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Human Immunodeficiency Virus (HIV)

Introduction: Human Immunodeficiency Virus (HIV) is a virus which attacks the cells
of the immune system and replicates through cell reproduction. It destroys the CD4 !
cells which are vital to immune function. !hrough the course of the HIV replication" the
num#er of CD4 ! cells drops allowing for opportunistic infections to infect the #ody$
thus #ecoming %ID&. HIV causes the destruction of lymph nodes and other immune
organs which is called immunosuppression. Immunosuppression then #egins to allow the
virus to duplicate much faster allowing for more cells to #e replicated and eventually
leading to death of the HIV infected person.
Epidemiology: It is the study of the distri#ution of health'related states or events
(including disease)" and the application of this study to the control of diseases and other
health pro#lems. Various methods can #e used to carry out epidemiological
investigations( surveillance and descriptive studies can #e used to study distri#ution$
analytical studies are used to study determinants.
&ince %ID& was first recogni)ed in *+,*" it has led to the deaths of more than 4-.
people" making it one of the most destructive diseases in recorded history.
Despite recent improved access to antiretroviral treatment and care in many regions of
the world in /001 the %ID& pandemic killed an estimated /.*. people" including 2203
children. %s of /0*0" it is estimated that there are 24. people worldwide living with
HIV4%ID&" with 2.4. new HIV infections per year and /.-. annual deaths due to %ID&.
!his is due to lack of access to retroviral treatment in huge areas such as the continent of
%frica" where less than *05 of infected are reported to have access to it.
!he pandemic is not homogeneous within regions" with some countries more afflicted
than others. 6ven at the country level" there are wide variations in infection levels
#etween different areas. !he num#er of people with HIV continues to raise in most parts
of the world" despite the implementation of prevention strategies" &u#'&aharan %frica
#eing #y far the worst'affected region" with an estimated //.+. at the end of /0*0" -,5
of the glo#al total. &outh and the &outh 6ast %sia have an estimated */5 of the glo#al
HIV/AIDS was first detected in Canada in 19!" An estimated #$%&&& Canadians
were li'ing wit( HIV )pre'alence* in !&& and t(e num+er of new infections
)incidence* (as not decreased since !&&$"
%t the end of /00," an estimated -7"000 Canadians were living with HIV8this
represents an increase of ,"000 persons (*45) since /007.
%n estimated /"200 to 4"200 new HIV infections occurred in Canada in /00,
compared to an estimated /"/00 to 4"/00 in /007.
Appro,imately one -uarter of people li'ing wit( HIV in Canada are unaware t(at
t(ey (a'e HIV"
%t the end of /00," an estimated *-"+00 or /-5 of the estimated -7"000 people
living with HIV remained undiagnosed.
AIDS diagnoses and deat(s among AIDS cases (a'e decreased o'er time"
9eported %ID& cases peaked in *++2 and have declined since that time.
9eported deaths among %ID& cases peaked in *++7 and have declined since that
%t the end of /00," an estimated //"200 people in Canada had died with an
HIV4%ID& infection since the #eginning of the HIV epidemic.
.(e HIV epidemic in Canada is concentrated in specific populations )pre'alence*"
:eople who were living with HIV in /00, include an estimated(
22"2-0 gay men and other men who have se; with men (.&.). !his represents
7*5 of all people living with HIV. !he estimate includes 2*"220 people whose
HIV status was attri#uted to se; #etween men and /"020 men whose HIV status
could either #e attri#uted to se; #etween men or in<ection drug use (.&.'ID=).
*2"/*0 people who use in<ection drugs (ID=). !his represents /05 of all people
living with HIV. !he estimate includes **"*,0 people whose HIV status was
attri#uted to in<ection drug use and /"020 .&.'ID= (please note that these /"020
men are the same as those noted in the #ullet a#ove).
*4"200 women. !his represents //5 of all people living with HIV.
