GROUP FIVE

(HIV) Human immunodeficiency virus is a lentivirus (a

INTRODUCTION

member of the retrovirus family) that causes Acquired Immunodeficiency Syndrome (AIDS)
Discovered in 1983 HIV has been divided into two primary strains

HIV-1 and HIV-2

HIV is highly a variable virus which mutates very readily.

CHARACTERISTICS OF HIV
HIV is a retrovirus that is believed to have evolved

from a simian immunodeficiency virus.

Group Family Genus Group VI (-ssRNA) Retroviridae Lentivirus

HIV can be characterized primarily by its; Structure Viral genome.

STRUCTURE OF HIV

HIV is different in structure from other retroviruses.

STRUCTURE OF HIV
It is composed of two copies of positive single-

stranded RNA.
A matrix composed of the viral protein surrounds the

capsid. It has a viral envelope It has glycoprotein's/receptors on its envelope

EPIDEMIOLOGY

UNAIDS and the WHO estimated that Sub-Saharan Africa remains by far the worst-affected region, with an estimated 22.5 million people currently living with HIV (67% of the global total), and 1.8 million new infections (69% of the global total). However, the number of new infections declined by 19% across the region between 2001 and 2009, and by more than 25% in 22 sub-Saharan African countries during this period. Asia is the second-worst affected region, with 4.9 million people living with HIV (15% of the global total).

EPIDEMIOLOGY
The first case of HIV in Ghana was reported in March

1986.
HIV PREVELANCE BY REGION(%), 2009.
Northern Upper East Volta Brong Ahafo Central Upper West Western Greater Accra Ashanti Eastern 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

EPIDEMIOLOGY
HIV PREVALENCE BY AGE GROUP(%), 2009
4 3.5 3

2.5
2 1.5 1 0.5 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-24

ETIOLOGY
The 3 main routes of HIV transmission is via; o blood, blood products o sexual intercourse o mother to child in intrauterine infection, perinatal transmission, or the mothers milk. NB. Infection via saliva or insect bite has not been confirmed.

PATHOGENESIS
Mode of Transmission

o Blood Products o Blood transfusion o Infected blood coming into contact with open wounds o Sexual intercourse o Mother to child o Child birth o Breast feeding

 Entry into host cell o HIV enters macrophages and CD4+ T cells by the

adsorption of glycoproteins on its surface to receptors on the target cell. o Followed by fusion of the viral envelope with the cell membrane and the release of the HIV capsid into the cell.
Replication and Transcription o On entry of the viral capsid, there is reverse transcription

of the +ssRNA, into a complementary DNA molecule by the reverse transcriptase. o The enzyme integrase, integrates the viral DNA into the host cell genome. o This integrated viral DNA may then lie dormant, in the latent stage of HIV infection.

Assembly and Release o Structural proteins, functional proteins and enzymes are packaged. o After assembly of the viral particle in the plasma membrane it buds out of the cell, thus acquiring an envelope in the process.

Stages of Infection
The stages of infection can be grouped into four.
Stage 1 Primary Short, flu-like illness - occurs one to six weeks after

infection
no symptoms at all

Infected person can infect other people

 Stage 2 Asymptomatic Lasts for an average of ten years

This stage is free from symptoms

There may be swollen glands

The level of HIV in the blood drops to very low levels HIV antibodies are detectable in the blood

 Stage 3 Symptomatic The symptoms are mild The immune system deteriorates emergence of opportunistic infections and cancers

Stage 4 - HIV AIDS

The immune system weakens The illnesses become more severe leading to an AIDS

diagnosis

Opportunistic Infections associated with HIV Infections

Bacterial
Tuberculosis (TB) Strep pneumonia

Viral
Kaposi Sarcoma Herpes Influenza (flu)

Immune responses
ANTIBODY RESPONSES Beneficial effect
Neutralizing antibody (demonstrated in vitro only)

might prevent primary infection and destroy some infectious particles.

Harmful effects Antibody may also help the virus to enter cells with Fc receptors Immune complexes may cause tissue damage, anemia and neutropenia.

CELLULAR IMMUNE RESPONSE Beneficial effects

A strong CD8 response is correlated with primary resistance

in some individuals and with long-term survival Cytotoxic T-cell antiviral factor (CAF) which inhibits viral replication and may be important in slowing disease progression

Harmful effects They may kill uninfected cells which take up shed gp120 Abnormal cytokine secretion may cause immunopathology (perhaps including encephalopathy)

Persistence
a. Acute infections b. Chronic infections

c. Latent infections

Laboratory Diagnosis
Detection of HIV is tackled on three different fronts; o Blood o Urine o Oral

Blood Detection Tests

Enzyme-Linked Immunosorbent Assay/Enzyme

Immunoassay (ELISA/EIA) Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIP/IFA) Polymerase Chain Reaction (PCR) Western Blot Confirmatory test

Urine Testing
Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV

Oral Testing
Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST!

PROGNOSIS
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resourcelimited settings is 6 and 19 months. . In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to 2050 years.

Treatment Options

Antiretroviral Drugs
Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)

Opportunistic Infection Treatment

Issued in an event where antiretroviral drugs are not

available

PREVENTION OPTIONS
Abstinence
Monogamous Relationship Protected Sex

Sterile needles

Abstinence
It is the only 100 % effective method of not acquiring

HIV/AIDS. Refraining from sexual contact: oral, anal, or vaginal. Refraining from intravenous drug use

Monogamous relationship
A mutually monogamous (only one sex partner)

relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected

Protected Sex
Use condoms (female or male) every time you have sex

(vaginal or anal) When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms

THANK YOU

REFERENCES
Adler, w. (2001): ABC of AIDS. London:

BMJ publishing group. Lucas, o., Gilles, M. (1990): A new short textbook of preventive medicine for the Tropics. Britain : The Bath Press, Avon. Kayser , F. , Bienz, K., Zinkernagel, R., (2005) Medical microbiology ( pp 449 455 ). Retrieved from 4shared.com books database.