AIDS viruses reproduce in CD4 cells and circulate in the blood. In this electron micrograph of a white blood cell, AIDS viruses can be seen as the small white dots covering the cell’s surface.
Credit: Centers for Disease Control and Prevention

Today, December 1, 2022, is World AIDS Day. AIDS is the final, life-threatening stages of infection with the human immunodeficiency virus (HIV). HIV damages the immune system, the human body’s most important defense against disease. AIDS stands for acquired immunodeficiency syndrome or acquired immune deficiency syndrome. On this day, we honor over 40 million people who have lost their lives to AIDS and look ahead to ending the AIDS pandemic through research, healthcare, and community support. The World Health Organization reported that 38.4 million people were living with HIV across the globe at the end of 2021.

AIDS is a relatively new life-threatening disease. HIV is spread through sexual intercourse with an infected person or exposure to blood from an infected person, many times through shared needles used to inject drugs. At first, it mainly affected young adults. In the public imagination, the disease soon became associated with risky sexual behavior and with drug abuse. For all these reasons, efforts to address AIDS or to prevent the spread of HIV have at times faced unique social challenges. An infected pregnant woman can transmit HIV to her unborn child before and during the delivery, even if the woman shows no symptoms. An HIV-infected mother may also pass HIV to her baby through breast-feeding.

Since 1986, the international health community has worked to coordinate the global fight against HIV and AIDS. The World Health Organization’s Global AIDS Programme formed the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 1996. Since that time, UNAIDS has worked with other international partners to coordinate the global fight against HIV and AIDS. UNAIDS reported recently that one obstacle to ending AIDS around the world is gender inequality. Many girls and women live with HIV and AIDS without treatment and education to prevent infection. They report that in countries where girls do not receive an education, the rates of HIV infection are higher. UNAIDS also stated that in countries where same-sex relationships are criminalized the probability of infection is increased.

Many individuals and organizations have worked to increase public awareness of AIDS. The most active organizations include community-based groups and the American Red Cross. They hope that greater awareness will generate more compassion and support for people living with AIDS. They also hope to ensure adequate funding for HIV prevention, treatment, and research. One prominent project bringing attention to the crisis is the AIDS Memorial Quilt. Begun by the NAMES Project Foundation in 1987, the quilt consists of thousands of individually designed panels. The panels memorialize people who died of AIDS. The quilt has been displayed throughout the world.

Poor understanding of HIV has at times stoked public fears, leading many people with the virus to suffer unjustly. Some of the infected have lost or been denied jobs or housing. Others have been denied medical care and health insurance. Many children with AIDS were initially barred from attending school or playing on sports teams. To prevent discrimination, people with HIV and AIDS are often included under laws protecting the rights of people with disabilities. The United States government and some states have also strengthened laws safeguarding the confidentiality of medical records relating to HIV infection and AIDS.

Preventing discrimination against people with HIV is not only just—it also protects public health. When people can live without fear of discrimination, they are more likely to seek counseling and treatment. In many cases, such measures lead to earlier diagnosis and a reduction in risky behavior.

AIDS was first identified as a disease by physicians in California and in New York City, New York, in 1981. Doctors recognized the condition as something new because all the patients were previously healthy, young gay men. They sought medical care because they were suffering from otherwise rare forms of cancer and pneumonia. In 1982, the disease was named AIDS. Scientists soon determined that AIDS occurred when the immune system became damaged. They also learned that the agent that caused the damage was spread through sexual contact, shared drug needles, and infected blood transfusions.

AIDS occurs in every nation. In areas such as Africa south of the Sahara, Southeast Asia, and India, HIV transmission has occurred mostly among heterosexual men and women, particularly young adults and teens. Many developing nations carry enormous burdens of HIV infection. For example, the United Nations reports that in some parts of Africa, the infection rate may reach over 30 percent in some urban areas. The huge number of young adults dying of AIDS in Africa south of the Sahara has decreased overall life expectancy across the continent. A growing number of people have also become infected in countries with increasing drug use, such as Russia, China, and the nations of central Europe.

A nurse greets a patient with an elbow bump.
Credit: © 2021 Prostock-studio/Shutterstock.

