acquired immunodeficiency syndrome

Entries

West's Encyclopedia of American Law Macmillan Encyclopedia of Death and DyingGale Encyclopedia of Alternative MedicineGale Encyclopedia of Medicine, 3rd ed. Further reading

NON JS

Acquired Immune Deficiency Syndrome

ACQUIRED IMMUNE DEFICIENCY SYNDROME

A disease caused by the human immunodeficiency virus (HIV) that produces disorders and infections that can lead to death.

Acquired immune deficiency syndrome (AIDS), a fatal disease that attacks the body's immune system making it unable to resist infection, is caused by the human immunodeficiency

What Causes AIDS—and What Does Not?

Since the first case was identified in 1981, acquired immune deficiency syndrome (AIDS) has grown into an epidemic that has taken approximately 500,000 lives in the United States alone. The Joint united nations Programme on HIV/AIDS estimates that at the end of 2002 there were 42 million people living with HIV/AIDS worldwide. During 2002, AIDS caused the deaths of an estimated 3.1 million people. At this time, women were increasingly affected by AIDS; it was estimated that women comprised approximately 50 percent or 19.2 million of the 38.6 million adults living with HIV or AIDS worldwide. No cure has been found, although existing treatment employing multiple drugs has made some gains in prolonging life and reducing pain. Despite the limits of medical science, however, much is known about the disease. It is caused by the human immunodeficiency virus (HIV). Transmitted by bodily fluids from person to person, HIV invades certain key blood cells that are needed to fight off infections. HIV replicates, spreads, and destroys these host cells. When the body's immune system becomes deficient, the person becomes AIDS-symptomatic, which means the person develops infections that the body can no longer ward off. Ultimately, a person with AIDS dies from diseases caused by other infections. The leading killer is a form of pneumonia.

Most of the fear surrounding AIDS has to do with its most common form of transmission: sexual behavior. The virus can be passed through any behavior that involves the exchange of blood, semen, or vaginal secretions. Anal intercourse is the highest-risk activity, but oral or vaginal intercourse is dangerous too. Thus, federal health authorities recommend using a condom—yet they caution that condoms are not 100 percent effective; condoms can leak, and they can break. Highly accurate HIV testing is widely available, and often advisable, since infected people can feel perfectly healthy. Although the virus can be contracted immediately upon exposure to it, symptoms of full-blown AIDS may take up to ten years to appear.

In addition to sexual behavior, only a few other means of HIV transmission exist. Sharing unsterilized needles used in drug injections is one way, owing to the exchange of blood on the needle, and thus intravenous drug users are an extremely high-risk group. Several cities have experimented with programs that offer free, clean needles. These programs have seen up to a 75 percent reduction in new HIV cases. Receipt of donations of blood, semen, organs, and other human tissue can also transmit HIV, although here, at least, screening methods have proved largely successful. Childbirth and breast feeding are also avenues of transmission, and thus children of HIV-positive mothers may be at risk.

The medical facts about HIV and AIDS are especially relevant to the law. Unless exposed in one of a few very specific ways, most people have nothing to fear. Casual contact with people who are infected is safe. Current medical knowledge is quite strong on this point: no one is known to have caught the virus by sitting next to, shaking the hand of, or breathing the same air as an infected person. For this reason, U.S. law has moved to protect the civil rights of HIV-positive and AIDS-symptomatic persons. Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 (1994) prohibits discrimination against otherwise qualified disabled individuals, including individuals with a contagious disease or an infection such as HIV or AIDS. The AIDS quilt, on display in Washington, D.C., has become a well-known symbol of support for victims of AIDS and their families. Families and supporters of victims of AIDS create a panel to commemorate that person's life and that panel is joined with others from around the country to create the quilt.

further readings

Barnett, Tony, and Alan Whiteside. 2003. AIDS in the Twenty-First Century. New York: Palgrave Macmillan.

Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: Univ. of California Press.

cross-references

Discrimination.

virus (HIV), which is communicable in some bodily fluids and transmitted primarily through sexual behavior and intravenous drug use.

Reading, Writing, and Aids

Teaching young people about AIDS is an enormously popular idea. Since the late 1980s, Gallup Polls have revealed that over 90 percent of respondents think public schools should do so. Agreement ends there, however. In the 1990s, more angry debate focused on AIDS education than on any issue facing schools since court-ordered busing in the 1970s. The core question of the debate is simple: What is the best way to equip students to protect themselves from this fatal disease? The answers may be miles apart. For one side, "equipping" means advocating the only sure means of protection, sexual and drug abstinence. For the other, it means supporting abstinence along with knowledge of sexual practices, the use of clean drug needles, and the use of prophylactics (condoms), which are distributed in some schools. Between these positions lie a great many issues of disagreement that have bitterly divided school districts, provoked lawsuits, and cost high-ranking Washington, D.C., officials their jobs.

Sex is an old battleground in public education. Liberals and conservatives argued over it in the decade following the sexual revolution of the 1960s, initially over whether sexual issues should be discussed in schools. After all, earlier generations who went to public schools learned mainly about reproductive organs. As new classes began appearing in the late 1970s, children learned about the sexual choices people make. If liberals appeared to win the "sex ed." debate, growing social problems helped: rises in teen pregnancies and sexually transmitted diseases secured a place for more explicit school health classes. The much greater threat of AIDS pushed state legislatures into action. By the mid-1990s, AIDS prevention classes had been mandated in at least 34 states and recommended in 14. But the appearance of even more explicit teaching has reinvigorated the sex ed. debate.

Supporters of a comprehensive approach say AIDS demands frankness. Originating in comprehensive sex ed. theory, their ideas also came from pacesetting health authorities such as former surgeon general c. everett koop. Arguing in the mid-1980s that AIDS classes should be specific and detailed and taught as early as kindergarten, Koop countered conservative arguments by saying, "Those who say 'I don't want my child sexually educated' are hiding their heads in the sand." This position holds that educators are obligated to teach kids everything that can stop the spread of the disease. "What is the moral responsibility?" Jerald Newberry, a health coordinator of Virginia schools, asked the Washington Times in 1992. "I think it's gigantic." Abstinence is a part of this approach, but expecting teens to refrain from having sex was considered by many to be unrealistic given some studies that show that nearly three out of four high school students have had sex before graduation. Thus, the comprehensive curriculum might well include explaining the proper use of condoms, discussing homosexual practices, describing the sterilization of drug needles, and so on.

Abstinence-only adherents think being less frank is being more responsible. They view sexuality as a moral issue properly left for parents to discuss with their children and one that lies beyond the responsibilities of schools. The conservative columnist Cal Thomas spoke for this viewpoint when he argued that parents "have lost a significant right to rear their children according to their own moral standards." Other objections come from religious conservatives who oppose any neutral or positive discussion of homosexuality. Koop, for example, was blasted for allegedly "sponsoring homosexually oriented curricula" and "teaching buggery in the 3rd grade." In addition to voicing moral objections, critics say comprehensive sex ed. is generally a failure because it encourages a false sense of security among teens that leads to experimentation with sex or drugs. "We have given children more information presumably because we think it will change their behavior, and yet the behavior has gotten worse, not better," said Gary Bauer, president of the Family Research Council.

Each side accuses the other of deepening the crisis. Comprehensive approach supporters think abstinence-only backers are moral censors, indifferent to pragmatic solutions. The liberal People for the American Way attacked "a growing wave of censorship ravaging sexuality education" that promotes only "narrow" curricula. It mocked such abstinence-only programs as Teen Aid and Sex Respect, both of which have brought threats of legal action from the american civil liberties union and Planned Parenthood. The conservative American Enterprise Institute asserted that liberal programs only prod students toward bad choices: "There has been a transition from protection to preparation." Neither side can agree on any data, other than to point out that the problems of AIDS and teen sexuality have appeared to worsen.

Nowhere are the two sides more split than on the issue of condoms. Schools in at least 23 cities sought to distribute condoms during the mid-to late-1990s. The assumption was that since students will have sex anyway—despite warnings not to—they had better be protected. Conservatives see this position as a cop-out in two ways: it sells values short and it undermines parental authority. In 1992, in Washington, D.C., critics erupted over a decision by the Public Health Commission to hand out condoms in junior and senior high schools without parental consent. William Brown, president of the D.C. Congress of Parents and Teachers, complained: "We are looking to build and reinforce and establish family values where they have been lost, and here we have an agency of our government that totally ignores those things we are working for." Dr. Mary Ellen Bradshaw, the commission's chief, replied: "Our whole focus is to save the lives of these children, stressing abstinence as the only sure way to avoid [AIDS] and making condoms available only after intensive education." In other cities, upset parents simply sued. By 1992, class action lawsuits had been brought against school districts in New York City, Seattle, and Falmouth, Massachusetts, arguing that condom distribution violated parents' right to privacy.

AIDS education in schools is not merely a local issue. While most decisions are made by states and school boards the federal government plays two important roles. First, it funds AIDS prevention programs: abstinence-based programs receive funding under the Adolescent Family Life Act of 1981, and programs that promote contraceptive use among teenagers are supported through the Family Planning Act of 1970. How these funds are spent is a matter of local control, but conservatives have sought to put limits on program content. During the early 1990s, Senator jesse helms (R-NC) twice tried to ban funding for programs that were perceived to promote homosexuality or that did not continuously teach abstinence as the only effective protection against AIDS. In response, one federal agency, the Center for Disease Control, adopted regulations that prohibited the use of funds on any materials that are found offensive by some members of communities.

The second role of the federal government is largely symbolic but no less controversial. It is to guide school efforts through advice, sponsorship, and public speeches, and primarily involves the offices of the surgeon general and of the federal AIDS policy coordinator. Koop, who was a Reagan appointee, roused a fair degree of controversy, yet it was nothing compared to the upheaval that greeted statements by appointees of the Clinton administration. AIDS policy czar Kristine Gebbie and surgeon general M. Joycelyn Elders were forced from their posts after making statements that conservatives found appalling—Gebbie promoting attitudes toward pleasurable sex and Elders indicating a willingness to have schools talk about masturbation. Thereafter, the administration frequently stressed abstinence as its top priority for school AIDS programs.

Problems surrounding AIDS education are unlikely to go away. Communities frequently disagree on sex education itself, and compromise is often difficult on such a divisive issue of values. As the experience of the Clinton administration suggested, Washington, D.C., could easily exacerbate an already contentious area, with policy coordinators becoming lightning rods for criticism. On the matter of what to say to kids about AIDS, poll data have been misleading. U.S. citizens are of three minds: say a lot, say a little, and do not say what the other side thinks.

further readings

Kelly, Pat. 1998. Coping When Your Friend Is HIV-Positive. New York: Rosen Publishing Group.

National Commission on Acquired Immune Deficiency Syndrome. 1993. National Commission on AIDS: An Expanding Tragedy: The Final Report of the National Commission on AIDS. Washington, D.C.: National Commission on Acquired Immune Deficiency Syndrome.

World Health Organization. 1989. Legislative Responses to AIDS. Boston: Martinus Nijhoff Publishers.

cross-references

Civil Rights Acts; Schools and School Districts.

The United States struggled to cope with AIDS from the early 1980s until the late 1990s, when new drug therapies started to extend the length and quality of life for many people with AIDS. Since the beginning, AIDS and its resulting epidemic in the United States have raised a great number of legal issues, which are made all the more difficult by the nature of the disease. AIDS is a unique killer, but some of its aspects are not: epidemics have been seen before; other sexually transmitted diseases have been fatal. AIDS is different because it was discovered in—and in the United States still predominantly afflicts—unpopular social groups: gay men and drug users. This fact has had a strong impact on the shaping of AIDS law. Law is often shaped by politics, and AIDS is a highly politicized disease. The challenge in facing an epidemic that endangers everyone is complicated by the stigma attached to the people most likely to be killed by it.

Epidemics have no single answer beyond a cure. Since no cure for AIDS existed as of the early 2000s, the law continued to grapple with a vast number of problems. The federal government has addressed AIDS in two broad ways: by spending money on research and treatment of the disease and by prohibiting unfairness to people with HIV or AIDS. It has funded medical treatment, research, and public education, and it has passed laws prohibiting discrimination against people who are HIV-positive or who have developed AIDS. States and local municipalities have joined in these efforts, sometimes with federal help. In addition, states have criminalized the act of knowingly transmitting the virus through sexual behavior or blood donation. The courts, of course, are the decision makers in AIDS law. They have heard a number of cases in areas that range from employment to education and from crimes to torts. Although a body of case law has developed, it remains relatively new with respect to most issues and controversial in all.

AIDS and the Federal Government

Political attitudes toward AIDS have gone through dramatically different phases. In the early 1980s, it was dubbed the gay disease and as such was easy for lawmakers to ignore. No one hurried to fund research into a disease that seemed to be killing only members of a historically unpopular group. When it was not being ignored, some groups dismissed AIDS as a problem that homosexuals deserved, perhaps brought on them by divine intervention. Discriminatory action matched this talk as gay men lost jobs, housing, and medical care. AIDS activists complained bitterly about the failure of

most U.S. citizens to be concerned. Public opinion only began to shift in the late 1980s, largely through awareness of highly publicized cases. As soon as AIDS had a familiar or more mainstream face, it became harder to ignore; when it became clear that heterosexuals were also contracting the disease, the epidemic acquired higher priority.

By the late 1980s, much of the harshness in public debate had diminished. Both liberals and conservatives lined up to support legislative solutions. President ronald reagan left office, recommending increases in federal funding for medical research on AIDS. Already the amount spent in this area had risen from $61 million in 1984 to nearly $1.3 billion in 1988. President george h.w. bush took a more active approach, and in 1990 signed two new bills into law. One was the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (Pub. L. No. 101-381, 104 Stat. 576), which provides much-needed money for states to spend on treatment. The other was the ground-breaking Americans with Disabilities Act (ADA) (42 U.S.C.A. §§ 12112–12117), which has proved to be the most effective weapon against the discrimination that individuals with the disease routinely suffer. Bush also hurried approval by the food and drug administration for AIDS-related drugs. Though he supported Americans with the disease, Bush agreed to a controversial ban by Congress on travel and immigration to the United States for people with HIV.

Like his predecessors, President bill clinton called for fighting the disease, rather than the people afflicted with it. In 1993, he appointed the first federal AIDS policy coordinator. He fully funded the Ryan White Care Act, increasing government support by 83 percent, to $633 million, and also increased funding for AIDS research, prevention, and treatment by 30 percent. These measures met most of his campaign promises on AIDS. He reneged on one: despite vowing to lift the ban on HIV-positive aliens, he signed legislation continuing it. In addition, he met a major obstacle on another proposal: Congress failed to pass his health care reform package, which would have provided health coverage to all U.S. citizens with HIV, delivered drug treatment against AIDS on demand to intravenous drug users, and prohibited health plans from providing lower coverage for AIDS than for other life-threatening diseases.

AIDS and Public Life

Having HIV is not a sentence to remove oneself from society. It does not limit a person's physical or mental abilities. Only later, when symptoms develop—as long as ten years from the time of infection—does the disease become increasingly debilitating. In any event, people who are HIV-positive and AIDS-symptomatic are fully able to work, play, and participate in daily life. Moreover, their rights to do so are the same as anyone else's. The chief barrier to a productive life often comes less from HIV and AIDS than from the fear, suspicion, and open hostility of others. Because HIV cannot be transmitted through casual contact, U.S. law has moved to defend the civil rights of those individuals with the disease.

AIDS in the Workplace The workplace is a common battleground. Many people with AIDS have lost their jobs, been denied promotions, or been reassigned to work duties that remove them from public contact. During the 1980s, this discrimination was fought through lawsuits based on older laws designed to protect the disabled. Plaintiffs primarily used the Rehabilitation Act of 1973 (29 U.S.C.A. § 701 et seq.), the earliest law of this type. But the Rehabilitation Act has a limited scope: it applies only to federally funded workplaces and institutions; it says nothing about those that do not receive government money. Thus, for example, the law was helpful to a California public school teacher with AIDS who sued for the right to resume teaching classes (Chalk v. United States District Court, 840 F.2d 701 [9th Cir. 1988]), but it would be of no use to a worker in a private business.

With passage of the ADA in 1990, Congress gave broad protection to people with AIDS who work in the private sector. In general, the ADA is designed to increase access for disabled persons, and it also forbids discrimination in hiring or promotion in companies with fifteen or more employees. Specifically, employers may not discriminate if the person in question is otherwise qualified for the job. Moreover, they cannot use tests to screen out disabled persons, and they must provide reasonable accommodation for disabled workers. The ADA, which took effect in 1992, quickly emerged as the primary means for bringing AIDS-related discrimination lawsuits. From 1992 to 1993, more than 330 complaints were filed with the U.S. equal employment opportunity commission (EEOC), which investigates charges before they can be filed in court. Given the lag time needed for EEOC investigations, those cases started appearing before federal courts in 1994 and 1995.

AIDS and Health Care Closely related to work is the issue of health care. In some cases, the two overlap: health insurance, social security, and disability benefits for people with AIDS were often hard to obtain during the 1980s. Insurance was particularly difficult because employers feared rising costs, and insurance companies did not want to pay claims. To avoid the costs of AIDS, insurance companies used two traditional industry techniques: they attempted to exclude AIDS coverage from general policies, and they placed caps (limits on benefits payments) on AIDS-related coverage. State regulations largely determine whether these actions were permissible. In New York, for example, companies that sell general health insurance policies are forbidden to exclude coverage for particular diseases. Caps have hurt AIDS patients because their treatment can be as expensive as that for cancer or other life-threatening illnesses. Insurance benefits can be quickly exhausted—in fact, AIDS usually bankrupts people who have the disease. The problem is compounded when employers serve as their own health insurers. In McGann v. H&H Music Co., 946, F.2d 401 (5th Cir. [1991]), a federal court ruled that such employers could legally change their policies to reduce coverage for workers who develop expensive illnesses such as AIDS.

In January 1995, the settlement in a lawsuit brought by a Philadelphia construction worker with AIDS illustrated that the ADA could be used to fight caps on coverage. In 1992, the joint union-management fund for the Laborers' District Council placed a $10,000 limit on AIDS benefits, in stark contrast to the $100,000 allowed for other catastrophic illnesses. At that time, the fund said the cap on AIDS benefits was designed to curb all health costs. In 1993, the EEOC ruled that the fund violated the ADA, and, backed by the AIDS Law Project of Philadelphia, the worker sued. Rather than fight an expensive lawsuit, the insurance fund settled: under the agreement, it extended coverage for all catastrophic illnesses to $100,000. Hailing the settlement as a major blow against widespread discrimination in insurance coverage, the law project's executive director, Nan Feyler, told thePhiladelphia Inquirer, "You can't single out someone based on a stereotype."

In other respects, health care is a distinct area of concern for AIDS patients and health professionals alike. Discrimination has often taken place. State and federal statutes, including the Rehabilitation Act, guarantee access to health care for AIDS patients, and courts have upheld that right. In the 1988 case of Doe v. Centinela Hospital, 57 U.S.L.W. 2034 (C.D. Cal.), for example, an HIV-infected person with no symptoms was excluded from a federally funded hospital residential program for drug and alcohol treatment because health care providers feared exposure to the virus. The case itself exposed the irrationality of such discrimination. Although its employees had feared HIV, the hospital argued in court that the lack of symptoms meant that the patient was not disabled and thus not protected by the Rehabilitation Act. A federal trial court in California rejected this argument, ruling that a refusal to grant services based solely on fear of contagion is discrimination under the Rehabilitation Act.

Other actions during the 1990s have relied upon the ADA. In 1994, the U.S. Justice Department reached a settlement in a lawsuit with the city of Philadelphia that ensures that city employees will treat patients with AIDS. The first settlement in a health care–related ADA suit, the case grew out of an incident in 1993: when an HIV-positive man collapsed on a Philadelphia street, emergency medical workers not only refused to touch him but told him to get on a stretcher by himself. The man sued. In settling the case, the city agreed to begin an extensive training program for its 900 emergency medical technicians and 1,400 firefighters. In addition, officials paid the man $10,000 in compensatory damages and apologized. The justice department viewed the suit as an important test of the ADA. Assistant Attorney General James Turner said the settlement would "send a clear message to all cities across the nation that we will not tolerate discrimination against persons with AIDS."

Health care professionals are not the only ones with concerns about HIV transmission. Patients may legitimately wonder if their doctors are infected. During the early 1990s, the medical and legal communities debated whether HIV-positive doctors have a duty to inform their patients of the illness. According to the Centers for Disease Control (CDC), the risk of HIV transmission from health care workers to patients is very small when recommended infection-control procedures are followed, yet this type of transmission has occurred. The first cases of patients contracting HIV during a medical procedure were reported in 1991: Dr. David J. Acer, a Florida dentist with AIDS, apparently transmitted HIV to five patients. One was Kimberly Bergalis, age twenty-three, who died as a result. Before her death, Bergalis brought a claim against the dentist's professional liability insurer, contending that it should have known that Acer had AIDS and effectively barred him from operating by refusing to issue him a malpractice insurance policy. Bergalis's claim was settled for $1 million. A second claim by Bergalis, against the insurance company that recommended Acer to her, was settled for an undisclosed amount.

Since the Bergalis case, many U.S. dentists, physicians, and surgeons with AIDS have begun disclosing their status to their patients. Faya v. Almaraz, 329 Md. 435, 620 A.2d 327 (Md. 1993), illustrates the consequences of not doing so. In Faya, the court held that an HIV-positive doctor has the legal duty to disclose this medical condition to patients and that a failure to inform can lead to a negligence action, even if the patients have not been infected by the virus. The doctor's patient did not contract HIV but did suffer emotionally from a fear of having done so. The unanimous decision held that patients can be compensated for their fears. Although this case dealt specifically with doctor-patient relationships, others have concerned a variety of relationships in which the fear of contracting AIDS can be enough for a plaintiff to recover damages.

Routine HIV-testing in healthcare facilities also raises legal issues. Most people who are HIV-positive want this information kept confidential. Facilities are free to use HIV testing to control the infection but in most states only with the patient's informed consent. Some states, such as Illinois, require written consent. The level of protection for medical records varies from state to state. California, for example, has broad protections; under its statutes, no one can be compelled to provide information that would identify anyone who is the subject of an HIV test. However, every state requires that AIDS cases be reported to the CDC, which tracks statistics on the spread of HIV. Whether the name of an HIV-infected person is reported to the CDC depends on state laws and regulations.

AIDS and Education Issues in the field of education include the rights of HIV-positive students to attend class and of HIV-positive teachers to teach, the confidentiality of HIV records, and how best to teach young people about AIDS. A few areas have been settled in court: for instance, the right of students to attend classes was of greater concern in the early years of the epidemic and later ceased to be a matter of dispute.

Certain students with AIDS may assert their right to public education under the Education for All Handicapped Children Act of 1975 (EAHCA), but the law is only relevant in cases involving special education programs. More commonly, students' rights are protected by the Rehabilitation Act. Perhaps the most important case in this area is Thomas v. Atascadero Unified School District, 662 F. Supp. 376 (C.D. Cal.1986), which illustrates how far such protections go. Thomas involved an elementary school student with AIDS who had bitten another youngster in a fight. Based on careful review of medical evidence, the U.S. District Court for the Central District of California concluded that biting was not proved to transmit AIDS, and it ordered the school district to readmit the girl. Similarly, schools that excluded teachers with AIDS have been successfully sued on the ground that those teachers pose no threat to their students or others and that their right to work is protected by the Rehabilitation Act, as in Chalk.

Confidentiality relating to HIV is not uniform in schools. Some school districts require rather broad dissemination of the information; others keep it strictly private. In the mid-1980s, the New York City Board of Education adopted a policy that nobody in any school would be told the identities of children with AIDS or HIV infection; only a few top administrators outside the school would be informed. The policy inspired a lawsuit brought by a local school district, which argued that the identity of a child was necessary for infection control (District 27 Community School Board v. Board of Education, 130 Misc. 2d 398, 502 N.Y.S.2d 325 [N.Y. Sup. Ct. 1986]). The trial court rejected the argument on the basis that numerous children with HIV infection might be attending school and instead noted that universal precautions in dealing with blood incidents at school would be more effective than the revelation of confidential information.

Schools play a major role in the effort to educate the public on AIDS. Several states have mandated AIDS prevention instruction in their schools. But the subject is controversial: it evokes personal, political, and moral reactions to sexuality. Responding to parental sensitivities, some states have authorized excused absences from such programs. The New York State Education

Department faced a storm of controversy over its policy of not allowing absences at parental discretion. Furthermore, at the local and the federal levels, some conservatives have opposed certain kinds of AIDS education. During the 1980s, those who often criticized liberal approaches to sex education argued that AIDS materials should not be explicit, encourage sexuality, promote the use of contraceptives, or favorably portray gays and lesbians. In Congress, lawmakers attached amendments to appropriations measures (bills that authorize the spending of federal tax dollars) that mandate that no federal funds may be used to "promote homosexuality." In response, the CDC adopted regulations that prohibit spending federal funds on AIDS education materials that might be found offensive by some members of certain communities. Despite the controversy, some communities have taken radical steps to halt the spread of AIDS. In 1991 and 1992, the school boards of New York City, San Francisco, Seattle, and Los Angeles voted to make condoms available to students in their public high school systems.

AIDS and Private Life

Although epidemics are public crises, they begin with individuals. The rights of people who have AIDS and those who do not are often in contention and seldom more so than in private life. It is no surprise that people with HIV continue having sex, nor is it a surprise that this behavior is, usually, legal. Unfortunately, some do so without knowing they have the virus. Even more unfortunately, others do so in full knowledge that they are HIV-positive but without informing their partners. This dangerous behavior has opened one area of AIDS law that affects individuals: the legal duty to warn a partner before engaging in behavior that can transmit the infection. A similar duty was recognized by courts long before AIDS ever appeared, with regard to other sexually transmitted diseases.

A failure to inform in AIDS cases has given rise to both civil and criminal lawsuits. One such case was brought by Mark Christian, the lover of actor Rock Hudson, against Hudson's estate. Christian won his suit on the ground that Hudson concealed his condition and continued their relationship, and the jury returned a multimillion-dollar verdict despite the fact that there was no evidence that Christian had been infected. Another case was brought in Oregon in 1991, when criminal charges were filed against Alberto Gonzalez for knowingly spreading HIV by having sex with his girlfriend. After Gonzalez pleaded no contest to third-degree assault (a felony) and to two charges of recklessly endangering others, he received an unusual sentence: the court ordered him to abstain from sex for five years and placed him under house arrest for six months. Although such convictions are increasingly common, courts have also recognized that not knowing one has HIV can be a valid defense. In C. A. U. v. R. L., 438 N.W.2d 441 (1989), for example, the Minnesota Court of Appeals affirmed a trial court's finding that the plaintiff could not recover damages from her former fiancé, who had unknowingly given her the virus.

State Legislation and the Courts To stem transmission of HIV, states have adopted several legal measures. Two states attempted to head off the virus at the pass: Illinois and Louisiana at one point required HIV blood testing as a prerequisite to getting a marriage license. Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states. Several states have taken a less stringent approach, requiring only that applicants for a marriage license must be informed of the availability—and advisability—of HIV tests. More commonly, states criminalize sexual behavior that can spread AIDS. Michigan law makes it a felony for an HIV or AIDS-infected person to engage in sex without first informing a partner of the infection. Florida law provides for the prosecution of any HIV-positive person committing prostitution, and it permits rape victims to demand that their attackers undergo testing. Indiana imposes penalties on persons who recklessly or knowingly donate blood or semen with the knowledge that they are HIV-infected.

Older state laws have also been applied to AIDS. Several states have statutes that make it a criminal offense for a person with a contagious disease—including a sexually transmitted disease—to willfully or knowingly expose another person to it, and some have amended these laws specifically to include AIDS. In addition, in many states, it has long been a crime to participate in an act of sodomy. The argument that punishing sodomy can stem HIV transmission was made in a case involving a Missouri sodomy statute specifically limited to homosexual conduct. In State v. Walsh, 713 S.W.2d 508 (1986), the Missouri Supreme Court upheld the statute after finding that it was rationally related to the state's legitimate interest in protecting public health. Other AIDS-related laws have been invalidated in court challenges: for instance, in 1993, a U.S. district judge struck down a 1987 Utah statute that invalidated the marriages of people with AIDS, ruling that it violated the ADA and the Rehabilitation Act.

Sex is only one kind of behavior that has prompted criminal prosecution related to AIDS. Commonly, defendants in AIDS cases have been prosecuted for assault. In United States v. Moor, 846 F.2d 1163 (8th Cir., 1988), the Eighth Circuit upheld the conviction of an HIV-infected prisoner found guilty of assault with a deadly weapon—his teeth—for biting two prison guards during a struggle. Teeth were also on trial in Brock v. State, 555 So. 2d 285 (1989), but the Alabama Court of Criminal Appeals refused to regard them as a dangerous weapon. In State v. Haines, 545 N.E.2d 834 (2d Dist. 1989), the Indiana Court of Appeals affirmed a conviction of attempted murder against a man with AIDS who had slashed his wrists to commit suicide; when police officers and paramedics refused to let him die, he began to spit, bite, scratch, and throw blood.

Civil Litigation tort law has seen an explosion of AIDS-related suits. This area of law is used to discourage individuals from subjecting others to unreasonable risks and to compensate those who have been injured by unreasonably risky behavior. The greatest number of AIDS-related liability lawsuits has involved the receipt of HIV-infected blood and blood products. A second group has concerned the sexual transmission of HIV. A third group involves AIDS-related psychic distress. In these cases, plaintiffs have successfully sued and recovered damages for their fear of having contracted HIV.

Advances in Treatment Though the search for an AIDS vaccine has consumed many researchers, by 2003 no breakthroughs had appeared. However, other researchers have concentrated on ways of controlling AIDS through drug treatment regimens that require individuals to consume many different types of medications at the same time. These anti-AIDS "cocktails" undergo constant study and modification as researchers learn more about the working of HIV. The medications are from a family of drugs called protease inhibitors.

Survival rates have dramatically improved for those individuals using protease inhibitors, but other problems have also arisen. Some persons do not respond to these medications or the side effects from taking the drugs diminish the quality of life. Protease inhibitors, for many people, are intolerable because of nausea, diarrhea, vomiting, headache, kidney stones, and serious drug interactions with other medications. By 2003 researchers had found that serious side effects include increased risk of heart attack, abnormalities in fat distribution, an increased propensity toward diabetes, and abnormalities in cholesterol metabolism.

Cost is another concern associated with protease inhibitors. To be effective, protease inhibitors must be used in combination with at least two other anti-HIV drugs. Annual costs for this treatment ranges between $12,000-$15,000 per person. Those persons without private health insurance must rely on public programs such as the AIDS Drug Assistance Program (ADAP), a federally funded initiative to provide AIDS-related drugs to people with HIV. Most ADAP programs, which are administered by

states, have lacked the funding to enroll everyone in need.

International Issues By 2003 the international AIDS problem had become a crisis in Africa and parts of Asia. The united nations(UN) and the World Health Organization (WHO) have worked together to address the issues of prevention and treatment, but the statistics reveal grim conditions. In December 2002 a joint UN-WHO report disclosed that 42 million people in the world are living with HIV and AIDS. In 2002 five million people contracted HIV and over three million people died of AIDS. The situation is gravest in sub-Saharan Africa, where over 29 million adults and children are living with HIV and AIDS, contracted mainly through heterosexual contact. These figures stand in stark contrast to North America, where less than one million people are living with HIV and AIDS.

The growth of AIDS in Africa and Asia has raised worries about global political and economic stability. Governments in these ravaged countries have not been able to afford the anti-viral drugs. In 2002 pharmaceutical companies agreed to sell these drugs to these countries as generic drugs, dropping the cost from $12,000 to $300 a year per patient; yet even at these prices many governments would be hard pressed to purchase them.

In 2003, President george w. bush proposed spending $15 billion over five years to

support international AIDS prevention and the purchase of anti-viral drugs. The largest share of the money would be contributed directly by the United States to other countries, such as through programs sponsored by the U.S. Agency for International Development. The proposal would account for almost half the money in a global fund committed to fight HIV and AIDS.

further readings

ACLU. 1996. The Rights of People Who Are HIV Positive. Carbondale: Southern Illinois Univ. Press.

——. 1995a. AIDS and Civil Liberties. Briefing paper no. 13.

——. 1995b. Lesbian and Gay Rights. Briefing paper no. 18.

