-what is HIV ? -Etiology & Structure -Difference between -HIV1 & HIV2 -Transmission -Risk Factors -symptoms of HIV in children -parthenogenesis of HIV -stages of HIV with symptoms -testing of HIV -Diagnosis -Epidemiology -Treatment -control and prevention

3. WHAT IS HIV ??WHAT IS HIV ??

4. WHAT IS HIV ??WHAT IS HIV ??
HIV infection is condition caused by Human HIV infection is condition caused by Human
Imuunodeficiency Viruse (HIV)Imuunodeficiency Viruse (HIV)
A unique type of virus (Retrovirus )A unique type of virus (Retrovirus )
This condition gradually destroys the immune systemThis condition gradually destroys the immune system
which makes it hard for the body to fight infections.which makes it hard for the body to fight infections.
It causes acquired immunodeficiency virus (ADIS)It causes acquired immunodeficiency virus (ADIS)
Threatening a global epidemic Threatening a global epidemic
Preventable , managable but Preventable , managable but NOTNOT curable .curable .

5. Other Names For HIVOther Names For HIV
Former names of the virus includeFormer names of the virus include::
Human T cell lymphotrophic virusHuman T cell lymphotrophic virus
(HTLV-III)(HTLV-III)
Lymphadenopathy associated virus (LAV)Lymphadenopathy associated virus (LAV)
AIDS associated retrovirus (ARV)AIDS associated retrovirus (ARV)

6. History Of HIVHistory Of HIV
It is now thought that HIV came from It is now thought that HIV came from
similar virus found in chimpanzees - SIV. similar virus found in chimpanzees - SIV.

7. HIV probably entered the United States HIV probably entered the United States
around 1970around 1970
CDC in 1981 noticed unusual clusters of CDC in 1981 noticed unusual clusters of
Kaposi’s sarcoma in gay men in NY and Kaposi’s sarcoma in gay men in NY and
San Francisco, which led to the disease to San Francisco, which led to the disease to
be called GRID (Gay Related Immune be called GRID (Gay Related Immune
Deficiency).Deficiency).

8. By 1982 the disease was apparent in By 1982 the disease was apparent in
heterosexuals and was renamed AIDS heterosexuals and was renamed AIDS
(Acquired Immune Deficiency).(Acquired Immune Deficiency).
1984- Scientists identify HIV (initially called 1984- Scientists identify HIV (initially called
HTLV-III or LAV) as the cause of AIDSHTLV-III or LAV) as the cause of AIDS
1987- AZT is the first drug approved for 1987- AZT is the first drug approved for
treating AIDStreating AIDS

9. Etiology & StructureEtiology & Structure
Causative agent : Human Immuno –Causative agent : Human Immuno –
deficiency Virus.deficiency Virus.

10. Enveloped RNA retrovirusEnveloped RNA retrovirus
Spherical 120 nm in diameter envelope proteins Spherical 120 nm in diameter envelope proteins
make the spikes on the membrane make the spikes on the membrane
Enveloped truncated conical capsidEnveloped truncated conical capsid
Electron dense coreElectron dense core
Two copies of the single stranded (+) RNATwo copies of the single stranded (+) RNA
Has enzymes: Reverse transcriptase, Integrase & Has enzymes: Reverse transcriptase, Integrase &
ProteaseProtease
Has LTR (long terminal repeats) and neg regulatory Has LTR (long terminal repeats) and neg regulatory
genesgenes
HIV virusHIV virusStructure ofStructure of

11. HIV-2 is lower transmissibilityHIV-2 is lower transmissibility
HIV-2 develops more slowly. HIV-2 develops more slowly.
MTCT MTCT ((Mother to child transmissionMother to child transmission))
is relatively rare with HIV-2.is relatively rare with HIV-2.
HIV-2 is found primarily in West AfricaHIV-2 is found primarily in West Africa
HIV-1 is more common worldwide.HIV-1 is more common worldwide.
Difference betweenDifference between
HIV1 & HIV2HIV1 & HIV2

12. Is HIV and AIDSIs HIV and AIDS
the same thing?the same thing?

13. “Human Immunodeficiency Syndrome”“Human Immunodeficiency Syndrome”
A specific type of virus (a retrovirus)A specific type of virus (a retrovirus)
HIV invades the helper T cells to replicate HIV invades the helper T cells to replicate
itself.itself.
No CureNo Cure
HIVHIV

14. Acquired Immunodeficiency SyndromeAcquired Immunodeficiency Syndrome
HIV is the virus that causes AIDSHIV is the virus that causes AIDS
Disease limits the body’s ability to fight Disease limits the body’s ability to fight
infectioninfection
A person with AIDS has a very weak immune A person with AIDS has a very weak immune
systemsystem
No CureNo Cure
AidsAids

15. Through Body Fluids :Through Body Fluids :
Blood productsBlood products
SemenSemen
Vaginal fluidsVaginal fluids
Breast MilkBreast Milk
TransmissionTransmission

16. Sharing Needles Without sterilization Sharing Needles Without sterilization
increases the chances of having HIVincreases the chances of having HIV
Unsterilized bladesUnsterilized blades
Through sex (oral ,anal ..)Through sex (oral ,anal ..)

