AIDS
[FACTS & MYTHS]
WHAT IS AIDS?
WHAT ARE THE SYMPTOMS?
HOW DOES IT SPREAD?
WHAT IS ITS TREATMENT?
HOW TO AVOID AIDS?
Dr. P.S. RAWAT
WHAT THEY SPEAK ABOUT AIDS
"For human kind, AIDS is now on par with the nuclear threat and global warming", said K.R. Narayan, Vice-President of India at the second International AIDS Congress, New Delhi.
"Unless the atmosphere of ‘Ignorance and fear' regarding the fate of AIDS patients was removed, we can never succeed in fighting the menace', declared M.L. Fotedar, Former Union Minister for Health and Family Welfare.
"The spread of HIV was fanned by ignorance and discrimination", said Prof. A.N. Malvia, Head of the Medicine, AIIMS, New Delhi and AIDS specialist.
"HIV is not about a virus but primarily about people and society" opined Jonathan Mann, former Director, and the Founder of the WHO's Global Programme on AIDS.
"We can say AIDS is a sleeping giant that awakes always to kill" ----- Dr. Bachi J. Karkar.
"Jokingly, AIDS may be called an ‘ailment invented to discourage sex' or nature's way of population control" ------ Dr. Raj Kumar.
INTRODUCTION
It was during October 1992 that I was entrusted with the responsibility to deliver a lecture on AIDS by the local unit of HMAI (Homoeopathic Medical Association of India), Chandigarh, for which I had to refer to "filed material on AIDS." The lecture could not be delivered as the meeting was postponed. However, I am glad that my strenuous labour has taken the shape of a small booklet which will serve as a guide to the common man as well as to concerned in the medical profession and the agencies dealing with the dreaded disease.
I have endeavoured my utmost in extracting and systematising various aspects of HIV/AIDS from the dissipated information available till date. Still I feel there might have been shortcomings. I would request the persons dealing with AIDS at any level or capacity to please send to me the latest information and other valuable suggestions so that the same could be incorporated in the next edition.
I stand deeply indebted to Mr. Andrew J. Gosain, Chairman, International Christian Education Foundation and St. Xavier's School Management, who has been a constant source of encouragement both morally and financially in my venture.
And, I am also grateful to Dr. (Mrs.) Shobha Sehgal, Professor and Head of Immunopathology Department, PGIMER, Chandigarh, many of my friends like D.D. Sundriyal and Mr. D.S. Panwar and well wishers who have directly or indirectly helped me in bringing out this booklet.
Dr. P.S. Rawat
B.Sc., B.M.S., B.H.M.S. (JPR.)
Assistant Professor and Ex-Principal,
Homoeopathic Medical College,
Chandigarh – 160026
Place: Chandigarh
Date: March 1, 1993
FOREWORD
Acquired immunodeficiency syndrome, AIDS, has emerged as one of the most dreadful diseases of the human race and has evoked a widespread alarm in the world.
Mass education and awareness about the disease is the need of the hour for prevention of the disease.
Dr. P.S. Rawat's book on AIDS throws light on the virus responsible for it, on its history and route through which it gains entry into our body, the defence mechanism and various other important facts connected with AIDS. I am sure his endeavour will help in the prevention of the disease which is a worldwide burning problem of this Century.
Dr. Meera,
Former Principal,
Homoeopathic Medical
College & Hospital,
Chandigarh.
Kothi No. 4
Sector 20-A,
Chandigarh
WHAT IS AIDS?
AIDS is a fatal viral disease which causes suppression of the disease-fighting mechanism in the body.
or
AIDS refers to the occurrence of a life-threatening opportunistic infection or Kaposi's Sarcoma or both in patients who have not received immunosuppressive drugs.
or
The term AIDS refers only to the last fatal stage of HIV infection in non-medical literature. However, the term can be used more loosely to refer both the earlier stages of HIV infection and to the later symptomatic stages of the disease.
In a person with AIDS, there is shortage of Helper T-cells i.e. T4. Therefore, white blood cells are destroyed and the immune system is rendered ineffective even against trivial infections.
For an AIDS patient, even a mild and simple infection like common cold might prove fatal.
DISCOVERY OF AIDS
According to PANOS (a London based voluntary and human rights organisation) publication ----"The Third World Epidemic Repercussion of the Fear of AIDS": AIDS started sometime in 50s or 60s, but the symptoms of the second epidemic AIDS or HIV infection became visible in 1980-81.
It was in the summer of 1981 that Gott Lab and Colleagues from New York and Friedman Kein and co-workers from California reported separately to the Centers of Disease Control (CDC), Atlanta, USA, the occurrence of a new syndrome of rare form of Pneumonia caused by an opportunistic micro-organism called Pneumocystic Carinii and rare cancer called Kaposi's Sarcoma in otherwise healthy young homosexuals. It appeared that they had somehow acquired a form of immunodeficiency characterised by the loss of cellular immunity. By December 1981, well documented reports from New York and Los Angles were published indicating the nature of this illness, its major clinical features, immunological abnormalities and the lethal course. By 1982, enough was known about this syndrome as a mysterious disease complex, a cluster of manifestations suddenly becoming common in homosexuals. The syndrome was termed as Acquired Immuno Deficiency Syndrome, AIDS.
The first case of AIDS could be diagnosed in the USA only in 1981 and the causative virus was identified in 1983 at the Institute Pasteur in Paris. It was named Lymphadenopathy associated virus (LAV). In 1984, the National Cancer Institute in Bethesda, USA, confirmed that the LAV was the cause for AIDS, the virus was named as Human T lymphotropic Virus type 3 (HTLV-3). In 1986, the term humn immuno deficiency virus (HIV) was introduced by an international expert committee. Recently a new AIDS virus has been identified in West Africa as a variant of the earlier identified AIDS virus with almost similar mode of transmission and ill-effects. The first identified virus is now HIV-1 and the variant as HIV-2.
Initially the disease was believed to be in homosexuals alone but very soon AIDS was reported in the USA among IV drug addicts who were sharing needles, persons who have received blood transfusion and blood products, haemophilic patients who got factor VIII and babies born to mothers having AIDS.
The discovery of AIDS in 1980 ended the silent period and inaugurated a phase of discovery and responses from 1981 to 1985. By early 1983, thanks to epidemiology, the routes of transmission were known and rational preventive recommendations were issued.
By the time it became clear that AIDS was caused by a transmissible agent with habits similar to hepatitis ‘B' virus, primarily showing heterosexual mode of spread, was reported from some tropical African countries Haiti and Caribbean islands. The disease in these countries was also spreading through blood transfusions and from infected mothers to their newborn babies.
In India, the first AIDS case came to light in 1986 and the cause attributed was blood transfusion. The person concerned had undergone bypass surgery in the USA where he was reported to have received the HIV-infected blood during the operation.
The first case of full-blown AIDS among prostitutes in the country was reported to be that of a 32-year-old woman from Bombay (who spent her early life as Devdasi in temples). She died of the dreaded disease at the J.J. Hospital in July, 1987.
HIV
The cause of AIDS is a tiny retrovirus (invisible to the naked eyes) called Human T-cell Lymphotropic virus type-III (HTLV-III) commonly known as HIV.
The virus is not new, yet its international spread did not really gain momentum until late 1970s.
The outer covering of HIV is proteinous. Inside remains nucleus. There are two strands of RNA in the nucleus. Both RNA strands enjoined together by three different molecules of a protein having molecular weights 25,000, 18,000 and 13,000 which are formed from 55,000 molecular weight protein.
When someone is referred to as HIV+, it only means that antibodies to the human immuno deficiency virus have been found in his blood. These are detected generally by ELISA kit and later by the confirmatory western BLOT test.
Carrying the virus in the body is not the same thing as having AIDS. One might be infected with virus but shows up no sign of the disease. And if one is infected, he/she in turn can infect his/her sexual partner with the virus even though the infector continues to be healthy. Some people have HIV infection but are not sick, at least not yet. They may become sick later on.
HIV is one of the most fragile virus known so far. It dies within 30 minutes of its exposure outside the human body or at a temperature about 56 degrees Centigrade. Thus, with the death of an AIDS victim, HIV also dies. Had it not been so, the disease would have been more violent.
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*Retroviruses were so named because they reverse their genetic information. These cannot replicate without taking over the biosynthetic part of the cells. In the cells, the genetic material is DNA.
Genetic material of the retrovirus is RNA. The retrovirus carries an enzyme called reverse transcriptase which can make its DNA. This DNA integrates with the genome of the host, but the DNA remains latent until making new virus particle called virion.
MECHANISM OF INVASION ON LYMPHOCYTES BY HIV
Generally speaking, viruses need living tissues for their survival. Whenever they come in contact with the body cells, they attack them and make inroads after dissolving cell walls. Once inside the cell, the virus leaves its genetic material and takes control of the cell. Then the cell acts like a slave without caring for itself and starts producing subunits of the virus. These subunits after combining themselves form virion.
The HIV (I & II) is a virus with difference. The HIV attacks cells that are integral part of the human immune system. It enters inside the lymphocytes through CD4* and after its entry into the cell, the virus does not produce its subunits. Instead it fixes up its genetic material with the genetic material of the host cell and whenever cell genetic material (chromosomes) multiplies, the genetic material of the virus gets multiplied simultaneously. In this way, the virus goes on proliferating and invading other uninfected lymphocytes.
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*CD4 protein is long and round knob like structure found on the surface of lymphocytes. AIDS virus attaches itself with the cells through these CD4. The lower part of CD4 remains inserted in the cell whereas the upper part is soluble.
ENTRY OF THE VIRUS IN THE BODY
The HIV after entering into the body of a healthy person through sexual act or blood transfusion forms antibodies within 6 weeks to 1-year period*: in few cases, the process may be delayed by years, perhaps even by decades. Any serological test during this period will obviously give false negative result. This is a matter of grave concern as regards the spread of the infection. During incubation** period, the person is infected with AIDS, but without any clinical evidence of the same and can transmit the infection to others, acting as what is called "carrier of the disease."
Once antibodies re formed and blood is tested for HIV, it will become a HIV-positive case. In a normal healthy body, symptoms develop within 2 to 10 years. Only then the disease can be diagnosed. The average duration of the asymptomatic period in HIV-infected adults may last 8 to 10 years. Once the symptoms develop, progression of the disease especially in developing countries is rapid. A majority of AIDS patients die within 2 years of the diagnosis
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*The time between the infection with HIV and the appearance of antibodies in the system.
**The time between the infection with HIV and the clinical evidence of AIDS. Also known as Latency period.
HOW BODY DEFENDS ITSELF FROM VIRUS AND BACTERIA
The human body defends itself against virus and bacteria by employing special white blood cells, the lymphocytes, which are capable to precisely identify, invade and produce chemical called antibodies to neutralise their action. The immune system includes a number of different members including T-lymphocytes and the killer cells.
The killer cells which are like specialised assassins cannot accomplish their task without direction from special T-lymphocytes called T-4 (helper cells). The
helper-killer combine distinguishes between healthy cells and the disease causing organism.
