HIV/AIDS

It's a retrovirus of the lentivirus group. It is the causative agent of AIDS. The genome of retroviruses is
made up of RNA, and each virus has two single strands of RNA.

History of HIV
Aids was first recognised as a disease syndrome in 1981 and HIV was identified as its cause in 1984.

Structure of HIV v

Like other viruses, HIV does not have a cell wall or a nucleus. The basic structure of the virus is as
follows:
1. Viral envelope It is the outer court of the virus consisting of two layers of lipids. Different
proteins are embedded in the viral envelope forming spikes consisting of the outer glycoprotein
(gp120) which is needed to attach to the host cell (docking glycoprotein). It also consists of a
tranmembrane protein (gp41) which is critical for the cell fusion process.
2. HIV matrix proteins It consists of the p17 protein. It lies between the envelope and the core.

3. Vial core/capsid It contains the viral protein p24 which surrounds to single strands of HIV
RNA and the enzymes needed for HIV replication i.e. Reverse transcriptase, protease, integrase

Life cycle of HIV

The main target of the HIV virus is the cd4 lymphocyte (T-cell or cd4 cell). This is because HIV has
proteins on its envelope that are strongly attracted to the cd4 surface receptor on the outside of the 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 down into the following steps.
1. Binding and fusion This the process by which HIV binds to a specific type of cd4 receptor on
the surface of the cd4 cell. This similar to a key entering a lock. Once unlocked, HIV can fuse
with host cell and release its genetic material into the cell.
2. Reverse transcription HIV genes are carried in two strands of RNA while the genetic material
of human cells is found in DNA. In order for the virus to infect the cell a process called reverse
transcription makes a DNA copy of the virus RNA through the use of an enzyme called reverse
transcriptase.
3. Integration The HIV DNA is then carried to the cells nucleus where the cell DNA is kept. A
viral enzyme called integrase is used to integrate the virus genetic material into the cell's genetic
material. When the cell tries to make new proteins it can accidentally make new HIVs.
4. Transcription Once HIVs genetic material is inside the cell's nucleus, it directs the cell to
produce new HIV. The strands of viral DNA in the nucleus separate and host cell enzymes

create a complementary strand to the genetic material called mRNA.

5. Translation The mRNA carries instructions for making new viral proteins from the nucleus to
a kind of workshop in a cell. Each section of the viral mRNA corresponds to a protein building
block for making a part of HIV. As each mRNA strand is processed a corresponding stream of
proteins is made.
6. Viral assembly Finally, a new virus is assembled. Long strings of proteins are cut up by a viral
enzyme called protease into smaller proteins. The proteins serve a variety of functions. Some
become structural elements of new HIV while others become enzymes. Once the new viral
particles are assembled, they bud of the host cell and create a new virus. The virus is then able
to infect new cells. Each infected cell can produce a large number of new viruses.

Transmission of HIV
HIV enters the body through open cuts, sores or breaks in the skin; through mucus membranes or
through direct injection. There are two main ways through which HIV spreads:
1. Sexual intercourse with an infected partner
2. Using recreational drugs intravenously with a syringe that has been used by someone carrying
the virus.
Other less common methods of transmission include:
1. Blood transfusion
2. Mother to child transmission
3. Infection in the health care setting

Disease progression
1. Acute infection stage. Within 2-4 weeks after HIV infection, people develop flu like symptoms.
These include: fever, swollen glands, sore throat, rush, muscle and joint pains, fatigue and
headache. This stage is also called acute retroviral syndrome (ARS) or primary HIV infection.
2. Clinical latency stage During this stage, people who are infected with HIV experience no HIV
related symptoms or only mild ones. This stage is also called asymptomatic HIV infection or
chronic HIV infection. The HIV virus continues to reproduce at very low levels. Although it is
still active. If on anti-retroviral therapy, one may live on clinical latency for several decades.
People in this symptom-free stage are still able to transmit HIV to others.
3. AIDS (Acquired Immune Deficiency Syndrome) This is the stage of HIV infection that occurs
when the immune system is badly damaged and one becomes vulnerable to infections called
opportunistic infections. One is considered to have progressed to AIDS when the number of cd4
cells falls below 200 cell/mm3 of blood and when one develops one or more opportunistic
illnesses regardless of the cd4 count. The symptoms at this stage include:

 Being very tired

fever and night sweats
dry cough
diarrhoea, vomiting and nausea
short term memory loss
quick weight loss
mouth, genital or anal sores
rash on the skin
Opportunistic illnesses
These take advantage of the opportunity offered by a weakened immune system. They include:
1. Bacterial diseases such as TB and pneumonia
2. Fungal diseases such as candidiasis
3. Viral diseases such as herpes simplex and herpes zooster
4. HIV associated malignancies e.g Kaposis sarcoma

Diagnosis
Window period Antibody tests may give false negative results during the window period (3 weeks 6
months) between the time of HIV infection and production of measurable antibodies to HIV.
Diagnostic tests detect HIV antibodies in serum. They include

ELISA (Enzyme Linked Immunosorbent Acid)

Western blot

Rapid antibody tests

Treatment
Anti-retroviral drugs are medications for the treatment of infection by retroviruses primarily HIV. Such
drugs are taken in combination (typically 3 or 4) the approach is known as highly active anti-retroviral
therapy (HAART). Anti-retroviral drugs are broadly classified by the phase of the retrovirus life cycle
that the drug inhibits.
1. Nucleoside and nucleotide reverse transcriptase inhibitors(NNRTI) They inhibit reverse
transcription by being incorporated into the newly synthesised viral DNA and preventing its
further elongation e.g. zidovudine (AZT)

2. Non-nucleoside nucleotide reverse transcriptase inhibitors (NNRTI) They inhibit reverse

transcriptase directly by binding to the enzyme and interfering with its function e.g Nevirapine.
3. Protease inhibitors They target viral assembly by inhibiting the activity of protease e.g
ritonavir.

Prevention
Abstinence
Be faithful
Christ centred lives