The term acquired immunodeficiency syndrome (AIDS) is a definition developed by the Centers for Disease Control to explain the epidemic of immunosuppression first seen in the United States among gay and bisexual men and intravenous drug users in the early 1980s. It is now known that the human immunodeficiency virus (HIV) is the necessary agent for the compromise of the immune system which results in AIDS; however, there is a wide range of manifestations associated with HIV infection. Individuals with AIDS tend to have severe opportunistic infections or malignancies, and the vast majority ofindividuals die within two years after the diagnosis. At least a fourth of the individuals with HIV infection in one study were found to remain asymptomatic after seven years of infection. Between the long period of asymptomatic infection and the development of life-threatening opportunistic infections, individuals may develop subacute manifestations of HIV infection. Some individuals may develop constitutional symptoms, without any other medical explanation. The clinical use of tests of immunologic function as well as newer tests that may describe the type of HIV infection, such as the serum antigen test, may enhance the ability of clinicians to give infected patients more specific information as to their prognosis. As newer therapies are developed, the utilization of newer diagnostic tests may allow for staging more rational treatment plans. The data suggesting increasing efficacy of Azidothymidine (AZT), as well as the development of newer chemotherapeutic agents, may lead to more widespread HIV testing in order to detect infection at early stages and intervene with specific therapies. Use of the test as a means of altering behavior remains controversial. The development of newer therapies is hindered by the need to avoid exposing HIV-infected individuals to agents that subsequently turn out to be harmful, such as HPA-23 and Suramin. But this must be balanced with the urgent need of individuals to try promising therapeutic agents. Preliminary data suggest that individuals who are treated with AZT at earlier stages of HIV infection may do better; thus, there may be a move in the future to treat people with AZT. The clinical dilemma will persist for some time to come, and the cost of care for individuals with AIDS and HIV infection will be extremely high. Although the illness is frequently fatal, it is most appropriate to be considerate of the individual's desire to have more aggressive therapies, given the variability of HIV infection for each person and the fact that new therapeutic breakthroughs are being made every day.



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