Talk:HIV

Pathophysiology

I wonder if the section on "Pathophysiology" could do with some rearranging and some extra information.

The first three subsections, "Sexual", "Blood or Blood Product" and "Mother to Child" would seem to me to belong under a different subheading - say "Transmission", and the subsection on "Genetic Variability" also probably belongs elsewhere.

The subsections "Structure and genome", "Tropism", and "Replication Cycle" are clear and informative and make an excellent start to the topic of the pathophysiology associated with HIV infection, but apart from a single sentence in the third paragraph of the article's introduction, there is nothing to follow about the mechanisms of CD4+ depletion and related phenomena. There is a "Pathophysiology" section in the AIDS article which attempts this, but it is currently marked for cleanup.

Thoughts? On A Leash (talk) 04:18, 18 November 2010 (UTC)

Can human work job and if he is HIV infected?

Does human can work at job if he is HIV infected and if he have AIDS? —Preceding unsigned comment added by 84.240.9.58 (talk) 12:17, 3 December 2010 (UTC)

Yes. Given modern treatment options, many HIV+ people are able to continue working for years. Also, since HIV is not communicable through air or skin contact, there is no health risk to having an HIV+ person in a workspace. This isn't, generally, the proper forum for such questions, however. Mr. G. Williams (talk) 11:11, 15 December 2010 (UTC)

It would be interesting to note that in some professions there are restrictions, like working as a dental doctor in UK —Preceding unsigned comment added by 85.219.24.75 (talk) 17:51, 26 February 2011 (UTC)

Evidence of cure

I did a Ctrl+F for "stem cell" in both the article and this talk page, and I was surprised to find no matches. If you guys haven't seen it already, it may be worth taking a look at the following recent journal article:

http://bloodjournal.hematologylibrary.org/cgi/content/abstract/blood-2010-09-309591v1

It may be too soon to incorporate into the article, but it's definitely worth keeping an eye on. --Cryptic C62 · Talk 03:52, 15 December 2010 (UTC)

In is now in the research section. Doc James (talk · contribs · email) 07:32, 15 December 2010 (UTC)

Treatment

Long term evidence of viable cure though bone marrow transplants albeit a risky and complicated procedure. In the journal Blood[1}, the doctors from the Charite University Hospital, Berlin say their findings "strongly suggest that cure of HIV has been achieved" in their patient. Fell free to reference source a journal quote and word appropriately

First accounts 2008

http://www.usatoday.com/news/health/2008-11-12-aids-cure_N.htm

http://www.foxnews.com/story/0,2933,451091,00.html

http://www.cbsnews.com/stories/2008/11/12/health/main4597542.shtml

End 2010 accounts

http://www.americanchronicle.com/articles/view/151468

http://uk.health.lifestyle.yahoo.net/Leukaemia-treatment-cures-man-of-HIV.htm

92.233.71.47 (talk) 18:17, 15 December 2010 (UTC)

As a single-subject study with no replication to date (I assume) you can't really say much. If this turns into a standard treatment then it should definitely be integrated. As is I'm not sure this is worth noting - depends in fair part on the reaction of the community. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:10, 17 December 2010 (UTC)

Hold on.. A man is cured from leukaemia and HIV in 2007, and 3,5 years later is still HIV negative without any medication, gets declared as the first person in human history who's ever been cured from HIV and you're not sure if it's worth mentioning? Ooookay........ --95.236.2.236 (talk) 12:51, 17 December 2010 (UTC)

See [2], the journal article was already on the page and actually forms a substantial section. Whether it's a realistic solution and cure (you'd have to wipe out the bone marrow of every HIV patient, it's possible the cure is worse than the disease) will have to be answered after more research. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:44, 17 December 2010 (UTC)

Agree with WLU, though i might go further. Single cases don't make for good medical evidence about a virus / diease in general, let alone encyclopedia entries. hamiltonstone (talk) 09:50, 18 December 2010 (UTC)

We do not know if this is a cure until we determine that it works in a number of people. We mention it in the section on research where it should be mentioned. Doc James (talk · contribs · email) 10:11, 18 December 2010 (UTC)

The way it's worded its an old paraphrasing of the source "in 2007 as part of a treatment for leukemia it appears that a persons HIV infection may have been cured." Can we deny that was the cure now it's been so long, even if it stays in the same section? 92.233.71.47 (talk) 22:16, 19 December 2010 (UTC)

