This document discusses HIV and opportunistic infections. It defines HIV as a virus that destroys immune cells, leaving the body vulnerable to opportunistic infections. Opportunistic infections are caused by various germs that typically do not cause disease in healthy individuals. Some common opportunistic infections in HIV patients include thrush, toxoplasmosis, and bacterial infections. The best way to prevent opportunistic infections is by taking antiretroviral drugs to suppress HIV and strengthen the immune system.

1. HIV and Opportunistic
Infections.
Presented by Miss Sudipa Roy
Designation : Associate Professor
East Point College of Pharmacy Bangalore

2. Definition.
• Human immunodeficiency virus (HIV) is a blood-borne
virus typically transmitted via sexual intercourse ,
shared intravenous drug paraphernalia, and mother to
child transmission (MTCT) , which can occur during the
birth process or during breastfeeding.
• The human immunodeficiency virus (HIV) kills or
impairs the cells of the immune system and
progressively destroys the body's ability to protect
itself. Over time , a person with a deficient immune
system (immunodeficiency) may become vulnerable to
common and even simple by disease-causing organisms
such as bacteria or viruses. These infections can
become life-threatning.

3. • The term AIDS comes from acquired
immunodeficiency syndrome . AIDS refers to the
most advanced stage of HIV infection. Medical
treatment can delay the onset of AIDS
, but HIV infection eventually results in a syndrome
of symptoms , diseases and infections.

4. • Clinical Manifestation.
• Primary infection occurs 4 to 10 weeks after unprotected sexual practice with an HIV-
infected person. The primary HIV infection is characterized by the following
symptoms :
• Fever
• Joint Pain
• Skin rash
• Sore throat
• Swollen lymph nodes
• Chronic HIV infection is characterized by the following signs and symptoms and can
last for decades :
• Fever
• Fatigue
• Diarrhoea
• Weight loss
• Oral Thrush
• Shingles

5. • Etiology.
• HIV disease is caused by infection with HIV-1 or
HIV-2 , which are retroviruses in the Retroviridae
family, Lentivirus genus. HIV infection is caused by
the human immunodeficiency virus. One can get
HIV from contact with infected blood , semen or
vaginal fluids.

6. • Patgophysiology.
• HIV attaches to CD4 molecule and CCR5 (a
chemokine co-receptor) , the virus surfcae fuses
with the cellular membrane that allows it entry into
a T-helper lymphocyte.
• After integration in the host genome, the HIV
provirus forms and then follows transcription and
the production of viral mRNAs.
• HIV structural proteins are made and assembled in
the host cell.

7. • Viral budding from host cells can release millions of
HIV particles that can go infect other cells.
• Binding to CD4 , then Internalization, then
uncoating ,then Reverse transcriptase , then
Integrated proviral DNA (Productive infection -
Mature HIV production , cell lysis and Latent
infection).

8. • Treatment.
• The management of the patient with HIV or AIDS in
complex and lifelong. Collaborations amongst
primary care physicians and specially trained
providers such as infectious disease , oncology ,
gastroenterology , neurology , cardiology and
dermatology will be required to handle the
complications of long term HIV infection, ART
medication side effects and the complications of
immunosuppression when the patient transmission
to AIDS.

9. • Medications.
• Antiretrovirals are drugs used to treat HIV infections
/AIDS and they are used in various combinations
commonly referred to as highly active retroviral
therapy (HAART).
• The antiretrovirals agent includes
nucleoside/nucleotide reverse transcriptase inhibitors
(NRTIs) , NRTI fixed-dose combinations , integrase
inhibitors , non-nucleoside reverse transcriptase
inhibitors (NNRTIs), Protease inhibitors and CCR5
inhibitors.

10. • All patients with HIV regardless of what level of CD4
should be started on HAART , which is treatment
for life.
• This therapy has been shown to reduce morbidity
and mortality plus lower the risk of transmitting the
infection to others , as long as the individual has
low or undectable viral load.
• No drug/treatment can cure HIV/AIDS , many of the
drugs used have side effects that can be severe and
most drug therapies are expensive.

11. • Common side effects of HAART medications are :
• Short term : Rush , Aneamia , Diarrhoea , Nausea ,
Headaches , Dizziness , Muscle Pain , Weakness ,
Fatigue and Insomnia.
• Long Term : Lipodystrophy - a problem in the way the
body produces , uses and stores fat , Insulin resistace
, Lipid Abnormalities, Decrease in bone density ,
Lactic Acidosis.
• Hepatotoxicity is also a common complications.

12. Opportunistic Infections.
• Definition.
• Opportunistic infections (OIs) are those infections
that are uncommon except when they are given an
opportunity to infect a person like an altered
microbiota (such as disrupted gut flora ), a
penetrating injury , weakened immune system etc.
• Opportunistic infections (OIs) are infections that
occur more frequently and are more severe in people
with weakened immune systems , including people
with HIV.

13. • Many OIs are considered AIDS-defining conditions.
That means if a person with HIV has one these
conditions , they are diagnosed with AIDS , the most
serious stage of HIV infection.
• OIs are caused by a variety of germs (viruses, bacteria
, fungi and parasite). These germs spread in different
ways , such as in the air , in body fluids or in
contaminated food or water . They can cause health
problems when a person's immune system is
weakened by HIV disease.

14. • Some of the most common OIs are -
• Herpes simplex virus 1 (HSV-1) ingfection-
• A viral infection that can cause sores on the lips and
mouth
• Salmonella infection - a bacterial infection that
affects the intestines
• Candidiasis (thrush) - a fungal infection of the
mouth , bronchi , trachea , lungs , esophagus or
vagina.
• Toxoplasmosis - A parasitic infection that can affect
the brain.

15. • Management .
• The best way to prevent OIs is to take HIV medication daily as prescribed so that
one can get and keep undectable viral load and keep immune system strong.
• It is also important to stay in HIV medical care and get lab tests done. Som of the
ways people living with HIV can reduce their risk of getting an OI include.
• Avoiding exposure to contaminated water and food.
• Taking medicines to prevent certain OIs
• Getting vaccinated against some preventable infections
• Travelling safely
• There are treatments available such as antiviral , antibiotic and antifungal drugs.
• The type of medicine used depends on the OI.
• Once an OI is suucessfully treated , a person may continue to use the same
medicine or an additional medicine to prevent the OI from coming back . Having
an OI may be a very serious medical situation and its treatment can be
challenging.