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{{AIDS}}
__NOTOC__
{{AIDS}}{{About1|Human Immunodeficiency Virus (HIV)}}
'''For patient information, click [[AIDS Patient Information|here]]'''


{{Infobox_Disease |
{{CMG}} "{{cv}}"; {{AE}} {{AL}}, {{Ammu}}, {{JH}}, {{TarekNafee}}, {{Marjan}}, {{Mohamed riad}}
Name = Acquired immunodeficiency syndrome (AIDS) |
Image = Red_Ribbon.svg |
Caption = The Red ribbon is a symbol for solidarity with HIV-positive people and those living with AIDS. |
Width = 200 |
DiseasesDB = 5938 |
ICD10 = {{ICD10|B|24||b|20}} |
ICD9 = {{ICD9|042}} |
ICDO = |
OMIM = |
MedlinePlus =|
MeshID =|
}}
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'''STI/STD''': [[Sexually transmitted infection]]/disease
'''STI/STD''': [[Sexually transmitted infection]]/disease
|}
|}
{{SK}} Acquired immunodeficiency syndrome; acquired immune deficiency syndrome
==[[AIDS overview|Overview]]==


'''For AIDS Patient Information click [[AIDS Patient Information|here]]'''
==[[AIDS historical perspective|Historical Perspective]]==
 
{{CMG}}
 
==[[AIDS overview|Overview]]==
==[[AIDS historical perspective|Historical perspective]]==


==[[AIDS epidemiology and demographics|Epidemiology & Demographics]]==
==[[AIDS classification|Classification]]==


==[[AIDS pathophysiology|Pathophysiology]]==
==[[AIDS pathophysiology|Pathophysiology]]==


==[[AIDS history and symptoms|History and Symptoms]]==
==[[AIDS causes|Causes]]==
 
[[Human Immunodeficiency Virus]]
==Cause==
{{details|HIV}}
[[Image:HIV-budding.jpg|right|thumbnail|300px|[[Scanning electron microscope|Scanning electron micrograph]] of HIV-1 budding from cultured [[lymphocyte]].]]
 
AIDS is the most severe acceleration of [[infection]] with HIV. HIV is a [[retrovirus]] that primarily infects vital organs of the human [[immune system]] such as [[T helper cell|CD4<SUP>+</SUP> T cells]] (a subset of [[T cell]]s), [[macrophage]]s and [[dendritic cell]]s. It directly and indirectly destroys CD4<SUP>+</SUP> T cells.<ref name=Alimonti>{{
 
cite journal
| author=Alimonti JB, Ball TB, Fowke KR
| title=Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS.
| journal=J. Gen. Virol. | year=2003 | pages=1649&ndash;1661 | volume=84 | issue=7 | pmid=12810858 | doi=10.1099/vir.0.19110-0
 
}}</ref> CD4<SUP>+</SUP> T cells are required for the proper functioning of the immune system. When HIV kills CD4<SUP>+</SUP> T cells so that there are fewer than 200 CD4<SUP>+</SUP> T cells per [[microliter]] (µL) of [[blood]], [[cellular immunity]] is lost. In some countries, such as the United States, this leads to a diagnosis of AIDS. In other jurisdictions, such as in Canada, AIDS is only diagnosed when a person infected with HIV is diagnosed with one or more of several AIDS-related opportunistic infections or cancers.<ref>[http://www.phac-aspc.gc.ca/publicat/haest-tesvs/a_e.html#AIDS_DIAGNOSIS Public Health Agency of Canada] (Note that this source is mistaken in its assertion that the U.S. definition of AIDS requires a CD4 count of <200.)</ref><ref>McGovern, Theresa and Smith, Raymond (1998). [http://www.thebody.com/content/art14002.html AIDS, Case Definition of.] TheBody.com.  Retrieved on 2008-03-10.</ref><ref>[http://www.aegis.com/topics/definition.html AEGIS]</ref> [[Acute (medicine)|Acute]] HIV infection progresses over time to clinical latent HIV infection and then to early [[symptomatic]] HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4<SUP>+</SUP> T cells in the blood, and/or the presence of certain infections, as noted above.
 
In the absence of [[Antiretroviral drug|antiretroviral therapy]], the median [[HIV Disease Progression Rates|time of progression from HIV infection to AIDS]] is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.<ref name=Morgan2>{{
 
cite journal
| author=Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R,  Whitworth JA
| title=HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?
| journal=AIDS | year=2002 | pages=597&ndash;632 | volume=16 | issue=4 | pmid=11873003
 
}}</ref> However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20&nbsp;years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.<ref name=Clerici>{{
 
cite journal
| author=Clerici M, Balotta C, Meroni L, et al | title=Type 1 cytokine production and low prevalence of viral isolation correlate with long-term non progression in HIV infection
| journal=AIDS Res. Hum. Retroviruses. | year=1996 | pages=1053&ndash;1061 | volume=12 | issue=11
| pmid=8827221
 
}}</ref><ref name=Morgan>{{
 
cite journal
| author=Morgan D, Mahe C, Mayanja B, Whitworth JA
| title=Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study
| journal=BMJ | year=2002 | pages=193&ndash;196 | volume=324 | issue=7331
| pmid=11809639 | doi=10.1136/bmj.324.7331.193
 
}}</ref> Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to [[health care]] and the existence of coexisting infections such as [[tuberculosis]] also may predispose people to faster disease progression.<ref name=Morgan2 /><ref name=Gendelman>{{
 
cite journal
| author=Gendelman HE, Phelps W, Feigenbaum L, et al | title=Transactivation of the human immunodeficiency virus long terminal repeat sequences by DNA viruses
| journal=Proc. Natl. Acad. Sci. U. S. A. | year=1986 | pages=9759&ndash;9763 | volume=83 | issue=24
| pmid=2432602
 
}}</ref><ref name=Bentwich>{{
 
cite journal
| author=Bentwich Z, Kalinkovich, A, Weisman Z
| title=Immune activation is a dominant factor in the pathogenesis of African AIDS.
| journal=Immunol. Today | year=1995 | pages=187&ndash;191 | volume=16 | issue=4
| pmid=7734046
 
}}</ref> The infected person's [[genetics|genetic inheritance]] plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the [[homozygous]] [[CCR5-Δ32]] variation are resistant to infection with certain [[strain (biology)|strains]] of HIV.<ref name=Tang>{{
 
cite journal
| author=Tang J, Kaslow RA
| title=The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy
| journal=AIDS | year=2003 | pages=S51&ndash;S60 | volume=17 | issue=Suppl 4
| pmid=15080180
 
}}</ref> HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.<ref name=Quinones>{{
 
cite journal
| author=Quiñones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E
| title=LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression
| journal=Virus Research | year=1998 | pages=11&ndash;20 | volume=57 | issue=1
| pmid=9833881
 
}}</ref><ref name=Campbell>{{
 
cite journal
| author=Campbell GR, Pasquier E, Watkins J, et al | title=The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis
| journal=J. Biol. Chem. | year=2004 | pages=48197&ndash;48204 | volume=279 | issue=46
| pmid=15331610 | doi=10.1074/jbc.M406195200
 
}}</ref><ref name=Kaleebu>{{
 
cite journal
| author=Kaleebu P, French N, Mahe C, et al | title=Effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression in a large cohort of HIV-1-positive persons in Uganda | journal=J. Infect. Dis. | year=2002 | pages=1244&ndash;1250 | volume=185 | issue=9
| pmid=12001041
 
}}</ref> The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.
 
