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Teacher resources and professional development across the curriculum
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| List of abbreviations used in this article
AIDS: Acquired immune deficiency syndrome
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a set of symptoms and infections resulting from the damage to the human immune system caused by the human immunodeficiency virus (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids.
AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it killed an estimated 2.1 million people, including 330,000 children. Over three-quarters of these deaths occurred in sub-Saharan Africa, retarding economic growth and destroying human capital. Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century. AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified by American and French scientists in the early 1980s.
Although treatments for AIDS and HIV can slow the course of the disease, there is currently no vaccine or cure. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS epidemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS. HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.
Pulmonary infectionsPneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii. Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.
Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.
Gastrointestinal infections
Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.
Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and viruses, astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis). In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.
Neurological and psychiatric involvement
HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.
Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs. Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.
AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin. Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 10–20% in Western countries but only 1–2% of HIV infections in India. This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less often seen with the advent of multi-drug therapy.
Tumors and malignancies
Patients with HIV infection have substantially increased incidence of several malignant cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).
Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).
In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as Hodgkin's disease and anal and rectal carcinomas. However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.
Other opportunistic infections
AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.
AIDS is the most severe acceleration of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. Once HIV has killed so many CD4+ T cells that there are fewer than 200 of these cells per microliter (µL) of blood, cellular immunity is lost. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4+ T cells remaining in the blood, and/or the presence of certain infections, as noted above.
In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function. Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression. The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the homozygous CCR5-Δ32 variation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.
Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of one person with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts are riskier than unprotected insertive sexual acts, and the risk for transmitting HIV through unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex. However, oral sex is not entirely safe, as HIV can be transmitted through both insertive and receptive oral sex. Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vagina frequently occurs, facilitating the transmission of HIV.
Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection, because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America suggest that genital ulcers, such as those caused by syphilis and/or chancroid, increase the risk of becoming infected with HIV by about four-fold. There is also a significant although lesser increase in risk from STIs such as gonorrhea, Chlamydial infection and trichomoniasis, which all cause local accumulations of lymphocytes and macrophages.
Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. However, each 10-fold increase in the level of HIV in the blood is associated with an 81% increased rate of HIV transmission. Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases. People who have been infected with one strain of HIV can still be infected later on in their lives by other, more virulent strains.
Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern of overlapping long-term romantic relationships. This allows the virus to quickly spread to multiple partners who in turn infect their partners. A pattern of serial monogamy or occasional casual encounters is associated with lower rates of infection.
HIV spreads readily through heterosexual sex in Africa, but less so elsewhere. One possibility being researched is that schistosomiasis, which affects up to 50 per cent of women in parts of Africa, damages the lining of the vagina.
Exposure to blood-borne pathogensintravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with HIV. Needle sharing is the cause of one third of all new HIV-infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce this risk. This route can also affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections. Because of this, the United Nations General Assembly has urged the nations of the world to implement precautions to prevent HIV transmission by health workers.
The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and between 5% and 10% of the world's HIV infections come from transfusion of infected blood and blood products.
Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during pregnancy, labor and delivery is 25%. However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%. The risk of infection is influenced by the viral load of the mother at birth, with the higher the viral load, the higher the risk. Breastfeeding also increases the risk of transmission by about 4 %.
A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between gay men can lead to AIDS infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.
The pathophysiology of AIDS is complex, as is the case with all syndromes. Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes. This weakens the immune system and allows opportunistic infections. T lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases. During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers.
Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. The reason for the preferential loss of mucosal CD4+ T cells is that a majority of mucosal CD4+ T cells express the CCR5 coreceptor, whereas a small fraction of CD4+ T cells in the bloodstream do so. HIV seeks out and destroys CCR5 expressing CD4+ cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically latent phase. However, CD4+ T cells in mucosal tissues remain depleted throughout the infection, although enough remain to initially ward off life-threatening infections.
Continuous HIV replication results in a state of generalized immune activation persisting throughout the chronic phase. Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. Another cause is the breakdown of the immune surveillance system of the mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease. This results in the systemic exposure of the immune system to microbial components of the gut's normal flora, which in a healthy person is kept in check by the mucosal immune system. The activation and proliferation of T cells that results from immune activation provides fresh targets for HIV infection. However, direct killing by HIV alone cannot account for the observed depletion of CD4+ T cells since only 0.01-0.10% of CD4+ T cells in the blood are infected. A major cause of CD4+ T cell loss appears to result from their heightened susceptibility to apoptosis when the immune system remains activated. Although new T cells are continuously produced by the thymus to replace the ones lost, the regenerative capacity of the thymus is slowly destroyed by direct infection of its thymocytes by HIV. Eventually, the minimal number of CD4+ T cells necessary to maintain a sufficient immune response is lost, leading to AIDS
Cells affected
The virus, entering through which ever route, acts primarily on the following cells:
- Lymphoreticular system:
- CD4+ T-Helper cells
- CD4+ Macrophages
- CD4+ Monocytes
- B-lymphocytes
- Certain endothelial cells
- Central nervous system:
- Microglia of the nervous system
- Astrocytes
- Oligodendrocytes
- Neurones - indirectly by the action of cytokines and the gp-120
The effect
The virus has cytopathic effects but how it does it is still not quite clear. It can remain inactive in these cells for long periods, though. This effect is hypothesized to be due to the CD4-gp120 interaction.
- The most prominent effect of the HIV virus is its T-helper cell suppression and lysis. The cell is simply killed off or deranged to the point of being function-less (they do not respond to foreign antigens). The infected B-cells can not produce enough antibodies either. Thus the immune system collapses leading to the familiar AIDS complications, like infections and neoplasms (vide supra).
- Infection of the cells of the CNS cause acute aseptic meningitis, subacute encephalitis, vacuolar myelopathy and peripheral neuropathy. Later it leads to even AIDS dementia complex.
