Human

Immunodeficiency Virus
(HIV)
Human
Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) is a
lentivirus (a member of the retrovirus family) that
can lead to acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the
immune system begins to fail, leading to life-
threatening opportunistic infections.
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Human
Immunodeficiency Virus

Human T-lymphotropic virus-III (HTLV-III),
lymphadenopathy-associated virus (LAV)

AIDS-associated retrovirus (ARV).
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Human
Immunodeficiency Virus
HIV primarily infects vital cells in the human
immune system such as helper T cells (specifically
CD4+ T cells), macrophages, and dendritic cells.
HIV infection leads to low levels of CD4+ T cells
through three main mechanisms: firstly, direct viral
killing of infected cells; secondly, increased rates of
apoptosis in infected cells; and thirdly, killing of
infected CD4+ T cells by CD8 cytotoxic lymphocytes
that recognize infected cells. When CD4+ T cell
numbers decline below a critical level,
cell-mediated immunity is lost, and the body
becomes progressively more susceptible to
opportunistic infections.
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Human
Immunodeficiency Virus
AIDS – Eventually most HIV-infected individuals develop
AIDS (Acquired Immunodeficiency Syndrome). These
individuals mostly die from opportunistic infections or
malignancies associated with the progressive failure of the
immune system. Without treatment, about 9 out of every 10
persons with HIV will progress to AIDS after 10-15 years.
Many progress much sooner Treatment with anti-retrovirals
increases the life expectancy of people infected with HIV.
Even after HIV has progressed to diagnosable AIDS, the
average survival time with antiretroviral therapy (as of 2005)
is estimated to be more than 5 years Without antiretroviral
therapy, death normally occurs within a year. It is hoped that
current and future treatments may allow HIV-infected
individuals to achieve a life expectancy approaching that of
the general public.
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Human
Immunodeficiency Virus
 Signs and Symptoms:
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 Acute HIV infection, the most common symptoms of which may include fever,
lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and
esophagal sores, and may also include, but less commonly, headache,
nausea and vomiting, enlarged liver/spleen, weight loss, thrush, and
neurological symptoms. Infected individuals may experience all, some, or
none of these symptoms. The duration of symptoms varies, averaging 28
days and usually lasting at least a week. Because of the nonspecific nature
of these symptoms, they are often not recognized as signs of HIV infection.
Even if patients go to their doctors or a hospital, they will often be
misdiagnosed as having one of the more common infectious diseases with
the same symptoms. Consequently, these primary symptoms are not used
to diagnose HIV infection as they do not develop in all cases and because
many are caused by other more common diseases. However, recognizing
the syndrome can be important because the patient is much more infectious
during this period.
Human
Immunodeficiency Virus
 Epidemiology:
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 In 2007, between 30.6 and 36.1 million people were believed to live with HIV,
and it killed an estimated 2.1 million people that year, including 330,000
children; there were 2.5 million new infections. Sub-Saharan Africa remains
by far the worst-affected region, with an estimated 21.6 to 27.4 million
people currently living with HIV. Two million [1.5–3.0 million] of them are
children younger than 15 years of age. More than 64% of all people living
with HIV are in sub-Saharan Africa, as are more than three quarters of all
women living with HIV. In 2005, there were 12.0 million [10.6–13.6 million]
AIDS orphans living in sub-Saharan Africa 2005.[3] South & South East Asia
are second-worst affected with 15% of the total. AIDS accounts for the
deaths of 500,000 children in this region. South Africa has the largest
number of HIV patients in the world followed by Nigeria. India has an
estimated 2.5 million infections (0.23% of population), making India the
country with the third largest population of HIV patients. In the 35 African
nations with the highest prevalence, average life expectancy is 48.3 years—
6.5 years less than it would be without the disease.
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Human
Immunodeficiency Virus
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HIV Testing

