Treatments Available For HIV And AIDS.

When AIDS first surfaced in the United States, no drugs were available to combat the underlying immune deficiency, and few treatments existed for the opportunistic infections that resulted. Over the past 10 years, however, therapies have been developed to fight both HIV infection and its associated infections and cancers.

Although there is no treatment currently available that can cure people of HIV or AIDS, a number of therapies have been developed to help them stay healthier and live longer.

• Some medications target HIV itself, to reduce the virus's assault on the immune system, or to even prevent the virus from entering human immune cells.
• Other treatments are used to treat or prevent specific opportunistic infections that threaten the health of people with HIV-damaged immune systems.

Treatments That Suppress HIV

Drugs that interfere with the activity of a retrovirus such as HIV are generally known as antiretrovirals. Nearly all antiretroviral medications currently approved to treat HIV infection target two viral enzymes used by the virus to replicate itself. These enzymes, reverse transcriptase and protease, are involved in different stages of viral replication. A new treatment approved in the past year works in a completely new way by preventing the virus from entering the human immune cells.

Four classes of antiretroviral drugs have been developed to interfere with the activity of these viral enzymes and slow down the multiplication of the virus. These are:

• Nucleoside analog reverse transcriptase inhibitors (NRTIs). NRTIs interrupt an early stage of HIV replication by interfering with the activity of reverse transcriptase. AZT (zidovudine), the first drug approved for treating HIV infection, is an NRTI, as are zalcitabine (ddC), didanosine (ddI), stavudine (d4T), lamivudine (3TC), and abacavir.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs also work by hindering the action of reverse transcriptase. This class of drugs includes delavirdine, nevirapine, and efavirenz.
• Protease inhibitors. Protease inhibitors interrupt a later stage of viral replication. This class of drugs includes saquinavir, indinavir, ritonavir, nelfinavir, and amprenavir.
• Fusion inhibitors. Fusion inhibitors prevent HIV from entering human immune cells. The only fusion inhibitor approved to date is enfuvirtide.

Studies have found that various combinations of antiretroviral drugs are more effective in suppressing HIV than antiretroviral drugs used alone. Experts refer to one common treatment approach, usually involving a protease inhibitor combined with two other antiretroviral drugs, as "highly active antiretroviral therapy" or HAART.

Drug combinations, or drug "cocktails," also can help reduce the risk that drug-resistant HIV will develop. When drug resistance occurs, medications that initially succeeded in suppressing the replication of HIV in the patient's body loose their effectiveness. Enfuvirtide works in a unique way that reduces the likelihood of cross-resistance with other HIV drugs.

Antiretroviral drugs have side effects that can limit their use in some people.

• AZT, for example, may result in a loss of blood cells.
• Protease inhibitors can cause nausea, diarrhea, and other symptoms.

Treating AIDS-Related Conditions

Other drugs and therapies are used to prevent or treat opportunistic infections and other AIDS-related conditions:

• Pneumocystis carinii pneumonia. People who develop this lung infection are generally treated with TMP/SMX (a combination of antibiotic drugs) or pentamidine. Doctors also prescribe these medications as preventive therapy for adult patients whose CD4+ T cell counts fall below 200.
• Yeast infections in women. Physicians often prescribe a drug called fluconazole to treat yeast and other fungal infections. Fluconazole also can safely prevent vaginal and esophageal candidiasis without development of drug resistance.
• Severe skin ulcers caused by herpes simplex virus infection. Skin ulcers sometimes respond to an antiviral medication, acyclovir.
• Pelvic inflammatory disease. PID is treated with antibiotics. Women with mild cases may be treated on an outpatient basis. HIV-positive pregnant women suspected of having PID are usually hospitalized, treated with intravenous antibiotics approved for use during pregnancy, and monitored closely.
• HIV-related wasting.Megestrol acetate (Megace) is often prescribed for HIV-associated wasting, but it can cause significant irregular vaginal bleeding in women. Another drug, nandrolone, may not have these side effects and is currently undergoing drug trials.
• Kaposi's sarcoma and other cancers. Cancers are treated with radiation, chemotherapy, or injections of alpha interferon, a genetically engineered, naturally occurring protein.
• CMV Retinitis. Improvements in anti-HIV treatments as well as preventive and therapeutic approaches to managing CMV have resulted in a decreased incidence of CMV retinitis. Today, the incidence of CMV retinitis is about one quarter what it was previous to the introduction of HAART. While early CMV retinitis therapies were delivered intravenously, current treatments include medications in pill form for all stages of CMV retinitis.

What Are Some Of The Problems With AIDS Drug Therapy?

AIDS drugs do not cure the condition, but they help to manage it and postpone life-threatening complications. However, there are problems with AIDS drug therapy:

• Side effects of drugs are a major concern in treatment.
• Another major problem is the cost of the drugs used in treating AIDS. AIDS patients in the United States depend on insurance and government grants to obtain them. The high price of these drugs makes it difficult for third-world countries, which have major AIDS epidemics, to afford to distribute them.

