HIV

Guan Xuehua（Shirley）
ID：2019164271
What is HIV?
What is HIV?
• The human immunodeficiency viruses (HIV) are
two species of Lentivirus (a subgroup of
retrovirus) that causes HIV infection and over
time acquired immunodeficiency syndrome
(AIDS).
 What is HIV?
• Human: Infecting human beings
• Immunodeficiency: Decrease or
weakness in the body’s ability to fight off
infections and illnesses
• Virus: A pathogen having the ability to
replicate only inside a living cell
HIV
 What is AIDS?

AIDS is the final stage of the disease

caused by infection with a type of virus
called HIV.

6
 What is AIDS?
• Acquired: To come into possession of something
new
• Immune Deficiency: Decrease or weakness in the
body’s ability to fight off infections and illnesses
• Syndrome: A group of signs and symptoms that
occur together and characterize a particular
abnormality

7
 HIV vs. AIDS
• HIV is the virus that causes AIDS
• Not everyone who is infected with HIV has
AIDS
• Everyone with AIDS is infected with HIV
• AIDS is result of the progression of HIV
Infection
• Anyone infected with HIV, although healthy,
can still transmit the virus to another person
8
 How is HIV Transmitted?
• Unprotected sexual contact with an
infected partner
• Exposure of broken skin or wound to
infected blood or body fluids
• Transfusion with HIV-infected blood
• Injection with contaminated objects
• Mother to child during pregnancy, birth or
breastfeeding

9
Contents

1. Epidemiology
2. Etiology
3. Pathophysiology
4. Risk Factors
5. Symptoms and Signs
6. Diagnostic tests
7. Treatment
1.Epidemiology
EPIDEMIOLOGY : WORLD

• The first cases were reported in 1981.

• In 2001: The global prevalence rate has
leveled.
• In 2012: 0.8%（1.6 million people died）.

12
EPIDEMIOLOGY

Worldwide：
• Women represent about half (52%)
• the leading cause of death among women
Young people：
• ages 15–24,approximately 39%
Children：
• 3.3 million living infections（in 2012）
• 210,000 AIDS deaths

13
 Adults and children estimated to be
living with HIV, 2007

Total: 33.2 million 14

EPIDEMIOLOGY

Sub-Saharan Africa：
• 71%（12% of the world’s population）
• children(88%)

Latin America & The Caribbean：

• 1.6 million
• an adult HIV(1%)

15
EPIDEMIOLOGY

Eastern Europe & Central Asia:

• 1.3 million

Asia:
• 4.8 million(South/South-East Asia and
East Asia)

16
EPIDEMIOLOGY

In Nepal
In 1988：
• the first-ever AIDS case
In 2011：
• 0.30 per cent among（15–49 years）
• males (58%)
• females (28%)

17
2.Etiology
Etiology

• Human Immuno Deficiency Virus

• Size: 1/10,000th of a millimeter in diameter.
• Two types: HIV-1 and HIV-2
Etiology

• It is a protein capsule containing two short

strands of genetic material (RNA) and enzymes.
Etiology Types of HIV Virus

21
Etiology
Types of HIV Virus
• HIV 1
– Most common in sub-Saharan Africa and
throughout the world
– Groups M, N, and O
– Pandemic dominated by Group M
 Group M comprised of subtypes A - J

• HIV 2
– Most often found in West Central Africa, parts of
Europe and India

22
Etiology

Gravity of Different mode of Transmission:

* Sexual intercourse = 80-90 %
* Blood Transfusion = 3-15 %
* Injecting Drug users = 5 -10 %
* Equipments/Needles = < 0.1 %
* Perinatal = 0.1%

23
3.Pathophysiology
Pathophysiology

The seven stages of the HIV life cycle are:

1) binding,
2) fusion,
3) reverse transcription,
4) integration,
5) replication,
6) assembly, and
7) budding.
25
Pathophysiology

26
Pathophysiology
Binding (also called Attachment): HIV binds (attaches itself) to
receptors on the surface of a CD4 cell

Fusion: The HIV envelope and the CD4 cell membrane fuse (join
together), which allows HIV to enter the CD4 cell.

Reverse Transcription: Inside the CD4 cell, HIV releases and uses
reverse transcriptase (an HIV enzyme) to convert its genetic
material-HIV RNA-into HIV DNA.The conversion of HIV RNA to HIV
DNA allows HIV to enter the CD4 cell nucleus and combine with
the cell's genetic material-cell DNA

27
Pathophysiology
Integration: Inside the CD4 cell nucleus.HIV releases integrase (an
HIV enzyme). HIV uses integrase to insert (integrate) its viral DNA
into the DNA of the CD4 cell.

