HUMAN IMMUNODEFICIENCY VIRUS (H.I.V.

INTRODUCTION:

The origin of the Human Immunodifiency Virus (HIV) has been a subject of scientific
research and debate since the virus was identified in the 1980s. Thee is now a wealth of
evidence on how, when and where HIV first began to cause illness in humans.
It is widely believed that HIV originated in Kinshasa, in the Democratic Republic of Congo
around 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, we
do not know how many people were infected with HIV or developed AIDS
Cases of AIDS were documented prior to 1970, available data suggests that the current
epidemic started in the mid- to late 1970s. By 1980, HIV may have already spread to five
continents (North America, South America, Europe, Africa and Australia). In this period,
between 100,000 and 300,000 people could have already been infected.

DEFINITIONS:

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening

condition caused by the human immunodeficiency virus (HIV). By damaging the immune
system, HIV interferes with the body's ability to fight the organisms that cause
disease. HIV is a sexually transmitted infection (STI).

What is HIV?

The human immunodeficiency virus (HIV) infects cells of the immune system, destroying
or impairing their function. Infection with the virus results in progressive deterioration of
the immune system, leading to "immune deficiency." The immune system is considered
deficient when it can no longer fulfil its role of fighting infection and disease. Infections
associated with severe immunodeficiency are known as "opportunistic infections", because
they take advantage of a weakened immune system.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is a term which applies to the most

advanced stages of HIV infection. It is defined by the occurrence of any of more than 20
opportunistic infections or HIV-related cancers.
AIDS (acquired immunodeficiency syndrome) is a syndrome caused by a virus called HIV
(human immunodeficiency virus). The disease alters the immune system, making people
much more vulnerable to infections and diseases. This susceptibility worsens if the syndrome
progresses.
STRUCTURE OF H.I.V.:

INCIDENCE

 Males are more affected than females

 Occurs in all ages and ethnic groups.
 All areas of the country are affected
 AIDS is now the second leading causes of death for all men aged 25 – 44 years.

INDIA
WORLD

MODES OF TRANSMISSION

H.I.V. AGENT

 It is a RNA virus
 Which replicates in actively dividing T4 lymphocytes
 Unique ability to destroy T4 helper cells

RESERVIOR SOURCE – Once a person gets infected virus remains in his body lifelong and
the person is symptomless carrier for years before the symptoms appear.
SOURCE – the virus is found in great concentrations in blood, CSF and skin.
However only blood and semen are know to transmit the virus.

H.I.V. IN BODY FLUIDS

HIV has been identified in various body fluids but it is especially highly concentrated in
blood, sexual fluids (semen and vaginal fluids), and in breast milk. Although HIV is present
in saliva, tears, sweat and urine, the concentration of the virus in these fluids is very low, and
transmission is unlikely.
HOST

Age –Most cases are among sexually active people between age 20 – 49 years.
High risk groups – heterosexual partners, I.V. drug abusers, blood transfusion recipients,
hemophiliacs and patients having STDs.

H.I.V. TRANSMISSION

H.I.V. enters the blood stream through :

 Open cuts
 Breaks in the skin
 Mucous membranes
 Direct injection

ROUTES OF TRANSMISSION

 Sexual contact
o Male to female or vice versa
 Blood exposure
o Injecting drugs use / needle sharing
o Occupational exposure
o Transfusion of blood products
 Perinatal
o Transmission from mothers to baby
o Breastfeeding
 Occupational transmission
o Health care worker/hospital staff
o Laboratory workers
 Others routes
o Organ transplantation
o Artificial insemination
o Needle prick

INCUBATION PERIOD
 The incubation period is from HIV infection till development of AIDS.
 It is from few months to 10 years or even more.
 However it is estimated that 75% of infected people with HIV will develop AIDS at the
10 years.

CAUSES

I. Initial infection
II. Asymptomatic carrier state
 III. AIDS related Complex (ARC)
IV. AIDS

 INITIAL INFECTION

Early HIV infection can cause a range of symptoms, which can be very similar to the flu
or others common viral illnesses. These symptoms are sometimes called
SEROCONVERSION illness, or acute retroviral syndrome.Usually within the first four
weeks of initial exposure to the virus: fever, rash, headache, feeling generally unwell,
aches and pains, mouth ulcers, sore throat, night sweats, weight loss, tiredness,
swollen glands, and neurological symptoms like meningitis.