- The CD4-gp120 interaction (vide supra) is also permissive to other viruses like Cytomegalovirus, Hepatitis virus, Herpes simplex virus, etc. These viruses lead to further cell damage i.e. cytopathy.
Molecular basis
For details, see:
The diagnosis of AIDS in a person infected with HIV is based on the presence of certain signs or symptoms. Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used.
WHO disease staging system
In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1. An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.
- Stage I: HIV infection is asymptomatic and not categorized as AIDS
- Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
- Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
- Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.
CDC classification system
There are two main definitions for AIDS, both produced by the Centers for Disease Control and Prevention (CDC). The older definition is to referring to AIDS using the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes. The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.
HIV test
Many people are unaware that they are infected with HIV. Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities. Therefore, donor blood and blood products used in medicine and medical research are screened for HIV.
HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. The window period (the time between initial infection and the development of detectable antibodies against the infection) can vary since it can take 3–6 months to seroconvert and to test positive. Detection of the virus using polymerase chain reaction (PCR) during the window period is possible, and evidence suggests that an infection may often be detected earlier than when using a fourth generation EIA screening test. Positive results obtained by PCR are confirmed by antibody tests. Routinely used HIV tests for infection in neonates, born to HIV-positive mothers, have no value because of the presence of maternal antibody to HIV in the child's blood. HIV infection can only be diagnosed by PCR, testing for HIV pro-viral DNA in the children's lymphocytes.
|Exposure Route
| Estimated infections
per 10,000 exposures
to an infected source
|Blood Transfusion
|Needle-sharing injection drug use
|Percutaneous needle stick
|Receptive anal intercourse*
|Insertive anal intercourse*
|Receptive penile-vaginal intercourse*
|Insertive penile-vaginal intercourse*
|Receptive oral intercourse*§
|Insertive oral intercourse*
| * assuming no condom use </br> § source refers to oral intercourse
performed on a man
The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.
Sexual contact
The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex. During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming pregnant. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion. The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms porous. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms.
The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina – inserting the female condom requires squeezing this ring. However, at present availability of female condoms is very low and the price remains prohibitive for many women. Preliminary studies suggest that, where female condoms are available, overall protected sexual acts increase relative to unprotected sexual acts, making them an important HIV prevention strategy.
Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year. Prevention strategies are well-known in developed countries, however, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV.
Randomized controlled trials have shown that male circumcision lowers the risk of HIV infection among heterosexual men by up to 60%. It is expected that this procedure will be actively promoted in many of the countries affected by HIV, although doing so will involve confronting a number of practical, cultural and attitudinal issues. Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.
Exposure to infected body fluids
Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of exposure to contaminated blood. These precautions include barriers such as gloves, masks, protective eyeware or shields, and gowns or aprons which prevent exposure of the skin or mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin immediately after being contaminated with blood or other bodily fluids can reduce the chance of infection. Finally, sharp objects like needles, scalpels and glass, are carefully disposed of to prevent needlestick injuries with contaminated items. Since intravenous drug use is an important factor in HIV transmission in developed countries, harm reduction strategies such as needle-exchange programmes are used in attempts to reduce the infections caused by drug abuse.
Mother-to-child transmission (MTCT)
Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.
- See also HIV Treatment and Antiretroviral drug.
Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available. Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults. In developed countries where HAART is available, doctors assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.
HAART allows the stabilization of the patient's symptoms and viremia, but it neither cures the patient of HIV, nor alleviates the symptoms, and high levels of HIV-1, often HAART resistant, return once treatment is stopped. Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART. Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to the plummeting of HIV-associated morbidity and mortality. In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2 months. HAART is thought to increase survival time by between 4 and 12 years.
For some patients, which can be more than fifty percent of patients, HAART achieves far less than optimal results, due to medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV. Non-adherence and non-persistence with therapy are the major reasons why some people do not benefit from HAART. The reasons for non-adherence and non-persistence are varied. Major psychosocial issues include poor access to medical care, inadequate social supports, psychiatric disease and drug abuse. HAART regimens can also be complex and thus hard to follow, with large numbers of pills taken frequently. Side effects can also deter people from persisting with HAART, these include lipodystrophy, dyslipidaemia, diarrhoea, insulin resistance, an increase in cardiovascular risks and birth defects. Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.
Future research
It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments. However, even after almost 30 years of research, HIV-1 remains a difficult target for a vaccine.
Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected. Patients with substantial immunosuppression are also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis as well.
Researchers have discovered an abzyme that can destroy the protein gp120 CD4 binding site. This protein is common to all HIV variants as it is the attachment point for B lymphocytes and subsequent compromising of the immune system.
Alternative medicine
Various forms of alternative medicine have been used to treat symptoms or alter the course of the disease. Acupuncture has been used to alleviate some symptoms, such peripheral neuropathy, but cannot cure the HIV infection. Several randomized clinical trials testing the effect of herbal medicines have shown that there is no evidence that these herbs have any effect on the progression of the disease, but may instead produce serious side-effects.
Some data suggest that multivitamin and mineral supplements might reduce HIV disease progression in adults, although there is no conclusive evidence on if they reduce mortality among people with good nutritional status. Vitamin A supplementation in children probably has some benefit. Daily doses of selenium can suppress HIV viral burden with an associated improvement of the CD4 count. Selenium can be used as an adjunct therapy to standard antiviral treatments, but cannot itself reduce mortality and morbidity.
Current studies indicate that that alternative medicine therapies have little effect on the mortality or morbidity of the disease, but may improve the quality of life of individuals afflicted with AIDS. The psychological benefits of these therapies are the most important use.
The AIDS pandemic can also be seen as several epidemics of separate subtypes; the major factors in its spread are sexual transmission and vertical transmission from mother to child at birth and through breast milk. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.1 million (range 1.9–2.4 million) lives in 2007 of which an estimated 330,000 were children under 15 years. Globally, an estimated 33.2 million people lived with HIV in 2007, including 2.5 million children. An estimated 2.5 million (range 1.8–4.1 million) people were newly infected in 2007, including 420,000 children.
