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HIV/AIDS
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{{pp-semi-protected|small=yes}}{{pp-move-indef}}{{short description|Spectrum of conditions caused by HIV infection}}{{redir|AIDS}}{{Good article}}{{Use mdy dates|date=December 2015}}{{Use American English|date=September 2016}}







factoids
UNAIDSwebsite=www.unaids.orgaccess-date=10 September 2017}}| alt = A red ribbon in the shape of a bowInfectious disease (medical specialty)>Infectious diseasewebsite=aidsetc.orgaccess-date=10 September 2017archive-url=https://web.archive.org/web/20171018065658weblinkdead-url=yes|df=mdy-all}}| symptoms = Early: Flu-like illnessLater: Large lymph nodes, fever, weight loss| complications = Opportunistic infections, tumors| onset =| duration = Lifelong| causes = Human immunodeficiency virus (HIV)| risks = Exposure to blood, breast milk, sex| diagnosis = Blood tests| differential =| prevention = Safe sex, needle exchange, male circumcision, pre-exposure prophylaxis, post-exposure prophylaxis| treatment = Antiretroviral therapy| medication =| prognosis = Near normal life expectancy with treatment11 years life expectancy without treatmentWEBSITE=UNAIDSACCESS-DATE=10 SEPTEMBER 2017, June 2017, | deaths = 1.0 million (2016)}}Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV).JOURNAL, Sepkowitz KA, AIDS – the first 20 years, The New England Journal of Medicine, 344, 23, 1764–72, June 2001, 11396444, 10.1056/NEJM200106073442306, BOOK, Alexander, Krämer, Mirjam, Kretzschmar, Klaus, Krickeberg, vanc, Modern infectious disease epidemiology concepts, methods, mathematical models, and public health, 2010, Springer, New York, 978-0-387-93835-6, 88, Online-Ausg.,weblink mdy-all, BOOK, Wilhelm, Kirch, vanc, Encyclopedia of Public Health, 2008, Springer, New York, 978-1-4020-5613-0, 676–77,weblink mdy-all, Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms.WEB, About HIV/AIDS,weblink CDC, 11 February 2016, December 6, 2015, mdy-all, As the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people who have uncompromised immune systems. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.HIV is spread primarily by unprotected sex (including anal and oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding.BOOK, Rom WN, Markowitz SB, Environmental and occupational medicine, 2007, Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-6299-1, 745,weblink 4th, mdy-all, Some bodily fluids, such as saliva and tears, do not transmit HIV.WEB, Centers for Disease Control and Prevention, 2003,weblink HIV and Its Transmission, May 23, 2006,weblink" title="web.archive.org/web/20050204141148weblink">weblink February 4, 2005, Methods of prevention include safe sex, needle exchange programs, treating those who are infected, pre- and post-exposure prophylaxis, and male circumcision. Disease in a baby can often be prevented by giving both the mother and child antiretroviral medication.WEB, HIV/AIDS Fact sheet N°360,weblink WHO, 11 February 2016, November 2015, no,weblink" title="web.archive.org/web/20160217160830weblink">weblink February 17, 2016, mdy-all, There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy.NEWS, The quest for an HIV vaccine,weblink May 18, 2012, UNAIDS, no,weblink" title="web.archive.org/web/20120524051113weblink">weblink May 24, 2012, mdy-all, Treatment is recommended as soon as the diagnosis is made.BOOK, Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, 2015, WHO, 978-92-4-150956-5, 13,weblink no,weblink" title="web.archive.org/web/20151014071803weblink">weblink October 14, 2015, mdy-all, Without treatment, the average survival time after infection is 11 years.WEB, Joint United Nations Programme on HIV/AIDS, UNAIDS, World Health Organization, WHO, December 2007, 2007 AIDS epidemic update,weblink March 12, 2008, yes,weblink" title="web.archive.org/web/20080527201701weblink">weblink May 27, 2008, In 2016, about 36.7 million people were living with HIV and it resulted in 1 million deaths.WEB, Fact sheet – Latest statistics on the status of the AIDS epidemic {{!, UNAIDS|url=http://www.unaids.org/en/resources/fact-sheet|website=www.unaids.org|access-date=21 July 2017|deadurl=no|archive-url=https://web.archive.org/web/20170713205307weblink|archive-date=July 13, 2017|df=mdy-all}} There were 300,000 fewer new HIV cases in 2016 than in 2015.NEWS,weblink Global HIV and AIDS statistics, 2015-07-16, AVERT, 2017-10-07, en, Most of those infected live in sub-Saharan Africa. From the time AIDS was identified in the early 1980s to 2017, the disease has caused an estimated 35 million deaths worldwide.WEB,weblink Fact sheet – Latest statistics on the status of the AIDS epidemic, www.unaids.org, en, 2018-03-16, UNAIDS, HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.JOURNAL, Kallings LO, The first postmodern pandemic: 25 years of HIV/ AIDS, Journal of Internal Medicine, 263, 3, 218–43, March 2008, 18205765, 10.1111/j.1365-2796.2007.01910.x, (subscription required) HIV originated in west-central Africa during the late 19th or early 20th century.JOURNAL, Sharp PM, Hahn BH, Origins of HIV and the AIDS pandemic, Cold Spring Harbor Perspectives in Medicine, 1, 1, a006841, September 2011, 22229120, 3234451, 10.1101/cshperspect.a006841, AIDS was first recognized by the United States Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.JOURNAL, Gallo RC, A reflection on HIV/AIDS research after 25 years, Retrovirology, 3, 1, 72, October 2006, 17054781, 1629027, 10.1186/1742-4690-3-72,weblink HIV/AIDS has had a large impact on society, both as an illness and as a source of discrimination.BOOK, Joint United Nations Programme on HIV/AIDS, UNAIDS, 2006, 2006 Report on the global AIDS epidemic, The impact of AIDS on people and societies,weblink 978-92-9173-479-5, The disease also has large economic impacts. There are many misconceptions about HIV/AIDS such as the belief that it can be transmitted by casual non-sexual contact.JOURNAL, Myth Busters, Science, 351, 6268, 35,weblink 14 February 2016, no,weblink" title="web.archive.org/web/20160222160217weblink">weblink February 22, 2016, mdy-all, 2016Sci...351...35E, Endersby, Jim, 2016, 10.1126/science.aad2891, The disease has become subject to many controversies involving religion including the Catholic Church's position not to support condom use as prevention.WEB, McCullom, Rob, An African Pope Won't Change the Vatican's Views on Condoms and AIDS,weblink The Atlantic, 14 February 2016, 26 Feb 2013, no,weblink" title="web.archive.org/web/20160308135849weblink">weblink March 8, 2016, mdy-all, It has attracted international medical and political attention as well as large-scale funding since it was identified in the 1980s.BOOK, Harden, Victoria Angela, AIDS at 30: A History, Potomac Books Inc, 2012, 324, 978-1-59797-294-9, File:Wikipedia-VideoWiki-HIV-AIDS.webm|thumb|thumbtime=2:46|upright=1.4|Video summary (script)]]{{TOC limit}}

Signs and symptoms

There are three main stages of HIV infection: acute infection, clinical latency, and AIDS.WEB, What Are HIV and AIDS? {{!, HIV.gov|url=https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids|website=www.hiv.gov|publisher=U.S. Department of Health and Human Services (HHS)|access-date=10 September 2017|language=en|date=2017-05-15}}Mandell, Bennett, and Dolan (2010). Chapter 121.

Acute infection

(File:Symptoms of acute HIV infection.svg|thumb|upright=1.25|alt=A diagram of a human torso labelled with the most common symptoms of an acute HIV infection|Main symptoms of acute HIV infection)The initial period following the contraction of HIV is called acute HIV, primary HIV or acute retroviral syndrome. Many individuals develop an influenza-like illness or a mononucleosis-like illness 2–4 weeks after exposure while others have no significant symptoms.BOOK, Diseases and disorders, 2008, Marshall Cavendish, Tarrytown, NY, 978-0-7614-7771-6, 25,weblink mdy-all, Symptoms occur in 40–90% of cases and most commonly include fever, large tender lymph nodes, throat inflammation, a rash, headache, tiredness, and/or sores of the mouth and genitals. The rash, which occurs in 20–50% of cases, presents itself on the trunk and is maculopapular, classically. Some people also develop opportunistic infections at this stage. Gastrointestinal symptoms, such as vomiting or diarrhea may occur. Neurological symptoms of peripheral neuropathy or Guillain–Barré syndrome also occurs. The duration of the symptoms varies, but is usually one or two weeks.Due to their nonspecific character, these symptoms are not often recognized as signs of HIV infection. Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in people presenting with an unexplained fever who may have risk factors for the infection.Mandell, Bennett, and Dolan (2010). Chapter 118.

Clinical latency

The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. Without treatment, this second stage of the natural history of HIV infection can last from about three yearsBOOK, Evian, Clive, Primary HIV/AIDS care: a practical guide for primary health care personnel in a clinical and supportive setting, 2006, Jacana, Houghton [South Africa], 978-1-77009-198-6, 29,weblink Updated 4th, mdy-all, to over 20 yearsBOOK, Charles B. Hicks, MD, Jacques W. A. J. Reeders & Philip Charles Goodman, Radiology of AIDS, 2001, Springer, Berlin [u.a.], 978-3-540-66510-6, 19,weblink mdy-all, (on average, about eight years).BOOK, Elliott, Tom, Lecture Notes: Medical Microbiology and Infection, 2012, John Wiley & Sons, 978-1-118-37226-5, 273,weblink mdy-all, While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. Between 50 and 70% of people also develop persistent generalized lymphadenopathy, characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of CD4+ T cells (T helper cells) without antiretroviral therapy for more than 5 years. These individuals are classified as "HIV controllers" or long-term nonprogressors (LTNP).JOURNAL, Blankson JN, Control of HIV-1 replication in elite suppressors, Discovery Medicine, 9, 46, 261–66, March 2010, 20350494, Another group consists of those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 infected persons.JOURNAL, Walker BD, Elite control of HIV Infection: implications for vaccines and treatment, Topics in HIV Medicine, 15, 4, 134–36, Aug–Sep 2007, 17720999,

Acquired immunodeficiency syndrome

(File:Symptoms of AIDS.svg|thumb|upright=1.25|alt=A diagram of a human torso labelled with the most common symptoms of AIDS|Main symptoms of AIDS.)Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4+ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV infection. In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%), and esophageal candidiasis. Other common signs include recurrent respiratory tract infections.Opportunistic infections may be caused by bacteria, viruses, fungi, and parasites that are normally controlled by the immune system.JOURNAL, Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA, Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa, Clinical Infectious Diseases, 36, 5, 652–62, March 2003, 12594648, 10.1086/367655, Which infections occur depends partly on what organisms are common in the person's environment. These infections may affect nearly every organ system.JOURNAL, Chu C, Selwyn PA, Complications of HIV infection: a systems-based approach, American Family Physician, 83, 4, 395–406, February 2011, 21322514, People with AIDS have an increased risk of developing various viral-induced cancers, including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer. Kaposi's sarcoma is the most common cancer occurring in 10 to 20% of people with HIV.Mandell, Bennett, and Dolan (2010). Chapter 169. The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%. Both these cancers are associated with human herpesvirus 8 (HHV-8). Cervical cancer occurs more frequently in those with AIDS because of its association with human papillomavirus (HPV). Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more common in those with HIV.JOURNAL, Mittal R, Rath S, Vemuganti GK, Ocular surface squamous neoplasia – Review of etio-pathogenesis and an update on clinico-pathological diagnosis, Saudi Journal of Ophthalmology, 27, 3, 177–86, July 2013, 24227983, 3770226, 10.1016/j.sjopt.2013.07.002, Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats (particularly at night), swollen lymph nodes, chills, weakness, and unintended weight loss.WEB, AIDS,weblink MedlinePlus, A.D.A.M., June 14, 2012, no,weblink" title="web.archive.org/web/20120618135541weblink">weblink June 18, 2012, mdy-all, Diarrhea is another common symptom, present in about 90% of people with AIDS.JOURNAL, Sestak K, Chronic diarrhea and AIDS: insights into studies with non-human primates, Current HIV Research, 3, 3, 199–205, July 2005, 16022653, 10.2174/1570162054368084, They can also be affected by diverse psychiatric and neurological symptoms independent of opportunistic infections and cancers.BOOK, Bradley's Neurology in Clinical Practice: Expert Consult – Online and Print, 6e (Bradley, Neurology in Clinical Practice e-dition 2v Set), 2012, Elsevier/Saunders, Philadelphia, 978-1-4377-0434-1, Murray ED, Buttner N, Price BH, 1, 6th, 101, Bradley WG, Daroff RB, Fenichel GM, Jankovic J, Depression and Psychosis in Neurological Practice,

