Human immunodeficiency virus (HIV) is a blood-borne, sexually transmissible virus (see the image below.

) The virus is ty ically transmitted via sexual intercourse, shared intravenous drug ara hernalia, and mother-to-child transmission (!T"T), which can occur during the birth rocess or during breastfeeding.

#lectron microsco y of human immunodeficiency virus (HIV)$% virions. "ourtesy of "&"'&r. #dwin (. #wing, )r. The most common route of infection varies from country to country and even among cities, reflecting the o ulation in which HIV was introduced initially and local ractices. "o-infection with other viruses that share similar routes of transmission, such as he atitis *, he atitis ", and human her es virus + (HHV+, also -nown as .a osi sarcoma her es virus /.0HV1), is common. Two distinct s ecies of HIV (HIV-% and HIV-2) have been identified, and each is com osed of multi le subty es, or clades. 3ll clades of HIV-% tend to cause similar disease, but the global distribution of the clades differs. This may have im lications on any future vaccine, as the * clade, which is redominant in the develo ed world (where the large harmaceutical com anies are located), is rarely found in the develo ing countries that are more severely affected by the disease. HIV-% robably originated from one or more cross-s ecies transfers from chim an4ees in central 3frica./51 HIV-2 is closely related to viruses that infect sooty mangabeys in western 3frica./%61 7enetically, HIV-% and HIV-2 are su erficially similar, but each contains uni8ue genes and its own distinct re lication rocess. HIV-2 carries a slightly lower ris- of transmission, and HIV-2 infection tends to rogress more slowly to ac8uired immune deficiency syndrome (3I&0). This may be due to a less-aggressive infection rather than a s ecific ro erty of the virus itself. (ersons infected with HIV-2 tend to have a lower viral load than eo le with HIV-%/%%, %21 , and a greater viral load is associated with more ra id rogression to 3I&0 in HIV-% infections./%9, %:1 HIV-2 is rare in the develo ed world. "onse8uently, most of the research and vaccine and drug develo ment has been ( erha s unfairly) focused on HIV-%. ;or information on HIV infection in children, see (ediatric HIV.

Initial description and early spread

In the <nited 0tates, HIV disease was first described in %5+% among 2 grou s, one in 0an ;rancisco and the other in =ew >or- "ity. =umerous young homosexual men resented with o ortunistic infections that, at the time, were ty ically associated with severe immune deficiency? Pneumocystis neumonia (("() and aggressive .a osi sarcoma./%@1 HIV itself was not identified for another 2 years./%A1 &uring that time, various other causes were considered, including lifestyle factors, chronic drug abuse, and other infectious agents./%B1 The HIV e idemic s read ra idly and silently in the absence of testing. However, clear clinical im lications arose before society became aware of the disease, for exam le, rior to the recognition of HIV, only one case of Pneumocystis neumonia not clearly associated with immune su ression was diagnosed in the <nited 0tates between )anuary %5BA and )une %5+6. In %5+% alone, :2 similar diagnoses were made, and by &ecember %55:, %2B,A2A cases of Pneumocystis neumonia with HIV infection as the only identified cause of immune su ression had been re orted to the "enters for &isease "ontrol and (revention ("&"). 3lso, .a osi sarcoma is u to 96,666 times more li-ely to develo in ersons with HIV infection than in immunocom etent ersons. The s read of HIV was retros ectively shown to follow the truc-ing routes across 3frica from logging cam s, and the bush-meat trade combined with aggressive logging and im roved trans ortation in the mid-26th century may have allowed what was li-ely occasional crosss ecies transmission events to ro agate across the country and, eventually, the globe./%+1

Stigma of HIV infection

3 considerable amount of stigma has been attached to HIV infection, mostly because of the virusCs association with sexual ac8uisition and the inference of sexual romiscuity. "onse8uences of this stigma have included discrimination and reluctance to be tested for HIV infection. The stigma of HIV infection is also associated with a fear of ac8uiring a ra idly fatal infection from relatively casual contact. 0uch attitudes are ina ro riate because HIV is oorly transmissible without sexual contact or blood contact. In addition, the ex ected survival is long in atients with HIV infection who are receiving treatment. HIV is not transmitted during casual contact and is readily inactivated by sim le detergents. !uch of the concern regarding HIV infection is due to the incurability of the infection and the relentless immune decline and eventual remature death in the vast maDority of infected eo le.

AIDS denialism
3 small but vocal minority of eo le, including some scientists, continue to argue that HIV does not exist, or does not cause 3I&0, and that the HIV tests are unreliable or that the thera ies are toxic. 0uch misinformation is usually based on a lac- of understanding of the scientific literature, deliberate misre resentation, or logical fallacies based on seudoscientific arguments.

3ll of the arguments ro osed by these dissenters have been addressed and rebutted in the scientific literature and ublic discussion and even tested and reDected in the legal system. =evertheless, they ersist, and such views can have extremely harmful effects on eo le who are ex osed to HIV infection unnecessarily or who refuse treatment for their rogressing infection. "linicians should be aware of these issues, should be able and willing to address misinformation, and should direct their atients to reliable sources of information. (olitical denial and inaction have also li-ely caused considerable damage. 0everal governments in countries with high HIV infection rates were slow to admit that they had an HIV e idemic, and at least one (0outh 3frica) initially reDected that 3I&0 was even a roblem, then that the disease was caused by HIV infection, and, most recently, that antiretroviral thera y was effective in treating HIV infection and reventing !T"T. "hanges have now occurred but have been slow and have cost hundreds of thousands of lives. 3 regularly u dated reference for addressing 3I&0 denial and misinformation can be found at 3I&0Truth.org.

The quest for understanding of HIV

0ince the discovery of HIV and its lin- to 3I&0, great strides have been made in understanding its biology and in develo ing effective treatments. The difficulty in dealing with HIV on a global scale is largely due to the fact that HIV infection is far more common in resource- oor countries. In the develo ed world, antiretroviral thera y has greatly im roved rognosis and increased survival rates. (ublic education rograms have raised awareness such that testing and revention of infection are more common. *oth of these a roaches are difficult in countries with undereducated or underfunded o ulations. 3 thorough discussion of the history of 3I&0 and the biologic lin- between HIV and 3I&0 can be found in an article entitled E The relationshi between the human immunodeficiency virus and the ac8uired immunodeficiency syndrome E at the =ational Institute of 3llergy and Infectious &iseases Feb site. The document was originally written in 0e tember %55@, rior to the advent of highly active antiretroviral thera y (H33GT), which has significantly im roved 3I&0-free survival in ersons infected with HIV. This version was u dated !arch 26%6.

Patient confidentiality
HIV-related health information is ty ically considered se arate from other health information and may re8uire se arate consent to share or divulge. Health care wor-ers who are infected with HIV may be re8uired to divulge their status to their em loyer or atients and may be restricted in the ty es of rocedures they can erform.

Pathophysiology
HIV roduces cellular immune deficiency characteri4ed by the de letion of hel er T lym hocytes ("&:H cells). The loss of "&:H cells results in the develo ment of o ortunistic infections and neo lastic rocesses.

Virology of HIV
HIV-% and HIV-2 are retroviruses in the Getroviridae family, Lentivirus genus. They are envelo ed, di loid, single-stranded, ositive-sense G=3 viruses with a &=3 intermediate, which is an integrated viral genome (a rovirus) that ersists within the host-cell &=3. HIV contains 9 s ecies-defining retroviral genes? gag, pol, and env. The gag gene encodes grou -s ecific antigen, the inner structural roteins. The pol gene encodes olymerase, it also contains integrase and rotease (the viral en4ymes) and is roduced as a "-terminal extension of the 7ag rotein). The env gene encodes the viral envelo eIthe outer structural roteins res onsible for cell-ty e s ecificity. 7lyco rotein %26, the viral-envelo e rotein, binds to the host "&:H molecule. HIV-% has A additional accessory genes? tat, rev, nef, vif, vpu, and vpr. HIV-2 does not have vpu but instead has the uni8ue gene vpx. The only other virus -nown to contain the vpu gene is simian immunodeficiency virus in chim an4ees (0IVc 4), which is the simian e8uivalent of HIV. /51 Interestingly, chim an4ees with active HIV-% infection are resistant to disease./%51 The accessory roteins of HIV-% and HIV-2 are involved in viral re lication and may lay a role in the disease rocess./26, 2%1 The outer art of the genome consists of long terminal re eats (JTGs) that contain se8uences necessary for gene transcri tion and s licing, viral ac-aging of genomic G=3, and dimeri4ation se8uences to ensure that 2 G=3 genomes are ac-aged. (0ee the image below.)

Genome layout of human immunodeficiency virus (HIV)1 and HIV-2.

The dimeri4ation, ac-aging, and gene-transcri tion rocesses are intimately lin-ed, disru tion in one rocess often subse8uently affects another. The JTGs exist only in the roviral &=3 genome, the viral G=3 genome contains only art of each JTG, and the com lete JTGs are recreated during the reverse-transcri tion rocess rior to integration into the host &=3.

