Session 25 Mmi

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HIV ia a

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RNA retrovirus

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HIV infects...

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CD4+ T cells, macrophages and dendritic cells

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HIV progresses to...

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AIDS- Acquired Immune Deficiency Syndome

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HIV has no...

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vaccine

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HIV Subtypes

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1. HIV-1: has around 11 subtypes (clades), major type of HIV

2. HIV: found in West Africa, much slower infection

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HIV originates from

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SIV Simian Immunodeficiency Virus

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HIV-1 origination

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monkey-chimpanzee/ gorilla-human

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HIV-2 origination

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monkey-human

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earliest documented case in 1959 in Africa called

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skinny disease

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HIV is a global

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pandemic

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more than .... carry the virus

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40 million

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only...are officially diagnosed

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5%

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every 24 hours the infected numbers

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15000

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every 24 hours...die

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8000

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leading cause of death in sub-Saharan Africa

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2.5 million AIDS deaths

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contrary to belief it is transmitted

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heterosexually as well

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HIV envelope

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1. a glycolipid envelope w/spikes called gp 120

2. means it is easy to inactivate

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HIV has two strands of

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identical RNA

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HIV has what enzyme

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1. reverse transcriptase

2. allows it to reproduce in the host

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AZT and HIV antivirals...

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targeted reverse transcriptase

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Front 22

HIV must attach to both ... for infection to occur

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CD4+ and chemokine receptors

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once in the host cell, viral RNA is..

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released and transcribed into DNA by reverse transcriptase

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newly formed viral DNA is incorporated into human DNA chromosome by the enzyme

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integrase

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new DNA can either

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produce more virus or can remain latent as a provirus

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of those infected % individuals never produces disease

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5% remain latent as a provirus

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HIV can undergo rapid changes in

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antigenic makeup which helps it evade the host defences- inducing drug resistance

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diagnosis for HIV

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1. repeatedly reactive tests for HIV antibodies

2. Virus PCR: virus load from blood

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Monitoring HIV: viral load

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keep track of number of HIV particles in blood

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monitoring HIV: CD4+ cells

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1. below 200/nm^3 is indicative of clinical AIDS

2. this occurs because CD4+ cells only live for 2 days when infected

3. virus inhibit new production of T cells

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stage A infection

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infection is asymptomatic or causes chronic swollen lymph nodes

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stage B infection

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persistent infections by opportunists like C. albicans, VZV, cryptosoridia, hairy lekoplakia

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stage C= clinical AIDS

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defined by "indicator conditions" such as C. albicans infections of the respiratory mucosa, CMV eye infections, TB, Pneumocystis pneumonia, toxoplasmosis of the brain and kaposi's sarcoma

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mild, flu-like symptoms for HIV may go...

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unnoticed

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oral candidiasis

HIV

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1. usually caused by C. albicans

2. most common infection is thrush

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Oral leukoplakia

HIV

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1. usually asymptomatic, no treatment needed

2. characterized by white lesions EBV

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HIV

gingivitis and periodontitis

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symptoms

1. severe pain

2. bleeding gums

3. loosening of teeth

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ocular infections with HIV

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very common, ranging from bening HIV retinopathy to sight threatening viral infections

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most common HOV ocular infection

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CMV retinitis, very serious

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Varicella-zoster retinitis

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severe necrotizing retinitis

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leading cause of mortality and morbidity in HIV infected patients

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HIV pulmonary disease

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most dangerous pulmonary HIV disease

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Pneumocystis jirovechi Pneumonia

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PJP

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1. insidious onset

2. early diagnosis and treatment important

3. dry cough- no purulent sputum

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antibiotic for PJP

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trimethoprim-sulfa "septra"

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first infectious complication for HIV

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mycobacterial diseases

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HIV increases reactivation of

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latent infections

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HIV patients have ... annual risk of developing active disease

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5-10%

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HIV increases the risk of

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symptomatic disease/ mycobacteria diseases after infection

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HIV increases dissemination of

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TB

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kaposi's sarcoma associated with infection of

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HHV 8

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Kaposi's Sarcoma treated by

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radio theraphy

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Kaposi's disease defining illness of

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AIDS

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usually seen in infected homosexual men

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vascular neoplastic disorder

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kaposi's sarcoma appears as

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cutaneous red-purple nodules or plaques

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sites usually affected by Kasopi's Sarcoma

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legs, feet, mucous membranes, hard palate, nose, trunk and scalp

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TRANSMISSION OF HIV

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1. contact with bodily fluid

2. sexual contact

3. blood contamination from needles, transplants and blood transfusions

3. transmission more effective if sores are present

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blood as bodily fluid of contamination

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has highest viral load

100000+ viruses/ml

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semen as a bodily fluid of contamination

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not as high as blood, around 50 viruses/ml

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vertical transmission of HIV

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1. pregnancy, delivery and breast feeding

2. artificial insemination: semen contaminated with HIV

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prevention of neonate infection

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1. antivirals during pregnancy and the first 6 months

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HAART

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combination of anti-HIV medicines

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problem with treatments

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rapid development of resistance

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when do we treat

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as soon as infection is found

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how to check for resistance?

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looking through HIV genome sequence

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TRUVADA

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1. uses combination of two RT inhibitors

2. can be used PrEP or pre-exposure, giving 75% protection

3. use for actual treatment for the disease in combination w/other drugs

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cure for HIV?

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there is no cure for HIV