AIDS

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A viral disease of humans caused by the human immunodeficiency virus (HIV), which attacks and compromises the body's immune system. Individuals infected with HIV proceed through a spectrum of stages that ultimately lead to the critical end point, acquired immune deficiency syndrome. The disease is characterized by a profound progressive irreversible depletion of T-helper-inducer lymphocytes (CD4+ lymphocytes), which leads to the onset of multiple and recurrent opportunistic infections by other viruses, fungi, bacteria, and protozoa, as well as various tumors (Kaposi's sarcoma, lymphomas). HIV infection is transmitted by sexual intercourse (heterosexual and homosexual), by blood and blood products, and perinatally from infected mother to child (prepartum, intrapartum, and postpartum via breast milk).

Since retroviruses such as HIV-1 integrate their genetic material into that of the host cell, infection is generally lifelong and cannot be eliminated easily. Therefore, medical efforts have been directed toward preventing the spread of virus from infected individuals. See also Retrovirus.

Approximately 50–70% of individuals with HIV infection experience an acute mononucleosis-like syndrome approximately 3–6 weeks following primary infection. In the acute HIV syndrome, symptoms include fever, pharyngitis, lymphadenopathy, headache, arthralgias, myalgias, lethargy, anorexia, nausea, and erythematous maculopapular rash. These symptoms usually persist for 1–2 weeks and gradually subside as an immune response to HIV is generated.

Although the length of time from initial infection to development of the clinical disease varies greatly from individual to individual, a median time of approximately 10 years has been documented for homosexual or bisexual men, depending somewhat on the mode of infection. Intravenous drug users experience a more aggressive course than homosexual men and hemophiliacs because their immune systems have already been compromised.

As HIV replication continues, the immunologic function of the HIV-infected individual declines throughout the period of clinical latency. At some point during that decline (usually after the CD4+ lymphocyte count has fallen below 500 cells per microliter), the individual begins to develop signs and symptoms of clinical illness, and sometimes may demonstrate generalized symptoms of lymphadenopathy, oral lesions, herpes zoster, and thrombocytopenia.

Secondary opportunistic infections are a late complication of HIV infection, usually occurring in individuals with less than 200 CD4+ lymphocytes per microliter. They are characteristically caused by opportunistic organisms such as Pneumocystis carinii and cytomegalovirus that do not ordinarily cause disease in individuals with a normally functioning immune system. However, the spectrum of serious secondary infections that may be associated with HIV infection also includes common bacterial pathogens, such as Streptococcus pneumoniae. Secondary opportunistic infections are the leading cause of morbidity and mortality in persons with HIV infection. Tuberculosis has also become a major problem for HIV-infected individuals. Therefore, HIV-infected individuals are administered protective vaccines (pneumococcal) as well as prophylactic regimens for the prevention of infections with P. carinii, Mycobacterium tuberculosis, and M. avium complex. See also Opportunistic infections; Pneumococcus; Streptococcus; Tuberculosis.

Antiretroviral treatment with deoxyribonucleic acid (DNA) precursor analogs—for example, azidothymidine (AZT), dideoxyinosine (ddI), and dideoxycytidine (ddC)—has been shown to inhibit HIV infection by misincorporating the DNA precursor analogs into viral DNA by the viral DNA polymerase. Nevertheless, these agents are not curative and do not completely eradicate the HIV infection.

Acquired immunodeficiency syndrome, or AIDS, is the final, life-threatening stage of infection with any of the human immunodeficiency viruses (HIV-1, its many subtypes, or HIV-2), which are transmitted from person to person sexually (including via anal, oral, and vaginal intercourse, both heterosexually and homosexually), through contact with blood (mainly via equipment used to inject illicit drugs and, rarely, via medical uses of blood), and perinatally (from mother to fetus or newborn during pregnancy, labor, and delivery, or after birth through breast-feeding).

Origin and History

HIV-1 and HIV-2 both appear to have been transmitted to humans from primates in Central and West Africa, probably to hunters or processors of carcasses of primates consumed as food (referred to as "bush meat"). Beginning as simian viruses, they became human viruses once they achieved sustained transmission from person to person. This appears to have occurred at least four times in history: three times from chimpanzees (Pan troglodytes); (possibly in the 1930s), representing the three major strains of HIV-1, and once from sooty mangabeys, representing HIV-2. Social and technological changes in Africa resulted in transmission of HIV to larger and larger numbers of adults as roads were built and river transport developed, making travel to cities, with their better economic opportunities, far easier and more rapid. A silent heterosexual epidemic occurred and spread via travelers to industrialized nations of Europe and North America, where the new syndrome was initially recognized as a distinct clinical entity in 1981, even though the number of cases then was minuscule. By 1983, epidemiologists had discerned the routes of transmission and pointed the way for laboratory investigators to identify the etiologic agents. In 1984, the laboratory culturing of HIV was described in the scientific literature, as was the first serologic test for detecting the HIV antibody, which has been used to screen blood donations since 1985. Originally given three different names by the French (1983) and two American (1984) research teams that "discovered" the virus, the name HIV was agreed upon in 1986.

Epidemiology

HIV-1 has spread worldwide, infecting more than 36 million people by 2001. HIV-2, which seems to be less clinically severe and possibly less transmissible from person to person, has mainly been a public health problem for West African nations. Originally epidemic in African and urban settings, HIV and AIDS are now among the most common serious infections globally, including in the Americas and Eurasia and in rural settings. All ages, racial and ethnic groups, and persons of all sexual orientations have been infected.

Virology

HIVs are all members of the family known as retroviruses, so named because of their unique method of reproduction which uses the enzyme (protein catalyst) reverse transcriptase (RT) to incorporate its genetic material (RNA) into the DNA of the infected host's cells. HIV infects specific white blood cells of the host's immune system, known as T-helper lymphocytes (often referred to as CD4+ cells), and destroys them. Even though the immune system produces millions of new CD4+ cells every day, HIV destroys them just as rapidly. The genetic material of HIV has been sequenced, providing a database useful for research on vaccine and antiviral drug development. Many subtypes of HIV-1 have been characterized, but all are transmitted via the same routes and result in the same immunodeficiency.

Symptoms, Diagnosis, and Treatment

Persons initially infected with HIV may develop an "acute retroviral syndrome" characterized by fever, lymph node enlargement, and flu-like symptoms. If symptoms are present, they clear spontaneously, but all infected persons, both with and without symptoms, remain infected and infectious to others indefinitely. The incubation period is highly variable, averaging about a decade, but ranging from a few months or years to possibly longer than two decades. When sufficient damage to the immune system has been sustained, measured either by laboratory cell counts of the Thelper cells or by onset of opportunistic infections, the patient is said to have AIDS. Common manifestations of HIV infection include tiredness, lymph node enlargement, fever, weight loss, and yeast infections of the mouth and vagina.

HIV infection is diagnosed by laboratory detection of evidence of infection, usually identification of HIV-specific antibodies in a blood, oral fluid, or urine specimen. AIDS can be diagnosed in HIV-infected persons in several ways, based on either laboratory evidence of immunodeficiency (lowered levels of CD4+ cells), or clinically by onset of any one or more of a specific list of opportunistic diseases. Opportunistic diseases are those that occur only, or most severely, in patients whose immune systems are impaired. The most common opportunistic diseases in AIDS patients are Pneumocystis carinii pneumonia, Kaposi's sarcoma, toxoplasmosis of the brain, tuberculosis and other mycobacterial infections, and severe herpes, cytomegalo virus, and yeast infections.

As of 2001, all of the more than seventeen antiviral drugs used to treat HIV infection act by interfering with one of the enzymes that HIV needs to complete its life cycle. No treatments result in a cure for HIV infection. The antiviral drugs prevent HIV from growing and further damaging the host's immune system. Thus, the goal of treatment is to preserve the patient's health. Patients must take several antiviral drugs daily. Research on more and better antiviral drugs, and on methods to reconstitute the impaired immune system, is ongoing. A key part of treatment is the prevention of opportunistic infections with specific vaccines and antibiotics.

Prevention

Prevention of HIV infections is deceptively simple: Refrain from having sexual contact and from sharing drug-injecting paraphernalia with anyone who is infected. However, the rapid and continuing global spread of HIV, despite its well-known and severe clinical consequences, points out how difficult it is to change risky sexual and drug-taking behaviors. Many successful educational and social interventions have been demonstrated, but sustaining them in large populations for long periods requires extensive resources and a strong public health commitment. For example, latex condoms effectively prevent sexual transmission of HIV, but making them available and educating infected persons or their sex partners to use them correctly and consistently has been accomplished only with extraordinary efforts in a few nations or settings. Some prevention efforts are considered controversial or are opposed by religious or other groups who interpret prevention efforts to reflect an acceptance of behaviors they do not condone on moral grounds.

The research effort to develop a vaccine to prevent HIV infection has been intense, but the biologic obstacles to success are immense and unprecedented. Because HIV permanently infects cells of the immune system, infection of a single cell results in lifelong infection for the host. Thus, a completely effective vaccine would need to prevent even a single cell from becoming infected. No such vaccine exists for any infection, so HIV will require a new vaccine paradigm. Possible lines of research include stimulating the immune system to detect and eliminate HIV-infected cells, or genetically transforming the HIV in an infected person so as to render it nonvirulent.

Further information on HIV and AIDS is widely available in many user-friendly and scholarly formats. The Internet is a rich source of information, with sites sponsored by public health agencies, such as the Joint United Nations Programme on HIV/AIDS (http://www.unaids.org) and the Centers for Disease Control and Prevention (http://www.cdc.gov) particularly recommended. Several texts, popular books, and scholarly journals have been devoted exclusively to AIDS public health issues and scientific research. The first of December has been designated World AIDS Day, and many governments, schools, and organizations sponsor community and educational events to coincide with that date each year.

(SEE ALSO: Behavioral Change; Condoms; Contagion; Epidemics; Prevention; Sexually Transmitted Diseases)

Bibliography

Feldman, E. A., and Bayer, R. (1999). Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster. New York: Oxford University Press.

Garrett, L. (1994). The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Farrar, Straus and Giroux.

Mann, J. M.; Tarantola, D.; and the Global AIDS Policy Coalition, eds. (1998). AIDS in the World II/Global Dimensions, Social Roots, and Responses. New York: Oxford University Press.

Shilts, R. (1987). And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press.

— D. PETER DROTMAN

In the late 1970s, physicians in New York and San Francisco began to encounter some unusual cases of fungal infections and a rare cancer called Kaposi's sarcoma. When the Centers for Disease Control in Atlanta, Georgia, were brought in to study the situation in 1980, they found some 500 cases of a mysterious disease that knocked out the immune system. Because more than 400 of the first known cases were among homosexual men, the newly discovered immune disorder was at first termed gay-related immune disorder, but in 1981 the name was changed to acquired immune deficiency syndrome, or AIDS.

By now, everyone knows about AIDS, but it was still fairly obscure in the early 1980s. In August 1985, however, the motion picture star Rock Hudson was revealed to have the disease (he died shortly afterward). Suddenly, it was clear to the American public that AIDS was a very serious problem. Furthermore, people soon learned that the syndrome extended far beyond the male homosexual community. Women, especially in Africa, developed the syndrome as did their children.

AIDS had already been shown to be the result of an infectious disease by 1985, caused by a virus now known as HIV (there are two forms, HIV-1 and HIV-2, with HIV-1 most common). The virus spreads exclusively by infected body fluids -- blood, semen, mother's milk. Before recognition of the virus by Luc Montagnier in 1983 and development of a blood test by Robert Gallo in 1984, HIV was being transmitted by blood transfusions and even by clotting factors used to ameliorate hemophilia. Not very much blood is needed to carry the virus from one person to another. A drug addict can be infected by reusing an unsterilized needle after an infected addict's injection. Needle reuse became the most significant mode of transmission in the United States, although sexual transmission also remained very important and has been the main source of infection around the world. Infected mothers can also pass the disease on to newborn babies, either during birth or while nursing.

HIV kills mainly by destroying the immune system, that part of the body designed to protect against viruses and other invaders. People do not die directly from HIV toxins or HIV-induced cell death, but from the many illnesses that infect a person with impaired immunity. There is no known cure for HIV infection, although various combinations of medicines have greatly slowed the progress of the disease. The medicines have proven most helpful in the United States and other Western countries where people can afford them. In Western nations, more than 1,000,000 people live with HIV infection. But HIV infection has often gone untreated in less developed regions, especially Africa, leading to AIDS and death.

In the United States about half a million persons have died of AIDS since 1981, but for the entire world the number of deaths exceeds 25,000,000. In Africa, however, nearly 30,000,000 persons are thought to be infected with HIV (out of 42,000,000 worldwide). Few with HIV in poor nations will escape AIDS unless there are major changes in the way that medicine is made available. Several efforts were in place to make such changes by early in the 21st century.

Shortly after the first cases of acquired immunodeficiency syndrome (AIDS) were recognized among civilians in 1981, early forms of the disease (AIDS‐related complex and lymphadenopathy syndrome) were detected among active duty personnel. The causative virus (now called the human immunodeficiency virus, HIV) was first isolated from ill soldiers and their asymptomatic but nonetheless infected wives in 1984. These military studies provided the first proof that HIV could be transmitted through heterosexual intercourse. Nationwide blood bank testing for HIV began in June 1985. Shortly thereafter, in October 1985, the Department of Defense (DoD) began screening all civilian applicants for military service; those who tested positive for the virus were medically disqualified from service. Overall, 1 in 650 applicants was found to be infected, but prevalence rates in various geographic and demographic subpopulations varied from as low as 1 in 20,000 in the upper Midwest to 1 in 50 in northeastern urban centers. The HIV screening program was the first population‐based screening program in the United States, and provided the first hard data that the epidemic had already spread silently throughout the country by the mid‐1980s.

HIV screening of active duty military personnel began in 1986. Based largely on the recommendations of the Armed Forces Epidemiological Board, policies for HIV infection were established to be comparable to those for any other chronic medical condition. Infected military personnel were to remain on active duty, to lodge in military quarters, and to continue work in their duty assignment. Implemented at a time when fear of HIV contagion was widespread in the United States, these policies were farsighted and courageous. All DoD HIV‐positive personnel were to be medically evaluated periodically, and those with advanced disease were honorably discharged with medical disability and benefits. HIV‐infected personnel were restricted from overseas deployment, from health care jobs where potentially risky procedures were performed, and from sensitive Personal Reliability Program (e.g., nuclear missile) positions. In an effort to decrease HIV transmission, HIV‐infected active duty personnel were counseled by their commanders that if they knowingly put others at risk of infection through sexual intercourse, they could be prosecuted through the military justice system. Overall, DoD policies were designed to reflect fair and rational public health principles.

Screening was originally undertaken annually for all active duty personnel, but this interval has gradually lengthened with a number of new service‐specific regulations. For example, testing takes place every five years for all air force personnel, or for the following clinically indicated reasons: during pregnancy; on entry into a drug/alcohol rehabilitation program; on presenting at a STD (sexually‐transmitted disease) clinic; on deployment overseas; on PCS (Permanent Change of Station) overseas. However, all personnel must be proven negative within six months of any overseas deployment.

The U.S. military HIV research program began in 1986, when Congress provided $40 million for this purpose. The U.S. Army Medical Research and Development Command, as the lead agency for infectious disease research, managed the tri‐service program. Major accomplishments include the following firsts: definition of antibody test criteria for a diagnosis of HIV (criteria used worldwide today); evidence that HIV was becoming a serious problem among minorities; detection of transmission of drug‐resistant HIV strains; tracking the global spread of genetic variants; vaccine therapy trials; and international preventive vaccine trials.

At the heart of the controversy over HIV/AIDS research is the question of its relevance to the military. HIV/AIDS has little or no direct impact on readiness or combat operations for U.S. forces. However, recent studies have shown very high HIV prevalences among some African (one in four) and Asian (one in ten) military populations. From a broader national security point of view, the global pandemic is a threat requiring maximal efforts by all capable U.S. agencies.

Rates for new infections have decreased; in 1995, the DoD's total of infections among active duty personnel was approximately 300. In 1996, an amendment to the department's authorization bill ruled that all HIV‐infected personnel on active duty must be involuntarily separated, regardless of their fitness for duty or years of service; however, as of 1999, the policy was not to separate HIV‐infected personnel who were physically fit. The impact of this legislation on the effectiveness of public health control of HIV within the military remains to be determined.

[See also Diseases, Sexually Transmitted; Medical Practice in the Military.]

AIDS as a subject in modern writing, see Gay And Lesbian Writing.

Acronym for Acquired Immune Deficiency Syndrome.

Acquired Immune Deficiency Syndrome (AIDS), an infectious disease that fatally depresses the human immune system, was recognized in the United States in 1980. By 1982 the disease had appeared in 24 states, 471 cases had been diagnosed, 184 people had died, and the Centers for Disease Control (CDC) in Atlanta had termed the outbreak an epidemic. AIDS has challenged the authority and integrity of respected medical institutions, strained the capacity of the health care system, forced the reevaluation of sexual mores, and tapped reservoirs of fear, prejudice, and compassion within individuals and communities.

On 5 June 1981, the CDC's Morbidity and Mortality Weekly Report (MMWR) published an article by Dr. Michael Gottlieb of the University of California at Los Angeles School of Medicine, describing five cases of Pneumocystis carinii pneumonia (PCP) in young homosexual men. A second MMWR article on 4 July documented ten additional cases of PCP, as well as twenty-six cases of Kaposi's sarcoma (KS), a rare skin cancer, in young homosexual males in New York City and San Francisco. PCP is normally seen only in patients with immune dysfunction and KS in elderly men. Under the direction of James Curran, the CDC began to investigate, hypothesizing that the young men were suffering from an immune-system deficiency related to their lifestyle. In early August, however, CDC staff identified the strange "gay plague" in heterosexual intravenous drug users in New York City.

In the first six months of 1982, cases were reported among hemophiliacs receiving blood components, Haitian refugees, and infants born to drug-using mothers. Transmission through blood transfusion was documented in June. Although physicians had named the outbreak gay-related immune deficiency (GRID), many suspected a viral infection transmissible through sexual contact or blood transfusion rather than a lifestyle-related disease; some proposed a multifactor etiology. At a meeting in July, the CDC coined the term "AIDS," which became accepted usage for the several related disorders.