Given the extrordinary circumstances required for this "cure" to work (must develop leukemia; must survive chemotherapy's 30% kill rate; must find a compatible bone marrow donor; donor must lack a specific CD4 surface antigen for the specific type of HIV the patient is infected with; bone marrow can't be rejected; patient can't die of leukemia) it's not something we can do much more than note in a brief article. In fact, I've updated the text to eliminate the perception that the procedure has been performed twice, based on the authors I'm guessing it's only happened once. I don't have access to the full texts of the articles used, so I can't give a full and detailed listing of the limitations of the potential treatment. If someone with full access would be willing to do so, that'd be great (or, you could e-mail me and I might get around to doing it). WLU (t) (c) Wikipedia's rules:^simple/_complex 20:43, 20 December 2010 (UTC)

Infection rate chart

This article used to have an excellent chart showing infection rates per act for different types of act with an HIV-positive partner (childbirth, blood transfusion, receptive/insertive oral/anal/vaginal sex) It was deleted on September 20, 2010 in the revision http://en.wikipedia.org/w/index.php?title=HIV&diff=385922353&oldid=385604169 with apparently no discussion. There was a pretty detailed discussion back in March, after which the table was kept (http://en.wikipedia.org/wiki/Talk:HIV/Archive_6#HIV_Risk_Table). Can we have the table restored, or at the very least discuss the possibility? The table was useful, and the edit summary for its deletion smacks of ignorance and politics ("Got rid of infection rate chart with a vengeance. You can't just stick random numbers from different studies. Or have more than 10,000 infections per 10,000 exposures."). 208.118.42.158 (talk) 08:01, 31 December 2010 (UTC)

Yes, I had concerns about the disappearance of this table, but didn't get around to looking at it again. My suggestion is to reinstate it and hunt through it for an error that is implied by the last comment in the edit summary. Agree that of course, provided sources are given, the very point of the table is to aggregate "numbers from different studies". I don't think there was anything random about it. Other views? hamiltonstone (talk) 03:37, 1 January 2011 (UTC)

I'm pretty sure the guy just misinterpreted the table, thinking that the table was supposed to be the fraction of every 10,000 infections that came from each infection vector. That's the only way I was able to make sense of it. 208.118.42.158 (talk) 10:18, 1 January 2011 (UTC)

I concur that User:Erc most likely misinterpreted the table, but will message him/her to confirm. Adrian J. Hunter^{(talk•contribs)} 10:36, 2 January 2011 (UTC)

I haven't followed wiki in a while, especially the bureaucratic side of things for ages. Or article making/writing/editing. Having said that, I remember (and follow) WP:BOLD and WP:IAR and construe them pretty liberally. To give some background for my actions, it appeared to me that the chart was severely malformed. Not having the time, interest, or expertise, I thought that not having bad information was superior to having badly formed/misleading information. Having looked over the chart again, it does make sense to me now, even though it was (apparently) profoundly unclear when I deleted it over three months ago. While I do think I should have probably took a little longer to reflect on the chart before deletion, I think that the fact that it went unnoticed/unactioned for over 3 months is a good indicator that there was no caretaker for the article, and I prefer a proactive stance to these things, so I don't have much regret for my actions, as much consternation as it seems to have caused. Finally, two more notes: I resent the statement that I edited out of "ignorance and politics". Perhaps ignorance in the true, neutral sense of the word, but not the colloquial implication. Secondly, I do hope the graph is better formatted, per the comments below erc ^{talk/contribs} 09:59, 6 January 2011 (UTC)

I remember that table. I thought it was interesting and extremely useful and informative. I say reinstate it. —Stephen (talk) 13:54, 1 January 2011 (UTC)

I was the one that posted a couple of days ago about the chart. I never meant for it to be taken down however as it is very informative and useful. I did suggest that it be altered so that it be more clear that the oral sex figures are only for those performed on men. As there are two figures for oral sex, unless you very carefully look at the table you will assume one is for when performed on a woman and the other a man but the two figures were both on a man and one was insertive the other receptive. My suggestion was simply that the box be extended to show stats of transmission rates when performed on a women and that, if those stats are unavailable, the box still be there reading 'N/A' or '--'. I did think the table is more helpful than not but just easily misinterpretable hence my suggestion for an alteration, not a deletion. — Preceding unsigned comment added by SomeUser5050 (talk • contribs) 17:14, 1 January 2011 (UTC)

