HIV/AIDS
HIV/AIDS | |
---|---|
Specialty | Infectious diseases ![]() |
List of abbreviations used in this article AIDS: Acquired immune deficiency syndrome |
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) in humans,[1] and similar viruses in other species (SIV, FIV, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to decelerate the virus's progression, there is currently no known cure. HIV, et al., are transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.[2][3] This transmission can come in the form of anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids.
Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century;[4] it is now a pandemic, with an estimated 33.2 million people now living with the disease worldwide.[5] As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981, making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, of which more than 570,000 were children.[6] A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth and destroying human capital. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.[7] AIDS death toll in Africa may reach 90-100 million by 2025.[8][9]
HIV/AIDS stigma is more severe than that associated with other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.
Infection by HIV
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/HIV-budding.jpg/300px-HIV-budding.jpg)
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 CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells.[10] CD4+ T cells are required for the proper functioning of the immune system. When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ 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.[11][12][13] 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+ T cells in the blood, and/or the presence of certain infections, as noted above.
In the absence of antiretroviral therapy, the median 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.[14] However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 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.[15][16] 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.[14][17][18] The infected person's 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 strains of HIV.[19] HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.[20][21][22] The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.
Diagnosis
Since June 5, 1981, many definitions have been developed for 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 (CDC) Classification System is used.
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.[23] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.
- Stage I: HIV infection is asymptomatic and not categorized as AIDS
- Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
- Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
- Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.
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.[24][25] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.[26] In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined.[27] However, after determining that AIDS was not isolated to the homosexual community,[26] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.[28] By September 1982 the CDC started using the name AIDS, and properly defined the illness.[29] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes.[30] 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+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.
HIV test
Many people are unaware that they are infected with HIV.[31] 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.[31] Therefore, donor blood and blood products used in medicine and medical research are screened for HIV. Typical HIV tests, including the HIV enzyme immunoassay and the Western blot assay, detect HIV antibodies in serum, plasma, oral fluid, dried blood spot or urine of patients. However, the window period (the time between initial infection and the development of detectable antibodies against the infection) can vary. This is why it can take 3–6 months to seroconvert and test positive. Commercially available tests to detect other HIV antigens, HIV-RNA, and HIV-DNA in order to detect HIV infection prior to the development of detectable antibodies are available. For the diagnosis of HIV infection these assays are not specifically approved, but are nonetheless routinely used in developed countries.
Symptoms and complications
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Hiv-timecourse.png/450px-Hiv-timecourse.png)
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.[32] HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas.
Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.[33][34] After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy (as of 2005) is estimated to be more than 5 years,[35] but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year.[14] Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[36]
The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function[15][16][19] health care and co-infections,[14][36] as well as factors relating to the viral strain.[21][37][38] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.
Major pulmonary illnesses
![](http://upload.wikimedia.org/wikipedia/commons/thumb/7/74/PCPxray.jpg/150px-PCPxray.jpg)
- Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii. Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL.[39]
- Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[40] Alternatively, symptoms may relate more to the site of extrapulmonary involvement.
Major gastro-intestinal illnesses
- Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.[41]
- Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria, Campylobacter, or Escherichia coli) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) colitis. In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.[42]
Major neurological illnesses
- Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain causing toxoplasma encephalitis but it can infect and cause disease in the eyes and lungs.[43]
- Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.[44]
- AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia which secrete neurotoxins of both host and viral origin.[45] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 10–20% in Western countries[46] but only 1–2% of HIV infections in India.[47][48] This difference is possibly due to the HIV subtype in India.
- Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.
Major HIV-associated malignancies
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/3c/Kaposi%27s_Sarcoma.jpg/150px-Kaposi%27s_Sarcoma.jpg)
Patients with HIV infection have substantially increased incidence of several malignant cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).[49][50] The following confer a diagnosis of AIDS when they occur in an HIV-infected person.
- Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
- High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
- Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).
In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as Hodgkin's disease and anal and rectal carcinomas. However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.[51]
Other opportunistic infections
AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.[52]
Transmission and prevention
Exposure Route | Estimated infections per 10,000 exposures to an infected source | |||
---|---|---|---|---|
Blood Transfusion | 9,000[54] | |||
Childbirth | 2,500[55] | |||
Needle-sharing injection drug use | 67[56] | |||
Percutaneous needle stick | 30[57] | |||
Receptive anal intercourse* | 50[58][59] | |||
Insertive anal intercourse* | 6.5[58][59] | |||
Receptive penile-vaginal intercourse* | 10[58][59][60] | |||
Insertive penile-vaginal intercourse* | 5[58][59] | |||
Receptive oral intercourse* | 1[59]§ | |||
Insertive oral intercourse* | 0.5[59]§ | |||
* assuming no condom use § source refers to oral intercourse 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.[61]
Sexual contact
The majority of HIV infections are acquired through unprotected sexual 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.[62][63][64] Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oral mucous membranes 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.[65] 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 gallons of saliva from a carrier to run a significant risk of becoming infected.[66]
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.[67] 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.[68]
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 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, Chlamydial infection and trichomoniasis which cause local accumulations of lymphocytes and macrophages.[69]
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.[69][70] 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.[71][72] People who are infected with HIV can still be infected by other, more virulent strains.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Condoms.jpg/200px-Condoms.jpg)
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.[73] 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.[74] 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.[75] 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,[76] and abstinence-only programs have been unsuccessful in the United States both in changing sexual behavior and in reducing HIV transmission.[77] 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.[78] 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 porous. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms.[79] 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 — 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.[80]
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.[81]
The United States government and 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, more has been done than just this. As Edward Green, a Harvard medical anthropologist, put it, "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." However, criticism of the ABC approach is widespread because a faithful partner of an unfaithful partner is at risk of contracting HIV and that discrimination against women and girls is so great that they are without voice in almost every area of their lives.[82] Other programs and initiatives promote condom use more heavily. Condom use is an integral part of 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.
In December 2006, the last of three large, 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.[83] 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.[84]
Exposure to infected body fluids
This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes 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 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce that small risk.[85] 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.[86] 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.[87] Drug abuse has an additional effect of an increased tendency to engage in unprotected sexual intercourse [88].
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 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".[89]
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.
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 sites. Additionally, many nations have decriminalized needle possession and made it possible to buy injection equipment from pharmacists without a prescription.
