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Three Words Echo around the World: AIDS Crisis Worsens! 2
History of Global Pandemics and Epidemics 2
Fear, Ignorance, and Condemnation: Who Is to Blame? 3
Imagine a World without AIDS 3
Overview of HIV/AIDS 5
HIV/AIDS: A Unique Disease 6
HIV/AIDS: A Cause of Death 6
Another Anniversary 6
Other Anniversaries 6
International AIDS Conferences 7
Means of Remembering 7
The 28th Candlelight Memorial 9
Walking to Change the Course of the HIV/AIDS Epidemic<&mdash>—United States 9
Bicycle Riding to Change the Course of the HIV/AIDS Epidemic<&mdash>—United States 10
The AIDS Olympics 11
World AIDS Day: An International Day of Coordinated Action: A Time to Recharge and Reconnect 12
The Future 13
National AIDS Hotlines 14
Useful Internet Addresses 15
The New Millennium 17
AIDS: A Disease or a Syndrome? 18
First Reaction to AIDS: Denial 19
What Causes AIDS? 20
The Centers for Disease Control and Prevention Reports 22
Discovery of What Causes AIDS 23
Defining the Illness: AIDS and Surveillance 24
Summary 26
Review Questions 27
The Cause of AIDS: The Human Immunodeficiency Virus (HIV) 28
HIV Does Not Cause AIDS: Dissidents and Their Cults: A Minority Point of View 28
News Flash 2010<&mdash>—Leading HIV/AIDS Dissident Cleared of Misconduct Following
Complaints Made After He and Others Published a 2009 Paper Arguing That There Is “As Yet No Proof That HIV Causes AIDS” 34
Dissidents (AIDS Doesn’t Exist or HIV Isn’t the Cause) 34
Summary of HIV/AIDS Dissidents’ Viewpoints 35
Evidence that HIV Causes AIDS 35
Origin of HIV: The AIDS Virus 37
Summary on the Origin of HIV 44
Summary 45
Review Questions 45
Viruses Need a Host Cell in Order to Replicate 46
Viruses Are Parasites 46
Viruses Specific to Cell Type 47
How Do Human T4 or CD4+ Lymphocytes Relate to HIV Infection and AIDS? 48
Description of HIV; How It Attaches to a Host Cell and Buds Out of the Cell 49
HIV Fitness 50
The HIV Life Cycle 51
Understanding How HIV Works 51
How HIV Escapes the Infected Cell 52
Distinct Genotypes (Subtypes/Clades) of HIV-1 Worldwide Based on ENV and GAG Proteins 60
Summary 63
Review Questions 63
Better Drugs, Better Technologies, and Lingering Problems 65
Antiretroviral Therapy or ART 65
The Good News About Antiretroviral Therapy (ART) 70
Antiretroviral Therapy (ART) Drugs with FDA Approval 70
The HIV Medicine Chest: ART Drugs Receiving FDA Approval 71
FDA-Approved Nucleoside/Non-Nucleoside Analog Reverse Transcriptase Inhibitors, Protease Inhibitors, Integrase Inhibitors, Entry Inhibitors, and Maturation Inhibitors 72
Use of Non-Nucleoside Analog Reverse Transcriptase Inhibitors 74
FDA-Approved Protease Inhibitors 76
Entry Inhibitors and Problems 77
Integrase Inhibitors 79
Development and Selection of HIV Drug-Resistant Mutants 80
Development of HIV Drug Resistance to Protease Inhibitors 80
How Combination Drug Therapy Can Reduce the Chance of HIV Drug Resistance 82
Viral Load: Its Relationship to HIV Disease and AIDS 91
Medical Complications Associated with Anti-HIV Drug Therapies (ART) 93
Update 2011 94
Summary 99
Disclaimer 100
Some AIDS Therapy Information Hotlines 100
Review Questions 100
The Immune System 102
Human Lymphocytes: T Cells and B Cells 105
Why CD4+ Cells Are Important in HIV Infection<&mdash>—What It Means 108
The CD4+ Cell Count<&mdash>—Why It Matters 108
Antibodies and HIV Disease 113
HIV Eradication Currently Not Possible Because of Infection of Latent Resting
CD4+ Cells and Immunologic Memory Cells 115
Immune System Dysfunction 116
Original Antigenic Sin 117
The Search for Additional Receptors (Coreceptors) to CD4: Fusin or CXCKR-4 (R-4) 119
CCKR-5 (R-5) Receptor 119
Emergence of HIV Strains That Vary in Their Lethal Abilities 120
In Search of Genetic Resistance to HIV Infection 120