——. 1994. ACLU Wins Precedent-Setting Claim in AIDS Case; Federal Court Rules That ADA Covers AIDS Discrimination. Press release, November 21.

——. 1993. ACLU Files AIDS Discrimination Suit; Challenges South Carolina Insurance Risk Pool. Press release, April 6.

"Fighting Aids." February 10, 2003. PBS News Hour. Available online at <www.pbs.org> (accessed May 29, 2003).

Health and Human Services Department. Social Security Administration. 1991. A Guide to Social Security and SSI Disability Benefits for People with HIV Infection. Pub. no. 05-10020, September.

Jarvis, Robert M., et al., eds. 1996. AIDS Law in a Nutshell. 2d ed. Minneapolis, Minn.: West.

Rollins, Joe. 2002. "AIDS, Law, and the Rhetoric of Sexuality." Law & Society Review 36 (April).

White House. Office of the Press Secretary. 1994. Proclamation for World AIDS Day, November 30, 1994. Press release.

cross-references

Disability Discrimination; Discrimination; Food and Drug Administration; Gay and Lesbian Rights; Health Care Law; Patients' Rights; Physicians and Surgeons; Privacy.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Acquired Immune Deficiency Syndrome." West's Encyclopedia of American Law. 2005. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Acquired Immune Deficiency Syndrome." West's Encyclopedia of American Law. 2005. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3437700097.html

"Acquired Immune Deficiency Syndrome." West's Encyclopedia of American Law. 2005. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3437700097.html

Aids

AIDS

In June 1981 scientists published the first report of a mysterious and fatal illness that initially appeared to affect only homosexual men. Subsequent early reports speculated that this illness resulted from homosexual men's sexual activity and, possibly, recreational drug use. In the months that followed, however, this same illness was diagnosed in newborns, children, men, and women, a pattern strongly suggesting a blood-borne infection as the cause of the observed illness. The illness was initially identified by several terms (e.g., "gay bowel syndrome," "lymphadenopathy virus (LAV)," and AIDS-associated retrovirus (ARV), but by 1982 this disease came to be known as acquired immune deficiency syndrome (AIDS) because of the impact of the infectious agent, human immunodeficiency virus (HIV), on an infected person's immune system. Since about 1995 the term HIV disease has been used to describe the condition of HIV-infected persons from the point of early infection through the development of AIDS.

Over the next two decades AIDS became one of the leading causes of death in the United States and in other parts of the world, particularly in persons younger than forty-five years of age. Since the 1990s in the United States AIDS has come to be viewed as an "equal opportunity" disease, because it affects persons of all colors, class, and sexual orientation. Despite the evolution of major treatment advances for HIV infection and AIDS, HIV disease has been the cause of death for about 450,000 persons living in the United States since the onset of the epidemic. In addition, an estimated 800,000 to 900,000 Americans are infected with the virus that causes AIDSand perhaps as many as 300,000 are unaware of their infection. Better treatments for HIV infection have resulted in a reduction in the number of deaths from AIDS and an increase in the number of persons living with HIV infection.

The cause of AIDS was identified in 1983 by the French researcher Luc Montagnier as a type of virus known as a "retrovirus." This newly identified retrovirus was eventually called "human immunodeficiency virus," or HIV. Scientists have established HIV as the cause of AIDS, even though a small group of individuals have questioned the link between HIV and AIDS. An HIV-infected person who meets specific diagnostic criteria (i.e., has one or more of the twenty-five AIDS-defining conditions indicative of severe immunosuppression and/or a seriously compromised immune system) is said to have AIDS, the end stage of a continuous pathogenic process. Multiple factors influence the health and functioning of HIV-infected persons. For example, some persons who meet the diagnostic criteria for AIDS may feel well and function normally, while other HIV-infected persons who do not meet the diagnostic criteria for AIDS may not feel well and have reduced functioning in one or more areas of their lives.

While drugs are now available to treat HIV infection or specific HIV-related conditions, these treatments are expensive and unobtainable to most of the world's infected individuals, the vast majority of whom live in poor, developing nations. Thus the most important and effective treatment for HIV disease is prevention of infection. Preventive measures are challenging because sexual and drug use behaviors are difficult to change; certain cultural beliefs that influence the potential acquisition of infection are not easily modified; many persons at highest risk lack access to risk-reduction education; and many persons (especially the young) deny their vulnerability to infection and engage in behaviors that place them at risk of infection.

An individual may be infected with HIV for ten years or more without symptoms of infection. During this period, however, the immune system of the untreated person deteriorates, increasing his or her risk of acquiring "opportunistic" infections and developing certain malignancies. While HIV disease is still considered a fatal condition, the development in the 1990s of antiretroviral drugs and other drugs to treat opportunistic infections lead many infected individuals to hope that they can manage their disease for an extended period of time. Unfortunately, the view that HIV disease is a "chronic" and "manageable" condition (as opposed to the reality that it is a fatal condition) may lead persons to engage in behaviors that place them at risk of infection. In the United States, for example, epidemiologists have noted an upswing in the number of HIV infections in young homosexual men who, these experts believe, engage in risky behaviors because HIV disease has become less threatening to them. These individuals are one generation removed from the homosexual men of the 1980s who saw dozens of their friends, coworkers, and neighbors die from AIDS and thus may not have experienced the pain and grief of the epidemic's first wave.

Origin of HIV

The origin of the human immunodeficiency virus has interested scientists since the onset of the epidemic because tracing its history may provide clues about its effects on other animal hosts and on disease treatment and control. While HIV infection was first identified in homosexual men in the United States, scientists have learned from studies of stored blood samples that the infection was present in human hosts yearsand perhaps decadesbefore 1981. However, because the number of infected individuals was small and the virus was undetectable prior to 1981, a pattern of disease went unrecognized. HIV disease may have been widespread, but unrecognized, in Africa before 1981.

While a number of theories, including controversial conspiracy theories, have been proposed to explain the origin of HIV and AIDS, strong scientific evidence supports the view that HIV represents a cross-species (zoonosis) infection evolving from a simian (chimpanzee) virus in Southwest Africa between 1915 and 1941. How this cross-species shift occurred is unclear and a topic of considerable debate. Such an infectious agent, while harmless in its natural host, can be highly lethal to its new host.

Epidemiology of HIV Disease

Because HIV has spread to every country of the world, it is considered a pandemic. By the end of 2001 an estimated 65 million persons worldwide had been infected with HIV and of these, 25 million had died. An estimated 14,000 persons worldwide are infected every day. Most (95%) of the world's new AIDS cases are in underdeveloped countries. About 70 percent of HIV-infected persons live in sub-Saharan Africa. Globally 1 in 100 people are infected with HIV. The effects of HIV disease on the development of the world have been devastating. Millions of children in developing nations are infected and orphaned. The economies of some developing nations are in danger of collapse; and some nations risk political instability because of the epidemic.

Over the past decade an estimated 40,000 persons living in the United States have become infected with HIV every year, a figure that has remained relatively stable. Between 1981 and 2000 more than 774,000 cases of AIDS were reported to the Centers for Disease Control and Prevention (CDC). Of these cases, more than 82 percent were among males thirteen years and older, while more than 16 percent were among females thirteen years and older. Less than 2 percent of AIDS cases were among children younger than thirteen years of age. More than 430,000 persons living in the United States had died from AIDS by the end of 1999. The annual number of deaths among persons with AIDS has been decreasing because of early diagnosis and improved treatments for opportunistic infections and HIV infection.

The epidemiologic patterns of HIV disease have changed significantly since the onset of the epidemic. In 1985, for example, 65 percent of new AIDS cases were detected among men who have sex with other men (MSM). Since 1998 only about 42 percent of new AIDS cases have been detected among MSM, although the rate of new infections in this group remains high. Increasing numbers of new AIDS cases are attributed to heterosexual contact (but still only about 11 percent of the cumulative AIDS cases) and among injection drug users (about 25 percent of cumulative AIDS cases). In 2002 women, who are primarily infected through heterosexual contact or injection drug use, account for about 30 percent of all new HIV infections, a dramatic shift in the United States since 1981. In developing parts of the world men and women are infected in equal numbers.

In the United States new HIV infections and AIDS disproportionately affect minority populations and the poor. Over half (54%) of new HIV infections occur among African Americans, who represent less than 15 percent of the population. Hispanics are disproportionately affected as well. African-American women account for 64 percent (Hispanic women, 18%) of new HIV infections among women. African-American men account for about half of new HIV infections among men, with about equal numbers (18%) of new infections in white and Hispanic men. HIV infections in infants have been dramatically reduced because of the use of antiretroviral drugs by HIV-infected women who are pregnant.

HIV Disease: The Basics

There are two major types of human immunodeficiency virus: HIV-1 and HIV-2. HIV-1 is associated with most HIV infections worldwide except in West Africa, where HIV-2 is prevalent. Both types of viruses may be detected through available testing procedures. HIV is a retrovirus and member of a family of viruses known as lentiviruses, or "slow" viruses. These viruses typically have a long interval between initial infection and the onset of serious symptoms. Lentiviruses frequently infect cells of the immune system. Like all viruses, HIV can replicate only inside cells, taking over the cell's machinery to reproduce. HIV, once inside a cell, uses an enzyme called reverse transcriptase to convert ribonucleic acid (RNA) into deoxyribonucleic acid (DNA), which is incorporated into the host cell's genes. The steps in HIV replication include: (1) attachment and entry; (2) reverse transcription and DNA synthesis; (3) transport to nucleus; (4) integration; (5) viral transcription; (6) viral protein synthesis; (7) assembly and budding of virus; (8) release of virus; and (9) maturation. In addition to rapid replication, HIV reverse transcriptase enzyme makes many mistakes while making DNA copies from HIV RNA, resulting in multiple variants of HIV in an individual. These variants may escape destruction by antibodies or killer T cells during replication.

The immune system is complex, with many types of defenses against infections. Some parts of this system have key coordinating roles in mobilizing these defenses. One such key is the CD4+ T-lymphocyte (also known as CD4+ T cell and T-helper cell), a type of lymphocyte that produces chemical "messengers." These messengers strengthen the body's immune response to infectious organisms. The cell most markedly influenced by HIV infection is the CD4+ T-lymphocyte. Over time HIV destroys these CD4+ T cells, thus impairing the immune response of people with HIV disease and making them more susceptible to secondary infections and some types of malignant tumors.

If HIV infection progresses untreated, the HIV-infected person's number of CD4+ T-lymphocytes declines. Therefore, early in the course of HIV disease the risk for developing opportunistic infections is low because the CD4+ T-lymphocytes may be nearly normal or at least adequate to provide protection against pathogenic organisms; however, in untreated individuals the risk of infection increases as the number of CD4+ cells falls. The rate of decline of CD4+ T lymphocyte numbers is an important predictor of HIV-disease progression. People with high levels of HIV in their bloodstream are more likely to develop new AIDS-related symptoms or die than individuals with lower levels of virus. Thus early detection and treatment of HIV infection and routine use of blood tests to measure viral load are critical in treating HIV infection. HIV may also directly infect other body cells (e.g., those of the brain and gastrointestinal tract), resulting in a range of clinical conditions. When cells at these sites are infected with HIV, such problems as dementia and diarrhea may result; thus even if HIV-infected persons do not develop an opportunistic infection or malignancy, they may experience a spectrum of other clinical problems that require medical treatment or interfere with their quality of life.

How Is HIV Spread?

The major known ways by which HIV infection is spread are: (1) intimate sexual contact with an HIV-infected person; (2) exposure to contaminated blood or blood products either by direct inoculation, sharing of drug apparatus, transfusion, or other method; and (3) passage of the virus from an infected mother to her fetus or newborn in utero, during labor and delivery, or in the early newborn (including through breast-feeding). Some health care workers have become occupationally infected with HIV, but these numbers are small in light of the millions of contacts between health care workers and persons with HIV infection. Most occupationally acquired HIV infections in such workers have occurred when established "universal precautions" have not been followed.

HIV-infected blood, semen, vaginal fluid, breast milk, and other bodily fluids containing blood have been proven to have the potential to transmit HIV. While HIV has been isolated from other cells and tissues, the importance of these bodily fluids in transmission is not entirely clear. Health care workers may come into contact with other bodily fluids that can potentially transmit HIV. While HIV has been transmitted between members in a household setting, such transmission is extremely rare. There are no reports of HIV being transmitted by insects; by nonsexual bodily contact (e.g., handshaking); through closed mouth or social kissing; or by contact with saliva, tears, or sweat. One cannot be HIV-infected by donating blood. Transfusion of blood products can pose a risk of infection, but the risk is low in the United States, where all such products are carefully tested.

Several factors (called "cofactors") may play a role in the acquisition of HIV infection, influence its transmission, affect development of clinical signs and symptoms, and influence disease progression. Cofactors that have been mentioned in scientific literature include anal receptive sex resulting in repeated exposure to absorbed semen; coexistence of other infections (e.g., syphilis, hepatitis B); injection and recreational drug use; use of immunosupressant drugs (e.g., cocaine, alcohol, or amyl/butyl nitrites); douching or enemas before sexual intercourse; malnutrition; stress; age at time of seroconversion; genetic susceptibility; multiple sexual partners; and presence of genital ulcers.

Preventing HIV Infection

HIV infection is almost 100 percent preventable. HIV infection may be prevented by adhering to the following measures:

  • engaging in one-partner sex where both participants are HIV-negative and are maintaining a sexual relationship that only involves those two participants;
  • using latex or polyurethane condoms properly every time during sexual intercourse, including oral sex;
  • not sharing needles and syringes used to inject drugs or for tattooing or body piercing;
  • not sharing razors or toothbrushes;
  • being tested for HIV if one is pregnant or considering pregnancy;
  • prohibiting oneself from breast-feeding if HIV-positive; and
  • calling the CDC National AIDS Hotline at 1-800-342-AIDS (2437) for more information about AIDS prevention and treatment (or by contacting www.cdc.gov/hiv to access the CDC Division of HIV/AIDS for information).

What Happens after Infection with HIV?

Following infection with HIV the virus infects a large number of CD4+ cells, replicating and spreading widely, and producing an increase in viral burden in blood. During this acute stage of infection, which usually occurs within the first few weeks after contact with the virus, viral particles spread throughout the body, seeding various organs, particularly the lymphoid organs (lymph nodes, spleen, tonsils, and adenoids). In addition, the number of CD4+ T cells in the bloodstream decreases by 20 to 40 percent. Infected persons may also lose HIV-specific CD4+ T cell responses that normally slow the replication of viruses in this early stage. Within a month of exposure to HIV the infected individual's immune system fights back with killer T cells (CD8+ T cells) and B-cell antibodies that reduce HIV levels, allowing for a rebound of CD4+ T cells to 80 to 90 percent of their original level. The HIV-infected person may then remain free of HIV-related symptoms for years while HIV continues to replicate in the lymphoid organs seeded during the acute phase of infection. Also at this point many infected persons experience an illness (called "primary" or "acute" infection) that mimics mononucleosis or flu and usually lasts two to three weeks.

In untreated HIV-infected persons, the length of time for progression to disease varies widely. Most (80 to 90 percent) HIV-infected persons develop AIDS within ten years of initial infection; another 5 to 10 percent of infected persons progress to AIDS within two to three years of HIV infection; about 5 percent are generally asymptomatic for seven to ten years following infection and have no decline in CD4+ T lymphocyte counts. Efforts have been made to understand those factors that affect disease progression, including viral characteristics and genetic factors. Scientists are also keenly interested in those individuals who have repeated exposures to HIV (and may have been acutely infected at some point) but show no clinical evidence of chronic HIV infection.

Testing and Counseling

Testing for HIV infection has complex social, ethical, legal, and health implications. HIV testing is done for several reasons: to identify HIV-infected persons who may benefit from early medical intervention; to identify HIV-negative persons who may benefit from risk reduction counseling; to provide for epidemiological monitoring; to engage in public health planning. Individuals who seek HIV testing expect that test results will remain confidential, although this cannot be entirely guaranteed. Anonymous testing is widely available and provides an additional measure of confidentiality.

HIV testing has been recommended for those who consider themselves at risk of HIV disease, including:

  • women of childbearing age at risk of infection;
  • persons attending clinics for sexually transmitted disease and drug abuse;
  • spouses and sex- or needle-sharing partners of injection drug users;
  • women seeking family planning services;
  • persons with tuberculosis;
  • individuals who received blood products between 1977 and mid-1995; and
  • others, such as individuals with symptoms of HIV-related conditions; sexually active adolescents; victims of sexual assault; and inmates in correctional facilities.

Detection of HIV antibodies is the most common approach to determine the presence of HIV infection, although other testing approaches can detect the virus itself. Testing for HIV infection is usually accomplished through standard or rapid detection (results are obtained in five to thirty minutes) of anti-HIV antibodies in blood and saliva. The most common types of antibody test for HIV serodiagnosis include the enzyme-linked immunosorbent assay (ELISA), the Western blot, immunofluorescence, radioimmuno-precipitation, and hemagglutination. These tests do not directly measure the presence of the virus but rather the antibodies formed to the various viral proteins. One home testing kitthe Home Access HIV-1 Test Systemis approved by the U.S. Food and Drug Administration. Oral and urine-based tests are available for rapid screening in medical offices but are typically followed up by one or more tests for confirmation. Most tests used to detect HIV infection are highly reliable in determining the presence of HIV infection, but false-positive and false-negative results have been documented by Niel Constantine and other health care professionals.

Testing for HIV infection should always include pre- and posttest counseling. Guidelines for such testing have been published by the CDC. Pretest counseling should include information about the test and test results, HIV infection, and AIDS; performance of a risk assessment and provision of information about risk and risk reduction behaviors associated with the transmission of HIV; discussion about the consequences (i.e., medical care, pregnancy, employment, insurance) of a positive or negative result for the person being tested and for others (family, sexual partner(s), friends); and discussion about the need for appropriate follow-up in the event of positive test results. Posttest counseling is dependent upon test results, but generally includes provision of test results, emotional support, education, and, when appropriate, referral for medical or other forms of assistance.

Clinical Manifestations of HIV Disease

The clinical manifestations of HIV vary greatly among individuals and depend upon individual factors and the effectiveness of medical intervention, among other factors. Primary infection may also offer the first opportunity to initiate antiretroviral therapy, although all experts do not agree that such therapy should be initiated at this stage of the infection. The symptom-free period of time following primary infection has been extended in many infected persons by the introduction of highly active antiretroviral therapy (HAART). Many HIV-infected persons, especially those who do not receive antiretroviral therapy, those who respond poorly to such therapy, and those who experience adverse reactions to these drugs, will develop one or more opportunistic conditions, malignancies, or other conditions over the course of their disease.

Opportunistic Infections

Prior to the HIV epidemic, many opportunistic infections (OIs) seen in HIV-infected persons were not commonly encountered in the health care community. Many of the organisms responsible for these OIs are everywhere (ubiquitous) in the environment and cause little or no disease in persons with competent immune systems. However, in those who are immunocompromised, these organisms can cause serious and life-threatening disease. Since the introduction of HAART the incidence of HIV-related opportunistic infections and malignancies has been declining. The epidemiological patterns of at least some of these opportunistic diseases vary by region and country. Ideally, treatment of OIs is aimed at prevention of infections, treatment of active infections, and prevention or recurrences. Over the course of the HIV epidemic several new drugs and treatment approaches aimed at OIs have been introduced or refined. Guidelines have also been developed concerning the prevention of exposure to opportunistic pathogens.

Opportunistic infections affecting HIV-infected persons fall into four major categories:

  1. Parasitic/Protozoa infectionscryptosporidiosis, toxoplasmosis, isosporiasis, and microsporidiosis.
  2. Fungal infectionspneumocystosis, cryptococcus, candidiasis (thrush), histoplasmosis, and coccidioidomycosis.
  3. Bacterial infectionsmycobacterium avium complex (MAC), mycobacterium tuberculosis (TB), and salmanellosis.
  4. Viral infectionscytomegalovirus, herpes simplex types 1 and 2, and varicella-zoster virus (shingles), cytomegalovirus, and hepatitis.

Parasitic infections can cause significant illness and death among HIV-infected persons. Fungal diseases may vary widely among persons with HIV disease because many are commonly found in certain parts of the world and less common in others. Bacterial infections are also seen as important causes of illness and death in HIV-infected persons. Viral infections are common in this population and are often difficult to treat because of the limited number of antiviral drugs that are available. Persons with HIV disease often suffer from recurrences of viral infections. Those whose immune systems are severely compromised may have multiple infections simultaneously.

Two categories of malignancies that are often seen in persons with HIV disease are Kaposi's sarcoma (KS) and HIV-associated lymphomas. Prior to the HIV epidemic KS was rarely seen in the United States. Since the mid-1990s, researchers have also suggested an association between cervical and anal cancers. When cancers develop in a person with HIV disease these conditions tend to be aggressive and resistant to treatment.

In addition to the opportunistic infections and malignancies, persons with HIV disease may experience Wasting syndrome and changes in mental functioning. Wasting syndrome is a weight loss of at least 10 percent in the presence of diarrhea or chronic weakness and documented fever for at least thirty days that is not attributable to a concurrent condition other than HIV infection. Multiple factors are known to cause this weight loss and muscle wasting, including loss of appetite, decreased oral intake, and nausea and vomiting. Wasting is associated with rapid decline in overall health, increased risk of hospitalization, development of opportunistic infection, decreased quality of life, and decreased survival. Interventions include management of infections, oral nutritional supplements, use of appetite stimulants, management of diarrhea and fluid loss, and exercise.

AIDS dementia complex (ADC) is a complication of late HIV infection and the most common cause of neurological dysfunction in adults with HIV disease. Its cause is believed to be direct infection of the central nervous system by HIV. This condition can impair the intellect and alter motor performance and behavior. Early symptoms include difficulty in concentration, slowness in thinking and response, memory impairment, social withdrawal, apathy, personality changes, gait changes, difficulty with motor movements, and poor balance and coordination. As ADC advances, the affected person's cognitive functioning and motor skills worsen. Affected persons may enter a vegetative state requiring total care and environmental control. Treatment focuses on supportive care measures and aggressive use of HAART.

Finally, persons with HIV disease frequently experience mental disorders, especially anxiety and depression. These are typically treated by standard drug therapy and psychotherapy. Persons with HIV disease are also at greater risk of social isolation, which can have a negative impact on their mental and physical health.

Management of HIV Disease

Better understanding of HIV pathogenesis, better ways to measure HIV in the blood, and improved drug treatments have greatly improved the outlook for HIV-infected persons. Medical management focuses on the diagnosis, prevention, and treatment of HIV infection and related opportunistic infections and malignancies. HIV-infected persons who seek care from such providers should expect to receive compassionate and expert care in such settings. Management of HIV disease includes:

  • early detection of HIV infection;
  • early and regular expert medical evaluation of clinical status;
  • education to prevent further spread of HIV infection and to maintain a healthy lifestyle;
  • administration of antiretroviral drugs;
  • provision of drugs to prevent the emergence of specific opportunistic infections;
  • provision of emotional/social support;
  • medical management of HIV-related symptoms;
  • early diagnosis and appropriate management of OIs and malignancies; and
  • referral to medical specialists when indicated.

The mainstay of medical treatment for HIV-infected persons is the use of antiretroviral drugs. Goals of antiretroviral therapy are to prolong life and improve quality of life; to suppress virus below limit of detection for as long as possible; to optimize and extend usefulness of available therapies; and to minimize drug toxicity and manage side effects.

Two major classes of antiretroviral drugs are available for use in the treatment of HIV infectionreverse transcriptase inhibitors (RTIs) and protease inhibitors (PIs). These drugs act by inhibiting viral replication. RTIs interfere with reverse transcriptase, an enzyme essential in transcribing RNA into DNA in the HIV replication cycle. Protease inhibitor drugs work by inhibiting the HIV protease enzyme, thus preventing cleavage and release of mature, infectious viral particles. Dozens of other drugs that may become available in the next few years to treat HIV infection are under development and testing. Because of the high costs of these drugs, individuals needing assistance may gain access to HIV-related medications through the AIDS Drug Assistance Program (ADAP) and national pharmaceutical industry patient assistance/expanded access programs.

Panels of HIV disease experts have released guidelines for the use of antiretroviral agents in infected persons. The guidelines, which are revised periodically to reflect rapidly evolving knowledge relative to treatment, are widely available on the Internet. These guidelines have greatly assisted practitioners to provide a higher standard of care for persons living with HIV disease.

Viral load tests and CD4+ T-cell counts are used to guide antiretroviral drug treatment, which is usually initiated when the CD4+ T-cell count falls below 500 and/or there is evidence of symptomatic disease (e.g., AIDS, thrush, unexplained fever). Some clinicians recommend antiretroviral drug treatment to asymptomatic HIV-infected persons.

Because HIV replicates and mutates rapidly, drug-resistance is a challenge, forcing clinicians to alter drug regimens when these instances occur. Inadequate treatment, poor adherence, and interruptions in treatment increase drug resistance. This resistance can be delayed by the use of combination regimens to achieve CD4+ T-cell counts below the level of detection. Careful adherence to prescribed HAART regimens is crucial in treatment and many interventions have been tried to improve patient adherence. Because some HIV-infected persons are taking multiple doses of multiple drugs daily, adherence challenges patients and clinicians alike. Once antiretroviral therapy has been initiated patients remain on this therapy continuously, although intermittent drug treatment is being studied. Because persons living with HIV disease may take numerous drugs simultaneously, the potential for drug interactions and adverse reactions is high. These persons typically have a higher incidence of adverse reactions to commonly used drugs than do non-HIV-infected patients.

In the United States HIV/AIDS is an epidemic primarily affecting men who have sex with men and ethnic/racial minorities. Homophobia, poverty, homelessness, racism, lack of education, and lack of access to health care greatly influence testing, treatment, and prevention strategies. While an effective vaccine is crucial to the prevention of HIV, efforts to develop such a vaccine have been unsuccessful to date; therefore, current and future prevention efforts, including behavior modification interventions, must be aimed at ethnic minorities, men who have sex with men, and other high-risk populations. Finally, a safe, effective antiviral product that women can use during sexual intercourse would greatly reduce their risk of infection.

See also: Causes of Death; Pain and Pain Management; Suicide Influences and Factors: Physical Illness; Symptoms and Symptom Management

Bibliography

Adinolfi, Anthony J. "Symptom Management in HIV/AIDS." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Berger, Barbara, and Vida M. Vizgirda. "Preventing HIV Infection." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Centers for Disease Control and Prevention. HIV/AIDS Surveillance Supplemental Report, 2000. Rockville, MD: Author, 2001.

Centers for Disease Control and Prevention. "HIV/AIDSUnited States, 19812000." Morbidity and Mortality Weekly Report 50 (2001):430434.

Cohen, Philip T., and Mitchell H. Katz. "Long-Term Primary Care Management of HIV Disease." In Philip T. Cohen, Merle A. Sande, and Paul Volberding, et al. eds, The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Coleman, Rebecca, and Christopher Holtzer. "HIV-Related Drug Information." In Philip T. Cohen, Merle A. Sande, and Paul Volberding, et al. eds., The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Corless, Inge. "HIV/AIDS." In Felissa Lashley and Jerry Durham eds., Emerging Infectious Diseases. New York: Springer, 2002.

Deeks, Steven, and Paul Volberding. "Antiretroviral Therapy for HIV Disease." In Philip T. Cohen, Merle A. Sande, and Paul Volberding, et al. eds., The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Erlen, Judith A., and Mary P. Mellors. "Adherence to Combination Therapy in Persons Living with HIV: Balancing the Hardships and the Blessings." Journal of the Association of Nurses in AIDS Care 10, no. 4 (1999):7584.

Ferri, Richard. "Testing and Counseling." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Horton, Richard. "New Data Challenge OPV Theory of AIDS Origin." Lancet 356 (2000):1005.

Kahn, James O., and Bruce D. Walker. "Primary HIV Infection: Guides to Diagnosis, Treatment, and Management." In Philip T. Cohen, Merle A. Sande, and Paul Volberding, et al. eds., The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Lamptey, Peter R. "Reducing Heterosexual Transmission of HIV in Poor Countries." British Medical Journal 324 (2002):207211.

Lashley, Felissa. "The Clinical Spectrum of HIV Infection and Its Treatment." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Lashley, Felissa. "The Etiology, Epidemiology, Transmission, and Natural History of HIV Infection and AIDS." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Osmond, Dennis H. "Classification, Staging, and Surveillance of HIV Disease." In P. T. Cohen, Merle A. Sande, and Paul Volberding, et al. eds, The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Wightman, Susan, and Michael Klebert. "The Medical Treatment of HIV Disease." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Young, John. "The Replication Cycle of HIV-1." In Philip T. Cohen, Merle A. Sande, Paul Volberding, et al. eds, The AIDS Knowledge Base: A Textbook on HIV Disease from the University of California, San Francisco and San Francisco General Hospital. New York: Lippincott Williams & Wilkins, 1999.

Zeller, Janice, and Barbara Swanson. "The Pathogenesis of HIV Infection." In Jerry Durham and Felissa Lashley eds., The Person with HIV/AIDS: Nursing Perspectives. New York: Springer, 2000.

Internet Resources

Centers for Disease Control and Prevention (CDC). "Basic Statistics." In the CDC [web site]. Available from www.cdc.gov/hiv/stats.htm#cumaids.

Centers for Disease Control and Prevention (CDC). "Recommendations to Help Patients Avoid Exposure to Opportunistic Pathogens." In the CDC [web site]. Available from www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4810a2.htm.

Centers for Disease Control and Prevention (CDC). "Revised Guidelines for HIV Counseling, Testing, and Referral." In the CDC [web site]. Available from www.cdc.gov/hiv/ctr/default.htm.

Constantine, Niel. "HIV Antibody Assays." In the InSite Knowledge Base [web site]. Available from http://hivinsite.ucsf.edu/InSite.jsp?page=kb-02-02-01#S6.1.2X.

Department of Health and Human Services. "Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents." In the HIV/AIDS Treatment Information Service [web site]. Available from www.hivatis.org/trtgdlns.html.

UNAIDS. "AIDS Epidemic UpdateDecember 2001." In the UNAIDS [web site]. Available from www.unaids.org/epidemic_update/report_dec01/index.html.

United States Census Bureau. "HIV/AIDS Surveillance." In the U.S. Census Bureau [web site]. Available from www.census.gov/ipc/www/hivaidsn.html.

JERRY D. DURHAM

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

DURHAM, JERRY D.. "Aids." Macmillan Encyclopedia of Death and Dying. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

DURHAM, JERRY D.. "Aids." Macmillan Encyclopedia of Death and Dying. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3407200015.html

DURHAM, JERRY D.. "Aids." Macmillan Encyclopedia of Death and Dying. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3407200015.html

AIDS

AIDS

Definition

Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981. AIDS is the advanced form of infection with the HIV virus, which may not cause disease for a long period after the initial exposure (latency). Infection with HIV weakens the immune system which makes infected people susceptible to infection and cancer .

Description

AIDS is considered one of the most devastating public health problems in recent history. In 1996, the Centers for Disease Control and Prevention (CDC) estimated that one million persons in the United States were HIV-positive, and 223,000 are living with AIDS. Of these patients, 44% were gay or bisexual men, 26% are heterosexual intravenous drug users, and 18% were women. In addition, approximately 1,000-2,000 children are born each year with HIV infection. In 2002, the CDC reported 42,136 new AIDS diagnoses in the United States, a 2.2% increase from the previous year. AIDS cases rose among gay and bisexual men (7.1% in 25 states that report regularly). The disease also seems to be rising among older Americans. From 1990 to 2001, the number of cases in Americans age 50 years or older rose from 16,288 to 90,153.

The World Health Organization (WHO) estimates that 40 million people worldwide were infected with AIDS/HIV as of 2001. Most of these cases are in the developing countries of Asia and Africa. In 2003, WHO cautioned that if treatment were not delivered soon to nearly 6 million people with AIDS in developing countries, there could be 45 million cases by 2010.

