AIDS AND ITS TREATMENTS

About Authors:
Sweet Naskar*, Sanjit Kr. Roy, Ketousetuo Kuotsu
Department of Pharmaceutical Technology,
Jadavpur University,
Kolkata – 700032,
West Bengal, India.
*sn62525@gmail.com

Abstract
The aim of the present investigation is to know about AIDS and its treatments. Various treatments for AIDS are described here.AIDS stands for acquired immunodeficiency syndrome. Acquired immune deficiency syndrome(AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). 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, breast feeding etc. As of 2009, AVERT estimated that there are 33.3 million people worldwide living with HIV/AIDS, with 2.6 million new HIV infections per year and 1.8 million annual deaths due to AIDS. Highly active antiretroviral therapy (HAART) continues to have a favourable impact on disease progression and mortality in settings where it is available to people living with HIV.

Reference Id: PHARMATUTOR-ART-1430

Introduction
AIDS stands for acquired immunodeficiency syndrome. Acquired immune deficiency syndrome (AIDS) is a disease of thehuman immune system caused by the humanimmunodeficiency virus (HIV). This condition progressively reduces the effectiveness of the immune systemand leaves individuals susceptible to opportunistic infectionsand tumors. HIV is transmitted through direct contact of amucous membrane or the bloodstream with a bodily fluidcontaining HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission caninvolve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between motherand baby during pregnancy, childbirth, breastfeeding etc.

HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease. AIDS is now a pandemic. As of 2009, AVERT estimated that there are 33.3 million people worldwide living with HIV/AIDS, with 2.6 million new HIV infections per year and 1.8 million annual deaths due to AIDS. According to UNAIDS 2009 report, worldwide some 60 million people have been infected, with some 25 million deaths, and 14 million to slow the spread of the virus. Orphaned children in southern Africa alone since the epidemic began.

Fig1: Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte

* History AND Origin
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC) 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.

The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. A recent study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969.

The HIV virus descends from the related simian immunodeficiency virus (SIV), which infects apes and monkey sin Africa. There is evidence that humans who participate in bush meat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, only a few of these infections were able to cause epidemics in humans.

* Replication AND Mutation Of HIV
HIV allows itself to be "eaten" by the defense cells and this way it gets into the defense cells of the human body. At the same time the virus brings along the enzyme "reverse transcriptase" which transforms the genetic material of the virus itself (RNA) into the human genetic material (DNA). The genetic material of the virus is then built into the one of the host cell, where it can lie dormant for many years.

When replicating, the virus tricks the defense cells in the same way. If the defense cell receives a command to replicate (for example to kill HIV or other viruses or bacteria), this triggers the replication of HIV. While replicating, the virus uses the host cell for its own purposes, exploiting its nutrients. Thousands of HIVs are immediately formed, destroying the defense cells. The new HIVs in turn attack other defense cells.

Fig2: HIV replication cycle in a helper cell

HIV is assimilated into the host cell (helper cell):
HIV docks with the CD4 receptor of the helper cell.
HIV smuggles in its genetic material (RNA).
Reverse transcriptase of the helper cell converts the RNA into DNA.
Integrase integrates the viral DNA into the DNA of the cell nucleus of the host cell.

The replication of HIV:
HIV-DNA is converted into RNA.
Protease builds up new HIV (sprouting).
HIV detaches itself from the host cell (budding).

* Course Of HIV Infection
The course of untreated HIV infection can be divided into three phases: the acute HIV disease, then the latency phase and finally the disease of Aids, ending in death. The acute HIV disease lasts a few weeks. This period is also known as the window of vulnerability, and it is characterized by an explosive replication of the HIV. During this phase, the HIVs invade the organs of the defense system and other bodily organs and establish themselves there. The latency phase lasts on average 10 years, during which the virus concentration is relatively low. In the Aids phase the defense system is completely destroyed, as the result of which death occurs after 1-2 years.

Fig3: Course of an HIV infection without treatment

* The HIV Life Cycle
Once HIV is in the body, it targets and infects a certain type of white blood cell called a CD4 cell. HIV then takes over or “hijacks” these cells and turns them into factories that produce thousands of copies of the virus. The steps HIV goes through to complete this process are as follows:

Binding and Fusion
HIV begins to enter a CD4 cell by binding or attaching itself to a specific point, called a CD4 receptor, on the cell’s surface. HIV must then bind to a second co-receptor, either the CCR5 co-receptor or the CXCR4 co-receptor. This allows the virus to join with the CD4 cell in a process called fusion. After fusion, HIV releases its RNA (genetic material) and enzymes (proteins that cause chemical reactions) into the CD4 cell.
Reverse Transcription
HIV’s RNA contains the “instructions" that will reprogram the CD4 cell so that it produces more viruses. In order to be effective, HIV’s RNA must be changed into DNA. An HIV enzyme called reverse transcriptase changes the HIV RNA into HIV DNA.
Integration
Next, the newly formed HIV DNA enters the nucleus (command center) of the CD4 cell. Another HIV enzyme called integrase combines or integrates HIV’s DNA with the CD4 cell’s DNA.
Transcription
Once the virus has become part of (is integrated into) the CD4 cell, it commands the CD4 cell to start making new HIV proteins. The proteins are the building blocks for new HIV viruses. They are produced in long chains.
Assembly
A HIV enzyme called protease cuts the long chains of HIV proteins into smaller pieces. As the smaller protein pieces come together with copies of HIV’s RNA, a new virus is put together (assembled).
Budding
The newly assembled virus pushes (“buds”) out of the original CD4 cell. This new virus is now able to target and infect other CD4 cells.

