Will I live to see tomorrow? Is there a hope for the future? These are probably
the most commonly asked questions among AIDS patients today. This paper delves
into the heart of the AIDS topic by giving a detailed definition of the virus,
risk factors associated with transmission, and the best treatment methods
studied by the Centers for Disease Control, the National Institutes of Health,
and other research organizations. AIDS. The word alone strikes fear into every
sexually active individual. Why is this? The reason is that everyone can relate
to the consequential symptoms of the disease, but not everyone knows the real
meaning of AIDS. AIDS is an acronym for “Acquired Immunodeficiency
Syndrome.” The Centers for Disease Control defines AIDS as the presence of at
least one of several opportunistic diseases, along with infection by the human
immunodeficiency virus (HIV). An opportunistic disease is described as a disease
that has an opportunity to occur because the immune system has been weakened.
Examples of opportunistic diseases would be Pneumocystis carinii pneumonia,
Kaposi’s sarcoma, or toxoplasmosis. The combination of such diseases, plus
HIV, deplete the complex natural defense system protecting the body from
infection by viruses and microorganisms. The definition of AIDS has also been
expanded to include a CD4+ T cell count less than 200 cells per cubic millimeter
(mm3) of blood. AIDS is characterized by the progressive loss of the CD4+ helper
cell, a type of white blood cell that helps the body fight off certain
infections. This cell is also known as the T, T-helper, and T4 cells. The CD4+
cells are white blood cells that stimulate B lymphocytes to produce antibodies,
lead to a severe reduction of functions of the body’s immune system (immunosuppression),
neurological complications, and opportunistic infections that rarely occur in
persons with intact immune function. Although the precise causes leading to the
destruction of the immune system have not been fully discovered, the detailed
studies of epidemiology, virology, and immunology support the conclusion the HIV
is the underlying cause of AIDS; hence HIV invades and destroys the CD4 cells.
Primary HIV infection is often associated with as abrupt decline of CD4 cells in
the peripheral blood. The decrease in circulating CD4 cells during primary
infection is probably due to two factors: 1) depletion by HIV, and 2) to
redirect cells to the lymphoid tissue and other organs. The median period
between the infection of HIV and the onset of clinically apparent disease is
approximately 10 years in western countries, according to prospective studies of
homosexual men. This period also applies to HIV-infected blood transfusion
recipients, injection drug users, and adult hemophiliacs. In 1981, clinical
investigators in New York and California observed among young, previously
healthy, homosexual men a strange clustering of cases of rare diseases, notably
Kaposi’s sarcoma (KS) and opportunistic infections such as Pneumocystis
carinii pneumonia (PCP), as well as cases of unexplained, persistent
lymphadenopathy. It soon became evident that these men had a common immunologic
deficit- the impairment in cell mediated immunity, resulting from a significant
loss of CD4 cells. The widespread development of KS and PCP in young people with
no previous history of disease was unusual. After detailed studies and searches
of autopsy records, medical history books, and tumor recordings, results showed
that KS and PCP had only occurred at very low levels in the United States
previously. KS, Kaposi’s sarcoma, is a skin neoplasm that affected older men,
cancer, or transplant patients undergoing immunosuppressive therapy. Before AIDS
became a big issue, the only reports of KS in the United States were 0.02 to
0.06 per 100,000 population. In addition, the disease was generally found in
certain parts of Africa among younger individuals. By 1984, men in San Francisco
were found 2,000 times more likely to develop KS! By 1994, at least a whopping
36,693 patients with AIDS had been reported. This shows how fast the spread of
the disease takes place. PCP, Pneumocystis carinii pneumonia, a lung infection
caused by a pathogen, was extremely rare before 1981. Taken from a survey in
1967, only 107 cases had been reported and documented in medical literature. In
that same year, the Centers for Disease Control became the sole supplier in the
US of pentmidinne isthionate- the only recommended PCP therapy at that time. The
CDC began collecting data on each PCP case diagnosed and treated. In 1981 alone,
42 requests for the drug were received for patient treatment. As an example of
how fast this disease was spread, note the following: the CDC had reported
127,626 individuals with AIDS in the US with a definite diagnosis of PCP! Now
that’s fast! There are most definitely certain risk factors associated with
AIDS. The most common risk behavior in acquiring AIDS is through sexual
intercourse. Today, ninety percent of new infections occur in the developing
world. Widespread poverty seems to stimulate the disease. Poor and disadvantaged
groups tend to be at higher risk for AIDS that others because they have less
access to AIDS info through the media and other channels. In addition, they may
not be able to afford the treatment of sexually transmitted diseases or buy
condoms from the store. In general, it is easier for the poor to contract this
