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STRATEGY FOR CONTROL OF HIV AND AIDS
Both HIV infection and other traditional sexually transmitteddiseases (STDs) share similar risk factors in relationto their spread, but in addition they can potentate eachother. Both of these facts need to be understood if effectivecontrol programmes are to be developed. The presenceof an STD, particularly genital ulcers, can enhanceboth the acquisition and transmission of HIV by increasedshedding of the virus within and from the genital tract.Several studies have shown that the risk of acquiring HIVin the presence of an ulcerative or non-ulcerative STD isincreased 2-6-fold. The shared risk factors for the acquisition of HIV and other STDs, and the interaction betweenthem, has led to the setting up of integrated control programmesin the hope of reducing STDs and slowing thespread of HIV. This strategy was reinforced by the resultsof one study in Africa which showed a significant reductionof HIV transmission rates with the provision of STDtreatment services.Control of HIV has two elements, primary and secondary. Primary prevention is aimed at stopping infectionoccurring in the first place. This is achieved through healtheducation and programmes to market and encourage theuse of condoms. In the UK, initial health education campaignsresulted in homosexual men, in particular, adoptingsafe sex practices. However, such changes are not alwayseasy to sustain, and repeated reinforcement and monitoringis required. Secondary prevention is aimed at promotinghealth-care seeking behaviour, so that those who couldbe infected recognize this, regardless of symptoms, and asa result come forward for HIV testing and care if required.This is particularly important, as primary prophylaxis canbe offered for PCP, and combination antiviral therapy canhave an effect on morbidity and mortality.
Everyone is potentially at risk of infection: even thoughthe prevalence among those without recognized riskfactors is currently low, it requires sexual contact with onlyone infected person for transmission to occur. Those whoare HIV seronegative and in a mutually monogamous relationshiphave nothing to fear. The sensible message toeveryone else must be: to reduce your risk, reduce yournumber of sexual partners, know about your partner's previoussexual and drug use history, and use a condom.Condoms may not provide total protection, but they willhelp considerably if used properly and every time.Preventing the transmission of HIV among injectingdrug users must rely on stopping the sharing of needles andother paraphernalia that go with injecting drugs (syringes,mixing bowls, spoons etc.), as well as advising on safer sexpractices. Users need to be advised of the risk of sharing;this applies to any form of injection, whether intravenous,intramuscular or subcutaneous. Equally important is adviceon the risk of transmitting or acquiring the virus sexually, aswell as the potential risk of both male and female prostitution,as this may be used to finance a drug habit. For anyindividual the best primary prevention is to stop usingdrugs, but if this is unrealistic at the time, the next option isto stop injecting and switch to sniffing, smoking or swallowingdrugs. In the realization that people still continue toinject, a large number of needle exchange programmeshave been set up throughout the UK, and are currentlythought to be useful in cutting down the sharing of needles.Vertical transmission from mother to child is uncommonin the UK. The risk of an HIV-positive pregnant womantransmitting HIV to her unborn child is thought to be about13% in developed countries, but up to 30% in the developingworld. Intrapartum transmission accounts for themajority of cases of vertical transmission. Factors associatedwith a higher risk include prematurity, the use ofinstrumentation during birth, maternal diagnosis of AIDS,maternal viral load levels and breastfeeding. Seropositivewomen, or women who are considering parenthood, needto be counselled about the risk of pregnancy, to both themother and her unborn child. A seropositive woman whobecomes pregnant can obviously be offered termination,but treatment interventions substantially reduce the risk ofperinatal transmission and therefore many wish to go to term.
Early clinical trials showed that zidovudine monotherapygiven to mothers from the second trimester up to andincluding the intrapartum period, together with 6 weeksof zidovudine therapy given to the infant, results in anapproximately 70% reduction in transmission rates. Subsequentstudies have shown a relationship between thelevel of maternal plasma viral load on treatment at birthand the risk of transmission. In the developed world it isnow common practice to initiate triple combination antiretroviraltherapy to achieve and sustain maximumsuppression of maternal plasma viral load levels duringpregnancy and through the intrapartum period. The avoidanceof breastfeeding is essential to sustain this reductionin risk. The implementation of these measures, however, isonly possible if both the mother and her physician areaware that she is seropositive during pregnancy. HIV antibodytesting should routinely be offered to all pregnantwomen, irrespective of the perception of risk.In the developing world vertical transmission is a majorproblem and complex triple combination therapies aretoo costly. Recent studies have investigated simpler andshorter-course treatments. A single dose of the nonnucleosidereverse transcriptase inhibitor nevirapine, givento the mother at the onset of labour and to the infant aged48 hours, has been shown to reduce perinatal transmissionby approximately 50%, compared to a short course ofzidovudine given to the mother during labour and postnatallyto the infant for 7 days. Peripartum therapeutic interventionwill have no effect on intrauterine transmission.The reduction in transmission rates in infants at 6 weeks islikely to be lost in a breastfeeding population at 2 years, asa result of continued postnatal transmission. The widescaleimplementation of an effective therapeutic intervention toprevent perinatal transmission in the developing world isa challenge that remains to be met.The risk of occupational transmission of HIV as a resultof needle-stick injuries has been estimated to be 0.3%.Although there is no substantial evidence of clinical efficacy,and based largely on biological rationale, it is recommendedthat health-care professionals who sustain asignificant exposure to a bodily fluid from an HIV-infectedperson should take a triple combination regimen as postexposureprophylaxis for 4 weeks after the incident. Prophylaxisshould be started as soon as possible after theincidence, preferably within 1-2 hours. The relative benefitof such a regimen remains uncertain. Postexposure prophylaxishas also been considered after sexual exposure,but in the absence of any data to support a relative benefitno specific guidelines have been recommended.
About the Author
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Hi Friends, I am Izhar, love all of you, and I'd like to write about my interest, and here i am sharing about my opinion, prevention regarding to many diseases, maintaining views for Health, Beauty & Younger looking Secrets at article base.
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