werner@aecom.UUCP (Craig Werner) (11/07/86)
<>
The Acquired Immune Deficiency Syndrome (AIDS) has been diagnosed in
26,566 persons with 14,977 deaths as of Oct. 20, 1986. Similar figures as
of Jan 13, 1986 were 16,458 persons (16,227 adults and 231 children), with
8,361 (51% of the adults and 59% of the children). 71% of the patients
diagnosed prior to July 1984 have since died.
A revised definition of AIDS recently proposed would increase the
number of cases to over 30,000 by reclassifying some patients currently
diagnosed as having AIDS-related complex (ARC).
In the first 42 weeks (Jan 1 - Oct. 18, 1986) of this year, 10,474 new
cases were reported (compared to 6,433 in the similar period last year).
In perspective, there were 713,742 (716,749) reported cases of
Gonnorhea, 21,253 (21,740) 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
The recently published Surgeon General's report is available
free from the Public Health Service by writing:
AIDS
Box 14252
Washington DC 20044
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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 actual diagnosis of AIDS is made according to a very strict
case definition set up by the Centers for Disease Control (CDC). Evidence
of infection and illness not meeting the strict case definition is called
AIDS-related complex (ARC). Assymptomatic infection is also possible.
It is not clear at this time what percentage of each group will progess,
however, once the diagnosis of full-blown AIDS is made, the mortality
approaches 100% by 5 years after diagnosis.
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.
It is also known that virtually all AIDS patients, if they live
long enough will develop changes in mental status. In most cases, these
are due to opportunistic infections of the nervous system. However, in
some cases it is due to a direct CNS infection by the virus itself.
*** 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.
*** 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.
Numbers may not add up to 100% due to incomplete reporting.
Blacks and Hispanics accounted for 23% and 14% of the male cases,
respectively, but 51% and 21% of the female cases. The relative risk
for Black and Hispanic women is 13.3 and 11.1 times higher than for
white women. The cumulative incidence among Blacks and Hispanics is
3 times as much as their proportional population.
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 (Blood and body fluid, includes IV drug use) 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, and have not engaged in
prostitution, contact your local Red Cross to become a blood donor.
--
Craig Werner (MD/PhD '91)
!philabs!aecom!werner
(1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
"Knowing you, you're probably doing twice as much as is healthy for you."