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contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy,
delivery, or breastfeeding.
[2
!ome bodily fluids, such as saliva and tears, do not transmit HIV.
["
#revention of HIV infection, primarily through safe sex andneedle$exchange programs, is a %ey
strategy to control the spread of the disease. &here is no cure or vaccine' ho(ever, antiretroviral
treatment can slo( the course of the disease and may lead to a near$normal life expectancy. )hile
antiretroviral treatment reduces the ris% of death and complications from the disease, these
medications are expensive and have side effects. )ithout treatment, the average survival time after
infection (ith HIV is estimated to be * to ++ years, depending on the HIV subtype.
[,
-enetic research indicates that HIV originated in (est$central .frica during the late nineteenth or
early t(entieth century.
[/
.I0! (as first recogni1ed by the 2nited !tates 3enters for 0isease 3ontrol
and #revention (303) in +*4+ and its cause5HIV infection5(as identified in the early part of the
decade.
[6
!ince its discovery, .I0! has caused an estimated "6 million deaths (orld(ide (as of
27+2).
[8
.s of 27+2, approximately "/." million people are living (ith HIV globally.
[8
HIV9.I0! is
considered a pandemic5a disease outbrea% (hich is present over a large area and is actively
spreading.
[4
HIV9.I0! has had a great impact on society, both as an illness and as a source of discrimination.
&he disease also has significant economic impacts. &here are manymisconceptions about
HIV9.I0! such as the belief that it can be transmitted by casual non$sexual contact. &he disease
has also become sub:ect to manycontroversies involving religion. It has attracted international
medical and political attention as (ell as large$scale funding since it (as identified in the +*47s
Acute infection
;ain symptoms of acute HIV infection
&he initial period follo(ing the contraction of HIV is called acute HIV, primary HIV or acute retroviral
syndrome. ;any individuals develop an influen1a$li%e illness or a mononucleosis$li%e illness 2<,
(ee%s post exposure (hile others have no significant symptoms.
[+"[+,
!ymptoms occur in ,7<*7= of
cases and most commonly include fever,large tender lymph nodes, throat inflammation, a rash,
headache, and9or sores of the mouth and genitals. &he rash, (hich occurs in 27</7= of cases,
presents itself on the trun% and is maculopapular, classically.!ome people also
develop opportunistic infections at this stage. -astrointestinal symptoms such as nausea, vomiting
ordiarrhea may occur, as may neurological symptoms of peripheral neuropathy or -uillain$>arre
syndrome.
&he duration of the symptoms varies, but is usually one or t(o (ee%s
0ue to their nonspecific character, these symptoms are not often recogni1ed as signs of HIV
infection. ?ven cases that do get seen by a family doctor or a hospital are often misdiagnosed as
one of the many common infectious diseases (ith overlapping symptoms. &hus, it is recommended
that HIV be considered in people presenting an unexplained fever (ho may have ris% factors for the
infection
Acquired immunodeficiency syndrome
;ain symptoms of .I0!.
.c@uired immunodeficiency syndrome (.I0!) is defined in terms of either a 30,
A
& cell count belo(
277 cells per BC or the occurrence of specific diseases in association (ith an HIV infection. In the
absence of specific treatment, around half of people infected (ith HIV develop .I0! (ithin ten
years.
[
&he most common initial conditions that alert to the presence of .I0! are pneumocystis
pneumonia (,7=), cachexia in the form of HIV (asting syndrome (27=) and esophageal
candidiasis. Dther common signs include recurring respiratory tract infections.
[
Dpportunistic infections may be caused by bacteria, viruses, fungi and parasites that are normally
controlled by the immune system.
[
)hich infections occur partly depends on (hat organisms are
common in the personEs environment. &hese infections may affect nearly every organ system.
#eople (ith .I0! have an increased ris% of developing various viral induced cancers
including FaposiEs sarcoma,>ur%ittEs lymphoma, primary central nervous system lymphoma,
and cervical cancer. FaposiEs sarcoma is the most common cancer occurring in +7 to 27= of people
(ith HIV. &he second most common cancer is lymphoma (hich is the cause of death of nearly +6=
of people (ith .I0! and is the initial sign of .I0! in " to ,=.>oth these cancers are associated
(ith human herpesvirus 4.