The AIDS virus has discovered a way to identify, infect and kill T-4 (helper) cells in a person to produce impaired immune system. Having infected with HIV, such a person becomes increasingly vulnerable to almost any type of infection caused by virus, bacteria, fungus, or parasites that would normally harm a person without a healthy immune system. Such opportunistic infection occurs primarily on the skin, in the lungs, in digestive system, in nerves or in brain. The HIV infected person suffers a long period of illness and disease. Medical treatment may make the symptoms less unpleasant for some time but ultimately the AIDS patient dies usually within 2 to 3 years of the diagnosis.
SYMPTOMS OF AIDS
The disease does not have characteristics that will make it stand out even to laymen. However, the clinical symptoms complex range from malaise, fatigue, diminished appetite, rapid weight loss, recurrent fever, chill, brownish purple skin patches, night sweat, candidiasis, dermatitis, headache, arthralagia, loose motions, sleeplessness to pneumocystis carinii pneumonia (PCP) and Kaposi's Sarcoma. Urological symptoms are insignificant. In most cases, lymph nodes are swollen.
Since AIDS has no unique symptoms of its own, it merely flings open the gates to all other infections after exterminating the body's defending army. Thus a HIV+ patient can present himself simply as suffering from diarrhoea, tuberculosis or Pneumonia (major symptoms of AIDS in India).
With the increase in the number of virus particles in the body, it affects nerves and brain. The result is further possibility of certain mental disorders like confusion, suicidal tendency, etc. The body cannot defend itself from even trivial ailments due to the weak immune system caused by the virus.
SPREAD OF VIRUS ---- MODE OF TRANSMISSION
AIDS is not a contagious disease as was believed initially. The AIDS virus HIV spreads through sexual fluids and through blood. The important mode of transmission of the virus from one person to another is penetrative sexual contact ---- vaginal, anal or possibly oral. During anal coition, skin of anus gets some negative conditions, the HIV virus also gets transmitted via such intact mucous membrane as exists inside the mouth.
The efficiency of female to male transmission is lower than the efficiency of male to female transmission indicating that prostitutes are at a lower risk of infecting their clients but they are at a high risk of getting infected by male clients.
The virus is also transmitted by sharing unsterilised hypodermic needles in case of intravenous drug users, blood transfusion of contaminated blood and blood products, transplanted organs, donated semen, or through blood from an infected person entering into another's cut or wound. A surgeon was inflicted with AIDS presumably after operating an AIDS victim. Miss Kimberly Bergalis who has since died of AIDS was reported to have contracted AIDS during her treatment by a dentist who himself was an AIDS patient. This is the first known case of doctor to patient infection.
It may also get transmitted to a baby through infected mother either before, during or possibly after the birth.
In the past 3 years, 33 percent of Saudi Arabians who got their kidneys transplanted from Indian donors were tested positive for AIDS virus.
People carrying the virus do not spread it to others by casual contact like touching or coughing. They do not pose any risk to the public.
AIDS is not transmissible by normal social contacts or interactions like shake-hands, hugging, kissing or touching of objects by AIDS patient. Swimming in the same pool, eating in the same restaurant or living in the same house may not spread the disease whereas casual heterosexual act is not totally safe as was earlier regarded to be.
Sharing forks and spoons does not spread the virus. Drinking from the same cup (after cleansing and washing it with the boiled water) is also without danger.
The virus does not spread through air. So, if someone with AIDS virus coughs on us, it is much the same as any healthy person coughing on. We may catch the cold but not the AIDS.
HIV infection does not spread through insects. Young children and old people are not at a higher risk of getting the HIV infection.
PREGNANCY, LABOR, LACTATION & HIV
It has become clear from the scientific knowledge that neither pregnancy affects the spread of HIV nor HIV affects the health of a pregnant woman, duration of pregnancy, labor pains, parturition and lactation after the child birth.
However, HIV can easily cross transplacental barrier and the fate of the unborn child is the major reason for concern in the context of a HIV infection during pregnancy.
Perinatal (pertaining to the periods shortly before and after the birth) infection occurs in 20 to 50 percent infants born to seropositive women.
It is estimated that perinatal transmission accounts for 1 percent to 10 percent of all infections in different regions of the world.
Women who have once given birth to HIV infected child, the chances for the second child getting infected with AIDS virus increase by 60 to 80 percent. From an infected mother, the possibility of congenital deformities in child also increases substantially.
So far, only pre-birth transmission of HIV virus to a child is a known fact. Transmission through breastfeeding is very rare. Since the HIV test shows only the presence of antibodies, it is too early to say that there is possibility of HIV infection through breast milk. Signs of HIV infection during lactation was found in those mothers who got infected blood transfused or infected blood products after parturition.
Progression of HIV infection in infancy and childhood is rapid. Fifty percent of the infants die by the time they are 2-year-old and over 90 percent do not survive beyond 5 years.
STAGES OF HIV INFECTION
The following 5 stages of the disease have been identified:
1. Initial HIV infection: With a few weeks of contracting the disease, a temporary seroconversion illness may be experienced by some, that may resemble influenza or glandular fever. This is usually followed by a time gap of months or even years, in which no further symptoms develop but during this period the infected person can transmit the virus to others.
2. Persistent generalized Lymphadenopathy (P.G.L.): The clinical features include enlarged lymph glands in the neck, axilla or groin with fever, night sweats, loss of weight and oral thrush.
3. AIDS related complex (A.R.C.0: This stage signifies considerable damage of the immune system and is marked by fatigue, unexplained diarrhoea lasting longer than one month, loss of more than 10 percent of body weight, fever, night sweat, oral thrush, P.G.L. and enlarged spleen.
4. Full blown AIDS: This is marked by a collapsing immune system and invasion of the life-threatening infections. The patient is usually extremely thin and grossly fatigued and has multiple infections including pneumonia and tuberculosis. Full blown AIDS is always fatal though with the passage of time, life expectancy in some PWAS (People with AIDS) has been increased by a few years.
5. AIDS Dementia: The AIDS virus can pass through blood brain barrier, which normally filters out substances in the blood, and once having passed this barrier, HIV can destroy certain brain cells causing symptoms ranging from mild confusion, memory loss and inappropriate behaviour to personality change, premature sterility and incontinence.
DIAGNOSIS, TEST OF HIV, AIDS
Since the disease is caused by a virus, the estimation of antibodies in the serum is the mainstay of diagnosis. An ELISA (Enzyme linked immuno sorbent assay) test can sometime be tricky and gives false positive reaction, the final proof however is provided by positive Western BLOT studies against a specific glycol-protein of the HTLV-III. Though there are other tests like Serodia and KARPAS but these are not in practice.
It is difficult through tests to get the full picture as a there is a gap (interval) between the time when the virus enters the body and when its presence manifests in the tests. Thus a test taken shortly after the virus enters someone's body may find the person ‘not infected.' This gap can last for a few months or sometime even longer. So a test during the gap may not give a true picture. Also, the test done to a newborn (of infected parents) does not give HIV + * because newborn carriers its mother's antibodies for the first 15 months of life. It is difficult to determine if a baby has been infected with an HIV virus from his/her mother.
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*Researchers from U.S. National Institute to Allergy and Infectious Diseases and John Hopkins University have come up with an expensive way to test babies just a few weeks old for their own antibodies which will indicate infection with the virus that causes AIDS.
COST OF THE TESTS
ELISA test costs about Rs 175 per sample and every kit analysis (Western BLOT) means an expenditure of nearly Rs. 1,000 per sample. At the PGIMER, Chandigarh, the HIV tests are free for government employees or for the patients who are already under its treatment. At Tata Memorial Hospital, Bombay, ELISA costs Rs. 110 per sample and the Western BLOT costs Rs. 700 per sample. For the culture of HIV virus, the test would cost about Rs. 5,000 per sample.
ISOLATION, CULTIVATION OF HIV
HIV has been isolated from semen, vaginal secretions, blood, saliva, tears, breast milk and CSF.
In a major breakthrough the Cancer Research Institute, Bombay has been successful in cultivating the HIV from Indian patients.
EPIDEMIOLOGY AND EPIDEMIOLOGICAL PATTERNS
In fact, AIDS is the first global epidemic. It has spread around the world silently and unnoticed from mid-1970s to 1981 when the disease was first recognised in the USA. It is presumed that nearly every minute a new person becomes infected with the HIV virus world over.
Dr. Jonathan Mann, the Founder of the WHO's Global Programme on AIDS has been warning the world about three successive AIDS epidemics ---- first set in invisibly sometime in the 50s, the second one fully visible and manifesting steady rise as described in the medical literature during 1981 and the third and most important of these concerns a social, rather than a medical infection: the denial, blame, stigmatization, prejudice and discrimination which the fear of AIDS brings out in individuals and societies.
In the face of serious threat to humanity posed by AIDS, WHO in 1988 decided to observe December 1 every year as "World AIDS DAY."
Till now, there had been 3 distinct epidemiological patterns differing from each other in mode of spread or transmission.
Pattern-I: It covers western Europe, North America, some parts of South America, Auustralia and New Zealand. Here infection was generally prevalent among homosexuals, bisexuals, intravenous drug users and sexual transmission with predominantly homosexuals.
In some urban areas, more than 50% homosexuals transmission occurred, but accounted for a very small percentage of sexually transmitted HIV Infection. Transmission of HIV through blood principally involved IV drug addicts.
Pattern-II: It was witnessed in Central, Eastern and Southern Africa and some parts of Caribbean states. Here sexual transmission was predominantly found in heterosexuals and both the sexes were equally affected. In these areas about 70 to 80 percent female prostitutes were found to be sero-positive. Here transfusion of HIV infected blood has been a serious public health problem. However, as a consequence of heterosexual transmission, perinatal transmission still remains a growing problem. In some areas where 5 to 15 percent of pregnant women were HIV positive as late as 1988, perinatal transmission has acquired grave proportion in recent times.
Pattern-III: It covers Asia, most part of Pacific region, Middle East and Eastern Europe. In these areas, HIV infection occurred through homosexual or heterosexual contacts and among the recipients of the contaminated blood and blood products. Prevalence of HIV infection among high risk behaviour groups such as male or female prostitutes, was very low.
HIV/AID INCIDENCE (WORLDWIDE)
In 1980, one lakh people world over were estimated to be infected by HIV. In 1990, this number increased a hundred fold. So, today approximately ten million adults are supposed to be infected. The HIV infected people are not uniformly distributed. At least six million are in Africa, one million each in North America, South America and Asia, and 1 million in Europe and the rest of the world.
Among HIV infected adults, over 6 million are men and nearly 4 million women. Of all HIV infections, approximately 75% were attributed to sexual intercourse, a large majority (4:1) of these heterosexually transmitted. About 10% of the HIV infection are linked with the injecting of drugs, 10% to the HIV infected mothers and remaining 5% to blood transfusion.
While 37,1803 cases of AIDS had been reported officially to WHO from 169 countries in July, 1991, according to Centre for Disease Control (C.D.C.), 20,2843 cases were reported from the USA up to the end of 1992 and 13,0867 had died from the disease. Thus, America is the leader in AIDS cases in Western countries. A more realistic estimate is that more than 1 million adults and 5,00000 children worldwide had developed AIDS since the beginning of pandemic.