Sub-Saharan Africa remains by far the worst affected region. In 2007 it contained an estimated 68% of all people living with AIDS and 76% of all AIDS deaths, with 1.7 million new infections bringing the number of people living with HIV to 22.5 million, and with 11.4 million AIDS orphans living in the region. Unlike other regions, most people living with HIV in sub-Saharan Africa in 2007 (61%) were women. Adult prevalence in 2007 was an estimated 5.0%, and AIDS continued to be the single largest cause of mortality in this region. South Africa has the largest population of HIV patients in the world, followed by Nigeria and India. South & South East Asia are second worst affected; in 2007 this region contained an estimated 18% of all people living with AIDS, and an estimated 300,000 deaths from AIDS. India has an estimated 2.5 million infections and an estimated adult prevalence of 0.36%. Life expectancy has fallen dramatically in the worst-affected countries; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study. In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to about 20 years.
As new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year. Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system. The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function health care and co-infections, as well as which particular strain of the virus is involved.
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control and Prevention recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles. In the beginning, the Centers for Disease Control and Prevention (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981. In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined. The CDC, in search of a name, and looking at the infected communities coined "the 4H disease," as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users. However, after determining that AIDS was not isolated to the homosexual community, the term GRID became misleading and AIDS was introduced at a meeting in July 1982. By September 1982 the CDC started using the name AIDS, and properly defined the illness.
A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine. According to scientific consensus, this scenario is not supported by the available evidence.
A recent study states that HIV probably moved from Africa to Haiti and then entered the United States around 1969.
Also seeAIDS origins opposed to scientific consensus
Society and culture
Stigmaostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.
AIDS stigma has been further divided into the following three categories:
- Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.
- Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
- Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.
Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, and intravenous drug use.
In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes. There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.
Economic impact
HIV and AIDS affects economic growth by reducing the availability of human capital. Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in countries with a significant AIDS populationi. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.
The increased mortality in this region will result in a smaller skilled population and labor force. This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers' time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents. By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.
On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.
AIDS denialism
A small group of activists, including several scientists who do not study HIV/AIDS, question the connection between HIV and AIDS, the existence of HIV itself, or the validity of current testing and treatment methods. Though these claims have been examined and thoroughly rejected by the scientific community,<ref name=consensus>For evidence of the scientific consensus that HIV is the cause of AIDS, see (for example):
- they continue to be promulgated through the Internet and have had a significant political impact, particularly in South Africa, where President Thabo Mbeki's embrace of AIDS denialism has been blamed for an ineffective response to that country's AIDS epidemic.
This article is licensed under the GNU Free Documentation License It uses material from the Wikipedia article AIDS


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U.K. stocks performed better during Margaret Thatcher's tenure compared to any other period of time over the last 50 years, delivering over 263 percent cumulative returns, according to research by Fidelity Investments.
On the day Thatcher, nicknamed the "Iron Lady", took office the FTSE All Share closed at 283.82, climbing to 1031.25 over the course of her 11 year premiership.
During Thatcher's three consecutive terms in office, between 1979 and 1990, the FTSE All Share delivered annualized returns of 11.79 percent.
Thatcher transformed the British economy through policies such as privatization, tax cuts and "big bang" financial reforms.
(Read More: Krugman Takes on Thatcher Legacy as Debate Rages)
During her successor John Major's premiership between 1990 and 1997, the FTSE delivered annualized returns of 12.04 percent.
The benchmark index delivered annualized returns of just 4.54 percent during Tony Blair's 10 years in office.
U.K. stocks had the worst run during Prime Minister Gordon Brown's tenure. The Labour Party leader, was in office just under three years between 2007 and 2010, and his tenure coincided with the demise of Lehman Brothers and the 2008 global financial crisis. The FTSE lost 18.2 percent cumulatively in this period.
The index has returned 13.52 percent under current Prime Minister David Cameron's tenure over the past three years.
(Read More: Did Thatcher's Reforms Pave Way for Euro Zone?)


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UW-Green Bay provides an 'RN to BSN' program in Nursing for registered nurses (RNs) who hold associate degrees or diplomas in nursing and want to complete their bachelor's degree in nursing. Students are required to have a current RN license before being formally accepted into UW-Green Bay's program.
UW-Green Bay does not offer nursing education for new freshmen or other newcomers to the field of nursing. Some students do, however, begin their studies with one or two years at UW-Green Bay before transferring to another nursing program. Students are advised to consult with their transfer school of choice regarding requirements, transfer information, and advising assistance before beginning course work at UW-Green Bay.
Newcomers to the field of nursing should consider other UW System programs at Oshkosh, Milwaukee, Madison, and Eau Claire. (Consult the UW System HELP website, www.uwhelp.wisconsin.edu , for details). Additionally, a number of private institutions in Wisconsin offer programs leading to a baccalaureate degree in nursing. Locally, for example, students of Bellin College in Green Bay can complete their general education requirements at UW-Green Bay through a dual-enrollment arrangement.


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Squidbillies: Volume 3 (US - DVD R1)
Gabe revisits the drunken, violent squids of the hills of Dougal County...
Get your Yankee ass of my property
Don't care if the bank gave you a deed
This farms been Cuyler land for generations
Since we beat back those slinky Japanese
In the war of 1812, bring our boys home.
Hmm. Here I am again, watching another Adult Swim series I've already reviewed in the past, and desperately trying to come up with new things to say about it. Everything I said last time pretty much stands – Squidbillies continues to blossom into one of the station's best on-going shows without approaching the dizzying, genre transcending heights of the best the company has to offer ( Venture Bros., Boondocks, Home Movies). This show is, like all the creators' shows (including ATHF, The Brak Show and Space Ghost Coast to Coast), still an acquired taste, but I continue to find viewings rewarding, even if the overall quality appears to have flattened out lately. This latest collection features a couple of real gems, some damn quotable dialogue, and the usual over-the-top, venom-tipped indictments of idiot redneck Americana.
