A brief description about acuired immuno deficiency virus (AIDS), including definition, ethiology, epidemiology, pathophysiology, treatment, drugs, doses and adverse effects etc.,

1. Human
Immunodeficiency
Virus Infection
Presented by:
A.Subha Sri

2. ETHIOLOGY:
• Acquired immunodeficiency syndrome
(AIDS) is caused by Human Immuno
Deficiency Virus (HIV).
• HIV is a member of genus Lentivirus & it is a
single stranded RNA retrovirus

3. Forms of HIV:
M
(main)
N
(new)
O
(outlier )
HIV-1
HIV-2
HIV
A to D
F to H
J
K
SUBTYPES
SEROLOGICAL
TYPES

5. EPIDEMIOLOGY:
• In 1981 - 30 million people have died as a result
of HIV infection.
• In 2009 - HIV infected approximately 33
million people worldwide (East Asia, Central
Asia, and Eastern Europe).
• In 2009 - approximately 1.8 million people died
from AIDS and 2.6 million people were newly
infected with HIV.

6. • HIV-1, the most prevalent worldwide, and
• HIV-2, the most common in western Africa.
• HIV-1 subtype B is primarily responsible for
the North American and Western European
epidemic.
EPIDEMIOLOGY:

7. Mode Of Transmission:
• HIV infection occurs through three primary
modes of transmission: sexual,
parenteral, and
perinatal.

8. PATHOPHYSIOLOGY
&PATHOGENESIS

9. DIAGNOSIS:
• HIV diagnosis is made either
• Initial Screening Tests:
ELISA
HIV RNA assay
• Confirmatory Tests:
Western blot (WB)
Indirect immunofluorescence assay (IFA)
• CD4+ cell count
• Viral Load

10. CLINICAL PRESENTATION:
• Patients with acute HIV infection may display
symptoms described as “acute retroviral syndrome.”
• Patients with chronic HIV infection may present with
these same nonspecific symptoms and/or opportunistic
infections.
Acute Retroviral Syndrome
The majority of patients may present with fever,
lymphadenopathy, pharyngitis, and/or rash.

11. Other symptoms include:
• Myalgia or arthralgia
• Diarrhea
• Headache
• Nausea and vomiting
• Hepatosplenomegaly
• Weight loss
• Thrush
• Neurologic symptoms (meningoencephalitis, aseptic
meningitis, peripheral neuropathy, facial palsy, or
cognitive impairment or psychosis)
CLINICAL PRESENTATION:

12. TREATMENT
Goals of treatment are
• To maximally and durably suppress viral
replication,
• Avoid the development of drug resistance,
• Restore and preserve immune function,
• Prevent opportunistic infections, and
• Minimize drug adverse effects.

13. HAART – Highly Active Anti Retroviral Therapy
• Six classes of drugs are available to treat HIV infection:
(a) Nucleoside reverse transcriptase inhibitors
(NRTIs): Zidovudine (AZT),
Didanosine,
Stavudine,
Lamivudine,
Abacavir,
Emtricitabine,
Tenofovir (Nt RTI)
(b) Nonnucleoside reverse transcriptase inhibitors
(NNRTIs): Nevirapine,
Efavirenz,
Delavirdine

14. (c) Protease inhibitors: Ritonavir,
Atazanavir,
Indinavir,
Nelfinavir,
Saquinavir,
Amprenavir,
Lopinavir
(d) Entry (Fusion) inhibitor: Enfuvirtide
(e) CCR5 receptor inhibitor: Maraviroc
(f) Integrase inhibitor: Raltegravir

15. DRUG DOSAGE FORMS ADVERSE EFFECTS
I) Nucleoside (tide) Reverse Transcriptase Inhibitors:
Abacavir
(Ziagen)
300-mg tablet;
20 mg/mL oral
solution
Potentially fatal hypersensitivity
reaction (rash, fever, malaise,
nausea,vomiting, shortness
of breath, sore throat, loss of appetite)
Didanosine
(Videx EC)
125-, 200-, 250-,400-mg
capsules
Pancreatitis; peripheral neuropathy;
nausea;diarrhea
Emtricitabine
(Emtriva)
200-mg capsule; 10
mg/mL oral solution
Minimal
Lamivudine
(Epivir)
150-mg and 300-mg tabs
or 10 mg/mL oral solution
Minimal
Stavudine
(Zerit)
15-, 20-, 30-, 40-mg
capsules or 1 mg/mL for
oral Solution
Peripheral neuropathy; rapidly progressive
ascending neuromuscular weakness (rare);
pancreatitis; lactic acidosis with hepatic
steatosis (higher incidence with stavudine
than with other NRTIs); Hyperlipidemia.