The biologic basis for AIDS

The s ecific details of the disease rocess that leads to 3I&0 are not fully understood des ite considerable rogress in the virology of HIV and the immunology of the human host, much of which has been driven by the urge to better understand 3I&0./22, 29, 2:1 There is a s ecific decline in the "&:H hel er T cells, resulting in inversion of the normal "&:'"&+ T-cell ratio and dysregulation of *-cell antibody roduction./2@, 2A1 Immune res onses to certain antigens begin to decline, and the host fails to ade8uately res ond to o ortunistic infections and normally harmless commensal organisms. *ecause the defect referentially affects cellular immunity, the infections tend to be nonbacterial (fungal, viral). The attern of o ortunistic infections in a geogra hic region reflects the athogens that are common in that area. ;or exam le, ersons with 3I&0 in the <nited 0tates tend to resent with commensal organisms such as Pneumocystis and Candida s ecies, homosexual men are more li-ely to develo .a osi sarcoma because of co-infection with HHV+, and tuberculosis is common in develo ing countries. 7ut-associated lym hoid tissue (73JT) lays a role in HIV re lication./2B1 3lthough the ortal of entry for HIV infection is ty ically through direct blood inoculation or ex osure of the virus to genital mucosal surfaces, the 7I tract contains a large amount of lym hoid tissue, ma-ing this an ideal site for HIV re lication. 73JT has been shown to be a site of early viral seeding and establishment of the roviral reservoir. This reservoir contributes to the difficulty of controlling the infection, and efforts to reduce the levels of HIV rovirus through sustained antiretroviral thera y (alone or in combination with interleu-in-2 activation of resting HIV-infected T cells) have consistently failed./2+1 3 feature of HIV re lication in 73JT is that it is com artmentali4ed, even among different areas of the gut./251 !easurements of "&:H T cells in 73JT show relatively less reconstitution with antiretroviral thera y than that observed in eri heral blood./96, 9%1 3t least one re ort has suggested that early treatment may result in better 73JT "&:H T-cell recovery/9%1 , but clinical data generally argue against early initiation of thera y, which has not been shown to im rove long-term survival. In addition, HIV re lication can be detected even in atients with su osedly su ressed re lication, as Dudged by lasma viral load measurements. "&+H -iller T-cell res onses to HIV occur in 73JT and do not decline with antiviral thera y as much as eri heral measurements do./921 These findings underscore the limitations of eri heral measurements in what is really a central viral re lication. Kne theory for the discre ancy between 73JT and blood measurements is that ongoing viral re lication in the lym hoid tissue, and the resulting immune activation, may actually ham er efficient "&:H T-cell re lenishment./991 0tudies of T-cell$re lication -inetics have revealed that untreated HIV infection is characteri4ed by ra id T-cell turnover but a defect in T-cell re lication from the thymus./9:, 9@, 9A1 These changes

can be reversed with effective long-term antiviral thera y,/9B, 9+1 suggesting that they are due to a direct effect of the virus or are a feature of the immune res onse against HIV. It is -nown that normal cell cycling is necessary to roduce a normal cyto-ine rofile/951 and that HIV causes cell-cycle arrest./:61 Fhether this is the exact mechanism is unresolved, however. 3nalysis of cyto-ine levels in HIV infected, uninfected, and H33GT-treated atients with HIV show that cyto-ines involved in T-cell homeostasis were definitely affected, and thera y artially corrected these defects. In articular there was decreased IJ-B, IJ-%2, IJ-%@ and ;7;-2, and increased T=;-al ha and I(-%6./:%, :21 0everal of the HIV roteins directly affect T-cell function, either by disru ting cell cycling or down-regulating the "&: molecule. The loss of T cells is clearly a rimary issue, as the T-cell re ertoire narrows in terms of which antigens the immune system will recogni4e and res ond to. 3ntiviral thera y is able to reverse these changes,/:91 but the degree of reversal is decreased if thera y is initiated very late in the infection and is further decreased when thera y is initiated when "&: T-cell counts are 266'LJ and below. &irect cytotoxic effects of viral re lication are li-ely not the rimary cause of "&: T-cell loss, a significant bystander effect/::1 is li-ely secondary to T-cell a o tosis as art of immune hy eractivation in res onse to the chronic infection. Infected cells may also be affected by the immune attac-. Kne interesting issue is that the co-rece tor usage of the virus strains tends to change over time. The initial infection nearly always involves a strain that uses the chemo-ine rece tor @ (""G@), which is found on macro hages and dendritic cells, as a co-rece tor with "&:. (eo le who are homo4ygous for deletions in the CCR5 gene (ie, ""G@-delta92) tend to be resistant to infection, /:@, :A1 and those with hetero4ygosity for the olymor hism tend to show slower rogression of disease./:B1 Kver time, the rece tor usage shifts to chemo-ine-related rece tor ("M"G:) and other related rece tors found on "&:H T cells. These virus strains are more li-ely to cause cell fusion (syncytia formation). This trend is far from absolute but does correlate in many eo le with disease rogression./:+1 3 single case re ort detailed a ossible cure resulting from stem-cell trans lantation from a ""G@-delta92 homo4ygous donor ( erformed to treat acute myelocytic leu-emia). 3lthough this im ortant finding is unli-ely to im act routine management of HIV infection, it does suggest that reconstitution of a host immune system with a o ulation of mutant cells is a ossible avenue of research to ex lore./:51 Gegardless of the cause for the disru tion, a loss of thymic re lacements in the face of an induced state of immune activation and T-cell loss seems to be a -ey com onent of the mechanism by which HIV narrows the T-cell re ertoire and rogresses to 3I&0./@6, @%, @21 Visible effects of HIV infection come in the form of disru ted lym h-node architecture. This disru tion is tem oral, and, at one oint, lym h-node bio sy was considered as a form of staging

the disease./@9, @:1 The disru tion of the follicular dendritic networ- in the lym h nodes and subse8uent failure of normal antigen resentation are li-ely contributors to the disease rocess. HIV re licates in activated T cells (its romotor contains a nuclear factor -a a * /=;--a a*1$binding region, the same rotein that romotes other roteins in activated T cells and macro hages), and activated T cells migrate to the lym h nodes. 3s such, much of the viral re lication occurs outside of the eri heral blood, even though serum viral load is still a useful surrogate mar-er of viral re lication. 3s mentioned above, with regards to 73JT, HIV infection may be com artmentali4ed, s ecifically, areas of immune- rivilege may occur such as in the testes and central nervous system where not only will there be differences in HIV seudos ecies but also different degrees of antiretroviral drug enetration. There is evidence that even with good eri heral control of HIV, the virus may still be detectable in the "0; and semen of some infected atients./@@, @A1

Phases of HIV infection

"linical HIV infection undergoes 9 distinct hases? acute seroconversion, asym tomatic infection, and 3I&0. #ach is discussed below. (0ee the image below.)

Timeline of C ! T-cell and viral-load chan"es over time in untreated human immunodeficiency virus (HIV) infection. #rom $i%i&edia' (ased on an ori"inal from )antaleo et al (1**+).

Acute seroconversion 3nimal models show that Jangerhans cells are the first cellular targets of HIV, which fuse with "&:H lym hocytes and s read into dee er tissues. In humans, ra id occurrence of lasma viremia with wides read dissemination of the virus is observed :-%% days after mucosal entrance of the virus. There is no fixed site of integration, but the virus tends to integrate in areas of active transcri tion, robably because these areas have more o en chromatin and more easily accessible &=3./@B, @+1 This greatly com licates eradication of the virus by the host, as latent roviral genomes can ersist without being detected by the immune system and cannot be targeted by antivirals. 0ee the image below. &uring this hase, the infection is established and a roviral reservoir is created./@5, A61 This reservoir consists of ersistently infected cells, ty ically macro hages, and a ears to steadily release virus. 0ome of the viral release re lenishes the reservoir, and some goes on to roduce more active infection.

The roviral reservoir, as measured by &=3 olymerase chain reaction (("G), seems to be incredibly stable. 3lthough it does decline with aggressive antiviral thera y, the half-life is such that eradication is not a viable ex ectation. The si4e of the roviral reservoir correlates to the steady-state viral load and is inversely correlated to the anti-HIV "&+H T-cell res onses. 3ggressive early treatment of acute infection may lower the roviral load, but generally, treatment in newly infected (but ostseroconversion) atients yields no long-term benefit. 3t this oint, the viral load is ty ically very high, and the "&:H T-cell count dro s reci itously. Fith the a earance of anti-HIV antibodies and "&+H T-cell res onses, the viral load dro s to a steady state and the "&:H T-cell count returns to levels within the reference range, although slightly lower than before infection. 0eroconversion may ta-e a few wee-s, u to several months. 0ym toms during this time may include fever, fluli-e illness, lym hadeno athy, and rash. These manifestations develo in a roximately half of all eo le infected with HIV. Asymptomatic HIV infection 3t this stage in the infection, ersons infected with HIV exhibit few or no signs or sym toms for a few years to a decade or more. Viral re lication is clearly ongoing during this time,/A%1 and the immune res onse against the virus is effective and vigorous. In some atients, ersistent generali4ed lym hadeno athy is an outward sign of infection. &uring this time, the viral load, if untreated, tends to ersist at a relatively steady state, but the "&:H T-cell count steadily declines. This rate of decline is related to, but not easily redicted by, the steady-state viral load. =o firm evidence has shown that the initiation of thera y early in the asym tomatic eriod is effective. However, very late initiation is -nown to result in a less effective res onse to thera y and a lower level of immune reconstitution. AI ! Fhen the immune system is damaged enough that significant o ortunistic infections begin to develo , the erson is considered to have 3I&0. ;or surveillance ur oses in the <nited 0tates, a "&:H T-cell count less than 266'LJ is also used as a measure to diagnose 3I&0, although some o ortunistic infections develo when "&:H T-cell counts are higher than 266'LJ, and some eo le with "&: counts under 266'LJ may remain relatively healthy. !any o ortunistic infections and conditions are used to mar- when HIV infection has rogressed to 3I&0. The general fre8uency of these infections and conditions varies from rare to common, but all are uncommon or mild in immunocom etent ersons. Fhen one of these is unusually severe or fre8uent in a erson infected with HIV and no other causes for immune su ression can be found, 3I&0 can be diagnosed./B1

