HIV/AIDS Overview

HIV (human immunodeficiency virus) infection has now spread to every country in the world. Statistics show that approximately 40 million people are currently living with HIV infection, and an estimated 25 million have died from this disease. The scourge of HIV has been particularly devastating in sub-Saharan Africa and South Africa, but infection rates in other countries remain high. In the United States, approximately 1 million people are currently infected. Here are a few key points about the disease:

Globally, 85% of HIV transmission is through heterosexual intercourse. In the United States, approximately one-third of new diagnoses appear to be related to heterosexual transmission. Male-to-male sexual contact still accounts for more than half of new diagnoses in the U.S.Intravenous drug use contributes to the remaining cases. Because the diagnosis may occur years after infection, it is likely that a higher proportion of recent infections are due to heterosexual transmission. Infections in women are increasing. Worldwide, 42% of people with HIV are women. In the United States, approximately 25% of new diagnoses are in women, and the proportion is rising. There is good news on one front. New HIV infections in U.S. children have fallen dramatically. This is largely a result of testing and treating infected mothers, as well as establishing uniform testing guidelines for blood products. In order to understand HIV and acquired immunodeficiency syndrome (AIDS), it is important to understand the meanings behind these terms:

HIV stands for the human immunodeficiency virus. It is one of a group of viruses known as retroviruses. After getting into the body, the virus kills or damages cells of the body's immune system. The body tries to keep up by making new cells or trying to contain the virus, but eventually the HIV wins out and progressively destroys the body's ability to fight infections and certain cancers. The virus structure has been studied extensively, and this has helped scientists develop new treatments for HIV/AIDS. Although all HIV viruses are similar, small variations or mutations in the genetic material of the virus create drug-resistant viruses. Larger variations in the viral genes are found in different viral subtypes. Currently, HIV-1 is the predominant subtype that causes HIV/AIDS. AIDS stands for the acquired immunodeficiency syndrome. It is caused by HIV and occurs when the virus has destroyed so much of the body's defenses that immune-cell counts fall to critical levels or certain life-threatening infections or cancers develop.

HIV/AIDS Transmission
HIV is transmitted when the virus enters the body, usually by injecting infected cells or semen. There are several possible ways in which the virus can enter. Most commonly, HIV infection is spread by having sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex. Although intercourse is the primary risk factor, oral sex transmission is also possible. HIV frequently spreads among injection-drug users who share needles or syringes that are contaminated with blood from an infected person. Women can transmit HIV to their babies during pregnancy or birth, when infected maternal cells enter the baby's circulation, or through breastfeeding. HIV can be spread in health-care settings through accidental needle sticks or contact with contaminated fluids. Very rarely, HIV spreads through transfusion of contaminated blood or blood components. All blood products are tested to minimize this risk. If tissues or organs from an infected person are transplanted, the recipient may acquire HIV. Donors are now tested for HIV to minimize this risk. HIV has been spread when organs from an infected person are transplanted into an uninfected recipient. Because donors are tested for HIV routinely in the United States, this does not usually

happen. However, a recent incident in Taiwan occurred when the HIV test results for the donor were mistakenly thought to have been negative. People who already have a sexually transmitted infections, such as syphilis,genital herpes, chlamydial infection, human papillomavirus (HPV), gonorrhea, or bacterial vaginosis, are more likely to acquire HIV infection during sex with an infected partner. The virus does not spread through casual contact such as preparing food, sharing towels and bedding, or via swimming pools, telephones, or toilet seats. The virus is also unlikely to be spread by contact with saliva, unless it is contaminated with blood.
HIV/AIDS Medications
Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are called highly active antiretroviral therapy (HAART) and have substantially reduced HIV-related complications and deaths. However, medications do not cure HIV/AIDS. In one case, a patient treated for cancer apparently was cured of HIV through use of a stem cell transplant, but this "stem cell cure" is not recommended for HIV due to the high risk of mortality and uncertain chance of success. Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three drugs is recommended to suppress the virus from replicating and boost the immune system. The following are the different classes of medications used in treatment.

Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. The following are examples: o Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). These include medications such aszidovudine (AZT/Retrovir), didanosine (ddI/Videx), zalcitabine (ddC/Hivid),stavudine (d4T/Zerit), lamivudine ( 3TC/Epivir), abacavir (ABC/Ziagen),emtricitabine (FTC/Emtriva), and tenofovir (Viread). o Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune),delavirdine (Rescriptor), and etravirine (Intelence). Rilpivirine (Edurant), the newest member of this class of drugs, was approved by the U.S. FDA in May of 2011. o Two complete HIV treatment regimens that combine two NRTIs and one NNRTI in one pill taken once a day are available for convenience. Atripla: a combination of efavirenz, emtricitabine, and tenofovir. Atripla was approved for use by the FDA in 2006. Complera: a combination of rilpivirine, emtricitabine, and tenofovir. This combination pill was approved in August 2011 by the FDA as another first-line treatment for HIV infection in patients who need to start therapy. Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra),saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase),fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir( Aptivus), and nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications. Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin. Another drug called maraviroc (Selzentry) binds to a protein on the surface of the human cell and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs. Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This is a newer class of drugs recently approved to help treat those who have developed resistance to the other medications.Raltegravir (Isentress) was the first drug in this class approved by the FDA in 2007.

Antiretroviral viral drugs stop viral replication and delay the development of AIDS. However, they also have side effects that can be severe. They include decreased levels of red or white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol level, diabetes, abnormal body-fat distribution, and painful nerve damage. An expert in infectious diseases should be consulted if the patient needs concomitant treatment for diseases such as cancer or hepatitis C.

Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss anti-HIV medications is crucial. .

Carl Leone
From Wikipedia, the free encyclopedia

Carl Desmond Leone (born c.1976) is a Canadian businessman from Windsor, Ontario. Leone was jailed after pleading guilty in a Windsor court to 15 counts of aggravated sexual assault for not informing his sexual partners of his positive HIV status.[1] It is believed he has been charged with exposing more women to the AIDS-causing virus than anyone in Canadian history.[2] In 1997, Leone was told by Windsor Essex County Health Unit workers that he was HIV-positive[citation needed]. Seven years later on June 6, 2004, he was arrested. On June 10, police issued a public safety advisory that resulted in more than 100 people seeking HIV tests for having been a partner of Leone or possibly being linked to him.[3] Under Canadian criminal law, people knowing they are HIV positive have a legal duty to disclose their HIV status before engaging in behaviors that put another person at significant risk of serious bodily harm. This is the result of the 1998 ruling by the Supreme Court of Canada (R. v. Cuerrier) stating that a partner cannot truly give informed consent if the other fails to disclose their HIV status. Complainants said they would not have been Leone's partner had he been truthful about his status. [4] Six of the 22 complainants tested positive for HIV (three of them learned of their condition after his arrest) with the same rare strain that Leone was infected with. The strain is extremely rare in Canada, and the number of local cases represented an unusually high concentration for the country and constituted a public health issue for the Public Health Agency of Canada. Dr. Paul Sandstrom, director of the National HIV & Retrovirology Laboratories, testified that Windsor cluster was unique in North America because it is a different HIV strain infection than the one that began spreading across North America in the early-1980s and is more commonly found in Southeast Asia.[5] Initially, Leone was refused bail but turned to well-known criminal defence lawyer Edward Greenspan who successfully appealed the decision. Leone was released after posting bail of nearly C$800,000. [6]

By the time of the trial, Leone was represented by Andrew Bradie. On April 27, 2007, prior to any of the complainants testifying, Leone agreed to plead guilty. The agreement spared the complainants the experience of testifying and also marked the first time he publicly acknowledged his HIV-positive status. [7] On October 23, 2007, The Attorney General of Ontario deputy approved the Crown attorney's motion to pursue a Dangerous offender designation for Leone.[8] Under the Criminal Code of Canada, a person designated a dangerous offender may be indefinitely incarcerated so that they do not get released into society if there is a fear they may re-offend due to their violent tendencies. Leone was sentenced to 18 years in prison in April 2008, with eligibility for parole in six years. The judge said he was unable to designate him a dangerous offender because there was insufficient evidence that he would commit similar offences if released. [9]