More than 1,000 Americans had been diagnosed with AIDS by early 1983; of those, 394 had died. Although the CDC had identified instances in which the infection had been transmitted through blood transfusion, the Red Cross and major blood banks refused to institute rigorous screening, which was costly and might discourage donors. In March 1983, the CDC and the Public Health Service, concerned about the risk of infection, issued a statement naming four "high-risk" groups of donors, advising them not to give blood and to avoid sexual contact. This warning, together with a May article in the Journal of the American Medical Association suggesting the possibility of infection through casual contact, heightened media and public awareness, intensified fears, and prompted ostracism of people with AIDS (PWAs). Some health care workers refused to treat PWAs. In many areas, moral objections blocked inexpensive control measures, such as condom distribution and sterile-needle exchanges for drug users.

Researchers, including Robert Gallo at the National Cancer Institute in Bethesda, Maryland, and Luc Montagnier at the Pasteur Institute in Paris, attempted to identify and characterize the viral agent that caused AIDS. By January 1984, Gallo's laboratory had cultured twenty samples of a virus he named HTLV-III, believing it related to the human T-cell leukemia virus he had isolated in 1980. In February 1984, Montagnier's group reported their discovery of lymphadenopathy-associated virus (LAV), which they asserted was the AIDS virus. Their work was confirmed by Donald Francis at the CDC. Genetic testing established that LAV and HTLV-III were nearly identical. Gallo and Margaret Heckler, Secretary of Health and Human Services, announced on 23 April 1984, however, that the National Cancer Institute had found the AIDS virus and had developed an antibody test for blood screening, clinical testing, and diagnosis. An international committee renamed the virus HIV (human immunodeficiency virus) in late 1986. Shortly thereafter, President Ronald Reagan and France's President Jacques Chirac announced that the Pasteur Institute and the National Cancer Institute would share credit for the discovery and royalties from the patented blood test. (Later probes of possible misappropriation of the French virus by Gallo and his lab assistant Mikulas Popovic were dropped in 1993.)

Isolation of the virus confirmed AIDS as an acute infectious disease, encouraging research into vaccines and therapeutic drugs. Lack of money hampered work, however. The Reagan administration was unwilling to initiate expensive programs to control a disease associated with homosexuality and drug use. Individual congressmen, including Phillip Burton of San Francisco and Henry A. Waxman of Los Angeles, together with Assistant Secretary for Health Edward Brandt, pushed for supplemental AIDS funding in 1983 and 1984, with limited success. Organizations such as the Gay Men's Health Crisis in New York and Mathilde Krim's AIDS Medical Foundation (AMF) provided funds, but support for research remained inadequate.

The burden of care for AIDS patients, many without private insurance, fell on state and local governments and on volunteers largely drawn from the gay community. Many gay men and lesbians initially resisted involvement with the "gay plague," which threatened to deepen the stigma attached to homosexuality. Others resented public-health warnings to alter sexual practices. Gay organizations fought both universal antibody-screening and the closing of public bathhouses in New York and San Francisco, which authorities saw as reservoirs of infection. At the same time gay groups provided support, patient care, and money to PWAs, including those who were not gay. Gay men volunteered as research subjects in community-based drug trials organized by local physicians and developed patient networks that circulated experimental and imported drugs to treat PWAs suffering from opportunistic infections such as PCP and cytomegalovirus. Gay leaders lobbied for more money. A few risked community ostracism by becoming public advocates for safer sexual practices.

Although hampered by lack of money from the federal government, research into therapeutic drugs did produce results. In early 1985, Samuel Broder at the National

Cancer Institute and other researchers confirmed that the compound azidothymidine (AZT), developed by the pharmaceutical firm Burroughs-Wellcome, appeared active against the AIDS virus in laboratory cultures. The Food and Drug Administration (FDA) quickly approved the manufacturer's plan for clinical trials and facilitated release to the market in 1987, although the efficacy trial lasted only seven months. The AIDS Clinical Trial Network, established by the National Institute for Allergy and Infectious Diseases (NIAID), developed protocols to test AZT in patient groups at hospitals across the country. Burroughs-Wellcome put AZT on the market in February 1987, at the price of $188 per 10,000 milligrams; the annual cost of the drug for some patients was reported to be $8,000 or higher. Although harshly criticized, the company waited until December before dropping the price 20 percent.

While NIAID pursued AZT trials, physicians and patients were trying other compounds to slow the disease or treat opportunistic infections. The FDA gave low priority to several compounds, such as AL721 and HPA23. In the case of others, such as the Syntex compound ganciclovir, PWAs received the drug at cost for several years under a compassionate use protocol. The FDA then required a blind comparison with a placebo before ganciclovir could be marketed, but few PWAs were willing to enroll in a placebo trial after they already had used an experimental compound or if they feared rapid progression of their disease. Investigators in the NIAID-endorsed AZT trials experienced difficulty recruiting subjects.

Gay AIDS activists sought access to more drugs, access to information about trials, trial protocols that recognized patient needs and risks, inclusion of minority PWAs in trials, and PWA participation in development and testing. The AIDS Coalition to Unleash Power (ACT UP) captured media attention with demonstrations and street theater; the group soon acquired a radical image that alienated researchers, the public, and more conservative gay groups. The small group Treatment and Data Subcommittee (later the Treatment Action Group), led by Iris Long, James Eigo, and Mark Harrington, created a registry of clinical trials and gave testimony to the President's Commission and at congressional hearings. At the request of President George H. W. Bush, the clinical-trial authority Louis Lasagna held hearings in 1989 on new drug approval procedures. The hearings accentuated lack of progress by the FDA and NIAID and provided a forum for Eigo and Harrington to present their program. Anthony Fauci, director of NIAID and a target of ACT UP criticism, met with activists and backed a new parallel track for community-based, nonplacebo drug trials. The parallel track system was in operation by early 1990, but the concept remained controversial as it competed for money and trial subjects with conventional controlled trials. President Bush in 1990 appointed David Kessler as FDA commissioner, who quickly gained a reputation for activism and endorsed parallel track.

By 1991, the character of AIDS in the United States had changed again. Although incidence was increasing in all population groups, rates were most rapid among the poor, African Americans, Hispanic Americans, and women and children. Health care providers, researchers, and PWAs no longer defined the epidemic as an acute infectious disease responsive to early aggressive intervention. They recognized AIDS as a chronic disease characterized by a lengthy virus incubation (up to eleven years); onset of active infection possibly related to medical or lifestyle cofactors; an extended course involving multiple infectious episodes; and the need for flexible treatment with a variety of drugs as well as long-term supportive services. Despite this progress, however, at the beginning of the twenty-first century, AIDS still remained a fatal disease and an effective vaccine was still years away.

As of 31 December 1984, 7,699 PWAs had been diagnosed and almost half of them were dead. Although the disease was taking a heavy toll among gay white males, more than half the cases now were nonwhite persons, including many women and children. The First International AIDS Conference, held in Atlanta in April 1985, made public much new clinical information. Participants debated screening programs advocated by the Reagan administration and public-health experts but opposed by gays and other potentially stigmatized groups. Conference reports contributed to increased fear and concern in 1985, which intensified when the country learned that the actor Rock Hudson was dying of AIDS. Shortly thereafter, the news that a school in Kokomo, Indiana, had denied a young PWA named Ryan White the right to attend school with his classmates epitomized Americans' fear of and aversion to the disease.

Attitudes were changing, however. Hudson's death in October shocked Hollywood, which was heavily affected by the disease. The American Foundation for AIDS Re-search, supported by a Hudson bequest, merged with Krim's AMF to form AmFAR, which attracted support from such celebrities as Elizabeth Taylor. Ryan White was accepted by another Indiana school and became a national symbol of courage before his death in 1990. In October 1986, Surgeon General C. Everett Koop broke with the Reagan administration with a bluntly worded report on the epidemic, calling for sex education in schools, widespread use of condoms, and voluntary antibody testing. Koop's report followed statements from the Public Health Service and the National Academy of Sciences Institute of Medicine that described the administration's response to AIDS as inadequate. President Reagan in 1987 created the President's Commission on the Human Immunodeficiency Virus Epidemic and shortly afterward spoke at the Third International AIDS Conference in Washington, D.C. Basketball player Magic Johnson's November 1991 announcement that he had contracted HIV through unprotected heterosexual sex, followed by the tennis player Arthur Ashe's disclosure five months later that he had AIDS as a result of a blood transfussion during bypass surgery, helped transform the public image of AIDS to a disease that reached beyond the gay community. In late 1993, public concern for PWAs was reflected in critical acclaim for the film Philadelphia and the stage play Angels in America, both of which examined the personal and social consequences of AIDS.

Public attitudes toward PWAs had gradually shifted from discrimination and fear to compassion and acceptance, but the burdensome costs of treatment and services were a challenge to the national will. In one example, the Comprehensive AIDS Resource Emergency Act of 1990, often called the Ryan White Act, authorized $2.9 billion for areas of high incidence. It passed both houses of Congress with enthusiastic bipartisan support but a few months later budget negotiations reduced the money drastically. Nevertheless, federal efforts to control the epidemic increased. On 5October 1993, Congress approved an increase of $227 million in support, bringing the 1994 total to $1.3 billion. Fulfilling a campaign promise, President Bill Clinton created the position of national AIDS policy coordinator and appointed Kristine Gebbie to the post. In 1994, after lobbying by PWAs and researchers, he appointed the NIAID immunobiologist William Paul to head the Office of AIDS Research, with full budgetary authority. As of January 1996, The AmFAR HIV/AIDS Treatment Directory listed 77 clinical trial protocols for HIV infection and 141 protocols for opportunistic infections and related disorders. Twenty-one drugs were available to patients through compassionate use or expanded access protocols. Researchers held out hope that the disease would prove susceptible to new agents used in combination with AZT and its relatives, ddl and ddo. Many trials, however, continued to have difficulty recruiting patients and some community-based trials were threatened by budget cuts.

By the end of the twentieth century, more than 774,000 AIDS cases had been diagnosed in the United States, and almost 450,000 people had died of the disease. New treatments had lengthened lives and education had slowed transmission of the disease; nevertheless an estimated 110 people were being infected with HIV each day. And even though a remedy remained elusive, the sense of urgency in the fight against AIDS had waned. President George W. Bush appointed Scott Evertz as director of the Office of National AIDS Policy, but was slow to fill other key appointments to offices in the CDC and the Department of Health and Human Services that dealt with AIDS research and policy. Bush created a White House Task Force on HIV/AIDS but in his first budget proposal did not recommend funding increases for domestic AIDS programs.

By the beginning of the twenty-first century, AIDS had been brought under control in the United States through political action, intensive education, and expensive drug therapy. But the disease continued to ravage other parts of the world. By the end of 2001, 40 million people were living with HIV/AIDS, 95 percent of whom were in developing countries. The hardest hit area was Sub-Saharan Africa where 2.5 million people were dying each year. The Bush Administration's response to this global crisis was as mixed as its response to the domestic one. Secretary of State Colin Powell made global AIDS issues a priority, but Bush refused to sign a United Nations declaration on children's rights that supported sex education for teenagers. The United States joined several international efforts to halt the spread of the epidemic, including the International Partnership Against HIV/AIDS in Africa (IPAA), but its initial contribution to the UN Global Fund to finance responses to AIDS and other deadly infectious diseases was only $200 million. The Fund, created in 2001, sought $7–10 billion per year from all donors. U.S. AIDS activists now fight on two fronts. On the domestic front, they push the federal government to provide more funding for research and the care of PWAs, and they push researchers to develop a vaccine and treatments with fewer side effects. Most important they continue to impress upon young people who do not remember the AIDS epidemic before AZT that they should use "safe sex" practices, because AIDS is still a fatal disease. On the global front, activists seek to encourage the U.S. government to increase aid for global AIDS programs, to support debt cancellation for developing countries ravaged by the disease, and to take steps to ensure access to treatment in foreign countries.

Bibliography

Altman, Dennis. AIDS in the Mind of America. Garden City, N.Y.: Anchor Press/Doubleday, 1986.

Fee, Elizabeth, and Daniel M. Fox, eds. AIDS: The Making of a Chronic Disease. Berkeley: University of California Press, 1992.

Goldstein, Nancy, and Jennifer L. Manlowe, eds. The Gender Politcs of HIV/AIDS in Women: Perspectives on the Pandemic in the United States. New York: New York University Press, 1997.

Grmek, Mirko D. History of AIDS: Emergence and Origin of a Modern Pandemic. Princeton, N.J.: Princeton University Press, 1990.

Hannaway, Caroline, Victoria A. Harden, and John Parascondola, eds. AIDS and the Public Debate: Historical and Contemporary Perspectives. Washington, D.C.: IOS Press, 1995.

Murphy, Timothy F. Ethics in an Epidemic: AIDS, Morality, and Culture. Berkeley: University of California Press, 1994.

Roiphe, Katie. Last Night in Paradise: Sex and Morals at the Century's End. Boston: Little, Brown, 1997.

Shilts, Randy. And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press, 1987.

—Daniel M. Fox

Acquired immune deficiency syndrome (AIDS) is a fatal disease that attacks the body's immune system, making it unable to resist infection, and is caused by the human immunodeficiency virus (HIV), which is communicable in some bodily fluids and transmitted primarily through sexual behavior and intravenous drug use.

The United States has struggled to cope with acquired immune deficiency syndrome since the early 1980s. For a somewhat shorter length of time, U.S. law has also tried to deal with it. Only in the mid-1990s did either society in general or the law in particular begin to achieve even moderate success. Since the beginning, AIDS and its resulting epidemic in the United States have raised a great number of legal issues, which are made all the more difficult by the nature of the disease. AIDS is a unique killer, but some of its aspects are not: epidemics have been seen before; other sexually transmitted diseases have been fatal. AIDS is different because it was discovered in, and in the United States still predominantly afflicts, unpopular social groups: homosexuals and drug users. This fact has had a strong impact on the shaping of AIDS law. Law is often shaped by politics, and AIDS is a very politicized disease. The challenge of facing an epidemic that endangers everyone is complicated by the stigma attached to the people most likely to be killed by it.

Epidemics have no single answer beyond a cure. Since no cure for AIDS exists, the law must grapple with a vast number of problems. The federal government has addressed AIDS in two broad ways: by spending money on the disease and by prohibiting unfairness to people with HIV or AIDS. It has funded medical treatment, research, and public education, and it has passed laws prohibiting discrimination against people who are HIV-positive or who have developed AIDS. States and local municipalities have joined in these efforts, sometimes with federal help. In addition, states have criminalized the act of knowingly transmitting the virus through sexual behavior or blood donation. The courts, of course, are the decision makers in AIDS law. They have heard a number of cases in areas that range from employment to education and from crimes to torts. Although a body of case law has developed, it remains relatively new in most areas and controversial in all.

AIDS and the Federal Government

Political attitudes toward AIDS have gone through dramatically different phases. In the early 1980s, it was dubbed the gay disease, and as such was easy for lawmakers to ignore. No one hurried to fund research into a disease that seemed to be killing only members of a historically unpopular group. When it was not being ignored, AIDS was dismissed by some groups as a problem that homosexuals deserved, perhaps brought on them by divine intervention. Discriminatory action matched this talk as gay men lost jobs, housing, and medical care. AIDS activists complained bitterly about the failure of most U.S. citizens to be concerned. Public opinion only began to shift in the late 1980s, largely through awareness of highly publicized cases. As soon as AIDS had a familiar face, it was harder to ignore; when it became clear that heterosexuals were also contracting the disease, the epidemic took higher priority.

By the late 1980s, much of the harshness in public debate had diminished. Both liberals and conservatives lined up to support legislative solutions. President Ronald Reagan left office recommending increases in federal funding for medical research on AIDS. Already the amount spent in this area had risen from $61 million in 1984 to nearly $1.3 billion in 1988. President George Bush took a more active approach, and in 1990 signed two new bills into law. One was the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (Pub. L. No. 101-381, 104 Stat. 576), which provides much-needed money for states to spend on treatment. The other was the groundbreaking Americans with Disabilities Act (ADA) (42 U.S.C.A. §§ 12112-12117), which has proved to be the most effective weapon against the discrimination that victims of the disease routinely suffer. Bush also sped up approval by the Food and Drug Administration for AIDS-related drugs. Though he supported Americans with the disease, Bush agreed to a controversial ban by Congress on travel and immigration to the United States for people with HIV.

Like his predecessors, President Bill Clinton called for fighting the disease, rather than people afflicted with it. He also appointed the first federal AIDS policy coordinator, in 1993. He fully funded the Ryan White Care Act, increasing the government's support by 83 percent, to $633 million, and also increased funding for AIDS research, prevention, and treatment by 30 percent. These measures met most of his campaign promises on AIDS. He reneged on one: despite vowing to lift the ban on HIV-positive aliens, he signed legislation continuing it. And he met a major obstacle on another: Congress failed to pass his health care reform package, which would have provided health coverage to all U.S. citizens with HIV, delivered drug treatment against AIDS on demand to intravenous drug users, and prohibited health plans from providing lower coverage for AIDS than for other life-threatening diseases.

AIDS and Public Life

Having HIV is not a sentence to remove oneself from society. It does not limit a person's physical or mental abilities. Only later, when symptoms develop— as long as ten years from the time of infection— does the disease become increasingly debilitating. In any event, HIV-positive and AIDS-symptomatic people work, play, and participate in daily life. Moreover, their rights to do so are the same as anyone else's. The chief barrier to a productive life often comes less from HIV and AIDS than from the fear, suspicion, and open hostility of others. Because HIV cannot be transmitted through casual contact, U.S. law has moved to defend the civil rights of the afflicted.

AIDS in the Workplace

The workplace is a common battleground. Many people with AIDS have lost their jobs, been denied promotions, or been reassigned to work duties that remove them from public contact. During the 1980s, this discrimination was fought through lawsuits based on older laws designed to protect the disabled. Plaintiffs primarily used the Rehabilitation Act of 1973 (29 U.S.C.A. § 701 et seq.), the earliest law of this type. But the Rehabilitation Act has a limited scope: it applies only to federally funded workplaces and institutions, and says nothing about those that do not receive government money. Thus, for example, the law was helpful to a California public school teacher with AIDS who sued for the right to resume teaching classes (Chalk v. United States Dist. Court, 840 F. 2d 701 [9th Cir. 1988]), but it would be of no use to the average worker in a private business.

