Prevention, Treatment, and Survival of HIV
Lyndsay Alexander
5-15-09

Abstract:
For most parts of the world the only practical means of control is minimizing transmission though educational programs that promote the use of condoms and sterile needles. In many lower economical countries prevention is harder to implement then in the high-income countries where there are many more options available. The best way to prevent infection is by knowing about your partner and being aware of any symptoms that pertain to HIV that they might have. What is trying to be developed is a HIV vaccine that would produce antibodies that prevent infection, but due to the rapid mutation of HIV this makes it difficult to develop. Not only does the virus mutate, but it differs from one geographic area to another due to clades the virus has developed. Also, trying to make a vaccine that is affordable to every region of the world is hard to come by. Some experts say that there will never be a cure all vaccine for HIV and are looking into more practical goals for a vaccine like moderating symptoms or severity of the infection. The most known treatment for HIV is chemotherapy. Chemotherapy, along with anti-HIV drugs, targets the virus enzymes and inhibits the synthesis of these enzymes. Anti-viral drugs like fusion inhibitors targets one of the required steps for the infection to place and integrase inhibitors targets the enzyme needed to form the HIV provirus. Due to its rapid reproduction rate many anti-viral drugs need to taken simultaneously, which is called highly active antiretroviral therapy. Survival of HIV can pertain to the age of the person because if they are older they are less able to replace CD4 T cell populations and if they are infants or younger children their immune systems haven’t fully developed, which makes HIV very dangerous for them. In cases where the mother is HIV positive doesn’t always mean the baby will be, only about 20% are.

Introduction:
My topic was of interest to me because HIV/AIDS is such a widespread, international phenomenon and that there is really no cure for HIV/AIDS because of the rapid mutation rate, how it differs from one area to the next, and our immune system has trouble coping with natural infections (Tortora et al). Likemany other infections, you go to the doctor, they diagnose it, they give you some medicines, and in about a week or so it will clear up and be gone. HIV is an infection, but isn't as easy to get "rid of" as many common infections. There are many different types of prevention methods that are trying to be incorporate around the world ranging from mass media awareness campaigns (Damian Walker) to individualized country based prevention programs. The most common treatment of HIV is Chemotherapy. Along with treatment comes side effects ranging from an increase in subcutaneous tissue (Shlay et al) to hair lose. With HAART (Highly Active Antiretroviral Therapy, administering several of these drugs at the same time) individuals are surviving longer when compared to no drug therapy (Zhi-hui et al).


external image AIDS_ribbon4.jpg

Prevention:
The only practical means or controling AIDS is minizing transmission. This ranges from safe sex to using clean needles. From the Oxford Journal in Health policy and planning, strategies that were considered for cost-effectiveness HIV/AIDS prevention included mass media, projects working with youth, and prevention of mother-to-child transmission.

Mass media:
-The Johannesburg City Health Department in South Africa put together an AIDS awareness campaign by using messages placed on the outside of the city buses. They also incorporated two telephone interviews that were done 2.5 and 6 months after the campaign began. Only 30.2% and 31.5% of respondents had seen the message. However, unfortunately, accurate recall of the message was generally poor.
Youth:
-In 1997 in Moscow, Russia a project called
A Médecins sans Frontières was put together to campaign to raise awareness of HIV/AIDS, and promote safe sex among the youth. The campaign distributed 800,000 leaflets, broadcast a TV commercial and placed ads in magazines and newspapers. An evaluation was used to see the impact that the campaign brought, so a random telephone sample of 1,228 people aged 15–25 years old was used. The survey found that 80% of the respondents had seen the campaign; 83% thought this type of information was important for a person their age; 84% thought this type of information should continue to be given; and 93% supported the introduction of sex education in schools.
Educational programs:
-An intervention, based in Hungary, involved a school-based education program for 11–14-year-olds in Budapest.
-Organizations like Save the Children have put together numerous programs that help in the education and care of HIV internationally; Positive Change: Children, Community, and Care in Ethiopia, South Sudan HIV/AIDS Impact Reduction Program in Sudan, Prevention of HIV/AIDS among Young People in Bangladesh, and SAFENET plus in Haiti.
Vaccine:
The immune system hasn’t shown much capability of coping with natural infections, so this makes it harder to come up with a vaccine for HIV to be developed. The rapid mutation rate of HIV doesn’t allow for an effective vaccine, plus clades
(a taxonomic group of organisms classified together on the basis of homologous features traced to a common ancestor, dictionary.com) from HIV differ from region to region. Since there is no cure for HIV/AIDS the more realistic idea for making a vaccine is for the purpose of reducing the symptoms and severity of the disease.



