Lee tried to stifle a sneeze but couldn’t. Invisible to the naked eye, a cloud of almost five thousand virus-filled droplets launched into the air at some 150 km/ hour or roughly 100 mph. Some passengers in the wide-body Airbus frowned. The Hong Kong to London flight was long and no one wanted to catch a cold.

Lee planned to fill every waking moment of his stay in London. A concert at the Millennium Dome, dinners at some of the finest hotels, shopping in crowded malls — “What a chance,” Lee thought. All he had to concentrate on was a few hours in front of the International Board. It was his job to present sales trends in China to the bosses who were also winging it towards Heathrow, one of the world’s busiest airports. “The global executives will get only good news from me,” figured Lee. “Pity I don’t feel better …”

The Diagnosis

Lee was exhausted. He had a cough, scratchy throat, runny nose and muscle aches. A fever started but it wasn’t until Lee began having difficulties breathing that he decided to get help.

Doctors huddled in subdued discussion. Experts were rushed in. It was finally determined that Lee’s body was fighting strenuously against two viruses. Lee had caught a highly infectious Influenza A virus — a flu bug. However, at much the same time he had also picked up a second virus called H5N1. The two viruses had mixed their genes and formed a hybrid. Since this was now a radically new pathogen, Lee had no immunity to it.

Lee was not the only one in this fight. Infected passengers from Lee’s plane from Hong Kong had connecting flights to major cities in most continents. The global executives Lee had addressed at the office had also flown home diseased. Sadly, some of the medical staff where Lee was diagnosed had also caught it not to mention the crowds Lee had interacted with at concerts, restaurants and on shopping sprees. The so-called Bird Flu or Avian Influenza had indeed spread its wings. It was the start of the first flu pandemic of the 21st century.

The News

Had Lee or any of the others known in time, they would have taken anti-viral drugs hoping to block or at least slow down the replication of the virus. At least the severity of some symptoms might have been eased not to mention a reduction in the duration of sickness. But time had run out – anti-viral medication needed to be taken within 48 hours of the first stages of the disease.

It wasn’t long before Lee was put on a respirator in quarantine. It also wasn’t long before the media found out Lee had Bird Flu. The public became nervous. The number of flu patients — real or imaginary — multiplied dramatically but nurses and hospital staff were strangely missing … using overdue holiday time or just not showing up for work at all. It was announced that schools, restaurants, and non-essential businesses would be closed. No deadline was given — no one knew for sure how long the measures would have to be in place.

The Public Announcement

Wisely, the public was advised to stock up on food and water. Newspapers advised people to stock up on toothpaste, toilet paper and treasure (cash). People were told to shop at off-peak hours and public transport was ordered to run 24 hours per day. But despite warnings to the contrary, doctor’s offices, hospitals and clinics were overrun. Faces masked in paper waited for hours in front of pharmacies in hope of getting relief. Despite clear instructions from health officials, panic broke out as folk finally fathomed that at best only one third of the population had access to anti-viral drugs. In rural areas and smaller towns, there wasn’t any chance at all.

The Short-term Havoc

Rumors and half-truths began to circulate causing public outcry and protests. Because the protests only helped spread the flu, quarantines were set in place. The public was told to stay at home indefinitely. Vibrant cities screeched to a halt as public transport shut down. Streets stank as garbage piled up. Shops were looted and in some cases those caught coughing were stoned. Safety services (fire, police, ambulance) were disrupted, fires burned out of control. Cross-border travel was curtailed killing tourism and all international sports events were cancelled. Food imports were banned creating shortages of meat, vegetables and wheat. Folk with chronic medical illnesses couldn’t get their medications. Soap and disinfectants — perhaps the simplest and most effective fight against the spread of disease — were in short supply; no one had thought to stock-pile soap.

The Controversy

Local governments and health organizations began to squabble over who had the power to do what. The question was of legalities: who would control distribution of anti-viral drugs and who would receive those drugs? Army barracks received attention but prisoners were ignored. Families with pets were labeled as ‘higher risk’ groups but no-one knew if these families should receive more help or less. As in-fighting became more severe, decision processing became more difficult. Who should give the daily press briefings? Who would organize mass cremation? Who would facilitate conferences for global medical meetings? The list grew rapidly.

