HIV and Medications By Dr. Ananda Kumar Saha Department of Zoology

2. HIV and Medications By Dr. Ananda Kumar Saha Department of Zoology University of Rajshahi, Rajshahi-6205

3. World AIDS Day – 2004 Five people worldwide die of AIDS every minute of every day Incidence / Prevalence of HIV / AIDS (Dec, 2004) Source:WHO & UNAIDS

4. Total population living with HIV/AIDS (Dec, 2004) : 39.4 million

5. HIV infected children An AIDS patient

6. WHAT IS THE DIFFERENCE BETWEEN HIV AND AIDS? HIV is the virus that causes AIDS. H - Human : Virus can only infect human beings. I - Immuno-deficiency : Body’s immune system failure to work properly. V - Virus : It reproduces by taking over the machinery of the human cell. A - Acquired : One must acquire or get infected with. I - Immune : Affect’s the body’s immune system. D - Deficiency : It makes the immune system deficient. S - Syndrom : Someone with AIDS may experience a wide range of different diseases and opportunistic infections.

7. HOW DO YOU GET AIDS? • Blood • Vaginal fluid • Semen • Breast milk of people infected with HIV

8. Anatomy of the HIV

9. The Different Stages of HIV Infection Primary HIV Infection This stage of infection lasts for a few weeks and is often accompanied by a short flu like illness which occurs just after infection. Clinically Asymptomatic Stage This stage lasts for an average of ten years and as its name suggests, is free from any symptoms, although there may be swollen glands.

10. Symptomatic HIV Infection • Over time the immune system loses the struggle to contain HIV. This is for three main reasons; • The lymph nodes and tissues become damaged or "burnt out" because of the years of activity; • HIV mutates and becomes more pathogenic, in other words stronger and more varied, lending to more T helper cell destruction; • The body fails to keep up with replacing the T helper cells that are lost.

11. Progression from HIV to AIDS As the immune system becomes more and more damaged the illnesses that present become more and more severe leading eventually to and AIDS diagnosis.

12. Most people get the HIV virus by: • Having sex with an infected person. • Sharing a needle (shooting drugs) with someone who's infected • Being born when the mother is infected, or drinking the breast milk of an infected woman.

13. WHAT HAPPENS IF I'M HIV POSITIVE? • Fever • Headache • Sore muscles and joints • Stomach ache • Swollen lymph glands or • A skin rash

14. HIV Life Cycle

15. HIV Life cycle

16. IS THERE A CURE FOR AIDS? • There is no cure for AIDS. • There are drugs that can slow down the HIV virus, and slow down the damage the immune system. • But there is no way to get all the HIV out of your body. • There are other drugs that you can take to prevent or to treat opportunistic infections.

17. HIV Positive Couple of Kenya

18. Bottle-Feeding

19. HOW DOES HIV SPREAD DURING SEX? • To spread HIV during sex, HIV infection in blood or sexual fluids must be transmitted to someone. • Sexual fluids come from a man's penis or from a woman's vagina. • HIV can be transmitted when infected fluid gets into someone's body. • If there is no contact with blood or sexual fluids, there is no risk.

20. HIV in the Environment • Scientists and medical authorities agree that HIV does not survive well in the environment. • No one has been identified as infected with HIV due to contact with an environmental surface. • HIV is unable to reproduce outside its living host

21. Businesses and Other Settings • There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments. • Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. • Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use.

22. Kissing • Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. • The risk of acquiring HIV during open-mouth kissing is believed to be very low.

23. Biting • Biting is not a common way of transmitting HIV. • HIV has been found in saliva and tears in very low quantities from some AIDS patients. • HIV has not been recovered from the sweat of HIV-infected persons. • Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

24. Insects • No evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. • HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites. • HIV does not reproduce (and does not survive) in insects.

25. Precautions: • Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit. • Cuts, sores, or breaks on both the care giver's and patient's exposed skin should be covered with bandages. • Hands and other parts of the body should be washed immediately after contact with blood or other body fluids. • Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided. • Needles and other sharp instruments should be used only when medically necessary. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers.

26. MEDICATIONS • Reverse Transcriptase Inhibitors (NUKES). • Block Reverse transcription (Viral DNA from RNA) • Protease Inhibitors • Block the action of protease to assemble a new copy of the virus. • Integrase Inhibitors • Block the action of integrase that inserts the viral DNA into the infected cell’s DNA strands.

27. INTERUPTING TREATMENT • Side effects are intolerable • There’s a drug interaction • Women might choose to stop treatment during the first three months of pregnancy.

28. WHEN TO START TREATMENT • Patients with symptoms of HIV diseases or with less than 200 T- Cells. • Patients with no symptoms who have less than 350 T- Cells, Viral load over 100,000 should be offered treatment.

29. GOALS OF THERAPY • Reduce viral load as much as possible for long as possible. • Preserve the Immune system • Improve the patient’s quality of life • Reduce sickness and death due to HIV

30. SIDE EFFECT OF ANTIVIRAL MEDICATIONS • Blood Sugar • High blood sugar can be a side effect of the HIV protease inhibitors. • HIV Protease inhibitor medications develop insulin resistance. • Blood Fats • Too much fat in the blood increases the risk of heart diseases or pancreatitis.

31. CAN THESE DRUGS CURE AIDS? • The drugs do not cure AIDS. • They make it possible for people with AIDS to live a long time.

32. Govt. of Bangladesh 2004 UNAIDS Global HIV/AIDS Report 2002 The World Fact book 2005 HIV positive person 465 13,000 13,000 Deaths due to HIV/AIDS 30 650 650 HIV/AIDS situation in Bangladesh:

33. Bangladesh: Low prevalence but high vulnerability • Less then 0.1% of the Bangladeshi population is HIV positive • A lack of HIV / AIDS awareness • High rate of injection drug use • Unsafe blood transfusion practice • Close proximity to Thailand, Myanmar and India

34. To decrease the risk of spreading HIV: • Use condoms during sexual activity • Do not share drug injection equipment • If you are HIV-infected and pregnant, talk with your doctor about taking anti-HIV drugs • If you are an HIV-infected woman, don't breast feed any baby • If you think you've been exposed to HIV, get tested and ask your doctor about taking anti-HIV medications.

35. Thank You