Transmission

{{Risk of acquiring HIV}}HIV is spread by three main routes: sexual contact, significant exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as vertical transmission). There is no risk of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat, tears, urine, or vomit unless these are contaminated with blood.JOURNAL, Kripke C, Antiretroviral prophylaxis for occupational exposure to HIV, American Family Physician, 76, 3, 375–76, August 2007, 17708137, It is also possible to be co-infected by more than one strain of HIV—a condition known as HIV superinfection.JOURNAL, van der Kuyl AC, Cornelissen M, Identifying HIV-1 dual infections, Retrovirology, 4, 67, September 2007, 17892568, 2045676, 10.1186/1742-4690-4-67,

Sexual

The most frequent mode of transmission of HIV is through sexual contact with an infected person. However, an HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually.WEB,weblink Dear Colleague: September 27, 2017, McCray, Eugene, Mermin, Jonathan, September 27, 2017, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, February 1, 2018, JOURNAL, LeMessurier, J, Traversy, G, Varsaneux, O, Weekes, M, Avey, MT, Niragira, O, Gervais, R, Guyatt, G, Rodin, R, 19 November 2018, Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review., CMAJ : Canadian Medical Association Journal = Journal de l'Association Medicale Canadienne, 190, 46, E1350–E1360, 10.1503/cmaj.180311, 30455270, 6239917, Globally, the most common mode of HIV transmission is via sexual contacts between people of the opposite sex; however, the pattern of transmission varies among countries. {{as of|2014}}, most HIV transmission in the United States occurred among men who had sex with men (83% of new HIV diagnoses among males aged 13 and older and 67% of total new diagnoses). In the US, gay and bisexual men aged 13 to 24 accounted for an estimated 92% of new HIV diagnoses among all men in their age group and 27% of new diagnoses among all gay and bisexual men.WEB, HIV Among Gay and Bisexual Men,weblink 1 January 2017, no,weblink December 18, 2016, mdy-all, About 15% of gay and bisexual men have HIV while 28% of transgender women test positive in the US.With regard to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries. In low-income countries, the risk of female-to-male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per act for male-to-female transmission. The risk of transmission from anal intercourse is especially high, estimated as 1.4{{ndash}}1.7% per act in both heterosexual and homosexual contacts.JOURNAL, Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, Brookmeyer R, Global epidemiology of HIV infection in men who have sex with men, Lancet, 380, 9839, 367–77, July 2012, 22819660, 10.1016/S0140-6736(12)60821-6, 3805037, While the risk of transmission from oral sex is relatively low, it is still present.JOURNAL, Yu M, Vajdy M, Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes, Expert Opinion on Biological Therapy, 10, 8, 1181–95, August 2010, 20624114, 2904634, 10.1517/14712598.2010.496776, The risk from receiving oral sex has been described as "nearly nil";BOOK, Stürchler, Dieter A., Exposure a guide to sources of infections, 2006, ASM Press, Washington, DC, 978-1-55581-376-5, 544,weblink mdy-all, however, a few cases have been reported.BOOK, Pattman R, etal, Oxford handbook of genitourinary medicine, HIV, and sexual health, 2010, Oxford University Press, Oxford, 978-0-19-957166-6, 95, 2nd, The per-act risk is estimated at 0{{ndash}}0.04% for receptive oral intercourse.JOURNAL, Dosekun O, Fox J, An overview of the relative risks of different sexual behaviours on HIV transmission, Current Opinion in HIV and AIDS, 5, 4, 291–97, July 2010, 20543603, 10.1097/COH.0b013e32833a88a3, In settings involving prostitution in low income countries, risk of female-to-male transmission has been estimated as 2.4% per act and male-to-female transmission as 0.05% per act.JOURNAL, Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M, Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies, The Lancet. Infectious Diseases, 9, 2, 118–29, February 2009, 19179227, 4467783, 10.1016/S1473-3099(09)70021-0, Risk of transmission increases in the presence of many sexually transmitted infectionsJOURNAL, Ng BE, Butler LM, Horvath T, Rutherford GW, Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection, The Cochrane Database of Systematic Reviews, 3, CD001220, March 2011, 21412869, 10.1002/14651858.CD001220.pub3, Butler, Lisa M, and genital ulcers. Genital ulcers appear to increase the risk approximately fivefold. Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.The viral load of an infected person is an important risk factor in both sexual and mother-to-child transmission.JOURNAL, Anderson J, Women and HIV: motherhood and more, Current Opinion in Infectious Diseases, 25, 1, 58–65, February 2012, 22156896, 10.1097/QCO.0b013e32834ef514, During the first 2.5 months of an HIV infection a person's infectiousness is twelve times higher due to the high viral load associated with acute HIV. If the person is in the late stages of infection, rates of transmission are approximately eightfold greater. Commercial sex workers (including those in pornography) have an increased likelihood of contracting HIV.BOOK,weblink The Global HIV Epidemics among Sex Workers, Kerrigan, Deanna, World Bank Publications, 2012, 978-0-8213-9775-6, 1–5, mdy-all, BOOK, Aral, Sevgi, The New Public Health and STD/HIV Prevention: Personal, Public and Health Systems Approaches, 2013, Springer, 978-1-4614-4526-5, 120,weblink mdy-all, Rough sex can be a factor associated with an increased risk of transmission.JOURNAL, Klimas N, Koneru AO, Fletcher MA, Overview of HIV, Psychosomatic Medicine, 70, 5, 523–30, June 2008, 18541903, 10.1097/PSY.0b013e31817ae69f, Sexual assault is also believed to carry an increased risk of HIV transmission as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections.JOURNAL, Draughon JE, Sheridan DJ, Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: a review, Psychology, Health & Medicine, 17, 2, 235–54, 2012, 22372741, 10.1080/13548506.2011.579984,

Body fluids

(File:AIDS Poster If You're Dabbling in Drugs 1989.jpg|thumb|alt=A black-and-white poster of a young black man with a towel in his left hand with the words "If you are dabbling with drugs you could be dabbling with your life" above him|CDC poster from 1989 highlighting the threat of AIDS associated with drug use)The second most frequent mode of HIV transmission is via blood and blood products. Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%.JOURNAL, Baggaley RF, Boily MC, White RG, Alary M, Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis, AIDS, 20, 6, 805–12, April 2006, 16549963, 10.1097/01.aids.0000218543.46963.6d, The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the risk following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. In the United States intravenous drug users made up 12% of all new cases of HIV in 2009,WEB, HIV in the United States: An Overview,weblink Center for Disease Control and Prevention, March 2012, yes,weblink" title="web.archive.org/web/20130501102910weblink">weblink May 1, 2013, and in some areas more than 80% of people who inject drugs are HIV positive.HIV is transmitted in about 93% of blood transfusions using infected blood. In developed countries the risk of acquiring HIV from a blood transfusion is extremely low (less than one in half a million) where improved donor selection and HIV screening is performed; for example, in the UK the risk is reported at one in five millionWEB, Will I need a blood transfusion?, NHS patient information, 2011,weblink National Health Services, August 29, 2012, no,weblink" title="web.archive.org/web/20121025050828weblink">weblink October 25, 2012, mdy-all, and in the United States it was one in 1.5 million in 2008.JOURNAL, HIV transmission through transfusion – Missouri and Colorado, 2008, MMWR. Morbidity and Mortality Weekly Report, 59, 41, 1335–39, October 2010, 20966896, Centers for Disease Control Prevention (CDC), In low income countries, only half of transfusions may be appropriately screened (as of 2008),UNAIDS 2011 pg. 60–70 and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections.WEB, World Health Organization, WHO, 2001,weblink Blood safety ... for too few, January 17, 2005,weblink" title="web.archive.org/web/20050117092135weblink">weblink Although rare because of screening, it is possible to acquire HIV from organ and tissue transplantation.JOURNAL, Simonds RJ, HIV transmission by organ and tissue transplantation, AIDS, 7 Suppl 2, S35–38, November 1993, 8161444, 10.1097/00002030-199311002-00008, Unsafe medical injections play a significant role in HIV spread in sub-Saharan Africa. In 2007, between 12 and 17% of infections in this region were attributed to medical syringe use.JOURNAL, Reid SR, Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review, Harm Reduction Journal, 6, 24, August 2009, 19715601, 2741434, 10.1186/1477-7517-6-24, The World Health Organization estimates the risk of transmission as a result of a medical injection in Africa at 1.2%. Significant risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.People giving or receiving tattoos, piercings, and scarification are theoretically at risk of infection but no confirmed cases have been documented.WEB, Basic Information about HIV and AIDS,weblink Center for Disease Control and Prevention, April 2012, no,weblink June 18, 2017, mdy-all, It is not possible for mosquitoes or other insects to transmit HIV.WEB,weblink Why Mosquitoes Cannot Transmit AIDS, rci.rutgers.edu, Rutgers University, New Jersey Agricultural Experiment Station Publication No. H-40101-01-93, June 1, 2010, March 29, 2014, Wayne J., Crans,weblink" title="web.archive.org/web/20140329183346weblink">weblink March 29, 2014,

Mother-to-child

HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk, resulting in the baby also contracting HIV.WEB,weblink Preventing Mother-to-Child Transmission of HIV, HIV.gov, en, 2017-12-08, This is the third most common way in which HIV is transmitted globally. In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%. As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%. Preventive treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn.JOURNAL, Thorne C, Newell ML, HIV, Seminars in Fetal & Neonatal Medicine, 12, 3, 174–81, June 2007, 17321814, 10.1016/j.siny.2007.01.009, Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in those who do breastfeed.JOURNAL, White AB, Mirjahangir JF, Horvath H, Anglemyer A, Read JS, Antiretroviral interventions for preventing breast milk transmission of HIV, The Cochrane Database of Systematic Reviews, 10, 10, CD011323, October 2014, 25280769, 10.1002/14651858.CD011323, However, many of these measures are not available in the developing world. If blood contaminates food during pre-chewing it may pose a risk of transmission.If a woman is untreated, two years of breastfeeding results in an HIV/AIDS risk in her baby of about 17%. Treatment decreases this risk to 1 to 2% per year. Due to the increased risk of death without breastfeeding in many areas in the developing world, the World Health Organization recommends either: (1) the mother and baby being treated with antiretroviral medication while breastfeeding being continued (2) the provision of safe formula.WEB, Infant feeding in the context of HIV,weblink www.who.int, 9 March 2017, April 2011, no,weblink" title="web.archive.org/web/20170309062212weblink">weblink March 9, 2017, mdy-all, Infection with HIV during pregnancy is also associated with miscarriage.BOOK, Williams Obstetrics, Cunningham, F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, McGraw-Hill, 2013, 5, Abortion,