The Waves

The first wave of the pandemic was over in three months time but not the shock. Bacterial disease such as cholera multiplied rapidly with catastrophic results across Africa and Asia. The longer-term, global recession began with the realization that supply-lines, manufacturing and food-production chains were desperately weakened through labor loss. Medical facilities were terribly understaffed. As usual, the poor had little chance of aid at all. And then came the second wave of Avian flu. It took over a year before the waves of sickness and death became controllable.

Lee actually survived it all. Although he “started” the pandemic, he also helped “end” it. Doctors used his blood to find the initial vaccine. Since Lee was also now immune, he not only volunteered to help where he could and also founded the World Association of Sensible Hygiene (WASH). More importantly, Lee and others like him helped disrupted societies regain their faith and hope and love. Since this was pandemic number 11 in the last 300 years, history had taught that it was inevitable that individuals and communities and countries would bounce back fairly quickly. But a bitter question remained. Would Lee and the rest of the world be better prepared for the next pandemic? Lee wondered that too as he bordered the wide-body Airbus destined for Mexico City.

 December 1 is recalled as the World AIDS Day. It is a method to educate the people about AIDS so that we can concentrate on the fight against AIDS and have the future planning to fight against it and find a solid solution to delete it from our planet earth.

What is AIDS (Acquired Immune Deficiency Syndrome)? It is a disorder of cell mediated immune system of the body. There is a reduction in the number of cells called helper T-cells which stimulate antibody production by B-cells. This result in the loss of natural defense against viral infection.

AIDS-Related Complex (ARC) It is a mild form of AIDS. Its symptoms are swollen lymph nodes, fever, sweating at night and weight loss. Patients with ARC have a high possibility of early development of AIDS. ARC is also known as a predromal AIDS.

Discovery of AIDS

AIDS was first noticed in USA in h-o-m-o-s-e-x-u-a-l-s in 1981. Virus of AIDS was isolated and identified by Prof. Luc Montagnier in France in 1983 and almost the same time by Prof. Robert Gallo in USA. AIDS infections were detected in India for the first time in prostitutes of Chennai in 1986.

The AIDS virus may have passed from a monkey host into human population in Africa during 1960s.

Pathogen (Causative Agent)

The virus was identified and named as HCLV III (Human cell leukemia Virus III), but now the name of the virus is changed to HIV (Human Immuno-Deficiency Virus). Structure of AIDS virus: it consist of glycoprotein cost, double layer of lipid membranes and two protein coats. It contains RNA and reverse transcriptase enzyme.

Incubation Period

The incubation period of HIV is between 15-27 months. Average incubation period is 28 months.

Diagnosis:

AIDS can be diagnosed by ELISA test and WESTERN BLOT test (year 2004).

Treatment: No specific treatments of AIDS have been found so far (year 2004) and the mortality from AIDS is 100%. Still two treatments are tried:

Antiviral therapy-against pathogen (HIV) Immuno-stimulative therapy to increase the number of resistance-providing cells in the body. A drug named Zidovudine prolongs the life of AIDS patients.

Reason for AIDS

AIDS virus is transmitted only via:

Blood Semen



Therefore the main causes for AIDS are the following:

Transmission of infected blood or blood products.

Use of contaminated needles and syringes to inject drugs or vaccines.

Use of contaminated razors.

Use of contaminated needles.

Having s-e-x with an infected partner without a c-o-n-d-o-m.

Parturition from mother to baby due to rupturing of blood vessels.

Artificial insemination.

Organ transplant.



Precaution against AIDS

At present we don’t have a perfect treatment to cure AIDS because no vaccine has been prepared so far against AIDS virus but a lot of precautions have been suggested. Following are the most important measures that may help in preventing the AIDS.

Use c-o-n-do-m while having s-e-x with such a partner about whom your knowledge is limited. Best is you should not maintain s-e-x-u-a-l relations with more than one partner. And a message to boys (men), have respect for girls (women), have s-e-x you’re your beloved/wife only don’t use them as s-e-x gadget.

Pay attention while donating blood for any purpose, Disposable needles and syringes should be used. Used needles and syringes must be destroyed.

Use your own blade and shaving razor and don’t share it with anyone, anyone means not even your family members.

Pay attention while taking treatment from a doctor, for example dentist should use sterilized equipments.

Take all precautionary First Aid measures while treating a wound or injuries i.e. wear hand gloves to prevent a direct contact with blood of the patient.



Myths about AIDS, it cannot be acquired by the following:

AIDS does not spread through air, water and normal physical contact.

It does not spread through insect bites like mosquito bites.

