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Author
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Topic: I have AIDs
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Eaichu250
Farting Nudist
Member # 826
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posted 12-05-2004 08:17 PM
fuck
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lol
From: Perth Amboy, NJ | Registered: Aug 2000
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spunman
Farting Nudist
Member # 1181
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posted 12-05-2004 08:19 PM
What the hell you doin' with AIDS? Get rid of 'em!
From: the middle | Registered: Nov 2000
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Cesar
Farting Nudist
Member # 529
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posted 12-06-2004 12:03 AM
This seems serious, but Eaichu's signature makes it funny.
[ 12-06-2004, 12:03 AM: Message edited by: Cesar ]
From: Toronto, Canada | Registered: Jun 2000
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Rolken
Vulcan
Member # 7
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posted 12-06-2004 12:41 AM
From: Provo, UT | Registered: Feb 2000
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Anthrax
Ultimate Authoritative Power in the Universe
Member # 335
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posted 12-16-2004 10:21 AM
beastman aids
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She told The Associated Press she first realized her son was mentally ill in 1996 when he killed her oldest child, a 25-year-old woman who suffered from cerebral palsy, by beating her with a dumbbell.
From: Somebody put shit in my pants! | Registered: Apr 2000
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Boodabonzi
like a virgin
Member # 2958
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posted 12-16-2004 02:51 PM
quote:
Originally posted by Anthrax:
beastman aids
I'll drink your ass like wine
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OK, I know I'm probably not the nicest Pokemon Trainer when it comes to giving advice, and if I get flamed on this, it is probably well deserved. So here goes...
From: Hitchin - biggest little shanty town in all of England | Registered: Jul 2002
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Eaichu250
Farting Nudist
Member # 826
Member Rated:
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posted 12-12-2005 03:11 AM
Still have them.
Damn.
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lol
From: Perth Amboy, NJ | Registered: Aug 2000
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Boodabonzi
like a virgin
Member # 2958
Member Rated:
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posted 12-12-2005 08:34 AM
if you were a good boy this year Santa will swap them out for Scabies
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OK, I know I'm probably not the nicest Pokemon Trainer when it comes to giving advice, and if I get flamed on this, it is probably well deserved. So here goes...
From: Hitchin - biggest little shanty town in all of England | Registered: Jul 2002
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Funnel Freak
James Albis' Bitch
Member # 910
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posted 12-13-2005 01:21 AM
yeah, thats something you would have
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"my mom walked in when i farted and it stank"
From: WINIPEGWINNIPEGWINNIPGWINNIGEG | Registered: Sep 2000
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Boodabonzi
like a virgin
Member # 2958
Member Rated:
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posted 01-09-2006 06:28 PM
hockey chick in club had them and tried to pull me but a mate grabbed her before she had the chance
that's the closest I've come
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OK, I know I'm probably not the nicest Pokemon Trainer when it comes to giving advice, and if I get flamed on this, it is probably well deserved. So here goes...
From: Hitchin - biggest little shanty town in all of England | Registered: Jul 2002
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Lark84
My skeleton is made of creamy nougat.
Member # 1186
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posted 01-10-2006 11:04 AM
It has always bothered me that asking a possible future girlfriend I'm about to get intimate with to go test herself for STD:s will invariably insult her and almost certainly cause her to dump me - but I can't think of any other way to make it as sure as possible that I won't get anything nasty.
Registered: Nov 2000
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Boodabonzi
like a virgin
Member # 2958
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posted 01-11-2006 04:06 PM
wear a condom you fuckwit
most stuff that that doesn't prevent can be treated
and seriously, if you're thinking that before you get it on then you're getting it on with the wrong girls
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OK, I know I'm probably not the nicest Pokemon Trainer when it comes to giving advice, and if I get flamed on this, it is probably well deserved. So here goes...
From: Hitchin - biggest little shanty town in all of England | Registered: Jul 2002
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Eaichu250
Farting Nudist
Member # 826
Member Rated:
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posted 01-22-2006 03:41 AM
quote:
Originally posted by Boodabonzi:
wear a condom you fuckwit
most stuff that that doesn't prevent can be treated
and seriously, if you're thinking that before you get it on then you're getting it on with the wrong girls
can you please get rid of my wonderaids for me
i'll give you five dolla
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lol
From: Perth Amboy, NJ | Registered: Aug 2000
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Boodabonzi
like a virgin
Member # 2958
Member Rated:
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posted 01-22-2006 08:36 AM
specify
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OK, I know I'm probably not the nicest Pokemon Trainer when it comes to giving advice, and if I get flamed on this, it is probably well deserved. So here goes...