(The post SomeUser5050 is referring to is here at Talk:AIDS.) Adrian J. Hunter^{(talk•contribs)} 12:15, 5 January 2011 (UTC)

I also remember the deletion of the table and was surprised no-one challenged it... I guess I should have been bold and done so myself. Originally the table was not at all random but based entirely on this table from a high-quality 2005 source. Over time additional sources and statistics were added, which I think is worthwhile but needs to be done with care to choose excellent sources. I've reproduced the table below, and indicated a suggested change which I think addresses SomeUser5050's concerns. Adrian J. Hunter^{(talk•contribs)} 10:36, 2 January 2011 (UTC)

If perfect clarity is the goal, the terms in question should be: [1] risk to a man receiving a blow-job and [2] risk of giving a blow-job to a man. If a compromise between clarity and "sounding scientific" is desired, the terms would be [1] risk to a man being fellated and [2] risk of fellating a man. A term like "penile-oral intercourse" has to be avoided because it includes the word "intercourse" which will suggest something else to most people and cause at least momentary confusion. No normal human being would use the term "penile-oral intercourse" unless (as in a clinical paper) they are deathly afraid of speaking plainly. - Nunh-huh 20:53, 2 January 2011 (UTC)

Yes, I take your point; I was following the pattern of the lines above, but a Google search shows that you are right. Also, I think it's better to avoid the terms "receptive" or "receive" with regard to oral sex, as typical medical use (receive sexual fluid) clashes with common use (receive pleasure). I've edited the table below per your suggestion. Adrian J. Hunter^{(talk•contribs)} 12:15, 5 January 2011 (UTC)

Estimated per-act risk for acquisition of HIV by exposure route

Exposure Route	Estimated infections per 10,000 exposures to an infected source
Blood transfusion	9,000
Childbirth	2,500
Needle-sharing injection drug use	67
Percutaneous needle stick	30
Receptive anal intercourse (2009 and 2010 studies)	170‡ [30-890] / 143 [48-285]
Receptive anal intercourse (based on data of a 1992 study)	50
Insertive anal intercourse for uncircumcised men (2010 study)	62a [7-168]
Insertive anal intercourse for circumcised men (2010 study)	11a [2-24]
Insertive anal intercourse (based on data of a 1992 study)	6.5
Low-income country female-to-male	38‡ [13-110]
Low-income country male-to-female	30‡ [14-63]
Receptive penile-vaginal intercourse	10
Insertive penile-vaginal intercourse	5
Receptive oral intercourse (performed on a man) Receptive penile-oral intercourse Fellating a man	1†b
Insertive oral intercourse (by a man) Insertive penile-oral intercourse Man being fellated	0.5†b
The data shown represents the rate of transmission when condoms were not used. Note that risk rates may change due to other factors such as commercial sex exposure, phase of HIV infection, presence or history of genital ulcers, and national income levels.
Bracketed values represent 95% confidence interval † "best-guess estimate" ‡ Pooled transmission probability estimate
a Other studies found insufficient evidence that male circumcision protects against HIV infection among men who have sex with men
b Oral trauma, sores, inflammation, concomitant sexually transmitted infections, ejaculation in the mouth, and systemic immune suppression may increase HIV transmission rate.

References

I think this table needs to be better formatted. I think a tree-like structure would help it immensely - the main rows would be along the lines of "vaginal intercourse", "anal intercourse", "oral ", etc., and each would be divided up like "receptive"/"insertive" for the first two and "receptive (female)", "insertive (male)", etc. for oral sex. "Oral sex" could instead be "fellatio" and "cunnilingus", if that's better. It wouldn't increase the width of the table unduly, but I think it would help immensely - the table is very dense to read as it is, and I can understand if some confusion has occurred. Dividing the data by sexual act and subdividing by partner should be intuitive and reduce clutter, and we can include numbers from different studies in the right column if we want to present multiple studies. 208.118.42.158 (talk) 21:03, 2 January 2011 (UTC)

Sounds sensible to me. For now I'll restore the table per current consensus and with the oral sex descriptions re-worded, without prejudice to restructuring as 208.118.42.158 suggests. If no-one here knows advanced table formatting, perhaps someone could be found through the helpdesk? Adrian J. Hunter^{(talk•contribs)} 12:15, 5 January 2011 (UTC)

