AIDS

AIDS
CHANDA MALVIYA
M. PHARMA, PHARMACOLOGY
VNS COLLEGE OF PHARMACY

OUTLINES
• INTRODUCTION
• KEY POINTS
• VIRAL STRUCTURE
• CYCLE OF HIV
• PHASES OF HIV INFECTION
• TRANSMISSION
• SYMPTOMS
• COMPLICATION
• PREVENTION
• DIAGNOSIS
• TREATMENT
• ALTERNATIVE MEDICATION
• REFERENCE
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KEY POINTS
• After a global epidermic that began in the 1980s, numbers of HIV diagnoses have
fallen over the last 15 years
• HIV infects the body’s immune system and progressively impairs it’s function
• Nowadays, the term AIDS is rarely used, this phase is now called advanced HIV
infection
• HIV is transmitted when certain body fluids come into contact with the mucous
membrane, damaged tissue or the bloodstream
• People with an undetectable viral load who are taking medication can not sexually
transmit the virus
(By Wilkins T 2020)
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INTRODUCTION
• Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life threatening
condition caused by the human immunodeficiency virus (HIV).
• By damaging immune system, HIV interfere with your body’s ability to fight infection and
disease. (By Mayo foundation 2021)
• HIV targets and destroyed essential components of the human immune system. (By Wilkins T 2020)
• It is belongs to a genus of virus called lentiviruses, which cause chronic disease in human.
• Untreated HIV affects and kills CD4 cells, which are type of immune T cell.
• Healthy adults generally have a CD4 count of 500 - 1,600/cubic mm. A person with HIV
whose CD4 count falls below 200/cubic mm. (By Joseph Vinetz 2020)
• In 1986 the global spread of HIV was coined an epidermic, with over 4000,000 cases
reported by WHO. (By Wilkins T 2020)
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VIRAL STRUCTURE
• It’s contains RNA genetic material in a single strands.
• RNA is protected by protein coat called a capsid.
• Outside the capsid are enzyme the virus uses to infect its host and replicate.
• These structures are surrounded by an envelope comprising glycoprotein, which help the
virus identify and binds to it’s target.
Fig. 1 HIV Virus (By Wilkins T 2020)
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CYCLE OF HIV
1. Binding and entry : the virus seeks out the CD4 cell and attaches itself to receptors on
the cell’s outer membrane, it then fuses itself to the cell and releases viral RNA and
enzymes into it.
2. Reverse transcription : the virus converts its single-stranded viral RNA into double-
stranded DNA using an enzyme called reverse transcriptase.
3. Integration : the virus integrates its newly created viral DNA into the CD4 cell’s nucleus
using an enzyme called integrase, by integrating its genetic instructions, it
commandeers the CD4 cell.
4. Replication : the CD4 cell starts to build new copies of the virus, this process can
sometimes be clumsy, causing mutations and variations in the new virions.
5. Budding and maturation : the new HIV virions migrate towards the outer membrane
of the CD4 cell. An enzyme called protease helps convert the immature virions into
mature, infectious virions. They then push themselves out of the cell, which is called
budding, and seek out other CD4 cells to repeat the process. (By Wilkins T 2020)
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PHASES OF HIV INFECTION
• Acute phases : 1. It’s refers to immediate weeks after initial infection with HIV. During this
time, the virus rapidly multiplies and spread, attacking CD4 cells at a significant pace. The
level of HIV in the blood very high, which greatly increases the risk of transmission.
2. There is an initial drop in the no. of CD4 cells, associated with high level of circulating
virus. Ab to HIV are produced during the early weeks of infection, which typically creates flu
like symptoms.
• Chronic latent phase : 1. After initial infection, the body develops Ab to the HIV virus, this
slows the viral replication. The virus continue to multiply, but at a reduced pace. Patients
are usually asymptomatic during this phase but may experience minor symptoms at their
no. of CD4 cells continue to decline. (By Wilkins T 2020)
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Conti…
2. People on effective HIV treatment will often stay in this stage because the virus is
supressed by medication. Damage of CD4 cells is, therefore significantly reduced and their
total no. can recover. (By Wilkins T 2020)
• Advance HIV infection (AIDS) : Without treatment chronic infection usually progresses
to an advanced stage in an avg of 8-10 years, although this can vary depending on virus and
host factors. In the most advanced stage of infection the immune system is severely
damaged and unable to fight infections. People who have a CD4 cell count less than
200cells/mm3 or develop certain opportunistic infection or cancer are diagnosed with
advanced HIV infection. (By Wilkins T 2020)
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Conti…
• Fig. 2 Typical course of infection if untreated
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(Fig by HIV i Base 2016)
Fig. 2 Untreated condition, transmission of HIV

