Hepatits & HIV

1. HIV & AIDs

2. Table of Content
I. Introduction
Definition of HIV and AIDS
Overview of the HIV/AIDS epidemic
II. The Biology of HIV
Structure of the virus
Life cycle of the virus
Modes of transmission
III. Immune Response to HIV
The role of CD4+ T cells in the immune system
How HIV affects the immune system
The stages of HIV infection

3. Table of Content
IV. Diagnosis and Treatment of HIV
Testing for HIV
Antiretroviral therapy (ART)
Side effects of ART
Challenges in treating HIV
V. Prevention and Control of HIV
HIV prevention strategies
HIV/AIDS education and awareness
The role of pharmacists in HIV care
Role of a Pharmacist in HIV & AIDs prevention
VI. Conclusion
The impact of HIV and AIDS on global health
Future directions for HIV research and treatment
Why HIV don’t have a vaccine till now

4. Hepatitis

5. Introduction
Hepatitis means inflammation of the liver.
The liver is a vital organ that processes nutrients, filters the blood, and fights
infections. When the liver is inflamed or damaged, its function can be affected.
Heavy alcohol use, toxins, some medications, and certain medical conditions can
cause hepatitis.
Types
Hepatitis is classified into five types (A, B, C, D, and E), each caused by different
viruses. These viruses are transmitted through contaminated food and water, blood
transfusions, or sexual contact.

6. Hepatitis A
Hepatitis A is caused by the hepatitis A virus (HAV) and is transmitted through
ingestion of contaminated food and water or through close contact with an infected
person.
It is an acute infection, which means that it usually resolves on its own without
treatment within a few weeks. However, in rare cases, it can cause severe liver
damage.
Incubation period: 3-5 weeks with an average of 25 days
Treatment
Most cases of hepatitis A do not require treatment as the body can clear the virus
on its own within a few weeks. However, supportive care such as rest, hydration,
and medication for symptoms like nausea and fever may be recommended.

7. Hepatitis B
Hepatitis B is caused by the hepatitis B virus (HBV) and is transmitted through
blood or other bodily fluids of an infected person, such as during unprotected
sex, sharing needles, or from mother to child during childbirth. It can cause
both acute and chronic infections, and chronic infections can lead to liver
damage or liver cancer.
Incubation period: 2-5 months
Treatment
Acute cases of hepatitis B also do not require treatment as the body can clear
the virus on its own. However, in chronic cases, antiviral medications such as
entecavir, tenofovir, and interferon-alpha may be prescribed to slow down the
progression of the disease and reduce the risk of liver damage.

8. Hepatitis E
Hepatitis B is complex structure with 3 distinct antigens:
HBcAg - Hepatitis B core antigen
HBsAg - Hepatitis B surface antigen
HBeAg – Independent protein circulating in blood

9. Hepatitis C
Hepatitis C is caused by the hepatitis C virus (HCV) and is transmitted through
blood-to-blood contact, such as sharing needles or receiving a blood
transfusion with infected blood. It can also be transmitted through sexual
contact with an infected person. Hepatitis C can cause chronic infection, which
can lead to liver damage or liver cancer.
Treatment
Antiviral medications such as direct-acting antivirals (DAAs) are the main
treatment for hepatitis C. These drugs can cure more than 95% of hepatitis C
cases, and the treatment usually lasts for 8-12 weeks. DAAs include drugs
such as sofosbuvir, ledipasvir, daclatasvir, and ombitasvir/paritaprevir/ritonavir.

10. Hepatitis D
Hepatitis D is caused by the hepatitis D virus (HDV) and can only infect people
who already have hepatitis B. It is transmitted through contact with infected
blood or other bodily fluids, and can cause acute or chronic infections.
Treatment
There is no specific treatment for hepatitis D, and the treatment for hepatitis B
is usually recommended to manage the symptoms and reduce the risk of liver
damage.

11. Hepatitis E
Hepatitis E is caused by the hepatitis E virus (HEV) and is transmitted through
ingestion of contaminated food or water. It is usually an acute infection, which
resolves on its own within a few weeks. However, it can cause severe liver
damage in pregnant women, and can lead to chronic infection in people with
weakened immune systems.
Treatment
Similar to hepatitis A, most cases of hepatitis E do not require treatment as the
virus can clear on its own. Supportive care is usually recommended, such as
rest and hydration.