Mother-to-child transmission (MTCT)
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%.[55] 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 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding.
Studies have shown that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child.[90] 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.[6] In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa.[91] Of the children currently living with HIV, 2 million (almost 90%) live in sub-Saharan Africa.[6]
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.[92] However, transmission of HIV between intravenous drug users has clearly decreased, and HIV transmission by blood transfusion has become quite rare in developed countries.
Treatment
- See also HIV Treatment and Antiretroviral drug.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Abacavir_%28Ziagen%29_300mg.jpg/100px-Abacavir_%28Ziagen%29_300mg.jpg)
There is currently no 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).[85] PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including diarrhea, malaise, nausea and fatigue.[93]
Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.[94] This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available.[7] 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 inhibitors (NARTIs or NRTIs) plus either a 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.[95] 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.[96]
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.[97][98] Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.[99] 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.[100][101][102] 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 months.[14] HAART is thought to increase survival time by between 4 and 12 years.[103][104] This average reflects the fact that for some patients — and in many clinical cohorts this may be more than fifty percent of patients — 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.[105] 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.[106][107][108] The side effects include lipodystrophy, dyslipidaemia, insulin resistance, an increase in cardiovascular risks and birth defects.[109][110]
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.[111] Some individual nutrients have also been tried.[112][113] 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.[114] 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.[114] However, after over 20 years of research, HIV-1 remains a difficult target for a vaccine.[114]
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.[115] 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.[93]
Various forms of alternative medicine have been tried to treat symptoms or alter the course of the disease.[116] 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,[117][118] and acupuncture;[116] 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.[119]
Epidemiology
![](http://upload.wikimedia.org/wikipedia/commons/thumb/d/d7/HIV_Epidem.png/290px-HIV_Epidem.png)
UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 2.8 million (between 2.4 and 3.3 million) lives in 2005 of which more than half a million (570,000) were children.[6]
Globally, between 33.4 and 46 million people currently live with HIV.[6] In 2005, between 3.4 and 6.2 million people were newly infected and between 2.4 and 3.3 million people with AIDS died, an increase from 2003 and the highest number since 1981.[6]
Sub-Saharan Africa remains by far the worst affected region, with an estimated 21.6 to 27.4 million people currently living with HIV. Two million [1.5–3.0 million] of them are children younger than 15 years of age. More than 64% of all people living with HIV are in sub-Saharan Africa, as are more than three quarters (76%) of all women living with HIV. In 2005, there were 12.0 million [10.6–13.6 million] AIDS orphans living in sub-Saharan Africa 2005.[6] South Africa has the largest population of HIV patients in the world, followed by Nigeria.[120] South & South East Asia are second worst affected with 15%. AIDS accounts for the deaths of 500,000 children in this region. India has an estimated 2.5 million infections (0.02% of population) making it the country with the third highest number of HIV infections in the world. In the 35 African nations with the highest prevalence, average life expectancy is 48.3 years— 6.5 years less than it would be without the disease.[121]
The latest evaluation report of the World Bank's Operations Evaluation Department assesses the effectiveness of the World Bank's country-level HIV/AIDS assistance, defined as policy dialogue, analytic work, and lending, with the explicit objective of reducing the scope or impact of the AIDS epidemic.[122] This is the first comprehensive evaluation of the World Bank's HIV/AIDS support to countries, from the beginning of the epidemic through mid-2004. Because the Bank's assistance is for implementation of government programs by government, it provides important insights on how national AIDS programs can be made more effective.
The development of HAART as effective therapy for HIV infection and AIDS has substantially reduced the death rate from this disease in those areas where it is widely available. This has created the misperception that the disease has gone away. In fact, as the life expectancy of persons with AIDS has increased in countries where HAART is widely used, the number of persons living with AIDS has increased substantially. In the United States, the number of persons with AIDS increased from about 35,000 in 1988 to over 220,000 in 1996.
In Africa, the number of MTCT and the prevalence of AIDS is beginning to reverse decades of steady progress in child survival. 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.
Economic impact
![](http://upload.wikimedia.org/wikipedia/commons/thumb/5/50/Life_expectancy_in_some_Southern_African_countries_1958_to_2003.png/295px-Life_expectancy_in_some_Southern_African_countries_1958_to_2003.png)
HIV and AIDS retard economic growth by destroying human capital. UNAIDS has predicted outcomes for sub-Saharan Africa to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection.[6]
Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people in these countries 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.
The increased mortality in this region will result in a smaller skilled population and labor force.[123] 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.[123] 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.
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.
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.[124] Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990–2025 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 1990–1997 with a further 0.3% per year lower in countries also affected by malaria.[125] 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.[123] However, these estimates may be an underestimate, as they do not look at the effects on output per capita.[126]
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. [127] 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.[128]
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.[129]
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 billion could avert nearly 30 million new infections by 2010.
Stigma
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.[130] 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.[131]
AIDS stigma has been further divided into the following three categories:
- Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.[132]
- Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.[132]
- Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.[133]
Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, and 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.[134] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.[132]
Those most likely to hold misconceptions about HIV transmission and to harbor HIV/AIDS stigma are less educated people and people with high levels of religiosity or conservative political ideology.[132][134][135]
- For more details on this topic, see Stigma and HIV-AIDS, A review of the literature[136]
Origin of HIV
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control and Prevention recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.[137]
Three of the earliest known instances of HIV infection are:
- A plasma sample taken in 1959 from an adult male living in Kinshasa, today part of the Democratic Republic of the Congo.[138]
- HIV found in tissue samples from "Robert R.", a 15 year old African-American teenager who died in St. Louis in 1969.[139]
- HIV found in tissue samples from Arvid Noe, a Norwegian sailor who died around 1976.[140]
Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted. HIV-1 is the source of the majority of HIV infections throughout the world, while HIV-2 is not as easily transmitted and is largely confined to West Africa.[141] Both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 is the Central Common Chimpanzee (Pan troglodytes troglodytes) found in southern Cameroon.[142] It is established that HIV-2 originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of Guinea Bissau, Gabon, and Cameroon.
