Thursday 21 April 2011 2 comments

AIDS About childs






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The Age of AIDS.


Pakistan is a country on the brink of a major AIDS epidemic, and experts say "time is of the essence" if this country of 159 million is to avoid following in the footsteps of neighboring India, which has the world's second largest number of HIV/AIDS cases.
Rising poverty, a growing number of intravenous drug users, severe social stigma, and an absence of basic sex education combine to make Pakistan particularly vulnerable. Although the recorded number of infections is under 3,000, UNAIDS believes the number to be closer to 73,000 and rising. "We are not actually diagnosing people," Dr. Asif Mirza of the Family Planning Association of Pakistan told the BBC. "... And the people who are already diagnosed, we don't look after them properly."
HIV testing remains expensive, and the cost of antiretroviral treatment, at $300 per month, is nearly twice the average person's salary. Meanwhile, the country lacks the basic central infrastructure to administer testing and treatment; health care is the responsibility of provincial governments -- and even blood donations are not universally screened for HIV.
Religion dominates every aspect of life in Pakistan, where AIDS is seen largely as divine retribution for immorality, but some non-governmental organizations have found that by working with the religious community they can promote a basic understanding of the disease and reduce its stigma. Amal, an NGO based in Islamabad, and Catholic Relief Services have operated programs in several madrassas that encourage future clerics to educate their worshipers about how the disease is spread and preach compassion for the infected by drawing on teachings from the Qu'ran. However, most Muslim clerics remain averse to teaching basic sex education -- particularly the use of condoms, which they argue promotes promiscuity.
The government of Pakistan recognizes the looming threat and has made HIV/AIDS education an optional extracurricular program in the country's high schools, but safe sex is not widely practiced here, even among the most at-risk groups. A survey of female sex workers in Karachi found that one in five cannot recognize a condom and 75 percent do not know condoms prevent HIV; one third had never even heard of AIDS. Intravenous drug users are similarly uninformed, and they account for 74 percent of known transmissions. Small, localized epidemics have already broken out among intravenous drug users in the cities of Karachi and Lakarna, where HIV infection rates are 23 percent and 10 percent respectively. For Pakistan, the time to prevent an epidemic may be running out.




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Karachi Has More Than 100,000 Prostitutes

Shumaila is one of the rare ones who are aware about the perils of HIV/AIDS an thus insist upon using condoms. Hundreds of thousands of condoms have been distributed to sex workers in the last two years, which have saved them from being infected with the lethal virus.
Karachi has up to 100,000 female sex workers, according to data gathered by Pakistan Society, a local welfare organisation. ‘This is 20 percent of their overall population in Pakistan.
Lahore comes next with 75,000 sex workers,’ Saleem Azam, head of the charity.
Prostitution may be illegal but it has prospered in Pakistan, where an economic downturn and widening poverty have forced women and men onto the streets to meet the rising cost of living.
Shaheena, 38, is a home-based sex worker. She is a skilled paramedic but seldom finds a permanent job. ‘So I opted to enter this business on the side,’ she said, veiling her face to hide her identity. ‘I have sibblings, cousins, nephews and nieces who don’t know about my second profession. So I don’t want to identify myself to embarass them. ‘But it’s a question of survival as none of my relatives support me with money. They are all too stretched themselves,’ she said.
More than 60 percent of Pakistan’s prostitutes work from homes or ply the streets, while the elite serve wealthy clients from kothikhanas (houses or rooms) in plush neighbourhoods.
A report said 60 percent of female sex workers and 45 percent of their male clients in Karachi and Lahore do not know that condoms can prevent transmission of HIV. Of those that do, few protect themselves. ‘The number of our clients who agree to wear a condom is small. Female condoms are not available, which can save us more effectively,’ said Nasreen, another prostitute in Napier Road. ‘I can’t carry condoms in my purse on the street as we’re vulnerable to the police and could be arrested if they find them,’ said Afshan, 29, who walks the city’s busy streets looking for clients.
The 2006 survey said only 18 percent of sex workers reported always using condoms. Around 96,000 people, or 0.1 percent of the population, live with HIV in Pakistan. The government says only 5,000 people are infected. The disease is spreading among high-risk groups, especially drug users, who mostly inject and use dirty needles, raising fears the virus could spread quickly from addicts to prostitutes. In 2006, Pakistan said HIV/AIDS prevalence among female sex workers was around 0.02 percent, but independent bodies put it much higher. ‘It is at least 15 per cent, ‘said Azam. ‘They are totally at the mercy of their clients. Most of their clients refuse to wear condoms,’ he said.
‘In Pakistan, this business is illegal, thus there is no law to seriously tackle the issue and save precious lives. Yet a way-out is desperately needed on humanitarian grounds.’ Baig said he had identified an HIV-positive sex worker a few months ago and tried to help her with treatment and a new job but she left because her colleagues considered her a blot on their business. ‘Now, no one knows where she is and what she is doing,’ he said.
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HIV/AIDS increasing in Pakistan