Anabololic-holic (episode 44) starts things off with a grotesque look at the world of steroid use and pro-wrestling. Former real life pro-wrestler Mick Foley steals the show as Thunder Clap – a has-been wrestler who hides in the Appalachian mountains and half-assedly tries to eek out a peaceful life.
The Liar, the Bitch and the Bored Rube (episode 42) is an average episode that covers the common subject of Early's fear of edumacation. The episode earns points for using Dean Koontz as the example of impressive literary performance, and for some hilarious dialogue between Granny and Early concerning grammar.
The Fine Ol' Solution (episode 43) is the collection's best. Though the subject of walling off Mexico to save jobs has been well lampooned by The Simpsons, Family Guy, and I believe South Park, this episode takes the joke about as far as it can comfortably be taken in 11 minutes, including shark-throwing gorillas, and a not so surprising ending.
Lerm (episode 41) is the other favourite. Early meets his equal in an intergalactic drunk driver named Lerm. Lerm's angry behavior (usually followed by a fervent 'Death to America') proves too much even for Early, until Lerm runs a successful, and entirely unlikely political run.
Confessions of a Gangrenous Mind (episode 45) doesn't have much of a specific, easy to sum-up plot, but mostly sees Granny discussing family history. The basic gag is that her stories are lies, or at least not related to the subject of lineage.
Atone Deaf (episode 47) is another better than average episode. After drunk driving his truck-boat-truck Early is forced into anger management and community service. As per the norm The Sheriff's soft hand, coupled with his utter stupidity ensures Early learns nothing. This one is fast paced and violent, and features a digital compression joke.
The Big Gay Throwdown (episode 46) is a bit obvious, and covers the oft-covered subject of rampant homophobia covering for closeted homosexual urges. This is one of the weaker episodes, but still features some funny moments.
God's Bro (episode 48) is another one of the better episodes. God's brother, who looks kind of like a biker in his early 50s, visits Dougal County and impresses with his divine powers.
Reunited, and It Feels No Good (episode 49) and Not without My Cash Cow! (episode 50) are the first two-parter I can recall in the series' history. The first part introduces a never before seen member of the Cuyler family – Derwood, who got out of the hills and into the city before it was too late. This episode nicely expands the show mythology, and continues the developing theme of Rusty needing to escape his terrible family. The second part vulgarly pokes fun at America's obsession with child abduction, though Early only really cares about his missing welfare check.
This Volume Three release basically matches the Volume Two release in terms of video quality. Short story shorter, it looks fine, but as in the case of the previous collection release, and recent Aqua Teen Hunger Force collections, the lack of a Blu-ray option is a disappointment. Squidbillies features so much stuff on screen at once, given the textures of the hand painted backgrounds, and the number of moving elements, that standard definition simply can't handle the overload. Still, once again appears to be a progressive scan transfer though, with only some slightly jagged edges, and some minor edge enhancement (especially around black lines) to really spoil things for fans. As I said last time around, things are generally better looking than most crudely animated, low budget television shows. Colours are still solid for a standard definition transfer, and well separated, with the exception of some noise and blocking in the brighter warm hues. Issues with the end credits appearing pixilated appear to have been corrected.
Squidbillies features some truly revolting sound effects, and in Dolby Digital 5.1 it's kind of like being assaulted by grossness. I mean that in a good way. The effects are pretty flat on their own, but are layered well on the track and work directionally, though most of the movement is in the front channels. The rear speakers mostly pick up echoes from the front channels, but do have some life during the more musical moments, when the characters are outside at night time, and when certain characters speak with incredibly volume. Squidbillies continues its love affair with heavy metal and southern rock, and the quality of the show's music remains among its strongest (and likely overlooked) aspects. Unfortunately there aren't any really big band cameos this season/volume.
There aren't any commentary tracks around this time, so the extras begin with another 'Art + Music' (13:30) collection. For those that may have forgotten this is a slide show of art from the collection's episodes (backgrounds, character designs, etc.). The only other substantial extras is a selection of questions from the 2009 Dragon Con (8:30), featuring creators Jim Fortier and Dave Willis, and voice actors Unknown Hinson and Dana Snyder. This includes a musical performance from Hinson. This is followed by 'This Ain't a Hat, It's a Ragtop for a Sex Convertible' (1:20), an animation loop of Early walking that includes every hat from the series, 'Funny Pete Stuff' (8:10), a series of promos, and a series of 'Bumps' (2:50).
Squidbillies continues its run as one of Adult Swim's better, and more underappreciated shows (watching the bumps and promos the channel appears to really be pushing the show despite ratings). Volumes one and two are better places to start for the uninitiated, so I'd recommend this collection to fans rather than those with passing interest. To experience the show's acquired tastes for yourself without spending a penny visit the official Adult Swim Website. This release looks and sounds pretty much the same as the Volume Two release, but features fewer episodes and extras, so is slightly disappointing. Hopefully enough people will buy this, though, and Adult Swim will put the money into a full on Blu-ray release some time in the future. Fingers crossed!
Review by Gabriel Powers
Shadowmoses Member Join Date: July 2007 Location: United States Posts: 173
I've seen Unknown Hinson live a few times, he's a super nice guy, and really gets a kick out of people howling like Early at his concerts. The guy has a unique voice that fits that show perfectly. I couldn't imagine anyone else doing it. That being said, I love this show! Woow!
