There have been in recent times, three important explosions: the information explosion, the population explosion and the AIDS explosion. The first is good; the second will be taken care of by Mother Nature; it is the third explosion that needs to be muffled. Fortunately, we have the arsenals do so.  

The strategies of AIDS prevention are directed against patients suffering from sexually transmitted diseases (STDs), commercial sex workers (CSWs), and other high risk persons including men who have sex with men (MSM), injecting drug users (IDU), long-distance truck drivers, street children, prison inmates, and migrant workers. Precautions relating to Hospitals and Blood banks also form part of AIDS prevention.  

CSWs are periodically examined for AIDS and other sexually transmitted diseases and treated if found positive. They are advised to insist on their clients wearing the condom. All brothels are made “condom use only” brothels. If possible the CSWs are rehabilitated by imparting them training in some craft and helped to land an honorable job.  

AIDS prevention for the benefit of high risk persons is by way of educating them about the safe sex practices and about the need for using only disposable syringes for self-administration of drugs.

All STD patients are detected as early as possible after the onset of illness and are treated. They are motivated to practice safe sex so that they do not again fall a prey to the STDs/AIDS.

A measure that helps in AIDS prevention as well as in solving the social problem of homelessness is to provide houses for the migrant laborers. For lack of proper accommodation these laborers are often forced to live in slums where the prevalence of HIV infection is high.

AIDS PREVENTION IN HOSPITALS 

Surfaces and materials in the medical institutions are disinfected with bleach solution prepared by adding 10 G of fresh bleaching powder to 250 ml of water.

Blood spills and objects contaminated with blood and body fluids are disinfected with a strong bleach solution made by adding 15 G of bleaching powder to 75 ml of water.  

Material soaked with blood/body fluids are first put into a disposal bag that is tied and then put into a second bag whose mouth is then tightly tied, and finally disposed of.  

All laboratories are well ventilated. Local exhaust ventilation is provided in the form of fume hoods.  

A plan for the control of exposure to blood/body fluids is prepared by the head of the medical institution, printed and circulated to all the staff. Among other details, this plan contains the following: The list of jobs/tasks/duties, where the concerned worker may come into contact with blood or body fluids. The procedure to be health worker should follow, if he spills blood on to his broken skin or if he accidentally pricks his skin with a contaminated needle.  

AIDS prevention and Blood Banks  

The managers of blood banks are strictly made to take the following precautions:

To collect blood form a donor only after HIV testing and verifying he/she is negative.  

It is important to dissuade persons, who have the history of multiple sex partners, from donating blood. Finally, blood transfusion has to be done, only if it is absolutely necessary.  

By following the AIDS prevention strategy as above, we may not succeed in wiping HIV out, but certainly the current number of 4.5 million new cases of AIDS can be reduced by a sizeable proportion, in the near future.  

Treatment of AIDS can be frustrating both to the patient as well as to the doctor. The patient may be frustrated because it is a life-long affair and the doctor may be frustrated because he knows the treatment of AIDS does not cure the disease. After all, he knows it does not exterminate the HIV virus but merely keeps them from reproducing.  

Treatment of aids has the following goals: 

1. To reduce the viral load to undetectable levels, i.e., less than 50 copies/milliliter, for as long as possible.
2. To increase the count, if low, and maintain it in the normal range.
3. To limit the development of resistance to medication.
4. To restore the body’s immune system by raising the level of CD4 cells and to maintain it at that level.
5. To prevent the patient acquiring opportunistic infections.
6. To reduce transmission of the disease from the patient to others.
7. To improve the quality of patient’s life and to extend its span, 

AIDS DRUGS 

Three groups of drugs are available for AIDS treatment: 

1. Reverse transcriptase inhibitors (RTIs). These prevent the reverse transcription of the viral RNA to DNA that is necessary for viral multiplication. RTIs are of two sub-types:  

• Nucleoside RTIs (NRTIs). Some examples with their dose follow:
  • Azidothymidine (AZT), retrovir or Zidovudine (ZDV), 300 mg b.d.
  • Didanosine (ddI), 200-350 mg b.d.
  • Zalcitabine (ddC), 0.5 mg t.d.s.
  • Stavudine (d4T), bd
  • Lamirudine (3TC), 150 mg b.d.
• Non-nucleoside RTIs (NNRTIs). Examples are Nevirapine (NVP), dose, 20 mg/KG daily, and Delaviridine (DLV), dose, 400 mg t.d.s.

2. Protease Inhibitors (PIs). They inhibit protease. Normally protease fractures host’s proteins. The resultant fractions are necessary for the multiplication of HIV. The disabling of protease therefore prevents HIV replication. Examples with dose are given below:

• Saquinavir, 600 mg/day
• Indinavir, 800 mg t.d.s.
• Ritonavir, 600 mg b.d.

