Seasann na litreacha '''SEIF''' don tSiondróm Easpa Imdhíonachta Faighte. Is é atá ann ná cnuasach d'airíonna, tholgáin agus ionfhabhtuithe a thagann ar an duine de thoradh an dochar ar leith a dhéanann an Víreas Easpa Imdhíonachta Daonna nó an VEID dá chóras imdhíonachta. Fágann céim dheireanach an tsiondróm an t-othar gan imdhíonacht ar bith ar tholgáin agus sceachaillí a thapaíonn an deis. Cé gur féidir an víreas a choinneáil siar le cóireáil, níl leigheas ann a ruaigfeadh an víreas as orgánach an othair. Tolgtar an víreas i dteagmháil dhíreach na seicne múcasaí nó shruth na fole le sreabhán coirp a bhfuil an víreas ann, cosúil le fuil, seimhean, sreabhán faighne, sreabhán réamhsheamhain, agus bainne cíche. Is féidir don teagmháil seo titim amach má sháitear an t-orgán gnéis san fhaighin, san anas nó sa bhéal. Is féidir, fosta, don fhuilaistriú an víreas a thabhairt ó dhuine go duine. Baineann an priacal céanna leis an dóigh a n-úsáideann na handúiligh dhrugaí an tsnáthaid chéanna leis an druga a instealladh. Is féidir don víreas dul ón máthair go dtí an páiste nuair atá sí ag iompar clainne, ag breith an linbh nó ag tabhairt cíche dó.

An chuid is mó de na saineolaithe, tá siad barúlach gur tháinig an Víreas Easpa Imdhíonachta Daonna ar an bhfód san Afraic, taobh theas den tSahára, san fhichiú haois. Inniu, is galar paindéimeach é an SEIF, agus meastar go bhfuil tolgadh an víris faighte ag corradh is 38.6 milliún de dhaoine ar fud an domhain. I Mí Eanáir sa bhliain 2006, mheasúnaigh Clár Comhair na Náisiún Aontaithe agus na hEagraíochta Domhanda Sláinte go raibh breis agus 25 milliún duine tar éis bás a fháil leis an SEIF ó haithníodh an chéad uair riamh é, ar an 5ú lá de Mhí an Mheithimh sa bhliain 1981. Mar sin, tá an SEIF ar ceann de na galair is mó a mharaigh daoine ó tháinig an chéad taifead stairiúil ar pár. Sa bhliain 2005, meastar gur cailleadh 2.4-3.3 milliún duine leis an SEIF, agus nach raibh 570,000 duine acu ach ina bpáistí. San Aifric taobh theas den tSahára a thit ceann as gach triúr de na básanna seo amach. Dá thoradh sin, tá sochaí na dtíortha sa chuid sin den domhan ag titim as a chéile ar fad ag an ngalar, nó má tá na daoine ag éileamh is ag imeacht, ní taise don eacnamaíocht é. Is féidir gearradh siar ar an mortlaíocht agus maolú ar chruachás na n-othar le cóireáil frith-reitrivíreasach, ach níl a leithéid de chógaisí ar fáil go réidh i ngach tír. Tarraingíonn an SEIF níos mó náire anuas ar an othar ná an chuid is mó de na galair mharfacha, agus is minic a ghreamaíonn an náire seo, fiú, de na daoine atá ag tabhairt sóláis don othar.



An Tolgadh



Is é an Siondróm Easpa Imdhíonachta Faighte an dóigh is tromchúisí ar féidir don ionfhabhtú leis an VEID teacht chun solais. Reitrivíreas is ea é an VEID is mó a ionfhabhtaíonn comhchodanna ardtábhachtacha an chórais imdhíonachta, cosúil leis na cillíní CD4+ T (sórt T-chillíní iad seo), macrafagaigh agus cillíní deindríteacha. Díothaíonn an VEID na cillíní CD4+ T go díreach agus go hindíreach, agus ní féidir don chóras imdhíonachta oibriú i gceart in uireasa na gcillíní seo. Nuair nach bhfuil oiread is 200 cillín den chineál seo fágtha i ngach micrilítear fola, tá an imdhíonacht chillíneach caillte, agus an SEIF ar na bacáin. I ndiaidh an chéad ionfhabhtú géar, is dual don VEID é féin a choinneáil faoi cheilt ar feadh tamaill, go dtí go dtiocfaidh na chéad luathairíonna chun solais. Ina dhiaidh sin, iompóidh an t-ionfhabhtú ina ShEIF, a bheidh inaitheanta ar an mbeagán cillíní den chineál CD4+ T a fhanfaidh san fhuil, chomh maith le hionfhabhtuithe ar leith a bhíonn coitianta ag na hothair SEIF.

Mura bhfuil cógaisí frith-reitrivíreasacha ar fáil, is gnách don ionfhabhtú iompú ina ShEIF i rith naoi nó deich mbliana, agus nuair a bheidh an SEIF ann, ní bheidh ach naoi mí agus seachtain fágtha ag an othar ar an saol seo, ar meán. Mar sin féin, bíonn forchéimniú an ghalair éagsúil go leor ag othair dhifriúla, agus é ag luainiú idir dhá sheachtain agus fiche bliain. Imríonn go leor imthoscaí a dtionchar ar ráta an fhorchéimnithe. Más duine óg atá againn agus coimpléasc capaill aige, is follasach go mbeidh sé níos faide in ann cúl a choinneáil ar an aicíd ná seanduine fannlag. Thairis sin, an duine a raibh an eitinn, cuir i gcás, mar leannán aige sular bhuail an VEID é, beidh sé i bhfad níos measa as ná an duine a raibh teacht aige ar dhochtúirí ó rugadh é. Tá oidhreacht ghéiniteach an othair tábhachtach freisin, chomh maith leis an tréithchineál den víreas a tholg sé. Tá a leithéid de riocht ann agus CCR5-Δ32. Is é an rud atá i gceist leis an gcód aisteach seo ná cineál sóchán nó éalang ghéiniteach a fhágann a lorg ar chóras imdhíonachta an duine. Cé gur riocht díobhálach é go bunúsach, fágann sé an t-othar díonta ar thréithchineálacha áirithe den víreas. Bíonn tréithchineálacha éagsúla den víreas ann, agus cuid acu ag dul i gcion ar an orgánach daonna níos sciobtha ná an chuid eile. Má úsáidtear cógaisí frith-reitrivíreasacha in am, is ea is faide a bheifear ábalta an SEIF a mhoilliú agus an t-othar a choinneáil beo breabhsánta.

