Major histocompatibility complex MHC A

group of genes that code for Human Leukocyte Antigens (HLA) (markers on the surface of cells for the differentiation of self from nonself). MHC consists of either of two classes of molecules on cell surfaces. MHC class I molecules exist on all cells and hold and present foreign antigens to CD8 cytotoxic t-lymphocytes if the cell is infected by a virus or other microbe. MHC class II molecules are found on the immune system's antigen presenting cells and display antigen to activate CD4 t-helper cells.

major medical insurance Insurance that covers expenses for most serious medical conditions, up to a maximum limit, usually after deductible and coinsurance provisions have been met. These policies usually complement hospital-medical-surgical coverages.

malabsorption Faulty or incomplete absorption of nutrients in the intestines.

Cells in the gastrointestinal (GI) tract are particularly prone to damage during HIV infection, and this results in reduced absorption of nutrients. The HIV virus itself, intestinal parasites, and colitis induced by cytomegalovirus (cmv) are the main sources of tissue damage. The diarrhea connected with these conditions may also result in malabsorption. Fat, carbohydrate, protein, and micronu-trient (vitamin and mineral) malabsorption can occur. Malabsorption may also be present before infection with HIV. Infection by intestinal parasites triggers diarrhea and malabsorption in persons with AIDS by causing atrophy of the villi, the small threadlike projections (on the interior of the small intestines) that absorb nutrients when working properly. The protozoan Cryptosporidium parvum, the most commonly identified parasite in people with AIDS, causes massive secretory diarrhea.

microsporidia (Enterocytozoon bieneusi or Septata intestinalis) is a second common GI parasite in people with AIDS. Infection can cause diarrhea and decreased intestinal absorption.

malabsorption syndrome Decreased intestinal absorption resulting in loss of appetite, muscle pain, and weight loss.

malaise A vague feeling of discomfort or uneasiness, often the result of infection or a drug's side effects.

malaria one of the most widespread infectious diseases in the world, malaria is an acute and sometimes chronic disorder caused by the presence of protozoan parasites within the red blood cells. Malaria is transmitted to the human by the bite of an infected female Anopheles mosquito. The mosquito becomes infected by ingesting the blood of a human infected with malaria. Chloro-quine and mefloquine, the medications that prevent malaria, do not interact with medications commonly prescribed for HIV-related indications. Despite prophylaxis, certain forms of malaria can occur weeks to months after an individual has left a malaria-infested area. Fever is the prominent symptom, and a simple blood test determines the diagnosis. Chloroquine phosphate is prescribed for all types of malaria except those due to drug-resistant Plasmodium falciparum. In drug-resistant P. falciparum, treatment with combinations of quinine, pyrimethamine, and a sulfonamide is indicated. Malaria due to other species should be treated with both chloroquine and primaquine. Severe malaria due to P. falciparum with evidence of cerebral involvement may be treated with continuous infusion of quinidine gluconate and exchange transfusion.

Similarities and differences between malaria and HIV bear noting. Like HIV, malaria kills millions of people each year and is a scourge of developing nations in Africa, India, Southeast Asia, and South America. Most people who contract malaria or HIV are poor. Whereas HIV is pandemic, spread from person to person by sexual contact in an increasingly mobile world, malaria is endemic, dependent on a local symbiosis between infected

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