It does not spread through k-i-s-s-i-n-g, shaking hands, coughing and sneezing.

It does not spread through sharing towels, utilities, telephone, swimming pools and toilets.

If a husband or wife is suffering from AIDS then it is not necessary that its partner too have the disease.

It is not necessary that a mother suffering from AIDS will always give birth to a child suffering from AIDS, new born babies can be protected by giving proper treatment.



Our Social Duties

AIDS cannot be removed from the earth unless we understand our social duties. To fight against AIDS we should perform these duties:

A person suffering from AIDS should not maintain s-e-x-u-a-l relations with anyone.

A person suffering from AIDS should take proper medical treatment when get injured and prevent any one to come in direct contact with the HIV infected blood.

We should not hate the AIDS patients instead increase their moral to a normal social life.

We should follow the necessary medical precautions listed above to live along the HIV infected person.

We should educate the people about AIDS like this or any other means.



AIDS reference centers in India

In India, four reference centers have been established (2004)

AIIMS, New Delhi

National Institute of Communicable Diseases, New Delhi

National Institute of Virology, Pune

Centre for Advanced Research on Virology, CMC, Vollore.



“HATE AIDS NOT THE PATIENT”

 

One difference between the threat of bird flu today and the 1918 flu is that in 1918 we did not have a large number of people with extremely weak immune systems.

Before antibiotics, people with really weak immune systems tended not to survive childhood.

Today, we have:

Many people who are deliberately taking drugs to reduce the strength of the immune systems, because they’ve had organ transplants.

Many more people who have weakened immune systems because they’re undergoing chemo or radiation treatment for cancer. There’re millions of such patients around the globe.

And yet many other people who are infected with the HIV virus, which weakens immune systems by infecting CD4 (or T-4) cells. According to the United Nations World Health Organization, there were 40.3 million HIV+ people in the world by the end of 2005.

We also have more people with severe chronic diseases such as heart disease, simply because we have more treatments to keep them alive.

That’s a total of many millions of people who must avoid all contact with bird flu during a pandemic.

And that is the best protection — avoid all contact with bird flu.

And that means avoiding contact with as many people as possible. Because during a pandemic anybody could have the virus. It infects you from 1 to 2 days before you know you’re sick, and you shed the most virus in the 2 to 5 days after infection.

There are no flu vaccines specifically for contagious bird flu, and they will likely not be produced until 6 months after the pandemic begins, which will be far too late for many people. And the virus will mutate more as it continues to spread and replicate, so it’s unlikely we’ll ever have an influenza vaccine that exactly matches the strain of H5N1 we’re exposed to. And it mutates and recombines so quickly that during a pandemic several different strains could be spreading at the same time.

Tamiflu may help these people more than others, because it does directly interfere with the bird flu virus’ ability to infect the cells of your respiratory tract. Unfortunately, we don’t yet know exactly how much Tamiflu is needed to fully protect against bird flu. And it’s quite likely that strains of the virus will develop resistance to Tamiflu — if they haven’t already.

Relenza works much like Tamiflu, except it’s inhaled. This reduces its effectiveness against H5N1 because it goes to the upper respiratory tract, but the virus likes to infect cells in the lower respiratory tract. Its makers are not working on creating an injectable form of it.

People with poor immune systems must do everything they can to avoid the virus. Reduce contact with people and wash their hands at least once an hour.

They should also do everything they can to keep up their general health: sleep a lot, eat a good balance of proteins, vegetables and fruit while avoiding sweets and starchy carbohydrates, stop smoking, reduce alcohol, exercise moderately and maintain a positive attitude.

They should also take immune boosting and strengthening food supplements: Omega-3, zinc, selenium, Vitamin C, Vitamin E, beta carotene, Vitamin B complex, green chlorophyll superfoods, and so on.

If possible, they should try to receive any medical care they need at home. If possible, they should avoid going to hospitals and clinics. These places have many strains of antibiotic-resistant bacteria even now.

During a bird flu pandemic they’ll be crowded with flu patients spreading the H5N1 virus — exactly what immune-compromised people must avoid.

And of course, consult with they should consult with their doctor.

The recent XVII International AIDS Conference, which ended on August 8 in Mexico City, addressed new medications that fortunate Americans have at their disposal. Indeed, medicine and pharmacology have come a long way since 1983 when concerned representatives from thirty nations met at the World Health Organization headquarters in Genera, Switzerland. That meeting was the precursor to what would eventually become the International AIDS Conferences, the first of which took place two years later in Atlanta, Georgia. In 1983, the discussions centered on questions regarding how to isolate the virus and ultimately, how to make an HIV antibody test so that “at risk individuals” could determine if they had been “exposed” to it.