The figures are frightening. The WHO has predicted that 4 crore persons (more than the combined population of Bhutan, Nepal, Sri Lanka, and Maldives) will be infected with the HIV virus by 2000 A.D., out of which about 8 million will be women and 10 million children. A majority of women at risk will not be prostitutes as earlier believed but others.
According to another survey done, the percentage of AIDS found in different categories of persons is as under:
1. Homosexuals………73%, 2. Drug addicts………17%,
3. Heterosexuals………1%, 4. Haemophilic………1%,
5. Blood transfusion………2% 6. HIV infected parent's newborn ………1%
7. Rest………5% (include patients with Cirrhosis of Liver, Renal failures needing dialysis and kidney transplants and surgical operation cases, etc.)
HIGH RISK GROUP
Homosexuals, drug addicts, prostitutes and haemophilics are put in the high risk groups from whom there are greater chances of the spread of HIV infection. Surveys are also being conducted on these categories of persons. Rest are put in another group i.e. people who get HIV infection from saliva, tears and urine of the AIDS patients.
ASIA AND PACIFIC REGION
According to the WHO, the total number of infected persons with HIV in Asia and Pacific region is 1.5 million. By 1996, the figure will touch 3 million mark while 17,900 cases will be of the full-blown AIDS. In Asia, in every 24 hours, 2000 new patients are infected with HIV.
INDIA'S CONCERN.
India became concerned about AIDS after the detection of first case in 1986. In 1986, the infection was reported merely from 8 states. Today (the end of 1992) as many as 21 states have reported cases of HIV/AIDS. The health authorise have already been alarmed after detection of multiple seropositive cases in the country.
The seropositivity rate in India progressed as follows:
In December 1986, the seropositivity rate was 2.5 per 1,000 people tested. By 1991, it had ballooned to 5.23 per 1,000 tests.
The data collected from ICMR's sero-surveillance centres indicate that between half to one-third seropositive persons in India are women. Most of them got infected through heterosexual transmission and are still in the asymptomatic phase, unaware of having been infected. Between 1 lakh and 4 lakh women in India are infected by HIV. Out of 24 million deliveries in the country every year, about 20,000 are likely to occur in seropositive women.
As identified by the National AIDS Control Organisation (NACO), between October 1985 and June 1992, the number of full blown AIDS cases in India were 181 and 8,309 people have been identified as HIV positive. By another report, it is said that 11,000 persons are infected with HIV, 238 have developed full-blown AIDS and 110 deaths have been reported.
According to Pervaiz Alam of the BBC's Hindi Service and producer of series on AIDS, the figures provided by the government cannot cope with the size of the epidemic across the country. Pervaiz Alam's conversations with non-governmental agencies reveal that at least 2 million Indians are believed to have been already infected with the virus. The spread of AIDS virus is so vast that in 5 to 10 years, the people will die like flies all over the country.
According to the latest data with the Institute of Immunohaematology (IIH), Bombay, the HIV infection which hitherto was found to be high only among prostitutes and professional blood donors, is now alarmingly increasing among voluntary donors, surgical and medical OPD patients, etc.
This is an alarming indication that HIV is spreading among general population of Bombay, the epicentre of the pandemic in the country. While in 1986, only 0.5% of those tested were found to be HIV +, the figure has risen sharply to 10% by the end of 1992. According to a study conducted in the city, 6 out of 996 surgical OPD patients got the infection and so did 28 of the 2406 patients in medical OPDs.
The incidence of HIV positive cases among voluntary blood donors was 0.36 per 1000 in 1988. It had gone upto 4.8 per 1000 in 1991; 13-fold increase in just 3 years. The fact that one out of every 200 donors are infected with the HIV, reflects the extent of prevalence of HIV in general public. All positive cases were from the city and not a single case was reported from rural areas. The infection was most probably spreading in Bombay through call girls and prostitutes, nearly 30 percent of whom carry the virus.
Now, as per the latest report published sometime in October, 1992, the rural belt of Western Maharashtra is virtually sitting on an AIDS bomb with over 75 percent of the last series of tests showing up HIV +. In Sangli, a sugarcane town in the region, 2% of the voluntary blood donors were tested positive in October, 1992 just double that of Bombay figures. The State government's efforts to check the spread seem to have come to a cropper.
A large number of IV drug addicts in Manipur and prostitutes in Tamil Nadu are also stated to be HIV + and presently under detention in order to contain the spread of HIV infection.
Manipur is acquiring the sad status of the AIDS capital of India. In this North-Eastern state, an estimated 1.2% of its total 18 lakh population is IV drug user, of whom 50% are thought to be AIDS carriers.
According to Dr. Shiv Lal, Deputy Director, NACO; in Bombay 32% prostitutes carry the HIV infection; in Madras 10%, in Calcutta 5 out of 500 (whose blood samples were tested), in Delhi 3 out of 100 women in the red light areas (a 1991 survey).
The main problem in India is the presence of a number of other diseases which camouflage this terrible disease. Also, the tests for detection of the horrible disease are not easily accessible.
In the fast growing AIDS epidemic in Asia, German researchers have found for the first time that India is among the countries afflicted by two parallel curses, one more deadly than other. Hitherto HIV-II infection was in near totality confined to countries of West Africa while the HIV-I has been responsible for the worldwide epidemic.
As per Pols Janseger, AIDS specialist at the Geneva based WHO, who deals with India; the epidemic in India described as a silent volcano, may turn out to be the largest in the region.
Approximately 74 percent of the HIV infected persons in India are of 20 to 35 years of age.
The nationwide average of HIV prevalence rate has gone up from 0.2 percent in 1986 to 1.3 percent in 1990. This represents a 7-fold increase in 7 years (as per World Bank document) which is an alarming phenomenon. Only 5.2 percent of Bombay prostitutes were HIV + in 1986. In 1990, the figure rose to 20% and in 1992 it stands at 32 %. Health experts estimate that each prostitute averages 6 contacts per night. In other words, 32000 HIV + prostitutes come in contact with 1,92,000 persons each night.
According to Dr. Khorshed Pavri, Project Director, C.A.R.C., Bombay's red light district alone is adding 3 to 4 new HIV infected people to the population every hour which means of the world's 400 new HIV victims every 15 minutes, one is from Bombay.
According to the statement of former Director General of ICMR, New Delhi,
Dr. A.S. Paintal; at any rate, in Bombay which has a population of 12 million, it is calculated that one out of every third pregnant woman could fall victim to the AIDS virus by 1995.
In the words of Mr. Khodak Vich, WHO representative, who is handling AIDS in India: "It is futile to go into numbers, we know that the virus is here and that
multi-partner sex is rampant. The focus should be on cleansing blood banks, treatment, education and behavioural change."
NORTHWEST (PUNJAB) REGION CONCERN
Sometime ago, 82 seropositive cases were documented by the PGIMER , Chandigarh, out of which 51 were Indian mostly from Punjab. At least 18 had full blown AIDS and between 20 and 25 percent of the Indians with fatal AIDS condition belonged to this region.
In some cases, exact sources could not be delineated as patients have never been out of Punjab. The incidence in Punjab has increased over the past two years and now it stands at 10 per 1000 amongst high risk group. These include a large number of patients referred from the sister institution, especially the C.M.C., Ludhiana, in Punjab.
W.H.O'S CONCERN
What makes AIDS most dreaded is the fact that the W.H.O. does not expect any vaccine or a cure to be developed at least in the next 10 years and by then the world may be in the tight grip of the epidemic.
TREATMENT, CURE AND MEDICINES
At present, there is no cure for AIDS and no medicine available to protect the people against it.
Although no permanent cure has been devised as yet, it is believed that AIDS patients can be kept alive for 2 to 3 years. There is a good chance that they might benefit from the optimistic treatment modalities now being developed.
A few drugs, like AZT (Azidothymidine) have been discovered which check the spread of the virus temporarily and prolong life. AZT (the only drug approved for use against AIDS by the U.S. Government so far) is supposed to inhibit the enzyme called Reverse Transcriptase and terminate the viral Deoxy Ribose Nucleic Acid (DNA) chain. The AZT is not only unsuccessful in completely suppressing replication of the virus and controlling progression of the disease over extended period but also has several undesirable side-effects, ranging from nausea to severe anaemia. It has also run into resistance by some HIV strains and in any case is not a cure.
Anti-AIDS drug in the trade name of Zidovudine (Indian equivalent to AZT) by CIPLA Laboratory, Bombay, will now be manufactured in the country itself and will be available shortly in the market at Rs. 15 per 1000 mg capsule. Comparatively the imported AZT costs Rs. 55 per 1000 mg capsule.
Other experimental drugs include Dideoxytidine and Foscarnate. According to
Dr. Heseltine of Boston University, USA, "Benzodiazepine among tranquilisers holds great promise for the future."
Nonoxynol-9 is recommended in addition to the use of condoms because it is as effective in killing the AIDS virus as in killing sperms.
Three Japanese scientists, including Hiroaki Mitsuya, Chief researcher at the National Cancer Insitute of the USA and the developer of AZT, are reported to have developed a drug by synthesising compounds that can effectively slow the spread of the AIDS virus with few side-effects. The other two are Yoshiaki Kiso, a Professor of Kyoto Pharmaceutical University and Tsutomu Mitsumoto, a researcher at Nippon Mining Institute.
As per the WHO reports; by 2000 A.D., almost 90 percent of AIDS cases will occur in the Third World countries and a majority of the patients will be treated through traditional healing systems. In regions like Africa and China, the process has already begun where herbal medicines, including Ginseng, have shown improvement in clinical symptoms in HIV infected patients.
ROLE OF CHINESE HERBS IN AIDS
Chinese and U.S. researchers have developed and tested a new drug known as Hongbao (red treasure) and registered under the trade mark ‘Anginlyc' in the USA. The medicine has been clinically tested on 18 AIDS patients at the California AIDS Prevention Centre in San Francisco and found to have improved the immune defence system. The pro-Beijing Wenwei Po added that tests by the U.S. Central Diagnostic Laboratory had sown that the drug was safe for use.
The Editor of American Foundation's Director, Mission Spear said: "We realise the capacity of these herbs in fighting AIDS because these herbs have succeeded in killing AIDS virus in test tube. We can say with confidence that thousands of AIDS patients will get new life when the medicine is developed from these herbs by Hinwig and coworker."
AYURVEDIC CLAIM
According to newspaper report dated November 4, 1992, Mr. P.A. Majid, Managing Director of some Ayurvedic Laboratory at Kochhi, claims that two AIDS patients were successfully treated through Ayurvedic medicines. While one of them was HIV positive case, the other was a full blown AIDS patient.
HOMOEOPATHIC CLAIM
As per Dr. Nik Omar Daud of Malaysia: "Practical studies undertaken at the Homoeopathic Research Centre at Bombay, India, have shown that 13 out of 129 HIV+ patients who had undergone homoeopathic treatment, were found to be free of AIDS causing virus." The claim has been confirmed by Dr. D.P. Rastogi, Director, Central Council of Research in Homoeopathy, New Delhi.