===Alternative hypotheses===
{{main|AIDS reappraisal}}
 
A small minority of scientists and activists question the connection between HIV and AIDS,<ref name=Duesberg>{{cite journal
| author=Duesberg PH
| title=HIV is not the cause of AIDS
| journal=Science | year=1988 | pages=514, 517 | volume=241 | issue=4865
| pmid=3399880 | doi=10.1126/science.3399880
}}</ref> the existence of HIV itself,<ref name=Papadopulos>{{
cite journal
| author=Papadopulos-Eleopulos E, Turner VF, Papadimitriou J, et al
| title=A critique of the Montagnier evidence for the HIV/AIDS hypothesis
| journal=Med Hypotheses | year=2004 | pages=597&ndash;601 | volume=63 | issue=4
| pmid=15325002 | doi=10.1016/j.mehy.2004.03.025
}}</ref> or the validity of current testing and treatment methods. Though these claims have been examined and widely rejected by the scientific community,<ref name=consensus>For evidence of the [[scientific consensus]] that HIV is the cause of AIDS, see (for example):
*{{cite journal |title=The Durban Declaration |journal=Nature |volume=406 |issue=6791 |pages=15&ndash;6 |year=2000 |pmid=10894520 |doi=10.1038/35017662}} – full text [http://www.nature.com/nature/journal/v406/n6791/full/406015a0.html here].
*{{cite journal
| author=Cohen J
| title=The Controversy over HIV and AIDS
| journal=Science | year=1994 | pages=1642&ndash;1649 | volume=266 | issue=5191
| url=http://www.sciencemag.org/feature/data/cohen/266-5191-1642a.pdf|format=PDF}}
*{{cite web
| publisher=[[National Institute of Allergy and Infectious Diseases]] | year=
| url=http://www3.niaid.nih.gov/news/focuson/hiv/resources/
| title=Focus on the HIV-AIDS Connection: Resource links
| accessdate = 2006-09-07
}}
*{{cite journal |author=O'Brien SJ, Goedert JJ |title=HIV causes AIDS: Koch's postulates fulfilled |journal=Curr. Opin. Immunol. |volume=8 |issue=5 |pages=613-8 |year=1996 |pmid=8902385 |doi=}}
*{{cite journal |author=Galéa P, Chermann JC |title=HIV as the cause of AIDS and associated diseases |journal=Genetica |volume=104 |issue=2 |pages=133&ndash;42 |year=1998 |pmid=10220906 |doi=}}</ref> they continue to be promulgated through the Internet<ref>{{cite journal |author=Smith TC, Novella SP |title=HIV denial in the Internet era |journal=PLoS Med. |volume=4 |issue=8 |pages=e256 |year=2007 |pmid=17713982 |doi=10.1371/journal.pmed.0040256}}</ref> and have had a significant political impact, particularly in South Africa, where until late 2006 the Thabo Mbeki government did not accept that AIDS was caused by HIV, lead to an ineffective response to that country's AIDS epidemic.<ref>{{cite journal |author=Watson J |title=Scientists, activists sue South Africa's AIDS 'denialists' |journal=Nat. Med. |volume=12 |issue=1 |pages=6 |year=2006 |pmid=16397537 |doi=10.1038/nm0106-6a}}</ref><ref>{{cite journal |author=Baleta A |title=S Africa's AIDS activists accuse government of murder |journal=Lancet |volume=361 |issue=9363 |pages=1105 |year=2003 |pmid=12672319 |doi=10.1016/S0140-6736(03)12909-1}}</ref><ref>{{cite journal |author=Cohen J |title=South Africa's new enemy |journal=Science |volume=288 |issue=5474 |pages=2168-70 |year=2000 |pmid=10896606 |doi=10.1126/science.288.5474.2168}}</ref><ref>Andrew Meldrum. [http://www.guardian.co.uk/world/2006/oct/27/aids.southafrica  South African government ends Aids denial], guardian.co.uk, 27 October 2006</ref>
 
===Misconceptions===
{{main|HIV and AIDS misconceptions}}
A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between gay men can lead to AIDS infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.<ref>{{cite book
|author=Blechner MJ
|title=Hope and mortality: psychodynamic approaches to AIDS and HIV
|publisher=Analytic Press
|location=Hillsdale, NJ
|year=1997
|isbn=0-88163-223-6
}}</ref>
 
==Diagnosis==
[[Image:TEM HIV.jpg|thumb|200px|Thin-section transmission electron micrograph (TEM) depicting the ultrastructural details of two ”human immunodeficiency virus” (HIV) virions]]
[[Image:Kaposi's_sarcoma.jpg|thumb|Kaposi's sarcoma lesion commonly found in patients with stage IV AIDS]]
Since June 5, 1981, many definitions have been developed for [[epidemiology|epidemiological]] surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the [[World Health Organization]] staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the [[Centers for Disease Control and Prevention|Centers for Disease Control]] (CDC) Classification System is used.
 
===WHO disease staging system for HIV infection and disease===
{{main|WHO Disease Staging System for HIV Infection and Disease}}
 
In 1990, the [[World Health Organization]] (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.<ref name=WHO>{{
 
cite journal
| author=World Health Organization
| title=Interim proposal for a WHO staging system for HIV infection and disease
| journal=WHO Wkly Epidem. Rec. | year=1990 | pages=221&ndash;228 | volume=65 | issue=29
| pmid=1974812
 
}}</ref> An update took place in September 2005. Most of these conditions are [[opportunistic infection]]s that are easily treatable in healthy people.
* Stage I: HIV infection is [[asymptomatic]] and not categorized as AIDS
* Stage II: includes minor [[Mucous membrane|mucocutaneous]] manifestations and recurrent [[upper respiratory tract]] infections
* Stage III: includes unexplained [[Chronic (medical)|chronic]] [[diarrhea]]<!--STOP CHANGING THIS: this article is written in American English throughout. --> for longer than a month, severe bacterial infections and [[pulmonary]] tuberculosis
* Stage IV: includes [[toxoplasmosis]] of the [[brain]], [[candidiasis]] of the [[esophagus]], [[Vertebrate trachea|trachea]], [[bronchi]] or [[lung]]s and [[Kaposi's sarcoma]]; these diseases are indicators of AIDS.
 
===CDC classification system for HIV infection===
 
{{main|CDC Classification System for HIV Infection}}
 
In the beginning, the [[Centers for Disease Control and Prevention]] (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, [[lymphadenopathy]], the disease after which the discoverers of HIV originally named the virus.<ref name=MMWR1982a>{{
 
cite journal
| author=Centers for Disease Control (CDC)
| title=Persistent, generalized lymphadenopathy among homosexual males.
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=249&ndash;251 | volume=31| issue=19
| pmid=6808340
 
}}</ref><ref name=Barre>{{cite journal | author=Barré-Sinoussi F, Chermann JC, Rey F, et al | title=Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS) | journal=Science | year=1983 | pages=868–871 | volume=220 | issue=4599 | pmid=6189183 | doi=10.1126/science.6189183 | format=
}}</ref> They also used ''Kaposi's Sarcoma and Opportunistic Infections'', the name by which a task force had been set up in 1981.<ref name=MMWR1982b>{{
 
cite journal
| author=Centers for Disease Control (CDC)
| title=Opportunistic infections and Kaposi's sarcoma among Haitians in the United States
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=353&ndash;354; 360&ndash;361 | volume=31 | issue=26
| pmid=6811853
 
}}</ref> In the general press, the term ''GRID'', which stood for [[Gay-related immune deficiency]], had been coined.<ref name=Altman>{{
 
cite news
| author=Altman LK
| title=New homosexual disorder worries officials
| work=The New York Times | date=1982-05-11
 
}}</ref> However, after determining that AIDS was not isolated to the homosexual community,<ref name=MMWR1982b/> the term GRID became misleading and ''AIDS'' was introduced at a meeting in July 1982.<ref name=Kher>{{
 
cite news
| author=Kher U
| title=A Name for the Plague
| work=Time | date=1982-07-27 | url=http://www.time.com/time/80days/820727.html |accessdate=2008-03-10
 
}}</ref> By September 1982 the CDC started using the name AIDS, and properly defined the illness.<ref name=MMWR1982c>{{
 
cite journal
| author=Centers for Disease Control (CDC)
| title=Update on acquired immune deficiency syndrome (AIDS)—United States.
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=507&ndash;508; 513&ndash;514 | volume=31 | issue=37
| pmid=6815471
 
}}</ref> In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4<SUP>+</SUP> T cell count below 200 per µL of blood or 14% of all [[lymphocyte]]s.<ref name=MMWR>{{
 
cite web | publisher=[[Centers for Disease Control and Prevention|CDC]] | publisher=CDC | year=1992
| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm
| title=1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults
| accessdate = 2006-02-09
 
}}</ref> The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4<SUP>+</SUP> T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.
 
===HIV test===
{{main|HIV test}}
 
Many people are unaware that they are infected with HIV.<ref name=Kumaranayake>
 
{{cite journal
| author=Kumaranayake L, Watts C | title=
Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa | journal=J. Int. Dev. | year=2001 | pages=451&ndash;466 | volume=13 | issue=4 | id={{DOI|10.1002/jid.798}}
 
}}</ref> Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.<ref name=Kumaranayake>
 
{{cite journal
| author=Kumaranayake L, Watts C | title=
Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa | journal=J. Int. Dev. | year=2001 | pages=451&ndash;466 | volume=13 | issue=4 | id={{DOI|10.1002/jid.798}}
 
}}</ref> Therefore, donor blood and blood products used in medicine and medical research are screened for HIV.
 
HIV tests are usually performed on venous blood. Many laboratories  use ''fourth generation'' screening tests which detect anti-HIV  antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative  is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. The window period (the time between initial infection and the development of detectable antibodies against the infection) can vary since it can take 3&ndash;6&nbsp;months to [[seroconversion|seroconvert]] and to test positive. Detection of the virus using polymerase chain reaction ([[PCR]]) during the window period is possible, and evidence suggests that an infection may often be detected earlier than when using a fourth generation EIA screening test.  Positive results obtained by PCR are confirmed by antibody tests.<ref name="pmid16706742">{{cite journal
|author=Weber B
|title=Screening of HIV infection: role of molecular and immunological assays
|journal=Expert Rev. Mol. Diagn.
|volume=6
|issue=3
|pages=399-411
|year=2006
|pmid=16706742
|doi=10.1586/14737159.6.3.399
|url=http://dx.doi.org/10.1586/14737159.6.3.399
}}</ref>
Routinely used HIV tests for infection in [[neonates]], born to HIV-positive mothers, have no value because of the presence of maternal antibody to HIV in the child's blood. HIV infection can only be diagnosed by  PCR, testing for HIV pro-viral DNA in the children's [[lymphocyte]]s.<ref name="pmid11791341">{{cite journal
|author=Tóth FD, Bácsi A, Beck Z, Szabó J
|title=Vertical transmission of human immunodeficiency virus
|journal=Acta Microbiol Immunol Hung
|volume=48
|issue=3-4
|pages=413-27
|year=2001
|pmid=11791341
}}</ref>
 
