werner@aecom.UUCP (Craig Werner) (10/09/86)
[Posted date: Oct. 9, last posted Sept. 10, 1986]
The Acquired Immune Deficiency Syndrome (AIDS) has been diagnosed in
16,458 persons (16,227 adults and 231 children), with 8,361 (51% of the adults
and 59% of the children) deaths as of Jan 13, 1986. 71% of the patients
diagnosed prior to July 1984 have since died.
In the first 37 weeks (Jan 1 - Sept. 17, 1986) of this year, 8,781 new
cases were reported (compared to 5,432 in the similar period last year).
In perspective, there were 612,692 (622,293) reported cases of
Gonnorhea, 18,283 (18,832) cases of Syphillis, and 15,394 (15,036) cases
of Tuberculosis.
Please do not followup this article. Post all queries on AIDS as
original postings to net.med only. However, note, that by and large, the
net is neither a fruitful nor a reliable source of AIDS information.
The following are reliable sources of information:
Centers for Disease Control (CDC) 1-800-342-AIDS (404-329-1290 in GA)
U.S. Public Health Service 1-800-447-AIDS (202-646-8182 in DC)
American Association of Physicians for Human Rights
P.O Bx 14366, San Francisco CA 94114
415-558-9353 (415-673-3189 in Bay Area)
National Gay Task Force 1-800-221-7044 (212-741-5800 in NY)
80 5th Ave, Suite 1601, NY NY 10011
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AIDS Summary
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*** What is it? ***
AIDS is a consequence of infection with a retrovirus that specifically
infects cells carrying the CD4 (OKT4) protein. These include white blood cells
of the Helper T-cell lineage. Infection with this virus, variously called
HTLV-3 (Human T-Cell Lymphotophic Virus, type III), LAV (Lymphadenopathy-
associated virus), ARV (AIDS-Related Virus), and HIV (Human Immunodeficiency
Virus), is not by itself fatal. However, the virus impairs the immune system
of the host to allow opportunistic infections. Opportunistic infections are
infections with organisms generally incapable of causing disease in healthy
individuals, but can be fatal in immunocompromised persons.
The Virus is an RNA virus that upon infecting a cell reverse
transcribes itself into a DNA and stably inserts into the cell's DNA,
using the cell's machinery to produce RNA copies of its genome as well as
viral proteins. The mechanism by which the virus actually kills the cell
has not been elucidated. It appears, however, to be a much more complex
process than the popular "cellular burnout" scenario.
*** How is it spread? ***
AIDS is spread by direct transfer of infected bodily fluids. Infection
via blood and semen have been proven. The virus has also been isolated
from saliva and tears, but no cases to date have been definitely linked to
these routes of transmission. Similarly, no evidence suggests that AIDS is
transmitted by casual contact, or even household contact, or by insect
vectors. In fact, a growing body of negative evidence suggests otherwise.
Similarly the virus cannot exist free for an extended period of time
(> 20 minutes or so), and is killed by routine sterile procedures (including
autoclaving and dilute chlorine bleach).
In short, it appears to have the same pattern as transmission as
Hepatitis B virus, but is much less virulent.
[See accompanying article: 'Focus: AIDS and Africa', Oct. 86 only]
*** Can it be cured? ***
At this time, great strides have been made in the understanding of
the causative virus, as well as the treatment of the superimposed
opportunistic infections. The average survival time from diagnosis has
been gradually and steadily increasing, but at this current time, there is
no way of successfully reversing the underlying immune deficiency.
Recent clinical trials with 5-Azidothymidine (AZT) appear to slow
the progression of the disease and improve quality of life in a defined
subset of patients, although the drug is not without side-effects. A
special AZT hotline has been set up by the National Institutes of Health
at (800)-843-9388.
*** Who is at risk? ***
Due to the nature of its transmission, AIDS has so far been limited
to certain defined risk groups. These are: Sexually active homosexual males,
Intravenous Drug Abusers, Hemophiliacs and others who received contaminated
blood products, the sexual partners of the above, and children born to
infected women. Recent immigrants from areas where AIDS is endemic (including
Haiti and Central Africa) also are at increased risk. Note, however, that
inclusion within a risk group is not in and of itself an increased risk,
but is merely an epidemiological tool to predict exposure to the virus, i.e.
a gay male who has been celibate since 1977 is at no increased risk of
developing AIDS.
The epidemiological data is as follows:
60% of adult AIDS victims are white, 25% Black, 14% Hispanic.
90% are between the ages of 20-49, 93% are men.
Gay men with no history of drug abuse account for 65% of all
cases, Gay drug abusers, 8% (total gay = 73%), Heterosexual drug
abusers, 17%, Hemophiliacs, 1%, Female Sexual Partners of infected men, 1%,
and Transfusion associated, 2%.
Among children, 19% are white, 60% black, 20% Hispanic. 55% are male.
75% of children were born to infected mothers, 14% are transfusion
associated, 5% are hemophiliacs.
AIDS has been reported in all 50 states, but over 3/4 of all cases
have occurred in just 4: New York, Florida, New Jersey, and California.
*** How to avoid AIDS? ***
Since over 99% of AIDS cases are linked to sexual or direct
parenteral (*) transmission, celibacy and avoidance of IV drug use will
efectively reduce one's chance of contracting AIDS to near Zero,
especially since blood products are now screened for contamination.
Given the general unpopularity of complete celibacy, the use of
condoms and other measures to avoid exchange of bodily fluids (especially
semen) and stable monogamous relationships will provide relative
protection. Avoiding shared razors and toothbrushes has also been
suggested, as these may be contaminated with blood.
Donated blood is now screened for contamination, and the risk
from of contracting AIDS by this route is nearly as low as it was in 1977.
There is absolutely NO RISK of contracting AIDS by DONATING blood.
This belief has caused a critical shortage of blood in this country.
Therefore, if you are healthy, have not used IV drugs or engaged in
sex with a male homosexual/bisexual since 1977, contact your local
Red Cross to become a blood donor.
(*) parenteral: defined as 'not by mouth', i.e., related to blood and
other body fluids. Example: Intravenous drugs.
It has nothing to do with parentage (that's 'parental')
[I am grateful for comments from Barry Hayes, Steve Dyer, Mike Lipsie,
hokey@plus5, Alan J. Rosenthal, James Van Artsdalen, Joseph Yao,
Peter Rubin, bam@bigbang, tim@uw-nsr, and Henry Mensch.]
[Also Andrew Klossner, Gary Cottrell, Matt Crawford, Stephen Hutchison,
and Jerry Natowitz for suggestions and corrections.]
--
Craig Werner (MD/PhD '91)
!philabs!aecom!werner
(1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
"Trust me. I'm almost a doctor."