On the eve of World AIDS Day (December 1) on Monday (today), Save the Children, UK, released a report conducted with the help of Protection and Health of Children against Abuse and Neglect (PEHCHAN) in Lahore. The estimated number of HIV positive cases is 74,000 people, ranging between 24,000 and up to 150,000 in Pakistan. A couple of children, including Imran and Nasir hailing from Vehari and Multan respectively, while talking to this correspondent here at Ali Park in redlight area, said that almost all the children in the vicinity were addicted to various kinds of drugs as well as involved in often unsafe sexual practices in one way or the other. They didn’t want to return their homes due to attraction towards drugs.



Talking to The News, Dr Naeem Zafar, a representative of PEHCHAN, confirmed that these vulnerable children were absolutely on their own, as everybody, including the officials of government, NGOs and even the media, were exploiting them for their own benefits.



In the report based on 58 respondents, the children’s average age was 15 year, 28 per cent reached up to grade five of their education, worked up to 10-12 hours, 100 per cent reported domestic violence with 8-member average family size with average monthly household income of $160 per month and individual child’s average income is $38 per month.



Out of total 58 respondents, 35 reported addiction to one or more substances and 23 claimed no addiction. The items of addiction include charas (cannabis), heroine, tobacco, alcohol, glue, injection and tablets/cough syrups. At least 36 children, including 28 boys and eight girls, reported one or more symptoms of Sexually Transmitted Infections (STIs) while 22 children, including 20 boys and two girls, did not report any symptoms of STIs.



A total of 19 per cent children said police positively helped them, 60 per cent were of the view that police didn’t help them when they needed it, 15 per cent claimed that the police officials were involved in their sexual exploitation and six per cent of them didn’t respond.



Most of the 15,000-20,000 estimated child sex workers present in Lahore live in areas near bus stands and railway station. Male child prostitution is more common than any other form of commercial sexual exploitation in Pakistan.



Though the trend of selling organs (kidney.) for cash does not seem to have caught hold in Lahore or was not reported, quite a few children were aware of the fact that they could sell their blood for money if the need arose. The limited blood screening facilities make such practice extremely unsafe and can spread HIV/AIDS on a rapid scale. Though not a single child admitted to resorting to this practice, they had come to know about this through adult drug addicts. In Pakistan, demographic vulnerability, high prevalence rates of Hepatitis B (around 10 per cent) and Hepatitis C (6-8 per cent), risky sexual behaviours and low contraceptive use compound the probability for contracting HIV/AIDS in Pakistan.



Since HIV virus spreads fastest among those who have unprotected sex with a large number of partners (especially if they have untreated Sexually Transmitted Infections -STIs) and those who engage in especially risky sexual practices and those who share injecting equipment (syringes and needles) with other people, therefore, children living in an unprotected environment-away from their primary caregivers-are especially vulnerable. Only 45 per cent of Pakistani adolescents surveyed in 14 districts knew about HIV/AIDS while 52 per cent of them believed they could resist peer pressure.



Tattooing, selling blood, organ removal, usage of unsafe dental equipment, ear and nose piercing make children on the streets more vulnerable to contracting HIV. Masochism through piercing oneself with blades, usually while sniffing glue, as a way to release anger is very common in nearly all street children. The report further says early marriage can make girls under 18 vulnerable to contracting HIV. In rural areas, as many as 42 per cent of girls below the age of 19 are married and their husbands, usually older men, were likely to be sexually experienced. Besides, lack of education and poverty also compound vulnerability to HIV/AIDS among the people.