Fig4: Targets for HIV Meds

* Signs And Symptoms
People with AIDS 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 live.

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Fig5: Main symptoms of Acute HIV infection

· Pulmonary
Pneumocystis pneumonia (originally known as Pneumocystis cariniipneumonia, 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 HIVbecause it is transmissible to immunocompetent people via therespiratory route, and is not easily treatable once identified, Multidrug resistance is a serious problem. Tuberculosis with HIV co-infection (TB/HIV) is a major world health problem according to the World Health Organization:

Fig6: X-ray of Pneumocystis pneumonia (PCP). There is increased white (opacity) in the lower lungs on both sides, characteristic of PCP

· Gastrointestinal
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, diarrhoea 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.

· Neurologic And Psychiatric
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 genii; 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 thefungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients mayalso 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.

· Tumors
Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma ssociated herpesvirus (KSHV) (also known as human herpesvirus-8 [HHV-8]), 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 gamma herpes 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. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract.When they occur in an HIV-infected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS. Invasive cervical cancer in HIV-infected women is also considered AIDS-defining, it is caused by human papillama virus (HPV). In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinomas, head and neck cancers, and lung cancer. Some of these are caused by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects. Interestingly, 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. In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.

Fig7: Kaposi's sarcoma in HIV infected individual

· Other Infections
AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic 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 crypto coccosis) in HIV-positive individuals within the endemic area of Southeast Asia. An infection that often goes unrecognized in AIDS patients is Parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretro viral drugs used to treat AIDS itself.

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic 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.

* Cause
AIDS is the ultimate clinical consequence 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 the number of CD4+ T cells per microliter (µL) of blood drops below 200, cellular immunity is lost. Acute HIV infection usually 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. 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.

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.

· Sexual Transmission
Sexual transmission occurs with the contact between sexual shear. 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 condoms are rarely employed and physical trauma to the vagina or rectum occurs frequently, 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. There is also a significant although lesser increase in risk from STIs such as gonorrhea, chlamydia 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 uninfectedpartner. Infectivity seems to vary during the course of illness and is not constant between individuals. Anundetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genitalsecretions.

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 sexual relationships. This allows the virus to quickly spread to multiple partners who in turn infect their partners.

· Blood Products
This transmission route is particularly relevant to intravenous user’s 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 inNorth America, China, and Eastern Europe. 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 healthcareinjections.

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 thehigher the viral load, the higher the risk. Breastfeeding also increases risk of transmission by about4%.

* Cells Affected
The virus, entering through which ever route, acts primarily on the following cells:

v Lymphoreticular system:

CD4+ T-Helper cells
Macrophages
Monocytes
B-lymphocytes

v Certain endothelial cells

v 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 HIV 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 cannot produce enough antibodies either. Thus the immune system collapses leading to the familiar AIDS complications, like infections and neoplasm’s (vide supra).
Infection of the cells of the CNS causes acute aseptic meningitis, subacute encephalitis, vacuolar myelopathy and peripheral neuropathy. Later it leads to even AIDS dementia complex.
The CD4-gp120 interaction is also permissive to other viruses like Cytomegalovirus, Hepatitis virus, Herpes simplex virus, etc. These viruses lead to further cell damage i.e. cytopathy.

* Diagonosis
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.

* Diagnosis Of HIV Infection
HIV can't be diagnosed through a medical examination or via disease symptoms. Diagnosis is only possible on the detection of the HIV virus or antibodies in body fluids (e.g. blood). Normally the presence of antibodies is tested.

The diagnostic window:
It takes some weeks before sufficient quantities of antibodies exist in the blood for the test. This period from infection to proof of infection is called the diagnostic window. The period varies from person to person and is dependent on several factors (transmission path, quantity of transferred viruses, immune system etc.).
The diagnostic window can be reduced by an average of 3 weeks with the use of an antigen (virus) test or a combination of antigen and antibody tests. For most people the time taken between infection and diagnosis is 3 months but it may take 6 months before it is possible..

Fig8: HIV infection and antibody reaction

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* 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.[95] 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.

* 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 and infants (i.e., patients younger than 2 years),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.

