HIV Aids (Deadly Diseases and Epidemics)

166 Pages·2004·2.51 MB·English

by  Consuelo M. Beck-Sague

HIV/AIDS
Anthrax
Cholera
HIV/AIDS
Influenza
Lyme Disease
Malaria
Mononucleosis
Polio
Syphilis
Toxic Shock Syndrome
Tuberculosis
Typhoid Fever
HIV/AIDS
Consuelo M. Beck-Sagué,
M.D., F.A.A.P.
Caridad C. Beck
CONSULTING EDITOR
The Late I. Edward Alcamo
Distinguished Teaching Professor of Microbiology,
SUNY Farmingdale
FOREWORD BY
David Heymann
World Health Organization
Writing performed by Consuelo M.Beck-Sagué in her private capacity.No
official support or endorsement by CDC is intended or should be inferred.
Dedication
We dedicate the books in the DEADLYDISEASESANDEPIDEMICSseries to Ed Alcamo,
whose wit,charm,intelligence,and commitment to biology education were
second to none.
CHELSEA HOUSE PUBLISHERS
VP,NEWPRODUCTDEVELOPMENT Sally Cheney
DIRECTOROFPRODUCTION Kim Shinners
CREATIVEMANAGERTakeshi Takahashi
MANUFACTURINGMANAGER Diann Grasse
Staff for HIV and AIDS
ASSOCIATEEDITORBeth Reger
PRODUCTIONEDITORMegan Emery
PHOTOEDITORSarah Bloom
SERIESDESIGNERTerry Mallon
COVERDESIGNER Keith Trego
LAYOUT21st Century Publishing and Communications,Inc.
©2004 by Chelsea House Publishers,
a subsidiary ofHaights Cross Communications.
All rights reserved.Printed and bound in the United States ofAmerica.
http://www.chelseahouse.com
First Printing
1 3 5 7 9 8 6 4 2
Library ofCongress Cataloging-in-Publication Data
Beck-Sague,Consuelo M.,1952–
HIV and AIDS / Consuelo M.Beck-Sague,Caridad Beck.
p.cm.—(Deadly diseases and epidemics)
Includes bibliographical references and index.
ISBN 0-7910-7717-9 (hardcover)
1.AIDS (Disease) I.Beck,Caridad,1983– II.Title.III.Series.
RC606.6.B43 2003
616.97'92—dc22
2004001603
Table of Contents
Foreword
David Heymann, World Health Organization 6
Preface 8
Test Your Knowledge About HIV and AIDS 10
1. History of the Epidemic in the United States 14
2. The HIV Pandemic: A World of Difference 34
3. The Virus 44
4. From Infection to Death: How HIV Causes AIDS 62
5. Diagnosing HIV Infection and AIDS 82
6. Treating HIV Infection With Antiretroviral Drugs 92
7. Preventing HIV Infection and AIDS 102
8. The Future of HIV/AIDS 116
9. Conclusion 126
Appendix 129
Glossary 134
Bibliography 152
Further Reading 153
Websites 154
Index 155
Foreword
In the 1960s, many of the infectious diseases that had terrorized
generations were tamed. After a century of advances, the leading
killers ofAmericans both young and old were being prevented with
new vaccines or cured with new medicines.The risk ofdeath from
pneumonia, tuberculosis (TB), meningitis, influenza, whooping
cough,and diphtheria declined dramatically.New vaccines lifted the
fear that summer would bring polio,and a global campaign was
on the verge of eradicating smallpox worldwide. New pesticides
like DDT cleared mosquitoes from homes and fields,thus reducing
the incidence of malaria,which was present in the southern United
States and which remains a leading killer of children worldwide.
New technologies produced safe drinking water and removed the
risk of cholera and other water-borne diseases. Science seemed
unstoppable.Disease seemed destined to all but disappear.
But the euphoria ofthe 1960s has evaporated.
The microbes fought back. Those causing diseases like TB
and malaria evolved resistance to cheap and effective drugs.The
mosquito developed the ability to defuse pesticides.New diseases
emerged, including AIDS, Legionnaires, and Lyme disease. And
diseases which had not been seen in decades re-emerged, as the
hantavirus did in the Navajo Nation in 1993. Technology itself
actually created new health risks. The global transportation
network, for example, meant that diseases like West Nile virus
could spread beyond isolated regions and quickly become global
threats.Even modern public health protections sometimes failed,
as they did in 1993 in Milwaukee,Wisconsin,resulting in 400,000
cases of the digestive system illness cryptosporidiosis. And,
more recently,the threat from smallpox,a disease believed to be
completely eradicated, has returned along with other potential
bioterrorism weapons such as anthrax.
The lesson is that the fight against infectious diseases will
never end.
In our constant struggle against disease, we as individuals
have a weapon that does not require vaccines or drugs, and that
is the warehouse of knowledge.We learn from the history of sci-
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ence that “modern” beliefs can be wrong. In this series of
books, for example, you will learn that diseases like syphilis
were once thought to be caused by eating potatoes.The inven-
tion of the microscope set science on the right path.There are
more positive lessons from history.For example,smallpox was
eliminated by vaccinating everyone who had come in contact
with an infected person. This “ring” approach to smallpox
control is still the preferred method for confronting an