Performed to detect antibodies (proteins made by the
human body) against the human immunodeficiency
virus (HIV) which indicates infection with the virus.
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Human
Immunodeficiency Virus
 Description of HIV Testing
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 Many HIV-infected individuals are unaware of their status, since the
characteristic complications of AIDS usually do not develop until several
years after HIV infection. The virus destroys immune cells known as CD4
cells or T helper cells. When the levels of CD4 cells fall below 200
cells/mm3 (generally the level is greater than 500 cells/mm3), a patient is
considered to have AIDS (as opposed to HIV infection earlier in the course
of the disease). With a weakened immune system, patients with AIDS are
unable to defend themselves against infections a normal healthy immune
system can usually ward off. Such infections are known as opportunistic
infections. Early knowledge of one’s HIV status may allow infected
individuals to seek treatment early enough in the course of the disease
before the onset of AIDS or such opportunistic infections occur. Knowing
one’s HIV status may also make an individual less likely to engage in high-
risk behavior reducing the risk of HIV transmission to other uninfected
individuals. The standard method of screening for HIV infection are
serologic tests which detect the presence of antibodies to HIV-1 and HIV-2
(the two -main types of HIV) in a patient’s blood.
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Human
Immunodeficiency Virus
 Pathophysiology


 HIV attaches to and penetrates host T cells via CD4+ molecules and
chemokine receptors. After attachment, HIV RNA and enzymes are
released into the host cell. Viral replication requires that reverse
transcriptase, an RNA-dependent DNA polymerase, copy HIV RNA,
producing proviral DNA; this copying is prone to errors, resulting in
frequent mutations. Proviral DNA enters the host cell's nucleus and
is integrated into host DNA in a process that involves HIV integrase.
With each cell division, the integrated proviral DNA is duplicated
along with host DNA. Proviral HIV DNA is transcribed to viral RNA
and translated to HIV proteins, including the envelope glycoproteins
40 and 120. The HIV proteins are assembled into HIV virions at the
inner cell membrane and budded from the cell surface; each host
cell may produce thousands of virions. Protease, another HIV
enzyme, cleaves viral proteins after budding, converting the virion
into an infectious form.
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Human
Immunodeficiency Virus
Infected CD4+ lymphocytes produce > 98% of plasma
HIV virions. A subset of infected CD4+ lymphocytes
constitutes a reservoir of HIV that can reactivate
(eg, if antiviral treatment is stopped). Virions have a
plasma half-life of about 6 h. In moderate to heavy
HIV infection, about 108 to 109 virions are created
and destroyed daily. With this much viral replication,
the high frequency of transcription errors by HIV
reverse transcriptase results in many mutations,
increasing the chance of developing strains
resistant to host immunity and drugs.
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Human
Immunodeficiency Virus
Transmission


Three main transmission routes for HIV have been

identified. HIV-2 is transmitted much less frequently
by the mother-to-child and sexual route than HIV-1.
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Human
Immunodeficiency Virus
Sexual
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The majority of HIV infections are acquired through

unprotected sexual relations. Sexual transmission can
occur when infected sexual secretions of one partner
come into contact with the genital, oral, or rectal
mucous membranes of another. In high income
countries, the risk of female-to-male transmission is
0.04% per act and male-to-female transmission is 0.08%
per act. For various reasons, these rates are 4 to 10
times higher in low income countries.
Human
Immunodeficiency Virus
 Blood or Blood Product


 In general if infected blood comes into contact with any open wound, HIV may
be transmitted. This transmission route can account for infections in
intravenous drug users, hemophiliacs and recipients of blood transfusions
(though most transfusions are checked for HIV in the developed world) and
blood products. It is also of concern for persons receiving medical care in
regions where there is prevalent substandard hygiene in the use of injection
equipment, such as the reuse of needles in Third World countries.
Health care workers such as nurses, laboratory workers, and doctors have
also been infected, although this occurs more rarely. People who give and
receive tattoos, piercings, and scarification procedures can also be at risk of
infection.
 Since transmission of HIV by blood became known medical personnel are
required to protect themselves from contact with blood by the use of
Universal precautions.
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Human
Immunodeficiency Virus
Mother-to-child


The transmission of the virus from the mother to the

child can occur in utero during pregnancy and
intrapartum at childbirth. In the absence of
treatment, the transmission rate between the mother
and child is around 25 percent. However, where
combination antiretroviral drug treatment and
Cesarian section are available, this risk can be
reduced to as low as one percent. Breast feeding
also presents a risk of infection for the baby.
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Human
Immunodeficiency Virus
Other routes