T4 Cell Depletion and Immune Suppression 123
Impact of T4 Cell Depletion 125
Role of Monocytes and Macrophages in HIV Infection 125
Where Do T4 or CD4+ Cells Become HIV Infected? 127
Summary 130
Review Questions 130
What Is an Opportunistic Disease? 131
The Prevalence of Opportunistic Diseases 132
Opportunistic Infections in HIV-Infected People 133
TB: The Leading Cause of Death among HIV-Positive People Worldwide 144
Cancer or Malignancy in HIV/AIDS Patients 144
Disclaimer 149
Summary 150
Review Questions 150
The Prediction 151
What Is Known and What Is Missing from Our Understanding of HIV/AIDS: The New Crisis 152
HIV Disease Defined 154
Stages of HIV Disease (without Drug Therapy) 156
HIV Disease without Symptoms, with Symptoms, and AIDS 163
Production of HIV-Specific Antibodies 164
Prognostic Biological Markers (Biomarkers) Related to AIDS Progression 168
HIV Infection of the Central Nervous System (CNS) 171
Neuropathies (Nerve Tissue Damage) in HIV Disease/AIDS Patients 172
Pediatric Clinical Signs and Symptoms 173
Finally, Hope, a Renewed Hope for the Future of Those Who Are HIV Infected 173
Summary 174
Review Questions 174
Epidemic/Epidemiology 176
We Must Stop HIV Transmission Now! 178
Epidemiology of HIV Infection 178
Transmission of Two Strains of HIV (HIV-1/HIV-2) 181
IS HIV Transmitted by Insects? 181
HIV Transmission 181
HIV Transmission in Family/Household Settings 182
Noncasual Transmission 182
Gay Men Putting Themselves at High Risk for HIV Infection 192
The Biological Factor 198
Injection-Drug Users and HIV Transmission 204
United States: Heterosexual Injection-Drug Use (IDU) 206
Injection-Drug Use and HIV Infections in Other Countries 207
Other Means of HIV Transmission 212
Influence of Sexually Transmitted Diseases (STDs) on HIV Transmission and Vice-Versa 213
Pediatric Transmission 220
Conclusion 222
National AIDS Resources 223
Summary 223
Challenge Your Assumptions about the HIV Infected 224
Review Questions 224
The AIDS Generation: “I Knew Everything about It, and I Still Got It!” 227
Prevention, Not Treatment, Is the Least Expensive and Most Effective Way to Reduce the Spread of HIV/AIDS 228
Global Prevention 229
Antiretroviral Drugs Have and Impact on Prevention, But We Can’t Treat Our Way Out of This Pandemic 230
Advancing HIV Prevention: New Strategies for a Changing Epidemic 236
Preventing the Transmission of HIV 237Sexual Risk Taking Depends on Sexual Activity 240
New Rules to an Old Game: Promoting Safer Sex<&mdash>—Nobody Has a Body to Die For! 243
The Male Condom 245
The Female Condom or Femidom (Vaginal Pouch) 248
An Alternative to Condoms: Vaginal Microbicides (Mi-cro-ba-cides) and Circumcision (Cir-cum-ci-sion) 252
Update 2010<&mdash>—The CAPRISA 004 Study Results 253
Circumcision and the Prevention of HIV Transmission 254
Injection-Drug Use (IDU) and HIV Transmission: The Twin Epidemics 255
HIV Prevention for Injection-Drug Users 255
Prevention of Blood and Blood Product HIV Transmission 261
Infection Control Procedures 262
Sexual Partner Notification: Disclosure 263
The U.S. Federal Government Has Now Adopted Partner Notification as Its Cornerstone in Its Effort to Help Control the Spread of HIV 264
The First Human Vaccine: The Impact of Vaccines on Infectious Diseases 268
The Journey Towards an HIV/AIDS Vaccine Now in Its 31st Year 268
HIV Vaccine Development and Its Role in Prevention 268
How These Two Neutralizing Antibodies Work 271
Types of Experimental HIV Vaccines 273
DNA Vaccine 275
Problems in the Search for HIV Vaccine 275
September 2009<&mdash>—News Broken that a Partially Effective HIV Vaccine Was Found! 276
Summary 277
Finally, Five Ways You Can Help Prevent HIV/AIDS 278
Review Questions 279
A Word about HIV/AIDS Data 282
Year 2012 284
