AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior [[consent]] or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the [[quarantine]] of HIV infected individuals.<ref name=UNAIDS2006Ch4>{{
 
cite book
| publisher =[[Joint United Nations Programme on HIV/AIDS|UNAIDS]]
| year = 2006
| title = 2006 Report on the global AIDS epidemic
| chapter = The impact of AIDS on people and societies
| chapterurl = http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH04_en.pdf
| accessdate = 2006-06-14
| format= PDF
 
}}</ref> Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.<ref name=Ogden>{{
 
cite web
| author =Ogden J, Nyblade L
| publisher = [[International Center for Research on Women]] | year = 2005 | title = Common at its core: HIV-related stigma across contexts | url = http://www.icrw.org/docs/2005_report_stigma_synthesis.pdf | format = PDF | accessdate = 2007-02-15
 
}}</ref>
 
AIDS stigma has been further divided into the following three categories:
 
# Instrumental AIDS stigma&mdash;a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.<ref name=Herek1999>{{
 
cite journal
| author=Herek GM, Capitanio JP | journal=American Behavioral Scientist | year=1999
| url=http://psychology.ucdavis.edu/rainbow/html/abs99_sp.pdf
| format= PDF
| title=AIDS Stigma and sexual prejudice
| accessdate = 2006-03-27
| volume=42
| issue=7
| pages=1130-1147
| doi=10.1177/0002764299042007006
 
}}</ref>
# Symbolic AIDS stigma&mdash;the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.<ref name=Herek1999 />
# Courtesy AIDS stigma&mdash;stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.<ref name=Snyder>{{
 
cite journal |
author=Snyder M, Omoto AM, Crain AL |
title=Punished for their good deeds: stigmatization for AIDS volunteers |
journal=American Behavioral Scientist | year=1999 | pages=1175&ndash;1192 | volume=42 | issue=7 | doi=10.1177/0002764299042007009
 
}}</ref>
 
Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with [[homosexuality]], bisexuality, promiscuity, and [[Intravenous drug use (recreational)|intravenous drug use]].
 
In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.<ref name=Herek2002>{{cite journal
|author=Herek GM, Capitanio JP, Widaman KF
|title=HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999
|journal=Am J Public Health
|volume=92
|issue=3
|pages=371–7
|year=2002
|pmid=11867313
|doi=
|url=http://psychology.ucdavis.edu/rainbow/html/ajph2002.pdf
|accessdate=2008-03-10
}}</ref> There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.<ref name=Herek1999/>
==Complications==
HIV infection weakens patients immune system, making them highly susceptible to variety of infections and certain types of cancers.
===Infections common to HIV/AIDS===
* [[Tuberculosis]] (TB).
* [[Salmonellosis]].
* [[Cytomegalovirus]] (CMV).
* [[Candidiasis]].
* [[Cryptococcus|Cryptococcal meningitis]].
* [[Toxoplasmosis]].
* [[Cryptosporidiosis]].
 
===Cancers common to HIV/AIDS===
* [[Kaposi's sarcoma]].
'''AIDS-associated Kaposi sarcoma''' presents with cutaneous [[lesion]]s that begin as one or several red to purple-red [[macule]]s, rapidly progressing to [[papule]]s, [[Nodule_(dermatology)|nodule]]s, and [[plaque_(dermatology)|plaque]]s, with a predilection for the head, neck, trunk, and [[mucous membrane]]s.<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref>
* [[Lymphomas]].
 
===Other complications===
 
==See Also==
* [[AIDS-related lymphoma]]
==References==
{{reflist|2}}

Latest revision as of 22:30, 20 September 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] ; Alejandro Lemor, M.D. [3]

Overview

There is currently no cure for HIV/AIDS. HIV infection leads to progressive decline in CD4+ T-lymphocyte count increasing the risk for opportunistic infections and malignancies. Despite having a variable rate of progression determined by specific host and viral factors, the median time from infection to the development of AIDS ranges from 8 to 10 years among untreated individuals.[1] With the advent of highly active antiretroviral therapy (HAART), both morbidity and mortality have dramatically decreased. Survival and the rate of CD4-count recovery is influenced by age, baseline CD4 cell count, baseline viral load and initial and sustained viral suppression.[2] In areas where HAART is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to near normal (assuming full compliance to HAART).[3] HIV infection makes individuals highly susceptible to severe opportunistic infections and neoplastic disease. Major complications of HIV/AIDS include Pneumocystis jirovecii pneumonia, disseminated Mycobacterium avium complex infection, cryptococcal meningitis, cytomegalovirus retinitis, Kaposi sarcoma, and primary CNS lymphoma.

Natural History

In the early days of the HIV epidemic, knowledge about the natural history of HIV accrued rapidly. However, the widespread use of effective antiretroviral therapy (ART) brought a shift in focus of the research community away from studies of natural history to those of treated infection.[4] HIV infection leads to progressive decline in CD4+ T-lymphocyte count increasing the risk for opportunistic infections and malignancies. Despite having a variable rate of progression determined by specific host and viral factors, the median time from infection to the development of AIDS ranges from 8 to 10 years among untreated individuals.[1] With the advent of highly active antiretroviral therapy (HAART), both morbidity and mortality have dramatically decreased. Survival and the rate of CD4-count recovery is influenced by age, baseline CD4 cell count, baseline viral load and initial and sustained viral suppression.[2]

Disease Progression

Natural history of untreated HIV - By Sigve - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=15383502