Risk factors

AIDS can be transmitted in several ways. The risk factors for HIV transmission vary according to category:

  • Sexual contact. Persons at greatest risk are those who do not practice safe sex, are not monogamous, participate in anal intercourse, and have sex with a partner with symptoms of advanced HIV infection and/or other sexually transmitted diseases (STDs). In the United States and Europe, most cases of sexually transmitted HIV infection have resulted from homosexual contact, whereas in Africa, the disease is spread primarily through sexual intercourse among heterosexuals.
  • Transmission in pregnancy . High-risk mothers include women married to bisexual men or men who have an abnormal blood condition called hemophilia and require blood transfusions, intravenous drug users, and women living in neighborhoods with a high rate of HIV infection among heterosexuals. The chances of transmitting the disease to the child are higher in women in advanced stages of the disease. Breast feeding increases the risk of transmission by 10-20% and is not recommended. The use of zidovudine (AZT) during pregnancy and delivery, however, can decrease the risk of transmission to the baby.
  • Exposure to contaminated blood or blood products. With the introduction of blood product screening in the mid-1980s, the incidence of HIV transmission in blood transfusions has dropped to 1 in 100,000.
  • Needle sticks among health care professionals. Present studies indicate that the risk of HIV transmission by a needle stick is about 1 in 250. This rate can be decreased if the injured worker is given AZT or triple therapy (HAART), the current standard.

HIV is not transmitted by handshakes or other casual non-sexual contact, coughing or sneezing , or by bloodsucking insects such as mosquitoes.

AIDS in women

AIDS in women is a serious public health concern. Women exposed to HIV infection through heterosexual contact are the most rapidly growing risk group in the United States. The percentage of AIDS cases diagnosed in women has risen from 7% in 1985 to 18% in 1996. For unknown reasons, women with AIDS do not live as long as men with AIDS.

AIDS in children

Because AIDS can be transmitted from an infected mother to her child during pregnancy, during the birth process, or through breast milk, all infants born to HIV-positive

mothers are at risk. As of 1997, it was estimated that 84% of HIV-positive women are of childbearing age; 41% of them are drug abusers. Between 15-30% of children born to HIV-positive women will be infected with the virus.

AIDS is one of the 10 leading causes of death in children between one and four years of age worldwide. The interval between exposure to HIV and the development of AIDS is shorter in children than in adults. Infants infected with HIV have a 20-30% chance of developing AIDS within a year and dying before age three. In the remainder, AIDS progresses more slowly; the average child patient survives to seven years of age. Some survive into early adolescence.

Causes & symptoms

Because HIV destroys immune system cells, AIDS is a disease that can affect any of the body's major organ systems. HIV attacks the body through three disease processes: immunodeficiency, autoimmunity, and nervous system dysfunction.

Immunodeficiency describes the condition in which the body's immune response is damaged, weakened, or is not functioning properly. In AIDS, immunodeficiency results from the way that the virus binds to a protein called CD4, which is found on certain white blood cells, including helper T cells, macrophages, and monocytes. Once HIV attaches to an immune system cell, it can replicate within the cell and kill the cell. In addition to killing some lymphocytes directly, the AIDS virus disrupts the functioning of other CD4 cells. Because the immune system cells are destroyed, infections and cancers that take advantage of a person's weakened immune system (opportunistic) can develop.

Autoimmunity is a condition in which the body's immune system produces antibodies that work against its own cells. Antibodies are specific proteins produced in response to exposure to a specific, usually foreign, protein or particle called an antigen. In this case, the body produces antibodies that bind to blood platelets that are necessary for proper blood clotting and tissue repair. Once bound, the antibodies mark the platelets for removal from the body, and they are filtered out by the spleen. Some AIDS patients develop a disorder, called immune-related thrombocytopenia purpura (ITP), in which the number of blood platelets drops to abnormally low levels.

The course of AIDS generally progresses through three stages, although not all patients will follow this progression precisely:

Acute retroviral syndrome

Acute retroviral syndrome is a term used to describe a group of symptoms that can resemble mononucleosis and that may be the first sign of HIV infection in 50-70% of all patients and 45-90% of women. The symptoms may include fever, fatigue , muscle aches, loss of appetite, digestive disturbances, weight loss, skin rashes, headache , and chronically swollen lymph nodes (lymphadenopathy). Approximately 25-33% of patients will experience a form of meningitis during this phase, in which the membranes that cover the brain and spinal cord become inflamed. Acute retroviral syndrome develops between one and six weeks after infection and lasts two to four weeks, sometimes up to six weeks. Blood tests during this period will indicate the presence of virus (viremia) and the appearance of the viral p24 antigen in the blood.

Latency period

After the HIV virus enters a patient's lymph nodes during the acute retroviral syndrome stage, the disease becomes latent for as many as 10 years or more before symptoms of advanced disease develop. During latency, the virus continues to replicate in the lymph nodes, where it may cause one or more of the following conditions.

PERSISTENT GENERALIZED LYMPHADENOPATHY (PGL). Persistent generalized lymphadenopathy, or PGL, is a condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period. The lymph nodes most frequently affected by PGL are those in the areas of the neck, jaw, groin, and armpits. PGL affects between 50-70% of patients during latency.

CONSTITUTIONAL SYMPTOMS. Many patients will develop low-grade fevers, chronic fatigue, and general weakness. HIV also may cause a combination of food malabsorption, loss of appetite, and increased metabolism that contribute to the so-called AIDS wasting or wasting syndrome.

OTHER ORGAN SYSTEMS. At any time during the course of HIV infection, patients may suffer from a yeast infection in the mouth called thrush, open sores or ulcers, or other infections of the mouth; diarrhea and other gastrointestinal symptoms that cause malnutrition and weight loss; diseases of the lungs and kidneys; and degeneration of the nerve fibers in the arms and legs. HIV infection of the nervous system leads to general loss of strength, loss of reflexes, and feelings of numbness or burning sensations in the feet or lower legs.

Late-stage AIDS

Late-stage AIDS usually is marked by a sharp decline in the number of CD4+ lymphocytes (a type of white blood cell), followed by a rise in the frequency of opportunistic infections and cancers. Doctors monitor the number and proportion of CD4+ lymphocytes in the patient's blood in order to assess the progression of the disease and the effectiveness of different medications. About 10% of infected individuals never progress to this overt stage of the disease.

OPPORTUNISTIC INFECTIONS. Once the patient's CD4+ lymphocyte count falls below 200 cells/mm3, he or she is at risk for opportunistic infections. The infectious organisms may include:

  • Fungi. Fungal infections include a yeast infection of the mouth (candidiasis or thrush) and cryptococcal meningitis.
  • Protozoa. The most common parasitic disease associated with AIDS is Pneumocystis carinii pneumonia (PCP). About 70-80% of AIDS patients will have at least one episode of PCP prior to death. PCP is the immediate cause of death in 15-20% of AIDS patients. It is an important measure of a patient's prognosis. Toxoplasmosis is another common infection in AIDS patients that is caused by a protozoan. Other diseases in this category include amebiasis and cryptosporidiosis.
  • Mycobacteria. AIDS patients may develop tuberculosis or MAC infections. MAC infections are caused by Mycobacterium avium-intracellulare, and occur in about 40% of AIDS patients.
  • Bacteria. AIDS patients are likely to develop bacterial infections of the skin and digestive tract.
  • Viruses. AIDS patients are highly vulnerable to cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Epstein-Barr virus (EBV) infections. Another virus, JC virus, causes progressive destruction of brain tissue in the brain stem, cerebrum, and cerebellum (multifocal leukoencephalopathy or PML), which is regarded as an AIDS-defining illness by the Centers for Disease Control and Prevention.
ESTIMATED NUMBER OF ADULTS AND CHILDREN LIVING WITH AIDS/HIV WORLDWIDE AS OF 2001
Regions Estimate
Australia & New Zealand 15,000
Caribbean 420,000
East Asia & Pacific 1,000,000
Eastern Europe & Central Asia 1,000,000
Latin America 1,500,000
North Africa & Middle East 500,000
North America 950,000
South & Southeast Asia 5,600,000
Sub-Saharan African 28,500,000
Western Europe 550,000
Global total 40,000,000+

AIDS DEMENTIA COMPLEX AND NEUROLOGIC COMPLICATIONS. AIDS dementia complex is a late complication of the disease. It is unclear whether it is caused by the direct effects of the virus on the brain or by intermediate causes. AIDS dementia complex is marked by loss of reasoning ability, loss of memory, inability to concentrate, apathy and loss of initiative, and unsteadiness or weakness in walking. Some patients also develop seizures.

MUSCULOSKELETAL COMPLICATIONS. Patients in late-stage AIDS may develop inflammations of the muscles, particularly in the hip area, and may have arthritis-like pains in the joints.

ORAL SYMPTOMS. Patients may develop a condition called hairy leukoplakia of the tongue. This condition also is regarded by the CDC as an indicator of AIDS. Hairy leukoplakia is a white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus.

AIDS-RELATED CANCERS. Patients with late-stage AIDS may develop Kaposi's sarcoma (KS), a skin tumor that primarily affects homosexual men. KS is the most common AIDS-related malignancy. It is characterized by reddish-purple blotches or patches (brownish in African-Americans) on the skin or in the mouth. About 40% of patients with KS develop symptoms in the digestive tract or lungs. KS appears to be caused by a herpes virus.

The second most common form of cancer in AIDS patients is a tumor of the lymphatic system (lymphoma). AIDS-related lymphomas often affect the central nervous system and develop very aggressively.

Invasive cancer of the cervix is an important diagnostic marker of AIDS in women.

Diagnosis

Because HIV infection produces such a wide range of symptoms, the CDC has drawn up a list of 34 conditions regarded as defining AIDS. The physician will use the CDC list to decide whether the patient falls into one of these three groups:

  • definitive diagnoses with or without laboratory evidence of HIV infection
  • definitive diagnoses with laboratory evidence of HIV infection
  • presumptive diagnoses with laboratory evidence of HIV infection

Physical findings

Almost all symptoms of AIDS can occur with other diseases. The general physical examination may range from normal findings to symptoms that are closely associated with AIDS. These symptoms are hairy leukoplakia of the tongue and Kaposi's sarcoma. When the doctor examines the patient, he or she will look for the overall pattern of symptoms rather than any one finding.

Laboratory tests for HIV infection

BLOOD TESTS (SEROLOGY). The first blood test for AIDS was developed in 1985. At present, patients who are being tested for HIV infection usually are given an enzyme-linked immunosorbent assay (ELISA) test for the presence of HIV antibody in their blood. Positive ELISA results then are tested with a Western blot or immunofluorescence (IFA) assay for confirmation. The combination of the ELISA and Western blot tests is more than 99.9% accurate in detecting HIV infection within four to eight weeks following exposure. The polymerase chain reaction (PCR) test can be used to detect the presence of viral nucleic acids in the very small number of HIV patients who have false-negative results on the ELISA and Western blot tests. In 2003, a one-step test that was quicker and cheaper was shown effective for detecting HIV in the physician office setting. However, further research was ongoing as to its effectiveness in replacing current tests as a first check for HIV.

OTHER LABORATORY TESTS. In addition to diagnostic blood tests, there are other blood tests that are used to track the course of AIDS. These include blood counts, viral load tests, p24 antigen assays, and measurements of β2-microglobulin (β2M).

Doctors will use a wide variety of tests to diagnose the presence of opportunistic infections, cancers, or other disease conditions in AIDS patients. Tissue biopsies, samples of cerebrospinal fluid, and sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography scans (CT) are used to diagnose AIDS-related cancers, some opportunistic infections, damage to the central nervous system, and wasting of the muscles. Urine and stool samples are used to diagnose infections caused by parasites. AIDS patients also are given blood tests for syphilis and other sexually transmitted diseases.

Diagnosis in children

Diagnostic blood testing in children older than 18 months is similar to adult testing, with ELISA screening confirmed by Western blot. Younger infants can be diagnosed by direct culture of the HIV virus, PCR testing, and p24 antigen testing.

In terms of symptoms, children are less likely than adults to have an early acute syndrome. They are, however, likely to have delayed growth, a history of frequent illness, recurrent ear infections, a low blood cell count, failure to gain weight, and unexplained fevers. Children with AIDS are more likely to develop bacterial infections, inflammation of the lungs, and AIDS-related brain disorders than are HIV-positive adults.

Treatment

AIDS patients turn to alternative medicine when conventional treatments are ineffective, and to supplement conventional treatment, reduce disease symptoms, counteract drug effects, and improve quality of life. Because alternative medicines may interact with conventional medicines, it is important for the patient to inform his or her doctor of all treatments being used.

A report released in 2003 showed trends in increased use of alternative medicine among HIV-positive individuals. Based on 1997 figures, the study reported that 79% of those seeking alternative therapy to help with AIDS treatment or symptom relief were men and 63% were women. The types of therapies they used most were relaxation techniques, massage, chiropractic care, self-help groups, commercial diets , and acupuncture .

Supplements

  • Lauric oils (coconut oil) are used by the body to make monolaurin, which inactivates HIV.
  • Selenium deficiency increases the risk of death due to AIDS-related illness. One study found that 250 micrograms of selenomethionin daily for one year showed no improvement in CD4 cell counts or disease symptoms. Greater than 1,000 micrograms daily is toxic.
  • Vitamin C has antioxidant and antiretroviral activities. One study found that treatment caused a trend to decrease viral load.
  • DHEA (dehydroepiandrosterone) is commonly used by AIDS patients to counteract wasting. One study found that DHEA had no effect on lymphocytes or p24 antigen levels. However, a 2002 study found that it was associated with a significant increase in measures that indicate mental health improvement.
  • Vitamin A deficiency is associated with increased mortality. One study of pregnant women with AIDS found that 5000 IU of vitamin A daily led to stabilized viral load as compared to a placebo group. Another study found that 60 mg of vitamin A had no effect on CD4 cells or viral load. Vitamin A has been associated with faster disease progression. Excessive vitamin A during pregnancy can cause birth defects.
  • Beta-carotene supplementation for AIDS is controversial as studies have shown both beneficial and detrimental effects. Beta-carotene supplementation has led to elevation in white blood cell counts and changes in the CD4 cell count. Some studies have found that beta-carotene supplementation led to an increase in deaths due to cancer and heart disease .

Naturopathic doctors often recommend the following supplements for AIDS:

  • beta-carotene, 150,000 IU daily
  • vitamin C, 2,000 mg thrice daily
  • vitamin E, 400 IU twice daily
  • cod liver oil, 1 tablespoon daily
  • multivitamin, as directed
  • coenzyme Q 10, 50-60 mg twice daily

Herbals and Chinese medicine

One small study of the effectiveness of Chinese herbal treatment in AIDS showed promise. AIDS patients took a tablet that contained 31 herbs that was based on the formulas Enhance and Clear Heat. Disease symptoms were reduced in the herbal treatment group as compared to the placebo group.

Herbals used in treating AIDS include:

  • Maitake mushroom extract. Recommended dose is 10 drops twice daily
  • Licorice (Glycyrrhiza glabra ) solid extract. Recommended dose is one quarter to one half teaspoon twice daily
  • Boxwood extract (SPV-30) has antiviral activity. Recommended dose is one capsule thrice daily.
  • Garlic concentrate (Allicin) helped reduce bowel movements, stabilized or increased body weight, or cured Cryptosporidium parvum infection in affected AIDS patients. However, a 2002 National Institutes of Health study cautioned that garlic supplements could reduce levels of a protease inhibitor that is used to treat AIDS patients, so patients should discuss using garlic supplements with their physicians.
  • Tea tree oil (Malaleuca ) improves or cures infection of the mouth by the yeast Candida. Tea tree oil is available as soap, dental floss, toothpick, and mouthwash.
  • Marijuana is used to treat wasting. Studies have found that patients who use marijuana had increased food intake and weight gain. The active ingredient delta-9-tetrahydrocannabinol is licensed for treating AIDS wasting.

Psychotherapy and stress reduction

Many therapies that are directed at improving mental state can have a direct impact on disease severity and quality of life. The effectiveness of many have been proven in clinical studies. These include:

  • massage
  • laughter/humor
  • stress management training
  • visualization
  • cognitive therapy
  • aerobic exercise
  • prayer

Other treatments for AIDS include homeopathy , naturopathy, acupuncture, and chiropractic.

Allopathic treatment

Treatment for AIDS covers four categories:

Antiretroviral treatment

In recent years researchers have developed drugs that suppress HIV replication. The drugs are used in combination with one another and fall into four classes:

  • Nucleoside reverse transcriptase inhibitors. These drugs work by interfering with the action of HIV reverse transcriptase, thus ending the virus replication process. These drugs include zidovudine (sometimes called Zidovudine or AZT, trade name Retrovir), didanosine (ddi, Videx), emtricitabine (FTC, Emtriva), zalcitabine (ddC, Hivid), stavudine (d4T, Zerit), abacavir (Ziagen), tenofovir (df, Viread), and lamivudine (3TC, Epivir).
  • Protease inhibitors. Protease inhibitors are effective against HIV strains that have developed resistance to nucleoside analogues, and often are used in combination with them. These compounds include saquinavir (Fortovase), ritonavir (Norvir), indinavir (Crixivan), amprenavir (Agenerase), lopinavir plus ritonavir (Reyataz), and nelfinavir (Viracept).
  • Non-nucleoside reverse transcriptase inhibitors. This is a newer class of antiretroviral agents. Three are available, nevirapine (Viramune), efavirenz (Sustiva), and delavirdine (Rescriptor).
  • Fusion inhibitors. These drugs are less common, expensive and difficult to use. They block infection early by preventing HIV from fusing with and entering a human cell. This class includes only one compound: Enfuvirtide (Fuzeon).

Treatment guidelines for these agents are in constant change as new medications are developed and introduced. In mid-2003, the U.S. Department of Health and Human Services revised its guidelines for the use of these agents to help clinicians better choose the best combinations. The new guidelines offer a list of suggested combination regimens classified as either "preferred" or "alternative".

Treatment of opportunistic infections and malignancies

Most AIDS patients require complex long-term treatment with medications for infectious diseases. This treatment often is complicated by the development of resistance in the disease organisms. AIDS-related malignancies in the central nervous system usually are treated with radiation therapy. Cancers elsewhere in the body are treated with chemotherapy.

Prophylactic treatment for opportunistic infections

Prophylactic treatment is treatment that is given to prevent disease. AIDS patients with a history of Pneumocystis pneumonia; with CD4+ counts below 200 cells/mm3 or 14% of lymphocytes; weight loss; or thrush should be given prophylactic medications. The three drugs given are trimethoprim-sulfamethoxazole, dapsone, or pentamidine in aerosol form.

STIMULATION OF BLOOD CELL PRODUCTION. Because many patients with AIDS suffer from abnormally low levels of both red and white blood cells, they may be given medications to stimulate blood cell production. Epoetin alfa (erythropoietin) may be given to anemic patients. Patients with low white blood cell counts may be given filgrastim or sargramostim.

Treatment in women

Treatment of pregnant women with HIV is particularly important because antiretroviral therapy has been shown to reduce transmission to the infant by 65%.

Expected results

At the present time, there is no cure for AIDS. Treatment stresses aggressive combination drug therapy when possible. The use of multi-drug therapies has significantly reduced the number of U.S. deaths resulting from AIDS. The potential exists to possibly prolong life indefinitely using these and other drug therapies to boost the immune system, keep the virus from replicating, and ward off opportunistic infections and malignancies.

Prognosis after the latency period depends on the patient's specific symptoms and the organ systems affected by the disease. Patients with AIDS-related lymphomas of the central nervous system die within two to three months of diagnosis; those with systemic lymphomas may survive for eight to ten months. In America, the successful treatment of AIDS patients with HAART has actually led to a growing number of people living with HIV. About 25,000 infected people per year are added to the list of HIV-infected Americans.

However, not only does HAART and other treatment prolong AIDS patients' lives, it has led to some improvement in quality of life too. A recent study shows that HAART therapy substantially reduces risk of AIDS-related pneumonia (PCP), although PCP still remains the most common AIDS-defining illness among opportunistic infections. Other recent studies show that these protease inhibitors may result in high cholesterol and put AIDS patients at eventual risk for heart disease. Further research must be done, since long-term effects of HAART treatment are just now being studied. Most clinicians would say the benefits outweigh the risks anyway.

Prevention

As of 2000, there is no vaccine effective against AIDS. Several vaccines to prevent initial HIV infection and disease progression are being tested. In 2002, reports showed a new "library" vaccine showed potential. The vaccine is composed of up to 32 HIV gene fragments that can induce a number of immune responses. In the same year, the British government worked with five African countries in a trial to find an effective gel that would protect women against HIV during sex. The study leaders believed if they could find a lotion that could be applied before intercourse that would help prevent HIV transmission, they would give women the ability to better protect themselves from HIV. In 2003, the first human test of a vaccine against the most common subtype of HIV was underway.

Precautions to take to prevent the spread of AIDS include:

  • Monogamy and practicing safe sex. Besides avoiding the risk of HIV infection, condoms are successful in preventing other sexually transmitted diseases and unwanted pregnancies.
  • Avoiding needle sharing among intravenous drug users.
  • Although blood and blood products are carefully monitored, those individuals who are planning to undergo major surgery may wish to donate blood ahead of time to prevent a risk of infection from a blood transfusion.
  • Healthcare professionals should wear gloves and masks when handling body fluids and avoid needle-stick injuries.
  • A person who suspects that he or she may have become infected should get tested. If treated aggressively and early, the development of AIDS can sometimes be postponed indefinitely. If HIV infection is confirmed, it also is vital to inform sexual partners.

Resources

BOOKS

Abrams, Donald I. "Alternative Therapies." AIDS Therapy. edited by Raphael Dolin et al. Philadelphia: Churchill Livingstone, 1999.

Early HIV Infection Guideline Panel. Evaluation and Management of Early HIV Infection. Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, 1994.

The Global AIDS Policy Coalition. AIDS in the World. Cambridge, MA: Harvard University Press, 1992.

Huber, Jeffrey T. Dictionary of AIDS-Related Terminology. New York and London: Neal-Schuman Publishers, Inc., 1993.

"Infectious Diseases: Human Immunodeficiency Virus (HIV)." In Neonatology: Management, Procedures, On-Call Problems, Diseases and Drugs. edited by Tricia Lacy Gomella, et al. Norwalk, CT: Appleton & Lange, 1994.

Katz, Mitchell H. and Harry Hollander. "HIV Infection." In Current Medical Diagnosis & Treatment 1998. edited by Lawrence M. Tierney Jr., et al. Stamford, CT: Appleton & Lange, 1998.

McCutchan, J. Allen. "Alternative, Unconventional, and Unproven Therapies." Textbook of AIDS Medicine, 2nd edition. edited by Thomas C. Merigan, et al. Baltimore: Williams & Wilkins, 1999.

McFarland, Elizabeth J. "Human Immunodeficiency Virus (HIV) Infections: Acquired Immunodeficiency Syndrome (AIDS)." In Current Pediatric Diagnosis & Treatment. edited by William W. Hay Jr., et al. Stamford, CT: Appleton & Lange, 1997.

So, Peter and Livette Johnson. "Acquired Immune Deficiency Syndrome (AIDS)." In Conn's Current Therapy. edited by Robert E. Rakel. Philadelphia: W. B. Saunders Company, 1997.

Standish, Leanna J., Roberta C.M. Wines, and Cherie Reeves. "Complementary/Alternative Therapies in Select Populations: Women with HIV and AIDS." In Complementary/Alternative Medicine: An Evidence Based Approach. edited by John W. Spencer and Joseph J. Jacobs. St. Louis: Mosby, 1999.

PERIODICALS

"DHEA in HIV Infection." Infectious Disease Alert. (March 1, 2002): S7.

Ernst, Jerome. "Alternative Treatment Modalities in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome." Clinical Infectious Diseases (September 1, 2003): 150154.

"First Human Tests Under Way of HIV Vaccine Pioneered at UNC." AIDS Vaccine Week (August 25, 2003): 2.

Fleck, Fiona. "British Medical Journal." British Medical Journal (September 27, 2003): 698.

Gangel, Elaine K. "Garlic Supplements and HIV Medication." American Family Physician (March 15, 2002): 1225.

"Government Lauches Trial of Gel to Protect Women Against HIV." AIDS Weekly (March 25, 2002): 11.

"HIV Drugs Approved as of August 2003." AIDS Treatment News (July 25, 2003): 4.

"HIV Rising Among Gay, Bisexual Men." Medical Letter on the CDC & FDA (August 24, 2003): 9.

"Is HAART Hard on the Heart" Science News (March 9, 2002): 158.

"Library Vaccine Shows Promise." Vaccine Weekly. (February 13, 2002): 2.

"One-step HIV Test May Be Cheaper, Faster, Less Wasteful." AIDS Weekly (September 29, 2003): 13.

Ozsoy, Metin and Edzard Ernst. "How Effective are Complementary Therapies for HIV and AIDS?a Systematic Review." International Journal of STD & AIDS 10 (1999): 629-635.

"Prevalence of HIV Infection Increasing in Older Americans." AIDS Weekly (September 1, 2003): 16.

"Revised Guidelines Will Ease Selection of HIV/AIDS Treatments." Drug Week (August 8, 2003): 10.

"Successful HAART Reduces Risk of Pneumonia." AIDS Weekly (January 14, 2002): 24.

"Success of Treatment Swells Ranks of HIV Infected." AIDS Weekly (March 25, 2002): 13.

Wootton, Jacqueline C. "WebWatch: Alternative and Complementary Therapies." AIDS Patient Care and STDs 12 (1998): 811-813.

ORGANIZATIONS

American Foundation for AIDS Research, 733 Third Avenue, 12th floor, 1515 Broadway, Suite 3601, New York, NY 10017. (212) 682-7440.

Gay Men's Health Crisis, Inc., 129 West 20th Street, New York, NY 10011-0022. (212) 807-6655.

National AIDS Hot Line. (800) 342-AIDS (English). (800) 344-SIDA (Spanish). (800) AIDS-TTY (hearing-impaired).

Belinda Rowland

Teresa G. Odle

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Rowland, Belinda; Odle, Teresa. "AIDS." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

Rowland, Belinda; Odle, Teresa. "AIDS." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3435100022.html

Rowland, Belinda; Odle, Teresa. "AIDS." Gale Encyclopedia of Alternative Medicine. 2005. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3435100022.html

AIDS

AIDS

Definition

Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981. AIDS is the advanced form of infection with the HIV virus, which may not cause recognizable disease for a long period after the initial exposure (latency). No vaccine is currently available to prevent HIV infection. At present, all forms of AIDS therapy are focused on improving the quality and length of life for AIDS patients by slowing or halting the replication of the virus and treating or preventing infections and cancers that take advantage of a person's weakened immune system.

Description

AIDS is considered one of the most devastating public health problems in recent history. In June 2000, the Centers for Disease Control and Prevention (CDC) reported that 120,223 (includes only those cases in areas that have confidential HIV reporting) in the United States are HIV-positive, and 311,701 are living with AIDS (includes only those cases where vital status is known). Of these patients, 44% are gay or bisexual men, 20% are heterosexual intravenous drug users, and 17% are women. In addition, approximately 1,000-2,000 children are born each year with HIV infection. The World Health Organization (WHO) estimates that 33 million adults and 1.3 million children worldwide were living with HIV/AIDS as of 1999 with 5.4 million being newly infected that year. Most of these cases are in the developing countries of Asia and Africa.

Risk of acquiring HIV infection by entry site
Entry site Risk virus
reaches entry
site
Risk virus
enters
Risk
inoculated
Conjuntiva Moderate Moderate Very low
Oral mucosa Moderate Moderate Low
Nasal mucosa Low Low Very low
Lower
respiratory
Very low Very low Very low
Anus Very high Very high Very high
Skin, intact Very low Very low Very low
Skin, broken Low High High
Sexual:
Vagina Low Low Medium
Penis High Low Low
Ulcers (STD) High High Very high
Blood:
Products High High High
Shared needles High High Very High
Accidental needle Low High Low
Traumatic wound Modest High High
Perinatal High High High

Risk factors

AIDS can be transmitted in several ways. The risk factors for HIV transmission vary according to category:

  • Sexual contact. Persons at greatest risk are those who do not practice safe sex, those who are not monogamous, those who participate in anal intercourse, and those who have sex with a partner with symptoms of advanced HIV infection and/or other sexually transmitted diseases (STDs). In the United States and Europe, most cases of sexually transmitted HIV infection have resulted from homosexual contact, whereas in Africa, the disease is spread primarily through sexual intercourse among heterosexuals.
  • Transmission in pregnancy. High-risk mothers include women married to bisexual men or men who have an abnormal blood condition called hemophilia and require blood transfusions, intravenous drug users, and women living in neighborhoods with a high rate of HIV infection among heterosexuals. The chances of transmitting the disease to the child are higher in women in advanced stages of the disease. Breast feeding increases the risk of transmission by 10-20%. The use of zidovudine (AZT) during pregnancy, however, can decrease the risk of transmission to the baby.
  • Exposure to contaminated blood or blood products. With the introduction of blood product screening in the mid-1980s, the incidence of HIV transmission in blood transfusions has dropped to one in every 100,000 transfused. With respect to HIV transmission among drug abusers, risk increases with the duration of using injections, the frequency of needle sharing, the number of persons who share a needle, and the number of AIDS cases in the local population.
  • Needle sticks among health care professionals. Present studies indicate that the risk of HIV transmission by a needle stick is about one in 250. This rate can be decreased if the injured worker is given AZT, an anti-retroviral medication, in combination with other medication.

HIV is not transmitted by handshakes or other casual non-sexual contact, coughing or sneezing, or by bloodsucking insects such as mosquitoes.

AIDS in women

AIDS in women is a serious public health concern. Women exposed to HIV infection through heterosexual contact are the most rapidly growing risk group in the United States population. The percentage of AIDS cases diagnosed in women has risen from 7% in 1985 to 23% in 1999. Women diagnosed with AIDS may not live as long as men, although the reasons for this finding are unclear.

AIDS in children

Since AIDS can be transmitted from an infected mother to the child during pregnancy, during the birth process, or through breast milk, all infants born to HIV-positive mothers are a high-risk group. As of 2000, it was estimated that 87% of HIV-positive women are of childbearing age; 41% of them are drug abusers. Between 15-30% of children born to HIV-positive women will be infected with the virus.

AIDS is one of the 10 leading causes of death in children between one and four years of age. The interval between exposure to HIV and the development of AIDS is shorter in children than in adults. Infants infected with HIV have a 20-30% chance of developing AIDS within a year and dying before age three. In the remainder, AIDS progresses more slowly; the average child patient survives to seven years of age. Some survive into early adolescence.

Causes and symptoms

Because HIV destroys immune system cells, AIDS is a disease that can affect any of the body's major organ systems. HIV attacks the body through three disease processes: immunodeficiency, autoimmunity, and nervous system dysfunction.

Immunodeficiency describes the condition in which the body's immune response is damaged, weakened, or is not functioning properly. In AIDS, immunodeficiency results from the way that the virus binds to a protein called CD4, which is primarily found on the surface of certain subtypes of white blood cells called helper T cells or CD4 cells. After the virus has attached to the CD4 receptor, the virus-CD4 complex refolds to uncover another receptor called a chemokine receptor that helps to mediate entry of the virus into the cell. One chemokine receptor in particular, CCR5, has gotten recent attention after studies showed that defects in its structure (caused by genetic mutations) cause the progression of AIDS to be prevented or slowed. Scientists hope that this discovery will lead to the development of drugs that trigger an artificial mutation of the CCR5 gene or target the CCR5 receptor.

Once HIV has entered the cell, it can replicate intracellularly and kill the cell in ways that are still not completely understood. In addition to killing some lymphocytes directly, the AIDS virus disrupts the functioning of the remaining CD4 cells. Because the immune system cells are destroyed, many different types of infections and cancers that take advantage of a person's weakened immune system (opportunistic) can develop.

Autoimmunity is a condition in which the body's immune system produces antibodies that work against its own cells. Antibodies are specific proteins produced in response to exposure to a specific, usually foreign, protein or particle called an antigen. In this case, the body produces antibodies that bind to blood platelets that are necessary for proper blood clotting and tissue repair. Once bound, the antibodies mark the platelets for removal from the body, and they are filtered out by the spleen. Some AIDS patients develop a disorder, called immune-related thrombocytopenia purpura (ITP), in which the number of blood platelets drops to abnormally low levels.

Researchers do not know precisely how HIV attacks the nervous system since the virus can cause damage without infecting nerve cells directly. One theory is that, once infected with HIV, one type of

KEY TERMS

Acute retroviral syndrome A group of symptoms resembling mononucleosis that often are the first sign of HIV infection in 50-70% of all patients and 45-90% of women.

AIDS dementia complex A type of brain dysfunction caused by HIV infection that causes difficulty thinking, confusion, and loss of muscular coordination.

Antibody A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.

Antigen Any substance that stimulates the body to produce antibody.

Autoimmunity A condition in which the body's immune system produces antibodies in response to its own tissues or blood components instead of foreign particles or microorganisms.