When a virus enters the human body, our brilliant immune system attempts to contain it by making “antibodies”. In the majority of cases, these antibodies are successful in their counter-attack and the virus is destroyed without the subject being aware that this miraculous, mini, internal war even took place. In relatively rare cases, however, the virus can out-smart the immune system which still, albeit futilely, produces antibodies. One can use an analogy of a soldier shooting at an unarmed enemy in successful cases of a destroyed virus, versus a soldier firing at an armored tank when a virus cannot be contained.  In such instances, a vaccine is the only long-term, truly effective method to protect the subject by immunization.

In 1983, the medical world was eagerly awaiting the discovery of the virus and the subsequent HIV antibody test. HIV was finally isolated in 1984 as an international fury erupted over who had been the real discoverer: The National Cancer Institute in Washington, DC, or the Pasteur Institute in Paris, France. This unfortunate legal dispute delayed the development of the first antibody test until 1985 when the HIV ELIZA (enzyme-linked immunosorbent assay) test was released to the public. The controversy over who actually isolated HIV was “settled” by President Reagan who declared that both researchers had miraculously discovered it at precisely the same moment. However, most authorities maintain HIV was first isolated by the French.

During this nascent phase of understanding HIV, the first 36,000 American victims had no treatments at their disposal. As a result, there were 20,000 American deaths before there was a tool to even determine if an individual had been exposed to the virus. Terrified people afflicted with the illness, as well as their friends and family, pooled resources and raced off to Mexico, France and other countries following reports of miracle drugs and bizarre treatments. One such weird “cure” was the injection of ozone into the anus. Others attempted to kill the virus by heating the patient’s blood and re-introducing it into the body, while still others went to Israel for an ineffective drug made from egg yolks. It was not until late 1987, six years after the first patients started dying, when the beginning of scientific yet primitive treatments became available in the form of an old antiviral medication: AZT (Azidothymidine), which was eventually renamed Retrovir. The first desperate infectious disease physicians had no alternative but to prescribe it in highly toxic doses to their frantic patients.

In 1988, as the number of reported AIDS cases in America reached 86,000, public demonstrations managed to put pressure on the FDA to accelerate new drug approvals. Consequently, early treatments for the often fatal illnesses caused by HIV were discovered, notably for Pneumocystis Carinii pneumonia and CMV (cytomegalovirus), the cause of blindness and severe intestinal distress in AIDS patients. Other than AZT, no medication to actually contain the virus was available much less a vaccine.

By mid-1989, the FDA created the “AIDS Clinical Trial Information Service” so that AIDS victims and their physicians could be informed of HIV drug trials. This encouraged many patients to “take control” of their health and to seek admission into clinical trials or question their doctors about new medications. Concurrently, scientists were developing what would eventually become a major diagnostic tool to measure the virus’ activity through “viral load testing” which determined how many “copies” of the virus were present in the afflicted individual’s blood.

Although the ensuing years saw the development of some prophylactic medications, it was not until 1996 for important new, break-through HIV medicines to appear on the market. The FDA approved a new category of anti-retroviral (ARV) medications called “protease inhibitors” as Glaxo Wellcome’s Epivir became widely prescribed. Clinical trials had demonstrated the drug’s ability to reduce the “viral load” in HIV patients. Numerous pharmaceutical companies, seeing huge profit potential, accelerated research and development of similar, expensive medications. Within months, four other large companies, Roche, Roxane Labs, Abbott Labs and Merck came out with their own protease inhibitors. As a result, “a sea change” emerged in the HIV/AIDS community that had far reaching implications. The newly prescribed combination of drugs, known as “the cocktail,” prolonged life. Many severely ill patients began to improve as symptoms lessened and they returned to some sort of normal existence. This development was not without great cost, however, both literally and figuratively. The new cocktails typically cost in excess of twelve hundred dollars a month. As one can imagine, many patients could not afford these expensive regimens while still others found the drug cocktails’ side effects very hard, or impossible, to tolerate. 

