What Is HIV?

The latest statistics of the global HIV and AIDS were published by UNAIDS in November 2009, and refer to the end of 2008.

In developing and transitional countries, 9.5 million people are in immediate need of life-saving AIDS drugs; of these, only

HIV is the human immunodeficiency virus that causes AIDS. A member of a group of viruses called retroviruses, HIV infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce.

31.1-35.8 million

29.2-33.7 million

14.2-17.2 million

0.15-0.41 million

1.2-2.9 million

1.7-2.4 million

Range

Global HIV/AIDS estimates, end of 2008

At the end of 2008, women accounted for 50% of all adults living with HIV worldwide

How Quickly Do People Infected with HIV Develop AIDS? In some people, the T-cell decline and opportunistic infections that signal AIDS develop soon after initial infection with HIV. Most people remain asymptomatic for 10 to 12 years, and a few for much longer. As with most diseases, early medical care can help prolong a person's life. How Many People Are Affected By HIV/AIDS? The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there are now over 34 million people living with HIV or AIDS worldwide. Most of them do not know they carry HIV and may be spreading the virus to others. Here in the U.S., nearly one million people have HIV infection or AIDS roughly one out of every 250 people. At least 40,000 Americans become newly infected with HIV each year, and it is estimated that half of all people with HIV in the U.S. have not been tested and do not know they are carrying the virus. Since the beginning of the epidemic, AIDS has killed nearly 19 million people worldwide, including some 425,000 Americans. AIDS has replaced malaria and tuberculosis as the world's deadliest infectious disease among adults and is the fourth leading cause of death worldwide. Over 13 million children have been orphaned by the epidemic.

HIV

33.4 million

31.3 million

15.7 million

Children living with HIV/AIDS in 2008

Women living with HIV/AIDS in 2008

People living with HIV/AIDS in 2008

Adults living with HIV/AIDS in 2008

0.28 million More than 25 million people have died of AIDS since 1981. Child AIDS deaths in 2008

Estimate

2.1 million

AIDS deaths in 2008

2.0 million

Africa has over 14 million AIDS orphans.

4 million (42%) are receiving the drugs.

YEAR 2010 PAULINA BUDRYTE, ELNA GAILTE

The basic structure of HIV is similar to that of other viruses (Figure 1). HIV has a core of genetic material surrounded by a protective sheath, called a capsid. The genetic material in the core is RNA (ribonucleic acid), which contains the information that the virus needs in order to replicate (make more copies of itself) and perform other functions. You can think of RNA as the set of rules the virus follows in order to live. In HIV, viral RNA has a protein called "reverse transcriptase" that is crucial for viral replication inside T cells, white blood cells that help coordinate activities of the immune system. (The function of reverse transcriptase, which means "writing backwards," will be explained later when we discuss how HIV infects T cells.) HIV, like all other viruses, has proteins that are particular to itself. These proteins are called antigens. Antigens have diverse functions in viral replication. In the case of HIV, a combination of two antigens, gp120 and gp41, allow the virus to hook onto T cells and infect them. These antigens are located on the surface of the virus. (Another HIV antigen is p24, an antigen of the core of the virus that is measured to estimate the amount of active free-floating virus in the blood of HIV positive people).

One important feature in the T cell's structure is the CD4 receptor site (Figure 2). CD4 is a protein on the surface of the T cell. HIV's gp120 antigen is a mirror image of the CD4 protein. If HIV bumps into the right place on the T cell's surface, the gp120 of the virus will lock onto the CD4 site of the T cell (Figure 4). Because of this, CD4 is called the receptor site or docking port for HIV.

The DNA makes RNA and sends it out to convey orders.) The genetic material's passport to leave the nucleus is to be transformed into single-stranded RNA. In the same fashion, the passport to enter the nucleus is to be transformed into double-stranded DNA. Viral RNA needs to become DNA in order to start the replication process. Reverse transcriptase allows the RNA to borrow material from the cell and to "write backwards" a chain of viral DNA.

HIV is considered a retrovirus because of its capacity to transform RNA into DNA, reversing the natural process that takes place in cells. This is accomplished by the reverse transcriptase. Retroviruses are a special family of viruses to which only a few known viruses belong (although many others might yet be discovered). HIV Replicates Once transformed, the viral DNA will travel into the T cell's nucleus and attach itself to the cell's DNA (a process similar to placing a "bug" in a computer software program). At this point, if the T cell is activated, it will start producing new virus instead of performing normal T cell functions. At this stage, several things can happen. The new virus, or provirus, can remain inactive for a long time without triggering viral replication, or it can divide into two proviruses (a process called "mitosis"), or it can start producing new virus that will bud off from the T cell wall, eventually destroying the T cell. Because it hijacks the "coordinator" T cells that help keep the immune system working, HIV is particularly devastating to immune health. In the process of replication, the virus destroys increasing numbers of T cells. The coordinator cells of an important part of the immune system are annihilated, leaving the body open to opportunistic infections.

When HIV successfully latches onto a T cell, the next step is to inject its core with the viral RNA and the reverse transcriptase (Figure 5).

HIV Targets T Cells T cells are the main target of HIV in the blood, and they act as the host that the virus needs in order to replicate. (However, macrophages, B cells, monocytes, and other cells in the body can also be infected by HIV.) The T cell has a nucleus that contains genetic material in the form of DNA (deoxyribonucleic acid) (Figure 2). The cell's DNA has all the information that the cell needs in order to function. The difference between RNA and DNA is that the former is a single strand of genetic material, while the latter is a double strand (Figure 3). This difference is crucial in the process of T cell infection by HIV.

HIV Takes Control of T Cells Once inside the cell, the capsid dissolves, liberating the viral RNA and the reverse transcriptase. Now, in order to infect the cell, the viral RNA needs to travel into the T cell's nucleus (where it can change the cell's rules and convert it into a virus factory). However, for that to happen, an important transformation needs to take place. Normally, the T cell's nucleus communicates with the rest of the cell by transforming DNA into RNA and sending it out of the nucleus. (In all the cells of the body, RNA acts as a messenger between the nucleus and the rest of the cell.