Acquired immunodeficiency syndrome (AIDS) is a fatal disease that was first reported in the United States in 1981 and has since become a major worldwide epidemic. By the end of 1999, more than 600,000 Americans had been diagnosed with AIDS, which began its spread among male homosexuals but is now more prevalent among minority populations.

Nearly a million Americans may be infected with the human immunodeficiency virus (HIV), which is the cause of AIDS. The progression from HIV infection to AIDS usually occurs within 10 years. With the development of new and more potent antiviral drugs, scientists hope that the time between HIV infection and the development of AIDS will lengthen.

HIV Infection

HIV kills or impairs cells of the immune system, progressively destroying the body's ability to fight infections and certain cancers. It does this by multiplying within and ultimately destroying cells called T4 lymphocytes (T cells or CD4 cells), which are central to proper functioning of the body's immune defenses.

Blood, semen, saliva, tears, nervous system tissue, breast milk, and vaginal secretions can all harbor the virus. Most often, the virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth during homosexual or heterosexual sex. HIV is readily spread among drug users who share needles and syringes contaminated with infected blood. Rarely, HIV is transmitted to or from a healthcare worker through accidental sticks with contaminated needles. Before universal screening of blood donors and the introduction of reliable techniques to destroy HIV in blood products, HIV could be transmitted through blood transfusions. In the past, many people with hemophilia acquired AIDS through blood transfusions with infected blood products.

One quarter to one third of all untreated pregnant women who are infected with HIV transmit the virus to their fetuses during pregnancy or childbirth. Drug treatment during pregnancy and cesarean section can reduce this transmission rate to 1 percent.

People infected with HIV may experience a flulike illness within a month or two of exposure to the virus; many have no symptoms. This symptom-free period lasts from a few months to a decade, although the virus is actively multiplying, infecting, and killing immune system cells during this time. The only sign of this virulent activity may be a decline in blood levels of CD4 cells from a normal level of about 1,000. Once a person's CD4-cell count falls below 200, he or she is considered to have AIDS. By that time, other signs of the immune system's deterioration have appeared: swollen glands, lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections, skin rashes, short-term memory loss, frequent and severe herpes infections, or a painful nerve disease called shingles.

Confirmation of HIV infection involves testing a blood sample for the presence of antibodies to fight the virus, which may not reach detectable levels for 1 to 3 months after exposure. A negative test result (meaning that no antibodies to the virus were detected in the blood) should be followed by repeated testing after 6 months if the person is still at risk or has symptoms.

Early diagnosis has become increasingly important as researchers have identified more effective drugs that, when used in combination, seem to delay development of the disease. These include drugs called nucleoside analog reverse transcriptase inhibitors (such as zidovudine, also called AZT), which interrupt an early stage of virus replication; and the more recent protease inhibitors, which interrupt the same process at a later stage. These "cocktail" drug regimens are

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