Most experts believe that HIV probably transferred to humans as a result of direct contact with primates, for instance during hunting or butchery.[143] A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine.[144][145] According to scientific consensus, this scenario is not supported by the available evidence.[146][147][148]
A 2007 study published in the Proceedings of the National Academy of Sciences by Michael Worobey and Dr. Arthur Pitchenik claimed that, based on the results of genetic analysis, HIV probably moved from Africa to Haiti and then entered the United States around 1969. [149]
Alternative hypotheses
A small minority of scientists and activists question the connection between HIV and AIDS,[150] the existence of HIV itself,[151] or the validity of current testing and treatment methods. Though these claims have been examined and widely rejected by the scientific community,[152] they have had a significant political impact, particularly in South Africa, where governmental acceptance of AIDS denialism has been blamed for an ineffective response to that country's AIDS epidemic.[153][154][155]
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.[156]
Notes and references
- ^ The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome, from the U.S. National Institutes of Health. Accessed December 18 2007.
- ^ Divisions of HIV/AIDS Prevention (2003). "HIV and Its Transmission". Centers for Disease Control & Prevention. Retrieved 2006-05-23.
- ^ San Francisco AIDS Foundation (2006-04-14). "How HIV is spread". Retrieved 2006-05-23.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^
Gao, F., Bailes, E., Robertson, D. L., Chen, Y., Rodenburg, C. M., Michael, S. F., Cummins, L. B., Arthur, L. O., Peeters, M., Shaw, G. M., Sharp, P. M. and Hahn, B. H. (1999). "Origin of HIV-1 in the Chimpanzee Pan troglodytes troglodytes". Nature. 397 (6718): 436–441. doi:10.1038/17130. PMID 9989410.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "Global HIV prevalence has levelled off; AIDS is among the leading causes of death globally and remains the primary cause of death in Africa" (PDF) (Press release). UNAIDS. 20 November 2007. Retrieved 2008-01-21.
- ^ a b c d e f g h UNAIDS (2006). "Overview of the global AIDS epidemic". 2006 Report on the global AIDS epidemic.
{{cite book}}
:|access-date=
requires|url=
(help);|format=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) Cite error: The named reference "UNAIDS2006" was defined multiple times with different content (see the help page). - ^ a b Palella, F. J. Jr, Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., Aschman and D. J., Holmberg, S. D. (1998). "Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators". N. Engl. J. Med. 338 (13): 853–860. PMID 9516219.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Aids could kill 90 million Africans, says UN
- ^ AIDS Toll May Reach 100 Million in Africa, Washington Post
- ^ Alimonti, J. B., Ball, T. B. and Fowke, K. R. (2003). "Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS". J. Gen. Virol. 84 (7): 1649–1661. doi:10.1099/vir.0.19110-0. PMID 12810858.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ 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.)
- ^ The Body
- ^ AEGIS
- ^ a b c d e Morgan, D., Mahe, C., Mayanja, B., Okongo, J. M., Lubega, R. and Whitworth, J. A. (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS. 16 (4): 597–632. PMID 11873003.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Clerici, M., Balotta, C., Meroni, L., Ferrario, E., Riva, C., Trabattoni, D., Ridolfo, A., Villa, M., Shearer, G.M., Moroni, M. and Galli, M. (1996). "Type 1 cytokine production and low prevalence of viral isolation correlate with long-term non progression in HIV infection". AIDS Res. Hum. Retroviruses. 12 (11): 1053–1061. PMID 8827221.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Morgan, D., Mahe, C., Mayanja, B. and Whitworth, J. A. (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ. 324 (7331): 193–196. doi:10.1136/bmj.324.7331.193. PMID 11809639.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Gendelman, H. E., Phelps, W., Feigenbaum, L., Ostrove, J. M., Adachi, A., Howley, P. M., Khoury, G., Ginsberg, H. S. and Martin, M. A. (1986). "Transactivation of the human immunodeficiency virus long terminal repeat sequences by DNA viruses". Proc. Natl. Acad. Sci. U. S. A. 83 (24): 9759–9763. PMID 2432602.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Bentwich, Z., Kalinkovich., A. and Weisman, Z. (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunol. Today. 16 (4): 187–191. PMID 7734046.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Tang, J. and Kaslow, R. A. (2003). "The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy". AIDS. 17 (Suppl 4): S51–S60. PMID 15080180.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Quiñones-Mateu, M. E., Mas, A., Lain de Lera, T., Soriano, V., Alcami, J., Lederman, M. M. and Domingo, E. (1998). "LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression". Virus Research. 57 (1): 11–20. PMID 9833881.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Campbell, G. R., Pasquier, E., Watkins, J., Bourgarel-Rey, V., Peyrot, V., Esquieu, D., Barbier, P., de Mareuil, J., Braguer, D., Kaleebu, P., Yirrell, D. L. and Loret E. P. (2004). "The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis". J. Biol. Chem. 279 (46): 48197–48204. doi:10.1074/jbc.M406195200. PMID 15331610.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) - ^ Kaleebu P, French N, Mahe C, Yirrell D, Watera C, Lyagoba F, Nakiyingi J, Rutebemberwa A, Morgan D, Weber J, Gilks C, Whitworth J. (2002). "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". J. Infect. Dis. 185 (9): 1244–1250. PMID 12001041.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ World Health Organization (1990). "Interim proposal for a WHO staging system for HIV infection and disease". WHO Wkly Epidem. Rec. 65 (29): 221–228. PMID 1974812.
- ^ Centers for Disease Control (CDC) (1982). "Persistent, generalized lymphadenopathy among homosexual males". MMWR Morb Mortal Wkly Rep. 31 (19): 249–251. PMID 6808340.
- ^ Barré-Sinoussi, F., Chermann, J. C., Rey, F., Nugeyre, M. T., Chamaret, S., Gruest, J., Dauguet, C., Axler-Blin, C., Vezinet-Brun, F., Rouzioux, C., Rozenbaum, W. and Montagnier, L. (1983). "Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS)". Science. 220 (4599): 868–871. doi:10.1126/science.6189183. PMID 6189183.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Centers for Disease Control (CDC) (1982). "Opportunistic infections and Kaposi's sarcoma among Haitians in the United States". MMWR Morb Mortal Wkly Rep. 31 (26): 353–354, 360–361. PMID 6811853.
- ^ Altman, L.K. (1982-05-11). "'New homosexual disorder worries officials'". New York Times.
{{cite news}}
: Cite has empty unknown parameter:|1=
(help) - ^ Kher, U. (1982-07-27). "A Name for the Plague". Time.