COMMENTS:
I do not claim to have cured any HIV/AIDS patient but would certainly like to bring it to the knowledge of the readers my observations in the treatment of two HIV/AIDS cases, and leave it to themselves to judge the efficacy of homoeopathic medicines in tackling HIV/AIDS. The brief history of the cases is as under: ----
Both the patients, one truck driver, another Gulf deportee had contracted HIV infection through sexual intercourse with prostitutes. They had developed sequential change of diseases after taking treatment for the initial complaints and were ultimately declared HIV/AIDS patients on the basis of blood tests, when they did not respond to the allopathic medicines, they were advised to start homoeopathic treatment.
One of them, besides a HIV positive was also diagnosed a case of Immunothrombocytopenia by PGIMER, Chandigarh. In addition to all other symptoms of AIDS, the patient used to have frequent relapses of high grade temperature which ranged between 104 to 106 degree Fahrenheit. So long he took homoeopathic treatment along with usual steroids and other antipyretic drugs, the temperature never went beyond 102 degree Fahrenheit. As soon as the patient discontinued the homoeopathic treatment, not only the temperature rose again to the same height but the patient also started bleeding from the mouth. He later succumbed to his fatal disease.
In the other case, the patient had bleeding along with 3 to 5 stools a day. On 10.11.92, when he started homoeopathic treatment, his ESR was found to be 40. It came down to 18 on 29.12.92 ----- indeed an indication that the patient was responding favourably to the treatment. Bleeding has now almost stopped and the frequency of stool reduced to 1-3 a day. The patient is still under my treatment and as soon as his ESR becomes normal, he will be sent for his HIV test at PGIMER, Chandigarh. I am confident the patient would be declared seronegative.
SIDDHA'S CLAIM
Since Siddha doctors have also claimd that their medicine can convert an HIV positive case into negative in 3 months time, Tamil Nadu government has therefore decided to scientifically try out the efficacy of Siddhha system for treating HIV positive cases especially those who are showing symptoms of becoming full blown AIDS cases. Siddha doctors say that the medicine is more effective for people with a vegetarian diet.
GOVERNMENT CENTRES FOR TREATMENT OF AIDS PATIENTS
1. AIIMS, New Delhi
2. J.J. Hospital, Bombay
3. Medical College, Calcutta*
4. General Hospital, Madras
5. C.M.C. Vellore
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*AIDS surveillance in the city as in most other parts of the country is still to take off.
AIDS VACCINE
There is no vaccine available, for the treatment of HIV virus. Since HIV's structure is changeable, difficulties are being faced in preparation of vaccine. However, investigators say that certain proteins of the virus do not change their molecular structure despite change in the structure of the virus. This fact may help in the preparation of a vaccine.
Although experiments are going on 14 types of vaccines to treat AIDS patients. However, it would take about another 10 years when a vaccine might come in the market. Till then precaution is the only answer.
The information tickling from the world AIDS conference at Amsterdam indicates that a candid vaccine against the AIDS virus has been demonstrated to be safe in a phase-I clinical trial involving 60 HIV negative volunteers. It has been christened immuno RGP-160 and the antibody response to it is larger than what has been achieved with similar doses of other vaccines.
According to Patrisia Fultz, AIDS researcher: "Three Chimpanzees, first injected with HIV infected blood and subsequently injected with new serum (vaccine) did not show signs of HIV. One of them died after 7 months due to cardiac arrest. The rest two remained free from HIV for 12 months. When one of them was again injected with HIV infected blood, the chimpanzee showed HIV infection." Fultz came to this conclusion that the vaccine cannot give protection for a long time and the vaccine is to be repeated frequently which is not practical.
As per Anthony Fauci, Head of U.S. Govt AIDS Research Program: "AIDS vaccine is still 5 years away."
According to Dr. Prakash Kothari, Professor & Head of the Department of Sexual Medicine and the President of Indian Association of Sex Educators, Counsellors and Therapists (IASECT): "Education is the only vaccine and the maxim should be ‘prevention is the only cure' instead of ‘prevention is better than cure'."
COST OF THE TREATMENT
The African experience has shown that the available treatment for AIDS costs about Rs. 12,000 per patient per year. AZT, the only drug known to prolong life by about 36 months, has to be imported and costs Rs. 3 lakh a year per patient, And should the patient develop cytomegalo virus which causes blindness and certain death, an additional Rs. 6.9 lakh per year needs to be added.
As per Dr. A.N. Malviya, Head of the Medicine, AIIMS, New Delhi, and AIDS specialist; nearly Rs. 24 lakhs are needed as the cost of treatment and care of one AIDS patient, an exorbitant amount to bear for any person or a country.
COST OF AIDS TO INDIA
As per the study made by Columbia University economists, David Bloom and Sherry Glied, AIDS is disproportionately affecting the poor in India and lost income from AIDS mortality and morbidity will touch $ 10,000 per case. The cost of AIDS to India by 2000 A.D. is expected to reach $ 11 billion says another study supported by the UNDP (United Nations Development Program).
At present, AIDS gets more than 8 percent of the country's health budget.
ERADICATION OF HIV/AIDS
The HIV/AIDS cannot be eradicated as long as the conditions which allow its spread persist.
PREVENTION AND PRECAUTIONS
Since AIDS is an infectious disease, physicians who are treating AIDS patients might become AIDS victims. Therefore, doctors and health workers should take necessary precautions. They should wear gloves while handling discharges like blood, saliva and excreta of the AIDS patients. The needles and syringes should be thoroughly sterilized if these cannot be disposed off.
In India, AIDS prevention program has frequently targeted prostitutes, as they are viewed "a pool of infection" of AIDS and other sexually transmitted diseases.
The most effective means of preventing the sexual spread of AIDS virus is by remaining faithful to an uninfected partner or not to have sexual intercourse at all.
Persons who had a blood transfusion after 1978 should get themselves tested for this disease. Tests are also recommended if a woman learns that her husband is bisexual or non-monogamous or if she had had an affair of even a one-night stand in the past 7 years with somebody who might have been bisexual or an IV drug user.
Since children born to infected mothers will certainly be HIV/AIDS patients by birth, such mothers should not conceive till AIDS becomes curable and they become free from AIDS.
According to the government's own conservative figures, already 1674 persons have contracted the virus through blood transfusions. Therefore, all blood donors should be tested for AIDS virus.
Those who had suffered from syphilis or other STDs should not donate blood.
Despite the testing of every bottle of blood for HIV being made mandatory as back as March, 1989, this statutory requirement is not being adhered to strictly. Therefore, HIV test before blood transfusions must be made mandatory.
Those going for a planned surgery must arrange for uninfected blood preferably of his/her own blood.
Heat treatment of blood products helps in preventing the spread of the virus.
Screening of a whole community is not viable since there are no centres in rural areas and technology is not available at primary health cure centre level. However, it is essential to identify seropositive (HIV +) pregnant women to keep a tab on their children and provide them with special care.
OBSTACLES, MYTHS
Many people who fear that they would have been exposed to the disease, don't like to be tested out of the sheer dread of learning the devastating truth.
The main obstacle in India is the incorrect perception that AIDS attack ‘them', i.e. prostitutes, homosexuals and people with multiple partners. Social stigma is attached to the disease. People do not want to be diagnosed as AIDS patients, not even an HIV+ case, purely because of shame and embarrassment emerging from sexual taboos in the Indian society. They should be educated that while certain categories carry high risk for the virus, everybody is vulnerable to the deadly disease. Therefore, all are at risk.
PUBLIC OPINION AND REACTIONS
This is a fact that in America and other countries AIDS patients are seen with contempt. They are treated like leprotics and convicts. They are socially ostracised by the community because of fear of spread of the AIDS.
The family members of an AIDS patient are treated like untouchables ---- said an American soldie.r
Children and youth with HIV+ are not given admission in schools and colleges. Kene, a British student was expelled from the school for this reason. Ambulance drivers hesitate to carry AIDS patients and their dead bodies.
The Russians believe the AIDS to be the disease of the idlers.
The people of Thailand say: "AIDS is a foreigner's disease. An Imam in Terangyanu of Thailand is reported to have threatened to kill any AIDS carrier that might come to his district.
In Philippines, pleasure girls are blamed for the spread of AIDS.
Many Africans regard AIDS as a ‘white man's disease' and refused to believe that it threatens them. Many students there see AIDS as a white plot to reduce the growth in the black population by promoting condoms.
Most of the fears arise from ignorance and if there is anything spreading faster than the virus, it is the fear. Even medics find it difficult to come to terms with AIDS.
It is common phenomenon now to hear doctors refusing to touch the patients once they know that they are carriers, something that happened in the USA only way back in 1983.
In the All India Institute of Medical Sciences, New Delhi, doctors from outside had to be summoned for conducting delivery of a HIV infected woman as the doctor on duty went on leave deliberately. On another occasion, Bipan was abandoned on the delivery table when doctors discovered that she was HIV+. Her baby was finally delivered by sister Raj Laxmi, the Nurse in AIDS ward.
When an African diplomat died of AIDS at the AIIMS, his body remained unattended and was subjected to endless insults.
The misery caused to the parents of Rohit and Vineet Oberoi of Delhi, who were found to be the haemophilics and seropositive, resulting from the callous behaviour of the AIIMS staff, was televised through the national TV network very recently and is still fresh in viewers' mind.
When a child was born to an AIDS patient at PGIMER, Chandigarh, extraordinary precautions were taken by doctors and nurses to protect themselves and preparations were made for any eventuality but (alas!), the delivery was normal and even forceps were not used.
RIGHTS OF AIDS VICTIMS
Already, there have been cases of private sector organisations in metropolis sacking AIDS-afflicted employees from service. However, eminent persons have started speaking with courage and conviction on the subject to safeguard the rights of HIV infected persons or people with AIDS and to help them and preserve their dignity. The fact is that the battle should be fought against the disease and not against the people.
Many developed countries have already enacted such anti-discriminatory laws. Experts have been arguing that an AIDS patient could have years of productive life still left in him even after testing positive for the dreaded HIV causing AIDS. Until the disease manifests, barring them from employment and livelihood would be a crime against humanity.
PROGNOSIS OF AIDS, RESEARCH
The outcome or AIDS research is a dismissal as the disease itself.
According to report in the New Scientist: "Reactivated tuberculosis is common in people with HIV infection in Zambia. Even in the USA, the spread of HIV infection is resulting in more cases of tuberculosis.
The future of patients with HIV infection and tuberculosis in the developing countries is bleak.
The average survival time after the onset of the disease is about 2 years in the developed countries and even less than 1 year in the developing ones.
CONCLUSION
AIDS affects every one; men, women and children over the world. No one is immune to it.
AIDS continues to surface like a serpent in the quiet of the night at the most unexpected places. First it was foreigners and Indians returning from Africa who carried the virus with them. Then it were prostitutes, haemophilic school children and now, patients suffering from renal failure needing dialysis and kidney transplants, liver cirrhosis and surgical operations, etc.
AIDS is not only a killer disease, it threatens to disrupt societies, damage economies and overstretch health services in the years to come.
HIV/AIDS has also demonstrated to cross all social, cultural, economic, political and geographical borders. It is now clea
Article Source: http://www.articlesbase.com/diseases-and-conditions-articles/aids-facts-and-myths-3618855.html
[FACTS & MYTHS]
WHAT IS AIDS?