Immunologic control of HIV

The rimary mechanism for immunologic control of HIV a ears to be "&+H cytotoxic T-cells. T-cell res onses are correlated with the steady-state viral load and hence, the rate of rogression. /A21 "ellular immunity is a arently res onsible for some multi ly-ex osed, but uninfected individuals./A9, A:1 3lthough antibodies against HIV can be detected, it is clear that they are not sufficiently neutrali4ing to assist with immunologic control of the infection. The role of =. (=atural .iller) cells may be im ortant in the initial control of HIV. #sca e mutations have been detected, im lying that immunologic ressure on HIV exists from =. cells.
/A@1

Opportunistic infections and conditions

#ven after starting thera y and with effective su ression of viral load, atients with ersistently low "&: counts remain at high ris- for o ortunistic infections. In general, all atients remain at a relatively high ris- for o ortunistic infections and other 3I&0-related events for the first A months of antiretroviral thera y./AA1 3n observational study of 26,B96 HIV atients in <ganda found that, among atients with more than six months of follow-u after the initiation of antiretroviral thera y, the re-thera y "&: count was still redictive of mortality. /AB1 K ortunistic infections and conditions include the following ( * added in the %559 3I&0 surveillance case definition)?

Candidiasis of (ronchi' trachea' or lun"s Candidiasis' eso&ha"eal Cervical cancer' invasive, Coccidioidomycosis' disseminated or e-tra&ulmonary Cry&tococcosis' e-tra&ulmonary Cry&tos&oridiosis' chronic intestinal (duration .1 mo) Cytome"alovirus disease (other than liver' s&leen' or nodes) Cytome"alovirus retinitis (/ith vision loss) 0nce&halo&athy' HIV-related Her&es sim&le-1 chronic ulcer or ulcers (duration .1 mo) or (ronchitis' &neumonitis' or eso&ha"itis Histo&lasmosis' disseminated or e-tra&ulmonary Isos&oriasis' chronic intestinal (duration .1 mo) 2a&osi sarcoma

3ym&homa' 4ur%itt (or e5uivalent term) 3ym&homa' immuno(lastic (or e5uivalent term) 3ym&homa' &rimary' of the (rain Mycobacterium avium com&le- or Mycobacterium kansasii infection' disseminated or e-tra&ulmonary M tuberculosis infection' any site (&ulmonary, or e-tra&ulmonary) Mycobacterium infection /ith other s&ecies or unidentified s&ecies' disseminated or e-tra&ulmonary Pneumocystis &neumonia )neumonia' recurrent, )ro"ressive multifocal leu%oence&halo&athy Salmonella se&ticemia' recurrent To-o&lasmosis of the (rain $astin" syndrome due to HIV infection

3lthough malaria is not ty ically considered an o ortunistic infection, its incidence was found to be significantly higher among children in Tan4ania that were erinatally infected with HIV than those without HIV infection./A+1 This was true for hysician-diagnosed clinical malaria, robable malaria involving laboratory testing for arasitemia as well as malaria that was confirmed by blood smear. There also a ears to be an increased rate of anal cancer in high-ris- grou s (in articular, men who have sex with men). This is unsur rising considering the lin- between anal cancer and human a illomavirus (H(V), and the fact that cervical cancer, also caused by H(V, is considered an 3I&0-defining condition./A51 HIV #nce halo athy is a severe condition usually seen in end-stage disease. !ilder cognitive im airments may exist with less advanced disease. ;or exam le, one study found significant deficits in cognition, lanning, coordination and reaction times in HIV-infected com ared to uninfected children, effects that were more ronounced in those with higher viral loads.
0tiolo"y HIV disease is caused (y infection /ith HIV-1 or HIV-2' (oth of /hich cause very similar conditions. They differ in transmission and &ro"ression ris%s.

Epidemiology
nited States statistics

3ccording to the "enters for &isease "ontrol and (revention ("&"), in 2665 the estimated rate of diagnoses of HIV infection in the :6 states that have confidential name-based re orting was %B.: er %66,666 o ulation. ;rom 266A to 2665, the estimated number and rate of annual diagnoses of HIV infection in those states remained stable./B%1 The "&" estimated that at the end of 266A, the most recent year for which national revalence estimates are available, there were %,%6A,:66 adults and adolescents living with HIV infection in the <nited 0tates. This re resents an increase of a roximately %%N from the revious estimate in 2669, the increase may reflect a higher ro ortion of HIV-infected eo le -nowing their status and see-ing care, and'or increased survival among eo le infected with HIV./B%1 In 2665, the estimated rate of 3I&0 diagnoses in the <0 was %%.2 er %66,666 o ulation./B%1 !ore than % million ersons were diagnosed with 3I&0 from %5+% to 266+, and more than A66,666 eo le died with 3I&0 (although re orting limitations mean that not every Edeath with 3I&0E is directly attributable to 3I&0 itself). <0 rates vary by state. 0ee the latest "&" surveillance re ort for full details. The overall figures may give a false im ression that the HIV e idemic is relatively homogeneous. In fact, the HIV e idemic is best viewed as numerous se arate e idemics among distinct ris- grou s, although the various e idemics clearly have some level of overla . In any given area, the infection may be most revalent among users of intravenous drugs who share needles. In another, the main ris- grou may be men who have sex with other men. 3nd in yet another, the main ris- grou may be female sex wor-ers. These sub-e idemics each follow their own attern, although there is some degree of interde endence. #arly on, nearly all cases of HIV infection detected in the Festern Hemis here were in homosexual men, but the s read of the disease to female artners of bisexual men with HIV infection gave rise to an increased rate among heterosexual ersons. "ontributing to the increased cross- revalence were ersons with hemo hilia who had been infected with HIV from contaminated factor VIII concentrate and ersons who used intravenous drugs, an activity that transcends all sexual references. "urrently, less than half of new HIV infections are re orted in homosexual men, and infected heterosexual women outnumber infected heterosexual men nearly two to one./B%1 (0ee the image below.)

Incidence of HIV infection (y ris% "rou&. #rom the C C $e( site (co&yri"ht free) derived from the revised 2667 estimated fi"ures.

Kne community-based study targeting areas where men who have sex with men (!0!) meet demonstrated that an average of ::N of study artici ants a eared unaware of their HIVositive status. High rates of ositivity and unawareness of ositive status were associated with younger artici ants, men of blac- non-His anic race, and lower education levels. Healthcare visits in the receding year were associated with a lower rate of unawareness (9BN vs +%N) but a higher rate of HIV- ositivity (2%N vs %2N). *ecause this study targeted a high-risgrou and may involve artici ation bias, the overall rate of HIV infection (%5N) cannot be easily extra olated to the overall o ulation./B21 !ortality from HIV disease has not been among the %@ leading causes of death in the <0 since %55B. The age-adDusted death rate for HIV disease ea-ed in %55@ at %A.9 er %66,666 o ulation, decreased A5.5N through %55+, then further decreased 96.2N from %555 through 266B, to 9.B er %66,666 o ulation. In 266B, a total of %%,25@ ersons died from HIV disease. However, HIV disease has remained among the @ leading causes of death for s ecific age grou s for females, and in the blac- o ulation./B91 Adolescents and young adults "&" HIV surveillance statistics from 26%6 re ort that 2@.BN (O%2,266 individuals) of new HIV infections in the <nited 0tates are in adolescents and young adults aged %9 to 2: years. !ales accounted for +2.+N of new HIV infections in youth. Kf these, B666 (@B.:N) were in 3frican 3mericans, 2956 (%5.AN) in His anics, and 29+6 (%5.@N) in whites. !ale-to-male sexual contact accounted for B2.%N (++66 individuals). The ercentage of youths tested for HIV infection was %2.5N in high- school students and 9:.@N in individuals aged %+-2: years. Testing was lower in males than females. !ore than half (@5.@N) of youths with HIV are unaware of their infection./B:1

