The availability of HAART since 1996 has had a dramatic effect on the face of HIV AIDS. HAART is a customized combination of different classes of medications that a physician prescribes based on such factors as the patient’s viral load, CD4⁺ lymphocyte count, and clinical symptoms. CD4⁺ lymphocytes are white blood cells that HIV infects and kills, leading to a weakened immune system and AIDS. Though not a cure, HAART controls viral load, helping to delay the onset of symptoms and achieve prolonged survival in people diagnosed with HIV/AIDS.

With HAART the medical implications that HIV has have been changed. New diagnoses of HIV-associated infections and some neurological complications, such as HIV dementia, have decreased since its introduction. Other neurological problems associated with long term use of this therapy include nerve damage. HAART is reported to have an effect to increase lipid (fat) levels in the blood, changed glucose metabolism and other complications.

Interactions with HAART and other medications used in the treatment of addiction may hurt both treatments. For example, methadone blood concentration drops as a result of the components in HAART therapy. There is currently research to determineif buprenorphine which is a treatment for opioid addictions has similar problems.

One issue for people treated with HAART is sticking to the medication regimen which is needed to benefit from HAART. Staying to the regimen can be hard for drug user’s lifestyles, due to their chaotic life styles. In addition, because HAART reduces viral load, some patients mistakenly believe that they do not need to adhere to the HIV treatment regimen or that reduced viral load means elimination of the risk of transmission of HIV/AIDS. This idea can lead to a resuming of old high risk behaviors, including use of dirty needles and unsafe sex. NIDAsupported research has helped to improve HIV outcomes among IDUs and has advanced new discoveries and approaches for treating medical consequences resulting from living longer with the disease.

The origin of HIV/AIDS has cme into the media spotlight as we learn of its existence in the human population much early then was orignally thought. This new information came to us by way of DNA analysis of the current HIV virus. Scientists now guess that HIV jump to human populations from monkeys in the early 1900’s. This has gone a long way to finally putting to rest conspiracy theorists who believed that HIV had been transmitted to humans during polio vaccination trials. HIV is thought to have jumped to the human population when indigenous African populations who consumed game meats regularly contracted it while butchering animals. A number of viruses humans have today have gotten into our population in similar ways including bird flu.

HIV 1 is the more virulent and common of the HIV strains. HIV 1 is the strain that infects most the world and qualifies HIV as a pandemic. HIV II is the less common strain of HIV that is less virulent. HIV 2 is mostly confined to West Africa, and not as prevalent. Both HIV 1 and HIV 2 are transmitted by bodily fluids. This means that the prevention of HIV rests on safe, and non risky practices. Including the use of condoms and safe sex practices. AIDS occurs when HIV AIDS has progressed to the point as to promote opportunistic infections and other AIDS defining illnesses.

As treatments become more available the battle against HIV becomes more viable. Prevention needs to be a central pillar in combating AIDS/HIV, as well as aggressive treatment. HAART regimens (combinations of AIDS drugs) are the primary weapon we have and it has been very effective in slowing the progression of HIV. Breakthroughs like these have helped patients live a much longer and healthier life. A critical element to winning the fight against HIV should be education, we need more HIV education in schools. Misinformation and lack of understanding has been a huge contributer to the spread of HIV.

HIV can be hard to diagnose, if you think you might have contracted hiv you should ge test as soon as possible. Symptoms often can take a long time to develop after the intial exposure to HIV, but common symptoms of AIDS include thrush or chronic yeast infections, skin discoloration, easy bruising, nausea, vommiting, and exhaustion. As your bodies immune system begins to be broken down more advance symptoms are simply more severe opportunistic infections. This includes chronic infections that don’t regularly happen in healthy indivduals and even some cancers. HIV tests are used to confirm the presence of anti HIV cells in your blood or saliva and not the actual virus. Advanced opportunistic infections begin to become prevalent as the immune systems CD4 cells drop below 200. HIV/AIDS transmission happens when infected bodily fluids enter your body. The most common occurances happen during sexual intercourse and the sharing of needles. Its always essential to practice safer sex, and always use condoms. Condoms are an effective method for preventing the transmission of HIV and prevents other STDs as well. Practicing safe sex means using a condom every time. If you use drugs that are injected, always use clean needles and never share them. Being vocal is an important aspect in preventing HIV transmission, the best thing we can do as a society is make sure that everyone is informed about the disease and how it is transmitted. Its important to get tested for HIV even if you think you are not infected, and if you are sexually active you should be routinely screened. Free HIV testing is often available, and some clinics perodically offer free HIV testing. Getting a HIV test is easy, with the advent of rapid result test you can get screened and get your results within 30 minutes typically. The test is performed by taking a sample of saliva and does not even require blood to be drawn.

AIDS/HIVwas first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus, or HIV. By harming the body’s immune system, HIV will eventually damage the body’s ability to fight off infection. People who have been diagnosed with HIV/AIDS can get dangerous infections called opportunistic infections. These infections are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.

HIV Causes AIDS

Since 1981, more than 980,000 cases of AIDS have been reported in the United States to the Centers for Disease Control and Prevention (CDC). The CDC states that more then 1,000,000 Americans have been infected with HIV, 25% of which are unaware of their infection. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. According to CDC, AIDS affects nearly seven times more African Americans and three times more Hispanics than whites. In recent years, an increasing number of African-American women and children are being affected by HIV AIDS.

HIV kills CD4 + cells, which are white blood cells that help maintain the immune system. As the virus attacks those cells, the person infected with HIV is less equipped to fight off infection and disease ultimately resulting in the development of AIDS.