Formula for Estimating HIV Infections 287
Behavioral Risk Groups and Statistical Evaluation 288
Aging with HIV/AIDS: The Hidden Side of This Crisis in the United States 301
September 18: Annual National HIV/AIDS Aging Awareness Day 301
Estimates of AIDS Cases and HIV Infection 302
Newly Infected 303
Shape of the HIV Pandemic: United States 304
Estimates of Deaths and Years of Potential Life Lost Due to AIDS in the United States 306
Selected Nations/Countries Have Different Epidemics. Each Faces Its Own Reality 310
Canada’s Estimated HIV/AIDS Cases through 2009: Population 110 Million 310
Mexico’s Estimated HIV/AIDS Cases through 2009: Population 110 Million 310
United Kingdom’s (UK) Estimated HIV/AIDS Cases through 2009: Population 61 Million 312
Global Prevalence and Impact of HIV/AIDS 314
Connected but Separate: Each Country a Different Reality, Different Countries, Similar Questions, but Different Answers, Different Epidemics 316
Workforce<&mdash>—South Africa: Some Examples 318
Education: Teachers and Students<&mdash>—South Africa and Some Countries in Southern Africa 319
Other HIV/AIDS Time Bombs in Asia: India, China, and Russia 320
Summary 324
Review Questions 325
HIV/AIDS Is Defining the Lives of Millions of Women 327
Female Vulnerability to HIV 328
Every Day a Tragedy 328
Triple Jeopardy 329
Annual International Women’s Day<&mdash>—March 8 329
Women: AIDS and HIV Infections Worldwide 329
Asia-Pacific Region, Over Five Million HIV Positive: 2010 330
Women: HIV-Positive and AIDS Cases<&mdash>—United States 331
Childbearing Women: Worldwide 344
Internet Resources 345
Pediatric HIV-Positive and AIDS Cases<&mdash>—United States: A Fight We Can Win! 345
Orphaned Children Due to HIV Infection and AIDS 347
The Phenomenon of AIDS Orphans 349
Summary 353
Review Questions 354
Global HIV Infections in Young Adults 355
Addressing the AIDS Pandemic among Young Adults: Know-Protect-Talk 357
How Large Is the Young Adult Population in the United States? 358
HIV/AIDS Won’t Affect Us! 360
Estimate of HIV-Infected and AIDS Cases among Young Adults in the United States,
Globally 362
Summary 368
Internet 368
Other Useful Sources 369
Review Questions 369
Determining the Presence of Antibody Produced When HIV Is Present 372
Requests for HIV Testing 372
Reasons for HIV Testing: I Know, I Took the Test 372
Laboratory Methods for Detecting HIV 374
ELISA HIV Antibody Test 375
Western Blot Assay 381
New ELISA Antibody Testing and Viral Load Procedures Reveal Early Versus Late HIV Infection 383
Rapid Result HIV Testing 386
Update 387
FDA Approves Home HIV Antibody Test Kit 389
Some Screening and Confirmatory Antigen-Detection Tests for HIV 390
Deciding Who Should Get an HIV Test and When 391
Why Is HIV Test Information Necessary? 392
Immigration and Travel Ban into the United States Is Lifted 392
Testing, Privacy, Competency, and Informed Consent 393
Summary 401
Review Questions 401
HIV/AIDS Is a Story in Our Lifetime 405
The New Millennium and HIV/AIDS 405
HIV/AIDS Is an Unusual Social Disease 406
Discrimination vs. Compassion and Support 406
HIV/AIDS Is Here to Stay 406
AIDS Comes to the United States 407
Blame Someone, D<´>éj<`>à Vu 408
Fear: Panic and Hysteria over the Spread of HIV/AIDS in the United States 409
Whom Is the General Public to Believe? 411
AIDS Education and Behavior: Dissipating Fear with Education 417
The Character of Society 423
Dealing with Discrimination: The Americans with Disabilities Act 426
Federal and Private Sector Financing: Creation of an AIDS Industry 428
U.S. Government Believes HIV/AIDS Is a Threat to National Security 433
Global HIV/AIDS Funding for Underdeveloped Nations 437
Forms of U.S. Monetary Assistance for HIV/AIDS 439
Summary 446
Review Questions 447
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