*+"+-0 people whose HIV status was attri#uted to heterose;ual se;. !his
represents 2*5 of all people living with HIV. >f these" +"/70 people (*45 of
people living with HIV) were from a country where HIV is endemic (primarily
countries in su#'&aharan %frica and the Cari##ean).
4"200 to -"*00 %#original people. !his represents ,5 of all people living with
700 people whose HIV status could not #e attri#uted to se; or in<ection drug use.
!his includes people who likely contracted HIV through #lood transfusions or
clotting factors" transmission from mother to child" or needle'stick in<uries in the
workplace. !his represents less than *5 of all people living with HIV.
.(e num+er of new HIV infections )incidence* may +e increasing among A+original
people and in people w(o in/ect drugs"
%n estimated 200 to 7/0 new HIV infections occurred in %#original people in
/00, (*25 of all estimated new infections) compared to an estimated /40 to 420
new infections in /007.
% infections in /007. !his does not include .&.'ID=.
.(e num+er of new HIV infections )incidence* may +e sta+le among gay men and
ot(er men w(o (a'e se, wit( men )0S0*% people e,posed t(roug( (eterose,ual se,%
0S01ID2 and women"
!here are numerous initiatives and campaigns which have #een used to cur# the spread of
HIV" such as the %#stinence" ?e faithful" =se a condom or %?C campaign" in %frica and
other parts of the world. >ne of the greatest pro#lems many countries with high
prevalence face is @HIV fatigue@" where populations are not interested in hearing more
a#out a disease they hear a#out constantly. In order to address this" novel approaches are
often reAuired. In /0**" the ?otswana .inistry of 6ducation has introduced new
HIV4%ID& educational technology for schools. !he !each %ID& prevention education
software" developed at &tanford =niversity" will #e distri#uted to every primary"
secondary and tertiary educational institution in the country" reaching all learners from -
to /4 years of age nationwide.
!he Canadian Bovt. also created the Cederal Initiative to address HIV4%ID& in Canada
to provide funding for prevention and support programs to assist vulnera#le people as
well as research" surveillance" pu#lic awareness and evaluation.
!he Canadian HIV Vaccine Initiative (CHVI)" CanadaDs contri#ution to the Blo#al HIV
Vaccine 6nterprise" is a five'year colla#orative initiative #etween the Bovt. of Canada
and the ?ill E .elinda Bates Coundation" and represents a significant Canadian
contri#ution of glo#al efforts to develop a safe" effective" afforda#le and glo#ally
accessi#le HIV vaccine.
0ode of .ransmission: HIV is transmitted mainly through se;ual contact. !his
however depends on several factors. !he main factor is whether or not the se;ual partner
is infected with HIV. %nother factor to consider is the type of se;ual practice" the
infectivity of the source partner" and other se;ually transmitted infections in either
partner$ especially genital ulcerations. %lso whether or not a condom was used" HIV has
#een transmitted #y vaginal" anal and oral intercourse. !he most common mode of
transmission with heterose;ual couples is through vaginal intercourse. %lthough some
studies show that receptive anal intercourse increases risks of HIV #eing passed from
man to woman. >ther ways to contract HIV are through unsterile or dirty instruments
during a #a#yFs circumcision" through contaminated #lood" through dirty needles that
have #een used for drug use" or #y an accidental needle poke from an infected needle.
%nother way to contract HIV is from mother to child. !his is one of the #iggest causes of
HIV infection in children. %#out -00"000 children are infected this way each year. %
mother can pass the virus to her child through the placenta" through #lood contamination
during #irth" or through #reast feeding. It is more likely for a mother to pass it to her
child if she #ecomes infected <ust #efore #ecoming pregnant or during pregnancy while
she is in the acute phase or if she is in the final stage of %ID&. %lso the mother can pass
the virus through #reastfeeding during these stages through cracked nipples" or if the
#a#y has oral thrush.