Diagnóis


Ón gcúigiú lá de Mhí an Mheithimh sa bhliain 1981 anuas, is iomaí sainmhíniú ar an SEIF a forbraíodh le haghaidh faireachas eipidéimeolaíoch, cosúil le sainmhíniú Bangui agus cás-sainmhíniú fairsingithe na hEagraíochta Domhanda Sláinte ar an SEIF ón mbliain 1994. Ní raibh na córais seo ceaptha le céimeanna an ghalair a aithint thar a chéile san ospidéal, áfach. Sna tíortha tearcfhorbartha, úsáidtear córas na hEagraíochta Domhanda Sláinte leis an ionfhabhtú VEID a aithint agus le céimeanna forbartha an ghalair a shainmhíniú de réir na sonraí cliniciúla agus saotharlainne. Sna tíortha forbartha, áfach, téitear i dtuilleamaí chóras aicmithe na Centers for Disease Control (CDC) sna Stáit.


Córas na hEagraíochta Domhanda Sláinte le céimeanna forbartha an ionfhabhtaithe agus an ghalair a aithint



Sa bhliain 1990, d'aicmigh an Eagraíocht Dhomhanda Shláinte na hionfhabhtuithe agus na riochtaí sláinte seo leanas le chéile le córas céimaitheanta a thabhairt isteach d'othair atá ionfhabhtaithe le VEID-1. Nuashonraíodh an córas i Mí Mheán Fómhair sa bhliain 2005. An chuid is mó de na riochtaí seo, níl iontu ach tolgáin a thapaíonn an deis nuair nach bhfuil imdhíonacht ag an othar: nuair a thagann siad ar an duine nach bhfuil ionfhabhtaithe leis an VEID, ní bhíonn sé deacair iad a leigheas.

Céim a hAon: Ní aithnítear airíonna ar bith ar an othar, cé go bhfuil sé ionfhabhtaithe leis an víreas. Ní aicmítear an riocht seo mar SEIF go fóill
Céim a Dó: Mionairíonna an ghalair le haithint ar an gcraiceann agus ar na seicneacha múcasacha. Bíonn an slaghdán ag teacht ar an othar anois is arís.
Céim a Trí: Síorbhuinneach dhomhínithe ar an othar le mí anuas, nó níos faide. Ionfhabhtuithe tromchúiseacha baictéaracha. Eitinn na scamhóg.
Céim a Ceathair: Tocsaplasmóis na hinchinne, candaidiáis an éasafagais, na traicé, na mbroncas nó na scamhóg. Sarcóma Kaposi. Ar na galair seo a aithnítear an SEIF thar aon dabht nó déidearbhadh.

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Córas Aicmithe CDC le haghaidh an Ionfhabhtaithe VEID



I dtús báire, d'aicmigh na Lárionaid um Srianadh agus Chosc na nAicídí (Centers for Disease Control and Prevention, CDC) sna Stáit an SEIF mar "GRID", is é sin, Gay Related Immune Disease, nó galar imdhíonachta na bhfeileacán. Ina dhiaidh sin, áfach, fuarthas amach nach raibh an SEIF teoranta do dhaoine homaighnéasacha amháin, agus mar sin, baisteadh an t-ainm nua, neodrach air. Sa bhliain 1993, d'fhairsingigh na Lárionaid seo a sainmhíniú ar choincheap an SEIF. Ó sin i leith, deirtear go bhfuil an SEIF ar gach duine atá ionfhabhtaithe leis an VEID agus a bhfuil níos lú ná 200 T-chill i micrilítear dá chuid fola, sin nó níos lú ná 14 % as na fuilchealla bána ar fad. An chuid is mó de na hothair nua sna tíortha forbartha, is de réir an tsainmhínithe seo nó an tsean-sainmhínithe ó na blianta roimh 1993 a aithnítear iad. An duine ar haithníodh an SEIF air de réir na sainmhínithe seo, beifear ag dearcadh air mar othar SEIF fiú i ndiaidh do na cealla seo éirí níos líonmhaire de bharr na cóireála, nó i ndiaidh do na seachghalair a bheith leigheasta.


An Tástáil


Duine as gach beirt, a bheag nó a mhór, dá bhfuil ionfhabhtaithe leis an VEID, níl a fhios acu an galar a bheith orthu ar aon nós sula dtaispeánann an tástáil é. An fhuil a fhaightear ó na deontóirí agus na táirgí fola a úsáidtear sna hospidéil agus sa taighde, cuirtear tástáil den chineál sin i bhfeidhm orthu le teacht ar an truailliú in am. Tá na modhanna tipiciúla tástála dírithe ar antasubstaintí an VEID a aithint ar shreabháin choirp na n-othar. Agus an méid sin ráite, bíonn sé difriúil ag na daoine éagsúla cé chomh fada a thógann sé orthu antasubstaintí a fhorbairt a bheadh inaitheanta sa tástáil. Mar sin, níl sé as an ngnáth nach mbeadh na hantasubstaintí ann ach leathbhliain, nó fiú bliain, i ndiaidh an tolgtha. Tá gléas tástála le ceannach a aithníonn aigéad ribeanúicléasach nó aigéad dí-ocsairibeanúicléasach an VEID sula dtagann na hantasubstaintí ar an bhfód ar aon nós. Ní ghlactar leis na measúnachtaí seo go hoifigiúil le haghaidh diagnóis an ionfhabhtaithe VEID, ach mar sin féin, baintear úsáid astu go forleathan sna tíortha forbartha.

