Herpes Simplex virus Type 2 infection

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Herpes Simplex virus Type 2 infection

Herpes simplex virus type 2 infection was one of the strongest risk factors for HIV acquisition among men who have sex with men.
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HIV Infection showing decline!

HIV Infection showing decline!
Report released by UNAIDS today said that: the global response to AIDS is showing results. As the world marks 30 years of AIDS, UNAIDS estimates about 34 million people are living with HIV and nearly 30 million people have died of AIDS-related causes since the first case of AIDS was reported on June 5, 1981.
Some of the facts:

  • Global rate of new HIV infections declined by nearly 25 per cent between 2001 and 2009.
  • The total number of HIV infections remains high, at about 7000 per day.
  • 26 per cent of all new global HIV infections are among young women aged 15-24.
  • The rate of new HIV infections fell by more than 50 per cent in India between 2001 and 2009, double of the average decline in the world.
  • In South Africa it fell by more than 35 per cent.
  • People were starting to adopt safer sexual behaviors, reflecting the impact of HIV prevention and awareness efforts.
  • 74 per cent of young men know that condoms are effective in preventing HIV infection, compared to just 49 per cent of young women.
  • In recent years, there has been significant progress in preventing new HIV infections among children as increasing numbers of pregnant women living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding.
  • The number of children newly infected with HIV in 2009 was 26 per cent lower than in 2001.
  • There has been an increase in rate of new HIV infections in Eastern Europe and in the Middle East and North Africa.
HIV ~ Human Immunodeficiency Virus

HIV- Management

HIV- Management 
In HIV infection there is intense and persistent viral replication which leads to gradual depletion of CD4 cells. The primary goal in managing the HIV patients is to prevent this process of replication to as low as possible and to maintain it as long as possible.  With this there is lower risk of clinical progression of the disease and prevention of opportunistic infection.
Classes of ANTIRETROVIRAL DRUGS: Anti retroviral drugs act by inhibiting the multiplication of the virus. The drugs mainly target 2 key enzymes the virus requires to multiply.These are PROTEASE , REVERSE TRASCRIPTASE. Drugs inhibiting the Reverse Transcriptase enzyme are divided into two types – Neucleoside Reverse Transcriptase Inhibitors (NRTIs) & Non-Neucleoside Reverse Transcriptase Inhibitors (NNRTIs).
Combination Therapy: HIV virus has the ability of developing resistance if any one drug is used alone. Hence current guidelines are to use at least 3 antiretroviral drugs in combination. This is the same principle used in the treatment of tuberculosis. This triple drug regime is commonly called HAART ( Highly Active Antiretoviral Therapy). HAART has been shown to inhibit viral replication to levels below the limit of detection.

Antiretroviral Drugs                                                                Incomplete list

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Protease Inhibitors (PIs)
Zidovudine  Nevirapine  Indinavir 
Stavudine  Efavirenz  Nelfinavir 
Lamivudine  Delavirdine  Ritonavir 
Didanosine   Saquinavir
Zalcitabine Amprenavir 
   Abacavir  Lopinavir / Rotinavir 
Initiating Antiretroviral Therapy: The antiretroviral therapy is started in persons with sign of compromised immune system or indication of presence of Opportunistic infection.
CD4+ cell count less than 500 cells/ micoliter or increase of viral load to more than 5,000 – 10,000 copies/ milliliter. are indications of reduced immune strength. All symptomatic patients with symptoms suggestive of active infection – wasting, thrush or unexplained fever for > 2 wks. should be started with antiretroviral drugs irrespective of the viral load. Proper counseling of the patients is also very important before commencing the therapy. Patients is told about the fact that the therapy has to be life long and it is not curative. Cost of the therapy and side effects should be known to the patient. Adherence to the treatment process should be thoroughly stressed. The patient should know that even if he or she is keeping fine transmission of the infection to others is possible and safe sex methods should be practiced.  

Commonly used initial Antiretroviral regimens

Antiretroviral drug regimens are comprised of one choice each from column A and B. 

Column A

Column B

Efavirenz Stavudine + Didanosine
Indinavir Stavudine + Lamivudine
Nelfinavir Zidovudine + Lamivudine
Nevirapine Zidovudine + Didanosine
Saquinavir
HIV positive patients should be kept up to date on immunizations.
Pneumococcal vaccine: Booster at 5 years.
Hepatitis B vaccine.
Influenza vaccine: yearly.

HIV in Females – its different!

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 HIV in Females – its different!

It has been found that the markers ( Viral Load, T-cells ) doctors generally use to determine progression of HIV infection behave differently in women and people of color as compared to white men.

  • Viral load, a measurement of how many virus particles are in the blood stream, is lower in women than in men infected for the same amount of time.
  • It remains low in people of color longer than in whites, so women of color generally have the lowest viral loads of all.
  • T-cells, protective immune cells whose number declines over the course of HIV infection, start out at higher levels in healthy women, and decline more slowly in HIV-infected women than they do in men.

More research is needed to determine what these differences mean in practical terms in the treatment of women.

HIV & Hepatitis G

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 HIV & Hepatitis G

Researchers have discovered that infection with an apparently harmless, newly recognized virus seems to interfere with HIV, slowing its progression and prolonging survival of AIDS patients. Virus called GBV-C or hepatitis G, inhibits HIV. Patients with both HIV and hepatitis G lived longer than those infected with HIV alone.