HIV, Polio and Rabies Viruses Explained

HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 1
VIRULOGYVIRULOGY
HIV, POLIOMYELITIS VIRUS,HIV, POLIOMYELITIS VIRUS,
RABIES VIRUSRABIES VIRUS

HUMAN IMMUNODEFICIENCYHUMAN IMMUNODEFICIENCY
VIRUSVIRUS
(HIV)(HIV)
Dr. Ashish JawarkarDr. Ashish Jawarkar
M.D. (Pathology)M.D. (Pathology)

HistoryHistory
 USA - 1981USA - 1981
 Sudden emergence of large number of cases ofSudden emergence of large number of cases of
Kaposci’s sarcoma and P. carinii pneumoniaKaposci’s sarcoma and P. carinii pneumonia
among homosexualsamong homosexuals
 Research showed they had low immunity thatResearch showed they had low immunity that
made them vulnerable to infection andmade them vulnerable to infection and
malignanciesmalignancies
 This condition was given the name –This condition was given the name –
ACQUIRED IMMUNO DEFICIENCYACQUIRED IMMUNO DEFICIENCY
SYNDROME - AIDSSYNDROME - AIDS

 This was found to be due to a virus –This was found to be due to a virus –
Human immunodeficiency virus - HIVHuman immunodeficiency virus - HIV

Problem statementProblem statement
 UNAIDS/WHO (2008)UNAIDS/WHO (2008)
 33.4 million people infected with HIV33.4 million people infected with HIV
 2.7 million new cases2.7 million new cases
 2 million deaths2 million deaths
 INDIAINDIA
 2-3.1 million cases2-3.1 million cases
 Males>femalesMales>females
 Prevalence is high in sexually active age group – 15-Prevalence is high in sexually active age group – 15-
49 years49 years

EpidemiologyEpidemiology
 Spread by ONLY three modesSpread by ONLY three modes
 Sexual contact with infected personSexual contact with infected person
 Blood and blood productsBlood and blood products
 Infected mother to babyInfected mother to baby

RELATIVE RISKRELATIVE RISK
 Blood and its productsBlood and its products 90%90%
 Mother to babyMother to baby 30%30%
 IntercourseIntercourse 0.1-1%0.1-1%
 Sharp injuriesSharp injuries 0.5-1%0.5-1%

Health care workers (OccupationalHealth care workers (Occupational
exposure)exposure)
 Needle stick injuriesNeedle stick injuries
 Disposable needlesDisposable needles
 Donot recapDonot recap
 Universal precautionsUniversal precautions

Structure of HIVStructure of HIV

 GenesGenes functionfunction
 gaggag p24p24
 envenv gp160gp160
 polpol p31, p51, p66p31, p51, p66

PathogenesisPathogenesis

Clinical featuresClinical features
 Symptoms are due to failure of immuneSymptoms are due to failure of immune
responseresponse
 AIDS patient dies not due to AIDS but dueAIDS patient dies not due to AIDS but due
to oppurtunistic infections andto oppurtunistic infections and
malignanciesmalignancies

Acute HIV infection (0-3 weeks)Acute HIV infection (0-3 weeks)
 FeverFever
 MalaiseMalaise
 HeadacheHeadache
 LymphadenopthyLymphadenopthy

 HIV p24 antigen – POSITIVEHIV p24 antigen – POSITIVE
 HIV antibodies - NegativeHIV antibodies - Negative

Asymptomatic/Clinically latentAsymptomatic/Clinically latent
stagestage
 Around 10 yearsAround 10 years
 HIV antibodies keep virus under checkHIV antibodies keep virus under check
 CD4 cell count is >200CD4 cell count is >200
 p24 antigen – Negativep24 antigen – Negative
 HIV antibodies - PositiveHIV antibodies - Positive

AIDSAIDS
 Irreversible break down of immune systemIrreversible break down of immune system
 CD4 cell count <200CD4 cell count <200
 p24 - positivep24 - positive
 Antibodies - positiveAntibodies - positive

 Presents with one or more of the followingPresents with one or more of the following
infections / malignanciesinfections / malignancies
 Respiratory systemRespiratory system
 TuberculosisTuberculosis
 P. carinii pneumoniaP. carinii pneumonia
 GITGIT
 CysypotsporoidosisCysypotsporoidosis
 ThrushThrush
 Herpetic stomatitisHerpetic stomatitis
 CNSCNS
 ToxoplasmosisToxoplasmosis
 CryptococcosisCryptococcosis
 MalignanciesMalignancies
 Kaposci’s sarcomaKaposci’s sarcoma
 DementiaDementia

AIDS related complex (ARC)AIDS related complex (ARC)
 Weight loss of >10% of body weightWeight loss of >10% of body weight
 Generalised lymphadenopathy andGeneralised lymphadenopathy and
splenomegalysplenomegaly

