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December 1st is World AIDS Day

Acquired Immune Deficiency Syndrome (AIDS) was first recognized in the United States in the summer of 1981. As the epidemiologic pattern of the disease unfolded, it was determined that an infectious agent, transmissible by sexual contact and by blood and blood products was the most likely cause of the disease.

In 1983, Human Immunodeficiency Virus (HIV) was first isolated from a patient, and by 1984 it became clear that this newly discovered microbe was the cause of AIDS. By 1985 a highly sensitive and specific assay, the Enzyme-Linked Immunosorbent Assay (ELISA) was developed. ELISA is a test which is currently used for the detection of HIV in the blood.

Throughout the past two decades, a great deal has been learned about the pathogenesis of HIV. The expansion of our knowledge base has led to new treatments for HIV disease, and for the opportunistic diseases which result. In addition, there have been great strives toward the development of an effective preventive vaccine.

HIV causes disease by infecting the immune cells that travel in our blood. These white blood cells are normally able to rid the body of any number of diseases before they even begin. But when HIV enters white cells, the virus effectively hijacks the cellular machinery, eventually rendering the immune system helpless. At this point, agents that would not usually cause infections or tumors will begin to cause such disorders. Among the most common of these so-called opportunistic diseases of AIDS are Pneumocystis carinii pneumonia and Kaposi’s sarcoma.

HIV can be transmitted by sexual contact, via blood and blood products, and by infected mothers to their fetuses or infants. There is no evidence that HIV can be spread by casual contact, or by insects. Of all new cases in the world, the number one means of HIV transmission is via unprotected heterosexual contact.

The practice of safer sex is the most effective way for sexually active individuals to prevent the sexual transmission of HIV. Partners engaged in monogamous sexual relations should both be tested for HIV antibodies; if both are negative, it should be understood that adherence to monogamy is important for the protection of both partners. If the status of any sexual partner is positive or unknown, the proper use of latex condoms during intercourse has been shown to greatly reduce the chances of infection. It is critical to use only water-based lubricants (such as K-Y Jellies) with latex condoms, as petroleum-based lubricants increase the risk of condom breakage.

It is important to understand that, while the risk of HIV infection is considerably less during fellatio than during intercourse, there have been documented cases of HIV transmission when fellatio was the only sexual act performed. Kissing is considered safe, since HIV survives in very low concentrations in the saliva of infected individuals.

The most effective way to prevent HIV transmission via injection drug use is to effectively discontinue all use of injectable drugs. For those who can not or will not participate in drug treatment and counseling, the avoidance of sharing needles and other drug paraphernalia is the best way to lessen the risk of infection. The transmission of HIV via blood products has been dramatically diminished by the “triple-screening” of blood donors, using questionnaires and two forms of clinical testing.

Transmission of HIV to fetuses and newborns has been greatly reduced by the use of a short course of a single anti-HIV medication during pregnancy. Because there is a further risk of transmission from an infected, breast-feeding woman to her infant, alternative methods of feeding are encouraged for HIV-positive mothers. Because such methods are not practical worldwide, the continued use of a single anti-HIV drug by the mother following birth decreases the risk of breast milk transmission.

From my own clinical experience in working at a large HIV disease clinic and hospital in New York City, a combination of three or more anti-HIV medications (known as Highly Active Anti-Retroviral Therapy, or HAART) is required for adequate control of known HIV infection. Here in the United States, many infected individuals are fortunate enough to have access to such medications; many other nations are not nearly as fortunate.

December 1, 2006 is World AIDS Day, sponsored by the by the UNAIDS, a division of the United Nations (UN). In a recent speech in New York City, UN Secretary General Kofi Annan called AIDS the “greatest challenge of our generation.” The full text of the Secretary General’s speech can be found here.

STOP AIDS Logo Courtesy of the Joint United Nations Programme on HIV/AIDS (UNAIDS)
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