{{cite news}}
: Cite has empty unknown parameter:|1=
(help) - ^ Centers for Disease Control (CDC) (1982). "Update on acquired immune deficiency syndrome (AIDS)—United States". MMWR Morb Mortal Wkly Rep. 31 (37): 507–508, 513–514. PMID 6815471.
- ^ CDC (1992). "1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults". CDC. Retrieved 2006-02-09.
- ^ a b
Kumaranayake, L. and Watts, C. (2001). "Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa". J. Int. Dev. 13 (4): 451–466. doi:10.1002/jid.798.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Holmes, C. B., Losina, E., Walensky, R. P., Yazdanpanah, Y., Freedberg, K. A. (2003). "Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa". Clin. Infect. Dis. 36 (5): 656–662. PMID 12594648.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Guss, D. A. (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1". J. Emerg. Med. 12 (3): 375–384. PMID 8040596.
- ^ Guss, D. A. (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2". J. Emerg. Med. 12 (4): 491–497. PMID 7963396.
- ^ Schneider, M. F., Gange, S. J., Williams, C. M., Anastos, K., Greenblatt, R. M., Kingsley, L., Detels, R., and Munoz, A. (2005). "Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984–2004". AIDS. 19 (17): 2009–2018. PMID 16260908.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Lawn, S. D. (2004). "AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection". J. Infect. Dis. 48 (1): 1–12. PMID 14667787.
- ^ Campbell, G. R., Watkins, J. D., Esquieu, D., Pasquier, E., Loret, E. P. and Spector, S. A. (2005). "The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells". J. Biol. Chem. 280 (46): 38376–39382. PMID 16155003.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Senkaali, D., Muwonge, R., Morgan, D., Yirrell, D., Whitworth, J. and Kaleebu, P. (2005). "The relationship between HIV type 1 disease progression and V3 serotype in a rural Ugandan cohort". AIDS Res. Hum. Retroviruses. 20 (9): 932–937. PMID 15585080.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Feldman, C. (2005). "Pneumonia associated with HIV infection". Curr. Opin. Infect. Dis. 18 (2): 165–170. PMID 15735422.
- ^ Decker, C. F. and Lazarus, A. (2000). "Tuberculosis and HIV infection. How to safely treat both disorders concurrently". Postgrad Med. 108 (2): 57–60, 65–68. PMID 10951746.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Zaidi, S. A. and Cervia, J. S. (2002). "Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection". J. Int. Assoc. Physicians AIDS Care (Chic Ill). 1 (2): 53–62. PMID 12942677.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Guerrant, R. L., Hughes, J. M., Lima, N. L., Crane, J. (1990). "Diarrhea in developed and developing countries: magnitude, special settings, and etiologies". Rev. Infect. Dis. 12 (Suppl 1): S41–S50. PMID 2406855.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Luft, B. J. and Chua, A. (2000). "Central Nervous System Toxoplasmosis in HIV Pathogenesis, Diagnosis, and Therapy". Curr. Infect. Dis. Rep. 2 (4): 358–362. PMID 11095878.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Sadler, M. and Nelson, M. R. (1997). "Progressive multifocal leukoencephalopathy in HIV". Int. J. STD AIDS. 8 (6): 351–357. PMID 9179644.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C. (2001). "Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments". Clin. Neuropathol. 20 (4): 146–155. PMID 11495003.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Grant, I., Sacktor, H., and McArthur, J. (2005). "HIV neurocognitive disorders". In H. E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.) (ed.). The Neurology of AIDS (2nd ed.). London, UK: Oxford University Press. pp. 357–373. ISBN 0-19-852610-5.
{{cite book}}
:|editor=
has generic name (help);|format=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help)CS1 maint: multiple names: authors list (link) - ^ Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K. (2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989–1996)". Indian J. Med. Res. 11: 14–23. PMID 10793489.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wadia, R. S., Pujari, S. N., Kothari, S., Udhar, M., Kulkarni, S., Bhagat, S., and Nanivadekar, A. (2001). "Neurological manifestations of HIV disease". J. Assoc. Physicians India. 49: 343–348. PMID 11291974.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Boshoff, C. and Weiss, R. (2002). "AIDS-related malignancies". Nat. Rev. Cancer. 2 (5): 373–382. PMID 12044013.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Yarchoan, R., Tosatom G. and Littlem R. F. (2005). "Therapy insight: AIDS-related malignancies — the influence of antiviral therapy on pathogenesis and management". Nat. Clin. Pract. Oncol. 2 (8): 406–415. PMID 16130937.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Bonnet, F., Lewden, C., May, T., Heripret, L., Jougla, E., Bevilacqua, S., Costagliola, D., Salmon, D., Chene, G. and Morlat, P. (2004). "Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy". Cancer. 101 (2): 317–324. PMID 15241829.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Skoulidis, F., Morgan, M. S., and MacLeod, K. M. (2004). "Penicillium marneffei: a pathogen on our doorstep?". J. R. Soc. Med. 97 (2): 394–396. PMID 15286196.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Smith, D. K., Grohskopf, L. A., Black, R. J., Auerbach, J. D., Veronese, F., Struble, K. A., Cheever, L., Johnson, M., Paxton, L. A., Onorato, I. A. and Greenberg, A. E. (2005). "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States". MMWR. 54 (RR02): 1–20.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Donegan, E., Stuart, M., Niland, J. C., Sacks, H. S., Azen, S. P., Dietrich, S. L., Faucett, C., Fletcher, M. A., Kleinman, S. H., Operskalski, E. A.; et al. (1990). "Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations". Ann. Intern. Med. 113 (10): 733–739. PMID 2240875.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ a b Coovadia, H. (2004). "Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS". N. Engl. J. Med. 351 (3): 289–292. PMID 15247337.
- ^ Kaplan, E. H. and Heimer, R. (1995). "HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data". J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 10 (2): 175–176. PMID 7552482.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Bell, D. M. (1997). "Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview". Am. J. Med. 102 (5B): 9–15. PMID 9845490.
- ^ a b c d European Study Group on Heterosexual Transmission of HIV (1992). "Comparison of female to male and male to female transmission of HIV in 563 stable couples". BMJ. 304 (6830): 809–813. PMID 1392708.