With passage of the ADA in 1990, Congress gave broad protection to people with AIDS who work in the private sector. In general, the ADA is designed to increase access for disabled persons, and it also forbids discrimination in hiring or promotion in companies with fifteen or more employees. Specifically, employers may not discriminate if the person in question is otherwise qualified for the job. Moreover, they cannot use tests to screen out disabled persons, and they must provide reasonable accommodation for disabled workers. The ADA, which took effect in 1992, has quickly emerged as the primary means for bringing AIDS-related discrimination lawsuits. From 1992 to 1993, more than 330 complaints were filed with the U.S. Equal Employment Opportunity Commission (EEOC), which investigates charges before they can be filed in court. Given the lag time needed for EEOC investigations, those cases started appearing before federal courts in 1994 and 1995.

AIDS and Health Care

Closely related to work is the issue of health care. In some cases, the two overlap: health insurance, Social Security, and disability benefits for AIDS victims were often hard to obtain during the 1980s. Insurance was particularly difficult because employers feared rising costs and insurance companies did not want to pay claims. To avoid the costs of AIDS, insurance companies used two traditional industry techniques: they attempted to exclude AIDS coverage from general policies, and they placed caps (limits on benefits payments) on AIDS-related coverage. State regulations largely determine whether this is permissible. In New York, for example, companies that sell general health insurance policies are forbidden to exclude coverage for particular diseases. Caps have hurt AIDS patients because their treatment can be as expensive as that for cancer or other life-threatening illnesses. Insurance benefits can be quickly exhausted — in fact, AIDS usually bankrupts its victims. The problem is compounded when employers serve as their own health insurers. InMcGann v. H&H Music Co., 946, F. 2d 401 (5th Cir. [1991]), a federal court ruled that such employers could legally change their policies to reduce coverage for workers who develop expensive illnesses such as AIDS.

In January 1995, the settlement in a lawsuit brought by a Philadelphia construction worker with AIDS illustrated that the ADA can be used to fight caps on coverage. In 1992, the joint union-management fund for the Laborers' District Council placed a $10,000 limit on AIDS benefits, in stark contrast to the $100,000 allowed for other catastrophic illnesses. At that time, the fund said the cap on AIDS benefits was designed to curb all health costs. In 1993, the EEOC ruled that it violated the ADA, and, backed by the AIDS Law Project of Philadelphia, the worker sued. Rather than fight an expensive lawsuit, the insurance fund settled: under the agreement, it extended coverage for all catastrophic illnesses to $100,000. Hailing the settlement as a major blow against widespread discrimination in insurance coverage, the law project's executive director, Nan Feyler, told thePhiladelphia Inquirer, "You can't single out someone based on a stereotype."

In other respects, health care is a distinct area of concern for AIDS patients and health professionals alike. Discrimination has often taken place. State and federal statutes, including the Rehabilitation Act, guarantee access to health care for AIDS patients, and courts have upheld that right. In the 1988 case ofDoe v. Centinela Hospital, 57 U.S.L.W. 2034 (C.D. Cal.), for example, an HIV-infected person with no symptoms was excluded from a federally funded hospital's residential program for drug and alcohol treatment because health care providers feared exposure to the virus. The case itself exposed the irrationality of such discrimination. Although its employees had feared HIV, the hospital argued in court that the lack of symptoms meant that the patient was not disabled — and thus not protected by the Rehabilitation Act. A federal trial court in California rejected this argument, ruling that a refusal to grant services based solely on fear of contagion is discrimination under the Rehabilitation Act.

More recent actions have used the ADA. In 1994, the U.S. Department of Justice reached a settlement in a lawsuit with the city of Philadelphia that ensures that city employees will treat AIDS patients. The first settlement in a health care-related ADA suit, the case grew out of an incident in 1993: when an HIV-positive man collapsed on a Philadelphia street, emergency medical workers not only refused to touch him but told him to get on a stretcher by himself. The man sued. In settling the case, the city agreed to begin an extensive training program for its nine hundred emergency medical technicians and fourteen hundred firefighters. In addition, officials paid the man $10,000 in compensatory damages, and apologized. The Justice Department viewed the suit as an important test of the ADA. Assistant Attorney General James Turner said the settlement would "send a clear message to all cities across the nation that we will not tolerate discrimination against persons with AIDS."

Health care professionals are not the only ones with concerns about HIV transmission. Patients may legitimately wonder if their doctors are infected. During the early 1990s, the medical and legal communities debated whether HIV-positive doctors have a duty to inform their patients of the illness. According to the Centers for Disease Control (CDC), the risk of HIV transmission from health care workers to patients is very small when recommended infection-control procedures are followed — yet this type of transmission has occurred. The first cases of patients contracting HIV during a medical procedure were reported in 1991: Dr. David J. Acer, a Florida dentist with AIDS, had apparently transmitted HIV to five patients. One was Kimberly Bergalis, age twenty-three, who died as a result. Before her death, Bergalis brought a claim against the dentist's professional liability insurer, contending that it should have known that Acer had AIDS and effectively barred him from operating by refusing to issue him a malpractice insurance policy. Bergalis's claim was settled for $1 million. A second claim by Bergalis, against the insurance company that recommended Acer to her, was settled for an undisclosed amount.

Since the Bergalis case, many U.S. dentists, physicians, and surgeons with AIDS have begun disclosing their status to their patients. Faya v. Almaraz, 329 Md. 435, 620 A.2d 327 (Md. 1993) illustrates the consequences of not doing so. InFaya, the court held that an HIV-positive doctor has the legal duty to disclose this medical condition to patients, and that a failure to inform can lead to a negligence action, even if the patients have not been infected by the virus. The doctor's patient did not contract HIV, but did suffer emotionally from a fear of having done so. The unanimous decision held that patients can be compensated for their fears. Although this case dealt specifically with doctor-patient relationships, others have concerned a variety of relationships in which the fear of contracting AIDS can be enough for a plaintiff to recover damages.

Routine HIV-testing in health care facilities also raises legal issues. Most people who are HIV-positive want this information kept confidential. Facilities are free to use HIV testing to control the infection, but in most states only with the patient's informed consent. Some states, such as Illinois, require written consent. The level of protection for medical records varies from state to state — California, for example, has broad protections; under its statutes, no one can be compelled to provide information that would identify anyone who is the subject of an HIV test. However, every state requires that AIDS cases be reported to the CDC, which tracks statistics on the spread of HIV. Whether the name of an HIV-infected person is reported to the CDC depends on state laws and regulations.

AIDS and Education

Issues in the field of education include the rights of HIV-positive students to attend class and of HIV-positive teachers to teach, the confidentiality of HIV records, and how best to teach young people about AIDS. A few areas have been settled in court: for instance, the right of students to attend classes was of greater concern in the early years of the epidemic, and no longer remains in dispute.

Certain students with AIDS may assert their right to public education under the Education for All Handicapped Children Act of 1975 (EAHCA), but the law is only relevant in cases involving special education programs. More commonly, students' rights are protected by the Rehabilitation Act. Perhaps the most important case in this area isThomas v. Atascadero Unified School District, 662 F. Supp. 376 (C.D. Cal. 1986), which illustrates how far such protections go.Thomas involved a young elementary school student with AIDS who had bitten another youngster in a fight. Based on careful review of medical evidence, the District Court for the Central District of California concluded that biting was not proved to transmit AIDS, and it ordered the school district to readmit the girl. Similarly, schools that excluded teachers with AIDS have been successfully sued on the ground that those teachers pose no threat to their students or others, and that their right to work is protected by the Rehabilitation Act, as inChalk.

Confidentiality relating to HIV is not uniform in schools. Some school districts require rather broad dissemination of the information; others keep it strictly private. In the mid-1980s, the New York City Board of Education adopted a policy that nobody in any school would be told the identities of children with AIDS or HIV infection; only a few top administrators outside the school would be informed. The policy inspired a lawsuit brought by a local school district, which argued that the identity of a child was necessary for infection control (District 27 Community School Board v. Board of Education, 130 Misc. 2d 398, 502 N.Y.S.2d 325 [N.Y. Sup. Ct. 1986]). The trial court rejected the argument on the basis that numerous children with HIV infection might be attending school, and instead noted that universal precautions in dealing with blood incidents at school would be more effective than the revelation of confidential information.

Schools play a major role in the effort to educate the public on AIDS. Several states have mandated AIDS prevention instruction in their schools. But the subject is controversial: it evokes personal, political, and moral reactions to sexuality. Responding to parental sensitivities, some states have authorized excused absences from such programs. The New York State Education Department faced a storm of controversy over its policy of not allowing absences at parental discretion. Furthermore, at the local and the federal levels, some conservatives have opposed certain kinds of AIDS education. During the 1980s, those who often criticized liberal approaches to sex education argued that AIDS materials should not be explicit, encourage sexuality, promote the use of contraceptives, or favorably portray gays and lesbians. In Congress, lawmakers attached amendments to appropriations measures (bills that authorize the spending of federal tax dollars) that mandate that no federal funds may be used to "promote homosexuality." In response, the CDC adopted regulations that prohibit spending federal funds on AIDS education materials that might be found offensive by some members of certain communities. Despite the controversy, some communities have taken radical steps to halt the spread of AIDS. In 1991 and 1992, the school boards of New York City, San Francisco, Seattle, and Los Angeles voted to make condoms available to students in their public high school systems.

AIDS and Private Life

Although epidemics are public crises, they begin with individuals. The rights of people who have AIDS and those who do not are often in contention, and seldom more so than in private life. It is no surprise that people with HIV continue having sex, nor is it a surprise that this behavior is, usually, legal. Unfortunately, some do so without knowing they have the virus. Even more unfortunately, others do so in full knowledge that they are HIV-positive but without informing their partners. This dangerous behavior has opened one area of AIDS law that affects individuals: the legal duty to warn a partner before engaging in behavior that can transmit the infection. A similar duty was recognized by courts long before AIDS ever appeared, with regard to other sexually transmitted diseases.

A failure to inform in AIDS cases has given rise to both civil and criminal lawsuits. One such case was brought by Mark Christian, the lover of actor Rock Hudson, against Hudson's estate. Christian won his suit on the ground that Hudson concealed his condition and continued their relationship, and the jury returned a multimillion-dollar verdict despite the fact that there was no evidence that Christian had been infected. Another case was brought in Oregon in 1991, when criminal charges were filed against Alberto Gonzalez for knowingly spreading HIV by having sex with his girlfriend. After Gonzalez pleaded no contest to third-degree assault (a felony) and to two charges of recklessly endangering others, he received an unusual sentence: the court ordered him to abstain from sex for five years and placed him under house arrest for six months. Although such convictions are increasingly common, courts have also recognized that not knowing one has HIV can be a valid defense. InC. A. U. v. R. L., 438 N.W.2d 441 (1989), for example, the Minnesota Court of Appeals affirmed a trial court's finding that the plaintiff could not recover damages from her former fiancé, who had unknowingly given her the virus.

State Legislation and the Courts

To stem transmission of HIV, states have adopted several legal measures. Two states attempted to head off the virus at the pass: Illinois and Louisiana at one point required HIV blood testing as a prerequisite to getting a marriage license. Both states ultimately repealed these statutes because they were difficult to enforce; couples simply crossed state lines to be married in neighboring states. Several states have taken a less stringent approach, requiring only that applicants for a marriage license must be informed of the availability — and advisability — of HIV tests. More commonly, states criminalize sexual behavior that can spread AIDS. Michigan law makes it a felony for an HIV- or AIDS-infected person to engage in sex without first informing a partner of the infection. Florida law provides for the prosecution of any HIV-positive person committing prostitution, and it permits rape victims to demand that their attackers undergo testing. Indiana imposes penalties on persons who recklessly or knowingly donate blood or semen knowing that they are HIV-infected.

Older state laws have also been applied to AIDS. Several states have statutes that make it a criminal offense for a person with a contagious disease — including a sexually transmitted disease — to willfully or knowingly expose another person to it, and some have amended these laws specifically to include AIDS. In addition, in many states, it has long been a crime to participate in an act of sodomy such as anal or oral sex. The argument that punishing sodomy can stem HIV transmission was made in a case involving a Missouri sodomy statute specifically limited to homosexual conduct. InState v. Walsh, 713 S.W.2d 508 (1986), the Missouri Supreme Court upheld the statute after finding that it was rationally related to the state's legitimate interest in protecting public health. Other AIDS-related laws have fallen in court challenges: for instance, in 1993, U.S. district judge Aldon J. Anderson struck down a 1987 Utah statute that invalidated the marriages of people with AIDS, ruling that it violated the ADA and the Rehabilitation Act.

Sex is only one kind of behavior that has prompted criminal prosecution related to AIDS. Commonly, defendants in AIDS cases have been prosecuted for assault. InUnited States v. Moor, 669 F. Supp. 289 (D. Minn., 1987),aff'd, 846 F.2d 1163 (8th Cir., 1988), the Eighth Circuit upheld the conviction of an HIV-infected prisoner found guilty of assault with a deadly weapon — his teeth — for biting two prison guards during a struggle. Teeth were also on trial inBrock v. State, 555 So. 2d 285 (1989), but the Alabama Court of Criminal Appeals refused to regard them as a dangerous weapon. InState v. Haines, 545 N.E.2d 834 (2d Dist. 1989), the Indiana Court of Appeals affirmed a conviction of attempted murder against a man with AIDS who had slashed his wrists to commit suicide; when police officers and paramedics refused to let him die, he began to spit, bite, scratch, and throw blood.

Civil Litigation

Tort law has seen an explosion of AIDS-related suits. This area of law is used to discourage individuals from subjecting others to unreasonable risks, and to compensate those who have been injured by unreasonably risky behavior. The greatest number of AIDS-related liability lawsuits has involved the receipt of HIV-infected blood and blood products. A second group has concerned the sexual transmission of HIV. A third group involves AIDS-related psychic distress. In these cases, plaintiffs have successfully sued and recovered damages for their fear of having contracted HIV.

See: Disabled Persons; Discrimination; Food and Drug Administration; Gay and Lesbian Rights; Patients' Rights; Physicians and Surgeons; Privacy.

Acronym for acquired immune deficiency syndrome, a fatal disease caused by the human immunodeficiency virus, or HIV. Believed to have originated in Africa, AIDS has become an epidemic, infecting tens of millions of people worldwide. The virus, which is transmitted from one individual to another through the exchange of body fluids (such as blood or semen), attacks white blood cells, thereby causing the body to lose its capacity to ward off infection. As a result, many AIDS patients die of opportunistic infections that strike their debilitated bodies. AIDS first appeared in the United States in 1981, primarily among homosexuals and intravenous drug users who shared needles, but throughout the world, it is also transmitted by heterosexual contact. Today, scientists are hopeful that AIDS can be managed by new drugs, such as protease inhibitors, and need not be fatal. (See AZT.)

Quotes:

"The AIDS epidemic has rolled back a big rotting log and revealed all the squirming life underneath it, since it involves, all at once, the main themes of our existence: sex, death, power, money, love, hate, disease and panic. No American phenomenon has been so compelling since the Vietnam War." - Edmund White

"The moral immune system of this country has been weakened and attacked, and the AIDS virus is the perfect metaphor for it. The malignant neglect of the last twelve years has led to breakdown of our country's immune system, environmentally, culturally, politically, spiritually and physically." - Barbara Streisand

"AIDS obliges people to think of sex as having, possibly, the direst consequences: suicide. Or murder." - Susan Sontag

"AIDS occupies such a large part in our awareness because of what it has been taken to represent. It seems the very model of all the catastrophes privileged populations feel await them." - Susan Sontag

"I have learned more about love, selflessness and human understanding in this great adventure in the world of AIDS than I ever did in the cut-throat, competitive world in which I spent my life." - Anthony Perkins

"We're all going to go crazy, living this epidemic every minute, while the rest of the world goes on out there, all around us, as if nothing is happening, going on with their own lives and not knowing what it's like, what we're going through. We're living through war, but where they're living it's peacetime, and we're all in the same country." - Larry Kramer

See more famous quotes about AIDS

acquired immune deficiency syndrome of humans, caused by the lentivirus, human immunodeficiency virus 1 (HIV1), less commonly HIV2. The virus initially infects macrophages and then attacks and destroys T helper CD4 lymphocytes, thereby producing immunodeficiency and resulting in death, usually after a very prolonged incubation period followed by a very prolonged clinical course. A very similar virus SIV1 causes simian AIDS in captive macaque monkeys. A further similar virus SIV2 has been isolated from healthy green monkeys.

• feline AIDS — see feline immunodeficiency virus.

• Diseases and Infestations - AIDS: acquired immunedeficiency syndrome; severe weakening or destruction of body's immune system by human immunodeficiency virus, allowing opportunistic diseases and infections to attack, spread by direct contact of body fluids such as blood or semen
• Anatomy and Physiology of Sex - AIDS: acquired immune deficiency syndrome; fatal disease characterized by inability of body to fight various infections due to HIV virus, which attacks immune system, transmitted by direct contact of body fluids

For other uses, see AIDS (disambiguation).

Acquired immunodeficiency syndrome (AIDS)
Classification and external resources
The red ribbon is a symbol for solidarity with HIV-positive people and those living with AIDS.
ICD-10	B24
ICD-9	042
DiseasesDB	5938
MedlinePlus	000594
eMedicine	emerg/253
MeSH	D000163

List of abbreviations used in this article AIDS: Acquired immune deficiency syndrome HIV: Human immunodeficiency virus CD4+: CD4+ T helper cells CCR5: Chemokine (C-C motif) receptor 5 CDC: Centers for Disease Control and Prevention WHO: World Health Organization PCP: Pneumocystis pneumonia TB: Tuberculosis MTCT: Mother-to-child transmission HAART: Highly active antiretroviral therapy STI/STD: Sexually transmitted infection/disease

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).^[1][2][3] The illness interferes with the immune system, making people with AIDS much more likely to get infections, including opportunistic infections and tumors that do not affect people with working immune systems. This susceptibility gets worse as the disease continues.

