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DR MD TIPU SULTAN Associate Professor Department of Microbiology Chittagong Medical College
DR
MD
TIPU
SULTAN
Associate Professor
Department of Microbiology
Chittagong
Medical College

HIV/AIDS

1

HIV H uman I mmunodeficiency V irus H = Infects only H uman beings I
HIV
H
uman
I
mmunodeficiency
V
irus
H
=
Infects
only
H
uman
beings
I
=
I
mmunodeficiency
virus
weakens
the
immune system
and
increases
the
risk
of
infection
V
=
Virus that attacks
the
body
2
AIDS A cquired I mmune D eficiency S yndrome A = Acquired, not inherited I
AIDS
A
cquired
I
mmune
D
eficiency
S
yndrome
A
=
Acquired,
not
inherited
I
=
Weakens
the
I
mmune
system
D
=
Creates
a
D
eficiency
of
CD4+
cells in the immune
system
S
=
Syndrome,
or
a
group
of
illnesses
taking place at the same time
3
of CD4+ cells in the immune system S = Syndrome, or a group of illnesses taking
HIV and AIDS • When the immune becomes weakened by illness progresses to • Some
HIV
and
AIDS
When
the
immune
becomes
weakened
by
illness
progresses
to
Some blood tests,
certain infections

system

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to
to

progression of HIV

the or
the
or
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
4
4
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,

HIV,

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,

AIDS

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,

symptoms

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,

indicate

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,

AIDS

to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
to • Some blood tests, certain infections system to progression of HIV the or 4 HIV,
“ The greatest single health challenge humanity has ever Dr. Robert Lue, Harvard
The
greatest
single
health
challenge
humanity
has
ever
Dr. Robert Lue,
Harvard

public

that

faced.”

University

5

HIV/AIDS Historical Perspective 1979  CDC reported unexplained PCP in 5 previously healthy, homosexual men
HIV/AIDS
Historical
Perspective
1979
CDC
reported
unexplained
PCP
in
5
previously healthy,
homosexual
men
CDC
reported
Kaposi’s
sarcoma
in
26
homosexual
men
Initially,then
the
disease
was
named
as
GRID
(Gay
related
immune deficiency)
1981-
AIDS was
recognized
as
separate
disease
1981-1982
 Increased association with IV drug use,
recipients of
blood transfusions, hemophiliacs
6
 Increased association with IV drug use, recipients of blood transfusions, hemophiliacs 6 previously healthy,

previously healthy,

HIV/AIDS Historical Perspective 1983  Virus isolated.Then it was 1 st named as LAV(Lymphadenopathy
HIV/AIDS
Historical
Perspective
1983
Virus
isolated.Then
it
was
1
st
named
as
LAV(Lymphadenopathy
associated
virus)
1984
Virus was
named
as
HTLV-III
(Human
T-cell
Lymphotrophic Virus)
1985
Virus was named as
ARV
(AIDS
related
Virus)
1986
 Virus was named as HIV by the International
committee on the taxonomy of viruses
7
(AIDS related Virus) 1986  Virus was named as HIV by the International committee on the
HIV/AIDS Historical Perspective 1985  ELISA test developed Today:  Broad spectrum of disease 
HIV/AIDS
Historical
Perspective
1985
ELISA
test
developed
Today:
Broad
spectrum
of
disease
Asymptomatic
infection
Clinical latency
Advanced disease
(AIDS)
Clearly sexually transmitted, and
transmitted through blood products
8
latency  Advanced disease (AIDS)  Clearly sexually transmitted, and transmitted through blood products 8
In Bangladesh, HIV cases was 1 st detected 1989 in Chittagong
In
Bangladesh,
HIV
cases was
1
st
detected
1989 in
Chittagong

positive

in

9

Global summary of the HIV and AIDS Number of people living Total 39.4 million Adults
Global
summary
of
the
HIV
and
AIDS
Number
of
people
living
Total
39.4
million
Adults
37.2
million
with
HIV
Women
17.6
million
(16.3 – 19.5
Children
under
15
years
2.2
People
newly
infected
Total
4.9
million (4.3 –
Adults
4.3
with
HIV
Children
under
15
years
640
000
AIDS
deaths
Total
3.1
million
Adults
2.6
million
Children
under
15
years
510
000
The
ranges
around
the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.
00003-E-1 –
December 2004
10
available information. 00003-E-1 – December 2004 10 epidemic ( 3 5 . 9 – 44.3 million)
available information. 00003-E-1 – December 2004 10 epidemic ( 3 5 . 9 – 44.3 million)

epidemic

(35.9 44.3 million)