- ^ a b c d e f Varghese, B., Maher, J. E., Peterman, T. A., Branson, B. M. and Steketee, R. W. (2002). "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". Sex. Transm. Dis. 29 (1): 38–43. PMID 11773877.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Leynaert, B., Downs, A. M. and de Vincenzi, I. (1998). "Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV". Am. J. Epidemiol. 148 (1): 88–96. PMID 9663408.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "Facts about AIDS & HIV". Retrieved 2007-11-30.
- ^ Johnson AM and Laga M (1988). "Heterosexual transmission of HIV". AIDS. 2 (suppl. 1): S49–S56. PMID 3130121.
- ^ N'Galy B and Ryder RW (1988). "Epidemiology of HIV infection in Africa". Journal of Acquired Immune Deficiency Syndromes. 1 (6): 551–558. PMID 3225742.
- ^ Deschamps MM, Pape JW, Hafner A, Johnson WD Jr. (1996). "Heterosexual transmission of HIV in Haiti". Annals of Internal Medicine. 125 (4): 324–330. PMID 8678397.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Rothenberg, R. B., Scarlett, M., del Rio, C., Reznik, D. and O'Daniels, C. (1998). "Oral transmission of HIV". AIDS. 12 (16): 2095–2105. PMID 9833850.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Mastro TD, de Vincenzi I (1996). "Probabilities of sexual HIV-1 transmission". AIDS. 10 (Suppl A): S75–S82. PMID 8883613.
- ^ World Health Organization (2006). "WHO Multi-country Study on Women's Health and Domestic Violence against Women". Retrieved 2006-12-14.
- ^ Koenig, Michael; et al. (2004). "Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda". International Family Planning Perspectives. 30 (4:156): 156.
{{cite journal}}
: Explicit use of et al. in:|author=
(help) - ^ a b Laga, M., Nzila, N., Goeman, J. (1991). "The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa". AIDS. 5 (Suppl 1): S55–S63. PMID 1669925.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tovanabutra, S., Robison, V., Wongtrakul, J., Sennum, S., Suriyanon, V., Kingkeow, D., Kawichai, S., Tanan, P., Duerr, A. and Nelson, K. E. (2002). "Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand". J. Acquir. Immune. Defic. Syndr. 29 (3): 275–283. PMID 11873077.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Sagar, M., Lavreys, L., Baeten, J. M., Richardson, B. A., Mandaliya, K., Ndinya-Achola, J. O., Kreiss, J. K., and Overbaugh, J. (2004). "Identification of modifiable factors that affect the genetic diversity of the transmitted HIV-1 population". AIDS. 18 (4): 615–619. PMID 15090766.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Lavreys, L., Baeten, J. M., Martin, H. L. Jr., Overbaugh, J., Mandaliya, K., Ndinya-Achola, J., and Kreiss, J. K. (2004). "Hormonal contraception and risk of HIV-1 acquisition: results of a 10-year prospective study". AIDS. 18 (4): 695–697. PMID 15090778.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Cayley, W. E. Jr. (2004). "Effectiveness of condoms in reducing heterosexual transmission of HIV". Am. Fam. Physician. 70 (7): 1268–1269. PMID 15508535.
- ^ Catholic Church (1997). "Offenses against chastity". Catechism of the Catholic Church : Second Edition. Vatican: Amministrazione Del Patrimonio Della Sede Apostolica. p. 2353.
{{cite book}}
:|access-date=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ Human Rights Watch (2005). "Restrictions on Condoms". The Less They Know, the Better. New York NY: Human Rights Watch.
{{cite book}}
: External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ Human Rights Watch (2002-09-02). "Ignorance only: HIV/AIDS, Human rights and federally funded abstinence-only programs in the United States. Texas: A case study". Human Rights Watch. Retrieved 2006-03-28.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Debra Hauser (2004). "Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact" (PDF). Advocates for Youth. Retrieved 2006-06-07.
- ^ Durex. "Module 5/Guidelines for Educators" (Microsoft Word). Retrieved 2006-04-17.
- ^ PATH (2006). "The female condom: significant potential for STI and pregnancy prevention". Outlook. 22 (2).
- ^ WHO (August, 2003). "Condom Facts and Figures". Retrieved 2006-01-17.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ The Economist (2005). "Too much morality, too little sense". Retrieved 2006-03-28.
- ^ NIAID (2006-12-13). "Adult Male Circumcision Significantly Reduces Risk of Acquiring HIV: Trials Kenya and Uganda Stopped Early". Retrieved 2006-12-15.
- ^ Various (2005). "Repeated Use of Unsterilized Blades in Ritual Circumcision Might Contribute to HIV Spread in S. Africa, Doctors Say". Kaisernetwork.org. Retrieved 2006-03-28.
- ^ a b Fan, H. (2005). Fan, H., Conner, R. F. and Villarreal, L. P. eds (ed.). AIDS: science and society (4th ed.). Boston, MA: Jones and Bartlett Publishers. ISBN 0-7637-0086-X.
{{cite book}}
:|editor=
has generic name (help); Cite has empty unknown parameter:|chapterurl=
(help)CS1 maint: multiple names: editors list (link) - ^ WHO (2003-03-17). "WHO, UNAIDS Reaffirm HIV as a Sexually Transmitted Disease". Retrieved 2006-01-17.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Physicians for Human Rights (2003-03-13). "HIV Transmission in the Medical Setting: A White Paper by Physicians for Human Rights". Partners in Health. Retrieved 2006-03-01.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Drugtext.org
- ^ WHO (2001). "Blood safety....for too few". Retrieved 2006-01-17.