International statistics
3ccording to the )oint <nited =ations (rogramme on HIV'3I&0 (<=3I&0),/B@1 worldwide in 266+ a roximately 99.: million eo le (%N of the global adult o ulation aged %@-:5 y) were infected with HIV, a decline from 266A (95.@ million re orted at that time). <=3I&0 estimates that 2.B million eo le were newly infected with HIV and that 2 million eo le died from 3I&0 in 266+, both statistics showing a slight decline over time. The vast maDority of infections remain in sub-0aharan 3frica, where @.2N of the o ulation is thought to be infected. *etween 266: and 266A, the revalence of HIV infection in central and eastern 3sia and #astern #uro e increased by 2%N. &uring this eriod, the number of new HIV infections in ersons aged %@ to A: years rose by B6N in #astern #uro e and central 3sia. The infection rates in many develo ed countries remain stable, and some develo ing countries have achieved significant gains in controlling and even reversing the effects of the HIV e idemic. However, this is artially due to deaths in HIV-infected eo le, together with simultaneous revention of new infections. India, for exam le, has used a national revention cam aign focusing on high-ris- o ulations that may have revented %66,666 new HIV

infections over the @ years it has been im lemented, with increasing results seen in areas with higher levels of investment./BA1 These figures together show that global HIV infection is in a state of flux. The mortality rate in some countries has greatly increased. In 0outh 3frica (a country that, des ite having a relatively late-onset HIV e idemic, has develo ed one of the highest revalence rates), the all-cause HIV-associated mortality rate increased by B5N between %55B and 266:. In women aged 2@-9: years, mortality rates increased by @66N during this eriod. 0wa4iland has the highest overall revalence of HIV infection (P2AN of all adults based on 266B figures). The !inistry of Health in Qambia redicts that, without thera y and assuming current levels of revalence, young adults have a @6N lifetime ris- of dying from 3I&0. In develo ing nations, co-infection with HIV and tuberculosis is very common. The immunosu ressed state induced by HIV infection contributes not only to a higher rate of tuberculosis reactivation but also to an increased disease severity, as with many other o ortunistic infections. ;urther details of the global e idemic can be found in the )oint <nited =ations (rogramme on HIV'3I&0 2665 # idemic < date.

!acial" se#ual" and age$related differences in incidence

In the <nited 0tates, the rate of HIV infection is highest in blac-s (+9.B cases er %66,666 o ulation). The revalence is also high among His anic ersons (25.9 er %66,666 o ulation). These increased rates are due to socioeconomic factors rather than genetic redis osition. In the develo ed world, HIV infection is much more common in males. In 2665, males accounted for BAN of all diagnoses of HIV infection among adults and adolescents in the <0./B%1 3mong heterosexuals, females are more li-ely to ac8uire HIV infection from an infected male than a male is from an infected female, but a large ro ortion of infections in males are due to homosexual contact, with or without inDection drug use. !ales are also more li-ely to ac8uire HIV infection from inDection drug use alone. !ales were also more li-ely to ac8uire HIV infection through contaminated blood roducts for treatment of hemo hilia before universal testing of the blood su ly was instituted. The ris- of HIV ex osure from factor VIII concentrates has been virtually eliminated by viricidal treatment of lasma-derived factor VIII concentrates, as well as the introduction of recombinant factor VIII concentrates and the gradual elimination of albumin from the roduction rocess used for these roducts. In the develo ing world, HIV infection is e8ually common in males and females. The rimary route of HIV transmission in the develo ing world is heterosexual contact.

>oung adults tend to be at higher ris- of ac8uiring HIV, ty ically through high-ris- activities such as un rotected sexual intercourse or intravenous drug use. In 2665 in the <0, the largest ercentage (%@N of all diagnoses) and the highest rate (9A.5 er %66,666 o ulation) were in ersons aged 26$2: years./B%1 "hildren may become infected by trans lacental transmission or by breastfeeding. Gare cases of children infected after sexual abuse by HIV-infected adults have also been re orted.

Prognosis
The rognosis in atients with untreated HIV infection is oor, with an overall mortality rate of more than 56N. The average time from infection to death is +-%6 years, although individual variability ranges from less than % year to long-term non rogression. !any variables have been im licated in HIVCs rate of rogression, including ""G@-delta92 hetero4ygosity, mental health, /BB1 concomitant drug or alcohol abuse, su erinfection with another HIV strain, nutrition, and age. There is less evidence that treatment of HIV-2 infection slows rogression, and certain antiretroviral medications (s ecifically the non-nucleoside$analogue reverse-transcri tase inhibitors) are not effective against HIV-2. The HIV-% viral-load assays are much less reliable at 8uantifying HIV-2, if they wor- at all. HIV-2 viral load assays have been develo ed, but none has been a roved by the <0 ;ood and &rug 3dministration exce t as blood donor$screening tools. Knce infection has rogressed to 3I&0, the survival eriod is usually less than 2 years in untreated atients. (ersons in whom the infection does not rogress long-term may not develo 3I&0 for %@ years or longer, although many still exhibit laboratory evidence of "&: T-cell decline or dysfunction./B+, B5, +6, +%1 The a ro riate use of combination antiretroviral thera ies and ro hylaxis for o ortunistic infections dramatically im roves survival and greatly decreases the ris- of secondary o ortunistic infections./+2, +9, +:1 The ris- of 3I&0-associated lym homa is not altered by antiviral thera y and, as such, has grown in revalence among overall 3I&0-defining conditions. 0ac-off et al found that between %555 and 266:, the HIV-related mortality rate in =ew >or"ity decreased each year by a roximately @6 deaths er %6,666 eo le with 3I&0. The rate of non$HIV-related deaths also showed a decline, more modest but consistent, with about B.@ fewer deaths er %6,666 eo le with 3I&0 er year./+91 Im ortantly, many researchers have consistently shown that the rimary ris- factor for infection affects mortality. ;or exam le, the mortality rate among intravenous drug users tends to be higher, whether related to HIV disease or non-HIV disease. Kverall, with the increasing use of antiretroviral thera y and the introduction of better antiviral regimens, survival with HIV infection has increased over time, although it is not yet e8uivalent to that in uninfected individuals. (0ee the image below.)

Chan"es in survival of &eo&le infected /ith HIV. 8s thera&ies have (ecome more a""ressive' they have (een more effective' althou"h survival /ith HIV infection is not yet e5uivalent to that in uninfected &eo&le. 9odified from an ori"inal &u(lished (y 3ohse et al (266:)' ;<urvival of &ersons /ith and /ithout HIV infection in enmar%' 1**=-266=.;

In addition to the concern for new o ortunistic infections, re-existing infections can reactivate and cause significant disease in eo le with 3I&0. The most im ortant exam le on a global scale is that of tuberculosis, as reactivated tuberculosis can cause sym tomatic disease with lower levels of reactivation. Kther im ortant athogens include cytomegalovirus, (which causes retinitis, neumonitis, and colitis) and Pneumocystis "iroveci (formerly -nown as Pneumocystis carinii, the causative organism in Pneumocystis neumonia). In immunocom etent hosts, these organisms are generally non athogenic, and asym tomatic infection is common (and in the case of cytomegalovirus infection, life-long). 3ntiviral medications are associated with adverse effects and thus contribute to atient morbidity and mortality rates, es ecially because of the growing o ulation of long-term survivors who are receiving combination antiviral thera y. In articular, rotease inhibitors may cause li id- rofile abnormalities.

Patient Education
(atients with HIV infection should be counseled about the ris-s of infecting their sexual artners with HIV. 0afer sex ractices and treatment of concurrent sexually transmitted diseases, both in the atient and in sexual artners, considerably reduces the ris- of transmission. (atients with HIV infection should be encouraged to inform their sexual artners of their status, failure to do so has resulted in successful rosecutions in several countries. 0exual contacts should be tested. 0ome HIV-infected eo le actively see- out other ersons with HIV infection for sex under the assum tion that they are not utting themselves or anyone else at an increased ris-. However, it is clear that co-infections with multi le HIV strains (whether the same or different clades) can and do occur, and that such events may result in a ra id deterioration of a reviously stable infection. 3 growing number of new infections are drug resistant u on first resentation, suggesting that these infections were transmitted from individuals receiving thera y. Higher viral loads in the source artner are associated with higher transmission rates, thus, because barrier contrace tion is im erfect (although by far the best method to revent sexual transmission), good control of viral load is im ortant.

Intravenous drug users should be counseled on the ris-s of sharing intravenous drug ara hernalia. ;or atient education information, see the Immune 0ystem "enter and 0exually Transmitted &iseases "enter, as well as HIV'3I&0 and Ga id Kral HIV Test.

History
The history should be carefully ta-en to elicit ossible ex osures to human immunodeficiency virus (HIV). Gis- factors include the following?

>n&rotected se-ual intercourse' es&ecially rece&tive anal intercourse (?-fold hi"her ris% of transmission) 8 lar"e num(er of se-ual &artners )rior or current se-ually transmitted diseases (<T s)1 Gonorrhea and chlamydia infections increase the HIV transmission ris% +-fold' sy&hilis raises the transmission ris% :-fold' and her&es "enitalis raises the transmission ris% u& to 2=-fold durin" an out(rea% <harin" of intravenous dru" &ara&hernalia @ecei&t of (lood &roducts ((efore 1*?= in the >nited <tates) 9ucosal contact /ith infected (lood or needle-stic% inAuries 9aternal HIV infection (for ne/(orns' infants' and children)1 <te&s ta%en to reduce the ris% of transmission at (irth include cesarean delivery and &renatal antiretroviral thera&y in the mother and antiretroviral thera&y in the ne/(orn immediately after (irth.

