hiv disease essay

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Acquired immunodeficiency syndrome (AIDS), is an ongoing, also called chronic, condition. It's caused by the human immunodeficiency virus, also called HIV. HIV damages the immune system so that the body is less able to fight infection and disease. If HIV isn't treated, it can take years before it weakens the immune system enough to become AIDS . Thanks to treatment, most people in the U.S. don't get AIDS .

HIV is spread through contact with genitals, such as during sex without a condom. This type of infection is called a sexually transmitted infection, also called an STI. HIV also is spread through contact with blood, such as when people share needles or syringes. It is also possible for a person with untreated HIV to spread the virus to a child during pregnancy, childbirth or breastfeeding.

There's no cure for HIV / AIDS . But medicines can control the infection and keep the disease from getting worse. Antiviral treatments for HIV have reduced AIDS deaths around the world. There's an ongoing effort to make ways to prevent and treat HIV / AIDS more available in resource-poor countries.

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The symptoms of HIV and AIDS vary depending on the person and the phase of infection.

Primary infection, also called acute HIV

Some people infected by HIV get a flu-like illness within 2 to 4 weeks after the virus enters the body. This stage may last a few days to several weeks. Some people have no symptoms during this stage.

Possible symptoms include:

• Muscle aches and joint pain.
• Sore throat and painful mouth sores.
• Swollen lymph glands, also called nodes, mainly on the neck.
• Weight loss.
• Night sweats.

These symptoms can be so mild that you might not notice them. However, the amount of virus in your bloodstream, called viral load, is high at this time. As a result, the infection spreads to others more easily during primary infection than during the next stage.

Clinical latent infection, also called chronic HIV

In this stage of infection, HIV is still in the body and cells of the immune system, called white blood cells. But during this time, many people don't have symptoms or the infections that HIV can cause.

This stage can last for many years for people who aren't getting antiretroviral therapy, also called ART. Some people get more-severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy immune cells, you may get mild infections or long-term symptoms such as:

• Swollen lymph glands, which are often one of the first symptoms of HIV infection.
• Oral yeast infection, also called thrush.
• Shingles, also called herpes zoster.

Progression to AIDS

Better antiviral treatments have greatly decreased deaths from AIDS worldwide. Thanks to these lifesaving treatments, most people with HIV in the U.S. today don't get AIDS . Untreated, HIV most often turns into AIDS in about 8 to 10 years.

Having AIDS means your immune system is very damaged. People with AIDS are more likely to develop diseases they wouldn't get if they had healthy immune systems. These are called opportunistic infections or opportunistic cancers. Some people get opportunistic infections during the acute stage of the disease.

The symptoms of some of these infections may include:

• Fever that keeps coming back.
• Ongoing diarrhea.
• Swollen lymph glands.
• Constant white spots or lesions on the tongue or in the mouth.
• Constant fatigue.
• Rapid weight loss.
• Skin rashes or bumps.

When to see a doctor

If you think you may have been infected with HIV or are at risk of contracting the virus, see a healthcare professional as soon as you can.

More Information

• Early HIV symptoms: What are they?

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HIV is caused by a virus. It can spread through sexual contact, shooting of illicit drugs or use of shared needles, and contact with infected blood. It also can spread from parent to child during pregnancy, childbirth or breastfeeding.

HIV destroys white blood cells called CD4 T cells. These cells play a large role in helping the body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes.

How does HIV become AIDS?

You can have an HIV infection with few or no symptoms for years before it turns into AIDS . AIDS is diagnosed when the CD4 T cell count falls below 200 or you have a complication you get only if you have AIDS , such as a serious infection or cancer.

How HIV spreads

You can get infected with HIV if infected blood, semen or fluids from a vagina enter your body. This can happen when you:

• Have sex. You may become infected if you have vaginal or anal sex with an infected partner. Oral sex carries less risk. The virus can enter your body through mouth sores or small tears that can happen in the rectum or vagina during sex.
• Share needles to inject illicit drugs. Sharing needles and syringes that have been infected puts you at high risk of HIV and other infectious diseases, such as hepatitis.
• Have a blood transfusion. Sometimes the virus may be transmitted through blood from a donor. Hospitals and blood banks screen the blood supply for HIV . So this risk is small in places where these precautions are taken. The risk may be higher in resource-poor countries that are not able to screen all donated blood.
• Have a pregnancy, give birth or breastfeed. Pregnant people who have HIV can pass the virus to their babies. People who are HIV positive and get treatment for the infection during pregnancy can greatly lower the risk to their babies.

How HIV doesn't spread

You can't become infected with HIV through casual contact. That means you can't catch HIV or get AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.

HIV isn't spread through air, water or insect bites. You can't get HIV by donating blood.

Risk factors

Anyone of any age, race, sex or sexual orientation can have HIV / AIDS . However, you're at greatest risk of HIV / AIDS if you:

• Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is riskier than is vaginal sex. Your risk of HIV increases if you have more than one sexual partner.
• Have an STI . Many STIs cause open sores on the genitals. These sores allow HIV to enter the body.
• Inject illicit drugs. If you share needles and syringes, you can be exposed to infected blood.

Complications

HIV infection weakens your immune system. The infection makes you much more likely to get many infections and certain types of cancers.

Infections common to HIV/AIDS

• Pneumocystis pneumonia, also called PCP. This fungal infection can cause severe illness. It doesn't happen as often in the U.S. because of treatments for HIV / AIDS . But PCP is still the most common cause of pneumonia in people infected with HIV .
• Candidiasis, also called thrush. Candidiasis is a common HIV -related infection. It causes a thick, white coating on the mouth, tongue, esophagus or vagina.
• Tuberculosis, also called TB. TB is a common opportunistic infection linked to HIV . Worldwide, TB is a leading cause of death among people with AIDS . It's less common in the U.S. thanks to the wide use of HIV medicines.
• Cytomegalovirus. This common herpes virus is passed in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system makes the virus inactive, but it stays in the body. If the immune system weakens, the virus becomes active, causing damage to the eyes, digestive system, lungs or other organs.
• Cryptococcal meningitis. Meningitis is swelling and irritation, called inflammation, of the membranes and fluid around the brain and spinal cord, called meninges. Cryptococcal meningitis is a common central nervous system infection linked to HIV . A fungus found in soil causes it.

Toxoplasmosis. This infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools. The parasites then can spread to other animals and humans.

Toxoplasmosis can cause heart disease. Seizures happen when it spreads to the brain. And it can be fatal.

Cancers common to HIV/AIDS

• Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes most often in the neck, armpit or groin.
• Kaposi sarcoma. This is a tumor of the blood vessel walls. Kaposi sarcoma most often appears as pink, red or purple sores called lesions on the skin and in the mouth in people with white skin. In people with Black or brown skin, the lesions may look dark brown or black. Kaposi sarcoma also can affect the internal organs, including the lungs and organs in the digestive system.
• Human papillomavirus (HPV)-related cancers. These are cancers caused by HPV infection. They include anal, oral and cervical cancers.

Other complications

• Wasting syndrome. Untreated HIV / AIDS can cause a great deal of weight loss. Diarrhea, weakness and fever often happen with the weight loss.
• Brain and nervous system, called neurological, complications. HIV can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. HIV -associated neurological conditions can range from mild symptoms of behavior changes and reduced mental functioning to severe dementia causing weakness and not being able to function.
• Kidney disease. HIV -associated nephropathy (HIVAN) is swelling and irritation, called inflammation, of the tiny filters in the kidneys. These filters remove excess fluid and waste from the blood and pass them to the urine. Kidney disease most often affects Black and Hispanic people.
• Liver disease. Liver disease also is a major complication, mainly in people who also have hepatitis B or hepatitis C.

There's no vaccine to prevent HIV infection and no cure for HIV / AIDS . But you can protect yourself and others from infection.

To help prevent the spread of HIV :

Consider preexposure prophylaxis, also called PrEP. There are two PrEP medicines taken by mouth, also called oral, and one PrEP medicine given in the form of a shot, called injectable. The oral medicines are emtricitabine-tenofovir disoproxil fumarate (Truvada) and emtricitabine-tenofovir alafenamide fumarate (Descovy). The injectable medicine is called cabotegravir (Apretude). PrEP can reduce the risk of sexually transmitted HIV infection in people at very high risk.

PrEP can reduce the risk of getting HIV from sex by about 99% and from injecting drugs by at least 74%, according to the Centers for Disease Control and Prevention. Descovy hasn't been studied in people who have sex by having a penis put into their vaginas, called receptive vaginal sex.

Cabotegravir (Apretude) is the first U.S. Food and Drug Administration-approved PrEP that can be given as a shot to reduce the risk of sexually transmitted HIV infection in people at very high risk. A healthcare professional gives the shot. After two once-monthly shots, Apretude is given every two months. The shot is an option in place of a daily PrEP pill.

Your healthcare professional prescribes these medicines to prevent HIV only to people who don't already have HIV infection. You need an HIV test before you start taking any PrEP . You need to take the test every three months for the pills or before each shot for as long as you take PrEP .

You need to take the pills every day or closely follow the shot schedule. You still need to practice safe sex to protect against other STIs . If you have hepatitis B, you should see an infectious disease or liver specialist before beginning PrEP therapy.

Use treatment as prevention, also called TasP. If you have HIV , taking HIV medicines can keep your partner from getting infected with the virus. If your blood tests show no virus, that means your viral load can't be detected. Then you won't transmit the virus to anyone else through sex.

If you use TasP , you must take your medicines exactly as prescribed and get regular checkups.

• Use post-exposure prophylaxis, also called PEP, if you've been exposed to HIV . If you think you've been exposed through sex, through needles or in the workplace, contact your healthcare professional or go to an emergency room. Taking PEP as soon as you can within the first 72 hours can greatly reduce your risk of getting HIV . You need to take the medicine for 28 days.

Use a new condom every time you have anal or vaginal sex. Both male and female condoms are available. If you use a lubricant, make sure it's water based. Oil-based lubricants can weaken condoms and cause them to break.

During oral sex, use a cut-open condom or a piece of medical-grade latex called a dental dam without a lubricant.

• Tell your sexual partners you have HIV . It's important to tell all your current and past sexual partners that you're HIV positive. They need to be tested.
• Use clean needles. If you use needles to inject illicit drugs, make sure the needles are sterile. Don't share them. Use needle-exchange programs in your community. Seek help for your drug use.
• If you're pregnant, get medical care right away. You can pass HIV to your baby. But if you get treatment during pregnancy, you can lessen your baby's risk greatly.
• Consider male circumcision. Studies show that removing the foreskin from the penis, called circumcision, can help reduce the risk of getting HIV infection.
• About HIV and AIDS . HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids. Accessed Oct. 18, 2023.
• Sax PE. Acute and early HIV infection: Clinical manifestations and diagnosis. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2023.
• Ferri FF. Human immunodeficiency virus. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Oct. 18, 2023.
• Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV . HIV.gov. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/immunizations. Accessed Oct. 18, 2023.
• AskMayoExpert. Human immunodeficiency virus (HIV) infection. Mayo Clinic; 2023.
• Elsevier Point of Care. Clinical Overview: HIV infection and AIDS in adults. https://www.clinicalkey.com. Accessed Oct. 18, 2023.
• Male circumcision for HIV prevention fact sheet. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/male-circumcision-HIV-prevention-factsheet.html. Accessed Oct. 19, 2023.
• Acetyl-L-carnitine. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed. Oct. 19, 2023.
• Whey protein. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed. Oct. 19, 2023.
• Saccharomyces boulardii. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.
• Vitamin A. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.
• Red yeast rice. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.

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• HIV is a virus that attacks the body's immune system.
• The only way to know if you have HIV is to get tested.
• There are many ways to prevent HIV, like using PrEP, PEP, condoms and never sharing needles.
• HIV treatment helps people live long, healthy lives and prevents HIV transmission.

HIV (human immunodeficiency virus) is a virus that attacks the body's immune system. Without treatment, it can lead to AIDS (acquired immunodeficiency syndrome).

There is currently no effective cure. Once people get HIV, they have it for life. But proper medical care can control the virus.

People with HIV who get on and stay on effective HIV treatment can live long, healthy lives and protect their partners.

Most people have flu-like symptoms within 2 to 4 weeks after infection. Symptoms may last for a few days or several weeks.

Having these symptoms alone doesn't mean you have HIV. Other illnesses can cause similar symptoms.

Some people have no symptoms at all. The only way to know if you have HIV is to get tested .

How it spreads

Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment.

Only certain body fluids can transmit HIV. These fluids include:

• semen ( cum ),
• pre-seminal fluid ( pre-cum ),
• rectal fluids,
• vaginal fluids, and
• breast milk.

These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.

Factors like a person's viral load, other sexually transmitted infections, and alcohol or drug use can increase the chances of getting or transmitting HIV.

But there are powerful tools that can help prevent HIV transmission .

Today, more tools than ever are available to prevent HIV.

Prevention strategies include:

• Using condoms the right way every time you have sex.
• Never sharing needles, syringes, or other drug injection equipment.
• Using PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).

If you have HIV, there are many ways to prevent transmitting HIV to others, including taking HIV treatment to get and keep an undetectable viral load.

The only way to know your HIV status is to get tested. Knowing your status gives you powerful information to keep you and your partner(s) healthy.

There are many options for quick, free, and painless HIV testing. If your test result is positive , you can take medicine to treat HIV to help you live a long, healthy life and protect others. If your test result is negative , you can take actions to prevent HIV .

Get tested for HIV‎

HIV treatment (antiretroviral therapy or ART) involves taking medicine as prescribed by a health care provider. You should start HIV treatment as soon as possible after diagnosis.

HIV treatment reduces the amount of HIV in the blood ( viral load ). HIV treatment can make the viral load so low that a test can't detect it ( undetectable viral load ). If you have an undetectable viral load, you will not transmit HIV to others through sex. Having an undetectable viral load also reduces the risk of HIV transmission through sharing drug injection equipment, and during pregnancy, labor, and delivery.

How it progresses

When people with HIV don't get treatment, they typically progress through three stages. But HIV treatment can slow or prevent progression of the disease. With advances in HIV treatment, progression to Stage 3 (AIDS) is less common today.

Stage 1: Acute HIV Infection

• People have a large amount of HIV in their blood and are very contagious.
• Many people have flu-like symptoms.
• If you have flu-like symptoms and think you may have been exposed to HIV, get tested .

Stage 2: Chronic HIV Infection

• This stage is also called asymptomatic HIV infection or clinical latency.
• HIV is still active and continues to reproduce in the body.
• People may not have any symptoms or get sick during this phase but can transmit HIV.
• People who take HIV treatment as prescribed may never move into Stage 3 (AIDS).
• Without HIV treatment, this stage may last a decade or longer, or may progress faster.
• At the end of this stage, the amount of HIV in the blood ( viral load ) goes up and the person may move into Stage 3 (AIDS).

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

• The most severe stage of HIV infection.
• People receive an AIDS diagnosis when their CD4 cell count drops below 200 cells per milliliter of blood, or they develop certain illnesses (sometimes called opportunistic infections).
• People with AIDS can have a high viral load and may easily transmit HIV to others.
• People with AIDS have damaged immune systems.
• They can get an increasing number of other serious illnesses.
• Without HIV treatment, people with AIDS typically survive about three years.

HIV and AIDS Timeline

Learn about HIV and how the virus is transmitted, how to protect yourself and others, and how to live well with HIV. Also learn how HIV impact the American people.

Essay on AIDS for Students and Children

500+ words essay on aids.

Acquired Immune Deficiency Syndrome or better known as AIDS is a life-threatening disease. It is one of the most dreaded diseases of the 20 th century. AIDS is caused by HIV or Human Immunodeficiency Virus, which attacks the immune system of the human body. It has, so far, ended more than twenty-nine million lives all over the world. Since its discovery, AIDS has spread around the world like a wildfire. It is due to the continuous efforts of the Government and non-government organizations; AIDS awareness has been spread to the masses.

AIDS – Causes and Spread

The cause of AIDS is primarily HIV or the Human Immunodeficiency Virus. This virus replicates itself into the human body by inserting a copy of its DNA into the human host cells. Due to such property and capability of the virus, it is also known as a retrovirus. The host cells in which the HIV resides are the WBCs (White Blood Cells) that are the part of the Human Immune system.

HIV destroys the WBCs and weakens the human immune system. The weakening of the immune system affects an individual’s ability to fight diseases in time. For example, a cut or a wound takes much more time to heal or the blood to clot. In some cases, the wound never heals.

HIV majorly transmits in one of the three ways – Blood, Pre-natal and Sexual transmission. Transfusion of HIV through blood has been very common during the initial time of its spread. But nowadays all the developed and developing countries have stringent measures to check the blood for infection before transfusing. Usage of shared needles also transmits HIV from an infected person to a healthy individual.