HIV is transmitted in many ways, such as: sexual intercourse (including oral sex and anal sex); contaminated blood transfusions and hypodermic needles; and exchange between mother and baby during pregnancy, childbirth, and breastfeeding. It can be transmitted by any contact of a mucous membrane or the bloodstream with a bodily fluid that has the virus in it, such as the blood, semen, vaginal fluid, preseminal fluid, or breast milk from an infected person.^[4][5]

The virus and disease are often referred to together as HIV/AIDS. The disease is a major health problem in many parts of the world, and is considered a pandemic, a disease outbreak that is not only present over a large area but is actively spreading.^[6] In 2009, the World Health Organization (WHO) estimated that there are 33.4 million people worldwide living with HIV/AIDS, with 2.7 million new HIV infections per year and 2.0 million annual deaths due to AIDS.^[7] In 2007, UNAIDS estimated: 33.2 million people worldwide were HIV positive; AIDS killed 2.1 million people in the course of that year, including 330,000 children, and 76% of those deaths occurred in sub-Saharan Africa.^[8] According to UNAIDS 2009 report, worldwide some 60 million people have been infected since the start of the pandemic, with some 25 million deaths, and 14 million orphaned children in southern Africa alone.^[9]

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century.^[10][11] AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and its cause, HIV, identified in the early 1980s.^[12]

Although treatments for HIV/AIDS can slow the course of the disease, there is no known cure or HIV vaccine. Antiretroviral treatment reduces both the deaths and new infections from HIV/AIDS, but these drugs are expensive and the medications are not available in all countries.^[13] Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.

Contents 1 Signs and symptoms 1.1 Pulmonary 1.2 Gastrointestinal 1.3 Neurological and psychiatric 1.4 Tumors 1.5 Other infections 2 Cause 2.1 Sexual transmission 2.2 Blood products 2.3 Perinatal transmission 2.4 Misconceptions 3 Pathophysiology 3.1 Cells affected 3.1.1 The effect 3.1.2 Molecular basis 4 Diagnosis 4.1 World Health Organization 4.2 Center for Disease Control 4.3 HIV test 5 Prevention 5.1 Sexual contact 5.2 Body fluid exposure 5.3 Mother-to-child 5.4 Education 6 Management 6.1 Antiviral therapy 6.2 Complementary and alternative medicine 7 Prognosis 8 Epidemiology 9 History and origin 10 Society and culture 10.1 Stigma 10.2 Economic impact 10.3 Religion and AIDS 10.4 AIDS denialism 10.5 AIDS conspiracy theories 11 Research directions 12 See also 13 Notes and references 14 Further reading 15 External links

Signs and symptoms

Main symptoms of AIDS.

X-ray of pneumocystis pneumonia (PCP). There is increased white (opacity) in the lower lungs on both sides, characteristic of PCP.

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages.^[14] These infections affect nearly every organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.^[15][16] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Pulmonary

Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii.

Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.^[17]

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, and is not easily treatable once identified.^[18] Multidrug resistance is a serious problem. Tuberculosis with HIV co-infection (TB/HIV) is a major world health problem according to the World Health Organization: in 2007, 456,000 deaths among incident TB cases were HIV-positive, a third of all TB deaths and nearly a quarter of the estimated 2 million HIV deaths in that year.^[19] Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.^[20]

Gastrointestinal

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV-infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.^[21]

Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and viruses,^[22] astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis).

In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.^[23]

Neurological and psychiatric

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.^[24]

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs.^[25] Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.^[26]

AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin.^[27] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4⁺ T cell levels and high plasma viral loads.

Prevalence is 10–20% in Western countries^[28] but only 1–2% of HIV infections in India.^[29][30] This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less frequently seen with the advent of multi-drug therapy.

Tumors

Kaposi's sarcoma

Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV) (also known as human herpesvirus-8 [HHV-8]), and human papillomavirus (HPV).^[31][32]

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs. High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract.^[33] When they occur in an HIV-infected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS.

Invasive cervical cancer in HIV-infected women is also considered AIDS-defining, it is caused by human papillomavirus (HPV).^[34]

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinomas, head and neck cancers, and lung cancer. Some of these are causes by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.

Interestingly, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.^[35] In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.

Other infections

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness.

Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.^[36]

An infection that often goes unrecognized in AIDS patients is Parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.^[37]

Cause

For more details on this topic, see HIV.

Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.

A generalized graph of the relationship between HIV copies (viral load) and CD4 counts over the average course of untreated HIV infection; any particular individual's disease course may vary considerably.                      CD4⁺ T Lymphocyte count (cells/mm³)                      HIV RNA copies per mL of plasma

AIDS is the ultimate clinical consequence of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4⁺ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4⁺ T cells.^[38]

Once the number of CD4⁺ T cells per microliter (µL) of blood drops below 200, cellular immunity is lost. Acute HIV infection usually progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4⁺ T cells remaining in the blood, and/or the presence of certain infections, as noted above.^[39]

In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.^[40] However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20  years.

Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.^[41][42] Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people.

Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression.^[40][43][44] The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the homozygous CCR5-Δ32 variation are resistant to infection with certain strains of HIV.^[45] HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.^[46][47][48]

Sexual transmission

Sexual transmission occurs with the contact between sexual secretions of one person with the rectal, genital or oral mucous membranes of another. Unprotected sexual acts are riskier for the receptive partner than for the insertive partner, and the risk for transmitting HIV through unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex.

However, oral sex is not entirely safe, as HIV can be transmitted through both insertive and receptive oral sex.^[49][50] Sexual assault greatly increases the risk of HIV transmission as condoms are rarely employed and physical trauma to the vagina or rectum occurs frequently, facilitating the transmission of HIV.^[51]

Drug use has been studied as a possible predictor of HIV transmission. Perry N. Halkitis found that methamphetamine usage does significantly relate to unprotected sexual behavior. The study found methamphetamine users to be at a higher risk for contracting HIV.^[52]

Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection, because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America suggest that genital ulcers, such as those caused by syphilis and/or chancroid, increase the risk of becoming infected with HIV by about fourfold. There is also a significant although lesser increase in risk from STIs such as gonorrhea, chlamydia and trichomoniasis, which all cause local accumulations of lymphocytes and macrophages.^[53]

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions.

However, each 10-fold increase in the level of HIV in the blood is associated with an 81% increased rate of HIV transmission.^[53][54] Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.^[55][56]

People who have been infected with one strain of HIV can still be infected later on in their lives by other, more virulent strains.

Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern of overlapping long-term sexual relationships. This allows the virus to quickly spread to multiple partners who in turn infect their partners. A pattern of serial monogamy or occasional casual encounters is associated with lower rates of infection.^[57]

HIV spreads readily through heterosexual sex in Africa, but less so elsewhere. One possibility being researched is that schistosomiasis, which affects up to 50% of women in parts of Africa, damages the lining of the vagina.^[58][59]

Blood products

CDC poster from 1989 highlighting the threat of AIDS associated with drug use

This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with HIV.

Needle sharing is the cause of one third of all new HIV-infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce this risk.^[60]

This route can also affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training.

The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.^[61] Because of this, the United Nations General Assembly has urged the nations of the world to implement precautions to prevent HIV transmission by health workers.^[62]

The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and between 5% and 10% of the world's HIV infections come from transfusion of infected blood and blood products.^[63]

Perinatal transmission

The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during pregnancy, labor and delivery is 25%.

However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%.^[64] The risk of infection is influenced by the viral load of the mother at birth, with the higher the viral load, the higher the risk. Breastfeeding also increases the risk of transmission by about 4 %.^[65]

Misconceptions

Main article: Misconceptions about HIV and AIDS

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can spread through casual contact (such as shaking hands, hugging, or a casual kiss), that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.^[66][67]

Pathophysiology

The pathophysiology of AIDS is complex.^[68] Ultimately, HIV causes AIDS by depleting CD4⁺ T helper lymphocytes. This weakens the immune system and allows opportunistic infections. T lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4⁺ T cell depletion differs in the acute and chronic phases.^[69]

During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4⁺ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4⁺ T cell numbers.

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4⁺ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.^[70] The reason for the preferential loss of mucosal CD4⁺ T cells is that a majority of mucosal CD4⁺ T cells express the CCR5 coreceptor, whereas a small fraction of CD4⁺ T cells in the bloodstream do so.^[71]

HIV seeks out and destroys CCR5 expressing CD4⁺ cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically latent phase. However, CD4⁺ T cells in mucosal tissues remain depleted throughout the infection, although enough remain to initially ward off life-threatening infections.

Continuous HIV replication results in a state of generalized immune activation persisting throughout the chronic phase.^[72] Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. Another cause is the breakdown of the immune surveillance system of the mucosal barrier caused by the depletion of mucosal CD4⁺ T cells during the acute phase of disease.^[73]

This results in the systemic exposure of the immune system to microbial components of the gut’s normal flora, which in a healthy person is kept in check by the mucosal immune system. The activation and proliferation of T cells that results from immune activation provides fresh targets for HIV infection. However, direct killing by HIV alone cannot account for the observed depletion of CD4⁺ T cells since only 0.01–0.10% of CD4⁺ T cells in the blood are infected.

A major cause of CD4⁺ T cell loss appears to result from their heightened susceptibility to apoptosis when the immune system remains activated. Although new T cells are continuously produced by the thymus to replace the ones lost, the regenerative capacity of the thymus is slowly destroyed by direct infection of its thymocytes by HIV. Eventually, the minimal number of CD4⁺ T cells necessary to maintain a sufficient immune response is lost, leading to AIDS

Cells affected

The virus, entering through which ever route, acts primarily on the following cells:^[74]

• Lymphoreticular system:
  • CD₄+ T-Helper cells
  • Macrophages
  • Monocytes
  • B-lymphocytes
• Certain endothelial cells
• Central nervous system:
  • Microglia of the nervous system
  • Astrocytes
  • Oligodendrocytes
  • Neurones – indirectly by the action of cytokines and the gp-120

The effect

The virus has cytopathic effects but how it does it is still not quite clear. It can remain inactive in these cells for long periods, though. This effect is hypothesized to be due to the CD₄-gp120 interaction.^[74]

• The most prominent effect of HIV is its T-helper cell suppression and lysis. The cell is simply killed off or deranged to the point of being function-less (they do not respond to foreign antigens). The infected B-cells can not produce enough antibodies either. Thus the immune system collapses leading to the familiar AIDS complications, like infections and neoplasms (vide supra).
• Infection of the cells of the CNS cause acute aseptic meningitis, subacute encephalitis, vacuolar myelopathy and peripheral neuropathy. Later it leads to even AIDS dementia complex.
• The CD₄-gp120 interaction (see above) is also permissive to other viruses like Cytomegalovirus, Hepatitis virus, Herpes simplex virus, etc. These viruses lead to further cell damage i. e. cytopathy.

Molecular basis

For details, see:

• Structure and genome of HIV
• HIV replication cycle
• HIV tropism

Diagnosis

The diagnosis of AIDS in a person infected with HIV is based on the presence of certain signs or symptoms. Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization's staging system for HIV infection and disease is used (using clinical and laboratory data), and in developed countries the CDC's classification system is used.

World Health Organization

Main article: WHO disease staging system for HIV infection and disease

In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for people infected with HIV-1.^[75] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

• Stage I: HIV infection is asymptomatic and not categorized as AIDS
• Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
• Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
• Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

Center for Disease Control

Main article: CDC classification system for HIV infection

There are two main definitions for AIDS. The older definition is to referring to AIDS using the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.^[76][77] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4⁺ T cell count below 200 per µL of blood or 14% of all lymphocytes.^[78] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4⁺ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

HIV test

Main article: HIV test

Many people are unaware that they are infected with HIV.^[79] Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.^[79] Therefore, donor blood and blood products used in medicine and medical research are screened for HIV.

HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results.

The window period (the time between initial infection and the development of detectable antibodies against the infection) can vary since it can take 3–6  months to seroconvert and to test positive. Detection of the virus using polymerase chain reaction (PCR) during the window period is possible, and evidence suggests that an infection may often be detected earlier than when using a fourth generation EIA screening test.

Positive results obtained by PCR are confirmed by antibody tests.^[80] Routinely used HIV tests for infection in neonates and infants (i. e., patients younger than 2 years),^[81] born to HIV-positive mothers, have no value because of the presence of maternal antibody to HIV in the child's blood. HIV infection can only be diagnosed by PCR, testing for HIV pro-viral DNA in the children's lymphocytes.^[82]

Prevention

Estimated per act risk for acquisition
of HIV by exposure route (US only)^[83]

Exposure Route	Estimated chance of infection
Blood Transfusion	90%[84]
Childbirth (to child)	25%[64]
Needle-sharing injection drug use	0.67%[85]
Percutaneous needle stick	0.30%[86]
Receptive anal intercourse*	0.50%[87][88]
Insertive anal intercourse*	0.065%[87][88]
Receptive penile-vaginal intercourse*	0.10%[87][88][89]
Insertive penile-vaginal intercourse*	0.05%[87][88]
Receptive oral intercourse*§	0.01%[88]
Insertive oral intercourse*§	0.005%[88]
* assuming no condom use § source refers to oral intercourse performed on a man

Know Aids – No Aids road sign in Spiti Valley, Himachel Pradesh, India, 2010

AIDS Clinic, McLeod Ganj, Himachel Pradesh, India, 2010

The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during the perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.^[90] Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels.^[91]

Sexual contact

The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex.^[92][93][94]

During a sexual act, only male or female condoms can reduce the risk of infection with HIV and other STDs. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.^[95] Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.^[96] Prevention strategies are well known in developed countries, but epidemiological and behavioral studies in Europe and North America suggest that a substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV.^[97][98]

The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms porous. If lubrication is desired, manufacturers recommend using water-based lubricants. Oil-based lubricants can be used with polyurethane condoms.^[99]

Female condoms are commonly made from polyurethane, but are also made from nitrile and latex. They are larger than male condoms and have a stiffened ring-shaped opening with an inner ring designed to be inserted into the vagina keeping the condom in place; inserting the female condom requires squeezing this ring. Female condoms have been shown to be an important HIV prevention strategy by preliminary studies which suggest that overall protected sexual acts increase relative to unprotected sexual acts where female condoms are available.^[100] At present, availability of female condoms is very low and the price remains prohibitive for many women.

Three randomized controlled trials showed that male circumcision lowers the risk of HIV infection among heterosexual men, from 51% to 60%.^[101] Based on these studies, WHO/UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007.^[102] Programs to encourage condom use, including providing them free to those in poverty, are estimated to be 95 times more cost effective than circumcision at reducing the rate of HIV in sub-Saharan Africa.^[103] See also Circumcision and HIV.

Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.^[104] However, one randomized controlled trial indicated that adult male circumcision was not associated with increased HIV risk behavior.^[105]

Studies of HIV infection rates among women who have undergone female genital cutting (FGC) have reported mixed results; for details see Female genital cutting.

A three-year study in South Africa, completed in 2010, found that an anti-microbial vaginal gel could reduce infection rates among women by 50% after one year of use, and by 39% after two and a half years. The results of the study, which was conducted by the Centre for the Aids Programme of Research in South Africa (CAPRISA), were published in Science magazine in July 2010, and were then presented at an international aids conference in Vienna.^[106]

Body fluid exposure

Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of exposure to contaminated blood. These precautions include barriers such as gloves, masks, protective eyeware or shields, and gowns or aprons which prevent exposure of the skin or mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin immediately after being contaminated with blood or other bodily fluids can reduce the chance of infection. Finally, sharp objects like needles, scalpels and glass, are carefully disposed of to prevent needlestick injuries with contaminated items.^[107] Since intravenous drug use is an important factor in HIV transmission in developed countries, harm reduction strategies such as needle-exchange programmes are used in attempts to reduce the infections caused by drug abuse.^[108][109]

Mother-to-child

Current recommendations state that when replacement feeding, as with a wet nurse, is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.^[110]

Education

One way to change risky behavior is health education. Several studies^{[citation needed]} have shown the positive impact of education and health literacy on cautious sex behavior. Education works only if it leads to higher health literacy and general cognitive ability. This ability is relevant to understand the relationship between own risky behavior and possible outcomes like HIV-transmission.^[111] In July 2010, a UNAIDS Inter-Agency Task Team (IATT) on Education commissioned literature review found there was a need for more research into non-African^{[112][clarification needed]} (especially non-South African contexts), more research on the actual implementation of sex-education programmes (such as teacher training, access to related services through schools and the community, or parental attitudes to HIV and AIDS education) and more longitudinal studies on the deeper complexities of the relationship between education and HIV.^[113]

Management

See also: HIV therapy

There is currently no publicly available HIV vaccine or cure for HIV or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called post-exposure prophylaxis (PEP).^[114] PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including diarrhea, malaise, nausea and fatigue.^[115]

Antiviral therapy

Abacavir – a nucleoside analog reverse transcriptase inhibitor (NARTI or NRTI)

The chemical structure of Abacavir

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.^[116] This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available.^[13] Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes, " of antiretroviral agents.

Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.^[117] In developed countries where HAART is available, doctors assess the viral load, CD4 counts, rapidity of CD4 decline and patient readiness while deciding when to recommend initiating treatment.^[118] Traditionally, treatment has been recommended for otherwise asymptomatic patients when CD4 cell counts fall to 200–250 cells per microliter of blood. However, beginning treatment earlier (at a CD4 level of 350 cells/microliter) may significantly reduce the risk of death.^[119]

Standard goals of HAART include improvement in the patient’s quality of life, reduction in complications, and reduction of HIV viremia below the limit of detection, but it does not cure the patient of HIV nor does it prevent the return, once treatment is stopped, of high blood levels of HIV, often HAART resistant.^[120][121] Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.^[122]

Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to the plummeting of HIV-associated morbidity and mortality.^{[123][124][125]} In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2  months.^[40] HAART is thought to increase survival time by between 4 and 12  years.^[126][127]

For some patients, which can be more than fifty percent of patients, HAART achieves far less than optimal results, due to medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV. Non-adherence and non-persistence with therapy are the major reasons why some people do not benefit from HAART.^[128] The reasons for non-adherence and non-persistence are varied. Major psychosocial issues include poor access to medical care, inadequate social supports, psychiatric disease and drug abuse. HAART regimens can also be complex and thus hard to follow, with large numbers of pills taken frequently.^{[129][130][131]}

Side effects can also deter people from persisting with HAART, these include lipodystrophy, dyslipidaemia, diarrhoea, insulin resistance, an increase in cardiovascular risks and birth defects.^[132] Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS. However, the costs of anti-retroviral drugs have fallen recently in low-income countries. Moreover, patients' quality of life indices benefit from anti-retroviral treatment especially if healthcare services are adequate.^[133] In the absence of a cure for AIDS, anti-retroviral treatment is likely to be a cost-effective strategy for enhancing well-being of AIDS patients and their dependents.