I'll read up on table formatting and post a reformatted table here as soon as I can, but in the meantime, do you mind changing the table back to float:right and putting 100px/130px width limits on the two columns? The table should be a sidebar, not this page-wide monstrosity that it was changed into right before it was deleted. —Preceding unsigned comment added by 208.118.42.158 (talk) 21:35, 5 January 2011 (UTC)

Sorry, I missed this comment at the time you made it. Apparently the old format wasn't good on some browsers; see this edit summary. Adrian J. Hunter^{(talk•contribs)} 14:12, 18 January 2011 (UTC)

I have to raise another point with this table: The reference cited for most of the values (the "study" from 2002: http://www.ncbi.nlm.nih.gov/pubmed/11773877) is not a classical study, it's just a calculation. And as a biologist myself, I can't really deduce from the paper where they got most of the values they use in their calculation. In the cases where they explicitly state how they arrive at an estimation, they insert "random" values like "10-fold lower" without explaining why it is ten. I know, this is wikipedia, and the "study" somehow got published in a journal, but I just wanted to document that this is not "good science", it's rather bad. For example, the values given for oral sex are in my opinion without any substance, because they were not taken out of the literature, but "guessed". Perhaps another scientist/wikipedian can have a look at the "study" and confirm my view. I'm hesitating to simply remove the values from the table, because they are sourced and the table obviously seems important to some editors. Opinions? --TheMaster17 (talk) 15:31, 19 January 2011 (UTC)

I appear not to have access to the full text, so cannot help with detailed examination. No, please don't remove the values without discussion here. I am not sure what you mean in saying it "is not a classical study, it's just a calculation", but the table itself is titled "Estimated...", so estimates, properly arrived at, are acceptable. The question is whether they were properly arrived at. The fact of the article's publication in a reliable source should be our main assurance that they are valid. If however there are other high quality reliable sources that appear to have superior methodologies, or are based on a more detailed analysis, then their estimates should be considered for inclusion. I would agree that it would be preferable, where possible, to cite the source studies for the data used by the article's authors, over the synthesising article itself, provided that the data was in fact data describing estimated per act risk of acquisition. Going to those original sources would also has the advantage of giving us a date for the source studies (see below).

We have had some debate here previously about what to include in the table, particularly in the event of different estimates being available. I think the principles should be:

• Remember what this table is about: estimated per act risk of acquisition. It is not intended exclusively to report retrospective analysis of acquisition, though such data usually forms the basis of the estimates in the table.
• Be extremely careful in evaluating what is being estimated or reported - different figures usually result from differing methodologies or populations. That doesn't make them invalid, just different - this is one of the reasons the table has ended up with so many lines and footnotes (it ised to be even more complicated IIRC).
• Prefer those published in medical journals to those published in other sources
• Prefer the more recent of two publications
• Prefer global or wide-sample studies to local, national or small-sample studies
• Report more than one result in one line of the table, if there are two differing figures that use broadly the same methodologies, are of a similar age, in similar-status publications, and where there is no analysis published in a reliable source that explicitly explanis why one is to be preferred over the other.

I hope this helps. hamiltonstone (talk) 00:23, 20 January 2011 (UTC)

I know those rules, and I agree that they are reasonable. And don't worry, I wont't delete anything without consensus, this is why I posted my comment on the talk page. I think the problem in this case is that I don't understand how the authors could publish a "study" like this. The referees must have been blind. Just as an example, that really blew my mind, the authors state that the risk of infection during oral sex is generally considered much lower than during vaginal intercourse (a true and traceable statement), and from this they deduce the introduction of a factor of 10 in their estimation formula, basically setting the risk 10fold lower than the risk of vaginal sex. Is this an accepted technique of estimating a value in the respective literature? I'm not really working in epidemiology, but I would think a scientific approach would at least need to name reasons for the number 10, because much lower could also mean 100fold, or 1000thousand fold. And then, in their results (and our table), they/we just put all these numbers next to each other, although some include "magic numbers", and others are really derived from a calculation with sourced values (from observations)... In my opinion, a table with estimates here on wikipedia should not be composed of guessed values! But I know I'm probably fighting a lost battle here, because published means published, and if we start to differentiate according to our opinion, constructive discussions are impossible... How about at least marking the dubious values as such? --TheMaster17 (talk) 10:09, 20 January 2011 (UTC)

