Acquired Immune Deficiency Syndrome:

Acquired means you can get infected with it; Immune Deficiency means a weakness in the body's system that fights diseases. Syndrome means a group of health problems that make up a disease. AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will try to fight the infection. It will make "antibodies," special molecules to fight HIV.

DESCRIPTION / NATURE AIDS is late-stage HIV infection, characterized by a severely weakened immune system that can no longer ward off life-threatening opportunistic infections and cancers. It is thought that everyone infected with HIV will eventually develop AIDS, because the body's immune system is steadily weakened by HIV. Unable to fight off infections, most people die within three years of the first signs of AIDS appearing

In this study, the scientists showed that the interaction actually takes the form of a tight cluster of five to seven rod-shaped features. This striking and unexpected arrangement was dubbed the entry claw by the researchers (see figure below). They also found that the arrangement of spikes across the rest of the virus seems to largely disappear upon formation of the entry claw, suggesting a shedding event that has not previously been noted, which may have some, still uncertain relevance to infectivity Human immunodeficiency virus (HIV), a retrovirus. Two major types of HIV have been recognized, HIV-1 and HIV-2. HIV-1 is the dominant type worldwide. HIV-2 is found principally in West Africa but cases have been reported from East Africa, Europe, Asia and Latin America. There are at least 10 different genetic subtypes of HIV-1, but their biological and epidemiological significance is unclear at present. Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections).

Is a fatal illness, has no definite treatment and a vaccine at present still being developed Previous names for the virus include Human T-lymphotropic virus-III (HTLVIII), lymphadenopathy-associated virus (LAV), or AIDS-associated retrovirus (ARV). Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, preejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The three major routes of transmission are unprotected sexual intercourse, contaminated needles, and transmission from an infected mother to her baby at birth, or through breast milk. Screening of blood products for HIV in the developed world has largely eliminated transmission through blood transfusions or infected blood products in these countries.

Transmission and prevention The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.

Sexual Contact The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Heterosexual intercourse is the primary mode of HIV infection worldwide. Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts are riskier than unprotected insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected anal intercourse is greater than the risk for transmission through vaginal intercourse or oral sex. The risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen; contrary to popular belief, one would have to swallow gallons of saliva from a carrier to run a significant risk of becoming infected. Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vaginal cavity frequently occurs which facilitates the transmission of HIV.

Mother-to-child transmission (MTCT) The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth

In the absence of treatment, the transmission rate between the mother to the child during pregnancy, labor and delivery is 25%. However, when the mother has access to antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 1015%. This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding. o o o antiretroviral drugs caesarean delivery formula feeding reduce the chance of transmission of HIV from mother to child. Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIVinfected mothers should avoid breast-feeding their infant.

In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa.

Epidemiology Worldwide: UNAIDS estimates that as of December 2000, there were an estimated 36.1 million people living with HIV/AIDS (34.7 million adults and 1.4 million children under 15). Since the epidemic began, an estimated 21.8 million people have died of AIDS (17.5 million adults and 4.3 million children under 15). An estimated 5.3 million new HIV infections occurred in 2000. During 2000, HIV- and AIDS-associated illnesses caused deaths of an estimated 3 million people, including 500,000 children under the age of 15. WHO (2006) Numbers of people living with HIV/AIDS across the globe: Sub-Saharan Africa: 14 million South and South-East Asia: 5.2 million North America, western Europe, Australia and New Zealand: 1.3 million Latin America 1.3 million.

Physiology HIV primarily infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages and dendritic cells.

Window Period The time it takes for a person who has been infected with HIV to seroconvert (test positive) for HIV antibodies ) When a person is infected with the HIV virus, statistics show that 95-97% (perhaps higher) of all infected individuals develop antibodies within 12 weeks (3-months). To be retested after 6 months The combination of an Eliza/Western Blot HIV Antibody Test is the accepted testing method for HIV infection. This combination test is looking for the antibodies that develop to fight the HIV virus. Through a blood test or an oral swab A positive result means: a. carrying the virus that causes AIDS. have the ability that can infect others and should try to implement precautions to prevent doing so A negative result means: No antibodies were found in your blood at this time. A negative result does NOT mean: You are not infected with HIV (if you are still in the window period). You are immune to AIDS. You have a resistance to infection. You will never get AIDS.

Elisa (Enzyme Linked Immunosorbent Assays) ELISA is the most commonly used test to screen for HIV infection. It detects antibodies to HIV. ELISA may not be sensitive during the initial 3-4 wks of infection because the HIV specific antibodies become positive about 22 to 27 days after acute infection. False positive tests may occur in multiparous women, recent recipients of Influenza or Hepatitis B vaccines or multiple transfusions, those with

hematological malignancies, multiple myeloma, primary biliary cirrhrosis or alcoholic hepatitis. False negative ELISA occurs in very early or late in the course of HIV disease when antibody production is low.

