AIDS update, 1998 : an annual overview of acquired immune deficiency syndrome

목차 (Table of Contents)

• CONTENTS
• Preface = xix
• Introduction: Histories of Global Pandemics, World AIDS Conferences, Overview of HIV/AIDS, and the AIDS Quilt = 1
• 1 Discovering AIDS, Naming the Disease = 26
• CHAPTER CONCEPTS = 26
• AIDS: A DISEASE OR A SYNDROME? = 26
• Naming the Disease = 27
• Point of Information 1.1 Announcement of CDC Name Change = 28
• DISCOVERY OF THE AIDS VIRUS = 28
• Naming the AIDS Viruses: HIV-1, HIV-2 = 29
• DEFINING THE ILLNESS: AIDS SURVEILLANCE = 30
• Definitions of AIDS for Surveillance Purposes = 30
• Arbitrary AIDS Definitions = 31
• Revised AIDS Definition Creates Backlog = 34
• Problems Stemming from Changing the AIDS Definition for Surveillance Purposes = 34
• SUMMARY = 34
• REVIEW QUESTIONS = 35
• REFERENCES = 35
• 2 What Causes AIDS: Origin of the AIDS Virus = 36
• CHAPTER CONCEPTS = 36
• THE CAUSE OF AIDS: THE HUMAN IMMUNODEFICIENCY VIRUS = 36
• HIV Does Not Cause AIDS: A Minority Point of View = 36
• Box 2.1 Sex and HIV Do Not Cause AIDS! = 37
• Duesberg's Belief That HIV Does Not Cause AIDS Continues = 38
• In Defense of Duesberg = 38
• A Member of the United States Government Enters the Dispute = 39
• Evidence That HIV Causes AIDS = 39
• Point of View 2.1 The United States Government Created HIV = 40
• Point of Information 2.1 The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome = 40
• ORIGIN OF HIV: THE AIDS VIRUS = 42
• Why Do Scientists Want to Know Where HIV Originated? = 42
• Ideas on the Origin of HIV, UFOs, Biological Warfare, and Cats = 42
• The Difference Between HIV, HIV Disease, and AIDS = 44
• SUMMARY = 45
• REVIEW QUESTIONS = 45
• REFERENCES = 45
• 3 Biological Characteristics of the AIDS Virus = 46
• CHAPTER CONCEPTS = 46
• RETROVIRUSES = 47
• HUMAN IMMUNODEFICIENCY VIRUS (HIV) = 47
• Production of Viral RNA Strands or RNA Transcripts = 48
• BASIC GENETIC STRUCTURE OF RETROVIRAL GENOMES = 50
• Retroviral Genome of HIV = 54
• GENETIC MUTATION = 59
• GENETIC RECOMBINATION IN HIV = 59
• Completing the Picture on Producing HIV Genetic Variability = 59
• DISTINCT GENOTYPES (SUBTYPES) OF HIV-1 WORLDWIDE BASED ON ENV AND GAG PROTEINS = 60
• Group M Subtypes = 61
• International Genetic Subtypes = 61
• HIV RNA Recombination = 61
• Point of Information 3.1 Mysteries of HIV Subtypes = 63
• Group O Subtypes = 64
• SUMMARY = 64
• REVIEW QUESTIONS = 64
• REFERENCES = 64
• 4 Anti-HIV Therapy = 66
• CHAPTER CONCEPTS = 66
• Box 4.1 Drug Therapy for William "Skip" Bluette = 67
• GOALS FOR ANTI-HIV THERAPY = 68
• Can HIV Infection Be Cured?: Never Say Never = 68
• Point of View 4.1 Medical Benefit. A Cure? = 68
• ANTI-HIV DRUGS HAVING FDA APPROVAL = 68
• Box 4.2 Vigil for William "Skip" Bluette = 69
• Box 4.3 William "Skip" Bluette: May 18, 1946-July 17, 1988 = 70
• FDA-APPROVED NUCLEOSIDE ANALOG REVERSE TRANSCRIPTASE INHIBITORS = 70
• Point of View 4.2 The End of AIDS? = 71
• Focus on the Five Nucleoside Analogs = 71
• Side Effects = 71
• SELECTION OF HIV DRUG-RESISTANT MUTANTS = 71
• Point of View 4.3 Does Society Want Miracle Drugs for HIV?: The New Treatments Could Make the Pandemic Worse! = 73
• The Demise of Monotherapy = 73