ØRegional Statistics For HIV and AIDS, End Of 2009

Region	Adults & children living with HIV/AIDS	Adults & children newly infected	Adult prevalence	AIDS-related deaths in adults & children
Sub-Saharan Africa	22.5 million	1.8 million	5.0%	1.3 million
North Africa & Middle East	460,000	75,000	0.2%	24,000
South and South-East Asia	4.1 million	270,000	0.3%	260,000
East Asia	770,000	82,000	<0.1%	36,000
Oceania	57,000	4,500	0.3%	1,400
Central & South America	1.4 million	92,000	0.5%	58,000
Caribbean	240,000	17,000	1.0%	12,000
Eastern Europe & Central Asia	1.4 million	130,000	0.8%	76,000
North America	1.5 million	70,000	0.5%	26,000
Western & Central Europe	820,000	31,000	0.2%	8,500
Global Total	33.3 million	2.6 million	0.8%	1.8 million

* Prevention
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.Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels.

* 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 risk of infection with HIV and other STDs. 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 lubrication is desired, manufacturers recommend using water-based lubricants. Oil-based lubricants can be used with polyurethane condoms.

Female condoms are commonly made from polyurethane, but are also made from nitrile and latex. They are larger than male condoms and have a stiffened ring-shaped opening with an inner ring designed to be inserted into the vagina keeping the condom in place; inserting the female condom requires squeezing this ring. Female condoms have been shown to be an important HIV prevention strategy by preliminary studies which suggest that overall protected sexual acts increase relative to unprotected sexual acts where female condoms are available.At present, availability of female condoms is very low and the price remains prohibitive for many women.

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 but epidemiological and behavioral studies in Europe and North America suggest that a substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV.

The results of the study, which was conducted by the Centre for the Aids Programme of Research in South Africa (CAPRISA), were published in Science magazine in July 2010, and were then presented at an international aids conference in Vienna.

Receptive anal intercourse* 50
Insertive anal intercourse* 6.5
Receptive penilevaginal intercourse* 10
Insertive penilevaginal intercourse* 5
Receptive oral intercourse*§ 1
Insertive oral intercourse*§ 0.5

* assuming no condom use § source refers to oral intercourse performed on a man

* Body Fluid Exposure
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 needle stick 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
Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant.Women can pass HIV to their babies during pregnancy, while the baby is being delivered, or through breast-feeding .Mother-to-child transmission is the most common way children become infected with HIV.

* Mechanism of Action of Antiretroviral drugs
* Nucleoside Reverse Transcriptase Inhibitors (NRTIs) interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.

* Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.

* Protease Inhibitors (PIs) inhibit protease, which is another protein involved in the HIV replication process.

* Fusion Inhibitors prevent HIV from binding to or entering human immune cells.

* Entry Inhibitors - CCR5 co-receptor antagonist prevent HIV from binding to or entering human immune cells.

* HIV integrase strand transfer inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells.

Fig9: Blocking HIV replication by ART

* Antiretroviral Drugs Used In The Treatment Of HIV Infection
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).

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses in a Day
Combivir	Lamivudine and zidovudine	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Buildup of lactic acid in the blood, enlarged liver, lipodystrophy, kidney problems, serious psychiatric symptoms including severe ,Anemia, neutropenia, myopathy, buildup of lactic acid in the blood.	Two
Emtriva	Emtricitabine, FTC	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, diarrhea, enlarged liver, aneamia.	One
Epivir	Lamivudine, 3TC	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, diarrhea, Anemia, neutropenia, buildup of lactic acid in the blood, enlarged liver, lipodystrophy, fatigue.	One or two
Epzicom	Abacavir and lamivudine	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, diarrhea, headaches, Hypersensitivity reaction, anemia, neutropenia, buildup of lactic acid in the blood, enlarged liver.	One
Retrovir	Zidovudine, azidothymidine, AZT, ZDV	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, vomiting, loss of appetite, headaches, fatigue, insomnia, Anemia, neutropenia, myopathy.	Two
Trizivir	Abacavir, zidovudine, and lamivudine	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, vomiting, diarrhea, loss of appetite Hypersensitivity reaction, anemia, neutropenia, myopathy.	Two
Truvada	Tenofovir disoproxil fumarate and emtricitabine.	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, diarrhea, headaches, skin rash, skin discoloration,kidney problems, bone problems, buildup of lactic acid in the blood.	One
Videx EC	Enteric coated didanosin, ddI EC.	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, diarrhea, Peripheral neuropathy, pancreatitis, buildup of lactic acid in the blood, enlarged liver, lip dystrophy.	One
Viread	Tenofovir disoproxil fumarate, TDF	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, vomiting, diarrhea, gas problems, bone problems, buildup of lactic acid in the blood, enlarged liver, lipodystrophy.	One
Zerit	Stavudine, d4T	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, vomiting, diarrhea or constipation, headaches, fatigue, skin rash, Peripheral neuropathy, pancreatitis, buildup of lactic acid in the blood.	Two
Ziagen	Abacavir sulfate, ABC	NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.	Nausea, vomiting, headaches, fatigue, loss of appetite, buildup of lactic acid in the blood, enlarged liver, lip dystrophy.	One or two

* NRTIs are available in most countries.