Virology

(File:HI-virion-structure en.svg|thumb|alt=diagram of microscopic viron structure|Diagram of a HIV virion structure)File:HIV-budding-Color.jpg|thumb|alt=A large round blue object with a smaller red object attached to it. Multiple small green spots are speckled over both.|Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocytelymphocyteHIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells.JOURNAL, Alimonti JB, Ball TB, Fowke KR, Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS, The Journal of General Virology, 84, Pt 7, 1649–61, July 2003, 12810858, 10.1099/vir.0.19110-0, HIV is a member of the genus Lentivirus,WEB, International Committee on Taxonomy of Viruses, International Committee on Taxonomy of Viruses, National Institutes of Health, 2002,weblinkweblink" title="web.archive.org/web/20060418135608weblink">weblink 61.0.6. Lentivirus, June 25, 2012, April 18, 2006, part of the family Retroviridae.WEB, International Committee on Taxonomy of Viruses, National Institutes of Health, 2002,weblink 61. Retroviridae,weblinkwww%2Encbi%2Enlm%2Enih%2Egov/ictvdb/ictvdb/61000000%2Ehtm, June 25, 2012, December 17, 2001, Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period.JOURNAL, Levy JA, HIV pathogenesis and long-term survival, AIDS, 7, 11, 1401–10, November 1993, 8280406, 10.1097/00002030-199311000-00001, Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors.JOURNAL, Smith JA, Daniel R, Following the path of the virus: the exploitation of host DNA repair mechanisms by retroviruses, ACS Chemical Biology, 1, 4, 217–26, May 2006, 17163676, 10.1021/cb600131q, Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system.BOOK, Martínez MA, RNA interference and viruses : current innovations and future trends, 2010, Caister Academic Press, Norfolk, 978-1-904455-56-1, 73, https:books.google.com/books?id=C5TY8W74scIC&pg=PA73, mdy-all, Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.BOOK, Gerald B. Pier, Immunology, infection, and immunity, 2004, ASM Press, Washington, DC, 978-1-55581-246-1, 550,weblink mdy-all, HIV is now known to spread between CD4+ T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it employs hybrid spreading mechanisms.JOURNAL, Zhang C, Zhou S, Groppelli E, Pellegrino P, Williams I, Borrow P, Chain BM, Jolly C, Hybrid spreading mechanisms and T cell activation shape the dynamics of HIV-1 infection, PLoS Computational Biology, 11, 4, e1004179, April 2015, 25837979, 4383537, 10.1371/journal.pcbi.1004179, 1503.08992, 2015PLSCB..11E4179Z, In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. HIV can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread.JOURNAL, Jolly C, Kashefi K, Hollinshead M, Sattentau QJ, HIV-1 cell to cell transfer across an Env-induced, actin-dependent synapse, The Journal of Experimental Medicine, 199, 2, 283–93, January 2004, 14734528, 2211771, 10.1084/jem.20030648, JOURNAL, Sattentau Q, Avoiding the void: cell-to-cell spread of human viruses, Nature Reviews. Microbiology, 6, 11, 815–26, November 2008, 18923409, 10.1038/nrmicro1972, The hybrid spreading mechanisms of HIV contribute to the virus's ongoing replication against antiretroviral therapies.JOURNAL, Sigal A, Kim JT, Balazs AB, Dekel E, Mayo A, Milo R, Baltimore D, Cell-to-cell spread of HIV permits ongoing replication despite antiretroviral therapy, Nature, 477, 7362, 95–98, August 2011, 21849975, 10.1038/nature10347, 2011Natur.477...95S, Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more virulent, more infective,JOURNAL, Gilbert PB, McKeague IW, Eisen G, Mullins C, Guéye-NDiaye A, Mboup S, Kanki PJ, Comparison of HIV-1 and HIV-2 infectivity from a prospective cohort study in Senegal, Statistics in Medicine, 22, 4, 573–93, February 2003, 12590415, 10.1002/sim.1342, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.JOURNAL, Reeves JD, Doms RW, Human immunodeficiency virus type 2, The Journal of General Virology, 83, Pt 6, 1253–65, June 2002, 12029140, 10.1099/0022-1317-83-6-1253,

Pathophysiology

(File:HIV and AIDS explained in a simple way.webm|thumb|upright=1.4|alt=video of AIDS explanation|HIV/AIDS explained in a simple way)(File:Hiv replication cycle.gif|thumb|upright=1.4|HIV replication cycle)After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood.JOURNAL, Piatak M, Saag MS, Yang LC, Clark SJ, Kappes JC, Luk KC, Hahn BH, Shaw GM, Lifson JD, High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR, Science, 259, 5102, 1749–54, March 1993, 8096089, 10.1126/science.8096089, 1993Sci...259.1749P, This response is accompanied by a marked drop in the number of circulating CD4+ T cells. The acute viremia is almost invariably associated with activation of CD8+ T cells, which kill HIV-infected cells, and subsequently with antibody production, or seroconversion. The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts recover. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.JOURNAL, Pantaleo G, Demarest JF, Schacker T, Vaccarezza M, Cohen OJ, Daucher M, Graziosi C, Schnittman SS, Quinn TC, Shaw GM, Perrin L, Tambussi G, Lazzarin A, Sekaly RP, Soudeyns H, Corey L, Fauci AS, The qualitative nature of the primary immune response to HIV infection is a prognosticator of disease progression independent of the initial level of plasma viremia, Proceedings of the National Academy of Sciences of the United States of America, 94, 1, 254–58, January 1997, 8990195, 19306, 10.1073/pnas.94.1.254, 1997PNAS...94..254P, Ultimately, HIV causes AIDS by depleting CD4+ T cells. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases.JOURNAL, Hel Z, McGhee JR, Mestecky J, HIV infection: first battle decides the war, Trends in Immunology, 27, 6, 274–81, June 2006, 16679064, 10.1016/j.it.2006.04.007, During the acute phase, HIV-induced cell lysis and killing of infected cells by CD8+ T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers.BOOK, Deenan, Pillay, Anna Maria, Genetti, Robin A., Weiss, Arie J., Zuckerman, etal, Principles and practice of clinical virology, 2007, Wiley, Hoboken, NJ, 978-0-470-51799-4, 905, Human Immunodeficiency Viruses,weblink 6th, Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.JOURNAL, Mehandru S, Poles MA, Tenner-Racz K, Horowitz A, Hurley A, Hogan C, Boden D, Racz P, Markowitz M, Primary HIV-1 infection is associated with preferential depletion of CD4+ T lymphocytes from effector sites in the gastrointestinal tract, The Journal of Experimental Medicine, 200, 6, 761–70, September 2004, 15365095, 2211967, 10.1084/jem.20041196, The reason for the preferential loss of mucosal CD4+ T cells is that the majority of mucosal CD4+ T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the cells, whereas only a small fraction of CD4+ T cells in the bloodstream do so.JOURNAL, Brenchley JM, Schacker TW, Ruff LE, Price DA, Taylor JH, Beilman GJ, Nguyen PL, Khoruts A, Larson M, Haase AT, Douek DC, CD4+ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract, The Journal of Experimental Medicine, 200, 6, 749–59, September 2004, 15365096, 2211962, 10.1084/jem.20040874, A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV-1 infection.JOURNAL, Olson WC, Jacobson JM, CCR5 monoclonal antibodies for HIV-1 therapy, Current Opinion in HIV and AIDS, 4, 2, 104–11, March 2009, 19339948, 2760828, 10.1097/COH.0b013e3283224015, HIV seeks out and destroys CCR5 expressing CD4+ T cells during acute infection.BOOK, editor, Julio Aliberti, Control of Innate and Adaptive Immune Responses During Infectious Diseases, Springer Verlag, New York, 978-1-4614-0483-5, 145,weblink 2011, mdy-all, A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4+ T cells in mucosal tissues remain particularly affected. Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase.JOURNAL, Appay V, Sauce D, Immune activation and inflammation in HIV-1 infection: causes and consequences, The Journal of Pathology, 214, 2, 231–41, January 2008, 18161758, 10.1002/path.2276, Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease.JOURNAL, Brenchley JM, Price DA, Schacker TW, Asher TE, Silvestri G, Rao S, Kazzaz Z, Bornstein E, Lambotte O, Altmann D, Blazar BR, Rodriguez B, Teixeira-Johnson L, Landay A, Martin JN, Hecht FM, Picker LJ, Lederman MM, Deeks SG, Douek DC, Microbial translocation is a cause of systemic immune activation in chronic HIV infection, Nature Medicine, 12, 12, 1365–71, December 2006, 17115046, 1717013, 10.1038/nm1511,

Diagnosis

(File:Hiv-timecourse.png|thumb|upright=1.35|alt=A graph with two lines. One in blue moves from high on the right to low on the left with a brief rise in the middle. The second line in red moves from zero to very high then drops to low and gradually rises to high again|A generalized graph of the relationship between HIV copies (viral load) and CD4+ T cell counts over the average course of untreated HIV infection. {{legend-line|blue solid 2px|CD4+ T Lymphocyte count (cells/mm³)}} {{legend-line|red solid 2px|HIV RNA copies per mL of plasma}}){| class="wikitable floatright"|Antibody test (rapid test, ELISA 3rd gen)|23–90|Antibody and p24 antigen test (ELISA 4th gen)|18–45|PCR|10–33HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms. HIV screening is recommended by the United States Preventive Services Task Force for all people 15 years to 65 years of age including all pregnant women.JOURNAL, Moyer VA, Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement, Annals of Internal Medicine, 159, 1, 51–60, July 2013, 23698354, 10.7326/0003-4819-159-1-201307020-00645, Additionally, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. In many areas of the world, a third of HIV carriers only discover they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.

HIV testing

Most people infected with HIV develop specific antibodies (i.e. seroconvert) within three to twelve weeks after the initial infection. Diagnosis of primary HIV before seroconversion is done by measuring HIV-RNA or p24 antigen. Positive results obtained by antibody or PCR testing are confirmed either by a different antibody or by PCR.Antibody tests in children younger than 18 months are typically inaccurate due to the continued presence of maternal antibodies.JOURNAL, Kellerman S, Essajee S, HIV testing for children in resource-limited settings: what are we waiting for?, PLoS Medicine, 7, 7, e1000285, July 2010, 20652012, 2907270, 10.1371/journal.pmed.1000285, Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen. Much of the world lacks access to reliable PCR testing and many places simply wait until either symptoms develop or the child is old enough for accurate antibody testing. In sub-Saharan Africa as of 2007–2009, between 30 and 70% of the population were aware of their HIV status.UNAIDS 2011 pg. 70–80 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested which represented a significant increase compared to previous years.