MODE OF TRANSMISSION
• Unprotected anal or vaginal intercourse
Example : semen, vaginal and rectal fluids
• Receiving a transfusion of infected blood
• Mother to child transmission through breastfeeding
• Sharing needles or syringes with someone who has HIV
• Does not spread via : Air, water, casual contact, sharing foods.
(By Wilkins T 2021)
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Complication
1. Pneumocystis Pneumonia : This fungal infection can cause severe illness. PCP is still the
most common cause of pneumonia in people infected with HIV.
2. Candidiasis(thrush) : common HIV related infection, causes inflammation, and a thick
white coating on mouth, tongue, esophagus or vagina.
3. Tuberculosis : most common cause associated with HIV leading cause of death among
people with AIDS.
4. Cytomegalovirus : common herpes virus is transmitted in body fluids such as saliva,
blood, urine, semen, and breast milk. If your immune system weaken, the virus causing
damage to your eyes, digestive tract, lungs or other organs.
5. Cryptococcal meningitis : common CNS infection associate with HIV caused by fungus
found in soil.
6. Toxoplasmosis : caused by Toxoplasma Gondii, parasite spread primarily by cats.
Infected cats pass the parasite in their stools and spread to animals or human causes
heart disease, seizures. (By Mayo Foundation 2021)
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PREVENTION
• There is no vaccine to prevent HIV infection and no cure for AIDS, but you can protect
yourself.
1. Use treatment as prevention : if you are living with HIV taking HIV medication can keep
your partner from becoming infected with the virus. Taking your medication exactly as
prescribed and getting regular checkup.
2. Use post exposure prophylaxis : if you have been exposed to HIV. (sexually or needles or
in the work place), contact to doctor as soon as possible take PEP treatment within 72
hrs can greatly reduce the risk becoming infected with HIV. Need to take medication for
28 days.
3. Use a new condom every time you have sex.
4. Use a clean needle : make sure it sterile don’t share it.
5. If you are pregnant : you can pass infection to your baby. But you receive treatment
during pregnancy, significantly cut your baby’s risk. (By Mayo Foundation 2021)
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DIAGNOSIS
• Ag/Ab test : involves drawing blood from a vein. Ag substances presents on HIV and
produced by the immune system when it exposed to HIV. It can take weeks to months for
Ab to become detectable. Combination of Ag or Ab tests can takes 2 to 6 weeks after
exposure to become positive.
• Ab test : looks for Ab to HIV in blood or saliva. Ab test can take 3 to 12 weeks after
exposed to become positive.
• Nucleic acid test (NAT’s) : looks for the actual virus in your blood (viral load).
• ELISA test : detects HIV Ab
After detecting HIV :
• CD4 Count : if your CD4 white T cell dips below 200, results positive.
• Viral load : measures amt of virus in blood. (By Mayo foundation 2021)
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TREATMENT
• These medication are called Anti- Retroviral Therapy.
• Classes :
1. Non- nucleoside reverse transcriptase inhibitor (NNRTI’s) : Turn off a protein needed by
HIV to make copies of itself. eg: Nevirapine, Efavirenz(sustiva), Delavirdine
2. Nucleoside or nucleotide reverse transcriptase inhibitors (NRTI’s) : Faulty version of
building blocks that HIV needs to make copies of itself. eg: Abacavir(ziagen), tenofovir
(viread), emtricitabine(emtriva), lamivudine(epivir) and zidovudine(Retrovir)
Combination drugs : emtricitabine/tenofovir(Truvada) and
emtricitabine/tenofovir/alafenamide(Descovy)
3. Protease inhibitors (PI’s) : Inactivate HIV protease, another protein that HIV needs to
make copies of itself. eg: Atazanavir(reyataz), darunavir(prezista) and
lopinavir/ritonavir(kaletra)
(By kd Tripathi 2013 or Mayo Foundation 2021)
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Conti…
4. Integrase inhibitors : Work by disabling a protein called integrase, which HIV uses to
insert it’s genetic material into CD4 cells. eg: Raltegravir
5. Entry or fusion inhibitors : Block HIV’s entry into CD4 cells. eg : Enfuvirtide(fuzeon),
6. Chemokine receptor 5 inhibitor (CCR 5) : Prevent entry of virus. eg : maraviroc
(selzentry)
(By kd Tripathi 2013 or Mayo foundation 2021)
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TREATMENT SIDE EFFECTS
1. Nausea, vomiting or diarrhoea {Protease inhibitors}
2. Heart disease
3. liver damage {NRTI’S, NNRTI’S, PI’S}
4. Weakened bones or bone loss {TENOFOVIR (VIREAD)}
5. Higher blood sugar {PI’S, NRTI’S}
6. Abnormal cholesterol levels {PI’S, NNRTI’S, NRTI’S}
(By Mayo Foundation)
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ALTERNATIVE MEDICINES
• Dietary supplements that claim to boost the immune system or counteract side effects of
anti- HIV drugs.
1. Whey protein and certain AA : early evidence suggests that whey protein, a cheese by
product, can help some people with HIV gain weight. It’s reduce diarrhoea and increase
CD4 T-cell counts. eg : amino acid L- glutamine and hydroxymethylbutyrate(HMB)
2. Probiotic : saccharomyces boulardii may help with HIV related diarrhoea, but use only as
directed by doctor.
3. Vitamin and minerals : vitamins A, D, E, C and B as well as minerals like zinc, iron and
selenium, help if you have low levels of them.
(By Mayo Foundation 2021)
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REFERENCE
• Wilkins T (2020) HIV1: epidemiology, pathophysiology and transmission. Nursing
times 116: 7, 39-41.
• By Joseph Vinetz, MD- written by Ann Pietrangelo, November 6, 2020.
• Mayo Foundation for Medical Education and Research, 1998-2021.
• Tripathi kd, Essential of Medical Pharmacology, Seventh edition, Jaypee Brother
Medical Publisher (P) LTD , 2013, New delhi.
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