By the end of last century, AIDS had killed an estimated twenty million people worldwide. In America, the face of AIDS had changed from the so-called “gay plague” to become largely an inner city catastrophe. As patients who were able to access physicians and obtain medications were living longer, infectious disease physicians were becoming experts in many medical disciplines. Given the broad spectrum of illnesses their patients were exhibiting, the partially contained virus had more time to gradually weaken its victims. A new sub-group of HIV patients called “long term survivors” had emerged.

The optimism regarding the efficacy of anti-retroviral therapy that took hold during the mid-nineteen nineties was short lived. At the International AIDS Conference in Geneva, Switzerland in 1998, the focus of the discussion centered on an alarming observation that infectious disease physicians had begun to observe called “anti-retroviral drug resistance.” Drug resistance occurs when a virus begins to “mutate”. Clever viruses figure out how to get around antiviral medications by transforming themselves. In the case of HIV, the mutated virus engages in a renewed attack and finds ways to enter, and destroy, the main building block of the immune system: the T-Cell. Physicians know an HIV mutation has occurred when they see a patient’s viral load climbing. A complicated and expensive new diagnostic tool called “genotypic assays” or “genotyping” allows physicians to specifically determine which medication has failed and, therefore, which parts of the individual patient’s drug cocktail need to be replaced.

The result has been a plethora of new, effective medications. The few available drugs of the early 1990’s have grown to dozens of medications distributed into six different “classes.” For now, the new drugs are very effective and the Department of Health and Human Services’ has issued new and ambitious guidelines. All treating physicians are urged to make their patients reach an “undetectable viral load” which, in turn, will keep the virus from further destroying the immune system and, hopefully, from mutating. Prior to these new classes of medications, the “undetectable” target was reached in relatively few cases.

The combined treatment called “HAART” (highly active antiretroviral therapy) is effective but complicated, costly and not without side-effects. Long term HIV survivors run risks of developing diabetes as well as cardiac, renal and hepatic problems. The official list of side effects contains fifty-one disorders, the six most common being abdominal pain, headaches, insomnia, rash, nausea and lipodystrophy (fat redistribution). 

Given the current efficacy of the new medications, there is renewed optimism.  However, constant viral level monitoring and an absolutely strict adherence to each patient’s program are essential. Only a few missed doses can create a circumstance where the virus may mutate, the patient runs the risk of developing serious illnesses and some, or all, of the medications have to be replaced.

The current advances have been achieved through successful research and focus on anti-retroviral therapies. In so doing HIV is — for now — under control if the subjects are very disciplined and seen regularly by competent infectious disease physicians.  It is important to remember, however, that in the history of virology, no completely successful anti-viral treatments have been effective in the long run. Only a vaccine which changes the host and renders the virus irrelevant is the real, long-term hope to eradicate AIDS.

While numerous groups around the world are researching an HIV vaccine, none have been successful. Many problems stand in the way of a vaccine including the complexities posed by HIV mutations and the ethical issues surrounding the safety of HIV vaccine trials. For the second time in as many years, and as recently as last month, one of the leading hopes for a therapeutic vaccine was, at the very least, severely delayed. A large, proposed human clinical trial to be conducted by a division of NIH (The National Institute of Health) was cancelled for security reasons.  Researchers behind the previously cancelled trial had also become concerned about heightened risks. Clearly, even one highly publicized transmission of the virus during trials will severely reduce the pool of potential, HIV negative trial volunteers forever.

Unless and until a successful vaccine is discovered, the best AIDS patients and infectious disease physicians can hope for is continued containment of a deadly and clever virus through costly, complex regimes rife with side-effects both short and long term.

©2008 Richard René Silvin

Author Bio

Born in New York, from the ages of seven through eighteen, Silvin grew to adulthood within the confines of strict and homophobic Swiss boarding schools. After earning his bachelor’s degree from Georgetown University (1970) and an MBA from Cornell (1972), where he also later lectured and was voted one of the most successful graduates. He spent twenty-five years as a senior executive in a New York Stock Exchange investor owned hospital company. There Silvin rose to the head of the international division of American Medical International, Inc., which owned and operated one hundred hospitals in ten countries. René lives with his beloved canine companion, T-Cell, in Atlanta, Georgia, and Palm Beach, Florida. His awards include being a Chevalier (Knight) of the Franco-Britanic Order. He has written numerous articles on hospital management and is listed in Who’s Who in the World (1988), Who’s Who in Finance and Industry, and Who’s Who in Health Care. His book, Walking the Rainbow, is available now from Whitmore Publishing Co.