Na hAiríonna is na Seachghalair


Na hairíonna ar a n-aithnítear an SEIF, ní airíonna don SEIF iad sa chiall liteartha, nó is torthaí iad do na galair a thagann ar an othar i ndiaidh don SEIF an córas imdhíonachta a chur ó mhaith. Dá mbeadh an córas sin ag oibriú mar ba chuí, ní bheadh oiread is deis ag na haicídí sin teacht a fhad leis sin. Na baictéir, na víreasanna, na fungais agus na seadáin a tharraingíonn na galair seo ar an othar, is iomaí ceann acu nach ndéanfadh a dhath ar an duine folláin. Téann an VEID i gcion ar gach cuid den orgánach, beagnach. Iad siúd a bhfuil an SEIF orthu, bagraíonn an ailse orthu freisin, nó tá cineálacha ailse ar leith a bhuaileann othair SEIF níos fusa ná na daoine eile, go háirithe sarcóma Kaposi, ailse an mhuiníl agus ailse an chórais imdhíonachta féin (liomfóma).

Na hothair a bhfuil an SEIF orthu, bíonn gnáthairíonna an othair ionfhabhtaithe ag luí orthu, ar nós fiabhras, bárcadh allais (istoíche ach go háirithe), faireoga ata, creathnú fuachta, fannlaige ghinearálta, agus cailleadh meáchain. Meastar go bhfuil níos mó ná cúig bliana saoil i ndán don othar i ndiaidh dhiagnóisiú an SEIF, ach ós rud é go bhfuiltear ag forbairt cóireálacha nua agus an víreas féin ag éirí frithsheasmhach do na seanchógaisí, is dócha go mbeidh athruithe agus ath-athruithe ag teacht ar an measúnú seo i rith na mblianta atá le teacht. An t-othar nach bhfuil fáil aige ar an gcóireáil fhrith-reitrivíreasach, ní mhaireann sé bliain i ndiaidh na diagnóise, de ghnáth. Cailltear an chuid is mó de na hothair leis na tolgáin a thapaíonn an deis nó leis na cineálacha aillse a thagann orthu i ndiaidh don chóras imdhíonachta teip orthu.

Bíonn an galar ag dul chun donais ag rátaí éagsúla ar othair éagsúla, agus é braiteach ar thionchar a lán fachtóirí ar nós so-ghabhálacht an othair, an riocht ina raibh a chóras imdhíonachta agus a shláinte roimh an tolgadh, feabhas an chúraim shláinte sa tír ina bhfuil sé ina chónaí, na hionfhabhtuithe lena raibh sé buailte nuair a tholg sé an VEID, agus an tréithchineál den víreas féin a bhuail é. Na seachghalair a bhuaileann an t-othar, bíonn siad ag brath ar aeráid na timpeallachta. An seachghalar a thiocfadh ort sa teochrios, ní thagann sé ort sa Ghraonlainn.

Na galair scamhógacha a bhuaileann an t-othar


  • An cineál niúmóine ar a dtugtar Pneumocystis jiroveci nó Pneumocystic carinii. Is ar éigean a thagann an niúmóine seo ar dhaoine folláine a bhfuil a gcóras imdhíonachta ag oibriú mar is cóir, ach is minic a bhíonn sé ag luí ar othair a fuair an tolgadh VEID. A fhad is nach raibh diagnóis, cóir leighis ná réamhchosc forbartha don ghalar seo, ba mhinic é a thug bás na n-othar SEIF, fiú sna tíortha saibhre. Maidir leis an Tríú Domhan, tá an galar seo i gcónaí ar ceann de phríomchomharthaí sóirt an SEIF ag othair nach ndeachaigh faoi thástáil VEID, cé nach gnách dó othar a bhualadh mura bhfuil leibhéal na gceall CD4 tite glan níos ísle ná 200 ceann in aghaidh an mhicrilítir.
  • An eitinn. Murab ionann agus na hionfhabhtuithe eile a bhíonn ag dul leis an SEIF, is féidir leis an eitinn dul ón othar SEIF go daoine nach bhfuil a dhath cearr lena gcóras imdhíonachta. Is é an córas ríospráide an bealach a thagann an tolgadh. Níl sé deacair an eitinn a leigheas le cógaisí an lae inniu, ach tá an dainséar ann i gcónaí go gcaillfidh na cógaisí a mbrí, agus na frídíní ag éirí díonta orthu. Cé go bhfuil an eitinn imithe as an gcuid is mó de na tíortha Iartharacha, agus an sláinteachas ag dul i bhfeabhas, níl an scéal leath chomh maith sna tíortha tearcfhorbartha ina bhfuil an SEIF féin ag rith damhsa. Go gairid i ndiaidh an ionfhabhtaithe, bíonn an eitinn teoranta do na scamhóga, ach de réir is mar atá an t-othar ag éirí lag agus an víreas ag fáil an lámh in uachtar air, is féidir leis an eitinn an t-orgánach a ionsaí taobh amuigh de na scamhóga. Is minic a bhíonn sí á leitheadú go dtí na cnámha agus go smior na gcnámh, chomh maith leis an ngoile agus na putóga, an chrua-ae, agus lárchóras na néaróg.

