HIV test

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Diagnosis

Main article: HIV test

Many HIV-positive people are unaware that they are infected with the virus. For example, less than 1% of the sexually active urban population in Africa have been tested and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counselled, tested or receive their test results. Again, this proportion is even lower in rural health facilities. Since donors may therefore be unaware of their infection, donor blood and blood products used in medicine and medical research are routinely screened for HIV.

HIV-1 testing consists of initial screening with an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV-1. Specimens with a nonreactive result from the initial ELISA are considered HIV-negative unless new exposure to an infected partner or partner of unknown HIV status has occurred. Specimens with a reactive ELISA result are retested in duplicate. If the result of either duplicate test is reactive, the specimen is reported as repeatedly reactive and undergoes confirmatory testing with a more specific supplemental test (e.g., Western blot or, less commonly, an immunofluorescence assay (IFA)). Only specimens that are repeatedly reactive by ELISA and positive by IFA or reactive by Western blot are considered HIV-positive and indicative of HIV infection. Specimens that are repeatedly ELISA-reactive occasionally provide an indeterminate Western blot result, which may be either an incomplete antibody response to HIV in an infected person, or nonspecific reactions in an uninfected person. Although IFA can be used to confirm infection in these ambiguous cases, this assay is not widely used. Generally, a second specimen should be collected more than a month later and retested for persons with indeterminate Western blot results. Although much less commonly available, nucleic acid testing (e.g., viral RNA or proviral DNA amplification method) can also help diagnosis in certain situations. In addition, a few tested specimens might provide inconclusive results because of a low quantity specimen. In these situations, a second specimen is collected and tested for HIV infection.Modern HIV testing is extremely accurate. The chance of a false-positive result in the two-step testing protocol is estimated to be 0.0004% to 0.0007% in the general U.S. population.[1]

Epidemiology

Main article: AIDS pandemic

Estimated prevalence of HIV among young adults (15-49) per country at the end of 2005.

Disability-adjusted life year for HIV and AIDS per 100,000inhabitants.

no data ≤10 10-25 25-50 50-100 100-500 500-1000 1000-2500 2500-5000 5000-7500 7500-10000 10000-50000 ≥50000

UNAIDS and the WHO estimate that AIDS has killed more than 25million people since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history. Despite recent improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.8million (between 2.4 and 3.3million) lives in 2005 of which more than half amillion (570,000) were children.

In 2007, between 30.6 and 36.1 million people were believed to live with HIV, and it killed an estimated 2.1million people that year, including 330,000 children; there were 2.5 million new infections.

Sub-Saharan Africa remains by far the worst-affected region, with an estimated 21.6 to 27.4million people currently living with HIV. Twomillion [1.5-3.0million] of them are children younger than 15 years of age. More than 64% of all people living with HIV are in sub-Saharan Africa, as are more than three quarters of all women living with HIV. In 2005, there were 12.0million [10.6-13.6million] AIDS orphans living in sub-Saharan Africa 2005. South & South East Asia are second-worst affected with 15% of the total. AIDS accounts for the deaths of 500,000 children in this region. South Africa has the largest number of HIV patients in the world followed by Nigeria. India has an estimated 2.5 million infections (0.23% of population), making India the country with the third largest population of HIV patients. In the 35 African nations with the highest prevalence, average life expectancy is 48.3 years—6.5 years less than it would be without the disease.

The latest evaluation report of the World Bank's Operations Evaluation Department assesses the development effectiveness of the World Bank's country-level HIV/AIDS assistance defined as policy dialogue, analytic work, and lending with the explicit objective of reducing the scope or impact of the AIDS epidemic. This is the first comprehensive evaluation of the World Bank's HIV/AIDS support to countries, from the beginning of the epidemic through mid-2004. Because the Bank aims to assist in implementation of national government programmes, their experience provides important insights on how national AIDS programmes can be made more effective.

The development of HAART as effective therapy for HIV infection has substantially reduced the death rate from this disease in those areas where these drugs are widely available. As the life expectancy of persons with HIV has increased in countries where HAART is widely used, the continuing spread of the disease has caused the number of persons living with HIV to increase substantially.