17. Mother to baby:Mother to baby:
Before birth Before birth
During Birth During Birth
Postpartum (after birth )Postpartum (after birth )
If mother is HIV positive, 100% of children If mother is HIV positive, 100% of children
will test positive at birthwill test positive at birth
Breast feeding increases transmission rate Breast feeding increases transmission rate

18. HIV cant be transmitted HIV cant be transmitted
through :through :
Toilet Toilet
Sharing Utensils Sharing Utensils
Mosquito Mosquito

20. Anyone of any age, race, sex or sexual orientation Anyone of any age, race, sex or sexual orientation
can be infected with HIV, but you're at greatest can be infected with HIV, but you're at greatest
risk of HIV/AIDS if you: risk of HIV/AIDS if you:
Have unprotected sex with multiple partners. Have unprotected sex with multiple partners.
You're at risk whether you're heterosexual, You're at risk whether you're heterosexual,
homosexual or bisexual. homosexual or bisexual. (do not use (do not use condomscondoms).).
Risk FactorsRisk Factors

21. a man who has sex with other mena man who has sex with other men
Have unprotected sex with someone who is HIV-Have unprotected sex with someone who is HIV-
positivepositive
Have another sexually transmitted disease, such Have another sexually transmitted disease, such
as syphilis, herpes, chlamydia, gonorrhea or as syphilis, herpes, chlamydia, gonorrhea or
bacterial vaginosis. bacterial vaginosis. People who People who inject drugsinject drugs or or
steroids, especially if they steroids, especially if they share needles.share needles.
Babies who are born to mothers who are Babies who are born to mothers who are
infected with HIV.infected with HIV.

22. children
children
inin
HIVHIV
Symptoms of
Symptoms of

23. Symptoms of HIV in childrenSymptoms of HIV in children
Symptoms of HIV in children:Symptoms of HIV in children:
Children who are HIV-positive may Children who are HIV-positive may
experienceexperience
Difficulty gaining weight Difficulty gaining weight
Problems walking Problems walking
Delayed mental developmentDelayed mental development
Severe forms of common childhood illnesses Severe forms of common childhood illnesses
such as ear infections (otitis media), such as ear infections (otitis media),
pneumonia and tonsillitispneumonia and tonsillitis

24. Pathogenesis ofPathogenesis of HIVHIV

26. HIV infects CD-4 positive cellHIV infects CD-4 positive cell
Entry into cell by fusion requires gp41 and Entry into cell by fusion requires gp41 and
coreceptorscoreceptors
Envelope lost and RNA uncoatedEnvelope lost and RNA uncoated
DNA made from RNA using reverse TranscriptaseDNA made from RNA using reverse Transcriptase
DNA and Integrase migrate to nucleus formingDNA and Integrase migrate to nucleus forming
a provirus by integrating viral DNA to host DNAa provirus by integrating viral DNA to host DNA

27. Rate of viral replication regulated by the activity of Rate of viral replication regulated by the activity of
regulatory proteins (tat/rev, nef, etc)regulatory proteins (tat/rev, nef, etc)
Co-infections (e.g., mycobacterial) stimulate the HIV-Co-infections (e.g., mycobacterial) stimulate the HIV-
infected cells to produce more virusinfected cells to produce more virus
Transcription and translation produces necessary Transcription and translation produces necessary
polyprotiens which are cleaved by the HIV proteasepolyprotiens which are cleaved by the HIV protease
AssemblyAssembly
Maturation/release of virusMaturation/release of virus

28. Stages of HIV
Stages of HIV
With its symptoms
With its symptoms

29. Stage 1:Stage 1:
Primary HIV InfectionPrimary HIV Infection
The first stage is called The first stage is called acute infection.acute infection.
It is often accompanied byIt is often accompanied by a short flu-like a short flu-like
illnessillness
It typically happens within It typically happens within 22 to to 66 weeksweeks
after exposure or becoming infected.after exposure or becoming infected.
During this stage there is a large amount of During this stage there is a large amount of
HIV in the peripheral blood and the immune HIV in the peripheral blood and the immune
system begins to respond to the virus by system begins to respond to the virus by
producing HIV antibodies. This process is producing HIV antibodies. This process is
known as (known as (seroconversion).seroconversion).