HIV infection leads to low levels of CD4+ T cells through three main mechanisms: a. direct viral killing of infected cells; b. increased rates of development in infected cells; c. killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. The depressed helper/suppressor T-cell ratio is the hallmark of the disorder. Immunodeficiency in AIDS is often further compounded by secondary opportunistic infections and immunosuppressive therapy2. It has been proposed that cytomegalovirus, other viruses and disseminated mycobacterial infection may be cofactors with HIV for the full expression of the virus While some individuals experience mild HIV-related disease soon after initial infection, nearly all then remain well for years. Then, as the virus gradually damages their immune system, they begin to develop illnesses of increasing severity, characterized by various combinations of symptoms and diseases, such as diarrhoea, fever, wasting, fungal infections, tuberculosis, pneumonia, lymphoma, failure to thrive and Kaposi's sarcoma. Manifestations of HIV disease Opportunistic Infections in AIDS The HIV virus causes a chronic infection that leads to profound immunosuppression. The course of the infection may vary with some individuals developing immunodeficiency with 2 to 3 years and others remaining AIDS free for 10-15 years. Eventually the infected individual develops Early symptomatic HIV, which progresses to AIDS with associated opportunistic infections and malignancies The majority of the infections occur when the CD4 cell count falls below 500 cells/mm. These include pneumoccocal and other pneumonia, pulmonary tuberculosis, Herpes Zoster, Candidiasis, Kaposi's sarcoma, cryptosporidiosis, Oral hairy leukoplakia. Levels lower than 200 cells/mm are associated with P.carini pneumonia, Toxoplasmosis, miliary and extra pulmonary tuberculosis.

Levels lower than 50 cells/mm is associated with disseminated CMV

Early symptomatic HIV disease At this stage symptoms including fever, unexplained weight loss, recurrent diarrhea, fatigue and headache. Cutaneous manifestations like seborrheic dermatitis, folliculitis, recurrent herpes simplex infections oral hairy leukoplakia may occur. During this period the CD4 T-cells count continues to come down. Usually anti retroviral therapy is started at this stage. Opportunistic Infections are important part of the HIV disease process. It is common to find AIDS patients with multiple OIs. These OIs result in more rapid decline in CD4 T-cell count than the decline resulting from HIV disease itself. Thus effective therapy is required to treat and prevent these infection. The incidence and type of OIs in HIV patients is directly related to the CD4 count in that individual.

Respiratory Infections: The most common infections affecting the person with AIDS. The causative organism is Pneumocystis Carinii Pneumonia (PCI) One of the first OIs described in association with AIDS. It cause disease only in immuno compromised host, causing severe symptoms of consolidation in the alveoli. Although it presents less acute symptoms in pts. with cancer than with HIV. Symptoms maybe significant as hypoxemia, cyanosis, tachypnea,eventually, respiratoy failure develops after 2-3 days if untreated Tuberculosis Will occur among HIV pts. with preexisting tuberculosis. Unlike other OIs, TB tends to occur early in the HIV infection, usually preceeding the diagnosis of aids.

GI Manifestations Diarrhea is present in about 50-90% 0f the AIDS pts. It maybe related to the direct effect of the virus on the intestines. In pts with aids, diarrhea can be devastating in terms of profound weight loss, fluid and electrolyte imbalances, perianal fissures Oral Candidiasis which is a fungal infection occurs nearly in all pts.with AIDS. Commonly preceeding other life threatening OIs. Associated symptoms include difficulty in swallowing and anorexia

Wasting Syndrome . Includes a diagnostic criteria of profound weight loss due to chronic diarrhea for more than 30 days, fever, anorexia, GI malabsorption. TNF and Interleukin 1 acts on the hypothalamus causing severe anorexia.

Oncologic Manifestations:

Kaposis Sarcoma - The most common HIV related Malignancy. Slow to progress and easily treated. Acquired KS occurs in pts. who have treated with ranging froimmunosuppressive agents. These agents when decreased dosage can help resolve the lesions. However, in endemic KS prevalent among young boys and homosexual males, those with AIDS is more virulent than the classic KS.

AIDs related KS exhibits a more aggressive form, from localised cutaneous lesions to disseminated disease involving multiple organ systems. A rapid development of lesions all over the body maybe flat or raised. Ulcerative lesions leads to impairment of skin integrity leads easily to infections. Neurologic Manifestations: HIV Encephalopathy . Formerly referred to as AIDS dementia. It is a clinical syndrome characterized by a decline in cognitive, behavioral, and motor functions. HIV virus has been found in the spinal fluid and brain tissues of pts. with HIV. Early manifestations maybe memory deficits, difficulty in concentration, progressive confusion, psychomotor slowing, delay in speech response, tremors, convulsions and mutism. Diagnosis can be made through CT scans, MRIs and lumbar puncture. Meningitis

Medical Management Treatment of Infections Treatment strategies now focus on maximal viral suppression and preventing drug resistance. Advances in antiretroviral therapy and chemoprophylaxis of opportunistic infections have increased the long-term survival of AIDS patients by 10 to 20 years. However, despite abundant research and advances in medical care, AIDS continues to be a devastating epidemic worldwide.