Complementary and alternative medicine

In the US, approximately 60% of HIV patients use various forms of complementary or alternative medicine (CAM).^[134] Despite the widespread use of CAM by people living with HIV/AIDS, the effectiveness of these therapies has not been established.^[135] A 2005 Cochrane review of existing high-quality scientific evidence concluded: "There is insufficient evidence to support the use of herbal medicines in HIV-infected individuals and AIDS patients. "^[136] Acupuncture has only been proposed for symptomatic relief, but not to treat or cure HIV or AIDS.^[137]

Vitamin or mineral supplementation has shown benefit in some studies. Daily doses of selenium can suppress HIV viral burden with an associated improvement of the CD4 count. Selenium can be used as an adjunct therapy to standard antiviral treatments,^[138][139] but cannot itself cure the infection. More evidence is needed before it can be established that selenium supplementation reduces mortality rates. There is some evidence that vitamin A supplementation in children reduces mortality and improves growth.^[140] A large Tanzanian trial in immunologically and nutritionally compromised pregnant and lactating women showed a number of benefits to daily multivitamin supplementation for both mothers and children.^[140] Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the World Health Organization (WHO).^[141] The WHO further states that several studies indicate that supplementation of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults.^[141]

Prognosis

Disability-adjusted life year for HIV and AIDS per 100,000  inhabitants as of 2004.

no data   ≤ 10   10–25   25–50   50–100   100–500   500–1000

1000–2500   2500–5000   5000–7500   7500-10000   10000-50000   ≥ 50000

Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype,^[8] and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.^[142] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to about 20 years.^[143]

As new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year after the individual progresses to AIDS.^[40] Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.^[144] The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function^[41][42][45] health care and co-infections,^[40][144] as well as which particular strain of the virus is involved.^{[47][145][146]}

Even with anti-retroviral treatment, over the long term HIV-infected patients may experience neurocognitive disorders, osteoporosis, neuropathy, cancers, nephropathy, and cardiovascular disease. It is not always clear whether these conditions result from the infection, related complications, or are side effects of treatment.^{[147][148][137][31][32][149][132][150]}

The largest cause of AIDS morbidity today, globally, is tuberculosis co-infection, see AIDS#Pulmonary infections. In Africa, HIV is the single most important factor contributing to the increase in the incidence of TB since 1990.^[151]

Epidemiology

Main article: AIDS pandemic

This section is outdated. Please update this section to reflect recent events or newly available information. Please see the talk page for more information. (December 2009)

Estimated prevalence of HIV among young adults (15–49) per country at the end of 2005.

Estimated number of people living with HIV/AIDS by country

The AIDS pandemic can also be seen as several epidemics of separate subtypes; the major factors in its spread are sexual transmission and vertical transmission from mother to child at birth and through breast milk.^[6] Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.1  million (range 1.9–2.4  million) lives in 2007 of which an estimated 330,000 were children under 15  years.^[8] Globally, an estimated 33.2  million people lived with HIV in 2007, including 2.5  million children. An estimated 2.5  million (range 1.8–4.1  million) people were newly infected in 2007, including 420,000 children.^[8]

Sub-Saharan Africa remains by far the worst affected region. In 2007 it contained an estimated 68% of all people living with AIDS and 76% of all AIDS deaths, with 1.7  million new infections bringing the number of people living with HIV to 22.5  million, and with 11.4  million AIDS orphans living in the region. Unlike other regions, most people living with HIV in sub-Saharan Africa in 2007 (61%) were women. Adult prevalence in 2007 was an estimated 5.0%, and AIDS continued to be the single largest cause of mortality in this region.^[8]

South Africa has the largest population of HIV patients in the world, followed by Nigeria and India.^[152] South & South East Asia are second worst affected; in 2007 this region contained an estimated 18% of all people living with AIDS, and an estimated 300,000 deaths from AIDS.^[8] India has an estimated 2.5  million infections and an estimated adult prevalence of 0.36%.^[8] Life expectancy has fallen dramatically in the worst-affected countries; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.^[6]

In the United States, young African-American women are also at unusually high risk for HIV infection.^[153] African Americans make up 10% of the population but about half of the HIV/AIDS cases nationwide.^[154] This is due in part to a lack of information about AIDS and a perception that they are not vulnerable, as well as to limited access to health-care resources and a higher likelihood of sexual contact with at-risk male sexual partners.^[155]

There are also geographic disparities in AIDS prevalence in the United States, where it is most common in the large metropolitan areas of the east coast and California and in urban areas of the deep south.^[156] Approximately 1.1  million persons are living with HIV/AIDS in the United States, and more than 56,000 new infections occur every single year.^[157]

History and origin

See also: Origin of AIDS

AIDS was first reported June 5, 1981, when the CDC recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.^[158] In the beginning, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.^[76][77] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.^[159]

In the general press, the term GRID, which stood for gay-related immune deficiency, had been coined.^[160] The CDC, in search of a name, and looking at the infected communities coined “the 4H disease, ” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users.^[161] However, after determining that AIDS was not isolated to the gay community,^[159] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.^[162] By September 1982 the CDC started using the name AIDS, and properly defined the illness.^[163]

The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier.^[11] A 2007 study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969.^[164]

HIV descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV.^[165] However, only a few of these infections were able to cause epidemics in humans, and all did so in the late 19th—early 20th century. To explain why HIV became epidemic only by that time, there are several theories, each invoking specific driving factors that may have promoted SIV adaptation to humans, or initial spread: social changes following colonialism,^[166] rapid transmission of SIV through unsafe or unsterile injections (that is, injections in which the needle is reused without being sterilised),^[167] colonial abuses and unsafe smallpox vaccinations or injections,^[168] or prostitution and the concomitant high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities.^[169][170] See the main article Origin of AIDS.

One of the first high profile victims of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on 2 October 1985 having announced that he was suffering from the virus on 25 July that year. It had been diagnosed during 1984.^[171] A notable British casualty of AIDS that year was Nicholas Eden, a gay Member of Parliament and son of the late prime minister Anthony Eden.^[172][173] The virus claimed perhaps its most famous victim yet on November 24, 1991, when British rock star Freddie Mercury, lead singer of the band Queen, died from an AIDS related illness having only announced that he was suffering from the illness the previous day.^[174] However he had been diagnosed as HIV positive during 1987.^[175] One of the first high profile heterosexual victims of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.^[176] He died, aged 49, as a result of the AIDS virus on 6 February 1993.^[177]

A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine.^[178][179] According to scientific consensus, the available evidence does not support this scenario.^{[180][181][182]}

Society and culture

Stigma

Ryan White became a poster child for HIV after being expelled from school because of his infection.

Main article: Discrimination against people with HIV/AIDS

AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.^[183] Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.^[184]

AIDS stigma has been further divided into the following three categories:

• Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.^[185]

• Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.^[185]
• Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.^[186]

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.^[187] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.^[185]

Economic impact

Main article: Economic impact of AIDS

Changes in life expectancy in some hard-hit African countries.                      Botswana                     Zimbabwe                     Kenya                     South Africa                     Uganda

HIV and AIDS affects economic growth by reducing the availability of human capital.^[188] Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people suffer and die from AIDS-related complications. They will not only be unable to work, but will also require significant medical care. The forecast is that this will probably cause a collapse of economies and societies in countries with a significant AIDS population. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.^[189]

The increased mortality has results in a smaller skilled population and labor force. This smaller labor force consists of increasingly younger people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave lowers productivity. Increased mortality reduces the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.

By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.^[189]

On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.^[190]

Religion and AIDS

Main article: Religion and AIDS

The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because many prominent religious leaders have publicly declared their opposition to the use of condoms,^{[191][192][Full citation needed]} which scientists feel is currently the only means of stopping the epidemic.^{[citation needed]} However, there is a growing openness to faith-based methods due to the failure rates associated with condoms.^[192] Other issues involve religious participation in global health care services^{[citation needed]} and collaboration with secular organizations such as UNAIDS and the World Health Organization.^{[citation needed]}

The religious approach to prevent the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global Aids Crisis argues that cultural changes are needed including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.^[192]

In addition to prevention, some religious groups have interrupted the treatment of AIDS. According to the African Health Policy Network, some churches in London claim that prayer will cure AIDS and the Hackney-based Centre for the Study of Sexual Health and HIV reports that several people have stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths.^[193] The Synagogue Church Of All Nations advertise an "anointing water" to promote God's healing, although the group deny advising people to stop taking medication,^[193] and US patent application 2001051133 similarly suggests that intravenous pure distilled water will eradicate HIV through the mercy of God.^[194]

AIDS denialism

Main article: AIDS denialism

A small number of activists question the connection between HIV and AIDS,^[195] the existence of HIV,^[196] or the validity of current treatment methods (even going so far as to claim that the drug therapy itself was the cause of AIDS deaths). Though these claims have been examined and thoroughly rejected by the scientific community,^[197] they continue to be promulgated through the Internet^[198] and have had a significant political impact. In South Africa, former President Thabo Mbeki's embrace of AIDS denialism resulted in an ineffective governmental response to the AIDS epidemic that has been blamed for hundreds of thousands of AIDS-related deaths.^[199][200]

AIDS conspiracy theories

Operation INFEKTION was a worldwide Soviet active measures operation to spread information that the United States had created HIV/AIDS. Surveys show that a significant number of people believed – and continue to believe – in such claims.^[201]

Research directions

"AIDS research" redirects here. For the journal formerly known as AIDS Research, see AIDS Research and Human Retroviruses.

It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments. However, even after almost 30 years of research, HIV-1 remains a difficult target for a vaccine.^[202]

Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected.^[203] Patients with substantial immunosuppression are also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis as well.^[115]

Researchers have discovered an abzyme that can destroy the protein gp120 CD4 binding site. This protein is common to all HIV variants as it is the attachment point for B lymphocytes and subsequent compromising of the immune system.^[204]

Researchers from the Hebrew University of Jerusalem have also discovered that a combination of peptides that stimulate integration together with the protease inhibitor Ro 31-8959 caused apoptotic cell death of HIV-infected cells with total extermination of the virus but did not harm healthy cells.^[205][206] It could take several years before a commercial treatment based on this discovery becomes available.^[207]

Reactivation of the retrocyclin pseudogene has been proposed as a possible prevention method, as was demonstrated in a proof-of-concept study in tissue culture cells.^[208]

In Berlin, Germany, a 42-year-old leukemia patient, Timothy Ray Brown (also referred to as the "Berlin Patient"),^[209] infected with HIV for more than a decade was given an experimental transplant of bone marrow with cells that contained an unusual natural variant of the CCR5 cell-surface receptor by a team around Gero Hütter. This CCR5-Δ32 variant has been shown to make some cells from people who are born with it resistant to infection with some strains of HIV. Almost two years after the transplant, and even after the patient reportedly stopped taking antiretroviral medications, HIV has not been detected in the patient's blood.^[210] As of December 2010, three years after the transplant, Brown was still free of any detectable HIV in his blood and was described, in a paper in the journal Blood, as "cured".^[209][211]