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Na galair ghastraistéigeacha a bhuaileann an t-othar


  • Is é is éasafagaíteas ann ná athlasadh íochtair an éasafagais. Is iad na fungais (candaidiáis) nó na víreasanna (herpes simplex a haon, nó citimeiglivíreas) is mó a tharraingíonn an t-éasafagaíteas ar an othar atá ionfhabhtaithe leis an VEID. Sa chorrchás, is féidir gur miceabaictéir is cúis leis.
  • An tsíorbhuainneach a bhuaileann an t-othar, is iomaí cineál baictéar is féidir a leithéid a tharraingt air: ''Salmonella'', ''Shigella'', ''Listeria'', an campaileabaictéar, nó ''Escherichia coli'', cuir i gcás, chomh maith le hinfhabhtuithe seadánacha agus infhabhtuithe neamhghnácha a thapaíonn an deis, ar nós crioptaspóiridióis, micreaspóiridióis, ''Mycobacterium avium'' (MAC) agus drólainníteas citimeiglivíreasach. Is féidir freisin gurb iad na cógaisí a tharraingíonn an bhuinneach ar an othar nó gurb é an VEID féin is cúis léi, go háirithe le linn chéim thosaigh an ionfhabhtaithe. Agus an galar ag dul chun donais, tagann athruithe ar an dóigh a n-ionsúnn an chonair stéigeach na cothaithigh, agus creidtear gurb é seo is cúis leis an mbuinneach teacht ar na seanothair.

Na galair néarógacha a bhuaileann an t-othar


  • Galar seadánach is ea í an tocsaplasmóis, agus is é an seadán aoncheallach úd ''Toxoplasma gondii'' is cúis leis. Is gnách don tseadán an inchinn a ionfhabhtú agus athlasadh inchinne nó einceifilíteas tocsaplasmach a tharraingt air, ach thairis sin, tá sé in ann na súile agus na scamhóga a ionfhabhtú chomh maith, agus dochar a dhéanamh dóibh.
  • Galar miailinscriosach is ea í an leoiceinceifileapaite ilfhócasach chéimnitheach (''progressive multifocal leukoencephalopathy'', PML). Scriosann an galar seo an mhiailin timpeall ar acsóin na néarcheall, agus mar sin, baineann sé de chumas an orgánaigh néar-ríoga a iompar. Is é an víreas "JC" is cúis leis an leoiceinceifileapaite. Tá an víreas seo ar iompar ag seachtar daoine as gach deichniúr faoi cheilt, ach má fhanann an córas imdhíonachta ag obair go maith, ní dhéanfaidh sé dochar ar bith. Nuair a chuirfidh an VEID an córas sin ó mhaith, áfach, tosóidh an víreas seo ag ionfhabhtú na néarcheall, agus má thosaíonn, ní bheidh sé i bhfad ag díothú an córas néarógach ar fad. Mar sin, ní mhairfidh an t-othar ach cupla mí i ndiaidh na diagnóise, de ghnáth.
  • Tugtar '''ADC''', nó '''néaltrú''' (dara leanbaíocht, aois leanbaíochta) '''de dheasca an SEIF''' ar einceifileapaite mheitibileach a gcuireann an t-ionfhabhtú VEID an chéad tús leis, agus é ag dul chun donais de réir mar atá an SEIF ag oibriú ar na macrafagaigh - na fuilchealla móra bána - agus ar na fagaicítí eile san inchinn atá ag iarraidh an t-orgánach a chosaint. Is é sin, má ionfhabhtaíonn an SEIF na cealla seo, tosóidh siad ag tál substaintí a dhéanann dochar do na néaróga (substaintí néarthocsacha). Is é is toradh don dochar seo ná mínormáltachtaí cognaíochta, iompraíochta, agus luaile, agus iad ag teacht chun solais, fiú, na blianta fada i ndiaidh an chéad ionfhabhtú VEID. Tá an "dara leanbaíocht de dheasca an SEIF" seo i bhfad níos coitianta ar na hothair sna tíortha Iartharacha ná san India. Is dócha gurb é an cineál den víreas atá coitianta san India is cúis leis an difríocht seo.
  • Is é atá i gceist leis an '''meiningíteas crioptacocúil''' ná meiningíteas nó athlasadh meininge (is é is meining ann ná an tseicin a chumhdaíonn an inchinn agus corda an dromlaigh) arb é an fungas úd ''Cryptococcus neoformans'' is cúis leis. Sórt fiabhras inchinne atá ann, mar sin. Is iad na hairíonna a théann leis an meiningíteas crioptacocúil ná fiabhras, tinneas cinn, atuirse, samhnas, agus múisc. Is féidir leis an meiningíteas seo bás an othair a thabhairt, mura thugtar cógas agus cóir leighis dó in am.

Na cineálacha ailse a théann leis an VEID


Tá cineálacha urchóideacha ailse ann a thagann ar na hothair VEID thar aon dream eile. Is é is cúis leis an íogaireacht seo ná an comh-ionfhabhtú le víreas oincigineach a bhfuil aigéad dí-ocsairibeanúicléasach ann. Víreasanna den chineál seo is ea iad Víreas Epstein agus Barr (EBV), an víreas úd KSHV a bhfuil sarcóma Kaposi ag baint leis, agus an cineál den víreas ''Papilloma'' a bhuaileann daoine (HPV). Má aithnítear na cineálacha ailse seo leanas ar othar atá ionfhabhtaithe leis an VEID, is féidir a rá go bhfuil an SEIF air.