• HOW COMBINATION DRUG THERAPY CAN REDUCE THE CHANCE OF HIV DRUG RESISTANCE = 74
• Point of Information 4.1 The Drug Development and Approval Process = 75
• Best Choices for Combination Therapy? = 77
• Problems in Drug Selection = 77
• VIRAL LOAD: ITS RELATIONSHIP TO HIV DISEASE AND AIDS = 77
• When Is Viral RNA Found in the Plasma? = 77
• USE OF NON-NUCLEOSIDE ANALOG REVERSE TRANSCRIPTASE INHIBITORS = 79
• FDA-APPROVED PROTEASE INHIBITORS = 79
• Point of Information 4.2 Determination of Viral Load and Questions People, Ask = 80
• Structure and Function of HIV Protease = 82
• Point of View 4.4 Viral Constraints That May Lead to HIV Elimination from the Body = 82
• The Four Protease Inhibitors in Use = 82
• Box 4.4 Protease Inhibitors: Extending Life; The Downside of this Gift-Recovery? = 83
• Protease Inhibitor Side Effects = 86
• Sidebar 4.1 Guidelines and Recommendations for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents = 87
• Point of Information 4.3 Current Problem Using Combination Therapy = 87
• Box 4.5 The New AIDS Drugs: Timing Is Crucial = 88
• Point of View 4.5 Current Drag/Patient Regimens May Call for a Specialist = 90
• HIV Resistance to Protease Inhibitors = 90
• Rapid Production of HIV Protease Inhibitor Mutations = 90
• Protease Inhibitor HIV Resistance Lessons Learned = 90
• Box 4.6 Can Combination Therapy Using Nucleoside Analogs with Protease Inhibitors Cure HIV Disease? = 91
• Point of Information 4.4 AIDS Deaths Decreasing in the United States = 92
• Point of View 4.6 Dramatic Health Improvements Among AIDS Patients Cause a Shift in United States Health Care Policies = 93
• Summary = 93
• PEDIATRIC ANTI-HIV THERAPY = 93
• Point of Information 4.5 The Cost of Staying Alive Increases with Each New Therapy = 95
• PROTEASE INHIBITORS AND PREGNANCY = 96
• DISCLAIMER = 96
• SUMMARY = 96
• SOME AIDS THERAPY INFORMATION HOTLINES = 96
• REVIEW QUESTIONS = 97
• REFERENCES = 97
• 5 The Immunology of HIV Disease/AIDS = 100
• CHAPTER CONCEPTS = 100
• Box 5.1 How Large Is a Trillion? = 101
• HUMAN LYMPHOCYTES: T CELLS AND B CELLS = 102
• The Microbial World Responds to the Human Immune System = 102
• T4 Cell Function and HIV Disease = 103
• Box 5.2 To Understand the Difference Between Health and Disease, Immunologists Need to Understand the Immune System! = 105
• B Cell Function and Disease = 108
• Point of Information 5.1 Class Ⅰ and Class Ⅱ Proteins 109
• Point of Information 5.2 Jeffrey Getty's HIV-Resistant Baboon Cell Transplant Fails 109
• T8 Cell Function and HIV Disease = 109
• Point of Information 5.3 The Big Questions = 110
• Summary: Immune Dysfunction Caused by HIV/AIDS = 110
• ANTIBODIES AND VIRUSES = 110
• The Antibody = 110
• B Cells Make Antibodies and Release Them into the Bloodstream = 111
• ANTIBODIES AND HIV DISEASE = 112
• HIV Protected from Human Antibodies = 112
• How HIV Attaches to the T4 Cell = 112
• How HIV Enters CD4+ Cells: T4 Cells and Macrophage = 113
• FUSIN or CXCKR-4 = 113
• GENETIC RESISTANCE TO HIV INFECTION = 114
• Will the Mutant CKR-5 Gene Protect People from All Subtypes of HW? = 115
• Should I Be Tested for the Presence of the CKR-5 Gene? = 115
• Who Carries the Defective CKR-5 Gene? = 115
• Why Does This Gene Exist? = 115
