Health 10
October 6, 2005
Victoria McLaughlin

I. What does the acronym AIDS stand for?
A. acquired immunodeficiency syndrome

II. What is the name of the virus that causes AIDS?
A. HIV (human immunodeficiency virus)

III. What segments of the population are most affected by the HIV/AIDS epidemic?
Men are most affected by the HIV/AIDS epidemic. In the world, African Americans are most affected, in the US as of 2000, whites were. Homosexual men have the most transmission. Deaths among men and women are not as different as the rates affected by HIV/AIDS.

Mode of transmission among men Percent
Men who have sex with men (MSM) 47%
Injection drug use (IDU) 25%
Heterosexual sex 10%
Other 18%

Mode of transmission among women Percent
Heterosexual sex 75%
Injection drug use (IDU) 25%

HIV/AIDS among ethnic populations (men) AIDS Cases U.S. Population
(male)
White, non-Hispanic 32% 71%
African American 47% 13%
Latino 19% 12%
Asian/Pacific Islander 1% 4%
American Indian/Alaska Native <1% <1%
HIV/AIDS among ethnic populations (women) AIDS Cases U.S. Population
(female)
White, non-Hispanic 19% 72%
African American 63% 12%
Latina 17% 12%
Asian/Pacific Islander <1% 4%
American Indian/Alaska Native <1% <1%

AIDS cases in 2000 3 million
Percent of AIDS cases in 2000 who were men 76%
Percent of AIDS cases in 2000 who were women 24%
Percent of AIDS cases in 2000 who were children (under the age of 15) 16%
Cumulative number of people who have died from AIDS 21.8 million
Percent of AIDS deaths who were men 59%
Percent of AIDS deaths who were women 41%
Percent of AIDS deaths who were children (under the age of 15) 20%

IV. What types of HIV-related illnesses does an HIV-infected individual start to develop once the immune system beings to weaken?
A. Flu-like symptoms
1. enlarged lymph glands, tiredness, fever, loss of appetite, diarrhea, night sweats
B. yeast infections of the mouth and vagina
C. oppurtunistic infections
1. Pneuomocystis pneumonia, yeast infections of the esophagus, cytomegalovirus retinitis, Kaposi’s sarcoma, tuberculosis

V. What is an oppurtunistic infection?
A. An infection that is not usually serious but takes advantage of a weakened immune system.

VI. What is Pneumocystis pneumonia? Include the specific organism that causes the condition and the spefici symptoms.
A. It is caused by the fungus Pneumocystis jirovecii.
B. Symptoms: dyspnea (difficulty breathing), nonproductive cough, and shortness of breath.
1. These symptoms worsen as time goes on.

VII. What is Karposi’s sarcoma? Include the specific organism that causes the condition and its symptoms.
A. It is a cancer caused by an interaction between HIV and human herpesvirus-8 (HHV-8).
B. Symptoms: bluish-red flat or raised lesions with irregular shape, bleeding from gastrointestinal lesions, shortness of breath from lesions in the lung, and bloody sputum from lesions in the lung.
1. significant symptoms located in the lung

VIII. Describe the specific methods of HIV transmission. Be specific about the manner in which the virus enters the bloodstream.
A. Sexual intercourse (vaginal and anal)
1. infect mucuos membranes directly
2. enters through unnoticed cuts and sores due to intercourse
B. Oral Sex (mouth-penis, mouth-vagina)
1. enters through throat, gums, and oral membranes
a. mouth in hospitable environment for HIV so chance of transmission by infected semen, vaginal fluid, or blood is lower
C. Heterosexual Transmission Studies
1. female to male transmission is less efficient
D. Sharing injection needles
1. the virus can directly enter the blood because a needle transmits the blood of one person to another
E. Needle sticks
1. in order to get the virus a health care worker had to fall onto the depressor a syringe filled with blood and another was working with a test tube of infected blood that cut him
a. there must be very intimate contact to transmit the disease and it is rather difficult to get (only 21 out of 2,000 exposed health care workers got the disease)
F. Blood transfusions
1. The infected blood is given to another person
a. since 1985 all blood in the US has been tested for HIV antibodies.
G. Hemophilia treatments
1. hemophiliacs take Factor VIII to help with blood clotting
2. made with pooled blood and 90% have been infected this way
a. Factor VIII is now being heat-treated to kill the disease
b. synthetic versions are available
H. Mother-to-Child
1. perinatal
a. the virus enters the babies bloodstream because it shares the blood with it’s mother.
1. AZT drugs and c-sections prevent transmission
2. breast feeding
a. the virus enters the bloodstream during the digestive process through the membranes
1. wouldn’t be harmful to an adult but babies are more susceptible because they have a weaker immune system.

