9781402057885

Preface	p. xiii
Fundamentals
Prologue	p. 3
The new "Plague"	p. 3
Global situation	p. 4
Sub-Saharan Africa	p. 5
The Caribbean	p. 5
South and South-East Asia	p. 6
Eastern Europe and Central Asia	p. 17
Latin America	p. 19
North America	p. 19
East Asia	p. 20
Other regions	p. 21
Situation in India	p. 23
Economic cost of the epidemic	p. 24
Challenges	p. 25
Fundamentals of Immunity	p. 27
Introduction	p. 27
Host defence mechanisms	p. 28
Immunoglobulins	p. 29
Passive immunity	p. 31
Active immunity	p. 31
Humoral immunity	p. 32
Cell-mediated immunity	p. 34
Mucosal immune system	p. 35
Vaccination	p. 36
Herd immunity	p. 36
Hypersensitivity	p. 37
Immune deficiency	p. 37
Human Immunodeficiency Virus (HIV)	p. 39
Retroviruses and HIV	p. 39
Structure of HIV	p. 41
Variants of HIV	p. 43
Target cells and organs	p. 46
Inactivation	p. 48
Routes of transmission	p. 48
Replication	p. 49
Origin of HIV	p. 50
Immunity to HIV?	p. 51
Social and Environmental Factors	p. 55
Social factors	p. 55
Biological factors	p. 57
Behavioural factors	p. 58
Socio-political factors	p. 60
Armed conflicts and natural calamities	p. 61
Religion and HIV/AIDS	p. 63
Immunopathology	p. 67
Primary infection	p. 67
Asymptomatic phase	p. 68
Advanced HIV infection and AIDS	p. 68
Opportunistic infections	p. 69
Hypersensitivity reactions	p. 72
Neurological disorders	p. 74
Malignancies	p. 74
Autoimmune disorders	p. 76
Natural History of HIV Infection	p. 79
Progression of HIV infection	p. 79
WHO clinical staging classification	p. 80
CDC classification	p. 81
Disease progression	p. 82
Long-term non-progressors	p. 82
Infection Control Methods	p. 85
Definitions	p. 85
Kinetics of sterilisation and disinfection	p. 86
Physical methods	p. 89
Chemical methods	p. 95
Barrier nursing	p. 107
Universal biosafety precautions	p. 107
Personal protective equipment (PPE)	p. 113
Management of biomedical waste	p. 115
Infection control checklist	p. 116
Diagnostic Aspects
Case Definitions	p. 123
Introduction	p. 123
NACO case definition for children (Upto 12 years of age)	p. 124
NACO case definition for adults	p. 125
WHO clinical case definitions	p. 125
AIDS-defining clinical conditions	p. 126
Systemic manifestations	p. 126
Laboratory Diagnosis of HIV Infection	p. 129
Purpose of HIV testing	p. 129
Types of tests	p. 130
Specific tests	p. 131
Testing protocols	p. 139
Strategies for HIV testing	p. 140
Quality assurance and safety	p. 141
Laboratory Diagnosis of Common Reproductive Tract and Sexually Transmitted Infections	p. 143
Bacterial vaginosis	p. 143
Infections in non-pregnant women	p. 145
Infections in pregnant women	p. 145
Need for laboratory diagnosis	p. 146
Tests for vaginal discharge	p. 146
Tests for urethral and endocervical discharge	p. 149
Laboratory tests for syphilis	p. 152
Clinical Aspects
Accidental Occupational Exposure	p. 161
Introduction	p. 161
Risk of HIV infection	p. 162
Prevention	p. 163
Management of accidental exposure	p. 163
Seeking specialist opinion	p. 168
HIV-Related Neurological Disorders	p. 171
AIDS dementia complex	p. 171
Vacuolar myelopathy	p. 172
Myopathies	p. 173
Peripheral neuropathy	p. 173
HIV-related headaches	p. 174
Seizures	p. 174
Cerebrovascular disease	p. 175
HIV-Related Psychological Disorders	p. 177
Psychological reactions to diagnosis	p. 177
Denial	p. 178
Effect of social stigma	p. 178
Living with HIV	p. 179
Role of the doctor	p. 179
Symptomatic HIV infection	p. 180
Psychological impact on providers	p. 180
Co-Infection with HIV and Tuberculosis	p. 183
Magnitude	p. 183
Sources of tuberculous infection	p. 185
Host factors	p. 185
Natural history of tuberculosis	p. 186
Pathogenesis and immunopathology	p. 187
Diagnostic techniques	p. 189
Directly observed treatment, short course	p. 189
HIV-tuberculosis co-infection	p. 191
Multidrug-resistant tuberculosis (MDR-TB)	p. 194
Antiretroviral therapy in co-infection	p. 195
Prevention	p. 196
Research	p. 196
Sexually transmitted infections	p. 199
Introduction	p. 199
Co-infection with HIV with STIs	p. 200
Syndromic management of STIs	p. 201
Managing STIs in HIV-infected individuals	p. 203
Clinical aspects	p. 204
Antiretroviral Therapy	p. 211
Introduction	p. 211
Clinical and laboratory monitoring	p. 213
ARV therapy for adults and adolescents	p. 214