The atient may resent with signs and sym toms of any of the stages of HIV infection. 3cute seroconversion manifests as a fluli-e illness, consisting of fever, malaise, and a generali4ed rash. The asym tomatic hase is generally benign. 7enerali4ed lym hadeno athy is common and may be a resenting sym tom. 3I&0 manifests as recurrent, severe, and occasionally life-threatening infections and'or o ortunistic malignancies. The signs and sym toms are those of the resenting illness, meaning that HIV infection should be sus ected as an underlying illness when unusual infections resent in a arently healthy individuals. HIV infection itself does cause some se8uelae, including 3I&0-associated dementia'ence halo athy and HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause). =o hysical findings are s ecific to HIV infection. The hysical findings are those of the resenting infection or illness. 7enerali4ed lym hadeno athy is common. Feight loss may be a arent.

#vidence for ris- factors or minor concurrent o ortunistic infections (eg, her etic lesions on the groin, wides read oral candidiasis) may be clues to HIV infection.

Medication Summary
#ffective antiretroviral thera y is the most im ortant intervention in terms of im roving longevity and reventing o ortunistic infections in atients with human immunodeficiency virus (HIV) infection. Thera y should involve combinations of drugsItwo nucleoside-analogue reverse-transcri tase inhibitors combined with either a rotease inhibitor or a non-nucleoside$ analogue reverse-transcri tase inhibitor./A, %2+1 3ntiretroviral drug classes and agents within each class are listed in Table %, below (see individual medication tables for more detail). 3s of 3ugust 26%2, a total of 2B antiretroviral drugs have been a roved for use in HIV-infected adults and adolescents, %: of these have an a roved ediatric treatment indication and %9 are available as a ediatric formulation or ca sule si4e. Kf the 2B antiretroviral drugs that have been a roved, 9 are no longer being manufactured either because of the develo ment of im roved formulations (ie, am renavir re laced by fosam renavir) or because of limited use (ie, delavirdine and 4alcitabine /dd"1). Human immunodeficiency virus, or HIV, is the virus that causes ac8uired immune deficiency syndrome (3I&0). The virus wea-ens a ersonCs ability to fight infections and cancer. (eo le with HIV are said to have 3I&0 when they develo certain infections or cancers or when their "&: (T-cell) count is less than 266. "&: count is determined by a blood test in a doctorCs office. Having HIV does not always mean that you have 3I&0. It can ta-e many years for eo le with the virus to develo 3I&0. HIV and 3I&0 cannot be cured. However with the medications available today, it is ossible to have a normal lifes an with little or minimal interru tion in 8uality of life. There are ways to hel eo le stay healthy and live longer. %% &illion People 'o( )i*e +ith HIV, Ho( Did +e -et Here.

Ho( Does HIV and AIDS /ause Illness.

HIV attac-s and destroys a ty e of white blood cell called a "&: cell, commonly called the Tcell. This cellCs main function is to fight disease. Fhen a ersonCs "&: cell count gets low, they are more susce tible to illnesses.

+hat Is AIDS.
3I&0 is the more advanced stage of HIV infection. Fhen the immune system "&: cells dro to a very low level, a ersonCs ability to fight infection is lost. In addition, there are several conditions that occur in eo le with HIV infection with this degree of immune system failure -these are called 3I&0-defining illnesses.

3ccording to the "&", %,6@%,+B@ eo le in the <.0. have been diagnosed with 3I&0 since the disease was first diagnosed in %5+%. They also estimate that @+9,25+ have died from the disease in the <.0.

Ho( Do People -et HIV.

3 erson gets HIV when an infected ersonCs body fluids (blood, semen, fluids from the vagina or breast mil-) enter his or her bloodstream. The virus can enter the blood through linings in the mouth, anus, or sex organs (the enis and vagina), or through bro-en s-in. *oth men and women can s read HIV. 3 erson with HIV can feel K. and still give the virus to others. (regnant women with HIV also can give the virus to their babies. Common ways people get HIV:

0haring a needle to ta-e drugs. Having un rotected sex with an infected erson.

You cannot get HIV from:

Touching or hugging someone who has HIV'3I&0. (ublic bathrooms or swimming ools. 0haring cu s, utensils, or tele hones with someone who has HIV'3I&0. *ug bites.

3nyone can get HIV if they engage in certain activities. >ou may have a higher ris- of getting HIV if you?

Ha*e unprotected se#, This means vaginal or anal intercourse without a condom or oral sex without a latex barrier with a erson infected with HIV. Share needles to inDect drugs or steroids with an infected erson. The disease can also be transmitted by dirty needles used to ma-e a tattoo or in body iercing. !ecei*e a blood transfusion from an infected erson. This is very unli-ely in the <.0. and Festern #uro e, where all blood is tested for HIV infection. Are born to a mother (ith HIV infection. 3 baby can also get HIV from the breast mil- of an infected woman.

If you fall into any of the categories above, you should consider being tested for HIV. Health care wor-ers are at ris- on the Dob and should ta-e s ecial recautions. 0ome health care wor-ers have become infected after being stuc- with needles containing HIV-infected blood or less fre8uently, after infected blood comes into contact with an o en cut or through s lashes into the wor-erCs eyes or inside their nose.

HIV Tests
The only way to -now if you have HIV is to ta-e an HIV test. !ost tests loo-s for signs of HIV in your blood. 3 small sam le of blood is ta-en from your arm. The blood is sent to a lab and tested for HIV. "linics that do HIV tests -ee your test results secret. 0ome clinics even erform HIV tests without ever ta-ing your name (anonymous testing). >ou must go bac- to the clinic to get your results. 3 ositive test means that you have HIV. 3 negative test means that no signs of HIV were found in your blood. Before taking an HIV test:

3s- the clinic what rivacy rules it follows. Thin- about how -nowing you have HIV would change your life. 3s- your doctor or nurse any 8uestions you have about HIV, 3I&0, or the HIV test.

Home HIV test -its are sold online or at your local drugstore. The ;&3 has a roved the Home 3ccess HIV-% Test 0ystem. To use this home test, ric- a finger with a s ecial needle and ut a few dro s of blood on a collection card. Then you mail the card to a lab. In about a wee-, you call a toll-free number to get the results. The whole rocess is anonymous because you use Dust the ersonal identification number in your -it when calling in for results. The KraRuic- In-Home HIV Test is also a roved by the ;&3. This test can detect antibodies of the virus from a saliva sam le. It can rovide results without a laboratory in 26 minutes. 3 ositive result doesnCt mean a definite infection with HIV, but rather that additional testing should be done in a medical setting. 3lso, a negative result doesnCt mean that you are definitely not infected with HIV, articularly when ex osure may have been within the revious three months.

+ho Should 0e Tested for HIV.

Gecently, the "&" changed testing recommendations. 3ll adults should be screened at least once. (eo le who are considered high ris- (needle drug users, multi le sex artners, for exam le) should be tested more often. 3ll regnant women should be tested. 3nyone who has sustained a needle stic- or significant blood ex osure from a erson -nown to have HIV or from an un-nown source should be tested, too.

Does HIV Ha*e Symptoms.

0ome eo le get flu-li-e sym toms within a month after they have been infected. These sym toms often go away within a wee- to a month. 3 erson can have HIV for many years before feeling ill.

3s the disease rogresses, both women and men may ex erience yeast infections on the tongue (thrush), and women may develo severe vaginal yeast infections or elvic inflammatory disease. 0hingles is often seen early on, often before someone is diagnosed with HIV.

+hat Are the Symptoms of AIDS.

0igns that HIV is turning into 3I&0 include?

3 fever that wonCt go away 0weating while you slee ;eeling tired all the time (not from stress or lac- of slee ) ;eeling sic- all the time Josing weight 0wollen glands (nec-, groin, or underarms) Kral thrush

+hat Infections Do People +ith AIDS -et.

(eo le with 3I&0 are extremely vulnerable to infection, called 3I&0-defining illnesses, and often exhibit the following conditions?

.a osiCs sarcoma, a s-in tumor that loo-s li-e dar- or ur le blotches on the s-in or in the mouth !ental changes and headaches caused by fungal infections or tumors in the brain and s inal cord 0hortness of breath and difficulty breathing because of infections of the lungs &ementia 0evere malnutrition "hronic diarrhea

Ho( Is AIDS Diagnosed.

If a erson with HIV infection has a "&: count that dro s below 266 -- or if certain infections a ear (3I&0-defining illnesses) -- that erson is considered to have 3I&0.

Ho( Is HIV Treated.

FeCve come a long way from the days when diagnosis with HIV e8ualed a death sentence. Today, there are a variety of treatments that, when used in combination can significantly slow down and in some cases sto altogether, the rogression of HIV infection. 3fter HIV infection is confirmed, your doctor will start you on a drug regimen consisting of several drugs, combinations of different ty es of anti-HIV drugs sometimes are called H33GT, for highly-active antiretroviral thera y (HIV is a -ind of virus called a retrovirus). Ta-ing H33GT thera y is very manageable yet isnSt necessarily easy. These drugs must be ta-en at the right time, every single day. 3lso, a range of side effects may occur, including? diarrhea, nausea, rash, vivid dreams, or abnormal distribution of body fat. 3nd, es ecially if medications are ta-en incorrectly or inconsistently, the virus can mutate, or change, into a strain resistant to treatment. The good news is that there are now several HIV medications that are only ta-en once a day. If there is resistant virus, however, these may not wor- and other medication o tions must be used. If your disease has rogressed to 3I&0, your treatment may also include drugs to combat and revent certain infections.

Ho( Do I 1no( If the HIV Treatments Are +or2ing.