WHAT ARE THE SYMPTOMS?
HOW DOES IT SPREAD?
WHAT IS ITS TREATMENT?
HOW TO AVOID AIDS?
Dr. P.S. RAWAT
WHAT THEY SPEAK ABOUT AIDS
"For human kind, AIDS is now on par with the nuclear threat and global warming", said K.R. Narayan, Vice-President of India at the second International AIDS Congress, New Delhi.
"Unless the atmosphere of ‘Ignorance and fear' regarding the fate of AIDS patients was removed, we can never succeed in fighting the menace', declared M.L. Fotedar, Former Union Minister for Health and Family Welfare.
"The spread of HIV was fanned by ignorance and discrimination", said Prof. A.N. Malvia, Head of the Medicine, AIIMS, New Delhi and AIDS specialist.
"HIV is not about a virus but primarily about people and society" opined Jonathan Mann, former Director, and the Founder of the WHO's Global Programme on AIDS.
"We can say AIDS is a sleeping giant that awakes always to kill" ----- Dr. Bachi J. Karkar.
"Jokingly, AIDS may be called an ‘ailment invented to discourage sex' or nature's way of population control" ------ Dr. Raj Kumar.
INTRODUCTION
It was during October 1992 that I was entrusted with the responsibility to deliver a lecture on AIDS by the local unit of HMAI (Homoeopathic Medical Association of India), Chandigarh, for which I had to refer to "filed material on AIDS." The lecture could not be delivered as the meeting was postponed. However, I am glad that my strenuous labour has taken the shape of a small booklet which will serve as a guide to the common man as well as to concerned in the medical profession and the agencies dealing with the dreaded disease.
I have endeavoured my utmost in extracting and systematising various aspects of HIV/AIDS from the dissipated information available till date. Still I feel there might have been shortcomings. I would request the persons dealing with AIDS at any level or capacity to please send to me the latest information and other valuable suggestions so that the same could be incorporated in the next edition.
I stand deeply indebted to Mr. Andrew J. Gosain, Chairman, International Christian Education Foundation and St. Xavier's School Management, who has been a constant source of encouragement both morally and financially in my venture.
And, I am also grateful to Dr. (Mrs.) Shobha Sehgal, Professor and Head of Immunopathology Department, PGIMER, Chandigarh, many of my friends like D.D. Sundriyal and Mr. D.S. Panwar and well wishers who have directly or indirectly helped me in bringing out this booklet.
Dr. P.S. Rawat
B.Sc., B.M.S., B.H.M.S. (JPR.)
Assistant Professor and Ex-Principal,
Homoeopathic Medical College,
Chandigarh – 160026
Place: Chandigarh
Date: March 1, 1993
FOREWORD
Acquired immunodeficiency syndrome, AIDS, has emerged as one of the most dreadful diseases of the human race and has evoked a widespread alarm in the world.
Mass education and awareness about the disease is the need of the hour for prevention of the disease.
Dr. P.S. Rawat's book on AIDS throws light on the virus responsible for it, on its history and route through which it gains entry into our body, the defence mechanism and various other important facts connected with AIDS. I am sure his endeavour will help in the prevention of the disease which is a worldwide burning problem of this Century.
Dr. Meera,
Former Principal,
Homoeopathic Medical
College & Hospital,
Chandigarh.
Kothi No. 4
Sector 20-A,
Chandigarh
WHAT IS AIDS?
AIDS is a fatal viral disease which causes suppression of the disease-fighting mechanism in the body.
or
AIDS refers to the occurrence of a life-threatening opportunistic infection or Kaposi's Sarcoma or both in patients who have not received immunosuppressive drugs.
or
The term AIDS refers only to the last fatal stage of HIV infection in non-medical literature. However, the term can be used more loosely to refer both the earlier stages of HIV infection and to the later symptomatic stages of the disease.
In a person with AIDS, there is shortage of Helper T-cells i.e. T4. Therefore, white blood cells are destroyed and the immune system is rendered ineffective even against trivial infections.
For an AIDS patient, even a mild and simple infection like common cold might prove fatal.
DISCOVERY OF AIDS
According to PANOS (a London based voluntary and human rights organisation) publication ----"The Third World Epidemic Repercussion of the Fear of AIDS": AIDS started sometime in 50s or 60s, but the symptoms of the second epidemic AIDS or HIV infection became visible in 1980-81.
It was in the summer of 1981 that Gott Lab and Colleagues from New York and Friedman Kein and co-workers from California reported separately to the Centers of Disease Control (CDC), Atlanta, USA, the occurrence of a new syndrome of rare form of Pneumonia caused by an opportunistic micro-organism called Pneumocystic Carinii and rare cancer called Kaposi's Sarcoma in otherwise healthy young homosexuals. It appeared that they had somehow acquired a form of immunodeficiency characterised by the loss of cellular immunity. By December 1981, well documented reports from New York and Los Angles were published indicating the nature of this illness, its major clinical features, immunological abnormalities and the lethal course. By 1982, enough was known about this syndrome as a mysterious disease complex, a cluster of manifestations suddenly becoming common in homosexuals. The syndrome was termed as Acquired Immuno Deficiency Syndrome, AIDS.
The first case of AIDS could be diagnosed in the USA only in 1981 and the causative virus was identified in 1983 at the Institute Pasteur in Paris. It was named Lymphadenopathy associated virus (LAV). In 1984, the National Cancer Institute in Bethesda, USA, confirmed that the LAV was the cause for AIDS, the virus was named as Human T lymphotropic Virus type 3 (HTLV-3). In 1986, the term humn immuno deficiency virus (HIV) was introduced by an international expert committee. Recently a new AIDS virus has been identified in West Africa as a variant of the earlier identified AIDS virus with almost similar mode of transmission and ill-effects. The first identified virus is now HIV-1 and the variant as HIV-2.
Initially the disease was believed to be in homosexuals alone but very soon AIDS was reported in the USA among IV drug addicts who were sharing needles, persons who have received blood transfusion and blood products, haemophilic patients who got factor VIII and babies born to mothers having AIDS.
The discovery of AIDS in 1980 ended the silent period and inaugurated a phase of discovery and responses from 1981 to 1985. By early 1983, thanks to epidemiology, the routes of transmission were known and rational preventive recommendations were issued.
By the time it became clear that AIDS was caused by a transmissible agent with habits similar to hepatitis ‘B' virus, primarily showing heterosexual mode of spread, was reported from some tropical African countries Haiti and Caribbean islands. The disease in these countries was also spreading through blood transfusions and from infected mothers to their newborn babies.
In India, the first AIDS case came to light in 1986 and the cause attributed was blood transfusion. The person concerned had undergone bypass surgery in the USA where he was reported to have received the HIV-infected blood during the operation.
The first case of full-blown AIDS among prostitutes in the country was reported to be that of a 32-year-old woman from Bombay (who spent her early life as Devdasi in temples). She died of the dreaded disease at the J.J. Hospital in July, 1987.
HIV
The cause of AIDS is a tiny retrovirus (invisible to the naked eyes) called Human T-cell Lymphotropic virus type-III (HTLV-III) commonly known as HIV.
The virus is not new, yet its international spread did not really gain momentum until late 1970s.
The outer covering of HIV is proteinous. Inside remains nucleus. There are two strands of RNA in the nucleus. Both RNA strands enjoined together by three different molecules of a protein having molecular weights 25,000, 18,000 and 13,000 which are formed from 55,000 molecular weight protein.
When someone is referred to as HIV+, it only means that antibodies to the human immuno deficiency virus have been found in his blood. These are detected generally by ELISA kit and later by the confirmatory western BLOT test.
Carrying the virus in the body is not the same thing as having AIDS. One might be infected with virus but shows up no sign of the disease. And if one is infected, he/she in turn can infect his/her sexual partner with the virus even though the infector continues to be healthy. Some people have HIV infection but are not sick, at least not yet. They may become sick later on.
HIV is one of the most fragile virus known so far. It dies within 30 minutes of its exposure outside the human body or at a temperature about 56 degrees Centigrade. Thus, with the death of an AIDS victim, HIV also dies. Had it not been so, the disease would have been more violent.
____________________________________________________________________
*Retroviruses were so named because they reverse their genetic information. These cannot replicate without taking over the biosynthetic part of the cells. In the cells, the genetic material is DNA.
Genetic material of the retrovirus is RNA. The retrovirus carries an enzyme called reverse transcriptase which can make its DNA. This DNA integrates with the genome of the host, but the DNA remains latent until making new virus particle called virion.
MECHANISM OF INVASION ON LYMPHOCYTES BY HIV
Generally speaking, viruses need living tissues for their survival. Whenever they come in contact with the body cells, they attack them and make inroads after dissolving cell walls. Once inside the cell, the virus leaves its genetic material and takes control of the cell. Then the cell acts like a slave without caring for itself and starts producing subunits of the virus. These subunits after combining themselves form virion.
The HIV (I & II) is a virus with difference. The HIV attacks cells that are integral part of the human immune system. It enters inside the lymphocytes through CD4* and after its entry into the cell, the virus does not produce its subunits. Instead it fixes up its genetic material with the genetic material of the host cell and whenever cell genetic material (chromosomes) multiplies, the genetic material of the virus gets multiplied simultaneously. In this way, the virus goes on proliferating and invading other uninfected lymphocytes.
_____________________________________________________________________
*CD4 protein is long and round knob like structure found on the surface of lymphocytes. AIDS virus attaches itself with the cells through these CD4. The lower part of CD4 remains inserted in the cell whereas the upper part is soluble.
ENTRY OF THE VIRUS IN THE BODY
The HIV after entering into the body of a healthy person through sexual act or blood transfusion forms antibodies within 6 weeks to 1-year period*: in few cases, the process may be delayed by years, perhaps even by decades. Any serological test during this period will obviously give false negative result. This is a matter of grave concern as regards the spread of the infection. During incubation** period, the person is infected with AIDS, but without any clinical evidence of the same and can transmit the infection to others, acting as what is called "carrier of the disease."
Once antibodies re formed and blood is tested for HIV, it will become a HIV-positive case. In a normal healthy body, symptoms develop within 2 to 10 years. Only then the disease can be diagnosed. The average duration of the asymptomatic period in HIV-infected adults may last 8 to 10 years. Once the symptoms develop, progression of the disease especially in developing countries is rapid. A majority of AIDS patients die within 2 years of the diagnosis
_____________________________________________________________________
*The time between the infection with HIV and the appearance of antibodies in the system.
**The time between the infection with HIV and the clinical evidence of AIDS. Also known as Latency period.
HOW BODY DEFENDS ITSELF FROM VIRUS AND BACTERIA
The human body defends itself against virus and bacteria by employing special white blood cells, the lymphocytes, which are capable to precisely identify, invade and produce chemical called antibodies to neutralise their action. The immune system includes a number of different members including T-lymphocytes and the killer cells.
The killer cells which are like specialised assassins cannot accomplish their task without direction from special T-lymphocytes called T-4 (helper cells). The
helper-killer combine distinguishes between healthy cells and the disease causing organism.
