Yusri Arif bin Sapaee

5th Year Medical Student

Kasr El-Ainy School of Medicine, Cairo University
Classification of retroviruses that cause
disease in humans
Structure of the human
immunodeficiency virus
HIV proviral genome
Binding of HIV to surface of lymphocyte
Attachment and entry of HIV virus
The HIV replication cycle
Common modes of transmission of HIV
Typical time course of HIV infection
Pathogenesis of HIV
Pattern of opportunistic infections
associated with declining CD4+ cell
counts
Highly active antiretroviral therapy
(HAART)
Retroviruses are non enveloped positive
sense ssRNA viruses
Retroviruses contain enzyme reverse
transcriptase

Retroviruses rely on the reverse

transcriptase (RT) enzyme to transcribe
their genome from RNA into a DNA
copy, which can then be integrated as a
DNA provirus into the genomic DNA of
the host cell.
Important members of Retroviridae family
that affect humans are?

HIV  Lentivirinae subfamily

HTLV  Oncovirinae subfamily
Human Immunodeficiency Viruses replicate
in?
HIV-2 is the major cause of AIDS worldwide
HIV-2 is characterized by the
following EXCEPT:

Limited mostly to West Africa and Portugal

Much less severe

Has 2 groups (M & O)

Slower in progression

First described in 1986

Group M viruses are rare and limited to
western part of Africa
HIV-1 and HIV-2 resemble each other
strikingly. However, they differ in?

The virus has spherical shape with a

diameter of 100nm.
The virus envelope is line with an HIV
protein called p17 (matrix protein, MA).
Inside, a conical-shaped capsid (CA) made of
protein called p24 (core antigen)
What is the most abundant protein in the
virus particle?
HIV antigens

Envelope antigens gp120

Core capsid antigens p66/51 complex

RT antigen gp120 (SU) & gp41 (TM)

Its absence  successful tx p17 and p24

Responsible for receptor binding p24

Cells that are not infected by HIV

Hepatocytes

Oligodendrocytes, astrocytes, neurones and glial cells

CD4+ T helper lymphocytes

Follicular dendritic cells (FDCs)

Monocytes/macrophages
Name receptors on the cell surface
required for the entry of HIV into the cell
Post-fusion events

First Assembly and budding

Second Transcription

Third Reverse transcription

Forth Integration

Fifth Translation
 Diagnosis of acute HIV infection
(acute retroviral syndrome)

HIV antibody positive Not infected

HIV antibody negative, HIV

RNA detectable Acute HIV infection

HIV antibody negative, HIV RNA  Established HIV infection & no

viral load >5000 copies/ml acute infection

HIV antibody negative, HIV RNA  Repeat HIV RNA test in the
viral load 50-5000 copies/ml same specimen

HIV antibody negative, HIV RNA  Indeterminate  repeat testing on

viral load <50 copies/ml follow up specimen
How to diagnose HIV infection in newborns?
 Highly active antiretroviral therapy
(HAART)
Nucleoside analogues
transcriptase inhibitors Enfuvirtide (Fuzeon)

Non-nucleoside analogues
transcriptase inhibitors Ritonavir

Protease inhibitors Lamivudine

Protease inhibitors Nevirapine

Fusion inhibitors Indinavir

How to monitor anti-HIV therapy?
Best regimen for post-exposure
chemoprophylaxis

1 reverse transcriptase inhibitor + 2 protease inhibitor

1 reverse transcriptase inhibitor + 2 fusion inhibitors

2 fusion inhibitors + 1 protease inhibitor

1 reverse transcriptase inhibitor + 1 protease inhibitor

2 reverse transcriptase inhibitors + 1 protease inhibitor