From: Hitchin - biggest little shanty town in all of England | Registered: Jul 2002
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Dweedle
My hands and feet are mangos
Member # 1209
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posted 01-22-2006 12:16 PM
you still got that shit man?
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the only way to get pass this will be to commit suicune
From: second of all, Quagmire's not really a bad guy! | Registered: Nov 2000
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sunburnt_aphid
most boring gimmick ever
Member # 3546
Member Rated:
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posted 01-22-2006 04:09 PM
i'll suck the aids out of your dick with my mouth
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I like Jessie from Team Rocket <3
From: Seattle | Registered: Oct 2003
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sunburnt_aphid
most boring gimmick ever
Member # 3546
Member Rated:
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posted 01-24-2006 12:14 AM
get it like i am sucking his dick
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I like Jessie from Team Rocket <3
From: Seattle | Registered: Oct 2003
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Mr. K
Racist
Member # 2
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posted 01-27-2006 02:06 PM
I've been using yogurt suppositories for years...and I love it!
From: Cinnabar Island | Registered: Feb 2000
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Eaichu250
Farting Nudist
Member # 826
Member Rated:
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posted 01-27-2006 10:09 PM
important tips revolving around AIDs, everybody
ADHERENCE TO POTENT ANTIRETROVIRAL THERAPY
The Panel recommends that certain persons living with HIV, including persons who are asymptomatic, should be treated with HAART for the rest of their lives. Adherence to the regimen is essential for successful treatment and has been reported to increase sustained virologic control, which is critical in reducing HIV-related morbidity and mortality. Conversely, suboptimal adherence has been reported to decrease virologic control and has been associated with increased morbidity and mortality [1, 2]. Suboptimal adherence also leads to drug resistance, limiting the effectiveness of therapy [3]. The determinants, measurements, and interventions to improve adherence to HAART are insufficiently characterized and understood, and additional research regarding this topic is needed.
Adherence to Therapy During HIV-1 Disease
Adherence is a key determinant in the degree and duration of virologic suppression. Among studies reporting on the association between suboptimal adherence and virologic failure, nonadherence among patients on HAART was the strongest predictor for failure to achieve viral suppression below the level of detection [2, 3]. Other studies have reported that 90%-95% of doses must be taken for optimal suppression, with lesser degrees of adherence being associated with virologic failure [1, 4]. No conclusive evidence exists to show that the degree of adherence required varies with different classes of agents or different medications in the HAART regimen.
Suboptimal adherence is common. Surveys have determined that one third of patients missed doses within (3 days of the survey [5]. Reasons for missed doses were predictable and included forgetting, being too busy, being out of town, being asleep, being depressed, having adverse side effects, and being too ill [6]. One fifth of HIV-infected patients in one urban center never filled their prescriptions. Although homelessness can lead to suboptimal adherence, one program achieved a 70% adherence rate among homeless persons by using flexible clinic hours, accessible clinic staff, and incentives [7].
Predictors of inadequate adherence to HIV medications include
1. lack of trust between clinician and patient;
2. active drug and alcohol use;
3. active mental illness (e.g., depression);
4. lack of patient education and inability of patients to identify their medications [6], and
5. lack of reliable access to primary medical care or medication [8].
Other sources of instability influencing adherence include domestic violence and discrimination [8]. Medication side effects can also cause inadequate adherence as can fear of or experiencing metabolic and morphologic side effects of HAART [9].
Predictors of optimal adherence to HIV medications, and hence, optimal viral suppression, include
1. availability of emotional and practical life supports;
2. a patient's ability to fit medications into his or her daily routine;
3. understanding that suboptimal adherence leads to resistance;
4. recognizing that taking all medication doses is critical;
5. feeling comfortable taking medications in front of others [10], and
6. keeping clinic appointments [11].