[
3ervical cancer occurs more fre@uently in those (ith .I0! due to its
association (ith human papillomavirus (H#V)
.dditionally, people (ith .I0! fre@uently have systemic symptoms such as prolonged
fevers, s(eats (particularly at night), s(ollen lymph nodes, chills, (ea%ness, and (eight loss.
0iarrhea is another common symptom present in about *7= of people (ith .I0!. &hey can also be
affected by diverse psychiatric and neurological symptoms independent of opportunistic infections
and cancers.
Transmission
HIV is transmitted by three main routesG sexual contact, exposure to infected body fluids or tissues,
and from mother to child during pregnancy, delivery, or breastfeeding (%no(n as vertical
transmission). &here is no ris% of ac@uiring HIV if exposed to feces, nasal secretions, saliva, sputum,
s(eat, tears, urine, or vomit unless these are contaminated (ith blood. It is possible to be co$
infected by more than one strain of HIV5a condition %no(n as HIV superinfection.
Sexual
&he most fre@uent mode of transmission of HIV is through sexual contact (ith an infected
person. &he ma:ority of all transmissions (orld(ide occur through heterosexual contacts (i.e. sexual
contacts bet(een people of the opposite sex)' ho(ever, the pattern of transmission varies
significantly among countries. In the 2nited !tates, as of 277*, most sexual transmission occurred
in men (ho had sex (ith men (ith this population accounting for 6,= of all ne( cases.
.s regards unprotected heterosexual contacts, estimates of the ris% of HIV transmission per sexual
act appear to be four to ten times higher in lo($income countries than in high$income countries. In
lo($income countries, the ris% of female$to$male transmission is estimated as 7."4= per act, and of
male$to$female transmission as 7."7= per act' the e@uivalent estimates for high$income countries
are 7.7,= per act for female$to$male transmission, and 7.74= per act for male$to$female
transmission. &he ris% of transmission from anal intercourse is especially high, estimated as +.,<
+.8= per act in both heterosexual and homosexual contacts. )hile the ris% of transmission from oral
sex is relatively lo(, it is still present. &he ris% from receiving oral sex has been described as Hnearly
nilHho(ever a fe( cases have been reported. &he per$act ris% is estimated at 7<7.7,= for receptive
oral intercourse. In settings involving prostitution in lo( income countries, ris% of female$to$male
transmission has been estimated as 2.,= per act and male$to$female transmission as 7.7/= per
act.
Iis% of transmission increases in the presence of many sexually transmitted infections and genital
ulcers. -enital ulcers appear to increase the ris% approximately fivefold. Dther sexually transmitted
infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated
(ith some(hat smaller increases in ris% of transmission.
&he viral load of an infected person is an important ris% factor in both sexual and mother$to$child
transmission. 0uring the first 2./ months of an HIV infection a personEs infectiousness is t(elve
times higher due to this high viral loadI of the person is in the late stages of infection, rates of
transmission are approximately eightfold greater.
[
3ommercial sex (or%ers (including those in pornography) have an increased rate of HIV. Iough
sex can be a factor associated (ith an increased ris% of transmission. !exual assault is also
believed to carry an increased ris% of HIV transmission as condoms are rarely (orn, physical trauma
to the vagina or rectum is li%ely, and there may be a greater ris% of concurrent sexually transmitted
infections.
Body fluids
303 poster from +*4* highlighting the threat of .I0! associated (ith drug use
&he second most fre@uent mode of HIV transmission is via blood and blood products.
[2
>lood$borne
transmission can be through needle$sharing during intravenous drug use, needle stic% in:ury,
transfusion of contaminated blood or blood product, or medical in:ections (ith unsterilised
e@uipment. &he ris% from sharing a needle during drug in:ection is bet(een 7.6" and 2.,= per act,
(ith an average of 7.4=. &he ris% of ac@uiring HIV from a needle stic% from an HIV$infected person
is estimated as 7."= (about + in """) per act and the ris% follo(ing mucus membrane exposure to
infected blood as 7.7*= (about + in +777) per act. In the 2nited !tates intravenous drug users made
up +2= of all ne( cases of HIV in 277*,