This html article is produced from an uncorrected text file through optical character recognition. Prior to 1940 articles all text has been corrected, but from 1940 to the present most still remain uncorrected. Artifacts of the scans are misspellings, out-of-context footnotes and sidebars, and other inconsistencies. Adjacent to each text file is a PDF of the article, which accurately and fully conveys the content as it appeared in the issue. The uncorrected text files have been included to enhance the searchability of our content, on our site and in search engines, for our membership, the research community and media organizations. We are working now to provide clean text files for the entire collection.
The most pressing public health problem in the United States is a disease caused by the Human Immunodeficiency Virus (HIV). Acquired Immune Deficiency Syndrome (AIDS) and AIDS-Related Complex (ARC) are the two best-known disease manifestations caused by HIV. It is well known that there is a serious AIDS epidemic, but there is an even larger epidemic of HIV infection itself.
Most people infected with HIV have not openly developed a disease. However, over time, a large percentage of these people may become ill as a result of the virus. In the midst of the epidemic, civilian and military leaders have grappled with a multitude of issues, provided answers, and made policy to address short- and long-term
goals. An explosion of knowledge about HIV complicates any effort to educate people about the disease.
derived from blood (such as hemophiliacs, who receive clotting factors made from blood plasma). By 1983, it was well established that AIDS was an infectious disease; by mid-1984. scientists had isolated an unusual virus from patients with AIDS and ARC. The virus is now called HIV.
HIV belongs to a family of ribonucleic acid (RNA) viruses called retroviruses, which store their genetic material in the fom1 of RNA, and have an enzyme called reverse transcriptase. This enzyme is crucial to the life cycle of the virus because it enables HIV to copy its genetic material into deoxyribonucleic acid (DNA), which is the chenii' cal most life (including human) uses to store genetic information. This reversal of the usual nucleic acid processing leads to the term retrovirus. Retroviruses can integrate their retrograde produced DNA into the DNA the infected host cell. This prop' erty, called “latency,” means that retroviruses can cause a lift' long infection, similar to herpes The latency property complicate5 efforts to control the current ep>" demic. For example, latency creates the potential for lifelong infection—an infection that ma)’ cause disease in the infected p°r' son at any time.
HIV causes disease in several ways. The primary target cell for HIV infection is the T4, or
AIDS was initially described in 1981, when an unusual pneumonia (Pneumocystis carinii pneumonia, or PCP) and an unusual cancer (Kaposi’s sarcoma, or KS) were noted in otherwise healthy male homosexuals and intravenous drug users. In retrospect, the fact that AIDS was first noted in these two groups is unfortunate because the general public then felt the problem was limited only to members of these groups. By 1983, however, it was apparent that others in the general public were at risk of developing AIDS, notably infants whose mothers had AIDS and those individuals receiving blood transfusions or materials suffered damaged immunity.
Service members are retained depending upon the level at which their immune system is functioning. Members who are infected with HIV, but who do not show signs of 'nimunodeficiency and are not clinically ill, remain on active duty. They are given a shore billet in the continental United States, within 300 miles of one of the 19 designated Navy hospitals. Members who show signs of immunodeficiency as a result of the tests or clinical illness are medically separated. Individuals with damaged immune
systems and those with clinical disease are placed on the temporary disability retired list (TDRL). The TDRL system attempts to be fair to both the individual and the Navy. The TDRL allows these individuals to be tracked by the Navy, temporarily medically retired with monetary benefits ranging from 30 to 100%, and recalled, if they return to normal.
As the HIV program began, service members diagnosed as infected began to need more education and counseling. Most people in the United States are aware of the AIDS
helper” lymphocyte. Lymphocytes are the central cells of human immunity, and the T4 lymphocyte can be likened to •he conductor of a symphony 0rchestra. Normal T4 lympho- cytes direct and integrate the functions of the entire immune Astern. Normal, healthy T4 lymphocytes are essential for n°rmal immune function. T4 lymphocytes infected with HIV work poorly, if at all. The result ls a breakdown of immunity, leading to susceptibility to infections and cancers. An orchestra whh a conductor is a symphony, hut without a conductor, it is Cacophony. AIDS is immunologic cacophony.
HIV also targets cells in the hfain and spinal cord. Instead °f> or in addition to, AIDS,
HlV infection may lead to serious nervous system diseases, sUch as dementia. Dementia is 'he loss of cognitive ability, the tihility to think and reason as a human being. Neurologic disease caused by HIV is a threat dually as serious as AIDS.
The epidemiology of HIV inaction mimics that of hepatitis a type of viral hepatitis. It is tiow apparent that HIV is transmitted three ways: sexually, by c°ntaminated blood, and perina- ti>lly (an infected mother passing
described as being transmitted by female homosexual contact.
- Contaminated blood may transmit HIV in several settings. Primarily, transmission occurs when unsterile needles are shared by drug users. However, it is also passed to others through contaminated blood transfusions and clotting-factor therapy provided to hemophiliacs. Very rarely, health care professionals are infected by accidentally sticking themselves with a needle when caring for patients infected with HIV.
- Perinatal infection occurs when a woman infected with HIV transmits the virus to her baby, either in utero at the time of delivery or postpartum (probably via breast milk).
TAlternate means of passing the virus, such as insect bites, sharing common facilities (berthing, head facilities, dining areas), or close nonsexual contact do not spread HIV. HIV is not spread by infected food- handlers. To reiterate, ‘‘sex and blood” are the means by which HIV circulates among humans.
About 42,000 cases of AIDS have been reported in the United States to date, resulting in more than 24,000 deaths. Most AIDS victims have died within two to three years, so that only half of that number are currently alive. Such an epidemic is unprecedented in our generation. Even more sinister, however, is the epidemic of HIV infection. It is estimated that upward of 1.5 million people are already in
fected with HIV in the United States alone. By 1991, there will have been more than 250,000 cases of AIDS diagnosed in the United States, with about 150,000 of those cases being diagnosed in 1991. The U. S. Public Health Service estimates that 54,000 AIDS deaths will occur in 1991 alone, a figure comparable to the number of people who die in motor vehicle accidents annually. Because the time between HIV infection and the development of disease symptoms (including AIDS) ranges from about six months to five years (or more), these predictions may be an underestimate. In fact, these numbers are likely to occur even in the unlikely event that HIV transmission ceased immediately and no one else became infected. It is estimated that more than 50% of those individuals infected with HIV will develop disease within the first two to seven years of contracting the infection. Most persons who develop an HIV- related illness will see their illness progress to AIDS within five years.
The importance of HIV infection to the civilian and military populations cannot be overestimated. It is time to educate ourselves about this threat, and to seek prevention until there is a cure.
R. Zajdowicz, L. Dembert, M. Stek, Jr.