(33.8 41.7 million)

million)

million (2.0 2.6 million)

6.4 million)

million (3.7 5.7 million)

(570 000 750 000)

(2.8 3.5 million) (2.3 2.9 million)

(460 000 600 000)

HIV/AIDS BANGLADESH SITUATION, END 2012 Total HIV-positive people - 238 4 People living with AIDS
HIV/AIDS
BANGLADESH
SITUATION,
END
2012
Total
HIV-positive
people
-
238
4
People
living
with
AIDS
-
676
Deaths
due
to
AIDS
-
263
Sources:DGHS,
MOH&FW,
December
1,
2012.
WHO:
Estimated to have 13,000 to 21,000 people
are likely to be infected with
HIV.
11
Prevalence Among Population in • The highest prevalence • Street and Hotel based • Brothel
Prevalence
Among
Population
in
The
highest
prevalence
Street
and
Hotel
based
Brothel based CSWs–
MSMs – 0.2%
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to
Hotel based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to

High

based • Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7%
Risk among 0.2% each. to 0.7%
Risk
among
0.2% each.
to
0.7%
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
12
12

IDUs 4%.

Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs

Bangladesh

Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs

is

Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs

CSWs–

Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs

0.2%

Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Brothel based CSWs– • MSMs – 0.2% High Risk among 0.2% each. to 0.7% 12 IDUs
Important Bangladesh was the first among the SAARC Countries to take the threat of HIV
Important
Bangladesh
was
the
first
among
the
SAARC
Countries
to
take
the
threat
of
HIV
epidemic
seriously
&
initiated
a
national
response
in
1985.
According
to
WHO,
Bangladesh
is
one
of
the
fortunate 111 countries
where
the
infection
rate
has
not
yet reached 1
adult
/
1000
.
13
Retrovirus
Retrovirus
Retrovirus RNA virus Enveloped Reverse transcriptase enzyme HIV, HTLV 14

RNA virus Enveloped Reverse transcriptase enzyme HIV, HTLV

14

Unique Characteristics of Retroviruses Enveloped and encloses a capsid containing two copies of RNA genome.
Unique
Characteristics
of
Retroviruses
Enveloped
and
encloses
a
capsid
containing
two copies
of
RNA
genome.
RNA-dependent
DNA
polymerase
(reverse
transcriptase)
and
integrase
enzymes
are
carried
in
the
virion.
Replication
proceeds
through
a
DNA
intermediate,
termed
the
provirus
.
The
provirus
integrates
randomly
into
the
host
chromosome and
becomes
a
cellular
gene.
Simple
retroviruses encode
gag,
pol,
and
env
Complex
viruses also encode
accessory
genes
genes.
(e.g., tat,
rev,
nef,
vif,
vpu for HIV).
Virus
assembles
and buds from the plasma membrane.
Final morphogenesis of HIV requires protease cleavage
of gag and gag-pol polypeptides.
15
HIV Structure HIV is composed of three main layers:  Envelope  Viral Matrix 
HIV
Structure
HIV
is
composed of
three
main
layers:
Envelope
Viral
Matrix
Core
Image from
http://www.brown.edu/Courses/Bio_160/Projects1999/hiv/images/Virion2.jpg
16
 Viral Matrix  Core Image from http://www.brown.edu/Courses/Bio_160/Projects1999/hiv/images/Virion2.jpg 16
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17
17
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure
17 HIV structure

HIV structure

Types of HIV HIV 1 Subtypes- A to I and O  Subtype A &
Types
of
HIV
HIV
1
Subtypes-
A
to
I
and
O
Subtype
A
&
D
found
in
sub
Sahara
Africa
Subtype
B
found
in
US
&
Canada
Subtype
C
found
in
South
Africa
&
India
Subtype
E
– found
in
south
east
Asia
Subtype G &
H
-
found
in
Russia
&
Central Africa
Subtype I – found
in
Cyprus
HIV
2
18
 Subtype G & H - found in Russia & Central Africa  Subtype I –
HIV-1 • HIV-1 and • Transmitted • Associated infections  • HIV-1 is more common
HIV-1
HIV-1
and
Transmitted
Associated
infections
• HIV-1
is more common
and HIV-2 are through with similar
and
HIV-2
are
through
with
similar
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2
is more common and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2