ARV therapy for women	p. 217
ARV therapy for infants and children	p. 218
ARV therapy for tuberculosis patients	p. 220
ARV therapy for injecting drug users	p. 220
Adherence to ARV therapy	p. 221
Surveillance of drug resistance	p. 223
Limitations of ARV therapy	p. 224
Appendices 1 - 6	p. 228
Traditional ethnomedicinal systems and alternative therapies	p. 251
Introduction	p. 251
Types of "alternative" therapies	p. 252
Intricacies	p. 253
Role of the physician	p. 254
Ayurveda	p. 254
Siddha medicine	p. 255
Unani-Tibb	p. 256
Chinese medicine	p. 257
Homeopathy	p. 260
Herbal therapies	p. 260
Yoga	p. 264
Other alternative therapies	p. 266
Side effects and interactions	p. 267
Approach to alternative therapies	p. 268
Prevention And Control
Strategies for Prevention and Control	p. 275
Information, education and communication	p. 275
Preventing sexual transmission	p. 277
Preventing injecting drug use	p. 280
Preventing blood-borne transmission	p. 280
Antiretroviral therapy	p. 282
Specific prophylaxis	p. 282
Sexually transmitted infections: diagnosis and treatment	p. 283
Primary health care	p. 283
Targeted interventions	p. 283
Surveillance for HIV	p. 287
Introduction	p. 288
Types of HIV surveillance	p. 288
Epidemic projection package	p. 290
Case reporting	p. 290
HIV sentinel surveillance in India	p. 292
HIV sentinel surveillance-2005	p. 293
Counselling	p. 297
Introduction	p. 297
Fundamentals of counselling	p. 298
HIV-related counselling	p. 299
Pre-test counselling	p. 301
Post-test counselling	p. 301
Partner counselling	p. 305
Counselling in special situations	p. 307
Referrals	p. 309
Evaluation of counselling	p. 310
Improving counselling services	p. 311
Voluntary Counselling and Testing Services	p. 313
Introduction	p. 313
Utility of VCT services	p. 314
Essential elements of VCT programme	p. 315
Methods for assessment	p. 315
Assessment of the community	p. 315
Organisational assessment	p. 316
Operational assessment	p. 316
Models for VCT service delivery	p. 318
Prevention of Mother-to-Child Transmission	p. 323
HIV infection in women	p. 323
Risk factors in pregnancy	p. 325
Probable timings for transmission	p. 326
Factors affecting MTCT	p. 327
Challenges in developing countries	p. 329
Possible intervention strategies	p. 329
Human Rights, Legal, and Ethical Issues	p. 337
Concepts	p. 337
Ethics in provision of health care	p. 338
Ethics in public education	p. 339
Ethical issues related to access	p. 340
Legal aspects	p. 340
Confidentiality	p. 342
Informed consent	p. 344
HIV testing and reporting	p. 345
Issues pertaining to treatment	p. 346
Issues pertaining to dying	p. 346
HIV and marriage	p. 347
Ethical issues in HIV/AIDS research	p. 348
Role of Health Care Providers	p. 355
Expectations from health care providers	p. 355
Continuing HIV education	p. 357
Role in public health	p. 358
Peer support organisations	p. 358
Preventive HIV Vaccine	p. 361
Introduction	p. 362
Study of immune responses	p. 363
Scientific obstacles	p. 364
Programme-related obstacles	p. 365
Various approaches	p. 366
Ethical issues	p. 368
India's role in HIV vaccine trials	p. 369
Conclusion	p. 369
Response to the HIV Epidemic in India	p. 373
Government's response	p. 373
National level programme management	p. 374
State-level programme management	p. 375
First phase of NACP	p. 375
Second phase of NACP	p. 378
National HIV policy	p. 379
Community response	p. 380
Private sector's response	p. 380
Conclusion	p. 381
Response to the HIV/AIDS Epidemic in Thailand	p. 383
Introduction	p. 383
Response to the epidemic	p. 384
Current situation	p. 384
Conclusion	p. 385
Response to the HIV/AIDS Epidemic in China	p. 387
Introduction	p. 387
Phases of China's epidemic and response	p. 388
Geographical variations	p. 389
High-risk groups	p. 390
Conclusion	p. 392
Epilogue	p. 395
Early years of the epidemic	p. 395
Theories about aetiology	p. 396
Socio-political consequences	p. 397
AIDS activism	p. 397
The Red Ribbon	p. 398
Advent of HAART	p. 398
Effect on blood-banking	p. 399
The global response	p. 400
Two epidemics	p. 401
Strategies for prevention	p. 402
The future	p. 403
Index	p. 407
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HIV and AIDS

1402057881

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