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Fourth Medical, 2007

Prof. Widad Al-Nakib, FRCPath.

• HIV (human immunodeficiency virus) infection
has now spread to every country in the world and
has infected over 40 million people worldwide.
About 5 million people get infected with HIV
each year and about 3 million people die each
year of HIV/AIDS related complications.
• By 2000, cumulative deaths due to HIV/AIDS
estimated to be 22 million
• The scourge of HIV has been particularly
devastating in Sub-Saharan Africa
• The proportion of adult women among those
infected with HIV is increasing
HIV contd.
• HIV: A lentivirus of a subgroup of retroviruses
• HIV 1 and 2 causes AIDS
• The virus kills or damages cells of the body’s
immune system
• HIV progressively destroys the body’s ability to
fight infections and certain cancers
• People diagnosed with AIDS may develop life-
threatening diseases from viruses or bacteria that
rarely make healthy people sick
• These infections are called opportunistic
HIV: Two Types Recognized


Both transmitted through sexual contact,

blood, from mother to child, and cause
indistinguishable AIDS
Predominant virus Less easily
Due to high rate of Period between initial
replication, mutates infection and illness
rapidly into subtypes longer than HIV-1
HIV-1 Subtypes
10 genetically distinct subtypes known

Major group (Group M) contains subgroups

A to J

Group O (Outliers) contains distinct group

of heterogeneous viruses

These subtypes are unevenly distributed

throughout the world
HIV-1 Subtype Distribution
Subtype Region found (predominantly)
B Americas, Japan, Australia, the Caribbean, and
A and D Sub-Saharan Africa
C South Africa and India
E Central African Republic, Thailand, and other
Southeast Asian countries
F Brazil and Romania
G and H Russia and Central Africa
I Cyprus
O Cameroon
HIV Particles
HIV Surface View
HIV Structure
HIV Receptor Attachment
HIV Replication Cycle
HIV Life Cycle
HIV Particles Budding out of Cells
HIV contd.

• AIDS: Acquired Immunodeficiency

Syndrome was first recognized in 1981 in New
York City
• The epidemic is growing most rapidly among
minority populations
• The virus was identified in 1983
• A diagnostic blood test was developed in 1985
HIV Contd.
• Most commonly, HIV infection is spread by having
sex with an infected partner. The virus can enter the
body through the lining of the vagina, vulva, penis,
rectum, or mouth during sex

• Although initially AIDS cases occurred primarily in

homosexual males in the United States, more recently,
the majority of new cases are in the heterosexual
HIV Contd.
• HIV also spreads through contact with infected
blood through a transfusion of contaminated
blood or blood components

• HIV frequently spreads among injection drug

users who share needles or syringes that are
contaminated with blood from an infected person

• Women can transmit HIV to their babies during

pregnancy or birth
HIV Contd.
• The virus does not spread through casual contact
such as sharing of food, utensils, towels and
bedding, swimming pools, telephones, or toilet
• The virus is also unlikely to be spread by contact
with saliva
• People who already have a sexually transmitted
disease, such as syphilis, genital herpes,
chlamydial infection, gonorrhea, or bacterial
vaginosis, are more likely to acquire HIV
infection during sex with an infected partner
Signs and Symptoms