  • Is é '''sarcóma Kaposi''' an siad is tipiciúla agus is coitianta a thagann ar na hothair seo. Sa bhliain 1981, tugadh faoi deara go raibh an sarcóma seo ag iompú ina eipidéim ar fhir óga homaighnéasacha, agus inniu, tá a fhios againn gurbh é an VEID agus an SEIF ba chúis leis an eipidéim seo. Víreas den chineál ''gáma-herpes'' ar a dtugtar KSHV (is é sin, "an víreas ''herpes'' atá ag baint le sarcóma Kaposi", nó ''Kaposi's sarcoma-associated herpes virus'' as Béarla) is cúis leis an sarcóma seo. Aithnítear an sarcóma mar nóidíní a bhfuil dath sórt purpartha iontu, ach is féidir dó orgáin eile a bhualadh chomh maith, go háirithe an béal, an chonair ghastraistéigeach, agus na scamhóga.
  • Liomfómaí áirithe, go háirithe liomfóma Burkitt agus liomfómaí atá cosúil leis sin, bíonn siad níos coitianta ar na hothair atá ionfhabhtaithe leis an VEID ná ar dhaoine eile. Na cineálacha seo ailse, is tuar tubaiste iad go minic don othar. I gcásanna áirithe, is féidir an SEIF a aithint ar na liomfómaí seo. Is iad KSHV agus víreas Epstein agus Barr is cúis le cuid mhór de na liomfómaí seo.
  • Ar mhná atá ionfhabhtaithe leis an VEID, is féidir an SEIF a aithint ar an ailse cheirbheacsach. Is é an víreas ''papilloma'', nó HPV, is cúis leis an ailse seo.

I mbreis ar na cineálacha ailse thuas ansin, is baol do na hothair VEID siadaí áirithe eile a tholgadh, go háirithe galar Hodgkin - sórt liomfóma é sin freisin - agus carcanómaí san anas agus sa reicteam (ailse sa tóin). Tá cuid mhaith cineálacha ailse ann, áfach, nach mbíonn níos coitianta ar na hothair VEID ná ar an gcuid eile den daonra - ailse na gcíoch agus ailse na drólainne, cuir i gcás. In áiteanna a mbaintear úsáid fhorleathan as an modh leighis ar a dtugtar HAART - is é sin, cóireáil fhrith-reitrivíreasach ardghníomhach, a chiallaíonn go dtugtar sraith de chógaisí frith-reitrivíreasacha éagsúla don othar - bíonn na cineálacha sainiúla ailse a théann leis an SEIF ag dul chun annaimhe, ach san am céanna, bíonn na hothair VEID ag fáil bháis le cineálacha eile ailse.

Ionfhabhtuithe Eile a Thapaíonn an Deis


Nuair nach bhfuil díonadh ná cosaint cheart fágtha san othar, is iomaí cineál baictéar nó frídín eile a thapaíonn an deis. Mar sin, bíonn ionfhabhtuithe éagsúla ag luí ar an othar VEID, agus airíonna sách ginearálta ag dul leo, ar nós fiabhras agus cailliúint mheáchain. Is féidir leis an ''Mycobacterium avium'' agus leis an citimeigilivíreas an t-othar a ionfhabhtú, mar shampla. Tagann an drólainníteas leis an gcitimeiglivíreas go minic, mar a chonaic muid thuas cheana, agus is féidir leis an víreas sin reitine na súl a bhualadh freisin agus an t-othar a fhágáil dall. San Áise Thoir-Theas, is minic a thagann peinicillióis ar an othar. Is é is cúis leis an bpeinicillióis ná an fungas úd ''Penicillium marneffei''. Go coitianta, ní gnách linn dearcadh ar fhungais an ghéinis úd ''Penicillium'' mar fhoinsí galair, ach mar fhoinsí leighis. An té atá fágtha gan imdhíonacht ag an VEID, áfach, is féidir leis éirí an-tinn de thoradh ionfhabhtú leis an b''Penicillium'', fiú bás a fháil.

Tolgadh agus Cosc an Ghalair



Seo meastachán a thaispeánann priacal tolgtha an VEID de réir an dóigh a dtéitear i dteagmháil leis an víreas. Taispeánann an figiúr na hionfhabhtuithe in aghaidh deich míle ócáid teagmhála le foinse an víris.

*Fuilaistriú: 9,000

*Breith an Linbh (seachadadh an víris ó mháthair go leanbh) 2,500

*Beirt ag baint úsáide as an tsnáthaid chéanna le druga a instealladh 67

*Comhriachtain tríd an tóin gan choiscín, an priacal don duine atá sa ról neamhghníomhach 50

*Comhriachtain tríd an bhfaighin gan choiscín, an priacal don bhean 10

*Comhriachtain tríd an tóin gan choiscín, an priacal don duine atá sa ról gníomhach 6.5

*Comhriachtain tríd an bhfaighin gan choiscín, an priacal don fhear 5

*Faoiseamh an bhéil gan choiscín, an priacal don duine atá ag tabhairt faoisimh 1

*Faoiseamh an bhéil gan choiscín, an priacal don duine atá ag fáil faoisimh 0.5


Is iad an trí phríomhbhealach a thagann an víreas isteach ná caidreamh gnéis, teagmháil dhíreach le sreabháin nó le fíocháin an othair agus an t-aistriú ón máthair go dtí an páiste. Is féidir teacht ar an víreas i seileog, i ndeora, agus i bhfual an othair, ach ós rud é nach bhfuil tiúchan an víris sna sreabháin seo ró-ard, níl mórán dainséir ag baint leo ach an oiread.