==Transmission and prevention==
 
{| class="prettytable" style="float:right; font-size:85%; margin-left:15px;"
|- bgcolor="#efefef"
|+ Estimated per act risk for acquisition<br/>of HIV by exposure route<ref name=MMWR3>{{
 
cite journal | author=Smith DK, Grohskopf LA, Black RJ, et al | title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States | journal=MMWR | year=2005 | pages=1&ndash;20 | volume=54 | issue=RR02 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1
 
}}</ref>
|- bgcolor="#efefef"
! style="width: 100px" abbr="Route" | Exposure Route
! style="width: 130px" abbr="Infections" | Estimated infections<br/>per 10,000 exposures<br/>to an infected source
|-
! style="text-align:left"| Blood Transfusion
| 9,000<ref name=Donegan>{{
 
cite journal | author=Donegan E, Stuart M, Niland JC, et al | title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | journal=Ann. Intern. Med. | year=1990 | pages=733&ndash;739 | volume=113 | issue=10
| pmid=2240875
 
}}</ref>
|-
! style="text-align:left"| Childbirth
| 2,500<ref name=Coovadia>{{
 
cite journal | author=Coovadia H | title=Antiretroviral agents&mdash;how best to protect infants from HIV and save their mothers from AIDS | journal=N. Engl. J. Med. | year=2004 | pages=289&ndash;292 | volume=351 | issue=3 | pmid=15247337
 
}}</ref>
|-
! style="text-align:left"| Needle-sharing injection drug use
| 67<ref name=Kaplan>{{
 
cite journal | author=Kaplan EH, Heimer R | title=HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data | journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. | year=1995 | pages=175&ndash;176 | volume=10 | issue=2
| pmid=7552482
 
}}</ref>
|-
! style="text-align:left"| Percutaneous needle stick
| 30<ref name=Bell>{{
 
cite journal | author=Bell DM | title=Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. | journal=Am. J. Med. | year=1997 | pages=9&ndash;15 | volume=102 | issue=5B | pmid=9845490
 
}}</ref>
 
|-
! style="text-align:left"| Receptive anal intercourse<sup>*</sup>
| 50<ref name=ESG>{{
 
cite journal | author=European Study Group on Heterosexual Transmission of HIV | title=Comparison of female to male and male to female transmission of HIV in 563 stable couples | journal=BMJ. | year=1992 | pages=809&ndash;813 | volume=304 | issue=6830 | pmid=1392708
 
}}</ref><ref name=Varghese>{{
 
cite journal | author=Varghese B, Maher JE, Peterman TA, Branson BM,Steketee RW | title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use | journal=Sex. Transm. Dis. | year=2002 | pages=38&ndash;43 | volume=29 | issue=1 | pmid=11773877
 
}}</ref>
|-
! style="text-align:left"| Insertive anal intercourse<sup>*</sup>
| 6.5<ref name=ESG /><ref name=Varghese />
|-
! style="text-align:left"| Receptive penile-vaginal intercourse<sup>*</sup>
| 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert>{{
 
cite journal | author=Leynaert B, Downs AM, de Vincenzi I | title=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV | journal=Am. J. Epidemiol. | year=1998 | pages=88&ndash;96 | volume=148 | issue=1 | pmid=9663408
 
}}</ref>
|-
! style="text-align:left"| Insertive penile-vaginal intercourse<sup>*</sup>
| 5<ref name=ESG /><ref name=Varghese />
|-
! style="text-align:left"| Receptive oral intercourse<sup>*§</sup>
| 1<ref name=Varghese />
|-
! style="text-align:left"| Insertive oral intercourse<sup>*</sup>
| 0.5<ref name=Varghese /><sup>§</sup>
|- bgcolor="#efefef"
! colspan=5 style="border-right:0px;";| <sup>*</sup> assuming no condom use </br> <sup>§</sup> source refers to oral intercourse<br/>performed on a man
|}
The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to [[fetus]] or child during [[perinatal]] period. It is possible to find HIV in the [[saliva]], [[tears]], and [[urine]] of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.<ref>{{
 
cite web
| url=http://www.avert.org/aids.htm
| publisher = avert.org
| title=Facts about AIDS & HIV
| accessdate = 2007-11-30
 
}}</ref>
 
===Sexual contact===
 
The majority of HIV infections are acquired through [[Bareback (sex)|unprotected sex]]ual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex.<ref>{{
 
cite journal | author=Johnson AM, Laga M
| title=Heterosexual transmission of HIV | journal=AIDS | year=1988 | pages=S49-S56| volume=2 | issue=suppl. 1
| pmid=3130121
 
}}</ref><ref>{{
 
cite journal | author=N'Galy B, Ryder RW
| title=Epidemiology of HIV infection in Africa | journal=Journal of Acquired Immune Deficiency Syndromes | year=1988 | pages=551-558 | volume=1 | issue=6
| pmid=3225742
 
}}</ref><ref>{{
 
cite journal | author=Deschamps MM, Pape JW, Hafner A, Johnson WD Jr.
| title=Heterosexual transmission of HIV in Haiti | journal=Annals of Internal Medicine | year=1996 | pages=324&ndash;330 | volume=125 | issue=4
| pmid=8678397
 
}}</ref>
Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oral [[mucous membrane]]s of another. Unprotected receptive sexual acts are riskier than unprotected insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected anal intercourse greater than the risk for transmission through vaginal intercourse or oral sex. Oral sex is not without its risks as HIV is transmissible through both insertive and receptive oral sex.<ref name=Rothenberg>{{
 
cite journal | author=Rothenberg RB, Scarlett M, del Rio C, Reznik D, O'Daniels C
| title=Oral transmission of HIV | journal=AIDS | year=1998 | pages=2095&ndash;2105 | volume=12 | issue=16
| pmid=9833850
 
}}</ref> The risk of HIV transmission from exposure to [[saliva]] is considerably smaller than the risk from exposure to [[semen]]; contrary to popular belief, one would have to swallow liters of saliva from a carrier to run a significant risk of becoming infected.<ref name=Vincenzi>{{
 
cite journal | author=Mastro TD, de Vincenzi I
| title=Probabilities of sexual HIV-1 transmission | journal=AIDS | year=1996 | volume=10 | pages=S75&ndash;S82 | issue=Suppl A | pmid=8883613
 
}}</ref>
 
Approximately 30% of women in ten countries representing "diverse cultural, geographical and urban/rural settings" report that their first sexual experience was forced or coerced, making sexual violence a key driver of the HIV/AIDS [[pandemic]].<ref name=vaw>{{
 
cite web
| publisher=[[World Health Organization]] | year=2006
| url=http://www.who.int/gender/violence/who_multicountry_study/en/index.html
| title=WHO Multi-country Study on Women's Health and Domestic Violence against Women
| accessdate = 2006-12-14
 
}}</ref> Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vaginal cavity frequently occurs which facilitates the transmission of HIV.<ref>{{cite journal
|author=Koenig MA, Zablotska I, Lutalo T, Nalugoda F, Wagman J, Gray R
|title=Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda
|journal=Int Fam Plan Perspect
|volume=30
|issue=4
|pages=156–63
|year=2004
|pmid=15590381
|doi=10.1363/ifpp.30.156.04
}}</ref>
 
[[Sexually transmitted infection]]s (STI) increase the risk of HIV transmission and infection because they cause the disruption of the normal [[epithelial]] barrier by genital [[ulcer]]ation and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells ([[lymphocyte]]s and [[macrophage]]s) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America have suggested that there is approximately a four times greater risk of becoming infected with HIV in the presence of a genital ulcer such as those caused by [[syphilis]] and/or [[chancroid]]. There is also a significant though lesser increased risk in the presence of STIs such as [[gonorrhea]], [[Chlamydia infection|Chlamydial infection]] and [[trichomoniasis]] which cause local accumulations of lymphocytes and macrophages.<ref name=Laga>{{
 
cite journal
| author=Laga M, Nzila N, Goeman J
| title=The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa
| journal=AIDS | year=1991 | pages=S55&ndash;S63 | volume=5 | issue=Suppl 1
| pmid=1669925
 
}}</ref>
 
Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma [[viral load]] does not necessarily indicate a low viral load in the seminal liquid or genital secretions. Each 10-fold increment of blood plasma HIV RNA is associated with an 81% increased rate of HIV transmission.<ref name=Laga /><ref name=Tovanabutra>{{
 
cite journal
| author=Tovanabutra S, Robison V, Wongtrakul J, et al
| title=Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand
| journal=J. Acquir. Immune. Defic. Syndr. | year=2002 | pages=275&ndash;283 | volume=29 | issue=3
| pmid=11873077
 
}}</ref> Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.<ref name=Sagar>{{
 
cite journal
| author=Sagar M, Lavreys L, Baeten JM, et al
| title=Identification of modifiable factors that affect the genetic diversity of the transmitted HIV-1 population
| journal=AIDS | year=2004 | pages=615&ndash;619 | volume=18 | issue=4
| pmid=15090766
 
}}</ref><ref name=Lavreys>{{
 
cite journal
| author= Lavreys L, Baeten JM, Martin HL Jr, et al | title=Hormonal contraception and risk of HIV-1 acquisition: results of a 10-year prospective study
| journal=AIDS | year=2004 | pages=695&ndash;697 | volume=18 | issue=4
| pmid=15090778
 
}}</ref> People who are infected with HIV can still be infected by other, more [[virulent]] strains.
 
