AIDS & progres

Although progress has been in treating HIV infection and AIDS, the epidemic remains a critical public health issue in all communities across the country and around the world.

Prevention, early detection, and ongoing treatment remain important aspects of care for people with HIV infections and AIDS.

Nurses in all settings encounter people with this disease; thus, nurses need an understanding of the disorder, knowledge of the physical and psychological consequences associated with the diagnosis, and expert assessment and clinical management skills to provide optimal care for people with HIV infection and AIDS.
In 1987, just 6 years after the first cases of AIDS were reported, the U.S. Food and Drug Administration (FDA) approved the first antiretroviral agent; in 1988nthe first randomized controlled trial of primary prophylaxis of Pneumocystis carinii pneumonia appeared in the literature; and in 1995 protease inhibitors joined the growing number of antiretroviral agents.
Improved treatment of HIV and AIDS has resulted in increased survival times; in 1996, 1997, and 1998, age-adjusted death rates fell 29%, 48%, and 21%, respectively.
II. Background
Since acquired immunodeficiency syndrome (AIDS) was first recognized more than 20 years ago, remarkable progress has been made in improving the quality and duration of life of persons with HIV infection.
During the first decade, this progress was associated with recognition of opportunistic disease processes, more effective therapy for complications, and introduction of prophylaxis against common opportunistic infections (OIs).
The second decade has witnessed progress in developing highly active antiretroviral therapies (HAART) as well as continuing progress in treating OIs (Letvin, Bloom & Hoffman, 2001).
Since the HIV serologic test (enzyme immunoassay [EIA], formerly enzyme-linked immunosorbent assay [ALISHA], became available in 1984, allowing early diagnosis of the infection before onset of symptoms, HIV infection has been best managed as a chronic disease  and most appropriately managed in an outpatient care setting (Gallant, 2001).
A. Epidemiology
In fall 1982, the Centers for Disease Control and Prevention (CDC) issued a case definition of AIDS after the first 100 cases were reported. Since then, the CDC has revised the case definition a number of times (1985, 1987, and 1993).
All 50 states, the District of Columbia, U.S. dependencies and possessions, and independent nations in free association with the United States report AIDS cases to the CDC using a uniform surveillance case definition and case report from (CDC, 2002).
Starting in the late 1990s, more states started to implement HIV case reporting in response to the changing epidemic and the need for information on persons with HIV infection who have not developed AIDS.
As of December 2001, there were 816,149 reported cases of HIV/AIDS and 506, 154 adults, adolescents, and children in the United States (including U.S. dependencies, possession, and associated nations) living with AIDS. Unprotected sex and sharing of injection drug use equipment are the major means of transmission of HIV.
A total of 43, 158 AIDS cases were diagnosed in 2001. For men diagnosed with AIDS during 2001, 59% were in the exposure category of men who have sex with men; 24% in injection drug use; and 7% in heterosexual contact.
In women diagnosed with AIDS during that same period, 44% reported injection drug use and 52% reported heterosexual contact. Comparing race/ethnicity amount the three largest groups diagnosed in 2001, 20,752 were black, not Hipics (CDC, 2002).
The number of people living with AIDS is not evenly distributed throughout the United States. States with the largest number of reported AIDS cases during 2001 were New York (7,476), Florida (5,138), California (4,315), Texas (2,892), and Maryland (1,860) (CDC, 2002).
AIDS has reached epidemic proportions in some other parts of the world. According to the Joint United Nations Program on HIV/AIDS, more than 18.3 million people worldwide have died of AIDS and 34.3 million people are infected with HIV, with 5.4 million people newly infected with HIV in 1999 alone (Letvin, Bloom & Hoffman, 2001).
UNAIDS (2001) reports that since the epidemic began, more than 60 million people have been infected with the virus, making it the most devastating disease ever.
The earliest confirmed case of HIV infection was found in blood drawn from an African man in 1959 (Stephenson, 2003). Although factors associated with the spread of HIV in Africa in the 1960s; however, social changes such as easier access to transportation, increasing population density, and more frequent sexual contacts may have been more important (Stephenson 2003).
III. Discussion
A. Symptoms
Treatment of specific manifestations of HIV infection and AIDS in the person with advanced disease targets symptoms. Patients with HIV/AIDS experience a number of symptoms related to the disease as well as the effects of treatment. Some of the vivid symptoms are as follows:
Respiratory Manifestation. Shortness of breath, dyspnea (labored breathing), cough, chest pain, and fever associated with various OIs, such as those caused by Pneumocystis carinii, Mycobacterium avium-intracellulare, CMV, and Legionella species.
The most common infection in people with AIDS is Pneumocystis carinii pneumonia (PCP), one of the first OIs described in association with AIDS.
PCP. PCP is the most common OIs resulting in an AIDS diagnosis. Without prophylactic therapy, PCP will develop in 80% of all HIV-infected individuals. P. carinii was originally classified as a protozoan; however, studies and analysis of its ribosomal RNA structure suggest that it is a fungus.
Its structure and antimicrobial sensitivity are very different from other disease-causing fungi. P. carinii causes disease only in immunocompromised hosts, invading and proliferating within the pulmonary alveoli with resultant consolidation of the pulmonary parenchyma.