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AIDS (Acquired Immune Deficiency Syndrome) I. Definition Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus or HIV (retrovirus). This is a condition in which there is a severe loss of the body's cellular immunity, greatly lowering the resistance to infection and malignancy. Individuals who suffer from it are at risk for severe illnesses that are usually not a threat to anyone whose immune system is working properly. As HIV progressively damage cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop. II. Synonym Before it was named AIDS, the syndrome was called GRID or gay-related immune deficiency. However, after determining that AIDS was not isolated to the homosexual community, the term GRID became misleading and AIDS was introduced III. Morphological Description of the multicultural HIV is different in structure from other retroviruses. It is roughly spherical with a diameter of about 120 nm, around 60 times smaller than a red blood cell, yet large for a virus. It is composed of two copies of positive single-stranded RNA that codes for the virus's nine genes enclosed by a conical capsid composed of 2,000 copies of the viral protein p24. The single-stranded RNA is tightly bound to nucleocapsid proteins, p7, and enzymes needed for the development of the virion such as reverse transcriptase, proteases, ribonuclease and integrase. A matrix composed of the viral protein p17 surrounds the capsid ensuring the integrity of the virion particle. This is, in turn, surrounded by the viral envelope that is composed of two layers of fatty molecules called phospholipids taken from the membrane of a human cell when a newly formed virus particle buds from the cell. Embedded in the viral envelope are proteins from the host cell and about 70 copies of a complex HIV protein that protrudes through the surface of the virus particle. This protein, known as Env, consists of a cap made of three molecules called glycoprotein (gp) 120, and a stem consisting of three gp41 molecules that anchor the structure into the viral envelope. This glycoprotein complex enables the virus to attach to and fuse with target cells to initiate the infectious cycle. Both these surface proteins, especially gp120, have been considered as targets of future treatments or vaccines against HIV.

Life Cycle of AIDS The HIV viruss life cycle begins as it is born in a host cell. The virus exits the cell through its cell membrane, and searches for a new T-cell to infect. The virus can identify the cell it wishes to find, the CD4+ T-cell, because they have CD4 molecules on their surface. Once the virus reaches a victim, it attaches itself to the CD4 molecules that make up its surface, and the viruss outer envelope merges with the cells and becomes one. After getting inside the cell, HIV uses a chemical called reverse transcriptase to convert RNA into DNA. This is the form of nucleic acid which can be used to produce copies of the virus. When the DNA enters the cells nucleus, the next stage of the process is complete. This is done with the help of a chemical known as integrase. Next, the HIV DNA is turned into RNA that can use the cells

machinery. After this is complete, this messenger RNA moves out of the nucleus and into the cytoplasm of the cell to take control of it. It creates proteins needed for more viruses using the host cells parts. The last stage occurs when these proteins join together and create young viruses. These are not yet ready to infect other cells. A chemical called protease cleans up the proteins and enzymes in these immature HIV strains, and then they gather up in the cells membrane and burst out. It is this eruption of new viruses that destroys the host cell.

IV. Modes of Transmission Most common ways in which HIV is transmitted from person to person: by having sex (anal, vaginal, or oral) with an HIV-infected person; by sharing needles or injection equipment with an injection drug user who is infected with HIV; or from HIV-infected women to their babies before or during birth, or through breast-feeding after birth.

V. Signs and Symptoms Symptoms of AIDS are caused by the deterioration of the immune system and the decline of CD4+ T cells, which are the immune system's key infection fighters. As soon as HIV enters the body, it begins to destroy these cells. Some common symptoms include: Diarrhea that lasts for more than a week Dry cough Memory loss, depression and neurological disorders Pneumonia Profound, unexplained fatigue Rapid weight loss Recurring fever or profuse night sweats Red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids Swollen lymph glands in the armpits, groin or neck White spots or unusual blemishes on the tongue, in the mouth, or in the throat

Infections Associated with AIDS Because people with AIDS have weakened immune systems, they're more prone to infections, called opportunistic infections. Opportunistic infections are caused by organisms that typically don't cause disease in healthy people but affect people with damaged immune systems. These organisms attack when there's an opportunity to infect. Deterioration of the immune system is caused by the decline in CD4+ T cells, which are key infection fighters. As soon as HIV enters the body, it begins to destroy these cells. Symptoms of opportunistic infections common with AIDS include: Coma Coughing and shortness of breath

Difficult or painful swallowing Extreme fatigue Fever Mental symptoms such as confusion and forgetfulness Nausea, abdominal cramps and vomiting Seizures and lack of coordination Severe, persistent diarrhea Severe headaches Vision loss Weight loss