National nurses week begins today, May 6, 2022. Each year an entire week is dedicated to the hardworking, brave, and caring nurses who take care of sick, injured, and vulnerable patients. If you know or see any nurses this week, make sure to tell them “thank you” for all that they do. The week always ends on May 12, the birthday of Florence Nightingale. Nightingale founded the nursing profession as we know it today.

Born into a wealthy British family in 1820, Nightingale was expected to marry. However, she felt called to help the sick. She led the care of injured soldiers in the Crimean War (1853-1856). From this work, she became a world authority on scientific care of the sick. In 1860, Nightingale used donations of about $222,000 to found the first school of nursing, Nightingale Training School for Nurses at St. Thomas’s Hospital in London. The United States asked Nightingale’s advice for setting up military hospitals during the American Civil War (1861-1865). Nightingale received many honors and became the first woman to be given the British Order of Merit. She died on Aug. 13, 1910.

Nursing is a profession that provides care to the sick, the injured, and other people in need of medical assistance. Nurses perform a wide variety of duties in many settings. Many nurses work in hospitals, outpatient clinics, or other health care facilities. Other nurses work in health insurance companies, research institutions, and pharmaceutical (medicinal drug) companies. Nurses also work in schools, factories, and the armed forces. Nurses may run general health screening or immunization clinics and blood drives.

Patients often get most of their direct health care through nurses. Among their duties, nurses record patient medical histories and symptoms, help perform medical tests, administer treatment and medications, operate medical machinery, and help with follow-up care and rehabilitation. They also provide advice and emotional support to patients and their families.

Nurses educate patients about various medical conditions. They teach patients and their families how to manage illnesses or injuries. They explain home care needs, including diet, nutrition, and exercise programs; physical therapy; and how to take medication. Some nurses work to promote public knowledge about health and health care. They may give public lectures on health and medical topics.

More women serve in the field of nursing than in any other profession except teaching. However, this trend is changing. Until the 1960′s, men made up only 1 percent of professional nurses. By the early 2000′s, men made up more than 10 percent of students enrolled in undergraduate professional nursing programs. Men make up about 6 percent of professional nurses.

Nursing offers satisfaction to those who desire to help others. It also provides a wide range of job opportunities. A capable nurse—especially one with an advanced degree—can generally feel sure of a job. Salaries for nurses are often high compared with those for other professions. A nurse must like people and want to help them. A nurse must also have self-reliance and good judgment. Patience, tact, honesty, responsibility, and the ability to work easily with others are valuable traits. Good health is another requirement.

Nurses have worked tirelessly throughout the COVID-19 pandemic. In 2020, many nurses took care of people sick from COVID-19 and quarantined away from their families and friends to prevent spreading the virus. While nurses always deserve praise and gratitude, throughout the past few years they have been true heroes.

Occupational therapist helping a child do a sensory exercise

April is occupational therapy month! Occupational therapy is a form of treatment that uses everyday activities to help people with illnesses or disabilities recover, develop, or maintain practical skills. Doctors often recommend occupational therapy for patients with health problems that interfere with their ability to perform daily tasks at home, school, or work. For example, a person who uses a wheelchair may need to learn how to get around in the kitchen and prepare a meal from a sitting position. A person who has lost sight or the use of an arm or leg may need to learn new ways to bathe or dress. Occupational therapy is often called curing by doing because patients improve their own physical and mental well-being by carrying out activities themselves.

Professionals called occupational therapists plan and supervise treatment activities for their patients. Occupational therapy assistants work under the supervision of an occupational therapist and do much of the hands-on work with patients, helping them learn and practice skills. Occupational therapists and assistants work in such places as hospitals, rehabilitation centers, mental health centers, schools, nursing homes, and day care centers. They also provide treatment in people’s homes.

An occupational therapist first needs to evaluate a patient’s health problems, background, and interests. The therapist uses this information to plan an individual program that will meet each patient’s needs and make the most of each patient’s abilities. Occupational therapists help people with serious illness or injury, permanent disabilities, such as blindness or the loss of a limb, and mental and emotional illnesses. Occupational therapists also aid the growth and development of children. Many children receive treatment at school. Occupational therapists help these children interact with others, develop self-confidence, and take full advantage of opportunities in the classroom and playground. Therapists also work closely with the children’s family members and teachers. Occupational therapy for children often includes playing with toys or participating in games.