As part of sexual transmission, HIV transfers through body fluids while performing sexual activity. HIV can easily be spread from an infected person to a healthy person if they perform unprotective sexual intercourse through oral, genital or rectal parts.

Pre-natal transmission implies that an HIV infected mother can easily pass the virus to her child during pregnancy, breastfeeding or even during delivery of the baby.

AIDS – Symptoms

Since HIV attacks and infects the WBCs of the human body, it lowers the overall immune system of the human body and resulting in the infected individual, vulnerable to any other disease or minor infection. The incubation period for AIDS is much longer as compared to other diseases. It takes around 0-12 years for the symptoms to appear promptly.

Few of the common symptoms of AIDS include fever , fatigue, loss of weight, dysentery, swollen nodes, yeast infection, and herpes zoster. Due to weakened immunity, the infectious person falls prey to some of the uncommon infections namely persistent fever, night sweating, skin rashes, lesions in mouth and more.

Get the huge list of more than 500 Essay Topics and Ideas

AIDS – Treatment, and Prevention

Till date, no treatment or cure is available for curing AIDS, and as a result, it is a life-threatening disease. As a practice by medical practitioners, the best way to curb its spread is antiretroviral therapy or ART. It is a drug therapy which prevents HIV from replicating and hence slows down its progress. It is always advisable to start the treatment at the earliest to minimize the damage to the immune system. But again, it is just a measure and doesn’t guarantee the cure of AIDS.

AIDS prevention lies in the process of curbing its spread. One should regularly and routinely get tested for HIV. It is important for an individual to know his/her own and partner’s HIV status, before performing any sexual intercourse activity. One should always practice safe sex. Use of condoms by males during sexual intercourse is a must and also one should restrict oneself on the number of partners he/she is having sex with.

One should not addict himself/herself to banned substances and drugs. One should keep away from the non-sterilized needles or razors.  Multiple awareness drives by the UN, local government bodies and various nonprofit organizations have reduced the risk of spread by making the people aware of the AIDS – spread and prevention.

Life for an individual becomes hell after being tested positive for AIDS. It is not only the disease but also the social stigma and discrimination, felling of being not loved and being hated acts as a slow poison. We need to instill the belief among them, through our love and care, that the HIV positive patients can still lead a long and healthy life.

Though AIDS is a disease, which cannot be cured or eradicated from society, the only solution to AIDS lies in its prevention and awareness. We must have our regular and periodical health checkup so that we don’t fall prey to such deadly diseases. We must also encourage and educate others to do the same. With the widespread awareness about the disease, much fewer adults and children are dying of AIDS. The only way to fight the AIDS disease is through creating awareness.

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee to Study HIV Transmission Through Blood and Blood Products; Leveton LB, Sox HC Jr., Stoto MA, editors. HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking. Washington (DC): National Academies Press (US); 1995.

HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking.

• Hardcopy Version at National Academies Press

8 Conclusions and Recommendations

The HIV epidemic has taught scientists, clinicians, public health officials, and the public that new infectious agents can still emerge. The nation must be prepared to deal with a fatal illness whose cause is initially unknown but whose epidemiology suggests it is an infectious disease. The AIDS epidemic has also taught us another powerful and tragic lesson: that the nation's blood supply—because it is derived from humans—is highly vulnerable to contamination with an infectious agent. A nation's blood supply is a unique, essential, life-giving resource. Whole blood and many blood products are lifesaving for many people. As a whole, our nation's system works effectively to supply the nation with necessary blood and blood products and its quality control mechanisms check most human safety threats. The events of the early 1980s, however, revealed an important weakness in the system—in its ability to deal with a new threat that was characterized by substantial uncertainty. The potential for recurring threats to the blood supply led this Committee to reappraise the processes, policies, and resources through which our society attempts to preserve its supply of safe blood and blood products.

• General Conclusions

The events and decisions that the Committee has analyzed underscore the difficulty of decisionmaking when the stakes are high, when decisionmakers may have personal or institutional biases, and when knowledge is imprecise and incomplete. The Committee attempted to understand the complexities of the decisionmaking process during the period analyzed in this report and develop lessons to protect the blood supply in the future. In retrospect, the system was not dealing well with contemporaneous blood safety issues such as hepatitis, and was not prepared to deal with the far greater challenge of AIDS .

By January 1983, the Centers for Disease Control (CDC) had accumulated enough epidemiological evidence to conclude that the agent causing AIDS was almost certainly transmitted through blood and blood products and could be sexually transmitted to sexual partners. The conclusion that the AIDS agent was blood-borne rested on two findings. First, AIDS was occurring in transfusion recipients and individuals with hemophilia who had received AHF concentrate; these AIDS patients did not belong to any other known high-risk group for contracting AIDS. Second, the epidemiologic pattern of AIDS was similar to hepatitis B, another blood-borne disease. However, the magnitude and consequences of the risk for transfusion and blood product recipients was not known at this time. Furthermore, the epidemiological pattern of the new disease was difficult to interpret because, unlike most infectious diseases, there seemed to be several years between exposure leading to infection and the development of symptoms. As a result, physicians and public health officials underestimated the large number of infectious people who had no symptoms of AIDS but could transmit the disease to others and therefore substantially understated the risk of infection.

Compared to the pace of many regulatory and public health decision processes, the federal government responded relatively swiftly to the early warnings that AIDS might be transmitted through blood and blood products. Public and private sector officials considered a range of clinical and public health interventions for reducing the risk of AIDS transmission through blood and blood products. This period, however, was characterized by a great deal of scientific uncertainty about the risks of HIV infection through blood and blood products and about the costs and benefits of the available options. The result, the Committee found, was a pattern of responses which, while not in conflict with the available scientific information, was very cautious and exposed the decisionmakers and their organizations to a minimum of criticism. This limited response can be seen in the refusal of blood banks in 1983 and 1984 to screen for and defer homosexuals or use surrogate tests ( Chapter 5 ), in the Food and Drug Administration's (FDA) cautious and inadequate regulatory approach to the recall of potentially contaminated AHF concentrate ( Chapter 6 ), and in the failure of physicians and the National Hemophilia Foundation to disclose completely the risks of using AHF concentrate and the alternatives to its use ( Chapter 7 ).

Blood safety is a shared responsibility of many diverse organizations. They include U.S. Public Health Service agencies such as the CDC, the FDA, and the National Institutes of Health (NIH), and private-sector organizations such as community blood banks and the American Red Cross, blood and plasma collection agencies, blood product manufacturers, groups such as the National Hemophilia Foundation (NHF), and others. The problems the Committee found were inadequate leadership and inadequate institutional decisionmaking processes in 1983 and 1984. No person or agency was able to coordinate all of the organizations sharing the public health responsibility for achieving a safe blood supply.

Decisionmaking Under Uncertainty

The management of a public health risk requires an evolving process of decisionmaking under uncertainty. It includes interpretive judgment in the presence of scientific uncertainty and disagreement about values. Public health officials must characterize and estimate the magnitude of the risk, which involves considering both the likelihood that infection might occur in various circumstances, and the costs and benefits associated with each of the possible uncertain outcomes. They must also develop and test public health and clinical care strategies, and communicate with the public about the risk and strategies for reducing it. When confronted with a poorly understood and anomalous public health threat, inertia often influences decisions. It is often easier to maintain the status quo than to make a change. In fact, regulatory policymakers, health scientists, and medical experts often require substantial scientific evidence before informing the public and adopting remedial action. Lack of scientific consensus becomes a kind of amplifier for the usual discord and conflict that can be expected whenever an important science-based public policy decision—one profoundly affecting lives and economic interests—must be made. First, uncertainty creates opportunities for advocates of self-interested and ideological viewpoints to advance plausible arguments that favor their desired outcome. Second, uncertainty intensifies bureaucrat cautiousness.

In the course of its investigations, the Committee learned several lessons about decisionmaking under uncertainty. These are set out here both as general lessons and to provide a framework for the recommendations that follow.

Risk Perception

Risk perception is shaped by social tensions, and cultural, political, and economic biases (Douglas 1985). It is important to understand the different contexts in which risk is perceived and the complex system of beliefs, values, and ideals that shape risk perception (Nelkin 1989). There are several other factors that influence risk perception, including locus of control, the type of risk posed by the threat, and the time interval involved in evaluating the risk. For example, people tend to underestimate risks that they perceive to be under their control, risks associated with a familiar situation, and low probability events (Douglas 1985). People have difficulty accepting estimates of a risk that is involuntary, uncertain, unfamiliar, and potentially catastrophic (Fischoff 1987). The epidemic caused by HIV in the blood supply illustrates these patterns of perception and behavior with respect to risk.

Risk Assessment Versus Risk Management

A central precept of risk management is to separate the assessment of risk from the management of its consequences (NRC 1983). Otherwise, risk managers tend to bias their estimates of the magnitude of the risk in favor of their preconceived notions about appropriate or desirable policy choices. The events that the Committee studied provide examples of what can happen when this precept is not followed. When there is uncertainty, it may be necessary to assess risk by making subjective estimates rather than by obtaining objective measures. Such was the case in 1983 when, as part of implicit risk-benefit calculations about donor screening and deferral, blood banks and blood product manufacturers had to make judgments about the risk that their products could transmit AIDS (see Chapter 5 ). Anticipating the consequences of taking action, which is in the domain of risk management, may bias risk estimates toward values that support risk-averse action. When blood bank officials estimated the risk of transmitting AIDS as ''one per million" transfusions, they chose a rate that was low enough to justify their reluctance to take further action. Despite mounting evidence that the risk was much higher, they maintained their original estimate throughout 1983. If the CDC had made numeric estimates of the risk, and the blood banks, blood product manufacturers, or the FDA had used these estimates in a formal analysis of the decision problem, they might have reached different conclusions about, for example, surrogate testing for AIDS.

Consider the Full Range of Possibilities

When there is uncertainty about the facts that will determine the consequences of a decision, a systematic approach is usually best (NRC 1994). One important principle is to consider the full range of assumptions and alternative actions, not only worst-case scenarios. In the events studied by the Committee, systematic denial of worst-case scenarios was a recurring theme, as can be seen in the way that the NHF and the FDA discussed the CDC's warnings in 1982 and early 1983. The plasma fractionators introduced a worst case scenario of their own at the July 1983 Blood Products Advisory Committee (BPAC) meeting, when they estimated that three or four suspect donors and an automatic recall policy could lead to recall of all of the nation's supply of AHF concentrate ( Chapter 6 ). A closely related principle is to scrutinize the evidence to ascertain what is based on fact, what is a "best-guess" estimate, and what is simply untested conventional wisdom.

One approach to such an analysis would be to use a formal group process to systematically sample expert opinion on relevant factors such as the probability of infection and the economic and noneconomic costs and benefits of each of the possible outcomes. Often these officials should use decision analysis, which takes into account the likelihood of events and the magnitude of their outcomes, as a tool to compare the expected value of the outcome of the policy alternatives under consideration. Two somewhat analogous models to consider include those used in Institute of Medicine studies to establish priorities for the development of new vaccines (IOM 1985) and to evaluate the artificial heart program of the National Heart, Lung, and Blood Institute (IOM 1991). The book Acceptable Risk (Fischoff, et al. 1981) also offers sensible approaches to dealing with this kind of situation.

Risk Reduction Versus Zero Risk

Decisionmakers tend to seek zero-risk solutions even when they are unattainable or unrealistically costly (NRC 1994). In doing so, they may run the risk of failing to implement solutions that are less effective but are certain to reduce illness. The failure to adopt risk-reduction strategies can be seen in the resistance of blood banks to screening for homosexual activity or using surrogate tests for AIDS ( Chapter 5 ) and in FDA's limited approach to product recall decisions ( Chapter 6 ). Chapter 7 also points out that many risk-reduction strategies for individuals with hemophilia were available but not fully disclosed or recommended. The perfect should not be the enemy of the good.

Risk Communication

Risk communication is a sensitive area because of its influence on the perceptions and behaviors of health professionals and consumers, regulatory policies, and public decisionmaking (Nelkin 1989). Many public health officials and physicians wish to appear in command and infallible. When uncertain, they remain silent rather than disclose their ambivalence (NRC 1989). In the Committee's view, however, the greater the uncertainty, the greater the need for communication. The Committee's analysis of physician–patient communications at the beginning of the AIDS era illustrates the tragedies that can accompany silence about risks ( Chapter 7 ). Risk-communication skills are equally important when presenting information to the general public. The blood banks' reluctance to acknowledge the risk of transfusion-associated AIDS ( Chapter 5 ) seems to have been due in part to the difficulties that they foresaw in presenting this information to potential donors and recipients.

Other important principles of risk communication are that the source of the information must be credible, the process should be open and two-way, and the message should be balanced and accurate (NRC 1989). When there was no other sources of information for physicians treating people with hemophilia and for their patients, the NHF and its Medical and Scientific Advisory Council (MASAC) took on an important risk-communication role—providing what would now be called "clinical practice guidelines." The NHF's credibility in this area was eventually seriously compromised by its financial connections to the plasma fractionation industry.

Bureaucratic Management of Potential Crises

Federal agencies had the primary responsibility for dealing with the national emergency posed by the AIDS epidemic. The Committee scrutinized bureaucratic function closely, and came to the following conclusions about the management of potential crises.

Coordination and Leadership

A crisis calls for extraordinary leadership. Legal and competitive concerns may inhibit effective action by agencies of the federal government. Similarly, when policymaking occurs against a backdrop of a great deal of scientific uncertainty, bureaucratic standard operating procedures designed for routine circumstances seem to take over unless there is a clear-cut decisionmaking hierarchy. An effective leader will insist upon coordinated planning and execution. Focusing efforts and responsibilities, setting timetables and agendas, and assuming accountability for expeditious action cannot be left to ordinary standard operating procedures. These actions are the responsibilities of the highest levels of the public health establishment.

The Public Health Service failed to bring these leadership functions to bear when CDC scientists raised concerns about the blood supply at the January 4, 1983 meeting but received no public support from the director of the CDC or the office of the Assistant Secretary for Health. Similarly, the record does not indicate that the highest levels of the FDA or the PHS were involved in responding to advice from the BPAC regarding donor deferral or product recall. Part of this leadership problem may stem from major changes in the PHS leadership that took place during this period: the leadership of the FDA, the CDC, and the NIH, and the person serving as the Assistant Secretary for Health all changed between 1982 and 1984.

Advisory Mechanisms

In the early 1980s, the FDA and other agencies did not have a systematic approach to conducting advisory committee proceedings. Such an approach requires that agencies tell their advisory committees what is expected of them, keep attention focused on high-priority topics, and independently evaluate the advice offered. No regulatory process should have its information base effectively controlled by an advisory panel. Public agencies must be able to generate and analyze the information that they need to assure that decisions serve the needs of the public. The FDA failed to observe this principle when it allowed statements and recommendations of the BPAC to go unchallenged, apparently because it could not independently analyze the information ( Chapter 6 ).

Because mistakes will always be made and opportunities sometimes missed, regulatory structures must be organized and managed to assure both the reality and the continuous appearance of propriety. The prominence of representatives from blood banks and blood product manufacturers on the BPAC, with no balancing influence from consumers and no process within the FDA to evaluate its recommendations ( Chapter 6 ), is a failure of advisory committee management. Perhaps advisory committees should contain fewer topical experts and more members with expertise in principles of good decisionmaking and the evaluation of evidence. A committee so constituted might run a reduced risk of standing accused of having conflicts of interest.

Analytic Capability and Long-Range Vision

Leadership passes to the organization that has access to information and the ability to analyze it. Federal agencies should avoid exclusive reliance upon the entities which they regulate for analysis of data and modeling of decision problems. The FDA should have had some independent capacity to analyze the information presented at the July 1983 BPAC meeting that suggested that with only three or four suspect donors, an automatic recall policy would completely deplete the nation's supply of AHF concentrate ( Chapter 6 ). In addition, there did not seem to be any focus within the Public Health Service prepared to, or charged to, analyze the options, costs, and benefits of the options for protecting the blood supply that were discussed at the January 4, 1983, meeting convened by CDC.

In addition, agencies need to monitor more systematically the long-term outcomes of blood transfusion and blood product infusion and to think far ahead to anticipate both new technologies and new threats to the safety of the blood supply. Because new pathogens can enter the blood supply and be propagated very rapidly through it, a low level of suspicion about a threat should trigger high-level consideration of how to manage and monitor the problem.

Through its fact-finding interviews and through written documents, the Committee found little evidence that the PHS agency heads and the Assistant Secretary for Health were involved in making decisions about protecting the blood supply in 1983 and 1984 when HIV was becoming increasing apparent as a threat. Most decisions and interagency communication seems to have occurred several levels below the top.