Classifications

Two main clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease, and the CDC classification system for HIV infection. The CDC's classification system is more frequently adopted in developed countries. Since the WHO's staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical purposes.The World Health Organization first proposed a definition for AIDS in 1986. Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007.BOOK, WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children, 6–16,weblink 2007, World Health Organization, Geneva, 978-92-4-159562-9, no,weblink" title="web.archive.org/web/20131031044253weblink">weblink October 31, 2013, mdy-all, The WHO system uses the following categories:
  • Primary HIV infection: May be either asymptomatic or associated with acute retroviral syndrome
  • Stage I: HIV infection is asymptomatic with a CD4+ T cell count (also known as CD4 count) greater than 500 per microlitre (µl or cubic mm) of blood. May include generalized lymph node enlargement.
  • Stage II: Mild symptoms, which may include minor mucocutaneous manifestations and recurrent upper respiratory tract infections. A CD4 count of less than 500/µl
  • Stage III: Advanced symptoms, which may include unexplained chronic diarrhea for longer than a month, severe bacterial infections including tuberculosis of the lung, and a CD4 count of less than 350/µl
  • Stage IV or AIDS: severe symptoms, which include toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi, or lungs, and Kaposi's sarcoma. A CD4 count of less than 200/µl
The United States Center for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008 and 2014.JOURNAL, Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT, Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months".{{cite journal, Siegfried N, Muller M, Deeks JJ, Volmink J, Male circumcision for prevention of heterosexual acquisition of HIV in men, The Cochrane Database of Systematic Reviews, 2, CD003362, April 2009, 19370585, 10.1002/14651858.CD003362.pub2, Siegfried, Nandi, Due to these studies, both the World Health Organization and UNAIDS recommended male circumcision in 2007 as a method of preventing female-to-male HIV transmission in areas with high rates of HIV.WEB, WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention, World Health Organization, Mar 28, 2007,weblink no,weblink" title="web.archive.org/web/20110703140439weblink">weblink July 3, 2011, mdy-all, However, whether it protects against male-to-female transmission is disputed,JOURNAL, Larke N, Male circumcision, HIV and sexually transmitted infections: a review, British Journal of Nursing, 19, 10, 629–34, May 27, 2010, 20622758, 3836228, 10.12968/bjon.2010.19.10.48201, JOURNAL, Eaton L, Kalichman SC, Behavioral aspects of male circumcision for the prevention of HIV infection, Current HIV/AIDS Reports, 6, 4, 187–93, November 2009, 19849961, 3557929, 10.1007/s11904-009-0025-9, (subscription required) and whether it is of benefit in developed countries and among men who have sex with men is undetermined.JOURNAL, Kim HH, Li PS, Goldstein M, Male circumcision: Africa and beyond?, Current Opinion in Urology, 20, 6, 515–19, November 2010, 20844437, 10.1097/MOU.0b013e32833f1b21, JOURNAL, Templeton DJ, Millett GA, Grulich AE, Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men, Current Opinion in Infectious Diseases, 23, 1, 45–52, February 2010, 19935420, 10.1097/QCO.0b013e328334e54d, JOURNAL, Wiysonge CS, Kongnyuy EJ, Shey M, Muula AS, Navti OB, Akl EA, Lo YR, Male circumcision for prevention of homosexual acquisition of HIV in men, The Cochrane Database of Systematic Reviews, 6, CD007496, June 2011, 21678366, 10.1002/14651858.CD007496.pub2, Wiysonge, Charles Shey, The International Antiviral Society, however, does recommend it for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men.JOURNAL, Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JS, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA, HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society–USA Panel, JAMA, 312, 4, 390–409, Jul 23–30, 2014, 25038358, 6309682, 10.1001/jama.2014.7999, Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behavior, thus negating its preventive effects.JOURNAL, Eaton LA, Kalichman S, Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies, Current HIV/AIDS Reports, 4, 4, 165–72, December 2007, 18366947, 2937204, 10.1007/s11904-007-0024-7, Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk.JOURNAL, Underhill K, Operario D, Montgomery P, Abstinence-only programs for HIV infection prevention in high-income countries, The Cochrane Database of Systematic Reviews, 4, CD005421, October 2007, 17943855, 10.1002/14651858.CD005421.pub2,weblink Operario,weblink" title="web.archive.org/web/20101125105707weblink">weblink mdy-all, no, Don, November 25, 2010, Evidence of any benefit from peer education is equally poor.JOURNAL, Tolli MV, Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies, Health Education Research, 27, 5, 904–13, October 2012, 22641791, 10.1093/her/cys055, Comprehensive sexual education provided at school may decrease high risk behavior.JOURNAL, Ljubojević S, Lipozenčić J, Sexually transmitted infections and adolescence, Acta Dermatovenerologica Croatica, 18, 4, 305–10, 2010, 21251451, BOOK,weblink International technical guidance on sexuality education: an evidence-informed approach, UNESCO, 2018, 978-92-3-100259-5, Paris, 12, A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV.JOURNAL, Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH, Discerning patterns of human immunodeficiency virus risk in healthy young adults, The American Journal of Medicine, 121, 9, 758–64, September 2008, 18724961, 2597652, 10.1016/j.amjmed.2008.04.022, Voluntary counseling and testing people for HIV does not affect risky behavior in those who test negative but does increase condom use in those who test positive.JOURNAL, Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M, Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries, The Cochrane Database of Systematic Reviews, 9, 9, CD001224, September 2012, 22972050, 3931252, 10.1002/14651858.CD001224.pub4, It is not known whether treating other sexually transmitted infections is effective in preventing HIV.

Pre-exposure

Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/µL is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP).JOURNAL, Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N, Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples, The Cochrane Database of Systematic Reviews, 4, 4, CD009153, April 2013, 23633367, 4026368, 10.1002/14651858.CD009153.pub3, TASP is associated with a 10 to 20 fold reduction in transmission risk.JOURNAL, Chou R, Selph S, Dana T, Bougatsos C, Zakher B, Blazina I, Korthuis PT, Screening for HIV: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation, Annals of Internal Medicine, 157, 10, 706–18, November 2012, 23165662, 10.7326/0003-4819-157-10-201211200-00007, Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in people at high risk including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa.JOURNAL, Owens, Douglas K., Davidson, Karina W., Krist, Alex H., Barry, Michael J., Cabana, Michael, Caughey, Aaron B., Curry, Susan J., Doubeni, Chyke A., Epling, John W., Kubik, Martha, Landefeld, C. Seth, Mangione, Carol M., Pbert, Lori, Silverstein, Michael, Simon, Melissa A., Tseng, Chien-Wen, Wong, John B., Preexposure Prophylaxis for the Prevention of HIV Infection, JAMA, 11 June 2019, 321, 22, 2203, 10.1001/jama.2019.6390, It may also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years.JOURNAL, Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, Chuachoowong R, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Hendrix CW, Vanichseni S, Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial, Lancet, 381, 9883, 2083–90, June 2013, 23769234, 10.1016/S0140-6736(13)61127-7, The USPSTF, ini a 2018 draft, recommended PrEP in those who are at high risk.WEB, Draft Recommendation Statement: Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis – US Preventive Services Task Force,weblink www.uspreventiveservicestaskforce.org, 21 November 2018, en, Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV.JOURNAL, Recommendations for prevention of HIV transmission in health-care settings, MMWR Supplements, 36, 2, 1S–18S, August 1987, 3112554,weblinkweblink mdy-all, no, July 9, 2017, Centers for Disease Control (CDC), Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programs and opioid substitution therapy appear effective in decreasing this risk.JOURNAL, Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN, Combination HIV prevention: significance, challenges, and opportunities, Current HIV/AIDS Reports, 8, 1, 62–72, March 2011, 20941553, 3036787, 10.1007/s11904-010-0063-3, JOURNAL, MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, Degenhardt L, Hickman M, Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis, BMJ, 345, oct03 3, e5945, October 2012, 23038795, 3489107, 10.1136/bmj.e5945,

Post-exposure

A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV-positive blood or genital secretions is referred to as post-exposure prophylaxis (PEP). The use of the single agent zidovudine reduces the risk of a HIV infection five-fold following a needle-stick injury.JOURNAL, HIV exposure through contact with body fluids, Prescrire International, 21, 126, 100–01, 103–05, April 2012, 22515138, {{as of|2013}}, the prevention regimen recommended in the United States consists of three medications—tenofovir, emtricitabine and raltegravir—as this may reduce the risk further.JOURNAL, Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL, Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis, Infection Control and Hospital Epidemiology, 34, 9, 875–92, September 2013, 23917901, 10.1086/672271, PEP treatment is recommended after a sexual assault when the perpetrator is known to be HIV positive, but is controversial when their HIV status is unknown.JOURNAL, Linden JA, Clinical practice. Care of the adult patient after sexual assault, The New England Journal of Medicine, 365, 9, 834–41, September 2011, 21879901, 10.1056/NEJMcp1102869, The duration of treatment is usually four weeksJOURNAL, Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford GW, Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure, The Cochrane Database of Systematic Reviews, 1, CD002835, January 2007, 17253483, 10.1002/14651858.CD002835.pub3, Young, Taryn, vanc, and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea (24%), fatigue (22%), emotional distress (13%) and headaches (9%).

Mother-to-child

Programs to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of transmission by 92–99%.JOURNAL, Coutsoudis A, Kwaan L, Thomson M, Prevention of vertical transmission of HIV-1 in resource-limited settings, Expert Review of Anti-Infective Therapy, 8, 10, 1163–75, October 2010, 20954881, 10.1586/eri.10.94, This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant and potentially includes bottle feeding rather than breastfeeding.JOURNAL, Siegfried N, van der Merwe L, Brocklehurst P, Sint TT, Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection, The Cochrane Database of Systematic Reviews, 7, CD003510, July 2011, 21735394, 10.1002/14651858.CD003510.pub3, Siegfried, Nandi, If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, mothers should avoid breastfeeding their infants; however exclusive breastfeeding is recommended during the first months of life if this is not the case.WEB,weblink March 12, 2008, WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV – Infections in Pregnant Women, Mothers and their Infants – Consensus statement, October 25–27, 2006,weblink" title="web.archive.org/web/20080409065845weblink">weblink April 9, 2008, no, If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.JOURNAL, Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS, Interventions for preventing late postnatal mother-to-child transmission of HIV, The Cochrane Database of Systematic Reviews, 1, CD006734, January 2009, 19160297, 10.1002/14651858.CD006734.pub2, Horvath, Tara, In 2015, Cuba became the first country in the world to eradicate mother-to-child transmission of HIV.WEB,weblink WHO validates elimination of mother-to-child transmission of HIV and syphilis in Cuba, WHO, June 30, 2015, August 30, 2015, no,weblink" title="web.archive.org/web/20150904154356weblink">weblink September 4, 2015, mdy-all,

Vaccination

Currently, there is no licensed vaccine for HIV or AIDS. The most effective vaccine trial to date, RV 144, was published in 2009 and found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine.JOURNAL, Reynell L, Trkola A, HIV vaccines: an attainable goal?, Swiss Medical Weekly, 142, w13535, March 2012, 22389197, 10.4414/smw.2012.13535, Further trials of the RV 144 vaccine are ongoing.WEB, U.S. Army Office of the Surgeon General, HIV Vaccine Trial in Thai Adults, ClinicalTrials.gov, March 21, 2011, June 28, 2011,weblink no,weblink" title="web.archive.org/web/20111019080046weblink">weblink October 19, 2011, mdy-all, WEB, U.S. Army Office of the Surgeon General, Follow up of Thai Adult Volunteers With Breakthrough HIV Infection After Participation in a Preventive HIV Vaccine Trial, ClinicalTrials.gov, June 2, 2010,weblink no,weblink" title="web.archive.org/web/20120609095117weblink">weblink June 9, 2012, mdy-all,

Treatment

There is currently no cure or effective HIV vaccine. Treatment consists of highly active antiretroviral therapy (HAART) which slows progression of the disease.JOURNAL, May MT, Ingle SM, Life expectancy of HIV-positive adults: a review, Sexual Health, 8, 4, 526–33, December 2011, 22127039, 10.1071/SH11046, {{as of|2010}} more than 6.6 million people were taking them in low and middle income countries.UNAIDS 2011 pg. 1–10 Treatment also includes preventive and active treatment of opportunistic infections.