See also

• Nutrition and HIV/AIDS
• List of HIV-positive people

Notes and references

1. ^ Sepkowitz KA (June 2001). "AIDS—the first 20 years". N. Engl. J. Med. 344 (23): 1764–72. doi:10.1056/NEJM200106073442306. PMID 11396444. 
2. ^ Weiss RA (May 1993). "How does HIV cause AIDS?". Science 260 (5112): 1273–9. Bibcode 1993Sci...260.1273W. doi:10.1126/science.8493571. PMID 8493571. 
3. ^ Cecil, Russell (1988). Textbook of Medicine. Philadelphia: Saunders. pp. 1523, 1799. ISBN 0-7216-1848-0. 
4. ^ "HIV and Its Transmission". Centers for Disease Control and Prevention. 2003. Archived from the original on February 4, 2005. http://web.archive.org/web/20050204141148/http://www.cdc.gov/HIV/pubs/facts/transmission.htm. Retrieved May 23, 2006. 
5. ^ "How HIV is spread". San Francisco AIDS Foundation. April 14, 2006. http://www.sfaf.org/aids101/transmission.html. Retrieved May 23, 2006. 
6. ^ ^{a b c} Kallings LO (2008). "The first postmodern pandemic: 25 years of HIV/AIDS". J Intern Med 263 (3): 218–43. doi:10.1111/j.1365-2796.2007.01910.x. PMID 18205765. http://www.blackwell-synergy.com/doi/full/10.1111/j.1365-2796.2007.01910.x. 
7. ^ "AIDS epidemic update". World Health Organization. http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2009/jc1700_epi_update_2009_en.pdf. Retrieved July 29, 2011. 
8. ^ ^{a b c d e f g} UNAIDS, WHO (December 2007). "2007 AIDS epidemic update" (PDF). http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf. Retrieved March 12, 2008. 
9. ^ http://data.unaids.org/pub/FactSheet/2009/20091124_FS_global_en.pdf
10. ^ Gao F, Bailes E, Robertson DL et al (1999). "Origin of HIV-1 in the Chimpanzee Pan troglodytes troglodytes". Nature 397 (6718): 436–441. Bibcode 1999Natur.397..436G. doi:10.1038/17130. PMID 9989410. 
11. ^ ^{a b} Worobey M, Gemmel M, Teuwen DE et al (October 2008). "Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960". Nature 455 (7213): 661–4. Bibcode 2008Natur.455..661W. doi:10.1038/nature07390. PMID 18833279. Archived from the original on March 30 2009. http://www.nature.com/nature/journal/v455/n7213/full/nature07390.html. Retrieved March 31, 2009. 
12. ^ Gallo RC (2006). "A reflection on HIV/AIDS research after 25 years". Retrovirology 3: 72. doi:10.1186/1742-4690-3-72. PMC 1629027. PMID 17054781. http://www.retrovirology.com/content/3//72. 
13. ^ ^{a b} Palella FJ Jr, Delaney KM, Moorman AC et al (1998). "Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators". N. Engl. J. Med. 338 (13): 853–860. doi:10.1056/NEJM199803263381301. PMID 9516219. 
14. ^ Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA (2003). "Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa". Clin. Infect. Dis. 36 (5): 656–662. doi:10.1086/367655. PMID 12594648. 
15. ^ Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1". J. Emerg. Med. 12 (3): 375–384. doi:10.1016/0736-4679(94)90281-X. PMID 8040596. 
16. ^ Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2". J. Emerg. Med. 12 (4): 491–497. doi:10.1016/0736-4679(94)90346-8. PMID 7963396. 
17. ^ Feldman C (2005). "Pneumonia associated with HIV infection". Curr. Opin. Infect. Dis. 18 (2): 165–170. doi:10.1097/01.qco.0000160907.79437.5a. PMID 15735422. 
18. ^ Kwara A, Ramachandran G, Swaminathan S (January 2010). "Dose adjustment of the non-nucleoside reverse transcriptase inhibitors during concurrent rifampicin-containing tuberculosis therapy: one size does not fit all". Expert Opinion on Drug Metabolism & Toxicology 6 (1): 55–68. doi:10.1517/17425250903393752. PMC 2939445. PMID 19968575. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2939445. 
19. ^ "Global Tuberculosis Control 2009" (PDF). http://www.who.int/tb/publications/global_report/2009/pdf/full_report.pdf. Retrieved November 1, 2011. 
20. ^ Decker CF, Lazarus A (August 2000). "Tuberculosis and HIV infection. How to safely treat both disorders concurrently". Postgraduate Medicine 108 (2): 57–60, 65–8. PMID 10951746. http://www.postgradmed.com/index.php?art=pgm_08_2000?article=1181. 
21. ^ Zaidi SA, Cervia JS (2002). "Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection". Journal of the International Association of Physicians in AIDS Care 1 (2): 53–62. doi:10.1177/154510970200100204. PMID 12942677. 
22. ^ Pollok RC (2001). "Viruses causing diarrhoea in AIDS". Novartis Foundation Symposium. Novartis Foundation Symposia 238: 276–83; discussion 283–8. doi:10.1002/0470846534.ch17. ISBN 978-0-470-84653-7. PMID 11444032. 
23. ^ Guerrant RL, Hughes JM, Lima NL, Crane J (1990). "Diarrhea in developed and developing countries: magnitude, special settings, and etiologies". Reviews of Infectious Diseases 12 (Suppl 1): S41–50. doi:10.1093/clinids/12.Supplement_1.S41. PMID 2406855. 
24. ^ Gazzard, B; Balkin, A; Hill, A (2010). "Analysis of neuropsychiatric adverse events during clinical trials of efavirenz in antiretroviral-naive patients: a systematic review". AIDS reviews 12 (2): 67–75. PMID 20571601.  edit
25. ^ Luft BJ, Chua A (August 2000). "Central Nervous System Toxoplasmosis in HIV Pathogenesis, Diagnosis, and Therapy". Current Infectious Disease Reports 2 (4): 358–362. doi:10.1007/s11908-000-0016-x. PMID 11095878. 
26. ^ Sadler M, Nelson MR (June 1997). "Progressive multifocal leukoencephalopathy in HIV". International Journal of STD & AIDS 8 (6): 351–7. doi:10.1258/0956462971920181. PMID 9179644. 
27. ^ Gray F, Adle-Biassette H, Chretien F, Lorin de la Grandmaison G, Force G, Keohane C (2001). "Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments". Clinical Neuropathology 20 (4): 146–55. PMID 11495003. 
28. ^ Grant I, Sacktor H, McArthur J (2005). "HIV neurocognitive disorders". In H.E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.) (PDF). The Neurology of AIDS (2nd ed.). London, UK: Oxford University Press. pp. 357–373. ISBN 0-19-852610-5. http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf. 
29. ^ Satishchandra P, Nalini A, Gourie-Devi M et al (January 2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989–96)". The Indian Journal of Medical Research 111: 14–23. PMID 10793489. 
30. ^ Wadia RS, Pujari SN, Kothari S et al (March 2001). "Neurological manifestations of HIV disease". The Journal of the Association of Physicians of India 49: 343–8. PMID 11291974. 
31. ^ ^{a b} Boshoff C, Weiss R (2002). "AIDS-related malignancies". Nat. Rev. Cancer 2 (5): 373–382. doi:10.1038/nrc797. PMID 12044013. 
32. ^ ^{a b} Yarchoan R, Tosato G, Little RF (2005). "Therapy insight: AIDS-related malignancies – the influence of antiviral therapy on pathogenesis and management". Nat. Clin. Pract. Oncol. 2 (8): 406–415. doi:10.1038/ncponc0253. PMID 16130937. 
33. ^ Ho-Yen C and Chang F (June 1, 2008). "Gastrointestinal Malignancies in HIV/AIDS". The AIDS Reader 18 (6). http://www.consultantlive.com/aids/article/1145619/1359079. 
34. ^ Palefsky J (2007). "Human papillomavirus infection in HIV-infected persons". Top HIV Med 15 (4): 130–3. PMID 17720998. 
35. ^ Bonnet F, Lewden C, May T et al (2004). "Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy". Cancer 101 (2): 317–324. doi:10.1002/cncr.20354. PMID 15241829. 
36. ^ Skoulidis F, Morgan MS, MacLeod KM (2004). "Penicillium marneffei: a pathogen on our doorstep?". J. R. Soc. Med. 97 (2): 394–396. doi:10.1258/jrsm.97.8.394. PMC 1079563. PMID 15286196. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1079563. 
37. ^ Silvero AM, Acevedo-Gadea CR, Pantanowitz L "" (June 4, 2009). "Unsuspected Parvovirus B19 Infection in a Person With AIDS". The AIDS Reader 19 (6). http://www.consultantlive.com/aids/article/1145619/1419436. 
38. ^ Alimonti JB, Ball TB, Fowke KR (2003). "Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS". J. Gen. Virol. 84 (7): 1649–1661. doi:10.1099/vir.0.19110-0. PMID 12810858. 
39. ^ M. C. I. Lipman, R. W. Baker and M. A. Johnson; with a foreword by P. A. Volberding. (2003). An Atlas of Differential Diagnosis in HIV Disease, Second Edition. CRC Press-Parthenon Publishers. pp. 22–27. ISBN 1-84214-026-4. 
40. ^ ^{a b c d e} Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS 16 (4): 597–632. doi:10.1097/00002030-200203080-00011. PMID 11873003. 
41. ^ ^{a b} Clerici M, Balotta C, Meroni L et al (1996). "Type 1 cytokine production and low prevalence of viral isolation correlate with long-term non progression in HIV infection". AIDS Res. Hum. Retroviruses. 12 (11): 1053–1061. doi:10.1089/aid.1996.12.1053. PMID 8827221. 
42. ^ ^{a b} Morgan D, Mahe C, Mayanja B, Whitworth JA (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ 324 (7331): 193–196. doi:10.1136/bmj.324.7331.193. PMC 64788. PMID 11809639. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=64788. 
43. ^ Gendelman HE, Phelps W, Feigenbaum L et al (1986). "Transactivation of the human immunodeficiency virus long terminal repeat sequences by DNA viruses". Proc. Natl. Acad. Sci. U.S. A. 83 (24): 9759–9763. Bibcode 1986PNAS...83.9759G. doi:10.1073/pnas.83.24.9759. PMC 387220. PMID 2432602. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=387220. 
44. ^ Bentwich Z, Kalinkovich, A, Weisman Z (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunol. Today 16 (4): 187–191. doi:10.1016/0167-5699(95)80119-7. PMID 7734046. 
45. ^ ^{a b} Tang J, Kaslow RA (2003). "The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy". AIDS 17 (Suppl 4): S51–S60. doi:10.1097/00002030-200317004-00006. PMID 15080180. 
46. ^ Quiñones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E (1998). "LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression". Virus Research 57 (1): 11–20. doi:10.1016/S0168-1702(98)00082-3. PMID 9833881. 
47. ^ ^{a b} Campbell GR, Pasquier E, Watkins J et al (2004). "The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis". J. Biol. Chem. 279 (46): 48197–48204. doi:10.1074/jbc.M406195200. PMID 15331610. 
48. ^ Kaleebu P, French N, Mahe C et al (2002). "Effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression in a large cohort of HIV-1-positive persons in Uganda". J. Infect. Dis. 185 (9): 1244–1250. doi:10.1086/340130. PMID 12001041. 
49. ^ Rothenberg RB, Scarlett M, del Rio C, Reznik D, O'Daniels C (1998). "Oral transmission of HIV". AIDS 12 (16): 2095–2105. doi:10.1097/00002030-199816000-00004. PMID 9833850. 
50. ^ Mastro TD, de Vincenzi I (1996). "Probabilities of sexual HIV-1 transmission". AIDS 10 (Suppl A): S75–S82. doi:10.1097/00002030-199601001-00011. PMID 8883613. 
51. ^ Koenig MA, Zablotska I, Lutalo T, Nalugoda F, Wagman J, Gray R (2004). "Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda". Int Fam Plan Perspect 30 (4): 156–63. doi:10.1363/ifpp.30.156.04. PMID 15590381. 
52. ^ Halkitis PN, Pandey Mukherjee P, Palamar JJ (2008). "Longitudinal Modeling of Methamphetamine Use and Sexual Risk Behaviors in Gay and Bisexual Men". AIDS and Behavior 13 (4): 783–791. doi:10.1007/s10461-008-9432-y. PMID 18661225. 
53. ^ ^{a b} Laga M, Nzila N, Goeman J (1991). "The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa". AIDS 5 (Suppl 1): S55–S63. PMID 1669925. 
54. ^ Tovanabutra S, Robison V, Wongtrakul J et al (2002). "Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand". J. Acquir. Immune. Defic. Syndr. 29 (3): 275–283. PMID 11873077. 
55. ^ Sagar M, Lavreys L, Baeten JM et al (2004). "Identification of modifiable factors that affect the genetic diversity of the transmitted HIV-1 population". AIDS 18 (4): 615–619. doi:10.1097/00002030-200403050-00005. PMID 15090766. 
56. ^ Lavreys L, Baeten JM, Martin HL et al (March 2004). "Hormonal contraception and risk of HIV-1 acquisition: results of a 10-year prospective study". AIDS 18 (4): 695–7. PMID 15090778. 
57. ^ Epstein, Helen (2007). The invisible cure: Africa, the West, and the fight against AIDS. New York: Farrar, Straus, and Giroux. ISBN 0-374-28152-1. 
58. ^ "Parasitic worms may boost African HIV rates". Newscientist.com. July 27, 2008. doi:10.1371/journal.pntd.0000265. http://www.newscientist.com/channel/health/mg19926665.600-parasitic-worms-may-boost-african-hiv-rates.html. Retrieved November 1, 2011. 
59. ^ Agnès-Laurence Chenine, Ela Shai-Kobiler, Lisa N. Steele, Helena Ong, Peter Augostini, Ruijiang Song, Sandra J. Lee, Patrick Autissier, Ruth M. Ruprecht, W. Evan Secor Acute Schistosoma mansoni Infection Increases Susceptibility to Systemic SHIV Clade C Infection in Rhesus Macaques after Mucosal Virus Exposure PLoS Neglected Tropical Diseases DOI: 10.1371/journal.pntd.0000265
60. ^ Fan H (2005). Fan, H., Conner, R. F. and Villarreal, L. P. eds. ed. AIDS: science and society (4th ed.). Boston, MA: Jones and Bartlett Publishers. ISBN 0-7637-0086-X. 
61. ^ "WHO, UNAIDS Reaffirm HIV as a Sexually Transmitted Disease". WHO. March 17, 2003. http://usinfo.org/wf-archive/2003/030314/epf506.htm. Retrieved January 17, 2006. 
62. ^ "Financial Resources Required to Achieve, Universal Access to HIV Prevention, Treatment Care and Support" (PDF). UNAIDS. Archived from the original on April 9 2008. http://data.unaids.org/pub/Report/2007/20070925_advocacy_grne2_en.pdf. Retrieved April 11, 2008. 
63. ^ "Blood safety....for too few". WHO. 2001. http://www.who.int/inf-pr-2000/en/pr2000-25.html. Retrieved January 17, 2006. 
64. ^ ^{a b} Coovadia H (2004). "Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS". N. Engl. J. Med. 351 (3): 289–292. doi:10.1056/NEJMe048128. PMID 15247337. 
65. ^ Coovadia HM, Bland RM (2007). "Preserving breastfeeding practice through the HIV pandemic". Trop. Med. Int. Health. 12 (9): 1116–1133. doi:10.1111/j.1365-3156.2007.01895.x. PMID 17714431. 
66. ^ Blechner MJ (1997). Hope and mortality: psychodynamic approaches to AIDS and HIV. Hillsdale, NJ: Analytic Press. ISBN 0-88163-223-6. 
67. ^ Kirby DB, Laris BA, Rolleri LA (March 2007). "Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world". J Adolesc Health 40 (3): 206–17. doi:10.1016/j.jadohealth.2006.11.143. PMID 17321420. 
68. ^ Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1". J Emerg Med 12 (3): 375–84. doi:10.1016/0736-4679(94)90281-X. PMID 8040596. 
69. ^ Hel Z, McGhee JR, Mestecky J (June 2006). "HIV infection: first battle decides the war". Trends Immunol. 27 (6): 274–81. doi:10.1016/j.it.2006.04.007. PMID 16679064. 
70. ^ Mehandru S, Poles MA, Tenner-Racz K, Horowitz A, Hurley A, Hogan C, Boden D, Racz P, Markowitz M (September 2004). "Primary HIV-1 infection is associated with preferential depletion of CD4⁺ T lymphocytes from effector sites in the gastrointestinal tract". J. Exp. Med. 200 (6): 761–70. doi:10.1084/jem.20041196. PMC 2211967. PMID 15365095. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2211967. 
71. ^ Brenchley JM, Schacker TW, Ruff LE, Price DA, Taylor JH, Beilman GJ, Nguyen PL, Khoruts A, Larson M, Haase AT, Douek DC (September 2004). "CD4⁺ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract". J. Exp. Med. 200 (6): 749–59. doi:10.1084/jem.20040874. PMC 2211962. PMID 15365096. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2211962. 
72. ^ Appay V, Sauce D (January 2008). "Immune activation and inflammation in HIV-1 infection: causes and consequences". J. Pathol. 214 (2): 231–41. doi:10.1002/path.2276. PMID 18161758. 
73. ^ Brenchley JM, Price DA, Schacker TW, Asher TE, Silvestri G, Rao S, Kazzaz Z, Bornstein E, Lambotte O, Altmann D, Blazar BR, Rodriguez B, Teixeira-Johnson L, Landay A, Martin JN, Hecht FM, Picker LJ, Lederman MM, Deeks SG, Douek DC (December 2006). "Microbial translocation is a cause of systemic immune activation in chronic HIV infection". Nat. Med. 12 (12): 1365–71. doi:10.1038/nm1511. PMID 17115046. 
74. ^ ^{a b} Textbook of Pathology by Harsh Mohan, ISBN 81-8061-368-2
75. ^ World Health Organization (1990). "Interim proposal for a WHO staging system for HIV infection and disease". WHO Wkly Epidem. Rec. 65 (29): 221–228. PMID 1974812. 
76. ^ ^{a b} Centers for Disease Control (CDC) (1982). "Persistent, generalized lymphadenopathy among homosexual males". MMWR Morb Mortal Wkly Rep. 31 (19): 249–251. PMID 6808340. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001096.htm. Retrieved August 31, 2011. 
77. ^ ^{a b} Barré-Sinoussi F, Chermann JC, Rey F et al (1983). "Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS)". Science 220 (4599): 868–871. Bibcode 1983Sci...220..868B. doi:10.1126/science.6189183. PMID 6189183. 
78. ^ "1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults". CDC. 1992. http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm. Retrieved February 9, 2006. 
79. ^ ^{a b} Kumaranayake L, Watts C (2001). "Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa". J. Int. Dev. 13 (4): 451–466. doi:10.1002/jid.798. 
80. ^ Weber B (2006). "Screening of HIV infection: role of molecular and immunological assays". Expert Rev. Mol. Diagn. 6 (3): 399–411. doi:10.1586/14737159.6.3.399. PMID 16706742. 
81. ^ "eMedicine – HIV Infection (Pediatrics: General Medicine)". Medscape.com. http://www.medscape.com/px/trk.svr/emedsearch?exturl=http://emedicine.medscape.com/article/965086-overview. Retrieved November 1, 2011. 
82. ^ Tóth FD, Bácsi A, Beck Z, Szabó J (2001). "Vertical transmission of human immunodeficiency virus". Acta Microbiol Immunol Hung 48 (3–4): 413–27. doi:10.1556/AMicr.48.2001.3-4.10. PMID 11791341. 
83. ^ Smith DK, Grohskopf LA, Black RJ et al (2005). "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States". MMWR 54 (RR02): 1–20. Archived from the original on April 2 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1. Retrieved March 31, 2009. 
84. ^ Donegan E, Stuart M, Niland JC et al (1990). "Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations". Ann. Intern. Med. 113 (10): 733–739. PMID 2240875. 
85. ^ Kaplan EH, Heimer R (1995). "HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data". J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 10 (2): 175–176. PMID 7552482. 
86. ^ Bell DM (1997). "Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview". Am. J. Med. 102 (5B): 9–15. doi:10.1016/S0002-9343(97)89441-7. PMID 9845490. 
87. ^ ^{a b c d} European Study Group on Heterosexual Transmission of HIV (1992). "Comparison of female to male and male to female transmission of HIV in 563 stable couples". BMJ. 304 (6830): 809–813. doi:10.1136/bmj.304.6830.809. PMC 1881672. PMID 1392708. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1881672. 
88. ^ ^{a b c d e f} Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW (2002). "Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use". Sex Transm Dis 29 (1): 38–43. doi:10.1097/00007435-200201000-00007. PMID 11773877. 
89. ^ Leynaert B, Downs AM, de Vincenzi I (1998). "Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV". Am. J. Epidemiol. 148 (1): 88–96. PMID 9663408. 
90. ^ "Facts about AIDS & HIV". avert.org. Archived from the original on December 2 2007. http://www.avert.org/aids.htm. Retrieved November 30, 2007. 
91. ^ "New HIV/AIDS Plan Calls For Reducing Infections". NPR. July 13, 2010. http://www.npr.org/templates/story/story.php?storyId=128495103. Retrieved November 1, 2011. 
92. ^ Johnson AM, Laga M (1988). "Heterosexual transmission of HIV". AIDS 2 (suppl. 1): S49–S56. doi:10.1097/00002030-198800001-00008. PMC 2545554. PMID 3130121. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2545554. 
93. ^ N'Galy B, Ryder RW (1988). "Epidemiology of HIV infection in Africa". Journal of Acquired Immune Deficiency Syndromes 1 (6): 551–558. PMID 3225742. 
94. ^ Deschamps MM, Pape JW, Hafner A, Johnson WD Jr. (1996). "Heterosexual transmission of HIV in Haiti". Annals of Internal Medicine 125 (4): 324–330. PMID 8678397. 
95. ^ Cayley WE Jr. (2004). "Effectiveness of condoms in reducing heterosexual transmission of HIV". Am. Fam. Physician 70 (7): 1268–1269. PMID 15508535. 
96. ^ "Condom Facts and Figures". WHO. August 2003. http://www.wpro.who.int/media_centre/fact_sheets/fs_200308_Condoms.htm. Retrieved January 17, 2006. 
97. ^ Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH (2008). "Discerning patterns of human immunodeficiency virus risk in healthy young adults". Am J Med 121 (4): 758–764. doi:10.1016/j.amjmed.2008.04.022. PMC 2597652. PMID 18724961. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2597652. 
98. ^ Dias SF, Matos MG, Goncalves, A. C. (2005). "Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups". Eur. J. Public Health 15 (3): 300–304. doi:10.1093/eurpub/cki085. PMID 15941747. 
99. ^ "Module 5/Guidelines for Educators" (Microsoft Word). Durex. Archived from the original on March 13, 2006. http://web.archive.org/web/20060313053035/http://www.durex.com/cm/assets/SexEdDownloads/Module_5_condoms.doc. Retrieved April 17, 2006. 
100. ^ PATH (2006). "The female condom: significant potential for STI and pregnancy prevention". Outlook 22 (2). 
101. ^ Weiss HA (February 2007). "Male circumcision as a preventive measure against HIV and other sexually transmitted diseases". Curr. Opin. Infect. Dis. 20 (1): 66–72. doi:10.1097/QCO.0b013e328011ab73. PMID 17197884. 
102. ^ "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". World Health Organization. Mar 28, 2007. http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html. 
103. ^ Mcallister RG, Travis JW, Bollinger D, Rutiser C, Sundar V (Fall 2008). "The cost to circumcise Africa". International Journal of Men's Health (Men's Studies Press) 7 (3): 307–316. doi:10.3149/jmh.0703.307. ISSN 1532-6306. http://www.thefreelibrary.com/The+cost+to+circumcise+Africa.-a0189486243. 
104. ^ Eaton LA, Kalichman S (December 2007). "Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies". Curr HIV/AIDS Rep 4 (4): 165–72. doi:10.1007/s11904-007-0024-7. PMC 2937204. PMID 18366947. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2937204. 
105. ^ Mattson, C. L.; R. T. Campbell, R. C. Bailey, K. Agot, J. O. Ndinya-Achola, S. Moses (June 18 2008). Myer, Landon. ed. "Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial". PLoS ONE 3 (6): e2443. Bibcode 2008PLoSO...3.2443M. doi:10.1371/journal.pone.0002443. PMC 2409966. PMID 18560581. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2409966. 
106. ^ Scientists say vaginal gel cuts HIV-infections by half, BBC News,July 19 2010, accessed July 19, 2010
107. ^ Centers for Disease Control (CDC) (August 1987). "Recommendations for prevention of HIV transmission in health-care settings". MMWR 36 (Suppl 2): 1S–18S. PMID 3112554. http://www.cdc.gov/MMWR/PREVIEW/MMWRHTML/00023587.htm. 
108. ^ Kerr T, Kimber J, Debeck K, Wood E (December 2007). "The role of safer injection facilities in the response to HIV/AIDS among injection drug users". Current HIV/AIDS Reports 4 (4): 158–64. doi:10.1007/s11904-007-0023-8. PMID 18366946. 
109. ^ Wodak A, Cooney A (2006). "Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence". Substance Use & Misuse 41 (6–7): 777–813. doi:10.1080/10826080600669579. PMID 16809167. 
110. ^ "WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV – Infections in Pregnant Women, Mothers and their Infants – Consensus statement" (PDF). October 25–27, 2006. Archived from the original on April 9 2008. http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf. Retrieved March 12, 2008. 
111. ^ Lakhanpal, M; Ram, R (2008). "Educational attainment and HIV/AIDS prevalence: A cross-country study". Economics of Education Review 27: 14–21. doi:10.1016/j.econedurev.2006.09.003. ; Rindermann, H; Meisenberg, G (2009). "Relevance of education and intelligence at the national level for health: The case of HIV and AIDS". Intelligence 37 (4): 383–395. doi:10.1016/j.intell.2009.03.005. 
112. ^ http://nfirindia.org/downloads/HIV_Aids.pdf
113. ^ Fiona Samuels (2010) Improving research quality: how good is the literature on the impact of education on HIV and AIDS? Overseas Development Institute
114. ^ Hamlyn E, Easterbrook P (August 2007). "Occupational exposure to HIV and the use of post-exposure prophylaxis". Occup Med (Lond) 57 (5): 329–36. doi:10.1093/occmed/kqm046. PMID 17656498. 
115. ^ ^{a b} "A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition". Department of Health and Human Services. February 2006. http://hab.hrsa.gov/tools/HIVpocketguide/PktGPEP.htm. Retrieved September 1, 2006. ^{[dead link]}