During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming [[pregnant]]. The best evidence to date indicates that typical condom use reduces the risk of [[heterosexual]] HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.<ref name=Cayley>{{
 
cite journal
| author=Cayley WE Jr.
| title=Effectiveness of condoms in reducing heterosexual transmission of HIV
| journal=Am. Fam. Physician | year=2004 | pages=1268&ndash;1269 | volume=70 | issue=7
| pmid=15508535
 
}}</ref> The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with contributing to the low rates of AIDS in these regions. Promoting condom use, however, has often proved controversial and difficult. Many religious groups, most noticeably the Roman Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and sexual morality. Defenders of the Catholic Church's role in AIDS and general STD prevention state that, while they may be against the use of contraception, they are strong advocates of abstinence outside marriage.<ref name=catechism>{{
 
cite book
| author = Catholic Church
| year = 1997
| title = Catechism of the Catholic Church : Second Edition
| chapter = Offenses against chastity
| chapterurl = http://www.scborromeo.org/ccc/p3s2c2a6.htm#II
| pages = 2353
| publisher = Amministrazione Del Patrimonio Della Sede Apostolica
| location = Vatican
| accessdate = 2006-06-14
 
}}</ref> This attitude is also found among some health care providers and policy makers in sub-Saharan African nations, where HIV and AIDS prevalence is extremely high.<ref name=HRW>{{
 
cite book
| author = Human Rights Watch
| year = 2005
| title = The Less They Know, the Better
| chapter = Restrictions on Condoms
| chapterurl = http://hrw.org/reports/2005/uganda0305/7.htm#_Toc98378385
| publisher = Human Rights Watch
| location = New York NY
 
}}</ref> They also believe that the distribution and promotion of condoms is tantamount to promoting sex amongst the youth and sending the wrong message to uninfected individuals. However, no evidence has been produced that promotion of condom use increases sexual promiscuity,<ref name=noauthors>{{
 
cite journal
| author=No authors listed
| title=Study shows condom use does not promote promiscuity
| journal=AIDS Policy Law | year=1997 | pages=6&ndash;7 | volume=12| issue=12
| pmid=11364411
 
}}</ref> and abstinence-only programs have been unsuccessful in the United States both in changing sexual behavior and in reducing HIV transmission.<ref name=HRW2>{{
 
cite web
| publisher=Human Rights Watch | date=2002-09-02
| url=http://www.hrw.org/reports/2002/usa0902/USA0902-04.htm
| title=Ignorance only: HIV/AIDS, Human rights and federally funded abstinence-only programs in the United States. Texas: A case study
| accessdate = 2006-03-28
 
}}</ref> Evaluations of several abstinence-only programs in the US showed a negative impact on the willingness of youths to use contraceptives, due to the emphasis on contraceptives' failure rates.<ref name=AbstinenceEvals>{{
 
cite web
| author=Hauser, Debra | publisher=Advocates for Youth | year=2004 | format=PDF
| url=http://www.advocatesforyouth.org/publications/stateevaluations.pdf
| title=Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact
| accessdate = 2006-06-07
 
}}</ref>
<!-- [[Image:Condoms by Morrhigan.jpg|thumb|right|Condoms in many colors]] -->
The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms [[Porosity|porous]]. If necessary, manufacturers recommend using [[water]]-based lubricants. Oil-based lubricants can however be used with [[polyurethane]] condoms.<ref name=Durex>{{
 
cite web
| publisher=Durex | year=
| url=http://www.durex.com/cm/assets/SexEdDownloads/Module_5_condoms.doc
| title=Module 5/Guidelines for Educators
| format= Microsoft Word
| accessdate = 2006-04-17
 
}}</ref> Latex condoms degrade over time, making them porous, which is why condoms have expiration dates. In Europe and the United States, condoms have to conform to European (EC 600) or American (D3492) standards to be considered protective against HIV transmission.
 
The [[female condom]] is an alternative to the male condom and is made from [[polyurethane]], which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina &ndash; inserting the female condom requires squeezing this ring. However, at present availability of female condoms is very low and the price remains prohibitive for many women. Preliminary studies suggest that, where female condoms are available, overall protected sexual acts increase relative to unprotected sexual acts, making them an important HIV prevention strategy.<ref name=PATH>{{
 
cite journal
| author=PATH
| title=The female condom: significant potential for STI and pregnancy prevention
| journal=Outlook | year=2006 | volume=22 | issue=2
 
}}</ref>
 
With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.<ref name=WHOCondoms>{{
 
cite web
| publisher=[[World Health Organization|WHO]]| year= August 2003
| url=http://www.wpro.who.int/media_centre/fact_sheets/fs_200308_Condoms.htm
| title=Condom Facts and Figures
| accessdate = 2006-01-17
}}</ref>
 
In December 2006, the last of three large, [[Randomized controlled trial|randomized trials]] confirmed that male [[circumcision]] lowers the risk of HIV infection among heterosexual African men by around 50%. It is expected that this intervention will be actively promoted in many of the countries worst affected by HIV, although doing so will involve confronting a number of practical, cultural and attitudinal issues. Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.<ref name=NIAIDCircumcision>{{
 
cite web
| publisher=[[National Institute of Allergy and Infectious Diseases|NIAID]]
| date=2006-12-13
| url=http://www3.niaid.nih.gov/news/newsreleases/2006/AMC12_06.htm
| title=Adult Male Circumcision Significantly Reduces Risk of Acquiring HIV: Trials Kenya and Uganda Stopped Early
| accessdate = 2006-12-15
 
}}</ref> Furthermore, South African medical experts are concerned that the repeated use of unsterilized blades in the ritual circumcision of adolescent boys may be spreading HIV.<ref name=Kaisercircum>{{
 
cite web
  | publisher=Kaisernetwork.org | year=2005 | url=http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=31199 | title=Repeated Use of Unsterilized Blades in Ritual Circumcision Might Contribute to HIV Spread in S. Africa, Doctors Say | accessdate = 2006-03-28
}}</ref>
 
Prevention strategies are well-known in developed countries, however, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV.<ref name=Dias>{{
 
cite journal
| author=Dias SF, Matos MG, Goncalves, A. C.
| title=Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups
| journal=Eur. J. Public Health | year=2005 | pages=300&ndash;304 | volume=15 | issue=3
| pmid=15941747
 
}}</ref>
 
===Exposure to infected body fluids===
[[Image:AIDS Poster If You're Dabbling in Drugs 1989.jpg|thumb|250px|CDC poster from 1989 highlighting the threat of AIDS associated with drug use]]
This transmission route is particularly relevant to [[Intravenous drug use (recreational)|intravenous drug]] users, [[Haemophilia|hemophiliacs]] and recipients of [[blood transfusion]]s and blood products. Sharing and reusing [[syringe]]s contaminated with HIV-infected blood represents a major risk for infection with not only HIV, but also [[hepatitis B]] and [[hepatitis C]]. Needle sharing is the cause of one third of all new HIV-infections and 50% of hepatitis C infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 ([[AIDS#Transmission and prevention|see table above]]). [[Post-exposure prophylaxis]] with anti-HIV drugs can further reduce that small risk.<ref name=Fan>{{
 
cite book
| author =Fan H | year = 2005
| title =AIDS: science and society |  chapterurl =
| editor = Fan, H., Conner, R. F. and Villarreal, L. P. eds
| edition = 4th | pages =
| publisher =Jones and Bartlett Publishers
| location = Boston, MA
| id = ISBN 0-7637-0086-X
 
}}</ref> Health care workers (nurses, laboratory workers, doctors etc) are also concerned, although more rarely. This route can affect people who give and receive tattoos and piercings. [[Universal precautions]] are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.<ref name=WHOJapan>{{ cite web
| publisher=[[World Health Organization|WHO]]| date= 2003-03-17
| url=http://64.233.179.104/search?q=cache:adH68_6JGG8J:tokyo.usembassy.gov//e/p/tp-20030317a3.html+site:tokyo.usembassy.gov+HIV+healthcare+injection&hl=en&gl=us&ct=clnk&cd=1
| title=WHO, UNAIDS Reaffirm HIV as a Sexually Transmitted Disease
| accessdate = 2006-01-17
 
}}</ref> Because of this, the United Nations General Assembly, supported by universal medical opinion on the matter, has urged the nations of the world to implement universal precautions to prevent HIV transmission in health care settings.<ref name=PHR>{{
 
cite web
| publisher=Physicians for Human Rights | work=Partners in Health | date=2003-03-13
| url=http://www.phrusa.org/campaigns/aids/who_031303.html
| title=HIV Transmission in the Medical Setting: A White Paper by Physicians for Human Rights | accessdate = 2006-03-01
 
}}</ref>
Drug abuse has an additional effect of an increased tendency to engage in unprotected sexual intercourse.<ref> [http://www.drugtext.org/library/articles/peddr0016.htm Drugtext.org]</ref>
 
The risk of transmitting HIV to [[blood transfusion]] recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the [[World Health Organization|WHO]], the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products".<ref name=WHO070401>{{
 
cite web
| publisher=[[World Health Organization|WHO]] | year= 2001
| url=http://www.who.int/inf-pr-2000/en/pr2000-25.html
| title=Blood safety....for too few
| accessdate = 2006-01-17
 