 ASYMPTOMATIC CARRIER STATE

An asymptomatic carrier (healthy carrier or just carrier) is a person or others

organism that has become infected with HIV, but who display no signs nor symptoms
except persistent generalized lymphadenopathy.
It is however not clear about how long does the asymptomatic stage lasts.

 AIDS RELATED COMPLEX (ARC)

A prodromal phase of infection with the human immunodeficiency virus (HIV).

Laboratory criteria separating AIDS-related complex(ARC) from AIDS include elevated
or hyperactive B-cell humoral immune responses, compared to depressed or normal
antibody reactivity in AIDS; follicular or mixed hyperplasia in ARC lymph nodes,
leading to lymphocyte degeneration and depletion more typical of AIDS; evolving
succession of histopathological lesions such as localization of Kaposi's sarcoma, signaling
the transition to the full-blown AIDS.

COMMON MANIFESTATION OF AIDS

 LUNG INFECTION
P.carinii pneumonia
  GASTRO INTESTINAL INFECTION
Candidiasis of mouth or esophagus
 SKIN INFECTION
Kaposi’s sarcoma – red or violent macules or papules
 CENTRAL NERVOUS SYSTEM INFECTION
Toxoplasmosis
Dementia
Meningitis
Primary CNS lymphomas ,Progressive multifocal leucoencephalopathy.

PATHOPHYSIOLOGY

PREVENTION

 PRIMARY The goal of primary prevention is to provide information and education

regarding transmission of HIV for the general population. Target populations for primary
prevention are: the general public, health care workers, sex educators and mental
health professionals, individuals at high risk for contracting HIV and sexual
partners or needle sharing partners of individuals who are at high risk.
 SECONDARY Secondary prevention is concerned with individuals who are ready
positive for HIV antibodies. They may possibly be symptomatic for ARC or AIDS. The
goal is to prevent them from being repeatedly exposed to HIV and from transmitting HIV.

 TERTIARY Tertiary prevention is concerned with preventing as many of the disabling

aspects of AIDS as possible. Called the "Living with AIDS Model," the intent is to
maximize the living potential of the person with AIDS, ARC or HIV infection. One
person with AIDS explained: "You're only dying the final week of the life. Until then
you're living with AIDS." Such an attitude helps prevent and manage some of the
hopelessness and others transitional affective responses for the person who is ill.

DIAGNOSIS

HIV is most commonly diagnosed by testing the blood or saliva for antibodies to the virus.
Unfortunately, it takes time for the body to develop these antibodies — usually up to 12
weeks.

Tests to stage disease and treatment

 CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and
destroyed by HIV. Even if the have no symptoms, HIV infection progresses to AIDS
when the CD4 T cell count dips below 200.(500 to 1400 normal)
 Drug resistance. Some strains of HIV are resistant to medications. specific form of the
virus has resistance
 ELISA Test — ELISA, which stands for enzyme-linked immunosorbent assay, is used to
detect HIV infection. If an ELISA test is positive, the Western blot test is usually
administered to confirm the diagnosis. If an ELISA test is negative, but the think the may
have HIV, the should be tested again in one to three months.
ELISA is quite sensitive in chronic HIV infection, but because antibodies aren't produced
immediately upon infection, the may test negative during a window of a few weeks to a
few months after being infected
 Saliva Tests — A cotton pad is used to obtain saliva from the inside of the cheek. The
pad is placed in a vial and submitted to a laboratory for testing. Results are available in
three days. Positive results should be confirmed with a blood test.
 Viral Load Test — This test measures the amount of HIV in the blood. Generally, it's
used to monitor treatment progress or detect early HIV infection. Three technologies
measure HIV viral load in the blood — Reverse Transcription Polymerase Chain
Reaction (RT-PCR), Branched DNA (bDNA) and Nucleic Acid Sequence-Based
Amplification Assay (NASBA). The basic principles of these tests are similar. HIV is
detected using DNA sequences that bind specifically to those in the virus. It is important
to note that results may vary between tests.
MANAGEMENT

There is no cure for HIV/AIDS, but many different drugs are available to control the virus.
Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in
different ways. The classes of anti-HIV drugs include:

 Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein

needed by HIV to make copies of itself. Examples include efavirenz (Sustiva),
etravirine (Intelence) and nevirapine (Viramune).
 Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty
versions of the building blocks that HIV needs to make copies of itself. Examples
include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir
(Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-
zidovudine (Combivir).
 Protease inhibitors (PIs) inactivate HIV protease, anothers protein that HIV
needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir
(Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).
 Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples
include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
 Integrase inhibitors work by disabling a protein called integrase, which HIV uses
to insert its genetic material into CD4 T cells. Examples include raltegravir
(Isentress) and dolutegravir (Tivicay).
SYMPTOMS