30. The symptoms of HIVThe symptoms of HIV
infection for stage 1infection for stage 1
Fever
Headache
Sore throat
Diarrhea that
lasts for more
than a week
Fatigue
vomiting

31. Stage 2:Stage 2:
Clinically Asymptomatic StageClinically Asymptomatic Stage
This stage lasts for an average of This stage lasts for an average of ten yearsten years
During this period During this period without symptomswithout symptoms, HIV is slowly , HIV is slowly
killing the CD4 T-cells and destroying the immune killing the CD4 T-cells and destroying the immune
system. system.
Blood tests during this time can reveal the number Blood tests during this time can reveal the number
of these CD4 T-cells. For an HIV-infected person, of these CD4 T-cells. For an HIV-infected person,
the number of CD4 T-cells steadily dropsthe number of CD4 T-cells steadily drops
No clear symptoms appear *No clear symptoms appear *

32. Stage 3:Stage 3:
Symptomatic HIV InfectionSymptomatic HIV Infection
AIDS (acquired immune deficiency AIDS (acquired immune deficiency
syndrome) is the advanced stage of HIV syndrome) is the advanced stage of HIV
infection. When the CD4 T-cell number infection. When the CD4 T-cell number
drops below 200, people are diagnosed drops below 200, people are diagnosed
with AIDS.with AIDS.

33. The symptoms of stage 3The symptoms of stage 3
BeingBeing tiredtired all of the time.all of the time.
Swollen lymph nodesSwollen lymph nodes in the neck .in the neck .
FeverFever lasting for more than 10 days.lasting for more than 10 days.
Night sweats.Night sweats.
UnexplainedUnexplained weight loss.weight loss.
PurplishPurplish spots on the skinspots on the skin that don't gothat don't go
away.away.
Shortness of breath.Shortness of breath.
Severe, long-lastingSevere, long-lasting diarrhea.diarrhea.

34. Infections associated with AIDSInfections associated with AIDS
HIV infected person at risk for HIV infected person at risk for infectionsinfections..
The following diseases The following diseases are are predictivepredictive of the of the
progression to progression to AIDSAIDS::

35. Oral Candidiasis (thrush)Oral Candidiasis (thrush)

36. Oral Hairy LeukoplakiaOral Hairy Leukoplakia
Being that HIV reduces Being that HIV reduces
immunologic activity, the immunologic activity, the
intraoral environment is a intraoral environment is a
prime target for chronic prime target for chronic
secondary infections and secondary infections and
inflammatory processes, inflammatory processes,
including OHL, which is due including OHL, which is due
to the Epstein-Barr virus to the Epstein-Barr virus
under immunosuppressed under immunosuppressed
conditions conditions

37. Kaposi’s sarcoma (KS)Kaposi’s sarcoma (KS)
Kaposi’s sarcoma Kaposi’s sarcoma
(shown) is a rare cancer (shown) is a rare cancer
of the blood vessels that of the blood vessels that
is associated with HIV. It is associated with HIV. It
manifests as bluish-red manifests as bluish-red
oval-shaped patches that oval-shaped patches that
may eventually become may eventually become
thickened. Lesions may thickened. Lesions may
appear singly or in appear singly or in
clusters. clusters.

38. Testing Options for HIVTesting Options for HIV

39. No name is usedNo name is used
Unique identifying Unique identifying
numbernumber
Results issued only Results issued only
to test recipientto test recipient
Anonymous TestingAnonymous Testing
23659874515
Anonymous

40. Confidential TestingConfidential Testing
Person’s name is recorded along with HIV Person’s name is recorded along with HIV
results.results.
-Name and positive results are reported to the -Name and positive results are reported to the
State Department and the Centers for State Department and the Centers for
Disease Control and PreventionDisease Control and Prevention
Results issued only to test recipientResults issued only to test recipient

41. Oral TestingOral Testing
Orasure:Orasure:
The only FDA approved The only FDA approved
HIV antibody.HIV antibody.
As accurate as blood As accurate as blood
testingDraws blood-testingDraws blood-
derivedderived
fluids from the gum fluids from the gum
tissue.tissue.
NOT A SALIVA TEST!NOT A SALIVA TEST!