Generally people who are infected with HIV can have the viruses for a realtively long period before the immune system starts to fail. However, there is a strong connection between high levels of HIV in the blood and the decline in CD4+ T cells and the development of AIDS. Antiretroviral medications can help slow the infection, save CD4+ T cells and ramatically slow the advance of HIV infection.

Each HIV infected patient who is entering into care should have a full medical history, physical, lab evaluation and counseling. This is to confirm the presenence of HIV, get historical and laboratory data, discuss treatment of HIV with patient, and initiate care as suggested by HIV primary care guidelines. Baseline data then is utilized to define management goals and future plans.

The following laboratory tests should be performed for a new patient during initial patient visits:

•  HIV antibody testing (if prior documentation not available) or if HIV RNA is undetectable (AI);
•  CD4 T-cell count (AI);
•  Plasma HIV RNA (viral load) (AI);
•  Complete blood count, chemistry profile, transaminase levels, BUN and creatinine, urinalysis, screening test
for syphilis (e.g., RPR, VDRL, or treponema EIA), tuberculin skin test (TST) or interferon-? release assay
IGRA (unless there is history of a prior TB or positive TST or IGRA), anti Toxoplasma gondii IgG,
hepatitis A, B, and C serologies, and Pap smear in women (AIII);
– Fasting blood glucose and serum lipids if the person is considered to be at risk for heart disease and for
baseline evaluation prior to initiation of combination antiretroviral therapy (AIII); and
• For patients who have pretreatment HIV RNA >1,000 copies/mL, genotypic resistance testing when the
patient enters into care, regardless of whether therapy will be initiated immediately (AIII). For patients who
have HIV RNA levels of 500–1,000 copies/mL, resistance testing also may be considered, even though
amplification may not always be successful (BII). If therapy is deferred, repeat testing at the time of
antiretroviral initiation should be considered (CIII).

Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues that are best
adressed with a multidisciplinary approach to HIV. The evaluation also must include assessment of
substance abuse, economic factors (e.g., unstable housing), social support, mental illness, comorbidities, high-risk behaviors, and other factors that are known to impair the ability to adhere to treatment and to promote education about HIV Once evaluated, these factors should be managed accordingly.
Lastly,  risk behaviors and effective strategies to prevent HIV transmission. to others should be
provided at all a patient’s clinical visits.

Despite substantial advances in the treatment of human immunodeficiency virusAIDS/HIV infection, the estimated number of annual new HIV infections in the United States has remained at 40,000 for over 10 years. HIV prevention in this country has largely focused on persons who are not HIV infected, to help them avoid becoming infected. However, further reduction of HIV transmission will require new strategies, including increased emphasis on preventing transmission by HIV-infected persons. People who are infected with HIV and are aware tend to reduce risky behaviors that might transmit HIV to others. Nonetheless, recent reports suggest that such behavioral changes often are not maintained and that a substantial number of HIV-infected persons continue to engage in behaviors that place others at risk for HIV infection.

Reverting to risky behavior can be as important in the transmission of HIV as the orignal failure to adopt safer sex practices. Unprotected anal sex appears to be occurring more frequently in some urban centers, particularly among young men who have sex with men (MSM). Viral and bacterial STDs in HIV infected patients receiving care has been noticed more frequently, indicating ongoing risky behaviors. Despite the decline in syphilis infection rate in the general U.S. population, continued outbreaks of syphilis in MSM, many of whom are co-infected with HIV, continue to happen in some areas; rates of gonorrhea and chlamydial infection have risen in this population as well. Rising STD rates among MSM indicate increased potential for HIV transmission, both because these rates suggest ongoing risky behavior and because STDs have a synergistic effect on HIV infectivity and susceptibility. Studies suggest that optimism about the effectiveness of highly active antiretroviral therapy (HAART) for HIV may be contributing to relaxed attitudes toward safer sex practices and increased sexual risk-taking by some HIV-infected persons.

Injection drug use also continues to play a key role in the HIV epidemic; at least 28% of AIDS cases among adults and adolescents with known HIV risk category reported to CDC in 2000 were associated with injection drug use. In some large drug-using communities, HIV seroincidence and seroprevalence among injection drug users (IDUs) have declined in recent years. This decline has been attributed to several factors, including increased use of sterile injection equipment, declines in needle-sharing, shifts from injection to noninjection methods of using drugs, and cessation of drug use. However, injection-drug use among young adult heroin users has increased substantially in some areas a reminder that, as with sexual behaviors, changes to less risky behaviors may be difficult to sustain.

Doctors and Clinicians caring for HIV-infected persons can help play a key role in help their patients reduce their risk factors. Clinicians can greatly affect patients’ risks for transmission of HIV to others by performing a brief screening for HIV transmission risk behaviors; communicating prevention messages; discussing sexual and drug-use behavior; positively reinforcing changes to safer behavior; referring patients for such services as substance abuse treatment; facilitating partner notification, counseling, and testing; and identifying and treating other STDs. These measures may also decrease patients’ risks of acquiring other STDs and bloodborne infections (e.g., viral hepatitis). Managed care plans can play an important role in HIV prevention by incorporating these recommendations into their practice guidelines, educating their providers and enrollees, and providing condoms and educational materials. Prevention services might be delivered in a clinical or office setting or even through referral to community programs. Some clinicians have expressed concern that reimbursement is often not provided for prevention services and note that improving reimbursement for such services might enhance the adoption and implementation of these guidelines.