Since antiviral drugs have so far not been curative, the hope is to find a vaccine. The technology for vaccine development is present, and serious efforts are being made to find one.

About sex workers in Nepal.

Nepal’s DPM Bamdev Gautam has declared a crusade against night restaurants in Kathmandu to curb the flourishing “nude dance” culture in the capital.

Sex Work in Nepal

 
 

Debates on prostitution in Nepal have been dominated by the issues of trafficking and the migration of females from Nepal’s middle hills to north Indian brothels but comparatively little research has been done on prostitution in Nepal itself.

The subsistence nature of large parts of the rural economy meant that there was no mass market for commercial sex until comparatively recently. Economic development and urbanization and the increasing integration of Nepal within global consumer cultures has altered this so that there is now an expanding domestic sex market in all parts of the country.

There is also a small but expanding trade catering to sex tourists and expatriates. Sex work sites tend to concentrate in urban areas of the Kathmandu Valley, Pokhara and in the cities and towns of the Terai where there are dense sexual networks linking the Indo-Nepal border areas.

There are many sex work sites along the main north-south transport routes and along porterage routes. Sex work sites can also be found in the bazaars of the hills. Usual sex work sites include ‘drinking pubs’, hotels, restaurants and lodges, the worker’s own home, roads, bus parks and jungle areas. Much of the trade is underground and FSW tend to be extremely mobile.

Women of all castes and classes become sex workers, although those who are trafficked or migrate to India come primarily from ethnic minority groups in the hills.

Contrary to popular belief not all females working in the Indian or Nepali sex industries have been trafficked as a result of abduction, drugging or deception. Many young women and girls are sent into sex work because they can earn relatively high wages that can be remitted back home to support families in impoverished villages.

Confusingly prostitution is neither legal nor illegal in Nepal – although sex workers are subject to police harassment and arrest. The estimated number of sex workers is over 25,000 with about 5,000 based in the Kathmandu Valley. Around 5,000 children are thought to be exploited in prostitution and around 35% enter sex work by the time they are fifteen. Around 100,000 Nepali women and girls are believed to work in the Indian sex industry although this figure is open to question with some estimates being significantly higher.

Big three decide to defer 17th round of PM election

Top leaders of the major three political parties in the Constituent Assembly (CA) - Unified CPN (Maoist), Nepali Congress (NC) and UML - have agreed to postpone the 17th round of election for the post of prime minister, which was scheduled to be held at the parliament today.

During the third round of 'decisive talks' to sort out the contentious issues in peace process, constitution drafting and government formation at Gokarna Forest Resort, Monday, the top leaders of the major three parties decided to hold the 17th round of election for the post of prime minister on November 19.

The leaders also reached a tentative agreement to bring budget after holding further discussion on the issue. They have also decided to hold the next round of three-party talks on November 18, according to a joint statement issued by Maoist chairman Pushpa Kamal Dahal, CPN-UML chairman Jhala Nath Khanal and Nepali Congress president Sushil Koirala.

Talking to media-persons, Maoist vice chairman Narayan Kaji Shrestha said that the meeting also decided to form a sub-committee comprising Maoist leader Baburam Bhattarai, CPN-UML leader Bharat Mohan Adhikari and NC's Ram Sharan Mahat to decide on some vital issues concerning the new budget.

In the meeting, NC proposed that its prime ministerial candidate Ram Chandra Poudel be declared the new prime minister unanimously, something which other parties immediately turned down.

Earlier, UML leader Bharat Mohan Adhikari, a member of the talk team, informed before the start of the meeting, that today's talks would be focused on army integration and new government formation.

But it was not known whether the top leaders of the major three parties reached any agreement on those issues.

Apart from UML chairman Khanal, Prime Minister Madhav Kumar Nepal and minister for home affairs Bhim Bahadur Rawal also participated in the meeting.

At least five leaders each from the three parties took part in today's meeting, Nepalnews has learnt.

UCPN (M)'s team, which was headed by chairman Puspha Kamal Dahal, comprised three vice-chairpersons, Dr. Baburam Bhattarai, Mohan Baidhya and Narayan Kaji Shrestha, and general secretary Ram Bahadur Thapa and politburo member Dev Gurung.

The Nepali Congress team consisted of party president Sushil Koirala, senior leader Sher Bahadur Deuba, parliamentary party leader Ram Chandra Poudel and central committee member Dr. Ram Sharan Mahat.

The leaders have already met twice before in similar manner without much progress.

First, they held the talks at Hattiban Resort, Pharping on November 5 and 6, which created much media hype. Then, they held the second round of talks on November 10 at Gokarna Forest Resort on November 10.

Like in previous talks, journalists have not been allowed near the venue, saying that the meeting is "highly secretive".

Although, leaders have been claiming they are close to a consensus, they have not revealed the details of the progress.

The major dispute is on the formation of the new government, it is learnt. Both the Unified CPN (Maoist) and Nepali Congress have staked claim to government leadership.