The AIDS virus has discovered a way to identify, infect and kill T-4 (helper) cells in a person to produce impaired immune system. Having infected with HIV, such a person becomes increasingly vulnerable to almost any type of infection caused by virus, bacteria, fungus, or parasites that would normally harm a person without a healthy immune system. Such opportunistic infection occurs primarily on the skin, in the lungs, in digestive system, in nerves or in brain. The HIV infected person suffers a long period of illness and disease. Medical treatment may make the symptoms less unpleasant for some time but ultimately the AIDS patient dies usually within 2 to 3 years of the diagnosis.
SYMPTOMS OF AIDS
The disease does not have characteristics that will make it stand out even to laymen. However, the clinical symptoms complex range from malaise, fatigue, diminished appetite, rapid weight loss, recurrent fever, chill, brownish purple skin patches, night sweat, candidiasis, dermatitis, headache, arthralagia, loose motions, sleeplessness to pneumocystis carinii pneumonia (PCP) and Kaposi's Sarcoma. Urological symptoms are insignificant. In most cases, lymph nodes are swollen.
Since AIDS has no unique symptoms of its own, it merely flings open the gates to all other infections after exterminating the body's defending army. Thus a HIV+ patient can present himself simply as suffering from diarrhoea, tuberculosis or Pneumonia (major symptoms of AIDS in India).
With the increase in the number of virus particles in the body, it affects nerves and brain. The result is further possibility of certain mental disorders like confusion, suicidal tendency, etc. The body cannot defend itself from even trivial ailments due to the weak immune system caused by the virus.
SPREAD OF VIRUS ---- MODE OF TRANSMISSION
AIDS is not a contagious disease as was believed initially. The AIDS virus HIV spreads through sexual fluids and through blood. The important mode of transmission of the virus from one person to another is penetrative sexual contact ---- vaginal, anal or possibly oral. During anal coition, skin of anus gets some negative conditions, the HIV virus also gets transmitted via such intact mucous membrane as exists inside the mouth.
The efficiency of female to male transmission is lower than the efficiency of male to female transmission indicating that prostitutes are at a lower risk of infecting their clients but they are at a high risk of getting infected by male clients.
The virus is also transmitted by sharing unsterilised hypodermic needles in case of intravenous drug users, blood transfusion of contaminated blood and blood products, transplanted organs, donated semen, or through blood from an infected person entering into another's cut or wound. A surgeon was inflicted with AIDS presumably after operating an AIDS victim. Miss Kimberly Bergalis who has since died of AIDS was reported to have contracted AIDS during her treatment by a dentist who himself was an AIDS patient. This is the first known case of doctor to patient infection.
It may also get transmitted to a baby through infected mother either before, during or possibly after the birth.
In the past 3 years, 33 percent of Saudi Arabians who got their kidneys transplanted from Indian donors were tested positive for AIDS virus.
People carrying the virus do not spread it to others by casual contact like touching or coughing. They do not pose any risk to the public.
AIDS is not transmissible by normal social contacts or interactions like shake-hands, hugging, kissing or touching of objects by AIDS patient. Swimming in the same pool, eating in the same restaurant or living in the same house may not spread the disease whereas casual heterosexual act is not totally safe as was earlier regarded to be.
Sharing forks and spoons does not spread the virus. Drinking from the same cup (after cleansing and washing it with the boiled water) is also without danger.
The virus does not spread through air. So, if someone with AIDS virus coughs on us, it is much the same as any healthy person coughing on. We may catch the cold but not the AIDS.
HIV infection does not spread through insects. Young children and old people are not at a higher risk of getting the HIV infection.
PREGNANCY, LABOR, LACTATION & HIV
It has become clear from the scientific knowledge that neither pregnancy affects the spread of HIV nor HIV affects the health of a pregnant woman, duration of pregnancy, labor pains, parturition and lactation after the child birth.
However, HIV can easily cross transplacental barrier and the fate of the unborn child is the major reason for concern in the context of a HIV infection during pregnancy.
Perinatal (pertaining to the periods shortly before and after the birth) infection occurs in 20 to 50 percent infants born to seropositive women.
It is estimated that perinatal transmission accounts for 1 percent to 10 percent of all infections in different regions of the world.
Women who have once given birth to HIV infected child, the chances for the second child getting infected with AIDS virus increase by 60 to 80 percent. From an infected mother, the possibility of congenital deformities in child also increases substantially.
So far, only pre-birth transmission of HIV virus to a child is a known fact. Transmission through breastfeeding is very rare. Since the HIV test shows only the presence of antibodies, it is too early to say that there is possibility of HIV infection through breast milk. Signs of HIV infection during lactation was found in those mothers who got infected blood transfused or infected blood products after parturition.
Progression of HIV infection in infancy and childhood is rapid. Fifty percent of the infants die by the time they are 2-year-old and over 90 percent do not survive beyond 5 years.
STAGES OF HIV INFECTION
The following 5 stages of the disease have been identified:
1. Initial HIV infection: With a few weeks of contracting the disease, a temporary seroconversion illness may be experienced by some, that may resemble influenza or glandular fever. This is usually followed by a time gap of months or even years, in which no further symptoms develop but during this period the infected person can transmit the virus to others.
2. Persistent generalized Lymphadenopathy (P.G.L.): The clinical features include enlarged lymph glands in the neck, axilla or groin with fever, night sweats, loss of weight and oral thrush.
3. AIDS related complex (A.R.C.0: This stage signifies considerable damage of the immune system and is marked by fatigue, unexplained diarrhoea lasting longer than one month, loss of more than 10 percent of body weight, fever, night sweat, oral thrush, P.G.L. and enlarged spleen.
4. Full blown AIDS: This is marked by a collapsing immune system and invasion of the life-threatening infections. The patient is usually extremely thin and grossly fatigued and has multiple infections including pneumonia and tuberculosis. Full blown AIDS is always fatal though with the passage of time, life expectancy in some PWAS (People with AIDS) has been increased by a few years.
5. AIDS Dementia: The AIDS virus can pass through blood brain barrier, which normally filters out substances in the blood, and once having passed this barrier, HIV can destroy certain brain cells causing symptoms ranging from mild confusion, memory loss and inappropriate behaviour to personality change, premature sterility and incontinence.
DIAGNOSIS, TEST OF HIV, AIDS
Since the disease is caused by a virus, the estimation of antibodies in the serum is the mainstay of diagnosis. An ELISA (Enzyme linked immuno sorbent assay) test can sometime be tricky and gives false positive reaction, the final proof however is provided by positive Western BLOT studies against a specific glycol-protein of the HTLV-III. Though there are other tests like Serodia and KARPAS but these are not in practice.
It is difficult through tests to get the full picture as a there is a gap (interval) between the time when the virus enters the body and when its presence manifests in the tests. Thus a test taken shortly after the virus enters someone's body may find the person ‘not infected.' This gap can last for a few months or sometime even longer. So a test during the gap may not give a true picture. Also, the test done to a newborn (of infected parents) does not give HIV + * because newborn carriers its mother's antibodies for the first 15 months of life. It is difficult to determine if a baby has been infected with an HIV virus from his/her mother.
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*Researchers from U.S. National Institute to Allergy and Infectious Diseases and John Hopkins University have come up with an expensive way to test babies just a few weeks old for their own antibodies which will indicate infection with the virus that causes AIDS.
COST OF THE TESTS
ELISA test costs about Rs 175 per sample and every kit analysis (Western BLOT) means an expenditure of nearly Rs. 1,000 per sample. At the PGIMER, Chandigarh, the HIV tests are free for government employees or for the patients who are already under its treatment. At Tata Memorial Hospital, Bombay, ELISA costs Rs. 110 per sample and the Western BLOT costs Rs. 700 per sample. For the culture of HIV virus, the test would cost about Rs. 5,000 per sample.
ISOLATION, CULTIVATION OF HIV
HIV has been isolated from semen, vaginal secretions, blood, saliva, tears, breast milk and CSF.
In a major breakthrough the Cancer Research Institute, Bombay has been successful in cultivating the HIV from Indian patients.
EPIDEMIOLOGY AND EPIDEMIOLOGICAL PATTERNS
In fact, AIDS is the first global epidemic. It has spread around the world silently and unnoticed from mid-1970s to 1981 when the disease was first recognised in the USA. It is presumed that nearly every minute a new person becomes infected with the HIV virus world over.
Dr. Jonathan Mann, the Founder of the WHO's Global Programme on AIDS has been warning the world about three successive AIDS epidemics ---- first set in invisibly sometime in the 50s, the second one fully visible and manifesting steady rise as described in the medical literature during 1981 and the third and most important of these concerns a social, rather than a medical infection: the denial, blame, stigmatization, prejudice and discrimination which the fear of AIDS brings out in individuals and societies.
In the face of serious threat to humanity posed by AIDS, WHO in 1988 decided to observe December 1 every year as "World AIDS DAY."
Till now, there had been 3 distinct epidemiological patterns differing from each other in mode of spread or transmission.
Pattern-I: It covers western Europe, North America, some parts of South America, Auustralia and New Zealand. Here infection was generally prevalent among homosexuals, bisexuals, intravenous drug users and sexual transmission with predominantly homosexuals.
In some urban areas, more than 50% homosexuals transmission occurred, but accounted for a very small percentage of sexually transmitted HIV Infection. Transmission of HIV through blood principally involved IV drug addicts.
Pattern-II: It was witnessed in Central, Eastern and Southern Africa and some parts of Caribbean states. Here sexual transmission was predominantly found in heterosexuals and both the sexes were equally affected. In these areas about 70 to 80 percent female prostitutes were found to be sero-positive. Here transfusion of HIV infected blood has been a serious public health problem. However, as a consequence of heterosexual transmission, perinatal transmission still remains a growing problem. In some areas where 5 to 15 percent of pregnant women were HIV positive as late as 1988, perinatal transmission has acquired grave proportion in recent times.
Pattern-III: It covers Asia, most part of Pacific region, Middle East and Eastern Europe. In these areas, HIV infection occurred through homosexual or heterosexual contacts and among the recipients of the contaminated blood and blood products. Prevalence of HIV infection among high risk behaviour groups such as male or female prostitutes, was very low.
HIV/AID INCIDENCE (WORLDWIDE)
In 1980, one lakh people world over were estimated to be infected by HIV. In 1990, this number increased a hundred fold. So, today approximately ten million adults are supposed to be infected. The HIV infected people are not uniformly distributed. At least six million are in Africa, one million each in North America, South America and Asia, and 1 million in Europe and the rest of the world.
Among HIV infected adults, over 6 million are men and nearly 4 million women. Of all HIV infections, approximately 75% were attributed to sexual intercourse, a large majority (4:1) of these heterosexually transmitted. About 10% of the HIV infection are linked with the injecting of drugs, 10% to the HIV infected mothers and remaining 5% to blood transfusion.
While 37,1803 cases of AIDS had been reported officially to WHO from 169 countries in July, 1991, according to Centre for Disease Control (C.D.C.), 20,2843 cases were reported from the USA up to the end of 1992 and 13,0867 had died from the disease. Thus, America is the leader in AIDS cases in Western countries. A more realistic estimate is that more than 1 million adults and 5,00000 children worldwide had developed AIDS since the beginning of pandemic.
