AIDS Update 2002

by Stine, Gerald J., Ph.D.

• ISBN13: 9780130664297
• ISBN10: 0130664294
• Format: Paperback
• Copyright: 2001-12-01
• Publisher: Pearson College Div

Summary

For use in any course with significant coverage of AIDS, Virology, Immunology, Endocrinology, and Human Sexuality. This text requires no biology prerequisite, and is the most comprehensive, authoritative, accurate, and up-to-date textbook on HIV/AIDS currently available as it is updated each and every year. It presents the entire 17-year chronology of the AIDS pandemic in a reasonable, logical, and scientific manner that interweaves biological, clinical, social, and legal discoveries in a uniquely readable presentation.

Table of Contents

Preface	xviii
Introduction: Histories of Global Pandemics, World AIDS Conferences, Overview of HIV/AIDS, and the AIDS Quilt	1	(23)
Discovering AIDS, Naming the Disease	24	(9)
Concepts	24	(1)
AIDS: A Disease or a Syndrome?	24	(1)
What Causes AIDS?	24	(1)
How Does HIV Cause AIDS?	24	(2)
Looking Back 1.1 The New York Times and A.I.D.S., August 8, 1982	26	(1)
The Centers for Disease Control and Prevention Reports	26	(1)
Discovery of the AIDS Virus	26	(2)
Defining the Illness: AIDS Surveillance	28	(3)
Summary	31	(1)
Review Questions	31	(1)
References	32	(1)
What Causes AIDS: Origin of the AIDS Virus	33	(19)
Chapter Concepts	33	(1)
The Cause of AIDS: The Human Immunodeficiency Virus	33	(6)
Box 2.1 Sex and HIV Do Not Cause AIDS!	34	(2)
Box 2.2 Science Takes a Backseat to Politics	36	(3)
Newsweek Magazine Again	39	(1)
What Do You Believe and Why?	39	(3)
Origin of HIV: The AIDS Virus	42	(8)
Box 2.3 The Cause and Effect of Diseases: The Unbroken Chain	42	(2)
Point of Information 2.1 Scientists Report on Earliest AIDS Case	44	(4)
Box 2.4 Origin of HIV in Humans: A Competing Hypothesis	48	(2)
Summary on the Origin of HIV	50	(1)
Summary	50	(1)
Review Questions	51	(1)
References	51	(1)
Biological Characteristics of the AIDS Virus	52	(20)
Chapter Concepts	52	(1)
Viruses Need Help	52	(1)
Viruses Are Parasites	52	(1)
Point of Information 3.1 Viral Specificity	53	(1)
Retroviruses	53	(1)
Human Immunodeficiency Virus (HIV)	53	(3)
Basic Genetic Structure of Retroviral Genomes	56	(8)
Genetic Revolution	64	(1)
Formation of Genetic Mutations in HIV	64	(1)
Formation of Genetic Recombination in HIV	64	(2)
Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins	66	(3)
Point of Information 3.2 Mysteries of HIV Subtypes	68	(1)
Point of Information 3.3 First Confirmed Cases of HIV Group O-Caused AIDS	69	(1)
Summary	69	(1)
Review Questions	70	(1)
References	70	(2)
Anti-HIV Therapy	72	(41)
Chapter Concepts	72	(1)
Goals for Anti-HIV Therapy	72	(2)
Anti-HIV Drugs With FDA Approval	74	(2)
Point of View 4.1 Medical Benefit: A Cure?	74	(2)
FDA-Approved Nucleoside, Non-Nucleoside Analog Reverse Transcriptase Inhibitors and Protease Inhibitors	76	(5)
Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors	81	(1)
FDA-Approved Protease Inhibitors	81	(1)
Protease Inhibitors	82	(2)
Development and Selection of HIV Drug-Resistant Mutants	84	(1)
Development of Drug-Resistant Protease Inhibitors	84	(3)
Box 4.1 Protease Inhibitors: Extending Life; The Downside of this Gift---Recovery?	85	(2)
