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hiv - Overview of HIV NANCY KLIMAS MD ANNE O'BRIEN KONERU...

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Overview of HIV N ANCY K LIMAS , MD, A NNE O’B RIEN K ONERU , MSN, ARNP, AND M ARY A NN F LETCHER , P H D This article provides an overview and reviews the HIV pandemic, the basic biology and immunology of the virus (e.g., genetic diversity of HIV and the viral life cycle), the phases of disease progression, modes of HIV transmission, HIV testing, immune response to the infection, and current therapeutic strategies. HIV is occurring in epidemic proportions, especially in Sub-Saharan Africa. In the US, men who have sex with men account for over half of AIDS diagnoses; racial and ethnic minorities are disproportionally affected. Factors influencing the progression and severity of HIV infection include type of immune response, coinfection (e.g., another sexually transmitted infection, including hepatitis B or C), age and behavioral and psychosocial factors. Antiretroviral therapies can achieve reduction in blood levels of the HIV virus below the limits of detection by current technology. However, effective treatment requires adherence to therapy. Patient failure to adhere to treatment regimens results in detectible circulating virus and in HIV disease progression, and is the primary cause of drug resistance. In addition to research on the immunology and virology of the disease, other studies focus on behavioral and psychosocial factors that may affect medication adherence and risk behaviors. Key words: HIV/AIDS, disease progression, immune response, treatment. CDC Centers for Disease Control and Prevention; PCP Pneumo- cystis carinii pneumonia; HCV hepatitis C virus; ART antiretro- viral treatment; HAART highly active antiretroviral therapy. INTRODUCTION A cquired immune deficiency syndrome (AIDS) is caused by a chronic infection with the HIV. The official start of the epidemic occurred in the summer of 1981 when the US Centers for Disease Control and Prevention (CDC) reported on a cluster of Pneumocystis carinii pneumonia (PCP) in five homosexual men (1). However, there is substantial evidence that HIV first crossed the simian-human species barrier much earlier, possibly in Cameroon in West Africa (2). There is also evidence that HIV found its way to the Caribbean before the 1980s (3). From 1981, approximately 1.7 million people have been infected with HIV in the United States, 550,000 have subsequently died, and 1.2 million are currently living with HIV/AIDS (4). Despite improved HIV medications and lower morbidity and death rates in the past decade, there is still great variability in HIV disease progression (5). This article will briefly review and provide an overview of the phases of disease progression, the HIV pandemic, genetic diversity of HIV, the basic biology of the virus (e.g., the viral life cycle), modes of HIV transmission, HIV testing, immune response to the infection, and current therapeutic strategies.
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