Presumptive Regulatory and Public Health Triggers

The Committee believes that the Public Health Service should prepare for future threats to the blood supply by specifying in advance the types of actions that should occur once the level of concern passes a threshold. In the face of scientific uncertainty, the PHS needs a series of criteria or triggers for taking regulatory or other public health actions to protect the safety of blood and blood products. The Committee favors a series of triggers in which the response is proportional to the magnitude of the risk and the quality of the information on which the risk estimate is based. Not all triggers should lead to drastic or irrevocable actions; some merely require careful consideration of the options or developing new information. This general principle is detailed by examples in each of the Committee's four areas of inquiry. Table 8.1 summarizes these triggers and corresponding actions.

Triggers for Taking Actions in Response to Uncertain.

Product Treatment

Whenever they propose new methods of protecting the safety of the blood supply, blood regulatory agencies must perform cost-utility or cost-benefit analyses to evaluate whether the intervention will advance the public health at reasonable costs. If manufacturers do not have market incentives, resources, or access to data to test promising methods, public agencies should create incentives or provide resources or access to data. In this case, the trigger is a new proposal to increase safety, and the action is for the public sector to assume responsibility for thorough analysis and development, or to create incentives for industry to do so.

When performing a cost-effectiveness analysis of new treatments for blood products, the potential to protect against other threats should always be a part of the analysis. Here, the trigger is the initiation of a cost-effectiveness analysis, and the action is to ensure that the analysis takes into account secondary benefits.

Donor Screening

Whenever epidemiologists identify a high-risk donor group, the FDA should immediately tell blood banks to create a way to defer that group and tell collection agencies to segregate and separately treat supplies obtained from those populations. Concerns about stigmatizing subpopulations and maintaining the supply of blood products should influence the means of taking actions, not whether to take action. In this case, the trigger to action is the identification of a high-risk population, and the action is deferral and segregation of lots.

Whenever any segment of the industry institutes a donor screening program, the FDA should require all segments of the industry to follow suit with actions that they believe will be at least as effective in promoting safety. Public regulators have a responsibility to monitor these efforts and to forge consensus or to impose the most effective methods as information concerning efficacy becomes available. Here, the trigger is one company's action to take an additional safety measure, and the response is for all companies to follow suit, or to be held accountable when they do not.

Blood banks should use a partially effective intervention that has little or no risk unless they can show that a better method will rapidly supersede it. In this case the trigger is the availability of an inherently risk-free, partially effective intervention, and the response to use that test/intervention unless it is certain to become redundant prior to realizing its full benefits.

When a test or treatment makes a product safer, manufacturers should withdraw all stocks of untested or untreated product as quickly as possible. Where immediate complete withdrawal might injure the public health, withdrawals should be partial or staged. Here, the trigger is the implementation of a new test or treatment process, and the action is to recall untested or untreated products as expeditiously as possible, given other considerations of public health.

A limited, staged, or selective recall places responsibility on public regulatory agencies to establish criteria for selecting lots for recall, to provide processes to permit effective implementation of the recall by industry, and to monitor the recall to assure that removal of the products occurs in the prescribed manner. In this case the trigger is the initiation of a recall action, and the response is to provide clear guidance and monitoring.

Communication to Patients and Providers

Whenever new information triggers inquiry into a possible threat to the blood supply, both patients and their physicians should have access to the information. Public officials should presume that candid statements and rigorous actions will enhance rather than erode public confidence and that persons using blood or blood products have the right to understand fully the risks and benefits of using these products. In this case, the trigger is new information relevant to the public health, and the action is to tell affected individuals what they need to make an informed choice: the facts, the gaps in knowledge, and the implications thereof.

• Recommendations

The Committee's charge was to learn from the events of the early 1980s the lessons that would help the nation prepare for future threats to the blood supply. The Committee identified potential problems with the system in place at that time (as summarized earlier in this chapter) and proposes changes that, if implemented in the early 1980s, might have moderated some of the effects of the AIDS epidemic on recipients of blood and blood products. This analysis has led the Committee to the following recommendations for Public Health Service agencies, for the blood and plasma fractionation industry, and for health care providers and the public. These recommendations address both public health options and individual clinical options.

The Committee is mindful of several caveats. First, the Committee is acutely aware of the difficulties of retrospective analysis, as described in Chapter 1 . Second, the Committee has not considered its recommendations from perspectives other than blood safety. Finally, the Committee tried to identify opportunities for institutional change that would respond to the problems that the Committee diagnosed. The Committee based its recommendations on the institutions as they functioned in the early 1980s, not as they exist now. The organizations responsible for blood safety and public health will have to evaluate their current policies and procedures to see if they fully address the issues raised by our recommendations.

The Public Health Service

Several federal agencies necessarily play important, often different roles in managing a public health crisis such as the contamination of blood and blood products by the AIDS virus. The National Blood Policy of 1973 charged the Public Health Service (including the CDC, the FDA, and the NIH) with responsibility for protecting the nation's blood supply.

The Committee has come to believe that a failure of leadership contributed to delay in taking effective action, at least during the period from 1982 to 1984. This failure led to incomplete donor screening policies, weak regulatory actions, and insufficient communication to patients about the risks of AIDS .

In the event of a threat to the blood supply, the PHS must, as in any public health crisis, insist upon coordinated action. The Secretary of Health and Human Services is responsible for all the agencies of the Public Health Service, 1 and therefore the Committee makes

Recommendation 1: The Secretary of Health and Human Services should designate a Blood Safety Director, at the level of a deputy assistant secretary or higher, to be responsible for the federal government's efforts to maintain the safety of the nation's blood supply.

Choosing a "lead person" is important because it is in the nature of federal agencies and their leaders to be at once competitive and protective. This condition is healthy in reasonable measure and in normal times. However, a serious threat to public health requires that agencies communicate, cooperate, and learn to view the world through each other's lenses. Once there is an action plan, the Secretary of Health and Human Services must hold the agency leaders accountable for enforcing cooperation in implementing the plan.

To be effective in coordinating the various agencies of the PHS, the Blood Safety Director should be at the level of a deputy assistant secretary or higher, and should not be a representative of any single PHS agency. When a threat does arise, the Blood Safety Director should create a crisis management team.

One such action was to establish, in July 1982, the Committee on Opportunistic Infections in Hemophiliacs (see Chapter 3 ). This group seems to have been organized by the CDC, but there is no record of its operations after August of that year.

Blood Safety Council

The AIDS crisis revealed that the institutions in place to ensure blood safety, both public and private, were unable to work cooperatively toward a common goal of a safe blood supply. The institutions were not accountable to anyone but themselves, and they failed to cooperate, to coordinate their activities, and to communicate effectively with physicians and the public. The Committee has become convinced that the nation needs a far more responsive and integrated process to detect, evaluate, and respond to emerging threats to the blood supply. To this end the Committee makes

Recommendation 2: The PHS should establish a Blood Safety Council to assess current and potential future threats to the blood supply, to propose strategies for overcoming these threats, to evaluate the response of the PHS to these proposals, and to monitor the implementation of these strategies. The Council should report to the Blood Safety Director (see Recommendation 1). The Council should also serve to alert scientists about the needs and opportunities for research to maximize the safety of blood and blood products. The Blood Safety Council should take the lead to ensure the education of public health officials, clinicians, and the public about the nature of threats to our nation's blood supply and the public health strategies for dealing with these threats.

Supplying safe blood and blood products to the nation—a public good—requires the cooperation of public and private institutions. The Blood Safety Council would give voice to the public's interest in having these institutions cooperate and would provide opportunities for them to do so.

The lessons of HIV transmission through blood and blood products show the need for an advisory council with a significantly greater level of diversity, responsibility, and authority than the current Blood Products Advisory Committee of the FDA. The BPAC is limited by the regulatory mission of the FDA which it advises, and there is no other body primarily concerned with blood safety as a whole. Representatives from governmental agencies, academia, the blood bank community, industry, and the public all have relevant expertise and perspectives and should be involved in the Blood Safety Council. A broad-based range of expertise in areas of hematology, infectious diseases, epidemiology, blood product manufacturing, blood collection and delivery, risk assessment, consumer advocacy, and cost-benefit analysis is essential.

The proposed Blood Safety Council would facilitate the timely transmission of information, assessment of risk, and initiation of appropriate action both during times of stability and during a crisis. The Council should report to the Blood Safety Director (see Recommendation 1). The Council would not replace the PHS agencies responsible for blood safety but would complement them by providing a forum for them to work together and with private organizations. The PHS agencies would be represented on the Council (see below and Figure 8.1 ). The Council would not have its own surveillance capability, but would work with CDC and FDA to interpret the information that those organizations can provide. It would not carry out or fund research itself, but would work with those at NIH and in the private sector to identify priorities for blood safety research. The Council would not have regulatory power, but would inform FDA actions from a blood safety rather than a product-specific perspective.

Figure 8.1.

Blood Safety Council relationships.

The organizations and groups that should be included in the Blood Safety Council, and the reasons for including them, are as follows:

• The FDA can provide a direct link between itself, the essential regulatory agency responsible for the safety of blood and blood products, and important sources of information, scientific support, and disease surveillance findings.
• The CDC can provide expertise in epidemiology, infectious diseases, and immunology as well as communicate the results of ongoing disease surveillance studies. The CDC's newly established emerging infectious disease program would also provide valuable information.
• The NIH can provide scientific expertise and the means to communicate information about essential research needs to the appropriate institutes for support of research.
• Representatives from academia can bring independent scientific and medical expertise, especially in hematology, infectious diseases, epidemiology, risk assessment, and cost-effectiveness analysis.
• Representatives from the volunteer blood collection community can bring experience with blood safety concerns and the knowledge of blood bank operations that is necessary to evaluate proposed change.
• Representatives from the private-sector blood product manufacturers and biotechnology companies can bring both experience with blood safety concerns and knowledge of plasma fractionation operations.
• Representatives of the general public (who may in the future require blood transfusions) and individuals who currently require frequent use of blood products, such as hemophilia patients, bring important perspectives on the trade-offs that must be considered in evaluating response options.

The Blood Safety Council should consider the following activities and issues:

Surveillance. Although the FDA and the CDC keep track of events in blood and blood product recipients, their surveillance systems are passive and incomplete. The Blood Safety Council should work with the CDC to design a system of active surveillance for adverse reactions in blood recipients, as described in Recommendation 5 below. If such a system is established, the Council would benefit from its results and should participate in its governance.

Expert Panel on Best Practices . Drawing on its members' knowledge about blood and blood product safety concerns, and about clinical alternatives, the Blood Safety Council could establish a panel of experts to provide the public and providers of care with information about risks and benefits, alternatives to using blood products, and recommended best practices, as described in more detail in Recommendation 13 below.

Investigate Methods to Make Blood Products Safer. The Council should evaluate new methods to make blood and blood products safer. One promising approach is double inactivation in the preparation of blood products, which minimizes the risk of transmission of infectious pathogens in the blood of the donor pool. At present, the FDA requires only a single inactivation process (usually solvent detergent or heat treatment) for most blood products manufactured in the United States. With the goal of maximizing the safety of the blood supply at minimal added cost, the Blood Safety Council should encourage the FDA to evaluate double inactivation methods and expeditiously relicense products manufactured by the improved technologies, if appropriate. The Blood Safety Council should also consider, at least yearly, in a public forum, opportunities to maximize the safety of the blood supply.

Another promising approach is to reconsider minimum pool size requirements in plasma product manufacturing. The FDA currently requires a large number of donors to be included in plasma pools used in the manufacture of plasma products in order to ensure a wide range of antibodies in preparations of intravenous gamma globulin. Pooling of plasma obtained from numerous donors, although permitting some economy of scale, also increases the risk that a large fraction of manufactured blood products will be contaminated by a single infected donor. The Blood Safety Council should consider this issue and address the safety and efficiency trade-offs in changing the minimum pool size.

The Blood Safety Council would provide information relevant to the decisions that individuals as well as public and private decisionmakers need to make. The forum would not have direct regulatory or other authority, but would function as a forum for holding the organizations with authority responsible for blood safety. In short, the Blood Safety Council could advocate the public's need for a responsible process for decisionmaking about public health policy. The following examples illustrate how regular public discussions of blood safety issues, in the presence of representatives from the relevant organizations' perspectives, could provide an opportunity to hold the organizations with authority accountable for blood safety.

If it had existed in the 1970s, for instance, the Blood Safety Council might have called for the development of heat-treated AHF concentrate to reduce the risk of hepatitis, which would have also reduced the risk of HIV transmission. It would have been able to do so if the NIH and blood products industry representatives on the Council had been called upon to make periodic reports to the Council during the 1970s about their efforts to deal with the hepatitis problem. These representatives would have fed the discussions of the Council back into their own organizations' decisionmaking.

In 1983, the Council could have provided a forum for CDC to present its concerns about HIV in the blood supply and held the FDA, the NHF, and the blood banks and fractionators accountable for responding constructively. CDC created a forum on its own by convening the January 4, 1983, meeting in Atlanta, but as the Committee's analysis indicates, the follow-up on this meeting was insufficient. If a standing Blood Safety Council had existed, the CDC scientists who had concerns about the safety of blood and blood products would have had an opportunity to hold blood collection organizations accountable for their decisions regarding donor deferral and surrogate testing. It would also provide an opportunity to hold plasma fractionators and the FDA accountable for its decisions with regard to heat-treated AHF.

Later that year, the Council could have provided a mechanism to evaluate the claims that automatic recall of AHF would have virtually eliminated the supply of AHF. As the analysis in Chapter 6 indicates, neither the BPAC nor the FDA staff had the capacity to analyze claims that a automatic recall would have such an effect. The Blood Safety Council could have insisted that the FDA commission a formal decision analysis of the options for surrogate testing, or the Council might have performed such an analysis itself. The FDA would retain its regulatory authority, and continue to get advice from the BPAC, but the Council would have provided critical information relevant to the agency's decision.

Finally, if the Council had established an expert panel on best practices as described above and in Recommendation 13, hemophilia patients and their physicians would have had a more credible source of information about the risks of HIV infection and their clinical options than the NHF was able to provide. The operations of such a panel are described below under Recommendation 13.

Compensation Policy

When a product or service provided for the public good has inherent risks, the common law tort system fails to protect the rightful interests of patients who suffer harm resulting from the use of those products or services. Each claim requires extended, costly, and complex adjudicative procedures to establish liability. The results are erratic and unpredictable, and therefore inequitable (IOM 1985).

The doctrine of strict liability holds manufacturers accountable for injuries that are incurred from products that are inherently dangerous because diligence cannot fully eliminate their risks. The public health imperative of assuring enough vaccine for widespread use argues for limits on the strict liability doctrine for vaccine-related injuries. The chief concern is that fear of liability will discourage manufacturers from producing a vital public good. To vitate this concern, a federal compensation system has removed vaccine-related injuries from the scope of strict liability laws (Mariner 1992). The federal government established a mechanism for compensating individuals suffering harm from vaccine-related complications. Its rationale is that consent to undergo vaccination confers benefits to the entire community.

Blood -product-related injuries have also been removed from the scope of strict liability law by blood shield laws, which are in force in most states, and which protect society's interests in having an adequate blood supply. The blood shield laws serve to protect providers and manufacturers of blood and blood products from liability claims in instances where they take all due care to ensure the safety of the product. These laws, however, are unique in the manner in which they limit liability. The shield laws have made it difficult, and often impossible, to obtain compensation for HIV infection acquired from blood or blood products. To address this asymmetry between the protection that blood shield laws offer for manufacturers and adequate protection of individual rights, the Committee makes

Recommendation 3: The federal government should consider establishing a no-fault compensation system for individuals who suffer adverse consequences from the use of blood or blood products. 2

An effective no-fault system requires prospective standards and procedures to guide its operations. In a no-fault system, individual plaintiffs would not have to prove that their adverse outcome was a result of negligence related to manufacture of a blood product. Therefore, there needs to be an objective, science-based process to establish which categories of adverse outcomes are caused by blood-borne pathogens and which individual cases deserve compensation. As with vaccines, a tax or fee paid by all manufacturers or by the recipients of blood products could finance a compensation system. Rather than attempt to allocate blame for HIV infections through blood and blood products, some countries have established such no-fault compensation programs for individuals infected with HIV as a result of their use of blood and blood products. Countries fund these programs in a variety of ways, including direct government support and joint public/private resources.

Making recommendations about compensating affected individuals for damages incurred in the past is outside the Committee's mandate. However, had there been a no-fault compensation system in the early 1980s, it could have relieved much financial hardship suffered by many who became infected with HIV through blood and blood products in the United States. The no-fault principles outlined in this recommendation might serve to guide policymakers as they consider whether to implement a compensation system for those infected in the 1980s.

