AIDS

Acquired Immunodeficiency Syndrome

By: Guillermo / Larumbe / Manicio

 HIV stands for Human Immunodeficiency Virus that can lead to AIDS.
HIV attacks the bodys immune system, specifically the CD4 cells (T
cells), which help the immune system fight off infections. If left
untreated, HIV reduces the number of CD4 cells (T cells) in the body,
making the person more likely to get infections or infection-related
cancers.
Over time, HIV can destroy so many of these cells that the body cant
fight off infections and disease. These opportunistic infections or cancers
take advantage of a very weak immune system and signal that the person
has AIDS, the last state of HIV infection.

What is HIV/AIDS?

 1981 - On June 5, the U.S. Center for Disease Control and Prevention (CDC) publish a
Morbidity and Mortality Weekly Report (MMWR), describing cases of rare lung infection,
Pneumocystis carinii pneumonia (PCP), in five young, previously healthy, gay men in
Los Angeles. All the men have other unusual infections as well, indicating that their
immune systems are not working. This edition of the MMWR marks the first official
reporting of what will become known as the AIDS epidemic.

1982 -

On September 24, CDC uses the term AIDS for the first time, and releases the
first case definition of
AIDS: A disease at least moderately predictive of a defect in cell mediated
immunity, occurring in a person with no known case for diminished resistance to that
disease.

HISTORY/BACKGROUND

 1986 - In May, the International Committee on the Taxonomy of Virus declares that the
virus causing AIDS will be known as Human Immunodeficiency Virus (HIV).

1988 The World Health Organization declares December 1 to be the first World AIDS
day.

1990 - On January 26, the U.S Public Health Service issues a statement on considering
the use of Antiretroviral drug, AZT.

1991 - The Visual AIDS Artist Caucus launches the Red Ribbon Project to create a
visual symbol to demonstrate compassion for people living with AIDS. Red Ribbon
becomes International symbol of AIDS awareness.
- November 7, American Basketball star Earvin Magic Johnson announced
that he is HIV positive.

HISTORY/BACKGROUND

 1993 - On December 18, the US. CDC expand the case definition of AIDS:

a person

with CD4 counts below 200/.

1996 US. FDA approved the use of Home test kit that detect levels of HIV in the
blood.
- The first Non-nucleoside reverse transcriptase inhibitor (NNRTI) drug,
neviraprine.

2002 - On November 7, the U.S FDA approves the first rapid HIV diagnostic kit for use
in the United States that provides results with 99.6% accuracy in as little as 20 minutes.

2011 International AIDS Society confirmed that patients who have been taking
antiretroviral drug experience infection 60% lower than those who dont.
For more information about the complete and detailed history of AIDS form 1981 to 2015, click this link:
https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/index.html

HISTORY/BACKGROUND

 The symptoms of HIV vary on individual and what stage you are in: the (1) early stage, (2) latency
stage and (3) progression to AIDS.
Common signs and symptoms of late stage of HIV infection includes:
a. Rapid weight loss
b. Recurring fever or profuse night sweats
c. Extreme and unexplained tiredness
d. Prolonged swelling of the lymph glands in the armpits, groin, or neck
e. Diarrhea that lasts for more than a week
f. Sores of the mouth, anus, or genitals
g. Pneumonia
h. Red, brown, pink, or purplish blotches on or under the skin or inside the
mouth, nose, or
eyelids
i. Memory loss, depression, and other neurologic disorders.
MOST symptoms of AIDS are caused by OPPORTUNISTIC INFECTIONS that occurs because of the
weakened immune system of the host.

SIGNS/SYMPTOMS

 Opportunistic infections are caused by normally harmless protists, fungi, bacteria,

and viruses.
The most common opportunistic disease in HIV/AIDS patients is pneumonia
caused by the fungus Pneumocystis jiroveci, found in the lungs of most people,
but only caused disease in immunosuppressed patients.
Opportunistic bacterial infections due to mycobacteria are often drug resistant.
Kaposis sarcoma, an atypical infection caused by co-infection of HIV and human
herpes virus 8, is characterized by purple patches on the surface of the skin,
frequently seen in the extremities.