>our doctor can monitor how well your HIV treatment is wor-ing by measuring the amount of HIV in your blood (also called the viral load.) The goal of treatment is to get the viral load undetectable on labs tests, ideally less than 26 co ies. This does not mean the virus is gone or cured, it means the medication is wor-ing and must be continued.

Ho( /an I 1eep 3rom -etting HIV.

The best way to rotect yourself from HIV is to avoid activities that ut you at ris-. ThereCs no way to tell by loo-ing at someone if he or she has HIV. 3lways rotect yourself.

<se latex condoms (rubbers) whenever you have any ty e of sex (vaginal, anal, or oral). &onCt use condoms made from animal roducts. <se water-based lubricants. Kil-based lubricants can wea-en condoms. =ever share needles to ta-e drugs. 3void getting drun- or high. (eo le who are drun- or high may be less li-ely to rotect themselves.

Ho( /an I Pre*ent HIV 3rom Progressing to AIDS.

>ou can hel rolong your life by ta-ing good care of yourself and develo ing a good relationshi with an ex erienced doctor s eciali4ing in HIV and 3I&0. 3lso, be consistent about ta-ing your HIV medications as rescribed and getting regular lab wor- to catch any roblems early.

+hat Is the Outloo2 for Someone +ith HIV or AIDS.

It de ends on if that erson is on treatment and how the virus res onds to early treatment. Fhen treatment fails to decrease the re lication of the virus, the effects can become life threatening, and the infection can rogress to 3I&0. #ven with treatment, some eo le seem to naturally ex erience a more ra id course towards 3I&0. However, the maDority of HIV atients who receive a ro riate treatment do well and live healthy lives for years. ;or more information contact the "&" =ational 3I&0 Hotline? % (+66) "&"-I=;K (292-:A9A)

+hat Increases 4our !is2

!ost eo le get HIV by having un rotected sex with someone who has HIV. 3nother common way of getting the virus is by sharing needles with someone who is infected with HIV when inDecting drugs. >ou have an increased ris- of becoming infected with HIV through sexual contact if you?

Recommended Related to HIV/AIDS

HIV Viral Joad Testing The HIV viral load is the number of co ies of the human immunodeficiency virus in your blood and other arts of your body. The HIV viral load test involves ta-ing a blood sam le from a vein in your arm. The amount of HIV in your blood is then measured. 3long with other tests, the HIV viral load test hel s monitor your disease, guide HIV thera y, and redict how your disease may rogress. .ee ing your viral load low can reduce com lications of HIV disease and extend your life. Two common test numbers... Gead the HIV Viral Joad Testing article P P

Have un&rotected se- (do not use condoms). Have multi&le se- &artners. 8re a man /ho has se- /ith other men. Have hi"h-ris% &artner(s) (&artner has multi&le se- &artners' is a man /ho has se- /ith other men' or inAects dru"s). Have or have recently had a se-ually transmitted disease' such as sy&hilis.

(eo le who inDect drugs or steroids, es ecially if they share needles, syringes, coo-ers, or other e8ui ment used to inDect drugs, are at ris- of being infected with HIV. *abies who are born to mothers who are infected with HIV are also at ris- of infection. 3 variety of HIV ris- factors can increase your chances of becoming infected with a virus called HIV (human immunodeficiency virus). This infection can lead to 3I&0 (ac8uired immunodeficiency syndrome), which ma-es it more difficult for your body to fight off infection and disease. 0ome ris- factors increase your HIV ris- more than others. >ou canCt entirely eliminate ris-, but you can do many things to lower your ris- and rotect yourself.

HIV5AIDS !is2 3actors

"ertain behaviors can increase your HIV ris-. These are some of the most common ris- factors?

Having un rotected vaginal, anal, or oral sex with someone who is infected with HIV or whose HIV status you donCt -now. Having many sexual artners. Having sex with a sex wor-er or an IV drug user. 0haring needles, syringes, or e8ui ment used to re are or inDect drugs with someone who is HIV infected. <sing needles for iercing or tattooing that are not sterile. (3n accidental needle sticwith a contaminated needle or medical instrument, however, is a very rare cause of HIV transmission.)

Other Possible HIV5AIDS !is2 3actors

Kther factors may also increase your HIV ris-. ;or exam le, having sex under the influence of alcohol or drugs may lead to other ris-y behaviors, such as having un rotected sex. Here are other otential HIV ris- factors?

Having another sexually transmitted disease (0T&), such as her es, chlamydia, sy hilis, or gonorrhea. 0T&s may cause changes in tissue that ma-e HIV transmission more li-ely. Having sex after drin-ing alcohol or ta-ing drugs. Having a mother who was infected with HIV before you were born. Having had a blood transfusion or received blood roducts before %5+@. 0ince that time, however, all blood in the <nited 0tates has been tested for HIV. Having fewer co ies of a gene that hel s to fight HIV. 3lthough not yet available, a screening test might one day be able to identify those who are more li-ely to get HIV and develo 3I&0.

+hat 4ou /an Do to Protect 4ourself and Others

*ecause HIV is transmitted through infected blood, semen, or vaginal secretions, or through a motherCs mil- during breastfeeding, these are the most im ortant ste s you can ta-e to lower your HIV ris- and the ris- to others?

<se a latex condom or s8uare of latex or lastic wra (Edental damE) each and every time you have anal, vaginal, or oral sex. (If you have a latex allergy, use olyethylene condoms with oil-based lubricants.) Jearn more about how to ractice safer sex. Jearn about the HIV drug Truvada. It has been a roved for use in those at high ris- as a way to revent HIV infection. Truvada should be used in conDunction with safe sex ractices. &onCt share needles, syringes, or e8ui ment used to re are inDection drugs or to inDect them. HIV can stay in syringes for a month or longer. 0ee- treatment for drug use, but in the meantime, be sure to use a clean needle each time you inDect. 0ee a 8ualified rofessional who uses sterile e8ui ment if you lan to get a tattoo or have your body ierced. &onCt share toothbrushes or ra4ors. Tal- to a doctor about getting tested for HIV if you are regnant or lanning to become regnant. If youCre HIV- ositive, see- counseling and treatment, which can revent HIV from being assed to a fetus or infant in most cases. &o not breastfeed if you have a newborn and are HIV- ositive.

HIV does not survive well outside the body. HIVcannot be s read from one erson to another in any of the following ways?

Casual contact
In studies of hundreds of households in which families have lived with and cared for eo le who have 3I&0, including situations in which no one -new that the erson was HIV-infected, HIV was s read only when there was sexual contact or needle-sharing with the infected erson or contact with the infected ersonCs blood.

Recommended Related to HIV/AIDS

=utrition and HIV'3I&0 If youCre HIV- ositive, nutrition and HIV is a subDect youCll want to ay s ecial attention to. ThatCs because your body will undergo changes, both from medications and the disease itself. ;or exam le, you may ex erience extreme weight loss, infections, or diarrhea. 3nother common

change is li odystro hy (fat distribution syndrome) which can cause body sha e changes and increases in cholesterol levels. !a-ing im rovements in your diet can im rove your health and how well you feel. Here are a few... Gead the =utrition and HIV'3I&0 article P P *ecause HIV is not s read in such settings where ex osures are re eated and rolonged and can involve contact with an infected ersonCs body fluids, it is therefore even less li-ely to be s read in other casual social settings, such as schools and offices.

Saliva, sweat, tears, urine, or feces

HIV cannot be s read by sharing drin-ing glasses or by casual -issing. The ris- of s reading the virus through Edee E -issing in which large amounts of saliva are exchanged is extremely low. Knly one un roven case has ever been re orted. =o cases of HIV s read have ever been re orted after a erson has come in contact with the sweat, tears, urine, or feces of an HIV-infected erson.

Vaccines
HIV is not s read by vaccines made from blood roducts, such as the he atitis * vaccine and various immune globulins a roved for use in the <nited 0tates.

He&atitis 4 vaccine no/ contains no human tissue or (lood. The other &roducts are made from screened (lood or &lasma and under"o &urification that destroys any harmful viruses or (acteria.

Insects
HIV is not s read by insects. Insects do not become infected and their saliva does not contain the virus. *lood-suc-ing insects, such as mos8uitoes, do not inDect blood into the next erson they bite.

Contact with common objects

HIV is not s read by touching common obDects such as toilet seats or faucet handles. The infection is caused by the human immunodeficiency virus (HIV). 3fter HIV is in the body, it attac-s and destroys "&:H cells, which are the art of the bodyCs immune system that fights infection and disease. Fhen HIV wea-ens or destroys the immune cells, it may lead to certain illnesses or diseases, such as some ty es of neumonia or cancer that are more li-ely to develo in someone who has a wea-ened immune system. These conditions are a sign that HIV has rogressed to 3I&0.

