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صدق ال العظيم
AIDS and the
skin
Prof. OSSAMA
HUSSEIN ROSHDY
AIDS and the skin
INTRODUCTION
5.
3.
4.
9.
2.
1. UNCOATING:
REVERSE
GENOME
VIRUS
FUSION:
7. PROTEIN
ASSEMBLY
8. BINDING:
6. PROTEIN
genes
TRANSCRIPTASE:
INTEGRATION:
AND
Viral andcell
SYNTHESIS:
SPREAD:
and
REPLICATION: enzymes
Cell
CLEAVAGE:
Virus attaches to a
Reverse
Viral
New
Cell integrase
membranes
uses
viral
uses HIV
particles
thefuse.
RNA
viralas a
Protease
cell enzyme
Transcriptase
splices
bud
DNA as viral
template
froma theDNA
for
cell
template
cuts long protein
copies
into
and
for cellular
viralon
synthesizing
move
reproducing RNA
DNA to
to the
viral
chain into individual
DNA
infect
HIV proteins.
RNAother cells.
genome.
proteins.
AIDS and the skin
NATURAL HISTORY:
Rapid progressors:
Develop AIDS within 2-3 years
Non progressors:
Remain free for 10-15 years
WHAT IS AIDS?
AIDS and the skin
CDC's definition
- All HIV-infected people who have
fewer than 200 CD4+ T cells per
cubic millimeter of blood (<
200X106 /L)
(Healthy adults usually have CD4+ T-cell
counts of 1,000 or more)
- AIDS indicator conditions: 26
clinical conditions that affect
people with advanced HIV disease
AIDS and the skin
CLINICAL PICTURE:
I- EARLY SYMPTOMS:
Fever (38.5 °C >one month)
Headache
Tiredness
Enlarged lymph nodes
AIDS and the skin
II- CASE DEFINITION of AIDS:
Category A:
Asymptomatic persistent generalized
lymphadenopathy
Category B (symptomatic):
- Conestitutional symptoms: fever and/or
diarrhoea > 1 month
AIDS and the skin
6- Idiopathic thrombocytopenic
purpura
7- Pelvic inflammatory disease
8- Peripheral neuropathy
AIDS and the skin
COMMON DERMATOLOGIC
CONDITIONS ASSOCIATED WITH
HIV INFECTION:
1- Seborrhoeic dermatitis
2- Psoriasis
3- Pruritic Papular eruption
4- Viral diseases (H S, H Z,
Molluscum, warts)
AIDS and the skin
DIAGNOSIS:
I- HIV antibody diagnosis:
- Detectable levels in the blood may need
1 to 3 months following infection
- The antibodies may take as long as 6
months to be produced in quantities
large enough to show up in standard
blood tests.
AIDS and the skin
*`Qualitative testing
- Tests for viral genome serves as a marker of
infection
* Quantitative testing
1- Peptide vaccine:
- Made of tiny pieces of proteins from the
HIV virus.
- It induced neutralizing
antibodies in nearly 100%
recipients
Merck developed experimental
vaccine (V520)
It prompts the body to produce
cytotoxic T –cells
Organizers expected results in
2009
In September 2007 vaccine
failure was declared
Causes of vaccine failure:
- Designed in 1996
- Multiple drugs (three or more) are used in
combination
- Can be used by people who are newly
infected with HIV as well as people with AIDS.
- HAART is not a cure for AIDS
- It has greatly improved the health of many
people with AIDS
- It reduces the amount of virus circulating in
the blood to nearly undetectable levels
- It is significantly reducing the number of
deaths from AIDS
AIDS and the skin
1- Azidothymidine( AZT):
- Nausea, bone marrow suppression, and
myopathy
2- zalcitabine (ddC):
- Peripheral neuropathy
3- Dideoxyinosine (ddI ):
- Nausea, diarrhoea, pancreatitis,
gynaecomastia, and peripheral neuropathy
AIDS and the skin
4- Stavudine (d4T) :
- Gynaecomastia, and peripheral
neuropathy
5- Lamivudine (3TC):
- Nausea, bone marrow suppression,
and peripheral neuropathy
6- Abacavir (ziagen)
7- Tenofovir (viread)
8- Emtriva (emtricitabine
AIDS and the skin
B- Non-nucleoside (NNRTIs):
1- Nevirapine (Viramune) :
- Clinical and biochemical hepatitis
2- Delavirdine (Rescriptor):
- Biochemical hepatitis
3- Efavirenz (Sustiva):
- Insomnia, and nightmares
AIDS and the skin
4- Amprenavir (Agenerase):
- Nausea, diarrhea
5- Nelfinavir (Viracept):
- diarrhea
6- Lopinavir (Kaletra):
- Nausea, diarrhea
7- Atazanavir (Reyataz)
8- Fosamprenavir (Lexiva)
AIDS and the skin
III- Fusion inhibitors (Chemokines ):
Fuzeon (enfuvirtide or T-20):
IV- ATRIPLA:
- FDA approved in July 12, 2006
- It is the first -once- daily single tablet
regimen
- Efavirenz 600 mg/ Emtricitabine 200 mg/
Tenofovir disoproxil fumarate 300 mg
- Emtricitabine and Tenofovir are NRTIs
- Efavirenz is a non-NRTI
AIDS and the skin
SIDE EFFECTS:
- Lactic acid acidosis, Hepatotoxicity
- "Flare-ups" of Hepatitis B Virus
infection
- Serious psychiatric problems
- Changes in bone density
(osteoporosis)
V- CCR5 antagonists (Maraviroc):
2- Treatment of opportunistic
infections:
CMV (cytomegalovirus) eye infections
Foscarnet and ganciclovir