Antiviral therapy

File:Stribild bottle Dutch labeling.jpg|thumb|alt=A white prescription bottle with the label Stribild. Next to it are ten green oblong pills with the marking 1 on one side and GSI on the other.|Stribild – a common once-daily ART regime consisting of elvitegravir, emtricitabine, tenofovir and the booster cobicistatcobicistatCurrent HAART options are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes," of antiretroviral agents.BOOK, Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach, 2010, World Health Organization, 978-92-4-159976-4, 19–20,weblink no,weblink" title="web.archive.org/web/20120709184257weblink">weblink July 9, 2012, mdy-all, Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC).BOOK, Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, 2013, 28–30, World Health Organization, 978-92-4-150572-7,weblink no,weblink" title="web.archive.org/web/20140209194943weblink">weblink February 9, 2014, mdy-all, Combinations of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness.The World Health Organization and United States recommends antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count.WEB, Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents,weblink Department of Health and Human Services, January 3, 2014, i, February 12, 2013, no,weblink November 1, 2016, mdy-all, Once treatment is begun it is recommended that it is continued without breaks or "holidays". Many people are diagnosed only after treatment ideally should have begun. The desired outcome of treatment is a long term plasma HIV-RNA count below 50 copies/mL.JOURNAL, Vogel M, Schwarze-Zander C, Wasmuth JC, Spengler U, Sauerbruch T, Rockstroh JK, The treatment of patients with HIV, Deutsches Arzteblatt International, 107, 28–29, 507–15; quiz 516, July 2010, 20703338, 2915483, 10.3238/arztebl.2010.0507, Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate. Inadequate control is deemed to be greater than 400 copies/mL. Based on these criteria treatment is effective in more than 95% of people during the first year.Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death.JOURNAL, Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR, Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies, Lancet, 373, 9672, 1352–63, April 2009, 19361855, 2670965, 10.1016/S0140-6736(09)60612-7, In the developing world treatment also improves physical and mental health.JOURNAL, Beard J, Feeley F, Rosen S, Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review, AIDS Care, 21, 11, 1343–56, November 2009, 20024710, 10.1080/09540120902889926, With treatment there is a 70% reduced risk of acquiring tuberculosis. Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission.JOURNAL, Attia S, Egger M, Müller M, Zwahlen M, Low N, Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis, AIDS, 23, 11, 1397–404, July 2009, 19381076, 10.1097/QAD.0b013e32832b7dca, The effectiveness of treatment depends to a large part on compliance. Reasons for non-adherence include poor access to medical care,JOURNAL, Orrell C, Antiretroviral adherence in a resource-poor setting, Current HIV/AIDS Reports, 2, 4, 171–76, November 2005, 16343374, 10.1007/s11904-005-0012-8, inadequate social supports, mental illness and drug abuse.JOURNAL, Malta M, Strathdee SA, Magnanini MM, Bastos FI, Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review, Addiction, 103, 8, 1242–57, August 2008, 18855813, 10.1111/j.1360-0443.2008.02269.x, The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence.JOURNAL, Nachega JB, Marconi VC, van Zyl GU, Gardner EM, Preiser W, Hong SY, Mills EJ, Gross R, HIV treatment adherence, drug resistance, virologic failure: evolving concepts, Infectious Disorders Drug Targets, 11, 2, 167–74, April 2011, 21406048, 5072419, 10.2174/187152611795589663, Even though cost is an important issue with some medications,JOURNAL, Orsi F, d'almeida C, Soaring antiretroviral prices, TRIPS and TRIPS flexibilities: a burning issue for antiretroviral treatment scale-up in developing countries, Current Opinion in HIV and AIDS, 5, 3, 237–41, May 2010, 20539080, 10.1097/COH.0b013e32833860ba, 47% of those who needed them were taking them in low and middle income countries {{as of|2010|lc=y}} and the rate of adherence is similar in low-income and high-income countries.JOURNAL, Nachega JB, Mills EJ, Schechter M, Antiretroviral therapy adherence and retention in care in middle-income and low-income countries: current status of knowledge and research priorities, Current Opinion in HIV and AIDS, 5, 1, 70–77, January 2010, 20046150, 10.1097/COH.0b013e328333ad61, Specific adverse events are related to the antiretroviral agent taken. Some relatively common adverse events include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus, especially with protease inhibitors. Other common symptoms include diarrhea,JOURNAL, Montessori V, Press N, Harris M, Akagi L, Montaner JS, Adverse effects of antiretroviral therapy for HIV infection, Canadian Medical Association Journal, 170, 2, 229–38, January 2004, 14734438, 315530, JOURNAL, Burgoyne RW, Tan DH, Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act, The Journal of Antimicrobial Chemotherapy, 61, 3, 469–73, March 2008, 18174196, 10.1093/jac/dkm499,weblink and an increased risk of cardiovascular disease.JOURNAL, Barbaro G, Barbarini G, Human immunodeficiency virus & cardiovascular risk, The Indian Journal of Medical Research, 134, 6, 898–903, December 2011, 22310821, 3284097, 10.4103/0971-5916.92634, Newer recommended treatments are associated with fewer adverse effects. Certain medications may be associated with birth defects and therefore may be unsuitable for women hoping to have children.Treatment recommendations for children are somewhat different from those for adults. The World Health Organization recommends treating all children less than 5 years of age; children above 5 are treated like adults.WEB, Summary of recommendations on when to start ART in children,weblink Consolidated ARV guidelines, June 2013, PDF, June 2013, no,weblink" title="web.archive.org/web/20141018175301weblink">weblink October 18, 2014, mdy-all, The United States guidelines recommend treating all children less than 12 months of age and all those with HIV RNA counts greater than 100,000 copies/mL between one year and five years of age.WEB, Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection,weblink Department of Health and Human Services, February 2014, March 2014, no,weblink September 14, 2015, mdy-all,

Opportunistic infections

Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections. Adults and adolescents who are living with HIV (even on anti-retroviral therapy) with no evidence of active tuberculosis in settings with high tuberculosis burden should receive isoniazid preventive therapy (IPT), the tuberculin skin test can be used to help decide if IPT is needed.WEB, Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings,weblink Department of HIV/AIDS, World Health Organization 2011, PDF, 2011, no,weblink" title="web.archive.org/web/20141019114659weblink">weblink October 19, 2014, mdy-all, Vaccination against hepatitis A and B is advised for all people at risk of HIV before they become infected; however it may also be given after infection.JOURNAL, Laurence J, Hepatitis A and B virus immunization in HIV-infected persons, The AIDS Reader, 16, 1, 15–17, January 2006, 16433468, Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age and ceasing breastfeeding in infants born to HIV positive mothers is recommended in resource limited settings.UNAIDS 2011 pg. 150–160 It is also recommended to prevent PCP when a person's CD4 count is below 200 cells/uL and in those who have or have previously had PCP.JOURNAL, Huang L, Cattamanchi A, Davis JL, den Boon S, Kovacs J, Meshnick S, Miller RF, Walzer PD, Worodria W, Masur H, HIV-associated Pneumocystis pneumonia, Proceedings of the American Thoracic Society, 8, 3, 294–300, June 2011, 21653531, 3132788, 10.1513/pats.201009-062WR, People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and MAC.WEB, United States Department of Health and Human Services, Department of Health and Human Services, February 2, 2007,weblink 26 July 2018, Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America, Appropriate preventive measures have reduced the rate of these infections by 50% between 1992 and 1997. Influenza vaccination and pneumococcal polysaccharide vaccine are often recommended in people with HIV/AIDS with some evidence of benefit.JOURNAL, Beck CR, McKenzie BC, Hashim AB, Harris RC, Zanuzdana A, Agboado G, etal, Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis, Influenza and Other Respiratory Viruses, 7 Suppl 2, 72–75, September 2013, 24034488, 5909396, 10.1111/irv.12084, JOURNAL, Lee KY, Tsai MS, Kuo KC, Tsai JC, Sun HY, Cheng AC, Chang SY, Lee CH, Hung CC, Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy, Human Vaccines & Immunotherapeutics, 10, 12, 3700–10, 2014, 25483681, 4514044, 10.4161/hv.32247,

Diet

The World Health Organization (WHO) has issued recommendations regarding nutrient requirements in HIV/AIDS.BOOK, World Health Organization, Nutrient requirements for people living with HIV/AIDS: Report of a technical consultation, May 2003, Geneva,weblink March 31, 2009,weblink" title="web.archive.org/web/20090325030154weblink">weblink March 25, 2009, no, A generally healthy diet is promoted. Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the WHO; higher intake of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults, and is not recommended unless there is documented deficiency.JOURNAL, Forrester JE, Sztam KA, Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations?, The American Journal of Clinical Nutrition, 94, 6, 1683S–1689S, December 2011, 22089440, 3226021, 10.3945/ajcn.111.011999, JOURNAL, Nunnari G, Coco C, Pinzone MR, Pavone P, Berretta M, Di Rosa M, Schnell M, Calabrese G, Cacopardo B, The role of micronutrients in the diet of HIV-1-infected individuals, Frontiers in Bioscience, 4, 2442–56, June 2012, 22652651,weblinkweblink mdy-all, no, April 16, 2015, JOURNAL, Zeng L, Zhang L, Efficacy and safety of zinc supplementation for adults, children and pregnant women with HIV infection: systematic review, Tropical Medicine & International Health, 16, 12, 1474–82, December 2011, 21895892, 10.1111/j.1365-3156.2011.02871.x, Dietary supplementation for people who are infected with HIV and who have inadequate nutrition or dietary deficiencies may strengthen their immune systems or help them recover from infections, however evidence indicating an overall benefit in morbidity or reduction in mortality is not consistent.JOURNAL, Visser ME, Durao S, Sinclair D, Irlam JH, Siegfried N, Micronutrient supplementation in adults with HIV infection, The Cochrane Database of Systematic Reviews, 5, CD003650, May 2017, 28518221, 5458097, 10.1002/14651858.CD003650.pub4, Evidence for supplementation with selenium is mixed with some tentative evidence of benefit.JOURNAL, Stone CA, Kawai K, Kupka R, Fawzi WW, Role of selenium in HIV infection, Nutrition Reviews, 68, 11, 671–81, November 2010, 20961297, 3066516, 10.1111/j.1753-4887.2010.00337.x, For pregnant and lactating women with HIV, multivitamin supplement improves outcomes for both mothers and children.JOURNAL, Siegfried N, Irlam JH, Visser ME, Rollins NN, Micronutrient supplementation in pregnant women with HIV infection, The Cochrane Database of Systematic Reviews, 3, CD009755, March 2012, 22419344, 10.1002/14651858.CD009755, If the pregnant or lactating mother has been advised to take anti-retroviral medication to prevent mother-to-child HIV transmission, multivitamin supplements should not replace these treatments. There is some evidence that vitamin A supplementation in children with an HIV infection reduces mortality and improves growth.JOURNAL, Irlam JH, Siegfried N, Visser ME, Rollins NC, Micronutrient supplementation for children with HIV infection, The Cochrane Database of Systematic Reviews, 10, CD010666, October 2013, 24114375, 10.1002/14651858.CD010666,

Alternative medicine

In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine,JOURNAL, Littlewood RA, Vanable PA, Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care, AIDS Care, 20, 8, 1002–18, September 2008, 18608078, 2570227, 10.1080/09540120701767216, even though the effectiveness of most of these therapies has not been established.JOURNAL, Mills E, Wu P, Ernst E, Complementary therapies for the treatment of HIV: in search of the evidence, International Journal of STD & AIDS, 16, 6, 395–403, June 2005, 15969772, 10.1258/0956462054093962, There is not enough evidence to support the use of herbal medicines.JOURNAL, Liu JP, Manheimer E, Yang M, Herbal medicines for treating HIV infection and AIDS, The Cochrane Database of Systematic Reviews, 3, CD003937, July 2005, 16034917, 10.1002/14651858.CD003937.pub2, Liu, Jian Ping, There is insufficient evidence to recommend or support the use of medical cannabis to try to increase appetite or weight gain.JOURNAL, Lutge EE, Gray A, Siegfried N, The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS, The Cochrane Database of Systematic Reviews, 4, 4, CD005175, April 2013, 23633327, 10.1002/14651858.CD005175.pub3,

