Confronting AIDS

Directions for Public Health, Health Care, and Research

Publisher: National Academies Press
ISBN: 9780309036993
eISBN Pdf: 9780309554954
Place of publication: United States
Year of digital publication: 1986
Month: January
Pages: 393
DDC: 616
Language: English

Caption

This volume examines the complex medical, social, ethical, financial, and scientific problems arising from the AIDS epidemic and offers dozens of public policy and research recommendations for an appropriate national response to this dread disease.

Confronting AIDS
Copyright
Preface
- TERMINOLOGY
- STRUCTURE OF THE REPORT
- ACKNOWLEDGMENTS
Contents
Abstract
1 Confronting AIDS: Summary and Recommendations
- STATUS OF THE EPIDEMIC
  - Infection and Transmission
  - Clinical Manifestations of the Disease
  - Statistical Dimensions of the Epidemic
- THE FUTURE COURSE OF THE EPIDEMIC
- OPPORTUNITIES FOR ALTERING THE COURSE OF THE EPIDEMIC
  - Public Education
    - Preventing HIV Infection Among IV Drug Users
  - Public Health Measures
    - Surveillance
    - Mandatory Screening
    - Voluntary Testing
    - The Role of Coercive Measures in Public Health Efforts
  - Funding for Education and Other Public Health Measures
  - Discrimination and AIDS
- CARE OF PERSONS INFECTED WITH HIV
  - Health Care Costs Resulting from HIV Infection
  - The Financing of Health Care for HIV-Related Conditions
- FUTURE RESEARCH NEEDS
  - Basic Research
  - The Natural History of HIV Infection
  - Epidemiologic Approaches
  - Animal Models
  - Antiviral Agents
  - Vaccines
  - Social Science Research Needs
  - Funding for Research on AIDS and HIV
- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION
  - Rationale for U.S. International Involvement
  - Risks of Infection Outside the United States
  - International Research Opportunities
- GUIDANCE FOR THE NATION'S EFFORTS
  - What Is Needed?
  - Establishment of the Commission
- MAJOR RECOMMENDATIONS
2 Understanding of the Disease and Dimensions of the Epidemic
- THE CAUSATIVE AGENT OF AIDS
  - Features of Retroviruses
  - Related Viruses
- PATHOGENESIS OF AIDS
- NATURAL HISTORY OF THE DISEASE
- CLINICAL MANIFESTATIONS OF HIV INFECTION
  - Opportunistic Infections
  - Kaposi's Sarcoma
  - Other Malignancies
  - Neurologic Complications Associated with HIV Infection
  - Pediatric AIDS
- MODES OF TRANSMISSION OF HIV
  - Sexual Transmission
  - Parenteral Transmission
  - Maternal-Infant Transmission
- POPULATION GROUPS AT INCREASED RISK OF HIV INFECTION
  - Homosexual Men
  - Intravenous Drug Users
  - Hemophiliacs
  - Recipients of Blood Transfusions
  - Heterosexual Contacts of HIV-Infected Persons
  - Infants and Children
  - Health Care Workers
- EPIDEMIOLOGIC STUDIES AND FINDINGS
  - Surveillance
  - National Disease Reporting
  - Epidemiologic Research
    - Case-Control Studies
    - Prospective Cohort Studies
    - Serologic Surveys
  - Findings of Epidemiologic Studies
    - The Prevalence of HIV Infection
    - AIDS Cases By Risk Group
    - AIDS Case Trends by Geographic Area
    - AIDS Case Trends by Sex, Race, and Age
    - AIDS Case Trends in Disease Presentation and Mortality
- HIV INFECTION AND AIDS OUTSIDE THE UNITED STATES
  - African Countries
  - Other Countries
- REFERENCES
3 The Future Course of the Epidemic and Available National Resources
- PROJECTIONS BY THE PUBLIC HEALTH SERVICE
- PROBLEMS IN MAKING PROJECTIONS
- THE EPIDEMIC WITHIN AND BEYOND HIGH-RISK GROUPS
- THE PROPORTION OF SEROPOSITIVE INDIVIDUALS WHO WILL DEVELOP AIDS
- LONG-TERM PROSPECTS
- NATIONAL RESOURCES FOR DEALING WITH AIDS AND HIV
  - Impediments to Involvement
  - Mechanisms for Coordinating Activities
- REFERENCES
4 Opportunities for Altering the Course of the Epidemic
- PUBLIC EDUCATION