The Centers for Disease Control and Prevention

The CDC has an indispensable role to play in protecting our nation's health: to detect potential public health risks and sound the alert. Because of its expertise in detecting and evaluating possible infectious disease outbreaks, the Committee believes that the CDC should take responsibility for a surveillance system to detect adverse outcomes from blood and blood products. The following two recommendations embody an important principle: separating the assessment of risk from the management of the consequences of risk. The FDA, in its role as guarantor of the safety of the blood supply, has the responsibility for managing threats to the blood supply. The CDC should detect potential threats and assess the magnitude of the danger.

Early Warning Systems

A nation needs individuals and organizations that identify problems and raise concerns that may be difficult to confront. The CDC plays this role in the Public Health Service. The CDC appears to have been prescient in raising the possibility that the blood supply was contaminated early in the AIDS epidemic, but it was relatively ineffective in convincing other agencies of the potential gravity of the situation. In order to improve CDC's efficacy in this critical role, the Committee makes

Recommendation 4: Other federal agencies must understand, support, and respond to the CDC's responsibility to serve as the nation's early warning system for threats to the health of the public.

Officials in the government, scientists, and physicians in the private sector seem to have discounted the CDC warnings about the transmissibility of AIDS through blood and blood products because the swine flu episode in the 1970s had cost the agency considerable credibility. If, in 1983, the involved public and private organizations had the attitude called for in this recommendation, CDC's recommendations regarding donor screening and surrogate testing might have led to earlier, more effective screening and donor deferral policies.

Consistent with the precept of separating risk assessment and risk management as described above, CDC's role is to characterize and assess risks, and communicate this to others. The FDA and other organizations have the responsibility to manage the risks through regulation, clinical practice guidelines, and other means. The Committee believes that CDC should be able to play its designated role without fearing loss of credibility if it sometimes proves to be wrong. Implementing this recommendation may be difficult. As a start, the Secretary of Health and Human Services should insist that an agency that wishes to disregard a CDC alert should support its position with evidence that meets the same standard as that used by the CDC in raising the alert.

Surveillance

In order to carry out its early warning responsibility effectively, the CDC needs good surveillance systems. Because blood products are derived from human beings and may contain harmful biologic agents that were present in the blood of a donor, blood products are inherently risky, a principle long recognized by blood shield laws. The Committee, believing that the degree of surveillance should be proportional to the level of risk, makes

Recommendation 5: The PHS should establish a surveillance system, lodged in the CDC, that will detect, monitor, and warn of adverse effects in the recipients of blood and blood products.

If such a system had existed in 1982, data about the risks of HIV transmission through blood and blood products might have been available sooner and might have been more definitive. In dealing with newly approved pharmaceuticals, the FDA increasingly demands careful post-approval study of potential adverse effects (the so-called ''Phase IV Trial"). Two existing systems for vaccine adverse events—the CDC/FDA Vaccine Adverse Event Reporting System (VAERS) and the CDC's Large-Linked Database (LLDB)—might be useful models (Institute of Medicine 1994).

The Food and Drug Administration

The FDA has legal authority to protect the safety of the nation's blood supply. Accordingly, it is the lead federal agency in regulating blood-banking practice, the handling of source plasma, and the manufacture of blood products from plasma. The Committee found cause for concern when it evaluated the FDA's actions in protecting the public from HIV in the nation's blood supply during the 1980s. The record reveals many opportunities to improve the agency's capacity to deal with crises involving the blood supply, most notably with respect to the safety of AHF concentrate. In responding to these opportunities, the Committee's recommendations focus on decisionmaking and the role of advisory committees in formulating the FDA's response to crises.

Risk Reduction

In a crisis, decisionmakers may become so preoccupied with seeking solutions that will dramatically reduce danger that they will fail to implement solutions that are less effective but are likely to improve public safety to some degree. Partially effective risk-reducing improvements, as described herein, can save lives, pending the development of more efficacious safety measures. In order that the perfect not be the enemy of the good, the Committee makes

Recommendation 6: Where uncertainties or countervailing public health concerns preclude completely eliminating potential risks, the FDA should encourage, and where necessary require, the blood industry to implement partial solutions that have little risk of causing harm.

In the event of a future threat to the blood supply, the FDA should encourage small, low-risk solutions to large, difficult problems. The FDA's actions during the early 1980s are evidence that the agency should change its attitude toward regulation in order to adopt this proactive approach. Some examples from Chapter 6 illustrate how the FDA might have encouraged practices that would have reduced the risk faced by recipients of blood or a blood product.

Example: Destroy Unscreened Blood When Possible . When hospital blood banks first started to screen donors by questioning them for risk factors, there was a period of transition during which its stocks contained two classes of blood or plasma: blood from screened donors, which was relatively safe; and blood from unscreened donors, which had a higher probability of containing HIV. Within a few weeks of starting to screen donors, blood from unscreened donors would have been either used or discarded. In the instructions contained in its letter of March 24, 1983, the FDA could have recommended that blood banks adopt a policy of using blood from screened donors whenever possible during the transition period, a policy that some blood banks may have adopted on their own. Requiring all blood banks to adopt this policy would not have compromised the nation's blood supply, and it would have prevented at least a few instances in which a patient received an infected unit of blood.

Example: Destruction of Potentially Contaminated Cryoprecipitate . Blood banks store cryoprecipitate from a single unit of donated blood in the frozen state for up to one year. The FDA could have issued a directive that required the blood banks to check their inventory of frozen cryoprecipitate and destroy possibly contaminated units whenever they learned of a previous donor who had AIDS or was strongly suspected of having AIDS.

Example: Phased Recall. In July 1983, there was considerable reluctance to recall untreated Factor VIII concentrate at a time when much of the supply was almost certainly contaminated with HIV. The FDA apparently feared that the ensuing shortage of Factor VIII would have caused more harm than the HIV virus. A phased withdrawal would have been a compromise between no withdrawal and immediate total withdrawal. This middle path might have avoided a factor concentrate shortage and still reduced the number of hemophiliacs who became infected.

Example: Lookback. The FDA formally instituted a "lookback" policy in 1991, years after it was clear that AIDS had a long incubation period during which a patient could transmit HIV through sexual contact or contact with blood. Lookback required blood banks to contact recipients of blood from infected donors and notify them that they might be a HIV carrier and should be tested for HIV antibodies. Earlier action on lookback might have reduced secondary transmission of HIV.

Decision Processes

In all fields, decisionmaking under uncertainty requires an iterative process. As the knowledge base for a decision changes, the responsible agency should reexamine the facts and be prepared to change its decision. The agency should also assign specific responsibility for monitoring conditions and identifying opportunities for change. In order to implement these principles at the FDA, the Committee makes

Recommendation 7: The FDA should periodically review important decisions that it made when it was uncertain about the value of key decision variables.

An example illustrates the principle of iterative decisionmaking. During 1983, most blood bank officials opposed asking prospective male donors if they had ever had sex with a man. They were worried that regular donors might take offense and stop donating blood. They were also concerned about some gays would lie about their homosexuality and donate blood in reprisal for being singled out as the target of the questioning. Eventually, some blood collection centers began to ask questions about sexual preference. If the FDA had carefully monitored these experiments, it would have soon learned that the blood bank officials' fears were groundless. The FDA might then have revised its requirements for donor screening to include direct questions about high-risk sexual practices.

Regulatory Efforts

Although the FDA has a great deal of regulatory power over the blood products industry, the agency appears to regulate by expressing its will in subtle, understated directives. This informal approach to regulation is often necessary to permit a timely response and to preserve needed flexibility. The FDA used this approach, for example, in July 1983 when it issued recommendations to withdraw lots of AHF concentrate that plasma fractionators had identified as containing material from a donor that had AIDS . The language in the July 1983 communication failed to specify, however, whether the agency considered the recommendations to be binding on industry. While most regulated industries might have interpreted these letters as mandatory, that question should not have been left to the judgment of individual entities. Taking this into account, the Committee makes

Recommendation 8: Because regulators must rely heavily on the performance of the industry to accomplish blood safety goals, the FDA must articulate its requests or requirements in forms that are understandable and implementable by regulated entities. In particular, when issuing instructions to regulated entities, the FDA should specify clearly whether it is demanding specific compliance with legal requirements or is merely providing advice for careful consideration.

In 1983, the FDA chose a middle ground when faced with the decision to withdraw all AHF concentrate. The agency recommended that plasma fractionators withdraw individual lots of AHF concentrate when a donor was suspected of having AIDS . This decision was certainly defensible. However, the process for this "case-by-case" withdrawal was seriously compromised by the vagueness of the criteria specified for a recall. The agency failed to specify a process for deciding whether a donor may have had AIDS. The agency should have specified a process for reviewing donors who did not fully satisfy the diagnostic criteria for AIDS but who were suspected of having the disease. When deciding whether to withdraw a lot of AHF concentrate, the FDA asked plasma fractionators to take into account the time of the donation in relation to the diagnosis of AIDS and the effect of the recall on product availability. However, the FDA did not specify parameters for assessing either of these decision criteria. With greater forethought, the FDA could have avoided the potential for a seriously flawed implementation of a policy that otherwise appeared to balance benefits, risks, and harms.

Advisory Committees

The FDA made several decisions in 1983 that appear to have been influenced by the blood-industry-based (profit and nonprofit) members of the BPAC. The BPAC membership did not include individuals with expertise in the social, ethical, political, and economic aspects of the issues that BPAC was deliberating at the time. The FDA apparently did not seek independent analysis of the recommendations made by the members of the BPAC, some of whom were employed by the blood industry. In the early 1980s, the FDA appeared too reliant upon analyses provided by industry-based members of the BPAC and the BPAC. For example, see the discussion in Chapter 6 of the July 19, 1983, BPAC meeting which resulted in the decision for case-by-case rather than automatic recall of lots of AHF when one donor was suspected of having AIDs. Chapter 6 also contains a discussion of the December 15, 1983, BPAC meeting, which effectively curtailed actions on surrogate testing of blood for months. The Committee's analysis of the FDA's management of its advisory committee leads to the following three recommendations:

Recommendation 9: The FDA should ensure that the composition of the Blood Products Advisory Committee reflects a proper balance between members who are connected with the blood and blood products industry and members who are independent of industry.

The FDA should select some BPAC members because they can provide independent judgment, question the analyses provided by blood-industry-based BPAC members, and hold the FDA accountable for a high standard of public responsiveness. The BPAC should have at least one voting member who is a representative of consumer interests. BPAC members who vote to establish policy should have neither the appearance of a conflict of interest nor a true conflict of interest.

An agency that is practiced in orderly decisionmaking procedures will be able to respond to the much greater requirements of a crisis. The BPAC meetings cited before Recommendation 9 above provide examples to support this recommendation. Applying this principle to the use of advisory committees, the Committee makes

Recommendation 10: The FDA should tell its advisory committees what it expects from them and should independently evaluate their agendas and their performance.

The FDA staff and its advisory committees should structure their relationship so that they invigorate each other. The agency should hold an advisory committee accountable for its performance through periodic independent evaluation. By placing unresolved issues on future agendas, the committee can hold the FDA accountable for taking follow-up action between committee meetings. The IOM Committee to Study the Use of Advisory Committees by the Food and Drug Administration makes further recommendations to strengthen the FDA advisory committee system (IOM 1992).

Advisory committees provide scientific advice to the FDA; they do not make regulatory decisions for the agency (IOM 1992). As Chapter 6 indicates, the FDA in 1983 did not independently verify the estimates of the risk of blood-product-related HIV infection. The FDA did not analyze the public health implications of the BPAC's recommendation against automatic recall of AHF concentrate that contained plasma from donors suspected of having AIDS . The FDA's lack of independent information and its own analytic capacity meant that it had little choice but to incorporate the advice of the BPAC into its policy recommendations. To ensure the proper degree of independence between the FDA and the blood products industry, the Committee makes

Recommendation 11: The FDA should develop reliable sources of the information that it needs to make decisions about the blood supply. The FDA should have its own capacity to analyze this information and to predict the effects of regulatory decisions.

Communication to Physicians and Patients

One of the crucial elements of the system for collecting blood and distributing blood products to patients is the means by which to convey concern about the risks inherent in blood products. In today's practice of medicine, in contrast to that of the early 1980s, patients and physicians each accept a share of responsibility for making decisions. Patients' informed consent is required for risky procedures. From early 1983, it was clear that AHF concentrate was a risky product. The failure to tell hemophilia recipients of Factor VIII concentrate about the risks of this treatment and about alternative treatments seems especially serious in the light of present-day emphasis on the autonomy of patients in decisions involving their health.

Clinical Practice

One powerful lesson of the AIDS crisis is the importance of telling patients about the potential harms of the treatments that they are about to receive. The NHF dedicated itself to providing information to individuals with hemophilia and their physicians. Their strategy, however, was seriously flawed. As discussed in Chapter 7 , the NHF provided treatment advice, not the information on risks and alternatives that would enable physicians and patients to decide for themselves on a course of treatment. Hemophilia patients did not have the basis for informed choice about a difficult treatment decision.

Considerable scientific and medical uncertainties characterized the early years of the AIDS epidemic. For individuals medically dependent on the use of blood and blood products, these uncertainties created complex dilemmas about clinical options for their continued care. In instances of great uncertainty, it is crucial for patients to be fully apprised of the full range of options available to them and to become active participants in the evaluation of the relative risks and benefits of alternative treatments. As the case studies in Chapter 7 indicate, the failure to communicate adequately about these options prevented many hemophiliacs from making choices in which they accepted responsibility for balancing the risk of AIDS and the risks of bleeding. Ultimately the failure to communicate led to a powerful sense of betrayal that exacerbated the tragedy of the epidemic for many patients and their families. To encourage better communication, the Committee makes

Recommendation 12: When faced with a decision in which the options all carry risk, especially if the amount of risk is uncertain, physicians and patients should take extra care to discuss a wide range of options.

Medicine has many "gray areas" in which the correct course of action is not clear. Guidelines should identify these areas and spotlight the importance of full disclosure of risks, discussion of the broadest range of clinical options, and incorporation of the patient's preferences into an individualized recommendation. Given the inherent risks and uncertainties in all blood products, the public and the providers of care need expert, unbiased information about the blood supply. This information includes risks and benefits, alternatives to using blood products, and recommended best practices. As Chapter 7 indicates, the NHF (the only organization that stepped in to provide information to hemophiliacs and the physicians who were treating them) focused on practice recommendations rather than complete information on risks and options. In order to provide the public and providers of care with the information they need, the Committee makes

Recommendation 13: An expert panel should be created to inform the providers of care and the public about the risks associated with blood and blood products, about alternatives to using them, and about treatments that have the support of the scientific record.

One lesson of the AIDS crisis is that a well-established, orderly decisionmaking process is important for successfully managing a crisis. This applies as much to clinical decisionmaking as to the public health decision process addressed by the earlier recommendations. As the narrative indicates, there are both public health and clinical approaches to reducing the risk of blood-borne diseases. The Blood Safety Council called for in Recommendation 2 would deal primarily with risk assessment and in the public health domain, actions that would reduce the chance that blood products could be vectors of infectious agents. The primary responsibility of the expert panel on best practices called for in Recommendation 13 would be to provide the clinical information that physicians and their patients need to guide their individual health care choices. To be most effective, this panel should be lodged in the Blood Safety Council (see Recommendation 2) so that both bodies can interact and coordinate their activities in order to share information about emerging risks and clinical options.

Any organization that supplies this information must adhere to accepted norms for documenting evidence. The Committee believes that the public's interest would be best served by creating one publicly accountable source of this information. This function would build on the experience of the Agency for Health Care Policy and Research, which has an established guideline development process and issues guidelines on topics such as the management of chronic pain, screening for AIDS , and management of urinary incontinence (El-Sadr, et al. 1994; Jacox, et al. 1994).

Experience in developing practice guidelines for hemophilia treatment and blood transfusion is an important element of preparedness for future threats to the blood supply. There are now well-established processes such as those recommended by the IOM Committee to Advise the Public Health Service on Practice Guidelines (IOM 1990, 1992) and used by the Agency for Health Care Policy and Research. The U.S. Preventive Services Task Force (1989) uses another system process. Guideline developers should perform a thorough literature search, identify well-designed studies, describe fully the evidence on harms and benefits, and explain the connection between the evidence and the recommendations. They should seek critical evaluation from a wide spectrum of individuals and organizations and should periodically reexamine the recommendations in the light of changing knowledge.

Credibility

During the early 1980s, in its role as the guardian of the interests of the hemophilia patient community, the NHF was the principal source of information about using blood products. The outcome of the NHF efforts was that individuals with hemophilia and their families lost faith in the NHF as the rightful steward of their interests. The reasons discussed in Chapter 7 include the NHF's unwavering recommendation to use AHF concentrate, its dependence on funds contributed by the plasma fractionation industry, and the composition of the NHF expert panel (MASAC) that formulated treatment recommendations (e.g., the panel's lack of infectious disease experts and decision analysts).

