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Currently, there are a few approaches for the HIV-1 treatment. The most practised method is the antiretroviral therapy. This approach involves targeting several points of viral replication. Then, pharmaceuticals which bond to and disrupt the replication of HIV-1 are created. The International AIDS Society has provided guidelines to ensure that each client receives a specially designed antiretroviral strategy which is appropriate and suits the client specifically. Various combinations of reverse transcriptase inhibitors and protease inhibitors are suggested. Depending on the different phases in the life cycle, multiple combinations of antiretrovirals can be administered to improve the overall inhibition of the HIV-1 replication. Hence, the American Nation Institutes of Health and other organisations recommend providing antiretroviral treatment to all seropositive patients. The current standard of this treatment is a combination of three or more antiretroviral drugs taken daily for life, which is known as the Highly Active Antiretroviral Treatment (HAART).
Table 1: Different combinations of antiretroviral treatment.
To prevent the vertical transmission of HIV, or in other words, to save a child from the virus, the regimen for Prevention of Mother to Child Transmission (PMTCT) is implemented. A single oral dose of nevirapine, a type of antiretroviral drug is self administered by a mother who is at the onset of labour. Within 72 hours of delivery, the baby is also given a single dose. As early as 15 weeks' gestation, HIV-1 virions can start to culture. This clearly shows that the virus is capable of penetrating the placenta to enter the fetal blood circulation. Zidovudine, another type of antiretroviral drug may decrease the vertical transmission by 67.5%. At the beginning of the second trimester, an infected pregnant woman starts taking in zidovudine orally. After delivery, the newborn is given oral zidovudine for the first 6 weeks of life. Studies show a marked decrease of HIV transmission with caesarean deliveries versus vaginal deliveries.
D:\Ong\Desktop\Howe\Issue Report\Caesarean.jpgFigure 2: The Caesarean Delivery
The Social and Economic Implication
Several social questions have been constantly raised regarding the HIV infection. HIV positive victims, ranging from children to adolescents may be subjected to discrimination. HIV infected people may find difficulties to be employed, to find a house, to receive education, childcare and custody. They are sometimes declined assistance when it comes to the provision of welfare services, medical and social aid. Seropositive individuals may lose their livelihoods, receive taunts, harassment, ostracism, ridicule, insults, homelessness, physical threats, assault and even murder. Economically and socially, women usually rely on men. Hence, the prospect of having violence, mistreatment and abandonment can prove to be frightening for them. The women's safety may be at risk. As a response to the scenario, the HIV Positive Young Women's Sexual and Reproductive Rights Charter in Swaziland was drawn up in year 2004. In a survey conducted in four Asian countries, it was found that there were twice as many women who were discriminated compared to men in Indonesia. Besides, people with HIV who have not attained the Centres for Disease Control criterion receive separate and unequal treatment in qualifying for public health care and financial benefits. This marginalized group is alienated as little, if any, attention are given for their particular need. In a survey conducted in the 1986-87, HIV patients were found losing their jobs due to health problems, fear and discrimination. Some have friends and family members rejecting them out of fear. Quite a number of them suffered losses of income as they became unemployed when their conditions were made public. Somehow, patients infected by HIV are not given equal human rights.
Table 2: Violations of reproductive rights in four Asian countries in 2001-2002
The economic realities in many developing countries may not be able to sustain the needs of those living with HIV. This may be due to the under-resourced health care services in these countries. Without a doubt, all the quality care for these people comes with a price. In the poorest countries in Africa, the rate of infection increases probably because many of the HIV infected people still die as the health service cannot reach all of them. In spite of the President's Emergency Plan for AIDS Relief, not all infected receive treatment and out of those who get treatment, several percent die due to complicating diseases or resistance to the drugs. It is unfortunate for it is obviously not feasible to provide to provide lifelong treatment to everyone. It is however incorrect to make a conclusion stating that economy is the key factor causing the rapid infection of HIV. The richer 20% in Tanzania has more HIV cases than the poorer ones. Factors causing HIV infection differs from one country to another. Generally, however, it is shown that the general health of a particular country is correlated to its Gross Domestic Product (GDP). As the GDP increases, the general life expectancy tends to increase as well.D:\Ong\Desktop\Howe\Issue Report\gw_chart_2010.jpg Figure 3: Gapminder World Map (2010)
Due to HIV, there are no doubt setbacks from the economic perspective. HIV affects the economic growth by reducing the availability of a country's human capital. An increase in mortality will cause a smaller skilled population and labour force. This in turn leads to a decrease in productivity. As more people succumb to the HIV infection, the taxable population of a country decreases accordingly. This scenario results in the exhaustion of the public expenditure, thus slowing the growth of the economy. Other sectors such as the education of a countrywill also be affected.