Replication: once integrated into the CD4 cell DNA, HIV begins to
use the machinery of the CD4 cell to make long chains of HIV
proteins.The protein chains are the building blocks for more HIV.

Assembly: New HIV proteins and HIV RNA move to the surface of
the cell and assemble into immature (noninfectious) HIV.

28
Pathophysiology

Buelding:Newly formed immature (noninfectious) HIV pushes

itself out of the host CD4 cell. The new HIV releases protease (an
HIV enzyme). Protease breaks up the long protein chains in the
immature virus, creating the mature (infectious) virus

29
4.Risk Factors
Risk Factors

Sex workers

Clients of sex workers

31
Risk Factors

Partners of migrants / house wives

32
Risk Factors

IDUs Labor migrant / Transport

workers

33
 Risk Factors

Street children

Health care workers

34
5.Symptoms and Signs
Symptoms and Signs

PHASES OF HIV INFECTION

1. Phase 1 (3-12 weeks)
 Acute HIV syndrome
 Sore throat
 Fever
 Skin rash
 Meningitis
 High viremia

36
Symptoms and Signs

PHASES OF HIV INFECTION

2. Middle chronic Phase(10-12 years)
 Competition between HIV and host immune
system
 Patient asymptomatic or has mild symptoms
 Moderate viremia

37
Symptoms and Signs

PHASES OF HIV INFECTION

3. Phase 3
 Full blown AIDS
 Severe immuno- suppression
 Drop in CD4 count below 200/µl (normal count:
> 950 CD4 cells/µl ）
 High viremia

38
Symptoms and Signs
AIDS-signs
1. Major
 Weight loss >10% body weight
 Chronic diarrhea >1 months duration
 Prolonged fever >1 month
2. Minor
 Recurrent oral-pharyngeal candidiasis
 Persistent generalized lymphadenopathy
 Persistent cough>1 month
 Recurrent herpes zoster
39
Symptoms and Signs

WHO Clinical Staging of HIV：

Clinical stage 1
Clinical stage 2
Clinical stage 3
Clinical stage 4

40
Diagnostic

41
Symptoms and Signs

WHO Clinical Stage I (APLA)

• Asymptomatic infection
• Persistent generalized Lymphadenopathy
• Acute retroviral infection

42
Symptoms and Signs
WHO Clinical Stage II(HUMR)
• Herpes zoster within previous 5 years
• Unintentional weight loss < 10%
• Recurrent upper respiratory tract infections
• Angular cheilitis
• Recurrent oral ulceration
• Papular pruritic eruption
• Fungal nail infections
• Seborrhoeic dermatitis
43
Symptoms and Signs
WHO Clinical Stage III(COUP VCOSP)
• Chronic diarrhea >1month
• Oral candidiasis
• Unintentional weight loss >10%
• Prolonged fever >1month
• Vulvovaginal Candidiasis >1month
• Oral hairy leukoplakia
• Severe bacterial infections
• Pulmonary tuberculosis (within the last year)

44
Symptoms and Signs
WHO Clinical Stage IV
• Atypical mycobacter iosis
• Nontyphoid Salmonella septicemia
• Extra pulmonary TB
• Cytopmegalovir al disease of an organ other
than liver, spleen, or lymph node
• Herpes simplex virus infection
• Any disseminated endemic mycosis
• Candidiasis of the esophagus, trachea, bronchi,
and lungs
45
Symptoms and Signs
WHO Clinical Stage IV
• Toxoplasma of the brain
• Cryptosporidiosis with diarrhea >1month
• Isosporiasis with diarrhea
• Extrapulmonary cryptococcosis
• HIV wasting syndrome
• HIV encephalopathy
• Lymphoma
• Kaposi’s sarcoma

46
6.Diagnostic
Diagnostic

Types of Test are

• ANTIBODY TESTS (ELIZA, RAPID TEST,
WESTERN BLOT)
• VIROLOGICAL TEST (HIV antigen test, DNA
PCR(below 18 month), Viral culture)
•Other:CD4 Cell Count with Percentage,In-
Home Test Kits

48
Diagnostic

ELIZA= Enzyme linked immunosorbant assy

• Positive → the Western blot test（confirm）
• Negative →be tested again（between three
and 12 weeks）

When used in combination with the confirmatory

Western blot test, ELISA tests are 99.9%
accurate.