3. Fusion inhibitors (FIs). These drugs can be injected. They block HIV from entering the healthy cells of the body. Enfuvirtide (T-20) is a fusion inhibitor. 

Evolution Of Aids Medication Regimens 

Originally, monotherapy with ZDV was employed. This was associated with rapid development of resistance.  

Later, two drugs were employed. Following were the different two drug combinations: (a) ZDV and 3TC; (b) ZDV and ddI; (c) Saquinavir and Ritonavir; and (d) Nelfinavir and d4T. These brought about an increase in the helper CD4 cell count and prevented opportunistic infections. However, the benefits were non-persistent and the problem of drug resistance remained.  

Today, AIDS is treated with what is called ‘Highly Active AntiRetroviral Therapy’ (HAART). It is a triple cocktail therapy with two NRTIs such as ZDV and 3TC and one PI such as Indinavir. The key to the success of HAART lies in the drug combination’s ability to disrupt HIV replication at two different stages. NRTIs restrain an enzyme crucial to an early stage of HIV replication. PIs hold back another enzyme that functions near the end of the HIV replication process.  

AIDS Drugs are not without side effects. The common ones are headache, rash, itching, anemia, hepatitis, neuropathy, hyperbilirubinemia and nephrolithiasis. They promote the onset of diabetes. In a diabetic, they worsen hyperglycemia. AIDS medicines may induce enhanced bleeding in people suffering from hemophilia types A or B.  

Treatment of AIDS in the mother is done to prevent her spreading it to the fetus. This achieved by the following steps:  

1. AZT is given to the HIV infected pregnant women  at 14 to 34 weeks of pregnancy by any one of these regimens:100 mg five times a day, 200 mg three times a day, or 300 mg twice a day.
2. During labor and delivery, the mother receives intravenous AZT.
3. The baby is treated with AZT (in liquid form) every 6 hours for 6 weeks after birth.

The maxim, what cannot be successfully treated should better be prevented, is very true with AIDS. 

The Beginning of the Killer Disease – History of AIDS 

The history of AIDS, the dreadful disease, goes back to the 20^th century. The United States of America began to investigate with the help of CDC, Centre for disease control around 1931. First African Americans were secretly tested for AIDS. They also tested AIDS in sheep. During 1951, the 1^st world conference on AIDS was held and US began to investigate the cause of the epidemic disease. There were no recorded cases prior to 1957. Only during 1962 year, creation of special virus program, Operation–X was launched.  

From 1963 onwards, every year ` Special Virus Program ‘was conducted. Tests are conducted for Lymphoma, the other name for AIDS. Slim disease was spotted in African countries such as Zaire, Uganda and Tanzania in late 1970. The United States and Haiti had a similar pattern of disease as in Africa, in 1980.  

Stanford Mycoplasma Lab gave their first presentation of papers on AIDS, “Viral Infections in Man Associated with Acquired Immunological Deficiency States.” The primary scientist, Dr. Thomas Merigan was the consultant to the special virus program. The disease at that time did not have a name. Therefore, different groups referred to it in different ways. The CDC generally, referred to it by symptoms like lymphadenopathy which has swollen glands. Also, called as GRID i.e., gay-related immune deficiency, AIDS i.e., acquired immunodeficiency disease. This is the history of AIDS.  

Causes and Spread of AIDS 

From 1980 – 1982, South California researchers inferred that the disease could have been caused by a sexually transmitted infectious agent i.e., homosexuals, heterosexuals, blood transfusions or vertical transmission from mother to child and exposure to unsterilized needles.  

Approximately, 452 cases registered from 23 states were diagnosed a disease due to sexual transmission, by the centre for disease control. Only during 1982, CDC first properly defined as AIDS (Acquired Immune Deficiency Syndrome). HIV and AIDS had also been detected in other parts of the globe, among sex workers causing fears that the disease would curb the entire globe under its iron claws.  

First Death Causes Realization of AIDS 

In 1981, a child about one and a half year old, who had received multiple transfusions of blood and blood products died from infections related to AIDS. This case provided clearer evidence that AIDS was caused by an infectious agent, and created awareness about the safety of the blood supply. Also, the CDC reported the first cases of possible mother to child transmission of AIDS.  

By the end of 1982, many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected.

It was also becoming clear that AIDS was not a disease that just occurred in the USA. There were separate reports of the disease occurring in a number of European countries also have AIDS epidemic.  

In Asia, UK, West Germany and Denmark, the majority of people with AIDS were homosexual. Many had a history of sex with American nationals. However, experts are skeptical that AIDS will spread as rapidly among heterosexuals, as it has among homosexuals.  

Today, this killer disease has spread beyond boundaries and every country is finding new ways to educate people about AIDS and prevent it.