An Teagmháil Ghnéis


De thoradh teagmháil ghnéis gan choiscín is mó a tholgtar an víreas. Is féidir dó dul ó dhuine go duine nuair a thagann sreabhán gnéis duine amháin le seicin mhúcasach an duine eile sa tóin, sna baill ghiniúna nó sa bhéal. Is mó an priacal don té a sáitear ball an duine eile isteach ann ná don té atá á shá. Níl faoiseamh an bhéil saor ón dainséar, ós rud é go bhfuil an víreas intolgtha ag an té atá ag sá agus ag an té atá ag sú. An priacal a bhaineann leis an tseileog, tá sé i bhfad níos ísle ná an priacal a bhaineann leis an seamhan.

An duine a bhfuil galar gnéis éigin eile air cheana féin, bíonn cneánna beaga ina chuid ball giniúna, rud a mhéadaíonn go mór ar an bpriacal an VEID a tholgadh.

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. Each 10-fold increment of seminal HIV RNA is associated with an 81% increased rate of HIV transmission.[49][50] Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.[51][52] People who are infected with HIV can still be infected by other, more virulent strains.

During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming pregnant. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.[53] The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with contributing to the low rates of AIDS in these regions.

Promoting condom use, however, has often proved controversial and difficult. Many religious groups, most visibly the Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and sexual morality. This attitude is found among some health care providers and policy makers in sub-Saharan African nations, where HIV and AIDS prevalence is extremely high.[54] They also believe that the distribution and promotion of condoms is tantamount to promoting sex amongst the youth and sending the wrong message to uninfected individuals. However, no evidence has been produced that promotion of condom use increases sexual promiscuity. Pope Benedict XVI commissioned a report on whether it might be acceptable for Catholics to use condoms to protect life inside a marriage when one partner is infected with HIV, or is sick with AIDS.[55] Defenders of the Catholic Church's role in AIDS and general STD prevention state that, while they may be against the use of contraception, they are strong advocates of abstinence outside marriage.[56] For this reason the Catholic Church is always quick to defend itself against allegations that it played a role in the spread of the disease. The Church argues that it goes to great lengths to push a very good prevention measure in abstinence, and also that an analysis of its teaching demonstrates clearly that it cannot be held responsible for the lack of condom use. The latter point arises from the fact that the principle of double effect allows married couples to use contraception if the prime reason for doing so is the prevention of infection. As for unmarried couples, the Church's abstinence rule is a far more serious consideration than the use of contraception. It is therefore unlikely that couples engaging in pre-marital sex are failing to use contraception out of respect to the Catholic Church if they are happy to commit a much greater sin.

Conversely, some religious groups have argued that preventing HIV infection is a moral task in itself and that condoms are therefore acceptable or even praiseworthy from a religious point of view.
Condoms in many colors
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Condoms in many colors

The male latex condom, if used correctly without oil-based lubricants, is the single most efficient available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms as they weaken the latex, making the condoms porous. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms.[57] Latex degrades over time, making them porous, which is why condoms have expiration dates. In Europe and the United States, condoms have to conform to European (EC 600) or American (D3492) standards to be considered protective against HIV transmission.

The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina – inserting the female condom requires squeezing this ring.

With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.[58]

The United States government and health organizations both endorse the ABC Approach to lower the risk of acquiring AIDS during sex:

Abstinence or delay of sexual activity, especially for youth,
Being faithful, especially for those in committed relationships,
Condom use, for those who engage in risky behavior.

This approach has been very successful in Uganda, where HIV prevalence has decreased from 15% to 5%. However, more has been done than implementing the ABC Approach as Edward Green, a Harvard medical anthropologist put it, "Uganda has pioneered approaches towards reducing stigma, bringing discussion of sexual behavior out into the open, involving HIV-infected people in public education, persuading individuals and couples to be tested and counseled, improving the status of women, involving religious organizations, enlisting traditional healers, and much more." Other programs and initiatives promote condom use more heavily. Condom use is an integral part of the CNN Approach. This is:

Condom use, for those who engage in risky behavior,
Needles, use clean ones,
Negotiating skills; negotiating safer sex with a partner and empowering women to make smart choices.

Criticism of the ABC approach is widespread because a faithful partner of an unfaithful partner is at risk of contracting HIV.[59]

Current research is clarifying the relationship between male circumcision and HIV in differing social and cultural contexts.[60] UNAIDS believes that it is premature to recommend male circumcision services as part of HIV prevention programs[61] even though male circumcision may lead to a reduction of infection risk in heterosexual men by up to 60%.[62] Moreover, South African medical experts are concerned that the repeated use of unsterilized blades in the ritual circumcision of adolescent boys may be spreading HIV.[63]
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Exposure to infected body fluids

This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with not only HIV, but also hepatitis B and hepatitis C. Needle sharing is the cause of one third of all new HIV-infections and 50% of hepatitis C infections in Northern America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV infected person though is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce that small risk.[64] Health care workers (nurses, laboratory workers, doctors etc) are also concerned, although more rarely. This route can affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.[65] Because of this, the United Nations General Assembly, supported by universal medical opinion on the matter, has urged the nations of the world to implement universal precautions to prevent HIV transmission in health care settings.[66][67]

The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products".[68]

Medical workers who follow universal precautions or body substance isolation such as wearing latex gloves when giving injections and washing the hands frequently can help prevent infection of HIV.

All AIDS-prevention organizations advise drug-users not to share needles and other material required to prepare and take drugs (including syringes, cotton balls, the spoons, water for diluting the drug, straws, crack pipes, etc). It is important that people use new or properly sterilized needles for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from needle exchanges. In some developed countries, clean needles are available free in some cities, at needle exchanges or safe injection sites. Additionally, many nations have decriminalized needle possession and made it possible to buy injection equipment from pharmacists without a prescription.
[edit]

Mother-to-child transmission (MTCT)

The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between the mother to the child during pregnancy, labor and delivery is 25%. However, when the mother has access to antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%.[41] A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding.