Occupational therapy as a profession dates back only to the early 1900′s, but people have long known that work and other activities speed recovery from illness or injury. In A.D. 172, the Greek physician Galen said, “Employment is nature’s best medicine and essential to human happiness.”

Modern occupational therapy developed from a nursing course called Invalid Occupations. This course was first offered to student nurses in 1906 by Susan E. Tracy, a Boston nurse. American architect George E. Barton originated the term occupational therapy. He himself received this form of treatment after one of his feet was amputated. The need to help disabled veterans of World Wars I (1914-1918) and II (1939-1945) stimulated the growth of occupational therapy. The World Federation of Occupational Therapists was established in Liverpool, England, in 1952.

Anyone who is interested in a career in occupational therapy must first earn a bachelor’s or master’s degree in occupational therapy from an accredited college or university. Accredited programs include courses in biology, psychology, sociology, and occupational therapy theory and practice. All programs require students to complete a period of supervised clinical training. A person who wants to become an occupational therapy assistant must complete an associate degree program. Associate’s programs also include academic coursework and supervised clinical training.

October 25, 2017

In late September, a team of European neuroscientists (people who study the nervous system) reported that a patient who had been in a persistent vegetative state (PVS) for 15 years showed signs of consciousness after receiving a new nerve-stimulation therapy. The patient, a 35-year-old man who suffered severe brain injuries in a car accident, regained a level of consciousness once thought impossible. This pioneering treatment challenges the widely accepted medical view that people who have been in a persistent vegetative state for a year or more can never recover. The scientists suggest that innovative treatment can bring about changes even in the most severe cases of PVS. The results of the treatment were published in the journal Current Biology.

Electroencephalograph (EEG) images show an increase of activity across the brain, as evidenced by the yellow and orange colors, following vagus nerve stimulation (VNS). Credit: © Martina Corazzol, Guillaume Lio, Arthur Lefevre, Gianluca Deiana, Laurence Tell, Nathalie André-Obadia, Pierre Bourdillon, Marc Guenot, Michel Desmurget, Jacques Luauté, Angela Sirigu

A persistent vegetative state is a rare but serious type of coma. PVS is caused by widespread damage to areas of the brain’s cerebral cortex and thalamus. These structures govern awareness of the self and its surroundings. The damage can result from head injury, stroke, or a lack of oxygen caused by drowning or cardiac arrest (heartbeat stoppage). People in a persistent vegetative state may have their eyes open, but they are not awake. The body’s automatic functions—such as breathing and heartbeat—continue even though the person is unconscious. However, a PVS patient cannot think, talk, see, hear, feel, eat, move voluntarily, or respond to other people.

The pioneering new therapy was developed by focusing on the vagus nerve, one of the 12 pairs of cranial nerves that connect directly to the brain. The vagus nerve connects the brain to almost all the vital organs in the body. It is also linked directly to two regions of the brain that scientists know play roles in alertness and consciousness. The scientists hypothesized that electrical stimulation of the vagus nerve may affect consciousness in PVS patients. They implanted a small electrical device in the patient’s neck. After one month of vagus nerve stimulation, the patient had achieved a level of minimal consciousness, and a dramatic improvement in brain activity.

The scientists now plan to conduct broader studies involving electrical stimulation of the vagus nerve. They hope to develop effective therapies to restore more PVS patients to consciousness. The research may also help scientists better understand how consciousness itself arises from the cells and structure of the brain. Understanding how the human conscious mind develops from the nervous system is considered so difficult that scientists have labeled it the “hard problem” of the mind.

October 3, 2017

Yesterday, October 2, the Nobel Assembly at the Karolinska Institute in Stockholm, Sweden, awarded the 2017 Nobel Prize in physiology or medicine to American chronobiologists Jeffrey C. Hall, Michael Rosbash, and Michael W. Young. The three scientists were awarded the prize for their discoveries on how circadian rhythms, also known as “biological clocks,” function in organisms, including humans. The science that deals with the study of biological clocks and rhythms is called chronobiology.