The figures are frightening. The WHO has predicted that 4 crore persons (more than the combined population of Bhutan, Nepal, Sri Lanka, and Maldives) will be infected with the HIV virus by 2000 A.D., out of which about 8 million will be women and 10 million children. A majority of women at risk will not be prostitutes as earlier believed but others.
According to another survey done, the percentage of AIDS found in different categories of persons is as under:
1. Homosexuals………73%, 2. Drug addicts………17%,
3. Heterosexuals………1%, 4. Haemophilic………1%,
5. Blood transfusion………2% 6. HIV infected parent's newborn ………1%
7. Rest………5% (include patients with Cirrhosis of Liver, Renal failures needing dialysis and kidney transplants and surgical operation cases, etc.)
HIGH RISK GROUP
Homosexuals, drug addicts, prostitutes and haemophilics are put in the high risk groups from whom there are greater chances of the spread of HIV infection. Surveys are also being conducted on these categories of persons. Rest are put in another group i.e. people who get HIV infection from saliva, tears and urine of the AIDS patients.
ASIA AND PACIFIC REGION
According to the WHO, the total number of infected persons with HIV in Asia and Pacific region is 1.5 million. By 1996, the figure will touch 3 million mark while 17,900 cases will be of the full-blown AIDS. In Asia, in every 24 hours, 2000 new patients are infected with HIV.
INDIA'S CONCERN.
India became concerned about AIDS after the detection of first case in 1986. In 1986, the infection was reported merely from 8 states. Today (the end of 1992) as many as 21 states have reported cases of HIV/AIDS. The health authorise have already been alarmed after detection of multiple seropositive cases in the country.
The seropositivity rate in India progressed as follows:
In December 1986, the seropositivity rate was 2.5 per 1,000 people tested. By 1991, it had ballooned to 5.23 per 1,000 tests.
The data collected from ICMR's sero-surveillance centres indicate that between half to one-third seropositive persons in India are women. Most of them got infected through heterosexual transmission and are still in the asymptomatic phase, unaware of having been infected. Between 1 lakh and 4 lakh women in India are infected by HIV. Out of 24 million deliveries in the country every year, about 20,000 are likely to occur in seropositive women.
As identified by the National AIDS Control Organisation (NACO), between October 1985 and June 1992, the number of full blown AIDS cases in India were 181 and 8,309 people have been identified as HIV positive. By another report, it is said that 11,000 persons are infected with HIV, 238 have developed full-blown AIDS and 110 deaths have been reported.
According to Pervaiz Alam of the BBC's Hindi Service and producer of series on AIDS, the figures provided by the government cannot cope with the size of the epidemic across the country. Pervaiz Alam's conversations with non-governmental agencies reveal that at least 2 million Indians are believed to have been already infected with the virus. The spread of AIDS virus is so vast that in 5 to 10 years, the people will die like flies all over the country.
According to the latest data with the Institute of Immunohaematology (IIH), Bombay, the HIV infection which hitherto was found to be high only among prostitutes and professional blood donors, is now alarmingly increasing among voluntary donors, surgical and medical OPD patients, etc.
This is an alarming indication that HIV is spreading among general population of Bombay, the epicentre of the pandemic in the country. While in 1986, only 0.5% of those tested were found to be HIV +, the figure has risen sharply to 10% by the end of 1992. According to a study conducted in the city, 6 out of 996 surgical OPD patients got the infection and so did 28 of the 2406 patients in medical OPDs.
The incidence of HIV positive cases among voluntary blood donors was 0.36 per 1000 in 1988. It had gone upto 4.8 per 1000 in 1991; 13-fold increase in just 3 years. The fact that one out of every 200 donors are infected with the HIV, reflects the extent of prevalence of HIV in general public. All positive cases were from the city and not a single case was reported from rural areas. The infection was most probably spreading in Bombay through call girls and prostitutes, nearly 30 percent of whom carry the virus.
Now, as per the latest report published sometime in October, 1992, the rural belt of Western Maharashtra is virtually sitting on an AIDS bomb with over 75 percent of the last series of tests showing up HIV +. In Sangli, a sugarcane town in the region, 2% of the voluntary blood donors were tested positive in October, 1992 just double that of Bombay figures. The State government's efforts to check the spread seem to have come to a cropper.
A large number of IV drug addicts in Manipur and prostitutes in Tamil Nadu are also stated to be HIV + and presently under detention in order to contain the spread of HIV infection.
Manipur is acquiring the sad status of the AIDS capital of India. In this North-Eastern state, an estimated 1.2% of its total 18 lakh population is IV drug user, of whom 50% are thought to be AIDS carriers.
According to Dr. Shiv Lal, Deputy Director, NACO; in Bombay 32% prostitutes carry the HIV infection; in Madras 10%, in Calcutta 5 out of 500 (whose blood samples were tested), in Delhi 3 out of 100 women in the red light areas (a 1991 survey).
The main problem in India is the presence of a number of other diseases which camouflage this terrible disease. Also, the tests for detection of the horrible disease are not easily accessible.
In the fast growing AIDS epidemic in Asia, German researchers have found for the first time that India is among the countries afflicted by two parallel curses, one more deadly than other. Hitherto HIV-II infection was in near totality confined to countries of West Africa while the HIV-I has been responsible for the worldwide epidemic.
As per Pols Janseger, AIDS specialist at the Geneva based WHO, who deals with India; the epidemic in India described as a silent volcano, may turn out to be the largest in the region.
Approximately 74 percent of the HIV infected persons in India are of 20 to 35 years of age.
The nationwide average of HIV prevalence rate has gone up from 0.2 percent in 1986 to 1.3 percent in 1990. This represents a 7-fold increase in 7 years (as per World Bank document) which is an alarming phenomenon. Only 5.2 percent of Bombay prostitutes were HIV + in 1986. In 1990, the figure rose to 20% and in 1992 it stands at 32 %. Health experts estimate that each prostitute averages 6 contacts per night. In other words, 32000 HIV + prostitutes come in contact with 1,92,000 persons each night.
According to Dr. Khorshed Pavri, Project Director, C.A.R.C., Bombay's red light district alone is adding 3 to 4 new HIV infected people to the population every hour which means of the world's 400 new HIV victims every 15 minutes, one is from Bombay.
According to the statement of former Director General of ICMR, New Delhi,
Dr. A.S. Paintal; at any rate, in Bombay which has a population of 12 million, it is calculated that one out of every third pregnant woman could fall victim to the AIDS virus by 1995.
In the words of Mr. Khodak Vich, WHO representative, who is handling AIDS in India: "It is futile to go into numbers, we know that the virus is here and that
multi-partner sex is rampant. The focus should be on cleansing blood banks, treatment, education and behavioural change."
NORTHWEST (PUNJAB) REGION CONCERN
Sometime ago, 82 seropositive cases were documented by the PGIMER , Chandigarh, out of which 51 were Indian mostly from Punjab. At least 18 had full blown AIDS and between 20 and 25 percent of the Indians with fatal AIDS condition belonged to this region.
In some cases, exact sources could not be delineated as patients have never been out of Punjab. The incidence in Punjab has increased over the past two years and now it stands at 10 per 1000 amongst high risk group. These include a large number of patients referred from the sister institution, especially the C.M.C., Ludhiana, in Punjab.
W.H.O'S CONCERN
What makes AIDS most dreaded is the fact that the W.H.O. does not expect any vaccine or a cure to be developed at least in the next 10 years and by then the world may be in the tight grip of the epidemic.
TREATMENT, CURE AND MEDICINES
At present, there is no cure for AIDS and no medicine available to protect the people against it.
Although no permanent cure has been devised as yet, it is believed that AIDS patients can be kept alive for 2 to 3 years. There is a good chance that they might benefit from the optimistic treatment modalities now being developed.
A few drugs, like AZT (Azidothymidine) have been discovered which check the spread of the virus temporarily and prolong life. AZT (the only drug approved for use against AIDS by the U.S. Government so far) is supposed to inhibit the enzyme called Reverse Transcriptase and terminate the viral Deoxy Ribose Nucleic Acid (DNA) chain. The AZT is not only unsuccessful in completely suppressing replication of the virus and controlling progression of the disease over extended period but also has several undesirable side-effects, ranging from nausea to severe anaemia. It has also run into resistance by some HIV strains and in any case is not a cure.
Anti-AIDS drug in the trade name of Zidovudine (Indian equivalent to AZT) by CIPLA Laboratory, Bombay, will now be manufactured in the country itself and will be available shortly in the market at Rs. 15 per 1000 mg capsule. Comparatively the imported AZT costs Rs. 55 per 1000 mg capsule.
Other experimental drugs include Dideoxytidine and Foscarnate. According to
Dr. Heseltine of Boston University, USA, "Benzodiazepine among tranquilisers holds great promise for the future."
Nonoxynol-9 is recommended in addition to the use of condoms because it is as effective in killing the AIDS virus as in killing sperms.
Three Japanese scientists, including Hiroaki Mitsuya, Chief researcher at the National Cancer Insitute of the USA and the developer of AZT, are reported to have developed a drug by synthesising compounds that can effectively slow the spread of the AIDS virus with few side-effects. The other two are Yoshiaki Kiso, a Professor of Kyoto Pharmaceutical University and Tsutomu Mitsumoto, a researcher at Nippon Mining Institute.
As per the WHO reports; by 2000 A.D., almost 90 percent of AIDS cases will occur in the Third World countries and a majority of the patients will be treated through traditional healing systems. In regions like Africa and China, the process has already begun where herbal medicines, including Ginseng, have shown improvement in clinical symptoms in HIV infected patients.
ROLE OF CHINESE HERBS IN AIDS
Chinese and U.S. researchers have developed and tested a new drug known as Hongbao (red treasure) and registered under the trade mark ‘Anginlyc' in the USA. The medicine has been clinically tested on 18 AIDS patients at the California AIDS Prevention Centre in San Francisco and found to have improved the immune defence system. The pro-Beijing Wenwei Po added that tests by the U.S. Central Diagnostic Laboratory had sown that the drug was safe for use.
The Editor of American Foundation's Director, Mission Spear said: "We realise the capacity of these herbs in fighting AIDS because these herbs have succeeded in killing AIDS virus in test tube. We can say with confidence that thousands of AIDS patients will get new life when the medicine is developed from these herbs by Hinwig and coworker."
AYURVEDIC CLAIM
According to newspaper report dated November 4, 1992, Mr. P.A. Majid, Managing Director of some Ayurvedic Laboratory at Kochhi, claims that two AIDS patients were successfully treated through Ayurvedic medicines. While one of them was HIV positive case, the other was a full blown AIDS patient.
HOMOEOPATHIC CLAIM
As per Dr. Nik Omar Daud of Malaysia: "Practical studies undertaken at the Homoeopathic Research Centre at Bombay, India, have shown that 13 out of 129 HIV+ patients who had undergone homoeopathic treatment, were found to be free of AIDS causing virus." The claim has been confirmed by Dr. D.P. Rastogi, Director, Central Council of Research in Homoeopathy, New Delhi.