}}</ref>


Medical workers who follow universal precautions or body-substance isolation, such as wearing latex gloves when giving injections and washing the hands frequently, can help prevent infection by HIV.
==[[AIDS differential diagnosis|Differentiating AIDS from other Diseases]]==


All AIDS-prevention organizations advise drug-users not to share needles and other material required to prepare and take drugs (including syringes, cotton balls, the spoons, water for diluting the drug, straws, crack pipes, etc). It is important that people use new or properly sterilized needles for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from needle exchanges. In some developed countries, clean needles are available free in some cities, at needle exchanges or [[safe injection site]]s. Additionally, many nations have decriminalized needle possession and made it possible to buy injection equipment from pharmacists without a prescription.
==[[AIDS epidemiology and demographics|Epidemiology and Demographics]]==


Transmission of HIV between intravenous drug users has clearly decreased, and HIV transmission by blood transfusion has become quite rare in developed countries.
==[[AIDS risk factors|Risk Factors]]==


===Mother-to-child transmission (MTCT)===
==[[AIDS screening|Screening]]==
The transmission of the virus from the mother to the child can occur ''[[in utero]]'' during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between the mother to the child during pregnancy, labor and delivery is 25%. However, when the mother has access to antiretroviral therapy and gives birth by [[caesarean section]], the rate of transmission is just 1%.<ref name=Coovadia /> A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the viral load, the higher the risk). [[Breastfeeding]] increases the risk of transmission by 4.04%.<ref name=Coovadia2>{{


cite journal
==[[AIDS natural history, complications, and prognosis|Natural History, Complications and Prognosis]]==
| author=Coovadia HM, Bland RM| title=Preserving breastfeeding practice through the HIV pandemic
| journal=Trop. Med. Int. Health.  | year=2007| pages=1116&ndash;1133 | volume=12 | issue=9
| pmid=17714431


}}</ref> This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding.<ref name=Coovadia2 />
==[[HIV Opportunistic Infections]]==


Studies have shown that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child.<ref name=Sperling>{{
==[[HIV Coinfections]]==


cite journal
==[[HIV and pregnancy|HIV and Pregnancy]]==
| author=Sperling RS, Shapirom DE, Coombsm RW, et al | title=Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant
| journal=N. Engl. J. Med. | year=1996 | pages=1621&ndash;1629 | volume=335 | issue=22
| pmid=8965861


}}</ref> Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.<ref>{{cite web |url=http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf |format=PDF |date=2006 |accessdate=2008-03-12 |title= Consensus statement |author= WHO HIV and Infant Feeding Technical Consultation
==[[HIV infection in infants|HIV Infection in Infants]]==
}}</ref> In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa.<ref name=avert>
{{ cite web
| author=Berry S
| publisher=avert.org
| date= 2006-06-08
| url=http://www.avert.org/children.htm
| title=Children, HIV and AIDS
| accessdate = 2006-06-15
}}</ref> Of the children currently living with HIV, almost 90% live in sub-Saharan Africa.<ref name=UNAIDS2007/>


In Africa, the number of MTCT and the prevalence of AIDS is beginning to reverse decades of steady progress in child survival.<ref name=UNMTCT>{{
==[[Cardiac diseases in AIDS| HIV and Cardiovascular System]]==


cite web
==[[AIDS diagnosis|Diagnosis]]==
| publisher=United Nations | year=2001
[[AIDS history and symptoms|History and Symptoms]] | [[AIDS physical examination|Physical Examination]] | [[AIDS laboratory findings|Laboratory Findings]] | [[AIDS electrocardiogram|Electrocardiogram]] | [[AIDS chest x ray|Chest X Ray]] | [[AIDS CT|CT]] | [[AIDS MRI|MRI]] | [[AIDS echocardiography|Echocardiography]]
| url=http://www.un.org/ga/aids/ungassfactsheets/html/fsmotherchild_en.htm
| title=Fact Sheet: Mother-to-child transmission of HIV
| accessdate = 2006-03-10
 
}}</ref> Countries such as Uganda are attempting to curb the MTCT epidemic by offering VCT (voluntary counseling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.


==Treatment==
==Treatment==
[[AIDS medical therapy|Medical Therapy]] | [[AIDS medical therapy|Nutrition]] | [[AIDS medical therapy|Drug-resistant]] | [[AIDS surgery|Surgery]] | [[AIDS primary prevention|Primary Prevention]]  | | [[AIDS secondary prevention|Secondary Prevention]] | [[AIDS cost-effectiveness of therapy|Cost-Effectiveness of therapy]] | [[AIDS future or investigational therapies|Future or Investigational Therapies]]


:''See also [[HIV#Treatment|HIV Treatment]] and [[Antiretroviral drug]].
==Case Studies==
[[Image:Abacavir (Ziagen) 300mg.jpg|right|thumb|100px|''[[Abacavir]]'' – a nucleoside analog reverse transcriptase inhibitors (NARTIs or NRTIs)]]
[[AIDS case study one|Case #1]]
[[Image:Abacavir_structure.svg|thumb|The chemical structure of Abacavir]]
 
There is currently no [[HIV vaccine|vaccine]] or cure for [[HIV]] or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called [[post-exposure prophylaxis]] (PEP).<ref name=Fan/> PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including [[diarrhea]], [[malaise]], [[nausea]] and [[Fatigue (physical)|fatigue]].<ref name=PEPpocketguide>{{
 
cite web
| publisher=Department of Health and Human Services
| date=February 2006
| url=http://hab.hrsa.gov/tools/HIVpocketguide/PktGPEP.htm
| title=A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition
| accessdate = 2006-09-01
 
}}</ref>
 
Current treatment for HIV infection consists of [[highly active antiretroviral therapy]], or HAART.<ref name=DhhsHivTreatment>{{
 
cite web
| publisher=Department of Health and Human Services
| date=February 2006
| url=http://hab.hrsa.gov/tools/HIVpocketguide/PktGARTtables.htm
| title=A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition
| accessdate = 2006-09-01
 
}}</ref> This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available.<ref name=Palella/> Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of [[antiretroviral]] agents. Typical regimens consist of two [[nucleoside analogue reverse transcriptase inhibitor]]s (NARTIs or NRTIs) plus either a [[protease inhibitor (pharmacology)|protease inhibitor]] or a [[non-nucleoside reverse transcriptase inhibitor]] (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.<ref name=2005dhhsHivChildren>{{
 
cite web
| publisher=Department of Health and Human Services Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children
| date=2005-11-03
| url=http://www.aidsinfo.nih.gov/ContentFiles/PediatricGuidelines_PDA.pdf
| title=Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
| format= PDF
| accessdate = 2006-01-17
 
}}</ref> In developed countries where HAART is available, doctors assess the [[viral load]], rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.<ref name=2005DhhsHivTreatment>{{
 
cite web
| publisher=Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection
| date=2005-10-06
| url=http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf
| title=Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
| format= PDF
| accessdate = 2006-01-17
 
}}</ref>
 
HAART allows the stabilization of the patient’s symptoms and viremia, but it neither cures the patient of HIV, nor alleviates the symptoms, and high levels of HIV-1, often HAART resistant, return once treatment is stopped.<ref name=martinez>{{
 
cite journal
| author=Martinez-Picado J, DePasquale MP, Kartsonis N, et al| title=Antiretroviral resistance during successful therapy of human immunodeficiency virus type 1 infection | journal=Proc. Natl. Acad. Sci. U. S. A. | year=2000 | pages=10948&ndash;10953 | volume=97 | issue=20 | pmid=11005867
 
}}</ref><ref name=Dybul>{{
 
cite journal
| author=Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK; Panel on Clinical Practices for Treatment of HIV.
| title=Guidelines for using antiretroviral agents among HIV-infected adults and adolescents
| journal=Ann. Intern. Med. | year=2002 | pages=381&ndash;433 | volume=137 | issue=5 Pt 2
| pmid=12617573
 
}}</ref> Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.<ref name=blankson>{{
 
cite journal
| author=Blankson JN, Persaud D, Siliciano RF | title=The challenge of viral reservoirs in HIV-1 infection | journal=Annu. Rev. Med. | year=2002 | pages=557&ndash;593 | volume=53 | issue= | pmid=11818490
 
}}</ref> Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to the plummeting of HIV-associated morbidity and mortality.<ref name=Pallelal>{{
 
cite journal
| author=Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD | title=Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection | journal=N. Engl. J. Med. | year=1998 | pages=853&ndash;860 | volume=338 | issue=13 | pmid=9516219
 
}}</ref><ref name=Wood>{{
 
cite journal
| author=Wood E, Hogg RS, Yip B, Harrigan PR, O'Shaughnessy MV, Montaner JS
| title=Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy?
| journal=AIDS | year=2003 | pages=711&ndash;720 | volume=17 | issue=5
| pmid=12646794
 
}}</ref><ref name=Chene>{{
 
cite journal
| author=Chene G, Sterne JA, May M, Costagliola D, Ledergerber B, Phillips AN, Dabis F, Lundgren J, D'Arminio Monforte A, de Wolf F, Hogg R, Reiss P, Justice A, Leport C, Staszewski S, Gill J, Fatkenheuer G, Egger ME and the Antiretroviral Therapy Cohort Collaboration
| title=Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies
| journal=Lancet | year=2003 | pages=679&ndash;686 | volume=362 | issue=9385
| pmid=12957089 | doi=10.1016/S0140-6736(03)14229-8
 
