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information is available at http://www.cdc.gov/hiv/dhap.htm.
Since 1995, there has been a large decline
in death rates because of antiretroviral therapy.
The overall prevalence of HIV/AIDS
has increased because of decline in death rates plus the steady
rate of new HIV infection; prevention of infection remains a high
intercourse is the most common route of transmission, irrespective
of gender or sexual orientation.
Injection drug use: Sharing
unsterilized injection equipment is a very efficient means of transmitting
from mother to infant can occur during gestation, delivery, or breast-feeding.
Blood transfusion: In
the U.S., screening blood for HIV has reduced the risk by transfusion
to almost zero.
Cofactors that enhance transmission
presence of sexually transmitted diseases may cause genital lesions
or genital/mucous membrane bleeding during sexual activity.
use lowers sexual inhibitions, impairs judgment, and increases impulsivity.
During the acute
phase, 50% to 90% of people experience a flulike
syndrome within 3 to 6 weeks of infection.
The clinically asymptomatic phase may last
for many years. The host seroconverts. The immune system may appear
to control infection, but chronic viral replication persists.
AIDS is defined by conditions indicating
significant immuno-suppression (e.g., opportunistic infections)
or other conditions (dementia, wasting). For criteria, see the web site of the Centers for Disease Control and Prevention (CDC) (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4813a1.htm).
on the use of antiretroviral agents, go to http://www.aidsinfo.nih.gov.
The goal of antiretroviral treatment is
to reduce viral load to undetectable levels and maintain this without
Lack of clinical response may be due to
problems with adherence, suboptimal antiretroviral treatment potency,
or genetic mutation of strains.
Adverse effects of antiretroviral treatment
include lipodystrophy (fat redistribution syndromes), hyperlipidemia,
nephrotoxicity, bone marrow suppression, neuropathy, nausea, diarrhea,
sleep disturbances, rash, and elevation of glucose levels, possibly
causing diabetes mellitus.
Combined cost for antiretroviral agents
in multidrug regimens is very expensive.
Adherence is of utmost concern with antiretroviral
treatment. Even minor deviations from the prescribed regimen can
result in viral resistance and permanent loss of efficacy. Studies
of antiretroviral treatment continue to indicate that near-perfect
adherence is needed to adequately repress viral replication.