This product has not been rated
Disc Details
Release Date: 6th July 2010
Discs: 1
Disc Type: Single side, dual layer
RCE: No
Video: NTSC
Aspect: 1.78:1
Anamorphic: Yes
Colour: Yes
Audio: Dolby Digital 5.1 English
Subtitles: English
Extras: Art + Music, Dragon Con 2009, This Ain't a Hat, It's a Ragtop for a Sex Convertible, Funny Pete Stuff, Bumps
Easter Egg: No
Feature Details
Director: Various
Cast: Unknown Hinson, Dana Snyder, Daniel McDevitt and Todd Hanson
Genre: Animation and Comedy
Length: 101 minutes
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Attorney General Lockyer and Secretary of State Bruce McPherson Announce Joint Investigation Into Allegations of Voter Registration Fraud
(SACRAMENTO) – Attorney General Bill Lockyer and Secretary of State Bruce McPherson today announced the formation of a joint investigation into allegations of voter registration irregularities in Riverside and Orange counties. Secretary McPherson had previously opened his own inquiry into the allegations and requested the Attorney General's assistance.
"The right to free and fair elections is fundamental to our democracy," Lockyer said. "The allegations of voter fraud not only involve serious crimes, they also strike at the heart of our constitutional form of government. We will aggressively investigate these claims and vigorously prosecute those who broke state laws."
"Ensuring that eligible voters have the ability to vote is my top priority," said Secretary McPherson. "This office has zero tolerance for fraud. I will continue to do everything within my power to make sure that the integrity of our democratic process is protected and the rights of our citizens are preserved."
As the state's chief elections officer, the Secretary of State is in charge of overseeing the elections process and partnering with local election officials to ensure fair and accurate elections. McPherson's Elections Fraud Investigation Unit vigorously responds to allegations of voter fraud and recommending for prosecution of those who would corrupt the people's basic right to a free and fair election.
Under state law and the state Constitution, the Attorney General has concurrent jurisdiction with county district attorneys to enforce criminal laws. The state Elections Code establishes criminal penalties for specified acts of voter registration fraud. Although district attorneys are primarily responsible for investigation criminal wrongdoing within their own county, the Attorney General often will get involved where related acts of criminal conduct allegedly occurred in multiple jurisdictions.


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A chorus of poverty experts says that new data from the Census Bureau show the human cost of putting safety net programs like food stamps and unemployment insurance on the chopping block as austerity-pushers warn of the so-called "fiscal cliff."
The new Supplemental Poverty Measure (SPM) released Wednesday from the U.S. Census Bureau shows 49.7 million Amerians living in poverty -- an increase from the 46.6 million reported in poverty in the Bureau's official estimate from September.
What the data also show is how government safety programs have kept millions from heading into poverty.
In contrast to the federal poverty figures released by the Census Bureau roughly two months ago, the SPM offers a more holistic look at poverty, explains Melissa Boteach, Director of the Poverty and Prosperity Program for Center for American Progress and Director of Half in Ten, "by taking into account factors such as work expenses and medical costs that push families into poverty. They also provide crucial information on the effectiveness of work and income supports in lifting families above the poverty line."
The fact that the SPM shows these programs keep people out of poverty proves austerity-pushing voices like that of Paul Ryan wrong, says Greg Kaufmann, whose blog on The Nation focuses on poverty. Kaufmann says that "Paul Ryan says we don't look at whether programs are working, we just throw money at problems. He's wrong. SPM is an example of how we look at whether programs are working and find that poverty would be much worse without SNAP (food stamps), child tax credits, the Earned Income Tax Credit (EITC), unemployment insurance, etc. -- all of the things the GOP and some democrats will attack during 'cliff' negotiations."
Boteach points out the millions who've escaped poverty through safety net programs, as shown in the new SPM:
Refundable tax credits for working families such as the earned income and child tax credits, for example, lifted 8.7 million people out of poverty in 2011, and the child poverty rate would have been 6.3 percentage points higher without them. Similarly, the Supplemental Nutrition Assistance Program lifted 4.7 million people out of poverty in 2011. Without it, the child poverty rate would have been 2.9 percentage points higher.
David Cooper, an economic analyst at the left-leaning Economic Policy Institute writes that that figures offer a blunt reminder of the human toll cuts to safety net government programs would have:
As Congress debates how to address the looming "fiscal obstacle course," [Wednesday's] release is a stark reminder of what is at stake. Budgetary decisions have real world consequences. Lawmakers must remember that the choices they make are not simply reconciling numbers in the federal ledger; for millions of Americans, these decisions are the difference between meeting their family's basic needs and falling into poverty.
The SPM's documentation of the poverty-saving benefits of these safety nets couldn't be more timely, Arloc Sherman, a senior researcher at the Center on Budget and Policy Priorities adds:
First, in coming weeks policymakers will likely consider deep program cuts as part of major budget negotiations. Second, key measures that account for part of the safety net's large anti-poverty impact are poised to expire. These include federal emergency unemployment insurance and the 2009 Recovery Act's improvements in refundable tax credits like the EITC. Third, this is all happening at a time when joblessness – particularly long-term joblessness – remains elevated and the need for safety net programs remains strong, both to reduce hardship for jobless households and to maintain the strength of the economy overall.
The SPM makes clear that, to help avert any rise in poverty going forward, federal and state policymakers need to protect programs like unemployment insurance, housing assistance, and nutrition programs. And they should extend key recent, recession-related improvements to these programs, such as those in unemployment benefits and working-family tax credits like the EITC.
Also included in this more comprehensive measure of poverty is Medical Out-of-Pocket Expenses (MOOP), which, as the graphic below shows, is pushing millions into poverty, a fact that would be eliminated by a national, single-payer health program.
* * *


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While this piece begins with an intense burst of energy, it quickly mellows out into a relaxing house groove that will soothe listeners and leave them craving more.
Perfectly suited for corporate media, video game background music, or any other material that requires an upbeat and lively groove. Instrumentation is a blend of electronic and acoustic instruments, featuring a powerful bassline, bouncy percussion, playful synth leads, and an uplifting piano.