CCR5 A chemokine receptor; defects in its structure caused by genetic mutation cause the progression of AIDS to be prevented or slowed.

CD4 A type of protein molecule in human blood, sometimes called the T4 antigen, that is present on the surface of 65% of immune cells. The HIV virus infects cells with CD4 surface proteins, and as a result, depletes the number of T cells, B cells, natural killer cells, and monocytes in the patient's blood. Most of the damage to an AIDS patient's immune system is done by the virus' destruction of CD4+ lymphocytes.

Chemokine receptor A receptor on the surface of some types of immune cells that helps to mediate entry of HIV into the cell.

Hairy leukoplakia of the tongue A white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus and is an important diagnostic sign of AIDS.

Hemophilia Any of several hereditary blood coagulation disorders occurring almost exclusively in males. Because blood does not clot properly, even minor injuries can cause significant blood loss that may require a blood transfusion, with its associated minor risk of infection.

Human immunodeficiency virus (HIV) A transmissible retrovirus that causes AIDS in humans. Two forms of HIV are now recognized: HIV-1, which causes most cases of AIDS in Europe, North and South America, and most parts of Africa; and HIV-2, which is chiefly found in West African patients. HIV-2, discovered in 1986, appears to be less virulent than HIV-1 and may also have a longer latency period.

Immunodeficient A condition in which the body's immune response is damaged, weakened, or is not functioning properly.

Kaposi's sarcoma A cancer of the connective tissue that produces painless purplish red (in people with light skin) or brown (in people with dark skin) blotches on the skin. It is a major diagnostic marker of AIDS.

Latent period Also called incubation period, the time between infection with a disease-causing agent and the development of disease.

Lymphocyte A type of white blood cell that is important in the formation of antibodies and that can be used to monitor the health of AIDS patients.

Lymphoma A cancerous tumor in the lymphatic system that is associated with a poor prognosis in AIDS patients.

Macrophage A large white blood cell, found primarily in the bloodstream and connective tissue, that helps the body fight off infections by ingesting the disease-causing organism. HIV can infect and kill macrophages.

Monocyte A large white blood cell that is formed in the bone marrow and spleen. About 4% of the white blood cells in normal adults are monocytes.

Mycobacterium avium (MAC) infection A type of opportunistic infection that occurs in about 40% of AIDS patients and is regarded as an AIDS-defining disease.

Non-nucleoside reverse transcriptase inhibitors The newest class of antiretroviral drugs that work by inhibiting the reverse transcriptase enzyme necessary for HIV replication.

Nucleoside analogues The first group of effective anti-retroviral medications. They work by interfering with the AIDS virus' synthesis of DNA.

Opportunistic infection An infection by organisms that usually don't cause infection in people whose immune systems are working normally.

Persistent generalized lymphadenopathy (PGL) A condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period.

Pneumocystis carinii pneumonia (PCP) An opportunistic infection caused by a fungus that is a major cause of death in patients with late-stage AIDS.

Progressive multifocal leukoencephalopathy (PML) A disease caused by a virus that destroys white matter in localized areas of the brain. It is regarded as an AIDS-defining illness.

Protease inhibitors The second major category of drug used to treat AIDS that works by suppressing the replication of the HIV virus.

Protozoan A single-celled, usually microscopic organism that is eukaryotic and, therefore, different from bacteria (prokaryotic).

Retrovirus A virus that contains a unique enzyme called reverse transcriptase that allows it to replicate within new host cells.

T cells Lymphocytes that originate in the thymus gland. T cells regulate the immune system's response to infections, including HIV. CD4 lymphocytes are a subset of T lymphocytes.

Thrush A yeast infection of the mouth characterized by white patches on the inside of the mouth and cheeks.

Viremia The measurable presence of virus in the bloodstream that is a characteristic of acute retroviral syndrome.

Wasting syndrome A progressive loss of weight and muscle tissue caused by the AIDS virus.

immune system cell, called a macrophage, begins to release a toxin that harms the nervous system.

The course of AIDS generally progresses through three stages, although not all patients will follow this progression precisely:

Acute retroviral syndrome

Acute retroviral syndrome is a term used to describe a group of symptoms that can resemble mononucleosis and that may be the first sign of HIV infection in 50-70% of all patients and 45-90% of women. Most patients are not recognized as infected during this phase and may not seek medical attention. The symptoms may include fever, fatigue, muscle aches, loss of appetite, digestive disturbances, weight loss, skin rashes, headache, and chronically swollen lymph nodes (lymphadenopathy). Approximately 25-33% of patients will experience a form of meningitis during this phase in which the membranes that cover the brain and spinal cord become inflamed. Acute retroviral syndrome develops between one and six weeks after infection and lasts for two to three weeks. Blood tests during this period will indicate the presence of virus (viremia) and the appearance of the viral p24 antigen in the blood.

Latency period

After the HIV virus enters a patient's lymph nodes during the acute retroviral syndrome stage, the disease becomes latent for as many as 10 years or more before symptoms of advanced disease develop. During latency, the virus continues to replicate in the lymph nodes, where it may cause one or more of the following conditions:

PERSISTENT GENERALIZED LYMPHADENOPATHY (PGL). Persistent generalized lymphadenopathy, or PGL, is a condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period. The lymph nodes that are most frequently affected by PGL are those in the areas of the neck, jaw, groin, and armpits. PGL affects between 50-70% of patients during latency.

CONSTITUTIONAL SYMPTOMS. Many patients will develop low-grade fevers, chronic fatigue, and general weakness. HIV may also cause a combination of food malabsorption, loss of appetite, and increased metabolism that contribute to the so-called AIDS wasting or wasting syndrome.

OTHER ORGAN SYSTEMS. At any time during the course of HIV infection, patients may suffer from a yeast infection in the mouth called thrush, open sores or ulcers, or other infections of the mouth; diarrhea and other gastrointestinal symptoms that cause malnutrition and weight loss; diseases of the lungs and kidneys; and degeneration of the nerve fibers in the arms and legs. HIV infection of the nervous system leads to general loss of strength, loss of reflexes, and feelings of numbness or burning sensations in the feet or lower legs.

Late-stage disease (AIDS)

AIDS is usually marked by a very low number of CD4+ lymphocytes, followed by a rise in the frequency of opportunistic infections and cancers. Doctors monitor the number and proportion of CD4+ lymphocytes in the patient's blood in order to assess the progression of the disease and the effectiveness of different medications. About 10% of infected individuals never progress to this overt stage of the disease and are referred to as nonprogressors.

OPPORTUNISTIC INFECTIONS. Once the patient's CD4+ lymphocyte count falls below 200 cells/mm3, he or she is at risk for a variety of opportunistic infections. The infectious organisms may include the following:

  • Fungi. The most common fungal disease associated with AIDS is Pneumocystis carinii pneumonia (PCP). PCP is the immediate cause of death in 15-20% of AIDS patients. It is an important measure of a patient's prognosis. Other fungal infections include a yeast infection of the mouth (candidiasis or thrush) and cryptococcal meningitis.
  • Protozoa. Toxoplasmosis is a common opportunistic infection in AIDS patients that is caused by a protozoan. Other diseases in this category include isoporiasis and cryptosporidiosis.
  • Mycobacteria. AIDS patients may develop tuberculosis or MAC infections. MAC infections are caused by Mycobacterium avium-intracellulare, and occur in about 40% of AIDS patients. It is rare until CD4+ counts falls below 50 cells/mm3.
  • Bacteria. AIDS patients are likely to develop bacterial infections of the skin and digestive tract.
  • Viruses. AIDS patients are highly vulnerable to cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Epstein-Barr virus (EBV) infections. Another virus, JC virus, causes progressive destruction of brain tissue in the brain stem, cerebrum, and cerebellum (multifocal leukoencephalopathy or PML), which is regarded as an AIDS-defining illness by the Centers for Disease Control and Prevention.

AIDS DEMENTIA COMPLEX AND NEUROLOGIC COMPLICATIONS. AIDS dementia complex is usually a late complication of the disease. It is unclear whether it is caused by the direct effects of the virus on the brain or by intermediate causes. AIDS dementia complex is marked by loss of reasoning ability, loss of memory, inability to concentrate, apathy and loss of initiative, and unsteadiness or weakness in walking. Some patients also develop seizures. There are no specific treatments for AIDS dementia complex.

MUSCULOSKELETAL COMPLICATIONS. Patients in late-stage AIDS may develop inflammations of the muscles, particularly in the hip area, and may have arthritis-like pains in the joints.

ORAL SYMPTOMS. In addition to thrush and painful ulcers in the mouth, patients may develop a condition called hairy leukoplakia of the tongue. This condition is also regarded by the CDC as an indicator of AIDS. Hairy leukoplakia is a white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus.

AIDS-RELATED CANCERS. Patients with late-stage AIDS may develop Kaposi's sarcoma (KS), a skin tumor that primarily affects homosexual men. KS is the most common AIDS-related malignancy. It is characterized by reddish-purple blotches or patches (brownish in African-Americans) on the skin or in the mouth. About 40% of patients with KS develop symptoms in the digestive tract or lungs. KS may be caused by a herpes virus-like sexually transmitted disease agent rather than HIV.

The second most common form of cancer in AIDS patients is a tumor of the lymphatic system (lymphoma). AIDS-related lymphomas often affect the central nervous system and develop very aggressively.

Invasive cancer of the cervix (related to certain types of human papilloma virus [HPV]) is an important diagnostic marker of AIDS in women.

While incidence of AIDS-defining cancers such as Kaposi's sarcoma and cervical cancer have decreased since increase use of antiretroviral therapy, other cancers has increased in AIDS patients. People with HIV has shown higher incidence of lung cancer, head and neck cancers, Hodgkin's lymphoma, melanoma, and anorectal cancer from 1992 to 2002.

Diagnosis

Because HIV infection produces such a wide range of symptoms, the CDC has drawn up a list of 34 conditions regarded as defining AIDS. The physician will use the CDC list to decide whether the patient falls into one of these three groups:

  • definitive diagnoses with or without laboratory evidence of HIV infection
  • definitive diagnoses with laboratory evidence of HIV infection
  • presumptive diagnoses with laboratory evidence of HIV infection.

Physical findings

Almost all the symptoms of AIDS can occur with other diseases. The general physical examination may range from normal findings to symptoms that are closely associated with AIDS. These symptoms are hairy leukoplakia of the tongue and Kaposi's sarcoma. When the doctor examines the patient, he or she will look for the overall pattern of symptoms rather than any one finding.

Laboratory tests for HIV infection

BLOOD TESTS (SEROLOGY). The first blood test for AIDS was developed in 1985. At present, patients who are being tested for HIV infection are usually given an enzyme-linked immunosorbent assay (ELISA) test for the presence of HIV antibody in their blood. Positive ELISA results are then tested with a Western blot or immunofluorescence (IFA) assay for confirmation. The combination of the ELISA and Western blot tests is more than 99.9% accurate in detecting HIV infection within four to eight weeks following exposure. The polymerase chain reaction (PCR) test can be used to detect the presence of viral nucleic acids in the very small number of HIV patients who have false-negative results on the ELISA and Western blot tests. These tests are also used to detect viruses and bacterium other than HIV and AIDS.

OTHER LABORATORY TESTS. In addition to diagnostic blood tests, there are other blood tests that are used to track the course of AIDS in patients that have already been diagnosed. These include blood counts, viral load tests, p24 antigen assays, and measurements of β2-microglobulin (β2M).

Doctors will use a wide variety of tests to diagnose the presence of opportunistic infections, cancers, or other disease conditions in AIDS patients. Tissue biopsies, samples of cerebrospinal fluid, and sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography scans (CT) are used to diagnose AIDS-related cancers, some opportunistic infections, damage to the central nervous system, and wasting of the muscles. Urine and stool samples are used to diagnose infections caused by parasites. AIDS patients are also given blood tests for syphilis and other sexually transmitted diseases.

Diagnosis in children

Diagnostic blood testing in children older than 18 months is similar to adult testing, with ELISA screening confirmed by Western blot. Younger infants can be diagnosed by direct culture of the HIV virus, PCR testing, and p24 antigen testing.

In terms of symptoms, children are less likely than adults to have an early acute syndrome. They are, however, likely to have delayed growth, a history of frequent illness, recurrent ear infections, a low blood cell count, failure to gain weight, and unexplained fevers. Children with AIDS are more likely to develop bacterial infections, inflammation of the lungs, and AIDS-related brain disorders than are HIV-positive adults.

Treatment

Treatment for AIDS covers four considerations:

TREATMENT OF OPPORTUNISTIC INFECTIONS AND MALIGNANCIES. Most AIDS patients require complex long-term treatment with medications for infectious diseases. This treatment is often complicated by the development of resistance in the disease organisms. AIDS-related malignancies in the central nervous system are usually treated with radiation therapy. Cancers elsewhere in the body are treated with chemotherapy.

PROPHYLACTIC TREATMENT FOR OPPORTUNISTIC INFECTIONS. Prophylactic treatment is treatment that is given to prevent disease. AIDS patients with a history of Pneumocystis pneumonia; with CD4+ counts below 200 cells/mm3 or 14% of lymphocytes; weight loss; or thrush should be given prophylactic medications. The three drugs given are trimethoprim-sulfamethoxazole, dapsone, or pentamidine in aerosol form.

ANTI-RETROVIRAL TREATMENT. In recent years researchers have developed drugs that suppress HIV replication, as distinct from treating its effects on the body. These drugs fall into four classes:

  • Nucleotide analogues. These drugs work by interfering with the action of HIV reverse transcriptase inside infected cells, thus ending the virus' replication process. These drugs include zidovudine (sometimes called azidothymidine or AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), and abacavir (ABC).
  • Protease inhibitors. Protease inhibitors can be effective against HIV strains that have developed resistance to nucleoside analogues, and are often used in combination with them. These compounds include saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, and lopinavir..
  • Non-nucleoside reverse transcriptase inhibitors. This is a new class of antiretroviral agents. Three are available, nevirapine, which was approved first, delavirdine and efavirin.
  • Fusion inhibitors, the newest class of antiretrovirals. They block specific proteins on the surface of the virus or the CD4 cell. These proteins help the virus gain entry into the cell.The only FDA approved fusion inhibitor as of spring 2004 was enfuvirtide.

Treatment guidelines for these agents are in constant change as new medications are developed and introduced. Two principles currently guide doctors in working out drug regimens for AIDS patients: using combinations of drugs rather than one medication alone; and basing treatment decisions on the results of the patient's viral load tests.

STIMULATION OF BLOOD CELL PRODUCTION. Because many patients with AIDS suffer from abnormally low levels of both red and white blood cells, they may be given medications to stimulate blood cell production. Epoetin alfa (erythropoietin) may be given to anemic patients. Patients with low white blood cell counts may be given filgrastim or sargramostim.

Treatment in women

Treatment of pregnant women with HIV is particularly important in that anti-retroviral therapy has been shown to reduce transmission to the infant by 65%.

Alternative treatment

Alternative treatments for AIDS can be grouped into two categories: those intended to help the immune system and those aimed at pain control. Treatments that may enhance the function of the immune system include Chinese herbal medicine and western herbal medicine, macrobiotic and other special diets, guided imagery and creative visualization, homeopathy, and vitamin therapy. Pain control therapies include hydrotherapy, reiki, acupuncture, meditation, chiropractic treatments, and therapeutic massage. Alternative therapies can also be used to help with side effects of the medications used in the treatment of AIDS.

Prognosis

At the present time, there is no cure for AIDS.

Treatment stresses aggressive combination drug therapy for those patients with access to the expensive medications and who tolerate them adequately. The use of these multi-drug therapies has significantly reduced the numbers of deaths, in this country, resulting from AIDS. The data is still inconclusive, but the potential exists to possibly prolong life indefinitely using these and other drug therapies to boost the immune system, keep the virus from replicating, and ward off opportunistic infections and malignancies.

Prognosis after the latency period depends on the patient's specific symptoms and the organ systems affected by the disease. Patients with AIDS-related lymphomas of the central nervous system die within two to three months of diagnosis; those with systemic lymphomas may survive for eight to ten months.

Prevention

As of 2005, there was no vaccine effective against AIDS. Several vaccines are currently being investigated, however, both to prevent initial HIV infection and as a therapeutic treatment to prevent HIV from progressing to full-blown AIDS.

In the meantime, there are many things that can be done to prevent the spread of AIDS:

  • Being monogamous and practice safe sex. Individuals must be instructed in the proper use of condoms and urged to practice safe sex. Besides avoiding the risk of HIV infection, condoms are successful in preventing other sexually transmitted diseases and unwanted pregnancies. Before engaging in a sexual relationship with someone, getting tested for HIV infection is recommended.
  • Avoiding needle sharing among intravenous drug users.
  • Although blood and blood products are carefully monitored, those individuals who are planning to undergo major surgery may wish to donate blood ahead of time to prevent a risk of infection from a blood transfusion.
  • Healthcare professionals must take all necessary precautions by wearing gloves and masks when handling body fluids and preventing needle-stick injuries.
  • If someone suspects HIV infection, he or she should be tested for HIV. If treated aggressively and early, the development of AIDS may be postponed indefinitely. If HIV infection is confirmed, it is also vital to let sexual partners know so that they can be tested and, if necessary, receive medical attention.

Resources

PERIODICALS

Boschert, Sherry. "Some Ca Increasing in Post-HAART Era." Clinical Psychiatry News June 2004: 75.

Godwin, Catherine. "WhatÆs New in the Fight Against AIDS." RN April 2004: 46-54.

ORGANIZATIONS

Gay Men's Health Crisis, Inc., 129 West 20th Street, New York, NY 10011-0022. (212) 807-6655.

National AIDS Hot Line. (800) 342-AIDS (English). (800) 344-SIDA (Spanish). (800) AIDS-TTY (hearing-impaired).

OTHER

"FDA Approved Drugs for HIV Infection and AIDS-RelatedConditions." HIV/AIDS Treatment Information Service website. January 2001. http://hivatis.org.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Frey, Rebecca; Odle, Teresa. "AIDS." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

Frey, Rebecca; Odle, Teresa. "AIDS." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3451600049.html

Frey, Rebecca; Odle, Teresa. "AIDS." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451600049.html

Acquired Immunodeficiency Syndrome (AIDS)

Acquired Immunodeficiency Syndrome (AIDS)


Acquired Immunodeficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV), which destroys the cells in the human body that combat infections. Although recent medical advances have caused a shift from the mindset of a terminal disease to one of a chronic, manageable condition in some areas of the world, this new approach brings challenges of its own, as the disease is eventually fatal (Ferri et. al 1997). HIV has brought about a global epidemic far more extensive than what was predicted even a decade ago. The issue of HIV/AIDS is not only relevant to medical documentation, but is complex and highly politically charged, affecting all communities regardless of race, age, or sexual orientation (Ginsberg 1995). At the end of the year 2000, it was estimated that there were 36.1 million adults and children living with HIV/AIDS, the vast majority of whom live in the developing world, with more than twenty-five million living in the continent of Africa ("Global Summary of the HIV/AIDS Epidemic, 2000" 2001).


History

The epidemic began in the late 1970s and early 1980s in sub-Saharan Africa, Latin America, the Caribbean, Western Europe, North America, Australia, and New Zealand. In the late 1980s, the epidemic continued to spread to North Africa and the Middle East, South and Southeast Asia, East Asia, and the Pacific. Only in the late 1990s did the epidemic spread significantly to Eastern Europe and Central Asia. (See Table 1 for a summary of HIV/AIDS statistics and features, including the primary mode(s) of transmission in each region.) Since 1981, the AIDS pandemic has brought sexually transmitted diseases to the center of medical

TABLE 1
HIV/AIDS statistics and features
regionmain mode(s) of transmission* for adults # living with hiv/aidsepidemic started
*hetero (heterosexual transmission), idu (transmission through intravenous drug use), msm (sexual transmission among men who have sex with men).
#the proportion of adults (15 to 49 years of age) living with hiv/aids.
australia & new zealandmsmlate 1970s – early 1980s
caribbeanhetero, msmlate 1970s – early 1980s
east asia & pacificidu, hetero, msmlate 1980s
eastern europe & central asiaiduearly 1990s
latin americamsm, idu, heterolate 1970s – early 1980s
north africa & middle easthetero, idulate 1980s
north americamsm, idu, heterolate 1970s – early 1980s
south & south-east asiahetero, idulate 1980s
sub-saharan africaheterolate 1970s – early 1980s

and social consciousness. Indeed, "not since the world-wide pandemic of swine influenza in 1918 have we faced a public health emergency of such tragic magnitude" (Brandt 1988, p. 151).

In response to this mysterious ailment, articles began to appear in newspapers and magazines in the United States that described an illness unofficially identified as gay-related immunodeficiency (GRID). As early as 1982, however, it became clear to the researchers at the Centers for Disease Control (CDC), that the disease was not exclusively a gay syndrome. Other groups began to get the disease: heterosexuals from sub-Saharan Africa, Haitians, prostitutes, and women who had sex with bisexual males (Tebble 1986).

The human T-cell lymphotropic virus (HTLVIII) was isolated as the retrovirus responsible for causing AIDS in 1984 (Getzel 1992; Levenson 1996). A retrovirus is a type of virus that replicates mutant strains, and then infects other cells (Gant 1998). "The virus, called HTLV-III by the Americans and LAV by the French—would eventually be designated as HIV" (Bethel 1995, p. 69). HIV-I (the most common type found worldwide) and HIV-II (found mostly in West Africa), both responsible for AIDS, are rapid replicators. The newer strains of HIV that were identified in the late 1990s are stronger and more resistant to medications.


Modes of Transmission

HIV is transmitted only through the intimate exchange of body fluids, specifically blood, semen, vaginal fluid, and mother's milk (Dane and Miller 1990). HIV is sometimes passed perinatally from mother to fetus, or through breastfeeding (Mulvi-hill 1996). HIV levels in the bloodstream are typically highest when a person is first infected and again in the late stages of the illness. High-risk behaviors include unprotected anal and vaginal intercourse (without condom) and intravenous drug use. Before blood screening began in 1986, the virus was also being contracted from transfusions and blood-clotting agents.

Testing and Diagnosis

One year after the isolation of HIV, the ELISA (enzyme-linked immunosorbent assay) test was developed, allowing detection of HIV antibodies well before the onset of any clinical manifestations, creating an opportunity for preventive therapy against opportunistic infections (Bellutta 1995). The required pre- and post-test counseling for the ELISA tests has been shown to help people to make informed decisions, cope better with their potential health condition, lead more positive lives, and prevent further transmission of HIV. Because the number of false positives is high, a positive ELISA test must be confirmed by a more specific test, the Western blot, which detects specific anti-bodies to a particular pathogen (Gant 1998). In many countries, home tests were approved in mid-1990s, and the oral collection (OraSure) for HIV antibody test was approved by the Food and Drug Administration (FDA) in the United States in 1996. These tests are not very reliable, and support such as pre- and post-test counseling is not available ("Fact Sheet 1 HIV/AIDS: The Infection" 2000).

The advent of HIV testing brought with it the need for guidelines surrounding the confidentiality of test results and anonymity of the individual during the testing process to protect that person against social stigmatization and economic exploitation. These measures are also intended to encourage widespread testing, so that medical care and support services can be instituted early in the process.

HIV attacks and destroys CD4 T-lymphocytes, which assist in the regulation of the entire immune system. CD-4 lymphocytes, also called CD-4 cells, T4cells, and CD-4 lymphocytes, are a type of blood cell important to the immune system. The loss of these cells reduces the system's ability to fight infection, increasing the risk of opportunistic infections, or infections that can take hold because a person's immune system is weak (Gant 1998). AIDS can be described as a continuum that begins with infection by the HIV virus leading to decreasing numbers of CD-4 cells and eventual progress to opportunistic diseases (Bellutta 1995).


Symptoms

HIV ranges from asymptomatic infection to severe forms of the disease (Aronstein and Thompson 1998). There is no dormant phase of the HIV infection. Rather, the body and the virus are locked in a pitched battle from the beginning. Every day the viral intruder produces a billion copies of itself, all intent on the destruction of CD-4 cells (Gorman 1996). With immune deficiency, the HIV-infected person becomes susceptible to opportunistic organisms that normally would be harmless (Aronstein and Thompson 1998).

Kaposi's sarcoma is a malignant tumor affecting the skin and mucous membranes and is usually characterized by the formation of pink to reddish-brown or bluish patches. In general, these tumors are quite rare, slow-growing, vascular in nature, and most commonly affect elderly men of Mediterranean descent. In the early AIDS cases, however, the tumors affected young white males in the United States and were found to grow and disseminate rapidly. Overwhelming infection and respiratory failure due to pneumocystis carinii pneumonia (PCP), a form of pneumonia caused by a microorganism that attacks the inner fibrous tissues of the lungs, were the leading causes of death in early AIDS cases (Bellutta 1995).

HIV-infected persons often experience acute symptoms including night sweats, sore throat, headache, fever, muscular pains, thrush, wasting, and rashes. It is estimated that more than half of the people diagnosed with AIDS at some time will display central nervous system dysfunction resulting from HIV infiltration of brain structures. The growing crisis of AIDS-related cognitive impairment ranges from mild cognitive disturbance to moderate and severe AIDS dementia complex (ADC).

Neuropsychological symptoms are typically more pronounced in the end stage of the disease; however, decreased concentration, memory loss, and confusion may be the first symptoms of AIDS.


Treatment

Researchers persist in their attempts to develop effective medical treatments to reduce the suffering of those who are HIV-infected or seriously ill with AIDS. Encouraging early treatment is crucial for persons that test HIV positive (Levenson 1996). HIV treatments include two components: first, prophylactic drugs to prevent and treat opportunistic infections, and, second, combination or three-drug combinations (also known as drug cocktails) to directly reduce replication of the virus (Linsk and Keigher 1997). Where available, the antiretroviral drug combinations (protease inhibitor combined with two or more Reverse Transcriptase inhibitors) require strict adherence to a complex drug regimen. The potential benefits and risks of the combinations are great. Many people taking drug combinations have been found to have reduced viral load to levels below the detection limits of current viral load tests, therefore appearing to be no longer HIV positive. However, the virus can easily become resistant to the medications if the regimen is not followed, often causing the viral load to increase. Many people infected with HIV are finding that eating a healthful diet, getting sufficient rest, and drinking little alcohol increase their level of functioning.

HIV/AIDS prevention through education, as well as safe-sex information, distribution of condoms, and needle exchange programs worldwide have greatly decreased the transmission of new HIV cases in many parts of the world since 1990. In addition, officials from many health organizations, including the World Health Organization (WHO), and governments from various countries, have been collaborating in an effort to address the urgent need for an HIV vaccine. Since 1991, these constituents have worked to prepare for HIV vaccine efficacy trials. In February of 1999, Thailand became the first developing nation to announce a three-year, Phase III vaccine field trial, AIDSVAX. A Phase III trial is done to determine if a vaccine is effective in protecting against infection or disease and is an important step in the evaluation process leading to licensure.


Psychosocial Issues

In the initial years of the epidemic, the complex clinical treatment dynamics, negative public attitudes, and limited personal and community resources available to people with AIDS challenged the advocacy and discharge-planning skills of many professionals (Mantell, Shulman, Belmont, and Spivak 1989). Repeated exposure to death, homophobia, negative attitudes about addictive lifestyles, antisocial behaviors, and fear of AIDS contagion have added stress to professionals employed in the health arena and supporting services (Wade, Stein, and Beckerman 1995).

Partially because disadvantaged populations are disproportionately affected by HIV/AIDS, there is often a stigma attached to the diagnosis (Diaz and Kelly 1991; Reamer 1993). People within the United States have been victims of hate crimes due to their HIV positive status. Within many countries in Africa, people have been stoned to death, or disowned when an HIV positive status was disclosed ("Fact Sheet 6 HIV/AIDS: Fear, Stigma, and Isolation" 2000). Fear and prejudice have been an integral part of this epidemic since its inception, often exacerbating already difficult situations for those dealing with the diagnosis of HIV/AIDS (Ryan and Rowe 1988). Responses to this difficult reality include depression, claiming illness is something other than HIV/AIDS, withdrawal from loved ones and work environments, and even suicide (Ellenberg 1998).


Global Implications

The challenges of HIV vary enormously from place to place, depending on how far and fast the virus is spreading, whether those infected have started to fall ill or die in large numbers, and what sort of access they have to medical care. In all parts of the world except sub-Saharan Africa, more men than women are infected with HIV and dying of AIDS. Men's behavior—often influenced by harmful cultural beliefs about masculinity—makes them the prime casualties of the epidemic. Male behavior also contributes to HIV infections in women, who often have less power to determine where, when, and how sex takes place ("Global Summary of the HI/AIDS Epidemic" 2001). Men's enormous potential to make a difference when it comes to curbing HIV transmission, caring for infected family members, and looking after orphans and other survivors of the epidemic has been noted in many countries.

As the number of children orphaned by HIV/AIDS rises, some calls have been heard for an increase in institutional care for children. This solution is impracticably expensive. In Ethiopia, for example, keeping a child in an orphanage costs about U.S. $500 a year, more than three times the national income per person. One solution developed by church groups in Zimbabwe is to recruit community members to visit orphans in the homes where they live—either with foster parents, grandparents or other relatives, or in child-headed households. Households caring for orphans are provided with clothing, blankets, school fees, seeds, and fertilizer as necessary, and communities contribute to activities such as farming communal fields and generating income to support the program. This community-driven approach to orphan support has been reproduced all over Zimbabwe, and replicas are now sprouting up in other African countries ("Global Summary of the HIV/AIDS Epidemic, 2000" 2001).

Internationally, a campaign by AIDS activists succeeded in 2000 in getting drug companies to lower prices for the antiretroviral medications. But even at prices 90 percent lower than in the United States, drugs are still beyond the reach of most Africans. There is a debate among those working on AIDS in Africa and elsewhere about whether the current emphasis on drugs is taking the spotlight off prevention, where many feel it should be. Apart from the staggering costs of drugs, world health leaders say huge sums of money are needed just for basic AIDS prevention and care in Africa and other developing nations ("Confronting AIDS" 2001).

UNAIDS and WHO now estimate that the number of people living with HIV or AIDS at the end of the year 2000 stands at 36.1 million, 50 percent higher than what the WHO's Global Programme on AIDS projected in 1991 ("Global Summary of the HIV/AIDS Epidemic, 2000" 2001). The unique situation in various countries and parts of the world will be presented in order to catch a glimpse of the diverse face of HIV/AIDS in the early twenty-first century. In each area, access to health care and medication, HIV transmission, and political responses will be considered.


Botswana. The first AIDS cases in Botswana were reported in 1985. An estimated 36 percent of adults were HIV positive as of 2000. The highest HIV prevalence rate is among twenty to thirty-nine year olds. An estimated 300,000 adults and 26,000 children under age five are living with HIV/AIDS. The mean age of death due to AIDS in Botswana is twenty-five in females and thirty-five in males, the reproductive and economically productive years.

Unlike many other African countries, Botswana has a strong and developed infrastructure that provides people with such social services as education and health care. The government, as well as many companies, are trying to provide antiretrovirals to all who need them, regardless of their ability to pay. Well-supplied hospitals and adequate foreign reserves make it easier for Botswana than for other African countries to provide the drugs. But even here, where the annual per capita income is $3,700 a year (high for Africa), many people remain poor. In the next ten years AIDS will slice 20 percent off the government budget, erode development gains, and bring about a 13 percent reduction in the income of the poorest households ("Global AIDS Program Countries" 2001).

The hope of treatment encourages people to be tested, and testing is considered crucial for prevention. Even as efforts to treat people get underway, prevention remains the highest priority, including visits to local bars to show people how to prevent HIV using male and female condoms and going to schools to keep the next generation HIV-free.


Brazil. HIV began to spread in Brazil in the 1980s. At of the end of the year 2000, slightly more than 196,000 cases of AIDS had been reported in Brazil, the largest number in South America. Brazil is unique among the Latin American countries in that it provides those people with HIV infection antiretroviral therapy free of charge if they meet the national medical guidelines for treatment.

An estimated 12,898 pregnant women had HIV infection in 1998, while 536,920 people between the ages of fifteen and twenty-nine were infected with HIV. Between the years 1978 and 1999, 29,929 children were orphaned in Brazil due to AIDS. Although rates of AIDS are decreasing among men who have sex with men and injection drug users, the rate of heterosexual transmission of AIDS is increasing. In many municipalities, especially along the coast, the ratio of AIDS between men and women is approaching 1:1 ("Global AIDS Program Countries" 2001).