Prognosis

(File:HIV-AIDS world map-Deaths per million persons-WHO2012.svg|upright=1.3|thumb|Deaths due to HIV/AIDS per million persons in 2012 {{legend|#ffff20|0}}{{legend|#ffe820|1–4}}{{legend|#ffd820|5–12}}{{legend|#ffc020|13–34}}{{legend|#ffa020|35–61}}{{legend|#ff9a20|62–134}}{{legend|#f08015|135–215}}{{legend|#e06815|216–458}}{{legend|#d85010|459–1,402}}{{legend|#d02010|1,403–5,828}})HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world. Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months.JOURNAL, Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA, HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?, AIDS, 16, 4, 597–603, March 2002, 11873003, 10.1097/00002030-200203080-00011, JOURNAL, Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis, Zwahlen M, Egger M,weblink 2006, March 19, 2008, UNAIDS Obligation HQ/05/422204,weblink" title="web.archive.org/web/20080409065844weblink">weblink April 9, 2008, no, HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years.JOURNAL, Knoll B, Lassmann B, Temesgen Z, Current status of HIV infection: a review for non-HIV-treating physicians, International Journal of Dermatology, 46, 12, 1219–28, December 2007, 18173512, 10.1111/j.1365-4632.2007.03520.x, JOURNAL, Antiretroviral Therapy Cohort Collaboration, Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies, Lancet, 372, 9635, 293–99, July 2008, 18657708, 3130543, 10.1016/S0140-6736(08)61113-7, JOURNAL, Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, Weinstein MC, Seage GR, Moore RD, Freedberg KA, The lifetime cost of current human immunodeficiency virus care in the United States, Medical Care, 44, 11, 990–97, November 2006, 17063130, 10.1097/01.mlr.0000228021.89490.2a, This is between two thirds and nearly that of the general population.JOURNAL, van Sighem AI, Gras LA, Reiss P, Brinkman K, de Wolf F, Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals, AIDS, 24, 10, 1527–35, June 2010, 20467289, 10.1097/QAD.0b013e32833a3946, If treatment is started late in the infection, prognosis is not as good: for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years. Half of infants born with HIV die before two years of age without treatment.File:HIV-AIDS world map - DALY - WHO2004.svg|thumb|left|upright=1.3|alt=A map of the world where much of it is colored yellow or orange except for sub Saharan Africa which is colored red or dark red|alt=A map of the world where much of it is colored yellow or orange except for sub Saharan Africa which is colored red or dark red|#b3b3b3|no data}}{{legend|#ffff65|≤ 10}}{{legend|#fff200|10–25}}{{legend|#ffdc00|25–50}}{{legend|#ffc600|50–100}}{{Col-break}}{{legend|#ffb000|100–500}}{{legend|#ff9a00|500–1000}}{{legend|#ff8400|1,000–2,500}}{{legend|#ff6e00|2,500–5,000}}{{legend|#ff5800|5,000–7500}}{{Col-break}}{{legend|#ff4200|7,500–10,000}}{{legend|#ff2c00|10,000–50,000}}{{legend|#cb0000|≥ 50,000}}{{col-end}}The primary causes of death from HIV/AIDS are opportunistic infections and cancer, both of which are frequently the result of the progressive failure of the immune system.BOOK, Smith, Blaine T., Concepts in immunology and immunotherapeutics, 2008, American Society of Health-System Pharmacists, Bethesda, MD, 978-1-58528-127-5, 143,weblink 4th, mdy-all, JOURNAL, Cheung MC, Pantanowitz L, Dezube BJ, AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy, The Oncologist, 10, 6, 412–26, Jun–Jul 2005, 15967835, 10.1634/theoncologist.10-6-412, Risk of cancer appears to increase once the CD4 count is below 500/μL. The rate of clinical disease progression varies widely between individuals and has been shown to be affected by a number of factors such as a person's susceptibility and immune function;JOURNAL, Tang J, Kaslow RA, The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy, AIDS, 17 Suppl 4, Suppl 4, S51–60, 2003, 15080180, 10.1097/00002030-200317004-00006, their access to health care, the presence of co-infections;JOURNAL, Lawn SD, AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection, The Journal of Infection, 48, 1, 1–12, January 2004, 14667787, 10.1016/j.jinf.2003.09.001, and the particular strain (or strains) of the virus involved.JOURNAL, Campbell GR, Pasquier E, Watkins J, Bourgarel-Rey V, Peyrot V, Esquieu D, Barbier P, de Mareuil J, Braguer D, Kaleebu P, Yirrell DL, Loret EP, The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis, The Journal of Biological Chemistry, 279, 46, 48197–204, November 2004, 15331610, 10.1074/jbc.M406195200, JOURNAL, Campbell GR, Watkins JD, Esquieu D, Pasquier E, Loret EP, Spector SA, The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells, The Journal of Biological Chemistry, 280, 46, 38376–82, November 2005, 16155003, 10.1074/jbc.M506630200, Tuberculosis co-infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV-infected people and causing 25% of HIV-related deaths.WEB, Tuberculosis,weblink Fact sheet 104, World Health Organization, March 2012, August 29, 2012, no,weblink" title="web.archive.org/web/20120823143802weblink">weblink August 23, 2012, mdy-all, HIV is also one of the most important risk factors for tuberculosis.BOOK, Global tuberculosis control 2011, World Health Organization,weblink 2011, 978-92-4-156438-0, August 29, 2012, yes,weblink" title="web.archive.org/web/20120906223650weblink">weblink September 6, 2012, Hepatitis C is another very common co-infection where each disease increases the progression of the other.BOOK, Rubin R, Strayer DS, Rubin E, Rubin's pathology : clinicopathologic foundations of medicine, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 978-1-60547-968-2, 154,weblink Sixth, 2011, mdy-all, The two most common cancers associated with HIV/AIDS are Kaposi's sarcoma and AIDS-related non-Hodgkin's lymphoma. Other cancers that are more frequent include anal cancer, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer.JOURNAL, Nelson VM, Benson AB, Epidemiology of Anal Canal Cancer, Surgical Oncology Clinics of North America, 26, 1, 9–15, January 2017, 27889039, 10.1016/j.soc.2016.07.001, Even with anti-retroviral treatment, over the long term HIV-infected people may experience neurocognitive disorders,JOURNAL, Woods SP, Moore DJ, Weber E, Grant I, Cognitive neuropsychology of HIV-associated neurocognitive disorders, Neuropsychology Review, 19, 2, 152–68, June 2009, 19462243, 2690857, 10.1007/s11065-009-9102-5, osteoporosis,JOURNAL, Brown TT, Qaqish RB, Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review, AIDS, 20, 17, 2165–74, November 2006, 17086056, 10.1097/QAD.0b013e32801022eb, neuropathy,JOURNAL, Nicholas PK, Kemppainen JK, Canaval GE, Corless IB, Sefcik EF, Nokes KM, Bain CA, Kirksey KM, Eller LS, Dole PJ, Hamilton MJ, Coleman CL, Holzemer WL, Reynolds NR, Portillo CJ, Bunch EH, Wantland DJ, Voss J, Phillips R, Tsai YF, Mendez MR, Lindgren TG, Davis SM, Gallagher DM, Symptom management and self-care for peripheral neuropathy in HIV/AIDS, AIDS Care, 19, 2, 179–89, February 2007, 17364396, 10.1080/09540120600971083, cancers,JOURNAL, Boshoff C, Weiss R, AIDS-related malignancies, Nature Reviews. Cancer, 2, 5, 373–82, May 2002, 12044013, 10.1038/nrc797, JOURNAL, Yarchoan R, Tosato G, Little RF, Therapy insight: AIDS-related malignancies – the influence of antiviral therapy on pathogenesis and management, Nature Clinical Practice Oncology, 2, 8, 406–15; quiz 423, August 2005, 16130937, 10.1038/ncponc0253, nephropathy,JOURNAL, Post FA, Holt SG, Recent developments in HIV and the kidney, Current Opinion in Infectious Diseases, 22, 1, 43–48, February 2009, 19106702, 10.1097/QCO.0b013e328320ffec, and cardiovascular disease. Some conditions, such as lipodystrophy, may be caused both by HIV and its treatment.

Epidemiology

File:AIDS and HIV prevalence 2008.svg|thumb|upright=1.3|alt=A map of the world where most of the land is colored green or yellow except for sub Saharan Africa which is colored red|Estimated percentage of HIV among young adults (15–49) per country {{as of|2011|lc=y}}.WEB, AIDSinfo,weblink UNAIDS, March 4, 2013, no,weblink" title="web.archive.org/web/20130305203900weblink">weblink March 5, 2013, mdy-all, {{Col-begin}}{{Col-break}}{{legend|#787878|No data}}{{legend|#94bf8b|AIDS was first clinically reported on June 5, 1981, with five cases in the United States.NEWS, 'How I told the world about Aids',weblink 12 February 2019, BBC News, 5 June 2006, The initial cases were a cluster of injecting drug users and homosexual men with no known cause of impaired immunity who showed symptoms of Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems.JOURNAL, Gottlieb MS, Pneumocystis pneumonia – Los Angeles. 1981, American Journal of Public Health, 96, 6, 980–81; discussion 982–83, June 2006, 16714472, 1470612, 10.2105/AJPH.96.6.980,weblinkweblink" title="web.archive.org/web/20090422042240weblink">weblink no, April 22, 2009, Soon thereafter, an unexpected number of homosexual men developed a previously rare skin cancer called Kaposi's sarcoma (KS).JOURNAL, Friedman-Kien AE, Disseminated Kaposi's sarcoma syndrome in young homosexual men, Journal of the American Academy of Dermatology, 5, 4, 468–71, October 1981, 7287964, 10.1016/S0190-9622(81)80010-2, JOURNAL, Hymes KB, Cheung T, Greene JB, Prose NS, Marcus A, Ballard H, William DC, Laubenstein LJ, Kaposi's sarcoma in homosexual men-a report of eight cases, Lancet, 2, 8247, 598–600, September 1981, 6116083, 10.1016/S0140-6736(81)92740-9, Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak.JOURNAL, Basavapathruni A, Anderson KS, Reverse transcription of the HIV-1 pandemic, FASEB Journal, 21, 14, 3795–808, December 2007, 17639073, 10.1096/fj.07-8697rev, In the early days, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.JOURNAL, Centers for Disease Control (CDC), Persistent, generalized lymphadenopathy among homosexual males, MMWR. Morbidity and Mortality Weekly Report, 31, 19, 249–51, May 1982, 6808340,weblinkweblink" title="web.archive.org/web/20111018015418weblink">weblink mdy-all, no, October 18, 2011, JOURNAL, Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, Dauguet C, Axler-Blin C, Vézinet-Brun F, Rouzioux C, Rozenbaum W, Montagnier L, Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS), Science, 220, 4599, 868–71, May 1983, 6189183, 10.1126/science.6189183, 1983Sci...220..868B, They also used Kaposi's sarcoma and opportunistic infections, the name by which a task force had been set up in 1981.JOURNAL, Centers for Disease Control (CDC), Opportunistic infections and Kaposi's sarcoma among Haitians in the United States, MMWR. Morbidity and Mortality Weekly Report, 31, 26, 353–54, 360–61, July 1982, 6811853,weblinkweblink" title="web.archive.org/web/20110920181924weblink">weblink mdy-all, no, September 20, 2011, At one point, the CDC coined the phrase "the 4H disease", since the syndrome seemed to affect heroin users, homosexuals, hemophiliacs, and Haitians.JOURNAL, AIDS and Syphilis: The Iconography of Disease, October, 43, 87–107, Gilman, Sander L., 1987, 3397566, Gilman, Sander L, 10.2307/3397566, WEB, American Association for the Advancement of Science, July 28, 2006,weblink Making Headway Under Hellacious Circumstances, June 23, 2008, no,weblink" title="web.archive.org/web/20080624235131weblink">weblink June 24, 2008, mdy-all, In the general press, the term "GRID", which stood for gay-related immune deficiency, had been coined.NEWS, Altman LK,weblink New homosexual disorder worries health officials, The New York Times, May 11, 1982, August 31, 2011, no,weblink" title="web.archive.org/web/20130430231803weblink">weblink April 30, 2013, mdy-all, However, after determining that AIDS was not isolated to the gay community, it was realized that the term GRID was misleading and the term AIDS was introduced at a meeting in July 1982.NEWS, Kher U, A Name for the Plague, Time, July 27, 1982,weblink March 10, 2008,weblink" title="web.archive.org/web/20080307015307weblink">weblink March 7, 2008, no, By September 1982 the CDC started referring to the disease as AIDS.JOURNAL, Centers for Disease Control (CDC), Update on acquired immune deficiency syndrome (AIDS) – United States, MMWR. Morbidity and Mortality Weekly Report, 31, 37, 507–08, 513–14, September 1982, 6815471, In 1983, two separate research groups led by Robert Gallo and Luc Montagnier declared that a novel retrovirus may have been infecting people with AIDS, and published their findings in the same issue of the journal Science.JOURNAL, Gallo RC, Sarin PS, Gelmann EP, Robert-Guroff M, Richardson E, Kalyanaraman VS, Mann D, Sidhu GD, Stahl RE, Zolla-Pazner S, Leibowitch J, Popovic M, Isolation of human T-cell leukemia virus in acquired immune deficiency syndrome (AIDS), Science, 220, 4599, 865–67, May 1983, 6601823, 10.1126/science.6601823, 1983Sci...220..865G, JOURNAL, Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, Dauguet C, Axler-Blin C, Vézinet-Brun F, Rouzioux C, Rozenbaum W, Montagnier L, Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS), Science, 220, 4599, 868–71, May 1983, 6189183, 10.1126/science.6189183, 1983Sci...220..868B, Gallo claimed that a virus his group had isolated from a person with AIDS was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) his group had been the first to isolate. Gallo's group called their newly isolated virus HTLV-III. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV). As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV.BOOK, Aldrich R, Wotherspoon G, Who's who in gay and lesbian history, 2001, Routledge, London, 978-0-415-22974-6, 154,weblink mdy-all,