Toward the end of providing the highest-quality, most credible information to patients and providers, the Committee makes

Recommendation 14: Voluntary organizations that make recommendations about using commercial products must avoid conflicts of interest, maintain independent judgment, and otherwise act so as to earn the confidence of the public and patients.

One of the difficulties with using experts to give advice is the interconnections that experts accumulate during their careers. Organizations that regulate an industry may get advice from the same experts who advise the industries. Organizations that give treatment advice may rely on experts whose employer relies upon support from industry. As a result, an expert may have a history of relationships that raise concerns about whether he or she can be truly impartial when advising a course of action in a complex situation. The Committee believes that the best way to avoid these risks is to choose some panelists who are not expert in the subject of the panel's assignment but have a reputation for expertise in evaluating evidence, sound clinical judgment, and impartiality.

Financial conflicts of interest influence organizations as well as individuals. As indicated in Chapter 7 and above, the financial relationships between the NHF and the blood products industry seriously compromised the NHF's credibility. The standards for acknowledging conflicts of interest are higher than they were 12 years ago. Public health officials and the medical professions must uphold this new standard. Failure to do so will threaten the fabric of trust that holds our society together.

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Essay on HIV AIDs Awareness

Students are often asked to write an essay on HIV AIDs Awareness in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on HIV AIDs Awareness

Understanding hiv and aids.

HIV stands for Human Immunodeficiency Virus. It attacks our body’s defense system. AIDS, or Acquired Immunodeficiency Syndrome, is the condition caused by HIV. It makes people very sick because their bodies can’t fight off illnesses well.

How HIV Spreads

HIV is passed from one person to another through blood, sharing needles, and from mother to baby during birth or breastfeeding. It’s also spread through sex without protection, like condoms.

Preventing HIV

Using new needles and safe sex practices, like condoms, can prevent HIV. Also, medicines can help mothers with HIV not pass the virus to their babies.

Living with HIV

People with HIV can live long, healthy lives with proper medicine. It’s important to get tested and start treatment early.

Spreading Awareness

Talking openly and learning more about HIV can help stop false beliefs and stop the virus from spreading. Schools and communities play a big role in this.

250 Words Essay on HIV AIDs Awareness

HIV stands for Human Immunodeficiency Virus. It attacks our body’s defense system, making it hard to fight off sickness. AIDS, which is Acquired Immune Deficiency Syndrome, happens when HIV has damaged the immune system a lot. People with AIDS can get very sick from infections that don’t usually make healthy people ill.

The Importance of Awareness

Knowing about HIV and AIDS is very important. It helps people learn how to protect themselves and others from getting the virus. Awareness also means understanding that people with HIV need support and should not be treated badly.

HIV can be passed from one person to another through blood, during sex, or from a mother to her baby during pregnancy, birth, or breastfeeding. It is not spread by touching, hugging, or sharing food.

Prevention is Key

Preventing HIV is better than trying to treat it. This means not sharing needles, using protection during sex, and getting tested if you think you might have been exposed to HIV. There are also medicines that can lower the risk of getting HIV.

Getting Tested

Getting tested for HIV is simple and can be private. If a test shows someone has HIV, it’s not the end of the world. With today’s medicines, people with HIV can live long and healthy lives.

Support and Respect

People with HIV deserve to be treated with kindness and respect. Being aware of HIV and AIDS means also fighting against wrong ideas and standing by those who have the virus. This way, we can all help stop HIV from spreading and support those living with it.

500 Words Essay on HIV AIDs Awareness

Understanding hiv/aids.

AIDS, which stands for Acquired Immune Deficiency Syndrome, is a serious health issue caused by the virus called HIV, or Human Immunodeficiency Virus. This virus attacks our body’s defense system, making it hard for the body to fight off diseases. People can get HIV from infected blood, sharing needles, or through unsafe sex. It’s also possible for a mother to pass it to her baby during pregnancy, birth, or breastfeeding.

Why Awareness is Important

Knowing about HIV/AIDS is very important because it helps prevent the spread of the disease. People who are aware are more careful and can protect themselves and others. They know the importance of safe practices, like using new needles for medicines and not sharing them. They also understand why it’s important to have safe sex, using protection to stop the virus from spreading.

One of the key parts of awareness is getting tested for HIV. Tests are the only way to know for sure if someone has the virus. Early testing means that if a person does have HIV, they can start treatment sooner. This helps them live a longer, healthier life and reduces the chance of passing the virus to someone else.

Treatments for HIV/AIDS

There is no cure for HIV/AIDS, but there are medicines called antiretroviral therapy (ART) that help control the virus. These medicines help people with HIV live longer, healthier lives and lower the chance of spreading the virus. Knowing about these treatments is a big part of awareness because it encourages people with HIV to get the help they need.

Support and Acceptance

People with HIV/AIDS often face tough times because others might not understand the disease. They can be treated unfairly or feel alone. HIV/AIDS awareness includes teaching people to be kind and supportive. When everyone understands the disease better, they can help those affected by HIV/AIDS feel accepted and not alone.

Education and Prevention

Teaching kids and adults about HIV/AIDS is a powerful way to stop the disease from spreading. Schools and community groups can give out information on how to stay safe and healthy. They can also explain that HIV is not spread by touching, hugging, or being friends with someone who has the virus.

Global Efforts

Countries around the world are working together to stop HIV/AIDS. They share information, support research for better treatments, and help people get the care they need. It’s a global fight, and awareness is a tool that everyone can use to join in.

HIV/AIDS awareness is about understanding the disease, knowing how to prevent it, and supporting those who have it. It’s about getting tested and starting treatment if needed. Most of all, it’s about kindness and working together to stop the spread of HIV/AIDS. When everyone knows more, they can do more to help themselves and others.

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• Essay on AIDS

HIV (human immunodeficiency virus) is an infection that causes cells in the body that help it fight infections, making a person more susceptible to other infections and diseases. Interaction with certain bodily secretions of an HIV-positive individual, most commonly during unprotected intercourse (sex without the use of a condom or HIV treatment to prevent or treat HIV), or sharing injection drug equipment spreads the virus.

If HIV is not treated, it can progress to AIDS (acquired immunodeficiency syndrome). HIV cannot be eradicated by the human body, and there is no effective HIV cure. As a result, whether you have HIV, you will have it for the rest of your life.

Long and Short AIDS Essay in English

There are many diseases causing microorganisms, like bacteria, viruses, fungi etc. The symptoms of the diseases depend on the type of microorganism that is spreading it. It can vary from mild to severe. AIDS which stands for Acquired Immunodeficiency Syndrome is a viral disease that is rampant in growth. It was only in the last century that this viral disease has proved to be lethal and fatal, taking away about twenty million lives globally. The awareness about the disease and the virus causing it which is HIV or Human Immunodeficiency Virus is more now compared to earlier. In this HIV AIDS essay, we can go through the important information about it and burst some myths.

Below are different ways to write an AIDS essay in English. The essay on HIV AIDS can be of 2 formats, a long essay on HIV AIDS or a short AIDS essay.

Short Essay on Aids

This AIDS essay is a brief one and will cover the important notes about the disease and the ways one can prevent it.

The way of occurrence of this disease is in the name itself, AIDS stands for Acquired Immunodeficiency Syndrome. The disease is acquired via the virus which is called Human Immunodeficiency Virus. It is not an auto-immune disease in the early stages of infection where the immune system in the body fights off infection to protect the body from diseases that go against itself. The virus enters from an outside source and destroys the efficiency of our immune system.

AIDS is transmitted through contact. The contact with infected blood of the HIV OR AIDS patient in any form can easily transfer this viral disease. It can also be transmitted through contact with semen or vaginal fluids of the infected person. This occurs in the case when one is sexually exposed to a person with HIV.

HIV once enters the body, invades and conquers the immune system making the body susceptible to other diseases. It is then very easy for the simple flu or cold infection to be severe as the immune system is no longer fit to fight it.

When detected in the early period can be battled with, but more often than not people assume the symptoms to not be AIDS so it spreads and kills the individual. To be protected when having sex and not sharing any form of toiletries with others is the way to prevent and keep this deadly virus at bay.

Long Essay on AIDS

This is the long format of an essay on HIV AIDS where its workings, causes and effects and remedies are discussed.

There are some diseases that have been borne by the living in this world which has created a ruckus in human history and the struggle to find a permanent cure still exists. AIDS is one such disease. Acquired Immunodeficiency Syndrome is the name of the disease which is also shortened as AIDS.

It has since only the 20 th century affected the human race and many people lost their lives, more than 20 million of them. The virus that aids in the transmission of this disease is Human Immunodeficiency Virus or also called HIV. Due to the same property of immunodeficiency, it is referred to as HIV/AIDS.

Since it affects the immune system severely, the cells and the workings of it in our body must be clearly understood. The immune system’s role in the body is that of a soldier wherein it identifies any sort of anomalies that enters or infiltrates the body and prepares antibodies against it. And kills them in order to prevent infection that has the probability of causing a harmful disease.

Since the cells of the immune system have already created the antibodies, the cell memory is activated when the entry occurs again and the immune system fights and destroys such foreign and harmful matter.

What Happens when HIV Enters the Body?

When a person is infected with the Human immunodeficiency virus, it directly attacks the immune system making the cells weak and incapable of creating antibodies for this particular virus. As they become weak their function to perform the task of defending against other microorganism entrants is also weakened.

When the fighter in our bodies becomes weak, we are more likely to fall ill. The illness can be a simple flu or an allergy and our body cannot fight any further. The symptoms once infected will start to appear within the first two weeks. The symptoms are very flu-like for instance, one will be more tired than usual and fatigue will be more frequent and regular. Other symptoms include sore throat and fever. The risk of opportunistic infections like tuberculosis and herpes also increases. Some people however remain asymptomatic even for longer periods after being infected with the virus.

Cause of HIV/AIDS

The main and only cause of this dreadful disease is the contact through blood, semen, pre-seminal fluid, vaginal fluids, rectal fluids and breast milk. The semen and vaginal fluids are transferred through sex and rectal fluids through anal sex. When people have multiple partners, and they have unprotected sex the transmission is highly likely. The contact through blood can also be via the unhygienic practice of sharing an infected person’s razors, blades. Even unsterilized syringes while taking drugs or even a tattoo parlor where they use unsterilized machines on the body can transmit the virus easily. The transmission means are endless so one must proceed with utmost caution to keep themselves safe either way.

What is the Life Expectancy for the Patients Carrying HIV or AIDs with Them?

Many factors can affect the life expectancy of people living with HIV. Depending on these factors there are many differences in the outcomes between people, and other factors. The factors on which life expectancy depend are:

Access to effective HIV treatment and quality health care.

Start HIV treatment as soon as possible after HIV infection, before your CD4 cell count drops to a low level. The sooner you are diagnosed and start HIV treatment, the better your long-term chances are.

Having serious HIV-related illnesses in the past. This may occur before HIV is diagnosed and/or before HIV treatment is started. These diseases have a detrimental effect on life expectancy.

Results one year after starting HIV treatment. Studies show that life expectancy is better for people who respond well within a year of starting treatment than people who do not respond. In particular, people with a CD4 count of at least 350 and an undetectable viral load during the year have a much better chance long-term.

Year of Diagnosis - HIV treatment and medical care have improved over the years. People who have been diagnosed in recent years are expected to live longer than people who were diagnosed long ago.

Heart diseases, liver diseases, cancer and other health conditions are more likely to be the cause of death than HIV or AIDs.

Injecting drug use - Life expectancy is short for people with HIV who inject drugs, due to drug overdose and viral infections.

Social and Economic Conditions - there are significant differences in life expectancy depending on where you grew up, your income, education, social status and more.

Gender – Men are supposed to live for a shorter period of time than women.

Genetics - you may have certain conditions if close relatives have.

Mental and Emotional Well-being - high levels of stress are associated with reduced life expectancy.

Lifestyle - longevity for people who eat a balanced diet, are physically active, maintain a healthy weight, avoid alcohol abuse or use drugs, and stay in touch with the community. Avoiding smoking is very important in life.

There are a few myths surrounding this disease. It is believed earlier that AIDS can spread even through contact or touch without any exchange of fluids. Like through a hug or just by being near the infected person. That myth has been debunked and it is absolutely untrue. One can freely hug an AIDS patient without worry.

The other one was when kissing, there is an exchange of saliva which is also a fluid and AIDS can spread through kissing, which also proved to be untrue. And HIV always means AIDS that is fatal was another rumor or myth, and this myth is proven wrong where many people have lived longer with HIV by medication and taking care of their health.

There is no permanent cure yet for treating HIV/AIDS, so it is our responsibility to look out for ourselves. The way one can first prevent themselves from being infected is by getting vaccinated. It is important to get tested in your adult life if you have multiple sexual partners and also get your partner tested for the same. The other way is being monogamous. The most used form of prevention is having protected and safe sex and using condoms that creates a barrier for transmission. Do check for sterilized needles in case you decide to get a tattoo or injected.  Lessen the use of alcohol and drugs as that is anyway weakening and altering the immune system.

According to the estimates of the Indian government  2.40 million Indians are living with HIV wherein, the infected ones fall in the age group of 15-49, and 39 %of them that is 9,30,00 of them are women. The numbers are alarming and the rate of increase is not slowing down anytime soon. We as a country must break the traditions and conversations about sex should be open and safe. It is high time we lose our lives to this disease which can be prevented.

FAQs on Essay on AIDS

1. Is AIDS an Autoimmune Disease?

In the early stages of HIV infection that leads to AIDS, the immune system only weakens so it is not an auto-immune disease. But during the later and final stages, the workings of the immune system are similar to that of an auto-immune system where it works against itself. And in such cases, the body of the individual is susceptible to many more diseases. AIDS, a disease found in immune deficiency disorder, is caused by HIV and weakens the human immune system. Autoimmune diseases, on the other hand, are where the immune system turns, attacking healthy cells.

2. Does one die from HIV Infection?

The HIV infection results in many symptoms that make the body weaker day by day. But some do not even suffer those symptoms and they may live longer than the ones showing severe symptoms. In any case, it is important to take medications that are prescribed to reduce the severity of symptoms and live a little longer. The best way is to keep healthy and lead an active lifestyle as much as possible. Although the death toll from AIDS has dropped dramatically around the world, this situation increases the risk of contracting a fatal disease — potentially leading to death. No treatment or cure is present for HIV.

3. What method was adopted by the hospitals to report HIV or AIDs cases?

The doctors took the active initiative for the reporting and diagnosis of HIV or AIDs cases all over the world. The methods that all the French hospital wards were known for, for their role in controlling HIV infection, were asked to report the 2000 deaths among HIV-positive adults. The causes of death were recorded using a standard questionnaire. The Mortality 2000 study was launched to explain the distribution of the leading causes of death of HIV-positive people at the national level in France in the year 2000.

4. What is the way of determining the root cause of death in AIDs patients?

Following the International Classification of Diseases, 10th Revision (ICD-10) to death, the information contained in the questionnaire was used to determine the single cause of death. The causes of AIDS were categorized as one cause of death, followed by definitions of AIDS-related diseases. If a standard questionnaire was lost, summarized quarter notices were used to determine the underlying cause of death, if possible. Determination of the AIDs cases was set to the most important things in the list, which was done from the abstracted quarterly notifications from the questionnaires.

5. Is Vedantu a reliable website for knowing about AIDs disease?

Vedantu is the most reliable website for referring to information about AIDs disease. Being one of the most dangerous diseases in the world with no proper treatment or cure, the world's physicians are still under pressure to decipher the way to save a person from this disease. The Vedantu website contains authentic or updated information about this disease and thus the readers and viewers can rely on this source of information for perfect knowledge about the disease and its prevention also.

• Essay Editor

AIDS/HIV: Description of the Disease Essay

1. introduction.

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a disease that affects the human immune system. As the disease progresses, the number of lymphocytes is reduced, making the body predisposed to a number of infectious diseases. The disease occurs as a result of infection with a virus called human immunodeficiency virus. The main modes of transmission of HIV from one person to another are through sexual contact. The second most frequent mode of transmission is the percutaneous route during the use of syringes and needles. The progress of medical science in the last twenty years has achieved great success in the field of producing new, safe, and efficient antiviral agents, as well as in the treatment of the infectious diseases associated with HIV infection. However, the control of this epidemic requires intensification of efforts of both healthcare personnel and society as a whole to enable rapid detection of HIV cases, prevention mechanisms targeting both individuals and high-risk groups, as well as education of the general population on the importance of avoiding the transmission of this disease. One of the goals of such education would be to familiarize people with the possibility of HIV transmission, as lack of knowledge makes people indifferent to the risk.