• Box 5.3 Mutant CKR-5 HIV Resistance May Just Be an Indicator of the More Complex Biology Involved in Long-Term Survival = 116
• T4 CELL DEPLETION AND IMMUNE SUPPRESSION = 116
• Means by Which T4 Cell May Be Lost = 116
• Box 5.4 Cofactors Expedite HIV Infection = 117
• IMPACT OF T4 CELL DEPLETION = 119
• ROLE OF MONOCYTES AND MACROPHAGES IN HIV INFECTION = 120
• Clinical Latency: Where Have All the Viruses Been Hiding? = 120
• T4 Cell Generation and Destruction = 122
• Implications of a High HIV Replication Rate = 123
• SUMMARY = 124
• REVIEW QUESTIONS = 124
• REFERENCES = 125
• 6 Opportunistic Infections and Cancers Associated with HIV Disease/AIDS = 127
• CHAPTER CONCEPTS = 127
• WHAT IS AN OPPORTUNISTIC DISEASE? = 127
• THE PREVALENCE OF OPPORTUNISTIC DISEASES = 128
• PROPHLAXIS AGAINST OPPORTUNISTIC INFECTIONS = 128
• OPPORTUNISTIC INFECTIONS IN HIV-INFECTED PEOPLE = 128
• Point of Information 6.1 Available Therapy for Opportunistic Infections = 129
• HIV-Related Opportunistic Infections Vary Worldwide = 129
• Socioeconomic Factors = 131
• Box 6.1 The Decision = 131
• Fungal Diseases = 133
• Viral Diseases = 138
• Box 6.2 A Physician's Agonizing Dilemma = 139
• Point of Information 6.2 New Therapies, Longer Life, Higher Incidence of Cytomegalovirus (CMV) = 140
• Protozoal Diseases = 141
• Bacterial Diseases = 143
• Point of Information 6.3 Wasting Syndrome = 144
• Point of Information 6.4 Tuberculosis (TB), a Major Killer = 145
• Other Opportunistic Infections = 146
• CANCER IN AIDS PATIENTS = 146
• Kaposi's Sarcoma = 146
• Box 6.3 Life Goes On! = 147
• Box 6.4 Autopsy Diagnoses of Diseases in AIDS Patients = 149
• Lymphoma = 152
• Progressive Multifocal Leukencephalopathy = 153
• HIV Provirus: A Cancer Connection = 153
• NEUROPATHIES IN HIV DISEASE/AIDS PATIENTS = 153
• HIV/AIDS SURVEILLANCE CHECKLIST/REPORT = 153
• DISCLAIMER = 153
• SUMMARY = 154
• REVIEW QUESTIONS = 154
• REFERENCES = 156
• 7 A Profile of Biological Indicators for HIV Disease and Progression to AIDS = 159
• CHAPTER CONCEPTS = 159
• HIV DISEASE DEFINED = 159
• Spectrum of HIV Disease = 160
• Case in Point 7.1 Variation of Initial Symptoms After HIV Infection = 160
• Point of Information 7.1 One Mistake Cost Him His Life = 160
• Defining Incubation and Latency = 161
• STAGES OF HIV DISEASE = 163
• Acute or Primary HIV Disease Stage = 163
• Asymptomatic HIV Disease Stage = 165
• Chronic Symptomatic HIV Disease Stage = 165
• Box 7.1 Description of an AIDS Patient = 166
• AIDS: Advanced HIV Disease Stage = 166
• Box 7.2 Evolution of HIV During HIV Disease Progression = 167
• HIV Can Be Transmitted During All Four Stages = 169
• HIV DISEASE WITHOUT SYMPTOMS, WITH SYMPTOMS, AND AIDS = 169
• INCREASES IN THE NUMBER OF HIV/AIDS CASES = 169
• ASPECTS OF HIV INFECTION = 169
• Post Infection = 169
• Box 7.3 Development of AIDS Over Time = 170
• Immunosilent HIV Infection: Time Before Seroconversion = 170
• Incubation and Window Period = 171
• PRODUCTION OF HIV-SPECIFIC ANTIBODIES = 171
• AIDS Survival Time Has Nearly Doubled = 172
• Point of Information 7.2 HIV Exposure: Failure to Seroconvert = 172
• Box 7.4 Are There Long-Term Adult Nonprogressors of HIV Disease-Yes!-Why? = 173
• Classification of HIV/AIDS Progression = 174
