Aids What S New Essay
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Is the message getting through? We already know enough about AIDS to
prevent its spread, but ignorance, complacency, fear and bigotry continue to
stop many from taking adequate precautions.
We know enough about how the infection is transmitted to protect ourselves
from it without resorting to such extremes as mandatory testing, enforced
quarantine or total celibacy. But too few people are heeding the AIDS
message. Perhaps many simply don't like or want to believe what they hear,
preferring to think that AIDS "can't happen to them." Experts repeatedly
remind us that infective agents do not discriminate, but can infect any and
everyone. Like other communicable diseases, AIDS can strike anyone. It is not
necessarily confined to a few high-risk groups. We must all protect ourselves
from this infection and teach our children about it in time to take effective
precautions. Given the right measures, no one need get AIDS.
The pandemic continues:
-----------------------
Many of us have forgotten about the virulence of widespread epidemics, such
as the 1917/18 influenza pandemic which killed over 21 million people,
including 50,000 Canadians. Having been lulled into false security by modern
antibiotics and vaccines about our ability to conquer infections, the Western
world was ill prepared to cope with the advent of AIDS in 1981. (Retro-
spective studies now put the first reported U.S. case of AIDS as far back as
1968.) The arrival of a new and lethal virus caught us off guard. Research
suggests that the agent responsible for AIDS probably dates from the 1950s,
with a chance infection of humans by a modified Simian virus found in African
green monkeys. Whatever its origins, scientists surmise that the disease
spread from Africa to the Caribbean and Europe, then to the U.S. Current
estimates are that 1.5 to 2 million Americans are now probably HIV carriers,
with higher numbers in Central Africa and parts of the Caribbean.
Recapping AIDS - the facts:
---------------------------
AIDS is an insidious, often fatal but less contagious disease than measles,
chicken pox or hepatitis B. AIDS is thought to be caused primarily by a virus
that invades white blood cells (lymphocytes) - especially T4-lymphocytes or
T-helper cells - and certain other body cells, including the brain. In 1983
and 1984, French and U.S. researchers independently identified the virus
believed to cause AIDS as an unusual type of slow-acting retrovirus now
called "human immunodeficiency virus" or HIV. Like other viruses, HIV is
basically a tiny package of genes. But being a retrovirus, it has the rare
capacity to copy and insert its genes right into a human cell's own chromo-
somes (DNA). Once inside a human host cell the retrovirus uses its own
enzyme, reverse transcriptase, to copy its genetic code into a DNA molecule
which is then incorporated into the host's DNA. The virus becomes an integral
part of the person's body, and is subject to control mechanisms by which it
can be switched "on" or "off". But the viral DNA may sit hidden and inactive
within human cells for years, until some trigger stimulates it to replicate.
Thus HIV may not produce illness until its genes are "turned on" five, ten,
fifteen or perhaps more years after the initial infection.
During the latent period, HIV carriers who harbour the virus without any
sign of illness can unknowingly infect others. On average, the dormant virus
seems to be triggered into action three to six years after first invading
human cells. When switched on, viral replication may speed along, producing
new viruses that destroy fresh lymphocytes. As viral replication spreads, the
lymphocyte destruction virtually sabotages the entire immune system. In
essence, HIV viruses do not kill people, they merely render the immune system
defenceless against other "opportunistic: infections, e.g. yeast invasions,
toxoplasmosis, cytomegalovirus and Epstein Barr infections, massive herpes
infections, special forms of pneumonia (Pneumocystis carinii - the killer in
half of all AIDS patients), and otherwise rare malignant tumours (such as
Kaposi's sarcoma.)
Cofactors may play a crucial contributory role:
-----------------------------------------------
What prompts the dormant viral genes suddenly to burst into action and
start destroying the immune system is one os the central unsolved challenges
about AIDS. Some scientists speculate that HIV replication may be set off by
cofactors or transactivators that stimulate or disturb the immune system.
Such triggers may be genetically determined proteins in someone's system, or
foreign substances from other infecting organisms - such as syphilis,
chlamydia, gonorrhea, HTLV-1 (leukemia), herpes, or CMV (cytomegalovirus) -
which somehow awaken the HIV virus. The assumption is that once HIV
replication gets going, the lymphocyte destruction cripples the entire immune
system. Recent British research suggest that some people may have a serum
protein that helps them resist HIV while others may have one that makes them
genetically more prone to it by facilitating viral penetration of T-helper
cells. Perhaps, says one expert, everybody exposed to HIV can become
infected, but whether or not the infection progresses to illness depends on
multiple immunogenic factors. Some may be lucky enough to have genes that
protect them form AIDS!