.reatment: &ince the discovery of HIV" new treatments have #een used" #ut there is not a
specific one" that can produce the #est results. !he first one and most commonly used is
%ntiretroviral (%9V) !herapy. !here are more than /0 approved antiretroviral drugs" #ut
not all are licensed or availa#le in every country. !he latest recommendations has shown
that methodi)e %9V therapy prove to #e effective. However" a very important step to
consider is the num#er of CD4 ! cells. !herefore" the guidelines conclude that %9V
!herapy should #e offered to every patient$ even those who are at risk of transmitting
HIV to a se;ual partner(s). .ost research e;perts say that new %9V drugs are generally
#etter tolerated" more convenient" and more effective than other drugs that have #een
used #efore. ?ut" there is not a lot of long term data availa#le and there are also concerns
of the adverse conseAuences of %9V !herapy. >ther factors to consider include the
possi#ility of %9V drug to;icities and how it will affect the Auality of life" not to mention
the high cost of this therapy. !ime and kind of treatment is another factor to consider. %
- month treatment for people newly infected with HIV can delay the need at a later day to
start long term treatment" according to a new study.
!here are also the possi#ilities of an alternative and complementary medicine. .any
HIV people say they feel #etter after using non'traditional medicine$ even when these
treatments are unproven according to conventional western medicine. !hese kinds of
treatments include$ her#al nutritional" supplements" acupuncture" aromatherapy"
homeopathy and even yoga" as a rela;ation techniAue. Complementary medicine is used
together with conventional medicine. It has #een said" that no matter which treatment the
patient is going to choose there is always the chance of side effects. 6ven
complementary and alternative medicines can cause harmful side effects. Cor e;ample"
using the her#al &t. GohnFs Hort" may also interact other medications" making them less
effective or worsening their side effects. Her#al remedies and dietary supplements are
not covered #y strict regulations that govern pharmaceutical drugs. Iuality is
inconsistent even amongst popular commercial formulations and other kinds of treatment.
3a+oratory Ha4ards 5 6recautions: &afety is very important in a la#oratory. !here is
always potential for ha)ards. HIV contraction is a #ig one. Collowing specific and
appropriate guidelines and instructions can keep you and every#ody around you safe.
&tandard la#oratory procedures should #e followed even if you donFt agree with them.
!hey are in place for a reason. &ome main ones to follow are wear <o# appropriate
personal protective eAuipment (::6) (e;amples( gloves" gowns" goggles or masks). Cuts"
scrapes and a#rasions should #e covered with gloves. !his protects the patient and
employee from possi#le HIV contraction. % ha)ard also e;ists when transporting a
specimen or sample. .asks" goggles or visor should #e worn when there is a potential
for a sample to splash onto your face. If you need to pour off serum" then the rim of the
tu#e should #e wiped with hypochlorite or glutaraldehyde. Jeedle sticks or #roken glass
also carry a ha)ard for HIV contraction. %lways place used needles in a puncture proof
container immediately after use. Clean up any #roken glass carefully and dispose of in a
sharps container. :lace all ha)ardous materials in containers provided. 9eusa#le
instruments also carry risk of HIV transmission. !he use of an autoclave for proper
sterili)ation can reduce the risk. It is also possi#le to inactivate the virus in the sample.
!he most common method for this is to heat up the sample to 7- degrees for 20 minutes.
!his inactivates the virus to undetecta#le levels. %lso spilling of samples of any kind in a
la# is a possi#ility. If this should happen #e sure to mop up the spill with gloves on and
disinfect the area immediately with glutaraldehyde or hypochlorite. HIV is effectively
inactivated with alcohol mi;tures" hydrogen pero;ide" hypochlorite and
paraformaldehyde at normal la#oratory strengths. !hen hot wash clothing or autoclave
them" and discard your gloves and wash your hands.
*) http(44www.avert.org4hiv.htm
/) http(44Virology'online.com4general4safety*0
2) http(44www.avert.org4aids'hiv'treatment.htm
4) http(44www.phac'aspc.gc.ca4id'mi4a)'inde;'eng.phpKhivaids