Human Immunodeficiency Virus & AIDS

1. Robin Russell & Daniela Kane Human Immunodeficiency Virus& AIDS

2. Basics • Human Immunodeficiency Virus (HIV) is a retrovirus that results in infections that are hard for the body to fight. • Acquired Immune Deficiency Syndrome is the fatal disease caused by HIV.

3. History Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. The virus most likely jumped to humans when humans hunted these chimpanzees for meat and came into contact with their infected blood. Over several years, the virus slowly spread across Africa and later into other parts of the world.

4. History • 1983 – Luc Montagnier of the Pasteur Institute in Paris, France, discovers HIV. • 1984 – Robert Gallo of the National Cancer Institute in Washington, DC, US co-discovered HIV.

5. A look at AIDS

6. A look at AIDS

7. HIV-Related Opportunistic Infections • Most common: - Kaposi’s Sarcoma - Pneumocystiscarinii pneumonia (PCP)

8. Kaposi’s Sarcoma • Grows into reddish-purple patches on skin • Considered AIDS related because it is seen in people with weakened immune systems. Most likely to occur with low CD4 counts – typically below 350 cells/ml

9. Pneumocystiscariniipneumoniacariniipneumonia (PCP) A parasite transitional between a fungus and protozoan, frequently occurring as aggregate forms existing within rounded cystlike structures.

10. BIOLOGY OF DISEASE • HIV is a retrovirus • Almost all organisms, including most viruses, store their genetic material on long strands of DNA. Retroviruses are the exception because their genes are composed of RNA (Ribonucleic Acid). • Retroviruses allow for a reversal of genetic transcription, from RNA to DNA rather than the usual DNA to RNA.

11. Biology of Disease • Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions). The surface of each particle is studded with lots of little spikes. • An HIV particle is around 100-150 billionths of a metre in diameter. That's about the same as: -one seventieth of the diameter of a human CD4+ white blood cell.

12. Biology of Disease • HIV particles surround themselves with a coat of fatty material known as the viral envelope (or membrane). Projecting from this are around 72 little spikes, which are formed from the proteins gp120 and gp41. Just below the viral envelope is a layer called the matrix, which is made from the protein p17. • The viral core is usually bullet-shaped and is made from the protein p-24. Inside the core are three enzymes required for HIV replication. - reverse transciptase - integrase - protease

13. Biology of Disease

14. PathophysiologyEntry • HIV can only replicate (make new copies of itself) inside human cells. • Infections begins when - a virus particle bumps into a cell that carries on its surface a special protein called CD4. • the spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to fuse with the cell membrane. • The contents of the HIV particle are then released into the cell, leaving the envelope behind.

15. PathophysiologyReverse Transcription and Integration • Once inside the cell, the HIV enzyme reverse transciptase converts the viral RNA into DNA, which is compatible with human genetic material. This DNA is transported to the cell's nucleus, where it is spliced into the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is known as provirus.

16. PathophysiologyTranscription and Translation • HIV provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human genes. First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used as a blueprint for producing new HIV proteins and enzymes.

17. PathophysiologyAssembly, Budding and Maturation • Among the strands of messenger RNA produced by the cell are complete copies of HIV genetic material. These gather together with newly made HIV proteins and enzymes to form new viral particles, which are then released from the cell. The enzyme protease plays a vital role at this stage of the HIV life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores. • The newly matured HIV particles are ready to infect another cell and begin the replication process all over again. In this way the virus quickly spreads through the human body. And once a person is infected, they can pass HIV on to others in their bodily fluids.

18. Federal recommendations for first line anti-HIV therapy • NNRTI-BASED REGIMENTS Preferred regimensefavirenz + 3TC + (AZT or tenofovir or d4t): except for pregnant women or women who whish to become pregnant. (3 to 5 pills a day) Alternative Regimensefavirenz + (3TC or (FTC) +ddl; except for pregnant women or women who wish to become pregnant (3 to 5 pills a day)nevirapine + (3TC or FTC) + (AZT or tenofovir or d4t) (4 to 6 pills a day)PI – based regimens Preferred regimensKaletra + 3TC + (AZT or d4t) (8 to 10 pills a day)

19. Diagnostic testing for HIV • Diagnostic Testing For HIVEISA/Western Blot Blood TestsThe OraQuick Rapid HIV-1 Antibody TestViral Load TestsCD4/CD8 ratio Tests

20. Diagnostic Testing • Diagnostic Testing on When to start your medication:Blood CountBlood Chemistry profile (including testing for your kidney and liver)Hepatitis B testHepatitis C testViral load test (amount of HIV in your blood) CD4 cell count (number of cells in your blood that fight infection, also called “T cells”)Syphilis Test TB skin TestToxoplasma antibody testGynecologic exam (with pap test and pregnancy test)-for women

21. Interesting Facts • Worldwide, AIDS kills more than 8,000 people every day; 1 person every 10 seconds • HIV accounts for the highest number of deaths by any single infectious agent. • Since the beginning of the epidemic, AIDS has claimed nearly 30 million lives; more than 14 million children have lost one or bother parents to AIDS

22. Aids wasting syndrome AIDS wasting is the involuntary lose of more than 10% of body weight, plus more than 30 days of either diarhhea, or weakness and fever. Wasting is linked to disease progression and death. Losing just 5% percent of body weight can have the same negative effects. There is no standard threatment for AIDS wasting.

23. Aids wasting syndrome

24. Aids wasting syndrome

25. Protection • To protect yourself, remember these ABCs: A=Abstinence B=Be Faithful C=Condoms

26. References Alexander, Ivy L. (4th ed.). (2008). AIDS Sourcebook. Detroit, MI: Omnigraphics, Inc. Avert: AVERTing HIV and AIDS. (2009). The Structure of HIV. Retrieved on April 19, 2009 from http://www.avert.org/virus.htm Black, Jacquelyn. (2008). Microbiology Principles and Explorations. Danvers, MA: John Wiley & Sons, Inc. Flanders, Stephen A. & Flanders, Carol N. (1991). Library in a Book: AIDS. New York, NY: Facts on File, Inc. Genesis of AIDS. (2005). Virus-Structure. Retrieved on April 19, 2009 from http://library.thinkquest.org/04oct/00924/hivstructure.html Handbook of Pathophysiology (2nd ed.).(2005). Ambler, PA: Lippincott Williams & Wilkins HIV/AIDS Therapy; Research from South Korea National Institute of Health in HIV/AIDS therapy provides new insights. (2008, November). Medical Letter on the CDC & FDA 28. Retrieved April 17, 2008, from Research Library. ProQuest. FMCC Library, Johnstown, NY. 3 November 2003. Marieb, E., & Hoehn, K. (2007) Human Anatomy & Physiology (7th ed.) San Francisco, CA: Pearson Education, Inc. Nixon, Nicholas, and Bebe Nixon. People with AIDS. Boston: David R. Godine Publisher, 1991 Storad, Conrad J. (1998). Inside AIDS: HIV Attacks the Immune System. Minneapolis, MN: Lerner Publications Co. Taylor, Barbara. (1988). Everything You Need To Know About AIDS. New York, NY: The Rosen Publishing Group, Inc. You Tube.com. (2008). 3D replication of HIV. Retrieved on April 18, 2009 from http://www.youtube.com/watch?v=RO8MP3wMvqg

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