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

Most people infected by HIV develop a flu-like illness within a month or two after the virus
enters the body. This illness, known as primary or acute HIV infection, may last for a few
weeks. Signs and symptoms include:

 Fever
 Headache
 Muscle aches and joint pain
 Rash
 Sore throat and painful mouth sores
 Swollen lymph glands, mainly on the neck
These symptoms can be so mild that might not even notice them. However, the amount of
virus in the bloodstream (viral load) is quite high at this time. As a result, the infection
spreads more easily during primary infection than during the next stage.
Clinical latent infection (Chronic HIV)

In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there
are no specific signs and symptoms. HIV remains in the body and in infected white blood
cells.

This stage of HIV infection generally lasts around 10 years if not receiving antiretroviral
therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop
more severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy immune cells — the cells in body that help
fight off germs — may develop mild infections or chronic signs and symptoms such as:

 Fever
 Fatigue
 Swollen lymph nodes — often one of the first signs of HIV infection
 Diarrhea
 Weight loss
 Oral yeast infection (thrush)
 Shingles (herpes zoster) – a painful acute inflammation of the nerve ganglia , with a
skin eruption often forming a girdle around the middle of the body.
Progression to AIDS

Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop
AIDS. Untreated, HIV typically turns into AIDS in about 10 years.

The signs and symptoms of some of these infections may include:

 Soaking night sweats

 Recurring fever
 Chronic diarrhea
 Persistent white spots or unusual lesions on the tongue or in the mouth
 Persistent, unexplained fatigue
 Weight loss
 Skin rashes or bumps
RISK FACTORS

Anyone of any age, race, sex or sexual orientation can be infected. However, they are at
greatest risk of HIV/AIDS if they:
  Have unprotected sex. Use a new latex or polyurethane condom every time
have sex. Anal sex is more risky than is vaginal sex. Risk of HIV increases if
have multiple sexual partners.
 Have an STI. Many STIs produce open sores on genitals. These sores act as
doorways for HIV to enter body.
 Use intravenous drugs. People who use intravenous drugs often share needles
and syringes. This exposes them to droplets of others people's blood.
 Are an uncircumcised man. Studies suggest that lack of circumcision increases
the risk of heterosexual transmission of HIV.
CAUSES

HIV is caused by a virus. It can spread through sexual contact or blood, or from mothers to
child during pregnancy, childbirth or breast-feeding.

How HIV spreads?

To become infected with HIV, infected blood, semen or vaginal secretions must enter body.
This can happen in several ways:

 By having sex. May become infected if have vaginal, anal or oral sex with an
infected partner whose blood, semen or vaginal secretions enter the body. The virus
can enter the body through mouth sores or small tears that sometimes develop in the
rectum or vagina during sexual activity.
 From blood transfusions. The virus may be transmitted through blood transfusions.
 By sharing needles. Sharing contaminated intravenous drug paraphernalia (needles
and syringes) puts at high risk of HIV and other infectious diseases, such as hepatitis.
 During pregnancy or delivery or through breast-feeding. Infected mother can
pass the virus on to their babies. HIV-positive mother who get treatment for the
infection during pregnancy can significantly lower the risk to their babies.
COMPLICATIONS

HIV infection weakens the immune system, making the much more likely to develop
numerous infections and certain types of cancers.

Infections common to HIV/AIDS

 Tuberculosis (TB). In resource-limited nations, TB is the most common

opportunistic infection associated with HIV. It's a leading cause of death among
people with AIDS.
 Cytomegalovirus. This common herpes virus is transmitted in body fluids such as
saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the
 virus, and it remains dormant in the body. If the immune system weakens, the virus
resurfaces — causing damage to the eyes, digestive tract, lungs or other organs.
 Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation
and a thick, white coating on the mucous membranes of the mouth, tongue,
esophagus or vagina.
 Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid
surrounding the brain and spinal cord (meninges). Cryptococcal meningitis is a
common central nervous system infection associated with HIV, caused by a fungus
found in soil.
 Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a
parasite spread primarily by cats. Infected cats pass the parasites in their stools,
which may then spread to others animals and humans. Seizures occur when it spreads
to the brain.
 Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly
found in animals. The get it when eat or drink contaminated food or water. The
parasite grows in the intestines and bile ducts, leading to severe, chronic diarrhea in
people with AIDS.
Cancers common to HIV/AIDS

 Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people
not infected with HIV, but common in HIV-positive people. It usually appears as
pink, red or purple lesions on the skin and mouth. In people with darker skin, the
lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal
organs, including the digestive tract and lungs.
 Lymphoma. This cancer starts in the white blood cells. The most common early sign
is painless swelling of the lymph nodes in the neck, armpit or groin.
Others complications

 Wasting syndrome. Aggressive treatment approaches have reduced the number of

cases of wasting syndrome, but it still affects many people with AIDS. It's defined as
a loss of at least 10 percent of body weight, often accompanied by diarrhea, chronic
weakness and fever.
 Neurological complications. Although AIDS doesn't appear to infect the nerve cells,
it can cause neurological symptoms such as confusion, forgetfulness, depression,
anxiety and difficulty walking. One of the most common neurological complications
is AIDS dementia complex, which leads to behavioral changes and reduced mental
functioning.
 Kidney disease. HIV-associated nephropathy (HIV-AN) is an inflammation of the
tiny filters in the kidneys that remove excess fluid and wastes from the blood and
pass them to the urine. It most often affects blacks or Hispanics. Anyone with this
complication should be started on antiretroviral therapy.
PREVENTION

There is no vaccine to prevent HIV infection and no cure for AIDS. But we can protect
ourselves and others from infection.

To help prevent the spread of HIV:

 Use a new condom every time the have sex. Use a new condom every time have
anal or vaginal sex. Women can use a female condom. If using lubricant, make sure
it's water-based. Oil-based lubricants can weaken condoms and cause them to break.
 Consider the drug Truvada. The drug emtricitabine-tenofovir (Truvada) can reduce
the risk of sexually transmitted HIV infection in people at very high risk
 Tell the sexual partners if have HIV. It's important to tell all current and past
sexual partners that you are HIV-positive. They'll need to be tested.
 Use a clean needle. If use a needle to inject drugs, make sure it's sterile and don't
share it.
 If pregnant, get medical care right away. If HIV-positive, may pass the infection
to the baby. But if receive treatment during pregnancy, can cut the baby's risk
significantly.
 Consider male circumcision. The evidence that male circumcision can help reduce
a man's risk of getting HIV infection.
SELF CARE

Along with receiving medical treatment, it's essential to take an active role in the own care.
The following suggestions may help the stay healthy longer:

 Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help
keep the strong, give the more energy and support the immune system.
 Avoid raw meat, eggs and more. Food borne illnesses can be especially severe in
people who are infected with HIV. Cook meat until it's well-done. Avoid
unpasteurized dairy products, raw eggs and raw seafood
 Get the right immunizations. These may prevent infections such as pneumonia and
the flu. Make sure the vaccines don't contain live viruses, which can be dangerous for
people with weakened immune systems.
 Take care with companion animals. Some animals may carry parasites that can
cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis,
reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis.
Wash hands thoroughly after handling pets or emptying the litter box.
SUMMARY

AIDS stands for acquired immunodeficiency syndrome. It is the final stage of infection
with HIV. Not everyone with HIV develops AIDS. It may also spread by sharing drug
needles or through contact with the blood of an infected person.

CONCLUSION

Unprotected sex with an HIV-positive individual does not inevitably lead to HIV
transmission. HIV exposure is also extremely unlikely when there is not enough infectious
virus in sexual fluids due to successful antiretroviral treatment. Neither are spitting, biting
and throwing body fluids significant risks of HIV exposure.

HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the
Simian Immunodeficiency Virus (SIV) attacks the immune systems of monkeys and apes.

Research found that HIV is related to SIV and there are many similarities between the two
viruses. HIV-1 is closely related to a strain of SIV found in chimpanzees, and HIV-2 is
closely related to a strain of SIV found in sooty mangabeys.

There are two types of HIV: HIV-1 and HIV-2.

HIV-1 is more virulent, is more easily transmitted and is the cause of the vast majority of
HIV infections globally. The pandemic strain of HIV-1 is closely related to a virus found
in chimpanzees of the subspecies Pan troglodytes troglodytes, which live in the forests of the
Central African nations of Cameroon, Equatorial Guinea, Gabon, Republic of Congo (or
Congo-Brazzaville), and Central African Republic.
HIV-2 is less transmittable and is largely confined to West Africa, along with its closest
relative, a virus of the sooty mangabey(Cercocebus atys atys), an Old World monkey
inhabiting southern Senegal, Guinea-Bissau, Guinea, Sierra Leone, Liberia, and
western Ivory Coast