In the many years since HIV/AIDS was first acknowledged as an epidemic, we have learned a great deal about our immune system and how it relates to opportunistic infections that we may encounter. Since the HIV disease has spread worldwide, no health care provider can be blind to the fact that some of our patients will present with symptoms of this disease and related co-infections. You may ask yourself, "Why should I be concerned about this disease?" The recent XVII International AIDS Conference, held Aug. 3-8 in Mexico City, highlighted facts of which we must be aware because they affect all of our practices.
To review the latest news from the conference: The pandemic is still going strong all over the world. The current low estimate of those living with HIV/AIDS worldwide is 33.2 million people, with 68 percent being in sub-Saharan Africa. More than 25 million have already died from AIDS. In the U.S., the new estimates show that gay and bisexual men of all races and ethnicities, and African-American men and women are the groups most affected by HIV. Fifty-three percent of all new infections in 2006 in the U.S. occurred in gay and bisexual men. African Americans, while comprising 13 percent of the U.S. population, accounted for 45 percent of the new HIV infections in 2006.
We are far from a cure, and we cannot address the disease just from a biomedical standpoint. We must focus on social reforms to prevent the disease from spreading. There needs to be more vocal discussions in our communities about sensitive issues including drug use, homophobia and gender violence; these are the major contributory factors that affect the spread of HIV.
In sub-Saharan Africa, 61 percent of women are infected. The African Strategy to prevent the spread of disease utilizes an approach called ABC:
Abstinence and delayed sexual debut for the inexperienced;
Being faithful to one's sexual partner and proper and consistent use of condoms; and
Circumcision for all males, which has been proven to reduce HIV transmission.
This evidence-based behavior strategy has shown to decrease the overall HIV infection rate by as much as 90 percent in some key regions of Africa. Education has been shown to be as important as drug therapy to decrease the spread of HIV. From a biomedical approach, there are three steps necessary to eradicate HIV from an infected person's body:
Currently, the treatment methods include a medication regimen using a combination of three highly active ARV drugs, which are much more effective than the use of a single drug because they interfere with the HIV at multiple stages in the life cycle. All ARV drugs are designed to block virus reproduction in cells and allow an increase in the immune-system cells (CD4 lymphocytes).
These current treatment methods are extending the lives of millions of HIV-infected people. Unfortunately, millions more are not getting the access to the drugs they need, especially children in the poorer countries. The reason is because prevention, care and the treatment of HIV are being left to families and communities. Without assistance, they are overburdened and/or do not have access to care.
Scientists are continuing to develop new drugs to treat HIV/AIDS. The goals for the future include reducing toxicity of the ARV regimens, simplifying the treatment regimens and decreasing drug resistance. Part of the problem in dealing with new treatments is that the HIV virus mutates continuously and patients develop resistance to existing medications. Thus, there is no one approach that can be uniform across the board in treating patients.
The ultimate goal in the treatment is to find a medication that has no side effects, is inexpensive, and doesn't matter if a dose is missed. Here are some facts:
Here are the recommendations for the traditional-based allopathic practice using an evidence-based approach for the care and treatment of individuals who may be at high risk:
We have always known that a proactive approach to maintaining a higher quality of life is the preferred method for our patients. In order to do this, we must continually educate ourselves and then our patients.
Resources
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