Nobel Prize medal (Credit: Nobel Foundation)

Biological clocks control the rhythms of functions and processes in organisms. They keep accurate time during each 24 hours and over days, weeks, months, and even years. Birds migrate, fish spawn, and flowers blossom on schedules that are set by their built-in clocks. In human beings, biological clocks regulate body activities and periods of sleep and wakefulness.

In their Nobel Prize-winning research, the scientists investigated the mechanisms that control the circadian rhythm in the common fruit fly (Drosophila melanogaster). The researchers isolated a particular gene responsible for producing a protein that builds up in the body at night and degrades at a set rate during the day, thus functioning as a biological clock. Hall, Robash, and Young discovered that this same mechanism functions in many other organisms, including people.

The scientists have also worked to raise awareness of the importance of proper sleep in maintaining good health. Their research suggests that a mismatch between the external environment and the internal biological clock may have a negative impact on human health. Such mismatches can occur when people travel across several time zones and experience “jet lag.”

Jeffery C. hall was born on May 3, 1945, in Brooklyn, a borough of New York City. He received his Ph.D. degree from the University of Washington in Seattle in 1971. He is a professor emeritus at Brandeis University in Waltham, Massachusetts, and also affiliated with the University of Maine. Michael Rosbash was born on Mar. 7, 1944, in Kansas City, Missouri. He earned a Ph.D. degree at the Massachusetts Institute of Technology in 1970. He is currently a professor at Brandeis University. Michael W. Young was born on March 28, 1949, in Miami, Florida. He earned a Ph.D. degree at the University of Texas in Austin in 1975. He is currently a professor at Rockefeller University in New York City.

September 28, 2017

An opioid drug crisis has swept parts of the United States in 2017 as unprecedented numbers of people became addicted—and many died. An opioid is any synthetic or semi-synthetic drug that resembles an opiate (drug that contains opium) in its effects. People most often take opioids—which are legally available by prescription—for pain, but the drugs are highly addictive. The opioid crisis has devastated thousands of families and communities.

A pharmacist doles out a prescription of fentanyl, a powerful synthetic opioid that is sometimes combined with heroin. Fentanyl overdoses have killed thousands of people. Credit: Dennis Yip, Fentanyl Safety

Opioid overdose incidents have been widespread and often shocking. For example, a mother collapsed in the stands at a Little League Baseball game in Ohio; an Indiana couple was found unconscious in a running car with two young children in the backseat; and a child called 911 after finding her mother and three adults passed out from overdoses in Massachusetts.

Public health officials have called the current epidemic of opioid overdoses the worst drug crisis in American history. In 2015, the most recent year for which complete data are available, more than 50,000 people died from drug abuse and overdose. Opioids played a role in 33,000 of those deaths. For the first time, deaths from opiate overdose surpassed deaths from homicide with a gun, and overdose deaths were nearly equal to the number of deaths from car crashes. Data from the U.S. Centers for Disease Control and Prevention show the current opioid epidemic has claimed an average of 142 lives each day in 2017.

In the United States, opioid-related visits to hospital emergency rooms have doubled since 2005, and admissions have increased 64 percent. According to a report from the Agency for Healthcare Research and Quality, a unit of the U.S. Department of Health and Human Services, American hospitals experienced an average of 3,500 visits per day for opioid-related issues in 2014, compared with 1,800 per day in 2005. While emergency room visits rose for all age groups, the largest increase was seen in adults age 25 to 44. Men and women were equally likely to seek medical care for opioid-related issues over that time.

Although the epidemic is nationwide, certain areas have been harder hit than others. The Appalachian and nearby regions of Kentucky, Ohio, Pennsylvania, and West Virginia have seen the highest rate of opioid overdose deaths, and parts of New England and the Southwest are also far above the national average.

Opioids are any drugs made from or containing opium and other synthetic drugs that have a similar molecular structure. Opium is a dried milky substance obtained from the opium poppy. Opioids have medicinal value as powerful analgesics (painkillers). Morphine and codeine are familiar medications traditionally made from the opium poppy. Heroin was originally developed by the Bayer pharmaceutical company as a replacement for morphine. Today, opioid drugs are available legally only with a prescription from a doctor, and they are meant to treat severe pain.