Origins

File:SIV primates.jpg|right|upright=1.35|thumb|alt=three primates possible sources of HIV|Left to right: the African green monkey source of SIV, the sooty mangabey source of HIV-2 and the chimpanzee source of HIV-1HIV-1Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century. HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes troglodytes).JOURNAL, Gao F, Bailes E, Robertson DL, Chen Y, Rodenburg CM, Michael SF, Cummins LB, Arthur LO, Peeters M, Shaw GM, Sharp PM, Hahn BH, Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes, Nature, 397, 6718, 436–41, February 1999, 9989410, 10.1038/17130, 1999Natur.397..436G, JOURNAL, Keele BF, Van Heuverswyn F, Li Y, Bailes E, Takehisa J, Santiago ML, Bibollet-Ruche F, Chen Y, Wain LV, Liegeois F, Loul S, Ngole EM, Bienvenue Y, Delaporte E, Brookfield JF, Sharp PM, Shaw GM, Peeters M, Hahn BH, Chimpanzee reservoirs of pandemic and nonpandemic HIV-1, Science, 313, 5786, 523–26, July 2006, 16728595, 2442710, 10.1126/science.1126531, 2006Sci...313..523K, The closest relative of HIV-2 is SIV(smm), a virus of the sooty mangabey (Cercocebus atys atys), an Old World monkey living in coastal West Africa (from southern Senegal to western Côte d'Ivoire). New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes.JOURNAL, Goodier JL, Kazazian HH, Retrotransposons revisited: the restraint and rehabilitation of parasites, Cell, 135, 1, 23–35, October 2008, 18854152, 10.1016/j.cell.2008.09.022, (subscription required)HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.JOURNAL, Sharp PM, Bailes E, Chaudhuri RR, Rodenburg CM, Santiago MO, Hahn BH, The origins of acquired immune deficiency syndrome viruses: where and when?, Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 356, 1410, 867–76, June 2001, 11405934, 1088480, 10.1098/rstb.2001.0863, yes, September 27, 2011, There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV.JOURNAL, Kalish ML, Wolfe ND, Ndongmo CB, McNicholl J, Robbins KE, Aidoo M, Fonjungo PN, Alemnji G, Zeh C, Djoko CF, Mpoudi-Ngole E, Burke DS, Folks TM, Central African hunters exposed to simian immunodeficiency virus, Emerging Infectious Diseases, 11, 12, 1928–30, December 2005, 16485481, 3367631, 10.3201/eid1112.050394, George, Zeh, Alemnji, Clement, Fonjungo, Aidoo, Michael, Peter N., However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV.JOURNAL, Marx PA, Alcabes PG, Drucker E, Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa, Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 356, 1410, 911–20, June 2001, 11405938, 1088484, 10.1098/rstb.2001.0867,weblinkweblink" title="web.archive.org/web/20130917170611weblink">weblink mdy-all, no, September 17, 2013, Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout the society, depend on the proposed timing of the animal-to-human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to circa 1910.JOURNAL, Worobey M, Gemmel M, Teuwen DE, Haselkorn T, Kunstman K, Bunce M, Muyembe JJ, Kabongo JM, Kalengayi RM, Van Marck E, Gilbert MT, Wolinsky SM, Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960, Nature, 455, 7213, 661–64, October 2008, 18833279, 3682493, 10.1038/nature07390,weblink 2008Natur.455..661W, (subscription required) Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities.JOURNAL, de Sousa JD, Müller V, Lemey P, Vandamme AM, High GUD incidence in the early 20 century created a particularly permissive time window for the origin and initial spread of epidemic HIV strains, PLOS One, 5, 4, e9936, April 2010, 20376191, 2848574, 10.1371/journal.pone.0009936, Martin, Darren P., 2010PLoSO...5.9936S, While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased many fold if one of the partners suffers from a sexually transmitted infection causing genital ulcers. Early 1900s colonial cities were notable due to their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern Kinshasa were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis.An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.JOURNAL, Chitnis A, Rawls D, Moore J, Origin of HIV type 1 in colonial French Equatorial Africa?, AIDS Research and Human Retroviruses, 16, 1, 5–8, January 2000, 10628811, 10.1089/088922200309548, (subscription required)NEWS, Donald G. McNeil, Jr., Donald G. McNeil, Jr., Precursor to H.I.V. Was in Monkeys for Millennia,weblink Dr. Marx believes that the crucial event was the introduction into Africa of millions of inexpensive, mass-produced syringes in the 1950s. ... suspect that the growth of colonial cities is to blame. Before 1910, no Central African town had more than 10,000 people. But urban migration rose, increasing sexual contacts and leading to red-light districts., New York Times, September 16, 2010, September 17, 2010, no,weblink" title="web.archive.org/web/20110511230019weblink">weblink May 11, 2011, mdy-all, The earliest well-documented case of HIV in a human dates back to 1959 in the Congo.JOURNAL, Zhu T, Korber BT, Nahmias AJ, Hooper E, Sharp PM, Ho DD, An African HIV-1 sequence from 1959 and implications for the origin of the epidemic, Nature, 391, 6667, 594–97, February 1998, 9468138, 10.1038/35400,weblinkweblink" title="web.archive.org/web/20110927233142weblink">weblink mdy-all, no, 1998Natur.391..594Z, September 27, 2011, The earliest retrospectively described case of AIDS is believed to have been in Norway beginning in 1966.BOOK, Lederberg J, Encyclopedia of Microbiology, 2000, Elsevier, Burlington, 978-0-08-054848-7, 106, 2nd,weblink mdy-all, In July 1960, in the wake of Congo's independence, the United Nations recruited Francophone experts and technicians from all over the world to assist in filling administrative gaps left by Belgium, who did not leave behind an African elite to run the country. By 1962, Haitians made up the second largest group of well-educated experts (out of the 48 national groups recruited), that totaled around 4500 in the country.BOOK,weblink Geographies of the Haitian Diaspora, Jackson, Regine O., 12, 2011, Routledge, 978-0-415-88708-3, mdy-all, BOOK,weblink The Origin of Aids, Pépin, Jacques, 188, 2011, Cambridge University Press, 978-0-521-18637-7, mdy-all, Dr. Jacques Pépin, a Quebecer author of The Origins of AIDS, stipulates that Haiti was one of HIV's entry points to the United States and that one of them may have carried HIV back across the Atlantic in the 1960s. Although the virus may have been present in the United States as early as 1966,NEWS, Kolata, Gina, Boy's 1969 Death Suggests AIDS Invaded U.S. Several Times, The New York Times, October 28, 1987,weblink February 11, 2009, no,weblink" title="web.archive.org/web/20090211024256weblink">weblink February 11, 2009, mdy-all, the vast majority of infections occurring outside sub-Saharan Africa (including the U.S.) can be traced back to a single unknown individual who became infected with HIV in Haiti and then brought the infection to the United States some time around 1969.JOURNAL, Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M, The emergence of HIV/AIDS in the Americas and beyond, Proceedings of the National Academy of Sciences of the United States of America, 104, 47, 18566–70, November 2007, 17978186, 2141817, 10.1073/pnas.0705329104,weblinkweblink" title="web.archive.org/web/20150924144548weblink">weblink mdy-all, no, 2007PNAS..10418566G, September 24, 2015, The epidemic then rapidly spread among high-risk groups (initially, sexually promiscuous men who have sex with men). By 1978, the prevalence of HIV-1 among homosexual male residents of New York City and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected.

Society and culture

Stigma

File:Ryan White.jpg|thumb|alt=A teenage male with the hand of another resting on his left shoulder smiling for the camera|Ryan White became a poster child for HIV after being expelled from school because he was infected.WEB,weblink Ryan White, an American AIDS Victim, Encyclopædia BritannicaEncyclopædia BritannicaAIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.WEB, Ogden J, Nyblade L, International Center for Research on Women, 2005, Common at its core: HIV-related stigma across contexts,weblink February 15, 2007, yes,weblink" title="web.archive.org/web/20070217044825weblink">weblink February 17, 2007, mdy-all, AIDS stigma has been further divided into the following three categories:
  • Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.JOURNAL, Herek GM, Capitanio JP, American Behavioral Scientist, 1999,weblink AIDS Stigma and sexual prejudice, March 27, 2006, 42, 7, 1130–47, 10.1177/0002764299042007006, yes,weblink" title="web.archive.org/web/20060409034211weblink">weblink April 9, 2006,
  • Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
  • Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.JOURNAL, Snyder M, Omoto AM, Crain AL, Punished for their good deeds: stigmatization for AIDS volunteers, American Behavioral Scientist, 1999, 1175–92, 42, 7, 10.1177/0002764299042007009,
Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.BOOK, Sharma, A.K., Population and society, Concept Pub. Co., New Delhi, 2012, 978-81-8069-818-7, 242,weblink mdy-all, In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice, such as anti-homosexual/bisexual attitudes.JOURNAL, Herek GM, Capitanio JP, Widaman KF, HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999, American Journal of Public Health, 92, 3, 371–77, March 2002, 11867313, 1447082, 10.2105/AJPH.92.3.371, There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men. However, the dominant mode of spread worldwide for HIV remains heterosexual transmission.JOURNAL, De Cock KM, Jaffe HW, Curran JW, The evolving epidemiology of HIV/AIDS, AIDS, 26, 10, 1205–13, June 2012, 22706007, 10.1097/QAD.0b013e328354622a, In 2003, as part of an overall reform of marriage and population legislation, it became legal for people with AIDS to marry in China.NEWS, China relaxes laws on love and marriage,weblink October 24, 2013, The Telegraph, August 21, 2003, Richard Spencer, no,weblink" title="web.archive.org/web/20131108082647weblink">weblink November 8, 2013, mdy-all, In 2013 the U.S. National Library of Medicine developed a traveling exhibition titled, "Surviving and Thriving: AIDS, Politics, and Culture",WEB,weblink Exhibition – Surviving and Thriving – NLM Exhibition Program, www.nlm.nih.gov, 2018-03-16, U.S. National Institutes of Health, National Library of Medicine, covering medical research, U.S. government's response, and personal stories from people with AIDS, caregivers, and activists.NEWS,weblink The Confusing and At-Times Counterproductive 1980s Response to the AIDS Epidemic, Geiling, Natasha, Smithsonian.com, December 4, 2013, 2018-03-16, en,