Benefits and Risks
Antiretroviral drugs have been shown to maintain control of viral replication. Antiretroviral treatment can also delay or prevent the immune system from failing due to the HIV infection. Furthermore, it slows the progression of HIV into AIDS. In general, this treatment reduces the morbidity and mortality of the HIV infected people. In Cape Town, South Africa, it is found that HAART is associated with decreased AIDS and death. Zidovudine, a type of antiretroviral drug, has been shown to reduce the occurrence and severity of opportunistic infections, improve body weights and increase CD4+ T lymphocytes in the peripheral blood. When zidovudine is administered, the disease is less likely to progress and worsen. With the delay of the onset of AIDS, people who are seropositive can enjoy an extended period of an uncompromised health. With the introduction of nevirapine, the vertical transmission of HIV is decreased. In Thailand, a single dose of perinatal nevirapine and zidovudine is used to reduce the mother-to-child transmission. HAART has markedly improved not only the quantity but the quality of the HIV infected people's lives. The long-term prognostication for them are greatly enhanced.
However, there are several risks concerning the antiretroviral therapy. In the Data Collection on Adverse Events of Anti-HIV Drugs (DAD), 126 out of 36, 165 people suffered from heart attacks. 36 of them were fatal. The occurrence of myocardial infarction increased with the increase in years of exposure to the treatment. A 16% increase in chances of myocardial infarction per year of drug exposure was noted. A similar figure was also obtained by Klein et al who followed more than 5000 HIV patients infection for a period of 9.5 years. There is a higher frequency of cardiovascular events among seropostive patients receiving the antiretroviral treatment. This shows that the treatment is capable of increasing the waist-to-hip ratio of a person, a factor which contributes to cardiovascular risk. Data from DAD shows that HAART increases the risk of cerebrovascular diseases, stroke and the development of premature atherosclerotic complications. In response to the situation, less toxic antiretroviral regimens are used and cardiovascular risk factors like tobacco, lipids and hypertension are monitored aggressively. Patients are advised by health officers to take antihypertensive medications and lipid-lowering agents.
Figure 4: Atherosclerosis
Professor Rosling says that, "In order to stop the pandemic, the focus must be on the prevention of the HIV." The major aim of the prophylactic therapy is to decrease the occurrence of opportunistic infections when the immune system fails. This approach is to prevent rather than to treat or cure the HIV infection. Professor Daniel Tarantola from the Global Programme on AIDS encouraged the prevention of the infection. Prevention of sexual transmission is possible if there are positive changes in sexual behavior, induced through information and education. Prevention of transmission through blood must be reinforced. The blood transfusion system must be strengthened while the preparation of blood products is monitored closely. The health officers should then exclude the infected blood from the blood bank. When used in the correct manner, latex condoms can reduce HIV transmission up to 98%. The client ought to be appropriately educated in using condoms and taught the negotiation skills to improve the usage. The goal in positive prevention should be 100% access to use of condoms and lubricants and no needle sharing.
D:\Ong\Desktop\Howe\Issue Report\Female condom.jpg
Figure 5: Female Condom
Immune modulation involves repairing or improving the immune system's defense against the HIV-1. The body is assisted to defend itself against the HIV-1 disease and other opportunistic infections. Both the humoral and cellular immune responses are enhanced. However, this approach is hampered by the rapid replication of the HIV-1. With the increase in replication, the amount of HIV-1 mutations produced may also be increased as well. In the immunomodulator therapy, the parenteral administration of the interleukin-2 (IL-2) is the most recent breakthrough. By definition, parenteral is known as a route of administration that involves piercing the skin or mucous membrane. Administration both intravenously and subcutaneously are shown to produce prolonged and dramatic increases of in levels of CD4+ T-cell counts of the HIV infected individuals.
Evaluation of References
The first source under the bibliography is a movie. It is a America Drama film from the year 1993. The title of the movie is Philadelphia. The story was inspired by a person with AIDS named Geoffrey Bowers. Hence, albeit being a movie, the plot in the movie is actually based on a true story of a plaintiff who went to a public hearing. The movie portrays a society which somehow discriminate against the HIV infected individuals.
Gapminder is a non-profit organisation. The website is display the time series of development for all countries statistically. A software known as the Trendanalyzer is used. Professor Hans Rosling is the Director of the Gapminder Foundation. He is a licensed physician in 1976. From 1979 and two years from then, he was the District Medical Officer in Nacala, a little town on the Northern coast of Mozambique. In addition, the statistical information is constantly kept up to date, preventing any data from being outdated. The quote mentioned by Professor Rosling was taken from his speech during a presentation, which is also under the Technology Entertainment and Design (TED). Besides, all the other web-based sources listed below are found to contain information which is similar factually to the information listed under Gapminder. It is therefore proven that the information of all these websites is not only valid but also very reliable. For example, the UNAIDS website is also an equally trustworthy source of information. It is internationally recognised and the information obtained doesn't contradict with that of any other sources.
The remaining references are either books or articles. These are published by professionals all around the world. The information has to be factually correct in order to be accepted by globally renowned institutions such as the World Health Organization (WHO) and the Joint United Nations Programme on the HIV and AIDS (UNAIDS). Before publishing their work, all of the professionals mentioned above did researches on the topic. The results published are thus very objective and reliable.