South Africa. The HIV/AIDS epidemic started in sub-Saharan Africa in the late 1970s and early 1980s. Half of all HIV positive people in the nine southern African countries hardest hit by the pandemic live in South Africa. The government estimates that 4.2 million persons, and 19.9 percent of the adult population, are infected with HIV, and by 2010 adult HIV prevalence could reach 25 percent, similar to infection rates in neighboring Zimbabwe and Botswana. In 1998 South Africa had approximately 100,000 AIDS orphans, and by 2008, 1.6 million children will have been orphaned by AIDS ("Global AIDS Program Countries" 2001).

Reasons cited for high rates of HIV/AIDS in South Africa are the realities of migrant labor, high prevalence of sexually transmitted disease, and presence of multiple strains of the disease. Exacerbating factors include a society in denial about an overwhelming epidemic that is ravaging the lives and bodies of many persons within a context of poverty and a thriving commercial sex work industry.

Families are especially hard hit by HIV/AIDS in South Africa. One in five pregnant women in South African clinics is HIV positive. Studies have shown that treating pregnant African women with the drug AZT significantly reduced the risk that they would transmit the virus to their babies. However, if these women then breastfed their infants, the risks of transmission rebounded, making it more urgent than ever to find acceptable alternatives to breastfeeding among infected African women. The AIDS virus accounts for most pediatric cases in hospitals. The worst is yet to come because most of the infected have not yet developed AIDS symptoms, and many still feed an infection spiral that is creating about 1,700 new cases every day.Thailand. Thailand has experienced a rapidly escalating and severe HIV epidemic since 1988. Among the sixty million inhabitants of Thailand, as many as 800,000 people are currently believed to be living with HIV. Despite innovative and persistent prevention efforts, HIV continues to spread rapidly, particularly among Thailand's population of injection drug users (IDUs). Methadone treatment, education, counseling on HIV prevention, and easy access to sterile needles have helped to slow the epidemic. Yet, among IDUs in Bangkok, 6 percent continue to become infected each year.

As part of the Thai National Plan for HIV vaccine research, the Bangkok Metropolitan Administration is leading the three-year collaborative research trial to evaluate the ability of AIDSVAX to prevent HIV infection among uninfected IDUs in Bangkok, Thailand. For people infected with HIV, the Thai government and health officials feel very strongly that treatment should follow the protocols that they have established for their country. Therefore, the triple drug therapies currently being used elsewhere are not considered feasible for use in Thailand, not only because of cost constraints, but also because of issues related to the complexity of the regimen, the necessary follow-up and monitoring of patients, and tolerance to the therapies.


United States. In the early 1980s, a number of unexplainable phenomena began to surface across the United States. As the incidents of pneumocystic pneumonia and Kaposi's sarcoma were reported to the Center for Disease Control, a pattern began to emerge. The CDC first published a report reflecting these observations in June of 1981, identifying all of the people demonstrating these symptoms as gay men (Black 1985). In the absence of services in established medical centers and social agencies, many gay men and lesbians joined with activists to establish community-based AIDS service organizations to meet the needs of people affected by HIV. The Names Project Quilt, or AIDS Quilt, has been an important mechanism for people within the United States to recognize the lives of those who have died of HIV/AIDS. The quilt was first displayed in Washington, DC, in 1987, and then in its entirety for the last time in October of 1996, with more than 30,000 panels.

In the United States, as of December 2000, 774,467 AIDS cases had been reported including 640,022 cases among men and 134,441 among women. The main modes of transmission for adults living with HIV/AIDS were men having sex with men, intravenous drug users, and heterosexual transmission. In the United States HIV and AIDS have disproportionately affected the most disadvantaged and stigmatized groups in American society (Barbour 1994). Analyzed by race, 330,160 AIDS cases have been reported among whites, 292,522 among blacks, and 141,694 among Hispanics.

In early 1998, AIDS deaths in the United States dropped by 47 percent. "In recent years, the rate of decline for both cases and deaths began to slow, and in 1999, the annual number of AIDS cases appears to be leveling, while the decline in AIDS deaths has slowed considerably" ("A Glance at the HIV Epidemic" 2001, p. 3). Overall, HIV prevalence rose risen slightly, mainly because antiretroviral therapy is keeping HIV positive people alive longer. Thousands of infections are still occurring through unsafe sex between men. In this era in which few young gay men have seen friends die of AIDS, and some mistakenly view antiretrovirals as a cure, there is growing complacency about the HIV risk, judging from reports of increased sexual risk behavior among this population.


Conclusion

The family is greatly affected in all cases of HIV/AIDS, regardless of where the person might live. Issues such as safe sex practices, planning for care of children during parents' illness and after death, dealing with prejudices and unmet expectations within the family unit, coming out as a homosexual, admitting to intravenous drug use, or to sexual activity with multiple partners, are often on the forefront during this difficult time. Until a vaccine is approved and widely disseminated, people must avoid risky behaviors in order to curb the spread of this devastating disease. One of the primary issues is to support extended family members who are taking in children orphaned by AIDS, while grieving the great loss of loved ones.

See also:Chronic Illness; Death and Dying; Dementia; Family Planning; Hospice; Sexuality; Sexuality Education; Sexually Transmitted Diseases; Stress


Bibliography

Aronstein, D. M., and Thompson, B. J., eds. (1998). HIV and Social Work: A Practitioner's Guide. Binghamton, NY: The Harrington Park Press.

Barbour, R. S. (1984). "Social Work Education: Tackling the Theory-Practice Dilemma." The British Journal of Social Work 14:557–577.

Bellutta, H. P. (1995). "AIDS." In Encyclopedia of Marriage and the Family, ed. D. Levinson. New York: Simon and Schuster Macmillan.

Bethel, E. R. (1995). AIDS: Readings on a Global Crisis. Boston: Allyn and Bacon.

Black, D. (1985). The Plague Years: A Chronicle of AIDS the Epidemic of our Times. New York: Simon and Schuster.

Brandt, A. (1988). "The Approaching Epidemic." Journal of Social Work and Human Sexuality 6:151–154.

Broder, S., and Gallo, R. C. (1984). "A Pathogenic Retrovirus (HTLV-III) Linked to AIDS." New England Journal of Medicine 311:1292–1297.

Dane, B. O., and Miller, S. O. (1990). "AIDS and Dying: The Teaching Challenge." Journal of Teaching in Social Work 4:85–100.

Diaz, Y. E., and Kelly, J. A. (1991). "AIDS-Related Training in United States Schools of Social Work." Social Work 36(1):38–42.

Ellenberg, L.W. (1998). "HIV Risk Assessment in Mental Health Settings." In HIV and Social Work: A Practitioner's Guide, ed. David M. Aronstein and Bruce J. Thompson. New York: The Harrington Park Press.

Ferri, R.; Fontaine, M.; Gallego, S. M.; Grossman, H. A.; Lynch, V. J.; Shiloh-Cryer, A.; Zevin, B.; and Zizzo, W., eds. (1997). "AIDS Deaths Drop 19% in United States, in Part from New Treatment." HIV Frontline: A Newsletter for Professionals who Counsel People Living with HIV 30:6.

Gant, L. M. (1998). "Essential Facts Every Social Worker Needs to Know." In HIV and Social Work: A Practitioner's Guide, ed. David M. Aronstein and Bruce J. Thompson. New York: The Harrington Park Press.

Getzel, G. S. (1992). "AIDS and Social Work: A Decade Later." Social Work in Healthcare 17(2):1–9.

Ginsberg, L. (1995). "AIDS." Social Work Almanac, 2nd edition. Washington, DC: NASW.

Gorman, C. (1996). "The Exorcists." Time 148:64–66.

Levenson, D. (1996). "Home Testing: Boon to the AIDS Battle?" NASW Press (September):3.

Linsk, N. L., and Keigher, S. M. (1997). "Of Magic Bullets and Social Justice: Emerging Challenges of Recent Advances in AIDS Treatment." Health and Social Work 22:70–74.

Mantell, J. E.; Shulman, L. C.; Belmont, M. F.; and Spivak, H. B. (1989). "Social Workers Respond to the AIDS Epidemic in an Acute Care Hospital." Health and Social Work 14:41–51.

Mulvihill, C. K. (1996). "AIDS Education for College Students: Review and Proposal for Research-Based Curriculum." AIDS Education and Prevention 8:11–25.

Reamer, F. G. (1993). "AIDS and Social Work: The Ethics and Civil Liberties Agenda." Social Work, 38(4): 412–419.

Ryan, C. C., and Rowe, M. J. (1988). "AIDS: Legal and Ethical Issues." Social Casework, 69(6):324–333.

Tebble, W. E. M. (1986). "AIDS and AIDS Related Conditions: Effects on Gay Men and Issues for Social Workers." Australian Social Work 39:13–18.

Wade, K.; Stein, E.; and Beckerman, N. (1995). "Tuberculosis and AIDS: The Impact on the Hospital Social Worker." Social Work in Health Care 21:29–41.


other resources

"Confronting AIDS." (2001). NewsHour with Jim Lehrer Transcript Online Focus. Available from http://www.pbs.org/newshour/bb/health/jan-june01/aids_2-21.html.

"Fact Sheet 1 HIV/AIDS: The Infection." (2000). World Health Organization. Available from http://www-int/whosis/statistics/factsheets-hiv-nurses/fact-sheet-1/index.html.

"Fact Sheet 6 HIV/AIDS: Fear, Stigma and Isolation." (2000). World Health Organization. Available from http://www-int/whosis/statistics/factsheets-hiv-nurses/fact-sheet-6/index.html.

"A Glance at the HIV Epidemic." (2001). Centers for Disease Control, Atlanta, Georgia. Available from http://www.cdc.gov/hiv/aidsupdate.htm.

"Global AIDS Program Countries." (2001). Center for Disease Control, Atlanta, Georgia. Available from http://www.cdc.gov/nchstp/od/gap/text/countries/south_africa.htm.

"Global AIDS Program Countries." (2001). Center for Disease Control, Atlanta, Georgia. Available from http://www.cdc.gov/nchstp/od/gap/text/countries/brazil.htm.

"Global Summary of the HIV/AIDS Epidemic, 2000." (2001). Joint United Nations Programme on HIV/AIDS and World Health Organization, Geneva, Switzerland. Available from http://www.unaids.org/was/2000/wad00/files/WAD_epidemic.html.

HOPE HASLAM STRAUGHAN

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Acquired Immunodeficiency Syndrome (AIDS)." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Acquired Immunodeficiency Syndrome (AIDS)." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3406900016.html

"Acquired Immunodeficiency Syndrome (AIDS)." International Encyclopedia of Marriage and Family. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406900016.html

AIDS Tests

AIDS Tests

Definition

AIDS tests, short for acquired immunodeficiency syndrome tests, cover a number of different procedures used in the diagnosis and treatment of HIV patients. These tests sometimes are called AIDS serology tests. Serology is the branch of immunology that deals with the contents and characteristics of blood serum. Serum is the clear light yellow part of blood that remains liquid when blood cells form a clot. AIDS serology evaluates the presence of human immunodeficiency virus (HIV) infection in blood serum and its effects on each patient's immune system.

Purpose

AIDS serology serves several different purposes. Some AIDS tests are used to diagnose patients or confirm a diagnosis; others are used to measure the progression of the disease or the effectiveness of specific treatment regimens. Some AIDS tests also can be used to screen blood donations for safe use in transfusions.

In order to understand the different purposes of the blood tests used with AIDS patients, it is helpful to understand how HIV infection affects human blood and the immune system. HIV is a retrovirus that enters the blood stream of a new host in the following ways:

  • by sexual contact
  • by contact with infected body fluids (such as blood and urine)
  • by transmission during pregnancy, or
  • through transfusion of infected blood products

A retrovirus is a virus that contains a unique enzyme called reverse transcriptase that allows it to replicate within new host cells. The virus binds to a protein called CD4, which is found on the surface of certain subtypes of white blood cells, including helper T cells, macrophages, and monocytes. Once HIV enters the cell, it can replicate and kill the cell in ways that are still not completely understood. In addition to killing some lymphocytes directly, the AIDS virus disrupts the functioning of the remaining CD4 cells. CD4 cells ordinarily produce a substance called interleukin-2 (IL-2), which stimulates other cells (T cells and B cells) in the human immune system to respond to infections. Without the IL-2, T cells do not reproduce as they normally would in response to the HIV virus, and B cells are not stimulated to respond to the infection.

Precautions

In some states such as New York, a signed consent form is needed in order to administer an AIDS test. As with all blood tests, healthcare professionals should always wear latex gloves and avoid being pricked by the needle used in drawing blood for the tests. It may be difficult to get blood from a habitual intravenous drug user due to collapsed veins.

Description

Diagnostic tests

Diagnostic blood tests for AIDS usually are given to persons in high-risk populations who may have been exposed to HIV or who have the early symptoms of AIDS. Most persons infected with HIV will develop a detectable level of antibody within three months of infection. The condition of testing positive for HIV antibody in the blood is called seroconversion, and persons who have become HIV-positive are called seroconverters.

It is possible to diagnose HIV infection by isolating the virus itself from a blood sample or by demonstrating the presence of HIV antigen in the blood. Viral culture, however, is expensive, not widely available, and slowit takes 28 days to complete the viral culture test. More common are blood tests that work by detecting the presence of antibodies to the HIV virus. These tests are inexpensive, widely available, and accurate in detecting 99.9% of AIDS infections when used in combination to screen patients and confirm diagnoses.

ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA). This type of blood test is used to screen blood for transfusions as well as diagnose patients. An ELISA test for HIV works by attaching HIV antigens to a plastic well or beads. A sample of the patient's blood serum is added, and excess proteins are removed. A second antibody coupled to an enzyme is added, followed by addition of a substance that will cause the enzyme to react by forming a color. An instrument called a spectrophotometer can measure the color. The name of the test is derived from the use of the enzyme that is coupled or linked to the second antibody.

KEY TERMS

Antibody A protein in the blood that identifies and helps remove disease organisms or their toxins. Antibodies are secreted by B cells. AIDS diagnostic tests work by demonstrating the presence of HIV antibody in the patient's blood.

Antigen Any substance that stimulates the body to produce antibodies.

B cell A type of white blood cell derived from bone marrow. B cells are sometimes called B lymphocytes. They secrete antibody and have a number of other complex functions within the human immune system.

CD4 A type of protein molecule in human blood that is present on the surface of 65% of human T cells. CD4 is a receptor for the HIV virus. When the HIV virus infects cells with CD4 surface proteins, it depletes the number of T cells, B cells, natural killer cells, and monocytes in the patient's blood. Most of the damage to an AIDS patient's immune system is done by the virus' destruction of CD4+ lymphocytes. CD4 is sometimes called the T4 antigen.

Complete blood count (CBC) A routine analysis performed on a sample of blood taken from the patient's vein with a needle and vacuum tube. The measurements taken in a CBC include a white blood cell count, a red blood cell count, the red cell distribution width, the hematocrit (ratio of the volume of the red blood cells to the blood volume), and the amount of hemoglobin (the blood protein that carries oxygen). CBCs are a routine blood test used for many medical reasons, not only for AIDS patients. They can help the doctor determine if a patient is in advanced stages of the disease.

Electrophoresis A method of separating complex protein molecules suspended in a gel by running an electric current through the gel.

Enzyme-linked immunosorbent assay (ELISA) A diagnostic blood test used to screen patients for AIDS or other viruses. The patient's blood is mixed with antigen attached to a plastic tube or bead surface. A sample of the patient's blood serum is added, and excess proteins are removed. A second antibody coupled to an enzyme is added, followed by a chemical that will cause a color reaction that can be measured by a special instrument.

Human immunodeficiency virus (HIV) A transmissible retrovirus that causes AIDS in humans. Two forms of HIV are now recognized: HIV-1, which causes most cases of AIDS in Europe, North and South America, and most parts of Africa; and HIV-2, which is chiefly found in West African patients. HIV-2, discovered in 1986, appears to be less virulent than HIV-1, but also may have a longer latency period.

Immunofluorescent assay (IFA) A blood test sometimes used to confirm ELISA results instead of using the Western blotting. In an IFA test, HIV antigen is mixed with a fluorescent compound and then with a sample of the patient's blood. If HIV antibody is present, the mixture will fluoresce when examined under ultraviolet light.

Lymphocyte A type of white blood cell that is important in the formation of antibodies. Doctors can monitor the health of AIDS patients by measuring the number or proportion of certain types of lymphocytes in the patient's blood.

Macrophage A large white blood cell, found primarily in the bloodstream and connective tissue, that helps the body fight off infections by ingesting the disease organism. HIV can infect and kill macrophages.

Monocyte A large white blood cell that is formed in the bone marrow and spleen. About 4% of the white blood cells in normal adults are monocytes.

Opportunistic infection An infection that develops only when a person's immune system is weakened, as happens to AIDS patients.

Polymerase chain reaction (PCR) A test performed to evaluate false-negative results to the ELISA and Western blot tests. In PCR testing, numerous copies of a gene are made by separating the two strands of DNA containing the gene segment, marking its location, using DNA polymerase to make a copy, and then continuously replicating the copies. The amplification of gene sequences that are associated with HIV allows for detection of the virus by this method.

Retrovirus A virus that contains a unique enzyme called reverse transcriptase that allows it to replicate within new host cells.

Seroconversion The change from HIV-negative to HIV-positive status during blood testing. Persons who are HIV-positive are called seroconverters.

Serology The analysis of the contents and properties of blood serum.

Serum The part of human blood that remains liquid when blood cells form a clot. Human blood serum is clear light yellow in color.

T cells Lymphocytes that originate in the thymus gland. T cells regulate the immune system's response to infections, including HIV. CD4 lymphocytes are a subset of T lymphocytes.

Viral load test A new blood test for monitoring the speed of HIV replication in AIDS patients. The viral load test is based on PCR techniques and supplements the CD4+ cell count tests.

Western blot A technique developed in 1979 that is used to confirm ELISA results. HIV antigen is purified by electrophoresis and attached by blotting to a nylon or nitrocellulose filter. The patient's serum is reacted against the filter, followed by treatment with developing chemicals that allow HIV antibody to show up as a colored patch or blot. If the patient is HIV-positive, there will be stripes at specific locations for two or more viral proteins. A negative result is blank.

WBC differential A white blood cell count in which the technician classifies the different white blood cells by type as well as calculating the number of each type. A WBC differential is necessary to calculate the absolute CD4+ lymphocyte count.

The latest generation of ELISA tests are 99.5% sensitive to HIV. Occasionally, the ELISA test will be positive for a patient without symptoms of AIDS from a low-risk group. Because this result is likely to be a false-positive, the ELISA must be repeated on the same sample of the patient's blood. If the second ELISA is positive, the result should be confirmed by the Western blot test.

WESTERN BLOT (IMMUNOBLOT). The Western blot or immunoblot test is used as a reference procedure to confirm the diagnosis of AIDS. In Western blot testing, HIV antigen is purified by electrophoresis (large protein molecules are suspended in a gel and separated from one another by running an electric current through the gel). The HIV antigens are attached by blotting to a nylon or nitrocellulose filter. The patient's serum is reacted against the filter, followed by treatment with developing chemicals that allow HIV antibody to show up as a colored patch or blot. A commercially produced Western blot test for HIV-1 is now available. It consists of a prefabricated strip that is incubated with a sample of the patient's blood serum and the developing chemicals. About nine different HIV-1 proteins can be detected in the blots.

When used in combination with ELISA testing, Western blot testing is 99.9% specific. It can, however, yield false negatives in patients with very early HIV infection and in those infected by HIV-2. In some patients the Western blot yields indeterminate results.

IMMUNOFLUORESCENCE ASSAY (IFA). This method is sometimes used to confirm ELISA results instead of Western blotting. An IFA test detects the presence of HIV antibody in a sample of the patient's serum by mixing HIV antigen with a fluorescent chemical, adding the blood sample, and observing the reaction under a microscope with ultraviolet light.

POLYMERASE CHAIN REACTION (PCR). This test is used to evaluate the very small number of AIDS patients with false-negative ELISA and Western blot tests. These patients are sometimes called antibody-negative asymptomatic (without symptoms) carriers, because they do not have any symptoms of AIDS and there is no detectable quantity of antibody in the blood serum. Antibody-negative asymptomatic carriers may be responsible for the very low ongoing risk of HIV infection transmitted by blood transfusions. It is estimated that the risk is between 1 in 10,000 and 1 in 100,000 units of transfused blood.

The polymerase chain reaction (PCR) test can measure the presence of viral nucleic acids in the patient's blood even when there is no detectable antibody to HIV. This test works by amplifying the presence of HIV nucleic acids in a blood sample. Numerous copies of a gene are made by separating the two strands of DNA containing the gene segment, marking its location, using DNA polymerase to make a copy, and then continuously replicating the copies. It is questionable whether PCR will replace Western blotting as the method of confirming AIDS diagnoses. Although PCR can detect the low number of persons (1%) with HIV infections that have not yet generated an antibody response to the virus, the overwhelming majority of infected persons will be detected by ELISA screening within one to three months of infection. In addition, PCR testing is based on present knowledge of the genetic sequences in HIV. Since the virus is continually generating new variants, PCR testing could yield a false negative in patients with these new variants. In 2004, researchers reported on a new test that was more sensitive to HIV, detecting the infection in as little as 12 days after infection. However, the manufacturer was still seeking FDA approval for the test, which would cost about the same as PCR testing.

In 1999, the U.S. Food and Drug Administration (FDA) approved an HIV home testing kit. The kit contained multiple components, including material for specimen collection, a mailing envelope to send the specimen to a laboratory for analysis, and provides pre- and post-test counseling. It uses a finger prick process for blood collection. Other tests have been in development that would allow patients to monitor their own therapy in the home without sending out for results.

Prognostic tests

Blood tests to evaluate patients already diagnosed with HIV infection are as important as the diagnostic tests. Because AIDS has a long latency period, some persons may be infected with the virus for 10 years or longer before they develop symptoms of AIDS. These patients are sometimes called antibody-positive asymptomatic carriers. Prognostic tests also help drug researchers evaluate the usefulness of new medications in treating AIDS.

BLOOD CELL COUNTS. Doctors can measure the number or proportion of certain types of cells in an AIDS patient's blood to see whether and how rapidly the disease is progressing, or whether certain treatments are helping the patient. These cell count tests include:

  • Complete blood count (CBC). A CBC is a routine analysis performed on a sample of blood taken from the patient's vein with a needle and vacuum tube. The measurements taken in a CBC include a white blood cell count (WBC), a red blood cell count (RBC), the red cell distribution width, the hematocrit (ratio of the volume of the red blood cells to the blood volume), and the amount of hemoglobin (the blood protein that carries oxygen). Although CBCs are used on more than just AIDS patients, they can help the doctor determine if an AIDS patient has an advanced form of the disease. Specific AIDS-related signs in a CBC include a low hematocrit, a sharp decrease in the number of blood platelets, and a low level of a certain type of white blood cell called neutrophils.
  • Absolute CD4+ lymphocytes. A lymphocyte is a type of white blood cell that is important in the formation of an immune response. Because HIV targets CD4+ lymphocytes, their number in the patient's blood can be used to track the course of the infection. This blood cell count is considered the most accurate indicator for the presence of an opportunistic infection in an AIDS patient. The absolute CD4+ lymphocyte count is obtained by multiplying the patient's white blood cell count (WBC) by the percentage of lymphocytes among the white blood cells, and multiplying the result by the percentage of lymphocytes bearing the CD4+ marker. An absolute count below 200-300 CD+4 lymphocytes in 1 cubic millimeter (mm3) of blood indicates that the patient is vulnerable to some opportunistic infections.
  • CD4+ lymphocyte percentage. Some doctors think that this is a more accurate test than the absolute count because the percentage does not depend on a manual calculation of the number of types of different white blood cells. A white blood cell count that is broken down into categories in this way is called a WBC differential.

It is important for doctors treating AIDS patients to measure the lymphocyte count on a regular basis. Experts consulted by the United States Public Health Service recommend the following frequency of serum testing based on the patient's CD4+ level:

  • CD4+ count more than 600 cells/mm3: Every six months.
  • CD4+ count between 200-600 cells/mm3: Every three months.
  • CD4+ count less than 200 cells/mm3: Every three months.

When the CD4+ count falls below 200 cells/mm3, the doctor will put the patient on a medication regimen to protect him or her against opportunistic infections.

HIV VIRAL LOAD TESTS. Another type of blood test for monitoring AIDS patients is the viral load test. It supplements the CD4+ count, which can tell the doctor the extent of the patient's loss of immune function, but not the speed of HIV replication in the body. The viral load test is based on PCR techniques and can measure the number of copies of HIV nucleic acids. Successive test results for a given patient's viral load are calculated on a base 10 logarithmic scale.

ORAL HIV TESTS. Scientists have developed oral HIV tests that can be conducted with saliva samples. One of the unintented effects of these tests is the misperception that HIV can be transmitted through saliva. Still, they present an excellent alternative to blood sample testing.

RAPID HIV TESTS. Researchers constantly work on more rapid tests for HIV that can be done in physician offices or by less skilled people and more convenient locations in developing countries. A finger-stick test that can be read quickly from a whole blood sample had shown promising results in the fall of 2003. Another test, called the VScan test kit, requires no refrigeration or electricity and can safely be stored at room temperature. Even if the positive results must be confirmed by ELISA or Western blotting, an accurate initial rapid test can help screen populations for HIV antibodies.

In 2004, a new three-minute test for HIV was lunched in the United States under FDA approval. The hope of this test is that health care providers such as family practice physician offices can quickly test a patient in the office and provide results while the patient waits, rather than sending results to a lab.

BETA2-MICROGLOBULIN (BETA2M). Beta-microglobulin is a protein found on the surface of all human cells with a nucleus. It is released into the blood when a cell dies. Although rising blood levels of β2M are found in patients with cancer and other serious diseases, a rising β2M blood level can be used to measure the progression of AIDS.

P24 ANTIGEN CAPTURE ASSAY. Found in the viral core of HIV, p24 is a protein that can be measured by the ELISA technique. Doctors can use p24 assays to measure the antiviral activity of the patient's medications. In addition, the p24 assay is sometimes useful in detecting HIV infection before seroconversion. However, p24 is consistently present in only 25% of persons infected with HIV.

GENOTYPIC DRUG RESISTANCE TEST. Genotypic testing can help determine whether specific gene mutations, common in people with HIV, are causing drug resistance and drug failure. The test looks for specific genetic mutations within the virus that are known to cause resistance to certain drugs used in HIV treatment. For example the drug 3TC, also known as lamivudine (Epivir), is not effective against strains of HIV that have a mutation at a particular position on the reverse transcriptase proteinamino acid 184known as M184V (MV, methionine to valine). So if the genotypic resistance test shows a mutation at position M184V, it is likely the person is resistant to 3TC and not likely to respond to 3TC treatment. Genotypic tests are only effective if the person is already taking antiviral medication and if the viral load is greater than 1,000 copies per milliliter (mL) of blood. The cost of the test, usually between $300 and $500, is usually now covered by many insurance plans.

PHENOTYPIC DRUG RESISTANCE TESTING. Phenotypic testing directly measures the sensitivity of a patient's HIV to particular drugs and drug combinations. To do this, it measures the concentration of a drug required to inhibit viral replication in the test tube. This is the same method used by researchers to determine whether a drug might be effective against HIV before using it in human clinical trials. Phenotypic testing is a more direct measurement of resistance than genotypic testing. Also, unlike genotypic testing, phenotypic testing does not require a high viral load but it is recommended that persons already be taking antiretroviral drugs. The cost is between $700 and $900 and is now covered by many insurance plans.

AIDS serology in children

Children born to HIV-infected mothers may acquire the infection through the mother's placenta or during the birth process. Public health experts recommend the testing and monitoring of all children born to mothers with HIV. Diagnostic testing in children older than 18 months is similar to adult testing, with ELISA screening confirmed by Western blot. Younger infants can be diagnosed by direct culture of the HIV virus, PCR testing, and p24 antigen testing. These techniques allow a pediatrician to identify 50% of infected children at or near birth, and 95% of cases in infants three to six months of age.

Preparation

Preparation and aftercare are important parts of AIDS diagnostic testing. Doctors are now advised to take the patient's emotional, social, economic, and other circumstances into account and to provide counseling before and after testing. Patients are generally better able to cope with the results if the doctor has spent some time with them before the blood test explaining the basic facts about HIV infection and testing. Many doctors now offer this type of informational counseling before performing the tests.

Aftercare

If the test results indicate that the patient is HIV-positive, he or she will need counseling, information, referral for treatment, and support. Doctors can either counsel the patient themselves or invite an experienced HIV counselor to discuss the results of the blood tests with the patient. They also will assess the patient's emotional and psychological status, including the possibility of violent behavior and the availability of a support network.

Risks

The risks of AIDS testing are primarily related to disclosure of the patient's HIV status rather than to any physical risks connected with blood testing. Some patients are better prepared to cope with a positive diagnosis than others, depending on their age, sex, health, resources, belief system, and similar factors.

Normal results

Normal results for ELISA, Western blot, IFA, and PCR testing are negative for HIV antibody.

Normal results for blood cell counts:

  • WBC differential: Total lymphocytes 24-44% of the white blood cells.
  • Hematocrit: 40-54% in men; 37-47% in women.
  • T cell lymphocytes: 644-2200/mm3, 60-88% of all lymphocytes.
  • B cell lymphocytes: 82-392/mm3, 3-20% of all lymphocytes.
  • CD4+ lymphocytes: 500-1200/mm3, 34-67% of all lymphocytes.

Abnormal results

The following results in AIDS tests indicate progression of the disease:

  • Percentage of CD4+ lymphocytes: less than 20% of all lymphocytes.
  • CD4+ lymphocyte count: less than 200 cells/mm3.
  • Viral load test: Levels more than 5000 copies/mL.
  • β:-2-microglobulin: Levels more than 3.5 mg/dL.
  • P24 antigen: Measurable amounts in blood serum.

Resources

BOOKS

Bennett, Rebecca, and Erin, Charles A., editors. HIV and AIDS Testing, Screening, and Confidentiality: Ethics, Law, and Social Policy. Oxford, England: Oxford University Press, 2001.

PERIODICALS

"Finger-stick Test is Accurate and Acceptable to Women in Thailand." Drug Week (September 5, 2003): 168.

Kaplan, Edward H., and Glen A. Satten. "Repeat Screening for HIV: When to Test and Why." The Journal of the American Medical Association.

Medical Devices & Surgical Technology Week (September 12, 2004): 102.

"Researcher Developing Home Test Kit for HIV Therapies." Medical Devices & Surgical Technology Week (December 23, 2001): 2.

"Researchers Report New Ultra-sensitive AIDS Test." Biotech Week (July 14, 2004): 246.

Weinhardt, Lance S., et al. "Human Immunodeficiency Virus Testing and Behavior Change." Archives of Internal Medicine (May 22, 2000): 1538.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Wells, Ken; Odle, Teresa. "AIDS Tests." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

Wells, Ken; Odle, Teresa. "AIDS Tests." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3451600050.html

Wells, Ken; Odle, Teresa. "AIDS Tests." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451600050.html

Acquired Immune Deficiency Syndrome

ACQUIRED IMMUNE DEFICIENCY SYNDROME

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS), an infectious disease that fatally depresses the human immune system, was recognized in the United States in 1980. By 1982 the disease had appeared in 24 states, 471 cases had been diagnosed, 184 people had died, and the Centers for Disease Control (CDC) in Atlanta had termed the outbreak an epidemic. AIDS has challenged the authority and integrity of respected medical institutions, strained the capacity of the health care system, forced the reevaluation of sexual mores, and tapped reservoirs of fear, prejudice, and compassion within individuals and communities.

On 5 June 1981, the CDC's Morbidity and Mortality Weekly Report (MMWR) published an article by Dr. Michael Gottlieb of the University of California at Los Angeles School of Medicine, describing five cases of Pneumocystis carinii pneumonia (PCP) in young homosexual men. A second MMWR article on 4 July documented ten additional cases of PCP, as well as twenty-six cases of Kaposi's sarcoma (KS), a rare skin cancer, in young homosexual males in New York City and San Francisco. PCP is normally seen only in patients with immune dysfunction and KS in elderly men. Under the direction of James Curran, the CDC began to investigate, hypothesizing that the young men were suffering from an immune-system deficiency related to their lifestyle. In early August, however, CDC staff identified the strange "gay plague" in heterosexual intravenous drug users in New York City.