Lab diagnosisLab diagnosis
 Antigen detectionAntigen detection
 As early as 2-3 weeks following infectionAs early as 2-3 weeks following infection
 For testing needle stick injury patientsFor testing needle stick injury patients
 For testing blood donorsFor testing blood donors
 Can be done by ELISA, PCRCan be done by ELISA, PCR

 Antibody detectionAntibody detection
 At around 6 weeksAt around 6 weeks
 Highly infectious in window periodHighly infectious in window period
 Cannot be used for blood donor screeningCannot be used for blood donor screening
 Screening test – ELISA (antibody detection)Screening test – ELISA (antibody detection)
 Confirmatory test – western blot (antigenConfirmatory test – western blot (antigen
isolation)isolation)

Why no vaccineWhy no vaccine
 Diverse antigenic types and subtypesDiverse antigenic types and subtypes
 Long latencyLong latency
 Persistence in infected cells as provirusesPersistence in infected cells as proviruses

Structure of HIVStructure of HIV

PreventionPrevention
 Health educationHealth education
 Identification of sourcesIdentification of sources
 Elimination of high risk activitiesElimination of high risk activities

TreatmentTreatment
 Treatment should be started on anyTreatment should be started on any
symptoms with CD4 count <350symptoms with CD4 count <350
cells/mm3cells/mm3
 Anti retroviral drugsAnti retroviral drugs
 ZidovudineZidovudine
 LamivudineLamivudine
 NevirapineNevirapine
 EfavirenzEfavirenz

POLIO VIRUSPOLIO VIRUS

POLIO VIRUSPOLIO VIRUS
 Polio – grayPolio – gray
 Myelitis – inflammation of spinal cordMyelitis – inflammation of spinal cord

 Gray matter – motor neuronsGray matter – motor neurons
 White matter – sensory neuronsWhite matter – sensory neurons
 Polio affects gray motor neurons – causesPolio affects gray motor neurons – causes
paralysisparalysis

 Exclusively human diseaseExclusively human disease
 Symptomless carrier shed virus in fecesSymptomless carrier shed virus in feces
 Spreads via contaminated food and waterSpreads via contaminated food and water
 Infection is asymptomaticInfection is asymptomatic
 Patient presents with paralysisPatient presents with paralysis

 Earliest – fever, headache, sore throat –Earliest – fever, headache, sore throat –
abortive poliomyelitisabortive poliomyelitis
 Later – biphasic fever, stiff neck – nonLater – biphasic fever, stiff neck – non
paralytic poliomyelitisparalytic poliomyelitis
 Still later – paralysis – paralyticStill later – paralysis – paralytic
poliomyelitispoliomyelitis

 Sample – blood, CSFSample – blood, CSF
 Isolation of polio virus in cell cultureIsolation of polio virus in cell culture

Serological testsSerological tests
 Demonstration of four fold rise in antibodyDemonstration of four fold rise in antibody
titre is diagnostictitre is diagnostic

ProphylaxisProphylaxis
 VaccineVaccine

OPVOPV IPVIPV
 Attenuated virusAttenuated virus
 OralOral
 CheaperCheaper
 Herd immunityHerd immunity
 Long lasting immunityLong lasting immunity
 Stops epidemicStops epidemic
 Easy to implementEasy to implement
 Killed virusKilled virus
 InjectableInjectable
 ExpensiveExpensive
 No herd immunityNo herd immunity
 Short lastingShort lasting
 Doesn’t stopDoesn’t stop
 Not easy toNot easy to
implementimplement

 India overcame huge challenges, with a strongIndia overcame huge challenges, with a strong
commitment that matched $ 2 billion allocation over thecommitment that matched $ 2 billion allocation over the
years to stop polio. Implementing innovative strategies,years to stop polio. Implementing innovative strategies,
the programme reaches an incredible 99 per centthe programme reaches an incredible 99 per cent
coverage in polio campaigns, ensuring every child, evencoverage in polio campaigns, ensuring every child, even
in the remotest corner of the country is protected againstin the remotest corner of the country is protected against
polio. polio.
 India introduced the oral polio vaccine in 1985 in theIndia introduced the oral polio vaccine in 1985 in the
Universal Immunisation Programme in the backdrop ofUniversal Immunisation Programme in the backdrop of
over 200,000 cases of polio annually (as per estimatesover 200,000 cases of polio annually (as per estimates
of the Indian Academy of Pediatrics). In 1995, the firstof the Indian Academy of Pediatrics). In 1995, the first
national polio immunization campaign was held; sincenational polio immunization campaign was held; since
then two national and multiple sub-national campaignsthen two national and multiple sub-national campaigns
are rolled out every year for children up to 5 years ofare rolled out every year for children up to 5 years of
age.age.
 In each national polio campaign, 2.3 million lakhIn each national polio campaign, 2.3 million lakh
vaccinators, led by 155,000 upervisors, visit 209 millionvaccinators, led by 155,000 upervisors, visit 209 million
households to immunize 170 million children up to thehouseholds to immunize 170 million children up to the
age of 5 years. age of 5 years.

