AIDS UPDATE 2012 presents a balanced review of current research and information on HIV infection, HIV disease, and AIDS. AIDS UPDATE 2012 places discussion within a biological, medical, and social framework, helping readers more fully understand this devastating pandemic.

Contents

About the Author iii

ThirtyYears of HIV/AIDS and Counting: A Humanitarian Crisis x

AIDS UPDATE 2012 xxii

Preface xxiv

Introduction: Histories of Global Pandemics, AIDS, Its Place in History, Overview of HIV/AIDS, International AIDS Conferences and Means of Remembering<&mdash>—the AIDS Quilt, Candlelight Memorial, and World AIDS Day 1

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

1 AIDS: Defining the Disease and Finding Its Cause 17

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

2 What Causes AIDS: Origin of the AIDS Virus 28

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

3 Biological Characteristics of HIV 46

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

4 Anti-HIV Therapy 64

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

5 The Immunology of HIV Disease/AIDS 102

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

6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS 131

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

7 A Profile of Biological Indicators for HIV Disease, Progression to AIDS, and Hope 151

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

8 Epidemiology and Transmission of the Human Immunodeficiency Virus 175

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

9 Preventing the Transmission of HIV 226

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 237

Sexual 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

10 Prevalence of HIV Infections, AIDS Cases, and Deaths among Select Groups in the United States and in Other Countries 280

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

E

ducation: 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

11 Prevalence of HIV Infection and AIDS Cases among Women and Children 326

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

12 Prevalence of HIV Infection and AIDS among Young Adults, Ages 13 to 24 355

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

13 Testing for Human Immunodeficiency Virus 370

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

14 AIDS and Society: Knowledge, Attitudes, and Behavior 403

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

Answers to Review Questions 448

Glossary 456

References 467

Index 494