This document provides information on HIV/AIDS including: - HIV causes AIDS by destroying CD4+ immune cells. It emerged in the 1930s from a virus in apes. - HIV is treated through antiretroviral therapy which has transformed AIDS into a chronic disease. However, developing an effective vaccine remains a challenge. - HIV transmission occurs sexually, through blood, and from mother to child. It disproportionately affects sex workers, men who have sex with men, injecting drug users, and those in developing countries.

1. HIV AND HPV

2. HIV/AIDS
• AIDS: acquired
immunodeficiency syndrome
• Syndrome: a collection of
symptoms
• Opportunistic infections
• caused by HIV (HIV-1):
human immunodeficiency
virus
• HIV causes AIDS by directly
causing the death of CD4+ Tcells (immune cells that fight
infections) or interfering with
the cells' normal functions, and
by triggering other events that
deteriorate a person's immune
system (Ois)

3. AIDS considered an “emerging disease”
• HIV mutated in 1930s from a form exclusive to apes to
one that could live in humans.
• Such diseases that move from one species to another are
known as zoonoses.
Ebola and tuberculosis are both examples of other zoonoses.
Where did HIV come from?
• http://youtu.be/UF3JGrt9Zvo

4. HIV/AIDS
• HIV is a virus
• All viruses unable to multiply outside a host cell, and therefore, are classified
as intracellular, obligate parasites
• Most often causes some type of cell damage or death
• Many viruses exist within host at a low enough level that the host is not aware of this
• Since viruses‟ survival depends entirely on host, most viruses tend to cause
mild infections
• Death in host = death of virus
• this is not the usual mode of action for most viruses because their existence would
cease to be
• Exceptions human immunodeficiency virus, ebola virus, pandemic influenza
• HIV is lentivirus, a class of retroviruses
• Unlike other retroviruses, which typically bud from infected cell for a long period
of time, HIV can lyze cell or lie dormant for many years, especially in resting T4
(CD4) lymphocytes;
• while HIV may disappear from cells of circulation, viral replication and budding
continues to occur in other tissues.
• recrudescence of viral production occurs that ultimately destroys the cell.

5. Short hx
• AIDS 1st described in 1981 by physicians in U.S.- saw
healthy patients become sickly and develop opportunistic
infections and cancers
• described AIDS in the medical literature.
• Public health officials (PHOs) started with this information
and amassed additional data about the patients, hoping to
identify a cause for the new disease.
• By mid-1982, epidemiologists had data demonstrating that
AIDS was transmissible. A virus was suspect.
• 1983, a candidate retrovirus isolated and in 1984, it was
demonstrated to be causative pathogen.
• This retrovirus destroyed helper T-cells, the master cells of the body‟s
immune response.

6. 1984-95
• Intensive research period to learn how
HIV worked
• HIV found to mutate 1,000 times faster than
influenza virus, thus dashing hopes for
making a traditional vaccine
• Antiviral drugs tested; AZT rapidly approved
as 1st anti-AIDS drug1987
• Public fear of AIDS and hostility towards
people with AIDS reached their zenith
• PHOs had to deal with epidemic of fear as
well as biological epidemic.
• 1988-95
• Congress increased funding for AIDS
research across U.S.
• Surgeon General C. Everett Koop mailed a
brochure, “Understanding AIDS,” to every
household in the U.S. so that citizens would
know facts about AIDS instead of believing
rumors.
• World Health Organization‟s AIDS
Programme began functioning

7. 1995-2006
• With introduction of first protease inhibitor drug in
1995, Highly Active Anti-Retroviral Therapy
(HAART) transformed AIDS into a chronic
disease.
• epidemiological focus of epidemic shifted to
developing countries and marginalized
populations in U.S.
• 2006, universal screening guidelines for HIV
infection aimed to make AIDS a routinely reported
disease in U.S.
• 2013 UN agency reports „dramatic‟ progress on
reducing new HIV infections

8. 8
HIV/AIDS Key driver of change in public
health
• Enormous impact because
• no biological control mechanism
• enormous cost
• many are vulnerable
• Effect on other infectious disease programs
• TB surveillance and control programs were successful public health
interventions, until HIV/AIDS epidemic reversed this achievement
• rise in active cases
• Effect on maternal child health programs and reproductive
health programs
• Changes to program planning and infrastructure due to:
• use of antiretroviral drugs for treatment
• prophylactic treatment for exposed babies
• breast feeding

9. HIV/AIDS epidemiology
• 2.3 million adults and children newly
infected with HIV in 2012,
• represents 33 % reduction in annual new
cases compared to 2001.
• new HIV infections among children fell 52 %
to 260,000 in 2012.
• greater access to antiretroviral TX led to a
30 per cent drop in AIDS-related deaths from
the peak in 2005.
• In the U.S., deaths typically through
Pneumocystis carinii
• In other parts of the world, it is TB
• > 90% of new HIV infections are in
developing countries.
• In Africa (mostly sub Saharan), > 24 million
people with HIV infection and about 1 million
new cases of AIDS per year
• .