.zip includes full song and 1:14 looping version


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High blood pressure, also called hypertension, is a condition most often associated with adults. But kids can have high blood pressure too, even as infants.
An estimated 3% of kids have high blood pressure. In babies, it's usually caused by prematurity or problems with the kidneys or heart. While hypertension is far more common among adults, the rate among kids is on the rise, a trend that experts link to the increase in childhood obesity.
Many kids and teens with high blood pressure have no other health problems but do have a family history of hypertension and an unhealthy lifestyle — a bad diet, excess weight, stress, and insufficient physical activity.
If it goes untreated, high blood pressure can eventually lead to damage to the heart, brain, kidneys, and eyes. But if it's caught early, monitored and treated, a child with high blood pressure can lead an active, normal life.
Understanding Blood Pressure
Blood pressure is the pressure exerted by blood against the blood vessel walls as the heart pumps. The pressure increases when the heart contracts and pushes blood into the vessels and the pressure decreases when the heart relaxes, but there's always a certain amount of pressure in the arteries.
Blood pressure is driven by two physical forces — the one from the heart as it pumps blood into the arteries and through the circulatory system, and the other from the arteries as they resist this blood flow.
Blood pressure changes from minute to minute and is affected by activity and rest, body temperature, diet, emotional state, posture, and medications.
Long-Term Consequences of High Blood Pressure
When someone has high blood pressure, the heart and arteries have a much heavier workload. The heart must pump harder and the arteries are under greater strain as they carry blood. If high blood pressure continues for a long time, the heart and arteries may no longer work as well as they should. Other organs that are receiving the blood, like the kidneys and brain, may also be affected. Having high blood pressure puts someone at a higher risk for stroke, heart attack, kidney failure, loss of vision, and atherosclerosis (fat deposition in arteries).
While high blood pressure doesn't always cause symptoms, it still affects the body and puts a person at risk for those long-term health problems. In rare cases, severe hypertension can cause headaches, visual changes, dizziness, nosebleeds, heart palpitations, and nausea.
If your child has severe high blood pressure and has any of these symptoms, seek medical care immediately.
Measuring Blood Pressure
Doctors measure blood pressure with a sphygmomanometer, which has a cuff that's wrapped around the upper arm and pumped up to create pressure. When the cuff is inflated, it compresses a large artery in the arm, stopping the blood flow for a moment. Blood pressure is measured as air is gradually let out of the cuff, which allows blood to flow through the artery again.
The doctor or nurse will also put a stethoscope over an artery to hear the first pulse as the blood flows through — this is the systolic pressure (or the pressure at the peak of each heartbeat). The diastolic pressure (the pressure when the heart is resting between beats) is noted when the sounds disappear.
When a blood pressure reading is taken, the higher number represents the systolic pressure and the lower number represents the diastolic pressure. For example: 120/80 (120 over 80) means that the systolic pressure is 120 and the diastolic pressure is 80.
Blood pressure also can be measured by automated devices, which are good for screening, but a manual blood pressure is more accurate.
As kids grow, their blood pressure increases from a systolic pressure of about 70-90 in an infant to adult values in a teenager. Among young kids, the "normal" range will depend on gender, age, and height; your doctor will be able to compare your child's blood pressure with national norms.
In kids, high blood pressure is defined as a blood pressure greater than the 95th percentile for their age, height, and gender (in other words, 95% of kids of the same age, height, and gender will have blood pressure below this number). It's not unusual for a first blood pressure reading to be high because a child is nervous, so the doctor will likely take three readings and use an average of the three to determine whether your child has high blood pressure or is at risk for developing it.
Some doctors use a test called ambulatory blood pressure monitoring in which a child wears a blood pressure cuff all day. Some consider it more accurate than blood pressure tests in the doctor's office because the child is less likely to be affected by any stress from the doctor visit.
Causes of High Blood Pressure
The causes of high blood pressure differ, depending on the age of the child. The younger the child, the more likely the high blood pressure is linked to some other illness.
High blood pressure among infants most commonly occurs in those born prematurely. Some newborns have high blood pressure because of problems with the kidneys (most commonly), lungs, heart, or vascular system. Often, these problems are due to bronchopulmonary dysplasia, an immaturity of the lungs in premature babies, or problems like coarctation of the aorta, a narrowing of part of the major blood vessel that transports blood away from the heart.
Among school-age kids and teens, hypertension is usually linked to excess weight. In some cases it's due to a problem with the kidneys, although other conditions — like abnormalities in the blood vessels and hormonal disorders — can also be responsible. Some medications (such as steroids or oral contraceptives) can lead to high blood pressure, as can overconsumption of alcohol and illegal drugs.
Diagnosing High Blood Pressure
Because high blood pressure usually doesn't produce any symptoms, diagnosing the condition in kids can be tricky. Blood pressure varies a lot from day to day so several blood pressure checkups are often necessary to make the diagnosis (unless the pressure is very high when treatment is needed promptly).
The only way to know whether a child has high blood pressure is to get it checked regularly. Doctors usually start measuring blood pressure during routine checkups when kids are 3 years old. So it's important not to miss these appointments, particularly if your child is obese or if there's a family history of high blood pressure.
Treating High Blood Pressure
If an underlying illness is causing hypertension, treating that illness may be enough to get the blood pressure back to normal. If there's no underlying illness, the doctor may recommend weight loss, increased intake of fruits and vegetables, decreased salt intake, increased exercise, and even relaxation techniques. Kids with hypertension should also quit or never start smoking, which can worsen the long-term associated heart problems.
Most doctors prefer not to prescribe medication for kids with mild hypertension. However, in cases in which lifestyle changes do not bring improvement, medications may be necessary.
Exercise and participation in organized sports is encouraged for all patients whose hypertension is not severe or is well-controlled. In fact, staying fit is the key to both weight and blood pressure control.