- ^ Sperling, R. S., Shapirom D. E., Coombsm R. W., Todd, J. A., Herman, S. A., McSherry, G. D., O'Sullivan, M. J., Van Dyke, R. B., Jimenez, E., Rouzioux, C., Flynn, P. M. and Sullivan, J. L. (1996). "Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant". N. Engl. J. Med. 335 (22): 1621–1629. PMID 8965861.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
Berry, S. (2006-06-08). "Children, HIV and AIDS". avert.org. Retrieved 2006-06-15.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Dias, S. F., Matos, M. G. and Goncalves, A. C. (2005). "Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups". Eur. J. Public Health. 15 (3): 300–304. PMID 15941747.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Department of Health and Human Services (February, 2006). "A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition". Retrieved 2006-09-01.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) Cite error: The named reference "PEPpocketguide" was defined multiple times with different content (see the help page). - ^ Department of Health and Human Services (February, 2006). "A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition". Retrieved 2006-09-01.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Department of Health and Human Services Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children (November 3, 2005). "Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection" (PDF). Retrieved 2006-01-17.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection (October 6, 2005). "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents" (PDF). Retrieved 2006-01-17.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ Martinez-Picado, J., DePasquale, M. P., Kartsonis, N., Hanna, G. J., Wong, J., Finzi, D., Rosenberg, E., Gunthard, H. F., Sutton, L., Savara, A., Petropoulos, C. J., Hellmann, N., Walker, B. D., Richman, D. D., Siliciano, R. and D'Aquila, R. T. (2000). "Antiretroviral resistance during successful therapy of human immunodeficiency virus type 1 infection". Proc. Natl. Acad. Sci. U. S. A. 97 (20): 10948–10953. PMID 11005867.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Dybul, M., Fauci, A. S., Bartlett, J. G., Kaplan, J. E., Pau, A. K.; Panel on Clinical Practices for Treatment of HIV. (2002). "Guidelines for using antiretroviral agents among HIV-infected adults and adolescents". Ann. Intern. Med. 137 (5 Pt 2): 381–433. PMID 12617573.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Blankson, J. N., Persaud, D., Siliciano, R. F. (2002). "The challenge of viral reservoirs in HIV-1 infection". Annu. Rev. Med. 53: 557–593. PMID 11818490.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Palella, F. J., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., Aschman, D. J. and Holmberg, S. D. (1998). "Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection". N. Engl. J. Med. 338 (13): 853–860. PMID 9516219.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wood, E., Hogg, R. S., Yip, B., Harrigan, P. R., O'Shaughnessy, M. V. and Montaner, J. S. (2003). "Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy?". AIDS. 17 (5): 711–720. PMID 12646794.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Chene, G., Sterne, J. A., May, M., Costagliola, D., Ledergerber, B., Phillips, A. N., 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, M. E. and the Antiretroviral Therapy Cohort Collaboration. (2003). "Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies". Lancet. 362 (9385): 679–686. doi:10.1016/S0140-6736(03)14229-8. PMID 12957089.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ King, J. T., Justice, A. C., Roberts, M. S., Chang, C. H., Fusco, J. S. and the CHORUS Program Team. (2003). "Long-Term HIV/AIDS Survival Estimation in the Highly Active Antiretroviral Therapy Era". Medical Decision Making. 23 (1): 9–20. PMID 12583451.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tassie, J.M., Grabar, S., Lancar, R., Deloumeaux, J., Bentata, M., Costagliola, D. and the Clinical Epidemiology Group from the French Hospital Database on HIV. (2002). "Time to AIDS from 1992 to 1999 in HIV-1-infected subjects with known date of infection". Journal of acquired immune deficiency syndromes. 30 (1): 81–7. PMID 12048367.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Becker SL, Dezii CM, Burtcel B, Kawabata H, Hodder S. (2002). "Young HIV-infected adults are at greater risk for medication nonadherence". MedGenMed. 4 (3): 21. PMID 12466764.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Nieuwkerk, P., Sprangers, M., Burger, D., Hoetelmans, R. M., Hugen, P. W., Danner, S. A., van Der Ende, M. E., Schneider, M. M., Schrey, G., Meenhorst, P. L., Sprenger, H. G., Kauffmann, R. H., Jambroes, M., Chesney, M. A., de Wolf, F., Lange, J. M. and the ATHENA Project. (2001). "Limited Patient Adherence to Highly Active Antiretroviral Therapy for HIV-1 Infection in an Observational Cohort Study". Arch. Intern. Med. 161 (16): 1962–1968. PMID 11525698.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Kleeberger, C., Phair, J., Strathdee, S., Detels, R., Kingsley, L. and Jacobson, L. P. (2001). "Determinants of Heterogeneous Adherence to HIV-Antiretroviral Therapies in the Multicenter AIDS Cohort Study". J. Acquir. Immune Defic. Syndr. 26 (1): 82–92. PMID 11176272.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Heath, K. V., Singer, J., O'Shaughnessy, M. V., Montaner, J. S. and Hogg, R. S. (2002). "Intentional Nonadherence Due to Adverse Symptoms Associated With Antiretroviral Therapy". J. Acquir. Immune Defic. Syndr. 31 (2): 211–217. PMID 12394800.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Montessori, V., Press, N., Harris, M., Akagi, L., Montaner, J. S. (2004). "Adverse effects of antiretroviral therapy for HIV infection". CMAJ. 170 (2): 229–238. PMID 14734438.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Saitoh, A., Hull, A. D., Franklin, P. and Spector, S. A. (2005). "Myelomeningocele in an infant with intrauterine exposure to efavirenz". J. Perinatol. 25 (8): 555–556. doi:10.1038/sj.jp.7211343. PMID 16047034.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Fawzi W, Msamanga G, Spiegelman D, Hunter DJ (2005). "Studies of vitamins and minerals and HIV transmission and disease progression". J. Nutrition. 135 (4): 938–944. PMID 15795466.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ (Selenium:) Hurwitz BE, Klaus JR, Llabre MM, Gonzalez A, Lawrence PJ, Maher KJ, Greeson JM, Baum MK, Shor-Posner G, Skyler JS, Schneiderman N. (2007). "Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial". Arch Intern Med. 167 (2): 148–155. PMID 17242315.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ (Vitamin C:) Cathcart, Robert F. (1984). "Vitamin C in the Treatment of Acquired Immune Deficiency Syndrome". Medical Hypotheses. 14 (4): 423–433. doi:10.1016/0306-9877(84)90149-X. PMID 6238227.
- ^ a b c Ferrantelli F, Cafaro A, Ensoli B. (2004). "Nonstructural HIV proteins as targets for prophylactic or therapeutic vaccines". Curr Opin Biotechnol. 15 (6): 543–556. PMID 15560981.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Laurence J. (2006). "Hepatitis A and B virus immunization in HIV-infected persons". AIDS Reader. 16 (1): 15–17. PMID 16433468.
- ^ a b Saltmarsh, S. (2005). "Voodoo or valid? Alternative therapies benefit those living with HIV". Positively Aware. 3 (16): 46. PMID 16479668.
- ^ Pharo, A.; et al. (1996). "Evaluation of the safety and efficacy of SPV-30 (boxwood extract) in patients with HIV disease". Int Conf AIDS (Jul 7–12): 11:19. abstract no. Mo. B.180.
