HIV/AIDS

SZL 2111
 HOW DOES YOUR IMMUNE SYSTEM WORK?
• Your immune system works because your
body is able to recognize "self" and "non-
self."
• This means that your body is able to tell if
an invader (virus, bacteria, parasite, or
other another person's tissues) has
entered it—even if you aren't consciously
aware that anything has happened.
• Your body recognizes this invader and uses
a number of different tactics to destroy it.
 Lymph nodes
• Lymph nodes (also called "lymph glands"): These small,
bean-shaped structures are part of your lymphatic
system.
• That system is made up of tissues and organs (bone
marrow, spleen, thymus, and lymph nodes) that produce
and store cells that fight infection and disease, along
with the clear fluid, lymph, that carries those cells to
different parts of the body.
• Lymph nodes filter the lymphatic fluid and store special
cells that can trap cancer cells or bacteria that are
traveling through your body in the lymph fluid.
• Lymph nodes are critical for your body's immune
response and many of your immune reactions begin
there. When you have an infection, your lymph nodes
can get larger and feel tender or sore.
 Thymus:
• A small organ located just behind your breastbone. This
is where your T-cells mature (That's why they are called
T-cells. The "T" is for "thymus.")
Spleen:
• The largest lymphatic organ in the body—it's about the
size of your fist.
• Your spleen is located in the upper-left part of your
abdomen.
• It contains white blood cells that fight infection or
disease.
• Your spleen also helps control the amount of blood in
your body and destroys old and damaged blood cells.
 Bone Marrow:
• The yellow tissue in the center of your bones
that is responsible for making white blood cells
that are destined to become lymphocytes.
Lymphocytes:
• A small white blood cell that plays a large role
in defending the body against disease. There
are two main types of lymphocytes: B-cells and
T-cells.
• B-cells make antibodies that attack bacteria
and toxins. T-cells help destroy infected or
cancerous cells attack body cells themselves
when they have been taken over by viruses or
have become cancerous.
 THE IMMUNE SYSTEM IN ACTION
• Your immune system has many different ways of
fighting off foreign invaders. When confronted with
a virus, your body responds by activating specific
processes of the immune system.
• First your body recognizes a foreign antigen and
delivers it to the lymph system, where it is ingested
by a macrophage.
• Then the macrophage processes the virus and
displays the antigens for that particular virus on its
own exterior. This antigen then signals a helper T-
cell.
• Next the T-cell reads this signal and sounds the
alarm for other parts of your immune system to
respond.
• The B-cell responds to this call and comes
to read the antigen from the surface of the
macrophage.
• The B cell then becomes activated and
produces millions of antibodies that are
specific to the antigen. These antibodies
are released into your body to attach to
the virus particles.
• These antibodies are important because
the invading virus may outnumber your
own immune system cells. The antibodies
attach to the antigens and hold on tight.
• These antibodies then send a signal to
other macrophages and other immune
cells to come and engulf and destroy the
antibody and whatever it has captured.
• The final stage of your immune response
involves the suppressor T-cell. Once the
number of invaders has dropped
significantly and the infection has resolved,
the suppressor T-cell will signal the other
cells of the immune system to rest.
• This is important as prolonged activation
of your immune response could eventually
lead to damage to your healthy cells.
 HOW HIV AFFECTS THIS COMPLEX PROCESS
• HIV disrupts this process by directly
infecting the helper T-cells.
• Your initial immune response does get rid
of a great deal of HIV, but some of it
manages to survive and infect these
important cells.
• Once the infected helper T-cells are
activated, they work to create new
viruses instead of doing the job they are
supposed to do in your immune system.
• In addition, many helper T-cells are
destroyed in the HIV replication process.
 HIV LIFECYCLE
WHAT HIV DOES IN YOUR BODY
• When you are infected with HIV, there are multiple
things happening in your immune system at the cellular
level.
Transmission
• When HIV enters your body through sexual contact,
transfusions with infected blood, or by injection with a
needle that has infected blood in or on it, researchers
believe that the virus attaches to a specific type
of immune system cell called a dendritic cell.
• These cells are found in mucocutaneous (mucosal
membranes) areas that line the mouth, the vagina,
rectum, penis, and the upper gastrointestinal tract.
• Scientists think that these dendritic cells transport the
virus from the site of the infection to your lymph nodes
where HIV can infect other immune system cells.