• PROGNOSTIC BIOLOGICAL MARKERS RELATED TO AIDS PROGRESSION = 175
• p24 Antigen Levels = 175
• Point of Infomation 7.3 Seroreversion: Change from HIV-Positive to HIV-Negative! = 176
• p24 Antibody Levels = 177
• Other Markers = 177
• T4 and T8 Lymphocyte Levels = 177
• CDC Insists That Performing T4 Cell Counts in HIV-Infected People Continues to Be Essential = 179
• Levels of HIV RNA in the Blood: Viral Load = 179
• HIV INFECTION OF THE CENTRAL NERVOUS SYSTEM = 179
• Point of Information 7.4 Viral Load and T4 Cell Counts: Their Use in Clinical Practice = 180
• Point Of Information 7.5 Anti-HIV Drag Therapy and the Blood-Brain Barrier = 181
• AIDS Dementia Complex = 181
• PEDIATRIC CLINICAL SIGNS AND SYMPTOMS = 182
• Box 7.5 Long-Term Survivors Among HIV-Infected Children = 182
• SUMMARY = 183
• REVIEW QUESTIONS = 183
• REFERENCES = 183
• 8 Epidemiology and Transmission of the Human Immunodeficiency Virus = 186
• CHAPTER CONCEPTS = 186
• WE MUST STOP HIV TRANSMISSION NOW! = 187
• Point of View 8.1 HIV/AIDS Can Be Stopped Now! = 188
• EPIDEMIOLOGY OF HIV INFECTION = 190
• Point of Information 8.1 Consequences of Ignoring HIV = 191
• TRANSMISSION OF TWO STRAINS OF HIV (HIV-1/HIV-2) = 191
• IS HIV TRANSMITTED BY INSECTS? = 192
• EXPOSURE TO HIV AND SUBSEQUENT INFECTION = 193
• TRANSMISSION OF HIV = 193
• CASUAL TRANSMISSION = 193
• HIV TRANSMISSION IN HOUSEHOLD SETTINGS = 194
• Home Nursing Exposure = 194
• HOME CARE PREVENTION = 194
• Living in the Same Household = 194
• NONCASUAL TRANSMISSION = 196
• Mobility and the Spread of HIV/AIDS = 197
• Point of Information 8.2 AIDS and Immigration 198 Number of HIVs Required for Infection = 198
• Box 8.1 Relative Dose: The Swimming Pool Analogy = 199
• Body Fluid Transmission = 199
• Cell-to-Cell Transmission = 200
• Presence of HIV-Infected Cells in Body Fluids = 200
• Point of Information 8.3 Danger of HIV Infection via Artificial Insemination = 202
• Transmission by Cell-to-Cell Fusion: Syncytia Formation = 203
• Dentist with AIDS Infects Patient During Tooth Extraction? = 203
• Point of Information 8.4 Deadly Innocence: a Murder Mystery? = 205
• Point of Information 8.5 Distribution of HIV-Contaminated Blood: France, Germany, the United States, and Other Countries = 206
• Point of Information 8.6 Effectiveness of Screening Health Care Workers for HIV in the United States = 210
• Sexual Transmission = 211
• Sidebar 8.1 HIV Infectivity = 211
• Box 8.2 Vasectomy Lowers But Does Not Eliminate HIV Transmission Risk During Unsafe Sex = 211
• Personal Choice-Personal Risks = 211
• Heterosexual HIV Transmission = 212
• Box 8.3 HIV/AIDS Roulette = 212
• Box 8.4 Re-infection Among HIV-Positive Gay Men = 213
• Box 8.5 Gay Men Putting Themselves at High Risk for HIV Infection = 214
• Box 8.6 Sports and HIV/AIDS: Earvin "Magic" Johnson and Other Athletes = 216
• Injection Drug Users and HIV Transmission = 222
• Point of Information 8.7 Rapid Spread of HIV Through Injection Drug Use = 223
• Other Means of HIV Transmission = 223
• Box 8.7 HIV Transmission: Preparation and Use of Injection Drugs = 225
• Box 8.8 Assault with HIV = 226
• Nosocomial = 226
• Influence of Sexually Transmitted Diseases on HIV Transmission and Vice Versa = 226