{{cite journal}}
: Explicit use of et al. in:|author=
(help) - ^ Durant, J.; et al. (1998). "Efficacy and safety of Buxussempervirens L. preparations (SPV-30) in HIV infected asymptomatic patients: a multi-centre, randomized, double-blind, placebo-controlled trial". Phytomedicine (5): 1–10.
{{cite journal}}
: Explicit use of et al. in:|author=
(help) - ^ Mills, E., Wu, P. and Ernst, E. (2005). "Complementary therapies for the treatment of HIV: in search of the evidence". Int. J. STD AIDS. 16 (6): 395–403. PMID 15969772.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
U.N. Agency to Say It Overstated Extent of H.I.V. Cases by Millions. 2007.
{{cite book}}
: External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ UNAIDS (2001). "Special Session of the General Assembly on HIV/AIDS Round table 3 Socio-economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS" (PDF). Retrieved 2006-06-15.
- ^ World Bank (2005). "Evaluating the World Bank's Assistance for Fighting the HIV/AIDS Epidemic". Retrieved 2006-01-17.
- ^ a b c Greener, R. (2002). "AIDS and macroeconomic impact". In S, Forsyth (ed.) (ed.). State of The Art: AIDS and Economics. IAEN. pp. 49–55.
{{cite book}}
:|editor=
has generic name (help);|format=
requires|url=
(help) - ^ Over, M. (1992). "The macroeconomic impact of AIDS in Sub-Saharan Africa, Population and Human Resources Department". The World Bank.
- ^ Bonnel, R. (2000). "HIV/AIDS and Economic Growth: A Global Perspective". S. A. J. Economics. 68 (5): 820–855.
{{cite journal}}
: Cite has empty unknown parameter:|1=
(help) - ^ Bell, C., Gersbach, H. and Devarajan, S. (2003). "The long-run economic costs of AIDS: theory and an application to South Africa". eldis. Retrieved 2006-03-28.
{{cite web}}
: CS1 maint: multiple names: authors list (link) - ^ Goetzel, R.Z. (2005). "Estimating the return-on-investment from changes in employee health risks on the Dow Chemical Company's health care costs". Journal of Occupational and Environmental Medicine. 47: 759–68. PMID 16093925.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ "AIDS and the private sector: The case of South Africa" (PDF). Overseas Development Institute. 2007.
{{cite web}}
: Unknown parameter|accessyear=
ignored (|access-date=
suggested) (help); line feed character in|title=
at position 21 (help) - ^ Mu Xuequan (2006). "Zimbabwe launches world's first AIDS training package". xinhua. Retrieved 2006-10-03.
- ^ UNAIDS (2006). "The impact of AIDS on people and societies". 2006 Report on the global AIDS epidemic.
{{cite book}}
:|access-date=
requires|url=
(help);|format=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ Ogden, J. and Nyblade, L. (2005). "Common at its core: HIV-related stigma across contexts" (PDF). International Center for Research on Women. Retrieved 2007-02-15.
{{cite web}}
: CS1 maint: multiple names: authors list (link) - ^ a b c d Herek, G. M. and Capitanio, J. P. (1999). "AIDS Stigma and sexual prejudice" (PDF). Am. Behav, Scientist. Retrieved 2006-03-27.
{{cite web}}
: CS1 maint: multiple names: authors list (link) - ^ Snyder M, Omoto AM, Crain AL. (1999). "Punished for their good deeds: stigmatization for AIDS volunteers". American Behavioral Scientist. 42 (7): 1175–1192.
{{cite journal}}
: Cite has empty unknown parameter:|1=
(help)CS1 maint: multiple names: authors list (link) - ^ a b Herek GM, Capitanio JP, Widaman KF. (2002). "HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999" (PDF). Am. J. Public Health. 92 (3): 371–377.
{{cite journal}}
: Text "PMID 11867313" ignored (help)CS1 maint: multiple names: authors list (link) - ^ Herek, GM, Widaman, KF, Capitanio, JP (2005). "When sex equals AIDS: Symbolic stigma and heterosexual adults' inaccurate beliefs about sexual transmission of AIDS" (PDF). Social Problems. 52 (1): 15–37.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ United States Health Resources and Services Administration. "Stigma and HIV-AIDS, A review of the literature". HRSA. Retrieved 2006-03-24.
- ^ CDC (1981). "Pneumocystis Pneumonia — Los Angeles". CDC. Retrieved 2006-01-17.
- ^ Zhu, T., Korber, B. T., Nahmias, A. J., Hooper, E., Sharp, P. M. and Ho, D. D. (1998). "An African HIV-1 Sequence from 1959 and Implications for the Origin of the Epidemic". Nature. 391 (6667): 594–597. doi:10.1038/35400. PMID 9468138.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^
Kolata, G. (1987-10-28). "Boy's 1969 death suggests AIDS invaded U.S. several times". The New York Times. Retrieved 2006-06-19.
{{cite news}}
: Check date values in:|date=
(help) - ^ Hooper, E. (1997). "Sailors and star-bursts, and the arrival of HIV". BMJ. 315 (7123): 1689–1691. PMID 9448543.
- ^ Reeves, J. D. and Doms, R. W (2002). "Human Immunodeficiency Virus Type 2". J. Gen. Virol. 83 (Pt 6): 1253–1265. PMID 12029140.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Keele, B. F., van Heuverswyn, F., Li, Y. Y., Bailes, E., Takehisa, J., Santiago, M. L., Bibollet-Ruche, F., Chen, Y., Wain, L. V., Liegois, F., Loul, S., Mpoudi Ngole, E., Bienvenue, Y., Delaporte, E., Brookfield, J. F. Y., Sharp, P. M., Shaw, G. M., Peeters, M., Hahn, B. H. (2006). "Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1". Science. 313 (5786): 523–6. doi:10.1126/science.1126531. PMID 16728595.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Cohen, J. (2000). "Vaccine Theory of AIDS Origins Disputed at Royal Society". Science. 289 (5486): 1850–1851. doi:10.1126/science.289.5486.1850. PMID 11012346.
- ^ Curtis, T. (1992). "The origin of AIDS". Rolling Stone (626): 54–59, 61, 106, 108.