 HIV Structure
• HIV is a spherical ribonucleic acid (RNA) virus particle with a
diameter of 80–100 nanometers (nm).
• The particle has an outer double lipid layer derived from the host
cell membrane.
• Within the lipid layer is the surface glycoprotein (Glycoprotein -
gp120) and the trans-membrane protein (gp41), which mediate
the entry of the virus into the host cell.
• The core (capsid) is made of several proteins: p24 (the main
protein), p17, p9, and p7. Within this capsid are two single strands
of identical
pieces of RNA, which are the genetic material of the virus (virion).
• The virion contains a number of enzymes, the most important of
which are reverse transcriptase (RT), protease, and integrase.
• Reverse transcriptase converts viral single-strand RNA into double-
strand deoxyribonucleic acid (DNA), which is then easily
incorporated into host cells as proviral DNA.
• Integrase enables integration of the newly formed double-strand
DNA into the host chromosomal DNA. Proteases split the
generated proteins so that they can be incorporated into the new
virions.
 THE LIFE-CYCLE OF HIV IN YOUR CELLS
• HIV can infect multiple cells in your body, including brain
cells, but its main target is the CD4 lymphocyte, also
called a T-cell or CD4 cell. When a CD4 cell is infected
with HIV, the virus goes through multiple steps to
reproduce itself and create many more virus particles.
• The process is broken up into the following steps:
 Binding and Fusion: This is the process by which HIV
binds to a specific type of CD4 receptor and a co-
receptor on the surface of the CD4 cell. This is similar
to a key entering a lock. Once unlocked, HIV can fuse
with the host cell (CD4 cell) and release its genetic
material into the cell.
 Reverse Transcription: A special enzyme called reverse
transcriptase changes the genetic material of the
virus, so it can be integrated into the host DNA.
 Integration: The virus’ new genetic material enters the nucleus of
the CD4 cell and uses an enzyme called integrase to integrate itself
into your own genetic material, where it may “hide” and stay
inactive for several years.
 Transcription: When the host cell becomes activated, and the
virus uses your own enzymes to create more of its genetic
material—along with a more specialized genetic material which
allows it make longer proteins.
 Assembly: A special enzyme called protease cuts the longer
HIV proteins into individual proteins. When these come together
with the virus’ genetic material, a new virus has been assembled.
 Budding: This is the final stage of the virus’ life cycle. In this stage,
the virus pushes itself out of the host cell, taking with it part of
the membrane of the cell. This outer part covers the virus and
contains all of the structures necessary to bind to a new CD4 cell
and receptors and begin the process again.

These steps of the life-cycle of HIV are important to know

because the medications used to control HIV infection act to
interrupt this replication cycle.
 Mechanism for Decline in CD4 Count
Several mechanisms are involved in causing the decline in CD4 count.
These include:
• CD4 T-cell depletion through single-cell killing caused by
accumulation of HIV DNA in the cell or by inhibition of cell
function.
• Cell membranes of infected cells fusing with cell membranes of
uninfected cells (syncitium induction), resulting in giant multi-
nucleated cells that are readily destroyed by the immune system.
• Programmed death (apoptosis) also contributes to T-cell
depletion. It is postulated that cross-linking of the CD4 molecule
with gp120-anti-gp120 antibody complexes programmes the cell
for death without direct infection of the cell with HIV.
• HIV infection induces neutralizing antibodies against regions of the
HIV envelope; these antibodies may play a role in mediating
antibody-dependent cellular toxicity after binding to natural killer
(cell killing) cells.
• HIV specific cytotoxic T-cells (CD8 cells) also play a role in killing
HIV-infected cells.
These events contribute to depletion of CD4 cells and deteriorating
immune function.
 Summary
• The HIV virus attacks the immune
system (the immune system contains a
body’s natural ability to fight infection).
• The virus attacks certain cells — called
cd4 cells — in the immune system that
help the body fight disease.
• The virus does not prefer certain types
of people; anyone can get HIV if he or
she is exposed to it.
•
 How does HIV affect the body?
• Since the HIV virus affects CD4 cells, the body
is unable to fight off diseases as it normally
would, and a person gets sick.
• HIV-positive people get infections that people
with strong immune systems do not usually
get.
• In some instances, HIV-positive people may get
the same infections as those with healthy
immune systems, but HIV-positive people will
become sicker or become sick more often.
• There is no cure for HIV. Once a person has HIV
he or she will always have it, despite
treatment.
