AIDS

What are HIV and AIDS?  Human immunodeficiency virus.  HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease.  Attacks the body's immune system.  Destroys infection-fighting cells.  When these cells are destroyed, the immune system can no longer defend the body against infections and cancers.  HIV infection becomes AIDS when patient lose the ability to fight off serious infections or tumors.

 These infections, called opportunistic infections, might not normally cause severe or fatal health problems.  If pregnant woman infected with HIV, baby may be infected by the virus before or during birth.  The baby can also get the virus from breast milk.  Babies who are infected may become very sick and die.

 Without treatment, about one third of babies born to HIV-infected mothers become infected with the virus.  HIV should be tested at first prenatal visit.  If infected with HIV, treatment can help prevent spread of the infection to the baby.

Modes of transmission

How does HIV infection occur?  Unprotected sex with an infected partner  Shared needles  Contact with infected body fluids (for example, blood, semen, or breast milk)  Transfusion with infected blood.  HIV can be passed to an unborn baby through the placenta, by exposure to blood and body fluids during labor and at delivery, or through breast-feeding.

What are the symptoms?  Fever that lasts from a few days to longer than a month  Unexplained weight loss  Loss of appetite  Nausea and vomiting  Tiredness  Prolonged swelling of the lymph nodes  Sore throat  Long-lasting or multiple viral skin problems, such as herpes sores or plantar warts

Swollen parts of the body

Deterioration of the body tissues

 Repeated, severe yeast infections in mouth or vagina despite treatment  Chronic muscle and joint pain  Diarrhea, especially if it lasts longer than a month  Headache  Enlarged spleen and liver.

Life Cycle  HIV particles enter the body in a fluid as it can not survive without a support medium.  The virus targets any cell expressing CD4, including T helper cells, macrophages, dendritic cells and monocytes.

HIV Life Cycle: Attachment Requires CD4 Receptor plus a Co- receptor

HIV Replication –Attachment –Penetration –Uncoating –Reverse Transcription –Integration –Replication –Assembly –Release Dr.T.V.Rao MD13

How is HIV infection diagnosed?  The screening test for HIV is usually a blood test called the ELISA test.  When this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the diagnosis.  If both tests are positive, AIDS is confirmed.  Tests can usually detect HIV infection within several weeks of exposure to the virus.  HIV tests are always strictly confidential whether the results are positive or negative

 Tests for other sexually transmitted diseases  Test for tuberculosis (TB)  Ultrasound scans to check for normal growth of the baby  Nonstress tests during the latter part of the pregnancy to check the baby's heartbeat for signs of stress  Tests for immune system every 2 to 3 months.

How is it treated?  If pregnant and have tested positively for HIV, antiviral drug zidovudine (also called ZDV or AZT) is necessary.  Having a cesarean section (C-section) instead of a vaginal delivery also reduces the risk of infecting the baby.  For opportunistic infections such as pneumonia, TB, yeast infection, or toxoplasmosis medicine is necessary.  During labor and delivery no need to be isolated.

 All hospital personnel use special precautions when they handle blood or other body fluids to prevent the spread of AIDS.  Baby to be treated with ZDV for at least the first 6 weeks of life to help prevent infection.  Should not breast-feed the baby. Give formula to the baby instead of breast milk to help prevent spread of the virus to the baby.  If a baby is born infected with HIV infection, the baby will be treated with antiviral drugs.  Baby will be tested for HIV after birth.

 Lab tests to see how well the immune system is working, to measure the amount of HIV in the blood, and to screen for infections or other medical problems  Antiviral medicines, such as non-nucleoside reverse transcriptase inhibitors (NNRTI's), nucleoside analogues (NRTI's), and protease inhibitors  Regular dental exams because people who are HIV positive often have mouth problems, including gum disease

 Preventive treatment for such diseases as:  Pneumocystis carinii pneumonia (PCP)  Tuberculosis  Toxoplasmosis (be sure to avoid raw meat and cat litter boxes)  Tetanus  Hepatitis B  Pneumococcal infections  Influenza (by getting flu shots)

 Treatments for other opportunistic infections and tumors as they develop.  CD4+ T-cell count is below 350 cells per cubic millimeter, or  Viral load is over 30,000 copies per milliliter (mL) when using the branched DNA test, or more than 55,000 copies/mL when using the RT-PCR test.

How long do the effects last?  The full effects of AIDS may not appear until 5 to 10 years after first infected with HIV.  AIDS is a fatal disease, life expectancy has increased greatly as new treatments are developed.

How to prevent spreading the HIV virus?