HIV has been found at low concentrations in the

saliva, tears and urine of infected individuals, but
there are no recorded cases of infection by these
secretions and the potential risk of transmission is
negligible.
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Human
Immunodeficiency Virus
Multiple Infection
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Unlike some other viruses, infection with HIV does not provide
immunity against additional infections, particularly in the case
of more genetically distant viruses. Both inter- and intra-clade
multiple infections have been reported, and even associated
with more rapid disease progression. Multiple infections are
divided into two categories depending on the timing of the
acquisition of the second strain. Coinfection refers to two
strains that appear to have been acquired at the same time
(or too close to distinguish). Reinfection (or superinfection) is
infection with a second strain at a measurable time after the
first. Both forms of dual infection have been reported for HIV
in both acute and chronic infection around the world
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Treatme
nt
Human
Immunodeficiency Virus
Abacavir - a nucleoside analog reverse transcriptase
inhibitors (NARTIs or NRTIs)
There is currently no vaccine or cure for HIV or AIDS.
The only known method of prevention is avoiding
exposure to the virus. However, a course of
antiretroviral treatment administered immediately
after exposure, referred to as
post-exposure prophylaxis, is believed to reduce the
risk of infection if begun as quickly as possible.
Current treatment for HIV infection consists of
highly active antiretroviral therapy, or HAART.
Human
Immunodeficiency Virus
 This has been highly beneficial to many HIV-infected individuals since its
introduction in 1996, when the protease inhibitor-based HAART initially
became available. Current HAART options are combinations (or "cocktails")
consisting of at least three drugs belonging to at least two types, or
"classes," of antiretroviral agents. Typically, these classes are two
nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs)
plus either a protease inhibitor or a
non-nucleoside reverse transcriptase inhibitor (NNRTI). New classes of
drugs such as Entry Inhibitors provide treatment options for patients who
are infected with viruses already resistant to common therapies, although
they are not widely available and not typically accessible in resource-limited
settings. Because AIDS progression in children is more rapid and less
predictable than in adults, particularly in young infants, more aggressive
treatment is recommended for children than adults. In developed countries
where HAART is available, doctors assess their patients thoroughly:
measuring the viral load, how fast CD4 declines, and patient readiness.
They then decide when to recommend starting treatment.
Human
Immunodeficiency Virus
Treatments in Development


Promising new treatments include Cre recombinase

and the enzyme Tre recombinase, both of which are
able to remove HIV from an infected cell. These
enzymes promise a treatment in which a patient's
stem cells are extracted, cured, and reinjected to
promulgate the enzyme into the body. The carried
enzyme then finds and removes the virus.
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Human
Immunodeficiency Virus
The list of risk factors mentioned for HIV/AIDS in
various sources includes:
Unprotected sex
Injection drug use
Homosexual behavior
Needle-stick injury - rare transmission
STDs - having other STDs makes catching HIV more
likely during sex.
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Human
Immunodeficiency Virus
HIV Prevention


Sexual transmission
Someone can eliminate or reduce their risk of
becoming infected with HIV during sex by choosing
to:
Abstain from sex or delay first sex
Be faithful to one partner or have fewer partners
Condomise, which means using male or female
condoms consistently and correctly
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Human
Immunodeficiency Virus
Transmission Through Blood


People who share equipment to inject recreational drugs

risk becoming infected with HIV from other drug users.
Methadone maintenance and other drug treatment
programmes are effective ways to help people eliminate
this risk by giving up injected drugs altogether. However,
there will always be some injecting drug users who are
unwilling or unable to end their habit, and these people
should be encouraged to minimise the risk of infection by
not sharing equipment.
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Human
Immunodeficiency Virus
Mother-to-child Transmission


HIV can be transmitted from a mother to her baby during

pregnancy, labour and delivery, and later through
breastfeeding. The first step towards reducing the number of
babies infected in this way is to prevent HIV infection in
women, and to prevent unwanted pregnancies.
There are a number of things that can be done to help a
pregnant woman with HIV to avoid passing her infection to
her child. A course of antiretroviral drugs given to her during
pregnancy and labour as well as to her newborn baby can
greatly reduce the chances of the child becoming infected.
Although the most effective treatment involves a combination
of drugs taken over a long period, even a single dose of
treatment can cut the transmission rate by half.
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