How Combination Drug Therapy can Reduce the Chance of HIV Drug Resistance	87	(5)
Point of Information 4.1 The Drug Development, Approval Process, and Clinical Trials	91	(1)
HIV Therapy Cut-Off Points	92	(1)
Viral Load: Its Relationship to HIV Disease and AIDS	92	(3)
Sidebar 4.1 Personal Testimony on HIV Drug-Resistant Mutants	93	(2)
Medical Complications Associated With Anti-HIV Drug Therapies	95	(3)
Point of Information 4.2 Determination of Viral Load and Questions People Ask	96	(2)
Point to Ponder 4.1 Ration of HIV/AIDS Physicians to the Population and the HIV-Infected	98	(1)
Update	98	(1)
Sidebar 4.2 Monetary Reasons for Producing Antiretroviral Drugs	99	(1)
Two Most Sobering Reports on AIDS-Related Deaths	99	(4)
Point of Information 4.3 Current Problems Using Combination Therapy	100	(3)
A New Class of Antiretroviral Drugs in Progress: Cell Entry HIV Inhibitors	103	(1)
Fusion Inhibitors	103	(4)
Box 4.2 Can Combination Therapy Using Nucleoside Analogs with Protease Inhibitors Cure HIV Disease?	105	(2)
Pediatric Anti-HIV Therapy	107	(1)
Box 4.3 Testing of Anti-HIV Drugs for Post Exposure Prevention	106	(1)
Protease Inhibitors and Pregnancy	107	(1)
Disclaimer	107	(1)
Summary	107	(1)
Some AIDS Therapy Information Hotlines	108	(1)
Other Organizations and Websites	108	(2)
Review Questions	110	(1)
References	110	(3)
The Immunology of HIV Disease/AIDS	113	(31)
Chapter Concepts	113	(1)
The Immune System	113	(1)
Development of Human Immune System Cells	113	(4)
Point of Information 5.1 Class I and Class II Proteins	115	(1)
Box 5.1 How Large Is a Trillion?	116	(1)
Human Lymphocytes: T Cells and B Cells	117	(1)
Antibodies and Viruses	118	(7)
Box 5.2 To Understand the Difference Between Health and Disease, People Need To Understand the Immune System!	119	(6)
Sidebar 5.1 Measures and Countermeasures: The Human Immune System vs. Viruses	125	(1)
Antibodies and HIV Disease	125	(2)
Point of Information 5.2 The Big Questions	126	(1)
Point of Information 5.3 What Are Cell Receptors?	127	(1)
Immune System Dysfunction	127	(3)
Point of Information 5.4 The First Look at How HIV's gp	120	(8)
Envelope Glycoprotein Changes Shape to Attach to CD4 and Chemokine Receptors	128	(2)
FUSIN or CXCKER-4 (R4)	130	(1)
CC-CKR-5 (R-5) Receptor	130	(1)
Sidebar 4.2 Rantes: A Double-Edged Molecule	131	(1)
CCKR-2 (R-2) and CCKR-3 (R-3) Receptors	131	(1)
Genetic Resistance to HIV Infection	131	(3)
T4 Cell Depletion and Immune Suppression	134	(2)
Box 5.3 Cofactors Expedite HIV Infection	134	(2)
Impact of T4 Cell Depletion	136	(1)
Role of Monocytes and Macrophages in HIV Infection	137	(3)
Summary	140	(1)
Review Questions	141	(1)
References	141	(3)
Opportunistic Infections and Cancers Associated with HIV Disease/AIDS	144	(26)
Chapter Concepts	144	(1)
What is an Opportunistic Disease?	144	(1)
The Prevalence of Opportunistic Diseases	145	(1)
Prophylaxis Against Opportunistic Infections	145	(1)
Opportunistic Infections in HIV-Infected People	145	(17)
Point of Information 6.1 The Changing Spectrum of Opportunistic Infections	147	(8)
Box 6.1 A Physician's Agonizing Dilemma	155	(4)
Point of Information 6.2 Viruses Associated With Cancer	159	(1)
Box 6.2 Life Goes On!	160	(2)
Cancer in AIDS Patients	162	(4)
Point of Information 6.3 Classification of Lymphomas	165	(1)