Do you mean dubious in *our* opinion, or dubious based on a reliable source's analysis? -- Scray (talk) 13:35, 20 January 2011 (UTC)

You both have a point. Scray is right, that the key to these judgements lies in the published literature rather than our own opinions. But we can exercise discretion provided we have a foundation for it. For example, if there is a published paper on the transmission risk from oral sex, and it is based on empirical research, we should generally favour that result over one that is an estimate based on other data. These sorts of judgements are ones we do need to make: "published means published" yes, but once there are two or more published accounts, we can and do have discussions about how to weigh these up. Any chance of you having a hunt for other published results on these transmission paths? Regards, hamiltonstone (talk) 22:41, 20 January 2011 (UTC)

Edit request from Pkuzel, 9 January 2011

{{edit semi-protected}} Could you please add the following link to the list of external links at the bottom of the HIV page?

 http://www.mediviews.com/dr-ameeta-singh-hivaids-2/

This is a link to a filmed interview with Dr. Ameeta Singh, on the topic of HIV/AIDS. She is an infectious disease specialist at the University of Alberta in Edmonton, Alberta, Canada, and mediviews.com is a medical website run by medical students from this institution. Only completely unbiased, factual, evidence-based information is presented in this and all other videos on the mediviews website. Thank you!

Pkuzel (talk) 07:42, 9 January 2011 (UTC)

Comment. I would decline this request, though it is made in good faith and I have no reason to doubt both Dr Singh and the quality of the material. Please read WP:EL. We try to keep external links to a minimum: those that are added are usually only reference materials of the highest quality, have the most general coverage in relation to hte subject of the article, and represent material that for some reason cannot or should not be added as references to the text of the article itself. Thanks for your input though. hamiltonstone (talk) 09:37, 9 January 2011 (UTC)

 Not done: I agree with Hamiltonstone. I'm sure that there are many reliable doctors or other experts who have made online resources available about HIV, which probably even contain good, quality info. However, per WP:NOT and WP:EL, our goal is not to provide an exhaustive list of all good links available. Qwyrxian (talk) 11:16, 9 January 2011 (UTC)

Experimental treatments and research

The addition of experimental or speculative treatments etc goes on and on. The article will be hopelessly unwieldy, and layered with detail that obscures important points, if every medical researcher / onlooker with some exciting results gets to add them in here, on the strength that they've been published in a peer-reviewed journal. My impulse is to be ruthless and cut all such material unless it involves drugs in actual use, or extensive coverage by other sources beyond the publication of the original medical research as well as publication in one or more of the top journals. Do other editors have a view on whether there should be some threshold(s) that must be met before material gets a spot in this vital article? hamiltonstone (talk) 11:07, 18 January 2011 (UTC)

Yes, this could be problematic. One possible solution is to move new ART agents that are not used in the clinic to treat patients, however are interesting research into the Antiretroviral drug

article, maybe we could insert a new subtitle under classes of drugs. On the HIV page a brief mention of the new drugs being developed eg. xyz is an entry inhibitor. My other concern with the treatment section is the location of latency subtitle. I'm going to suggest moving this. Aqua112233 (talk) 11:59, 18 January 2011 (UTC)

I agree with Hamiltonstone. The article should not be a catch-all for proposed treatments, and any such additions should be removed unless and until they are widely reviewed. Keepcalmandcarryon (talk) 16:49, 10 March 2011 (UTC)

I removed some of these, such as Banlec. Let's follow Hamiltonstone's suggestions for future additions. Keepcalmandcarryon (talk) 17:41, 10 March 2011 (UTC)

Latency paragraph to move?

I think that the latency paragraph in the treatment section needs to be moved. It seems out of place. One option would be to move it to the viral replication cycle. Another would to have an independent subtitle separate from the treatment. How do other editors feel about this suggestion? Aqua112233 (talk) 12:05, 18 January 2011 (UTC)

Transmission probability

While I realize that 1/10000 may be an accepted unit in medical research, percent numbers would me more useful for the average person. Please consider adding a separate column indicating percent numbers. Or what's 38/10000 again? 0.38% ist just so more intuitive and obvious. Also 2500/10000 is not as obvious as 1/4. See [[3]] for collective astonishment. --Haeikou (talk) 13:47, 18 January 2011 (UTC)