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses a Day:
Intelence	Etravirine	NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.	Rash, diarrhea, nausea, Hypersensitivity, Stefen-Johnson syndrome.	Two
Rescriptor	Delavirdine, DLV	NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.	Nausea, diarrhea, headaches, fatigue, skin rash, fever, Stevens Johnson Syndrome, liver problems.	Three
Sustiva	Efavirenz, EFV	NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.	Nausea, diarrhea, headaches, skin rash, insomnia, increased liver..	One
Viramune (Immediate Release)	Nevirapine, NVP	NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.	Nausea, headaches, skin rash, fever, fatigue, Stevens-Johnson syndrome, liver problems.	Two (start with a lower dose for two weeks, then increase to full dose)

* NNRTIs are available in most countries.

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• Protease Inhibitors (PIs)

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses a Day
Agenerase	Amprenavir, APV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Diarrhoea, cardiovascular risks, birth defects lypodystrophy, insulin resistance.	Two
Aptivus	Tipranavir, TPV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, vomiting, diarrhea, abdominal pain, fatigue Liver problems, lipodystrophy, sulfa allergy, increased bleeding, Stevens-Johnson syndrome	Aptivus is only taken boosted with Norvir
Crixivan	Indinavir, IDV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, heartburn, Nausea, vomiting, diarrhea anemia, lipodystrophy, increased bleeding in people with hemophilia, abdominal pain, heartburn,	Three
Invirase	saquinavir mesylate, SQV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, abdominal pain, gas, headaches, fatigue, insomnia, Lipodystrophy, increased bleeding in people with hemophilia	Invirase is only taken boosted with Norvir
Kaletra	Lopinavir and ritonavir, LPV/RTV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, vomiting, abdominal pain, headaches, Liver problems, pancreatitis, lipodystrophy, increased bleeding in people with hemophilia	One or two
Lexiva	Fosamprenavir Calcium, FOS-APV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, vomiting, diarrhea, abdominal pain, gas, headaches, Heart attacks and increases in cholesterol and kidney stones, liver problems, Stevens-Johnson syndrome .	Two
Norvir	Ritonavir, RTV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, abdominal pain, loss of appetite, headaches, heartburn, fatigue, weakness, Liver problems, pancreatitis, lipodystrophy.	Two
Prezista	Darunavir	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, headaches, skin rash, Liver problems, lipodystrophy, sulfa allergy, increased bleeding in people with hemophilia, Stevens-Johnson syndrome.	Prezista is only taken boosted with Norvir
Reyataz	Atazanavir sulfate, ATV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, abdominal pain, Liver problems, changes in heart rhythm, peripheral neuropathy, lipodystrophy, kidney stones,skin rash.	One
Viracept	Nelfinavir mesylate, NFV	PIs inhibit protease, which is another protein involved in the HIV replication process.	Nausea, diarrhea, abdominal pain, gas, skin rash, weakness, increased cholesterol& triglycerides,liver problems, lipodystrophy.	Two or three

* Protease inhibitors are generally less suitable for starting treatment in resource-limited settings due to the cost, number of pills which need to be taken, and the particular side effects caused by protease drugs.

• Fusion Inhibitors

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses a Day
Fuzeon	Enfuvirtide, T-20	Fusion inhibitors prevent HIV from binding to or entering human immune cells.	Skin irritation (at injection site), insomnia, and headache.	Two injection

* Fusion inhibitors are usually only available in resource-rich countries.

• Entry Inhibitors - CCR5 Co-Receptor Antagonist

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses a Day
Selzentry	Maraviroc	Entry inhibitors prevent HIV from binding to or entering human immune cells.	Cough, fever, colds, rash, muscle and joint pain, toxicity, cardiovascular problem.	Two (dose is dependent on other drugs being taken)

* Entry inhibitors are usually only available in resource-rich countries.

• HIV Integrase Strand Transfer Inhibitors

Brand Name	Generic Name	How they attack HIV	Side Effects	Number of Doses a Day:
Isentress	Raltegravir	Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells.	Diarrhea, nausea, h Liver toxicity, elevated levels of a muscle enzyme called creatine kinase eadaches.	Two

* Integrase inhibitors are usually only available in resource-rich countries.

* Combination Therapy
Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).
• Contents Of Combination Therapy
The most common drug combination given to those beginning treatment consists of two NRTIs combined with either an NNRTI or a "boosted" protease inhibitor. Ritonavir (in small doses) is most commonly used as the booster; it enhances the effects of other protease inhibitors so they can be given in lower doses. An example of a common antiretroviral combination is the two NRTIs zidovudine and lamivudine, combined with the NNRTI efavirenz.
· Need Of Combination Therapy
If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly reduces the the rate at which resistance would develop, making treatment more effective in the long term.