Neuropathies in HIV Disease/AIDS Patients	166	(1)
Disclaimer	166	(1)
Summary	166	(1)
Review Questions	167	(1)
References	167	(2)
HIV/AIDS Self-Education Quiz	169	(1)
A Profile of Biological Indicators for HIV Disease and Progression to AIDS	170	(25)
Chapter Concepts	170	(1)
HIV Disease Defined	170	(1)
Case in Point 7.1 Variation of Initial Symptoms After HIV Infection	171	(1)
Stages of HIV Disease	171	(7)
Point of Information 7.1 One Mistake Cost Him His Life	175	(3)
HIV Disease Without Symptoms, With Symptoms, and AIDS	178	(1)
Sidebar 7.1 Primary Case Presentations	178	(1)
Aspects of HIV Infection	179	(1)
Production of HIV-Specific Antibodies	179	(7)
Box 7.1 Evolution of HIV During HIV Disease Progression	180	(2)
Box 7.2 Development of AIDS Over Time	182	(2)
Box 7.3 Are There Long-Term Adult Nonprogressors of HIV Disease---Yes!---Why?	184	(2)
Prognostic Biological Markers Related to AIDS Progression	186	(4)
Point of Information 7.2 Viral Load and T4 Cell Counts: Their Use in Clinical Practice	189	(1)
HIV Infection of the Central Nervous System	190	(1)
Pediatric Clinical Signs and Symptoms	191	(1)
Summary	192	(1)
Review Questions	192	(1)
References	193	(2)
Epidemiology and Transmission of the Human Immunodeficiency Virus	195	(55)
Chapter Concepts	195	(1)
HIV as a Communicable Disease	196	(1)
Looking Back 8.1 Public Opinion on How the New Disease---AIDS---Was Transmitted June 1983	196	(1)
We Must Stop HIV Transmission Now!	197	(1)
Epidemiology of HIV Infection	197	(1)
Transmission of Two Strains of HIV (HIV-1/HIV-2)	197	(1)
Is HIV Transmitted by Insects?	198	(1)
Point of Information 8.1 Consequences of Ignoring HIV	199	(1)
HIV Transmission	199	(1)
HIV Transmission in Family/Household Settings	199	(2)
Box 8.1 A Neighbor's Story: Public Image, Public Fear	200	(1)
Noncasual Transmission	201	(25)
Looking Back 8.2 Federal Study Committee Advises the Food and Drug Administration on the Acceptance of Blood Donations in the Time of AIDS, July 1983	205	(1)
Point of Information 8.2 Danger of HIV Infection via Artificial Insemination	206	(4)
Box 8.2 HIV/AIDS Roulette	210	(7)
Box 8.3 Gay Men Putting Themselves at High Risk for HIV Infection	217	(4)
Point of Information 8.3 Distribution of HIV-Contaminated Blood: France, Germany, the United States, and Other Countries	221	(1)
Box 8.4 Sports and HIV/AIDS: Earvin ``Magic'' Johnson and Other Athletes	221	(5)
United States: Heterosexual IDU	226	(16)
Box 8.5 HIV Transmission: Preparation and Use of Injection Drugs	231	(1)
Box 8.6 Assault with HIV	232	(3)
Sidebar 8.1 HIV Terrorism, Johannesburg, South Africa	235	(1)
Sidebar 8.2 Mexican Doctors Transplant HIV-Infected Kidneys	236	(2)
Point of View 8.1 Probably the Number One Risk Cofactor for HIV Is a Sexually Transmitted Disease (STD)	238	(3)
Case in Point 8.1 When the Wonderful News ``You're Pregnant'' Becomes a Tragedy	241	(1)
Caesarean Section	242	(1)
Box 8.7 Is Breast Feeding Policy for Women in Undeveloped Nations Changing?	242	(1)
Public Confidence: Acceptance of Current Dogma on Routes of HIV Transmission	243	(1)
Box 8.8 HIV and Senior Citizens	243	(1)
National AIDS Resources	244	(1)
Summary	245	(1)
Review Questions	245	(1)
References	246	(4)
Preventing the Transmission of HIV	250	(48)