IX. Describe the step-by-step process by which HIV invades and weakens the immune system. Include specific cells that are affected and how.
A. HIV infects the T-helper white blood cells, macrophages, and CD4 cells.
B. The virus attaches itself to the CD4 receptor molecules on the outside of the cell and inputs its own genes into the cells’ reproduction information.
1. the cell becomes an HIV cell and produces more and more HIV cells. a. HIV infected cells eventually die.
2. Although the body produces millions of CD4 cells per day they are killed by HIV almost as soon as they are produced.

X. What is a macrophage and how is it related to HIV infection?
A. Macrophages kill germs and rogue cells (such as cancer-causing ones) and aid in antibody production.
1. “scavengers of the immune system”
B.It is suspected that they cause dementia
1. the temporal lobe is swollen because of the concentration of macrophages fighting the virus and memories are damaged.

XI. What treatments are available for individuals who are HIV-infected?
A. Reverse Transcriptase Inhibitors (AZT)
1. HIV uses the enzyme reverse transciptase to reproduce and this blocks it.
2. HIV can develop resistance to the drug when given singly so doctors perscribe multiple ones to be take in different orders
3. toxic side effects such as severe anemia that required blood transfusions
4. examples: Retrovir; Videx
B. Protease Inhibitors
1. HIV uses another enzyme not natural to human body, blocking protease causes HIV to only make forms of itself that can’t infect other cells.
2. HIV can develop resistance to a single protease inhibitor
3. side effects include diabetes, lipodystrophy, and liver toxicity
4. examples: Crixivan; Zrivada
C. Prophylaxis Meds
1. Preventative anit-HIV medication that must be given no more than 72 hours after exposure for a duration of 28 days
2. There is a high cost as well as high risk of liver complications
3. examples: Efavirenz; Abacavir
D. Alternative Approaches
1. Chinese acupuncture
a. corrects energy balance
b. HIV patients use it to combat side effects of medications
c. side effects: slight pain, numbness, tingling when the needles are removed
2. Marijuana (Cannabis)
a. stimulates appetite and decreases nausea (lack of appetite and nausea are both side effects of many HIV/AIDS medications)
b. side effects: same health effects as tobacco, the ‘high’ from marijuana (ie: dizziness), and possible dependency
E. Fusion Inhibitors
1. blocks the activity of HIV where the virus sends out a projectile
2. might affect a heart rate called the QT time
3. examples: CCRX5; CXCR4
F. Integrase Inhibitoris
1. prevent the integration of the DNA of HIV into the cell
2. side effects not listed
3. Merck and GlaxoSmithKane are developing drugs
G. “Cocktail Approach”
1. taking multiple meds at once
2. more beneficial because
a. attack from all sides
b. prevents the virus from developing resistance.

XII. Why is it so difficult to find a cure for HIV/AIDS?
A. The virus is constantly mutating itself
B. The virus invades cells and in order to get rid of it host cells of would have to be killed
C. There are many different strains of HIV just like there are of the flu

XIII. Describe the process by which a person is tested for HIV infection. Include testing sites, specific lab tests utilized and required counseling sessions.
A. antibody test
1. a test is done to see if there is a higher level of antibodies present in the blood
B. EIA (enzyme immune assay)
C. Western Blot
1. done if the EIA test is positive
D. alternatives to drawing blood
1. urine and oral fluid tests
E. rapid HIV tests
1. these take 20minutes as opposed to 1-2 weeks
2. ex: OraQuick, Multispot
F. if you test positive...
1. go see a doctor with HIV experience
2. have a TB test done
3. quit smoking, drinking, and/or using drugs because these further weaken the immune system
4. get tested for STDs
G. Testing Centers:
1. Greenwich House Incorporated (zip: 10001)
a. free testing, anoynmous testing, and rapid testing available
2. AIDS Center of Queens County (zip: 11374)
a. free testing, anonymous testing, rapid testing, and confidential testing available



Bibliography

“AIDS.” World Book Encyclopedia. 2003. CD-ROM.

Conway, Alberta. “Recent Developments in Treatments for HIV/AIDS Patients.” New Hampshire Medical Quarterly. March 2002, 23-30.

“National HIV Testing Resources”. [http://www.hivtest.org/subindex.cfm?FuseAction=FAQ#6a]. 2002.

Putri, Nadia. “HIV/AIDS: What You Should Know.” Staying Healthy. January 2001, 7-11.

“The HIV/AIDS Epidemic: 20 years in the US.” [http://www.whitehouse/gov/onap/facts.html]. 2000.