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SThe AIDS Epidemic 2 Looking Ahead 2 Introduction 2 The Early Years 3 The First Observations 3 The Breakthrough 7 Another AIDS Virus 10 A Pandemic 12 Origin of the AIDS Epidemic 13 The Origin of HIV 14 The Jump to Humans 16 Out of Africa 18 Entry into the United States 19 The First Decades and Beyond 21 Twenty-Four Years of AIDS 21 AIDS in the Twenty-First Century 23 Looking Back 26 2 Viruses and HIV 30 Looking Ahead 30 Introduction 30 Structure of Viruses and HIV 31 Replication of Viruses and HIV 36 Adsorption 36 Penetration and Infection 41 Lysogeny of HIV 42 HIV Activation and Release 44 Cell Destruction 45 The HIV Genome 47 Nine Genes 47 Three Groups of HIV 49 Inhibiting Viruses 50 Looking Back 52 3 The Immune System and HIV 58 Looking Ahead 58 Introduction 58 Overview of the Immune System 60 Antigens 64 The Immune Process 64 Cell-Mediated Immunity 66 Antibody-Mediated Immunity 68 HIV and the Immune System 72 The Focus of HIV 72 The Effects of HIV 77 Looking Back 79 L4 Defining and Recognizing AIDS 84 Looking Ahead 84 Introduction 84 The Case Definition 85 HIV Infection 86 AIDS-Related Complex 91 Acquired Immune Deficiency Syndrome 93 The CDC Stages of Disease 95 The Walter Reed Classification System 95 Tissue Specific HIV-Associated Diseases 97 Opportunistic Diseases 102 Pediatric AIDS 108 Looking Back 111 5 The Epidemiology of AIDS 114 Looking Ahead 114 Introduction 114 AIDS and the Epidemlologist 115 The Spreading Epidemic 117 The Fragility of HIV 120 AIDS in Homosexual Men 121 AIDS in Injection Drug Users 124 AIDS in Heterosexuals 125 AIDS in Women 129 AIDS in Newborns 131 AIDS in Africa 135 AIDS in the World 138 Other Transmission Methods 141 How AIDS Is Not Transmitted 142 Improbable Transmissions 142 The Mosquito Connection 143 AIDS In Schools and Colleges 144 Looking Back 147 6 Preventing HIV Transmission 152 Looking Ahead 152 Introduction 152 Personal Protection 153 Safer Sex Practices 155 For Injection Drug Users 159 Protecting Health Care Workers 162 Universal Precautions 163 Invasive Procedures 164 Dentistry 165 Autopsy and Embalming 166 Medical Laboratories 167 Decontamination Procedures 168 Exposures to HIV 170 Protecting Public Safety Workers 172 Fire and Emergency Medical Services 173 Law Enforcement Officers 175 AIDS Education In the Schools 177 Looking Back 180 7 HIV Testing and Diagnosis 184 Looking Ahead 184 Introduction 184 HIV Antibody Tests 185 Enzyme-Linked Immunosorbent Assay (ELISA) 186 Western Blot Analysis 187 False Positives and Negatives 190 Other Antibody Tests 192 Home and Simplified Tests 193 HIV Antigen (Viral Load) Tests 195 Gene Probes 196 The Polymerase Chain Reaction 197 Advantages of the Viral Load Test 198 Protein and T-Lymphocyte Tests 201 Implications of HIV Testing 202 Mandatory Testing 203 Voluntary Testing 205 Looking Back 207 8 Treating HIV Infection and AIDS 212 Looking Ahead 212 Introduction 213 General Principles of AIDS Treatment 214 Objectives of Therapeutic Drugs 214 Approaches to Drug Therapy 216 Mutations and Other Considerations 218 Reverse Transcriptase inhibitors 220 Azidothymidine (AZT) 221 Other Dideoxynucleosides 227 Nonnucleoside Analogs 229 Other Therapeutic Agents 229 Protease Inhibitors 230 Fusion Inhibitors 234 Entry Inhibitors 236 Interleukin-2 238 Antisense Molecules 238 Miscellaneous Therapeutic Agents 240 Postexposure Prophylaxis 243 Treating Opportunistic Diseases 244 Pentamidine Isethionate 244 Other Drugs 245 Drug Development and Testing 246 Drug Trials 247 Key Questions about Drug Testing 249 Alternative Therapies 250 Bone Marrow Transplants 251 Gene Therapy 252 Thinking Well 253 Looking Back 255 9 An AIDS Vaccine 260 Looking Ahead 260 Introduction 260 General Vaccine Strategies 262 Types of Vaccine 263 AIDS Vaccine Strategies 265 Sterilizing and Therapeutic Immunities 266 AIDS Subunit Vaccines 267 Viable-Vector Vaccines 271 A Whole-Virus Vaccine 272 DNA Vaccines 274 Problems in Vaccine Development 275 Complexity of HIV 275 Economic Issues 276 Lack of Animal Models 277 Vaccine Trials 279 Issues to Consider 280 The Race to Vaccine 282 Looking Back 284 10 AIDS in Perspective 288 Looking Ahead 288 Introduction 288 AIDS and Society 289 AIDS in the Workplace 291 Legal Issues 294 Economic Issues 300 AIDS and Medical Professionals 303 Caring for the AIDS Patient 304 Education and Terminology 307 Home Care 307 The Future of AIDS 308 The Complexity of AIDS 309 The Lessons of AIDS 310 Looking Back 313