• Multi-Class Combination Products

Brand Name	Generic Name	Who produce the drug	Side effects	Number of Doses a Day:
Atripla	Efavirenz, emtricitabine and tenofovir disoproxil fumarate	Bristol-Myers Squibb and Gilead Sciences.	Dizziness, trouble sleeping, drowsiness, nausea, headache, Buildup of lactic acid in the blood, enlarged liver, lipodystrophy, kidney problems, serious psychiatric symptoms including severe.	One

* Mother To Child Transmission Therapy
Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding Without treatment, around 15-30 percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5-20 percent will become infected through breastfeeding.

• WHO Guidelines For Mother-To-Child Transmission (MTCT) Drug Regimens During Pregnancy In Resource-Limited Settings.

Recommendations	Pregnancy	Labour	After birth: mother	After birth: infant
2010 Recommendations option A	AZT after14 weeks	Single dose nevirapine; AZT+3TC	AZT+3TC for seven days	Daily NVP until 1 week after breastfeeding has finished
2010 Recommendations option B	Triple ARVs after 14 weeks	Triple ARVs	Triple ARVs until 1 week after breastfeeding has finished	6 weeks of daily NVP
2006 Recommendations	AZT after 28 weeks	Single dose nevirapine; AZT+3TC	AZT+3TC for seven days	Single dose nevirapine; AZT for seven days
Alternative (higher risk of drug resistance)	AZT after 28 weeks	Single dose nevirapine	_	Single dose nevirapine; AZT for seven days
Minimum (less effective)	_	Single dose nevirapine; AZT+3TC	AZT+3TC for seven days	Single dose nevirapine
Minimum (less effective; higher risk of drug resistance)	_	Single dose nevirapine	_	Single dose nevirapine

* Triple Combinations
The most effective Mother-to-child transmission (MTCT) therapy during pregnancy involves a combination of three antiretroviral drugs taken during the later stages of pregnancy and during labour. This therapy is essentially identical to the treatment taken by HIV-positive people for their own health, except that it is taken only for a few months, and the choice of drugs may be slightly different. Triple therapy is usually recommended to women in high-income countries, and is becoming more widespread in the rest of the world and the WHO guideline 2010reflects this.

* Complementary And Alternative Medicine

A) Ayurvedic treatments for AIDS:
Ayurvedic herbal formula which increases ojas, and restores the digestive, eliminative, respiratory and sexual systems. It is frequently employed in wasting conditions where it has been clinically shown to improve health and assist with weight gain.Some of the propritery ayurvedic medicines achieving good improvement in the quality of life of patients include 'Chyavanprash', 'Raktavardhak' for Immunity building and 'Sookshma triphla tabs' to keep awaythe the infection.

An example of an Ayurvedic remedy which may be of use in the treatment of persons diagnosed with AIDS is 'Chyavanprash'. 'Chyavanprash' is most useful and most popular rejuvenator tonic (Rasayana) of Ayurveda. This is an Ayurvedic herbal formula which increases ojas, and restores the digestive, eliminative, respiratory and sexual systems. It is frequently employed in wasting conditions where it has been clinically shown to improve health and assist with weight gain. The main ingredient in Chyavanprash is 'Amalaki'- the Indian gooseberry (Emblica officinalis), which has the highest yield of natural source vitamin C, with 3000 mg per fruit. It is also a rich source of naturally occurring anti-oxidants including bioflavonoids, vitamin B-complex and carotenes (vitamin A). Chayvanprash also contains about 35 others herbs which amplify and augment the effects of its main ingredient; such a powerful formulation may indeed be helpful in the treatment of persons who have been diagnosed with AIDS.

B) Dietary Managements For AIDS
* Diet And Nutrition
The role of good nutrition in the management of HIV/AIDS has assumed increasing importance over the past decade. In fact, medical research has shown that nutritious food is one of the most powerful weapons available for fighting the often-calamitous effects of AIDS. Furthermore, it has been clinically confirmed that malnutrition is the fatal manifestation of AIDS for many of the people who succumb to the disease. People living with AIDS may require up to twice the normal daily caloric intake to protect themselves from the dangers of HIV-related malnutrition: heightened immunosuppression, muscle wasting, and outright starvation due to malabsorption and abnormal metabolism of nutrients. In addition, appropriate dietary modifications can significantly reduce both the side effects of medications and the symptoms of opportunistic infections.

Good nutrition means getting enough macronutrients and micronutrients. Macronutrients contain calories (energy): proteins, carbohydrates, and fats. They help you maintain your body weight. Micronutrients include vitamins and minerals. They keep your cells working properly, but will not prevent weight loss.

When you lose weight, you might be losing fat, or you might be losing lean body weight like muscle. If you lose too much lean weight, your body chemistry changes. This condition is called wasting syndrome or cachexia.Persons with inadequate nutrition, who are HIV positive, manifest symptoms such as nausea, vomiting, malabsorption, diarrhea, oral/esophagealid disease progression. Even when nutritional intake is adequate, an HIV-positive person may lose weight long before he or she develops AIDS. This happens because, throughout the progression of HIV have an increased to opportunistic infections and a more rapstatus is challenged by the fectiosusceptibilityn, the patient`s nutritional problems, and infections that impede fat storage. People with HIV may also develop lactose intolerance. After HIV infection has progressed to AIDS, malabsorption of nutrients may become severe. Weight loss can cause a vicious cycle of fatigue, muscle wasting, and loss of appetite.

