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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Appendix F Glossary and Acronyms 3TC: Also known as lamivudine. An antiretroviral drug in the class of nucleoside reverse transcriptase inhibitors (NRTIs). Used to treat HIV/ AIDS. Acquired Immunodeficiency Syndrome (AIDS): The most severe manifestation of infection with the human immunodeficiency virus (HIV). The Centers for Disease Control and Prevention (CDC) lists numerous opportunistic infections and cancers that, in the presence of HIV infection, constitute an AIDS diagnosis. In 1993, CDC expanded the criteria for an AIDS diagnosis in adults and adolescents to include CD4+ T-cell count at or below 200 cells per microliter in the presence of HIV infection. In persons (age 5 and older) with normally functioning immune systems, CD4+ T-cell counts usually range from 500 to 1,500 cells per microliter. Persons living with AIDS often have infections of the lungs, brain, eyes, and other organs, and frequently suffer debilitating weight loss, diarrhea, and a type of cancer called Kaposi’s sarcoma. Antenatal: Occurring before birth. Antifungal: A substance that kills or inhibits the growth of a fungus. Antimalarial: An antimicrobial drug used to prevent or treat malaria, an infectious disease caused by the genus Plasmodium. Malaria is transmitted by mosquito bites. See Malaria.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Antimicrobial: A drug for killing microorganisms or suppressing their multiplication or growth. For the purposes of this report, antimicrobials include antibiotics and antivirals. Antiretroviral Drugs: Substances used to kill or inhibit the multiplication of retroviruses such as HIV. There are four classes of antiretroviral drugs for the treatment of HIV/AIDS. Asymptomatic: Having no symptoms. AZT: Also known as lamivudine. Also known as ZDV. An antiretroviral drug in the class of nucleoside reverse transcriptase inhibitors (NRTIs). Used to treat HIV/AIDS. CD4 (T4) or CD4+ Cells: 1. A type of T cell involved in protecting against viral, fungal, and protozoal infections. These cells normally orchestrate the immune response, signaling other cells in the immune system to perform their special functions. Also known as T helper cells. 2. HIV’s preferred targets are cells that have a docking molecule called “cluster designation 4” (CD4) on their surfaces. Cells with this molecule are known as CD4-positive (or CD4+) cells. Destruction of CD4+ lymphocytes is the major cause of the immunodeficiency observed in AIDS, and decreasing CD4+ lymphocyte levels appear to be the best indicator for developing opportunistic infections. Although CD4 counts fall, the total T cell level remains fairly constant through the course of HIV disease, due to a concomitant increase in the CD8+ cells. The ratio of CD4+ to CD8+ cells is therefore an important measure of disease progression. See CD8 (T8) Cells; Immunodeficiency. CD8: A glycoprotein found especially on the surface of killer T cells that usually function to facilitate recognition by killer T cell receptors of antigens complexed with molecules of a class that are found on the surface of most nucleated cells and are the product of genes of the major histocompability complex. Cocci: A spherical bacterium. Cotrimoxazole: An antimicrobial drug. A bactericidal combination of trimethoprim and sulfamethoxazole that is used to prevent and treat infections in patients with HIV/AIDS. Cytomegalovirus: A herpes virus that is a common cause of opportunistic diseases in persons with AIDS and other persons with immune suppression. Most adults in the United States have been infected by CMV; however the
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities virus does not cause disease in healthy people. Because the virus remains in the body for life, it can cause disease if the immune system becomes severely damaged or suppressed by drugs. While CMV can infect most organs of the body, persons with AIDS are most susceptible to CMV retinitis (disease of the eye) and colitis (disease of the colon). D4T: Also known as stavudine. An antiretroviral drug in the class of nucleoside reverse transcriptase inhibitors (NRTIs). Used to treat HIV/ AIDS. Dapsone: An antimicrobial drug. Used to prevent Pneumocystis carinii pneumonia in patients intolerant to use of sulfa-containing drugs. Also used to treat leprosy, an infectious disease caused by Mycobacterium leprae. Dual Therapy: The use of two drugs to treat a disease such as HIV/AIDS. Efavirenz: An antiretroviral drug in the class of nonnucleoside reverse transcriptase inhibitors (NNRTIs). Used to treat HIV/AIDS. Epidemic: A disease that spreads rapidly through a demographic segment of the human population, such as everyone in a given geographic area; a military base, or similar population unit; or everyone of a certain age or sex, such as the children or women of a region. Epidemic diseases can be spread from person to person or from a contaminated source such as food or water. Epidemiology: The branch of medical science that deals with the study of incidence and distribution and control of a disease in a population. Genotype: The internally coded, inheritable information carried by all living organisms. This stored information is used as a blueprint or set of instructions for building and maintaining a living creature. These instructions are found within almost all cells (the internal part), they are written in a coded language (the genetic code); they are copied at the time of cell division or reproduction and are passed from one generation to the next (inheritable). These instructions are intimately involved with all aspects of the life of a cell or an organism. They control everything from the formation of protein macromolecules, to the regulation of metabolism and synthesis. Gross Domestic Product: A measure of the output produced by factors of production located in the domestic country regardless of who owns these factors.