AIDS is caused by the human immunodeficiency virus (HIV). HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid and breast milk. This transmission can come in the form of: (anal or vaginal) sex; blood transfusion; contaminated needles; exchange between mother and infant during pregnancy, childbirth, or breastfeeding; or other exposure to one of the above bodily fluids.
The spread of AIDS can be prevented through safe sex and the use of needle exchanges where people who regularly use needles can get free needles. Effective screening for people donating blood is another way.
2006-06-07 23:32:52
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answer #3
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answered by Anonymous
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Transmission
HIV is transmitted by the directtransfer of bodily fluids, such as blood and blood products, semen and other genital secretions, or breast milk, from an infected person to an uninfected person. The primarymeans of transmission worldwide is heterosexual intercourse with an infected individual; the virus can enter the body through the lining of the vagina, penis, rectum, or mouth. HIV frequently is spreadamong intravenous drug users who share needles or syringes. Prior to the development of screening procedures and heat-treating techniques that destroy HIV in blood products, transmission also occurred through contaminated blood products; many people with hemophilia contracted HIV in this way. Today, the risk of contracting HIV from a blood transfusion is extremely small. In rare cases transmission to health care workers may occur by an accidental stick with a needle used to obtain blood from an infected person. The virus also can be transmitted across the placenta or through the breast milk from mother to infant; administration of antiretroviral medications to both the mother and infant around the time of birth reduces the chance that the child will be infected with HIV. HIV is not spread by coughing, sneezing, or casual contact (e.g., shaking hands). HIV is fragile and cannot survive long outside of the body. Therefore, direct transfer of bodily fluids is required for transmission. Other sexually transmitted diseases, such as syphilis, genital herpes, gonorrhea, and chlamydia, increase the risk of contracting HIV through sexual contact, probably through the genital lesions that they cause.
AIDS is a zoonosis, an infection that is shared by humans andlower vertebrate animals. A virus that is genetically similar to HIV has been found in chimpanzees in western equatorial Africa. Interestingly, this virus, known as simian immunodeficiency virus (SIV), does not readily cause disease in chimpanzees. The practice of hunting and butchering chimpanzees for meat may have allowed transmission of the virus to humans, probably in the first half of the 20th century.A different form of SIV that infects African green monkeys may have given rise to the virus called HIV-2. HIV-2 can cause AIDS, but it does so more slowly than HIV-1. Worldwide, the most common human immunodeficiency virus is HIV-1. HIV-2 is found mostly in western Africa.
Diagnosis, treatment, and prevention
Tests for the disease check for antibodies to HIV, which appearfrom four weeks to six months after exposure. The most common test for HIV is the enzyme-linked immunosorbent assay (ELISA). If the result is positive, the test is repeated on the same blood sample. Another positive result is confirmed using a more specifictest such as the Western blot. Aproblem with ELISA is that it produces false positive results in people who have been exposed to parasitic diseases such as malaria; this is particularly troublesome in Africa, where both AIDS and malaria are rampant. Polymerase chain reaction (PCR) tests, which screen for viral RNA and therefore allow detection of the virus after very recent exposure, and Single Use Diagnostic Screening (SUDS) are other options. Because these tests are very expensive, they are often out of reach for the majority of the population at risk for the disease.Pharmaceutical companies are developing new tests that are less expensive and that do not need refrigeration, allowing fora greater testing of the at-risk population around the world.
There is no cure or effective vaccine for HIV infection. Efforts at prevention have focused primarily on changes in sexual behaviour such as the practice of abstinence and the use of condoms. Attempts to reduce intravenous drug use and to discourage the sharing of needles have also led to a reductionin infection rates in some areas. HIV infection is treated with three classes of antiretroviral medications. Protease inhibitors, which inhibit the action of an HIV enzyme called protease, include ritonavir, saquinivir, indinavir, amprenivir, nelfinavir, and lopinavir. Nucleoside reverse transcriptase (RT) inhibitors (e.g., abacavir [ABC], zidovudine [AZT], zalcitabine [ddC], didanosine [ddI], stavudine [d4T], and lamivudine [3TC]) and non-nucleoside RT inhibitors (e.g., efavirenz, delavirdine, and nevirapine) both inhibit the action of reverse transcriptase. Each drug has unique side effects, and, in addition, treatment with combinations of these drugs leads to additional side effects including a fat-redistribution condition called lipodystrophy.
Because HIV rapidly becomes resistant to any single antiretroviral drug, combination treatment is necessary for effective suppression of the virus. Highly active antiretroviral therapy (HAART), a combination of three or more RT and protease inhibitors, has resulted in a marked drop in the mortality rate from HIV infection in the United States and other industrialized states since its introduction in 1996. Because of its high cost, HAART is generally not available in regions of the world hit hardest by the AIDS epidemic. Although HAART does not appear to eradicate HIV, it largely halts viral replication, thereby allowing the immune system toreconstitute itself. Levels of free virus in the blood become undetectable; however, the virus is still present in reservoirs, the best-known of which is a latent reservoir in a subset of helper T cells called resting memory T cells. The virus can persist in a latent state in these cells, which have a long life span due to their role in allowing the immune system to respond readily to previously encountered infections. These latently infected cells represent a major barrier to curing the infection. Patients successfully treated with HAART no longer suffer from the AIDS-associated conditions mentioned above, although severe side effects may accompany the treatment. Patients must continue to take all of the drugs without missing doses in the prescribed combination or risk developing a drug-resistant virus; viral replication resumes if HAART is discontinued.
Robert Siliciano
2006-06-07 23:31:55
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answer #8
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answered by babar 3
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