42. DiagnosisDiagnosis

43. The HIV TestThe HIV Test
Enzyme-linked Enzyme-linked
immunosorbent assay immunosorbent assay
(ELISA). (ELISA).
This test is usually the first This test is usually the first
one used to detect infection one used to detect infection
with HIV. If antibodies to with HIV. If antibodies to
HIV are present (positive), HIV are present (positive),
the test is usually repeated the test is usually repeated
to confirm the diagnosis.to confirm the diagnosis.

44. Expensive – $ 80 – 100Expensive – $ 80 – 100
technically more difficulttechnically more difficult
visual interpretationvisual interpretation
lack standardisationlack standardisation
- performance- performance
–– - interpretation- interpretation
–– - indeterminate reactions – - indeterminate reactions –
resolution of ??resolution of ??
‘Gold Standard’ for confirmation‘Gold Standard’ for confirmation
Western BlotWestern Blot

45. Polymerase chain reaction (PCR).Polymerase chain reaction (PCR).
This test finds either the RNA of the HIV virusThis test finds either the RNA of the HIV virus
or the HIV DNA in white blood cells infectedor the HIV DNA in white blood cells infected
with the virus.with the virus.

46. If you receive a diagnosis of HIV/AIDS,
several types of tests can help your doctor
determine what stage of the disease you
:have. These tests include
CD4 count. CD4 count.
-- CD4 cells are a type of white blood cell that's specifically CD4 cells are a type of white blood cell that's specifically
targeted and destroyed by HIV. targeted and destroyed by HIV.
-- CD4 count vary from 500 to more than 1,000= healthy person CD4 count vary from 500 to more than 1,000= healthy person ..
-- CD4 count becomes less than 200 =HIV infection progresses to CD4 count becomes less than 200 =HIV infection progresses to
AIDS.AIDS.
Viral load: Viral load:
-- This test measures the amount of virus in your blood.This test measures the amount of virus in your blood.

47. Baby’s investigation ofBaby’s investigation of
HIV after birthHIV after birth
Most HIV tests look for antibodies to HIV, not the Most HIV tests look for antibodies to HIV, not the
virus itself. But these tests aren’t very useful for virus itself. But these tests aren’t very useful for
babies born to HIV-positive mothers.babies born to HIV-positive mothers.
WHY ?WHY ?
That’s because the mother’s HIV antibodies That’s because the mother’s HIV antibodies
get into the baby’s blood during pregnancy. get into the baby’s blood during pregnancy.
If the mother is HIV-positive, the regular If the mother is HIV-positive, the regular
HIV test will show that the baby is HIV-HIV test will show that the baby is HIV-
positive, even when that isn’t true.positive, even when that isn’t true.

48. Epidem
iology

49. EpidemiologyEpidemiology
Zimbabwe is Zimbabwe is one of the five one of the five
countries hardest countries hardest hit by hit by HIVHIV and and
AIDSAIDS globally. One in five globally. One in five
Zimbabwean adults were living Zimbabwean adults were living
with HIV and AIDS in 2009 while with HIV and AIDS in 2009 while
approximately approximately 66,073 people died 66,073 people died
of AIDS related causesof AIDS related causes..
It is estimated that It is estimated that 343,460 adults 343,460 adults
are in need of are in need of Anti-RetroviralAnti-Retroviral
TherapyTherapy (ART).(ART).

51. Treatment

52. TreatmentTreatment
Anti-retroviral medicinesAnti-retroviral medicines work by stopping the HIV fromwork by stopping the HIV from
making copies of itself .making copies of itself .
- To strengthen the immune system.- To strengthen the immune system.
-- The amount of virus in your body (viral load) is decreased.The amount of virus in your body (viral load) is decreased.
-- Allows your body to make more CD4 T cells.Allows your body to make more CD4 T cells.
Commonly three different types of medicines are takenCommonly three different types of medicines are taken
together. This is calledtogether. This is called combination therapycombination therapy. And that helps. And that helps
to prevent the virus from becoming resistant to theto prevent the virus from becoming resistant to the
medicines. These medicines are usuallymedicines. These medicines are usually taken for lifetaken for life..

53. The classes of anti-HIVThe classes of anti-HIV
:drugs includedrugs include
Non-nucleoside reverse transcriptase inhibitors (NNRTIs).Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
It disables a protein needed by HIV to make copies of itself.It disables a protein needed by HIV to make copies of itself.
Nucleoside reverse transcriptase inhibitors (NRTIs).Nucleoside reverse transcriptase inhibitors (NRTIs).
They are faulty versions of building blocks that HIV needs to They are faulty versions of building blocks that HIV needs to
make copies of itself.make copies of itself.
Protease inhibitors (PIs).Protease inhibitors (PIs).
It disables protease, another protein that HIV needs to make It disables protease, another protein that HIV needs to make
copies of itself.copies of itself.