Measurement of adherence is imperfect and lacks established standards. Patient self-reporting is an unreliable predictor of adherence; however, a patient's estimate of suboptimal adherence is a strong predictor and should be strongly considered [10, 12]. A clinician's estimate of the likelihood of a patient's adherence is also an unreliable predictor [13]. Aids for measuring adherence (e.g., pill counts, pharmacy records, "smart" pill bottles with computer chips that record each opening [i.e., medication event monitoring systems or MEMS caps]) might be useful, although each aid requires comparison with patient self-reporting [12, 14]. Clinician and patient estimates of the degree of adherence have been reported to exceed measures that are based on MEMS caps. Because of its complexity and cost, MEMS caps technology might be used as an adjunct to adherence research, but it is not useful in clinical settings.
Self-reporting should include a short-term assessment of each dose that was taken during the recent past (e.g., ( 3 days) and a general inquiry regarding adherence since the last visit, with explicit attention to the circumstances of missed doses and possible measures to prevent further missed doses. Having patients bring their medications and medication diaries to clinic visits might be helpful also.
Approaching the Patient
Patient-related strategies
The first principle of patient-related strategies is to negotiate a treatment plan that the patient understands and to which he or she commits [15, 16]. Before writing the first prescription, clinicians should assess the patient's readiness to take medication, which might take two or three office visits and patience. Patient education should include the goals of therapy, including a review of expected outcomes that are based on baseline viral load and CD4+ T cell counts (e.g., MACS data from the Guidelines [4]), the reason for adherence, and the plan for and mechanics of adherence. Patients must understand that the first HAART regimen has the best chance for long-term success [17]. Clinicians and health teams should develop a plan for the specific regimen, including how medication timing relates to meals and daily routines. Centers have offered practice sessions and have used candy in place of pills to familiarize the patient with the rigors of HAART; however, no data exist to indicate if this exercise improves adherence. Daily or weekly pillboxes, timers with alarms, pagers, and other devices can be useful. Because medication side effects can affect treatment adherence, clinicians should inform patients in advance of possible side effects and when they are likely to occur. Treatment for side effects should be included with the first prescription, as well as instructions on appropriate response to side effects and when to contact the clinician. Low literacy is also associated with suboptimal adherence. Clinicians should assess a patient's literacy level before relying on written information, and they should tailor the adherence intervention for each patient. Visual aids and audio or video information sources can be useful for patients with low literacy [18].
Education of family and friends and their recruitment as participants in the adherence plan can be useful. Community interventions, including adherence support groups or the addition of adherence concerns to other support group agendas, can aid adherence. Community-based case managers and peer educators can assist with adherence education and strategies for each patient.
Temporary postponement of HAART initiation has been proposed for patients with identified risks for suboptimal adherence [19, 20]. For example, a patient with active substance abuse or mental illness might benefit from psychiatric treatment or treatment for chemical dependency before initiating HAART. During the 1-2 months needed for treatment of these conditions, appropriate HIV therapy might be limited to OI prophylaxis, if indicated, and therapy for drug withdrawal, detoxification, or the underlying mental illness. In addition, readiness for HAART can be assessed and adherence education can be initiated during this period. Other sources of patient instability (e.g., homelessness) can be addressed during this time. Patients should be informed and in agreement with plans for future treatment and time-limited treatment deferral.
Selected factors (e.g., sex, race, low socioeconomic status or education level, and past drug use) are not reliable predictors of suboptimal adherence. Conversely, higher socioeconomic status and education level and a lack of past drug abuse do not predict optimal adherence [21]. No patient should automatically be excluded from antiretroviral therapy simply because he or she exhibits a behavior or characteristic judged by the clinician to indicate a likelihood of nonadherence.
Clinician and health team-related strategies
Trusting relationships among the patient, clinician, and health team are essential. Clinicians should commit to communication between clinic visits, ongoing adherence monitoring, and timely response to adverse events or interim illness. Interim management during clinician vacations or other absences must be clarified with the patient.
Optimal adherence requires full participation by the health-care team, with goal reinforcement by more than 2 team members. Supportive and nonjudgmental attitudes and behaviors will encourage patient honesty regarding adherence and problems. Improved adherence is associated with interventions that include pharmacist-based adherence clinics [21]. street-level drop-in centers with medication storage and flexible hours for homeless persons [22], adolescent-specific training programs [23], and medication counseling and behavioral intervention [24]. For all health-care team members, specific training regarding HAART and adherence should be offered and updated periodically.
