1. HIV/AIDS Melissa Schreiber

2. Overview What is AIDS: Origin and Scope? –Prevalence of AIDS –The Epidemiology ands AIDS Demographic –Transmission of HIV Phases of an HIV Infection HIV Structure and Life Cycle Drug Therapy for HIV Infection –Prevention and Treatment –Living with HIV or AIDS

3. Origin of HIV/AIDS Originated in Africa and spread to the US and Europe Found preserved 1959 blood sample Humans may have ate nonhuman primates for meat and mutated to HIV AIDS was coined in 1982 HIV was found to be the cause of AIDS in 1983-84

4. HIV/AIDS Human Immunodeficiency Virus (HIV) –Immune system deficient, cannot resist disease –Virus responsible for Acquired Immune Deficiency Syndrome (AIDS) Acquired Immune Deficiency Syndrome (AIDS) –Descriptive of the infection and it’s progression –First observed in U.S. cities in early 1980s –Young, healthy men dying of rare diseases

5. Definition of AIDS Positive blood test indicating the presence if HIV antibodies –T-cell count below 200 –If T-cell count is higher than 200, he or she must have one or more of the opportunistic infections or conditions associated with AIDS If a person has HIV antibodies, but does not meet the other criteria, classified “have HIV,” “be HIV-positive,” “be HIV infected,” or “be living with HIV”

6. 6 Opportunistic Infections of AIDS

7. Symptoms of HIV Infection and AIDS Unexplained persistent fatigue Fever, chills, night sweats Unexplained weight loss Swollen lymph nodes Pink, red, purple, or brown blotches Persistent dry cough Persistent, fuzzy, white spots in mouth, tongue, or throat Memory loss or depression Abnormal pap smears Persistent vaginal candidiasis Abdominal cramping (due to Pelvic inflammatory Disease) Persistent Diarrhea

8. Epidemiology and Transmission of HIV Epidemiology – study of the incidence, process, distribution, and control of diseases Epidemic – wide and rapid spread of a contagious disease World Health Organization reports 25 million people have died from AIDS Estimated that 40.3 million people are living with HIV

9. Epidemiology and Transmission of HIV Global increases in number of people living with AIDS African continent the largest concentration 2/3 of all AIDS cases are in Sub- Saharan Africa 77% of women living with AIDS are in Sub-Saharan Africa

11. Epidemiology and Transmission of HIV in the United States Through 2004, CDC reports 944, 000 individuals had lived with AIDS End of 2004, 400,000 people were living with AIDS 40,000 cases are diagnosed annually Changes in current transmission modes Changes across ethnic groups

12. AIDS Differs by Gender, 2003

13. Change in AIDS Cases by Race/Ethnicity

14. U.S. AIDS Cases by Race/Ethnicity, 2003

15. Modes of Transmission Sexual transmission: anal and vaginal intercourse, and oral sex Injection drug and substance abuse: sharing needles Mother-to-child transmission: passing virus from mother to fetus, breast-feeding Blood transfusions: contaminated blood transfusions or organ transplants performed before April 1, 1985

16. 16 Primary Sources and Possible Routes of Infection by HIV

17. Changes in Transmission Category

18. The Immune System and HIV Leukocytes – white blood cells Play major roles in defending the body against invading organisms or cancerous cells Macrophages Engulf foreign particles and displays the invader’s antigens Antigens Stimulate immune system, react with antibodies Antibodies Inactivate antigens, mark them for destruction B cells and T cells (Lymphocytes) Helper T cells and killer T cells

19. Effect on T Cells HIV enters the bloodstream, helper T cells rush to the invading viruses Immune process starts to break down HIV injects its contents into the host T cell Copies its own genetic code, RNA, into the cell’s genetic material (DNA) Immune system is activated and the T cell begins producing HIV instead of replicating itself

20. How the Disease Progresses T-cell (CD4) count: # of helper T cells present in cubic mL of blood Viral load counts Phases of infection –Months to years –Early flu-like symptoms AIDS Death

21. Phases of an HIV Infection Category A: Acute Phase –T helper cells above 500 per mm 3 –Viral load: # of HIV particles in the blood Category B: Chronic Phase –T helper cells 200 to 499 per mm 3 of blood –HIV virus increases Category C: AIDS –T helper cells fallen below 200 per mm 3 –Opportunistic infection

22. General Pattern of HIV Infection

23. HIV Virus Protein coated package of genes that invades a cell and alters the way in which the cell reproduces itself Host dependent GP 120: antigens on HIV that attract the CD4 receptors on helper T cells Within virus’s protein core –Genetic material (RNA) –Enzyme, reverse transcriptase Retrovirus – reverses the normal genetic writing process

24. Infection of a CD4 T Cell by HIV

25. Minority Races/Ethnicities and HIV In the early 80s, was viewed as a disease in whites and gays Currently identified in all ethnic groups Occurs in groups with –Poverty –Lack of access to or willingness to use health care –Substance abuse

26. Minority Races/Ethnicities and HIV African Americans Hispanics Asian Americans/Pacific Islanders American Indians and Alaska Natives

27. The Gay Community Men who have sex with men Stigma slowed prevention efforts Special consideration of ethnic groups Psychological long term effects Increased risk taking Other STIs U.S. AIDS Demographics by gender

28. Other Groups and HIV Women and HIV Children and HIV Teens and College Students and HIV Older adults and HIV Geographic Region and HIV

29. Prevention of HIV/AIDS Protecting Ourselves –Be aware that alcohol and drug use increases risky behaviors –Develop communication skills to be able to discuss risks and prevention with partners –Use HIV testing and make appropriate decisions –Use condoms

30. Prevention of HIV/AIDS Saving lives through prevention –Reduced new infections from 150,000/year to 40,000/year Obstacles to prevention: blame and denial –AIDS seen as disease of marginalized group, not “us” Needle exchange programs HIV testing

31. HIV Testing Tests should be taken 12 weeks after high- risk behavior, repeated 6 months after an uncertain result Types of Tests –ELISA: enzyme-linked immunosorbent assay –Western Blot: rechecks ELISA results –Viral load tests measure HIV in bloodstream (PCR) Getting Tested Partner Notification

32. Treatment Antiretroviral Medications –Nonnucleoside reverse transcriptase inhibitors –Nucleoside reverse transcriptase inhibitors –Protease inhibitors –Fusion Inhibitor HAART – Highly Active Antiretroviral Therapy –Combination of three or more medications Atripla – newest antiretroviral –Combination of three medications in one pill –Lowers the amount of HIV (called viral load) by interfering with the way HIV makes copies of itself

33. Living with HIV or AIDS If You Are HIV Positive –Taking care of your health –Addressing your other needs –If you are caring for someone with HIV or AIDS

34. Summary What is AIDS: Origin and Scope? –Prevalence of AIDS –The Epidemiology and Transmission of HIV –AIDS Demographic Phases of an HIV Infection HIV Structure and Life Cycle Drug Therapy for HIV Infection –Prevention and Treatment –Living with HIV or AIDS