1.1 Definition of AIDS/HIV

AIDS (Acquired Immune Deficiency Syndrome) is the name given to an advanced form of infection with the Human Immunodeficiency Virus (HIV). One or more of a series of infections, which are called opportunistic infections, occur in a person who has been infected with HIV. In common usage, people with 'cases of AIDS' are those who are HIV seropositive and have common parasitic illnesses, or children born to such people. Full-blown AIDS can be defined based on immunological and/or clinical criteria. However, these are often unreliable, and a definite diagnosis requires appropriate laboratory tests, such as PCR or virus culture and antigen detection. A blood test for the detection of antibodies to HIV is now used to confirm the diagnosis of HIV infection. HIV is a clinical term. It encompasses both infection by HIV and the disease caused by it. The virus may be dormant or latent for decades in infected individuals, during which time the infected individuals are asymptomatic and can transmit the virus. During that time, their immune systems are damaged, and their health will eventually deteriorate. They will feel well, but their immune system will have been damaged, and they can transmit the virus. When their immune system becomes so weak that it cannot facilitate an immune response to other infections, the infection rate with a wide variety of pathogens skyrockets. Opportunistic agents, which do not normally cause disease, begin to attack the AIDS patient. The patient may then manifest a variety of clinical diseases, many of which are difficult or impossible to treat, and many of which are life-threatening.

1.2 Historical background

The term "acquired immunodeficiency syndrome" (AIDS) was first introduced in 1982, and it was later established that the condition was caused by a single-stranded ribonucleic acid (RNA) virus known as the human immunodeficiency virus (HIV). The earliest confirmed case of HIV was documented in the Belgian Congo in 1959 after the infection of a 46-year-old female. It was determined through the use of stored samples of plasma and the polymerase chain reaction (PCR) that one year later she was infected by two sub-strains of the HIV viral strain. Interestingly, this case was not associated with the Western Hemisphere and indicated that the virus might not have been introduced in the United States as it is commonly believed. The first case to be associated with the United States was the so-called Patient Zero, a flight attendant who was responsible for the spread of the virus along the east coast. HIV likely originated in the late 1800s to early 1900s as a result of species cross-jumping, which occurs when a Simian Immunodeficiency Virus (SIV) infects a human and becomes HIV. This occurred as a result of eating monkey meat, a practice that is now discouraged. The subtypes M and N are the oldest, and they likely arrived in humans around 1910 in the French Congo, as evidenced by nucleic acid sequencing and phylogenetic analyses. The driving factor for the introduction of HIV was migration of the human population, likely occurring as a result of war and the acquisition of new territories by the colonial powers.

1.3 Global impact of the disease

The AIDS pandemic is a major cause of food insecurity. The rural situation has improved marginally with the introduction of antiretroviral treatment (ARVs). However, implementation of economic and food security policies and programs has been slow. Their success was hoped to result from the development of human capital (increased number of healthy adults), but this has not been the case. In part, social security programs such as food support were successful in the past, but these have decreased in number under retrenchment policies. Food security programs are thin on the ground and allow access to food only on a very short-term basis. A World Food Program official explained that, although the rural situation was somewhat improving, it is currently more difficult to reach the rural population as it is dispersed over a very wide area. Funding for food security is dwindling and is directed only towards the very needy in the rural areas. This contrasts with the urban areas where there is greater concentration of the ill, and households can rely on the existing system to help their members access food. There are trends in the 2000s towards the marginalization of certain categories of population from the food security system. These include HIV/AIDS victims in the rural areas, internally displaced and other undeclared refugees, and a growing population of unemployed. There is some evidence that migration interventions are increasingly needed to avoid a bigger crisis. There are large numbers of people in the rural and urban areas who cannot afford enough food or, at times, nothing at all.

2. Transmission and Prevention

AIDS is transmitted by blood and blood products, or through semen or any other body secretion that may be contaminated with blood from an infected person. In developing countries, the possibility of hospitals and blood banks having unsafe grafts is the origin of many cases of the disease. Intravenous drug users are also threatened, since the viruses can exist in the blood their used needles. Children born to infected mothers, but who are not carrying the virus, are not at risk of contagion from their mother unless, during childbirth, the baby's swallow a drop of blood or amniotic liquid of the mother. There is no way to prevent disease in these individuals. During labor, AAP is also at risk of developing AIDS if the mother and newborn share blood to cause serious lesions in the nipples. Studies show that there is no risk of contagion during pregnancy as long as the couple follows certain care and regulations made available in centers. It should be noted, however, that we are increasingly contacting such situations, since the number of infected children of uninfected mothers who have been abused by their caregivers is increasing. In common those aged 2 to 11 follow the same standards of care used in hospital workplaces, surgery, or other procedures. Finally, mouthwashes for AIDS can also reduce the risk of contamination by kissing, particularly when there are lesions or canker sores. For sex workers, the use of condoms is the highest. The condom demonstrates a risk of contagion, although some married women live with an infected spouse will not have intercourse.

2.1 Modes of transmission

The human immunodeficiency virus (HIV) is transmitted in several ways. The three major modes of transmission in the UK and Western Europe are receptive anal or vaginal sexual intercourse without a condom; the sharing of contaminated equipment for injecting drug use; and transmission from mother to baby before, during, or after birth. The virus can also be transmitted through contaminated blood or blood products. The male sexual partner of a woman infected with HIV has a modest risk of acquiring HIV through intercourse. The female sexual partner of a man who has intercourse with women is at a higher risk. The routes of transmission of HIV have now been clearly defined. HIV is found in all body fluids, but the transmission of HIV has been shown only with certain body fluids. The three principal routes are through blood, blood products, and contaminated equipment for injecting drug use; through sexual contact; and from mother to child. Most people with HIV are infected through sexual transmission or drug use. Infection, which usually results from injecting drug use, is sometimes transmitted through contaminated blood or blood products. It is important to appreciate that HIV is not transmitted, except very rarely, during daily social, family, or work activities. Transmission of HIV, and risk of infection, depend on the body fluid that contains HIV and the type of contact. Transmission has been documented with blood, semen, vaginal fluid, breast milk, and other body fluids that contain blood. Blood and genital secretions of people with acute and end-stage AIDS also contain HIV.

2.2 High-risk behaviors

High-risk behaviors, as defined by CDC, are behaviors that could increase the risk of transmission of acquired immune deficiency syndrome (AIDS). These behaviors include being sexually active with more than one partner: homosexual, bisexual, or heterosexual contact with an infected partner, and abusing drugs or alcohol. In addition, the sharing of needles, syringes, or other equipment to inject drugs is considered a high-risk behavior. Socioeconomic and cultural factors such as poverty, lack of education, instability within the family unit, poor self-image, marginal living or working conditions, and diminished occupational opportunities are more pronounced determinants of a young person's susceptibility to drug abuse, high-risk sexual behaviors, and noncompliance with prophylactic measures than are biological, psychological, or behavioral factors. At high risk for human immunodeficiency virus (HIV) infection are adolescents who have not yet adopted responsible and safe behaviors, especially those in certain populations who are affected disproportionately. Adolescents who are sexually active have the highest risk for both acquiring and transmitting HIV. Adolescents are at considerable risk for HIV, other sexually-transmitted diseases (STDs), and unintended pregnancy if they start having sex in early adolescence, engage in multiple sexual activities or have sexual activity with high-risk partners, or use drugs or alcohol associated with sexual activity. It is imperative that preventative education is initiated to delay onset of sexual activity or to reduce adolescent involvement in high-risk sexual activities.

2.3 Prevention strategies

Prevention strategies targeting people with established risk factors are important interventions for achieving public safety. They also aim to prevent human immunodeficiency virus transmission, the major risk factors of the illness. Irrational lifestyle changes, massive disease treatment strategies, and promoting a low-risk approach based on the evidence of prevention that touch on each population's local needs and circumstances—a general approach to prevention. HIV transmission can be prevented not only by changing body fluids with a person who has the virus but also by changing with a person harmful substances that tamper with a person's fluid. Therefore, different adjustments are implemented to prevent HIV from spreading from person to person. Techniques of preventing the dissemination of one person's illness to another person vary. Among these are: 1) modifications in expectations and behaviors focused on the physical and social conditions of communities and persons in the region; 2) changing aims, expectations and languages at the cultural and social level. One of the most serious and threatening responsibilities in the face of the spread of illness is to provide high-quality healthcare services to prevent infection. Such a responsibility arises from different patient rights, including the right to the conservation of personal structural and social integrity. It implies both the discoverability of safety instruments for the provision of services and the meaning, acceptance and management do not change the right of HIV-infected persons nor the nature of the illnesses. Not only in standard healthcare systems is the need of HIV-infected patients over time getting a form of scientific care—the time between the request for analysis/operation and the plenary of specialized care. It is very important, at least based on the physical integrity possibilities for patients infected with HIV, to assess the alarming safety and/or transfusion structures; protect healthcare workers from the preventing rough structures; and detect the CCT infections in a forward structure without modifying their training.

2.4 Importance of education and awareness

Education is the strongest tool against AIDS. Although for many years it was thought that AIDS was mainly transmitted between the homosexual or bisexual sectors and the refuse or drug to the heavy users, a triple epidemic in Africa, Asia, and Eastern Europe reached us. In many countries, HIV is related to poverty, promiscuous sexual activity, and discrimination of social sectors targets. Given the increasing rate of sex that AIDS spreads within society, education and knowledge about AIDS/HIV is a critical issue. It is very important for citizens to be informed about what they protect themselves from the disease and what they protect themselves from further spreading. The response to AIDS has led to a new level of collaboration between countries, institutions, and individuals that affects all aspects of society. Many governments have been encouraged to reconsider their priorities in healthcare and to use the emotional response to AIDS to strengthen their efforts to eliminate the inadequacy of sexual health and sexually transmitted diseases. Sponsored by activists, public and private partners were forced to look for new ways to provide access to essential resources, explore community health strategies, develop interventions, and involve people living with HIV/AIDS in the fight against the disease. Education as a tool can be used by public health crises and needed for the global response in the retrieval of social responses, recognizing that prevention does not modify the behavior without understanding. The closest thing to that response has been political action, which has led to international policies that directly affect the lives of millions of AIDS.

3. Symptoms and Progression

Often, but not always, the acute infection is associated with fever, sore throat, swollen lymph glands, headaches, and a generalized blotchy rash. This may last a few days but resolves to give a period during which the patient is virtually asymptomatic except perhaps for a lingering sore throat. There is considerable weight loss and eventually, after several years of progressive immune destruction, the patient becomes susceptible to a variety of life-threatening opportunistic infections that are the hallmark of the complications of AIDS. Symptoms of AIDS and the Premature Cell Death Associated with It. Treatments that extend the period between the time of infection and the manifestation of symptoms have increased the expectation of life but not sufficiently to offer protection from the eventual syndrome of immune destruction associated with AIDS. According to the Center for Disease Control and Prevention (CDC), many people live with AIDS for many years without manifesting evidence of immune destruction, which is their criteria for establishing a diagnosis of AIDS. They use a list of approximately 29 different infections that can lead to a diagnosis of AIDS, depending on the measurement of declining T-cell numbers. Any HIV-infected individual who develops one of the infections from the CDC list of 29 could be diagnosed with AIDS. According to a special report published in Newsweek and reprinted in 1999 by the Saskatchewan Association for Communicable Disease Control, "...since the introduction of the use of protease inhibitors in late 1995, hospital admissions, doctor visits, hospice care, and death have dropped significantly."

3.1 Early symptoms of HIV infection

Shortly after infection, the virus enters the bloodstream and may cause symptoms that are similar to those of a cold or the flu. Early symptoms of HIV infection include the following: loss of appetite, fever, sudden weight loss, fatigue, rashes, and headache. In some instances, it may cause no discomfort and therefore may not be recognized for what it is. This period of no symptoms that may occur after the person is infected is called the incubation period. When symptoms are experienced after the first time, the person is considered to have AIDS. In some individuals, antibodies develop in the blood that can prevent the virus from entering and destroying the white cells. Antibodies are special proteins that are synthesized by the body to make our immune system strong. As the immune system responds to the virus in this manner, the person may begin to feel better. The symptoms may disappear or come back later, and they are part of what we call the acute infection. The development of such antibodies is not always successful for a period of one to two months, and people just start to get AIDS. Although not complete and accurate results, a few weeks and tests can help determine whether the person has become infected with HIV. In the laboratory, blood is taken for antibody tests. A positive test means that infection with the virus has occurred, but a few positive tests are false. The best way to determine if you are infected with the virus is multiple negative tests. Once infected with the virus, the patient is referred to an infectious disease specialist. These are doctors who train how the diagnosis is made and the disease is detected and try to treat the disease. Assistant in the bombing of the immune system release preparations used to treat certain types of infections. Some of the drugs most commonly used for the treatment of people with AIDS. Some drugs can reduce the amount of the virus in the bloodstream of people with HIV. This, in turn, can prevent any discomfort that can happen when the immune system becomes weak.

3.2 Stages of HIV disease progression

The human immunodeficiency virus (HIV) disease is a progressive type of immune system suppression (i.e., disease). This means that the disease progresses in multiple steps. Aldrovandi gives a simple example: consider that after a person becomes infected by HIV at time 0, five hours later there would be 500 infected milestone in a group of 10,000 lymphocytes (i.e., one-tenth of what is usually found). In contrast to this large quantity of newly proposed HIV cell, there would be approximately seven million lymphocytes in that cell than normal. Then, after about 10 years, those seven million lymphocytes could be about 1.8 million, and whereas those 500 newly infected milestone cell could be approximately ten million. Thus, with time, that HIV infected cell can and does become an important cell and the byproduct of this enlarged lymphocyte are other HIV infected lymphocytes. It is eventually one of these HIV-infected lymphocytes that also become infected and the byproducts are more HIV-infected cells. It is the high replication rate that occurs between these HIV-infected cells that leads to the eventual destruction of the normal interaction between the virus and the immune system. This is the third step in corralling the disease. Finally, as is the case with many diseases, the body often fights with many fights at the multi-defense infection. This is also true for the immune response to HIV infection. At time 0, both the immune response and the amount of virus in the blood but over the six months, the virus begins circulating in the blood in larger and larger quantities. However, the body can and does put up an impressive fight in response to this increased viral load. The current conceptual model is that by 100 or so days prior to the onset of symptoms, the body has brought the infection back under control.

3.3 Complications and opportunistic infections

AIDS patients often develop massive enlargement of lymph glands and abnormalities in immunological testing, including inversion of the normal ratio of T4 to T8 cells and the appearance of cells infected with the HIV virus. The incidence of this immune disorder increases with the development of certain complications partially unique to AIDS, as well as with the occurrence of serious infection. Common complications of the immune suppression seen with HIV are pneumonia caused by the Pneumocystis carinii, which in the past occurred in less than 2% of the population but can reach a cumulative incidence of 35%-65% within 5 years of diagnosis with the infection. The Kaposi's sarcoma, a type of tumor seen with AIDS, has two unique forms characterized by purple-tinged areas which can grow inside the mouth and/or on the skin or mucous membranes of the body. This cancer can be found anywhere within the body and might involve the lymph nodes. A common infection seen in both early and later stages of AIDS are systemic mycoses, a group of diseases caused by a wide variety of pathogenic fungi. The most common major opportunistic infection is Pneumocystis carinii pneumonia. Without effective therapy, this frequently causes death. Pneumocystis pneumonia can occur at any stage of HIV infection. It is the infection that, by itself, first suggests the diagnosis of AIDS in patients who do not know they have HIV infection. In early HIV history, an important factor in the likelihood of developing Pneumocystis pneumonia was the patient's previous residential area, including whether the patient lived in a high-incidence or low-incidence area. Then, in 1990, it was one of the factors in the Festival, a large, multicenter, European study of 2,378 patients who had a previous episode of Pneumocystis pneumonia. Further support to the utility of Pneumocystis prophylaxis for patients at high risk without immunological testing was provided by the Festival and other studies.

4. Treatment and Management

Currently, the only treatment for HIV/AIDS includes a combination of antiretroviral drugs. These drug combinations can be expensive and carry significant side effects. A small number of individuals infected with HIV seem to be able to suppress the virus without treatment. A recent study from a cohort of long-term nonprogressors (LTNP) indicated that differences in antibody responses, not genetics, predict an individual’s prognosis. LTNP is a rare clinical course of people infected with HIV being able to suppress the virus without antiretroviral treatment; however, it is unclear why most stop progressing while some people can control the infection from the beginning. The most promising aspect of both prevention and management of the AIDS epidemic is a vaccine. However, despite 20 years of research and several promising candidates, there is currently no vaccine for HIV on the market. Although strong HIV-specific responses have been shown to negatively associate with viral control, the presence of HIV-specific non-neutralizing antibodies remains a potential correlate of immunity and continued research in these studies is critical for new preventive and therapeutic strategies. Suppressive combination therapy has led to a considerable decline in illness and death, and injection drug use resulting in HIV has declined. However, worldwide, deaths from AIDS-related illness continue to prevail overall deaths caused by various infectious diseases, bacterial sepsis, and chronic obstructive pulmonary disease. Therefore, there is a significant need for developing a prophylactic HIV vaccine and a curative strategy that assists in eradicating the virus.