Economic impact

(File:Life expectancy in select Southern African countries 1960-2012.svg|thumb|upright=1.5|alt=A graph showing an number of increasing lines followed by a sharp fall of the lines starting in mid-1980s to 1990s|Changes in life expectancy in some African countries, 1960–2012)HIV/AIDS affects the economics of both individuals and countries. The gross domestic product of the most affected countries has decreased due to the lack of human capital.JOURNAL, Bell C, Devarajan S, Gersbach H, 2003,weblink The long-run economic costs of AIDS: theory and an application to South Africa, April 28, 2008, World Bank Policy Research Working Paper No. 3152, PDF, yes,weblink" title="web.archive.org/web/20130605151302weblink">weblink June 5, 2013, mdy-all, Without proper nutrition, health care and medicine, large numbers of people die from AIDS-related complications. They will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans. Many are cared for by elderly grandparents.BOOK, Greener R, 2002, State of The Art: AIDS and Economics, AIDS and macroeconomic impact, S, Forsyth, 49–55, IAEN,weblink no,weblink" title="web.archive.org/web/20121012090520weblink">weblink October 12, 2012, mdy-all, Returning to work after beginning treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. Unemployment in people with HIV/AIDS also is associated with suicidal ideation, memory problems, and social isolation. Employment increases self-esteem, sense of dignity, confidence, and quality of life for people with HIV/AIDS. Anti-retroviral treatment may help people with HIV/AIDS work more, and may increase the chance that a person with HIV/AIDS will be employed (low quality evidence).JOURNAL, Robinson R, Okpo E, Mngoma N, Interventions for improving employment outcomes for workers with HIV, The Cochrane Database of Systematic Reviews, 5, 5, CD010090, May 2015, 26022149, 10.1002/14651858.CD010090.pub2, 2164/6021, By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.At the household level, AIDS causes both loss of income and increased spending on healthcare. A study in Côte d'Ivoire showed that households having a person with HIV/AIDS spent twice as much on medical expenses as other households. This additional expenditure also leaves less income to spend on education and other personal or family investment.JOURNAL, Over M, The macroeconomic impact of AIDS in Sub-Saharan Africa, Population and Human Resources Department, The World Bank, 1992,weblink May 3, 2008,weblink" title="web.archive.org/web/20080527201655weblink">weblink May 27, 2008, no,

Religion and AIDS

The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because some religious authorities have publicly declared their opposition to the use of condoms.WEB,weblink AIDS Stigma, News-medical.net, November 1, 2011, no,weblink" title="web.archive.org/web/20111112214833weblink">weblink November 12, 2011, mdy-all, 2009-12-07, WEB,weblink Thirty years after AIDS discovery, appreciation growing for Catholic approach, Catholicnewsagency.com, June 5, 2011, November 1, 2011, no,weblink" title="web.archive.org/web/20111016214921weblink">weblink October 16, 2011, mdy-all, The religious approach to prevent the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global AIDS Crisis argues that cultural changes are needed including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.Some religious organizations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths.NEWS,weblink Church HIV prayer cure claims 'cause three deaths', October 18, 2011, October 18, 2011, BBC News, no,weblink" title="web.archive.org/web/20111018164909weblink">weblink October 18, 2011, mdy-all, The Synagogue Church Of All Nations advertised an "anointing water" to promote God's healing, although the group denies advising people to stop taking medication.

Media portrayal

One of the first high-profile cases of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on October 2, 1985 having announced that he was suffering from the virus on July 25 that year. He had been diagnosed during 1984.WEB,weblink Rock Hudson announces he has AIDS – History.com This Day in History – 7/25/1985, History.com, November 1, 2011, no,weblink" title="web.archive.org/web/20111227114929weblink">weblink December 27, 2011, mdy-all, A notable British casualty of AIDS that year was Nicholas Eden, a gay politician and son of the late prime minister Anthony Eden.WEB, Coleman, Brian,weblink Thatcher the gay icon, New Statesman, June 25, 2007, November 1, 2011, no,weblink" title="web.archive.org/web/20111114044756weblink">weblink November 14, 2011, mdy-all, On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, lead singer of the band Queen, who died from an AIDS-related illness having only revealed the diagnosis on the previous day.NEWS,weblink November 24, 1991: Giant of rock dies, BBC On This Day, BBC News, November 1, 2011, November 24, 1991,weblink" title="web.archive.org/web/20111021020133weblink">weblink October 21, 2011, no, However, he had been diagnosed as HIV positive in 1987.WEB,weblink Freddie Mercury, Nndb.com, November 1, 2011, no,weblink" title="web.archive.org/web/20111107035734weblink">weblink November 7, 2011, mdy-all, One of the first high-profile heterosexual cases of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on August 31, 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.WEB, Bliss, Dominic,weblink Frozen In Time: Arthur Ashe, iTENNISstore.com, June 25, 2012, no,weblink" title="web.archive.org/web/20130730170201weblink">weblink July 30, 2013, mdy-all, He died as a result on February 6, 1993 at age 49.NEWS,weblink Tributes to Arthur Ashe, London, The Independent, February 8, 1993, July 24, 2012, no,weblink" title="web.archive.org/web/20121111124842weblink">weblink November 11, 2012, mdy-all, Therese Frare's photograph of gay activist David Kirby, as he lay dying from AIDS while surrounded by family, was taken in April 1990. LIFE magazine said the photo became the one image "most powerfully identified with the HIV/AIDS epidemic." The photo was displayed in LIFE magazine, was the winner of the World Press Photo, and acquired worldwide notoriety after being used in a United Colors of Benetton advertising campaign in 1992.WEB, Cosgrove, Ben, Behind the Picture: The Photo That Changed the Face of AIDS,weblink LIFE magazine, August 16, 2012, no,weblink" title="web.archive.org/web/20120814045129weblink">weblink August 14, 2012, mdy-all, In 1996, Johnson Aziga, a Ugandan-born Canadian was diagnosed with HIV, but subsequently had unprotected sex with 11 women without disclosing his diagnosis. By 2003 seven had contracted HIV, and two died from complications related to AIDS.WEB, Aziga found guilty of first-degree murder,weblink CTV.ca News, April 9, 2013, no,weblink" title="web.archive.org/web/20131029204016weblink">weblink October 29, 2013, mdy-all, WEB, HIV killer ruled dangerous offender,weblink CBC News, April 9, 2013, no,weblink" title="web.archive.org/web/20120903081633weblink">weblink September 3, 2012, mdy-all, Aziga was convicted of first-degree murder and was sentenced for life.WEB, A fraudster, not a murderer,weblink National Post, April 9, 2013, yes,weblink May 15, 2016, mdy-all,

Criminal transmission

Criminal transmission of HIV is the intentional or reckless infection of a person with the human immunodeficiency virus (HIV). Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure.WEB, HIV-Specific Criminal Laws,weblink cdc.gov, November 22, 2014, June 30, 2014, no,weblink" title="web.archive.org/web/20141031203041weblink">weblink October 31, 2014, mdy-all, Others may charge the accused under laws enacted before the HIV pandemic.

Misconceptions

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS,NEWS, ‘Virgin cure’: Three women killed to ‘cure’ Aids,weblink September 14, 2013, International Herald Tribune, February 28, 2013, no,weblink" title="web.archive.org/web/20131015000557weblink">weblink October 15, 2013, mdy-all, BOOK, Jenny, Carole, Child Abuse and Neglect: Diagnosis, Treatment and Evidence – Expert Consult, 2010, Elsevier Health Sciences, 978-1-4377-3621-2, 187,weblink mdy-all, BOOK, Klot, Jennifer, Monica Kathina Juma, HIV/AIDS, Gender, Human Security and Violence in Southern Africa, Africa Institute of South Africa, Pretoria, 2011, 47, 978-0-7983-0253-1,weblink mdy-all, and that HIV can infect only gay men and drug users. In 2014, some among the British public wrongly thought one could get HIV from kissing (16%), sharing a glass (5%), spitting (16%), a public toilet seat (4%), and coughing or sneezing (5%).WEB, HIV Public Knowledge and Attitudes 2014,weblink National AIDS Trust, February 12, 2015, 9, Nov 2014, yes,weblink" title="web.archive.org/web/20150212142740weblink">weblink February 12, 2015, mdy-all, Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of HIV and homosexuality in schools will lead to increased rates of AIDS.BOOK, Blechner MJ, Hope and mortality: psychodynamic approaches to AIDS and HIV, Analytic Press, Hillsdale, NJ, 1997, 978-0-88163-223-1, JOURNAL, Kirby DB, Laris BA, Rolleri LA, Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world, The Journal of Adolescent Health, 40, 3, 206–17, March 2007, 17321420, 10.1016/j.jadohealth.2006.11.143, A small group of individuals continue to dispute the connection between HIV and AIDS,JOURNAL, Duesberg P, HIV is not the cause of AIDS, Science, 241, 4865, 514, 517, July 1988, 3399880, 10.1126/science.3399880, 1988Sci...241..514D, JOURNAL, Cohen J, The Duesberg phenomenon, Science, 266, 5191, 1642–44, December 1994, 7992043, 10.1126/science.7992043,weblink yes,weblink" title="web.archive.org/web/20070101111630weblink">weblink mdy-all, 1994Sci...266.1642C, January 1, 2007, the existence of HIV itself, or the validity of HIV testing and treatment methods.BOOK, Kalichman, Seth, Seth Kalichman, Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy, Copernicus Books (Springer Science+Business Media), New York, 2009, 978-0-387-79475-4,weblink JOURNAL, Smith TC, Novella SP, HIV denial in the Internet era, PLoS Medicine, 4, 8, e256, August 2007, 17713982, 1949841, 10.1371/journal.pmed.0040256, These claims, known as AIDS denialism, have been examined and rejected by the scientific community.WEB, Various, National Institute of Allergy and Infectious Diseases, January 14, 2010,weblink Resources and Links, HIV-AIDS Connection, February 22, 2009, no,weblink" title="web.archive.org/web/20100407225045weblink">weblink April 7, 2010, mdy-all, However, they have had a significant political impact, particularly in South Africa, where the government's official embrace of AIDS denialism (1999–2005) was responsible for its ineffective response to that country's AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections.JOURNAL, Watson J, Scientists, activists sue South Africa's AIDS 'denialists', Nature Medicine, 12, 1, 6, January 2006, 16397537, 10.1038/nm0106-6a, JOURNAL, Baleta A, S Africa's AIDS activists accuse government of murder, Lancet, 361, 9363, 1105, March 2003, 12672319, 10.1016/S0140-6736(03)12909-1, JOURNAL, Cohen J, South Africa's new enemy, Science, 288, 5474, 2168–70, June 2000, 10896606, 10.1126/science.288.5474.2168, Several discredited conspiracy theories have held that HIV was created by scientists, either inadvertently or deliberately. Operation INFEKTION was a worldwide Soviet active measures operation to spread the claim that the United States had created HIV/AIDS. Surveys show that a significant number of people believed—and continue to believe—in such claims.WEB, Boghardt, Thomas, Operation INFEKTION Soviet Bloc Intelligence and Its AIDS Disinformation Campaign,weblink Central Intelligence Agency, 2009, no,weblink May 14, 2011, mdy-all,

Research

HIV/AIDS research includes all medical research which attempts to prevent, treat, or cure HIV/AIDS along with fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral health interventions such as sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include the topics of pre-exposure prophylaxis, post-exposure prophylaxis, and circumcision and HIV. Public health officials, researchers, and programs can gain a more comprehensive picture of the barriers they face, and the efficacy of current approaches to HIV treatment and prevention, by tracking standard HIV indicators.WEB,weblink Indicators – Program Evaluation – CDC, www.cdc.gov, en-us, 2018-08-24, Use of common indicators is an increasing focus of development organizations and researchers.WEB,weblink Community-Based Indicators for HIV Programs – MEASURE Evaluation, www.measureevaluation.org, en-us, 2018-08-24, WEB,weblink Data and statistics, World Health Organization, en-GB, 2018-08-24,

References

{{Reflist}}

External links

{{Medical resources| DiseasesDB = 5938B20}} – {{ICD1024 b|20}}042}}–{{ICD9|044}}| ICDO =| OMIM = 609423| MedlinePlus = 000594| eMedicineSubj = emerg| eMedicineTopic = 253| MeshID = D000163}}{{Offline|med}}{{Commons category|AIDS}} {{Diseases of Poverty}}{{AIDS}}{{Viral diseases}}{{STD/STI}}{{Authority control}}

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