HIV-2

and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
and HIV-2 are through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic
routes Mozambique,
routes
Mozambique,
19
19
through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found
through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found
through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found
through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found
through with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found

HIV-2

with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in
with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in
with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in
with similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in

the

same

similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West

opportunistic

similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West

worldwide

is found in West Africa,

similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West
similar  • HIV-2 routes Mozambique, 19 HIV-2 the same opportunistic worldwide is found in West

and Angola

HIV-1 and HIV-2 • HIV-2 is less easily transmitted • HIV-2 is less pathogenic •
HIV-1
and
HIV-2
HIV-2
is
less
easily
transmitted
HIV-2 is
less
pathogenic
Duration of HIV-2 infection
is shorter
20
HIV-2 is less easily transmitted • HIV-2 is less pathogenic • Duration of HIV-2 infection is
Important antigens: 1) Group-Specific Antigens p17: inner surface p24: nucleocapsid p9: nucleocapsid associated
Important
antigens:
1)
Group-Specific
Antigens
p17:
inner
surface
p24:
nucleocapsid
p9:
nucleocapsid associated with
RNA
GAG gene
21
2) Type -Specific envelope glycoprteins gp120 & gp41 ENV gene 22
2)
Type
-Specific
envelope
glycoprteins
gp120
&
gp41
ENV gene
22
3. Enzymes • Polymerase (reverse transcriptase) • Integrase • Protease • POL gene 23
3.
Enzymes
Polymerase
(reverse
transcriptase)
Integrase
Protease
• POL gene
23
Transmission of HIV
Transmission
of HIV

24

Transmission of HIV HIV is transmitted by • Direct contact with infected blood • Sexual
Transmission
of
HIV
HIV
is
transmitted
by
Direct
contact
with
infected
blood
Sexual
contact:
oral,
anal,
or
Direct contact
with
semen
or
vaginal
vaginal and
cervical secretions
HIV-infected mothers
to
infants
during
pregnancy, delivery,
or breastfeeding
25
and cervical secretions • HIV-infected mothers to infants during pregnancy, delivery, or breastfeeding 25
HIV enter the body via the bloodstream sexual intercourse needle drug abuse transfusion with or
HIV
enter
the
body
via
the
bloodstream
sexual
intercourse
needle
drug
abuse
transfusion
with
or via
the
placenta
During
sexual
intercourse,
HIV
1
infects
cells
in
the
epithelium and these
can
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
HIV 1 infects cells in the epithelium and these can into blood, the then On and
into blood, the
into blood,
the
cells in the epithelium and these can into blood, the then On and injection dendritic during
cells in the epithelium and these can into blood, the then On and injection dendritic during
cells in the epithelium and these can into blood, the then On and injection dendritic during
cells in the epithelium and these can into blood, the then On and injection dendritic during

then

in the epithelium and these can into blood, the then On and injection dendritic during blood

On

and

injection

dendritic

these can into blood, the then On and injection dendritic during blood products travel to is
these can into blood, the then On and injection dendritic during blood products travel to is
these can into blood, the then On and injection dendritic during blood products travel to is
these can into blood, the then On and injection dendritic during blood products travel to is
these can into blood, the then On and injection dendritic during blood products travel to is
during blood products travel to is likely to infect
during
blood
products
travel
to
is
likely
to infect
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
during blood products travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes.
26
26

Langerhans dendritic

travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus
travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus
travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus
travel to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus

either

to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other
to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other
to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other
to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other
to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other
to is likely to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other

contaminated

to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage

lymph nodes.

to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.

virus

of virus

to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.

other monocyte-macrophage lineage cells.