Chapter Concepts	250	(1)
Prevention, Not Treatment, Is the Least Expensive and Most Effective Way to Stop the Spread of AIDS	250	(1)
Global Prevention	250	(1)
Prevention of Infectious Diseases: HIV/AIDS	251	(1)
Preventing the Transmission of HIV	252	(3)
Box 9.1 HIV Prevention Education---United States	253	(1)
Looking Back 9.1 The ``Magic'' Event: A Force for Prevention, November 1991	254	(1)
Behavioral Change	255	(2)
New Rules to an Old Game: Promoting Safer Sex	257	(13)
Box 9.2 HIV/AIDS Prevention Works?	258	(2)
Sidebar 9.1 Two Anecdotes on Condom Use in South Africa	260	(2)
Point to Ponder 9.1 Education Versus Risk: It's Not What You Know, It's What You Do	262	(1)
Point of Information 9.1 Clarifying the Issues over Condom Use	263	(6)
Point of Information 9.2 Questions and Answers About the Female Condom	269	(1)
Injection Drug Use and HIV Transmission: The Twin Epidemics	270	(1)
HIV Prevention for Injection Drug Users	270	(6)
Box 9.3 The Controversy: Providing Sterile Syringes and Needles to Injection Drug Users (IDUs)	273	(3)
Prevention of Blood and Blood Product HIV Transmission	276	(1)
Infection Control Procedures	277	(4)
Box 9.4 Americans Support Sex Education and Condoms in Schools and in TV Ads, and Needle Exchange Programs	278	(1)
Box 9.5 Blood Transfusions: A Gift of Life or the Carrier of Death?	279	(2)
Partner Notification	281	(3)
Point of View 9.1 The Goal of Developing an HIV Vaccine	284	(1)
Vaccine Development	284	(2)
Vaccine Production	286	(1)
DNA Vaccine	286	(3)
Point of Information 9.3 HIV Vaccine: Prevention and Therapy	287	(2)
Problems in the Search for HIV Vaccine	289	(1)
Human HIV Vaccine Trials	290	(2)
Update 2001/2002 Vaccinology Break through	292	(1)
Summary	293	(1)
Review Questions	294	(1)
References	294	(4)
Prevalence of HIV Infections, AIDS Cases, and Deaths Among Select Groups in the United States and AIDS in Other Countries	298	(40)
Chapter Concepts	298	(1)
A Word About Data	298	(1)
The Millennium: Year 2002	299	(1)
Formula for Estimating HIV Infections	300	(2)
Behavioral Risk Groups and Statistical Evaluation	302	(14)
Box 10.1 The HIV/AIDS Scenario	303	(4)
Point to Ponder 10.1 On the Down Low	307	(2)
Sidebar 10.1 The Latino Community	309	(6)
Point of Information 10.1 Where Older Patients With HIV Disease Can Get Help	315	(1)
Estimates of HIV Infection and Future AIDS Cases	316	(2)
Box 10.2 HIV/AIDS Data Collection and Deficiencies	317	(1)
Point of View 10.1 Justificationfor HIV Case Reporting in the United States	318	(1)
Newly Infected	318	(3)
U. S. Estimates Lead to Confusion. Whose Figures Are Correct?: Issues of Credibility	321	(1)
Shape of the HIV Pandemic: United States	322	(1)
Shape of AIDS Pandemic: United States	323	(2)
Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States	325	(3)
Sidebar 10.2 No AIDS-Related Obituaries: First Time in 17 Years	326	(1)
Looking Back 10.1	327	(1)
United States---Who Is Dying of AIDS?	328	(1)
Life Expectancy	329	(1)
Connected But Separate	329	(3)
Africa Is Dying Through Darwinian Perversion	332	(1)
Other Time Bombs: China, India, and Russia	333	(1)
Summary	333	(1)
Resources	334	(1)
Review Questions	335	(1)
References	335	(3)
Prevalence of HIV Infection and AIDS Cases Among Women, Children, and Teenagers in the United States	338	(33)