Zimmerman explained the general principles of Nutritional healing in HIV/AIDS:
1. Maintain normal body weight. Be aware of the caloric intake you need to achieve and maintain a normal weight.
2. Build muscles/maintain lean body mass (avoid wasting). Use strength training and, if necessary, steroids or hormones to build/maintain muscle mass.
3. Optimize digestion. The digestive tract is your center of health—simple steps like chewing your food carefully can make its job much easier! Eating 4-6 small meals is more efficient than eating 1-3 large meals.
4. Eat more `healing foods`, fewer processed foods.
5. Drink 6-10 cups of non-caffeinated fluids daily.
6. Use supplements rationally and consistently.
7. Address social and emotional isolation, as these factors can negatively influence your food choices.

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* Dietary Supplements
Dietary supplements are commonly used in an effort to boost the immune system. Foods or substances derived from foods (garlic, Chinese bitter melon, and turmeric) are used, as well as nonfood dietary supplements such as shark cartilage or blue-green algae (spirulina). Vitamins, minerals, and amino acids are also used in an attempt to boost the immune system.
Some specific supplement suggestions are:

Name of specific supplements	Use of specific supplements
Protein/Calorie (Boost, Ensure, etc.)	Weight gain. *not for people with severe thrush or yeast infections.
Protein Powders (whey, glutamine, soy)	Increase protein intake (can help build/preserve muscle mass) *not for people with severe liver or kidney disease
Therapeutic Multivitamins	Provides 100% of the recommended daily allowance of many vitamins.
Selenium	Antioxidant. This is the only supplement directly related to improved mortality in HIV infection. The recommended daily allowance can be obtained in 1-2 Brazil nuts or in pill form.
Alpha Lipoic/Thioctic Acid	Antioxidant. Good for liver detoxification and neuropathy relief.
Calcium	Preserves bone, muscle, nerve function and diarrhea.
Coenzyme Q10	Support body`s energy pathways.

C) Yogic Treatment For AIDS
Yoga is to help the individual balance the body`s chakras or energy centers. Yoga can aid in detoxification, strengthen particular organs, improve stamina, and alleviate chronic fatigue. Yoga techniques can do much to help one reduce excessive fear and anxiety, learn stress-coping skills, and build inner strength through the relaxation and self-awareness training of meditation. Although it is certainly not necessary for someone who is HIV positive to take a specially designed yoga class, it could be beneficial. Yoga is quickly gaining ground as an important complementary therapy in the treatment of HIV and AIDS because of its adaptability and its physiological and psychological benefits.
Yoga has also helped to manage the symptoms of HIV, along with the side effects of his medication. There are certain poses that assist in relieving fatigue, diarrhea, anxiety and depression.

i) Primary Sequence of Poses for HIV/ AIDS:
1. Handstand (Adho Mukha Vkrasana)
2. Peacock pose (Pinca Mayurasana) (optional pose, to be done only if student is strong enough and can perform other poses).
3. Supported downwards dog (Ado Mukha Svanasana) (with head supported by a block).
4. Headstand (Sirsasana) (students with neck problems or weakness may try chair headstand).
5. Inverted staff pose (Viparita Dandasana) (supported with chair).
6. Supported bridge pose (Setu Bandha Sarvangasana) (supported by setu bandha bench or blocks).
7. Simple cross leg pose (Sukhasana) (leaning forward, head supported by chair).
8. Supported shoulder stand (Salaam Sarvangasana) (use chair or halasana bench for support).
9. Supported plow pose (Ardha Halasana) (use chair or halasana bench for support).
10. Legs up the wall (Viparita Karani) (with buttocks supported by blankets or bolsters).
11. Supine bound angle pose (Supta Baddha Konasana) (with back and head supported by blankets or bolsters)
12. Supported relaxation pose (Savasana) (with back and head supported by blankets or blosters).

ii) Alternative Sequence of Poses for HIV/AIDS:
This sequence is for students who should not perform the full inversions, but it can be done by others as well.
1. Supported downwards dog (Adho Mukha Svanasana) (with head supported by a block).
2. Supported head/knee forward bend (Janu Sirsasana) (support head with blankets or blosters).
3. Three part forward bend (Triang Mukhaikapada Pascimottanasana) (support head with blankets or blosters).
4. Seated forward bend, or Halasana (use chair or halasana bench for support).
5. Supported half bound lotus forward bend (Ardha Baddha Padma Pascimottanasana) ( support head with blankets or boosters).
6. Supported shoulder stand (West stretch) (Pascimottanasana) (support head with blankets or blosters).
7. Supported plow pose (Ardha Salamba Sarvangasana) (use chair for support).
8. Supported bridge pose (Setu Bandha Sarvangasana) (supported by setu bandha bench or blocks).
9. Legs up the wall (Viparita Karani) (with buttocks supported by blankets or blosters).
10. Supine bound angle pose (Supta Baddha Konasana) (with back and head supported by blankets and blosters).
11. Supported relaxation pose (Savasana) (with back and head supported by blankets .