Other treatment

 Stem cell transplantation
 In 2007, a 40-year-old HIV-positive patient was given a stem cell transplant as part of his treatment for acute myelogenous leukemia    
 (AML).[153] The bone marrow used was chosen for being homozygous for a CCR5-Δ32 mutation that confers resistance to HIV infection.[154][155] 
 After 600 days without antiretroviral drug treatment, HIV levels in the person's blood, bone marrow, and bowel were below the limit of 
 detection, though it was suspected that the virus was still present in other tissues. The treatment is not considered a a possible cure 
 because of its anecdotal nature, the mortality risk associated with bone marrow transplants, and other concerns.[156]

Some new info is out about this guy, he's actually completely cured: http://www.sw-gm.com/index.php?t=6716#82961 Can I add that and his name, etc to the article? --Synethos (talk) 17:17, 21 February 2011 (UTC)

Two things: 1) that website does not meet our standards for reliable sources for medical claims, and 2) we would need significant new information, probably in the form of a review article before we give any more weight to this one method of "treatment" that is unlikely to be repeated any time soon. Yobol (talk) 17:27, 21 February 2011 (UTC)

There's enough articles here (Googled his name): http://www.google.com/#sclient=psy&hl=en&safe=off&site=&source=hp&q=Timothy+Ray+Brown&aq=f&aqi=g10&aql=&oq=&pbx=1&bav=on.1,or.&fp=b5fc6a07c812d0bf

Example: http://gizmodo.com/#!5713498/man-officially-cured-of-hiv?comment=34103725 http://www.queerty.com/is-timothy-ray-brown-the-first-man-to-be-cured-of-hiv-by-stem-cells-20101214/

Plus, they guy is mentioned in those treatments already, so some more info about it won't hurt? --Synethos (talk) 17:54, 21 February 2011 (UTC)

More info would actually probably be inappropriate, per WP:UNDUE. This is one person, with a dangerous "cure" that is unlikely to be repeated. Any more information would have to come from a top notch WP:MEDRS (such as peer reviewed journal review articles) rather than random website Google hits. Yobol (talk) 17:58, 21 February 2011 (UTC)

Ah ok, I get it. Sorry. --Synethos (talk) 18:45, 21 February 2011 (UTC)

No need to apologize, understanding the multitude of policies and guidelines when first starting out can be difficult. Yobol (talk) 18:52, 21 February 2011 (UTC)

This is a very important development, but as Yobol notes, this is one case and it would be unacceptably risky to perform a bone marrow transplant that wasn't medically necessary. Furthermore, it will be impossible to confirm a complete cure until potential reservoir tissues can be examined, and that couldn't occur until the end of what I hope is a long and healthy life for this man. The term "functional cure" has been tossed about, though, and if insights from this case lead to new therapies that don't require transplants, the article eventually will be expanded. Keepcalmandcarryon (talk) 19:52, 21 February 2011 (UTC)

• Here is the scientific reference you should site if you are going to include this case study.

Allers K, Hütter G, Hofmann J; et al. (2010). "Evidence for the cure of HIV infection by CCR5{Delta}32/{Delta}32 stem cell transplantation". Blood. doi:10.1182/blood-2010-09-309591. PMID 21148083. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Aqua112233 (talk) 09:32, 24 February 2011 (UTC)

SERIOUS PROBLEMS IN THE STUDIES

Most of the studies were made with people already in treatment (of course, its hard to find people before they begin treatment, when most don't even they have HIV)! When someone is doing the treatment the virus drop to LESS THAN 50 COPIES PER MILILITER. But when someone didn't begin the treatment often they have MORE THAN 100.000 COPIES PER MILILITER (and it can go beyond a million)! So the studies investigate mostly people who have MORE THAN 1000% LESS CHANCE to infect with HIV than the average transmissor!!! This chart needs to make this clear! Or be removed, with I prefer. EternamenteAprendiz (talk) 11:52, 6 March 2011 (UTC)

That's simply not true - this (obvious) potential pitfall was addressed. Many of the studies were done at a time/place when/where effective treatment was not yet available. Also, the essay on shouting may help you understand why over-user of capitalization will not help you make a point. -- Scray (talk) 16:54, 6 March 2011 (UTC)