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Hemopoietic: The formation of blood or of blood cells in the living body. Hepatic: Pertaining to the liver. Hepatoxicity: Toxic to the liver. High-Income Country: A country having an annual gross national product (GNP) per capita equivalent to $9,361 or greater in 1998. Most high-income countries have an industrial economy. There are currently about 29 high-income countries in the world with populations of one million people or more. Their combined population is about 0.9 billion, less than one-sixth of the world’s population. In 2003, the cutoff for high-income countries was adjusted to $9,206 or more. Highly Active Antiretroviral Therapy (HAART): The name given to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and progress of HIV disease. The usual HAART regimen combines three or more different drugs, such as two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI), two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI), or other combinations. These treatment regimens have been shown to reduce the amount of virus so that it becomes undetectable in a patient’s blood. Human Leukocyte Antigens: Marker molecules on cell surfaces that identify cells as “self” and prevent the immune system from attacking them. Immune Reconstitution: Immune reconstitution is the regeneration of memory and naïve T cells in response to antiretroviral therapy. Immunodeficiency: Inability to produce normal antibodies or immunologocially sensitized T cells especially in response to specific antigens. Immunology: A science that deals with the immune system and the cell-mediated and humoral aspects of immunity and immune responses. In vivo: In the living body of a plant or animal. Intrapartum: Time during labor and delivery. Intrauterine: Inside the uterus. Isoniazid: An antimicrobial drug. Used to prevent or treat tuberculosis infections.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Kaletra: Trade name of an antiretroviral drug in the class of protease inhibitors (PIs). It is a combination of two PI: lopinavir and ritonavir. Used to treat HIV/AIDS. Lamivudine: Also known as 3TC. An antiretroviral drug in the class of nucleoside reverse transcriptase inhibitors (NRTIs). Used to treat HIV/ AIDS. Lipodystrophy: A disturbance in the way the body produces, uses, and distributes fat. Lipodystrophy is also referred to as buffalo hump, protease paunch, or Crixivan potbelly. In HIV disease, lipodystrophy has come to refer to a group of symptoms that seem to be related to the use of protease inhibitor (PI) and nucleoside reverse transcriptase inhibitor (NRTI) drugs. Also called lipodystrophy syndrome, pseudo-Cushing’s syndrome. Lopinavir: An antiretroviral drug in the class of protease inhibitors (PIs). Used to treat HIV/AIDS. Low-income country: A country having an annual gross national product (GNP) per capita equivalent to $760 or less in 1998. The standard of living is lower in these countries; there are few goods and services; and many people cannot meet their basic needs. In 2003, the cutoff for low-income countries was adjusted to $745 or less. At that time, there were about 61 low-income countries with a combined population of about 2.5 billion people. Malaria: An acute or chronic infectious disease caused by parasites of the genus Plasmodium. There are four Plasmodium species that infect humans. Plasmodium infect the red blood cells. The usual cause of malaria is by infection following the bite of a mosquito. Malaria is characterized by periodic attacks of chills and fever that coincide with mass destruction of blood cells and the release of toxic substances by the Plasmodium parasite at the end of each reproductive cycle. Middle-income country: A country having an annual gross national product (GNP) per capita equivalent to more than $760 but less than $9,360 in 1998. The standard of living is higher than in low-income countries, and people have access to more goods and services, but many people still cannot meet their basic needs. In 2003, the cutoff for middle-income countries was adjusted to more than $745, but less than $9,206. At that time, there were about 65 middle-income countries with populations of one million or more. Their combined population was approximately 2.7 billion.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Monotherapy: The use of a single drug to treat a disease such as HIV/ AIDS. Morbidity: The condition of being diseased or sick; also the incidence of disease or rate of sickness. Mortality: The number of deaths in a given time or place; also the proportion of deaths to population. Neuropathy: The name given to a group of disorders involving nerves. Symptoms range from a tingling sensation or numbness in the toes and fingers to paralysis. It is estimated that 35 percent of persons with HIV disease have some form of neuropathy. There are multiple causes of neuropathy, including drug side effects. Nevirapine: Also known as NVP. An antiretroviral drug in the class of nonnucleoside reverse transcriptase inhibitors (NNRTIs). Used to treat HIV/ AIDS. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI): A class of antiretroviral drugs used to treat HIV/AIDS. A group of structurally diverse compounds that bind to the catalytic site of HIV-1’s reverse transcriptase enzyme. Unlike the nucleoside reverse transcriptase inhibitors (NRTIs), the NNRTIs have no activity against HIV-2. As noncompetitive inhibitors of reverse transcriptase, their antiviral activity is additive or synergistic with most other antiretroviral agents. Nucleoside Analog: An artificial copy of a nucleoside. When incorporated into the DNA or RNA of a virus during viral replication, the nucleoside analog acts to prevent production of new virus. Nucleoside analogs may take the place of natural nucleosides, blocking the completion of a viral DNA chain during infection of a new cell by HIV. The HIV enzyme reverse transcriptase is more likely to incorporate the nucleoside analogs into the DNA it is constructing than is the DNA polymerase normally used for DNA creation in cell nuclei. Nucleoside Reverse Transcriptase Inhibitors (NRTI): A class of antiretroviral drugs used to treat HIV/AIDS. A nucleoside analog antiretroviral drug whose chemical structure constitutes a modified version of a natural nucleoside. These compounds suppress replication of retroviruses by interfering with the reverse transcriptase enzyme. The nucleoside analogs cause premature termination of the proviral (viral precursor) DNA chain. All NRTIs