Monitoring can identify periods of inadequate adherence. Evidence indicates that adherence wanes as time progresses, even among patients whose adherence has been optimal, a phenomenon described as pill fatigue or treatment fatigue [19, 25]. Thus, monitoring adherence at every clinic encounter is essential. Reasonable responses to decreasing adherence include increasing the intensity of clinical follow-up, shortening the follow-up interval, and recruiting additional health team members, depending on the problem [20]. Certain patients (e.g., chemically dependent patients, mentally retarded patients in the care of another person, children and adolescents, or patients in crisis) might require ongoing assistance from support team members from the outset.
New diagnoses or symptoms can influence adherence. For example, depression might require referral, management, and consideration of the short- and long-term impact on adherence. Cessation of all medications at the same time might be more desirable than uncertain adherence during a 2-month exacerbation of chronic depression.
Responses to adherence interventions among specific groups have not been well-studied. Evidence exists that programs designed specifically for adolescents, women and families, injection-drug users, and homeless persons increase the likelihood of medication adherence [21, 23, 26, 27]. The incorporation of adherence interventions into convenient primary care settings; training and deployment of peer educators, pharmacists, nurses, and other health-care personnel in adherence interventions; and monitoring of clinician and patient performance regarding adherence are beneficial adherence [22, 28, 29]. In the absence of data, a reasonable response is to address and monitor adherence during all HIV primary care encounters and incorporates adherence goals in all patient treatment plans and interventions. This might require the full use of a support team, including bilingual providers and peer educators for non-English–speaking populations, incorporation of adherence into support group agendas and community forums, and inclusion of adherence goals and interventions in the work of chemical-dependency counselors and programs.
Regimen-related strategies
Regimens should be simplified as much as possible by reducing the number of pills and therapy frequency and by minimizing drug interactions and side effects. For certain patients, problems with complex regimens are of lesser importance, but evidence supports simplified regimens with reduced pill numbers and dose frequencies [30, 31]. With the effective options for initial therapy noted in this report and the observed benefit of less frequent dosing, twice-daily dosing of HAART regimens is feasible for the majority of patients. Regimens should be chosen after review and discussion of specific food requirements and patient understanding of and agreement to such restrictions. Regimens requiring an empty stomach multiple times daily might be difficult for patients with a wasting disorder, just as regimens requiring high fat intake might be difficult for patients with lactose intolerance or fat aversion. However, an increasing number of effective regimens do not have specific food requirements.
Directly observed therapy
Directly observed therapy (DOT), in which a health-care provider observes the ingestion of medication, has been successful in tuberculosis management, specifically among patients whose adherence has been suboptimal. DOT, however, is labor-intensive, expensive, intrusive, and programmatically complex to initiate and complete; and unlike tuberculosis, HIV requires lifelong therapy. Pilot programs have studied DOT among HIV patients with preliminary success. These programs have studied once-daily regimens among prison inmates, methadone program participants, and other patient cohorts with a record of repeated suboptimal adherence. Modified DOT programs have also been studied in which the morning dose is observed and evening and weekend doses were self-administered. The goal of these programs is to improve patient education and medication self-administration during a limited period (e.g., 3-6 months); however, the outcome of these programs, including long-term adherence after DOT completion, has not been determined [32-35].
REFERENCES
1. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med, 2000. 133(1):21-30.
2. Carmona A, Knobel H, Guelar A, et al. Factors influencing survival in HIV infected patients treated with HAART. 13th International AIDS Conference. Durban, South Africa. 2000. (Abstract TuOrB417).
3. Walsh JC, Hertogs K, Gazzard B. Viral drug resistance, adherence and pharmacokinetic indices in HIV-1 infected patients on successful and failing protease inhibitor based HAART. 40th Interscience Conference of Antimicrobial Agents and Chemotherapy. Toronto, Canada. 2000. (Abstract 699).
4. Arnsten J, Demas P, Gourevitch M, et al. Adherence and viral load in HIV-infected drug users: comparison of self-report and medication events monitors. 7th Conference on Retroviruses and Opportunistic Infections. San Francisco, CA, 2000. (Abstract 69).
