Etiologic Agent

Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus

 most familiar of the retroviruses

Other Names:
 human T-lymphotropic virus-III (HTLVIII), lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus (ARV)

Morphology
Spherical Lipid envelope that contains glycoproteins Cone-shaped capsid Contains 2 copies of single-stranded RNA Medium-sized virus diameter- 120 nm Has several molecules of reverse transcriptase

Microscopic view and Anatomy of the HIV

Diseases it cause
Acquired Immune Deficiency Syndrome (AIDS)  a disease of the human immune system leading to depletion of CD4 helper T-lymphocyte cells  This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors.

Different Complications:
Pulmonary Disease
Pneumocystis pneumonia
 relatively rare in people with normal immune systems but common among people with weakened immune system especially AIDS patients

Other bacterial, mycobacterial and viral pneumonia

Central Nervous System 4 categories: Intracerebral space-occupying lesions Encephalopathy Meningitis Spinal cord processes

Rheumatologic and Ocular Arthritis Reiter Syndrome Systemic Lupus Erythematosus (SLE) Retinitis

Oral Hairy Leukoplakia Oral Candidiasis Gingival Disease Aphthous Ulcers

Aphthous ulcers

Oral candidiasis Hairy leukoplakia

Gastrointestinal Esophageal Candidiasis Gastropathy and malabsorption Enterocolitis Cholecystitis

Skin Staphylococcus Herpes simplex and herpes zoster Kaposis sarcoma Seborrheic dermatitis
Herpes zoster

Kaposis sarcoma

Herpes simplex

Seborrheic dermatitis

Malignancies Kaposis sarcoma Anal dysplasia and squamous cell carcinoma

Gynecologic Vaginal candidiasis Cervical dysplasia Cervical cancer Pelvic inflammatory disease

Mode of Transmission:
Sexual contact Parenteral Vertical

Incubation Period:
varies from several months to many years

Pathogenesis
1. 2. 3. 4. 5. 6. 7. 8. 9. Binding Fusion Uncoating Reverse transcription Genome integration Genome replication Protein synthesis Protein cleavage Virus assembly and spread

The Clinical Course of Infection

Four Stages:  Incubation period-is asymptomatic and usually lasts between two and four weeks.  Acute infection-lasts an average of 28 days and can include symptoms such as fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, myalgia (muscle pain), malaise, and mouth and esophageal sores.  Latency stage-shows few or no symptoms and can last anywhere from two weeks to twenty years and beyond  AIDS-the fourth and final stage of HIV infection shows as symptoms of various opportunistic infections

Clinical Manifestation
*PHYSICAL: *MENTAL: -Maculo-papular rashes -Forgetfulness -Weight loss -Fever -Malaise -Persistent diarrhea -Aesophageal candidiasis -Kaposis sarcoma -Pneumocystis pneumonia -Gaunt-looking

*EARLY STAGE: -loss of concentration -loss of libido -apathy -psychomotor retardation

*LATER STAGE:
-confusion -disorientation -seizures -mutism -loss of memory -myelopathy -coma

Diagnosis
ELISA- Enzyme-linked immunosorbent assay -presumptive or screening test -laboratory test used to detect specific antigens or antibodies Western blot test- confirmatory test -laboratory blood test to detect antibodies to specific antigens. -used to check the validity of the ELISA

Treatment
-depends largely on targeting viral reverse transcriptase and protease enzymes -no drug can cure HIV/AIDS but when used in combination, drugs can delay the appearance of symptoms HAART-Highly Active Antiretroviral Theraphy -uses a combination of several antiretroviral drugs -slows down the development of AIDS

Antiviral Medicines
Nucleoside reverse transcriptase inhibitors (NRTIs; abacavir) didanosine, lamivudine, stavudine, zalcitabine, zidovudine Nucleotide inhibitors- tenofovir Nonnucleotide reverse transcriptase inhibitors (NNRTIs; delavirdine,efavirenz,navirapine) Protease inhibitors (amprenavir, indinavir, nelfinavir, ritonavir, saquinavir) Fusion inhibitors (enfuvirtide)

HIV Prophylaxis for Opportunistic Infections

ORGANISM
Pneumocystis jiroveci (PCP) Toxoplasma gondii Mycobacterium avium (MAC)

CD4 COUNT
<200/mm3 <100/mm3 <50/mm3

TREATMENT
TMP-SMX TMP-SMX Azithromycin

Prevention
Maintain monogamous relationship Avoid promiscuous sexual contact Sterilize needles, syringes, and instruments used for cutting operations Proper screening of blood donors Rigid examination of blood and other products for transfusion Avoid oral, anal contact and swallowing of semen Use of condoms and other protective device

Reported by:
Jessa A. Urriza BSN III-A