HIV disease progression and epidemiology since initial recognition

¶ … Disease

HIV disease is viewed as a continuing progressive damage to the immune system from the period of infection to that of the manifestation of severe immunologic damages by means of neoplasms, opportunistic infections, wasting, or further by means of low CD4 lymphocyte count that indicate AIDS. (Epidemiology of Disease Progression in HIV) People first became aware of HIV disease with publication of a brief report in 1981, published in the Morbidity and Mortality Weekly Report, of a rare pneumonia generated by Pneumocystis carinii, presently recognized as P. jirovecy, along with other uncommon infections in 5 young homosexual men in Los Angeles. This has become spread as an epidemic with increasing reports on similar immune deficiency syndromes concentrating in New York, California and other areas among "intravenous drug users, homosexual men, recipients of blood transfusions, infants, hemophiliacs, female sexual partners of infected men prisoners, Haitians and Africans." (Clinical Overview of HIV Disease)

While studies were attempted to represent the epidemiology and risk elements associated in a systematic manner, many theories come out with regard to the reasons of the mysterious disease. Many postulated about the presence of an infectious agent and in 1983 a novel human retrovirus was delineated as the putative etiologic agent. That virus was gradually named human immunodeficiency virus, or HIV. Irrespective of the radical advances in basis virology and clinical management, HIV infection has grown into a worldwide virulent disease, with about an infection of tens of millions of people by the virus and several more millions infected by it. Serology Assays have been developed by the year 1985 to test for HIV infection in asymptomatic persons, to detect new infections by seroconverison and to screen the several blood donations. Zidovudine has been developed as the first drug in 1987 with approval of U.S. Food and Drug Administration for the treating AIDS.

The inception of protease inhibitors -- PIs during mid 1990s radically improved the treatment of HIV in combination with antiretroviral therapy as a standard care in U.S. And Western Europe. Analyses made on the patients administered with new therapies brought new ideas on pathogenesis. It has been found that in relation to the viruses HIV-1 and the HIV-2 which is found to be less common evolves from the group consisting of retroviruses. The persons who have been infected with HIV are able to show both cellular and humoral immune responses in relation to the virus, but such responses are not in a position to avoid the final progression of disease in several multitudes of infected individuals. (Clinical Overview of HIV Disease)

2. Facts/statistics on the number of HIV cases based on race -- Whites, Black, Hispanic/Latino, & Other

The Survey of Americans on HIV / AIDS conducted by the Kaiser Family Foundation revealed that the African-Americans and young people in the age groups of 18-29 are considered as the most vulnerable group to HIV / AIDS in the United States. The basic finding of the survey conducted during 2004 reveal that the HIV / AIDS ranks second only next to cancer as the most significant health concern of the nation among the public in general but ranks first as a problem among the African-Americans. About 43% of African-Americans and 30% of Latinos are more concerned personally of becoming infected with HIV, in comparison to 17% whites. The African-Americans are more prone to come across someone who has HIV or AIDS or has died of this. (Kaiser Family Foundation Survey of Americans on HIV / AIDS Part Three - Experiences and Opinions by Race/Ethnicity and Age)

The African-Americans are noticed to have been affected disproportionately by HIV / AIDS since the inception of the epidemics. Presently, the African-Americans constitute about more than 50% of all the new HIV infection which are estimated to happen in the U.S. annually and about fifty percent of newly reported AIDS cases, actually far higher than their real proportionate constituent in the population. Such wide variation in the influence is also noticed among the various subgroups of African-Americans, inclusive of teens, women, children and homosexual men and the influence differs from across the nation. Irrespective of the fact that the African-Americans constitute about 12% of the U.S. population, they constitute about 38% of the total AIDS cases reported in the U.S. since the inception of the epidemic. The cases reported among African-Americans during 2001 were almost half of about 49% of cases considered higher than any other racial/ethnic group. This influence is even more prominent when viewed at new HIV infections. African-Americans constitute about 54% of the estimated new HIV infections in the United States annually. Presently, about 42% of people having AIDS or the prevalence of AIDS in the U.S. are African-American, which is the highest racial and ethnic group. (Key facts African-Americans and HIV / AIDS)