4.1 Antiretroviral therapy

With advances in medical treatment, we know more than ever about the human immunodeficiency virus (HIV) that causes AIDS, and we have some of the tools (antiretrovirals, counseling, and safer sex instruction) to manage the damage this infection causes. Unfortunately, we cannot yet cure HIV or AIDS. Having HIV (the virus that causes AIDS) greatly increases the chances of becoming very ill from COVID-19; coronavirus infection (COVID-19) may cause a small percentage of people more severe complications, and it is important for a person living with HIV to take steps to be safer and limit risk of exposure to COVID-19. For people living with HIV who have COVID-19 and a low CD4 count or not taking HIV medication consistently may be much more likely to become very ill from the virus. Antiretroviral (ARV) treatment that reduces HIV to undetectable levels makes transmission highly unlikely. Regardless of your viral load, safer sex practices and use of risk reduction tools always remain important. The introduction of combination antiretroviral treatment has turned the otherwise fatal infection with the human immunodeficiency virus (HIV) into a chronic medical condition, as long as the patients have access to highly active antiretroviral therapy (HAART). The profound suppressive effects of HAART result in reduced plasma viral load, increased CD4+ T cell counts, and restored specific and non-specific immune responses, as well as significant reductions in morbidity and mortality. The remarkable inability of HAART to eradicate HIV from the infected host. The initial reduction of viremia that can be achieved with antiretroviral monotherapy, HIV establishes a provirus in memory CD4+ T cells, of which the long half-lives enable HIV to persist in the form of viral load below the threshold of assay detection. It is for this reason that antiretroviral treatment must be continued indefinitely without interruption. Interrupted antiretroviral therapy may have both immediate and long-term consequences. Individual patients rescue viral replication after treatment interruption follows a predictable two-phase pattern.

4.2 Adherence to treatment

Patients infected with HIV require the highest levels of adherence because any fluctuation in adherence may lead to a major decrease in the effects of treatment. Since the benefits are not all immediate and typically take years to be observed, it is important to identify why patients may not be taking their medications. A number of factors that contribute to nonadherence with antiretroviral regimens have been identified, including psychosocial and sociodemographic factors, substance abuse, partner-related factors, and medication-related factors. Nonadherence may also lead to the development of drug-resistant strains of HIV. There is an overwhelming amount of evidence that in the case of HIV/AIDS, nonadherence is linked to a worsening of health outcomes. In combination with education and other interventions, technologies can improve adherence. The five main types of digital technologies that have been described as being used to reduce nonadherence include short message service (SMS) interventions; telephone-based call reminders; technology-based adherence monitoring; mobile health (mHealth) technologies and other mobile technologies; and computer-based interventions. Multiple factors, including patients' preferences, comfort level with new technologies, disability status, cost, and adequateness of the interventions for an individual patient and their HCPs, should be considered when selecting a digital platform for the recommended intervention. This review highlights the current literature on the use of digital technologies for improving adherence in adults with HIV/AIDS.

4.3 Supportive care and palliative measures

Palliative measures are essential for the management of late-stage disease in HIV-positive individuals. These include management of pain, symptom control, and support for the family, which constitutes the cornerstone of management in terminal care. AIDS-related symptoms that require palliative care are fever, weight loss, diarrhea, oral thrush, glossitis, neuropathy, wasting or cachexia, confusion or dementia, and severe mental disorders. Pain in AIDS patients is often related to peripheral neuropathy, para-neoplastic syndromes, lesions involving the central or peripheral nervous system, neoplastic infiltration, myoskeletal pain, or visceral pain. Other incapacitating symptoms closely related to terminal HIV infection are anxiety, depression, dyspnea, anorexia, pruritus, insomnia or hypersomnia, cough, and vomiting. Care must be taken to optimize nutritional and sociocultural support, as well as effective pain control. The patient must be given high-dose opiates but will need higher or more frequent doses as the disease progresses. Care management at home is important to maintain the patient's quality of life. Terminal sedation for intractable symptoms or psychosocial distress may be necessary to relieve symptoms that cannot otherwise be controlled. Mitigation strategies must aim to improve the patient's quality of life, in particular during the last months or weeks and days of life during which it is no longer possible to slow the progression of neurological disorders.

4.4 Current research and future prospects

One thrust of current biomedical research is to understand how the HIV virus crosses cellular membranes. HIV infertility appears to begin with the attachment of the virus's envelope protein (Env) to a quiescent receptor protein. This interaction facilitates the subsequent engagement of additional cell surface receptors and the complete formation of a stalk connecting the virus and cell membranes. Multiple targets within the first few steps experienced by the virus on the cell surface are known to broadly neutralize the virus, especially when also in concert with at least one additional therapeutic. Actually, even before the recent discovery that broadly neutralizing antibodies can be elicited by vaccination, it was already well appreciated from extensive and longitudinal studies of HIV-ill individuals that antibodies by themselves cannot immunize one against the virus. The HIV genome is single-stranded but assumes base-paired domains in some places as well as hairpins, particularly at the ends of the strand. Genomic DNA of AIDS has utility in the ability of the latent provirus to produce complementary RNA, thus reconstituting broken strands. The long strand contains all of the genetic information, but it is normally only the non-translated strand that is transcribed by the host into the mRNA that codes for the enzyme, reverse transcriptase, and all of the other envelope and capsid proteins of the virus.

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Essay About HIV/AIDS

Introduction.

Human Immunodeficiency Virus, abbreviated as HIV, attacks the body’s immune system, and if left untreated, it can cause AIDS (Acquired Immune Deficiency Syndrome). HIV is a retroviral disease transmitted through unprotected sexual activity, from mother to child, blood transfusion, contact with infected body fluids, or hypodermic needles (Melhuish & Lewthwaite, 2018). The disease originated from a zoonotic animal, a chimpanzee in Central Africa. The virus version in chimpanzees, Simian Immunodeficiency Virus, is thought to have been passed to humans during their hunting activities way back in 1800. The disease has further been spread across Africa over the decades and eventually into other parts of the world. Its existence in the United States occurred between the mid to late 1970s.

Disease Manifestation

HIV weakens the immune system through infection and destruction of the CD4+ T cells, leading to immunodeficiency at the later stages of the disease. The virus adheres to the CD4+ protein on its surface and other cells to gain entry into the body  ( Melhuish & Lewthwaite, 2018 ).  Other coreceptors such as CCR5 and CXCR4 are essential in enabling the virus to gain complete access and cause infection to the body cells. HIV infection undergoes three stages: acute illness, chronic infection, and acquired immunodeficiency syndrome (AIDS) (Velloza et al., 2020). The first stage usually develops between 2 to 4 weeks after initial exposure. The stage often goes unrecognized because of the occasionally mild and nonspecific symptoms. Some of the clinical manifestations observed in the first stage include typical rushes distributed on the face and trunk, although they may also appear in the palms and soles. Oral and genital mucocutaneous ulceration is also another clinical manifestation that can be experienced during the first stage. In this stage, gastrointestinal manifestation, facial nerve palsy, acute encephalopathy, and many other clinical symptoms may participate.

In the second stage of infection, the virus continues to multiply but at low levels. Infected individuals who are in this stage may not have any alarming symptoms. The stage can last for up to 10 to 15 years, although it may move so fast in some individuals c. AIDs infection occurs in the third stage. The infection may be manifested by symptoms such as rapid loss of weight, recurring fever, extreme tiredness, prolonged swelling of the lymph glands in the groin, armpits, or neck, sores in the mouth, diarrhea that lasts for more than a week, or memory loss and other neurologic disorder (Nasuuna et al., 2018). When infected individuals are not treated, they may develop severe diseases such as serious bacterial infections, cryptococcal meningitis, tuberculosis, and cancers like Kaposi’s sarcoma and lymphomas.

Diagnosis and Treatment

HIV diagnosis can be made by a rapid diagnostic test that provides results on the same day. Individuals may also test themselves using an HIV self-test kit, although a confirmatory test has to be done later on by a qualified health professional (Mayo Clinic, 2020). The diagnostic test works by detecting antibodies produced by a person as part of their immune response to fight the virus. When the results turn out positive, immediate treatment should be done to manage the virus (Mayo Clinic, 2020). A combination of three or more antiretroviral drugs (ARVs) or antiretroviral therapy (ART) may suppress the symptoms and viral replication within an individual hence allowing recovery of the immune system and regain the ability to protect the body from opportunistic infections.

The public health measures of HIV prevention can be divided into three categories; primary, secondary, and tertiary prevention. Primary prevention measures protect an individual from acquiring HIV infection. It involves strategies such as abstaining from sex, not sharing needles and sharp objects and using condoms when engaging in sexual activities. Prevention medicines such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) may also be used to protect yourself from the infection (Mayo Clinic, 2020). Secondary HIV prevention involves measures that should be directed to infected individuals to prevent transmission to negative people (Mayo Clinic, 2020). Strategies used in secondary prevention entails giving health education to those who are infected, supporting ART adherence efforts, providing ongoing risk assessment regarding substance use and sexual behavior, encouraging infected individuals to disclose their HIV status to their sexual and drug use partners, prescribing condoms for positive individuals and providing counseling to them (Mayo Clinic, 2020). Tertiary prevention measures ensure the improved treatment to reduce the impact of HIV/AIDS disease and promote recovery. A tertiary prevention strategy aims at reducing complications that may be caused by HIV infection.

Surveillance measures

Local surveillance of HIV may be carried out using various reporting tools to fill HIV infection cases and later submitted to the local health departments for further analysis. The Centre for Disease Control and Prevention (CDC) plays a big role in collecting, analyzing, and disseminating data for national surveillance on HIV/AIDS. The CDC’s National surveillance system monitors HIV trends in the U.S (CDC, 2020). Moreover, the World Health organization can conduct international surveillance of HIV/AIDS, which surveys on HIV sentinel, STDs, and behavior.

Prevalence and Incidence

According to WHO (2020), the global prevalence of HIV is estimated to be over 37.7 million people, including 1.7 million children. The percentage prevalence in adults is 0.7%. Additionally, the incidence of HIV infection was 1.5 million (WHO, 2020). Most people living with HIV live in low and middle-income countries, with East and Southern Africa being the most affected region globally. In 2020, there were 670,000 new cases which amounted to 20.6 million infected individuals in East and Southern Africa.

Interesting facts

According to the WHO, some of the current interesting facts about HIV/AIDS is that it has claimed over 36.3 million people since its emergence; hence, it is still a major public health concern (WHO, 2021). Additionally, over 37.7 million were HIV positive in 2020, whereby 25.4 million were in the WHO African region. WHO also reports that over 680 thousand individuals succumbed to HIV-related infections, and over 1.5 million people acquired HIV/AIDS.

CDC. (2020, June 19).  Tracking AIDS Trends . Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/statistics/surveillance/index.html

Eisinger, R. W., & Fauci, A. S. (2018). Ending the HIV/AIDS pandemic.  Emerging infectious diseases ,  24 (3), 413.

Mayo Clinic. (2020, February 13).  HIV/AIDS – Symptoms and causes . https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524

Melhuish, A., & Lewthwaite, P. (2018). Natural history of HIV and AIDS.  Medicine ,  46 (6), 356-361.

Nasuuna, E., Kigozi, J., Babirye, L., Muganzi, A., Sewankambo, N. K., & Nakanjako, D. (2018). Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda.  BMC Public Health ,  18 (1), 1-9.

Velloza, J., Kemp, C. G., Aunon, F. M., Ramaiya, M. K., Creegan, E., & Simoni, J. M. (2020). Alcohol use and antiretroviral therapy non-adherence among adults living with HIV/AIDS in Sub-Saharan Africa: a systematic review and meta-analysis.  AIDS and Behavior ,  24 (6), 1727-1742.

WHO. (2021, June 9).  HIV/AIDS . WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hiv-aids

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Home — Essay Samples — Nursing & Health — AIDS — AIDS and HIV epidemic

AIDS and HIV Epidemic

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Published: Dec 18, 2018

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Emily Mullin

There’s New Hope for an HIV Vaccine

Since it was first identified in 1983, HIV has infected more than 85 million people and caused some 40 million deaths worldwide.

While medication known as pre-exposure prophylaxis , or PrEP, can significantly reduce the risk of getting HIV, it has to be taken every day to be effective. A vaccine to provide lasting protection has eluded researchers for decades. Now, there may finally be a viable strategy for making one.

An experimental vaccine developed at Duke University triggered an elusive type of broadly neutralizing antibody in a small group of people enrolled in a 2019 clinical trial. The findings were published today in the scientific journal Cell .

“This is one of the most pivotal studies in the HIV vaccine field to date,” says Glenda Gray, an HIV expert and the president and CEO of the South African Medical Research Council, who was not involved in the study.

A few years ago, a team from Scripps Research and the International AIDS Vaccine Initiative (IAVI) showed that it was possible to stimulate the precursor cells needed to make these rare antibodies in people. The Duke study goes a step further to generate these antibodies, albeit at low levels.

“This is a scientific feat and gives the field great hope that one can construct an HIV vaccine regimen that directs the immune response along a path that is required for protection,” Gray says.

Vaccines work by training the immune system to recognize a virus or other pathogen. They introduce something that looks like the virus—a piece of it, for example, or a weakened version of it—and by doing so, spur the body’s B cells into producing protective antibodies against it. Those antibodies stick around so that when a person later encounters the real virus, the immune system remembers and is poised to attack.

While researchers were able to produce Covid-19 vaccines in a matter of months, creating a vaccine against HIV has proven much more challenging. The problem is the unique nature of the virus. HIV mutates rapidly, meaning it can quickly outmaneuver immune defenses. It also integrates into the human genome within a few days of exposure, hiding out from the immune system.

“Parts of the virus look like our own cells, and we don’t like to make antibodies against our own selves,” says Barton Haynes, director of the Duke Human Vaccine Institute and one of the authors on the paper.

The particular antibodies that researchers are interested in are known as broadly neutralizing antibodies, which can recognize and block different versions of the virus. Because of HIV’s shape-shifting nature, there are two main types of HIV and each has several strains. An effective vaccine will need to target many of them.

Some HIV-infected individuals generate broadly neutralizing antibodies, although it often takes years of living with HIV to do so, Haynes says. Even then, people don’t make enough of them to fight off the virus. These special antibodies are made by unusual B cells that are loaded with mutations they’ve acquired over time in reaction to the virus changing inside the body. “These are weird antibodies,” Haynes says. “The body doesn’t make them easily.”

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Haynes and his colleagues aimed to speed up that process in healthy, HIV-negative people. Their vaccine uses synthetic molecules that mimic a part of HIV’s outer coat, or envelope, called the membrane proximal external region. This area remains stable even as the virus mutates. Antibodies against this region can block many circulating strains of HIV.

The trial enrolled 20 healthy participants who were HIV-negative. Of those, 15 people received two of four planned doses of the investigational vaccine, and five received three doses. The trial was halted when one participant experienced an allergic reaction that was not life-threatening. The team found that the reaction was likely due to an additive in the vaccine, which they plan to remove in future testing.

Still, they found that two doses of the vaccine were enough to induce low levels of broadly neutralizing antibodies within a few weeks. Notably, B cells seemed to remain in a state of development to allow them to continue acquiring mutations, so they could evolve along with the virus. Researchers tested the antibodies on HIV samples in the lab and found that they were able to neutralize between 15 and 35 percent of them.

Jeffrey Laurence, a scientific consultant at the Foundation for AIDS Research (amfAR) and a professor of medicine at Weill Cornell Medical College, says the findings represent a step forward, but that challenges remain. “It outlines a path for vaccine development, but there’s a lot of work that needs to be done,” he says.

For one, he says, a vaccine would need to generate antibody levels that are significantly higher and able to neutralize with greater efficacy. He also says a one-dose vaccine would be ideal. “If you’re ever going to have a vaccine that’s helpful to the world, you’re going to need one dose,” he says.

Targeting more regions of the virus envelope could produce a more robust response. Haynes says the next step is designing a vaccine with at least three components, all aimed at distinct regions of the virus. The goal is to guide the B cells to become much stronger neutralizers, Haynes says. “We’re going to move forward and build on what we have learned.”

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HIV/AIDS as a Communicable Disease Essay

Introduction, the organism that causes hiv/aids, how hiv/aids is transmitted, symptoms of hiv/aids, symptoms appear how long after someone is infected with hiv/aids, short and long term complications of hiv/aids, works cited.

According to Webber (1), the communicable disease is one that can easily be passed on from one person or animal to another directly or through an intermediate host. Ostensibly, the transmission of communicable diseases depends on an individual being vulnerable to imminent attacks.

