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HIV Aids (Deadly Diseases and Epidemics) PDF

166 Pages·2004·2.51 MB·English
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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- 6 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 7 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. 8 CH.DDE.HIV.aFM.Final.q 4/22/04 1:39 PM Page 9 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. 9

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