In Africa, the number of MTCT and the prevalence of AIDS is beginning to reverse decades of steady progress in child survival. Countries such as Uganda are attempting to curb the MTCT epidemic by offering VCT (voluntary counselling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.

STAGE AIDS pandemic:

Initially started with the transmission in the homosexual (gay). Because among homosexual groups also have a bisexual, then the infection spread to the heterosexual population who frequently changing partners.

In the second stage, the infection began to spread on the prostitutes and their clients. In the third stage, developing transmission on whore wife from customers. In the fourth phase began to increase transmission to infants and children of mothers with HIV.

History
Origins

Main article: Origin of AIDS

See History of known cases and spread for early cases of HIV / AIDS

HIV is thought to have originated in non-human primates in sub-Saharan Africa and transferred to humans early in the 20th century. The first paper recognizing a pattern of opportunistic infections was published on June 4, 1981.

Both types of the virus are believed to have originated in West-Central Africa and jumped species (zoonosis) from a non-human primate to humans. HIV-1 is thought to have originated in southern Cameroon after jumping from wild chimpanzees (Pan troglodytes troglodytes) to humans during the twentieth century. It evolved from a Simian Immunodeficiency Virus (SIVcpz). HIV-2, on the other hand, may have originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of Guinea-Bissau, Gabon, and Cameroon.

New World Monkeys are an interesting exception to the transmission of HIV. Their immunity is believed to be caused by retrotransposition of the Cyclophilin gene into an intron of TRIM5. The result is fusion gene that provides the owl monkey with resistance to HIV-1 infection.[2]

Prevention. Three main lines (routes) the entry of HIV into the body is through sexual contact, contiguity (exposure) with fluid or infected tissue, and from mother to fetus or infant during the period around birth (perinatal period). Although HIV can be found in saliva, tears and urine of infected people, but there is no record of cases of infections due to these fluids, thus the risk of infection can generally be ignored.

Intercourse. The majority of HIV infection from unprotected sexual relations between individuals, one of whom has HIV. Heterosexual contact is the main mode of HIV infection in the world. During sexual intercourse, only the male condom or female condom can reduce the possibility of HIV infection and other sexually transmitted diseases and the possibility of pregnancy. The best evidence now shows that typical condom use reduces the risk of HIV transmission to about 80% in the long run, although this benefit is greater if condoms are used correctly on every occasion. Male condoms made from latex, if used correctly without oil-based lubricants, is the only one of the most effective technology today to reduce the sexual transmission of HIV and other sexually transmitted diseases. Side condom manufacturers recommend that oil lubricants like petroleum jelly, butter, and lard not be used with latex condoms because these materials can dissolve latex condoms and make holes. If necessary, the manufacturers recommend using water-based lubricants. Oil-based lubricants are used with polyurethane condoms. Female condom is an alternative to male condoms made of polyurethane, which allows it to be used with oil-based lubricants. Female condom is larger than male condoms and having an open end of the ring-shaped hard, and designed to be inserted into the vagina. Female condom has a ring that makes the inside of the condom remains in the vagina - to insert the female condom, the ring should be pressed. Problem with condoms is that now women are still rarely available and the price is not affordable for large numbers of women. Initial studies showed that with the availability of female condoms, sexual relations with protective overall increase relative to unprotected sexual intercourse so that the female condom is an HIV prevention strategy is important.

The study of one couple who are infected show that with consistent condom use, HIV infection rate of uninfected partner are below 1% per year. Prevention strategy has been well recognized in developed countries. However, research on the behavioral and epidemiological in Europe and North America showed the presence of young minorities who remain at high risk activities despite knowing about the HIV / AIDS, thus ignoring the risks of HIV infection. However, HIV transmission has declined between user drugs, and HIV transmission by blood transfusion to be quite rare in developed countries.

