HUMAN

IMMUNODEFICIENCY
VIRUS (HIV)
EPIDEMIOLOGY AND MODE
OF TRANSMISSION
 MORPHOLOGY
Family : Retroviridae
Subfamily :Lentivirus

 RNA virus, 120nm in diameter

 Icosahedral symmetry
 Single stranded,enveloped,diploid RNA
genome
 Envelope surrounding nucleocapsid:
gp120&gp41 protein
=>Gp120 binds CD4+ cells and
co-receptors(CXCR4 OR CCR5)

 Nucleocapsid:
-Outer matrix protein (p17)
-Major capsid protein (p24)
-Nuclear protein (p7)

 Inside the capsid – viral genome&3

enzymes(reverse
transcriptase,integrase&protease)
 HIV PROTEINS AND ITS FUNCTIONS

• Interacts with CD4+ receptor & co-receptor of host cell

gp120
env • Mediates fusion of viral envelope with cell membrane
gp41

p24,p7 • Nucleocapsid, useful for diagnosis (early HIV infection)

gag
p17 • Matrix protein

Reverse
transcriptase • Transcribes the RNA genome into the DNA
pol
integrase
• Integrates viral DNA into host cell DNA
protease
• Cleaves the precursor polyproteins into functional viral envolpes
 Main reservoir There are 7 steps in life cycle
for HIV is of HIV:
CD4+Tcells
1)Binding
2)Fusion
3)Reverse transcription
4)Integration
Cellular targets:- 5)Replication
-CD4+ T cells 6)Assembly
-macrophages 7)Budding
-dendrites
Clinical Features
 Acute HIV Infection Acute retroviral syndrome

• About 40% to 90% of people have within

after HIV infection.

• While other people during this stage,

which is also known as .

• And some people who have HIV for

.
Acute HIV Infection Acute retroviral syndrome

included:
• Fever
• Chills
• Rash
• Night sweats
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Mouth ulcers
Chronic HIV Infection Clinical Latency

• People with chronic HIV infection may

, or only mild ones.

• After your immune system loses the battle with HIV, the
flu-like symptoms will go away.
Immunodeficiency stage Acquired immunodeficiency
syndrome (AIDS)

• If you have HIV and you are not on

, eventually the virus will weaken your body’s immune
system and you will progress to AIDS (acquired
immunodeficiency syndrome), the late stage of HIV infection.

• At this stages, there are .

Immunodeficiency stage Acquired immunodeficiency
syndrome (AIDS)

included:
• Rapid weight loss
• Recurring fever or profuse night sweats
• Extreme and unexplained tiredness
• Prolonged swelling of the lymph glands in the armpits, groin, or neck
• Diarrhea that lasts for more than a week
• Sores of the mouth, anus, or genitals
• Pneumonia
• Red, brown, pink, or purplish blotches on or under the skin or inside the
mouth, nose, or eyelids
• Memory loss, depression, and other neurologic disorders
(HUMAN IMMUNODEFICIENCY VIRUS)
 Test for HIV

• ELISA Test — ELISA, which stands for enzyme-linked

immunosorbent assay # Positive - The Western blot test is use to confirm the
diagnosis.
# Negative - You should be tested again in one to three months.

ELISA is quite sensitive in chronic HIV infection, but because antibodies

aren't produced immediately upon infection, you may test negative during a
window of a few weeks to a few months after being infected. Even though your
test result may be negative during this window, you may have a high level of the
virus and be at risk of transmitting infection.
• Home Tests — Approved by the U.S. Food and Drug Administration is called the
Home Access Express Test,
- Sold in pharmacies.

• Saliva Tests — A cotton pad is used to obtain saliva from the inside of your
cheek.
- Placed in a vial and submitted to a laboratory for testing.
- Results are available in three days. Positive results
should be confirmed with a blood test.
• Viral Load Test — This test measures the amount of HIV in your
blood. Generally, it's used to monitor treatment progress or detect
early HIV infection.
-Three technologies measure HIV viral load in the blood:
1) Reverse transcription polymerase chain reaction (RT-PCR),
2) Branched DNA (bDNA)
3) Nucleic acid sequence-based amplification assay (NASBA).
The basic principles of these tests are similar. HIV is detected using
DNA sequences that bind specifically to those in the virus. It is
important to note that results may vary between tests.
• Western Blot — This is a very sensitive blood test used to confirm
a positive ELISA test result.
Treatment & Control
 Antiretroviral therapy(ART)
• Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a
combination of HIV medicines (called an HIV treatment regimen) every day.

• ART is recommended for everyone who has HIV. People with HIV should start ART as soon as possible.
ART can’t cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces
the risk of HIV transmission.

• A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load
means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who
maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative
partner through sex.

• Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV
regimens cause fewer side effects than regimens used in the past. It's recommended to combine three drugs
from two classes to avoid creating drug-resistant strains of HIV.
The classes of anti-HIV drugs include:
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed
by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine
(Intelence) and nevirapine (Viramune).
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty
versions of the building blocks that HIV needs to make copies of itself. Examples
include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir
(Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-
zidovudine (Combivir).

• Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to
make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista),
fosamprenavir (Lexiva) and indinavir (Crixivan).

• Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include
enfuvirtide (Fuzeon) and maraviroc (Selzentry).

• Integrase inhibitors work by disabling a protein called integrase, which HIV uses to
insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress)
and dolutegravir (Tivicay).
 Prevention of HIV
To help prevent the spread of HIV:

• Use a new condom every time you have sex. Use a new condom every time you have anal or vaginal sex.
Women can use a female condom. If using lubricant, make sure it's water-based. Oil-based lubricants can
weaken condoms and cause them to break. During oral sex use a nonlubricated, cut-open condom or a
dental dam — a piece of medical-grade latex.

• Consider the drug Truvada. The drug emtricitabine-tenofovir (Truvada) can reduce the risk of sexually
transmitted HIV infection in people at very high risk. You need to take it every day. It doesn't prevent
other STIs, so you'll still need to practice safe sex. If you have hepatitis B you should be evaluated by an
infectious disease or liver specialist before beginning therapy. You will need a blood test to check your
kidney function before taking this drug.

• Tell your sexual partners if you have HIV. It's important to tell all your current and past sexual partners
that you're HIV-positive. They'll need to be tested.
• Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and
don't share it. Take advantage of needle-exchange programs in your community
and consider seeking help for your drug use.
• If you're pregnant, get medical care right away. If you're HIV-positive, you may
pass the infection to your baby. But if you receive treatment during pregnancy, you
can cut your baby's risk significantly.
• Consider male circumcision. There's evidence that male circumcision can help
reduce a man's risk of getting HIV infection.