}}</ref> In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2&nbsp;months.<ref name=Morgan2 /> HAART is thought to increase survival time by between 4 and 12&nbsp;years.<ref name=JTKing>{{
 
cite journal
| author=King JT, Justice AC, Roberts MS, Chang CH, Fusco JS and the CHORUS Program Team
| title=Long-Term HIV/AIDS Survival Estimation in the Highly Active Antiretroviral Therapy Era
| journal=Medical Decision Making | year=2003 | pages=9&ndash;20 | volume=23 | issue=1
| pmid=12583451
 
}}</ref><ref name=Tassie>{{
 
cite journal
| author=Tassie JM, Grabar S, Lancar R, Deloumeaux J, Bentata M, Costagliola D and the Clinical Epidemiology Group from the French Hospital Database on HIV
| title=Time to AIDS from 1992 to 1999 in HIV-1-infected subjects with known date of infection
| journal=Journal of acquired immune deficiency syndromes | year=2002 | pages=81&ndash;7 | volume=30 | issue=1
| pmid=12048367
 
}}</ref> This average reflects the fact that for some patients &ndash; and in many clinical cohorts this may be more than fifty percent of patients &ndash; HAART achieves far less than optimal results. This is due to a variety of reasons such as medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV. However, non-adherence and non-persistence with antiretroviral therapy is the major reason most individuals fail to get any benefit from and develop resistance to HAART.<ref name=becker>{{
 
cite journal
| author=Becker SL, Dezii CM, Burtcel B, Kawabata H, Hodder S. | title=Young HIV-infected adults are at greater risk for medication nonadherence | journal=MedGenMed. | year=2002 | pages=21 | volume=4| issue=3 | pmid=12466764
 
}}</ref> The reasons for non-adherence and non-persistence with HAART are varied and overlapping. Major psychosocial issues, such as poor access to medical care, inadequate social supports, psychiatric disease and drug abuse contribute to non-adherence. The complexity of these HAART regimens, whether due to pill number, dosing frequency, meal restrictions or other issues, along with side effects that create intentional non-adherence, also has a weighty impact.<ref name=Nieuwkerk>{{
 
cite journal
| author=Nieuwkerk P, Sprangers M, Burger D, Hoetelmans RM, Hugen PW, Danner SA, van Der Ende ME, Schneider MM, Schrey G, Meenhorst PL, Sprenger HG, Kauffmann RH, Jambroes M, Chesney MA, de Wolf F, Lange JM and the ATHENA Project | title=Limited Patient Adherence to Highly Active Antiretroviral Therapy for HIV-1 Infection in an Observational Cohort Study | journal=Arch. Intern. Med. | year=2001 | pages=1962&ndash;1968 | volume=161 | issue=16 | pmid=11525698
 
}}</ref><ref name=Kleeberger>{{
 
cite journal
| author=Kleeberger C, Phair J, Strathdee S, Detels R, Kingsley L, Jacobson LP | title=Determinants of Heterogeneous Adherence to HIV-Antiretroviral Therapies in the Multicenter AIDS Cohort Study| journal=J. Acquir. Immune Defic. Syndr. | year=2001 | pages=82&ndash;92 | volume=26 | issue=1 | pmid=11176272
 
}}</ref><ref name=heath>{{
 
cite journal
| author=Heath KV, Singer J, O'Shaughnessy MV, Montaner JS, Hogg RS | title=Intentional Nonadherence Due to Adverse Symptoms Associated With Antiretroviral Therapy | journal=J. Acquir. Immune Defic. Syndr. | year=2002 | pages=211&ndash;217 | volume=31 | issue=2 | pmid=12394800
 
}}</ref> The side effects include [[lipodystrophy]], [[dyslipidaemia]], [[insulin resistance]], an increase in [[cardiovascular]] risks and [[birth defect]]s.<ref name=Montessori>{{
 
cite journal |
author=Montessori V, Press N, Harris M, Akagi L, Montaner JS |
title=Adverse effects of antiretroviral therapy for HIV infection. |
journal=CMAJ | year=2004 | pages=229&ndash;238 | volume=170 | issue=2 | pmid=14734438
 
}}</ref><ref name=Saitoh>{{
 
cite journal
| author=Saitoh A, Hull AD, Franklin P, Spector SA
| title=Myelomeningocele in an infant with intrauterine exposure to efavirenz
| journal=J. Perinatol. | year=2005 | pages=555&ndash;556 | volume=25 | issue=8
| pmid=16047034 | doi=10.1038/sj.jp.7211343
 
}}</ref>
 
Daily multivitamin and mineral supplements have been found to reduce HIV disease progression among men and women. This could become an important low-cost intervention provided during early HIV disease to prolong the time before antiretroviral therapy is required.<ref name=Fawzi>{{
 
cite journal
| author=Fawzi W, Msamanga G, Spiegelman D, Hunter DJ
| title=Studies of vitamins and minerals and HIV transmission and disease progression
| journal=J. Nutrition| year=2005 | pages=938&ndash;944 | volume=135 | issue=4
| pmid=15795466
}}
</ref> Some individual nutrients have also been tried.<ref name=Hurwitz>([[Selenium]]:) {{
 
cite journal
| author=Hurwitz BE, Klaus JR, Llabre MM, Gonzalez A, Lawrence PJ, Maher KJ, Greeson JM, Baum MK, Shor-Posner G, Skyler JS, Schneiderman N
| title=Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial
| journal=Arch Intern Med.| year=2007 | pages=148&ndash;155 | volume=167 | issue=2
| pmid=17242315
}}</ref><ref name=Cathcart1>([[Vitamin C]]:) {{
 
cite journal
| author=Cathcart RR
| title=Vitamin C in the Treatment of Acquired Immune Deficiency Syndrome
| journal=Medical Hypotheses | year=1984 | volume=14 | issue=4 | pages=423-433
| pmid=6238227 | doi=10.1016/0306-9877(84)90149-X
| url=http://www.doctoryourself.com/aids_cathcart.html
 
}}</ref> Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.<ref name=Ferrantelli>{{
 
cite journal
| author=Ferrantelli F, Cafaro A, Ensoli B | title=Nonstructural HIV proteins as targets for prophylactic or therapeutic vaccines | journal=Curr Opin Biotechnol. | year=2004 | pages=543&ndash;556 | volume=15 | issue=6
| pmid=15560981
 
}}</ref> It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments.<ref name=Ferrantelli/> However, after over 20&nbsp;years of research, HIV-1 remains a difficult target for a vaccine.<ref name=Ferrantelli/>
 
Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. [[Vaccination]] against [[hepatitis]] A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected.<ref name=Laurence>{{
 
cite journal
| author=Laurence J
| title=Hepatitis A and B virus immunization in HIV-infected persons
| journal=AIDS Reader | year=2006 | pages=15&ndash;17 | volume=16 | issue=1
| pmid=16433468
 
}}</ref> Patients with substantial immunosuppression are also advised to receive prophylactic therapy for [[Pneumocystis jiroveci pneumonia]] (PCP), and many patients may benefit from prophylactic therapy for [[toxoplasmosis]] and [[Cryptococcus]] [[meningitis]] as well.<ref name=PEPpocketguide>{{
 
cite web
| publisher=Department of Health and Human Services
| date = 2007-02-02
| url=http://www.guideline.gov/summary/summary.aspx?ss=14&doc_id=6223&string=infected+AND+patients
| title=Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America.
| accessdate = 2007-02-05
 
}}</ref>
 
Various forms of [[alternative medicine]] have been used to treat symptoms or alter the course of the disease.<ref name=Saltmarsh>{{
 
cite journal
| author=Saltmarsh S
| title=Voodoo or valid? Alternative therapies benefit those living with HIV
| journal=Positively Aware | year=2005 | pages=46 | volume=3 | issue=16
| pmid=16479668 | url=http://www.tpan.com/publications/pa/may_jun_05/voodoo.shtml
 
}}
</ref> In the first decade of the [[epidemic]] when no useful conventional treatment was available, a large number of people with AIDS experimented with alternative therapies. The definition of "alternative therapies" in AIDS has changed since that time. Then, the phrase often referred to community-driven treatments, untested by government or pharmaceutical company research, that some hoped would directly suppress the virus or stimulate immunity against it. Examples of alternative medicine that people hoped would improve their symptoms or their quality of life include massage, stress management, herbal and flower remedies such as boxwood,<ref name=Pharo>{{
 
cite journal
| author=Pharo A, et al
| title=Evaluation of the safety and efficacy of SPV-30 (boxwood extract) in patients with HIV disease
| journal=Int Conf AIDS | year=1996 | issue=Jul 7–12 | pages=11:19 | id=abstract no. Mo. B.180
| url=http://www.aegis.org/conferences/iac/1996/MoB180.html
 
}}
</ref><ref name=Durant>{{
 
cite journal
| author=Durant J, et al
| title=Efficacy and safety of Buxussempervirens L. preparations (SPV-30) in HIV infected asymptomatic patients: a multi-centre, randomized, double-blind, placebo-controlled trial.
| journal=Phytomedicine | year = 1998 | issue=5 | pages=1–10
 
}}
</ref> and [[acupuncture]];<ref name=Saltmarsh /> when used with conventional treatment, many now refer to these as "complementary" approaches. Despite the widespread use of complementary and alternative medicine by people living with HIV/AIDS, the effectiveness of these therapies has not been established.<ref name=Mills>{{
 
cite journal
| author=Mills E, Wu P, Ernst E
| title=Complementary therapies for the treatment of HIV: in search of the evidence.
| journal=Int. J. STD AIDS.| year=2005 | pages=395&ndash;403 | volume=16 | issue=6
| pmid=15969772
 
}}</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,<ref name=UNAIDS2007/> 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>
 
===Economic impact===
[[Image:Life expectancy in some Southern African countries 1958 to 2003.jpg|right|295px|thumb|Changes in life expectancy in some hard-hit African countries.
{{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}}]]
 
HIV and AIDS retard economic growth by destroying human capital.<ref name=Bell-et-al-2003/>
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
| 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 />
 
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>{{
 
cite journal |
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>
 
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>{{
 
cite journal |
author=Bonnel R |
title=HIV/AIDS and Economic Growth: A Global Perspective |
journal=S. A. J. Economics | year=2000 | pages=820&ndash;855 | volume=68 | issue=5 |
 
}}</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>{{
 
cite paper
|author= Bell C, Devarajan S, Gersbach H |date=2003
|url=http://ssrn.com/abstract=636571
| title=The long-run economic costs of AIDS: theory and an application to South Africa
|accessdate= 2008-03-12
|version= World Bank Policy Research Working Paper No. 3152
 
}}</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.
 