• Point of View 8.2 Probably the Number One Risk Cofactor for HIV Is a Sexually Transmitted Disease(STD) = 227
• Pediatric Transmission = 229
• Antiviral Therapy Decreases Perinatal HIV Transmission = 232
• Case in Point 8. 1 When the Wonderful News "You're Pregnant" Becomes a Tragedy = 233
• HIV Infection in Older People = 234
• HIV Transmission in the Workplace = 234
• PUBLIC CONFIDENCE: ACCEPTANCE OF CURRENT DOGMA ON ROUTES OF HIV TRANSMISSION = 234
• NATIONAL AIDS RESOURCES = 234
• SUMMARY = 235
• REVIEW QUESTIONS = 235
• REFERENCES = 236
• 9 Preventing the Transmission of HIV = 241
• CHAPTER CONCEPTS = 241
• PREVENTION OF INFECTIOUS DISEASES = 241
• Box 9.1 HIV Prevention Education-United States = 242
• PREVENTING THE TRANSMISSION OF HIV = 243
• HIV/AIDS: The News Is Mostly Bad = 243
• The Hard Questions = 243
• Is There Hope? = 243
• Educators Given the Job of Prevention = 243
• Grim Reality = 244
• Quarantine = 245
• Point of Information 9.1 A Lesson on Condom Use from World Wars I and Ⅱ = 247
• NEW RULES TO AN OLD GAME: PROMOTING SAFER SEX = 248
• Barriers to HIV Infection = 248
• Condom-A Medical Device? = 248
• History of Condoms = 248
• Point Of Information 9.2 Clarifying the Issues Over Condom Use = 249
• Safer Sex, the Choice of Condom = 251
• Condom Availability in Developing Nations = 254
• Condom Quality = 254
• Redressing the Balance of Power = 257
• Point of Information 9.3 French Bishop Supports Some Use of Condoms to Prevent HIV Infection AIDS = 257
• Condom Lubricants = 257
• An Alternative: Chemical Barrier Protection-Vaginal Microbicides: A Protection Method That Women Can Control = 257
• Chemical Barriers = 258
• Chemical Barriers Used in Foam, Gel, or Sponge = 258
• Point of Information 9.4 Questions and Answers About the Female Condom = 259
• Update on Vaginal Microbicide Research = 259
• INJECTION DRUG USE AND HIV TRANSMISSION: THE TWIN EPIDEMICS = 260
• HIV PREVENTION FOR INJECTION DRUG USERS = 260
• Box 9.2 The Magnitude of the Epidemics of Drug Use and HIV/AIDS = 260
• The Syringe Exchange Program Strategy = 261
• Free Syringe Exchange Programs in the United States = 261
• Box 9.3 The Controversy: Providing Sterile Syringes and Needles to Injection Drug Users (IDUs) = 262
• Point of Information 9.5 Syringe Laws-United States = 264
• Evaluation of Syringe Exchange Programs = 265
• Sidebar 9.1 Syringe Exchange Survey: How Many Syringes Are Being Exchanged? = 266
• Syringe Exchange Programs in Other Countries = 266
• Summary = 267
• PREVENTION OF BLOOD AND BLOOD PRODUCT HIV TRANSMISSION = 267
• Blood Donors = 267
• Blood Collection and Blood Screening for HIV = 267
• Box 9.4 Example of Blood Supply HIV Prevention = 268
• Box 9.5 Blood Transfusions: A Gift of Life or the Carrier of Death? = 269
• INFECTION CONTROL PROCEDURES = 269
• Universal Precautions = 269
• Point of Information 9.6 Universal Precautions = 270
• Blood and Body Substance Isolation (BBSI) = 271
• Box 9.6 Does the Patient Have HIV? I Can't Tell = 272
• PARTNER NOTIFICATION = 273
• History of Partner Notification = 273
• The Use of Partner Notification: An Example = 273
• Opposition to Partner Notification for HIV Disease = 273
• In Support of Partner Notification = 274
