ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) 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 (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. It is the final and most serious stage of HIV disease. II. Synonyms GRID (Gay-Related Immune Deficiency) 4H disease (Haitians, Homosexuals, Hemophiliacs, Heroin) III. Morphological Description/Pathophysiology Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes AIDS. HIV attaches with its new host body CD4 cells (Tcells). Inside the T-cells, HIV changes its body to be part of the persons DNA. At this point, the body is now forced to produce the virus. *Life Cycle of HIV cells HIV cells -> Glycoprotein 140 -> CD4 cells receptors -> removal of HIV envelope -> Reverse Transcriptase which converts the viral RNA to DNA -> incorporated to human DNA by disintegrase -> formation of viral protein -> divided by protease -> new HIV cells IV. Mode of Transmission The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and perinatal transmission. HIV is transmitted through direct contact with a bodily fluid containing HIV. V. Signs and Symptoms The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called opportunistic infections. People with AIDS have had their immune system depleted by HIV and are very susceptible to these opportunistic infections. Common symptoms are fevers, sweats (particularly at night), swollen lymph glands, chills, weakness, and weight loss usually 2 weeks after contracting the virus. Some people with HIV infection remain without symptoms for years between the time they are exposed to the virus and when they develop AIDS. VI. Laboratory Test

HIV test. HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. ELISA. The enzyme-linked immunosorbent assay (ELISA) was the first screening test commonly employed for HIV. It has a high sensitivity. It is based on the principle of antibody-antibody interaction. This test allows for easy visualization of results and can be completed without the additional concern of radioactive materials use. ELISA results are reported as a number. Western blot. Like the ELISA procedure, the western blot is an antibody detection test. However, unlike the ELISA method, the viral proteins are separated first and immobilized. In subsequent steps, the binding of serum antibodies to specific HIV proteins is visualized. Rapid HIV Test. These tests are based on the same technology as ELISA tests, but instead of sending the sample to a laboratory to be analyzed, the rapid test can produce results within 20 minutes. Rapid tests can use either a blood sample or oral fluids. They are easy to use and do not require laboratory facilities or highly trained staff. All positive results from a rapid test must be followed up with a confirmatory test, the results of which can take from a few days to a few weeks. HIV PCR Test. It is a blood test that is used to determine the amount of HIV virus in a persons blood. The PCR test is very useful to find a very recent infection, determine if an HIV infection is present when antibody test results were uncertain, and screen blood or organs for HIV before donation. p24 Antigen Test. detects the presence of the p24 protein of HIV (also known as CA), the capsid protein of the virus. Monoclonal antibodies specific to the p24 protein are mixed with the person's blood. Any p24 protein in the person's blood will stick to the monoclonal antibody and an enzyme-linked antibody to the monoclonal antibodies to p24 causes a color change if p24 was present in the sample.

VII. Period of Communicability AIDS begins with HIV infection. People infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. Meanwhile, if the infection is not detected and treated, the immune system gradually weakens, and AIDS develops. Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3). VIII. Prognosis Without treatment, survival time after infection with HIV is estimated to be 9 to 11 years. 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. 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 IX. Complications Opportunistic Infections is an infection caused by pathogens that causes disease

Full Blown HIV - immune system functions very little if at all and is susceptible to all infections Pneumocystis pneumonia (PCP) caused by Pneumocystis jirovecii.

Tuberculosis is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, and is not easily treatable once identified. Esophagitis - an inflammation of the lining of the lower end of the esophagus. In HIV-infected individuals, this is normally due to fungal (candidiasis) [*also side effects of steroids] or viral (herpes simplex-1 or cytomegalovirus) infections. Unexplained chronic diarrhea - many possible causes, including common bacterial and parasitic infections; and uncommon opportunistic infections. Wasting Syndrome - a condition where AIDS patient lose 10% of body weight.

AIDS dementia complex (ADC) - a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. T Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4+ T cell levels and high plasma viral loads. Tumors- Patients with HIV infection have substantially increased incidence of several cancers. Two known cancers related to HIV include Kaposis sarcoma results from tumor in the blood vessel wall that appears as disfiguring lesions in the skin and mouth. Non-Hodgkins Lymphoma originates from lymphocytes that appear as swelling of the lymph nodes. X. Treatment There is no cure for AIDS. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life of those who have already developed symptoms. Intake of Entry Inhibitor (EI) which attaches with either T-cells or HIV to prevent binding. Nucleoside Reverse Transcriptase Inhibitor (NRTI) stops the process of converting RNA to DNA by interfering with the nucleotides that converts RNA to DNA. While Non-Nucleoside Reverse Transcriptase (NNRTI) attaches themselves to reverse transcriptase enzymes to prevent the virus from converting RNA to DNA. Protease Inhibitor (PI) stops viral assembly of HIV by blocking protease enzymes from cutting up the genetic material that will be HIV thus stopping production of new cells. Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed highly active antiretroviral therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream, as measured by the viral load (how much virus is found in the blood). When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for the treatment of drug-resistant HIV. Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise (a general sick feeling), and fat accumulation on the back ("buffalo hump") and abdomen. When used for a long time, these medications increase the risk of heart attack perhaps by increasing the levels of fat and glucose in the blood. *EI Fuzeon *NRTI Zudovidine (AZT) *NNRTI Sustiva, Rescriptor, Aptrivla, Viramune *PI Aptivus, Kaleptra, Viracept

XI. Preventive Measures 1. 2. 3. 4. See and read articles on safe sex to learn how to reduce the chance of acquiring or spreading HIV, and other sexually transmitted diseases. Do not use injected drugs. If IV drugs are used, do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones for free. These programs can also provide referrals to addiction treatment. Avoid contact with another person's blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured. Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. An infected person should tell any prospective sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use whatever preventive measures (such as condoms) will give the partner the most protection. HIV-positive women who wish to become pregnant should seek counseling about the risk to unborn children, and medical advances that may help prevent the fetus from becoming infected. Use of certain medications can dramatically reduce the chances that the baby will become infected during pregnancy. Mothers who are HIV-positive should not breast feed their babies. Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. However, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV. END

5. 6. 7.