Studies have shown that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child.[69] Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.[5] In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa.[70] Of the estimated 2.3 million [1.7-3.5 million] children currently living with HIV, 2 million (almost 90%) live in sub-Saharan Africa.[5]

Prevention strategies are well known in developed countries, however, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV. [71] However, transmission of HIV between intravenous drug users has clearly decreased, and HIV transmission by blood transfusion has become quite rare in developed countries.
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Treatment

There is currently no vaccine against HIV or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, on an antiviral treatment directly after a highly significant exposure. Also, not a single case has been documented in which systemic HIV infection has been cured and even on the theoretical level, no plausible way of eradicating HIV infection has so far been found. Treatment for HIV can suppress viral replication to a degree sufficient to apparently stop disease progression, but success is critically dependent on the patients ability to keep perfect adherence to their drug schedule, which many people will fail to achieve. Also, modern combination therapy has been around for merely ten years, so it is not presently known whether treatment failure or inacceptable long-term side effects can be avoided in the majority even of perfectly compliant patients over a time-span of potentially many decades. However, it is known that without major medical and scientific breakthroughs, HIV will not have any problem surviving combination therapy for said decades. Still, in western countries, most patients survive many years following diagnosis because of the availability of the highly active antiretroviral therapy (HAART).[21] In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2 months.[7] HAART dramatically increases the time from diagnosis to death, and treatment research continues.

Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of anti-retroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This treatment is frequently referred to as HAART (highly-active anti-retroviral therapy).[72] Anti-retroviral treatments, along with medications intended to prevent AIDS-related opportunistic infections, have played a part in delaying complications associated with AIDS, reducing the symptoms of HIV infection, and extending patients' life spans. Over the past decade the success of these treatments in prolonging and improving the quality of life for people with AIDS has improved dramatically.[73][74]

Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.[75] In developed countries where HAART is available, doctors assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.[76]

There are several concerns about antiretroviral regimens, as side effects of these antiretrovirals have caused problems such as lipodystrophy, dyslipidaemia, insulin resistance, an increase in cardiovascular risks and birth defects.[77][78] Regimens can be complicated, requiring patients to take several pills at various times during the day, although treatment regimens have been greatly simplified in recent years. If patients miss doses, drug resistance can develop contributing to the rise of viral escape.[79][80] Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS. Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance.

A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of getting infected. In addition, AIDS patients should receive vaccination against Streptococcus pneumoniae and should receive yearly vaccination against influenza virus. Patients with substantial immunosuppression are generally advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.

Various forms of alternative medicine have been used to try to treat symptoms or to try to affect the course of the disease itself, although none is a substitute for conventional treatment.[81] In the first decade of the epidemic when no useful conventional treatment was available, a large number of people with AIDS experimented with alternative therapies. The definition of "alternative therapies" in AIDS has changed since that time. Then, the phrase often referred to community-driven treatments, untested by government or pharmaceutical company research, that some hoped would directly suppress the virus or stimulate immunity against it. These kinds of approaches have become less common over time as the benefits of AIDS drugs have become more apparent.

Examples of alternative medicine that people hoped would improve their symptoms or their quality of life include massage, herbal and flower remedies and acupuncture;[81] when used with conventional treatment, many now refer to these as "complementary" approaches. None of these treatments has been proven in controlled trials to have any effect in treating HIV or AIDS directly.[82] However, some may improve feelings of well-being in people who believe in their value. Additionally, people with AIDS, like people with other illnesses such as cancer, sometimes use marijuana to treat pain, combat nausea and stimulate appetite.
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Epidemiology

Main article: AIDS pandemic

Prevalence of HIV among adults per country at the end of 2005 ██ 15-50% ██ 5-15% ██ 1-5% ██ 0.5-1.0% ██ 0.1-0.5% ██ <0.1% ██ no data
Enlarge
Prevalence of HIV among adults per country at the end of 2005 ██ 15-50% ██ 5-15% ██ 1-5% ██ 0.5-1.0% ██ 0.1-0.5% ██ <0.1% ██ no data

UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 2.8 million (between 2.4 and 3.3 million) lives in 2005 of which more than half a million (570,000) were children.[5]

Globally, between 33.4 and 46 million people currently live with HIV.[5] In 2005, between 3.4 and 6.2 million people were newly infected and between 2.4 and 3.3 million people with AIDS died, an increase from 2003 and the highest number since 1981.[5]

Sub-Saharan Africa remains by far the worst affected region, with an estimated 21.6 to 27.4 million people currently living with HIV. Two million [1.5–3.0 million] 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 (76%) of all women living with HIV. In 2005, there were 12.0 million [10.6–13.6 million] AIDS orphans living in sub-Saharan Africa 2005.[5] South & South East Asia are second worst affected with 15%. AIDS accounts for the deaths of 500,000 children in this region. Two-thirds of HIV/AIDS infections in Asia occur in India, with an estimated 5.7 million infections (estimated 3.4 - 9.4 million) (0.9% of population), surpassing South Africa's estimated 5.5 million (4.9-6.1 million) (11.9% of population) infections, making it the country with the highest number of HIV infections in the world.[83] 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.[84]

The latest evaluation report of the World Bank's Operations Evaluation Department assesses the 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.[85] 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's assistance is for implementation of government programs by government, it provides important insights on how national AIDS programs can be made more effective.

The development of HAART as effective therapy for HIV infection and AIDS has substantially reduced the death rate from this disease in those areas where it is widely available. This has created the misperception that the disease has gone away. In fact, as the life expectancy of persons with AIDS has increased in countries where HAART is widely used, the number of persons living with AIDS has increased substantially. In the United States, the number of persons with AIDS increased from about 35,000 in 1988 to over 220,000 in 1996.[86]

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 counseling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.
[edit]

Economic impact
Changes in life expectancy in several African countries. Botswana Zimbabwe Kenya South Africa Uganda
Enlarge
Changes in life expectancy in several African countries.