Opportunistic infection

Opportunistic infection

Biological structure of HIV

 HIV is a round, ball-shaped virus. It has two single strands of RNA for its genome. The
RNA is used to carry the genetic information that is passed on when new HIV particles are
produced.
The outermost layer of the HIV particle is the envelope. The envelope also has some proteins
in it that help the virus invade the next host cell. One protein, gp120, helps the virus to attach
to the CD4 receptor on the host cell. The other protein, gp41, helps the virus fuse with the cell
membrane and enter the cell.
Inside the envelope is the viral matrix. The p17 in the matrix helps hold the envelope
proteins gp120 and gp41 to the rest of the virus. Inside the matrix is the viral core/capsid,
made up of p24. The core houses the viral genome, as well as enzymes that the virus will need
to replicate in the host cell.

Biological structure of HIV

OVERVIEW:
HIV infects cells that have CD4
cell surface protein, which is
mostly found on two types of
cell (1) macrophage and (2) a
class of lymphocytes called THelper cells. Both important
components of the immune
system. Once these cells are
infected, they produce and
release large number of HIV
particles, which in turn infect
other cells with CD4 receptor.

MECHANISM OF PATHOGENICITY

BINDING:
(Typically HIV normally occurs first in macrophages, a type of
antigen presenting cell with very low CD4 receptor on its surface,
before it infects T cells.)
At cell surface, gp120 of HIV interacts with
Macrophages receptor: CD4 + CCR5 (a chemokine receptor and
macrophages coreceptor) are perfect complementary set of receptors
needed to form a docking site for HIV.
FUSION & UNCOATING:
Binding allows the fusion of HIVs envelope with the hosts
cytoplasmic membrane and allows the insertion of nucleocapsid into
the cell then releases the viral DNA into the hosts cytoplasm.
REVERSE TRANSCRIPTION:

The release RNA from HIV will undergo reverse transcription

using the enzyme reverse transcriptase that will convert the
ssRNA into dsDNA.

GENOME INTEGRATION & REPLICATION:

This process explains why HIV infection does not immediately

kill the host cell. HIV can exist as a provirus and not an
infectious virion.
Provirus retroviral DNA is permanently inserted/attached
to the host genome.
The reverse transcribed HIV genome, now DNA, is integrated
into host chromosomal DNA by the enzyme integrase. Cell
may show no outward sign of infection, and HIV DNA can
remain latent for long periods, replicating as the host DNA
replicates.
BUDDING & NEW VIRAL PARTICLE:

Eventually, virus synthesis occurs and new HIV particles, with

a variant gp120 that attaches to CXCR4 (chemokine
coreceptor on T-cells) are produced and released from the cell.

HIV then infects T cells:

HIV with variant gp120 will repeat the process in t-cells.
Transcription of provirus in T-cells will result to release of HIV particle and gp120
will surface on t-cells (capable of binding to other CD4 receptor of healthy t-cells).
Syncytium formation occurs, binding of one infected HIV t-cell to 50 other
uninfected cell, then the fused cells loose immunity and die.

HIV can live in a used needle up to 42 days depending on temperature and other factors.

MODE OF TRANSMISSION

MODE OF TRANSMISSION

GLOBAL STATISTICS

Information from WHO, UNAIDS and Kaiser Family Foundations Global health Policy Division
2014.
Link from: https://www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/index.html

EPIDEMIOLOGY

PHILIPPINE STATISTICS

The regions with the highest number of reported

cases for December 2015 were: National Capital
Region (NCR) with 250 (38%) cases, Region 4A
with 98 (15%) cases, Region 3 with 62 (10%)
cases, Region 11 with 54 (8%) cases, and Region 7
with 48 (7%) cases. One hundred thirty-eight
(21%) cases came from the rest of the country