•
 How do we measure sickness in someone with HIV?
• Counting CD4 cells is one way to measure how sick a person with
HIV is.
• The fewer the number of cd4 cells, the sicker the person.
• A viral load test measures the amount of virus in a person’s blood.
• We can also evaluate how many opportunistic infections the
patient has.
Opportunistic Infections
• Opportunistic infections (OIs) affect people with HIV depending on
how well each of their immune systems is functioning.
• OIs do not usually affect people with strong immune systems.
What is aids?
• A person has aids when the HIV virus has severely damaged his or
her immune system and the person can no longer fight infections.
• Aids progresses from HIV. A person has aids when either:
He or she displays certain illnesses (“aids-defining illnesses”).
His or her cd4 count is fewer than 200 cells per ml 3 of blood.
HOW DO YOU GET HIV OR AIDS?
 HOW DO YOU GET HIV?
Certain body fluids from an HIV-infected
person can transmit HIV.
These body fluids are:
• Blood
• Semen (cum)
• Pre-seminal fluid (pre-cum)
• Rectal fluids
• Vaginal fluids
• Breast milk
• These body fluids must come into
contact with a mucous membrane or
damaged tissue or be directly injected
into your bloodstream (by a needle or
syringe) for transmission to possibly
occur.
• Mucous membranes are the soft,
moist areas just inside the openings to
your body.
• They can be found inside the rectum,
the vagina or the opening of the penis,
and the mouth.
HIV is spread mainly by:
• Having sex with someone who has HIV.
In general:
 Anal sex (penis in the anus of a man or woman) is
the highest-risk sexual behavior.
 Receptive anal sex (“bottoming”) is riskier than
insertive anal sex (“topping”).
 Vaginal sex (penis in the vagina) is the second
highest-risk sexual behavior.
 Having multiple sex partners or having sexually
transmitted infections can increase the risk of HIV
infection through sex.
• Sharing needles, syringes, rinse water, or other
equipment (“works”) used to prepare injection
drugs with someone who has HIV.
Less commonly, HIV may be spread by:
• Being born to an infected mother. HIV can be passed from
mother to child during pregnancy, birth, or breastfeeding.
• Being stuck with an HIV-contaminated needle or other sharp
object. This is a risk mainly for health care workers.
• Receiving blood transfusions, blood products, or organ/tissue
transplants that are contaminated with HIV. This risk is
extremely small because of rigorous testing of the US blood
supply and donated organs and tissues.
• Eating food that has been pre-chewed by an HIV-infected
person. The contamination occurs when infected blood from a
caregiver’s mouth mixes with food while chewing, and is very
rare.
• Being bitten by a person with HIV. Each of the very small
number of documented cases has involved severe trauma with
extensive tissue damage and the presence of blood. There is no
risk of transmission if the skin is not broken.
• Oral sex—using the mouth to stimulate
the penis, vagina, or anus
• Contact between broken skin, wounds,
or mucous membranes and HIV-
infected blood or blood-contaminated
body fluids. These reports have also
been extremely rare.
• Deep, open-mouth kissing if the person
with HIV has sores or bleeding gums
and blood is exchanged. HIV is not
spread through saliva. Transmission
through kissing alone is extremely rare.
HIV is NOT spread by:
• Air or water
• Insects, including mosquitoes or ticks
• Saliva, tears, or sweat
• Casual contact, like shaking hands, hugging
or sharing dishes/drinking glasses
• Drinking fountains
• Toilet seats
• HIV is not spread through the air and it
does not live long outside the human
body.
• Having an undetectable viral load greatly lowers the chance
that a person living with HIV can transmit the virus to a
partner, but there is still some risk. “Viral load” refers to the
amount of HIV in an infected person’s blood. An
“undetectable viral load” is when the amount of HIV in a
person’s blood is so low that it can’t be
measured. antiretroviral therapy (ART) reduces a person’s
viral load, ideally to an undetectable level, when taken
consistently and correctly. However, a person with HIV can
still potentially transmit HIV to a partner even if they have an
undetectable viral load, because:
• HIV may still be found in a person’s genital fluids (e.g.,
semen, vaginal fluids). The viral load test only measures virus
in a person’s blood.
• A person’s viral load may go up between tests. When this
happens, they may be more likely to transmit HIV to
partners.
• Sexually transmitted diseases (STDs) increase viral load in a
person’s genital fluids.