Transmission, safe sex and treatment

This edit was an interesting change, but I'm not sure the sources support the assertion that refusal to practice safe sex or take ART is responsible for significant HIV transmission. It would seem that lack of knowledge about one's HIV status, lack of awareness and education and availability of treatment are more influential factors than personal decisions. In addition, the relationship of viral load and transmission risk is more complicated than it may at first appear, remaining somewhat controversial even in the literature. Let's discuss these proposed changes and agree on how and if to change the current language. Keepcalmandcarryon (talk) 22:25, 9 March 2011 (UTC)

I will reword the portion of text you object to. --I am 51% Vulcan, 49% Klingon. Don’t push it. 100px 22:39, 9 March 2011 (UTC) — Preceding unsigned comment added by MuzeMarc (talk • contribs)

Let's discuss your proposed changes and agree on sources and wording first. Thanks. Keepcalmandcarryon (talk) 01:57, 10 March 2011 (UTC)

• The last three sentances in the treatment section are worded as:

"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. Unfortunately, only a vaccine is thought to be able to halt the pandemic. This is because a vaccine would cost less, thus being affordable for developing countries, and would not require daily treatment. However, after over 20 years of research, HIV-1 remains a difficult target for a vaccine."

since this material is research related, it should be moved to the research section. It is also out of date. --I am 51% Vulcan, 49% Klingon. Don’t push it. 100px 02:14, 10 March 2011 (UTC) — Preceding unsigned comment added by MuzeMarc (talk • contribs)

• Two studies [4] have confirmed predictions that the life expectancy of gay men who begin treatment early in the course of infection (and attain and undetectible viral load)have normal life expectancies. These results have not been replicated for women (probably because of poor resolving power of the research)or IV drug abusers (probably because they do not have normal life expectancies). This matirial belongs at the end of the sixth paragraph of the treatment section. --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 02:35, 10 March 2011 (UTC)
• The claim "However, HAART sometimes achieves far less than optimal results, in some circumstances being effective in less than fifty percent of patients" was true 20 years ago. This is 2011, not 1991. --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 02:56, 10 March 2011 (UTC)
• The claim "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 contribute to this problem" is "supported" by three citations, the most reasent of which is nine years old. Modern combination therapy is a once a day regumen which can be taken with or without food and has few side affects. (Tenofovir, the back-bone of the current state-of-the-art regumen still should not be taken with a number of other drugs including: ddI, d4T, and AZT. --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 03:15, 10 March 2011 (UTC))
• Lipodystrophy is caused by drugs which inhibit adipose mitochondrial DNA synthesis (d4T > ddI > AZT). These drugs are not components of modern therapies. --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 03:22, 10 March 2011 (UTC)
• Some commonly used drug combinations cause kidney diesease. --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 03:27, 10 March 2011 (UTC)

Muze, you're making some good points, and others that seem to reflect misunderstandings of the literature. For example, AZT, ddI and d4T are components of several combination therapies. I completely agree with you that there are many updates to be made, but confrontational remarks ("this is 2011, not 1991") and inaccurate statements are unlikely to facilitate this goal. Keepcalmandcarryon (talk) 03:35, 10 March 2011 (UTC)

The Antiretroviral drug page lists several state-of-the-art fixed dose combinations, none of which contain AZT, ddI or d4T. All of these combinations contain tenofovir. Tenofovir should not be used in combination with AZT, ddI or d4T due to enhanced nephrotoxicity. Once a day dosing is the current fashion though I admit to still using a TID regumen (if it ain't broke, I don't believe in fixing it.) This is 2011. What year do you think it is? --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 04:00, 10 March 2011 (UTC)

• In San Fransisco, treatment for HIV infection is now initiated imediately regardless of CD4 count. [5] --100px I am 51% Vulcan, 49% Klingon. Don’t push it. (talk) 04:10, 10 March 2011 (UTC)

AZT, ddI and d4T are used in several available combination meds, and many combinations are available that do not contain PMPA. Keepcalmandcarryon (talk) 05:25, 10 March 2011 (UTC)

Update request

In the section above, MuzeMarc comments on the current state of the article. Although the reliable sources don't support all of the editor's statements, MuzeMarc is certainly correct that the article could use a good updating. There's nothing that's necessarily wrong with a primary article from, say, 1997, but most likely much progress has been made and many secondary sources written in the interim. If not, it's probably time to reconsider our inclusion of that 1997 publication. Is anyone willing to join me in a line-by-line review of the article and sources in the near future? Keepcalmandcarryon (talk) 16:46, 10 March 2011 (UTC)