EPIDEMIOLOGY
Source: Department of Health, Epidemiology Bureau /HARP

PHILIPPINE STATISTICS

EPIDEMIOLOGY
Source: Department of Health, Epidemiology Bureau /HARP

PHILIPPINE STATISTICS

EPIDEMIOLOGY
Source: Department of Health, Epidemiology Bureau /HARP

PHILIPPINE STATISTICS

EPIDEMIOLOGY
Source: Department of Health, Epidemiology Bureau /HARP

PHILIPPINE STATISTICS

EPIDEMIOLOGY
Source: Department of Health, Epidemiology Bureau /HARP

HIV antibody testing (since 1985) : screening test - Enzyme Linked Immunosorbent Assay
tests blood, urine, or oral fluid for presence of HIV antibodies
Rapid HIV test results are ready in less than an hour
Tests blood or oral mucosal transudate
Reactive positive rapid tests are confirmed using Western Blot test determines presence of HIV
proteins and antibodies
Follow-up testing
performed if the initial test result is positive.
Follow-up testing allows you and your health care provider to be sure the diagnosis is right.
Follow-up tests include:

antibody differentiation tests, which distinguishes HIV-1 from HIV-2 antibodies;

HIV-1 nucleic acid tests, which looks for the virus RNA directly;
Western blot and indirect immunofluorescence assay, which detect antibodies.

HIV test for screening and Diagnosis

All of the following tests will fail to detect HIV positive individuals who have recently
acquired the virus and have not yet made a detectable antibody response. HIV will be only
known after 6 weeks of prior exposure to the virus.

HIV test for screening and Diagnosis

HIV/STI PREVENTION PROGRAM of DOH

Goal: Aims to reduce & control the transmission of HIV in the Philippines
Project 3S: Smart, Safe, and Sexy of DOH
Composed of two unique thrusts:
1) A partnership with MSM (men who have sex with men community) advocates who
will be role models to others and ensure that those who are HIV free will maintain that
status.
2) Continuum of Care Approach makes sure that there is immediate access to post-test
counselling, and (ART) Anti-Retro Viral Therapy management.

PREVENTION & CONTROL

(From DOH program)

The following provides information on the various intervention methods that can be utilized to
reduce the risk of transmitting HIV:
Anti-retroviral therapy (ART) which is medication to people with HIV to stay healthy and
reduce the amount of virus in the body.
Pre-exposure prophylaxis (PrEP) is for people who do not have HIV but who are at
substantial risk of getting it to prevent HIV infection by taking a pill: Truvada everyday.
Use of Condom
Abstinence or No sexual activity or intercourse

INTERVENTION & STRATEGIES

 Availability of free voluntary HIV Counseling and Testing

Service;
100% Condom Use Program (CUP) especially for
entertainment establishments;
Peer education and outreach;
Multi-sectoral coordination through Philippine National AIDS
Council (PNAC);
Empowerment of communities;
Community assemblies and for a to reduce stigma;
Augmentation of resources of social Hygiene Clinics; and
Procured male condoms distributed as education materials
during outreach.

INTERVENTION & STRATEGIES

(From DOH program)

1. Current medicine status to AIDS: No permanent cure or eradication of

the virus
2. Discrimination to HIV infected individuals.
3.Emerging cases of HIV to younger age group (15 24 years old) in the
Philippines.
4.Lack of funds and support by the government that leads to poor
implementation of programs that raises awareness of HIV in the
Philippines.
5. Lack of proper education. Vague interpretation/discussion of
AIDS/HIV in public or private secondary education. We treat this topic as
something that is obscene and inappropriate.

ISSUES & PROBLEMS

 HIV prevention by DOH programs [Cited February 2015] [Internet] from: http://
www.doh.gov.ph/national-hiv/sti-prevention-program
HIV Interventions by DOH [Cited Februayt 2015] [Internet] from: http://
www.loveyourself.ph/2012/09/doh-launches-new-hiv-program-in.html
HIV History and Origin of Disease AIDS [Cited February 2015] [Internet] from: https://http://
www.avert.org/professionals/history-hiv-aids/origin
AIDS from a global stand [Cited March 2015] [Internet] from: https://www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/
index.html
Center for Diseases Control and Prevention, AIDS. [Cited March 2015] [Internet] from: http://www.cdc.gov/hiv/risk/art/
index.html
Madigan, Martikino et al. 2011 Brocks Biology of Microorganisms 13 th Edition. Pearson company, UK.

REFERENCES

Philippine Statistics Report of AIDS for 2015 from Department of Health Epidemiology Bureau and HIV/AIDS ART Registry of
the Philippines (HARP)