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Retrovirusuri
Caracteristici
Caracteristici
virion nvelit (80-120 nm)
capsid coninnd 2 copii de ARN m.c.+
ADN polimeraz ARN-dependent (revers transcriptaza):
provirus ADN d.c. diploid (se integreaz linear n genomul
celulei gazd)
2 genome cu informaie identic (ARN, ADN)
genom viral flancat de secvene nucleotidice repetate LTR
(Long Terminal Repeats)
3 gene-proteine structurale: gag, env, pol
gene accesorii: tat, rev, nef, vif, vpu (HIV)
virionii nmuguresc prin mb citoplasmic transformat prin
glicoproteine virale
morfogeneza final a HIV necesit clivarea prin proteaze a
polipeptidelor gag i gag-pol dup nvelire
3 subfamilii care conin i specii care infecteaz omul, fr a
produce ntotdeauna boal
Oncornavirinae
- asociate cu cancer i boli neurologice
- HTLV-1, HTLV-2, HTLV-5
Spumavirinae
- nu sunt asociate cu vreo boal la om, produc efect citopatic
vacuolare spumoas
- virus uman spumos
Lentivirinae
- boli cronice, lent progresive
- produc boli neurologice i imunosupresie
- HIV-1, HIV-2
Clasificare
Clasificare
Structura
- virus ARN nvelit, 80-120 nm
- nucleocapsid - simetrie icosaedric; p24 (proteina intern major), p17
- miez 2xARN, p15, RT, integraza
- membrana proteic p17, proteaza viral
- anvelop proteine majore ale nveliului viral: gp120, gp41
- genom
- diploid, 2 molecule identice ARNm.c.+
- 2 secvene LTR la fiecare extremitate a genomului (rol n transcripie, integrare)
- 3 gene majore, care codific poliproteine
- gag (proteine capsidale)
- pol (polimeraz, proteaz, integraz)
- env (anvelop, glicoproteine)
- gene adiionale care codific mai multe proteine reglatorii vif, vpr, vpu, tat, rev, nef
Proteine structurale
gag p24, p17
- p24 prezena n ser este marker de replicare viral; dispariia terapie eficace
- pol proteaza, revers trascriptaza, integraza
- env gp 160 este clivat n gp41 i gp120
- gp 120 ligand la celula int
- gp 41 fuziunea anvelopei virale cu membrana celulei gazd
- Ac mpotriva acestor gp sunt prezente n ser
HIV-1 este foarte variabil
HIV-2 este stabil antigenic
Virusul
Virusul
imunodeficineei
imunodeficineei
umane (HIV)
umane (HIV)
1. ataarea gp120 la Lf Th i Mf (CD4)
2. fuziunea i penetrarea n citoplasm
1. gp41 (domeniu fuziune HIV) R fuziune cel gazd
2. clivaj bucla V3 a gp120 (proteaze celulare) modif conformaional gp
nveli
3. recunoaterea altor prot mb (coreceptori chemokine CCR5, CXCR4)
fuziunea mb cel i virale
4. ptrunderea nucleocapsidei decapsidare
3. ARN m.c.+ ADN m.c.- ADN d.c. (proviral) integrarea n genomul
celulei gazd (integraza)
4. eliberare prin nmugurire, imature
5. proteaza viral
Doar Lf CD4 activate (citokine) replicare HIV (secv ce interac cu
LTR)
Replicarea
Replicarea
HIV
HIV
Eficiena dezinfeciei
Eficiena dezinfeciei
etanol 50%
isopropanol 30%, lizol 0,5%
H
2
O
2
0,3%
hipoclorit Na 0,5%
56C cldur umed, 30 min
Patogenez
Patogenez
Sindroame clinice
Sindroame clinice
Infecia primar
- sdr mononucleozic acut
- limfadenopatie persistent generalizat
- asimptomatic
Prodrom SIDA (AIDS-related complex)
- pierdere n greutate
- oboseal
- transpiraii nocturne
- diaree persistent
- herpes-zoster prelungit
- candidoz oral
- leucoplazie proas a limbii
Boli neurologice
demena
- encefalit subacut
- mielopatie
- meningit aseptic
- neuropatie periferic
Infecii oportuniste
- Toxoplasma gondii Pneumocystis carinii
- Cryptococcus neoformans M. avium
- Cryptosporidium M. tuberculosis
- Histoplasma Listeria monocytogenes
- Candida CMV, Herpes virus
Cancere, forme neobinuite
sarcom Kaposi HHV8
- limfom non-Hodgkin