D) Natural Treatment for HIV
Although one can be gifted genetically with a powerful immune system, nutrients from food ensure the full development of it. Without proper nutrients, immune system of animals or humans can never function to the optimum. Since plants constitute the basic food chain, it provides the most valuable source of natural nutrients and even of medicinal value. Herbivores living only on plants without any use of drugs testify this.

Health herbs have been used extensively in hopes of improving immune response and reducing symptoms. No known herbal remedy has been shown to cure AIDS or even reduce chances of AIDS-related infections.

Aloe vera, St. Johnswort, echinacea, licorice, and ginseng are just a few of the herbs used to treat HIV/AIDS. Taking immunity-boosting herbs (such as astragalus, echinacea, and ginkgo) may help revive an ailing immune system, and certain herbs (such as garlic) may help battle bacteria and viruses. Deglycyrrhizinated licorice can soothe the mouth and throat ulcers that often accompany full-blown AIDS.

E) Hyper Baric Oxygen Therapy
Inhaling pure, pressurized oxygen won`t drive HIV out of the body, but it may alleviate bothersome symptoms of AIDS, including numbness in the arms and legs and fatigue. It may even help stave off certain opportunistic infections. However, using this therapy to treat or relieve symptoms of AIDS, stroke, cancer, senility, and multiple sclerosis is much more speculative and right now too uncertain to justify using this costly therapy. Plus, oxygen under high pressure can cause serious damage (including ruptured membranes, collapsed lungs, and cataracts), so this is not a technique to be undertaken lightly.

A certain amount of oxidation has to happen for the body to function. Oxidation therapy is based on the theory that repeated environmental stress cuts down on the ideal amount of oxidation. Restoring it with extra doses of oxygen—in one of several forms—is supposed to rev up these reactions and, in the process, heal just about any ailment.

F) Bodywork Treatment For AIDS
There is much evidence that suggests that many complementary and alternative therapies have a therapeutic effect on the body, relieving stress, anxiety and depression in HIV and AIDS patients. People living with AIDS have the opportunity of using aromatherapy and massage. Aromatherapy is the use of essential oils extracted from plants that are applied to the body giving relief to particular conditions. One oil which has been valuable to people suffering from AIDS, is Tea Tree. This has been found to have antibacterial, antiviral and antifungal action. As the HIV virus depletes the immune system, bacterial and fungal opportunistic diseases develop in individuals. For example Candida Albicans is a fungal disease which affects the tongue, throat, esophagus and the bowel. This disease causes discomfort and pain in AIDS patients. However, Tea Tree is an effective method of controlling the disease.

There is evidence that massage has many benefits. Massage therapy is a viable health option to help alleviate pain and discomfort from everyday life, overuse, habitual patterns, occupational stresses, and many chronic pain syndromes. Massage therapy is the manipulation of the soft tissues of the body to gain a therapeutic response. Soft tissue includes muscles, skin and connective tissue, tendons, ligaments and membranes.

Massage is the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. Therapeutic massage is not only beneficial in relieving a variety of physical symptoms including chronic pain, but it may also be effective for relaxation and stress reduction. Massage can help people with HIV/AIDS relieve chronic muscle tension and ease the mental and emotional stress that accompany the illness. Body manipulation/massage techniques that are being used to treat HIV/AIDS include acupressure, the Alexander technique, Deep muscle therapy, Polarity therapy, Reiki, Rolfing, Shiatsu, Rubenfeld Synergy, Swedish massage, and Therapeutic massage.
The Benefits of Massage:
• Anxiety levels are reduced.
• Muscular tension and fatigue are reduced.
• Pain minimized by the hormone endorphins.
• Reduction in emotional stress.
• A feeling of warmth gained by improved local blood circulation.

G) Traditional Chinese Medicine
The use of acupuncture and Chinese herbal medications has become one of the most commonly used alternative therapies for AIDS. Central to the philosophy of Chinese medicine is the concept of ch`i, or qi, which can loosely be defined as the vital energy of the universe, of which all things are made. Ch`i patterns fluctuate between the polarities of what are called yin and yang, the active and passive sides of the life force. Illnesses can crudely be viewed as either excesses or deficiencies in either the yin or yang components of chic.

Chinese herbs may be a rich source of therapeutic agents for AIDS and its related illnesses. It is essential that people with HIV have all the information they need to select the treatment options most suited to their own needs and dispositions. Chinese medicine is a promising option which is safe, appears to be somewhat effective, and is affordable. Many of the herbs have been found to inhibit HIV and other viruses in laboratory experiments. Other herbs have been shown to act as biological response modifiers, enhancing certain immune responses. It was reported that individuals receiving correctly applied acupuncture needling had notable increases in their CD4 counts after only a brief course of therapy.