Recommended Related to HIV/AIDS

HIV and 3I&0 in 3frican-3mericans In many ways, 3frican-3mericans are bearing the brunt of the HIV crisis in the <nited 0tates. HIV is the virus that causes 3I&0 (ac8uired immunodeficiency syndrome). 3frican-3mericans receive more 3I&0 diagnoses and ex erience more HIV-related deaths than any other racial or ethnic grou in the <nited 0tates. Here is a brief overview of the im act, ossible causes, and otential ways to reduce the ris- of HIV and 3I&0 in blac-s. Gead the HIV and 3I&0 in 3frican-3mericans article P P HIV is s read when blood, semen, or vaginal fluids from an infected erson enter another ersonCs body, usually through sexual contact, from sharing needles when inDecting drugs, or from mother to baby during birth. HIV is rarely s read by blood transfusions or organ trans lants in the <nited 0tates because of im roved screening rocedures. 3I&0 (ac8uired immune deficiency syndrome) isnCt a disease in itself, rather, 3I&0 is a condition that develo s when a ersonCs body has been wea-ened by HIV (the human immunodeficiency virus). HIV is found in blood and sexual fluids and s reads mainly through un rotected sexual contact and the sharing of hy odermic needles and e8ui ment. Fhen a erson becomes infected with HIV, it damages his or her immune system, leading to immunodeficiency, the immune system can no longer fight off common germs and athogens, so a erson infected with HIV becomes ill from diseases that donCt usually affect someone without HIV. It can ta-e HIV many years to damage the immune system enough to ma-e the erson vulnerable to these diseases, called o ortunistic infections. These infections, including .a osiCs sarcoma, a form of s-in cancer, ta-e the o ortunity to invade because they donCt encounter resistance. Fhen doctors see someone with one of these diseases, they -now that HIV is robably res onsible, and the erson may be diagnosed with 3I&0. 3s HIV slowly invades a s ecific immune cell -- the "&: T-cell -- HIV uses the immune cellCs genetic material to re roduce itself and then -ills the "&: T-cell. 3n HIV-infected erson may not have any sym toms of disease during this time -- called the asym tomatic eriod. This can last %6 years or more for some eo le. &uring this time, the ersonCs "&: T-cell count is watched closely to guide treatment. The goal is to -ee an infected erson from advancing to 3I&0. Knce the "&: T-cell count goes below 266, a erson is diagnosed with 3I&0.

The +orld(ide HIV5AIDS Pandemic

The first 3I&0 case was documented in %5+%, and HIV has since s read worldwide. In 2665, almost 2 million eo le died worldwide, and the e idemic continues to s read. 0ub-0aharan 3frica has the greatest number of eo le who are infected. The Forld Health Krgani4ation (FHK) and the <nited =ationsC <=3I&0 office estimate that over 99N of adults are infected with HIV in some areas of 3frica. !illions of children have been or haned. The e idemic is also growing ra idly in #astern #uro e and 3sia. !ore than 9: million eo le worldwide are now living with HIV. In the <nited 0tates and the develo ed world, the use of combination treatments has turned 3I&0 into a chronic disease. (eo le now live long lives with HIV when they wor- closely with their health care roviders and are committed to their treatment lans. <nfortunately, 3I&0 medications are ex ensive and unavailable to the maDority of eo le in the world living with 3I&0. There are growing concerns that some high-ris- grou s believe they donCt have to be worried about HIV anymore. The fact that eo le now live longer with HIV doesnCt change the fact that HIV is a life-threatening illness and can infect anyone who exchanges infected blood or sexual fluids with another erson.

+hat /auses HIV5AIDS.

HIV lives in human blood and sexual fluids (semen and vaginal secretions). The infection is s read from erson to erson when these body fluids are shared, usually during vaginal or anal sexual contact or when sharing inDectable drugs. It can also be assed from dirty needles used for tattoos and body iercing. HIV does not live in saliva, tears, urine, or ers iration -- so HIV cannot be s read by casual contact with these body fluids. It can be s read through oral sex, although the ris- is small. HIV cannot survive for long outside the human body and dies 8uic-ly when the body fluid in which it is contained dries u . It is not s read by animals or insects and is not found on ublic surfaces. ItCs actually not as easy to get as other infectious diseases. 3 mother can ass HIV to her child during birth when the child is ex osed to the motherCs infected blood. *reastfeeding does carry a ris- for HIV infection, though in some areas of the develo ing world, breastfeeding is considered safer than feeding a newborn contaminated water. There are two main ty es of HIV, called HIV-% and HIV-2. HIV-2 is rarely found outside 3frica and arts of 3sia, so there is no need to test for it s ecifically -- unless a erson has had contact with someone from an area of the world where HIV-2 is common. *lood transfusions were once a concern, but all blood roducts used in the <nited 0tates today are tested for several infectious diseases, including HIV. If signs of disease or other roblems are found in donated blood, the erson who donated the blood is notified to be re-tested by their health care rovider and is not ermitted to continue donating blood. 3ny donated blood that tests ositive for HIV is dis osed of and never ma-es it into the ublic blood su ly.

In many ways, 3frican-3mericans are bearing the brunt of the HIV crisis in the <nited 0tates. HIV is the virus that causes 3I&0 (ac8uired immunodeficiency syndrome). 3frican-3mericans receive more 3I&0 diagnoses and ex erience more HIV-related deaths than any other racial or ethnic grou in the <nited 0tates. Here is a brief overview of the im act, ossible causes, and otential ways to reduce the ris- of HIV and 3I&0 in blac-s.

The Impact of HIV in 0lac2s

0tatistics only begin to show the tremendous toll HIV in blac-s is ta-ing.

&ore HIV infections, 3frican 3mericans ma-e u %:N of the <.0. o ulation, but they re resent ::N of new HIV cases. The icture is even blea-er in blac- women, teens, and children. In 2665, the "&" estimates that the rate of new HIV infections in 3frican 3merican women was %@ times as high as the rate for white women. Shorter sur*i*al, Kn average, the survival time for 3frican-3mericans with 3I&0 is lower than for other racial or ethnic grou s. Increased numbers of deaths, 3I&0 is a leading cause of death in 3frican-3mericans, es ecially in young women.

Ho( HIV in 0lac2s Spreads

HIV in blac- men is s read most often through (in this order)?

=ot using a condom or other rotection when having sex with a man who is infected with HIV. 0haring inDection drug needles or syringes with someone who is infected with HIV =ot using a condom or other rotection when having sex with a woman who is infected with HIV.

HIV in blac- women is s read most often through (in this order)?

=ot using a condom or other rotection when having sex with a man who is infected with HIV. 0haring inDection drug needles or syringes with someone who is infected with HIV.

+hy Are There so &any 0lac2s +ith HIV.

There are many ideas about why HIV in blac-s is such a big roblem. ;actors li-e these are contributing to this growing e idemic?

Po*erty, 3frican-3mericans are more li-ely to be uninsured or ublicly insured than whites. This can limit access to information, testing, and treatment for HIV and other diseases, and lead to higher rates of hos itali4ation. ;inancial challenges can also create de endence on drugs. This may also lead to behaviors such as an exchange of sex for drugs, which increase the ris- for HIV infection. In addition, women who are financially de endent may fall rey to ower imbalances that can wea-en their ability to rotect themselves in sexual relationshi s. In6ecting drug use, This increases the s read of HIV through blood, as well as leading to more ris-y sexual behavior. Se#ually transmitted diseases, In 266:, 3frican-3mericans were %5 times more li-ely than whites to have gonorrhea, one of many sexually transmitted diseases (0T&s). Having 0T&s increases the chances of also getting HIV. )ac2 of information, !any may be HIV ositive and not -now it, so they continue to s read the disease. In addition, distrust in governmental sources of information and research lingers due to the historic Tus-egee 0y hilis 0tudy, which ex loited blac-s without their -nowledge. Stigma about HIV in blac2s, 0ome eo le in the 3frican-3merican community still mista-enly believe that HIV is a white, gay disease. This view may ma-e it difficult to learn about or discuss their HIV status with others. 0tigma may also silence men who have sex with men but donSt tell their women sex artners. This is often called being on the Edown low.E "urrent studies may reveal Dust how much this ractice contributes to the s read of HIV in blac-s.

!educing the !is2 of HIV in 0lac2s

These are a few of the ways to reduce the ris- of HIV in blac-s?

Jearn about safer sex. <se a latex condom and water -based lubricant each and every time you have sex. Jearn what you can about your sex artnersS ast sex and drug use. *efore you have sex, as- yourself -- is it worth the ris-T "ontact a local HIV'3I&0 organi4ation for ti s on communicating with sex artners about HIV and safe sex. 7et information about the HIV drug Truvada. It has been a roved for use in those at high ris- as a way to revent HIV infection and can be used in conDunction with safe sex ractices. If you thin- you may have an 0T&, get treatment. This will hel lower your ris- for HIV. Thin- about getting tested during each of your regular medical chec--u s. &onCt let fear of discovery sto you from getting tested. >ou may need to as- your doctor s ecifically for an HIV test.

&o whatever you can to avoid sex when you drin- alcohol or ta-e drugs. If you inDect drugs, always use clean needles and syringes, donSt share them with others. *e sure to get tested at least once a year. Gemember that counseling or treatment can hel you sto using drugs. The infection is caused by the human immunodeficiency virus (HIV). 3fter HIV is in the body, it attac-s and destroys "&:H cells, which are the art of the bodyCs immune system that fights infection and disease. Fhen HIV wea-ens or destroys the immune cells, it may lead to certain illnesses or diseases, such as some ty es of neumonia or cancer that are more li-ely to develo in someone who has a wea-ened immune system. These conditions are a sign that HIV has rogressed to 3I&0.