to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
to infect 26 Langerhans dendritic either contaminated lymph nodes. virus of virus other monocyte-macrophage lineage cells.
Blood Up to 10,000 infectious particles per ml Shared drug/drug-injecting equipment  needles, syringes
Blood
Up
to
10,000
infectious
particles
per
ml
Shared
drug/drug-injecting
equipment
needles,
syringes
Blood Up to 10,000 infectious particles per ml Shared drug/drug-injecting equipment  needles, syringes
Blood Transfusions  plasma, whole blood,  clotting factors (decreased
Blood
Transfusions
plasma,
whole
blood,
clotting
factors
(decreased

platelets

Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
1985)
1985)
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
28
28
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since

since

Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Blood Transfusions  plasma, whole blood,  clotting factors (decreased platelets 1985) 28 since
Sexual STD’s increase risk of  epidemiological trend  exposed to one, may  inflammation
Sexual
STD’s
increase
risk
of
epidemiological
trend
exposed
to
one,
may
inflammation
make
vulnerable to HIV
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
to one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean
exposed to others more
exposed
to others
more
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person

Contact

one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person

transmission

one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person

mean

one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person

person

one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person

invasion

one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
one, may  inflammation make vulnerable to HIV exposed to others more Contact transmission mean person
Sexual Intercourse (without  anal:  vaginal:  oral:
Sexual
Intercourse
(without
anal:
vaginal:
oral:
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)

Contact

Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)

barrier)

Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Intercourse (without  anal:  vaginal:  oral: Contact barrier)
Sexual Contact Semen: only 10-50 infectious virons per ml  artificial insemination a risk Vaginal/cervical
Sexual
Contact
Semen:
only
10-50
infectious
virons per
ml
artificial
insemination
a
risk
Vaginal/cervical secretions:
less
than 1
viron
per ml
virons per ml  artificial insemination a risk Vaginal/cervical secretions: less than 1 viron per ml
Perinatally In utero (maternal-fetal circulation)  HIV crosses the placenta During delivery Breast-feeding
Perinatally
In
utero
(maternal-fetal
circulation)
HIV
crosses
the
placenta
During
delivery
Breast-feeding
low
incidence
(maternal-fetal circulation)  HIV crosses the placenta During delivery Breast-feeding  low incidence
Risk Factors What you do not who you
Risk
Factors
What you do
not
who
you

are

33

High risk groups 1) homosexual/bisexual men 2) IV drug use/abuse 3) hemophiliacs 4) sex partners
High
risk
groups
1)
homosexual/bisexual
men
2)
IV drug
use/abuse
3)
hemophiliacs
4)
sex
partners
in
abuse
groups
5)
infants
of above
groups
34
men 2) IV drug use/abuse 3) hemophiliacs 4) sex partners in abuse groups 5) infants of
Transmission of HIV HIV is not transmitted by • • Public baths Coughing, sneezing •
Transmission
of
HIV
HIV
is
not
transmitted
by
Public
baths
Coughing,
sneezing
Handshakes
Insect bites
Work
or
school
contact
Touching, hugging
Using
telephones
Water, food
Sharing
cups,
glasses,
Kissing
plates,
or
other
utensils
35
• Using telephones • Water, food • Sharing cups, glasses, • Kissing plates, or other utensils
Important • HIV primarily infects cells macrophage lineage • Monocytes • Macrophages • Dendritic
Important
HIV
primarily
infects
cells
macrophage
lineage
Monocytes
Macrophages
Dendritic cells
Microglial cells (CNS)
properties: CD4 T CD4 (skin)
properties:
CD4
T
CD4
(skin)
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their

and

cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells of the on their surface
cells
of the
on
their surface
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
36
36
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their

proteins

cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
cells • Microglial cells (CNS) properties: CD4 T CD4 (skin) and cells of the on their
Which cells does HIV-1 infect? Identification of molecular targets. Lymphocytes Receptor: CD4 +, Coreceptor:
Which
cells
does
HIV-1
infect?
Identification
of
molecular
targets.
Lymphocytes
Receptor:
CD4
+,
Coreceptor:
CXCR4
Macrophages: Receptor:
CD4
+
Coreceptor: CCR5
Dendritic
cells (DC): DC recognized
by
gp120
on
HIV
DC:
primary
target of mucosal
infection!
DC
present
HIV antigen to resting lymphocytes
Microglial cells: Receptor: Galactosyl ceremide
37
mucosal infection! DC present HIV antigen to resting lymphocytes Microglial cells: Receptor: Galactosyl ceremide 37
Replication 38