Chapter Concepts	338	(1)
Women and AIDS Worldwide	339	(2)
Point of Information 11.1 Africa: Poverty and Rituals Lead to the Spread of HIV	340	(1)
Women: HIV-Positive and AIDS Cases---United States	341	(9)
Point of Information 11.2 Profile: Women With HIV/AIDS in the United States	341	(3)
Point of Information 11.3 HIV Infection Among Women	344	(1)
Box 11.1 Women + Sexual Partners + Deception = AIDS	345	(3)
Point of View 11.1 One Woman's Comments on Her HIV Disease Treatments	348	(1)
Point of Information 11.4 Pregnant of Women and Knowledge of HIV Transmission	349	(1)
Box 11.2 Ruth's Poem	350	(1)
Internet	350	(2)
Box 11.3 HIV-Infected Women: Difficult Choices During Pregnancy	351	(1)
Pediatric HIV-Positive and AIDS Cases---United States	352	(2)
Orphaned Children Due to HIV Infection and AIDS	354	(6)
Looking Back 11.1 Adoption Advertisements for Parents with AIDS	355	(1)
Sidebar 11.1 Central America---Honduras	356	(3)
Point to Ponder 11.1 Disturbing Thoughts	359	(1)
Box 11.4 Johannesburg, South Africa	360	(1)
Global HIV Infections in Young Adults	360	(2)
Point of View 11.2 Perils of Unsafe Sex	362	(1)
Teenagers: HIV-Positive and AIDS Cases---United States	362	(1)
HIV/AIDS Won't Affect Us!	363	(5)
Point of Information 11.5 HIV-Infected Children: Living Longer---Paying a Price	363	(1)
Point of Information 11.6 Federal Public Health Policy Supports Abstinence-Only Program: Education Sex	364	(1)
Box 11.5 HIV Spreading Rapidly Among Teenage Gay Males	365	(1)
Box 11.6 Teenagers and HIV/AIDS in Africa	366	(1)
Point of View 11.3 Thoughts and Comments from a Generation at Risk	366	(1)
Sidebar 11.2 Can Life Get Worse Than Being Young, Homeless, and Dying of AIDS?	367	(1)
Summary	368	(1)
Internet	368	(1)
Other Useful Sources	368	(1)
Review Questions	368	(1)
References	369	(2)
Testing for Human Immunodeficiency Virus	371	(43)
Chapter Concepts	371	(1)
Determining the Presence of Antibody Produced When HIV Is Present	372	(1)
Requests for HIV Testing	372	(1)
Sidebar 12.1 Annual National HIV Testing Day	372	(1)
Reasons for HIV Testing	372	(1)
Avoiding HIV Testing	373	(1)
Immunodiagnostic Techniques for Detecting Antibodies to HIV	373	(1)
ELISA HIV Antibody Test	373	(3)
Box 12.1 An Assumption of AIDS Without the HIV Test: It Shatters Lives	374	(1)
Looking Back 12.1 The Miami Herald and Chicago Tribune, 1985	375	(1)
Understanding the ELISA Test	376	(9)
Point of Information 12.1 HIV Testing of Teenagers	378	(2)
Box 12.2 Pretest Patient Information	380	(2)
Point of Information 12.2 Improved ELISA Testing, Blood Donor Interviews, Screening for p24 Antigen, and Nucleic Acid Testing Lower HIV in Nation's Blood Supply	382	(3)
Western Blot Assay	385	(2)
Box 12.3 The Performance Rate for the Combined ELISA and Western Blot HIV Test	386	(1)
Other Screening and Confirmatory Tests	387	(5)
Point of Information 12.3 New ELISA Testing Procedures Reveal Early vs. Late HIV Infection	388	(1)
Point of View 12.1 Some Relative Drawbacks to the Current HIV Screening Test---ELISA/Western Blot	389	(3)
Rapid HIV Testing	392	(3)
Point of Information 12.4 Caution Regarding Rapid Tests	392	(2)
Sidebar 12.2 Blood vs. Urine: Outcome of HIV Test May Differ (Discordant Results)	394	(1)