Recommended Related to HIV/AIDS

HIV Vaccines 3bout :6 million eo le are living with HIV (human immunodeficiency virus) or 3I&0 (ac8uired immunodeficiency syndrome). #ach day, %:,666 more become infected. HIVdrugs have vastly im roved the 8uality of life for many of these eo le, but they donCt yet rovide a cure. ThatCs why researchers are wor-ing so hard to develo an HIV vaccine. Gead the HIV Vaccines article P P HIV is s read when blood, semen, or vaginal fluids from an infected erson enter another ersonCs body, usually through sexual contact, from sharing needles when inDecting drugs, or from mother to baby during birth. HIV is rarely s read by blood transfusions or organ trans lants in the <nited 0tates because of im roved screening rocedures.

3n estimated 2.@ million children around the world are living with HIV'3I&s, according to the )oint <nited =ations (rogram on HIV'3I&0 ()=3I&0) E26%6 Ge ort on the 7lobal 3I&0 # idemic.E HIV (human immunodeficiency virus) is the virus that causes 3I&0 (ac8uired immune deficiency syndrome). The virus damages or destroys the cells of the immune system, leaving them unable to fight infections and certain cancers.

/auses of HIV in /hildren

!ost HIV infections in children are assed from mother to child during regnancy, labor and delivery, or breastfeeding. However, than-s to reventive treatment regimens, the incidence of mother-to-child HIV transmission is decreasing. In 2665, an estimated 9B6,666 children

contracted HIV during the erinatal and breastfeeding eriod, down from @66,666 in 266%, according to the )=3I&0 re ort. Kther causes of child HIV include? 0lood transfusions, *lood transfusions using infected blood or inDections with unsterili4ed needles can lead to HIV infection and 3I&0 in children. In the <.0. and other wealthier countries this roblem has been virtually eliminated, but in oor countries this still occurs. Illicit drug use, In central and #astern #uro e, inDected drug use continues to s read HIV among young eo le living on the streets. In one study in the <-raine, high-ris- behaviors, including sharing needles, were revalent among children as young as %6. Se#ual transmission, 3lthough sexual transmission is not a main cause of HIV'3I&0 among children, it does occur in countries where children become sexually active at an early age. "hildren may also become infected through sexual abuse or ra e.

Symptoms of HIV5AIDS in /hildren

!any babies and children living with HIV are -nown or sus ected to have the infection because their mothers are -nown to be infected. However, sometimes infection is not sus ected until a child develo s sym toms. 0ym toms of HIV infection vary by age and individual child, but following are some of the more common sym toms?

;ailure to thrive, which is the failure to gain weight or grow according to standardi4ed growth charts used by ediatricians. ;ailure to reach develo mental milestones during the ex ected time frame. *rain or nervous system roblems, characteri4ed by sei4ures, difficulty with wal-ing, or oor erformance in school. ;re8uent childhood illnesses such as ear infections, colds, u set stomach, and diarrhea.

3s HIV infection becomes more advanced, children start to develo o ortunistic infections. These are infections that rarely affect healthy eo le but can be deadly for eo le whose immune systems arenCt wor-ing ro erly. "ommon o ortunistic infections related to HIV include?

(neumocystis neumonia -- a fungal infection of the lungs 0erious infection due to cytomegalovirus ("!V) 3 condition of lung scarring called lym hocytic interstitial neumonitis (JI() Kral thrush or severe dia er rash due to "andida, a yeast infection

Treatments for /hild HIV and AIDS

&ue to im roved revention and treatment, 3I&0-related deaths among children around the world are declining.

Treatments for /hild HIV and AIDS continued,,,

Treatment for HIV and 3I&0 is essentially the same for children as for adults? a combination of antiviral medications to -ee the virus from becoming resistant to any one drug. However, there are s ecial considerations when treating children. 0ome HIV drugs are not available in a li8uid form that babies and small children can swallow and some drugs cause serious side effects in children. #ven if young children show no signs or sym toms of their HIV infection, doctors may choose to start treatment to im rove their general heath and increase long-term survival. &octors often decide whether to treat based on lab tests for viral load (the amount of virus in a bodily fluid) and the level of white blood cells (immune cells) called "&: T-cells affected by HIV infection.

/oping +ith AIDS

;inding out that your child is infected with HIV is frightening. Kne way to co e with fear of the un-nown is to learn as much as you can about HIV and 3I&0. The more you -now, the better you will be able to ta-e care of your child. To allay your childCs fears, discuss the disease in an age-a ro riate manner. Jet your child -now it is im ortant to ta-e medicine -- ossibly for the rest of his or her life -- to -ee from getting sic-. Fhen com lications develo , -now how to treat them and -ee your child comfortable. ;or exam le?

)oss of appetite, Kffer a variety of foods through the day, avoiding foods such as carbonated drin-s that can create gas in the stomach and ma-e your child feel bloated. Diarrhea, 7ive your child lenty of fluids, including sou s, fruit Duice diluted with water, and an oral rehydration solution. Kffer soft, moist foods such as mashed otations, s8uash, um -ins, and carrots. 3void fatty, sweet foods. /ough and cold, 3llow your child to rest. Kffer lenty of water and other fluids. "lean clogged nasal assages by filling a large bowl or ot with very hot water and having your child breathe in the va ors.

;or hel dealing emotionally with a childCs HIV diagnosis, s ea- to a member of the clergy or mental health rofessional or contact an organi4ation that offers su ort and services for children

with HIV'3I&s and their families. 0everal that offer summer cam s for -ids with HIV and other services are? Kne Heartland "am .indle 0unburst (roDects

Ho( /an I Pre*ent HIV5AIDS.

The most common way eo le are infected with HIV is by having sex with an infected erson. >ou canCt tell by loo-ing at a erson whether they have HIV, so you have to rotect yourself -and your sex artner. Safe Se# and HIV Pre*ention

Recommended Related to HIV/AIDS

HIV, 3I&0, and !ycobacterium 3vium "om lex !ycobacterium avium com lex (!3") is a grou of bacteria that are related to tuberculosis. These germs are very common in food, water, and soil. 3lmost everyone has them in their bodies. If you have a strong immune system, they donCt cause roblems. *ut they can cause serious illness in eo le with HIV (human immunodeficiency virus). Fith the right combination of medications, however, you can revent or treat !3". In some cases, you may need lifelong thera y. Gead the HIV, 3I&0, and !ycobacterium 3vium "om lex article P P

onBt have un&rotected se- outside marria"e or a committed relationshi&. If you or your &artner has ever had un&rotected se- -- or if either of you uses inAected dru"s -- the only /ay to (e sure you donBt have HIV is to "et tested. Have t/o HIV tests si- months a&art' /ith no ne/ se- &artners or inAection dru" use (et/een tests. Cou canBt "et HIV if your &enis' mouth' va"ina' or anus doesnBt touch another &ersonBs &enis' mouth' va"ina' or anus. 2issin"' erotic massa"e' and mutual mastur(ation are safe se- activities. Cou can "reatly reduce your ris% (y usin" a late- or &olyurethane condom durin" se-. onBt use natural-s%in condoms -- they &revent &re"nancy' (ut they donBt &revent infections. )ut on the condom on as soon as you or a male &artner has an erection' not Aust (efore eAaculation. >se a lu(ricant -- (ut never use an oil-(ased lu(ricant /ith a late- condom. The female condom' called a va"inal &ouch' also &rotects a"ainst disease. Dral se- /ithout a condom or late- dam is not safe' (ut itBs far safer than un&rotected intercourse.

The HIV dru" Truvada has (een a&&roved for use in those at hi"h ris% as a /ay to &revent HIV infection. ItBs to (e used in conAunction /ith safe se- &ractices.

Drug se and HIV Pre*ention <sing drugs increases your HIV ris-. If youCre not ready to sto ta-ing drugs, you can still reduce your ris- of getting HIV'3I&0. HereCs how?

onBt have se- /hen youBre hi"h. ItBs easy to for"et a(out safe se- /hen youBre on dru"s. If you must use dru"s' donBt inAect them. If you must inAect dru"s' donBt share the e5ui&ment. This includes every &iece of it1 needles' syrin"es' coo%ers' cotton' and rinse /ater. <ome states have needle-e-chan"e &ro"rams /here you can trade in dirty e5ui&ment for ne/ e5ui&ment.

Pregnancy and HIV Pre*ention !others with HIV can give the virus to their infants during regnancy, delivery, or breastfeeding. If youCre regnant, get an HIV test. 3nti-HIV drugs ta-en during regnancy and delivery can greatly reduce the ris- of assing the virus to your baby. If you have HIV, feed your infant formula or breast mil- from an uninfected woman. 0lood /ontact and HIV Pre*ention 3lthough transmission is rare, you can be infected by HIV from contact with the blood of an infected erson. If youCre hel ing a bleeding erson, be careful to avoid getting his or her blood into any cuts or o en sores on your own s-in -- or in your eyes or mouth. If ossible, wear gloves and rotective eyewear.

/all 4our Doctor About HIV5AIDS If7

>ou thin- you may have been ex osed to HIV, see your doctor or visit an emergency center immediately. >our doctor may recommend ta-ing anti-HIV drugs to try to revent the virus from infecting you. These drugs are most effective if started right away. This is not li-e ta-ing a Emorning-after ill,E treatment involves several wee-s of ta-ing drugs with otentially serious side effects -- but it can -ee you from getting HIV infection.