On a day when the people of the world come together in the fight against ‘HIV/AIDS’, in an exclusive interview with Salome Phelamei of Zeenews.com, Dr. Jai Babu discusses the chronic and critical condition stimulated by the deadly virus, its care and precautionary measures that need to be taken. December 1 is observed as World AIDS Day every year. Dr. Jai Babu did his MBBS from Bangalore Medical College, and MD in General Medicine from PGIMER, Chandigarh. He also completed his Senior Residency from JIPMER, Pondicherry.What is HIV/AIDS? Human immunodeficiency virus (HIV) is the name of the virus that causes acquired immunodeficiency syndrome (AIDS). The virus interferes with the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers. Can you please tell us about the history of HIV/AIDS? The earliest known identification of the HIV-1 virus comes from Congo in 1959 and 1960, though genetic studies indicate that it passed onto the human population from chimpanzees around fifty years earlier. A strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969. HIV descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. AIDS was first reported in the US on June 5, 1981. Who are at risk? - Unprotected sexual contact with an infected person- Transmission from an infected woman to her fetus or baby- Through needle sharing among intravenous drug users- Rarely, through accidents involving needle-stick injuries and other blood exposures of healthcare providers Which body fluids are responsible for HIV transmission? HIV has been found in saliva, tears, nervous system tissue, spinal fluid, blood, semen, vaginal fluid and breast milk. Blood, semen, vaginal secretions, and breast milk generally transmit infection to others. How is HIV linked to other sexually transmitted disease? Individuals who are infected with sexually transmitted diseases are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another sexually transmitted disease, he or she is more likely to transmit HIV through sexual contact than other HIV-infected persons. What is the prevalence rate of HIV/AIDS in India and abroad? And what is the mortality rate of the disease worldwide? According to estimates from the UNAIDS Global Report 2010 around 30.8 million adults and 2.5 million children were living with HIV at the end of 2009. More than 60% of the HIV-infected population lives in African countries. South Africa is reported to have the largest population living with the disease, followed by Nigeria in 2nd place and India in the 3rd. India is estimated to have 23.9 lakh people infected with HIV, at an estimated adult HIV prevalence of 0.31%. Adult HIV prevalence among men is 0.36%, while among women it is 0.25%. Right now, there is no cure for AIDS. It is always fatal without treatment. Many patients survive many years after diagnosis because of the availability of highly active anti retroviral therapy (HAART). HAART has dramatically increased the duration people with HIV remain alive. What are the tests available to diagnose HIV/AIDS? HIV infection can be diagnosed by serologic tests that detect antibodies against HIV-1 and HIV-2 and by virologic tests that can detect HIV antigens or ribonucleic acid (RNA). Antibody testing begins with a sensitive screening test (e.g., the conventional or rapid enzyme immunoassay [EIA]. Reactive screening tests must be confirmed by a supplemental antibody test (i.e., Western blot [WB] and indirect immunofluorescence assay [IFA]) or virologic test (i.e., the HIV-1 RNA assay). What are the social aspects of HIV/AIDS? AIDS epidemic is a relatively recent and a global phenomenon. The impact of AIDS and HIV infection on social and economic development is crucial. Public awareness for AIDS needs to be increased. Psychological attributes such as guilt, anxiety, depression and other stressful emotions have to be addressed. Effective therapy should aim at inducing a sense of well-being and a positive outlook towards life. Emphasis should be on mass media programmes in both urban and rural areas as part of public health measures. People should be aware of the origin of the disease, modes of transmission, prevention, testing and therapies available. Myths surrounding the illness should be dispelled. Please elaborate about the treatment aspects… There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms. Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. Preventing the virus from replicating can help the immune system recover from HIV infection. HAART is not a cure for HIV, but it has been very effective. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved. CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells". However, HIV may become resistant to HAART, especially in patients who do not take their medications on schedule every day. Medications are also used to prevent opportunistic infections if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen. What are the recent advances made in the treatment protocol for HIV/AIDS? Many antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF or Neupogen), are sometimes used to treat anemia and low white blood cell counts associated with AIDS. There has been a case where bone marrow transplant has been successful. The patient received the marrow from a carefully selected donor with a mutated form of the CCR5 gene. HIV requires the CCR5 protein, which is on the surface of white blood cells, in order to attach to and infect the cell. Another experimental approach to finding a cure for HIV is the development of therapeutic vaccines. Therapeutic HIV vaccines work by enhancing the body’s natural immune response, helping to control HIV in people already infected with the virus. This is in contrast to preventive vaccines, which are used in HIV-negative individuals to prevent infection. Gene therapy is an experimental approach that is currently in early stages of clinical testing. Gene therapy involves modifying the genetic information in a cell so that it becomes, for example, resistant to HIV infection.
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