5. Ickovics JR, Meisler AW. Adherence in AIDS clinical trials: A framework for clinical research and clinical care. J Clin Epidemiol, 1997. (4):385-91.
6. Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis, 2000. 30 Suppl 2:S171-6.
7. Bangsberg D, Tulsky JP, Hecht FM, Moss AR. Protease inhibitors in the homeless. J Am Med Assoc, 1997. 278(1):63-5.
8. Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: Results from the HIV Cost and Services Utilization Study. J Am Med Assoc, 1999. 281(24):2305-15.
9. Max B, Sherer R. Management of the adverse effects of antiretroviral therapy and medication adherence. Clin Infect Dis, 2000. 30 Suppl 2:S96-S116.
10. Cheever L. Forum for Collaborative HIV Research. What do we know about adherence levels in different populations? Adherence to HIV therapy: Building a bridge to success. Available at http://www.gwhealthpolicy.org. Washington, D.C. 1999:10.
11. Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: Risk factors for virologic failure and adverse drug reactions. Ann Intern Med, 1999. 131(2):81-7.
12. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther, 1984. 6(5):592-9.
13. Crespo-Fierro M. Compliance/adherence and care management in HIV disease. J Assoc Nurses AIDS Care, 1997. 8(4):43-54.
14. Singh N, Squier C, Sivek C, et al. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 1996. 8(3):261-9.
15. Williams A, Friedland G. Adherence, compliance, and HAART. AIDS Clin Care, 1997. 9(7):51-54, 58.
16. Fowler ME. Recognizing the phenomenon of readiness: Concept analysis and case study. J Assoc Nurses AIDS Care, 1998. 9(3):72-6.
17. CDC. Report of the NIH panel to define principles of therapy of HIV infection and guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR, 1998. 47(RR-5):1-41.
18. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med, 1999. 14(5):267-73.
19. Mannherheimer S, Friedland G, Matts J, et al. Self-reported antiretroviral adherence correlates with HIV viral load and declines over time. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract TuOrB421).
20. Sherer R. Adherence and antiretroviral therapy in injection drug users. J Am Med Assoc, 1998. 280(6):567-8.
21. Luber AD, Sherman M, Gotterer H, et al. Community collaborations between physicians and pharmacists improved adherence with HIV Consensus Panel Guidelines and enhances the care of HIV infected individuals. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, Canada, 2000. (Abstract 800).
22. Bangsberg DR, Hecht FM, Clague H, et al. Provider estimate and structured patient report of adherence compared with unannounced pill count. 7th Conference on Retroviruses and Opportunistic Infections. San Francisco, CA, 2000. (Abstract 70).
23. Rogers A. Forum for Collaborative HIV Research. TREAT - a clinical management tool for adolescents. Adherence to HIV therapy: Building a bridge to success. Available at http://www.gwhealthpolicy.org. Washington, D.C. 1999:16-7.
24. McPherson-Baker S, Malow RM, Penedo F, et al. Enhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive men. AIDS Care, 2000. 12(4):399-404.
25. Nieuwkerk P, Burger D, Hugen P, et al. Patient adherence to highly active antiretroviral therapy for HIV-1 infection in a nationwide cohort study in the Netherlands. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract MoPpD1055).
26. Ahdieh L, Silverberg M, Palacio H, et al. Factors associated with discontinuation of HAART in a large cohort of HIV+ women. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract WePeB4293).
27. Tyndall M, Yip B, Hogg R, et al. Coverage, adherence, and sustainability of antiretroviral therapy among injection drug users in Vancouver, Canada. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract ThPeB4990).
28. Parienti JJ, Massari V, Verdon R, et al. Adherence to antiretroviral therapy is associated with results of pills identification test. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, Canada, 2000. (Abstract 793).
29. Knobel H, Carmona A, Grau S, et al. Strategies to optimize adherence to highly active antiretroviral treatment. 12th International AIDS Conference. Geneva, Switzerland, 1998. (Abstract 32322).
30. Bartlett JA, DeMasi R, Quinn J, et al. Overview of the effectiveness of triple combination therapy in antiretroviral-naďve HIV-1 infected adults. AIDS, 2001. 15(11):1369-77.
31. Cahn P. Potential advantages of a compact triple nucleoside regimen: Efficacy and adherence with combivir/abacavir versus combivir/indinavir in an open-label randomised comparative study (CNAB3014). 40th Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, Canada. 2000. (Abstract 695).