external image chemotherapy.jpg

Treatment:
A well known treatment for people with HIV/AIDS is chemotherapy. Chemotherapy is the treatment of disease by chemicals that kill cells, both good and bad, but specifically those of micro-organisms or cancer. Antiviral drugs used in the chemotherapy of people with HIV are placed in four categories:
-Nucleoside Reverse Transcriptase Inhibitors: Didanosine, Zalcitabine
-Non-Nucleoside Reverse Transcriptase Inhibitors:
Nevirapine, Delavirdine
-Protease Inhibitors: Saquinavir, Indinavir
-Fusion Inhibitors: Enfuvirtide, Aplaviroc
When administering these drugs the body tends to have many different reactions and side effects. This can range from bruising to hair lose.
A study done on the effects of Individual Antiretroviral Drugs on Body Composition in HIV-Infected Persons Initiating Highly Active Antiretroviral Therapy stated that the nucleoside reverse transcriptase inhibitors stavudine (d4T) and zidovudine (ZVD) was associated in decrease subcutaneous tissue areas, while lamivudine (3TC) was associated with increase subcutaneous tissue areas and waist nonsubcutaneous tissue area.


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Survival:
Not all women who are infected with HIV will pass it on to their new-borns; it is estimated that the mother-to-child transmission rate is 25–30% (Walker). The infant can acquire the infection in utero, during labor and delivery, and by breastfeeding. Also, the age of the person infected with HIV/AIDS can play an important factor in survival. If an individual is older they are less able to replace CD4 T cell populations and if they are infants or younger children their immune system hasn't fully developed leaving them exposed to infection and more susceptible to HIV (Tortora et al). A study was done to investigate the survival time of blood donors engaged in unsafe blood donations in China. There were 530 cases of HIV infection; 334 developed AIDS, 168 received antiretroviral therapy (ART), and 152 died. The 166 that did not receive ART there average survival was about 9 years, with a 52% rate of 8 years. The 168 that did receive ART survived for around 12 years, with an 80% rate of 12 years. The results showed that with just 3 years of ART survival was longer compared to the no treatment group and that HAART (Highly Active Antiretroviral Therapy) was the strongest protective factor for prolong survival and decreasing the risk of death.


References:
Shlay, J.C., Sharma, S, Peng, G, Gilbert, CL, and Gunfeld, C. "The Effect of Individual Antiretroviral Drugs on Body Composition in HIV-Infected Persons Initiating Highly Active Antiretroviral Therapy." Medline/Pub Med. [SSU], [Rohnert Park], [CA]. 5 May 2009. http://www.ncbi.nlm.nih.gov/pubmed/19412117?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Tortora, Gerard J., Funke, Berdell R., Case, Christine L. Microbiology: An Introduction. San Francisco. Pearson Education, 2007: 570, 575-576.

Walker, Damian. "Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base?" Oxford Journals: Health Policy and Planning. 18.1 (2003). 4-17. 30 April 2009. http://heapol.oxfordjournals.org/cgi/content/abstract/18/1/4

Wikipedia.org. Clade. 9 May 2009. http://en.wikipedia.org/wiki/Clade

Zhi-hui, Dou, Yu Lan, Zhao Hong-xin, Ma Ye, Peng Guo-ping, Lu Li-xing, Li Zhi-he, Fu Ji-hua, and Zhang Fu-jie. "Survival analysis of 530 HIV infected former unsafe commerical blood and plasma donor." Biological Abstracts. [EBSCO]. Volume 42 (12). 879-883. December 2008. [SSU], [Rohnert Park], [CA]. 9 May 2009. http://0-web.ebscohost.com.iii.sonoma.edu/ehost/detail?vid=1&hid=8&sid=4100c6c5-a761-41ed-8bd6-206ece012765%40sessionmgr2&bdata=JmxvZ2lucGFnZT1Mb2dpbi5hc3Amc2l0ZT1laG9zdC1saXZlJnNjb3BlPXNpdGU%3d#db=boh&AN=BACD200900148416.

Photos:
http://blog.danielkenneth.com/images/AIDS_ribbon4.jpg
http://www.connecttristates.com/uploadedImages/Shared/News/National_Stories/chemotherapy.jpg
http://farm1.static.flickr.com/67/189120838_787c3a7176.jpg?v=0