12. Dignostic tests for hepatitis
Liver function tests (LFTs): These tests measure the levels of certain enzymes and
proteins in the blood, which can indicate liver damage or inflammation.
Hepatitis virus serology: This involves testing for the presence of specific antibodies
and antigens associated with Hepatitis A, B, C, D, and E.
Polymerase chain reaction (PCR) test: This test can detect and measure the
genetic material (DNA or RNA) of the Hepatitis virus in the blood.
Liver biopsy: This involves taking a small sample of liver tissue to examine under a
microscope for signs of inflammation, scarring, or other damage.
Imaging tests: Ultrasound, CT scans, and MRI scans can be used to visualize the
liver and detect abnormalities such as swelling or scarring.

13. Introduction
HIV (Human Immunodeficiency Virus) is a virus that attacks the immune
system and can lead to AIDS (Acquired Immune Deficiency Syndrome). AIDS
is a condition where the immune system is weakened and unable to fight off
infections and diseases.
Since the first case was identified in 1981, HIV/AIDS has become a global
epidemic, with over 38 million people living with HIV worldwide. Sub-Saharan
Africa is the region most affected by HIV, accounting for two-thirds of all people
living with HIV.
In Pakistan, according to the National AIDS Control Program, there were an
estimated 160,000 people living with HIV at the end of 2020. The prevalence of
HIV in Pakistan is relatively low, at 0.09% of the general population.

14. Stages of Life Cycle
1. q

15. The Biology of HIV
Structure: HIV is a retrovirus, which means it has RNA as its genetic material and
uses the enzyme reverse transcriptase to convert RNA to DNA. The virus has a
lipid envelope that contains surface proteins, including the gp120 protein that binds
to CD4+ T cells.

16. The Biology of HIV
Life cycle of the virus: HIV infects CD4+ T cells and uses the cell machinery
to replicate its genetic material and produce new virus particles. The virus can
also infect other immune cells and organs, such as the brain and lymph nodes.
Stages of Life Cycle:
1. Binding
2. Fusion
3. Reverse Transcription
4. Integration
5. Replication
6. Assembly
7. Budding

17. Stages of Life Cycle
1. Attachment
occurs when the GP120 protein projections make contact and bind with a CD4
receptor. In addition, there is also binding with certain co-receptors called CCR5 or
CXCR4 to gain entry into the cell.
2. Fusion
occurs when the virus becomes united with the cell and dumps its content into the
cell, which is genetic material (RNA) and enzymes (unpacks it “suitcase”).
3. Reverse transcription
Now it’s time for getting into the cell’s nucleus and becoming integrated with the
cell! Therefore, the single strand of viral RNA needs to turn into viral DNA. The HIV
virus brought along with it an enzyme called reverse transcriptase. This enzyme
causes the viral RNA to turn into double stranded DNA. This viral DNA moves into
the nucleus of the cell.

18. Stages of Life Cycle
4. Integrate
Once inside the nucleus it needs to hijack the cell’s DNA (hence become part of it
so it can take control, produce more HIV virus, and kill the cell). To do this, the HIV
DNA strand releases another enzyme called integrase, which allows it to become
part of the cell’s DNA. So, it’s now integrated into the cell’s DNA.
5. Replicate
Now that the HIV’s DNA is in control, it starts to use the parts of the hijacked cell to
make long chains of the virus.
6. Assembly
These long chains and other viral material are being assembled and start to move
toward the cell’s surface.

19. Stages of Life Cycle
7. Budding
The assembled parts start to grow (hence bud) off the cell wall.
8. Maturity
Once it has completely grown off the cell’s surface, it pops off. Then protease (an
enzyme that cuts the long chain of virus prepping it for maturity) completes its job of
maturing the viral material, and a new mature virus is born. The cell that the HIV
virus hijacked dies, and this new mature HIV virus has a mission of finding another
cell victim with a CD4 receptor. It then starts the whole process again.

21. The Biology of HIV
Modes of transmission: HIV can be transmitted through blood, semen, vaginal
fluids, breast milk, and other bodily fluids. The most common modes of
transmission are sexual contact, sharing of needles or syringes, and mother-to-
child transmission during pregnancy, childbirth, or breastfeeding.

22. Immune Response to HIV
Role of CD4+ T cells in the immune system: CD4+ T cells are a type of
white blood cell that help coordinate the immune response to infections. They
recognize foreign pathogens and activate other immune cells to eliminate
them.
How HIV affects the immune system: HIV infects and destroys CD4+ T cells,
leading to a weakened immune system that is susceptible to opportunistic
infections and cancers.

23. Immune Response to HIV
The stages of HIV infection: HIV infection progresses through Three Stages:
• Acute infection
• Clinical latency
• AIDS.