32. Flanigan T. Forum for Collaborative HIV Research. Directly observed therapy. Adherence to HIV therapy: Building a bridge to success. Available at http://www.gwhealthpolicy.org. Washington, D.C. 1999:21-2.
33. Rappaport E. Forum for Collaborative HIV Research. Correctional Institutions. Adherence to HIV therapy: Building a bridge to success. Available at http://www.gwhealthpolicy.org. Washington, D.C. 1999:31-32.
34. Fischl M, Rodriguez A, Scerpella E, et al. Impact of directly observed therapy on outcomes in HIV clinical trials. 7th Conference on Retroviruses and Opportunistic Infections. San Francisco, CA, 2000. (Abstract 71).
35. Stenzel MS, McKenzie M, Adelson-Mitty J, Flanigan T. Modified directly observed therapy to enhance highly active therapy: 12 month follow-up. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract ThPeB4992).
INTRODUCTION
AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.
More than 900,000 cases of AIDS have been reported in the United States since 1981. As many as 950,000 Americans may be infected with HIV, one-quarter of whom are unaware of their infection. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. According to the Centers for Disease Control and Prevention (CDC), AIDS affects nearly seven times more African Americans and three times more Hispanics than whites. In recent years, an increasing number of African-American women and children are being affected by HIV/AIDS. In 2003, two-thirds of U.S. AIDS cases in both women and children were among African-Americans.
TRANSMISSION
HIV is spread most commonly by having unprotected sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex.
Risky behavior
HIV can infect anyone who practices risky behaviors such as
* Sharing drug needles or syringes
* Having sexual contact, including oral, with an infected person without using a condom
* Having sexual contact with someone whose HIV status is unknown
Infected blood
HIV also is spread through contact with infected blood. Before donated blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely small.
Contaminated needles
HIV is frequently spread among injection drug users by the sharing of needles or syringes contaminated with very small quantities of blood from someone infected with the virus.
It is rare, however, for a patient to give HIV to a health care worker or vice-versa by accidental sticks with contaminated needles or other medical instruments.
Mother to child
Women can transmit HIV to their babies during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus. If the mother takes certain drugs during pregnancy, she can significantly reduce the chances that her baby will get infected with HIV. If health care providers treat HIV-infected pregnant women and deliver their babies by cesarean section, the chances of the baby being infected can be reduced to a rate of 1 percent. HIV infection of newborns has been almost eradicated in the United States due to appropriate treatment.
A study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) in Uganda found a highly effective and safe drug for preventing transmission of HIV from an infected mother to her newborn. Independent studies have also confirmed this finding. This regimen is more affordable and practical than any other examined to date. Results from the study show that a single oral dose of the antiretroviral drug nevirapine (NVP) given to an HIV-infected woman in labor and another to her baby within 3 days of birth reduces the transmission rate of HIV by half compared with a similar short course of AZT (Azidothymidine). For more information on preventing transmission from mother to child, go to http://aidsinfo.nih.gov/guidelines.
Saliva
Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect, and the amount of virus in saliva appears to be very low. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva by kissing. The lining of the mouth, however, can be infected by HIV, and instances of HIV transmission through oral intercourse have been reported.
Scientists have found no evidence that HIV is spread through sweat, tears, urine, or feces.
Casual contact
Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.
HIV is not spread by biting insects such as mosquitoes or bedbugs.
Sexually transmitted infections
If you have a sexually transmitted infection (STI) such as syphilis, genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis appears, you may be more susceptible to getting HIV infection during sex with infected partners.
EARLY SYMPTOMS OF HIV INFECTION
If you are like many people, you will not have any symptoms when you first become infected with HIV. You may, however, have a flu-like illness within a month or two after exposure to the virus. This illness may include
* Fever
* Headache
* Tiredness
* Enlarged lymph nodes (glands of the immune system easily felt in the neck and groin)
These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.
More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.
Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood-the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms.
As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include
* Lack of energy
* Weight loss
* Frequent fevers and sweats
* Persistent or frequent yeast infections (oral or vaginal)
* Persistent skin rashes or flaky skin
* Pelvic inflammatory disease in women that does not respond to treatment
* Short-term memory loss
Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles. Children may grow slowly or be sick a lot.