• HIV VACCINE DEVELOPMENT = 274
• Goal of HIV Vaccination = 274
• What the World Needs NOW Is a Vaccine for HIV Disease-Why Isn't There One? = 274
• Point of View 9.1 The Goal of Developing an HIV Vaccine = 275
• What Is a Vaccine? = 276
• Types of HIV Vaccines = 277
• VACCINE PRODUCTION = 277
• Attenuated Viruses = 277
• Inactivated Viruses = 278
• ROLE OF GENETIC DIVERSITY IN VACCINE DEVELOPMENT = 278
• Subunit Vaccines = 278
• PROBLEMS IN THE SEARCH FOR HIV VACCINE = 278
• Point of Information 9.7 HIV Vaccine Therapies: Prevention and Therapy = 279
• A Vaccine-Induced Enhancement of HIV Infection = 280
• Point of Information 9.8 Pathological Uniqueness of HIV = 281
• Testing HIV Vaccines = 281
• Morality of Testing HIV Vaccines = 281
• HIV Vaccine Costs =282
• HUMAN HIV VACCINE TRIALS = 282
• Vaccine Testing Confidentiality = 283
• SUMMARY = 283
• REVIEW QUESTIONS = 284
• REFERENCES = 284
• 10 Prevalence of HIV Infections, AIDS Cases, and Deaths Among Select Groups in the United States = 287
• CHAPTER CONCEPTS = 287
• Box 10.1 The HIV/AIDS Scenario = 288
• Box 10.2 The HIV/AIDS Pandemic Has Limits = 289
• OLD FORMULA FOR ESTIMATING HIV INFECTIONS = 289
• NEWER FORMULA FOR ESTIMATING HIV INFECTIONS = 289
• Single or Multiple Exposure Categories =289
• BEHAVIORAL RISK GROUPS AND STATISTICAL EVALUATION = 289
• Behavioral Risk Groups and AIDS Cases = 289
• Statistical Evaluation of Selected Risk Behavioral Group AIDS Cases = 292
• Behavioral Risk Groups and Percentages of HIV-Infected People = 293
• Comments on a Variety of Individual Behavioral Risk Groups = 295
• Point of Information 10.1 Were Older Patients with HIV Disease Can Get Help = 301
• Health Care Workers with HIV/AIDS = 302
• ESTIMATES OF HIV INFECTION AND FUTURE AIDS CASES = 302
• Box 10.3 HIV/AIDS Data Deficiencies = 302
• Reportability = 303
• How Many People in the United States Are HIV-Infected? = 303
• United States Estimates Lead to Confusion = 303
• Point of View10.1 Justification for HIV Case Reporting in the United States = 304
• WHOSE FIGURES ARE CORRECT?-ISSUES OF CREDIBILITY = 304
• Rise in HIV/AIDS Cases Among Heterosexuals = 307
• Point of Information 10.2 United States: 640,000 AIDS Cases Beginning 1998 = 309
• SHAPE OF THE HIV PANDEMIC: UNITED STATES = 309
• ESTIMATES OF DEATHS AND YEARS OF POTENTIAL LIFE LOST DUE TO AIDS IN THE UNITED STATES = 310
• Deaths Due to AIDS = 310
• AIDS Deaths Postponed = 312
• Prevalence and Impact of HIV/AIDS = 312
• LIFE EXPECTANCY = 312
• SUMMARY = 312
• REVIEW QUESTIONS = 313
• REFERENCES = 314
• 11 Prevalence of HIV Infection and AIDS Cases Among Women, Children, and Teenagers in the United States = 317
• CHAPTER CONCEPTS = 317
• WOMEN: HIV-POSITIVE AND AIDS CASES-UNITED STATES = 319
• Transmission Categories = 322
• Prostitutes = 322
• Point of Information 11.1 HIV Infection Among Women = 323
• Box11. 1 Women + Sexual Partners + Deception = AIDS = 324
• Women Who Have Sex with Women (Lesbians) = 324
• Point of Information 11.2 Special Problems for Heterosexual Women = 325
• Special Concerns of HIV/AIDS Women = 325
• Gender and HIV Disease = 326
• Point of Information 11.3 An AIDS Clinical Drug Trial-By Definition = 327
