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.