10. HIV/AIDS epidemiology
• Of adult infections, 40% are in
women and 15% in individuals of
15-25 years of age.
• Perinatal infection resulting in a
large # of children being born with
HIV.
• 30-50% of mother to child
transmissions of HIV results from
breast feeding and about a ¼ of
babies born to HIV-infected mothers
are themselves infected.
• Reduced through HAART
Figure 1. Prenatal Antiretroviral
Therapy and Impact on
Perinatal HIV Transmission

12. HIV Transmission
• Sexual Transmission
• Blood Transmission
• Mother to Child

13. HIV/AIDS Risk Groups
• Paid/commercial sex workers (CSWs)
• Men who have sex with men (MSM)
• Injecting drug users (IDUs)
• Prisoners
• Any sexually active person who does not assume she/he is at
risk and take preventive measures
• Women
• HIV/AIDS Mother-to-child transmission
• Risk of
•
•
•
•
acquiring HIV during delivery without intervention: 15% to 30%
HIV transmission during delivery if the mother is taking ARVs: <2%
acquiring HIV from breastfeeding without intervention: 25% to 45%
HIV transmission during breastfeeding if the mother is taking ARVs: much
lower

14. Testing for HIV
• Antibody tests: Once infected, takes 3-6 months
for enough antibodies to be formed for screening
tests to be positive
• If test negative, person should be retested in 6 months
• ELISA (also called EIA)
• Western blot or indirect immunofluorescence assay
(IFA).
• Rapid assessment tests
• PCR tests.
• Once positive additional tests may be done for
• CD4 count. Important because healthy person's CD4
count can vary from 500 to more than 1,000. Even if a
person has no symptoms, HIV infection progresses to
AIDS when CD4 count becomes < 200.
• Viral load. measures amount of virus in blood; people
with higher viral loads generally fare more poorly than
do those with a lower viral load.
• Drug resistance. determines whether strain of HIV will
be resistant to certain anti-HIV medications and which
ones work better

15. The Course of the disease
From HIV Infection to AIDS
Acute infection (acute retroviral
syndrome)
• Initially, HIV infection produces a
mild disease
• . This is not seen in all patients.
• In period immediately after
infection, virus titer rises (about 4 to
11 days after infection) and
continues at a high level over a
period of a few weeks.
• Mononucleosis-like symptoms
(fever, rash, swollen lymph glands
but none of these are lifethreatening.
•
may mimic the flu
• result is an initial fall in the number
of CD4+ cells but the numbers
quickly return to near normal.

16. The Course of the disease
From HIV Infection to AIDS
• No other symptoms may occur until enough CD4 cells
have been destroyed by HIV
• With loss of CD4 cells, the immune system cannot protect
• When CD4 count reaches 200 – person considered to have AIDS
• Without therapy, time from infection to AIDS = approximately 8-10
years
• Despite possible co-factors associated with lifestyle, HIV infected
persons progress to AIDS at a remarkably similar rate
• Antiretroviral therapy can prolong this time span
• Some people naturally have not progressed from HIV
infection to AIDS
• Referred to as long-term nonprogressors

17. Preventive interventions for HIV/AIDS
• Safe sex, including condom use
• Unused needles for drug users
• Male circumcision
• Treatment of other sexually transmitted infections (STIs)
• Safe, screened blood supplies
• Antiretrovirals (ARVs) in pregnancy to prevent mother-to-
child transmission (MTCT) and after occupational
exposure

18. Treatment Interventions for HIV/AIDS
• Antitretroviral drugs (ARVs)
• Highly active antiretroviral therapy (HAART): combination of
antiretroviral drugs that are used as medications to control
retroviruses
• Extend years between infection and onset of clinical AIDS
• Extend years between onset of AIDS and death
• works against HIV by using drugs in combination to suppress HIV replication
as many times as possible.
• problems for HIV replication, keeps HIV offspring low, and reduces the possibility of
HIV mutating.
• must be used in combination to suppress HIV for long periods of time
• Treatment of opportunistic infections (OIs)
• Palliative care (pain management)

19. High Costs of HIV Medication Cause
'Terrible Dilemma' in Mozambique
• http://www.youtube.com/watch?v=sETtnySexxy
• 10:30
• In Mozambique, where 1 in 8 adults is living with HIV, the
number of patients on antiretroviral drugs has expanded
thanks to international AIDS funding, but a debate is
emerging over whether foreign donors can continue to
fund an ever-expanding pool of patients.

20. Role of Advocacy and Activism
• International response to epidemic
• U.S. PEPFAR program
• Global Fund to treat AIDS, TB, and Malaria
• Bill and Melinda Gates Foundation
• World Bank
20

21. HIV/AIDS Critical Challenges
• Developing a vaccine to prevent the 2.6 million new
infections per year
• Cost-effective approaches to prevention in different
settings
• Universal treatment for all those who are eligible
• Management of TB and HIV coinfection