• Point of View 11.1 One Woman's Comments on Her HIV Disease Treatments = 327
• Female HIV/AIDS Deaths = 327
• Identifying and Preventing HIV Infection = 327
• Point of Information 11.4 Proportion of Women Taking HIV Test = 329
• Childbearing Women = 329
• Box 11.2 HIV-Infected Women: Difficult Choices During Pregnancy = 330
• Sidebar11.1 Natural Conception in HIV-Negative Women with HIV-Infected Partners = 330
• PEDIATRIC HIV-POSITIVE AND AIDS CASES-UNITED STATES = 331
• Ethnic Prevalence of Pediatric AIDS Cases = 331
• The 1990s: Decade of the Orphans = 331
• Vertical HIV Transmission = 331
• Box 11.3 Orphaned Children Due to AIDS and HIV Infection = 333
• Point of Information 11.5 Worldwide: Children with HIV/AIDS = 334
• States and Territories Most Affected by Pediatric Cases = 335
• AIDS Cases Among Children Declining = 336
• Contacts for Information on Use of Antiretroviral Drugs During Pregnancy = 336
• TEENAGERS: HIV-POSITIVE AND AIDS CASES-UNITED STATES = 336
• Teenagers/Young Women at Greatest Risk = 337
• Safer Sex = 337
• Point Of View11.2 Perils of Unsafe Sex = 337
• HIV/AIDS Won't Affect Us! = 338
• How Large Is the Teenage and Young Adult Population? = 338
• Estimate of HIV-Infected and AIDS Cases Among Teenagers and Young Adults = 33 8
• Teenagers and Incidence of AIDS Cases by Gender and Color = 338
• Teenage HIV Infections Worldwide: At-Risk Behavior Is Universal = 339
• Categories of Teenage HIV Infection 339 Box 11.4 HIV Spreading Rapidly Among Teenage Gay Males = 339
• Point of View 11.3 Thoughts and Comments from a Generation at Risk = 339
• Runaway Teenagers = 340
• The Homeless = 340
• SUMMARY = 340
• REVIEW QUESTIONS = 340
• REFERENCES = 341
• 12 Testing for Human Immunodeficiency Virus = 343
• CHAPTER CONCEPTS = 343
• DETERMINING THE PRESENCE OF ANTIBODY PRODUCED WHEN HIV IS PRESENT = 344
• REQUESTS FOR HIV TESTING = 344
• REASONS FOR HIV TESTING IN THE UNITED STATES = 344
• IMMUNODIAGNOSTIC TECHNIQUES FOR DETECTING ANTIBODIES TO HIV = 344
• Box 12.1 An Assumption of AIDS Without the HIV Test: It Shatters Lives = 345
• Box 12.2 Pre-test Patient Information = 346
• ELISA HIV-ANTIBODY TEST = 347
• Point of Information 12.1 HIV Testing of Teenagers = 349
• Understanding the ELISA Test = 349
• Problems with the ELISA Test = 350
• Purpose of the ELISA Test = 350
• Point of Information 12.2 Improved. ELISA Testing, Screening for p24 Antigen, and Blood Donor Interviews Lower HIV in Nation's Blood Supply = 350
• WESTERN BLOT ASSAY = 354
• Box12.3 The Performance Rate for the Combined ELISA and Western Blot HIV Test = 355
• Relative Costs of ELISA and Western Blot Tests = 356
• OTHER SCREENING AND CONFIRMATORY TESTS =356
• Immunofluorescent Antibody Assay = 356
• Point of View 12.1 Some Relative Drawbacks to the Current HIV Screening T est-ELISA/Western Blot = 357
• Recombigen HIV-1 Latex Agglutination Test = 358
• Polymerase Chain Reaction = 358
• Single-Use Diagnostic Test = 359
• Point of Information 12.3 Saliva HIV Test: is It as Good as the ELISA? = 359
• Saliva and Urine Tests = 361
• HIV Gene Probes = 362
• Passive Hemagglutination Assay = 362
• VIRAL LOAD: MEASURING HIV RNA = 362
• Amplicor HIV Monitor Test = 362
• Branched-DNA Testing = 363
• DETECTION OF HIV INFECTION IN NEWBORNS = 363