Variable period until those infected develop antibodies:
--------------------------------------------------------
While HIV hides within human cells, the body may produce antibodies, but,
for reasons not fully understood, they don't neutralise all the viruses. The
presence of HIV antibodies thus does not confer immunity to AIDS, nor prevent
HIV transmission. Carriers may be able to infect others. The usual time taken
to test positive for HIV antibodies after exposure averages from four to six
weeks but can take over a year. Most experts agree that within six months all
but 10 per cent of HIV-infected people "seroconvert" and have detectable
antibodies.
While HIV antibody tests can indicate infection, they are not foolproof.
The ELISA is a good screening test that gives a few "false positives" and
more "false negatives" indicating that someone who is infected has not yet
developed identifiable antibodies.) The more specific Western Blot test, done
to confirm a positive ELISA, is very accurate. However, absence of antibodies
doesn't guarantee freedom form HIV, as someone may be in the "window period"
when, although already infected, they do not yet have measurable levels of
HIV antibodies. A seropositive result does not mean someone has AIDS; it
means (s)he is carrying antibodies, may be infectious and may develop AIDS at
some future time. As to how long seropositive persons remain infectious, the
June 1987 Third International Conference on AIDS was told to assume "FOR
LIFE".
What awaits HIV-carriers who test positive?:
--------------------------------------------
On this issue of when those who test HIV positive will get AIDS, experts
think that the fast track to AIDS is about two years after HIV infection; the
slow route may be 10, 15, or more years until symptoms appear. Most
specialists agree that it takes at least two years to show AIDS symptoms
after HIV infection, and that within ten years as many as 75 per cent of
those infected may develop AIDS. A report from Atlanta's CDC based on an
analysis of blood collected in San Francisco from 1978 to 1986, showed a
steady increase with time in the rate of AIDS development among HIV-infected
persons - 4 percent within three years; 14 percent after five years; 36
percent after seven years. The realistic, albeit doomsday view is that 100
percent of those who test HIV-positive may eventually develop AIDS.
Still spread primarily by sexual contact:
-----------------------------------------
AIDS is still predominantly a sexually transmitted disease: The other main
route of HIV infection is via contaminated blood and shared IV needles. Since
the concentration of virus is highest in semen and blood, the most common
transmission route is from man to man via anal intercourse, or man to woman
via vaginal intercourse. Female HIV carriers can infect male sex partners.
Small amounts of HIV have been isolated from urine, tears, saliva, cereb-
rospinal and amniotic fluid and (some claim) breast milk. But current
evidence implicates only semen, blood, vaginal secretions and possibly breast
milk in transmission. Pregnant mothers can pass the infection to their
babies. While breastfeeding is a rare and unproven transmission route, health
officials suggest that seropositive mothers bottle feed their offspring.
AIDS is not confined to male homosexuals and the high risk groups: There
are now reports of heterosexual transmission - form IV drug users, hemo-
philiacs or those infected by blood transfusion to sexual partners. There are
a few reported cases of AIDS heterosexually acquired from a single sexual
encounter with a new, unknown mate. And there are three recent reports of
female-to-female (lesbian) transmissions.
Spread of AIDS among drug users alarming:
-----------------------------------------
In many cities, e.g. New York and Edinburgh, where IV drug use is wide-
spread, IV drug users often share blood-contaminated needles. In New York,
more than 53 percent of drug users are HIV-infected and may transmit the
infection to the heterosexual population by sexual contact and transmission
from mother to child. Studies in Edinburgh, where 51 percent of drug users
are HIV-infected, show that providing clean needles isn't enough to stem
infection. Even given free disposable needles, many drug abusers preferred
the camaraderie of shared equipment. Only with added teaching programs and
free condom offers, are educational efforts likely to pay off. In New Jersey,
offering free treatment coupons plus AIDS education brought 86 percent of
local drug users to classes. A San Francisco program issued pocket-size
containers of chlorine bleach to IVDAs with instructions on how to kill HIV
viruses. The Toronto Addiction Research Foundation notes a similar demand for
AIDS information.
Risk of infection via blood transfusion very slight:
----------------------------------------------------
Infection by blood transfusion is very rare in Canada today. As of November
1985, the Red Cross, which supplies all blood and blood products to Canadian
hospitals, had routinely tested all blood donations for the HIV antibody. In
1986, when we last discussed AIDS, the Red Cross reported the incidence of
HIV-positive blood samples as 25 in 100,000. Now, at the start of 1988, only
10 per...
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