From 2005-2006 I lectured on HIV/AIDS for the Pathology Department at New York Medical College, School of Basic Medical Sciences, in the Introduction to Pathology and Systemic Pathology courses. If you would like a copy of the Powerpoint lectures please email me using the link to the left. I am happy to share. I apologize if some of the information is outdated by a year or two. It seems once I get one fact updated three others go out of date; it is a constantly changing area of knowledge as we are still learning about this disease. A simplified version of the facts is published here. I also have a series of articles on Helium. A commentary on HIV vaccine. Jan 11, 2008 Epidemic Update

What:

HIV: Human Immunodeficiency Virus, a member of the lentivirus family it infects human immune cells, particularly CD4+ T cells. Has an RNA genome and carries its own special enzyme (RNA transcriptase) which allows it to take over the functions of human cells and produce more virus thus slowly destroying the immune system of those infected. This immunosuppression leaves the infected person vulnerable to other infections. The virus has been known to lie dormant in immune cells for decades or to act quickly, leading to death 5 years after being infected. AIDS: Acquired Immunodeficiency Syndrome, the final stage of HIV infection. Characterized by a group of symptoms (syndrome) common to those with a deteriorated immune system. Defined by the U.S. Centers for Disease Control as a CD4 cell count below 200 or by the presence of particular opportunistic infections in individuals who have tested positive for HIV. I will elaborate upon this further down the page.

How:

The virus is transmitted from body fluid to body fluid and cannot live outside of the human body for any significant length of time. Disinfectants and barriers (such as bleach, condoms, and surgical gloves) are effective preventative measures to the spread of the virus. Sexual contact with an infected person, accidental blood exchange with an infected person, and sharing needles are the more common routes of transmission in the United States. Breast milk has also been found to be infectious and it is a common source of infection Africa.

Treatment:

Anti-retroviral therapy (ARVs) – attacks the reverse transcriptase necessary for virus replication, since human genomes are not made of RNA this does not affect their replication. Protease inhibitors – prevents the full formation of viral proteins thus preventing virus replication Most drugs are given as cocktails to attack the virus on many levels and prevent drug resistance by the virus. Depending on the strain of infection and the stage at which treatment is started, different drugs will work differently for different people in different combinations. This is why it is so difficult to treat HIV infection. HIV is persistent and will remain in the lymph nodes even with treatment, so it is a lifelong obligation. As of now there is no vaccine. The virus mutates too rapidly to use a dead strain and the use of a weakened strain is not possible due to how it infects. It is predicted that a comprehensive approach to prevention avert 63% of projected new infections by 2010!

Who is at risk:

Everyone – Most new infections occur in those between the ages of 15 and 24. AIDS is the 5th largest cause of death in adults between the ages of 25 and 44. The largest infected group in the United States is homosexual and bisexual men, comprising 56% of all infected men and 46% of reported cases. AIDS was once mistakenly referred to as the “gay disease”. This way of thinking is what has allowed it to be the epidemic it is today. The largest growing group of infected individuals are the heterosexual female partners of infected men! Prevention is the only cure or vaccine. Intravenous drug users – comprise 25% of all reported cases, infected blood is passed from shared needles. Hemophiliacs – Prior to testing blood bank donations for HIV (1986) some individuals were infected when undergoing transfusions for bleeding disorders. The most famous patient was Ryan White who became infected in 1984 as an adolescent and died at the age of 19. He is the namesake of the HIV/AIDS Treatment Modernization Act of 2006. Babies – spread from mother to child can occur in utero from transplacental spread (meaning it crosses the placenta from the mothers bloodstream to the fetus’), during birth trauma if there is blood exchanged, and from the ingestion of infected breast milk. Breast milk infects approximately 2000 infants a day worldwide. New information was released in a study in early 2008 indicating that children may also be infected by consumer an infected parent's prechewed food.

The stats:

More than 25 million people have already died from AIDS and more than 33 million are currently infected. Half of those infected are women and children, half of the infected live in Africa. According to the World Heath Organization (WHO), 2.5 million new infections occurred in 2007. The WHO predicted at the beginning of the century that 45 million new infections will occur worldwide between 2002 and 2010.

Opportunistic infections:

These are infections that are sometimes seen in non-AIDS patients, but for the most part define AIDS because healthy individuals tend to clear the infectious agents without incident Pneumonia caused by Pneumocystis carnii Fungal infections including mucosal candidiasis Severe herpes ulcerations Meningitis and toxoplasmosis infections of the central nervous system Kaposi’s Sarcoma – a secondary vascular neoplasm, or growth AIDS dementia – brain damage due to infection spreading to the brain; manifests as headaches, swelling of the brain, and cognitive difficulties. This is still being characterized and little is known as to why this occurs.

For more information visit the Centers for Disease Control and the World Health Organization. Click here if you would like to know more about the genetics of the disease.

References:
	Centers for Disease Control World Health Organization Robbins and Cotran Pathological Basis of Disease 6th edition by Kumar et al and Robbins Basic Pathology 7th edition by Kumar et al.

For testing
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