Winning battles, but losing the war

There have been numerous advancements in the battle against HIV and AIDS. HIV was isolated and its genome cloned and sequenced in less than three years after the first cases were announced in mid-1981.

Charles John Palenik, MS, PhD

There have been numerous advancements in the battle against HIV and AIDS. HIV was isolated and its genome cloned and sequenced in less than three years after the first cases were announced in mid-1981. Eighteen months later, an antibody test for HIV was developed. Three major routes of transmission were quickly identified — sexual contact with an infected person, blood-to-blood, such as sharing of needles and syringes, and from infected mothers to their fetuses or newborns. Significant effort also has been extended in preventive programs that emphasize behavior modification. Antiretroviral therapies became available in 1987. Because of more effective combination therapies, HIV-infected persons have begun to live longer. Perinatal transmission of HIV has been controlled when combination therapies are used properly. AIDS has become a treatable and somewhat manageable chronic affliction in the developed world.

A major battle yet to be won involves the development of a preventive or therapeutic vaccine. No trial vaccine to date has produced broadly neutralizing antibodies.

In spite of continuous progress, the world is losing the war on HIV and AIDS. Much of our attention lately has been directed toward terrorism and personal safety. Nevertheless, HIV and AIDS, when added to poverty and the socioeconomic status of women, wreaks far more havoc each day than terrorist acts.

A study recently released by the Centers for Disease Control and Prevention indicates an overall increase in HIV diagnoses in the United States. The CDC study reports a 5.1 percent rise during 1999-2002. Data came from 29 states that have confidential reporting schemes. Unfortunately, several states (California, Illinois, New York, Maryland, and Washington) did not participate because they have either just started confidential reporting or have alternative surveillance schemes. Nationwide reporting of HIV diagnoses would improve estimates of the HIV-infected population.

Of the 102,590 newly diagnosed, more than half (55 percent) are black. Significant increases also were observed among Hispanics (a 26 percent increase) and non-Hispanic whites (an 8 percent increase). HIV diagnoses increased 17 percent among gay and bisexual men and 7 percent among men overall. The study suggests that the rise in new HIV diagnoses likely represents new infections and not more testing.

The CDC estimates between 850,000 and 950,000 persons in the United States are living with HIV — the most since the epidemic began. The CDC also estimates that of 25 percent of persons living with HIV, approximately 180,000 to 280,000 remain unaware of their infections. Some 40,000 new HIV infections continue to occur annually in the United States.

Challenges concerning the HIV and AIDS epidemic remain. Those having high-risk behaviors need to seek testing, treatment, and prevention counseling. A new CDC initiative, "Advancing HIV Prevention," helps communities, governmental groups, and health-care providers help at-risk individuals. The goal is for the select population to learn their HIV status, attain a better understanding of prevention and, if infected, learn treatment options and methods of care.

A rapid HIV test, which can provide preliminary results in as little as 20 minutes, is central to the CDC effort. The test was approved in November 2002 and offers a 99.6 percent accuracy rate. The new test provides preliminary information about a person's HIV status. Greater use should result in care being afforded more quickly, thus slowing disease progression, and in faster starts for precautionary measures, preventing disease spread. More than 8,000 HIV-infected people who go to public health clinics for HIV testing each year do not return a week later for their test results.

According to CDC Director Julie Gerberding, the new CDC study supports three key realities of the current HIV and AIDS situation: the HIV epidemic in the United States is not over; more often than not, the face of HIV is black or Hispanic; and gay and bisexual men in some communities are facing a possible resurgence of HIV infection.

The Organization for Safety & Asepsis Procedures is dentistry's prime source for evidence-based information on infection control and prevention and human safety and health. More information on HIV and AIDS is available on the OSAP Web site, www.osap.org.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters, and monographs. He is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the executive board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection-control issue may be directed to office@osap.org.

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