Sub-Saharan Africa22 500 000South & Southeast Asia6 700 000Latin America1 400 000North America890 000East Asia and Pacific560 000Western Europe500 000Caribbean330 000Eastern Europe and Central Asia270 000North Africa and Middle East210 000Australia and New Zealand12 000TOTAL33 400 000Management – Treatment and Side Effects, ImmunizationMany drugs are used to fight off HIV. Some of these treatments disrupt the RNA of the HIV-infected cells, preventing them from making more HIV cells; others find and kill off the infected cells. Doctors believe that taking at least three drugs at a time will increase the drug efficiency and lower the risk of getting any more severe symptoms. They believe this because if you take just one drug, then HIV has a chance of resisting the drug after a while. However, if you take more than one drug, it takes longer for the HIV virus to adapt to the medication. When you take three, it takes even longer, so the risk is decreased.
It also helps when the drugs that are being taken have no similar side effects. For example, AZT was one of the first drugs that were found to slow down the rush of HIV. But, it also has some side effects that include headaches and stomach aches. However, these go away after several weeks.
But what about the more severe side effects? Well, for starters, there’s Abacavir. Abacavir is a drug that is potentially powerful, but causes hypersensitivity to about three percent of the patients. This symptom usually starts anywhere from about several days to four weeks after the drug has been used. Stopping the drug use and never taking it again can solve this problem. It can also cause fever, nausea, and malaise. Others, such as Adefovir, can cause vomiting and nausea, and Indinavir may cause stomach aches, generalized discomfort and kidney stones.
Doctors must be careful when prescribing several drugs for HIV, because if some of the side effects are the same, then that increases the risk of that symptom. Part of the responsibility also lies in the patient. The patient must be diligent in administering the drugs to themselves, and if they miss taking the drugs for a day, then they should stop because then there is a possibility that the HIV virus has had a chance to adapt and that drug(s) is no longer effective.
Other drugs, such as protease, are categories rather than individual drugs. Other categories include Ribonucleotide Reductase Inhibitors, such as Hydroxyurea, or Hydrea. Although Hydrea is the only drug that works this way, but there are other drugs like this under development; Protease Inhibitors, like Ritonavir, work by targeting the protease enzyme of the virus, which is essential for HIV to assemble copies of itself. Nucleotide Reverse Transcriptase Inhibitors, Non-Nucleoside Reverse Transcriptase Inhibitors, and Nucleoside Analog Reverse Transcriptase Inhibitors are other examples of drug categories and how they work.
Brand NameGeneric NameFirm NameApproval Date Retrovir capsulesZidovudine, AZTGlaxo, WellcomeMar. 19, 87 Retrovir syrupZidovudine, AZTGlaxo, WellcomeSept. 28, 89 Retrovir InjectionZidovudine, AZTGlaxo, WellcomeFeb. 2, 90 VidexDidanosine, ddlBristol Myers-SquibbOct. 9, 91 HividZalcitabine, ddcHoffman-La RocheJune 19, 1992 ZeritStavudine, d4tBristol Myers-SquibbJune 24, 1994 Epivirlamivudine, 3TCGlaxo, WellcomeNov. 17, 1995 InvirasesaquinavirHoffmann-La RocheDec. 6, 1995 NorvirritonavirAbbott LaboratoriesMar. 1, 1996 CrixivanindinavirMerck & Co., Inc.Mar. 13, 1996 ViramunenevirapineBoehringer Ingelheim Pharmaceuticals, Inc.June 21, 1996 ViraceptnelfinavirAgouron PharmaceuticalsMar. 14, 1997 RescriptordelavirdinePharmacia & UpjohnApril 4, 1997 Combivirzidovudine & lamivudineGlaxo WellcomeSept. 26, 1997 FortovasesaquinavirHoffmann-La RocheNov. 7, 1997 SustivaefavirenzDuPont PharmaceuticalsSept. 17, 1998 ZiagenabacavirGlaxo WellcomeDec. 17, 1998 AgeneraseamprevanirGlaxo WellcomeApril 15, 1999Drug ResistanceIn 1996, optimism about HIV treatment had people wondering if AIDS was over. Yet late in 1997, reports of widespread drug failure began to appear. Several media reports that followed the disappointing research findings all but eulogized people living with HIV-again. (Aug. 7, 97 edition of San Francisco’s Bay Area Reporter)
While the problem of HIV drug resistance may be overcome or prevented by better use of available agents, many experts state that the best hope for overcoming the virus are better drugs- that is, drugs that are active against resistant HIV. However, the recent news suggests that existing pharmaceutical company development programs are not finding these drugs. In a few years, will we be filled with drugs that work against “wild type” (non-resistant) virus, only to find that those viruses no longer exist in people, but only in test tubes? (tpan.com)
All of the currently approved antiretroviral therapies (AZT, ddI, ddC, d4T) interfere with viral reverse transcription of HIV (an enzyme that is capable of copying RNA into DNA therefore being an important step of the life cycle of HIV) and are thus able to slow viral replication. However the usefulness of these therapies is often short-lived because their antiviral capability diminishes over time. As these drugs are not able to completely suppress viral replication, resistance develops and ultimately limits their usefulness. Eventually, resistance may render a drug completely ineffective. (projinf.org)(www.aegis.com)
HISTORY AND GEOGRAPHICAL PATTERNSNobody knows exactly when the HIV retrovirus popped up in history. Most believe that it mutated from the Simian Immunodeficiency Virus (SIV), and this theory is quite possible for HIV-2 from Africa, where there are a lot of monkeys, but not so likely for HIV-1 from the United States where there are not so many monkeys. According to many scientists the minimum time HIV could have mutated from SIV is approximately forty years, but it is also possible it could have existed since the beginning of time (History of AIDS, Mirko D. Grmek). There are other scientists that have put the age of HIV at 140-160 years old (Paul M. Sharp, and Wen-Hsung Li), while the calculations of S. Yokoyama indicate that HIV has existed for at least 280 years.