 To immunize children on the move, transit vaccinatorsTo immunize children on the move, transit vaccinators
are positioned at bus stands, train stations, on trains,are positioned at bus stands, train stations, on trains,
market places and important road intersections. Nearlymarket places and important road intersections. Nearly
10 million children are immunized by the transit teams in10 million children are immunized by the transit teams in
each polio campaign, of them 100,000 on trains.each polio campaign, of them 100,000 on trains.
 Focusing on the migrant population, the people on theFocusing on the migrant population, the people on the
move in search of livelihood who miss poliomove in search of livelihood who miss polio
immunization in view of their transient nature, theimmunization in view of their transient nature, the
programme covers 70,000 brick kilns and 38,000programme covers 70,000 brick kilns and 38,000
construction sites. Nearly 4.5 million children areconstruction sites. Nearly 4.5 million children are
immunized in the high-risk migrant settlements in eachimmunized in the high-risk migrant settlements in each
polio campaign.polio campaign.
 Since the start of the polio campaigns in 1995, as manySince the start of the polio campaigns in 1995, as many
as 131 polio campaigns have been held in India till date,as 131 polio campaigns have been held in India till date,
in which 12.1 billion doses of polio vaccines have beenin which 12.1 billion doses of polio vaccines have been
administered.administered.

RABIES VIRUSRABIES VIRUS

RabiesRabies
 Derived from sanskrit –Derived from sanskrit – rabhasrabhas - mad- mad

Pasteur and MeisterPasteur and Meister

 Virus is present in all terrestrial animalsVirus is present in all terrestrial animals
 India – 30,000 death due to rabies / yearIndia – 30,000 death due to rabies / year
 Can be prevented by simple vaccination ofCan be prevented by simple vaccination of
humanshumans
 Dog/cat/bat population in India is non vaccinatedDog/cat/bat population in India is non vaccinated
 Rabies has been eliminated from Britain andRabies has been eliminated from Britain and
Japan by strict vaccination and quarantineJapan by strict vaccination and quarantine

 Acute encephalitisAcute encephalitis
 HydrophobiaHydrophobia
 Generalised convulsionsGeneralised convulsions
 Death due to respiratory arrestDeath due to respiratory arrest

 Ante mortemAnte mortem
 Biopsy from cornea/skin (face)Biopsy from cornea/skin (face)
 salivasaliva
 Post mortemPost mortem
 Brain biopsyBrain biopsy

Ante mortemAnte mortem
 Demonstration of rabies virus byDemonstration of rabies virus by
immunofluorescenceimmunofluorescence

Post mortemPost mortem
 Brain biopsy – negri bodies inBrain biopsy – negri bodies in
hippocampus and cerebellumhippocampus and cerebellum

ProphylaxisProphylaxis
 Pre exposure prophylaxisPre exposure prophylaxis
 Three doses on days 0,7,21 or 0,28,56Three doses on days 0,7,21 or 0,28,56
 Booster after 1 year and then every 5 yearsBooster after 1 year and then every 5 years
 Post exposure prophylaxis (humans)Post exposure prophylaxis (humans)
 Wound cleaned with soap and waterWound cleaned with soap and water
 Apply betadine, savlon, 70% alcoholApply betadine, savlon, 70% alcohol
 Donot sutureDonot suture
 Administer TTAdminister TT
 Give anti rabies immunoglobulin – both locally intoGive anti rabies immunoglobulin – both locally into
wound and systemicallywound and systemically
 Anti rabies vaccineAnti rabies vaccine

Anti rabies vaccineAnti rabies vaccine
 Neural vaccine – out dated – no longerNeural vaccine – out dated – no longer
used – epileptogenicused – epileptogenic
 Non neural (cell culture vacccines) –Non neural (cell culture vacccines) –
routinely usedroutinely used

Vaccination scheduleVaccination schedule
 Five to six dosesFive to six doses
 Days 0,3,7,14,30 and optionally 90Days 0,3,7,14,30 and optionally 90
 Gives protection for 5 yearsGives protection for 5 years
 Given in deltoid regionGiven in deltoid region

TreatmentTreatment
 Rabies is fatalRabies is fatal
 No treatment availableNo treatment available

HIV, Polio and Rabies Viruses Explained

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