54. Entry or fusion inhibitors.Entry or fusion inhibitors.
These drugs block HIV's entry into CD4 cells.These drugs block HIV's entry into CD4 cells.
Integrase inhibitorsIntegrase inhibitors
Raltegravir (Isentress) works by disabling Raltegravir (Isentress) works by disabling
integrase, a protein that HIV uses to insert its integrase, a protein that HIV uses to insert its
genetic material into CD4 cells.genetic material into CD4 cells.

55. Will HealthWill Health
Insurance Pay forInsurance Pay for
HIV treatment ?HIV treatment ?
HIV is a disease that requires a lot of managementHIV is a disease that requires a lot of management
including doctor visits and treatments.including doctor visits and treatments.
Fortunately,Fortunately, most major health insurance will covermost major health insurance will cover
HIV treatment under normal circumstances.HIV treatment under normal circumstances.
Unfortunately,Unfortunately, there are some exceptions that canthere are some exceptions that can
occur and some concerns of which you shouldoccur and some concerns of which you should
make yourself aware.make yourself aware.

56. Because HIV is a relatively new disease, a lotBecause HIV is a relatively new disease, a lot
of treatments and medications for it are stillof treatments and medications for it are still
experimental. For the most part, insuranceexperimental. For the most part, insurance
companies are not required to covercompanies are not required to cover
experimental medications and treatmentsexperimental medications and treatments
for HIV.for HIV.

57. Control &
Control &
Prevention
Prevention

58. ••I recommend the same therapies I recommend the same therapies
for all humans with HIV. There is for all humans with HIV. There is
no reason to believe that no reason to believe that
physiologic responses to therapy physiologic responses to therapy
will vary across lines of class, will vary across lines of class,
culture, race or nationality.culture, race or nationality.

59. There's no vaccine to prevent HIV There's no vaccine to prevent HIV
infection and no cure for AIDS. infection and no cure for AIDS.
But it's possible to protect yourself and But it's possible to protect yourself and
others from infection.others from infection.
That means educating yourself about That means educating yourself about
HIV and avoiding any behavior that HIV and avoiding any behavior that
allows HIV-infected into your body.allows HIV-infected into your body.

60. If you're HIV-negativeIf you're HIV-negative
Educate yourself and others. Educate yourself and others.
Know the HIV status of any sexual partner. Know the HIV status of any sexual partner.
Use a new condom every time you have sex.Use a new condom every time you have sex.
Consider male circumcision. Consider male circumcision.
Use a clean needle.Use a clean needle.
Be cautious about blood products in certain Be cautious about blood products in certain
countries. countries.
Get regular screening tests.Get regular screening tests.
Don't become complacent. Don't become complacent.

61. If you're HIV-positiveIf you're HIV-positive
Follow safe-sex practices.Follow safe-sex practices.
Tell your sexual partners you have HIV. Tell your sexual partners you have HIV.
If your partner is pregnant, tell her you If your partner is pregnant, tell her you
have HIV.have HIV.
Tell others who need to know.Tell others who need to know.
Don't share needles or syringes. Don't share needles or syringes.
Don't donate blood or organs. Don't donate blood or organs.
Don't share toothbrushes.Don't share toothbrushes.
If you're pregnant, get medical care right If you're pregnant, get medical care right
away.away.

62. Prevention byPrevention by
Common SenseCommon Sense
ABC rule :ABC rule :
AbstinenceAbstinence
Be faithful (one partner)Be faithful (one partner)
CondomCondom

63. How to protect your baby How to protect your baby
:from getting HIV from getting HIV
Mother-to-child transmission of HIVMother-to-child transmission of HIV
can be prevented by usingcan be prevented by using antiretroviralantiretroviral
drugsdrugs, which reduce the chances of a, which reduce the chances of a
child becoming infected with HIV fromchild becoming infected with HIV from
20% to less than 5%.20% to less than 5%.

64. focused education efforts in high risk focused education efforts in high risk
populations. populations.
Prevention of Mother to Child TransmissionPrevention of Mother to Child Transmission
behavior change:(faithfulness to one partner)behavior change:(faithfulness to one partner)
condom promotion condom promotion
vaccine developmentvaccine development
Blood Safety Blood Safety
Support to People Living with HIVSupport to People Living with HIV
Prevention strategies isPrevention strategies is
based on:based on:

66. THTHANANK K YOYOUU