Although the virus may have existed for hundreds or thousands years it first manifested itself among homosexuals in the United States and Western Europe around 1978 but the cases were so few that nobody really noticed anything abnormal. Here is a chronological history of important events in the history of HIV and AIDS:
1981It took until 1981 for it to become noticed in the national Untied States. In the beginning a related disease, Kaposi?s sarcoma, seemed to only affected homosexuals and because of this it was nick named ?gay cancer?, or GRID (Gay Related Immune Deficiency). Soon afterwards, it because apparent that IV drug users were also affected by the virus.
1982 The term AIDS was first used.
1983HIV was first isolated by Dr. Luc Montagnier of the French Institute Pasteur but it took the Americans (Dr. Robert Gallo of the U.S. National Institutes of Health) another year to isolate the virus even though they had patients with the virus a year longer.
1984A young French Canadian flight attendant named Gaetan Dugas was identified as patient zero for HIV-1.
1985The first international conference on AIDS was held in Atlanta, and the first HIV antibody test was approved by the Food and Drug Administration (FDA – USA). The death of Rock Hudson in 1985 greatly changed the way the public looked at HIV and AIDS.
1987AZT was first legalized in the United States in 1987. It was also during this year that the US would not allow any HIV positive immigrants or travellers to enter the country. Canada started screening blood.
1988The United States finally banned discrimination against federal workers with HIV.
1993 The CDC revised its definition of AIDS to include a list of opportunistic infections. Magic Johnson told the world he had HIV in 1993 thus helping the world deal with the fact that anyone could get HIV. Arthur Ashe also died in 1993, which finally allowed the public to see that anyone could be infected with HIV. The death toll in the US rose drastically to 43,465 in 1993 (compared to 128 deaths in 1981). Since the discovery of the virus the world death toll has reached about 6,400,00 and the number of people infected with the virus had risen to 22,000,000, the majority of both statistics are from sub-Saharan Africa.
As mentioned above, most of the HIV/AIDS casualties have been in sub-Saharan Africa. HIV began its reign of terror in Africa between the years of 1983-1985. For a long while sub-Saharan Africa denied that the HIV/AIDS epidemic was going on in their country because they were worried about being judged on the same level of druggies and homosexuals in the West. It got to a point where the African people made such jokes as to create a false acronym for AIDS that stood for An Imaginary Discourager of Sex. After this, the rate of HIV infection consistently rose. Today, seven out of every ten adults newly infected with the disease are from sub-Saharan Africa. Nine out of every ten people under fifteen infected with HIV are from Africa. Eighty-three percent of all AIDS casualties are from this region, and at least ninety-five percent of all AIDS orphans are from Africa, yet only one-tenth of the world?s population live in sub-Saharan Africa. The most interesting thing about Africa is that HIV/AIDS is much more prevalent in the literate sections of Africa than in the less literate parts. (UN AIDS report 1998)
HIV/AIDS will be a very interesting epidemic to watch because either the human race will adapt to it (like every other major disease so far) or will be wiped out by it. The worst part about HIV is, it might very well wipe out the Third World before the human race can adapt to it or before we can come up with a resistance, other than the condom, that_is_cheap_enough_for_the_third_world.
Social and Economical InfluenceSociety plays a very important role on epidemics such as AIDS and HIV because mankind is the main source of transmission for the HIV virus. People?s influences are positive and negative towards the epidemic.
The positive influence on AIDS helps spread the awareness of the disease and helps people better understand how to prevent the epidemic. Condom distributions and needle exchange programs in the U.S. and Canada proved to have spread awareness and have helped people be careful of what they do. Although programs like these have been criticized for encouraging kids to engage in sexual behaviour and to have promoted drug abuse, these programs have gained popularity and will remain in schools and community centers.
AIDS and HIV victims face discrimination almost everyday. This is mainly because the transmission of HIV is well known and some people believe that it can be prevented. Even young children with HIV have been discriminated against. Many laws had to be inducted by the United States government in order to let them go to school. Currently in the U.S., AIDS victims fall under the American Disabilities Act which makes it illegal to discriminate against them for jobs, housing and other social benefits.