In the first six months of 1982, cases were reported among hemophiliacs receiving blood components, Haitian refugees, and infants born to drug-using mothers. Transmission through blood transfusion was documented in June. Although physicians had named the outbreak gay-related immune deficiency (GRID), many suspected a viral infection transmissible through sexual contact or blood transfusion rather than a lifestyle-related disease; some proposed a multifactor etiology. At a meeting in July, the CDC coined the term "AIDS," which became accepted usage for the several related disorders.

More than 1,000 Americans had been diagnosed with AIDS by early 1983; of those, 394 had died. Although the CDC had identified instances in which the infection had been transmitted through blood transfusion, the Red Cross and major blood banks refused to institute rigorous screening, which was costly and might discourage donors. In March 1983, the CDC and the Public Health Service, concerned about the risk of infection, issued a statement naming four "high-risk" groups of donors, advising them not to give blood and to avoid sexual contact. This warning, together with a May article in the Journal of the American Medical Association suggesting the possibility of infection through casual contact, heightened media and public awareness, intensified fears, and prompted ostracism of people with AIDS (PWAs). Some health care workers refused to treat PWAs. In many areas, moral objections blocked inexpensive control measures, such as condom distribution and sterile-needle exchanges for drug users.

Researchers, including Robert Gallo at the National Cancer Institute in Bethesda, Maryland, and Luc Montagnier at the Pasteur Institute in Paris, attempted to identify and characterize the viral agent that caused AIDS. By January 1984, Gallo's laboratory had cultured twenty samples of a virus he named HTLV-III, believing it related to the human T-cell leukemia virus he had isolated in 1980. In February 1984, Montagnier's group reported their discovery of lymphadenopathy-associated virus (LAV), which they asserted was the AIDS virus. Their work was confirmed by Donald Francis at the CDC. Genetic testing established that LAV and HTLV-III were nearly identical. Gallo and Margaret Heckler, Secretary of Health and Human Services, announced on 23 April 1984, however, that the National Cancer Institute had found the AIDS virus and had developed an antibody test for blood screening, clinical testing, and diagnosis. An international committee renamed the virus HIV (human immunodeficiency virus) in late 1986. Shortly thereafter, President Ronald Reagan and France's President Jacques Chirac announced that the Pasteur Institute and the National Cancer Institute would share credit for the discovery and royalties from the patented blood test. (Later probes of possible misappropriation of the French virus by Gallo and his lab assistant Mikulas Popovic were dropped in 1993.)

Isolation of the virus confirmed AIDS as an acute infectious disease, encouraging research into vaccines and therapeutic drugs. Lack of money hampered work, however. The Reagan administration was unwilling to initiate expensive programs to control a disease associated with homosexuality and drug use. Individual congressmen, including Phillip Burton of San Francisco and Henry A. Waxman of Los Angeles, together with Assistant Secretary for Health Edward Brandt, pushed for supplemental AIDS funding in 1983 and 1984, with limited success. Organizations such as the Gay Men's Health Crisis in New York and Mathilde Krim's AIDS Medical Foundation (AMF) provided funds, but support for research remained inadequate.

The burden of care for AIDS patients, many without private insurance, fell on state and local governments and on volunteers largely drawn from the gay community. Many gay men and lesbians initially resisted involvement with the "gay plague," which threatened to deepen the stigma attached to homosexuality. Others resented public-health warnings to alter sexual practices. Gay organizations fought both universal antibody-screening and the closing of public bathhouses in New York and San Francisco, which authorities saw as reservoirs of infection. At the same time gay groups provided support, patient care, and money to PWAs, including those who were not gay. Gay men volunteered as research subjects in community-based drug trials organized by local physicians and developed patient networks that circulated experimental and imported drugs to treat PWAs suffering from opportunistic infections such as PCP and cytomegalovirus. Gay leaders lobbied for more money. A few risked community ostracism by becoming public advocates for safer sexual practices.

Although hampered by lack of money from the federal government, research into therapeutic drugs did produce results. In early 1985, Samuel Broder at the National


Cancer Institute and other researchers confirmed that the compound azidothymidine (AZT), developed by the pharmaceutical firm Burroughs-Wellcome, appeared active against the AIDS virus in laboratory cultures. The Food and Drug Administration (FDA) quickly approved the manufacturer's plan for clinical trials and facilitated release to the market in 1987, although the efficacy trial lasted only seven months. The AIDS Clinical Trial Network, established by the National Institute for Allergy and Infectious Diseases (NIAID), developed protocols to test AZT in patient groups at hospitals across the country. Burroughs-Wellcome put AZT on the market in February 1987, at the price of $188 per 10,000 milligrams; the annual cost of the drug for some patients was reported to be $8,000 or higher. Although harshly criticized, the company waited until December before dropping the price 20 percent.

While NIAID pursued AZT trials, physicians and patients were trying other compounds to slow the disease or treat opportunistic infections. The FDA gave low priority to several compounds, such as AL721 and HPA23. In the case of others, such as the Syntex compound ganciclovir, PWAs received the drug at cost for several years under a compassionate use protocol. The FDA then required a blind comparison with a placebo before ganciclovir could be marketed, but few PWAs were willing to enroll in a placebo trial after they already had used an experimental compound or if they feared rapid progression of their disease. Investigators in the NIAID-endorsed AZT trials experienced difficulty recruiting subjects.

Gay AIDS activists sought access to more drugs, access to information about trials, trial protocols that recognized patient needs and risks, inclusion of minority PWAs in trials, and PWA participation in development and testing. The AIDS Coalition to Unleash Power (ACT UP) captured media attention with demonstrations and street theater; the group soon acquired a radical image that alienated researchers, the public, and more conservative gay groups. The small group Treatment and Data Subcommittee (later the Treatment Action Group), led by Iris Long, James Eigo, and Mark Harrington, created a registry of clinical trials and gave testimony to the President's Commission and at congressional hearings. At the request of President George H. W. Bush, the clinical-trial authority Louis Lasagna held hearings in 1989 on new drug approval procedures. The hearings accentuated lack of progress by the FDA and NIAID and provided a forum for Eigo and Harrington to present their program. Anthony Fauci, director of NIAID and a target of ACT UP criticism, met with activists and backed a new parallel track for community-based, nonplacebo drug trials. The parallel track system was in operation by early 1990, but the concept remained controversial as it competed for money and trial subjects with conventional controlled trials. President Bush in 1990 appointed David Kessler as FDA commissioner, who quickly gained a reputation for activism and endorsed parallel track.

By 1991, the character of AIDS in the United States had changed again. Although incidence was increasing in all population groups, rates were most rapid among the poor, African Americans, Hispanic Americans, and women and children. Health care providers, researchers, and PWAs no longer defined the epidemic as an acute infectious disease responsive to early aggressive intervention. They recognized AIDS as a chronic disease characterized by a lengthy virus incubation (up to eleven years); onset of active infection possibly related to medical or lifestyle cofactors; an extended course involving multiple infectious episodes; and the need for flexible treatment with a variety of drugs as well as long-term supportive services. Despite this progress, however, at the beginning of the twenty-first century, AIDS still remained a fatal disease and an effective vaccine was still years away.

As of 31 December 1984, 7,699 PWAs had been diagnosed and almost half of them were dead. Although the disease was taking a heavy toll among gay white males, more than half the cases now were nonwhite persons, including many women and children. The First International AIDS Conference, held in Atlanta in April 1985, made public much new clinical information. Participants debated screening programs advocated by the Reagan administration and public-health experts but opposed by gays and other potentially stigmatized groups. Conference

reports contributed to increased fear and concern in 1985, which intensified when the country learned that the actor Rock Hudson was dying of AIDS. Shortly thereafter, the news that a school in Kokomo, Indiana, had denied a young PWA named Ryan White the right to attend school with his classmates epitomized Americans' fear of and aversion to the disease.

Attitudes were changing, however. Hudson's death in October shocked Hollywood, which was heavily affected by the disease. The American Foundation for AIDS Re-search, supported by a Hudson bequest, merged with Krim's AMF to form AmFAR, which attracted support from such celebrities as Elizabeth Taylor. Ryan White was accepted by another Indiana school and became a national symbol of courage before his death in 1990. In October 1986, Surgeon General C. Everett Koop broke with the Reagan administration with a bluntly worded report on the epidemic, calling for sex education in schools, widespread use of condoms, and voluntary antibody testing. Koop's report followed statements from the Public Health Service and the National Academy of Sciences Institute of Medicine that described the administration's response to AIDS as inadequate. President Reagan in 1987 created the President's Commission on the Human Immunodeficiency Virus Epidemic and shortly afterward spoke at the Third International AIDS Conference in Washington, D.C. Basketball player Magic Johnson's November 1991 announcement that he had contracted HIV through unprotected heterosexual sex, followed by the tennis player Arthur Ashe's disclosure five months later that he had AIDS as a result of a blood transfussion during bypass surgery, helped transform the public image of AIDS to a disease that reached beyond the gay community. In late 1993, public concern for PWAs was reflected in critical acclaim for the film Philadelphia and the stage play Angels in America, both of which examined the personal and social consequences of AIDS.

Public attitudes toward PWAs had gradually shifted from discrimination and fear to compassion and acceptance, but the burdensome costs of treatment and services were a challenge to the national will. In one example, the Comprehensive AIDS Resource Emergency Act of 1990, often called the Ryan White Act, authorized $2.9 billion for areas of high incidence. It passed both houses of Congress with enthusiastic bipartisan support but a few months later budget negotiations reduced the money drastically. Nevertheless, federal efforts to control the epidemic increased. On 5October 1993, Congress approved an increase of $227 million in support, bringing the 1994 total to $1.3 billion. Fulfilling a campaign promise, President Bill Clinton created the position of national AIDS policy coordinator and appointed Kristine Gebbie to the post. In 1994, after lobbying by PWAs and researchers, he appointed the NIAID immunobiologist William Paul to head the Office of AIDS Research, with full budgetary authority. As of January 1996, The AmFAR HIV/AIDS Treatment Directory listed 77 clinical trial protocols for HIV infection and 141 protocols for opportunistic infections and related disorders. Twenty-one drugs were available to patients through compassionate use or expanded access protocols. Researchers held out hope that the disease would prove susceptible to new agents used in combination with AZT and its relatives, ddl and ddo. Many trials, however, continued to have difficulty recruiting patients and some community-based trials were threatened by budget cuts.

By the end of the twentieth century, more than 774,000 AIDS cases had been diagnosed in the United States, and almost 450,000 people had died of the disease. New treatments had lengthened lives and education had slowed transmission of the disease; nevertheless an estimated 110 people were being infected with HIV each day. And even though a remedy remained elusive, the sense of urgency in the fight against AIDS had waned. President George W. Bush appointed Scott Evertz as director of the Office of National AIDS Policy, but was slow to fill other key appointments to offices in the CDC and the Department of Health and Human Services that dealt with AIDS research and policy. Bush created a White House Task Force on HIV/AIDS but in his first budget proposal did not recommend funding increases for domestic AIDS programs.

By the beginning of the twenty-first century, AIDS had been brought under control in the United States through political action, intensive education, and expensive drug therapy. But the disease continued to ravage other parts of the world. By the end of 2001, 40 million people were living with HIV/AIDS, 95 percent of whom were in developing countries. The hardest hit area was Sub-Saharan Africa where 2.5 million people were dying each year. The Bush Administration's response to this global crisis was as mixed as its response to the domestic one. Secretary of State Colin Powell made global AIDS issues a priority, but Bush refused to sign a United Nations declaration on children's rights that supported sex education for teenagers. The United States joined several international efforts to halt the spread of the epidemic, including the International Partnership Against HIV/AIDS in Africa (IPAA), but its initial contribution to the UN Global Fund to finance responses to AIDS and other deadly infectious diseases was only $200 million. The Fund, created in 2001, sought $7–10 billion per year from all donors. U.S. AIDS activists now fight on two fronts. On the domestic front, they push the federal government to provide more funding for research and the care of PWAs, and they push researchers to develop a vaccine and treatments with fewer side effects. Most important they continue to impress upon young people who do not remember the AIDS epidemic before AZT that they should use "safe sex" practices, because AIDS is still a fatal disease. On the global front, activists seek to encourage the U.S. government to increase aid for global AIDS programs, to support debt cancellation for developing countries ravaged by the disease, and to take steps to ensure access to treatment in foreign countries.

BIBLIOGRAPHY

Altman, Dennis. AIDS in the Mind of America. Garden City, N.Y.: Anchor Press/Doubleday, 1986.

Fee, Elizabeth, and Daniel M. Fox, eds. AIDS: The Making of a Chronic Disease. Berkeley: University of California Press, 1992.

Goldstein, Nancy, and Jennifer L. Manlowe, eds. The Gender Politcs of HIV/AIDS in Women: Perspectives on the Pandemic in the United States. New York: New York University Press, 1997.

Grmek, Mirko D. History of AIDS: Emergence and Origin of a Modern Pandemic. Princeton, N.J.: Princeton University Press, 1990.

Hannaway, Caroline, Victoria A. Harden, and John Parascondola, eds. AIDS and the Public Debate: Historical and Contemporary Perspectives. Washington, D.C.: IOS Press, 1995.

Murphy, Timothy F. Ethics in an Epidemic: AIDS, Morality, and Culture. Berkeley: University of California Press, 1994.

Roiphe, Katie. Last Night in Paradise: Sex and Morals at the Century's End. Boston: Little, Brown, 1997.

Shilts, Randy. And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press, 1987.

Daniel M.Fox

Marcia L.Meldru

Cynthia R.Poe

See alsoACT UP ; Centers for Disease Control and Prevention ; Clinical Research ; Epidemics and Public Health ; Gay and Lesbian Movement ; National Institutes of Health ; Sexuality ; Sexually Transmitted Diseases .

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Acquired Immune Deficiency Syndrome." Dictionary of American History. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Acquired Immune Deficiency Syndrome." Dictionary of American History. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3401800029.html

"Acquired Immune Deficiency Syndrome." Dictionary of American History. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3401800029.html

AIDS

AIDS

Definition

Acquired immunodeficiency syndrome (AIDS) is the final and most serious stage of the disease caused by the human immunodeficiency virus. Symptoms begin when an HIV-positive person presents a CD4-cell (also called T cell, a type of immune cell) count below 200. AIDS happens concurrently with numerous opportunistic infections and tumors that are normally associated with the HIV infection.

The most common neurological complications of AIDS involve opportunistic infections of the brain such as progressive multifocal leucoencephalopathy (PML) and meningitis, other opportunistic infections such as herpes zoster (shingles ), peripheral neuropathy , depression , and AIDS-related dementia .

Description

AIDS was first recognized in 1981 and has since become a major worldwide pandemic. Abundant evidence indicates that the human immunodeficiency virus (HIV), discovered in 1983, causes AIDS. By leading to the destruction and/or functional impairment of immune cells, notably CD4+ T cells, HIV progressively destroys the body's ability to fight infections and to resist certain cancer formation.

Before the HIV infection became widespread in the human population, AIDS-like syndromes occurred extremely rarely, and almost exclusively in individuals with known causes of immune suppression, such as those receiving chemotherapy or those with underlying cancers. A marked increase in unusual infections and tumors characteristic of severe immune suppression was first recognized in the early 1980s in homosexual men who had been otherwise healthy and had no recognized cause for immune suppression. An infectious cause of AIDS was suggested by geographic clustering of cases, a sexual link among cases, mother-to-infant transmission, and transmission by blood transfusion.

Isolation of the HIV from patients with AIDS strongly suggested that this virus was the cause of AIDS. Since the early 1980s, HIV and AIDS have been repeatedly associated; the appearance of HIV in the blood supply has preceded or coincided with the occurrence of AIDS cases in every country and region where AIDS has been noted. Individuals of all ages from many risk groups, including homosexual men, infants born to HIV-infected mothers, heterosexual women and men, hemophiliacs, recipients of blood and blood products, health care workers and others occupationally exposed to HIV-tainted blood, and injection drug users have all developed AIDS with only one common denominator: HIV.

HIV destroys CD4+ T cells, which are crucial to the normal function of the human immune system. In fact, depletion of CD4+ T cells in HIV-infected individuals is an extremely powerful predictor of the development of AIDS. Studies of thousands of individuals have revealed that most HIV-infected people carry the virus for years before enough damage is done to the immune system for AIDS to develop; however, with time, a near-perfect correlation has been found between infection and the subsequent development of AIDS.

Demographics

In the United States, more than 733,000 people have AIDS, and an estimated one to two million people have HIV infection without the symptoms of AIDS.

Internationally, since the AIDS epidemic began, more than 16 million deaths have been attributed to AIDS. The current estimate of worldwide disease prevalence is more than 33 million HIV infections. Ninety-five percent of these cases are in developing countries, generally in sub-Saharan Africa and Southeast Asia.

Most HIV infections still occur in men; however, the frequency of infection in women is increasing, especially in developing countries. In the United States, fewer than 16% of all HIV cases are in women, whereas worldwide an estimated 46% of all HIV patients are women.

Causes and symptoms

The cause of primary AIDS is infection with the HIV virus, transmitted via infected blood or body fluids. Methods of transmission of the virus include unprotected sex, especially anal intercourse; occupational needle stick or body fluid splash, which has an estimated transmission rate of less than 0.3%; sharing of needles in drug abuse; and receiving contaminated blood products.

Opportunistic infections occur in individuals whose CD4 count is less than 200 cells/mm3 and those not taking preventative drugs.

Symptoms of AIDS include:

  • cough and shortness of breath
  • seizures and lack of coordination
  • difficult or painful swallowing
  • confusion and forgetfulness
  • severe and persistent diarrhea
  • fever
  • vision loss
  • nausea, abdominal cramps, and vomiting
  • weight loss and extreme fatigue
  • severe headaches with neck stiffness

Neurological complications of AIDS

Almost 30% of people with AIDS develop peripheral neuropathy, causing tingling, numbness, and weakness in the arms and legs due to nerve damage. If severe, peripheral neuropathy can cause difficulty walking. Several drugs used to treat people with AIDS can contribute to the development of peripheral neuropathy.

Several opportunistic infections experienced by people with AIDS involve the nervous system. Progressive multifocal leucoencephalopathy (PML) is a serious viral infection of the brain, most often caused by the JC virus. PML is fatal in more than 90% of cases within six months of diagnosis. Nearly 4% of people with AIDS, especially those with T-cell counts below 100, will develop the disease. Meningitis is an infection of the lining of the spinal cord and brain, and also occurs in some people with AIDS. Cryptococcus, a fungus that normally occurs in the soil and seldom affects persons with intact immune systems, can cause recurring meningitis in people with AIDS whose T-cell count is below 100. The common parasite Toxoplasma gondii often present in cat feces, raw meat, raw vegetables, and the soil can also cause encephalitis, or inflammation of the brain, in AIDS patients. Shingles is a painful nerve inflammation caused by a reactivation of the herpes varicella zoster virus, the same virus that causes chicken pox. Although not directly linked to HIV, shingles seems to occur more frequently in people with AIDS.

Other neurological conditions associated with AIDS include depression, occurring at any time during the disease, and dementia, which sometimes occurs in the later stages of AIDS. Depression can stem from living with a chronic and progressive disease. AIDS-related dementia involves problems with thinking, memory, and usually also with controlling the arms and legs, and can stem from direct infection in the brain with the HIV virus. In the initial stages of the pandemic, almost 20% of persons with AIDS developed severe dementia. With the development of combination antiviral drugs , the rate of severe dementia in AIDS has been reduced by more than half. The number of persons with HIV and milder dementia has increased, however, as people with HIV live longer.

Diagnosis

In the early stages of infection, HIV often causes no symptoms and the infection can be diagnosed only by testing a person's blood. Two tests are available to diagnose HIV infection, one that looks for the presence of antibodies produced by the body in response to HIV and the other that looks for the virus itself. Antibodies are proteins produced by the body whenever a disease threatens it. When the body is infected with HIV, it produces antibodies specific to HIV. The first test, called ELISA (enzyme-linked immunosorbent assay), looks for such antibodies in the blood.

A positive ELISA has to be confirmed by another test called western blot or immunofluorescent assay (IFA). All positive tests by ELISA are not accurate and hence, western blot and repeated tests are necessary to confirm a person's HIV status. A person infected with HIV is termed HIV positive or seropositive.

Rapid tests that give results in five to 30 minutes are increasingly being used worldwide. The accuracy of rapid tests is stated to be as good as that of ELISA. Though rapid tests are more expensive, researchers have found them to be more cost effective in terms of the number of people covered and the time the tests take.

The HIV antibodies generally do not reach detectable levels in the blood until about three months after infection. This period, from the time of infection until the blood is tested positive for antibodies, is called the window period. Sometimes, the antibodies might take up to six months to be detected. Even if the tests are negative, during the window period the amount of virus is very high in an infected person. If a person is newly infected, therefore, the risk of transmission is higher.

Another test for HIV is called polymerase chain reaction (PCR), which looks for HIV itself in the blood. This test, which recognizes the presence of the virus' genetic material in the blood, can detect the virus within a few days of infection. There are also tests like radio immuno precipitation assay (RIPA), a confirmatory blood test that may be used when antibody levels are difficult to detect or when western blot test results are uncertain.

Treatment team

The treatment team often includes personal care-givers, physical therapists, dietitians, specialists (infectious disease specialists, dermatologists, nephrologists, ophthalmologists, pediatrists, psychiatrists, and neurologists), and social workers .

Treatment

Since the early 1990s, several drugs to fight both the HIV infection and its associated infections and cancers have become available, including:

  • Reverse transcriptase inhibitors: They interrupt the virus from making copies of itself. These drugs are AZT (zidovudine [Retrovir]), ddC (zalcitabine [Hivid], dideoxyinosine), d4T (stavudine [Zerit]), and 3TC (lamivudine [Epivir]).
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIS): These medications are used in combination with other drugs to help keep the virus from multiplying. Examples of NNRTIS are delavirdine (Rescriptor) and nevirapine (Viramune).
  • Protease inhibitors: These medications interrupt virus replication at a later step in its lifecycle. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase), and nelfinavir (Viracept). Using both classes of drugs reduces the chances of developing resistance in the virus.
  • Fusion inhibitors: This is the newest class of anti-HIV drugs. The first drug of this class (enfuvirtide [Fuzeon]) has recently been approved in the United States. Fusion inhibitors block HIV from entering the human immune cell.
  • A combination of several drugs called highly active antiretroviral therapy (HAART): This treatment is not a cure. The virus still persists in various body sites such as in the lymph glands.

The antiretroviral drugs do not cure people of the HIV infection or AIDS. They stop viral replication and delay the development of AIDS. However, they may also have side effects that can be severe. These include decrease of red or white blood cells, inflammation of the pancreas, and painful nerve damage. Other complications are enlarged or fatty liver, which may result in liver failure and death.

Recovery and rehabilitation

As there is no cure for AIDS, the focus is on maintaining optimum health, activity, and quality of life rather than on complete recovery.

Occupational therapy can have a crucial role in assisting people living with HIV/AIDS to reengage with life, particularly through vocational rehabilitation programs. Occupational therapy can provide the patient with a series of learning experiences that will enable the individual to make appropriate vocational choices.

Clinical trials

There are many ongoing clinical trials for AIDS. "HIV Vaccine Designed for HIV Infected Adults Taking Anti-HIV Drugs," "When to Start Anti-HIV Drugs in Patients with Opportunistic Infections," and "Outcomes of Anti-HIV Therapy during Early HIV Infection" are some trials that are currently recruiting patients at the National Institute of Allergy and Infectious Diseases (NIAID). Updated information on these and other trials for the study and treatment of AIDS can be found at the National Institutes of Health website for clinical trials at <http://www.clinicaltrials.gov>.

Prognosis

Presently, there is no cure for HIV infection or AIDS, nor is there a vaccine to prevent the HIV infection. However, there are new medications that help slow the progression of the infection and reduce the seriousness of HIV consequences in many people.

Special concerns

The surest way to avoid AIDS is to abstain from sex, or to limit sex to one partner who also limits his or her sex in the same way (monogamy). Condoms are not 100% safe, but if used properly they will greatly reduce the risk of AIDS transmission. Also, avoiding the use of intravenous drugs (drug abuse, sharing contaminated syringes) is highly recommended.

Resources

BOOKS

Conner, R. F., L. P. Villarreal, and H. Y. Fan. AIDS: Science and Society. Sudbury, MA: Jones & Bartlett Publishers, 2004.

Stine, G. J. AIDS Update 2004. Essex, England: Pearson Benjamin Cummings, 2003.

PERIODICALS

Grant, A. D, and K. M. De Cock. "ABC of AIDS: HIV Infection and AIDS in the Developing World." BMJ 322 (June 2001): 14751478.

OTHER

"AIDS Factsheets." AIDS.ORG. April 20, 2004 (May 27, 2004). <http://www.aids.org/factSheets/>. "

How HIV Causes AIDS." National Institute of Allergy and Infectious Disease. April 20, 2004 (May 27, 2004). <http://www.niaid.nih.gov/factsheets/howhiv.htm>.

UNAIDS. The Joint United Nations Program on HIV/AIDS. April 20, 2004 (May 27, 2004). <http://www.unaids.org/>.

ORGANIZATIONS

Centers for Disease Control (Office of Public Inquiries). Clifton Road, Atlanta, GA 30333. (800) 342-2437. <http://www.cdc.gov>.

National Institute of Allergy and Infectious Disease. 6610 Rockledge Drive MSC 6612, Bethesda, MD 20892-6612. <http://www.niaid.nih.gov/>.

Greiciane Gaburro Paneto

Brenda Wilmoth Lerner, RN

Iuri Drumond Louro, MD, PhD

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

Paneto, Greiciane; Lerner, Brenda; Louro, Iuri. "AIDS." Gale Encyclopedia of Neurological Disorders. 2005. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

Paneto, Greiciane; Lerner, Brenda; Louro, Iuri. "AIDS." Gale Encyclopedia of Neurological Disorders. 2005. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3435200019.html

Paneto, Greiciane; Lerner, Brenda; Louro, Iuri. "AIDS." Gale Encyclopedia of Neurological Disorders. 2005. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3435200019.html

AIDS

AIDS

The advent of AIDS (acquired immunity deficiency syndrome) in early 1981 surprised the scientific community, as many researchers at that time viewed the world to be on the brink of eliminating infectious disease. AIDS, an infectious disease syndrome that suppresses the immune system , is caused by the Human Immune Deficiency Virus (HIV ), part of a group of viruses known as retroviruses . The name AIDS was coined in 1982. Victims of AIDS most often die from opportunistic infections that take hold of the body because the immune system is severely impaired.

Following the discovery of AIDS, scientists attempted to identify the virus that causes the disease. In 1983 and 1984 two scientists and their teams reported isolating HIV, the virus that causes AIDS. One was French immunologist Luc Montagnier (1932 ), working at the Pasteur Institute in Paris, and the other was American immunologist Robert Gallo (1937 ) at the National Cancer Institute in Bethesda, Maryland. Both identified HIV as the cause of AIDS and showed the pathogen to be a retrovirus, meaning that its genetic material is RNA instead of DNA . Following the discovery, a dispute ensued over who made the initial discovery, but today Gallo and Montagnier are credited as co-discoverers.

Inside its host cell, the HIV retrovirus uses an enzyme called reverse transcriptase to make a DNA copy of its genetic material. The single strand of DNA then replicates and, in double stranded form, integrates into the chromosome of the host cell where it directs synthesis of more viral RNA. The viral RNA in turn directs the synthesis protein capsids and both are assembled into HIV viruses. A large number of viruses emerge from the host cell before it dies. HIV destroys the immune system by invading lymphocytes and macrophages, replicating within them, killing them, and spreading to others.

Scientists believe that HIV originated in the region of sub-Saharan Africa and subsequently spread to Europe and the United States by way of the Caribbean. Because viruses exist that suppress the immune system in monkeys, scientists hypothesize that these viruses mutated to HIV in the bodies of humans who ate the meat of monkeys, and subsequently caused AIDS. A fifteen-year-old male with skin lesions who died in 1969 is the first documented case of AIDS. Unable to determine the cause of death at the time, doctors froze some of his tissues, and upon recent examination, the tissue was found to be infected with HIV. During the 1960s, doctors often listed leukemia as the cause of death in many AIDS patients. After several decades however, the incidence of AIDS was sufficiently widespread to recognize it as a specific disease. Epidemiologists, scientists who study the incidence, cause, and distribution of diseases, turned their attention to AIDS. American scientist James Curran, working with the Centers for Disease Control and Prevention (CDC), sparked an effort to track the occurrence of HIV. First spread in the United States through the homosexual community by male-to-male contact, HIV rapidly expanded through all populations. Presently new HIV infections are increasing more rapidly among heterosexuals, with women accounting for approximately twenty percent of the AIDS cases. The worldwide AIDS epidemic is estimated to have killed more than 6.5 million people, and infected another 29 million. A new infection occurs about every fifteen seconds. HIV is not distributed equally throughout the world; most afflicted people live in developing countries. Africa has the largest number of cases, but the fastest rate of new infections is occurring in Southeast Asia and the Indian subcontinent. In the United States, though the disease was concentrated in large cities, it has spread to towns and rural areas. Once the leading cause of death among people between the ages of 25 and 44 in the Unites States, AIDS is now second to accidents.

HIV is transmitted in bodily fluids. Its main means of transmission from an infected person is through sexual contact, specifically vaginal and anal intercourse, and oral to genital contact. Intravenous drug users who share needles are at high risk of contracting AIDS. An infected mother has a 15 to 25% chance of passing HIV to her unborn child before and during birth, and an increased risk of transmitting HIV through breast-feeding. Although rare in countries such as the United States where blood is screened for HIV, the virus can be transmitted by transfusions of infected blood or blood-clotting factors. Another consideration regarding HIV transmission is that a person who has had another sexually transmitted disease is more likely to contract AIDS.

Laboratories use a test for HIV-1 that is called Enzyme-linked immunosorbant assay (ELISA) . (There is another type of HIV called HIV-2.) First developed in 1985 by Robert Gallo and his research team, the ELISA test is based on the fact that, even though the disease attacks the immune system, B cells begin to produce antibodies to fight the invasion within weeks or months of the infection. The test detects the presence of HIV-1 type antibodies and reacts with a color change. Weaknesses of the test include its inability to detect 1) patients who are infectious but have not yet produced HIV-1 antibodies, and 2) those who are infected with HIV-2. In addition, ELISA may give a false positive result to persons suffering from a disease other than AIDS. Patients that test positive with ELISA are given a second more specialized test to confirm the presence of AIDS. Developed in 1996, this test detects HIV antigens, proteins produced by the virus, and can therefore identify HIV before the patient's body produces antibodies. In addition, separate tests for HIV-1 and HIV-2 have been developed.

After HIV invades the body, the disease passes through different phases, culminating in AIDS. During the earliest phase the infected individual may experience general flu-like symptoms such as fever and headache within one to three weeks after exposure; then he or she remains relatively healthy while the virus replicates and the immune system produces antibodies. This stage continues for as long as the body's immune response keeps HIV in check. Progression of the disease is monitored by the declining number of particular antibodies called CD4-T lymphocytes. HIV attacks these immune cells by attaching to their CD4 receptor site. The virus also attacks macrophages, the cells that pass the antigen to helper T lymphocytes. The progress of HIV can also be determined by the amount of HIV in the patient's blood. After several months to several years, the disease progresses to the next stage in which the CD4-T cell count declines, and non-life-threatening symptoms such as weakness or swollen lymph glands may appear. The CDC has established a definition for the diagnosis of AIDS in which the CD4 T-cell count is below 200 cells per cubic mm of blood, or an opportunistic disease has set in.

Although progress has been made in the treatment of AIDS, a cure has yet to be found. In 1995 scientists developed a potent cocktail of drugs that help stop the progress of HIV. Among other substances, the cocktail combines zidovudine (AZT), didanosine (ddi), and a protease inhibitor. AZT and ddi are nucleosides that are building blocks of DNA. The enzyme, reverse transcriptase, mistakenly incorporates the drugs into the viral chain, thereby stopping DNA synthesis. Used alone, AZT works temporarily until HIV develops immunity to the nucleoside. Proteases are enzymes that are needed by HIV to reproduce, and when protease inhibitors are administered, HIV replicates are no longer able to infect cells. In 1995 the Federal Drug Administration approved saquinaviras, the first protease inhibitor to be used in combination with nucleoside drugs such as AZT; this was followed in 1996 by approval for the protease inhibitors ritonavir and indinavir to be used alone or in combination with nucleosides. The combination of drugs brings about a greater increase of antibodies and a greater decrease of fulminant HIV than either type of drug alone. Although patients improve on a regimen of mixed drugs, they are not cured due to the persistence of inactive virus left in the body. Researchers are looking for ways to flush out the remaining HIV. In the battle against AIDS, researchers are also attempting to develop a vaccine . As an adjunct to the classic method of preparing a vaccine from weakened virus, scientists are attempting to create a vaccine from a single virus protein.

