H –Human ………………..

only infect human beings

I - Immunodeficiency …↓body's immune system
V –Virus …………“obligate intracellular pathogen”

……….Not hereditary
…. Affects the body's immune system
………….. Not function properly
………….. Experience a wide range of
 What is HIV?
is a member of retroviruses that causes AIDS

A retrovirus has an RNA genome and a reverse

transcriptase , integrase & protease enzyme.

By the help of the enzyme the virus uses its RNA as a

template for making cDNA, which can integrate into the
DNA of the host organism.
).
Medical history information, signs or symptoms
suggest presence of HIV in a patient?

SPUR infection
Salmonella,
HSV &TB
 1. Detection of anti- ….
3 months post infection……

< 350 cells/mm3 2. :

500 -1500 cells/ mm3

< 200 cells/mm3

< 50 cells/mm3 3. (HIV RNA)…PCR

 - ,
2 drugs of NRTIS + 1 drug of PIs or nNRTIs
Adult 1st line regimen.
Zidovudine or Stavudine + lamivudine +neverapine or
efavirenz

Adult 2nd line regimen.

Didanosine + abacavir +lopinavir or retonavir
 ?

➢liver problem, diabetes,

➢abnormal fat distribution (lipodystrophy syndrome)
➢high cholesterol

➢↑bleeding in patients with hemophilia

➢↓ bone density or skin rash
➢ pancreatitis (e.g. Didanosine)

➢ fever nausea, fatigue

Enfuvirtide [fuzeon .injection] approved in 2003 as first
fusion inhibitor
Mechanism:
binds to the gp41 subunit of the viral envelope
glycoprotein, preventing the conformational changes
required for the fusion of the viral and cellular
membranes.
Uses: in combination with other drugs for adult &
children > 6 years with advanced
Infection ,who are resistant to other drugs
 integrase inhibitor CCR5 blocker

-approved by FDA in Blocks chemokine co-

October 2007 only for receptor that used by HIV
peoples whose infection to enter the cell
resistant to other HAART
drugs Side effects: Nausea,
Headache and Diarrhea
 • Co-trimoxazole ? ? ?
PCP
• Fluconazole not
Candidiasis ketoconazole? Why?

HSV
•Acyclovir
 • Gancyclovir
CMV
• Clarithromycin, azithro-
M. bact.avium mycin
 Case 1
A 43-year-old male hospitalized AIDS patient developed progressive
weakness, abdominal cramping, fevers, poor appetite, nausea and vomiting. He
had a CD4+ lymphocyte count of 150/μl and "high" HIV-1 viral load. He was
being treated with anti-HIV drug (cocktail) composed of didanosine, zidovudine
and indinavir. Other drugs being administered include
trimethoprim/sulfamethoxazole for secondary Pneumocystis carinii pneumonia
(PCP) prophylaxis. Current laboratory values included amylase 240 units/L
(Normal 35-110) and creatinine 1mg/dl (Normal 0.5-1.3). At this time, didanosine
therapy was discontinued and his HAART regimen was switched to lamivudine,
zidovudine and indinavir. The patient’s gastrointestinal symptoms resolved but
several months later the patient complained of feeling weak and presented with
symptoms of thrush.
Because of didanosine cause
peripheral neuropathy & pancreatitis
Where GI symptoms & ↑amylase level
[N 35-110 unit /l] are reasons for stopping
didanosine & replacing it by another NARTIs like
lamivudine
I.e. Lamivudine & Didanosine, indinavir
Class: NRTIs, protease inhibitor
Mechanism:
phosphorylated, act as false substrate →inhibit
reverse transcriptase enzyme → No reverse
transcription of RNA to DNA
Act as chain terminating drugs
protease inhibitor:
inhibit protease which cleaves Gag- pol polyprotein lead to
production of immature, non-infectious viral particles
Treatment Adverse
Efficacy effects

measuring blood
level of
CD4 count, lactic acid, glucose,
viral load amylase & lipids
yes, because
HAART is
combination between
2 drugs of NRTIs & 1 PIs or nNRTIs
Afforded treatment for this pt includes
didanosine, zidovudine (2NRTIs) and indinavir
(1PI).
disturb lipid, glucose metabolism
lipodystrophy
thrombocytopenia,
Nephrolithiasis,
hyperbilirubinemia
Tenofovir, inhibit both HIV & HBV, be effective
in persons resistant to NRTIs,
Side effects: →
N, V, Diarrhea,
sever liver damage like any other RTI
-TB therapy start at least 2 months before starting ARV,
As delaying ARV for 2months→
Will simplify the ttt regimen &
will not slow recovery or
compromise pt immune status
-Yes, Control OIs like TB in HIV +ve pt →
will rise CD4 count (Or at least slow its decline)
this phenomenon is the reason for using co-trimoxazole
In all HIV pt ?
to slow the decline in immunity by prevention of many
OIs.
HIV –ve→ Find & test HIV +ve →Send him to
source person HIV clinic for cure

HIV –ve ……..Reassure the victim

HIV +ve or unknown …….Start ARV prophylaxis immediately or with in 72 hrs

HIV –ve …Reassure HIV +ve ...Send him

the victim to HIV clinic
-Nevirapine
to mother at onset of labor &
to her baby with in 3days After birth
→↓risk of transmission from 30 %
>>>>>>>>>>> 12-15%
-
✓ Avoid sexual contact with anyone has AIDS.

✓ Avoid contact with contaminated blood.

✓ Don't share toothbrushes, razors or others.

✓ Avoid acupuncture, tattooing, ear piercing, etc.,

✓ Do not share needles or syringes.

✓ Clean the needle before using.