Handling of the AIDS. Until now there is no vaccine or cure for HIV or AIDS. The only method known to prevention based on the avoidance of contact with the virus or, if it fails, antiretroviral treatment directly after contact with the virus significantly, called post-exposure prophylaxis (PEP)[3]. PEP has a four-week dosing schedule that requires a lot of time. PEP also has side effects such as diarrhea is not fun, not feeling well, nausea, and fatigue.

Antiviral therapy

Handling of recent HIV infection is antiretroviral therapy highly active (highly active antiretroviral therapy, HAART abbreviated). This therapy has been very useful for people infected with HIV since 1996, ie after the discovery of HAART using protease inhibitors. HAART best option right now, is a combination of at least three drugs (called a "cocktail), which consists of at least two kinds (or" classes ") antiretroviral materials. This combination is commonly used nucleoside analogue reverse transcriptase inhibitor (or nucleoside) with protease inhibitors , or with non-nucleoside reverse transcriptase inhibitors (NNRTIs). Because HIV disease progress faster in children than in adults, the recommendations were more aggressive treatment for children than for adults. In developing countries that provide HAART treatment, a doctor will consider the quantity of viral load, CD4 reduced speed, and mental readiness of patients, when choosing when to start treatment early. HAART treatment of symptoms and enables stable viremia (the amount of virus in the blood) in patients, but he was not cured from HIV or eliminate the symptoms. HIV-1 in high levels are often resistant to HAART and the symptoms return after treatment is stopped. After all, it took more than one lifetime to clear HIV infection using HAART. Even so, many people with HIV have a great improvement in general health and quality of their lives, resulting in a drastic decrease in the levels of morbidity (morbidity) and death rate (mortality) due to HIV. Without HAART treatment, the change in HIV infection to AIDS occurs at an average (median) between nine to ten years, and subsequent survival time after contracting AIDS was 9.2 months. The application is considered HAART increases survival time of patients during 4 to 12 years. For some other patients, probably numbering more than fifty percent, HAART treatment gives results far from optimal. This is because of the side effects / treatment effects can not be tolerated, previous antiretroviral therapy is not effective, and specific HIV infection resistant drug. Disobedience and disorder in implementing antiretroviral therapy is the main reason why most individuals fail to benefit from the application of HAART. There are various reasons for being disobedient and not regular for the implementation of HAART. Psychosocial issues is a major lack of access to health facilities, lack of social support, psychiatric illness, and drug abuse. HAART treatment is also complex, because of various combinations of pills, dosage frequency, meal restrictions, and others that must be run on a regular basis. Various side effects that also lead to reluctance to regularly in the implementation of HAART, including lipodystrophy, dislipidaemia, insulin resistance, increased risk of cardiovascular system, and congenital abnormalities in babies born. Anti-retroviral drugs were expensive, and the majority of infected individuals in the world does not have access to treatment and care for HIV and AIDS.[4]

Medicinal treatment for sufferer AIDS. Constraints faced for the treatment is expensive. Side effect of expensive drugs and the availability of cost for the implementation of vaccination, causing the emergence of new discrimination issue that is rich and the poor. Rich with HIV will be able to provide triple the cost for drugs, but the poor continue to die. The people who infected by virus HIV, usually avoided by others, because the others think that they are bad people and unresponsibility person. Because of that, for treat the patient need special attention and support full. Attention of family is the most important, because the family is the only one who know condition of them. Families with at least understand and want to assist those affected by AIDS during treatment. Chance of living for people with AIDS is very small, but if you continue to be given support and encouragement, at least they can still enjoy life and still feel the love.

CONCLUSION :

Prevention is better and cost-effective compared with treatment efforts. For that we need socialized AIDS prevention efforts for all levels of society, including youth-student group.

[1] http://en.wikipedia.org/wiki/HIV-AIDS

[2] http://en.wikipedia.org/wiki/HIV-AIDS

[3] http://www.google.co.id/search?client=firefox-a&channel=s&hl=id&source=hp&q=aids&meta=&btnG=Telusuri+dengan+Google

[4] http://en.wikipedia.org/wiki/Aids#Antiviral_therapy

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