disease because they have no education about the risks and causes of the
disease. Another group at high risk for AIDS is women. Today, women account for
forty-two percent of people living with HIV/AIDS. Women are also becoming
infected at younger ages than men are. Women tend to marry older men who have
had more sexual partners and experience, and they are associated with a lower
social economic and social status than men are. Biologically, the risk of HIV
infection during unprotected vaginal intercourse is two to four times higher for
women than men. The reason is that women have a bigger surface area of mucosa
exposed to their partner’s sexual secretions during intercourse. Semen also
contains a higher concentration of HIV than vaginal secretions, and it can stay
in the vagina hours after intercourse. Although anyone who is sexually active is
at risk of exposure to the AIDS, the gay and bisexual community has been most
affected by the disease. Sexual activities among the gay community can be found
all over the world, but little data is available on this subject matter for
sufficient coverage. AIDS is transmitted through the exchange of certain body
fluids. The bottom line is, any type of sexual activity without adequate
protection (condoms) or with multiple partners can put individuals at a
dangerously high risk of contracting HIV/AIDS. Another form of risk behavior
would be the use of sharing infected drug needles. The use of infected drug
needles and polluted needles are risks that certainly can not be avoided, and
this is a very common method of contraction. Some countries and cities have
places to go to obtain clean needles and to get rid of used ones. Although some
evidence suggests that injection drug use can cause certain immunologic
abnormalities, such as reduction of CD4 cells, this has been shown rare in HIV-seronegative
injection drug users in the absence of other immunosuppressive conditions. Blood
transfusions have been known to transmit HIV during earlier years, but more
precautions have been taken since then to ensure all needles are sterile in an
effort to reduce all possibilities of transmission. Treatments for HIV/AIDS vary
from lab studies and blood analysis, symptom observation, to the more common
drug therapy. Lab studies and blood analysis shows indications of illness well
before the illness becomes apparent, but it is more difficult to act on test
results because the patient often feels fine; hence, patients who feel healthy
are less motivated to begin treatment. Symptom observation is based on the
evidence presented by active interventions and disease processes. In HIV, this
means watching out for such things as thrush, pneumocystis, and Kaposi’s
sarcoma legions. Federal healthcare guidelines now call for including a potent
protease inhibitor as part of combination treatments to fight HIV/AIDS. By
taking the protease inhibitors such as CRIXVAN, AZT (zidovudine), and 3TC, this
can help lower the amount of HIV in your body (called “viral load”) and
raise your CD4 (T) cell count. Although the drugs are not a cure for HIV or
AIDS, they can help reduce the chance of illnesses and death associated with
HIV. Recent year-long study conducted by the National Institutes of Health
studied over 1,000 patients and confirmed results from another study. A
combination of these drugs have been shown to have reduced the frequency and
severity of opportunistic infections, improved body weight, and increased counts
of CD4 cells in the peripheral blood. Further studies show that drug therapy has
extended patient’s life expectancy by at least 21 months after initiation.
Because HIV/AIDS is a life and death matter, it is crucial to take a
preventative approach once infected. After infection, individuals that have
HIV/AIDS do not get better naturally or by waiting. There is no natural
remission. The purpose of preventative treatment is to buy time and to slow
progression of the disease while researchers seek better treatment methods.
Taking a preventative approach makes it possible to:  Use treatments at
the stage that they are most effective,  Head off serious optic
infections and further damage they do to the immune system, and  Slow
the spread and replication of the virus. Taking the preventative approach
clearly offers hope to those infected with this devastating virus. Research is
rapidly progressing in the HIV/AIDS era. Molecular biologists are interested in
the workings of cells and infectious organisms at the cellular level. The recent
advances and breakthroughs in understanding the mechanisms that bring about
programmed cell death may ultimately explain HIV and AIDS in detail. Currently,
there are no tests that can offer a total picture of immune health. Some
researchers believe that as we manage HIV/AIDS as a chronic illness, testing
will provide guidance about what treatments to use, when to use them, and how
well they are working. In conclusion, HIV and AIDS have been repeatedly linked
in time, place, and population. Individuals as different as homosexuals,
transfusion recipients, injection drug users, and heterosexuals have all
developed AIDS with one common denominator: infection with HIV. We must remember
that AIDS is fatal, and that there is no known cure. The most troubling view is
that individuals will forget about the threat of AIDS and continue to engage in
risky behavior, eternally adding to the global tragedy of this epidemic.