If your child is overweight, an ongoing weight-loss program monitored by your doctor and a minimum of 30 minutes of aerobic exercise every day may be recommended. But kids with severe hypertension should not participate in weight- or power-lifting, bodybuilding, or strength training until their blood pressure is under control and a doctor OK's it.
Although rare in kids, mild to moderate hypertension over time can cause damage to the heart, kidneys, and blood vessels. Diagnosing and treating high blood pressure will help prevent this damage.
Author Name:
Dr Fazeel Zubai


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of degrees
& programs
Concentration: Applied Mathematics
Fall: February 15
Spring: November 15
Applications are processed on a semi-rolling basis.
Number Required: 3
From Whom: Letters of recommendation should be obtained from individuals who are well acquainted with the applicant's abilities and achievements in mathematics and related areas, particularly former instructors in mathematics courses and projects. Letters from instructors in related areas such as computation or the physical and life sciences are also appropriate. In certain cases, letters from employment supervisors or project leaders may be appropriate as well.
Applicants must complete fundamental undergraduate mathematics courses.
A Statement of Goals should describe the strengths and motivation of the applicant, the purpose for applying to a graduate program in mathematics, and why the applicant is interested in the intended degree. It should be well written. This forum should be used to make the applicant's strongest case for admission.
The GRE is required. The department considers an applicant's overall record and does not use rigid minimum score criteria. Students who wish to discuss their scores are encouraged to contact the department directly.
Minimum TOEFL score or range of scores needed to be accepted:
550 paper-based (PBT), 213 computer-based (CBT) or 79 Internet based (IBT).
A resume is required.
Students who have taken graduate courses at other institutions, or at Temple University prior to matriculation, may apply for transfer credit. Applications will not be considered until the student has completed at least one semester of full-time graduate study or the equivalent, if the student is part-time. All applicants for transfer credit are reviewed by the Mathematics Graduate Committee and may be denied if the Committee decides that the courses involved are substantially inferior to similar courses offered by the department. No course completed more that five years before the date of application will be awarded credit. Credit for courses substantially similar to courses taken since matriculation will not be awarded. If a course was taken before the bachelor's degree was earned, it cannot be awarded transfer credit. Transfer credit is only available for graduate-level courses in mathematical content. The maximum number of credits a student may transfer is 9.
An applicant who wishes to have certain admission requirements waived must contact the department directly to discuss the situation. Requests will be considered by the department on a case-by-case basis. In some cases, an additional appeal to the Graduate School may be required. In such a case, the department will make a preliminary determination for the applicant and, if positive, will issue a supporting letter to the Graduate School for the applicant.
Number of Credit Hours Required Beyond the Baccalaureate: 30
Required Courses:
Students must complete 10 graduate courses in mathematics, chosen in consultation with the graduate advisor. The following courses are recommended for students in the applied mathematics track: Mathematics 8013, 8031, and 8141.
Students in the applied mathematics track must choose either to write an M.A. thesis or to take the M.A. written comprehensive examination (or the Ph.D. comprehensive examination) in applied mathematics when their coursework is complete. The examination is based on material from the courses listed above.
Internship: No internship is required.
Language Examination: No language examination is required.
Comprehensive Examination:
The department offers two examinations for the M.A. degree. The master's comprehensive examinations are taken by students in the M.A. degree programs at the conclusion of their graduate study, typically at the end of the final semester prior to graduation. The M.A. comprehensive examinations are scheduled for 9:00 a.m. to 12:00 p.m. on the last Friday in May. Master's students may, if they wish, take the Ph.D. comprehensive examination. Otherwise, they take an examination designed specifically for the master's degree.
The M.A. examination consists of ten questions, assembled from five areas, with two questions from each area. The student is required to answer five questions, with no restriction as to the choice. Subject areas in applied mathematics include differential equations, numerical analysis, operations research, probability and statistics.
The comprehensive examinations are typically designed by faculty, usually two per exam, who have recently taught courses relevant to the subjects covered. Each question is graded independently by two faculty members, using a scale of 0-5. The grades are reconciled if there is a discrepancy. A total score of at least 15 out of 25 is passing. The case of any student whose total score is slightly less than 15 will be discussed by the graduate faculty, who will review the student's academic record and then decide whether or not the student has passed. If one of these examinations is failed, it may be repeated once, or the other examination may be attempted.
Students plan their thesis under the supervision of a faculty advisor with the approval of the Departmental Graduate Committee. The date, time, and location of a thesis defense are set by the graduate chair in consultation with the student's advisory committee.
Department of Mathematics
1805 North Broad Street
Wachman Hall (038-16)
Philadelphia, PA 19122
Kathleen Paul
Graduate Chairperson:
Cristian Gutierrez
Omar Hijab
The Department of Mathematics offers graduate work leading to the Master of Arts degree. The aim of the M.A. program is to provide students with a foundation sufficient to pursue careers in mathematics in industry, government, or education. The program offers opportunities to conduct original research under the supervision of a faculty member.
Time Limit for Degree Completion: 3 years
Students are able to complete the degree program through classes offered before 4:30 p.m. Students are able to complete the degree program on a part-time basis (8 credit hours or less per semester).
Department of Mathematics
1805 North Broad Street
638 Wachman Hall (038-16)
Philadelphia, PA 19122
The program encourages interdisciplinary coursework, research, and interactions among faculty and students with interest in computer and information sciences, physical and life sciences, statistics, and engineering.
The mathematics program at Temple University is affiliated with the American Mathematical Society and the Mathematical Association of America.
Department faculty are active internationally and sometimes travel overseas for conferences and extended research visits. In some cases, it may be possible for students to participate in these activities as well.
Not applicable.
This program adheres to accepted professional standards of mathematics education and research.
The M.A. is offered in two tracks: Applied Mathematics and Pure Mathematics. Both can be continued to the PhD. The applied track emphasizes computational mathematics and probability/statistics. The pure track emphasizes the classical areas of mathematics, such as analysis, algebra, probability, and topology.
