AIDS Info – Medical Application Appraisal Essay
AIDS Info – Medical Application Appraisal Essay
Just about two decades ago, HIV/AIDS pandemic was the only thing that is mentioned in social media (Gus “Introduction to HIV/AIDS”). Proved to be originally from Sub Saharan Africa (S.S Africa) region, HIV/AIDS has spread throughout not only the S.S. Africa, but it eventually becomes the global disaster in the late 20th century.AIDS Info – Medical Application Appraisal Essay.
Pros and cons to HIV/AIDS Prevention and Treatment Essay
In the 1980s the National Institutes of Health (NIH1) faced an unprecedented challenge in responding to the epidemic of human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS), modern biology’s first pandemic of a new, deadly infectious disease. Once the magnitude of the epidemic became clear-especially once HIV was identified as the causal agent-NIH was given the mandate and resources to develop a large, multifaceted AIDS research program to understand the virus’s pathogenesis, discover and test therapies, and develop prevention strategies and a vaccine. Research supported and conducted by NIH has led to rapid increases in basic knowledge about HIV and its replication, the molecular and behavioral aspects of transmission, the human immune response to HIV infection, and the clinical course of AIDS.AIDS Info – Medical Application Appraisal Essay. Researchers have discovered and developed some partially effective therapies, and recent advances in vaccine research have convinced many scientists that an effective vaccine may someday be available.
Citations about Foundation Funding for AIDS Education Essay
Risk perception is shaped by social tensions, and cultural, political, and economic biases (Douglas 1985). It is important to understand the different contexts in which risk is perceived and the complex system of beliefs, values, and ideals that shape risk perception (Nelkin 1989). There are several other factors that influence risk perception, including locus of control, the type of risk posed by the threat, and the time interval involved in evaluating the risk. For example, people tend to underestimate risks that they perceive to be under their control, risks associated with a familiar situation, and low probability events (Douglas 1985). People have difficulty accepting estimates of a risk that is involuntary, uncertain, unfamiliar, and potentially catastrophic (Fischoff 1987). AIDS Info – Medical Application Appraisal Essay. The epidemic caused by HIV in the blood supply illustrates these patterns of perception and behavior with respect to risk. Meanwhile, however, the epidemic continues to grow and spread to new areas and populations, trends that argue for a well-planned, well-organized long-term research program leading to the control and eventual eradication of the disease.
Conclusion
In the end, every AIDS prevention program funded by a foundation is an experiment. It would seem wasteful to disregard the potential knowledge to be gained from such experience. Without evaluation, each program is a monumental gamble; if an ineffectual program is continued or emulated by others, then it has the potential of doing harm rather than good. Evaluation is first a management tool for strategic planning and intervention.
References
Douglas, M. Risk Acceptability According to the Social Sciences. Russell Sage Foundation, New York; 1985.
Fischoff, B. Treating the Public with Risk Communications: A Public Health Perspective. Science, Technology and Human Values, vol. 12 ; 1987. AIDS Info – Medical Application Appraisal Essay.
Fischoff, B., et al. Acceptable Risk. 1981.
Note: The National Clinician Consultation Center provides consultations on issues related to the management of perinatal HIV infection (1-888-448-8765; 24 hours a day, 7 days a week). |
| Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials in children† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion † Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents |
Diagnosis of HIV in Infants and Children
HIV can be definitively diagnosed by virologic testing in most nonbreastfed infants with perinatal HIV exposure by age 1 to 2 months, and in virtually all infants with HIV by age 4 to 6 months. Antibody tests, including the newer antigen-antibody combination immunoassays (sometimes referred to as fourth- and fifth-generation tests), do not establish the presence of HIV in infants because of transplacental transfer of maternal HIV antibodies; therefore, a virologic test must be used.1,2 Positive virologic tests (i.e., nucleic acid tests [NATs]—a class of tests that includes HIV RNA and HIV DNA polymerase chain reaction [PCR] assays and related RNA qualitative or quantitative assays) indicate likely HIV infection. The first test result should be confirmed as soon as possible by repeat virologic testing, because false-positive results can occur with both RNA and DNA assays.3 For additional information on the diagnosis of Group M non-subtype B, Group O HIV-1 infections, and HIV-2 infections, see the relevant sections below. AIDS Info – Medical Application Appraisal Essay.