COMMENTS:
I do not claim to have cured any HIV/AIDS patient but would certainly like to bring it to the knowledge of the readers my observations in the treatment of two HIV/AIDS cases, and leave it to themselves to judge the efficacy of homoeopathic medicines in tackling HIV/AIDS. The brief history of the cases is as under: ----
Both the patients, one truck driver, another Gulf deportee had contracted HIV infection through sexual intercourse with prostitutes. They had developed sequential change of diseases after taking treatment for the initial complaints and were ultimately declared HIV/AIDS patients on the basis of blood tests, when they did not respond to the allopathic medicines, they were advised to start homoeopathic treatment.
One of them, besides a HIV positive was also diagnosed a case of Immunothrombocytopenia by PGIMER, Chandigarh. In addition to all other symptoms of AIDS, the patient used to have frequent relapses of high grade temperature which ranged between 104 to 106 degree Fahrenheit. So long he took homoeopathic treatment along with usual steroids and other antipyretic drugs, the temperature never went beyond 102 degree Fahrenheit. As soon as the patient discontinued the homoeopathic treatment, not only the temperature rose again to the same height but the patient also started bleeding from the mouth. He later succumbed to his fatal disease.
In the other case, the patient had bleeding along with 3 to 5 stools a day. On 10.11.92, when he started homoeopathic treatment, his ESR was found to be 40. It came down to 18 on 29.12.92 ----- indeed an indication that the patient was responding favourably to the treatment. Bleeding has now almost stopped and the frequency of stool reduced to 1-3 a day. The patient is still under my treatment and as soon as his ESR becomes normal, he will be sent for his HIV test at PGIMER, Chandigarh. I am confident the patient would be declared seronegative.
SIDDHA'S CLAIM
Since Siddha doctors have also claimd that their medicine can convert an HIV positive case into negative in 3 months time, Tamil Nadu government has therefore decided to scientifically try out the efficacy of Siddhha system for treating HIV positive cases especially those who are showing symptoms of becoming full blown AIDS cases. Siddha doctors say that the medicine is more effective for people with a vegetarian diet.
GOVERNMENT CENTRES FOR TREATMENT OF AIDS PATIENTS
1. AIIMS, New Delhi
2. J.J. Hospital, Bombay
3. Medical College, Calcutta*
4. General Hospital, Madras
5. C.M.C. Vellore
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*AIDS surveillance in the city as in most other parts of the country is still to take off.
AIDS VACCINE
There is no vaccine available, for the treatment of HIV virus. Since HIV's structure is changeable, difficulties are being faced in preparation of vaccine. However, investigators say that certain proteins of the virus do not change their molecular structure despite change in the structure of the virus. This fact may help in the preparation of a vaccine.
Although experiments are going on 14 types of vaccines to treat AIDS patients. However, it would take about another 10 years when a vaccine might come in the market. Till then precaution is the only answer.
The information tickling from the world AIDS conference at Amsterdam indicates that a candid vaccine against the AIDS virus has been demonstrated to be safe in a phase-I clinical trial involving 60 HIV negative volunteers. It has been christened immuno RGP-160 and the antibody response to it is larger than what has been achieved with similar doses of other vaccines.
According to Patrisia Fultz, AIDS researcher: "Three Chimpanzees, first injected with HIV infected blood and subsequently injected with new serum (vaccine) did not show signs of HIV. One of them died after 7 months due to cardiac arrest. The rest two remained free from HIV for 12 months. When one of them was again injected with HIV infected blood, the chimpanzee showed HIV infection." Fultz came to this conclusion that the vaccine cannot give protection for a long time and the vaccine is to be repeated frequently which is not practical.
As per Anthony Fauci, Head of U.S. Govt AIDS Research Program: "AIDS vaccine is still 5 years away."
According to Dr. Prakash Kothari, Professor & Head of the Department of Sexual Medicine and the President of Indian Association of Sex Educators, Counsellors and Therapists (IASECT): "Education is the only vaccine and the maxim should be ‘prevention is the only cure' instead of ‘prevention is better than cure'."
COST OF THE TREATMENT
The African experience has shown that the available treatment for AIDS costs about Rs. 12,000 per patient per year. AZT, the only drug known to prolong life by about 36 months, has to be imported and costs Rs. 3 lakh a year per patient, And should the patient develop cytomegalo virus which causes blindness and certain death, an additional Rs. 6.9 lakh per year needs to be added.
As per Dr. A.N. Malviya, Head of the Medicine, AIIMS, New Delhi, and AIDS specialist; nearly Rs. 24 lakhs are needed as the cost of treatment and care of one AIDS patient, an exorbitant amount to bear for any person or a country.
COST OF AIDS TO INDIA
As per the study made by Columbia University economists, David Bloom and Sherry Glied, AIDS is disproportionately affecting the poor in India and lost income from AIDS mortality and morbidity will touch $ 10,000 per case. The cost of AIDS to India by 2000 A.D. is expected to reach $ 11 billion says another study supported by the UNDP (United Nations Development Program).
At present, AIDS gets more than 8 percent of the country's health budget.
ERADICATION OF HIV/AIDS
The HIV/AIDS cannot be eradicated as long as the conditions which allow its spread persist.
PREVENTION AND PRECAUTIONS
Since AIDS is an infectious disease, physicians who are treating AIDS patients might become AIDS victims. Therefore, doctors and health workers should take necessary precautions. They should wear gloves while handling discharges like blood, saliva and excreta of the AIDS patients. The needles and syringes should be thoroughly sterilized if these cannot be disposed off.
In India, AIDS prevention program has frequently targeted prostitutes, as they are viewed "a pool of infection" of AIDS and other sexually transmitted diseases.
The most effective means of preventing the sexual spread of AIDS virus is by remaining faithful to an uninfected partner or not to have sexual intercourse at all.
Persons who had a blood transfusion after 1978 should get themselves tested for this disease. Tests are also recommended if a woman learns that her husband is bisexual or non-monogamous or if she had had an affair of even a one-night stand in the past 7 years with somebody who might have been bisexual or an IV drug user.
Since children born to infected mothers will certainly be HIV/AIDS patients by birth, such mothers should not conceive till AIDS becomes curable and they become free from AIDS.
According to the government's own conservative figures, already 1674 persons have contracted the virus through blood transfusions. Therefore, all blood donors should be tested for AIDS virus.
Those who had suffered from syphilis or other STDs should not donate blood.
Despite the testing of every bottle of blood for HIV being made mandatory as back as March, 1989, this statutory requirement is not being adhered to strictly. Therefore, HIV test before blood transfusions must be made mandatory.
Those going for a planned surgery must arrange for uninfected blood preferably of his/her own blood.
Heat treatment of blood products helps in preventing the spread of the virus.
Screening of a whole community is not viable since there are no centres in rural areas and technology is not available at primary health cure centre level. However, it is essential to identify seropositive (HIV +) pregnant women to keep a tab on their children and provide them with special care.
OBSTACLES, MYTHS
Many people who fear that they would have been exposed to the disease, don't like to be tested out of the sheer dread of learning the devastating truth.
The main obstacle in India is the incorrect perception that AIDS attack ‘them', i.e. prostitutes, homosexuals and people with multiple partners. Social stigma is attached to the disease. People do not want to be diagnosed as AIDS patients, not even an HIV+ case, purely because of shame and embarrassment emerging from sexual taboos in the Indian society. They should be educated that while certain categories carry high risk for the virus, everybody is vulnerable to the deadly disease. Therefore, all are at risk.
PUBLIC OPINION AND REACTIONS
This is a fact that in America and other countries AIDS patients are seen with contempt. They are treated like leprotics and convicts. They are socially ostracised by the community because of fear of spread of the AIDS.
The family members of an AIDS patient are treated like untouchables ---- said an American soldie.r
Children and youth with HIV+ are not given admission in schools and colleges. Kene, a British student was expelled from the school for this reason. Ambulance drivers hesitate to carry AIDS patients and their dead bodies.
The Russians believe the AIDS to be the disease of the idlers.
The people of Thailand say: "AIDS is a foreigner's disease. An Imam in Terangyanu of Thailand is reported to have threatened to kill any AIDS carrier that might come to his district.
In Philippines, pleasure girls are blamed for the spread of AIDS.
Many Africans regard AIDS as a ‘white man's disease' and refused to believe that it threatens them. Many students there see AIDS as a white plot to reduce the growth in the black population by promoting condoms.
Most of the fears arise from ignorance and if there is anything spreading faster than the virus, it is the fear. Even medics find it difficult to come to terms with AIDS.
It is common phenomenon now to hear doctors refusing to touch the patients once they know that they are carriers, something that happened in the USA only way back in 1983.
In the All India Institute of Medical Sciences, New Delhi, doctors from outside had to be summoned for conducting delivery of a HIV infected woman as the doctor on duty went on leave deliberately. On another occasion, Bipan was abandoned on the delivery table when doctors discovered that she was HIV+. Her baby was finally delivered by sister Raj Laxmi, the Nurse in AIDS ward.
When an African diplomat died of AIDS at the AIIMS, his body remained unattended and was subjected to endless insults.
The misery caused to the parents of Rohit and Vineet Oberoi of Delhi, who were found to be the haemophilics and seropositive, resulting from the callous behaviour of the AIIMS staff, was televised through the national TV network very recently and is still fresh in viewers' mind.
When a child was born to an AIDS patient at PGIMER, Chandigarh, extraordinary precautions were taken by doctors and nurses to protect themselves and preparations were made for any eventuality but (alas!), the delivery was normal and even forceps were not used.
RIGHTS OF AIDS VICTIMS
Already, there have been cases of private sector organisations in metropolis sacking AIDS-afflicted employees from service. However, eminent persons have started speaking with courage and conviction on the subject to safeguard the rights of HIV infected persons or people with AIDS and to help them and preserve their dignity. The fact is that the battle should be fought against the disease and not against the people.
Many developed countries have already enacted such anti-discriminatory laws. Experts have been arguing that an AIDS patient could have years of productive life still left in him even after testing positive for the dreaded HIV causing AIDS. Until the disease manifests, barring them from employment and livelihood would be a crime against humanity.
PROGNOSIS OF AIDS, RESEARCH
The outcome or AIDS research is a dismissal as the disease itself.
According to report in the New Scientist: "Reactivated tuberculosis is common in people with HIV infection in Zambia. Even in the USA, the spread of HIV infection is resulting in more cases of tuberculosis.
The future of patients with HIV infection and tuberculosis in the developing countries is bleak.
The average survival time after the onset of the disease is about 2 years in the developed countries and even less than 1 year in the developing ones.
CONCLUSION
AIDS affects every one; men, women and children over the world. No one is immune to it.
AIDS continues to surface like a serpent in the quiet of the night at the most unexpected places. First it was foreigners and Indians returning from Africa who carried the virus with them. Then it were prostitutes, haemophilic school children and now, patients suffering from renal failure needing dialysis and kidney transplants, liver cirrhosis and surgical operations, etc.
AIDS is not only a killer disease, it threatens to disrupt societies, damage economies and overstretch health services in the years to come.
HIV/AIDS has also demonstrated to cross all social, cultural, economic, political and geographical borders. It is now clea
Article Source: http://www.articlesbase.com/diseases-and-conditions-articles/aids-facts-and-myths-3618855.html
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