  - What Should Be the Content of Public Education?
  - What Are the Aims of Public Education?
  - Who Needs Education?
  - Who Should Do the Educating?
  - Assessing Educational Interventions
  - A Special Case—Changing Behavior among IV Drug Users
    - Drug Abuse Treatment Programs
    - Distribution of Sterile Needles and Syringes
  - Recommendations
- PUBLIC HEALTH MEASURES
  - Tests for Infection with HIV
  - Blood Banking
  - Surveillance
  - Reporting Schemes
  - Contact Tracing and Notification
  - Mandatory Screening
  - Voluntary Testing
  - Compulsory Measures
    - Compulsory Measures among Institutionalized Populations
    - Compulsory Closing and Regulation of Facilities
  - Recommendations
- FUNDING FOR EDUCATION AND OTHER PUBLIC HEALTH MEASURES
  - Recommendation
- DISCRIMINATION AND AIDS
  - Recommendations
- REFERENCES
5 Care of Persons Infected with HIV
- ROLES OF HEALTH CARE PROVIDERS
  - Recommendations
- HEALTH CARE SETTINGS FOR AIDS PATIENTS
  - Hospital Care
  - Outpatient Care
  - Community-Based AIDS Care
  - Recommendations
- NEEDS OF SPECIFIC PATIENT POPULATIONS
- PSYCHIATRIC AND PSYCHOSOCIAL SUPPORT
  - Needs of Patients with AIDS
  - Needs of Patients with ARC
  - Needs of Patients with Subclinical HIV Infections
  - Needs of Seronegative Persons
  - Recommendations
- ETHICAL ASPECTS OF PROVIDING CARE
- COSTS OF HEALTH CARE FOR HIV-RELATED CONDITIONS
  - Direct Costs of Care for AIDS Patients
  - Costs of Care for ARC Patients and Seropositive Individuals
  - Indirect Costs of HIV-Related Conditions
  - Cost Implications of Projected AIDS Cases
  - Projected Hospitalization Facilities
  - Conclusions and Recommendations
- FINANCING OF HEALTH CARE FOR HIV-RELATED CONDITIONS
  - Sources of Financing
    - Medicaid
    - Medicare
    - Private Insurance
  - Improving the Coverage of Health Care Costs
  - Emerging Issues
  - Policy Issues
  - Conclusions and Recommendations
- REFERENCES
6 Future Research Needs
- THE STRUCTURE AND REPLICATION OF HIV
  - Retroviral Structure
  - Retroviral Replication
  - Definition of the Structural and Functional Constituents of HIV
  - Determination of the Structure of the HIV Virion
  - Interrupting Infection by HIV
  - Conclusions and Recommendations
- NATURAL HISTORY OF HIV INFECTION
  - Transmission of HIV
  - The Immune System Response to HIV Infection
  - The Immunologic Consequences of HIV Infection
  - Recommendations
- EPIDEMIOLOGIC APPROACHES TO UNDERSTANDING THE TRANSMISSION AND NATURAL HISTORY OF HIV INFECTION
  - Recommendations on Surveillance
  - Recommendations on Natural History of HIV Infection
  - Recommendations on Transmission of HIV
  - Recommendations on the Need for Improved Serologic and Virologic Tests
- ANIMAL MODELS
  - HIV Infection of Chimpanzees
  - HIV-Related Viruses in Old World Primates
  - Lentiviruses of Ungulates
  - Conclusions and Recommendations
- ANTIVIRAL AGENTS
  - Drug Evaluation in Vitro
  - Drug Evaluation in Humans
  - Current Antiviral Agents under Clinical Study
    - Suramin
    - HPA-23
    - Azidothymidine (AZT)
    - Ribavirin
    - Foscarnet
    - Alpha Interferon
  - New Antiviral Agents against AIDS
  - Conclusions and Recommendations
  - Vaccines
  - Animal Retrovirus Vaccines
  - Vaccines against HIV
  - Models of Vaccine Delivery
  - Approaches to HIV Vaccine Development and Evaluation
  - Conclusions and Recommendations
  - Social Science Research Needs
  - Breaking the Chain of Transmission
  - Reducing Public Fear and Its Effects
  - Organizing Health and Social Services
  - Conclusions and Recommendations
- FUNDING FOR RESEARCH RELATED TO AIDS AND HIV
  - Current Levels of and Mechanisms for Funding
    - Centers for Disease Control
    - National Institutes of Health