• FDA APPROVES TWO HOME HIV-ANTIBODYTEST KITS = 363
• Test Kit Operation = 365
• Test Kit Availability = 365
• Pro and Con of Home-Use HIV Test (Collection) Kits = 365
• REPORTING HIV INFECTIONS = 366
• Does the United States Need a National System for HIV Reporting? = 367
• WHO SHOULD BE TESTED FOR HIV INFECTION? = 367
• WHY IS HIV TEST INFORMATION NECESSARY? = 368
• Box12.4 The Physician's Dilemma = 368
• Entry into Foreign Countries = 368
• Testing for HIV Infection = 369
• Point of Information 12.4 United States Public Health Service (USPHS) Recommendations for HIV Counseling and Voluntary Testing for All Pregnant Women = 369
• Informed Consent = 370
• Box 12.5 Boxer Stripped of Featherweight Title After Positive HIV Test = 371
• Testing Without Consent = 371
• Voluntary Named HIV Testing = 371
• Voluntary Unnamed HIV Testing = 371
• Mandatory HIV Testing = 372
• Why Mandatory Testing? = 372
• Compulsory HIV Testing = 372
• Point of View 12.2 Mandatory = 372
• Testing = 373
• Box 12.6 Florida: Health Care Worker Leaks Confidential HIV Information = 374
• Confidential, Anonymous, and Blinded Testing = 375
• Point of Information 12.5 Legislature Survey of State Confidentiality Laws = 376
• Box 12.7 Confidentiality and Sexual Partner Betrayal = 376
• SUMMARY = 378
• REVIEW QUESTIONS = 378
• REFERENCES = 379
• 13 AIDS and Society: Knowledge, Attitudes, and Behavior = 381
• CHAPTER CONCEPTS = 381
• BLAME SOMEONE, D$$\acute E$$J$$\grave A$$ VU = 381
• PANIC AND HYSTERLA, OVER THE SPREAD OF HIV/AIDS IN THE UNITED STATES = 382
• The Fear Factor = 383
• Point of View 13.1 Do People Really Trust Science? = 383
• Box 13.1 An Example of Uncontrolled Fear and Hostility = 384
• ACTIONS OF COURAGE = 384
• WHOM IS THE GENERAL PUBLIC TO BELIEVE? = 385
• Misconceptions About AIDS Linger = 386
• Point of View 13.2 A Southern University Student's Experience = 386
• Box 13.2 How Some People Responded After Learning That Someone Had AIDS = 388
• Point of View 13.3 Hatred Expressed = 390
• Point of View 13.4 Newspaper Headline Shocks Readers = 390
• Box 13.3 When One with AIDS Comes Forth = 391
• AIDS EDUCATION AND BEHAVIOR = 392
• Point of Information 13.1 Changing Attitudes = 393
• Box 13.4 The Way We Are = 393
• Public AIDS Education Programs = 394
• Point of View 13.5 The Red Ribbon = 396
• Public School AIDS Education: just Say Know = 396
• Box 13.5 Anecdote.- Father and Son Exchange Sex Information = 396
• THE CHARACTER OF SOCIETY = 399
• Rumors of Destruction = 399
• Point of View 13.6 The Right to Privacy = 400
• Good News, Bad News, and Late News = 401
• When People Pretend to Be HIV-Positive or to Have AIDS = 401
• Physicians' Public Duty: A Historical Perspective of Professional Obligation = 402
• Medical Moral Issues = 403
• HIV-Infected Physicians = 403
• Point of Information 13.2
• HIV Transmitted by Australian Surgeon = 405
• Physician-Patient Relationships = 405
• Box 13.6 My First AIDS Experience = 406
• Physicians with AIDS = 406
• Point of Information 13.3 Current View of Health Care Workers Who Are HIV-Infected = 408
• SUMMARY = 408
• REVIEW QUESTIONS = 409
• REFERENCES = 409
• Epilogue = 411
• Answers to Review Questions = 413
• Glossary = 419
• Index = 428