H) Siddha Medicine
Siddha system is based on hypothetical and biological laws of nature. The Siddhars were pioneers to the world in the field of minerals, metals, and medicinal herbs. They found out the methods of processing metals, minerals, herbs and natural raw materials to make churnams, chenthurams and leyhams (Churnam is powdered formulation, leyhams is thick batter like formulation).

The body`s immunity gets heavily depleted by excess indulgence as stated by the Siddhars. Siddhars have evaluated that Azhal thathu is responsible for the defense of the body. Disease takes place with the deterioration of the Vindhu thathu. Such deterioration leads to diseases such as pain, skin lesions, formation of nodes, malignancy, fistula, abscess, cervical adenitis, inquinal adentitis (adentitis is inflammation of the glands), ulcers in the loin, eczematous eruptions, pustules, constipation, TB, diarrhea, chronic dysentery, anemia, jaundice and upper respiratory infections. Siddha medicines are formulated in such a way as to have a total rejuvenating effect on the body and not only effective against a particular disorder.

The special feature of the Siddha medicine is that most of the preparations are in compound formulation, and because of its synergistic action, toxicity is diminished, thereby increasing bioavailability through the cells of the body. The pharmacodynamics of this system is entirely different from other systems of medicines.

Drugs that could be prepared for AIDS may be classified as follows:

Drugs that could be prepared for AIDS	Example of Drugs preparation
Herbal preparations	Serankottai Nei (herbal ghee), Mahavallathy leyham, Pa’anga rasayanam
Herbo mineral preparations	Gandhak Perham, Gandhaka Rasayanam
Herbo mercuric preparations	Idivallathy Mezhugu, Poona Chandrodayam
Herbo-mercuric-arsenal preparations.	Rasagandhi Mezhugu, Nandhi Mezhugu, Sivandar Amirtham, Kshayakulanthan Chenduram

I) Homeopathy
Homeopathic medicines, which include minerals, vitamins, and animal products, are natural substances given in very low doses. Homeopathy is based on the principle that "like cures like", that is, substances that in large doses would cause adverse symptoms will, in small doses, treat those same symptoms. Homeopathy is highly individualized to a patient`s symptoms.

One of the advantages of using homeopathy in treating people with AIDS is that they tend to get various unusual symptoms, diseases, and syndromes which evade immediate diagnosis. A homeopath, however, can prescribe a remedy before a definitive conventional diagnosis is made. Because homeopathic medicines are prescribed on the basis of a person`s unique pattern of symptoms, a conventional diagnosis is not necessary for a curative remedy to be prescribed.

Mumbai-based homeopath Dr. Mukesh Batra also treats HIV/AIDS. Says Batra: "We have treated about half-a-dozen AIDS cases in the three years. The treatment works on building up the immune system. Our success rate has been almost 100 per cent in treatments that relieve symptoms of AIDS patients such as repeated cold, cough, weight loss, and diarrhea. A patient with AIDS was treated at our clinic in Mauritius a couple of years ago. He tested HIV positive. He was losing weight and had repeated attacks of cold, cough and pneumonia. With homeopathic treatment for about a year and a half he began to put on weight and his tests returned to normal."

J) Acupuncture
Acupuncture involves the relatively painless insertion of extremely thin needles into the skin at specific points to help balance the body`s flow of energy, referred to as qi ("chew"). When needles are inserted into the appropriate points, it is thought that energy is unblocked, and symptoms can be relieved. Variations of acupanture include acupuncture and shiatsu (pressure and massage of acupuncture points). Acupuncture is sometimes used to relieve some HIV-related symptoms such as neuropathy, fatigue, and pain. It is also used in an attempt to strengthen the immune system.

Acupuncture is based on the understanding that just as energy can be disrupted or depleted, so also can it be rechanneled and replenished. Thus, the acupuncture needles may stimulate the body`s own energy reserves or they may transmit energy from the environment into the body. Because each individual will have a unique interplay of energies, organs, and elements, as well as a unique character, the treatment is, theoretically, individualized.

It is important to find a licensed acupuncturist who is experienced in treating people with HIV. Local AIDS hotlines and community-based organizations may be helpful in offering referrals. After finding a qualified acupuncturist, the first step in treatment is accurate diagnosis. The practitioner uses several traditional diagnostic techniques to determine whether treatment should be aimed at stimulating or dispersing energy. Needles are then inserted at specific points along the appropriate meridian. Initially, practitioners used acupuncture to provide symptom-relief for persons with AIDS.

There is no claim that acupuncture has direct antiviral effect on HIV. But many professionals trained in both Western and Chinese medicine, have found that acupuncture offers many benefits to the overall health of a person with HIV. In fact, more and more people with HIV are using acupuncture to reduce stress, pain, and tension, among other conditions.

Conclusion
Remember AIDS does not discriminate caste, creed, race, religion, educational or social status. Prevention of AIDS is our joint responsibility. Education and awareness is the only weapon in our hand. Let us accept the challenge to fight against AIDS. We must support and care for the people with HIV / AIDS with compassion and understanding.

References