24. Immune Response to HIV
During acute infection, the virus replicates rapidly and causes flu-like symptoms.
Clinical latency is a period of relatively low viral activity, but CD4+ T cells are
gradually depleted.
AIDS is characterized by a CD4+ T cell count below 200 cells/mm3 or the
occurrence of opportunistic infections.

25. Diagnosis and Treatment of HIV
Testing for HIV: HIV can be detected through blood tests that look for antibodies
to the virus or viral proteins. Rapid tests are also available that can provide results
within minutes.
Some of the laboratories in Pakistan that provide HIV testing facilities include:
• National AIDS Control Program (NACP)
• Pakistan Institute of Medical Sciences (PIMS)
• Aga Khan University Hospital (AKUH)
• Shaukat Khanum Memorial Cancer Hospital and Research Centre
• Chughtai Lab
• Punjab AIDS Control Program (PACP)
• Dow University Hospital
• Pakistan Red Crescent Society (PRCS)

26. Diagnosis and Treatment of HIV
Tests used for Diagnosis of HIV:
Antibody screening test: This is a blood test that detects HIV antibodies
produced by the body in response to HIV infection. The test can be conducted
using various methods, including enzyme-linked immunosorbent assay
(ELISA), rapid antibody tests, and oral fluid tests.
Western blot test: This is a confirmatory test that is used to confirm the results
of an antibody screening test. The Western blot detects specific HIV proteins in the
blood to confirm the presence of HIV antibodies.

27. Diagnosis and Treatment of HIV
Nucleic acid test (NAT): This is a blood test that detects the genetic material (RNA) of
the virus itself. NAT can detect HIV infection earlier than antibody tests, but it is more expensive
and may not be as widely available.
p24 antigen test: This is a blood test that detects the p24 protein produced by the virus
during the early stages of HIV infection. The test is less commonly used than antibody tests or
NAT but can be useful for detecting HIV in the early stages of infection.
 It's important to note that no single test can definitively diagnose HIV infection. Rather, a
sequence or algorithm of tests is typically used to confirm the presence of HIV antibodies or the
virus itself. Additionally, a positive HIV test result does not necessarily mean that a person has
AIDS, as HIV infection can be effectively managed with antiretroviral therapy.

28. Diagnosis and Treatment of HIV
Antiretroviral therapy (ART): ART is a combination of drugs that suppress the
replication of HIV and reduce the viral load in the body. The goal of ART is to maintain
a low viral load and preserve CD4+ T cells to prevent opportunistic infections and
prolong survival.

29. Diagnosis and Treatment of HIV
Side effects of ART: ART can cause side effects such as nausea, diarrhea,
fatigue, and changes in body fat distribution. These side effects can affect
medication adherence and quality of life for people living with HIV.

30. Diagnosis and Treatment of HIV
Challenges in treating HIV: HIV treatment requires lifelong adherence to
medication, which can be challenging for some patients.
In addition, drug resistance can develop if ART is not taken as prescribed.

31. Prevention and Control of HIV
HIV prevention strategies: HIV can be prevented through strategies such as
condom use, pre-exposure prophylaxis (PrEP), and harm reduction programs for
people who inject drugs. HIV education and awareness campaigns can also help
reduce stigma and discrimination against people living with HIV.
HIV/AIDS education and awareness: Education and awareness about HIV/AIDS
can help reduce the spread of the virus and improve the quality of life for people
living with HIV. This can include teaching about safe sex practices, providing
information on HIV testing and treatment, and promoting HIV prevention and care

32. Role of a Pharmacist in HIV and AIDs
Pharmacists play a vital role in the prevention, treatment, and management of HIV
and AIDS. Here are some ways in which pharmacists can contribute:
 Dispensing antiretroviral therapy (ART)
 Monitoring drug interactions
 Providing counseling and education
 Promoting HIV prevention
 Advocating for access to care

33. Conclusion
HIV and AIDS continue to be a significant global health challenge, affecting millions
of people worldwide. Despite progress in HIV prevention, testing, and treatment,
much work remains to be done to end the epidemic. The impact of HIV and AIDS
extends beyond health, affecting social, economic, and political systems, and
further efforts are needed to address the social and structural drivers of HIV
transmission.
The future of HIV research and treatment is promising, with ongoing efforts to
develop new prevention and treatment options, such as long-acting medications,
vaccines, and gene therapies. Additionally, research is exploring the potential for
HIV cure, which would represent a significant advance in HIV treatment.

34. Why HIV don't have a vaccine till
now?
There are several reasons for this:
• HIV is a highly variable virus
• The immune response to HIV is complex
• Lack of animal models
• Limited understanding of protective immunity

35. Bas Khatam!!