In Pakistan, the estimated population aged below 18 years is 71 million, and 3.6 million children are involved in child labour. About 1.2 million children are on the streets in Pakistan’s large cities, working as beggars, vendors or shoeshine boys.



As many as 15 to 25 per cent children in Pakistan are affected by Child Sexual Abuse (CSA) of varying forms and intensity while only heinous crimes are highlighted by the media. Occupational safety for working children is non-existent. Trash pickers often handle used syringes and children working in auto shops are vulnerable to cuts and injuries from tools handled by everyone.



Furthermore, it is mentioned that a total of 40.3 million people are globally affected by HIV and AIDS out of which two million adolescents and 570,000 children died in 2005. A child dies of AIDS every minute somewhere in the world. Every minute, one child under 15 years becomes HIV positive somewhere in the world.


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World AIDS Day, Pakistan

A popular South Asian rock guitarist of Junoon, Pakistan

Wednesday 20 April 2011 0 comments

HIV breakthrough as scientists discover new vaccine to prevent infection


A microscopic image of the HIV virus.
medical trial in Thailand has raised hopes of a major breakthrough in the fight against Aids after scientists said an experimental vaccine had reduced the risk of HIV infection by a third.
The world's largest HIV/Aids vaccine trial of more than 16,000 volunteers was the first in which infection has been prevented, according to the US army, which sponsored the trial with the National Institute of Allergy and Infectious Diseases.
A combination of two vaccines was tested on HIV-negative Thai men and women aged 18 to 30 at average risk of becoming infected. All the volunteers were given counselling and condoms to help them avoid HIV. Then half were randomly picked to receive the vaccine, while the other half got dummy shots. Until the trial ended, nobody knew who had been given the genuine vaccine and who had not.
A relatively small number of people became infected with HIV – 51 of the 8,197 people given the vaccine, and 74 of the 8,198 who received dummy shots – but the difference was statistically significant, which means scientists believe it could not have happened by chance. It worked out at a 31% lower risk of infection for the vaccine group.
Colonel Jerome Kim, who helped to lead the $105m (£64m) study for the US army, said it was "the first evidence that we could have a safe and effective preventive vaccine".
Recent failures had led many scientists to believe that such a vaccine might not be achievable. In 2007, the drug company Merck abandoned what had looked at the time like the most promising avenue of research after disappointing trial results. Today the National Institute's director, Dr Anthony Fauci, warned it was "not the end of the road", but said he was surprised and very pleased by the outcome.
"It gives me cautious optimism about the possibility of improving this result," he said. "This is something that we can do."
Every day, 7,000 people worldwide are newly infected with HIV; 2 million died of Aids in 2007, the UN agency Unaids estimates.
The Aids Vaccine Advocacy Coalition, an international group that has worked towards developing a vaccine, welcomed the results of the trial – the third major study since 1983, when HIV was identified as the cause of Aids – as "a historic milestone".
The executive director, Mitchell Warren, said: "There is little doubt that this finding will energise and redirect the Aids vaccine field."
Frances Gotch, professor of immunology at Imperial College London, said the results appeared to be statistically significant and may have been the effect of the two different vaccines working in tandem to more powerful effect.
"The fact that they have seen a response with people with such a low incidence of infection is impressive," Gotch, who is also the principal investigator for the International Aids Vaccine Initiative, told the Guardian.
"Of course it's not 100% of people [protected] but 31% could make an enormous difference in the world. I think this is something we can work with."
Thailand's ministry of public health conducted the study, which used strains of HIV common in Thailand.
Scientists stressed it was not known whether such a vaccine would work against other strains elsewhere in the world. The study was done in Thailand because US army scientists carried out pivotal research in that country when the Aids epidemic emerged there, isolating virus strains and providing genetic information on them to vaccine makers.
The study tested a two-vaccine combination in a "prime-boost" approach, where the first one primes the immune system to attack the HIV virus, and the second one strengthens the response.
Alvac uses canarypox, a bird virus, altered so it can't cause human disease, to ferry synthetic versions of three HIV genes into the body. AidsVax contains a genetically engineered version of a protein on HIV's surface.
It is unclear whether vaccine makers will seek to license the two-vaccine combination in Thailand. Before the trial began, the US Food and Drug Administration said other studies would be needed before the vaccine could be considered for US licensing. The full results of the trial will be presented at an international Aids vaccine conference in Paris in October.
The executive director of the Global HIV Vaccine Enterprise, an alliance of research bodies and funders like the Gates Foundation, said the results showed a vaccine was an achievable goal. "This is a historic day in the 26-year quest to develop an Aids vaccine," said Dr Alan Bernstein. "This trial is the first demonstration in humans that, with more research, it will be possible to develop a vaccine that is fully protective against HIV."
Deborah Jack, chief executive of the National Aids Trust in the UK, said a vaccine, by far the most effective way of tackling serious infectious diseases, was desperately needed. More work was needed, but the promising findings "justify the continuing investments and efforts of the international community, including the UK government, to develop a vaccine."
The Terrence Higgins Trust said it was treating the results with "cautious optimism".
"This is the first step on a very long road," said the policy manager, Vicky Sheard.
"There's a lot of research needed into how a vaccine can be rolled out, how costly it's going to be, whether it's going to be effective against different strains."