16. DRUG DOSAGE FORMS ADVERSE EFFECTS
Tenofovir (Viread) 300-mg tablet Asthenia, headache, diarrhea, nausea,
vomiting, and flatulence; renal insufficiency
Zidovudine
(Retrovir)
100-mg capsule, 300-
mg tablet, 10 mg/mL
IV solution, 10 mg/mL
oral solution
Bone marrow suppression: macrocytic
anemia or neutropenia; GI intolerance,
headache, insomnia,
II) Nonnucleoside Reverse Transcriptase Inhibitors
Delavirdine
(Rescriptor)
100-, 200-mg
Tablets
Rash; increased LFTs,
headaches
Efavirenz
(Sustiva)
50-, 100-, 200-mg
capsules or 600- mg
tablet
Rash; CNS symptoms
(insomnia, irritability, lethargy, dizziness,
vivid dreams) usually resolve in 2 weeks.
Etravirine
(Intelence)
100-, 200-mg
tablets
Rash, nausea
Nevirapine
(Viramune)
200-mg tablet or
50 mg/5 mL oral
suspension
Rash including Stevens-Johnson
syndrome;symptomatic hepatitis, including
fatal hepatic necrosis

17. DRUG DOSAGE FORMS ADVERSE EFFECTS
Rilpivirine
(Edurant)
25-mg tablet Rash; depressive
disorders;
III) Protease Inhibitors
Atazanavir
(Reyataz)
100-, 150-, 200-,
300-mg capsules
Indirect hyperbilirubinemia; prolonged PR
interval hyperglycemia; fat maldistribution;
increased bleeding episodes in patients with
hemophilia
Darunavir
(Prezista)
400-, 600-mg tablets Skin rash ; diarrhea, nausea; headache;
hyperlipidemia; hyperglycemia; fat
maldistribution
Fosamprenavir
(Lexiva)
700-mg tablet; 50
mg/mL oral
suspension
Skin rash; diarrhea, nausea and vomiting;
headache; hyperlipidemia; LFT elevation;
hyperglycemia; fat maldistribution; increased
bleeding episodes in patients with hemophilia
Indinavir
(Crixivan)
200-, 333-, 400-mg
capsules
GI intolerance, nausea; indirect
hyperbilirubinemia; hyperlipidemia; headache,
asthenia, blurred vision, dizziness, rash,
metallic taste, thrombocytopenia, alopecia,
hemolytic anemia; hyperglycemia.

18. DRUG DOSAGE FORMS ADVERSE EFFECTS
Nelfinavir
(Viracept)
250–625-mg tablets,
50 mg/g oral powder
Diarrhea; hyperlipidemia; hyperglycemia; fat
maldistribution; increased bleeding in
hemophiliacs; LFT elevation
Ritonavir (Norvir) 100-mg tablet, 600
mg/7.5-mL solution
GI intolerance, nausea, diarrhea;
paresthesias; hyperlipidemia; hepatitis;
asthenia; taste perversion; hyperglycemia; fat
maldistribution; increased bleeding in
hemophiliacs
IV) Fusion Inhibitors
Enfuvirtide
(Fuzeon)
Injectable, in
lyophilized powder.
Each single use vial
contains 108 mg of
enfuvirtide to be
reconstituted with 1.1
mL of sterile water for
injection for delivery
of Approx. 90mg/1mL
Local injection site reaction (pain, erythema,
induration, nodules and cysts,pruritus,
eachymosis) in most patients; increased rate
of bacterial pneumonia; less than 1%
Hypersensitivity reaction (rash,fever, nausea,
vomiting, chills, rigors, hypotension, or
elevated serum transaminases); do not
rechallenge

19. DRUG DOSAGE FORMS ADVERSE EFFECTS
V) Chemokine Receptor Antagonists (CCR5 Antagonists)
Maraviroc
(Selzentry
150-mg and 300-
mg tablets
Abdominal pain; cough; dizziness;
Musculoskeletal symptoms; pyrexia; rash;
upper RTI; hepatotoxicity; Orthostatic
hypotension
VI) Integrase Inhibitors
Raltegravir
(Isentress)
400-mg tablet Nausea; headache; diarrhea; pyrexia; CPK
elevation

20. MECHANISM OF ACTION:

21. COMMON REGIMENS:

22. DRUGS IN PREGNANCY:

23. COMBINATIONS TO BE AVOIDED:

24. PREVENTION:
• Protected sex.
• Avoiding sex with multiple partners.
• Care should be taken during blood transfusion.

25. THANK YOU