116. ^ "A Pocket Guide to Adult HIV/AIDS Treatment February 2006 edition". Department of Health and Human Services. February 2006. http://hab.hrsa.gov/tools/HIVpocketguide/PktGARTtables.htm. Retrieved September 1, 2006. ^{[dead link]}
117. ^ "Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection" (PDF). Department of Health and Human Services Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. November 3, 2005. http://www.aidsinfo.nih.gov/ContentFiles/PediatricGuidelines_PDA.pdf. Retrieved January 17, 2006. 
118. ^ "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents" (PDF). Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection. October 6, 2005. http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Retrieved January 17, 2006. 
119. ^ Siegfried, N.; Uthman, O.; Rutherford, G. (2010). Siegfried, Nandi. ed. "Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults". Cochrane Database of Systematic Reviews (3): CD008272. doi:10.1002/14651858.CD008272.pub2. PMID 20238364.  edit
120. ^ Martinez-Picado J, DePasquale MP, Kartsonis N et al (2000). "Antiretroviral resistance during successful therapy of human immunodeficiency virus type 1 infection". Proc. Natl. Acad. Sci. U.S. A. 97 (20): 10948–10953. Bibcode 2000PNAS...9710948M. doi:10.1073/pnas.97.20.10948. PMC 27129. PMID 11005867. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=27129. 
121. ^ Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK; Panel on Clinical Practices for Treatment of HIV. (2002). "Guidelines for using antiretroviral agents among HIV-infected adults and adolescents". Ann. Intern. Med. 137 (5 Pt 2): 381–433. PMID 12617573. 
122. ^ Blankson JN, Persaud D, Siliciano RF (2002). "The challenge of viral reservoirs in HIV-1 infection". Annu. Rev. Med. 53: 557–593. doi:10.1146/annurev.med.53.082901.104024. PMID 11818490. 
123. ^ Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD (1998). "Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection". N. Engl. J. Med. 338 (13): 853–860. doi:10.1056/NEJM199803263381301. PMID 9516219. 
124. ^ Wood E, Hogg RS, Yip B, Harrigan PR, O'Shaughnessy MV, Montaner JS (2003). "Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy?". AIDS 17 (5): 711–720. doi:10.1097/00002030-200303280-00009. PMID 12646794. 
125. ^ Chene G, Sterne JA, May M, Costagliola D, Ledergerber B, Phillips AN, Dabis F, Lundgren J, D'Arminio Monforte A, de Wolf F, Hogg R, Reiss P, Justice A, Leport C, Staszewski S, Gill J, Fatkenheuer G, Egger ME and the Antiretroviral Therapy Cohort Collaboration (2003). "Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies". Lancet 362 (9385): 679–686. doi:10.1016/S0140-6736(03)14229-8. PMID 12957089. 
126. ^ King JT, Justice AC, Roberts MS, Chang CH, Fusco JS and the CHORUS Program Team (2003). "Long-Term HIV/AIDS Survival Estimation in the Highly Active Antiretroviral Therapy Era". Medical Decision Making 23 (1): 9–20. doi:10.1177/0272989X02239652. PMID 12583451. 
127. ^ Tassie JM, Grabar S, Lancar R, Deloumeaux J, Bentata M, Costagliola D and the Clinical Epidemiology Group from the French Hospital Database on HIV (2002). "Time to AIDS from 1992 to 1999 in HIV-1-infected subjects with known date of infection". Journal of acquired immune deficiency syndromes 30 (1): 81–7. doi:10.1097/00126334-200205010-00011. PMID 12048367. 
128. ^ Becker SL, Dezii CM, Burtcel B, Kawabata H, Hodder S. (2002). "Young HIV-infected adults are at greater risk for medication nonadherence". MedGenMed. 4 (3): 21. PMID 12466764. 
129. ^ Nieuwkerk P, Sprangers M, Burger D, Hoetelmans RM, Hugen PW, Danner SA, van Der Ende ME, Schneider MM, Schrey G, Meenhorst PL, Sprenger HG, Kauffmann RH, Jambroes M, Chesney MA, de Wolf F, Lange JM and the ATHENA Project (2001). "Limited Patient Adherence to Highly Active Antiretroviral Therapy for HIV-1 Infection in an Observational Cohort Study". Arch. Intern. Med. 161 (16): 1962–1968. doi:10.1001/archinte.161.16.1962. PMID 11525698. 
130. ^ Kleeberger C, Phair J, Strathdee S, Detels R, Kingsley L, Jacobson LP (2001). "Determinants of Heterogeneous Adherence to HIV-Antiretroviral Therapies in the Multicenter AIDS Cohort Study". J. Acquir. Immune Defic. Syndr. 26 (1): 82–92. PMID 11176272. 
131. ^ Heath KV, Singer J, O'Shaughnessy MV, Montaner JS, Hogg RS (2002). "Intentional Nonadherence Due to Adverse Symptoms Associated With Antiretroviral Therapy". J. Acquir. Immune Defic. Syndr. 31 (2): 211–217. doi:10.1097/00126334-200210010-00012. PMID 12394800. 
132. ^ ^{a b} Burgoyne RW, Tan DH (March 2008). "Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act". J. Antimicrob. Chemother. 61 (3): 469–73. doi:10.1093/jac/dkm499. PMID 18174196. http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18174196. 
133. ^ Bhargava, A.; Booysen, F. L. (2010). "Healthcare infrastructure and emotional support are predictors of CD4 cell counts and quality of life indices of patients on antiretroviral treatment in Free State Province, South Africa". AIDS Care 22 (1): 1–9. doi:10.1080/09540120903012585. PMID 20390475.  edit
134. ^ Littlewood RA, Vanable PA (September 2008). "Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care". AIDS Care 20 (8): 1002–18. doi:10.1080/09540120701767216. PMC 2570227. PMID 18608078. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2570227. 
135. ^ Mills E, Wu P, Ernst E (June 2005). "Complementary therapies for the treatment of HIV: in search of the evidence". Int J STD AIDS 16 (6): 395–403. doi:10.1258/0956462054093962. PMID 15969772. 
136. ^ Liu JP, Manheimer E, Yang M (2005). Liu, Jian Ping. ed. "Herbal medicines for treating HIV infection and AIDS". Cochrane Database Syst Rev (3): CD003937. doi:10.1002/14651858.CD003937.pub2. PMID 16034917. 
137. ^ ^{a b} Nicholas PK, Kemppainen JK, Canaval GE et al (February 2007). "Symptom management and self-care for peripheral neuropathy in HIV/AIDS". AIDS Care 19 (2): 179–89. doi:10.1080/09540120600971083. PMID 17364396. 
138. ^ Hurwitz BE, Klaus JR, Llabre MM et al (January 2007). "Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial". Arch. Intern. Med. 167 (2): 148–54. doi:10.1001/archinte.167.2.148. PMID 17242315. 
139. ^ Schrauzer, Gerhard N.; Juliane Sacher (1994). "Selenium in the maintenance and therapy of HIV-infected patients". Chemico-Biological Interactions 91 (2–3): 199–205. doi:10.1016/0009-2797(94)90040-X. PMID 7514960. http://www.sciencedirect.com/science/article/pii/000927979490040X. Retrieved 20110918. 
140. ^ ^{a b} Irlam JH, Visser ME, Rollins N, Siegfried N (2005). Irlam, James JH. ed. "Micronutrient supplementation in children and adults with HIV infection". Cochrane Database Syst Rev (4): CD003650. doi:10.1002/14651858.CD003650.pub2. PMID 16235333. 
141. ^ ^{a b} World Health Organization (2003-05). Nutrient requirements for people living with HIV/AIDS: Report of a technical consultation. Geneva. Archived from the original on March 25 2009. http://www.who.int/nutrition/publications/Content_nutrient_requirements.pdf. Retrieved March 31, 2009. 
142. ^ Zwahlen M, Egger M (2006) (PDF). Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis. UNAIDS Obligation HQ/05/422204. Archived from the original on April 9 2008. http://data.unaids.org/pub/Periodical/2006/zwahlen_unaids_hq_05_422204_2007_en.pdf. Retrieved March 19, 2008. 
143. ^ Knoll B, Lassmann B, Temesgen Z (2007). "Current status of HIV infection: a review for non-HIV-treating physicians". Int J Dermatol 46 (12): 1219–28. doi:10.1111/j.1365-4632.2007.03520.x. PMID 18173512. 
144. ^ ^{a b} Lawn SD (2004). "AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection". J. Infect. Dis. 48 (1): 1–12. doi:10.1016/j.jinf.2003.09.001. PMID 14667787. 
145. ^ Campbell GR, Watkins JD, Esquieu D, Pasquier E, Loret EP, Spector SA (2005). "The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells". J. Biol. Chem. 280 (46): 38376–39382. doi:10.1074/jbc.M506630200. PMID 16155003. 
146. ^ Senkaali D, Muwonge R, Morgan D, Yirrell D, Whitworth J, Kaleebu P (2005). "The relationship between HIV type 1 disease progression and V3 serotype in a rural Ugandan cohort". AIDS Res. Hum. Retroviruses. 20 (9): 932–937. doi:10.1089/aid.2004.20.932. PMID 15585080. 
147. ^ Woods, S.; Moore, D.; Weber, E.; Grant, I. (2009). "Cognitive neuropsychology of HIV-associated neurocognitive disorders". Neuropsychology review 19 (2): 152–168. doi:10.1007/s11065-009-9102-5. PMC 2690857. PMID 19462243. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2690857.  edit
148. ^ Brown, T.; Qaqish, R. (2006). "Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review". AIDS (London, England) 20 (17): 2165–2174. doi:10.1097/QAD.0b013e32801022eb. PMID 17086056.  edit
149. ^ Post, F. .; Holt, S. . (2009). "Recent developments in HIV and the kidney". Current opinion in infectious diseases 22 (1): 43–48. doi:10.1097/QCO.0b013e328320ffec. PMID 19106702.  edit
150. ^ "AIDS Patients Now Living Longer, But Aging Faster". Npr.org. http://www.npr.org/templates/story/story.php?storyId=120249388. Retrieved November 1, 2011. 
151. ^ "Tuberculosis". World Health Organization (WHO).
152. ^ McNeil DG Jr (November 20, 2007). "U. N. agency to say it overstated extent of H. I. V. cases by millions". New York Times. Archived from the original on February 19 2008. http://query.nytimes.com/gst/fullpage.html?res=9C01EEDF103BF933A15752C1A9619C8B63. Retrieved March 18, 2008. 
153. ^ Report: Black U.S. AIDS rates rival some African nations
154. ^ "DTL&feed=rss. news_politics White House summit on AIDS' impact on black men^{[dead link]}". San Francisco Chronicle. June 3, 2010.
155. ^ >Arya M, Behforouz HL, and Viswanath K (March 9, 2009). "African American Women and HIV/AIDS: A National Call for Targeted Health Communication Strategies to Address a Disparity". The AIDS Reader 19 (2). http://www.consultantlive.com/aids/article/1145619/1385623. 
156. ^ http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf
157. ^ "Obama Ends U.S. Travel Ban On Visitors, Immigrants With HIV-AIDS". ABC News. October 30, 2009.
158. ^ Gottlieb MS (2006). "Pneumocystis pneumonia—Los Angeles. 1981". Am J Public Health 96 (6): 980–1; discussion 982–3. PMC 1470612. PMID 16714472. Archived from the original on April 22 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm. Retrieved March 31, 2009. 
159. ^ ^{a b} Centers for Disease Control (CDC) (1982). "Opportunistic infections and Kaposi's sarcoma among Haitians in the United States". MMWR Morb Mortal Wkly Rep. 31 (26): 353–354; 360–361. PMID 6811853. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001123.htm. Retrieved August 31, 2011. 
160. ^ Altman LK (May 11, 1982). "New homosexual disorder worries health officials". The New York Times. http://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html?scp=1&sq=New%20homosexual%20disorder%20worries%20officials&st=cse. Retrieved August 31, 2011. 
161. ^ "Making Headway Under Hellacious Circumstances" (PDF). American Association for the Advancement of Science. July 28, 2006. http://www.scienceonline.org/cgi/reprint/313/5786/470b.pdf. Retrieved June 23, 2008. 
162. ^ Kher U (July 27, 1982). "A Name for the Plague". Time. Archived from the original on March 7 2008. http://www.time.com/time/80days/820727.html. Retrieved March 10, 2008. 
163. ^ Centers for Disease Control (CDC) (1982). "Update on acquired immune deficiency syndrome (AIDS)—United States". MMWR Morb Mortal Wkly Rep. 31 (37): 507–508; 513–514. PMID 6815471. 
164. ^ Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M (2007). "The emergence of HIV/AIDS in the Americas and beyond". Proc. Natl. Acad. Sci. U.S. A. 104 (47): 18566–70. Bibcode 2007PNAS..10418566G. doi:10.1073/pnas.0705329104. PMC 2141817. PMID 17978186. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2141817. 
165. ^ Kalish ML, Wolfe ND, Ndongmo CD, McNicholl J, Robbins KE et al (2005). "Central African hunters exposed to simian immunodeficiency virus". Emerg Infect Dis 11 (12): 1928–30. doi:10.3201/eid1112.050394. PMID 16485481. 
166. ^ Sharp, P. M.; Bailes, E.; Chaudhuri, R. R.; Rodenburg, C. M.; Santiago, M. O.; Hahn, B. H. (2001). "The origins of acquired immune deficiency syndrome viruses: where and when?". Philosophical Transactions of the Royal Society B: Biological Sciences 356 (1410): 867–76. doi:10.1098/rstb.2001.0863. PMC 1088480. PMID 11405934. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1088480. 
167. ^ Marx PA, Alcabes PG, Drucker E (2001). "Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa". Philos Trans R Soc Lond B Biol Sci 356 (1410): 911–20. doi:10.1098/rstb.2001.0867. PMC 1088484. PMID 11405938. http://rstb.royalsocietypublishing.org/content/356/1410/911.abstract. 
168. ^ Chitnis, Amit; Rawls, Diana; Moore, Jim (2000). "Origin of HIV Type 1 in Colonial French Equatorial Africa?". AIDS Research and Human Retroviruses 16 (1): 5–8. doi:10.1089/088922200309548. PMID 10628811. 
169. ^ Sousa, João Dinis de; Müller, Viktor; Lemey, Philippe; Vandamme, Anne-Mieke; Vandamme, Anne-Mieke (2010). Martin, Darren P.. ed. "High GUD Incidence in the Early 20th Century Created a Particularly Permissive Time Window for the Origin and Initial Spread of Epidemic HIV Strains". PLoS ONE 5 (4): e9936. doi:10.1371/journal.pone.0009936. PMC 2848574. PMID 20376191. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2848574. 
170. ^ Donald G. McNeil, Jr. (September 16, 2010). "Precursor to H. I. V. Was in Monkeys for Millennia". New York Times. Archived from the original on September 19 2010. http://www.nytimes.com/2010/09/17/health/17aids.html?_r=1&src=me&ref=general. Retrieved September 17, 2010. "Dr. Marx believes that the crucial event was the introduction into Africa of millions of inexpensive, mass-produced syringes in the 1950s. ... suspect that the growth of colonial cities is to blame. Before 1910, no Central African town had more than 10,000 people. But urban migration rose, increasing sexual contacts and leading to red-light districts." 
171. ^ "Rock Hudson announces he has AIDS – History.com This Day in History – 7/25/1985". History.com. http://www.history.com/this-day-in-history/rock-hudson-announces-he-has-aids. Retrieved November 1, 2011. 
172. ^ "Anthony Eden". Nndb.com. http://www.nndb.com/people/817/000088553/. Retrieved November 1, 2011. 
173. ^ Coleman, Brian (June 25, 2007). "Thatcher the gay icon". New Statesman. http://www.newstatesman.com/blogs/brian-coleman/2007/06/lady-thatcher-gay-tory. Retrieved November 1, 2011. 
174. ^ "BBC ON THIS DAY | 24 | 1991: Giant of rock dies". BBC News. November 24, 1963. http://news.bbc.co.uk/onthisday/hi/dates/stories/november/24/newsid_2546000/2546945.stm. Retrieved November 1, 2011. 
175. ^ "Freddie Mercury". Nndb.com. http://www.nndb.com/people/521/000044389/. Retrieved November 1, 2011. 
176. ^ http://www.itennisstore.com/Tennis-Latest-News/FROZEN-IN-TIME—ARTHUR-ASHE-by-Dominic-Bliss.aspx
177. ^ The Independent (London). February 8, 1993. http://www.independent.co.uk/news/tributes-to-arthur-ashe-1471622.html. 
178. ^ Curtis T (1992). "The origin of AIDS". Rolling Stone (626): pp. 54–59, 61, 106, 108. Archived from the original on February 17, 2008. http://web.archive.org/web/20080217014508/http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/AIDS/Curtis92.html. Retrieved March 10, 2008. 
179. ^ Hooper E (1999). The River: A Journey to the Source of HIV and AIDS (1st ed.). Boston, Massachusetts: Little Brown & Co. pp. 1–1070. ISBN 0-316-37261-7. 
180. ^ Worobey M, Santiago ML, Keele BF et al (2004). "Origin of AIDS: contaminated polio vaccine theory refuted". Nature 428 (6985): 820. Bibcode 2004Natur.428..820W. doi:10.1038/428820a. PMID 15103367. 
181. ^ Berry N, Jenkins A, Martin J et al (2005). "Mitochondrial DNA and retroviral RNA analyses of archival oral polio vaccine (OPV CHAT) materials: evidence of macaque nuclear sequences confirms substrate identity". Vaccine 23 (14): 1639–1648. doi:10.1016/j.vaccine.2004.10.038. PMID 15705467. 
182. ^ "Oral Polio Vaccine and HIV / AIDS: Questions and Answers". Centers for Disease Control and Prevention. March 23, 2004. http://www.cdc.gov/nip/vacsafe/concerns/aids/poliovac-hiv-aids-qa.htm. Retrieved November 20, 2006. 
183. ^ "The impact of AIDS on people and societies" (PDF). 2006 Report on the global AIDS epidemic. UNAIDS. 2006. ISBN 92-9173-479-9. http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH04_en.pdf. Retrieved June 14, 2006. 
184. ^ Ogden J, Nyblade L (2005). "Common at its core: HIV-related stigma across contexts" (PDF). International Center for Research on Women. http://www.icrw.org/docs/2005_report_stigma_synthesis.pdf. Retrieved February 15, 2007. 
185. ^ ^{a b c} Herek GM, Capitanio JP (1999). "AIDS Stigma and sexual prejudice" (PDF). American Behavioral Scientist 42 (7): 1130–1147. doi:10.1177/0002764299042007006. http://psychology.ucdavis.edu/rainbow/html/abs99_sp.pdf. Retrieved March 27, 2006. 
186. ^ Snyder M, Omoto AM, Crain AL (1999). "Punished for their good deeds: stigmatization for AIDS volunteers". American Behavioral Scientist 42 (7): 1175–1192. doi:10.1177/0002764299042007009. 
187. ^ Herek GM, Capitanio JP, Widaman KF (2002). "HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999" (PDF). Am J Public Health 92 (3): 371–7. doi:10.2105/AJPH.92.3.371. PMC 1447082. PMID 11867313. Archived from the original on March 7 2008. http://psychology.ucdavis.edu/rainbow/html/ajph2002.pdf. Retrieved March 10, 2008. 
188. ^ Bell C, Devarajan S, Gersbach H (2003) (PDF). org/hiv_aids/docs/BeDeGe_BP_total2.pdf The long-run economic costs of AIDS: theory and an application to South Africa. World Bank Policy Research Working Paper No. 3152. http://www1.worldbank. org/hiv_aids/docs/BeDeGe_BP_total2.pdf. Retrieved April 28, 2008. 
189. ^ ^{a b} Greener R (2002). "AIDS and macroeconomic impact". In S, Forsyth (ed.). State of The Art: AIDS and Economics. IAEN. pp. 49–55. 
190. ^ Over M (1992) (PDF). The macroeconomic impact of AIDS in Sub-Saharan Africa, Population and Human Resources Department. The World Bank. Archived from the original on May 27 2008. http://www.worldbank.org/aidsecon/macro.pdf. Retrieved May 3, 2008. 
191. ^ "AIDS Stigma". News-medical.net. http://www.news-medical.net/health/AIDS-Stigma.aspx. Retrieved November 1, 2011. 
192. ^ ^{a b c} "Thirty years after AIDS discovery, appreciation growing for Catholic approach". Catholicnewsagency.com. June 5, 2011. http://www.catholicnewsagency.com/news/thirty-years-after-aids-discovery-appreciation-growing-for-catholic-approach/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+catholicnewsagency%2Fdailynews+%28CNA+Daily+News%29. Retrieved November 1, 2011. 
193. ^ ^{a b} "Church HIV prayer cure claims 'cause three deaths'". BBC News. October 18, 2011. http://www.bbc.co.uk/news/uk-england-london-14406818. Retrieved October 18, 2011. 
194. ^ US application 2001051133 
195. ^ Duesberg PH (1988). "HIV is not the cause of AIDS". Science 241 (4865): 514, 517. Bibcode 1988Sci...241..514D. doi:10.1126/science.3399880. PMID 3399880. 
196. ^ Papadopulos-Eleopulos E, Turner VF, Papadimitriou J et al (2004). "A critique of the Montagnier evidence for the HIV/AIDS hypothesis". Med Hypotheses 63 (4): 597–601. doi:10.1016/j.mehy.2004.03.025. PMID 15325002. 
197. ^ For evidence of the scientific consensus that HIV is the cause of AIDS, see (for example):
     • "The Evidence That HIV Causes AIDS". National Institute of Allergy and Infectious Diseases. 2003. http://www.niaid.nih.gov/Factsheets/evidhiv.htm. Retrieved December 20, 2008. 
     • , (2000). "The Durban Declaration". Nature 406 (6791): 15–6. doi:10.1038/35017662. PMID 10894520. http://www.nature.com/nature/journal/v406/n6791/full/406015a0.html. Retrieved May 3, 2008. 
     • Cohen J (1994). "The Duesberg Phenomenon: A Berkeley virologist and his supporters continue to argue that HIV is not the cause of AIDS. A 3-month investigation by Science evaluates their claims" (PDF). Science 266 (5191): 1642–1649. Bibcode 1994Sci...266.1642C. doi:10.1126/science.7992043. PMID 7992043. Archived from the original on March 25 2009. http://www.sciencemag.org/feature/data/cohen/266-5191-1642a.pdf. Retrieved March 31, 2009. 
     • gov/topics/HIVAIDS/Understanding/connectionResources.htm "HIV/AIDS Connection: Resource and links". National Institute of Allergy and Infectious Diseases. http://www3.niaid.nih. gov/topics/HIVAIDS/Understanding/connectionResources.htm. Retrieved March 31, 2009. ^{[dead link]}
     • O'Brien SJ, Goedert JJ (1996). "HIV causes AIDS: Koch's postulates fulfilled". Curr. Opin. Immunol. 8 (5): 613–8. doi:10.1016/S0952-7915(96)80075-6. PMID 8902385. 
     • Galéa P, Chermann JC (1998). "HIV as the cause of AIDS and associated diseases". Genetica 104 (2): 133–42. doi:10.1023/A:1003432603348. PMID 10220906. 
198. ^ Smith TC, Novella SP (2007). "HIV denial in the Internet era". PLoS Med. 4 (8): e256. doi:10.1371/journal.pmed.0040256. PMC 1949841. PMID 17713982. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1949841. 
199. ^ Chigwedere P, Seage GR, Gruskin S, Lee TH, Essex M (October 2008). "Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa". Journal of acquired immune deficiency syndromes (1999) 49 (4): 410. doi:10.1097/QAI.0b013e31818a6cd5. PMID 18931626. Lay summary. 
200. ^ Baleta A (2003). "S Africa's AIDS activists accuse government of murder". Lancet 361 (9363): 1105. doi:10.1016/S0140-6736(03)12909-1. PMID 12672319. 
201. ^ Operation INFEKTION – Soviet Bloc Intelligence and Its AIDS Disinformation Campaign. Thomas Boghardt. 2009
202. ^ Karlsson Hedestam GB, Fouchier RA, Phogat S, Burton DR, Sodroski J, Wyatt RT (February 2008). "The challenges of eliciting neutralizing antibodies to HIV-1 and to influenza virus". Nat. Rev. Microbiol. 6 (2): 143–55. doi:10.1038/nrmicro1819. PMID 18197170. 
203. ^ Laurence J (2006). "Hepatitis A and B virus immunization in HIV-infected persons". AIDS Reader 16 (1): 15–17. PMID 16433468. 
204. ^ Planque S, Nishiyama Y, Taguchi H, Salas M, Hanson C, Paul S (June 2008). "Catalytic antibodies to HIV: Physiological role and potential clinical utility". Autoimmun Rev 7 (6): 473–9. doi:10.1016/j.autrev.2008.04.002. PMC 2527403. PMID 18558365. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2527403. 
205. ^ Even, Dan (September 3, 2010). "Hebrew U. researchers develop treatment to kill HIV cells". Haaretz. Archived from the original on September 6 2010. http://www.haaretz.com/print-edition/news/hebrew-u-researchers-develop-treatment-to-kill-hiv-cells-1.311823. Retrieved October 11, 2010. 
206. ^ Levin, Aviad; Hayouka, Zvi; Friedler, Assaf; Loyter; Abraham (August 19, 2010). "Specific eradication of HIV-1 from infected cultured cells". AIDS Research and Therapy 7 (31): 31. doi:10.1186/1742-6405-7-31. PMC 2933580. PMID 20723214. Archived from the original on August 26 2010. http://www.aidsrestherapy.com/content/7/1/31. Retrieved October 11, 2010. 
207. ^ Klein Leichman, Abigail (October 7, 2010). org/201010038374/health/on-the-hiv-warpath "On the HIV warpath". Israel 21c Innovation News Service. http://israel21c. org/201010038374/health/on-the-hiv-warpath. Retrieved October 11, 2010. 
208. ^ "Retrocyclin pseudogene reactivation as defense to AIDS". Plosbiology.org. http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000095. Retrieved November 1, 2011. 
209. ^ ^{a b} "German HIV patient cured after stem cell transplant". Belfast Telegraph. December 15, 2010. http://www.belfasttelegraph.co.uk/news/world-news/german-hiv-patient-cured-after-stem-cell-transplant-15030473.html. Retrieved December 15, 2010. 
210. ^ Schoofs, Mark (November 2008). "A Doctor, a Mutation and a Potential Cure for AIDS: A Bone Marrow Transplant to Treat a Leukemia Patient Also Gives Him Virus-Resistant Cells; Many Thanks, Sample 61". Wall Street Journal. http://online.wsj.com/article/SB122602394113507555.html. Retrieved November 12, 2008. 
211. ^ Allers, K.; Hutter, G.; Hofmann, J.; Loddenkemper, C.; Rieger, K.; Thiel, E.; Schneider, T. (2010). "Evidence for the cure of HIV infection by CCR5 32/ 32 stem cell transplantation". Blood 117 (10): 2791–2799. doi:10.1182/blood-2010-09-309591. PMID 21148083.  edit