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What does HIV/AIDS cost? The answer to this question depends a lot on whom you ask

Ask the UN and you’ll get the staggering sum of $10 billion. A year. The annual per capita cost of treating infected Africans, where much of the UN money goes, is around $1,100. One of the major problems facing HIV/AIDS advocates is their inability to lower this number. An estimated $600 is spent on anti-retroviral drugs, while the remaining $500 is spent on other AIDS associated conditions. Even $10 billion wouldn’t cover treatment for the more than 20 million Africans with HIV/AIDS. A considerable portion of the proposed UN budget is directed not towards treatment but towards prevention. A major problem is that no one can seem to agree on the actual cost. Although the UN has held firm to their estimate, other groups have presented vastly different figures. The World Health Organization has presented four different scenarios which vary wildly in both the projected outcome and cost. To merely maintain the current status quo, WHO estimates more than $400 billion will need to be spent over the next 20 years. To significantly reduce annual new HIV infections, WHO’s figure is more than $700 billion. Unfortunately such different figures can sometimes complicate funding by making it hard for donors to decide how much to give.

Ask someone who is living with HIV/AIDS and you’ll get a number that’s a lot smaller. The average AIDS patient in America takes a combination of drugs that add up to around $14,000 a year . Much of this cost in the US is defrayed by private insurance, government insurance or sometimes through AIDS drug assistance programs (ADAPs) . These programs are meant to provide access to drugs for low income individuals. Currently 89% of people enrolled in ADAPs make less than 300% of the federal poverty level. However recently the economic conditions have forced many states to scale back their support of these programs. States have either closed enrollment entirely, or narrowed eligibility-forcing people to drop out. Currently the nationwide waiting list is at an all time high of 3,586 people .





Ask the companies that manufacture these lifesaving drugs and you’ll be back to huge figures. One of the newest drugs to enter the market, Fuzeon , is produced by the giant Swiss company, Roche. Roche maintains that Fuzeon’s price (nearly $20,000 a year, or three times the next most expensive drug) is due to the $600 million cost of development. The average drug begins to turn a profit in 16 years, but analysts estimate that Fuzeon’s pricing, and anticipated demand, could mean profits for Roche in as little as three years.

Ask an economist and you’ll get a couple different figures. By 1995 more than $75 billion had been spent on AIDS. Since then, spending has increased most years, with an average of $10 billion more being spent every year. But money spent directly on AIDS does not even begin to cover the true cost. In addition, economists have tried to measure the costs related to lost productivity, wages, and premature death, due to the disease. Figures vary, but some think that indirect costs account for nearly 80 percent of the total cost of AIDS. Worst case scenario guesses estimate that AIDS robs the world of 1.4% of gross domestic product, or the equivalent of wiping out the economy of Australia.




A government study in Uganda found that some companies are hiring and training two employees for a single job in the hope that one will stay healthy. The UN estimates that since 1981 AIDS has reduced Africa’s overall labor force by 25%. Sick days and absenteeism due to AIDS related illness have further reduced productivity in the countries hit hardest by AIDS.

Ultimately the cost of HIV/AIDS is extraordinarily difficult to measure. The disease affects so many people worldwide that it would be impossible to assess the impact that it has had on everyone. However it is obvious that unless something drastic changes, the costs will continue to grow until they become unbearable.


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'Feel Good' Data on AIDS, does it say truth?