Irrespective of the fact that the Latino consisting of about 14% of the U.S. population, they represent approximately 19% of the 929,985 AIDS cases diagnosed ever since the beginning of the epidemic and about 20% of the 43171 cases diagnosed in the year 2003 alone. About 80,623 Latinos were living with AIDS at the beginning of the year 2004 constituting about one fifth of all individuals estimated to be having AIDS in the U.S. The proportion of new AIDS detected has persistently increased from 15% in the year 1985 to 20% in the year 2003. (HIV / AIDS Policy Fact Sheet-Latinos and HIV / AIDS)

3. Diagnosis

The diagnosis process of HIV infection includes testing for HIV antibody with the help of standard ELISA or Western blot evaluations and/or finding of replicating virus by testing for viral RNA concentrations or that of the P24 antigen levels. Primary HIV infection is confirmed by the presence of HIV-1 replication before developing HIV-1 antibodies as being decided by ELISA or Western blot. The early HIV infection is indicated to be the HIV-1 antibody noticed to be positive, with prior records of a negative HIV-1 antibody test within the span of past 6 to 12 months. The early HIV-1 state infection also indicated to necessitate quantification of the antibody response. When the HIV-1 RNA and antibody do not succeed in revealing HIV infection, then these laboratory tests are to be conducted frequently within four to six weeks after the period of initial testing. (Diagnosis and Management of Primary HIV Infection)

The HIV infected patients as a group mostly is relatively younger and the live in the prognosis of a chronic, stigmatizing, transmissible, disfiguring and prospectively deadly disease. The clinicians are required to take into consideration such facts while informing patients of a diagnosis of HIV disease. Such consideration and the principles of honesty and practical support are required to guide the physician in such conveying of facts. However, the success rate of the present therapy has considerably reduced the amount of stress of conveying and receiving a diagnosis in relation to the HIV disease. (How to Tell Patients They Have (or Do Not Have) HIV)

5. Treatment

The treatment of HIV as approved by FDA involves antiretroviral medication that operates by inhibiting one of three steps in the life cycle of HIV and they involve: blocking of the reverse transcriptase enzyme, blocking of the protease enzyme, affecting fusion of the viral and host membranes. Presently the antiretroviral medications that are under development also incorporates better formulations of presently approved drugs, new drugs in the same classes as presently approved drugs like PIs or NNRTIs with less adverse impacts or particular resistance patterns. The ART treatment is administered only with those of the HIV-infected persons whose CD4 count and clinical evaluation show a lower amount of risk of the progression of the disease, the prospective after effects of the immediate amount of treatment would be anticipated to overrule any advantages. The HIV infected persons for whom the start of ART is not depicted must be watched carefully for variations in immune status that might indicate enhanced risk of opportunistic infections and thus spark the initiation of ART, OI prophylaxis or other interventions. The decisions to initiate ART are required to be made with clear objectives that address the concerns of the patients along with the provider. (Clinical Overview of HIV Disease)

6. Prevention methods and related facts

The activities towards HIV / AIDS prevention during the last 20 years have improved radically and have substantial impact on the rate of infections. In the United States, the mother-to-child HIV transmission has been decreased drastically from 2500 perinatal HIV infections in the year 1992 to an estimated amount of 300 to 400 annual infections in the last few years. This is due to the spread of HIV counseling and voluntary testing in the case of pregnant women and the availability of zidovudine and other drugs to affect transmission from them to the baby. The vulnerability of infection among many men who are homosexuals, users of injection drug and women has been decreased substantially by means of community level interferences and multifarious behavioral prevention that challenges the ability of the people to form healthy decisions and maintain protective behaviors. However, the successes of prevention have not been so evident with the populations now at higher levels of risk, especially people of color, younger MSM and women. The need of the time to develop prevention activities which are targeted, which are efficient and sustained that create community capacity in order to deliver the ongoing, lifelong prevention programming for those who are at risk and those who already been infected. (Centers for Disease Control and Prevention HIV Prevention Strategic Plan through 2005)