Prevention and Treatment

One of the most important developments in the prevention of AIDS has been the finding that transmission from mother to newborn can be interrupted in about two-thirds of the cases by chemotherapy. Another effective preventive measure is to supply injected-drug abusers with sterile needles and syringes in exchange for used ones, proven to decrease transmissions of the virus without encouraging addiction. Specifically designed educational programs targeting certain groups of people have also been effective short term in decreasing risky sexual practices. Lastly, identification and treatment of other STDs decreases the risk of contracting HIV disease, as does consistent use of latex condoms.

Treatment is designed to block replication of HIV, but it does not affect viral nucleic acid integrated in the host genome. Two classes of medications are currently available, those that block reverse transcriptase activity, and those that act against viral protease. These two enzymes act at different stages of viral replication and are vital for its reproduction. Viral mutants resistant to a single medication, however, quickly arise. To help prevent the selection of resistant variants, a "cocktail" of several medications each acting in a different way are given simultaneously, usually a protease inhibitor along with two reverse transcriptase inhibitors that act at different sites on the reverse transcriptase molecule. In many cases this therapy can clear the patient's blood of viral nucleic acid, halt the progress of the disease, and even allow partial recovery of immune function. Other approaches to treatment are being evaluated, the most promising a medicine given by frequent injection to prevent fusion of HIV with host cells. Therapy is very expensive and the medications often have serious side effects, two features that preclude use of the regimen in most of the world's HIV disease sufferers. While not curative, chemotherapy can markedly prolong and improve the quality of life for a lucky minority. ■ HIV replication, p. 745

Each person has a role to play in controlling the AIDS pandemic by studying the disease and doing his or her part in preventing spread from one person to another. About 25% of the 900,000 people in the United States infected with HIV are unaware of their infection. Those who, since the 1980s, have engaged in injected drug use or risky sexual behavior, and anyone having had unprotected sexual intercourse with them, could consider obtaining a blood test to rule out HIV infection. An individual who knows that his or her HIV test is positive can receive optimum treatment sooner and prevent transmission of the virus to others.

Table 25.15 presents the main features of HIV disease and AIDS.

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