Since celebrities play a very important role on society, when a notable person gets a highly recognized disease, the community is in shock because the attitudes of people are ?it could never happen to me!? So when a rich and famous person gets HIV, it hits the community hard because superstars seem untouchable and invincible, if people like that can get AIDS, then anyone can.
Many community organizations have been set up to help victims and to spread the awareness of the epidemic. Based especially in urban areas, organizations such and Inform and Act-Up were formed to help victims of AIDS and HIV by providing information. These establishments have helped victims cope with the financial and emotional problems of AIDS. ?On Saturday, May 31st, 300 hundred AIDS activists from New York, Philadelphia and Cleveland protested and participated in a giant die-in inside the Jacob Javits Convention Center, site of the POZ Life Expo, a major AIDS trade show and exposition travelling the United States.?(http://www.actupny.org) These demonstrations were to encourage pharmaceutical companies to release medicines that are being tested so that current HIV/AIDS victims have a chance at life.
Associations like these have a problem with funding, without money it?s very difficult to help victims and it?s up to the government and people to help fund these very helpful organizations.
Friends and families made a very famous memorial to AIDS victims; the AIDS Memorial Quilt (see Figure 8-2) has traveled around the world to spread awareness of AIDS and to raise money. Each panel is dedicated to a victim that has died from AIDS. The AIDS Quilt makes up one of many memorials to victims of the epidemic.
The economical issues facing AIDS and HIV could be the deciding objective in finding a cure or not. It?s all about money! With more money, pharmaceutical companies have a better chance of finding a cure. They can experiment with all sorts of things with more cash.
The most reported cases of AIDS are in the third world countries with a very poor economy, countries South Africa can not financially support victims of AIDS and HIV because they do not have enough money. (See figure 8-4) On top of that, lack of jobs results in prostitution and sometimes drug abuse, which will spread the HIV virus faster. The more victims of AIDS, the more the country has to spend and this will further decline the economy.
In Western and European countries where the funding for health care is high, the chance of getting AIDS is less. Also, the funding for people with AIDS is greater. (see figure 8-4) With better economy in these countries, more money can be put into developing a cure for this epidemic. Many international organizations have helped raise money to find a cure for AIDS, although none have been successful, the need for a cure is more needed than ever and the fight will continue.
Attitudes and Values Associated with HIV/AIDSHIV/AIDS has changed quite a few values in society. One type of bias given to AIDS is the one given by religious fanatics. This is the one that God sent HIV/AIDS to punish those who do not live by God’s laws; for example, homosexuals, drug users and all those bad and evil. Lots of people used to, and still believe, that only homosexuals, IV drug users, and third world country inhabitants get HIV/AIDS. In other words, only the ?undesirables? could get HIV so when they cried for help few of the rich Caucasian people cared. Only when HIV/AIDS started breaking out in North America did people start caring. Only then did things like the Tour de Cure, and Fashions Cures pop up. Even now most of these fund raising events mention nothing about the ones suffering in the Third World.
HIV has changed the public’s attitude towards “free love”. Some people believe that if someone is infected with HIV/AIDS, they lead a life style of “free love” and unprotected sex. People also stereotype all homosexuals as being infected with HIV. Many people believe that if you are gay, you automatically have HIV. Homosexuals have just the same chance of getting HIV as the people who have this bias. Being homosexual does not increase your chance of contracting HIV/AIDS. This bias is given to IV drug users as well. The risk is highest for IV drug users that share needles. People believe that everybody that has HIV is gay, an IV druggie, or some ?undesirable?. It took the diagnoses of famous people such as Arthur Ashe, Magic Johnson, and Rock Hudson to make people believe that any group of people could get it.
Millions of people around the world contracted HIV/AIDS incidentally though medical treatment. Some people in Africa received HIV because of the practice of re using syringes in hospitals and doctor’s offices (for malaria vaccinations). The people that received HIV from tainted blood during blood transfusions sure don’t believe that only dirty, “undesirables” can get HIV. Another bias associated with the disease is that the person that has it is unclean, dirty and one that ?sleeps” around. Generally this is not true. Once again the people who received tainted blood from the Red Cross were generally lead low risk lifestyles. HIV/AIDS has changed the whole concept of donating blood and blood transfusions. It used to be that people would walk into a blood clinic and give some blood, but now people are given paperwork to fill out, questionnaires to answer, and their blood is screened. These changes have drastically reduced the chances of giving HIV/AIDS to an otherwise, healthy person.
Another attitude that needs to be dispelled is the one that people with HIV/AIDS are weak, bedridden and waiting for death. This myth is not true. For example, Magic Johnson came back to play basketball for a season, and Eduardo Esidio, one of the leading scorers in the Peru Premier soccer league, continues to play soccer. He was the first soccer player to be diagnosed with HIV. Another myth is that if someone is diagnosed as HIV+, they automatically have AIDS. Many people that are diagnosed with HIV do not even develop AIDS.
HIV has certainly changed the way in which we look at medical treatment. It is mandatory for all health professionals to wear sterile latex gloves when treating patients. Even sports officials now wear sterile gloves in case there is an injury. Despite the tremendous advances we have made in understanding HIV/AIDS, many people still treat its victims as undesirables.