The department has approximately 40 faculty members actively involved in research and graduate education. With a graduate student body of about the same number, we are a program of moderate size with a high faculty/student ratio. Therefore, we provide students with unique opportunities for flexible program design and ample interaction with faculty. Classes are small and are held in an informal atmosphere enabling students and faculty to work closely together.
The department offers a great variety of choices for areas of specialization. Areas in which there is a strong research presence include computational mathematics, numerical analysis, mathematics of materials, mathematical physics, related probability and mathematical statistics, algebra, algebraic and analytic number theory, combinatorics, several complex variables, harmonic analysis, partial differential equations, differential and computational geometry and topology, and global geometry. Both prospective and matriculated students are encouraged to browse faculty web pages and contact faculty directly for more detailed information regarding areas of specialization and opportunities for further research.
Graduates either continue advanced educational programs or pursue employment in industry, education, or government laboratories and agencies.
Non-matriculated students must coordinate coursework with the graduate chair.
Teaching assistants teach basic undergraduate mathematics courses, ranging from remedial courses through calculus. The standard teaching load is 20 hours per term. In determining the load, credit is given for more difficult and challenging teaching assignments. Research Assistantships are sometimes available, typically through special projects and grants. Support generally covers stipend and tuition, up to 9 credits per term.
September 2007


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It's Not Me...It's We
When you're in a relationship, the key is to remember that you're part of a duo! Communication is the key to every good relationship. In order for a couple to function, the two parties must convey how they feel. There are no mind readers in a relationship, so if you want to make a point or express an opinion you must voice it.
At times relationships can seem difficult but remember that you were lucky enough to find your soul mate. Here are seven tips to communicate better as a couple.


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MONTGOMERY — Troy University's Rosa Parks Museum will offer free tours on Monday, Dec. 2, to celebrate the 58th anniversary of the Montgomery Bus Boycott and Rosa Parks' historic arrest.
The museum will offer free admission to both the main Rosa Parks Museum and the Children's Wing from 9 a.m. to 5 p.m. on Dec. 2. Groups of 10 or more are asked to make reservations by calling (334) 241-8661.
The Montgomery Bus Boycott started with Rosa Parks' arrest on Dec. 1, 1955.
Constructed on the site of the Empire Theatre where Rosa Parks was famously arrested for refusing to give up her seat on a Montgomery city bus, the Rosa Parks Museum opened in December 2000 with the mission of preserving and interpreting the story and lasting legacy of the Montgomery Bus Boycott. In its 13 years of operation, it has become a major downtown landmark and has garnered state, national and international recognition.
For additional information on the free tours, contact Kathryn Palmer, scheduling specialist, at 334-241-8661.


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Ongoing HIV Infection Could Explain Low CD4 Counts Despite Undetectable Viral Loads, Study Suggests
September 23, 2012
Ongoing HIV infection of CD4+ cells may be the reason why some individuals with undetectable viral loads exhibit poor CD4+ cell count responses, according to study results presented at ICAAC 2012.
Researchers in Montpellier, France, used a qPCR assay to look for HIV DNA in the CD4+ cell cytoplasm. They posited that since cytoplasm has a short half-life, it could be a reliable marker of recent CD4+ cell infection.
The investigators studied CD4+ cell samples from virologically suppressed individuals who were on treatment. Further baseline information was reported by NATAP:
The researchers found the presence of HIV DNA in the CD4+ cell cytoplasm of 10 of the participants, according to the study abstract. Average CD4+ cell count trends were lower in these 10 individuals (-4 CD4+ cells per month) than in the other 23 individuals (+13 CD4+ cells per month). Though the study group was small, this finding was statistically significant (P = .035).
The researchers also compared immune responses by measuring CD38, a marker for immune activation, at the surface of CD8+ cells in a subgroup of 20 participants. The percentage of activated CD8+ cells in the individuals with detectable cytoplasmic HIV DNA rose an average of 1.7% monthly, whereas in the other individuals it decreased an average of 0.5% monthly (P = .052). This finding further suggested that ongoing HIV infection was occurring despite virologic suppression.
NATAP reported:
While these findings could lead to better ways of increasing CD4+ cell counts in people living with HIV, more research needs to be done in larger groups.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
Copyright © 2012 Remedy Health Media, LLC. All rights reserved.
HIV-Infected Patients More at Risk for Early Onset and Late Diagnosis of Coronary Artery Disease, Study Suggests
This article was provided by TheBodyPRO. It is a part of the publication The 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2012).
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Senator Tammy Duckworth gives birth to baby girl
WASHINGTON (Circa) – Senator Tammy Duckworth, D- Ill, has become the first senator to give birth while in office.
The senator tweeted the news of the birth of her second daughter, Malie Pearl, Monday afternoon.
Duckworth says Maile is named after her husband's great aunt, who was an Army officer and nurse in World War II, according to the Associated Press.
She thanked friends and family for their support during this time.
Members of the Senate held a baby shower at the capitol for Duckworth March 20, according to the Chicago-Sun Times.
The report said Duckworth, 50, is only one of 10 women to give birth while serving in Congress, the other women had children while serving in the U.S. House of Representatives.
Her daughter Abigail was born in 2014 while she was serving in the U.S. House of Representatives.


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Pregnant former Playboy pin-up Holly Madison is determined to keep her daughter from the pages of men's magazines.
The pretty blonde made a name for herself by stripping off for publications like her ex-boyfriend Hugh Hefner's monthly, but she doesn't want her child following mum into the flesh business.
The 32 year old mother-to-be tells In Touch magazine, "I don't think people are treated with respect in that environment. I'm from a small town and you grow up seeing people like Jenny McCarthy or Pamela Anderson, who made it big after doing Playboy.
"You think it's this glamorous thing until you realise how much you're judged for it."


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