Replication

38

HIV chemokine Mutant CD4 CCR5 CCR5 CD4 CCR5 CD4 macrophage Chemokine receptors are necessary co-receptors
HIV
chemokine
Mutant
CD4
CCR5
CCR5
CD4
CCR5
CD4
macrophage
Chemokine receptors are necessary co-receptors along with CD4
antigen
39
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40
40
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus

Provirus

40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
40 Provirus
41
41
41
41
41
41
41
41
41
41
41
41
41
41
Pathogenesis 42

Pathogenesis

42

43
43
43
43
43
43
43
Reduction in the numbers of CD4 T cells may HIV-infected cytolysis, cytotoxic T-cell immune result
Reduction
in
the
numbers
of
CD4
T
cells
may
HIV-infected
cytolysis,
cytotoxic
T-cell
immune
result from
cytolysis.
The
increased
release
of
virus
into
the
blood
as
the
numbers
of
CD4
cells
decrease
gives
development
of
symptoms.
Macrophages
may be spared
the
cytolytic
action of HIV because they
express
less
CD4 than T cells.
44
symptoms. Macrophages may be spared the cytolytic action of HIV because they express less CD4 than
Macrophage-lineage cells express both the CCR5 & CXCR4 chemokine receptors and can be infected by
Macrophage-lineage
cells
express
both
the
CCR5
&
CXCR4
chemokine
receptors
and
can
be
infected
by
M-&
L-tropic HIV.
The
virus
reaches
the
lymph
node
within
2
days
of
infection
and
there
the
CD4
T
cells
are
infected.
Macrophages
are
persistently
infected
with
HIV
and
are
probably
the
major
reservoirs.
Continuous
replication of the
virus
occurs
in
the
lymph
nodes, with
subsequent
release of the virus and
infected T cells into the blood
45
Pathogenesis(contd) The hallmark of pathogenesis is the profound immunodeficiency, primarily affecting CMI HIV
Pathogenesis(contd)
The
hallmark
of
pathogenesis
is
the
profound
immunodeficiency,
primarily
affecting
CMI
HIV
infect
any
cells
bearing
CD
4
receptor
-Severe depletion
of
CD4+
T-cell
-Impairment of
function
of
surviving
CD4+ T-cell
46
bearing CD 4 receptor -Severe depletion of CD4+ T-cell -Impairment of function of surviving CD4+ T-cell
Pathogenesis(contd) Monocyte/Macrophage abnormalities- Relatively resistant to cytolytic effect of HIV and the
Pathogenesis(contd)
Monocyte/Macrophage
abnormalities-
Relatively
resistant
to
cytolytic
effect
of HIV and
the
consequences
are
*Acts
as
reservoir
of
virus
*Transport
the
virus
to
different
part
of the body
B-cell
abnormalities-
Polyclonal activation
leads
to
hypergammaglobulinaemia
Unable to mount antibody response to a new antigen
due
to
lack of T cell help
47
Steps for pathogenesis of HIV : rapid early dissemination of virus seeding of virus in
Steps
for
pathogenesis
of
HIV
:
rapid
early
dissemination
of
virus
seeding
of
virus
in
lymphoid
tissue
partial
host
immune
responses
that
down-
regulates
viral
replication
sequestration
of
extracellular
virus
into
germinal center of
lymph
nodes
chronic activation
of
T
lymphocytes
and
secretion of immune
system
activating
cytokines
48
of lymph nodes chronic activation of T lymphocytes and secretion of immune system activating cytokines 48
Steps for pathogenesis of HIV :(cont.) destruction of lymphoid tissue escape of viral elements into
Steps
for
pathogenesis
of
HIV
:(cont.)
destruction
of
lymphoid
tissue
escape
of
viral
elements
into
peripheral
blood
cells
direct
killing
of
CD
cells
4
49
of lymphoid tissue escape of viral elements into peripheral blood cells direct killing of CD cells
Potential mechanism of CD4 T cell depletion/dysfunction Direct HIV mediated cytopathic effect HIV mediated
Potential
mechanism
of
CD4 T
cell
depletion/dysfunction
Direct
HIV
mediated
cytopathic
effect
HIV
mediated
formation
of
syncytia
Virus
specific
immune
response
Autoimmune
mechanism
Anergy-Inappropriate
cell
signaling
(gp120-CD4
interaction
Superantigen
Apoptosis
50
Autoimmune mechanism Anergy-Inappropriate cell signaling (gp120-CD4 interaction Superantigen Apoptosis 50
Three mechanisms by which HIV evades immune system 1. Integration of viral DNA into host
Three
mechanisms
by
which
HIV
evades
immune
system
1.
Integration
of
viral
DNA
into
host
cell
DNA
resulting
in
a
persistent
infection.
2.
A
high
rate
of
mutation
of
the
env
gene.
3.
Production of the Tat
and
Nef
proteins that
downregulate class I MHC proteins required for
cytotoxic
T cells to recognize and kill
HIV-infected cell
51
Progression the
Progression
the