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
| author=Mu Xuequan | publisher=xinhua | year= 2006
| url=http://news.xinhuanet.com/english/2006-10/04/content_5167991.htm
| title=Zimbabwe launches world's first AIDS training package
| accessdate = 2006-10-03
 
}}</ref>
 
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>{{
 
cite web
| publisher=kaisernetwork.org | year= 2002
| url=http://kaisernetwork.org/aids2002/syndication.asp?show=daily_report_1.html
| title=$27 Billion Boost for HIV Prevention Programs Could Avert Majority of Projected HIV Infections Worldwide
| accessdate = 2008-03-10
 
}}</ref>
 
===Stigma===
[[Image:Saigon AIDS Sign.jpg|thumb|250px|right|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/>
 
== Prevention ==
The diverse transmission routes of HIV are well-known and established. Also well-known is how to prevent transmission of HIV. However, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV (Dias et al., 2005). However, transmission of HIV between intravenous drug users has clearly decreased and HIV transmission by blood transfusion has become almost obsolete in this population.
 
== Prevention of sexual transmission of HIV ==
 
=== Underlying science ===
* Unprotected receptive sexual acts are at more risk than unprotected insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected insertive anal intercourse (UIAI) greater than the risk for transmission through receptive anal intercourse or oral sex. According to the French ministry for health, the probability of transmission per act varies from 0.03% to 0.07% for the case of receptive vaginal sex, from 0.02 to 0.05% in the case of insertive vaginal sex, from 0.01% to 0.185% in the case of insertive anal sex, and 0.5% to 3% in the case of receptive anal sex [1].
* Sexually-transmitted infections (STI) increase the risk of HIV transmission and infection because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America have suggested that there is approximately, a four times greater risk of becoming HIV-infected in the presence of a genital ulcer such as caused by syphilis and/or chancroid; and a significant though lesser increased risk in the presence of STIs such as gonorrhoea, chlamydial infection and trichomoniasis which cause local accumulations of lymphocytes and macrophages (Laga et al., 1991).
* Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not mean that you have a low viral load in the seminal liquid or genital secretions. Each 10 fold increment of seminal HIV RNA is associated with an 81% increased rate of HIV transmission (Tovanabutra et al., 2002).
* People who are infected with HIV can still be infected by other, more virulent strains. 
* Oral sex is not without its risks as it has been established that HIV can be transmitted through both insertive and receptive oral sex (Rothenberg et al., 1998).
* Women are more susceptible to HIV-1 due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases (Sagar et al., 2004; Lavreys et al., 2004).
 
=== Prevention strategies ===
 
During a sexual act, only condoms, be they male or female, can reduce the chances of infection with HIV and other STIs and the chances of becoming pregnant. They must be used during all penetrative sexual intercourse with a partner who is HIV positive or whose status is unknown (Cayley, 2004). The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with the low rates of AIDS in these regions. Adopting these effective prevention methods in other regions has proved controversial and difficult. Some claim this is in part because of the strong influence of the Roman Catholic Church, which opposes the use of condoms.
* The male latex condom is the single most efficient available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. In order to be effective, they must be used correctly during each sexual act. Lubricants containing oil, such as petroleum jelly, or butter, must not be used as they weaken latex condoms and make them porous. If necessary, lubricants made from water are recommended. However, it is not recommended to use a lubricant for fellatio. Also, condoms have standards and expiration dates. It is essential to check the expiration date and if it conforms to European (EC 600) or American (D3492) standards before use.
* The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom also contains an inner ring which keeps the condom in place inside the vagina - inserting the female condom requires squeezing this ring.
With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year
 
=== Government programs ===
The U.S. government and U.S. health organizations both endorse the ABC Approach to lower the risk of acquiring AIDS during sex:
 
* Abstinence or delay of sexual activity, especially for youth,
* Being faithful, especially for those in committed relationships,
* Condom use, for those who engage in risky behavior.
 
This approach has been very successful in Uganda, where HIV prevalence has decreased from 15% to 5%. However, the ABC approach is far from all that Uganda has done, as "Uganda has pioneered approaches towards reducing stigma, bringing discussion of sexual behavior out into the open, involving HIV-infected people in public education, persuading individuals and couples to be tested and counseled, improving the status of women, involving religious organizations, enlisting traditional healers, and much more." (Edward Green, Harvard medical anthropologist). Also, it must be noted that there is no conclusive proof that abstinence-only programs have been successful in any country in the world in reducing HIV transmission. This is why condom use is heavily co-promoted. There is also considerable overlap with the CNN Approach. This is:
 
* Condom use, for those who engage in risky behavior.
* Needles, use clean ones
* Negotiating skills; negotiating safer sex with a partner and empowering women to make smart choices
 
The ABC approach has been criticized, because a faithful partner of an unfaithful partner is at risk of AIDS [3]. Many think that the combination of the CNN approach with the ABC approach will be the optimum prevention platform.
 
=== Circumcision ===
 
Current research is clarifying the relationship between male circumcision and HIV in differing social and cultural contexts. UNAIDS believes that it is premature to recommend male circumcision services as part of HIV prevention programmes [4].
 
Moreover, South African medical experts are concerned that the repeated use of unsterilised blades in the ritual circumcision of adolescent boys may be spreading HIV.
 
== Prevention of blood or blood product route of HIV transmission ==
 
=== Underlying science ===
* Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with not only HIV but also hepatitis B and C. In the United States a third of all new HIV infections can be traced to needle sharing and almost 50% of long-term addicts have hepatitis C.
 
* The risk of being infected with HIV from a single prick with a needle that has been used on an HIV infected person though is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce that small risk.
* Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.Because of this, the United Nations General Assembly, supported by universal medical opinion on the matter, has urged the nations of the world to implement universal precautions to prevent HIV transmission in health care settings.
 
=== Prevention strategies ===
 
* In those countries where improved donor selection and antibody tests have been introduced, the risk of transmitting HIV infection to blood transfusion recipients has been effectively eliminated. According to the WHO, the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products."
 
* Medical workers who follow universal precautions or body substance isolation such as wearing latex gloves when giving injections and washing the hands frequently can help prevent infection of HIV.
 
* All AIDS-prevention organizations advise drug-users not to share needles and other material required to prepare and take drugs (including syringes, cotton balls, the spoons, water for diluting the drug, straws, crack pipes etc). It is important that people use new or properly sterilized needles for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from needle exchanges. In the United States and other western countries, clean needles are available free in some cities, at needle exchanges or safe injection sites.
 
== Mother to child transmission ==
 
=== Underlying science ===
 
* There is a 15–30% risk of transmission of HIV from mother to child during pregnancy, labour and delivery (Orendi et al., 1998). In developed countries the risk can of transmission of HIV from mother to child can be as low as 0-5%. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding.
 
=== Prevention strategies ===
 
* Studies have shown that antiretroviral drugs, cesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child (Sperling et al., 1996).
 
* When replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers are recommended to avoid breast feeding their infant. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible.
 