Viral Load: Measuring HIV RNA	395	(2)
Sidebar 12.3 Viral Load Detection Problems	397	(1)
Detection of HIV Infection in Newborns	397	(1)
FDA Approves Two Home HIV Antibody Test Kits	397	(2)
Reporting HIV Infections	399	(1)
Sidebar 12.5 Federal Trade Commission Warns of Poor HIV Home Test Kits	399	(1)
Who Should Be Tested for HIV Infection?	400	(1)
Why Is HIV Test Information Necessary?	401	(4)
Box 12.4 The Physician's Dilemma	401	(1)
Point of Information 12.5 Black Ministers Lead by Example	402	(2)
Point of Information 12.6 U.S. Public Health Service (USPHS) Recommendations for HIV Counseling and Voluntary Testing for All Pregnant Women	404	(1)
Point of Information 12.7 A Weak Link in HIV Testing	405	(1)
Testing Competency, and Informed Consent	405	(5)
Box 12.5 Boxer Stripped of Featherweight Title After Positive HIV Test	405	(3)
Box 12.6 Florida: Health Care Workers Leaks Confidential HIV Information	408	(1)
Point of Information 12.8 Legislature Survey of State Confidentiality Laws	409	(1)
Person-to-Person: Disclosure of HIV Infection	410	(1)
Box 12.7 Confidentiality and Sexual Partner Betrayal	410	(1)
Summary	411	(1)
Review Questions	411	(1)
References	412	(2)
AIDS and Society: Knowledge, Attitudes, and Behavior	414	(42)
Chapter Concepts	414	(1)
The New Millennium and HIV/AIDS	414	(1)
HIV/AIDS Is an Unusual Disease	415	(1)
AIDS Is Here to Stay	415	(1)
AIDS	415	(1)
Sidebar 13.1 A Mother's Nightmare	416	(1)
Blame Someone, Deja Vu	416	(1)
Fear: Panic and Hysteria Over the Spread of HIV/AIDS in the United States	417	(1)
Actions of Courage	418	(1)
Whom Is the General Public to Believe?	418	(7)
Box 13.1 Examples of Uncontrolled Fear and Hostility	419	(2)
Point of View 13.1 A Southern University Student's Experience	421	(2)
Box 13.1 How Some People Responded After Learning That Someone Had AIDS	423	(2)
AIDS Education and Behavior	425	(11)
Point of View 13.2 Hatred Expressed	426	(1)
Point of View 13.3 Newspaper Headline Shocks Readers	426	(1)
Box 13.3 When One With AIDS Comes Forth	427	(2)
Point of Information 13.1 After 20 years, Americans Still Say AIDS Is a Top Health Concern for the Nation and the World	429	(1)
Box 13.4 The Way We Are	430	(1)
Box 13.5 Anecdote: Father and Son Exchange Sex Information	430	(1)
Point of View 13.4 The Red Ribbon	431	(1)
Sidebar 13.2 Recommended Film: Dawn's Gift	432	(1)
Looking Back 13.1	432	(1)
Sidebar 13.3 Examples of Adult Reactions to HIV/AIDS vs. the Courts	433	(2)
Point of View 13.5 The Right to Privacy	435	(1)
The Character of Society	436	(10)
Point of Information 13.2 Dealing With Discrimination: The Americans With Disabilities Act	440	(2)
Point of Information 13.3 HIV Transmitted by Australian and French Surgeons	442	(2)
Box 13.6 My First AIDS Experience	444	(1)
Point of Information 13.4 Current View of Health Care Workers Who Are HIV-Infected	445	(1)
Federal and Private Sector Financing: Creation of an AIDS Industry	446	(2)
U. S. Government Believes HIV/AIDS Is a Threat to National Security	448	(1)
Point of Information 13.5 Early Global Response to AIDS and National Security	449	(1)
Global HIV/AIDS Funding for Africa	449	(4)
Summary	453	(1)
Review Questions	454	(1)
References	454	(2)
Epilogue	456	(3)
Answers to Review Questions	459	(6)
Glossary	465	(8)
Index	473