Many opportunistic infections associated with AIDS cause serious illness. Some may be prevented. Below is a list of the most common opprtunistic infections and how they affect the body. Candidiasis (Thrush) is a fungal infection of the mouth, throat, or vagina. CD4 cell range: can occur even with fairly high CD4 cells. Cytomegalovirus (CMV) is a viral infection that causes eye disease that can lead to blindness.CD4 cell range: under 50. Herpes simplex viruses can cause oral herpes (cold sores) or genital herpes. These are fairly common infections, but if you have HIV, the outbreaks can be much more frequent and more severe. They can occur at any CD4 cell count. Malaria is common in the developing world. It is more common and more severe in people with HIV infection. Mycobacterium avium complex (MAC or MAI) is a bacterial infection that can cause recurring fevers, general sick feelings, problems with digestion, and serious weight loss. CD4 cell range: under 75. Pneumocystis pneumonia (PCP) is a fungal infection that can cause a fatal pneumonia. CD4 cell range: under 200. Unfortunately this is still a fairly common OI in people who have not been tested or treated for HIV. Toxoplasmosis (Toxo) is a protozoal infection of the brain. T-cell range: under 100. Tuberculosis (TB) is a bacterial infection that attacks the lungs, and can cause meningitis. CD4 cell range: Everyone with HIV who tests positive for exposure to TB should be treated. VI. Diagnostic/ Lab tests HIV-1 testing consists of initial screening with an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV-1. Specimens with a nonreactive result from the initial ELISA are considered HIVnegative unless new exposure to an infected partner or partner of unknown HIV status has occurred. Specimens with a reactive ELISA result are retested in duplicate. If the result of either duplicate test is reactive, the specimen is reported as repeatedly reactive and undergoes confirmatory testing with a more specific supplemental test (e.g., Western blot or, less commonly, an immunofluorescence assay (IFA)). Only specimens that are repeatedly reactive by ELISA and positive by IFA or reactive by Western blot are considered HIV-positive and indicative of HIV infection. Specimens that are repeatedly ELISA-reactive occasionally provide an indeterminate Western blot result, which may be either an incomplete antibody response to HIV in an infected person or nonspecific reactions in an uninfected person. Although IFA can be used to confirm infection in these ambiguous cases, this assay is not widely used. In general, a second specimen should be collected more than a month later and retested for persons with

indeterminate Western blot results. Although much less commonly available, nucleic acid testing (e.g., viral RNA or proviral DNA amplification method) can also help diagnosis in certain situations. In addition, a few tested specimens might provide inconclusive results because of a low quantity specimen. In these situations, a second specimen is collected and tested for HIV infection. VII. Period of Communicability A person can spread HIV to others before it is detectable in the body and anyone infected remains a lifelong carrier of the virus. HIV-infected mothers should consult a health care provider. Certain medications prevent transmission to the developing baby. VIII. Incubation period for aids The incubation period is the time between infection and the onset of symptoms of disease. The incubation period between HIV infection and the onset of AIDS can vary anywhere from six months to an unknown period of time. Some people who are HIV antibody positive may never develop AIDS. CDC has stated that the average length of incubation at this time is seven years or more, however, this number continues to change due to various factors. IX. Prognosis Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.[164] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to about 20 years. As new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year after the individual progresses to AIDS. Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system. The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function health care and coinfections, as well as which particular strain of the virus is involved Epidemiology The AIDS pandemic can also be seen as several epidemics of separate subtypes; the major factors in its spread are sexual transmission and vertical transmission from mother to child at birth and through breast milk.Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.1 million (range 1.92.4 million) lives in 2007 of which an estimated 330,000 were children under 15 years. Globally, an estimated 33.2 million people lived with HIV in 2007, including 2.5 million children. An estimated 2.5 million (range 1.84.1 million) people were newly infected in 2007, including 420,000 children.

X. Treatment Treatment for AIDS involves the following: Prophylactic Treatment for Opportunistic Infections. Prophylactic treatment is treatment given to prevent disease. Certain symptoms, such as persistent weight loss, low white blood cell counts,

and the presence of thrush, are used to determine when prophylactic treatments should be given. Three drugs used in treatment are trimethoprim-sulfamethoxazole, dapsone, and pentamidine Treatment of Opportunistic Infections and Cancers. These treatments are often made more difficult because the organisms that cause the diseases may become resistant to the usual drugs used to kill them. In such cases, doctors have to look for other drugs with which to treat the infections. Both radiation therapy and chemotherapy can be used to treat some types of infections and forms of cancer. Anti-retroviral Treatment. Anti-retroviral treatments make use of drugs that attack and destroy the virus itself rather than treating the infections and diseases it causes. The first successful drugs of this kind were nucleoside analogues. The best known of these drugs is zidovudine, sometimes called azidothymidine or AZT.

One of the most serious problems in developing treatments for AIDS is that HIV mutates (changes) rapidly. In a short period of time, it can become resistant to drugs that could once kill it. As those drugs become ineffective against the disease, new ones must be found to replace them. In 1997, the first of a new class of drugs was approved for use with AIDS patients. This class of drugs is the protease inhibitors and includes saquinavir (pronounced suh-KWIN-uh-ver). The protease inhibitors are now used by themselves or in combination with nucleoside analogues to kill the virus.

XI. Preventive Measures: 1. Sexual Contact - use of condoms - circumcision 2. Body Fluid Exposure- use of barriers (gloves, masks, protective eyeware or shields, and gowns or aprons) - proper disposal of needles, scalpels and glass 3. Mother-to-child Contact - Antiretroviral therapy administered to the mother during pregnancy, labor and delivery, and then to the newborn, as well as elective cesarean section for women with high viral loads (more than 1,000 copies/ml)