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|group1 = HIV
|list1  = [[HIV]]{{·}} [[AIDS]]{{·}} [[HIV structure and genome|HIV&nbsp;structure and&nbsp;genome]]{{·}} {{nowrap|[[HIV test]]}}{{·}} [[CDC Classification System for HIV Infection|CDC&nbsp;Classification&nbsp;System&nbsp;for HIV&nbsp;Infection]]{{·}} [[HIV disease progression rates|HIV&nbsp;disease progression&nbsp;rates]]{{·}} {{nowrap|[[HIV vaccine]]}}{{·}} [[WHO Disease Staging System for HIV Infection and Disease|WHO&nbsp;Disease&nbsp;Staging&nbsp;System for HIV&nbsp;Infection&nbsp;and Disease]]{{·}} {{nowrap|[[AIDS dementia complex]]}}{{·}} {{nowrap|[[Antiretroviral drug]]}}
 
|group2 = History
|list2  = [[AIDS origin]]{{·}} [[AIDS pandemic]]{{·}} [[AIDS Museum]]{{·}} {{nowrap|[[Timeline of AIDS]]}}{{·}} [[OPV AIDS hypothesis|Oral&nbsp;polio vaccine AIDS&nbsp;hypothesis]]{{·}} [[AIDS reappraisal|Reappraisal&nbsp;of HIV&ndash;AIDS&nbsp;Hypothesis]]{{·}} {{nowrap|[[Duesberg hypothesis]]}}
 
|group3 = Culture
|list3  = [[International AIDS Conference]]{{·}} [[International AIDS Society]]{{·}} {{nowrap|[[World AIDS Day]]}}{{·}} [[Treatment Action Campaign]]{{·}} [[Joint United Nations Programme on HIV/AIDS|UNAIDS]]{{·}} [[Pepfar|PEPFAR]]{{·}} [[NAMES Project AIDS Memorial Quilt]]{{·}} [[HIV and AIDS misconceptions|HIV&nbsp;and AIDS&nbsp;misconceptions]]{{·}} [[List of HIV-positive people|List&nbsp;of HIV-positive&nbsp;people]]{{·}} [[People With AIDS Self-Empowerment Movement|People&nbsp;With AIDS Self-Empowerment&nbsp;Movement]]{{·}} [[:Category:HIV-positive fictional characters|HIV&ndash;positive fictional&nbsp;characters]]
 
|group4 = {{nowrap|[[AIDS pandemic]] in}}
|list4  = [[HIV/AIDS in Africa|Sub-Saharan Africa]]&nbsp;<small>([[HIV/AIDS in South Africa|in South&nbsp;Africa]]&nbsp;• [[HIV/AIDS in Uganda|Uganda]])</small>{{·}} [[HIV/AIDS in Asia|Asia]]&nbsp;<small>([[HIV/AIDS in China|in&nbsp;China]]&nbsp;• [[HIV/AIDS in India|India]]&nbsp;• [[HIV/AIDS in Myanmar|Myanmar]]&nbsp;• [[HIV/AIDS in Pakistan|Pakistan]]&nbsp;• [[HIV/AIDS in Taiwan|Taiwan]]&nbsp;• [[HIV/AIDS in Japan|Japan]])</small>{{·}} {{nowrap|[[HIV/AIDS in Latin America|in Latin America]]}}&nbsp;<small>([[HIV/AIDS in Brazil|in&nbsp;Brazil]])</small>{{·}} [[HIV/AIDS in the Caribbean|Caribbean]]{{·}} [[HIV/AIDS in Eastern Europe and Central Asia|Eastern&nbsp;Europe&nbsp;and Central&nbsp;Asia]] <small>([[HIV/AIDS in Russia|in Russia]]</small>){{·}} [[HIV/AIDS in Western Europe|Western&nbsp;Europe]]{{·}} [[HIV/AIDS in the United States|United&nbsp;States]]{{·}} [[List of countries by HIV/AIDS adult prevalence rate|List&nbsp;of countries&nbsp;by HIV/AIDS adult prevalence&nbsp;rate]]
 
}}<noinclude>
 
 
<!--Categories-->
[[Category:HIV/AIDS|{{PAGENAME}}]]
[[Category:LGBT-related navigation templates|{{PAGENAME}}]]
 
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</noinclude>
 
 
===== References =====
http://en.wikipedia.org/wiki/Acquired_Immune_Deficiency_Syndrome#Prevention
 


==References==
==Related Chapters==
{{reflist|3}}
* [[HIV infection in infants|HIV Infection in Infants]]
* [[HIV infected adolescents|HIV Infected Adolescents]]
* [[AIDS defining clinical condition|AIDS defining Clinical Condition]]
* [[AIDS dementia complex|AIDS Dementia Complex]]
* [[AIDS-related lymphoma|AIDS-related Lymphoma]]
* [[AIDS education and training centers|AIDS Education and Training Centers]]
* [[AIDS-related complex|AIDS-related Complex]]
*[[HIV pediatric classification system]]
*[[HIV and AIDS misconceptions]]
*[[Criminal transmission of HIV]]


==Further reading==
==Further Reading==
*{{cite web
*{{cite web
|url=http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf
|url=http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf
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}}
}}


==External links==
==External Links==
* {{Dmoz|Health/Conditions_and_Diseases/Immune_Disorders/Immune_Deficiency/AIDS/|HIV/AIDS}}
* {{cite web
|url=http://aidsinfo.nih.gov/
|title=AIDSinfo - HIV/AIDS Treatment Information
|accessdate=2008-03-21
|publisher=US Department of Health and Human Services
|format=
|work=
}}
* {{cite web
* {{cite web
|url=http://www.unaids.org/en/
|url=http://www.unaids.org/en/
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|work=
}}
}}
{{AIDS}}
 
{{Viral diseases}}
[[AIDS#top|back to top]]
{{STD/STI}}
 
{{WH}}
{{WS}}


[[Category:HIV/AIDS]]
[[Category:HIV/AIDS]]
[[Category:Disease]]
[[Category:Immune system disorders]]
[[Category:Immune system disorders]]
[[Category:Infectious disease]]
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[[Category:AIDS origin hypotheses]]
[[Category:AIDS origin hypotheses]]
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[[Category:Medical disasters]]
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[[Category:Immunodeficiency]]
[[Category:Microbiology]]
[[Category:Microbiology]]
[[Category:Overview complete]]
[[Category:Emergency mdicine]]
 
[[Category:Up-To-Date]]
{{Link FA|he}}
[[Category:Infectious disease]]
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[[af:Vigs]]
[[als:AIDS]]
[[am:ኤድስ]]
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[[ar:متلازمة العوز المناعي المكتسب]]
[[ast:SIDA]]
[[az:QİÇS]]
[[bat-smg:AIDS]]
[[be-x-old:СНІД]]
[[bg:Синдром на придобитата имунна недостатъчност]]
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[[es:SIDA]]
[[et:AIDS]]
[[eu:Hartutako Immuno Eskasiaren Sindromea]]
[[fa:ایدز]]
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[[fr:Syndrome d'immunodéficience acquise]]
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[[gd:AIDS]]
[[gl:SIDA]]
[[gu:એડ્સ]]
[[he:איידס]]
[[hi:एड्स]]
[[hr:Sindrom stečene imunodeficijencije]]
[[ht:Sida]]
[[hu:AIDS]]
[[hy:ՁԻԱՀ]]
[[id:AIDS]]
[[is:Alnæmi]]
[[it:AIDS]]
[[ja:後天性免疫不全症候群]]
[[ka:შიდსი]]
[[ki:AIDS]]
[[km:ជំងឺអេដស៍]]
[[kn:ಏಡ್ಸ್ ರೋಗ]]
[[ko:에이즈]]
[[ku:AIDS]]
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[[pl:Zespół nabytego niedoboru odporności]]
[[ps:اېډز]]
[[pt:Síndrome da imunodeficiência adquirida]]
[[qu:Unquy hark'aypa chaskisqa waqlliynin]]
[[ro:SIDA]]
[[ru:Синдром приобретённого иммунного дефицита]]
[[scn:AIDS]]
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[[simple:AIDS]]
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[[sw:Ukimwi]]
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[[zh:艾滋病]]
[[zh-min-nan:AIDS]]
[[zh-yue:愛滋病]]
 
 
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Latest revision as of 01:05, 15 June 2021

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This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Human Immunodeficiency Virus (HIV).

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] "Carla Vorsatz, M.D.[2]"; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [3], Ammu Susheela, M.D. [4], Jesus Rosario Hernandez, M.D. [5], Tarek Nafee, M.D. [6], Marjan Khan M.B.B.S.[7], Mohamed Riad, M.D.[8]

List of abbreviations used in this article

AIDS: Acquired immune deficiency syndrome
HIV: Human immunodeficiency virus
CD4+: T helper cells
CCR5: Chemokine (C-C motif) receptor 5
CDC: Centers for Disease Control and Prevention
WHO: World Health Organization
PCP: Pneumocystis pneumonia
TB: Tuberculosis
MTCT: Mother-to-child transmission
HAART: Highly active antiretroviral therapy
STI/STD: Sexually transmitted infection/disease

Synonyms and keywords: Acquired immunodeficiency syndrome; acquired immune deficiency syndrome

Overview

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History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography

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Medical Therapy | Nutrition | Drug-resistant | Surgery | Primary Prevention | | Secondary Prevention | Cost-Effectiveness of therapy | Future or Investigational Therapies

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Related Chapters

Further Reading

  • "2007 AIDS epidemic update" (pdf). UNAIDS. Retrieved 2008-03-21.
  • "UNAIDS Annual Report - Making the money work" (pdf). UNAIDS. Retrieved 2008-03-21.
  • "Financial Resources Required to Achieve, Universal Access to HIV Prevention, Treatment Care and Support" (pdf). UNAIDS. Retrieved 2008-03-21.
  • "Practical Guidelines for Intensifying HIV Prevention" (pdf). UNAIDS. Retrieved 2008-03-21.
  • "Antiretroviral Formulations" (pdf). US Department of Health and Human Services. Retrieved 2008-03-21.
  • "Approved Medications to Treat HIV Infection" (pdf). US Department of Health and Human Services. Retrieved 2008-03-21.
  • "The HIV Life Cycle" (pdf). US Department of Health and Human Services. Retrieved 2008-03-21.

External Links

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