Human

Immunodefecien
cy Virus Infection

Prof. Sanaa M. Kamal

Epidemiology

HIV infection is usually diagnosed through blood

Epidemiology
tests detecting the presence or absence of HIV
antibodies.
Preventable, manageable but not curable. .
Effective treatment with antiretroviral drugs can
control the virus so that people with HIV can enjoy
healthy and productive lives.
In 2012, more than 9.7 million people living with HIV

 When the immune system becomes

weakened by HIV, the illness progresses

to AIDS

Some blood tests, symptoms or certain

infections indicate progression of HIV to

AIDS

Microbiology of HIV
Human Immunodeficiency Virus (HIV)

Retrovirus
RNA viruses (RNA is their basic genetic
material)
Belongs to the lentivirus subgroup
1. HIV-1 produces the acquired
immunodeficiency syndrome (AIDS)
2. HIV-2 produces a similar disease that
is at present, largely restricted to West
Africa.
Has the enzyme reverse transcriptase that can
make DNA from the RNA and allow them to
integrate into the host cell genome
HIV virus targets the host immune system
Infects CD4+ T cells and macrophages.

 Coughing, sneezing

Public baths

Insect bites

Touching, hugging
Water, food
Kissing

Handshakes
Work or school contact
Using telephones
Sharing cups, glasses,
plates, or other
utensils

HIV makes contact with cells located within the

genital mucosa
Virus is carried to regional lymph nodes
(1-2 Days)
Exponential viral replication
Widespread systemic
dissemination to the brain,
spleen, distant lymph nodes,
etc. (5-11 Days)
9

HIV ATTACKS T-Cells

HIV binds to two protein
receptors on cells surface :
CD4 and a co-receptor,
usually CCR5.
Host cell membrane and
viral coat fuse and virus
contents enter cell.

I
1. Infection: The moment the
virus gets into the body
2. Window period: The time
between infection & enough
antibodies for a positive HIV
test
3. Seroconversion: The body
starts to make antibodies

II
Asymptomatic
period:
No illness

III
HIV/AIDS-related
illness: Less
serious illnesses
AIDS: Serious
illnesses

Duration of different phases of HIV/AIDS will vary

in different people
It is not possible to predict the course of the
disease in any one person
Factors affecting the course of HIV/AIDS include
nutrition, emotional stress, and access to health
care
People infected with HIV can infect others at any
phase of the disease
13

Progression of HIV
Acute Seroconversion
Asymptomatic HIV (Clinical
latency)
Symptomatic HIV
Acquired Immune Deficiency
Syndrome (AIDS)

14

Patterns of HIV Progression

1. Typical progressors
2. Rapid progressors
3. Slow progressors
4. Long-term non-progressors

15

Lasts for an average of ten years

This stage is free from symptoms
There may be lymphadenopathy
The level of HIV in the blood
drops to low levels
HIV antibodies are detectable in
the blood

 The immune system

deteriorates

Opportunistic infections
and cancers start to
appear.

The immune system

weakens too much as CD4
cells decrease in number.

I. CD4<500
1.
2.
3.
4.
5.
6.
7.

Bacterial infections
Tuberculosis (TB)
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposis sarcoma

CD4<200
1.Pneumocystic carinii
2.Toxoplasmosis
3.Cryptococcosis
4.Coccidiodomycosis
5.Cryptosporiosis
6.Non hodgkins
lymphoma

CD4 <50
1. Disseminated mycobacterium avium complex
(MAC) infection
2. Histoplasmosis
3. CMV retinitis
4. CNS lymphoma
5. Progressive multifocal leukoencephalopathy
6. HIV dementia

HIV enzyme-linked
immunosorbent assay (ELISA)

Screening test for HIV

Sensitivity > 99.9%

Western blot

Confirmatory test
Specificity > 99.9% (when combined with
ELIZA)

HIV rapid antibody test

Screening test for HIV

Simple to perform

Absolute CD4 lymphocyte count

Predictor of HIV progression

Risk of opportunistic infections and AIDS
when <200

HIV viral load tests

Best test for diagnosis of acute HIV

infection
Correlates with disease progression and
response to HAART

If the source patient has unknown HIV status, twodrug PEP is indicated based on the source patients HIV
risk factors.
In such patients, rapid HIV testing also is indicated to
aid in determining the need for PEP.
When the source HIV status is unknown, PEP is
indicated in settings where exposure to HIV-infected
persons is likely.
If PEP is indicated, it should be started as quickly as
possible.

 Nucleoside Reverse

Transcriptase inhibitors
AZT (Zidovudine)
Non-Nucleoside
Transcriptase inhibitors
Viramune
(Nevirapine)
Protease inhibitors
Norvir (Ritonavir)

Two nucleosides for low-risk

exposures
Two nucleosides plus a boosted
protease inhibitor for high-risk
exposures.

Examples of commonly used dual nucleoside

regimens are Zidovudine plus Lamivudine
(coformulated as Combivir) or Tenofovir plus
Emtricitabine (coformulated as Truvada).
Current recommendations indicate that PEP should
be continued for four weeks, with concurrent
clinical and laboratory evaluation for drug toxicity.

 Nucleoside Reverse

Transcriptase inhibitors
AZT (Zidovudine)
Non-Nucleoside
Transcriptase inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)

 Nucleoside Reverse

Transcriptase inhibitors
AZT (Zidovudine)
Non-Nucleoside
Transcriptase inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)

Two nucleosides for low-risk

exposures
Two nucleosides plus a boosted
protease inhibitor for high-risk
exposures.

Examples of commonly used dual

nucleoside regimens are Zidovudine
plus Lamivudine (coformulated as
Combivir) or Tenofovir plus Emtricitabine
(coformulated as Truvada).
Current recommendations indicate that
PEP should be continued for four
weeks, with concurrent clinical and
laboratory evaluation for drug toxicity.

VACCINE ISSUES IN HIV+

Patients
Potential exposure to pathogen
Potential increase in side effects to
vaccine
Potential decreased efficacy of
vaccine

NY/NJ AETC Stuart Haber, MD

VACCINES

VACCINES
Killed (inactivated): Hepatitis A, Inactivated

Polio (IPV), Rabies, Japanese encephalitis

Live (attenuated): MMR, Yellow fever, oral
Typhoid
Subunit: Hepatitis B
Polysaccharide: Pneumococcal,
Meningococccal, Typhoid Vi
Split antigen: Influenza

FOLLOW UP OF HIV
INFECTED PATIENTS
For HIV-infected individuals with CD4 < 200
cells/mcL:
Pneumocystis jiroveci1 prophylaxis
For HIV-infected individuals with CD4 < 75
cells/mcL:
Mycobacterium avium complex prophylaxis
For HIV-infected individuals with CD4 < 50
cells/mcL:
Consider CMV prophylaxis