Today, most prescription opioid painkillers are partly or totally synthetic. These opioids include hydromorphone (sold under the name Dilaudid); hydrocodone (combined with acetaminophen under the brand name Vicodin); and oxycodone (combined with aspirin under the brand name Percodan). Oxycodone is an opioid drug made from a chemical in the opium poppy called thebaine. A popular slow-release form of the drug is sold under the brand name OxyContin. Like their chemical cousin heroin, synthetic opioids can cause people to become physically dependent or addicted.

For many people, addiction to opioids often begins at the doctor’s office or after a visit to the emergency room. When administered under a doctor’s care, opioids are safe and effective. But should patients continue using these powerful drugs, as they increasingly do for conditions that result in chronic pain, the risk of addiction becomes very real. The same chemistry by which prescription opioids dull severe pain can also lead to crippling addiction and drug abuse—and often overdose and death.

After prescriptions run out or become too expensive, addicted people may resort to buying heroin on the street. Despite being illegal, heroin is widely available and cheaper than prescription pills. Heroin is often mixed with other ingredients or spiked with fentanyl, a synthetic opioid 50 times more potent than heroin.

Fentanyl overdoses have overtaken those caused by heroin in some regions of the United States, and the opioid has been increasingly found among drugs seized by law enforcement officers across the country. Fentanyl and other synthetics with a similar chemical structure, called fentanyl analogues, are so powerful that doses equal to the amount of a few grains of salt can be lethal.

Naloxone is a temporary antidote for opioid overdoses, including those caused by Fentanyl. When properly administered it can restore normal breathing and consciousness to opioid overdose victims. Credit: Dennis Yip, Fentanyl Safety

A drug called naloxone, marketed under the brand name Narcan, is used to treat opioid overdose in emergency situations. The drug blocks or reverses the effects of opioids, which include extreme drowsiness, slowed breathing, and loss of consciousness. Naloxone is administered through an injection. However, emergency medical teams may be unable to revive people who overdose on fentanyl analogues even after multiple injections of naloxone.

As demand for naloxone has increased in response to the opioid epidemic, the price of the drug has followed suit. Many towns and counties burned through their annual budgets for the life-saving drug half way through 2017. Cash-strapped state and local emergency medical response teams are being pushed to the limit because of the crisis. This drain on resources prevents communities from dealing adequately with other medical care needs, further darkening the nation’s health care situation.

Opioid drugs remain an essential treatment for patients with severe pain, and the United States Food and Drug Administration (FDA) requires all manufacturers of such drugs to demonstrate that they are both safe and effective. However, medical experts recognize that more needs to be done to prevent opioid treatment from escalating to addiction.

Medical experts believe that solving the current opioid crisis is more than a matter of law enforcement cutting off the supply of illegally obtained opioid drugs. Treatment for addicts and education programs that emphasize prevention and the seeking of help are also vitally important. Medical experts at the FDA have proposed a policy of “opioid exceptionalism” for prescribing pain medications. Before prescribing opioids to treat pain, doctors would be instructed to consider the risks that a patient might develop an opioid use disorder or become addicted. Doctors would also consider the risk of addicted patients making a transition to other opioids or turning to illicit drugs such as heroin.

In March 2017, President Donald Trump appointed a commission to investigate the opioid crisis. On July 31, the commission recommended that the president declare a national emergency to deal with the epidemic. Public health experts agreed that such bold action is necessary to help Americans understand the severity of the opioid epidemic and to recognize that it is an unparalleled crisis requiring urgent attention.

The opioid commission’s report called for increasing access to naloxone and other medications used to treat overdose or addiction and requiring opioid drug prescribers to receive more education about the proper use of these drugs. The commission also proposed waiving a federal rule that limits addiction treatment for people who receive health care from government-funded Medicaid.

The federal report echoed similar reports from state and local counterparts across the United States. Medical experts emphasized that federal actions to complement state and local efforts help reduce rates of opioid dependence, overdose, and deaths, giving communities the greatest chance of success for ending the current crisis. President Trump, however, dismissed many of the findings detailed in the commission’s report. Instead, he focused on issues unrelated to the opioid crisis, such as stopping the influx of illicit drugs at the border with Mexico. Trump’s insistence on repealing the Affordable Care Act (commonly known as Obamacare) would risk making matters worse by stripping funding for Medicaid—so far the best source of government help for curbing the epidemic.