HUMAN IMMUNODEFICIENCY VIRUS HIV stands for Human Immunodeficiency Virus.

HIV is a virus (of the type called retrovirus) that infects cells of the human immune that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, preejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The immune system is considered deficient when it can no longer fulfill its role of fighting off infections and diseases. Immunodeficient people are more susceptible to a wide range of infections, most of which are rare among people without immune deficiency. Infections associated with severe immunodeficiency are known as 'opportunistic infections', because they take advantage of a weakened immune system.

CAUSATIVE AGENT Lentivirus HIV is a tricky virus to diagnose and treat, due to the fact that there are actually two forms of it:

HIV-1 is the most common form, and is also stronger, it invades first the dendritic cells in the genital and oral mucosa; this cells fuse with CD4 lymphocytes and spread to deeper tissues

HIV-2 is found in limited areas, mostly in western Africa, and is less potent but no less alarming.

SIGNS AND SYMPTOMS Most people infected with HIV do not know that they have become infected, because they do not feel ill immediately after infection. However, some people at the time of seroconversion develop Acute retroviral syndrome which is a glandular fever like illness with fever, rash, joint pains and enlarged lymph nodes. Seroconversion refers to the development of antibodies to HIV and usually takes place between 1 and 6 weeks 1

after HIV infection has happened. Whether or not HIV infection causes initial symptoms, an HIV-infected person is highly infectious during this initial period and can transmit the virus to another person. The only way to determine whether HIV is present in a person's body is by testing for HIV antibodies or for HIV itself. After HIV has caused progressive deterioration of the immune system, increased susceptibility to infections may lead to symptoms. HIV is staged on the basis of certain signs, symptoms, infections, and cancers grouped by the World Health Organization (WHO). Primary HIV infection - may be asymptomatic or experienced as Acute retroviral syndrome Clinical stage 1 - asymptomatic or generalized swelling of the lymph nodes Clinical stage 2 - includes minor weight loss, minor mucocutaneous manifestations, and recurrent upper respiratory tract infections Clinical stage 3 - includes unexplained chronic diarrhea, unexplained persistent fever, oral candidiasis or leukoplakia, severe bacterial infections, pulmonary tuberculosis, and acute necrotizing inflammation in the mouth. Some persons with clinical stage 3 have AIDS. Clinical stage 4 - includes 22 opportunistic infections or cancers related to HIV. All persons with clinical stage 4 have AIDS. Most of these conditions are opportunistic infections that can be treated easily in healthy people.

INCUBATION PERIOD It can take as little as 2 weeks or as long as 6 months from the time you become infected with HIV for the antibodies to be detected in your blood. This is commonly called the "window period," During the window period; you are contagious and can spread the virus to others. If you think you have been infected with HIV but you test negative for it, you should be tested again 6 months later. After you become infected with HIV, your blood, semen, or vaginal fluids are always infectious, even if you receive treatment for the HIV infection.

MEDICATION The most effective treatment for HIV is highly active antiretroviral therapy (HAART)-a combination of several antiretroviral medicines that aims to control the amount of virus in your body. Other steps you can take include keeping your immune system strong, taking medicines as prescribed, and monitoring your CD4+ (white blood cells) counts to check the effect of the virus on your immune system. If HIV is not treated, it eventually progresses to AIDS, the last and most severe stage of HIV infection. People with AIDS are more likely to develop certain illnesses, called opportunistic infections. Examples include Pneumocystispneumonia and some cancers. These illnesses are common in people who have weakened immune systems.

Treatment to prevent infection (postexposure prophylaxis) Health care workers who are at risk for HIV because of an accidental needlestick or other exposure to body fluids may need medicine to prevent infection. Medicine may also prevent HIV infection in a person who has been raped or was accidentally exposed to the body fluids of a person who may have HIV. This type of treatment is usually started within 72 hours of the exposure.

Initial treatment If patient is diagnosed with HIV infection during the initial symptoms of early HIV (acute retroviral syndrome), discuss the use of highly active antiretroviral therapy (HAART). Information about treatment of early HIV from clinical trials suggests that treatment of early HIV with antiretroviral medicines have long-term benefits. HAART medicines that are most often used to treat HIV infection include:

Nucleoside/nucleotide reverse transcriptase inhibitors, such as tenofovir, emtricitabine, and abacavir. These medicines are often combined with other medicines for best results.

Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, or etravirine.

Protease inhibitors (PIs), such as atazanavir, ritonavir, or darunavir. Fusion and entry inhibitors, such as enfuvirtide and maraviroc. 3

Integrase inhibitors, such as raltegravir.

DIAGNOSTIC TEST Diagnostic Examination: 1. ELA or ELISA Enzyme link immunosorbent assay 2. Particle agglutination (PA) test 3. Western blot analysis confirmatory diagnostic test 4. Immunofluorescent test 5. Radio immuno-precipitation assay (RIPA)

Many people are unaware that they are infected with HIV. HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen.

The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection.

Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results.

PATHOPHYSIOLOGY Predisposing Factor

Age Sex

Precipitating Factor
Poor Diet

Risk Factor
Multiple Sex Partner Same Sex Unsafe Sex Prick by Contaminated needle Transmission from mother to child

Blood or fluid containing virus enters the circulation Allowing the HIV virus to enuculate the blood stream Stimulates B Lymphocytes and secretion of immunoglobulins together with neutrophils

HIV attacks the macrophages, Langerhans cells, neurons within the CNS

Occurrence of minor signs and symptoms

HIV attacks the immune system Virus attaches to CD4 at the T4 surface Virus enters T4 and insert its genetic materials Virus replicates T4 image

T4 dies

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Complication and major signs and symptoms occur Virus mutates rapidly making it more difficult for the bodys immune system to recognize the invaders