Appendix B Glossary

Complete cessation of substance-using behavior.

An array of symptoms that arises after initial infection with HIV that includes fever, sore throat, swollen glands, muscle and joint pain, nausea, and rash.

Strict observation of a prescribed treatment regimen, including correct dosage and number of doses per day, as well as taking doses with or without food or other medications.

A sudden, severe drop in white blood cell count that can occur upon the administration of certain HIV medications.

AIDS is the end stage of HIV disease and is characterized by a severe reduction in CD4+ T cells. At this point, an infected person has a very weak immune system and is vulnerable to contracting life-threatening infections.

A medication that weakens or halts the reproduction of retroviruses such as HIV.

A physical barrier between the blood vessels and the brain that only allows certain substances to pass through and enter the brain.

The number of CD4+ T cells in a milliliter of blood. These cells (white blood cells within the immune system) are constantly measured in HIV-infected clients because their number reflects the overall health of the immune system.

A component of outreach that identifies individuals at higher risk for HIV infection and that stresses HIV/AIDS prevention, along with the distribution of items to facilitate compliance with risk reduction techniques.

The treatment of HIV disease with multiple medications. Combinations of three or more different medicines are used to treat a client, with each medicine working in a different way to stop the virus. While this is the most effective treatment to date, once combination therapy is begun, it must not be stopped because the virus could then develop resistance to these medications.

Resistance that can develop in the HIV virus once a medication from a certain class is used (e.g., protease inhibitors, nucleosides) to treat it. The virus not only becomes resistant to one particular drug but also becomes resistant to some or all of the other drugs from that class. For this reason, it is widely believed that the best chance for success in HIV treatment is with the first treatment regimen.

An aspect of treatment that takes into account the cultural heritage of the client. Culturally competent providers recognize the customs, beliefs, and social forms of the racial, religious, or social group to which the client belongs and work within these parameters to interact successfully with the client.

Any of the group of herpes viruses that appear as opportunistic infections in patients with HIV disease, generally in the latter stages of AIDS. CMV most commonly causes retinitis, which can lead to blindness if untreated, and may also cause gastrointestinal, adrenal, pulmonary, and other systemic problems.

The positive or negative effect that one medication has on another when an HIV-infected client is taking both.

Bacterial endocarditis is a well-recognized complication of unsterile injection drug use that produces inflammation of the endocardium (the lining of the heart). It can also appear as an HIV-related opportunistic infection.

Aggressive combination therapy that usually includes a powerful protease inhibitor medication.

An approach to treatment that emphasizes incremental decreases in substance abuse or HIV risk behaviors as treatment goals. This method attempts to keep clients in treatment even if complete abstinence is not achieved.

A virus that often appears as an initial indication of HIV disease and begins with itching or pain on only one side of the face or body, followed by a rash that looks like chicken pox or poison ivy.

The retrovirus that causes AIDS in humans. HIV is transmitted through direct contact with human bodily fluids; roughly 10 years after infection, AIDS-defining conditions begin to occur. AIDS is characterized by a severe reduction in CD4+ T cells, which greatly weakens the immune system and leaves the patient vulnerable to contracting life-threatening infections. New medicines can control HIV and extend the life of the patient; however, AIDS is inevitably fatal.

An irrational aversion to gay men and lesbians and to their lifestyle.

A program or facility that provides care for clients in the last stages of a terminal disease such as AIDS and creates a compassionate environment in which clients can die peacefully.

A virus that causes white patches in the mouth and is one of the initial indications of HIV infection.

Swollen lymph nodes, the most common symptom during the HIV latency period. The lymph nodes can be found around the neck and under the arms and contain cells that fight infections. When an infection is present, lymph nodes usually swell. Inside the lymph nodes HIV is trapped and destroyed, but eventually the HIV breaks down the tissue of the nodes and spills into the rest of the body.

Treatment of HIV infection with only one medication, usually AZT. This was the standard treatment for HIV before 1995 and is now outdated.

Men who have sex with men.

Bone marrow suppression, which can occur upon the administration of certain HIV medications.

A type of medication that binds to HIV's reverse transcriptase enzyme and stops the virus from replicating. NNRTI medications include delaviridine, efavirenz, and nevirapine.

A drug that mimics HIV's genetic material and halts it from reproducing. This class of drugs includes AZT, abacavir, didanosine, zalcitabine, stavudine, and lamivudine.

An infection that usually does not harm a healthy person but that can cause a life-threatening illness in someone with a compromised immune system.

Transmission of HIV from a mother to her child either in the uterus, during birth, or through breast-feeding.

A condition in which the peripheral nerves of the hands or feet are afflicted, producing numbness, tingling, pain, or weakness.

The act of drawing blood.

PCP is the most common AIDS-related infection and is characterized by a dry cough, fever, night sweats, and increasing shortness of breath. Since the late 1980s, the widespread use of PCP prophylaxis has resulted in a dramatic decrease in the incidence of this opportunistic infection. However, despite the availability of effective prophylaxis, PCP is still the most common opportunistic infection; many patients who develop PCP are unaware of their HIV status and hence are not receiving prophylaxis.

Antiretroviral therapy that is administered within 72 hours after exposure to HIV in an attempt to eradicate the virus from the body.

One of a powerful class of drugs used in combination therapy that acts by interfering with the protease enzyme that cuts HIV proteins into the small pieces required to create new copies of the virus. This slows or halts the replication of HIV. Protease inhibitors include indinavir, nelfinavir, ritonavir, and saquinavir.

A drug that halts HIV replication by interfering with the reverse transcriptase enzyme used by the HIV virus to transform its genetic material into a form that can be used to produce more viruses. This class of drugs includes nucleoside analogs like AZT and lamivudine.

An approach to treatment that emphasizes graduated behavior change rather than immediate abstinence. By identifying areas of risk in the client's life, such as sexual risk or needle sharing, the provider can discuss strategies with the client for avoiding or reducing them.

Syringe exchange programs.

Frequency of presence of antibodies in blood serum as a result of infection.

Sexually transmitted diseases.

A drug of abuse, a medication, or a toxin.

A pattern of substance use that results in harmful consequences for the abuser. This condition is not as severe as substance dependence.

Repeated self-administration of a substance that usually results in tolerance, withdrawal, and compulsive substance-abusing behavior.

Oral candidiasis, or thrush, is a symptom of initial HIV infection and usually appears as white plaques at the back of the mouth. Without treatment, thrush often spreads throughout the mouth and can affect the esophagus in persons with advanced disease, leading to severe pain on swallowing and the need for prolonged systemic treatment.

An AIDS-defining symptom caused by infection with the protozoan toxoplasma and one of the two most common brain infections in HIV. Toxoplasmosis, which produces seizures, usually does not appear until a client's CD4+ T cell count drops below 100.

Treatment involving three medications, which can lower the rate of disease progression and mortality more than can two medicines alone. Triple combination therapy was developed after combination-resistant forms of HIV began to appear.

The level of HIV circulating in the bloodstream. This level becomes very high soon after initial infection, then drops until it returns with the onset of AIDS. Drug therapy can keep viral load low or undetectable, but the client can still infect others since the virus still exists—it is simply not visible. Even when testing reveals a low viral load, HIV continues to live inside certain cells in the body and can begin reproducing at any time if the infected person is not on effective treatment. If a person is not in treatment, HIV produces billions of new virions (viral particles) every day.