A retrovirus that infects immune system cells, HIV is spread by contact with bodily fluids through unprotected sexual contact, mother-to-child transmission during birth or breastfeeding, sharing contaminated drug needles, or receiving contaminated blood products. The Centers for Disease Control (CDC) estimates the number of new diagnoses of HIV infection in 2013 in the United States was 47,352.[1] There are two main strains of HIV, HIV-1 and HIV-2, but this essay will use the terms HIV or HIV/AIDS. There is no cure for HIV infection, but there is treatment.
Antiretroviral therapy (ART) drugs help keep the amount of HIV at low levels in the body, stopping weakening of the immune system. Using a combination of three or more ARTs is called highly active antiretroviral therapy (HAART), aka the “drug cocktail.” More than twenty drugs are now approved by the US Food and Drug Administration (FDA) to treat HIV/AIDS. Ongoing clinical trials are testing dozens of new investigational drugs needed due to drug resistance or side effects from treatment (e.g., increased risk of diabetes and heart problems). New infections can be curbed by behavioral changes such as use of condoms, abstinence, and limiting the number of sexual partners. Male circumcision and needle exchange programs are also effective in reducing infections. Initial attempts at creating a vaccine have failed, but numerous vaccine trials are under way. New classes of drugs are being researched, and other types of prevention, for example, microbial gels, are being studied.
Those interested in basic information about HIV/AIDS written in layperson language can go to the US National Library of Medicine’s website MedlinePlus, which offers fact sheets on all stages of infection and for specific populations. Textbooks (many of which are regularly updated) can be valuable introductory resources outside the classroom. For example, Hung Fan, Ross Conner, and Luis Villarreal’s AIDS: Science and Society (now in its seventh edition) offers a comprehensive introduction; reviews biological, psychological, behavioral, and societal aspects of HIV/AIDS; and provides a companion website with summaries and Q&A review questions. Another introductory textbook is Benjamin Weeks and Teri Shors’s AIDS: The Biological Basis, which offers a comprehensive overview in layperson terminology and test questions at the end of each chapter. Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, edited by Raymond Smith, is in need of updating, but it contains reliable information on many subjects from experts in the field. For greater depth of clinical information, Sande’s HIV/AIDS Medicine: Medical Management of AIDS, an annual edited by Paul Volberding et al., covers all clinical aspects of HIV/AIDS infection. Jay Levy’s HIV and the Pathogenesis of AIDS (now in its third edition) is also a reliable clinical text. Journals focused on HIV/AIDS are numerous. Among those addressing current treatment and research are AIDS: Official Journal of the International AIDS Society and JAIDS: Journal of Acquired Immune Deficiency Syndromes, both available online.
New drugs would not be possible without clinical testing. Among the resources on clinical trials is Sana Loue and Earl Pike’s valuable Case Studies in Ethics and HIV Research. The authors use case studies to examine the ethical complexities of dealing with an ill population desperate for a cure, and they address such topics as informed consent, human-subject research committees, confidentiality, and research in vulnerable populations. Those interested in current clinical trials will find detailed information at AIDSinfo, an online resource from the US Department of Health and Human Services, and ClinicalTrials.gov, the primary source for clinical trials in the United States. For international trials, the World Health Organization’s International Clinical Trials Registry Platform is a comprehensive resource.
[1] Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, HIV/AIDS Statistics Overview, http://www.cdc.gov/hiv/statistics/overview/index.html.