WHAT IS AIDS?
The term AIDS applies to the most advanced stages of HIV infection. CDC developed official criteria for the definition of AIDS and is responsible for tracking the spread of AIDS in the United States.
CDC's definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease. Most of these conditions are opportunistic infections that generally do not affect healthy people. In people with AIDS, these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses, fungi, parasites, and other microbes.
Symptoms of opportunistic infections common in people with AIDS include
* Coughing and shortness of breath
* Seizures and lack of coordination
* Difficult or painful swallowing
* Mental symptoms such as confusion and forgetfulness
* Severe and persistent diarrhea
* Fever
* Vision loss
* Nausea, abdominal cramps, and vomiting
* Weight loss and extreme fatigue
* Severe headaches
* Coma
Children with AIDS may get the same opportunistic infections as do adults with the disease. In addition, they also have severe forms of the typically common childhood bacterial infections, such as conjunctivitis (pink eye), ear infections, and tonsillitis.
People with AIDS are also particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.
During the course of HIV infection, most people experience a gradual decline in the number of CD4+ T cells, although some may have abrupt and dramatic drops in their CD4+ T-cell counts. A person with CD4+ T cells above 200 may experience some of the early symptoms of HIV disease. Others may have no symptoms even though their CD4+ T-cell count is below 200.
Many people are so debilitated by the symptoms of AIDS that they cannot hold a steady job or do household chores. Other people with AIDS may experience phases of intense life-threatening illness followed by phases in which they function normally.
A small number of people first infected with HIV 10 or more years ago have not developed symptoms of AIDS. Scientists are trying to determine what factors may account for their lack of progression to AIDS, such as
* Whether their immune systems have particular characteristics
* Whether they were infected with a less aggressive strain of the virus
* If their genes may protect them from the effects of HIV
Scientists hope that understanding the body's natural method of controlling infection may lead to ideas for protective HIV vaccines and use of vaccines to prevent the disease from progressing.
DIAGNOSIS
Because early HIV infection often causes no symptoms, your health care provider usually can diagnose it by testing your blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach noticeable levels in the blood for 1 to 3 months following infection. It may take the antibodies as long as 6 months to be produced in quantities large enough to show up in standard blood tests. Hence, to determine whether you have been recently infected (acute infection), your health care provider can screen you for the presence of HIV genetic material. Direct screening of HIV is extremely critical in order to prevent transmission of HIV from recently infected individuals.
If you have been exposed to the virus, you should get an HIV test as soon as you are likely to develop antibodies to the virus-within 6 weeks to 12 months after possible exposure to the virus. By getting tested early, if infected, you can discuss with your health care provider when you should start treatment to help your immune system combat HIV and help prevent the emergence of certain opportunistic infections (see section on treatment below). Early testing also alerts you to avoid high-risk behaviors that could spread the virus to others.
Most health care providers can do HIV testing and will usually offer you counseling at the same time. Of course, you can be tested anonymously at many sites if you are concerned about confidentiality.
Health care providers diagnose HIV infection by using two different types of antibody tests: ELISA and Western Blot. If you are highly likely to be infected with HIV but have been tested negative for both tests, your health care provider may request additional tests. You also may be told to repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.
Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months. If these babies lack symptoms, a doctor cannot make a definitive diagnosis of HIV infection using standard antibody. Health care providers are using new technologies to detect HIV to more accurately determine HIV infection in infants between ages 3 months and 15 months. They are evaluating a number of blood tests to determine which ones are best for diagnosing HIV infection in babies younger than 3 months.
TREATMENT
When AIDS first surfaced in the United States, there were no medicines to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. Researchers, however, have developed drugs to fight both HIV infection and its associated infections and cancers.
HIV infection
The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections. This class of drugs, called nucleoside analogs, include
* AZT (Azidothymidine)
* ddC (zalcitabine)
* ddI (dideoxyinosine)
* d4T (stavudine)
* 3TC (lamivudine)
* Abacavir (ziagen)
* Tenofovir (viread)
* Emtriva (emtricitabine)
Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as
* Delavridine (Rescriptor)
* Nevirapine (Viramune)
* Efravirenz (Sustiva) (in combination with other antiretroviral drugs)
FDA also has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle. They include
* Ritonavir (Norvir)
* Saquinivir (Invirase)
* Indinavir (Crixivan)
* Amprenivir (Agenerase)
* Nelfinavir (Viracept)
* Lopinavir (Kaletra)
* Atazanavir (Reyataz)
* Fosamprenavir (Lexiva)
FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV's ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules.
Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS.
Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.
Side effects
Despite the beneficial effects of HAART, there are side effects associated with the use of antiviral drugs that can be severe. Some of the nucleoside RT inhibitors may cause a decrease of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause inflammation of the pancreas and painful nerve damage. There have been reports of complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore, health care experts recommend that you be routinely seen and followed by your health care provider if you are on antiretroviral therapy.
The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs resulting in serious side effects. Fuzeon may also cause severe allergic reactions such as pneumonia, trouble breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure. Local skin reactions are also possible since it is given as an injection underneath the skin.
If you are taking HIV drugs, you should contact your health care provider immediately if you have any of these symptoms.
Opportunistic infections
A number of available drugs help treat opportunistic infections. These drugs include
* Foscarnet and ganciclovir to treat CMV (cytomegalovirus) eye infections
* Fluconazole to treat yeast and other fungal infections
* TMP/SMX (trimethoprim/sulfamethoxazole) or pentamidine to treat PCP (Pneumocystis carinii pneumonia)
Cancers
Health care providers use radiation, chemotherapy, or injections of alpha interferon-a genetically engineered protein that occurs naturally in the human body-to treat Kaposi's sarcoma or other cancers associated with HIV infection.
PREVENTION
Because no vaccine for HIV is available, the only way to prevent infection by the virus is to avoid behaviors that put you at risk of infection, such as sharing needles and having unprotected sex.
Many people infected with HIV have no symptoms. Therefore, there is no way of knowing with certainty whether your sexual partner is infected unless he or she has repeatedly tested negative for the virus and has not engaged in any risky behavior. You should either abstain from having sex or use male latex condoms or female polyurethane condoms, which may offer partial protection, during oral, anal, or vaginal sex. Only water-based lubricants should be used with male latex condoms.
Although some laboratory evidence shows that spermicides can kill HIV, researchers have not found that these products can prevent you from getting HIV.
RESEARCH
NIAID-supported investigators are conducting an abundance of research on all areas of HIV infection, including developing and testing preventive HIV vaccines and new treatments for HIV infection and AIDS-associated opportunistic infections. Researchers also are investigating exactly how HIV damages the immune system. This research is identifying new and more effective targets for drugs and vaccines. NIAID-supported investigators also continue to trace how the disease progresses in different people.
Scientists are investigating and testing chemical barriers, such as topical microbicides, that people can use in the vagina or in the rectum during sex to prevent HIV transmission. They also are looking at other ways to prevent transmission, such as controlling STIs and modifying personal behavior, as well as ways to prevent transmission from mother to child.
MORE INFORMATION
AIDSinfo is a comprehensive resource for up-to-date information on government and industry sponsored HIV/AIDS treatment and prevention clinical trials. AIDSinfo also maintains the most current, federally approved guidelines for treating and preventing HIV/AIDS in adults and children, for AIDS related illnesses, for managing occupational exposure to HIV and for preventing HIV transmission from mother-to-child during pregnancy.
AIDSinfo is sponsored by the National Institutes of Health (NIH) Office of AIDS Research, NIAID, National Library of Medicine, CDC, Health Resources and Service Administration, and Centers for Medicare and Medicaid Services.
AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
1-800-HIV-0440 (1-800-448-0440) or 301-519-0459
1-888-480-3739 (TTY/TDD)
http://aidsinfo.nih.gov
For information on HIV vaccine clinical trials conducted by the NIH Vaccine Research Center, call 1-866-833-LIFE (1-866-833-5433) (http://www.niaid.nih.gov/vrc/clintrials/clin_steps.htm).
For information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov).
To receive materials or to talk with a Health Communication Specialist, contact the CDC National HIV and STD Hotline. This service is available 24 hours a day.
1-800-227-8922
1-800-342-2437
1-800-243-7889 (TTY/TDD)
[ 01-27-2006, 10:09 PM: Message edited by: Eaichu250 ]
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