A communicable disease differs from a non-communicable disease because of the presence of an organism involved in the transmission process. By and large, communicable diseases spread through body fluids or the air.

This paper presents a discussion about HIV/AIDS, a communicable disease that is widespread in the present-day society.

HIV is an acronym for human immunodeficiency virus. Drawing from a study by Ngatchou (9), the choice of the word human is linked to the fact that the virus only causes disease in human beings. Similarly, the word immunodeficiency was selected because the body’s immune system responsible for shielding an individual from illness is weakened. HIV is a minute organism that transmits illness to living creatures and makes replicates itself.

HIV is the virus that causes acquired immune deficiency syndrome (AIDS). The study by Ngatchou (9) further indicates that AIDS is a group of illnesses that come about due to an individual’s weak immunity. Generally, people with HIV appear healthy during the first few years after being infected with a virus. Later, the HIV viruses in their bodies lead to AIDS. As noted by Jamison (238), AIDS was first considered to be a disease during the 1980s and later spread very fast to become one of the world’s killers diseases.

In most cases, HIV is spread when an individual is involved in unprotected sex with an infected person. Arguably, this makes it very difficult to control the disease associated with HIV (Jamison 238). However, HIV can also be transmitted through blood transfusion or using dirty medical equipment. To avoid transmission as a result of blood transfusion, patients should donate their blood days or weeks before a scheduled operation.

Common symptoms of HIV/AIDS include but are not limited to fever, sweat, fatigue, loss of appetite, loss of weight, nausea, vomiting, diarrhea, cough, and short breaths (Chopra, Niyogi, and Katyal 66). However, these symptoms are not specific. They may also be encountered by people suffering from illness other than HIV/AIDS. According to Sonenklar (10), people with HIV often display flu-like symptoms a few days after being infected.

As has been explained in the preceding section, HIV/AIDS symptoms appear a few days or weeks after one has been infected. Based on a study by Kalichman and Evian (32), most people infected by HIV/AIDS seem to be alright during the first five to ten years. After a lengthy period of HIV infection without notable symptoms, a person later becomes sick. The earliest signs may include fever and fatigue.

By damaging the body’s immune system, HIV slowly weakens the ability of the body to fight off infections. An infected person thus becomes vulnerable to what are commonly known as opportunity infections. Eventually, a person’s condition progresses to AIDS. Short term complications include tiredness, nausea and vomiting, sleep problems, and sexual problems among others. The long term complications of HIV/AIDS include the presence of abnormal fat deposits in a person’s body and development of heart disease.

Chopra Parul, Rageshree Niyogi and Gauri Katyal. HIV and AIDS: Your Questions Answered. New Delhi, IN: Byword Books Private Limited, 2008. Print.

Jamison, Dean. Disease and Mortality in Sub-Saharan Africa . Washington, DC: World Bank Publications, 2006. Print.

Kalichman, Seth and Clive Evian. Questions and Answers about HIV and AIDS: Science . Gallo Manor, South Africa: Awareness Publishing, 2006. Print.

Ngatchou, Hugues. ABCZ of HIV/AIDS . North Carolina, United States: Lulu Press, n.d. Print.

Sonenklar, Carol. AIDS . Minneapolis, MN: Twenty-First Century Books, 2011. Print.

Webber, Roger. Communicable Diseases: A Global Perspective . Boston, MA: CABI, 2016. Print.

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IvyPanda. (2020, August 5). HIV/AIDS as a Communicable Disease. https://ivypanda.com/essays/hivaids-as-a-communicable-disease/

"HIV/AIDS as a Communicable Disease." IvyPanda , 5 Aug. 2020, ivypanda.com/essays/hivaids-as-a-communicable-disease/.

IvyPanda . (2020) 'HIV/AIDS as a Communicable Disease'. 5 August.

IvyPanda . 2020. "HIV/AIDS as a Communicable Disease." August 5, 2020. https://ivypanda.com/essays/hivaids-as-a-communicable-disease/.

1. IvyPanda . "HIV/AIDS as a Communicable Disease." August 5, 2020. https://ivypanda.com/essays/hivaids-as-a-communicable-disease/.

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IvyPanda . "HIV/AIDS as a Communicable Disease." August 5, 2020. https://ivypanda.com/essays/hivaids-as-a-communicable-disease/.

In a 1st, HIV vaccine triggers rare and elusive antibodies in humans

Scientists have taken a big step toward making an effective HIV vaccine.

An HIV vaccine is one step closer to reality following a human trial that produced rare and elusive antibodies, a new study reports. 

Many hurdles stand in the way of an effective HIV vaccine. The virus is a master of evasion, dodging the immune system by coating itself in sugars that resemble those made by the body, said Dr. Barton Haynes , a leader of the recent trial and director of the Duke Human Vaccine Institute. The virus also mutates rapidly, changing its form so that the immune system struggles to make antibodies that can grab hold of it.

A major goal in HIV vaccine development is triggering the production of broadly neutralizing antibodies, which latch onto parts of the virus's outer coating, or envelope, that are very similar between different HIV strains. This makes the antibodies protective against a wide variety of strains, regardless of how they mutate.

The challenge is that "these antibodies, naturally during infection, are very rare to find," said Thomas Hope , a professor of cell and developmental biology who studies HIV at Northwestern University Feinberg School of Medicine. "It takes a couple years of real infection to make these antibodies," said Hope, who was not involved in the new study but has collaborated with some of its authors in the past.

Related: We could end the AIDS epidemic in less than a decade. Here's how.

Vaccines typically work by eliciting a similar immune reaction to what's seen during a real infection. But in the case of HIV, vaccine developers have to dramatically expedite the process, calling forth antibodies in weeks that would usually take years to show up. 

Now, in a study published Friday (May 17) in the journal Cell , scientists have demonstrated that this feat is possible in humans.

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"We're gathering proof of concept that a vaccine could be made — can be made," Haynes told Live Science. "We're having to coax the immune system, to guide the immune system in a way we've never had to do."

In the trial, the researchers targeted a protein embedded in HIV's envelope — specifically, part of the protein called the membrane proximal external region (MPER). The coveted antibodies that target MPER bind to both the backbone of this protein and to the fatty membrane it's embedded within. 

"These are very unusual because they bind two things at once," Haynes said, and this makes the antibodies oddly shaped. To make antibodies of the right shape, immune cells must pick up genetic mutations over time, following exposure to a pathogen. But for reasons not fully understood, the mutations required to make antibodies against MPER and similar targets happen only very rarely . 

The idea behind the new vaccine is to make these mutations more probable by exposing the immune system to a series of reaction-triggering substances. These substances, or immunogens, contain short snippets of protein and bubbles of fat. "What we're learning to do is design immunogens that can select for these rare mutations very efficiently," Haynes said. 

This strategy has been demonstrated in various animal models and early human studies that aimed for targets other than MPER. These previous studies successfully coaxed immune cells to make precursors to the final, desired antibodies — but the new trial represents the first time that the end-goal antibodies have been achieved in people.

"This supports the whole concept," Hope told Live Science. "Many worry if this is possible," so the new study lends credence to this iterative HIV vaccination strategy. 

— How are people cured of HIV? Here's everything you need to know

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The trial included 20 HIV-negative volunteers. Fifteen received two vaccine doses, spaced two months apart, while the remaining five got a third dose four months after their second. Tests showed that two doses of vaccine triggered a robust response from immune cells and kicked off the production of broadly neutralizing antibodies. The team further confirmed the presence of these antibodies in the three-dose group by closely analyzing their immune cells.

The original goal of the trial was for everyone to get four doses, but it was paused after one participant given three doses had a serious allergic reaction to a vaccine ingredient called polyethylene glycol (PEG). PEG helps to stabilize certain types of vaccines in the body, but rarely, patients can have a reaction to it . The researchers have now reformulated the vaccine without PEG and will soon test the new version.

This is just one step toward making an effective HIV vaccine, Haynes emphasized. The ideal vaccine would induce four different types of broadly neutralizing antibodies — that is, anti-MPER antibodies plus three more kinds. This would help prevent HIV from escaping the vaccine's protection. In addition, the antibodies need to be made in high quantities and hang around in the body for a long time.

"It's a decent starting point and it can be built upon and combined with other people's work," Hope said of the recent trial. He added that he hopes this vaccine strategy pans out, given the potential it has shown so far. Hope has been studying HIV since the late 1980s. 

"I would really like to see the end of this virus," he said. "It'll lose eventually, but I'd like to see it losing."

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun ? Send us your questions about how the human body works to [email protected] with the subject line "Health Desk Q," and you may see your question answered on the website!

Nicoletta Lanese is the health channel editor at Live Science and was previously a news editor and staff writer at the site. She holds a graduate certificate in science communication from UC Santa Cruz and degrees in neuroscience and dance from the University of Florida. Her work has appeared in The Scientist, Science News, the Mercury News, Mongabay and Stanford Medicine Magazine, among other outlets. Based in NYC, she also remains heavily involved in dance and performs in local choreographers' work.

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A trial HIV vaccine triggered elusive and essential antibodies in humans

Finding points the way toward a successful vaccine that elicits broadly neutralizing antibodies.

An HIV vaccine candidate developed at the Duke Human Vaccine Institute triggered low levels of an elusive type of broadly neutralizing HIV antibodies among a small group of people enrolled in a 2019 clinical trial.

The finding, reported May 17 in the journal Cell , not only provides proof that a vaccine can elicit these antibodies to fight diverse strains of HIV, but that it can also initiate the process within weeks, setting in motion an essential immune response.

The vaccine candidate targets an area on the HIV-1 outer envelope called the membrane proximal external region (MPER), which remains stable even as the virus mutates. Antibodies against this stable region in the HIV outer coat can block infection by many different circulating strains of HIV.

"This work is a major step forward as it shows the feasibility of inducing antibodies with immunizations that neutralize the most difficult strains of HIV," said senior author Barton F. Haynes, M.D., director of the Duke Human Vaccine Institute (DHVI). "Our next steps are to induce more potent neutralizing antibodies against other sites on HIV to prevent virus escape. We are not there yet, but the way forward is now much clearer."

The research team analyzed data from a phase 1 clinical trial of a vaccine candidate developed by Haynes and S. Munir Alam, Ph.D., at DHVI.

Twenty healthy, HIV-negative people enrolled in the trial. Fifteen participants received two of four planned doses of the investigational vaccine, and five received three doses.

After just two immunizations, the vaccine had a 95% serum response rate and a 100% blood CD4+ T-cell response rate -- two key measurements that demonstrated strong immune activation. Most of the serum responses mapped to the portion of the virus targeted by the vaccine.

Importantly, broadly neutralizing antibodies were induced after just two doses.

The trial was halted when one participant experienced a non-life-threatening allergic reaction, similar to rare incidents reported with COVID-19 vaccinations. The team investigated the cause of the event, which was likely from an additive.

"To get a broadly neutralizing antibody, a series of events needs to happen, and it typically takes several years post-infection," said lead author Wilton Williams, Ph.D., associate professor in Duke's Department of Surgery and member of DHVI. "The challenge has always been to recreate the necessary events in a shorter space of time using a vaccine. It was very exciting to see that, with this vaccine molecule, we could actually get neutralizing antibodies to emerge within weeks."

Other features of the vaccine were also promising, most notably how the crucial immune cells remained in a state of development that allowed them to continue acquiring mutations, so they could evolve along with the ever-changing virus.

The researchers said there is more work to be done to create a more robust response, and to target more regions of the virus envelope. A successful HIV vaccine will likely have at least three components, all aimed at distinct regions of the virus.

"Ultimately, we will need to hit all the sites on the envelope that are vulnerable so that the virus cannot escape," Haynes said. "But this study demonstrates that broadly neutralizing antibodies can indeed be induced in humans by vaccination. Now that we know that induction is possible, we can replicate what we have done here with immunogens that target the other vulnerable sites on the virus envelope."

In addition to Haynes and Williams, study authors include S. Munir Alam, Gilad Ofek, Nathaniel Erdmann, David Montefiori, Michael S. Seaman, Kshitij Wagh, Bette Korber, Robert J. Edwards, Katayoun Mansouri, Amanda Eaton, Derek W. Cain, Mitchell Martin, Robert Parks, Maggie Barr, Andrew Foulger, Kara Anasti, Parth Patel, Salam Sammour, Ruth J. Parsons, Xiao Huang, Jared Lindenberger, Susan Fetics, Katarzyna Janowska, Aurelie Niyongabo, Benjamin M. Janus, Anagh Astavans, Christopher B. Fox, Ipsita Mohanty, Tyler Evangelous, Yue Chen, Madison Berry, Helene Kirshner, Elizabeth Van Itallie, Kevin Saunders, Kevin Wiehe, Kristen W. Cohen, M. Juliana McElrath, Lawrence Corey, Priyamvada Acharya, Stephen R. Walsh, and Lindsey R. Baden.

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Story Source:

Materials provided by Duke University Medical Center . Note: Content may be edited for style and length.

Journal Reference :

• Wilton B. Williams, S. Munir Alam, Gilad Ofek, Nathaniel Erdmann, David C. Montefiori, Michael S. Seaman, Kshitij Wagh, Bette Korber, Robert J. Edwards, Katayoun Mansouri, Amanda Eaton, Derek W. Cain, Mitchell Martin, JongIn Hwang, Aria Arus-Altuz, Xiaozhi Lu, Fangping Cai, Nolan Jamieson, Robert Parks, Maggie Barr, Andrew Foulger, Kara Anasti, Parth Patel, Salam Sammour, Ruth J. Parsons, Xiao Huang, Jared Lindenberger, Susan Fetics, Katarzyna Janowska, Aurelie Niyongabo, Benjamin M. Janus, Anagh Astavans, Christopher B. Fox, Ipsita Mohanty, Tyler Evangelous, Yue Chen, Madison Berry, Helene Kirshner, Elizabeth Van Itallie, Kevin O. Saunders, Kevin Wiehe, Kristen W. Cohen, M. Juliana McElrath, Lawrence Corey, Priyamvada Acharya, Stephen R. Walsh, Lindsey R. Baden, Barton F. Haynes. Vaccine induction of heterologous HIV-1-neutralizing antibody B cell lineages in humans . Cell , 2024; DOI: 10.1016/j.cell.2024.04.033

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• HIV Long-Term Survivors Awareness Day June 5
• National HIV Testing Day June 27
• Zero HIV Stigma July 21
• Southern HIV/AIDS Awareness Day August 20
• National Faith HIV/AIDS Awareness Day August 27
• National African Immigrant and Refugee HIV/AIDS and Hepatitis Awareness Day September 9
• National HIV/AIDS and Aging Awareness Day September 18
• National Gay Men's HIV/AIDS Awareness Day September 27
• National Latinx AIDS Awareness Day October 15
• World AIDS Day December 1
• Event Planning Guide
• U.S. Conference on HIV/AIDS (USCHA)
• National Ryan White Conference on HIV Care & Treatment
• AIDS 2020 (23rd International AIDS Conference Virtual)

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Resources for 2024 HIV Vaccine Awareness Day

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Resources to highlight HIV Vaccine Awareness Day on May 18, a day to recognize the community members, health professionals, and scientists working together to develop a vaccine for HIV prevention.

This week, on May 18, we observe the 27th annual HIV Vaccine Awareness Day (HVAD ). As we work toward a preventative vaccine, HVAD is an opportunity to learn more about HIV vaccine research and the latest developments. It is also a day to recognize the many volunteers, community members, health professionals, and scientists working together to develop a safe and effective vaccine for HIV prevention.

The National institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) leads this day and has spearheaded several initiatives focused on the advancement of HIV research, prevention, and treatment. Please stay tuned for an additional video resource discussing more about this day on HIV.gov.

You can also learn more about HIV vaccines on HIV.gov and find more information about the day on our events page .

You can find more data about HIV in the United States using the AHEAD dashboard .

HIV.gov regularly blogs on key developments in HIV vaccine research; our goal is to provide user-friendly content informing the general public and scientists researching and working in other health arenas about the research. To keep up with the science,  follow the “vaccines” blog tag on HIV.gov and follow @NIAIDNews and @HIVgov on social media.

Join the Conversation:

You can find social media resources here . Use the hashtag #HVAD and follow, like, or share content on these channels:

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• X/Twitter:  @HIVGov Exit Disclaimer ,  @CDC_HIV Exit Disclaimer , @NIAIDNews Exit Disclaimer
• Instagram:  @HIVgov Exit Disclaimer ,  @stophivtogether Exit Disclaimer , @NIAID Exit Disclaimer
• LinkedIn: National Institute of Allergy and Infectious Diseases (NIAID) Exit Disclaimer

Related HIV.gov Blogs

• Awareness Days
• HIV Vaccine Awareness Day
• NIAID National Institute of Allergy & Infectious Diseases