Body

Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
HIV in
HIV
in
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
52
52
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936

of

Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Progression the Body HIV in 52 of Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936
Initially, large burst of virus viremia, which corresponds to of a mononucleosis-like
Initially,
large
burst
of
virus
viremia,
which
corresponds
to
of
a
mononucleosis-like
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
the occurrence
the
occurrence
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53

production &

syndrome.

of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
53
53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
of virus viremia, which corresponds to of a mononucleosis-like the occurrence production & syndrome. 53
Virus levels in the blood clinically latent period, but continues in the lymph nodes.
Virus
levels
in
the
blood
clinically
latent
period,
but
continues
in
the
lymph
nodes.
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
during a replication
during a
replication
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral

decrease

viral

the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
54
54
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
the blood clinically latent period, but continues in the lymph nodes. during a replication decrease viral
in the disease, virus levels in the blood CD4 levels are significantly the structure of
in
the
disease,
virus
levels
in
the
blood
CD4
levels
are
significantly
the
structure
of
the
lymph
nodes
is
destroyed,
and
the
patient
becomes
immunosuppressed
55

Late

increase,

of the lymph nodes is destroyed, and the patient becomes immunosuppressed 55 Late increase, decreased.

decreased.

Clinical
Clinical

Manifestations

56

Initial Fever and other flu-like  lympadenopathy
Initial
Fever
and
other
flu-like
lympadenopathy

symptoms

Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
57
57
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection

infection

Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Initial Fever and other flu-like  lympadenopathy symptoms 57 infection
Prolonged person is  lasts for  viral  up  chronic lymphadenopathy
Prolonged
person
is
lasts for
viral
 up
chronic lymphadenopathy

asymptomatic

viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
viral  up  chronic lymphadenopathy asymptomatic HIV+ but several years replication to 58 Asymptomatic
HIV+ but several years replication to
HIV+
but
several
years
replication
to
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10
58
58
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion
asymptomatic HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion

Asymptomatic

HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons
HIV+ but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons

Infection

but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day

(subclinical)

occurring

but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day

10

billion

virons

per

day

but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
but several years replication to 58 Asymptomatic Infection (subclinical) occurring 10 billion virons per day
Early Symptomatic Disease CD4 counts drop to 500-600 cells/ml symptoms : recurrent fever, night sweats,
Early
Symptomatic
Disease
CD4
counts
drop
to
500-600
cells/ml
symptoms
:
recurrent
fever,
night
sweats,
malaise,
headache
physical findings
:
lymphadenopathy,
spleen enlarged,
rash,
weight
loss
59
night sweats, malaise, headache physical findings : lymphadenopathy, spleen enlarged, rash, weight loss 59
Opportunistic infection by a pathogenic  that is normally present  becomes infectious in
Opportunistic
infection
by
a
pathogenic
that
is
normally
present
becomes
infectious
in
immunocompromised
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person

but

that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
not harmful
not
harmful
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
60
60
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person

Infection

that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person

organism

that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person

person

that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
that is normally present  becomes infectious in immunocompromised but not harmful 60 Infection organism person
AIDS AIDS vs. HIV positive
AIDS
AIDS vs. HIV positive