- ^ Hooper, E. (1999). The River : A Journey to the Source of HIV and AIDS (1st ed.). Boston, MA: Little Brown & Co. pp. 1–1070. ISBN 0-316-37261-7.
- ^ Worobey M, Santiago ML, Keele BF, Ndjango JB, Joy JB, Labama BL, Dhed'A BD, Rambaut A, Sharp PM, Shaw GM, Hahn BH (2004). "Origin of AIDS: contaminated polio vaccine theory refuted". Nature. 428 (6985): 820. doi:10.1038/428820a. PMID 15103367.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Berry N, Jenkins A, Martin J, Davis C, Wood D, Schild G, Bottiger M, Holmes H, Minor P, Almond N (2005). "Mitochondrial DNA and retroviral RNA analyses of archival oral polio vaccine (OPV CHAT) materials: evidence of macaque nuclear sequences confirms substrate identity". Vaccine. 23: 1639–1648. doi:10.1016/j.vaccine.2004.10.038. PMID 15705467.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Centers for Disease Control and Prevention (2004-03-23). "Oral Polio Vaccine and HIV / AIDS: Questions and Answers". Retrieved 2006-11-20.
{{cite web}}
: Check date values in:|year=
(help)CS1 maint: year (link) - ^ AIDS virus invaded U.S. from Haiti: study
- ^ Duesberg, P. H. (1988). "HIV is not the cause of AIDS". Science. 241 (4865): 514, 517. doi:10.1126/science.3399880. PMID 3399880.
- ^ Papadopulos-Eleopulos, E., Turner, V. F., Papadimitriou, J., Page, B., Causer, D., Alfonso, H., Mhlongo, S., Miller, T., Maniotis, A. and Fiala, C. (2004). "A critique of the Montagnier evidence for the HIV/AIDS hypothesis". Med Hypotheses. 63 (4): 597–601. doi:10.1016/j.mehy.2004.03.025. PMID 15325002.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ For evidence of the scientific consensus that HIV is the cause of AIDS, see (for example):
- "The Durban Declaration". Nature. 406 (6791): 15–6. 2000. doi:10.1038/35017662. PMID 10894520. - full text here.
- Cohen, J. (1994). "The Controversy over HIV and AIDS" (PDF). Science. 266 (5191): 1642–1649.
- Various. "Focus on the HIV-AIDS Connection: Resource links". National Institute of Allergy and Infectious Diseases. Retrieved 2006-09-07.
- O'Brien SJ, Goedert JJ (1996). "HIV causes AIDS: Koch's postulates fulfilled". Curr. Opin. Immunol. 8 (5): 613–8. PMID 8902385.
- Galéa P, Chermann JC (1998). "HIV as the cause of AIDS and associated diseases". Genetica. 104 (2): 133–42. PMID 10220906.
- ^ Watson J (2006). "Scientists, activists sue South Africa's AIDS 'denialists'". Nat. Med. 12 (1): 6. doi:10.1038/nm0106-6a. PMID 16397537.
- ^ Baleta A (2003). "S Africa's AIDS activists accuse government of murder". Lancet. 361 (9363): 1105. doi:10.1016/S0140-6736(03)12909-1. PMID 12672319.
- ^ Cohen J (2000). "South Africa's new enemy". Science. 288 (5474): 2168–70. doi:10.1126/science.288.5474.2168. PMID 10896606.
- ^ Blechner, M. (1997) Hope and Mortality: Psychodynamic Approaches to AIDS and HIV. Hillsdale, NJ: The Analytic Press.
External links
![](http://upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/40px-Wiktionary-logo-en-v2.svg.png)
![](http://upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/30px-Commons-logo.svg.png)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/34px-Wikiquote-logo.svg.png)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/24/Wikinews-logo.svg/40px-Wikinews-logo.svg.png)
- HIV/AIDS resources
- 2006 Report on the Global AIDS Epidemic by UNAIDS
- AIDSinfo.nih.gov Comprehensive resource for HIV/AIDS treatment and clinical trial information from the U. S. Department of Health and Human Services
- MEDSCAPE.com An extensive site dedicated to everything medical related with an impressive HIV/AIDS section.
- PlusNews HIV/AIDS news and analysis from Africa, Asia and the Middle East; one of the largest producers of original HIV/AIDS reporting.
- POZ.com Comprehensive resource for the HIV/AIDS community, including all 12 years of POZ Magazine archives.
- AEGiS.org AIDS Education Global Information System
- HIV Medicine 2006 Free medical textbook updated annually.
- Eldis HIV and AIDS — latest research and other resources on HIV and AIDS in developing countries
- HIV/AIDS glossary from the U. S. Department of Health and Human Services
- AIDSmeds.com: Comprehensive lessons on HIV/AIDS and their treatments
- The Body: The Complete HIV/AIDS Resource
- AIDS facts and news from the National Institute of Allergy and Infectious Diseases
- HIV and AIDS from New Scientist
- The National Center for HIV, STD, and TB Prevention — A Division of the Centers for Disease Control and Prevention
- AIDS Community Research Initiative of America — Community-based research and education for people living with HIV.
- Strategies for Hope— A series of books and videos promoting practical action, particularly in Sub-Saharan Africa
- Cambridge University Pathology Review of HIV and AIDS pathogenesis, progression, spread, prophylaxis and therapy.
- Resources for HIV/AIDS and Sexual and Reproductive Health Integration Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs
- HIV/AIDS associations and programs
- The STOP AIDS project
- The Joint United Nations Programme on HIV/AIDS (UNAIDS)
- International AIDS Society — the world's leading independent association of HIV/AIDS professionals
- AIDS.gov Portal to all Federal domestic HIV/AIDS information and resources.
- Documentaries & Reports
- FRONTLINE: The Age of AIDS This 2006 program chronicles the scientific, political and social history of the epidemic.
- Documentation on the oral polio vaccine (OPV) theory of AIDS origin AIDSOrigin.com
- Documentary about AIDS in Africa: Living with AIDS
- Origin of Aids Video Watch Free online : Origin of Aids Video
- Recorded interview with Prof. Robert Gallo about the progress in HIV vaccine research
- CBC Digital Archives — The Early Years of the AIDS Crisis
- Documentary "THE GIFT" The Phenomenon of deliberate HIV infection
- "The Graying of AIDS" Older Americans Living with HIV Face Unique Challenges TIME magazine, August 14 2006