Botswana

Zimbabwe

Kenya

South Africa

Uganda

HIV and AIDS retard economic growth by destroying human capital. UNAIDS has predicted outcomes for sub-Saharan Africa to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection.[5]

Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people in these countries are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.

The increased mortality in this region will result in a smaller skilled population and labor force.[87] This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.[87] By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This then results in slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers) and sick pay and caring for AIDS orphans, especially if the sharp increase in adult mortality shifts the onus from the family to the government in caring for these orphans.

On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.[88]

UNAIDS, WHO and the United Nations Development Programme have documented a correlation between the decreasing life expectancies and the lowering of gross national product in many African countries with prevalence rates of 10% or more. Indeed, since 1992 predictions that AIDS would slow economic growth in these countries have been published. The degree of impact depended on assumptions about the extent to which illness would be funded by savings and who would be infected.[89] Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990–2025 were that the economic growth rates of these countries would be between 0.56 and 1.47% lower. The impact on gross domestic product (GDP) per capita was less conclusive. However, in 2000, the rate of growth of Africa's per capita GDP was in fact reduced by 0.7% per year from 1990–1997 with a further 0.3% per year lower in countries also affected by malaria.[90] The forecast now is that the growth of GDP for these countries will undergo a further reduction of between 0.5 and 2.6% per annum.[87] However, these estimates may be an underestimate, as they do not look at the effects on output per capita.[91]

Many governments in sub-Saharan Africa denied that there was a problem for years, and are only now starting to work towards solutions. Underfunding is a problem in all areas of HIV prevention when compared to even conservative estimates of the problems.
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Stigma

AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.[92]

AIDS stigma has been further divided into the following three categories:

1. Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.[93]
2. Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or “lifestyles” perceived to be associated with the disease.[93]
3. Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.[94]

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, and intravenous drug use.

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.[95] There is also a perceived association between all male-male sexual behavior and AIDS.[93][96]

For more details on this topic, see Stigma and HIV-AIDS, A review of the literature [97]

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Origin of HIV

Main article: AIDS origin

The AIDS epidemic was discovered June 5, 1981, when the U.S. Centers for Disease Control and Prevention reported a cluster of Pneumocystis carinii pneumonia (now classified as Pneumocystis jiroveci pneumonia) in five homosexual men in Los Angeles.[98] Originally dubbed GRID, or Gay-Related Immune Deficiency, health authorities soon realized that nearly half of the people identified with the syndrome were not homosexual men. In 1982, the CDC introduced the term AIDS to describe the newly recognized syndrome.

Three of the earliest known instances of HIV infection are as follows:

1. A plasma sample taken in 1959 from an adult male living in what is now the Democratic Republic of Congo.[99]
2. HIV found in tissue samples from a 15 year old African-American teenager who died in St. Louis in 1969.[100]
3. HIV found in tissue samples from a Norwegian sailor who died around 1976.[101]

Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted. HIV-1 is the source of the majority of HIV infections throughout the world, while HIV-2 is not as easily transmitted and is largely confined to West Africa.[102] Both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 is the Central Common Chimpanzee (Pan troglodytes troglodytes) found in southern Cameroon.[103] It is established that HIV-2 originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of Guinea Bissau, Gabon, and Cameroon.

Although a variety of theories exist explaining the transfer of HIV to humans, there is no widely accepted scientific consensus of any single hypothesis and the topic remains controversial. Freelance journalist Tom Curtis discussed one currently controversial possibility for the origin of HIV/AIDS in a 1992 Rolling Stone magazine article. He put forward what is now known as the OPV AIDS hypothesis, which suggests that AIDS was inadvertently caused in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a polio vaccine.[104] Although subsequently retracted due to libel issues surrounding its claims, the Rolling Stone article motivated another freelance journalist, Edward Hooper, to probe more deeply into this subject. Hooper's research resulted in his publishing a 1999 book, The River, in which he alleged that an experimental oral polio vaccine prepared using chimpanzee kidney tissue was the route through which simian immunodeficiency virus (SIV) crossed into humans to become HIV, thus starting the human AIDS pandemic.[105] Subsequently, this hypothesis has been refuted by examination of these original polio vaccine stocks and establishing that they do not contain material of chimpanzee origin.[106]
[edit]

Alternative theories

Main article: AIDS reappraisal

A minority of scientists and activists question the connection between HIV and AIDS,[107] or the existence of HIV,[108] or the validity of current testing methods. These claims are met with resistance by, and often evoke frustration and hostility from most of the scientific community, who accuse the dissenters of ignoring evidence in favor of HIV's role in AIDS, and irresponsibly posing a dangerous threat to public health by their continued activities.[109]

Some assert that the current mainstream approach to AIDS, based on HIV causation, has resulted in inaccurate diagnoses, psychological terror, toxic treatments, and a squandering of public funds.[110] The debate and controversy regarding this issue from the early 1980s to the present has provoked heated emotions and passions from both sides.
[edit]

Common misconceptions

Main article: Common misconceptions about HIV and AIDS

A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users.

One possibility for the misconception that AIDS infects only homosexual men is that AIDS was termed Gay Related Immune Deficiency Syndrome when it was first recognized in 1981 (it was subsequently renamed after it was recognised that there were methods of transmission other than male-male intercourse). HIV appears to have entered the United States around the late 1960s and seems to have then been unknowingly spread by people throughout the U.S. and Europe. In a survey on AIDS conducted in 1983 in Belgium, Denmark, Finland, France, Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom a slight majority of those infected with HIV were male homosexuals (58% of all cases).[111]