outbreak,should the disease be intentionally reintroduced.
At the same time,we are constantly adding new drugs,new
vaccines,and new information to the warehouse.Recently,the
entire human genome was decoded.So too was the genome
of the parasite that causes malaria. Perhaps by looking at
the microbe and the victim through the lens of genetics we
will to be able to discover new ways to fight malaria, which
remains the leading killer of children in many countries.
Because ofadvances in our understanding ofsuch diseases
as AIDS, entire new classes of anti-retroviral drugs have
been developed.But resistance to all these drugs has already
been detected, so we know that AIDS drug development
must continue.
Education, experimentation, and the discoveries that
grow out ofthem are the best tools to protect health.Opening
this book may put you on the path of discovery. I hope so,
because new vaccines,new antibiotics,new technologies,and,
most importantly, new scientists are needed now more than
ever if we are to remain on the winning side of this struggle
against microbes.
David Heymann
Executive Director
Communicable Diseases Section
World Health Organization
Geneva,Switzerland
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Preface
No hay mal de que un bien no venga.
Dicho Cubano
(“There is no evil from which some good does not come.”
Cuban Saying)
We dedicate this book to all the children, women, and men
worldwide living with HIV and to those whose compassionate
care and brilliant research are making all the difference. In
particular we dedicate this book to Ronald Valdiserri, M.D.,
M.P.H.,and to our father and grandfather,Dr.Miguel Angel
Sagué,who is so supportive ofour work.
CBS,CCB
In June 1981, after completing my medical residency in pediatrics,
I was about to start a job as a pediatrician in a clinic in Chicago.
I dreaded leaving the Northeast and being far from my best friend
from medical school in Philadelphia, Pennsylvania, Dr. Edwin
(Eddie) Valdiserri,a brilliant,funny,kind,and caring person.
Before I moved to Chicago, I visited Eddie in Philadelphia.
During that visit, Eddie and I discussed a recent article that had
appeared in the Morbidity and Mortality Weekly Report (MMWR),
a weekly newsletter published by the Centers for Disease Control
and Prevention (CDC).The article was about five young,previously
healthy homosexual men who had been treated for Pneumocystis
carinii pneumonia and candida (yeast) infection of the mouth
(thrush).Although these diseases were well known,they were never
seen in healthy adults; these illnesses were seen only in people who
had been treated with medicines that suppressed their immune
defenses so they would not reject transplanted organs, or in other
very severely ill patients.
The article stated that two of the men had died.Descriptions of
the five patients’ cases were very strange. These patients had never
been seriously ill before. They had not had transplants. They had
never taken medicines that could suppress their immune defenses.
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They were healthy young adults.An editorial in the case reports
included this sentence: “The fact that these patients were all
homosexuals suggests an association between some aspect ofa
homosexual lifestyle or disease acquired through sexual contact
and Pneumocystis carinii pneumonia in this population.”1The
article also stated that,“Two of the 5 reported having frequent
homosexual contacts with various partners.”
During the 1970s, many people, both homosexuals and
heterosexuals,had sex with various partners.Rates of sexually
transmitted diseases, infectious diseases spread during sexual
intercourse,such as syphilis and gonorrhea,soared.The number
of syphilis and rectal gonorrhea cases was particulary high
among homosexual men.
After reading that article,we had no idea that a new disease
had emerged.In medical school,we were taught that infectious
diseases were declining in importance. In fact, one deadly
infectious disease, smallpox, which had been a scourge for
centuries, was completely eliminated while Eddie and I
attended medical school in Philadelphia.The first time I real-
ized that new infectious diseases could emerge was in 1976,
when a new infectious disease, Legionnaires’ disease, killed
several people who had attended an American Legion meeting
in Philadelphia.We were stunned to think that an epidemicof
a new infectious disease could occur in the United States.
Eddie and I did not know that the disease we read about
in the MMWR,which did not resemble a sexually transmitted
disease at all, was, in fact, mostly spread by sexual relations.
We also did not know that it would eventually kill millions of
people worldwide,becoming a leading cause ofdeath in many
countries,including the United States.Eddie and I had no way
of knowing that it would claim the lives of many people we
loved,including his own.
C.B.S.
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