61

Average time between AIDS was 10 years  time has increased with inhibitors
Average
time
between
AIDS
was
10
years
time
has
increased
with
inhibitors
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
and protease
and
protease
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection

infection

Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection

new

Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Average time between AIDS was 10 years  time has increased with inhibitors and protease infection
Symptoms of HIV - “classic 6” fatigue/malaise lymphadenopathy weight loss fever night sweats diarrhea 63
Symptoms
of
HIV
-
“classic
6”
fatigue/malaise
lymphadenopathy
weight
loss
fever
night sweats
diarrhea
63
AIDS CD4 count less than 200/mm  majority of manifestations due to opportunistic infections rather
AIDS
CD4
count
less
than
200/mm
majority
of
manifestations
due
to
opportunistic
infections
rather than
due
to
immunosuppression
direct
injury
by
virus
It
is
a
condition
in
which
common
curable
infectious disease turned
into
incurable
form
due
to
immunodeficiency,
caused
by
HIV
infection
64
curable infectious disease turned into incurable form due to immunodeficiency, caused by HIV infection 64
Clinical Course of HIV/AIDS HIV Infection  Virus deposited on mucosal surface  Acute infection
Clinical
Course
of
HIV/AIDS
HIV
Infection
Virus deposited
on
mucosal
surface
Acute infection
(mono-like
symptoms)
Viral
dissemination
HIV-specific
immune
response
Replication
of virus
Destruction
of CD4+
lymphocytes
Rate
of progression is correlated with viral load
Latent
Period
65
virus  Destruction of CD4+ lymphocytes  Rate of progression is correlated with viral load Latent
Clinical AIDS  Immunologic dysregulation  Opportunistic infections  Risk of infections is of CD4+
Clinical
AIDS
Immunologic
dysregulation
Opportunistic
infections
Risk of
infections
is
of
CD4+ lymphocytes
Average patient with
AIDS
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3
is of CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3

HIV/AIDS

CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course
CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course
CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course
CD4+ lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course
of
of
lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and
lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and
lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and
lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and
lymphocytes  Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and
cancers with number in 1-3
cancers
with
number
in
1-3
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
66
66
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated

Course

 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated

and

 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated

correlated

 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated

dies

 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated

years

 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
 Average patient with AIDS HIV/AIDS of cancers with number in 1-3 66 Course and correlated
WHO classification of clinical stages of infection Children – Three stages Adults & Adolescents –
WHO
classification
of
clinical
stages
of
infection
Children
Three
stages
Adults
&
Adolescents
Four
stages
67
of clinical stages of infection Children – Three stages Adults & Adolescents – Four stages 67
WHO Clinical stage I in Children Asymptomatic Generalized lymphadenopathy 68
WHO
Clinical
stage
I
in
Children
Asymptomatic
Generalized
lymphadenopathy
68
WHO Clinical stage I in Children Asymptomatic Generalized lymphadenopathy 68
WHO Clinical stage II in Children Unexplained chronic diarrhoea Severe persistent or recurrent candidiasis
WHO
Clinical
stage
II
in
Children
Unexplained
chronic
diarrhoea
Severe
persistent
or
recurrent
candidiasis
outside
the
neonatal
period
Weight loss or
failure
to
thrive
Persistent fever
Recurrent severe bacterial infection
69
the neonatal period Weight loss or failure to thrive Persistent fever Recurrent severe bacterial infection 69
WHO Clinical stage III in Children AIDS – defining opportunistic infections Severe failure to thrive
WHO
Clinical
stage
III
in
Children
AIDS
defining
opportunistic
infections
Severe
failure
to
thrive
Progressive encephalopathy
Malignancy
Recurrent septicaemia or
meningitis
70
infections Severe failure to thrive Progressive encephalopathy Malignancy Recurrent septicaemia or meningitis 70
WHO Clinical stage I in Adults & Adolescents Asymptomatic Persistent generalized lymphadenopathy
WHO
Clinical
stage
I
in
Adults
&
Adolescents
Asymptomatic
Persistent
generalized
lymphadenopathy
Performance
scale
1:
asymptomatic,
normal
activity
71
Asymptomatic Persistent generalized lymphadenopathy Performance scale 1: asymptomatic, normal activity 71
WHO Clinical stage II in Adults & Adolescents Weight loss, <10% of the body weight
WHO
Clinical
stage
II
in
Adults
&
Adolescents
Weight
loss,
<10%
of
the
body
weight
Minor mucocutaneous
manifestations
Herpes
Zoster
within
the
last
5
years
Recurrent
upper
respiratory
tract
infections
Performance scale 2: symtomatic,
normal activity
72