India is celebrating the data that showed the number of HIV infected people have come down by half to 2.47 million. The recently released estimate data has tried to give people of India a cause to laugh and laugh on our leaders. The National AIDS Control Organisation (NACO) has opted to choose more unknown methods than known ones in its methodology to find the new figure.
In 2006, the government had applied some different approaches to find the real number of HIV affected people in the country. In those approaches the count was restricted to ’sentinel’ surveys. Several UN agencies as being the best way to track the AIDS epidemic were somehow pushed India’s approaches.
Now, this time, the government opted to appendage the results of sentinel surveys with community data. According to this process, an HIV/AIDS component was included in the third National Family Health Survey (NFHS) that was conducted in 2005.
Now, the major question is that ‘can a combined effort give us more accurate numbers of HIV-affected people’? The NFHS survey that compiled HIV/AIDS data itself is actually complicated one. It has not released the results of sentinel surveillance for the current year. To compare final figures taken through different approaches cannot show the real performance of the national AIDS control program.
While stating the data, the Union Health minister Anbumani Ramadoss was looking satisfied without telling the reason. He gave the details that sentinel surveillance in pregnant women was expanded to 1,122 sites in 2006 from the earlier 703 sentinel sites but opted to remain silent on the results of the expanded exercise in so many sites.
The NACO’s latest estimate says that the occurrence of HIV/AIDS in India has to be scaled down from one in 100 or about 0.9 per cent to one in 300 or 0.36 per cent, or to 2-3.1 million from the previous estimate of 5.2 million.
Prabhat Jha of the Center for Global Health Research, Toronto, commented on this new data as it is hard to know how much of this drop is due to a new computer program rather than the efforts of the AIDS control program in India.
Health minister Ramadoss himself accepted that there was a minor reduction in prevalence. Now, if we compare the latest sentinel survey with the earlier one, the prevalence of HIV/AIDS is as much as where it was at 0.9 per cent.
Let me explain you the meaning of sentinel surveys. In this survey, the clinics intensively monitor pregnant women patients tested for presence of HIV for about eight weeks every year.
The main reason behind this practice is to know how the epidemic is progressing at specific locations. The STD-affected people also get a treatment here at that time to know how the disease was progressing in the so-called ‘high risk’ groups.
After a period of time, it gives a ‘good’ data to know whether HIV/AIDS spread is on an upward direction or not. This has led to a new approach this time round.
At the same time, the ministry of health and family welfare also decided to collect data under NFHS-3, by carrying out an AIDS test. But this approach under-represents certain populations because at least 100,000 people in the age group 15-54 voluntarily undertook an AIDS test.
According to this data, India has the prevalence of HIV/AIDS at 0.28 per cent. It means there are about 280 HIV positive cases in India those were actually detected by the surveyors.
The Integrated Behavioral and Biologic Assessment (IBBA) system data has assisted NACO in producing the ‘feel-good’ data. It was not the government but UNAIDS which made this fact public. Whatever the data says, one thing is very much clear that the numbers are still large and worrying so we should not let down our fight with this epidemic at any cost.

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Does HIV cause AIDS

Does HIV cause AIDS
The failure of a much sought-after vaccine against the virus has re-ignited an old debate. Mayank Tiwari explores the controversy

The recently reported pessimism among researchers over the failure of an AIDS vaccine has reignited a spectacular science controversy.
Is HIV the cause of AIDS?

Last September, AIDS researchers were dealt a heavy blow when clinical trials of the most promising candidate for an HIV vaccine were stopped after it turned out to be a dud. 

The clinical trials showed that the vaccine might have put the people who received it at greater risk of infection rather than preventing HIV or reducing its effect. A survey of top AIDS scientists conducted by The Independent showed most believed a vaccine was nowhere near, with some even believing that effective immunization against HIV may never be possible.

“Nearly a billion dollars is spent globally on AIDS research annually, and yet the sobering reality is that at present there are no promising candidates for an HIV vaccine,” wrote Harvard Medical School’s Bruce Walker in the journal Science, summing up the failure of the expensive effort.

The development has strengthened the position of a vocal minority of scientists who argue that HIV is a harmless passenger virus (found in diseased tissue, but not contributing to the cause of the disease).

