THE HUMAN IMMUNODEFICIENT VIRUS

Arley Gómez Lopez. MD.,MSc.,PhD Coordinador Unidad de Medicina Tropical y Enfermedades infecciosas

HIV EPIDEMIOLOGY
‡Number of people living with HIV in 2007
‡Total Adults million] Women million] Children under 15 years 33 million [30 ± 36 million] 30.8 million [28.2 ± 34.0 15.5 million [14.2 ± 16.9 2.0 million [1.9 ± 2.3 million]

‡People newly infected ‡with HIV in 2007 ‡AIDS deaths ‡in 2007

‡Total Adults Children under 15 years 000]

2.7 million [2.2 ± 3.2 million] 2.3 million [1.9 ± 2.8 million] 370 000 [330 000 ± 410

‡Total Adults Children under 15 years 000]

2.0 million [1.8 ± 2.3 million] 1.8 million [1.6 ± 2.1 million] 270 000 [250 000 ± 290

‡Global summary of the AIDS epidemic, December 2007 ± JULY 2008 Data WHO

HIV EPIDEMIOLOGY
‡ People living with HIV ‡ New HIV infections in 2007 ‡ Deaths due to AIDS in 2007
33 million [30 ± 36 million] 2.7 million [2.2 ± 3.2 million] 2.0 million [1.8 ± 2.3 million]

‡Global summary of the AIDS epidemic, December 2007 ± JULY 2008 Data WHO

HIV EPIDEMIOLOGY
‡Adults & children living with HIV
‡Latin America

‡Adults & children newly infected with HIV

‡Adult prevalence (15 49) [%]

‡Adult & child ‡deaths due to AIDS

‡1.7 million ‡[1.5 ± 2.1 million]

‡140 000 ‡[88 000 ± 190 000]

‡0.5% ‡[0.4% ± 0.6%]

‡63 000 ‡[49 000 ± 98 000]

‡Global summary of the AIDS epidemic, December 2007 ± JULY 2008 Data WHO

HIV EPIDEMIOLOGY
Children (<15 years) estimated to be living with HIV, 2007

‡North America

‡4400
‡[2600 ² 7300]

‡Sub-Saharan Africa ‡Latin America

‡44 000
‡[37 000 ² 58 000]

‡1.8 million
‡[1.7 ² 2.0 million]

HIV EPIDEMIOLOGY
Estimated deaths in children (<15 years) from AIDS, 2007

‡North America

‡4400
‡[2600 ² 7300]

‡Sub-Saharan Africa ‡Latin America

‡44 000
‡[37 000 ² 58 000]

‡1.8 million
‡[1.7 ² 2.0 million]

HIV VIRUS PARTICLES

HIV VIRUS PARTICLES

HIV VIRUS PARTICLES

HIV I and HIV II

WHAT ARE THE DIFFERENCES?

‡ HIV II is less easy transmitted ‡ Incubation period is longer in case of HIV II ‡ More frequent in West Africa

How many subtypes of HIV-1 are there?
HIV I

Gr. M

Gr. N

Gr. O

A

B

C

D

F

G

H

J

K

CRFs

How many subtypes of HIV-1 are there?
‡ One of the CRFs is called A/E because it is thought to have resulted from hybridization between subtype A and some other "parent" subtype E. ‡ A virus isolated in Cyprus was originally placed in a new subtype I, before being reclassified as a recombinant form A/G/I

Where are the different subtypes and CRFs found?
‡ Subtype A and CRF A/G predominate in West and Central Africa ‡ Subtype B has been the most common subtype/CRF in Europe, the Americas, Japan and Australia. ‡ Subtype C is predominant in Southern and East Africa, India and Nepal

Where are the different subtypes and CRFs found?
‡ Subtype D is generally limited to East and Central Africa. CRF A/E is prevalent in South-East Asia, but originated in Central Africa. ‡ Subtype F has been found in Central Africa, South America and Eastern Europe. ‡ Subtype G and CRF A/G have been observed in West and East Africa and Central Europe ‡ Subtype H has only been found in Central Africa; J only in Central America; and K only in the Democratic Republic of Congo and Cameroon.

Are more subtypes likely to "appear"?
‡ It is almost certain that new HIV genetic subtypes and CRFs will be discovered in the future ‡ Indeed new ones will develop as virus recombination and mutation continue to occur. ‡ The current subtypes and CRFs will also continue to spread to new areas as the global epidemic continues.

Does subtype affect disease progression?
‡ A study presented in 2006 found that Ugandans infected with subtype D or recombinant strains incorporating subtype D developed AIDS sooner than those infected with subtype A, and also died sooner. ‡ The study's suggested that subtype D is more virulent because it is more effective at binding to immune cells ‡ Study presented in 2007, which found that Kenyan women infected with subtype D had more than twice the risk of death over six years compared with those infected with subtype A

Are there differences in transmission?
‡ It has been observed that certain subtypes/CRFs are predominantly associated with specific modes of transmission. ‡ Subtype B is spread mostly by homosexual contact and intravenous drug use ‡ Subtype C and CRF A/E tend to fuel heterosexual epidemics (via a mucosal route).

Is it possible to be infected more than once?
‡ Until about 1994, it was generally thought that individuals do not become infected with multiple distinct HIV-1 strains. ‡ Since then, many cases of people coinfected with two or more strains have been documented

Do HIV antibody tests detect all types, groups and subtypes?
‡ EIA tests which can detect either one or both types of HIV have been available for a number of years. ‡ According to the US Centers for Disease Control and Prevention, current HIV-1 EIAs "can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes. ‡ However, because HIV-2 and group O infections are extremely rare in most countries, routine screening programs might not be designed to test for them. ‡ Anyone who believes they may have contracted HIV-2, HIV-1 group O or one of the rarer subtypes of group M should seek expert advice.

HIV CYCLE

VIRUS ATTACHMENT

VIRUS ATTACHMENT

VIRUS ATTACHMENT

VIRUS CYCLE

Clinical Symptoms
‡ Phase I ± Asymptomatic phase
± CD4 count >500 cells per microliter of blood ± Flu like symptoms

‡ Phase II ± Symptomatic
± CD4 count around 200 cells per microliter of blood ± Weight loss, fatigue, ± diarrhea, infections, etc.

‡ Phase ± Late Symptomatic
± CD4 count <200 cells per microliter of blood ± Full blown AIDS

Stage 1 - Primary
‡ Short, flu-like illness - occurs one to six weeks after infection ‡ no symptoms at all ‡ Infected person can infect other people

Stage 2 - Asymptomatic
‡ Lasts for an average of ten years ‡ This stage is free from symptoms ‡ There may be swollen glands ‡ The level of HIV in the blood drops to very low levels ‡ HIV antibodies are detectable in the blood

Stage 3 - Symptomatic
‡ The symptoms are mild ‡ The immune system deteriorates ‡ emergence of opportunistic infections and cancers

Stage 4 - HIV @ AIDS
‡ The immune system weakens ‡ The illnesses become more severe leading to an AIDS diagnosis

Opportunistic Infections associated with AIDS
‡ Bacterial
± Tuberculosis (TB) ± Strep pneumonia

‡ Viral
± Kaposi Sarcoma ± Herpes ± Influenza (flu)

Opportunistic Infections associated with AIDS
‡ Parasitic
± Pneumocystis carinii

‡ Fungal
± Candida ± Cryptococcus

Post-test Counseling
‡ ‡ ‡ ‡ Clarifies test results Need for additional testing Promotion of safe behavior Release of results

This HIV-positive patient presented to a dental office exhibiting signs of a secondary erythematous candidiasis infection