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities require phosphorylation in the host’s cells prior to their incorporation into the viral DNA. Pandemic: A disease prevalent throughout an entire country, continent, or the whole world. Pediatric AIDS Clinical Trial Group (PACTG): This is the U.S.-based scientific organization that evaluates treatments for HIV-infected children and adolescents and develops new approaches for the interruption of mother-to-infant transmission. Perinatal: Events that occur at or around the time of birth. Peripartum: Occurring in or being the period preceding or following birth. Pharmacokinetics: The processes of absorption, distribution, metabolism, and excretion of a drug or vaccine. Phenotype: The outward, physical manifestation of the organism. These are the physical parts, the sum of the atoms, molecules, macromolecules, cells, structures, metabolism, energy utilization, tissues, organs, reflexes and behaviors; anything that is part of the observable structure, function or behavior of a living organism. Plasma viremia: Having virus in the bloodstream. Pneumocystis: A genus of microorganisms of that are usually considered protozoans or sometimes fungi. One species is Pneumocystis carinii. This species can cause pneumonia in immunocompromised individuals. Prophylaxis: Treatment to prevent the onset of a particular disease (primary prophylaxis), or the recurrence of symptoms in an existing infection that has been brought under control (secondary prophylaxis, maintenance therapy). Protease inhibitors (PIs): A class of antiretroviral drugs used to treat HIV/ AIDS. These drugs act by inhibiting the virus’ protease enzyme, thereby preventing viral replication. Specifically, these drugs block the protease enzyme from breaking apart long strands of viral proteins to make the smaller, active HIV proteins that comprise the virion. If the larger HIV proteins are not broken apart, they cannot assemble themselves into new functional HIV particles.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Renal: Pertaining to the kidneys. Rifampicin: An antimicrobial drug. It is used for the treatment of tuberculosis. Ritonavir: An antiretroviral drug in the class of protease inhibitors (PI). Used to treat HIV/AIDS. Usually used in combination with another protease inhibitor, lopinavir, to “boost” the effect of lopinavir. Seroprevalence: As related to HIV infection, the proportion of persons who have evidence of HIV infection in their blood at any given time. Symptomatic: Having symptoms of a disease. Teratogenicity: The ability to cause birth defects. Teratogenicity is a potential side effect of some drugs, such as efavirenz, a drug to treat HIV/ AIDS. Toxoplasma: A genus containing the parasite Toxoplasma gondii. Tuberculosis (TB): A bacterial infection caused by Mycobacterium tuberculosis. TB bacteria are spread by airborne droplets expelled from the lungs when a person with active TB coughs, sneezes, or speaks. Exposure to these droplets can lead to infection in the air sacs of the lungs. The immune defenses of healthy people usually prevent TB infection from spreading beyond a very small area of the lungs. If the body’s immune system is impaired because of HIV infection, aging, malnutrition, or other factors, the TB bacteria may begin to spread more widely in the lungs or to other tissues. TB is seen with increasing frequency among HIV-infected persons. Most cases of TB occur in the lungs (pulmonary TB). The disease may also occur in the larynx, lymph nodes, brain, kidneys, or bones (extrapulmonary TB). Extrapulmonary TB infections are more common among persons living with HIV. Undetectable Virus: The threshold at which measurements of plasma HIV RNA levels (viral load) are not detectable depends on the assay used. Common thresholds are <400 copies/ml or <50 copies/ml. Valganciclovir: An antimicrobial drug used to treat viruses. This drug can be used to treat cytomegalovirus infections that people with HIV/AIDS may develop. It does not cure these infections.
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Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities Varicella: Also known as chickenpox. Varicella is caused by the varicella zoster virus, a type of herpes virus. It is an acute contagious infectious disease—especially of children. The infection spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. The disease is marked by a low-grade fever and a blister-like rash on the body. The rash causes itching. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. Viral Fitness: As HIV obtains certain genetic mutations, its ability to replicate can be diminished compared to that of wild-type strain. Virologic Failure: Based on U.S. Department of Health and Human Services guidelines, this is defined as detectable HIV virus in the blood after 24 weeks from initiating therapy or changing therapy. HIV RNA level greater 500 copies/ml at 12 to 16 weeks is a good predictor of failure. Virology: The study of viruses and viral disease. Zidovudine: Also known as AZT or ZDV. An antiretroviral drug in the class of nucleoside reverse transcriptase inhibitors. It was the first drug approved in the U.S. for treatment of HIV/AIDS. It was approved in 1987.
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