Antigen/antibody combination immunoassays that detect HIV-1/2 antibodies as well as HIV-1 p24 antigen are not recommended for diagnosis of HIV infection in infants. In the first months of life, the antigen component of antigen/antibody tests is less sensitive than an HIV NAT, and antibody tests should not be used for HIV diagnosis in infants and children <18 months of age.4-6 Children with perinatal HIV exposure who are aged 18 to 24 months occasionally have residual maternal HIV antibodies; definitive confirmation of HIV infection in children in this age group who remain HIV antibody-positive should be based on a NAT and antibody retesting at 24 months (see the section below titled Diagnostic Testing in Children with Perinatal HIV Exposure in Special Situations). Diagnosis in children aged >24 months relies primarily on HIV antibody and antigen/antibody tests (see the section below titled Diagnostic Testing in Children with Nonperinatal HIV Exposure or Children with Perinatal Exposure Aged >24 Months).1
An infant who has a positive HIV antibody test but whose mother’s HIV status is unknown (see Maternal HIV Testing and Identification of Perinatal HIV Exposure) should be assumed to have been exposed to HIV. AIDS Info – Medical Application Appraisal Essay. The infant should undergo HIV diagnostic testing as described below7 and receive antiretroviral (ARV) prophylaxis or presumptive HIV therapy as soon as possible. For ARV management of newborns who have been exposed to HIV and newborns with HIV infection (including those who do not yet have confirmed infection), see Antiretroviral Management of Newborns with Perinatal HIV Exposure or HIV Infection.8,9
Timing of Diagnostic Testing in Infants with Perinatal HIV Exposure
Confirmation of HIV infection is based on the results of two positive virologic tests from separate blood samples in infants and children younger than 18 months. Figure 1 and 2 summarize the timing of recommended virologic diagnostic testing for infants based on HIV transmission risk. Infants at higher risk on combination ARV prophylaxis regimens may require testing at additional time points (see Figure 1) compared to infants at low risk of transmission (see Figure 2). The risk of transmission is determined based on whether a mother is receiving antiretroviral therapy (ART) and virally suppressed.
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HIV infection can be presumptively excluded in nonbreastfed infants with two or more negative virologic tests (one at age ≥2 weeks and one at age ≥4 weeks) or one negative virologic test (i.e., negative NAT [RNA or DNA]) at age ≥8 weeks, or one negative HIV antibody test at age ≥6 months.1,7
Definitive exclusion of HIV infection in a nonbreastfed infant is based on two or more negative virologic tests (i.e., negative NATs [RNA or DNA]), one at age ≥1 month and one at age ≥4 months, or two negative HIV antibody tests from separate specimens obtained at age ≥6 months. AIDS Info – Medical Application Appraisal Essay.
For both presumptive and definitive exclusion of HIV infection, a child must have no other laboratory evidence (i.e., no positive virologic test results or low CD4 T lymphocyte [CD4] cell count/percent) or clinical evidence of HIV infection and must not be breastfeeding. Many experts confirm the absence of HIV infection in infants with negative virologic tests by performing an antibody test at age 12 to 18 months to document seroreversion to HIV antibody-negative status.
Pneumocystis jirovecii pneumonia (PCP) prophylaxis is recommended for infants with indeterminate HIV infection status starting at age 4 to 6 weeks until they are determined to be definitively or presumptively without HIV.10Thus, PCP prophylaxis can be avoided or discontinued if HIV infection is presumptively excluded (see Initial Postnatal Management of the Neonate Exposed to HIV and the Pediatric Opportunistic Infection Guidelines).
The case definition for indeterminate HIV infection status is a child who has been exposed to HIV, who is aged <18 months, who was born to a woman living with HIV, and who does not meet the criteria for having HIV infection or for not having contracted HIV. This includes infants who do not meet the minimum requirement for presumptively uninfected. AIDS Info – Medical Application Appraisal Essay.
