HIV

Human Immunodeficiency Virus

The Global situation:

The HIV accounts for the highest number of

death by any single infectious agent The highest burden is in Sub -Saharan Africa followed by South-East Asia Women and girls account for half of those living with HIV/AIDS Young people(15-26 years) accounts for half of all new infections,

HIV/AIDS IN SOUTH EAST ASIA

South East Asia has the second highest number

of HIV infected person(6.4 millions ) among all WHO Regions Four countries India, Thailand, Myanmar, and Indonesia accounts for 99% of the estimated HIV burden in South East Asia HIV epidemics are largely concentrated among population sub groups with high risk behaviors, namely, commercial sex workers and their clients, injecting drug users.

Basic facts about HIV/AIDS

HIV is believed to have originated in non-human

primates in sub-Saharan Africa and was transferred to humans late in the 19th or early in the 20th century. HIV is the virus that causes AIDS HIV/AIDS is treatable, but not curable It is estimated that 1 in 20 people in are living with HIV

The high risk fluids:

Blood

Semen
Breast Milk Vaginal Fluids

These are the four high risk fluids that transmit HIV.

Transmitting HIV
HIV is transmitted when one or more of the four fluids is transferred from one person to another. The most common ways HIV is transmitted is by: Unprotected sex Transfusion of Unsafe Blood and blood products Mothers to child transmission. Breastfeeding from infected mother to baby

Susceptible:
Commercial female and male sex worker.

Injecting drug users:

Mobile populations: workers migerating within and

across the countries Men who have sex with men and transgenders.

HIV attacks on bodys immune system

The immune system is the bodys natural defense against disease and infections White blood cells help fight infections HIV attacks and destroys T-cells, which are a type of white blood cell (also known as CD4 cells) HIV replicates itself and attacks more T-cells to weaken the immune system so that it no longer functions

Structure of the Human Immunodeficiency Virus HIV is a Retrovirus

Life Cycle of HIV

1. Attachment: Virus binds to surface molecule (CD4) of T helper cells and macrophages. 2. Fusion: Viral envelope fuses with cell membrane, releasing contents into the cell.

Life Cycle of HIV

3. Reverse Transcription: Viral RNA is converted into DNA by unique enzyme reverse transcriptase.

RNA ---------------------> DNA Reverse transcriptase is the target of several HIV drugs: AZT.

Reverse transcriptase

Life Cycle of HIV

4. Integration: Viral DNA is inserted into host cell chromosome by unique enzyme integrase. Integrated viral DNA may remain latent for years and is called a provirus. 5. Replication: Viral DNA is transcribed and RNA is translated, making viral proteins. Viral genome is replicated. 6. Assembly: New viruses are made. 7. Release: New viruses bud through the cell membrane

HIV Life Cycle: Attachment Requires CD4 Receptor plus a Coreceptor

HIV Life Cycle: Reverse Transcriptase Converts RNA into DNA

AIDS Associated Disease Categories

1. Gastrointestinal: Cause most of illness and death of late AIDS. Symptoms:
Diarrhea Wasting (extreme weight loss) Abdominal pain Infections of the mouth and esophagus.

Pathogens: Candida albicans, cytomegalovirus, Microsporidia, and Cryptosporidia.

Opportunistic Oral Yeast Infection by Candida albicans in an AIDS Patient

AIDS Associated Disease Categories

2. Respiratory: 70% of AIDS patients develop serious respiratory problems.
Partial list of respiratory problems associated with AIDS:
Bronchitis Pneumonia Tuberculosis Lung cancer Sinusitis

AIDS Associated Disease Categories

3. Neurological: Opportunistic diseases and tumors of central nervous system. Symptoms many include: Headaches, peripheral nerve problems, and AIDS dementia complex (Memory loss, motor problems, difficulty concentration, and paralysis).

AIDS Associated Disease Categories

4. Skin Disorders: 90% of AIDS patients develop skin or mucous membrane disorders.
Kaposis sarcoma

1/3 male AIDS patients develop KS Most common type of cancer in AIDS patients Herpes zoster (shingles) Herpes simplex Thrush Invasive cervical carcinoma

5. Eye Infections: 50-75% patients develop eye conditions.

Conjunctivitis Dry eye syndrome

Extensive tumor lesions of Kaposiss sarcoma in AIDS patient. Source: AIDS, 1997

Types of HIV Tests

Blood tests for antibodies against HIV

Most common: Enzyme immune assay/enzymelinked immunosorbent assay (ELISA)

Gold standard: Western blot (more specific than

ELISA and used as a confirmatory test)

Radio- immunobinding assay (expensive, used as a

confirmatory test when antibodies low)

Dot-blot immunobinding assay (cost-effective rapid

screening blood test)

Once CD4 count drops below 500, HIV infected

person at risk for opportunistic infections.

Preventions:
Behaviors change and condom promotion

Reduction among injecting drug users

Blood safety Treatment of sexually transmitted infection Comprehensive reproductive health programmes

to prevent HIV infection in women, infants and young children. Interventions for risk groups

CARE AND SUPPORT:

Clinical and nursing care

Psychosocial support
Treatment adherence counseling Economic and employment support Housing Human rights and legal support Care and support for orphans and widows Nutrition

Treatment:
Anti -retroviral treatment Prevention and treatment of

opportunistic infections

Drugs Against HIV

Reverse Transcriptase Inhibitors: Competitive

enzyme inhibitors. Example: AZT Protease Inhibitors: Inhibit the viral proteases. Prevent viral maturation Azatanavir, Idinavir. Problem with individual drug treatments: Resistance. Drug Cocktails: A combination of:
One or two reverse transcriptase inhibitors One or two protease inhibitors.

Drug cocktails have been very effective in

suppressing HIV replication and prolonging the life of HIV infected individuals, but long term effectiveness is not clear

Recommendations for Therapy in Antiretroviral HIV-infected Patients

Condition
In presence of AIDS-defining illness Pregnancy HIV-associated nephropathy HBV co-infection when HBV therapy is indicated and/or CD4 count <350 cells/mm3 CD4 count 350-500 cells/mm3

Recommendation

Start ART

ART is recommended 55% of Panel members strongly recommended starting ART 45% moderately recommended starting ART ART is recommended or optional 50% recommended starting ART 50% viewed starting ART as optional

CD4 count >500 cells/mm3

Treatment of AIDS-related opportunistic infections and malignancies.

Antiretroviral therapy.

AIDS is Changing the world :

It has direct influence on Human social and economic

cost : It is social problem, orphaning millions of children and destroying families and communities. AIDS is affecting national economics AIDS is affecting household economics AIDS is affecting women and girls who works as a care giver to their family. AIDS is changing structure of population.

Conclusions
HIV attacks and weakens the immune system,
reducing its ability to fight infection. Main transmission routes are Blood, Semens, Breast milk, Vaginal fluid HIV is recognized mainly by testing antibodies formed to fight the virus. ART can prevent and slow progression of AIDS. A comprehensive package of HIV and AIDS interventions should include infection prevention, ART, care , support and education.

Thank You