- limfoame corelate cu VEB limfom Burkitt, carcinom nasofaringian
- cancer invaziv de col uterin
SIDA
SIDA
- Ac nu sunt suficieni datorit variaiei Ag mari a HIV;
presiunea imunologic selecteaz variante noi
- scderea anti-p24 = debut SIDA
Imunit
Imunit
ate
ate
HIV and AIDS
HIV and AIDS
The cellular and immunological picture -The course of the disease
Diagnostic de laborator al HIV infeciei
Diagnostic de laborator al HIV infeciei
Test Scop
Serologie
ELISA
Latex aglutinare
Western blot
Imunofluorescen
Screening iniial
Screening iniial
Test de confirmare
Test de confirmare
ARN viral (RT-PCR) Detectarea virusului n snge
Branched-chain DNA Detectarea virusului n snge
Ag p24 Marker precoce al infeciei
Izolare de virus Nu este nc disponibil
Inhibitori de RT
zidovudina anemie, neutropenie
didanosina - pancreatit
zalcitabina, stavudina neuropatie periferic
- asociere pentru a preveni selecia variantelor rezistente
- tratamentul nu previne SIDA, dar ncetinete progresia
- femei nsrcinate HIV+ zidovudina S14-34 reduce cu 60%
transmisia perinatal a infeciei
- terapia ncepe la 500CD4/L
- eficiena terapiei concentraia CD4
- Ag p24
- ncrctura viral
Trat
Trat
a
a
ment
ment
Epidemiologie
Epidemiologie
Factori virali
virus nvelit, inactivat uor; trebuie transmis n fluidele
corpului
boal cu prodrom lung
virusul poate fi replicat nainte de apariia simptomelor
Transmitere
virus prezent n snge, sperm, secreii vaginale
Grupe de risc
drogai i.v.
persoane active sexual cu parteneri multipli (homosexuali i
heterosexuali)
prostituate
n.n. din mame HIV+
transfuzai sau transplantai i hemofilici: nainte de 1985
22
Cumulative AIDS cases world
Cumulative AIDS cases world
-
-
wide: 1998
wide: 1998
Reported cases
(n = 1,987,217)
Adjusted for under reporting
(n = 13 million)
Oceania
<0.5%
Europe
10.6% USA 34.8%
Africa 35.5% Americas* 13.1%
Asia 5.5%
Americas* 5%
Asia 7%
USA 5%
Europe 2%
Oceania <1%
Africa 81% * Excluding USA
Source: World Health Organisation, Weekly Epidemiological Report
23
Estimated number of HIV infected people alive:
Estimated number of HIV infected people alive:
to end 1998 by region (percentage of total of 33.4m)
to end 1998 by region (percentage of total of 33.4m)
Source: UNAIDS
North America
890,000 (2.7%)
Latin America
1.4 million (4.2%)
Western Europe
500,000 (1.5%)
North Africa & Middle East
210,000 (0.6%)
Sub-Saharan
Africa
22.5 million (67%)
Eastern Europe &
Central Asia
270,000 (0.8%) East Asia
& Pacific
560,000 (1.7%)
South &
South East Asia
6.7 million (20%)
Australasia
12,000 (<0.1%)
CDSC
Caribbean
330,000 (1%)
Transmiterea HIV infeciei
Transmiterea HIV infeciei
Ci de transmitere cunoscute
transmitere parenteral
transfuzii de snge i produse de snge
utilizarea n comun a acelor (drogai i.v.)
neptura de ac, plag, expunere mucoas la personal medical
ace de tatuaje
transmitere sexual
contact anal i vaginal
mai riscant: contact anal, brbatfemeie
transmitere perinatal
intrauterin
peripartum
lapte
Ci neimplicate n transmitere
contact personal strns
membrii familiei
personal medical neexpus la snge
Profilaxia
Profilaxia
vaccin, chimioprofilaxie nu exist
sex protejat, monogamie
ace sterile de unic utilizare
screening pe scar larg: snge pentru transfuzii, organe
pentru transplant, factori de coagulare pentru hemofilici
obiecte personale de toalet
control serologic nainte de a hotr o sarcin
Adenovirusuri
Adenovirusuri
Adenovirusuri
Adenovirusuri
ADN d.c. linear
nude
simetrie icosaedric
prelungiri pentone - fibra pentonei
ligand
6 grupe A-F
47 serotipuri
Patogenez
Patogenez