This community of scientists includes Peter Duesberg, professor of molecular and cell biology at the University of California, Berkeley, David Rasnick, a prominent American biochemist, and Nobel laureate Kary Mullis, another American biochemist, and enjoys the support of South African President Thabo Mbeki. They have from the very beginning of the AIDS era—supposed to be 1984 when US biomedical researcher Robert Gallo published a series of papers arguing that HIV was the cause of AIDS—questioned the “causal link” between the virus and the disease.

Other developments, too, have strengthened the position of the AIDS dissidents. Among these are: periodic revisions of the number of people suffering from AIDS; the demographic factor, which is against the nature of infectious viruses to spread regardless of identity clusters; and AIDS symptoms like tuberculosis and cancer being common results of lifestyle conditions. 

Duesberg even says that it is AIDS drugs, such as AZT, that cause the disease owing to their high toxicity. The dissenters also cite data showing HIV+ individuals tend to get AIDS when they take AZT and get better if they stop taking the drug.

Among the main reasons dissenters cite in favour of their movement is skewed health funding, especially in developing countries. On May 10, the British Medical Journal carried an article calling for UNAIDS to be shut down as it distorts health funding. In it, Roger England, who heads a Grenada-based think tank, Health Systems Workshop, argued that too much is being spent on HIV compared to other diseases which kill more people. 

“It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems. Although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big chunk of domestic expenditure. HIV aid often exceeds total domestic health budgets themselves.”

Purushottam Muloli, a New Delhi-based member of Rethinking AIDS, a loose group of scientists and policy makers who do not agree with the prevalent HIV/AIDS theory, says he has been questioning the Indian health ministry and UNAIDS about the scientific evidence behind labelling sections of the population, such as homosexuals, high-risk 
groups. 

“The health policy of the country is being controlled by international donors. Can you believe that the entire health budget of India is less than the amount of international funding the country receives on HIV?”

Rethinking AIDS president David Crowe says the AIDS “dogma” persists because doctors are trained to obey their superiors. “There are many examples of bad medical advice becoming dogma due to the power of senior medical people. The dogma of AIDS has resulted in hopelessness and despair caused by the stigma of HIV+ status. ”
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AIDS Used to Fight… AIDS!


A recent report from Reuter’s brings hope to the nearly 40 million people currently infected with the AIDS virus worldwide.
An AIDS virus genetically engineered to fight other AIDS viruses worked better than expected, suppressing the virus and renewing the immune systems of a few patients…

Basically, the story is that University of Pennsylvania researchers genetically modified some infected cells in a manner which caused them to target other AIDS cells. They then injected these into 5 people who’s sickness was so severe that they were no longer responding to medications.
Three years after injecting the patients with the modified strain, four of the patients show restoration of their damaged immune systems, with partial suppression of the HIV virus.
AIDS has already killed over 25 million humans worldwide. The population of the state of Texas is under 21 million.
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AIDS keep a child

5 facts about AIDS

AIDS is caused by infection with the human immunodeficiency virus, or HIV. Infection with HIV is preventable.

AIDS stands for acquired immune deficiency syndrome, a condition in which the body's immune system is slowly but ultimately destroyed.

There's no cure for AIDS, but new medications such as protease inhibitors can significantly slow the progression of the disease.

The epidemic affects people of all ages, races and sexual preferences.

HIV isn't spread through casual contact. You can't get HIV by shaking hands, hugging or sharing restrooms, equipment, food utensils or drinking fountains.



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Human Brain Damage For Aids

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Is There Cure For AIDS Or Medicine For AIDS?

AIDS-Acquired immune deficiency syndrome, generally, by listening this term, we all think of it as a sexual transmitted disease with no cure or no vaccine.
But, do you really know there is medicine for this deadly disease. Is it not really good news!
Actually, AIDS is the most advanced stages of Human Immunodeficiency Virus (HIV), a virus that damages cells of the body’s immune system, a system responsible for fighting against foreign cells in the body.
Literally, there is no cure however you have many medicines to fight against HIV infection and the infections as well as cancers that develop from it.


AIDS epidemic began in the early 1980s, where the patients with AIDS, rarely, lived longer than a few years. However, in these days, the patients with HIV, the virus that causes AIDS, are living longer with healthier life.