49
Diagnostic

Rapid test: ( Single test)

- Celerity
- Determine
- Simplify
- No needle
- Less harmful

50
Diagnostic
Western blot test：
• The Western blot test separates the blood
proteins and detects the specific proteins
(called HIV antibodies) that indicate an HIV
infection.
• The Western blot is used to confirm a positive
ELISA, and the combined tests are 99.9%
accurate.

51
Diagnostic

52
Diagnostic

When used in combination with the confirmatory

Western blot test, ELISA tests are 99.9% accurate.
53
Diagnostic
Polymerase Chain Reaction (PCR)
• Polymerase chain reaction (PCR) tests are
used to detect HIV's genetic material, called
RNA.
• This test may be performed just days or
weeks after exposure to HIV.
• They are expensive and also time- and labor-
intensive.

54
Diagnostic
Viral culture
Three technologies measure HIV viral load in
the blood:
① Reverse transcription polymerase chain
reaction (RT-PCR),
② branched DNA (bDNA) ，
③ Nucleic acid sequence-based amplification
assay (NASBA).

55
Diagnostic
CD4 Cell Count with Percentage:
• Detection of related complications,
• Best laboratory indicators,
• May be affected by drugs, and
• Small variability

56
Diagnostic

HIV RNA Levels and CD4 Cell Counts and Risk of Developing AIDS 57
Diagnostic
In-Home Test Kits
Two kits are available in the U.S. (Make sure
the one you choose is FDA-approved)：
• One option is to prick your finger to get a
small blood sample that you send to a lab.
• You'll swab your upper and lower gums and
test the sample in a vial. You get a result in 20
minutes.

58
7.Treatment
Treatment（Drug therapy）

There's no cure for HIV/AIDS, but

many different drugs are available to
control the virus. Such treatment is
called antiretroviral therapy( ART).

60
Treatment（Drug therapy）

Five categories：
1.Non-nucleoside reverse transcriptase inhibitors
(NNRTIs) turn off a protein needed by HIV to make
copies of itself.

Examples include efavirenz (Sustiva), etravirine

(Intelence) and nevirapine (Viramune).

61
Treatment（Drug therapy）
Five categories：
2.Nucleoside or nucleotide reverse transcriptase
inhibitors (NRTIs) are faulty versions of the building
blocks that HIV needs to make copies of itself.

Examples include Abacavir (Ziagen), and Descovy

(tenofovir alafenamide/emtricitabine), and
lamivudine-zidovudine (Combivir).

62
Treatment（Drug therapy）
Five categories：
3.Protease inhibitors (PIs) inactivate HIV
protease, another protein that HIV needs to make
copies of itself.

Examples include atazanavir (Reyataz), darunavir

(Prezista), fosamprenavir (Lexiva) and indinavir
(Crixivan).

63
Treatment（Drug therapy）

Five categories：
4.Entry or fusion inhibitors Tblock HIV's entry into
CD4 T cells.

Examples include enfuvirtide (Fuzeon) and

maraviroc (Selzentry).

64
Treatment（Drug therapy）

Five categories：
5.Integrase inhibitors work by disabling a protein
called integrase, which HIV uses to insert its
genetic material into CD4 T cells.

Examples include raltegravir (Isentress) and

dolutegravir (Tivicay).

65
Treatment（Drug therapy）

Five categories：
5.Integrase inhibitors work by disabling a protein
called integrase, which HIV uses to insert its
genetic material into CD4 T cells.

Examples include raltegravir (Isentress) and

dolutegravir (Tivicay).

66
Treatment（Drug therapy）

Current Department of Health and Human

Services (DHHS) guidelines on the timing of
initiation of antiretroviral therapy are as follows :

1.Antiretroviral therapy should be initiated in all

patients with a history of an AIDS-defining illness
or with a CD4 count below 350/µL.

67
Treatment（Drug therapy）

Current Department of Health and Human

Services (DHHS) guidelines on the timing of
initiation of antiretroviral therapy are as follows :

2.Antiretroviral therapy should be initiated

regardless of CD4 count in pregnant patients,
patients with HIV-associated nephropathy, and
those with hepatitis B virus (HBV) coinfection
when treatment of HBV infection is indicated.

68
Treatment（Drug therapy）

Current Department of Health and Human

Services (DHHS) guidelines on the timing of
initiation of antiretroviral therapy are as follows :

3.Panel divided on initiation of therapy with CD4

counts of 350-500/µL; 55% considered this a
strong recommendation, 45% considered it a
moderate recommendation.

69
Treatment（Drug therapy）

Current Department of Health and Human

Services (DHHS) guidelines on the timing of
initiation of antiretroviral therapy are as follows :

4.Panel also divided on initiation of therapy with

CD4 counts above 500/µL: half favored initiation
in this setting, and half considered treatment
initiation optional.