Further reading

• Lengauer, Thomas; André Altmann, Alexander Thielen, Rolf Kaiser (2010). "Chasing the AIDS virus". Communications of the ACM 53 (3): 66. doi:10.1145/1666420.1666440. ISSN 00010782. 
• "UNAIDS Annual Report—Making the money work" (PDF). UNAIDS. Archived from the original on March 17 2008. http://data.unaids.org/pub/Report/2007/2006_unaids_annual_report_en.pdf. Retrieved March 21, 2008. 
• "Practical Guidelines for Intensifying HIV Prevention" (PDF). UNAIDS. Archived from the original on March 17 2008. http://data.unaids.org/pub/Manual/2007/20070306_prevention_guidelines_towards_universal_access_en.pdf. Retrieved March 21, 2008. 
• "Antiretroviral Formulations" (PDF). US Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/AntiretroviralFormulations_FS_en.pdf. Retrieved March 21, 2008. 
• "Approved Medications to Treat HIV Infection" (PDF). US Department of Health and Human Services. Archived from the original on February 26 2008. http://aidsinfo.nih.gov/contentfiles/ApprovedMedstoTreatHIV_FS_en.pdf. Retrieved March 21, 2008. 
• "The HIV Life Cycle" (PDF). US Department of Health and Human Services. Archived from the original on February 26 2008. http://aidsinfo.nih.gov/contentfiles/HIVLifeCycle_FS_en.pdf. Retrieved March 21, 2008. 

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v t e Diseases of poverty Diseases of poverty AIDS Malaria Tuberculosis Measles Pneumonia Diarrheal diseases Neglected diseases Cholera Chagas disease African Sleeping Sickness Schistosomiasis Guinea worm River blindness Leishmaniasis Miscellaneous Malnutrition Priority Review Voucher

v t e HIV/AIDS topics HIV HIV Structure and genome of HIV Subtypes of HIV HIV test CDC Classification System for HIV Infection HIV disease progression rates HIV prevention HIV vaccine RV 144 WHO Disease Staging System for HIV Infection and Disease Children Teens / Adults Antiretroviral drug HIV Drug Resistance Database HIV superinfection Super AIDS Conditions AIDS dementia complex Tuberculosis coinfection HIV-associated nephropathy HIV-associated lipodystrophy HIV-associated pruritus Gay bowel syndrome Diffuse infiltrative lymphocytosis syndrome AIDS defining clinical condition History Origin of AIDS AIDS pandemic AIDS Museum Countries by AIDS prevalence rate AIDS timeline Social AIDS orphan Catholic Church and AIDS Circumcision and HIV Criminal transmission Economic impact Safe sex Sex education AIDS denialism Culture Media portrayal of HIV/AIDS International AIDS Conference International AIDS Society World AIDS Day Treatment Action Campaign Joint United Nations Programme on HIV/AIDS (UNAIDS) President's Emergency Plan for AIDS Relief (PEPFAR) NAMES Project AIDS Memorial Quilt Southern AIDS Living Quilt Misconceptions List of HIV-positive people People With AIDS Self-Empowerment Movement   AIDS pandemic by region / country Africa South Africa Uganda Egypt Nigeria Ethiopia Rwanda Senegal Swaziland Tanzania Congo Angola Benin Botswana Côte d'Ivoire (Ivory Coast) Ghana Guinea Kenya Lesotho Madagascar Malawi Mali Mozambique Namibia Niger Zambia Zimbabwe North America United States Canada Latin America Brazil Mexico Peru Bolivia El Salvador Guatemala Guyana Honduras Nicaragua Asia China (PRC) India Bangladesh Cambodia Indonesia Japan Myanmar (Burma) Thailand Taiwan (ROC) East Timor Laos Nepal Philippines Vietnam Caribbean Haiti Jamaica Dominican Republic Eastern Europe Central Asia Russia Ukraine United Arab Emirates Pakistan Iraq Jordan Western Europe United Kingdom Oceania Australia New Zealand Papua New Guinea List of countries by HIV/AIDS adult prevalence rate List of HIV/AIDS cases and deaths registered by region M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc)

v t e Infectious diseases · Viral systemic diseases (A80–B34, 042–079) Oncovirus DNA virus: HBV (Hepatocellular carcinoma) · HPV (Cervical cancer, Anal cancer) · Kaposi's sarcoma-associated herpesvirus (Kaposi's sarcoma) · Epstein-Barr virus (Nasopharyngeal carcinoma, Burkitt's lymphoma, Primary central nervous system lymphoma) · MCPyV (Merkel cell cancer) · SV40 RNA virus: HCV (Hepatocellular carcinoma) · HTLV-I (Adult T-cell leukemia/lymphoma) Immune disorders HIV (AIDS) Central nervous system Encephalitis/ meningitis DNA virus: JCV (Progressive multifocal leukoencephalopathy) RNA virus: MeV (Subacute sclerosing panencephalitis) · LCV (Lymphocytic choriomeningitis) · Arbovirus encephalitis · Orthomyxoviridae (probable) (Encephalitis lethargica) · RV (Rabies) · Chandipura virus  · Herpesviral meningitis · Ramsay Hunt syndrome type II Myelitis Poliovirus (Poliomyelitis, Post-polio syndrome) · HTLV-I (Tropical spastic paraparesis) Eye Cytomegalovirus (Cytomegalovirus retinitis) · HSV (Herpetic keratitis) Cardiovascular CBV (Pericarditis, Myocarditis) Respiratory system/ acute viral nasopharyngitis/ viral pneumonia DNA virus Epstein-Barr virus (EBV infection/Infectious mononucleosis) · Cytomegalovirus RNA virus IV: SARS coronavirus (Severe acute respiratory syndrome) V, Orthomyxoviridae: Influenzavirus A/B/C (Influenza/Avian influenza) V, Paramyxovirus: Human parainfluenza viruses (Parainfluenza) · RSV · hMPV Digestive system Oropharynx/Esophagus MuV (Mumps) · Cytomegalovirus (Cytomegalovirus esophagitis) Gastroenteritis/ diarrhea DNA virus: Adenovirus (Adenovirus infection) RNA virus: Rotavirus · Norovirus · Astrovirus · Coronavirus Hepatitis DNA virus: HBV (B) RNA virus: CBV · HAV (A) · HCV (C) · HDV (D) · HEV (E) · HGV (G) Pancreatitis CBV Urogenital BK virus · MuV (Mumps) M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc)

v t e Sexually transmitted diseases and infections (STD/STI) (primarily A50–A64, 090–099) Bacterial Chancroid (Haemophilus ducreyi) Chlamydia/Lymphogranuloma venereum (Chlamydia trachomatis) Donovanosis or Granuloma Inguinale (Klebsiella granulomatis) Gonorrhea (Neisseria gonorrhoeae) Syphilis (Treponema pallidum) Ureaplasma infection (Ureaplasma urealyticum) Protozoal Trichomoniasis (Trichomonas vaginalis) Parasitic Crab louse/crabs Scabies Viral AIDS (HIV-1/HIV-2) Cervical cancer, vulvar cancer & Genital warts (condyloma), Penile cancer, Anal cancer (Human papillomavirus (HPV)) Hepatitis B (Hepatitis B virus) Herpes simplex (HSV1/HSV2) Molluscum contagiosum (MCV) General inflammation female Cervicitis Pelvic inflammatory disease (PID) male Epididymitis Prostatitis either Proctitis Urethritis/Non-gonococcal urethritis (NGU) M: ♀ FRS anat/phys/devp noco/cong/npls, sysi/epon proc/asst, drug (G1/G2B/G3CD) M: ♂ MRS anat/phys/devp noco/cong/tumr, sysi/epon proc, drug (G3B/4BE/4C)

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Dansk (Danish)
n. - AIDS, erhvervet immunitetsskade syndrom, Acquired Immune Deficiency Syndrome

Nederlands (Dutch)
AIDS

Français (French)
n. - SIDA, Syndrome d'immunodéficience acquise

Deutsch (German)
n. - Aids

Ελληνική (Greek)
n., -
abbr. - (ιατρ.) 'Ειτζ, επίκτητη ανοσολογική ανεπάρκεια

Italiano (Italian)
Sindrome da Immunodeficienza Acquisita, AIDS

Português (Portuguese)
n. - síndrome (f) da imunodeficiência adquirida (Med.)
abbr. - AIDS (f)

Русский (Russian)
СПИф

Español (Spanish)
n. - SIDA

Svenska (Swedish)
n. - AIDS
abbr. - AIDS

中文（简体）(Chinese (Simplified))
爱滋病

中文（繁體）(Chinese (Traditional))
n. - 愛滋病

한국어 (Korean)
n. - 후천성 면역 결핍증

日本語 (Japanese)
n. - エイズ

العربيه (Arabic)
‏(الاسم) مرض يدمر جهاز المناعه ألذي يحمي الجسم من الأمراض (اختصار) مصطلح ل : ظاهرة ضعف المناعه ألمكتسبه‏

עברית (Hebrew)
n. - ‮תסמונת כשל חיסוני נרכש, כשלת, איידס (מחלה)‬

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