Wednesday 13 April 2011 0 comments

HIV



Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome(AIDS),[1][2] a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections andcancers to thrive. Infection with HIV occurs by the transfer of bloodsemenvaginal fluidpre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (perinatal transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.
HIV infection in humans is considered pandemic by the World Health Organization (WHO). Nevertheless, complacency about HIV may play a key role in HIV risk.[3][4] From its discovery in 1981 to 2006, AIDS killed more than 25 million people.[5] HIV infects about 0.6% of the world's population.[5] In 2009, AIDS claimed an estimated 1.8 million lives, down from a global peak of 2.1 million in 2004.[6] Approximately 260,000 children died of AIDS in 2009.[6] A disproportionate number of AIDS deaths occur in Sub-Saharan Africa, retarding economic growth and increasing poverty.[7] In 2005, it was estimated that HIV would infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.[8] Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection.[9] Although antiretroviral medication is still not universally available, expansion of antiretroviral therapy programmes since 2004 has helped to turn the tide of AIDS deaths and new infections in many parts of the world.[6] Intensified awareness and preventive measures, as well as the natural course of the epidemic, have also played a role. Nevertheless, an estimated 2.6 million people were newly infected in 2009.[6]
HIV infects primarily vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells.[10] HIV infection leads to low levels of CD4+ T cells through three main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosis in infected cells; and third, killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.
Most untreated people infected with HIV-1 eventually develop AIDS.[11] These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[12] HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some will take much longer.[13][14] Treatment with anti-retrovirals increases the life expectancy of people infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with antiretroviral therapy was estimated to be more than 5 years as of 2005.[15] Without antiretroviral therapy, someone who has AIDS typically dies within a year.[16]

Classification


HIV is a member of the genus Lentivirus,[17] part of the family of Retroviridae.[18] Lentiviruses have many morphologies andbiological properties in common. Many species are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period.[19] Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors.[20] Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system. Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.
Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was initially discovered and termed both LAV and HTLV-III. It is more virulent, more infective,[21] and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 compared to HIV-1 implies that fewer of those exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.[22]


Blood products

In general, if infected blood comes into contact with any open wound, HIV may be transmitted. This transmission route can account for infections in intravenous drug usershemophiliacs, and recipients of blood transfusions (though most transfusions are checked for HIV in the developed world) and blood products. It is also of concern for persons receiving medical care in regions where there is prevalent substandard hygiene in the use of injection equipment, such as the reuse of needles in Third World countries. Health care workers such as nurses, laboratory workers, and doctors have also been infected, although this occurs more rarely. Since transmission of HIV by blood became known medical personnel are required to protect themselves from contact with blood by the use of universal precautions. People giving and receiving tattoospiercings, and scarification procedures can also be at risk of infection.
HIV has been found at low concentrations in the salivatears, and urine of infected individuals, but there are no recorded cases of infection by these secretions and the potential risk of transmission is negligible.[58] It is not possible for mosquitoes to transmit HIV.[59]

Mother-to-child

The transmission of the virus from the mother to the child can occur in utero (during pregnancy), intrapartum (at childbirth), or via breast feeding. In the absence of treatment, the transmission rate up to birth between the mother and child is around 25%.[35] However, where combination antiretroviral drug treatment and Cesarian section are available, this risk can be reduced to as low as one percent.[35] Postnatal mother-to-child transmission may be largely prevented by complete avoidance of breast feeding; however, this has significant associated morbidity. Exclusive breast feeding and the provision of extended antiretroviral prophylaxis to the infant are also efficacious in avoiding transmission.[60] UNAIDS estimate that 430,000 children were infected worldwide in 2008 (19% of all new infections), primarily by this route, and that a further 65,000 infections were averted through the provision of antiretroviral prophylaxis to HIV-positive women.[61]

Multiple infection

Unlike some other viruses, infection with HIV does not provide immunity against additional infections, in particular, in the case of more genetically distant viruses. Both inter- and intra-clade multiple infections have been reported,[62] and even associated with more rapid disease progression.[63] Multiple infections are divided into two categories depending on the timing of the acquisition of the second strain. Coinfection refers to two strains that appear to have been acquired at the same time (or too close to distinguish). Reinfection (or superinfection) is infection with a second strain at a measurable time after the first. Both forms of dual infection have been reported for HIV in both acute and chronic infection around the world.[64][65][66][67]



 
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