70
Treatment（Drug therapy）

Limitations of ART：
• ART does not CURE HIV infection
• With currently available medications, the
virus can never be completely eradicated, so
the person should take the drugs forever,
even if symptoms have disappeared.

71
Treatment（Drug therapy）

ART : Therapy
• Reduce viral load: halt disease
• Prevent & reduce resistant variant
• Achieve immune reconstitution ( > CD-4)
• Prolong & improve quality of life.

72
Treatment（Drug therapy）

Post exposure prophylaxis

• Candidates:
– Health care workers with needle prick injury
– Condom breakage
– Victims of rape
– Relapses in IV drug users
• First dose to be taken as soon as possible
(within hours).

73
Treatment（Drug therapy）
Principles of PEP Management:
• Exposure Site Management
• Exposure Reporting
• Evaluation of transmission Risk
• Counselling
• Consideration of PEP
• Follow up: 6 W, 12W, 6M
Area of Uncertainty: 99.7% occupational injury
involving percutaneous exposure to HIV do not
transmit infection.
74
Treatment（Drug therapy）

PEP
Immediate measures
• Use soap and water
• Antiseptics not better

75
Treatment（Drug therapy）

Follow up
• For 6 months.
• Tested at base line, 6Wks, 12 Wks & 6 Months.
• Monitor drug toxicity
• Counseling
• Behavioural precautions.

76
 Treatment（NURSING）
13 Nursing Care Plans (NCP) and nursing diagnosis :

1.Imbalanced Nutrition: Less Than Body Requirements

2.Fatigue
3.Acute/Chronic Pain
4.Impaired Skin Integrity
5.Impaired Oral Mucous Membrane
6.Disturbed Thought Process

77
Treatment（NURSING）

7.Anxiety/Fear
8.Social Isolation
9.Powerlessness
10.Deficient Knowledge
11.Risk for Injury
12.Risk for Deficient Fluid Volume
13.Risk for Infection
14.Other Possible Nursing Care Plans

78
Treatment（NURSING）
How to prevent AIDS？

A (abstinace)
B (be faithful)
C (condom)
D (do not use drugs)
E (equipment)

79
Treatment（Health education）
Health education
• Prevention from infection
• Use of boiled water and well cocked food
• Use of proper/clean latrine, kitchen and bath-room
• Perform proper hand hygiene
• Avoid play with pets
• Maintain Perineal hygiene
• Have safe sex practice

80
Treatment（Health education）
Health education
• Treat any infection promptly
• Not to let down self confidence
• Not to depressed with social behaviors
• Eat balanced diet
• Engaged in diversnal activities
• Use of sterile syringe and needles
• Made the family members to accept the situations

81
 REFERENCES
① Weiss RA (May 1993). "How does HIV cause AIDS?". Science. 260 (5112):
②1273–9. Bibcode:1993Sci...260.1273W. doi:10.1126/science.8493571. PMID 8493571.
③ ^ Douek DC, Roederer M, Koup RA (2009). "Emerging Concepts in the
Immunopathogenesis of AIDS". Annual Review of Medicine. 60: 471–
84. doi:10.1146/annurev.med.60.041807.123549. PMC 2716400. PMID 18947296.
④ ^ UNAIDS, WHO (December 2007). "2007 AIDS epidemic update" (PDF). p. 10.
Retrieved March 12, 2008.
⑤ ^ Jump up to:a b c d Rodger, Alison J.; Cambiano, Valentina; Bruun, Tina; Vernazza,
Pietro; Collins, Simon; Degen, Olaf; et al. (2019). "Risk of HIV transmission through
condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive
antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational
study". The Lancet. 393 (10189):2428–2438. doi:10.1016/S0140-6736(19)30418-
0. PMC 6584382. PMID 31056293.
⑥ ^ Jump up to:a b Eisinger, Robert W.; Dieffenbach, Carl W.; Fauci, Anthony S. (2019).
"HIV viral load and transmissibility of HIV infection: Undetectable equals
untransmittable". JAMA. 321 (5): 451–452. doi:10.1001/jama.2018.21167. PMID 30629090.
⑦ "Preventing Mother-to-Child Transmission of HIV". HIV.gov. May 15, 2017.
Retrieved December 8, 2017. This article incorporates text from this source, which is in
the public domain.
⑧ Reeves JD, Doms RW (2002). "Human Immunodeficiency Virus Type 2" (PDF). Journal
of General Virology. 83 (Pt 6): 1253–65. doi:10.1099/0022-1317-83-6-1253. PMID 12029140.
82