Acute HIV syndrome

Approximately half of patients that acquire HIV develop a mononucleosis-like syndrome within 3-6 weeks during which the viral titers are very elevated. Common symptoms include acute but brief and nonspecific influenza-like retroviral syndrome that can include fever, malaise, lymphadenopathy, pharyngitis, arthritis, or skin rash.[5] This causes a rapid drop in CD4 T-Cell count as these cells are the primary host for viral replication. Within several weeks patients mount a strong immune response to the virus that causes a drop in the viral titers. However, this response is not adequate to completely suppress viral replication. Although viremia may become undetectable, replication persists in the lymphoid organs. Although a significant number of patients do not have an acute HIV syndrome, these processes do occur albeit without symptoms.[6]

Clinical Latency

This period is sometimes called asymptomatic HIV infection or chronic HIV infection. After the initial phase, the majority of patients with HIV develop a clinical latency period that lasts several years. During this period, all patients have a progressive decline in immune status and gradual depletion of CD4 T-cells. This period does not represent a true microbiological or pathological latency, but rather defines a time period without clinically manifest disease. People who are on highly active antiretroviral therapy (HAART) may live with clinical latency for several decades.[6]

Clinically Apparent Disease (AIDS)

The eventual outcome of most HIV infections is gradual immune system deterioration resulting in AIDS. Clinically apparent disease is classically diagnosed following an AIDS-defining illness i.e. an opportunistic infection or neoplasm that demonstrates a significant compromise of the immune system. Another diagnostic sign, although not strictly clinical, is the decline of CD4 T-cell count below 200 cells/mm3. Without treatment, individuals diagnosed with AIDS may survive approximately 1-3 years.[6]

Distinct Patterns of Progression

The natural course of untreated HIV infection varies widely. The past decade has seen considerable interest in the identification of subgroups of HIV-positive persons who exhibit distinct patterns of disease progression:[4]

  • Long-term nonprogressors (LTNP) are individuals who remain asymptomatic for a prolonged period of time off ART with a high CD4 cell count. Although it is widely reported that 1–5% of the HIV-positive population are LTNP, these estimates are complicated by the fact that there is no standardized definition of a LTNP, and thus definitions used (and the way in which they are applied, particularly in the presence of varying follow-up and irregularly measured CD4 cell counts) differ widely. LTNP status can be lost, and thus the reported prevalence of LTNP within a study will depend on the required period of follow-up. Predictors of loss of LTNP status are a high baseline HIV DNA level and a more rapid increase in HIV DNA over the first year of follow-up, suggesting the presence of ongoing (but low-grade) viral replication. Indeed, HIV RNA levels in plasma increased by 0.04 log10 copies/ml per year over the first 8 years after diagnosis. As such, it is likely that virtually all HIV-positive persons will eventually experience disease progression if left untreated.[4]
  • Elite controllers or viral controllers are individuals who are able to suppress HIV replication to such an extent that viral load levels remain undetectable in the absence of ART. As with LTNP, several studies have attempted to identify factors associated with elite controller status. Loss of naive CD4 T cells seems to be a universal feature of elite controllers, despite the ability of such individuals to maintain undetectable viral loads. However, CD4 naive lymphocytes from elite controllers tend to be less susceptible to HIV infection than such lymphocytes from progressors or uninfected individuals. This specific feature was linked with upregulation of a cellular kinase (p21). HIV-specific CD4 activation is a hallmark of viral control but, many other host factors have been linked with this phenotype, including cellular restriction factors such as APOBEC, tetherin, and SAMHD1. In addition, several viral factors may also play a role, including deletions or mutations with the viral genes that may have an impact on the ability of the virus to replicate. [4]

Complications

HIV infection makes individuals highly susceptible to severe opportunistic infections and neoplastic disease. The following complications are classically observed among patients with significant immunocompromise and rarely manifest among patients with a CD4 count greater than 350 cells/mm3.

1. Infections

2. Cancers

3. Other Complications

Prognosis

Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.[7] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to near normal (assuming full compliance to HAART).[8]

References

  1. ↑ 1.0 1.1 Vergis EN, Mellors JW (2000). "Natural history of HIV-1 infection". Infect Dis Clin North Am. 14 (4): 809–25, v–vi. PMID 11144640.
  2. ↑ 2.0 2.1 Giles M, Workman C (2009). "Clinical manifestations and the natural history of HIV" (PDF). Australian Society for HIV Management: 125–32. ISBN 9781920773571.
  3. ↑ Knoll B, Lassmann B, Temesgen Z (2007). "Current status of HIV infection: a review for non-HIV-treating physicians". Int J Dermatol. 46 (12): 1219–28. doi:10.1111/j.1365-4632.2007.03520.x. PMID 18173512.
  4. ↑ 4.0 4.1 4.2 4.3 Sabin CA, Lundgren JD (2013). "The natural history of HIV infection". Curr Opin HIV AIDS. 8 (4): 311–7. doi:10.1097/COH.0b013e328361fa66. PMC 4196796. PMID 23698562.
  5. ↑ Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 Pantaleo G, Graziosi C, Fauci AS (1993). "New concepts in the immunopathogenesis of human immunodeficiency virus infection". N Engl J Med. 328 (5): 327–35. doi:10.1056/NEJM199302043280508. PMID 8093551.
  7. ↑ Template:Cite paper
  8. ↑ Knoll B, Lassmann B, Temesgen Z (2007). "Current status of HIV infection: a review for non-HIV-treating physicians". Int J Dermatol. 46 (12): 1219–28. doi:10.1111/j.1365-4632.2007.03520.x. PMID 18173512.

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