• Many people do not develop symptoms after

getting infected with HIV
• Some people have a flu-like illness within several
days to weeks after exposure to the virus. They
complain of fever, headache, tiredness, and
enlarged lymph glands in the neck
• These symptoms usually disappear on their own
within a few weeks
Progression Course of HIV Infection
Progression Course of HIV Infection
Signs and Symptoms Contd.
• Following initial infection, infected individuals may
have no symptoms. The progression of disease
varies widely among individuals.This state may last
from a few months to more than 10 years
• During this period, the virus continues to multiply
actively and infects and kills the cells of the immune
• The immune system allows us to fight against the
bacteria, viruses, and other infectious causes
• The virus destroys the cells that are the primary
infection fighters, called CD4+ or T4 cells
Signs and Symptoms Contd.
Once the immune system weakens, a person infected
with HIV can develop the following symptoms:
• Lack of energy
• Weight loss
• Frequent fevers and sweats
• Persistent or frequent yeast infections
• Persistent skin rashes or flaky skin
• Short-term memory loss
• Mouth, genital, or anal sores from herpes
• AIDS is the most advanced stage of HIV infection.
The definition of AIDS includes all HIV-infected
people who have fewer than 200 CD4+ cells per
cubic millimetres of blood
• The definition also includes 26 conditions that are
common in advanced HIV disease but that rarely
occur in healthy people
• Most of these conditions are infections caused by
bacteria, viruses, fungi, parasites, and other
• Opportunistic infections are common in people with
AIDS. Nearly every organ system is affected. Some of
the common symptoms include the following:
Relationship Between Viral Load,CD4
Count and Progression to AIDS
AIDS/Signs and Symptoms
• Cough and shortness of breath
• Seizures and lack of coordination
• Difficult or painful swallowing
• Mental symptoms such as confusion and
• Severe and persistent diarrhea
• Fever
• Vision loss
• Nausea, abdominal cramps, and vomiting
• Weight loss and extreme fatigue
• Severe headaches with neck stiffness
• Coma

• People with AIDS are prone to develop various

cancers such as Kaposi sarcoma, cervical
cancer, and cancers of the immune system known
as lymphomas
• Kaposi sarcoma causes round, brown, reddish
or purple spots that develop in the skin or in
the mouth
• After the diagnosis of AIDS is made, the
average survival time has been estimated to be
2-3 years
Kaposi’s Sarcoma
Kaposi’s Sarcoma on Arm
Kaposi’s Sarcoma Under the Arm
Laboratory Diagnosis
• The diagnosis of HIV infection can be made by detecting the
presence antibodies in the blood.
• These HIV antibodies are not generally seen until 1-3 months
following infection.
• Early testing is important because it is generally believed that
the earlier treatment is started, the better the outcome.
Furthermore, high-risk behaviours that could spread the virus to
others can be avoided
• Antibody tests- enzyme-linked immunoassay (ELISA) and
Western blot, are available.
• ELISA is the screening test.
• Western Blot is the confirmatory test.
• Both of these tests can be negative for up to 3 months after the
exposure. In this situation, if the suspicion for HIV infection
remains high
• HIV RNA by PCR and HIV Antigen by ELISA in the blood-
very important to monitor the efficacy of therapy and when
antibody may be undetectable.
HIV Treatment Contd.

• Presently, a combination of several drugs

called “highly active antiretroviral therapy”
(HAART) is used to treat people with HIV.
This treatment is not a cure. The virus still
persists in various body sites, such as in the
lymph glands
• Currently, the survival rates for patients who
are fully compliant and well managed can be
as high as 80-90%.
• Antiretroviral will be covered separately later
HIV Treatment Contd.
• People infected with HIV are prone to
opportunistic infections. Various drugs are
available to treat these infectious complications.
These drugs include foscarnet sodium
(Foscavir) and ganciclovir (Cytovene, Vitrasert)
to treat cytomegalovirus eye infection,
fluconazole (Diflucan) to treat yeast infections,
and trimethoprim and sulfamethoxazole
(Trimeth-Sulfa) to treat Pneumocystis carinii

• Treatments for Kaposi sarcoma or other cancers

include radiation, chemotherapy, and
injections of alpha-interferon
HIV Prevention
• The only way to prevent infection by the virus is to avoid
behaviours that put you at risk, such as sharing needles or
having unprotected sex.
• Many people infected with HIV don't have any
symptoms. There is no way to know with certainty
whether a sexual partner is infected
• Infected individuals should either abstain from having
sex or use latex condoms, which may offer partial
protection, during oral, anal, or vaginal sex.
• Only condoms made of latex should be used.
• Only water-based lubricants should be used with latex
HIV Prevention Contd.

• The risk of HIV transmission from a

pregnant woman to her baby is
significantly reduced if the mother takes
AZT during pregnancy, labour, and
delivery and her baby takes it for the first
6 weeks of life.
Research on HIV infection includes the development
and testing of HIV vaccines and new therapies for
the disease and its associated conditions
Currently, 28 HIV vaccines are being tested on
humans, and many drugs for HIV- or AIDS-
associated infections are either being developed or
Researchers are also investigating how HIV
damages the immune system and are trying to
trace how the disease progresses in different