HIV and AIDS

Acquired Immunodeficiency
Syndrome
Disease caused by an infectious
agent:
a retrovirus

1
2
 HIV and AIDS
an infectious agent

In Los Angeles 1967-1978 only two cases of

Pneumocystis carinii pneumonia

• 1979 - 5 cases of
Pneumocystis carinii

All Homosexual

3
 HIV and AIDS
an infectious agent – Kaposi’s Sarcoma

Early 1981 : 5 cases of

Kaposi’s sarcoma
Hitherto: rare

• 1981 - 26 cases of Kaposi’s

sarcoma
• Young
• San Francisco and
New York 4
 HIV and AIDS
Two rare diseases in the gay community
linked to

IMMUNOSUPPRESSION

OPPORTUNISTIC INFECTIONS
Also
Lymphadenopathy
Hodgkin’s Lymphoma

5
HIV and AIDS

Candida infections are

common with AIDS, but most
often appear as oral thrush,
which is a nuisance but not
life-threatening. 6
 HIV and AIDS

Distinguishing characteristics

• Clusters of infected men

• Apparent concentration within
sexually interactive groups
• High numbers of sex partners

Suggests an
infectious agent
7
 HIV and AIDS

Obvious agent:
A virus……that is
now in the blood
supply
Primary route of
transmission: Sex
AIDS is a sexually-transmitted disease
8
 AIDS
Definition
• AIDS is currently defined in persons
older than 13 years as the presence of
one of 25 conditions indicative of severe
immunosuppression
• HIV infection in an individual with a
CD4+ cell count of <200 cells per cubic
mm of blood.
• AIDS is therefore the end point of an
infection that is continuous, progressive
and pathogenic

• With the prevalence of HIV in the

developing world, HIV and its 9
 AIDS
Statistics
Approximately 8500 new HIV infections
occur daily around the world
Over 90% of these are in developing
countries
1000 are in children less than 15 years of
age.
Of adult infections, 40% are in women and
15% in individuals 15-25 years.

As of December 1999, 733,374 Americans

reported with AIDS. At least 430,441 of
them have died.
10
 AIDS Statistics
Sub-Saharan Africa
• About 1 million new cases of AIDS per year

• 24 million people with HIV infection

• AIDS is responsible for a decrease in life

expectancy and increase in child mortality. Child
mortality rates in East Africa will double by 2010
and adult life expectancy has already declined by 2
years in that region.

• Several countries in sub-Saharan Africa report

infection rates of 20-25%, especially urban areas.
11
•Botswana: 35.8% of adult population infected
 AIDS Statistics
South and East Asia
• In south and east Asia
there are more than
200,000 new cases per
year and 7.3 million
people with HIV

Worldwide

• Current estimates
are that in 2000, 34.3
million people have 12
 Biological Properties

Membrane: host derived

Two glycoproteins: gp160 gp120 and
gp41
gp41 is fusogen that spans the membrane
There are two distinct types of human AIDS viruses13
Virus receptor

HIV uses as a receptor the CD4

molecule, which is expressed on
macrophages and T lymphocytes. A second
co-receptor in addition to CD4 is necessary for
HIV-1 to gain entry to cells 。 The second
receptor is required for fusion of the virus with
the cell membrane 。 CCR5 is the
predominant co-receptor for macrophage-
tropic strains of HIV-1 ； is the co-receptor for
lymphocyte-tropic strains of HIV-1 。 14
HIV - Life History

A retrovirus
• Latency
• Specific destruction of
CD4+ cells

• How does the virus

enter the cell?

15
 Disinfections and inactivation
 HIV is completely inactivated by treatment
for 10 minutes at room temperature with
any of the following ：
50%ethanol ， 35% isopropanol ， 0.3%
hydrogen peroxide 。 The virus is also
inactivated by extremes in pH （ pH
1.0and 13.0 ） .HIV is readily inactivated
in liquids or 10% serum by heating at
56℃ for 10 minutes
16
 Pathogenesis
 Sources and routes of transmission ：
Patients with AIDS and asymptomatic virus-positive
individuals can transmit the virus 。
HIV is transmitted
--during sexual contact （ homosexual and
heterosexual activity and including genital-oral
sex ）；
--through parenteral exposure to contaminated
blood or blood products contaminated clotting factor
injection ； intravenous drug abusers are infected
through the use of contaminated needles
--and from mother to child during the perinatal
period （ in utero ， during the birth process ， or
more commonly ， through breast feeding ） 17
 Overview of course of HIV infection

 The typical course of untreated HIV infection

spans about a decade stages 10 年 include the
primary infection ， dissemination of virus to
lymphoid organs ， clinical latency ， elevated
HIV expression ， clinical disease (AIDS) ， and
death 。 In untreated cases ， death usually
occurs within 2 years ， after the onset of clinical
symptoms

18
 Following primary infection ， there is a 4- to 11-
day period between mucosal infection and initial
viremia ； The viremia is detectable for about 8-12
weeks 。 An acute mononucleosis-like syndrome
develops in many patients (50-75%) 3-6 weeks after
primary infection 。 Symptoms of acute HIV infection
are nonspecific and include
fatigue ， rash ， headache ， nausea ， and night
sweats 。

19
This period of clinical latency may last for as long as
10 years 。 During this time there is a high level of
ongoing viral replication 。 Eventually, the patient
will develop constitutional symptoms and clinically
apparent disease ， such as opportunistic infections
or neoplasms (especially Kaposi's sarcoma) 。 The
more serious symptoms in adults are often preceded
by a prodrome that can include fatigue ， malaise ，
weight loss ， fever ， shortness of breath ， chronic
diarrhea ， white patches on the tongue ， and
lymphadenopathy

20
Kaposi's sarcoma is a vascular tumor that
appears in skin ， mucous
membranes ， lymph nodes, and visceral
organs 。 It was considered to be a very rare
cancer 。 It is now 20 ， 000 times more
common in untreated AIDS patients than in
the general population.

21
 Treatment and Prevention

 Antiviral drugs
 Vaccines against HIV
 Control measures
 Health education

22
 Remember!
• Education led to leveling off of
rate of increase in AIDS
• HAART has greatly slowed death
rate
•The fact that fewer people are
dying per year from the infection
means that the number of HIV-
infected people in the population is
rising!
• Unless education continues to be
successful and unless we can cure 23