In addition to treatment, the battle against AIDS includes preventing transmission of the disease. Infected individuals pass HIV-laden macrophages and T lymphocytes in their bodily fluids to others. Sexual behaviors and drug-related activities are the most common means of transmission. Commonly, the virus gains entry into the bloodstream by way of small abrasions during sexual intercourse or direct injection with an infected needle. In attempting to prevent HIV transmission among the peoples of the world, there has been an unprecedented emphasis on public health education and social programs; it is vitally important to increase public understanding of both the nature of AIDS and the behaviors that put individuals at risk of spreading or contracting the disease.

See also AIDS, recent advances in research and treatment; Antibody and antigen; Blood borne infections; Centers for Disease Control (CDC); Epidemics, viral; Human immunodeficiency virus (HIV); Immunodeficiency disease syndromes; Immunodeficiency diseases; Immunological analysis techniques; Infection and resistance; Infection control; Latent viruses and diseases; Sexually transmitted diseases; T cells or T lymphocytes; Viral genetics; Viral vectors in gene therapy; Virology; Virus replication; Viruses and responses to viral infection

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." World of Microbiology and Immunology. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." World of Microbiology and Immunology. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3409800017.html

"AIDS." World of Microbiology and Immunology. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3409800017.html

Aids

Aids

BIBLIOGRAPHY

As the twenty-first century moves forward, the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) epidemic remains a major public health concern. As of 2006, a cure for HIV/AIDS remained to be found. While medical researchers focus their efforts on finding a cure and a vaccine, social scientists work hard to find ways to prevent the spread of HIV/AIDS. These efforts have emphasized reducing behaviors that increase the risk of exposure to HIV, such as having unprotected vaginal or anal sex and sharing needles when injecting drugs. Such efforts require an understanding of which groups of people are most at risk for contracting HIV.

During the late 1990s and early 2000s, the Centers for Disease Control and Prevention (CDC) estimated that approximately forty thousand new cases of HIV infection occurred each year in the United States. Among the 23,153 men diagnosed with HIV in 2003 (73 percent of all cases reported by thirty-three states), men who have sex with men (MSM) accounted for the largest proportion (63%), followed by those reporting heterosexual contact (17%) or injection-drug use (14%), MSM and injection-drug use (5%), and other-unspecified (1%). Among women diagnosed with HIV in 2003 (27% of all cases), heterosexual contact accounted for the largest proportion (79%), followed by injection-drug use (19%), with 2% reported as other-unspecified. While a much higher percentage of men are infected with HIV in the United States, women make up a rising percentage of those living with HIV/AIDS (their numbers increasing from 14% in 1992 to 22 percent in 2003), and heterosexual transmission has become an increasingly important factor for men. Race/ethnicity diagnoses in 2003 were disproportionately led by African Americans (50%), followed by whites (32%) and Hispanics (15%).

Social scientists use demographic information to design and implement prevention programs specifically tailored to minimize exposure for population groups at risk for HIV/AIDS. Because each population is primarily at risk through a single but unique means of HIV/AIDS transmission, prevention programs vary tremendously in emphasis depending on the target population. Identifying and effectively targeting those at risk for HIV/AIDS are fundamental to setting up a situation in which social prevention programs can be effective. The late 1990s and early 2000s have seen a variety of prevention programs, ranging from intense, individual therapy to group programs and public announcements addressing a large audience.

Three primary components of prevention programs appear most effective: providing attitudinal arguments, basic information, and behavioral skills training. Although attitudes do not always predict behavior, research has shown that certain attitudes can influence the likelihood that one engages in a certain behavior. For example, positive attitudes toward condoms are associated with more frequent condom use. Basic information made available in prevention programs typically includes discussions of how the virus is transmitted, how to evaluate ones personal level of risk exposure, and how to prevent transmission. Behavioral skills training allows participants to practice skills related to reducing high-risk sexual behavior. Training can include skills such as discussing condom use with partners, condom application and removal, and cleaning and disinfecting needles and syringes. Although attitudinal arguments, basic information, and behavioral skills training are common components of effective prevention programs, an individuals gender, ethnicity, age, and risk group can have an impact on that effectiveness.

Other prevention approaches have produced varied results. Programs providing only basic information have little impact on reducing risky behaviors. Fear-based approaches most often target mass audiences, but are only effective if an individual believes he or she can accomplish the desired behavior and that doing so will lead to the expected outcome. With condom use, for example, fear-based appeals only work when people believe they can use condoms and that, if they do, they wont get HIV/AIDS.

There are several barriers to HIV/AIDS prevention efforts. These barriers include, but are not limited to, religious objections to sex education, substance use, unknown HIV status, underestimating risk, denial of sexual preference, sexual inequality in relationships, and AIDS stigma. Despite the extremely low rates of HIV/AIDS in countries with rigorous sex education programs, such as the Netherlands and Sweden, religious-based objections to sex education remain an obstacle for prevention researchers. People under the influence of alcohol or drugs are more likely to engage in high-risk behaviors, such as unprotected sexual intercourse. An additional factor in the spread of HIV is people living with HIV/AIDS who are unaware of their status, an estimated 250,000 people in the United States alone. Research has shown that a high percentage of those testing positive for HIV considered themselves at low risk for the virus. This is problematic because those who underestimate their risk of infection are less likely to engage in risk-preventing behaviors. Similarly, and particularly among African American MSM, denial of sexual preference is high. In addition to underestimating risk, these men are less likely to respond to, and thus benefit from, prevention efforts targeting MSM. Among women, perceived inequality in a relationship can reduce prevention efforts. For example, some women may fear violence or abandonment should they insist that their partners use condoms.

Perhaps the strongest barrier to prevention efforts comes from AIDS panic or AIDS stigma. There are three primary sources of AIDS stigma: fear of HIV infection; the labeling of risk groups (e.g., identifying AIDS as a gay disease); and negative attitudes toward death and dying. In addition to implementing programs aimed at reducing risky behavior, social scientists also work to eliminate stigmas associated with HIV/AIDS. By 2006, there was some evidence of positive effects from these programs; however, research in this area is limited, and the observed effects may be minor and short-lived. Nonetheless, continuing these efforts is important because of the severe negative effects stigma can have on those living with HIV/AIDS. These effects include psychological problems such as anxiety and depression, strained social relationships, abandonment by family members, loss of medical insurance, and employment discrimination.

Although most barriers to prevention are widespread, internationally the AIDS epidemic is even more troubling and the additional barriers to prevention in Africa, Asia, and third world countries have elevated the challenges facing prevention researchers. A persons religious beliefs may discourage the use of condoms for contraceptive reasons, for example. In some countries, poor economic conditions and access to medical care or antiviral medications, coupled with an even greater social stigma associated with the virus, decrease the likelihood of persons living with HIV/AIDS seeking and receiving medical treatment. The early twenty-first century is marked by a global effort to help countries where HIV/AIDS cases are alarmingly high yet medical resources are scarce.

In the absence of a vaccine, social science offers the only effective means of preventing HIV/AIDS transmission. The 1900s and early 2000s have seen great advances in the effectiveness of prevention programs, especially those targeting specific high-risk groups. Despite these efforts, HIV/AIDS remains an international epidemic requiring an international response.

SEE ALSO AIDS-HIV in Developing Countries, Impact of; Developing Countries; Disease; Medicine

BIBLIOGRAPHY

Albarracin, Dolores, Jeffery C. Gillette, Allison N. Earl, et al. 2005. A Test of Major Assumptions about Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic. Psychological Bulletin 131 (6): 856-897.

Brigham, Thomas A., Patricia Donohoe, Bo James Gilbert, et al. 2002. Psychology and AIDS Education: Reducing High-risk Sexual Behavior. Behavior and Social Issues 12 (1): 10-18.

Brown, Lisanne, Kate Macintyre, and Lea Trujillo. 2003. Interventions to Reduce HIV/AIDS Stigma: What Have We Learned? AIDS Education and Prevention 15 (1): 49-69.

Centers for Disease Control and Prevention. HIV/AIDS Prevention. http://www.cdc.gov/hiv/dhap.htm.

Dana F. Lindemann

Thomas A. Brigham

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Aids." International Encyclopedia of the Social Sciences. 2008. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Aids." International Encyclopedia of the Social Sciences. 2008. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3045300049.html

"Aids." International Encyclopedia of the Social Sciences. 2008. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3045300049.html

AIDS (Acquired Immunodeficiency Syndrome)

AIDS (acquired immunodeficiency syndrome)

Acquired immunodeficiency syndrome (AIDS) is a disease caused by the human immunodeficiency virus (HIV). HIV damages the immune system by attacking certain white blood cells called lymphocytes (specifically those called helper T cells). Lymphocytes normally help to protect the body against invading microorganisms. When these cells are destroyed, the body loses its ability to fight infection and becomes vulnerable to a variety of infections and rare cancers that are the hallmarks of AIDS.

From 1981 (when cases of AIDS were first recorded) through 2000, more than 753,000 cases of AIDS had been reported in the United States, resulting in over 360,000 deaths, 5,086 of which were children under the age of 15. It is the leading cause of death for people between the ages of 25 and 44. The World Health Organization estimated that at the beginning of the twenty-first century, 36.1 million adults and children around the world were living with AIDS or the virus. An estimated 21.8 million people have died from AIDS since the epidemic began. In 2000 alone, AIDS caused the deaths of an estimated 3 million people, including 1.3 million women and 500,000 children under 15. Eighty percent of those deaths occurred in Africa. Cases in Eastern Europe and Russia almost doubled in 2000. No cure has yet been found for the disease, and no vaccine is presently available to prevent it.

History and spread of AIDS

In the late 1970s, a rare form of cancer called Kaposi's sarcoma and an unusual type of pneumonia called Pneumocystis carinii began to appear in previously healthy homosexual and bisexual men in the United States. It was found that the patient's immune systems were not functioning properly, causing them to be susceptible to diseases that would not normally occur in a healthy person. Named AIDS in 1981, this destruction of the immune system also began to be seen among intravenous drug users, persons who had received blood transfusions, and sexual partners of people with the disease. It was determined that AIDS was caused by a virus that could be passed from person to person through contact with blood or bodily fluids. In 1983, the virus believed to cause AIDS was discovered and named HTLV-III (human T-cell lymphotropicvirus type III). It's name was soon changed to human immunodeficiency virus, or HIV.

In early 2000, scientists at the Los Alamos National Lab in New Mexico traced the origin of the AIDS epidemic to one or a small group of humans around 1930. Previously, scientists had believed the epidemic arose around the 1950s. Experts now believe that the original virus normally infected chimpanzees. Somehow it spread to people, perhaps through a bite or a hunting mishap, in west equatorial Africa. Just when and how this happened still mystifies scientists.

Words to Know

Full-blown AIDS: The stage of HIV infection in which the immune system is so damaged that it can no longer fight off disease.

Helper T cell: A type of lymphocyte that is involved in the immune response and that is the primary target for the AIDS virus.

Immune system: The body's natural defense system that guards against foreign invaders and that includes lymphocytes and antibodies.

Intravenous drug: A drug injected into a vein of the body with a needle.

Kaposi's sarcoma: A rare cancer that forms purplish patches on the skin and mucous membranes in various parts of the body.

Lymphocyte: A type of white blood cell that is involved in the body's immune response.

Pneumocystis carinii: A pneumonia caused by a parasite and seen especially in persons whose immune systems are damaged.

Vaccine: A substance made from a killed or weakened live virus that is given to a person to provide them with immunity to a particular disease.

How HIV damages the immune system

HIV damages the immune system by invading infection-fighting lymphocytes called helper T cells and eventually killing them. HIV enters helper T cells, then replicates (makes exact copies of itself) and produces new virus particles that are released into the bloodstream to attack other cells. A person infected with HIV may have no symptoms for 10 years or more before progressing to AIDS. In fact, by the late 1990s, some people who had been diagnosed as HIV-positive seemed to have been able to "beat" the virus before it turned into full-blown AIDS. After treatment with a combination of drugsknown informally as cocktailsthe levels of HIV in their blood decreased dramatically or even disappeared. (It is still unclear how these patients will fare over the long run.) Once a person is diagnosed with full-blown AIDS, however, survival rates drop sharply; death often occurs within five years.

Methods of transmission

AIDS can be transmitted through semen or vaginal fluids during unprotected sex with an infected person and through direct contact with infected blood. Intravenous drug users who share hypodermic needles are at an especially high risk. The AIDS virus can also be passed from an infected mother to her unborn child. Since screening measures began in 1985, transmission of the disease through transfusions of donated blood or blood products is now rare.

Scientists do not believe AIDS can be transmitted through saliva. There are enzymes in saliva that can break down the virus, and the pH (measure of the acidity of a solution) of the mouth is detrimental to the survival of the virus.

Stopping the spread of AIDS

Efforts by health officials to stop the spread of AIDS have included urging couples to use condoms when engaging in sexual intercourse and promoting sex education. In addition, certain communities have instituted needle-exchange programs, in which intravenous drug users can turn in used hypodermic needles for new sterile ones.

HIV does not survive well outside the human body. It can be easily killed or deactivated by using heat, hand soap, hydrogen peroxide, or any solution containing 25 percent alcohol, bleach, Lysol, or other disinfectants.

AIDS therapies, vaccines, and a new treatment approach

There is presently no cure for AIDS. However, new therapies involving a combination of old drugs such as AZT and new drugs called protease inhibitors (the aforementioned cocktails) have shown some success in preventing HIV from reproducing itself once infection has taken place. This has the effect of reducing the amount of the virus present in the blood and seems to postpone the onset of full-blown AIDS in patients with early HIV infection. For those who already suffer from AIDS, the new therapies may help extend the lives of some patients. Research into developing an effective vaccine to prevent AIDS is ongoing, including the testing of several experimental AIDS vaccines. A new class of drugs, called entry inhibitors, works to block HIV before it even enters the cells of an infected person. These drugs may be made available to patients as early as 2002 or 2003. At the beginning of 2001, 18 anti-retroviral agents were available for prescription, either alone or in combination.

In early February 2001, federal health officials called for a new approach to treating people infected with the AIDS virus. Since the development of protease inhibitors and so-called drug cocktails in the mid-1990s, physicians have been quick to treat people infected with the virus, even if they were otherwise healthy. This "hit early, hit hard" approach was undertaken with hopes that, in a short time, the drugs might eliminate HIV from the body of an infected person.

However, research at the beginning of the twenty-first century showed that the drug cocktails do not cure HIV; once a person stops taking the drugs, the virus rebounds. This means that the person will have to continue taking the drugs throughout his or her life. In addition, researchers found that people undergoing the drug therapy suffered a higher risk of nerve damage, weakened bones, diabetes, high levels of cholesterol, and other serious side effects.

To limit these toxic side effects, health officials urged that treatment using the drug cocktails be delayed for as long as possible for people who had HIV but did not show outward symptoms. The officials believed that in early treatment, the side effects tipped the balance between benefitting infected individuals and making their health worse.

[See also Immune system; Protease inhibitors; Virus ]

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS (Acquired Immunodeficiency Syndrome)." UXL Encyclopedia of Science. 2002. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS (Acquired Immunodeficiency Syndrome)." UXL Encyclopedia of Science. 2002. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3438100026.html

"AIDS (Acquired Immunodeficiency Syndrome)." UXL Encyclopedia of Science. 2002. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3438100026.html

AIDS

AIDS


AIDS (Acquired Immune Deficiency Syndrome) is the final stage of a lethal infectious disease, beginning with an infection caused by a virus and progressing to a serious and severe damage to the body's immune system. Infection occurs when the virus integrates with the genetic material of a CD4 white blood cell in the immune system. AIDS was first reported on June 5, 1981, in the United States.

The Human Immunodeficiency Virus (HIV), which is the cause of AIDS, attacks key cells in the human immune system and destroys them. This leaves the body exposed to life-threatening infections, specific cancers, and other illnesses. HIV is a latent virus. People infected by it may have no symptoms for many years, while their immune system weakens until they develop AIDS. The first pediatric AIDS cases were reported in San Francisco in 1982.

A laboratory test counting less than 200/ml CD4 white blood cells is the method used by the U.S. Centers for Disease Control to define AIDS. HIV/AIDS is now a chronic and treatable, but not yet curable, disease. Almost all people infected with HIV will progress to AIDS.

Persons who are carriers of HIV may transmit the virus to others, even in the symptom-free period. However, HIV does not spread as easily as many other pathogens (such as those causing tuberculosis or influenza). The virus can be transmitted from an infected individual to others only through four bodily fluids: blood, semen, breast milk, and vaginal secretions. Worldwide, women are infected more frequently than men.

Transmission of HIV is possible when:

Having unprotected anal, vaginal or oral sexual contact with an infected individual. Sexual intercourse is the most common route for HIV transmission from an infected to a noninfected person; 50 percent of cases are youths between fifteen and twenty-four years old.

Through transfusions of blood and blood products (now extremely rare in the United States and other developed countries), needle sharing (e.g., drug use, medical care in developing countries, piercing or tattooing).

Mother-to-child transmission from a pregnant woman to her fetus, via the placenta, at birth or when breast feeding the infant; the most common cause of HIV infection in young children.

Rare circumstances such as accidental needle or laboratory injuries, artificial insemination or through organ donations.

HIV infection is not spread by air, water or by casual contacts, donating blood or organs (in developed countries where sterilized equipment is used), mosquito bites, or during participation in sports.

HIV/AIDS is a public health, social, developmental, and serious humanitarian crisis in many regions of the world. The total number of people infected by HIV from the start of the epidemic was estimated in 2003 to be 60 million. During 2002 alone eight hundred thousand children younger than 15 years old were infected, at a rate of about two thousand per day.

The most affected region is sub-Saharan Africa, followed by Asia, Latin America, and Eastern Europe. By the year 2010 it is expected that 20 million of the 42 million orphans in Africa will have lost one or both parents due to AIDS. AIDS has led to a dramatic decline in life expectancy in Africa.

Complex biological, psychological, and sociological factors put young people at greater risk for HIV infection. As a result, efforts to prevent infections are focused on this population, with distinctions between in-school, out-of-school and high-risk youth. Curricula, multimedia initiatives, mass media campaigns, games, and role modeling are just a few of the strategies to promote knowledge and skills for HIV/AIDS prevention worldwide. The key prevention messages focus on eliminating or reducing risks for infection by practicing safe behaviors:

Abstaining from sexual intercourse. (Abstinence is the only way to fully prevent sexual transmission of HIV.)

Reducing the number of sexual partners, delaying the initiation of penetrative sex, and correctly using a condom for intercourse in every case where the HIV status of one of the individuals is unknown reduces the risk of infection.

Avoiding any injection of drugs.

Using one-time, nonshared, sterile needle and syringe for injection of medications, blood transfusions or drugs.

For mothers who are HIV-positive, avoiding breast-feeding their infants.

Avoiding direct contact with blood where the HIV status of the bleeding individual is unknown.

Undergoing an HIV test, to determine one's and one's partners' HIV status.

Mother-to-child infection is preventable in most cases by administering medications to the mother before birth and to the infant after birth.

Children with AIDS were able to mobilize enormous public support and attention since the first days of the epidemic. For example, Ryan White (1971-1990) was a hero in his determination to fight both AIDS and AIDS-related discrimination at school. A federal legislation in the United States that addresses the unmet health needs of persons living with HIV was named after him. Nkosi Johnson (1989-2001), South Africa's longest surviving child born with HIV, captured the hearts of thousands when he spoke of his experiences with HIV/AIDS. Ariel and Jake Glaser and their mother, Elizabeth, all infected with HIV, gave rise in 1988 to the Pediatric AIDS Foundation in the United States.

The UN General Assembly Session on HIV/AIDS decided in June 2001 to ensure a massive reduction in HIV's prevalence and a dramatic increase in access of youth education and youth-specific services necessary to reduce their vulnerability to HIV infection globally by 2010.

See also: Contagious Diseases; Epidemics.

bibliography

Mann, J., D. Tarantola, and T. Netter. 1992. AIDS in the World. Cambridge, MA: Harvard University Press.

Schenker, Inon. 2001. "New Challenges for School AIDS Education within an Evolving HIV Pandemic." Prospects 31, no 3: 415-434.

Schenker, Inon, G. Sabar-Friedman, and S. S. Sy. 1996. AIDS EducationInterventions in Multi-Cultural Societies. New York: Plenum Press.

World Bank. 2002. Education and HIV/AIDS: A Window of Hope. Washington, DC: World Bank.

internet resources

Centers for Disease Control. "Division of HIV/AIDS Prevention." Available from <www.cdc.gov/hiv/dhap.htm>.

Elizabeth Glaser Pediatric AIDS Foundation. Available from <www.pedaids.org>.

Joint United Nations Program on HIV/AIDS. Available from <www.unaids.org>.

The Body. "An AIDS and HIV Information Resource." Available from <www.thebody.com>.

Inon I. Schenker

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

SCHENKER, INON I.. "AIDS." Encyclopedia of Children and Childhood in History and Society. 2004. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

SCHENKER, INON I.. "AIDS." Encyclopedia of Children and Childhood in History and Society. 2004. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3402800028.html

SCHENKER, INON I.. "AIDS." Encyclopedia of Children and Childhood in History and Society. 2004. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3402800028.html

Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS)

A progressive, degenerative disease involving several major organ systems, including the immune system and central nervous system. Uniformly fatal, it is associated with human immunodeficiency virus (HIV), a viral infection that progressively weakens the immune system.

Since Acquired Immune Deficiency Syndrome (AIDS) manifests itself in a number of different diseases and conditions, it has been difficult to arrive at a formal definition. In an attempt to standardize the definition of AIDS, the Centers for Disease Control in 1992 included among its diagnostic criteria a count of 200 or fewer CD4T lymphocyte cells per cubic ml of blood (a sign of severe immune system suppression). AIDS was first recognized in 1981 as a cluster of symptoms in homosexual men in New York City and San Francisco. Eventually, similar symptoms were found among intravenous drug users, hemophiliacs, and other recipients of blood transfusions. In 1984, the human immunodeficiency virus (HIV) was isolated and subsequently determined as the probable cause of AIDS.

HIV is transmitted through sexual intercourse, contact with infected blood and blood products, and the birth process. However, casual social contacteven if close and prolongedhas not been found to spread HIV. The greatest number of HIV cases are sexually transmitted, through both homosexual and heterosexual intercourse. Screening of donated blood and blood products since 1985 has drastically reduced the risk of transfusion-related HIV. Children may be infected in utero or by exposure to blood and vaginal secretions during childbirth. The child of an infected mother has a 25 to 35 percent chance of acquiring the virus.

Persons infected with HIV initially show no symptoms. Within three to six weeks after infection they may exhibit flu-like symptoms that last up to three weeks and resolve spontaneously. According to long-term studies, all or almost all persons infected with HIV eventually become ill with full-blown AIDS, although the incubation period varies from less than a year to as long as 15 years. AIDS is considered full-blown when the immune system is seriously suppressed. At this point, the patient becomes vulnerable to opportunistic infections and diseases that are able to attack because of reduced immune system defenses. These include candiasis, pneumocystis carinii pneumonia (PCP), herpes and other viral infections, toxoplasmosis, and tuberculosis. AIDS also weakens the body's defenses against carcinomas, and conditions such as lymphoma and Kaposi's sarcoma are common complications of the disease. AIDS also attacks the nervous system . Neurological disorders such as encephalitis and dementia occur in over two-thirds of AIDS patients. HIV/AIDS patients are also prone to blood abnormalities, respiratory infections, and gastrointestinal problems, including diarrhea, which is partly responsible for the weight loss that occurs in the course of the disease.

Comforting a person with AIDS or any other fatal illness is challenging for friends, family , and others around him. Isolation is one of the most difficult aspects of this disease, often resulting from misinformation and fear about how the disease is spread. There is no scientific evidence that AIDS is spread through casual contact, and there is no reason to avoid gestures of friendship and comfort, such as a personal visit, a hug, or holding the patient's hand.

According to the World Health Organization, an estimated five to ten million people worldwide are infected with HIV. The highest incidence of AIDS is in major cities in Asia, Africa, and the United States. In the United States alone, there are thought to be over one million infected with HIV, and over 250,000 cases of full-blown AIDS have been reported. AIDS has become a leading cause of death in men and women under the age of 45 and children under the age of five. Originally thought of as a "gay men's disease," in 1993 AIDS was the nation's fourth leading cause of death in women between the ages of 15 and 44.

HIV is usually diagnosed through a test called ELISA (enzyme-linked immunosorbent assay), which screens the blood for HIV antibodies. If the test is positive, a more specific test, the Western blot assay, is administered. Most patients will test positive for HIV one to three months after being infected, and 95 percent will test positive after five months. There is no effective vaccine against the HIV virus, and no known cure for AIDS, but antiviral drugs have been effective in slowing the progression of the disease, particularly the suppression of the immune system. One of the earliest of these medications to be effective was azidothymidine (AZT), which inhibits viral DNA polymerase.

The best method of containing the AIDS epidemic is education and prevention. Much of the anti-AIDS effort both in the United States and globally has been directed toward promoting safer sex practices, including abstinence (especially among young people) and the use of latex condoms, which greatly reduce the chance of infection. The threat of HIV among intravenous drug users has been addressed by programs offering education, rehabilitation , and the free dispension of sterile needles. Modification of sexual behavior among homosexuals has been successful in reducing the incidence of new HIV infections among the gay population. However, risk-related behavior is increasing among young homosexuals under the mistaken belief that the threat of AIDS applies mostly to older gay men. Risky sexual behavior has also remained widespread among heterosexual teenagers in the 1990s, especially among African-American and Hispanic males.

Further Reading

Anonymous. It Happened to Nancy. New York: Avon Books, 1994.

A Conversation With Magic. Lucky Duck Productions, 1992. Videorecording.

Foster, Carol, et al., eds. AIDS. Wylie, TX: Information Plus, 1992.

Siegel, Larry. AIDS, The Drug and Alcohol Connection. Center City, MN: Hazelden, 1989.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Acquired Immune Deficiency Syndrome (AIDS)." Gale Encyclopedia of Psychology. 2001. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Acquired Immune Deficiency Syndrome (AIDS)." Gale Encyclopedia of Psychology. 2001. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3406000016.html

"Acquired Immune Deficiency Syndrome (AIDS)." Gale Encyclopedia of Psychology. 2001. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406000016.html

AIDS

AIDS. Shortly after the first cases of acquired immunodeficiency syndrome (AIDS) were recognized among civilians in 1981, early forms of the disease (AIDS‐related complex and lymphadenopathy syndrome) were detected among active duty personnel. The causative virus (now called the human immunodeficiency virus, HIV) was first isolated from ill soldiers and their asymptomatic but nonetheless infected wives in 1984. These military studies provided the first proof that HIV could be transmitted through heterosexual intercourse. Nationwide blood bank testing for HIV began in June 1985. Shortly thereafter, in October 1985, the Department of Defense (DoD) began screening all civilian applicants for military service; those who tested positive for the virus were medically disqualified from service. Overall, 1 in 650 applicants was found to be infected, but prevalence rates in various geographic and demographic subpopulations varied from as low as 1 in 20,000 in the upper Midwest to 1 in 50 in northeastern urban centers. The HIV screening program was the first population‐based screening program in the United States, and provided the first hard data that the epidemic had already spread silently throughout the country by the mid‐1980s.

HIV screening of active duty military personnel began in 1986. Based largely on the recommendations of the Armed Forces Epidemiological Board, policies for HIV infection were established to be comparable to those for any other chronic medical condition. Infected military personnel were to remain on active duty, to lodge in military quarters, and to continue work in their duty assignment. Implemented at a time when fear of HIV contagion was widespread in the United States, these policies were farsighted and courageous. All DoD HIV‐positive personnel were to be medically evaluated periodically, and those with advanced disease were honorably discharged with medical disability and benefits. HIV‐infected personnel were restricted from overseas deployment, from health care jobs where potentially risky procedures were performed, and from sensitive Personal Reliability Program (e.g., nuclear missile) positions. In an effort to decrease HIV transmission, HIV‐infected active duty personnel were counseled by their commanders that if they knowingly put others at risk of infection through sexual intercourse, they could be prosecuted through the military justice system. Overall, DoD policies were designed to reflect fair and rational public health principles.

Screening was originally undertaken annually for all active duty personnel, but this interval has gradually lengthened with a number of new service‐specific regulations. For example, testing takes place every five years for all air force personnel, or for the following clinically indicated reasons: during pregnancy; on entry into a drug/alcohol rehabilitation program; on presenting at a STD (sexually‐transmitted disease) clinic; on deployment overseas; on PCS (Permanent Change of Station) overseas. However, all personnel must be proven negative within six months of any overseas deployment.

The U.S. military HIV research program began in 1986, when Congress provided $40 million for this purpose. The U.S. Army Medical Research and Development Command, as the lead agency for infectious disease research, managed the tri‐service program. Major accomplishments include the following firsts: definition of antibody test criteria for a diagnosis of HIV (criteria used worldwide today); evidence that HIV was becoming a serious problem among minorities; detection of transmission of drug‐resistant HIV strains; tracking the global spread of genetic variants; vaccine therapy trials; and international preventive vaccine trials.

At the heart of the controversy over HIV/AIDS research is the question of its relevance to the military. HIV/AIDS has little or no direct impact on readiness or combat operations for U.S. forces. However, recent studies have shown very high HIV prevalences among some African (one in four) and Asian (one in ten) military populations. From a broader national security point of view, the global pandemic is a threat requiring maximal efforts by all capable U.S. agencies.

Rates for new infections have decreased; in 1995, the DoD's total of infections among active duty personnel was approximately 300. In 1996, an amendment to the department's authorization bill ruled that all HIV‐infected personnel on active duty must be involuntarily separated, regardless of their fitness for duty or years of service; however, as of 1999, the policy was not to separate HIV‐infected personnel who were physically fit. The impact of this legislation on the effectiveness of public health control of HIV within the military remains to be determined.
[See also Diseases, Sexually Transmitted; Medical Practice in the Military.]

Donald S. Burke

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

John Whiteclay Chambers II. "AIDS." The Oxford Companion to American Military History. 2000. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

John Whiteclay Chambers II. "AIDS." The Oxford Companion to American Military History. 2000. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O126-AIDS.html

John Whiteclay Chambers II. "AIDS." The Oxford Companion to American Military History. 2000. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O126-AIDS.html

AIDS

AIDS (acquired immune deficiency syndrome) (aydz) n. a syndrome caused by the human immunodeficiency virus (HIV), which destroys a subgroup of lymphocytes, resulting in suppression of the body's immune response (see (helper) T-cell). AIDS is essentially a sexually transmitted disease, either homosexually or heterosexually, but it can also be spread via infected blood or blood products and from an infected mother to her child in the uterus, during parturition, or in breast milk. Acute infection following exposure to the virus results in the production of antibodies (seroconversion), but not all those who seroconvert progress to chronic infection. The chronic stage may include persistent generalized involvement of the lymph nodes; AIDS-related complex (ARC), including intermittent fever, weight loss, diarrhoea, fatigue, and night sweats; and AIDS itself, presenting as opportunistic infections (especially pneumonia caused by Pneumocystis jiroveci) and/or tumours, such as Kaposi's sarcoma.