    - Other Federal and State Agencies
    - Industry
  - Current NIH Funding Mechanisms
  - Distribution of Funds among Agencies and to Specific Research Areas
  - Assessing Desirable Levels of Research Support
  - Recommendations
- REFERENCES
7 International Aspects of AIDS and HIV Infection
- PROJECTIONS OF THE DISEASE OUTSIDE THE UNITED STATES
- INTERNATIONAL ORGANIZATIONS
- RATIONALE FOR U.S. INTERNATIONAL INVOLVEMENT
  - Foreign Policy Considerations
  - Health Improvement Assistance
  - International Spread of Diseases
  - Opportunities for Mutually Beneficial Research
  - Agencies and Organizations with International Responsibilities or Operations
  - Importation
- INFECTION RISKS OUTSIDE THE UNITED STATES
  - Sexual Exposure
  - Exposure Through Blood Transfusion
  - IV Drug Use
  - Use of Unsterile Needles and Implements
  - Lack of Evidence for Transmission by Insect Vectors and Casual Contact
  - Conclusions
- INTERNATIONAL RESEARCH OPPORTUNITIES
- THE U.S. CONTRIBUTION TO INTERNATIONAL EFFORTS
- CONCLUSIONS AND RECOMMENDATIONS
- REFERENCES
Appendixes
- A Clinical Manifestations of HIV Infection
  - Opportunistic Infections
    - Protozoal Infections
      - Pneumocystis carinii Pneumonia
      - Toxoplasma gondii
      - Cryptosporidium
      - Isospora belli
    - Fungal Infections
      - Candida
      - Cryptococcus
    - Bacterial Infections
      - Mycobacterium Tuberculosis
      - Mycobacterium Avium-Intracellulare
      - Salmonella Infections
      - Pyogenic Bacteria
    - Viral Infections
      - Herpes Simplex Virus
      - Herpes Zoster
      - Cytomegalovirus
    - Other Infections in Members of Risk Groups
  - Malignancies and Other Neoplastic Diseases
    - Kaposi's Sarcoma
      - Kaposi's Sarcoma in Non-AIDS Populations
    - Non-Hodgkin's Lymphoma in AIDS
    - Hodgkin's Disease in Homosexual Men
    - Other Cancers in AIDS
  - Neurologic Complications
    - Clinical and Pathologic Features of Neurologic Diseases
      - Aseptic Meningitis
      - Subacute Encephalitis
      - Myelopathy
      - Peripheral Neuropathies
    - HIV Infection of the Nervous System
      - Cellular Localization of HIV
      - Unsolved Problems
  - Pediatric AIDS
    - Clinical Features and Diagnosis
    - Diagnostic Criteria
  - References
- B Serologic and Virologic Testing
  - Performance Characteristics of the Tests
  - Bibliography
- C Risk of HIV Transmission from Blood Transfusion
  - References
- D U.S. Public and Private Sector Resources for Fighting AIDS
  - Public Sector
    - Federal
    - State, City, and Local Authorities
  - Private Sector
    - Commercial Entities
    - Noncommercial Organizations
- E The Centers for Disease Control's Surveillance Definition of AIDS
  - Protozoal and Helminthic Infections
    - Fungal Infections
    - Bacterial Infections
    - Viral Infections
    - Cancer
    - Other Opportunistic Infections with Positive Test for HIV
    - Chronic Lymphoid Interstitial Pneumonitis
    - Non-Hodgkin's Lymphoma with Positive Test for HIV
- F CDC Classification System for HIV Infections
  - INTRODUCTION
  - GOALS AND OBJECTIVES OF THE CLASSIFICATION SYSTEM
  - DEFINITION OF HTLV-III/LAV INFECTION
  - CLASSIFICATION SYSTEM
  - REFERENCES
- G PHS Plan for Prevention and Control of AIDS and the AIDS Virus
  - FOREWORD
  - PURPOSE
  - GOALS
  - BACKGROUND
  - PROJECTIONS
  - PATHOGENESIS AND CLINICAL MANIFESTATIONS
  - THERAPEUTICS
  - VACCINES
  - PUBLIC HEALTH CONTROL MEASURES
  - PATIENT CARE AND HEALTH CARE NEEDS
  - REFERENCES
- H List of Background Papers
- I List of Presentations at Public Meetings
  - San Francisco, California, April 8, 1986
  - New York City, May 15, 1986
- J Acknowledgments
- K Biographical Notes on Committee Members
Glossary
Index