Ordinary social contact with HIV-positive subjects involves no risk of infection. However, high standards of clinical practice are required by all health workers in order to avoid inadvertent infection via blood, blood products, or body fluids from HIV-positive people. Staff who become HIV-positive are expected to declare their status and will be counselled.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." A Dictionary of Nursing. 2008. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." A Dictionary of Nursing. 2008. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O62-AIDS.html

"AIDS." A Dictionary of Nursing. 2008. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-AIDS.html

acquired immune deficiency syndrome

acquired immune deficiency syndrome (AIDS) Fatal disease caused by a retrovirus, called Human Immunodeficiency Virus (HIV), that mainly attacks T-4 cells (which help the production of antibodies) and renders the body's immune system incapable of resisting infection. The first diagnosis was made in New York in 1979. In 1983, scientists at the Pasteur Institute in France and the National Cancer Institute in the USA isolated HIV as the cause of the disease. The virus can remain dormant in infected cells for up to 10 years. Initial AIDS-related complex (ARC) symptoms include severe weight loss and fatigue. It may develop into the AIDS syndrome, characterized by secondary infections, neurological damage and cancers. AIDS is transmitted only by a direct exchange of body fluids. Transmission is most commonly through sexual intercourse, the sharing of contaminated needles by intravenous drug users, and the uterus of infected mothers to their babies. In the USA and Europe, more than 90% of victims have been homosexual or bisexual men. However, 90% of reported cases are in the developing world, and many victims are heterosexual. AIDS is now the leading cause of death in sub-Saharan Africa. Recent combinations of drugs have met with some success in controlling symptoms. By 2002, c.25 million people had died from AIDS.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"acquired immune deficiency syndrome." World Encyclopedia. 2005. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"acquired immune deficiency syndrome." World Encyclopedia. 2005. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O142-acquiredimmundfcncysyndrm.html

"acquired immune deficiency syndrome." World Encyclopedia. 2005. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O142-acquiredimmundfcncysyndrm.html

aids (in feudalism)

aids, in feudalism, type of feudal due paid by a vassal to his suzerain (overlord). Aids varied with time and place, although in English-speaking countries aids were traditionally due on the knighting of the lord's eldest son, on the marriage of the lord's eldest daughter, and for ransom of the lord from captivity. These are the three aids specified in the Magna Carta (1215), which forbade the king to levy aids from the barons on occasions other than these, except by the "common counsel" of the realm. It is difficult to distinguish aids from other feudal dues such as scutage and tallage. The term had a much wider scope than was indicated in the Magna Carta. In general, aids fell into disuse with the decline of feudalism, although they continued nominally in most places. On the Continent, the aids often became land or justice taxes due the local lords. In France, the aids were converted later into a royal tax that continued until the French Revolution.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"aids (in feudalism)." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"aids (in feudalism)." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1E1-aids.html

"aids (in feudalism)." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-aids.html

AIDS (in medicine)

AIDS or acquired immunodeficiency syndrome, fatal disease caused by a rapidly mutating retrovirus that attacks the immune system and leaves the victim vulnerable to infections, malignancies, and neurological disorders. It was first recognized as a disease in 1981. The virus was isolated in 1983 and was ultimately named the human immunodeficiency virus (HIV). There are two forms of the HIV virus, HIV-1 and HIV-2. The majority of cases worldwide are caused by a subgroup of HIV-1. In 1999 an international team of genetic scientists reported that the strain of HIV-1 responsible for most cases of AIDS can be traced to a closely related strain of virus, called simian immunodeficiency virus (SIV), that infects a subspecies of chimpanzee (Pan troglodytes troglodytes) in W central Africa. Chimpanzees are hunted for meat in this region, and it is believed the virus may have passed from the blood of chimpanzees into humans through superficial wounds, probably in the early 1930s.

Action of the Virus

In a process still imperfectly understood, HIV infects the CD4 cells (also called T4 or T-helper cells) of the body's immune system, cells that are necessary to activate B-lymphocytes and induce the production of antibodies (see immunity). Although the body fights back, producing billions of lymphocytes daily to fight the billions of copies of the virus, the immune system is eventually overwhelmed, and the body is left vulnerable to opportunistic infections and cancers.

Signs and Symptoms

Some people develop flulike symptoms shortly after infection, but many have no symptoms. It may be a few months or many years before serious symptoms develop in adults; symptoms usually develop within the first two years of life in infants infected in the womb or at birth. Before serious symptoms occur, an infected person may experience fever, weight loss, diarrhea, fatigue, skin rashes, shingles (see herpes zoster), thrush, or memory problems. Infants may fail to develop normally.

The definition of AIDS has been refined as more knowledge has become available. In general it refers to that period in the infection when the CD4 count goes below 200 (from a normal count of 1,000) or when the characteristic opportunistic infections and cancers appear. The conditions associated with AIDS include malignancies such as Kaposi's sarcoma, non-Hodgkin's lymphoma, primary lymphoma of the brain, and invasive carcinoma of the cervix. Opportunistic infections characteristic of or more virulent in AIDS include Pneumocystis cariniipneumonia, herpes simplex, cytomegalovirus, and diarrheal diseases caused by cryptosporidium or isospora. In addition, hepatitis C is prevalent in intravenous drug users and hemophiliacs with AIDS, and an estimated 4 to 5 million people who have tuberculosis are coinfected with HIV, each disease hastening the progression of the other. Children may experience more serious forms of common childhood ailments such as tonsillitis and conjunctivitis. These infections conspire to cause a wide range of symptoms (coughing, diarrhea, fever and night sweats, and headaches) and may lead to extreme weight loss, blindness, hallucinations, and dementia before death occurs.

Transmission and Incidence

HIV is not transmitted by casual contact; transmission requires a direct exchange of body fluids, such as blood or blood products, breast milk, semen, or vaginal secretions, most commonly as a result of sexual activity or the sharing of needles among drug users. Such a transmission may also occur from mother to baby during pregnancy or at birth. Saliva, tears, urine, feces, and sweat do not appear to transmit the virus. Since 2010 several studies have shown that transmission of HIV is significantly reduced to individuals who take antiretroviral drugs prophylactically. In 2012 the Food and Drug Administration approved a pill that combines two antiretroviral drugs, tenofovir and emtricitabine, for use in preventing HIV infection, and in 2014 the Centers for Disease Control and Prevention called for the regimen to be prescribed to individuals at risk for infection.

By 2012 it was estimated that as many as 34 million people were infected with HIV worldwide, the great majority in Third World countries; some 30 million had died from AIDS. The disease in sub-Saharan Africa, which has been especially hard hit, in the main has been transmitted heterosexually and has been exacerbated by civil wars and refugee problems and less restrictive local mores with regard to sex. Some 22.5 million people were infected with HIV in this region, where, in many countries, the prevalence of AIDS has lowered the life expectancy. Nonetheless, the spread of the disease had slowed somewhat during the previous decade; an estimated 3.2 million new HIV infections occurred in 2001, but only 2.1 million in 2013.

In the United States, the demographics of AIDS have changed over time. In the 1980s it was seen mainly in homosexual and bisexual men and was one of the spurs to the gay-rights movement, as activists lobbied for research and treatment monies and began education and prevention programs. Also in the early years, before careful screening of blood products was deemed necessary, the virus was contracted by an estimated 9,000 hemophiliacs (see hemophilia), and a small number of people were infected by surgical or emergency blood transfusions. Before long, however, the majority of new HIV infections were seen in drug users who contracted the disease from shared needles or unprotected sex; a large proportion of infected women were drug users or partners of drug users. Nearly a third of the infants born to HIV-infected women are infected with the virus. (Some of these infants test positive for AIDS only because of the mother's antibodies and later test negative.) In the early 21st cent., however, the majority of new cases, which averaged 50,000 per year in 2002–11, were again in homosexual and bisexual men, and while the rate of infection was falling generally, there were increases in homosexual and bisexual men.

Tests and Treatment

Various blood tests now are used to detect HIV. The most frequently used test for detecting antibodies to HIV-1 is enzyme immunoassay. If it indicates the presence of antibodies, the blood is more definitively tested with the Western blot method. A test that measures directly the viral genes in the blood is helpful in assessing the efficacy of treatments.

There is no cure for AIDS, but it may be treated with a number of different antiretroviral drugs, often in combination. Early treatment with retrovirals, as soon as a person tests positive for infection with HIV, has been shown in studies to reduce to the transmission of HIV. Drugs such as AZT, ddI, and 3TC, which are reverse transcriptase inhibitors, have proved effective in delaying the onset of symptoms in certain subsets of infected individuals. The addition of a protease inhibitor, such as saquinovir, amprenavir, or atazanavir, to AZT and 3TC has proved very effective, but the drug combination does not eliminate the virus from the body. Efavirenz (Sustiva), another type of reverse transcriptase inhibitor, must be taken with protease inhibitors or older AIDS medicines. Highly active antiretroviral therapy (HAART), a combination typically of three or more anti-AIDS drugs, is now the preferred treatment. Opportunistic infections are treated with various antibiotics and antivirals, and patients with malignancies may undergo chemotherapy. These measures may prolong life or improve the quality of life, but drugs for AIDS treatment may also produce painful or debilitating side effects.

Many experimental AIDS vaccines have been developed and tested, but none has yet proved more than modestly effective, including some that underwent full-scale testing. The development of a successful vaccine against AIDS has been slowed because HIV mutates rapidly, causing it to become unrecognizable to the immune system, and because, unlike most viruses, HIV attacks and destroys essential components of the very immune system a vaccine is designed to stimulate.

Governments and the pharmaceutical industry continue to be under pressure from AIDS activists and the public in general to find a cure for AIDS. Attempts at prevention through teaching "safe sex" (i.e., the relatively safer sex accomplished by the use of condoms), sexual abstinence in high-risk situations, and the dangers to drug users of sharing needles have been impeded by those who feel that such education gives license to promiscuity and immoral behaviors.

Bibliography

See S. Sontag, AIDS and Its Metaphors (1989); S. Flanders, AIDS (1991); G. Corea, The Story of Women and AIDS (1992); J. Pepin, The Origins of AIDS (2011); publications of Gay Men's Health Crisis, the National Institute of Allergy and Infectious Diseases, and the Centers for Disease Control and Prevention.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS (in medicine)." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS (in medicine)." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1E1-AIDS.html

"AIDS (in medicine)." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-AIDS.html

AIDS

AIDS (acquired immune deficiency syndrome) A disease of humans characterized by defective cell-mediated immunity and increased susceptibility to infections. It is caused by the retrovirus HIV (human immunodeficiency virus). This infects and destroys helper T cells, which are essential for combating infections. HIV is transmitted in blood, semen, and vaginal fluid; the major routes of infection are unprotected vaginal and anal intercourse, intravenous drug abuse, and the administration of contaminated blood and blood products. A person infected with HIV is described as HIV-positive; after the initial infection the virus can remain generally dormant for up to ten years before AIDS develops. A combination of antiviral drugs, including reverse transcriptase inhibitors (e.g. zidovudine, lamivudine) and protease inhibitors, can delay the development of full-blown AIDS for many years.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." A Dictionary of Biology. 2004. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." A Dictionary of Biology. 2004. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O6-AIDS.html

"AIDS." A Dictionary of Biology. 2004. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O6-AIDS.html

AIDS

AIDS

DEFINITION


AIDS is the abbreviation for acquired immune deficiency syndrome. The disease is caused by a virus known as the human immunodeficiency virus, or HIV. The disease was first recognized in the United States in 1981.

A person can be infected with HIV without developing AIDS. The virus can remain in a person's body for many years without causing serious health problems. During this period, the virus is said to be latent, or inactive. Eventually, however, most people who are infected with HIV do develop AIDS. Treatment of HIV patients involves trying to slow or stop the virus from spreading in the body's cells and treating or preventing diseases that develop when a person's immune system has been damaged by the virus.

DESCRIPTION


AIDS is considered one of the most serious public health problems in modern history. In 1998 the U.S. Centers for Disease Control and Prevention (CDC) estimated that between 650,000 and 900,000 Americans were HIV-positive. HIV-positive means that a person has been infected with the virus. The CDC estimates that as of 1998 some 300,000 Americans were living with AIDS.

Nearly half of all AIDS patients are gay or bisexual men. About one quarter are intravenous drug users. An intravenous drug user is someone who takes drugs illegally by means of injection with a hypodermic needle. About 18 percent of AIDS patients are women. In addition, between one thousand and two thousand children are born infected with HIV each year.

AIDS is a far worse problem in some parts of the world than it is in others. The World Health Organization (WHO) estimates that 32.2 million adults and 1.2 million children worldwide were infected with HIV or AIDS as of 1998. Most of these cases occur in the developing countries of Asia and Africa.

At one time, people were concerned that HIV could be transmitted by casual contact, such as shaking hands or eating in the same room with an infected person. Scientists now know that the virus is never passed during casual contact of this kind. HIV can be transmitted in several ways:

SEXUAL CONTACT. HIV can be transmitted any time two people exchange bodily fluids, such as semen or blood. Most forms of sexual contact involve some exchange of bodily fluids. The risk of contracting the virus increases if an individual has a high number of different sexual partners or practices unsafe sex. Unsafe sex refers to having sexual contact without using any method to prevent the exchange of bodily fluids. In the United States and Europe, most cases of sexually transmitted HIV infection occur during homosexual contact, that is, between two people of the same gender. In Africa, Asia, and other parts of the world, HIV is transmitted primarily through heterosexual contact, that is, between two people of opposite genders.

EXPOSURE TO CONTAMINATED BLOOD OR BLOOD PRODUCTS. Early in the HIV epidemic, the virus was sometimes transmitted during blood transfusions. Blood taken from one person with the HIV infection was given to a second person for medical treatment, he or she also received the virus. Hemophiliacs (pronounced hee-muh-FIH-lee-ak; see hemophilia entry), people who require blood transfusions quite often, were especially at high risk for HIV infection.

In the 1980s, new rules were adopted for the screening of donated blood. Since that time, the rate of HIV infections from contaminated blood and blood products has been greatly reduced. However, HIV infection is still spread by this method among illegal drug users. These men and women often share the same needle with each other. When they do so, the blood from one person is easily transferred to a second person. If the first person is infected with HIV, the virus may be passed on.

Aids: Words to Know

Acute retroviral syndrome:
A group of symptoms resembling mononucleosis that are the first sign of HIV infection in 50 to 70 percent of all patients and 45 to 90 percent of women.
AIDS dementia complex:
A type of brain dysfunction caused by HIV infection that causes confusion, difficulty thinking, and loss of muscular coordination.
Antibody:
A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Antigen:
Any substance that stimulates the body to produce antibody.
Autoimmunity:
A condition in which the body's immune system (the system that fights disease and infection) produces antibodies in response to its own tissues or blood components instead of foreign particles or microorganisms.
CD4:
A type of protein molecule in human blood that is present on the surface of 65 percent of immune cells. The HIV virus infects cells that have CD4 surface proteins, and as a result, depletes the number of T cells, B cells, natural killer cells, and monocytes in the patients blood. Most of the damage to an AIDS patient's immune system is done by the virus's destruction of CD4 lymphocytes.
Hairy leukoplakia of the tongue:
A white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus and is an important diagnostic sign of AIDS.
Hemophilia:
Any of several hereditary blood coagulation disorders occurring almost exclusively in males. Because blood does not clot properly, even minor injuries can cause significant blood loss that may require a blood transfusion, with its associated minor risk of infection.
Human immunodeficiency virus (HIV):
A transmissible virus that causes AIDS in humans. Two forms of HIV are now recognized: HIV-1, which causes most cases of AIDS in Europe, North and South America, and most parts of Africa; and HIV-2, which is chiefly found in West African patients. HIV-2, discovered in 1986, appears to be less virulent that HIV-1 and may also have a longer latency period.
Immunodeficient:
A condition in which the body's immune response is damaged, weakened, or is not functioning properly.
Kaposi's sarcoma:
A cancer of the connective tissue that produces painless purplish red or brown blotches on the skin. It is a major indication that a patient has AIDS.
Latent period:
Also called incubation period, the time between infection with a disease-causing agent and the development of the disease.
Lymphocyte:
A type of white blood cell that is important in the formation of antibodies and that can be used to monitor the health of AIDS patients.
Lymphoma:
A cancerous tumor in the lymphatic system that is associated with a poor prognosis in AIDS patients.
Macrophage:
A large white blood cell, found primarily in the bloodstream and connective tissue, that helps the body fight off infections by ingesting the disease-causing organism. HIV can infect and kill macrophages.
Monocyte:
A large white blood cell that is formed in the bone marrow and spleen. About 4 percent of the white blood cells in normal adults are monocytes.
Nucleoside analogues:
A medication that interferes when HIV tries to make copies of itself inside cells.
Opportunistic infection:
An infection by organisms that usually don't cause infection in people whose immune systems are working normally.
Persistent generalized lymphadenopathy (PGL):
A condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period.
Protease inhibitors:
The second major category of drug used to treat AIDS that works by suppressing the replication of the HIV virus.
T Cells:
Lymphocytes that originate in the thymus gland. T cells regulate the immune system's response to infections, including HIV. CD4 lymphocytes are a subset of T lymphocytes.
Wasting Syndrome:
A progressive loss of weight and muscle tissue caused by AIDS.

NEEDLE STICKS. Health professionals sometimes poke themselves accidentally with a needle when drawing blood from a patient. If the patient is infected with HIV, the health professional may receive the virus from the needle stick. The risk of transmitting the virus this way is very small (virtually zero) when health professionals use standard procedures for drawing blood and handling needles.

PREGNANCY AND BIRTH. A woman infected with HIV can transmit the virus to her unborn child. The virus passes through the amniotic fluid (the fluid surrounding the unborn baby) and into the child's bloodstream. A young baby can also get the virus from an infected woman during breast feeding.

CAUSES


AIDS develops when HIV attacks and destroys certain types of cells that are part of the immune system. The immune system consists of all those cells, tissues, and substances that protect the body from infection by foreign bodies, such as bacteria. An important element of the immune system is a group of white blood cells that include helper T cells, macrophages (pronounced MAK-ruh-fages), and monocytes (pronounced MON-uh-sites). These cells attack foreign bodies and prevent them from causing disease and infection.

After it enters the body, HIV attaches itself to a certain part of these cells called the CD4 protein. The virus then takes command of the chemical changes that take place within the cell. It orders the cell to start making copies of the HIV virus. It eventually causes the cell's death. As the cell dies, it breaks apart and releases many new copies of the HIV. The new HIV cells then travel through the bloodstream and attack other white blood cells.

As white blood cells die, the immune system becomes weaker. The body is no longer able to fight back against infection. Infections that would normally be relatively harmless, such as the common cold (see common cold entry), can become life-threatening to someone who is HIV positive.

SYMPTOMS


A person who has been infected with HIV is likely to pass through three stages of the disease. Not all individuals experience all of the stages.

Acute Retroviral Syndrome

Acute retroviral syndrome is a term used to describe a group of symptoms that can resemble mononucleosis (pronounced MON-o-NOO-klee-O-siss; see infectious mononucleosis entry). Mononucleosis is a flu-like infection. Its symptoms include fever, fatigue, muscle aches, loss of appetite, upset stomach, weight loss, skin rash, headache, and swollen lymph nodes. These symptoms occur in 50 to 70 percent of all men who are HIV positive and in 45 to 90 percent of all women with the infection. The symptoms develop between one and six weeks after infection and last for two to three weeks.

Latency Period

After entering a person's lymph nodes, the virus becomes latent. Latency means that the virus is still present in the body, but that there are no signs of infection. Therefore, a person may appear to be perfectly healthy even though blood tests show that the virus is present.

HIV infection has an unusually long latency period. It may last for ten years or more. During this period, the virus continues to reproduce itself in the lymph nodes. As a result, certain abnormal conditions and symptoms may develop. These include the following:

  • Persistent Generalized Lymphadenopathy (PGL). As HIV continues to reproduce, it can cause swelling of the lymph nodes known as persistent generalized lymphadenopathy (pronounced lim-fad-uhn-AP-uh-thee). The nodes become larger, but are usually not sore or painful. The lymph nodes most commonly affected are those in the neck, jaw, groin, and armpits. PGL affects between 50 to 70 percent of all patients during latency.
  • Constitutional Symptoms. Many patients will develop low-grade fevers, fatigue, and general weakness. The virus may also cause a loss of appetite, a decrease in the body's ability to absorb food, and an increased rate of metabolism, the process by which the body converts food to energy. These changes result in a condition called wasting in which a person continually loses weight and energy.
  • Other Symptoms. At any time during the course of HIV infection, the virus may cause problems with organs and tissues throughout the body. A common problem is a yeast infection in the mouth known as thrush. Ulcers and open sores can also develop in the mouth. The virus can also damage the digestive system. Patients may develop diarrhea or malnutrition as a result. The virus can also destroy cells in the lungs, kidneys, and nervous system. Damage to the nervous system leads to a general loss of strength, loss of reflexes, and feelings of numbness or burning sensations in the feet or lower legs.

Late-stage AIDS

Late-stage AIDS is the period of HIV infection when the virus has become very active and has started to cause massive damage to the immune system. One sign of late-stage AIDS is a sharp decrease in the number of white blood cells known as CD4 lymphocytes. The patient also begins to have more frequent and more serious medical problems, such as infectious diseases and cancers (see cancer entry). The infections that occur are called opportunistic infections. That term means that foreign bodies, such as bacteria, have taken advantage of the bodies weakened immune systems.

CD4 cell counts are an important indication of the course of the HIV infection. Doctors use these counts to determine how far the disease has developed and what treatments to use. About 10 percent of those individuals infected with HIV never reach this final stage of disease. Researchers do not know why these individuals are more resistant to the virus than others who do develop late-stage AIDS.

AIDS dementia (pronounced dih-MEN-sha) complex usually occurs late in the progress of AIDS. It is marked by loss of reasoning ability, loss of memory, inability to concentrate, listlessness, and unsteadiness in walking. Scientists do not understand how HIV causes AIDS dementia. There are no treatments for the condition.

Patients in late-stage AIDS may develop inflammation of the muscles, especially in the hip area. They may experience pain in their joints similar to those that occur with arthritis (see arthritis entry). Thrush and ulcers (open sores) in the mouth continue to occur during the late stages of AIDS. Another common condition of this stage is hairy leukoplakia (pronounced looko-PLA-kee-uh) of the tongue. Hairy leukoplakia is characterized by a white area on the tongue that may be flat or slightly raised.

Patients with late-stage AIDS may develop a form of cancer known as Kaposi's (pronounced kuh-PO-seez) sarcoma (KS). KS is a form of skin cancer characterized by reddish-purple blotches or patches. The disease may also occur in the digestive tract or lungs. KS is one of the most common causes of death in AIDS patients.

DIAGNOSIS


HIV infection can be difficult to diagnosis. Its symptoms are often similar to those of other diseases. To aid doctors in diagnosing the disease, the CDC has drawn up a list of thirty-four conditions to look for. These conditions can be used to decide which of three categories a patient falls into. Those categories include the following:

  • Definite diagnosis with or without laboratory evidence of HIV infection.
  • Definite diagnosis with laboratory evidence of HIV infection.
  • Probable diagnosis with laboratory evidence of HIV infection.

Many symptoms discovered during a physical examination suggest the possibility of HIV infection. Some of these are more reliable predictors than others. Hairy leukoplakia of the tongue and KS are examples of strong predictors of HIV infection.

The presence of HIV infection is always confirmed with one or more blood tests. The first of these tests is called an enzyme-linked immunosorbent assay (ELISA). A person who tests positive on an ELISA test is then given a second blood test. That test is called a Western blot or immunofluorescence (pronounced im-yuh-no-flur-ES-uhnts) assay (IFA). A combination of the ELISA and Western blot test is 99.9 percent accurate in diagnosing HIV infection. In rare cases where doubt still exists, a third test is available, the polymerase (pronounced POL-uh-muh-raze) chain reaction (PCR) test.

A variety of tests are available to track the course of HIV infection. Among these are blood counts that measure the number and kind of white blood cells present. Tests also track the development of opportunistic infections, such as damage to the nervous system, and cancers.

TREATMENT


Treatment for AIDS involves the following:

  • Prophylactic Treatment for Opportunistic Infections. Prophylactic (pronounced pro-fuh-LAK-tik) treatment is treatment given to prevent disease. Certain symptoms, such as persistent weight loss, low white blood cell counts, and the presence of thrush, are used to determine when prophylactic treatments should be given. Three drugs used in treatment are trimethoprim-sulfamethoxazole (pronounced tri-METH-o-prim SULL-fuhmeth-OCK-suh-zole), dapsone, and pentamidine (pronounced pen-TAM-uh-deen).
  • Treatment of Opportunistic Infections and Cancers. These treatments are often made more difficult because the organisms that cause the diseases may become resistant to the usual drugs used to kill them. In such cases, doctors have to look for other drugs with which to treat the infections. Both radiation therapy and chemotherapy (pronounced kee-mo-THAIR-uh-pee) can be used to treat some types of infections and forms of cancer.
  • Anti-retroviral Treatment. Anti-retroviral treatments make use of drugs that attack and destroy the virus itself rather than treating the infections and diseases it causes. The first successful drugs of this kind were nucleoside analogues. A nucleoside analogue is a chemical that interferes when the virus tries to make copies of itself inside cells. If the virus cannot reproduce in cells, it cannot continue to damage white blood cells. The best known of these drugs is zidovudine (pronounced zie-DOE-vyoo-deen), sometimes called azidothymidine (pronounced AZE-ih-do-thi-mih-deen) or AZT.

One of the most serious problems in developing treatments for AIDS is that HIV mutates (changes) rapidly. In a short period of time, it can become resistant to drugs that could once kill it. As those drugs become ineffective against the disease, new ones must be found to replace them.

In 1997, the first of a new class of drugs was approved for use with AIDS patients. This class of drugs is the protease inhibitors and includes saquinavir (pronounced suh-KWIN-uh-ver). The protease inhibitors are now used by themselves or in combination with nucleoside analogues to kill the virus.

Stimulation of Blood Cell Production

Many AIDS patients have very low levels of white and red blood cells. People with low red blood cell counts often suffer from anemia (see anemia entry), a condition that causes weakness, exhaustion, and generally poor health. People with low white blood cell counts are unable to fight off infections. To protect AIDS patients against these conditions, drugs may be given to stimulate the production of both red and white blood cells.

Alternative Treatment

For many years, doctors were able to offer AIDS patients little assistance in treating their disease. As a result, patients became very interested in alternative forms of treatment. Among those treatments were a variety of Chinese and Western herbal medicines and specialized diets designed to strengthen the immune system. Patients also tried nonphysical methods, such as visualization. In visualization, a person tries to imagine what a virus looks like and what kind of battle is going on in his or her body. By this method, the person believes that he or she may have some control over that battle.

Patients have tried a variety of pain control techniques as well. These have included hydrotherapy (the use of water baths and treatments), acupuncture (a Chinese therapy technique where fine needles puncture the body), meditation, and chiropractic (pronounced KIRE-uh-prak-tik; therapy that involves manipulation of the spine).

PROGNOSIS


At present there is no cure for AIDS. At one time, however, a diagnosis of HIV infection was thought to be a death sentence. Today, that situation has changed. The development of new drugs and new ways of using those drugs has made it possible to prolong the life of an AIDS patient. Since the introduction of drug cocktails (the combining of two or more drugs) in the treatment of HIV infection, the death rate from AIDS in the United States and other developed countries has dropped dramatically.

The situation is quite different in some countries because the drugs used to treat AIDS are very expensive. People who are HIV positive in developing nations are seldom able to afford the expense of taking such drugs. The AIDS epidemic is, therefore, still out of control in most parts of the world.

PREVENTION


The ultimate goal of many AIDS researchers is to find a vaccine against the virus. If such a vaccine were found, people could be protected against the disease as they are against measles, mumps, and other infectious diseases. As of 1999 more than a dozen different vaccines were being tested.

Until a vaccine is developed, the best protection against AIDS is to avoid contracting the HIV virus by doing the following:

  • Limiting the number of sexual partners and practicing safer sex. The fewer partners one has and the better one knows those partners, the less the risk of HIV infection. The risk of transmitting the virus can also be reduced by some simple practices, such as using a condom.
  • Avoiding the sharing of needles among intravenous drug users.
  • Making plans to use one's own blood when major surgery is planned. By doing so, there is no risk of contracting HIV from the blood of an infected donor.
  • Observing normal and standard procedures for handling needles and blood products by health care professionals. These procedures include the wearing of face masks and gloves when working with patients.
  • Having an HIV test as soon as one suspects that he or she may have been infected with the virus. In general, the sooner one knows that infection has occurred, the more effective treatment can be.

FOR MORE INFORMATION


Books

Check, William A. AIDS: The Encyclopedia of Health. New York: Chelsea House Publishers, 1998.

Newton, David E. AIDS Issues: A Handbook. Hillside, NJ: Enslow Publishers, 1992.

Silverstein, Alvin, Virginia B. Silverstein, and Laura Silverstein Nunn. AIDS: An All-About Guide for Young Adults. Hillside, NJ: Enslow Publishers, 1999.

Organizations

AIDS Action. 1875 Connecticut Avenue NW, Washington, DC 20009. (202) 9861300. http://www.aidsaction.org.

American Foundation for AIDS Research (AmFAR). 120 Wall Sreet, 13th floor, New York, NY 10005. (212) 8061600. http://www.amfar.org.

Gay Men's Health Crisis, Inc. 129 West 20th Street, New York, NY 100110022. (212) 8076655.

National AIDS Hot Line. (800) 342AIDS (English); (800) 344SIDA (Spanish); (800) AIDSTTY (hearing impaired).

Web sites

AVERT-AIDS Education and Research Trust. [Online] http://www.avert.org (accessed on June 15, 1999).

HIV InSite: Gateway to AIDS Knowledge. [Online] http://HIVinsite.ucsf.edu (accessed on October 7, 1999).

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." UXL Complete Health Resource. 2001. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." UXL Complete Health Resource. 2001. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3437000088.html

"AIDS." UXL Complete Health Resource. 2001. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3437000088.html

immunodeficiency

immunodeficiency (im-yoo-noh-di-fish-ĕn-si) n. deficiency in the immune response. This can be acquired, as in AIDS, but there are many varieties of primary immunodeficiency occurring as inherited disorders characterized by hypogammaglobulinaemia, defects in T-cell function, or both.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"immunodeficiency." A Dictionary of Nursing. 2008. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"immunodeficiency." A Dictionary of Nursing. 2008. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O62-immunodeficiency.html

"immunodeficiency." A Dictionary of Nursing. 2008. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-immunodeficiency.html

AIDS

AIDS / ādz/ • n. acquired immune deficiency syndrome, a disease in which there is a severe loss of the body's cellular immunity, greatly lowering the resistance to infection and malignancy.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O999-aids.html

"AIDS." The Oxford Pocket Dictionary of Current English. 2009. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O999-aids.html

Aids

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Aids." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"Aids." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3406900025.html

"Aids." International Encyclopedia of Marriage and Family. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406900025.html

AIDS

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." Dictionary of American History. 2003. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." Dictionary of American History. 2003. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1G2-3401800066.html

"AIDS." Dictionary of American History. 2003. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3401800066.html

acquired immunodeficiency syndrome

acquired immunodeficiency syndrome, see AIDS.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"acquired immunodeficiency syndrome." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"acquired immunodeficiency syndrome." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1E1-X-acqimmu.html

"acquired immunodeficiency syndrome." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-X-acqimmu.html

acquired immune deficiency syndrome

acquired immune deficiency syndrome n. see AIDS.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"acquired immune deficiency syndrome." A Dictionary of Nursing. 2008. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"acquired immune deficiency syndrome." A Dictionary of Nursing. 2008. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O62-acquiredimmundfcncysyndrm.html

"acquired immune deficiency syndrome." A Dictionary of Nursing. 2008. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-acquiredimmundfcncysyndrm.html

AIDS

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"AIDS." World Encyclopedia. 2005. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"AIDS." World Encyclopedia. 2005. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O142-AIDS.html

"AIDS." World Encyclopedia. 2005. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O142-AIDS.html

acquired immune deficiency syndrome

acquired immune deficiency syndrome See AIDS.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"acquired immune deficiency syndrome." A Dictionary of Biology. 2004. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

"acquired immune deficiency syndrome." A Dictionary of Biology. 2004. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O6-acquiredimmundfcncysyndrm.html

"acquired immune deficiency syndrome." A Dictionary of Biology. 2004. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O6-acquiredimmundfcncysyndrm.html

AIDS

AIDS accident information display system
• aircraft integrated data system
• air force intelligence data-handling system

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "AIDS." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "AIDS." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O25-AIDS.html

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "AIDS." The Oxford Dictionary of Abbreviations. 1998. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O25-AIDS.html

Aids

Aids (or AIDS) (eɪdz) acquired immune deficiency syndrome

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "Aids." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. 29 Jul. 2016 <http://www.encyclopedia.com>.

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "Aids." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. (July 29, 2016). http://www.encyclopedia.com/doc/1O25-Aids.html

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "Aids." The Oxford Dictionary of Abbreviations. 1998. Retrieved July 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O25-Aids.html

Facts and information from other sites