THE HUMAN

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

•Number of people living •Total 33 million [30 – 36 million]

with HIV in 2007 Adults 30.8 million [28.2 – 34.0
million] Women 15.5 million [14.2 – 16.9
million] Children under 15 years 2.0 million [1.9 – 2.3 million]

•Total 2.7 million [2.2 – 3.2 million]

•People newly infected Adults 2.3 million [1.9 – 2.8 million]
•with HIV in 2007 Children under 15 years 370 000 [330 000 – 410
000]

•AIDS deaths •Total 2.0 million [1.8 – 2.3 million]

Adults 1.8 million [1.6 – 2.1 million]
•in 2007 Children under 15 years 270 000 [250 000 – 290
000]

•Global summary of the AIDS epidemic,

December 2007 – JULY 2008 Data WHO
 HIV EPIDEMIOLOGY

• People living with HIV 33 million [30 – 36 million]

• New HIV infections in 2007 2.7 million [2.2 – 3.2 million]

• Deaths due to AIDS in 2007 2.0 million [1.8 – 2.3 million]

•Global summary of the AIDS epidemic,

December 2007 – JULY 2008 Data WHO
 HIV EPIDEMIOLOGY
•Adults & •Adults & •Adult •Adult & child
children living children newly prevalence •deaths due to
with HIV infected with HIV (15‒49) [%] AIDS
•1.7 million •140 000 •0.5% •63 000
•Latin America •[1.5 – 2.1 •[88 000 – 190 •[0.4% – •[49 000 –
million] 000] 0.6%] 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 – 7300]

•Sub-Saharan Africa
•Latin America •1.8 million
•44 000 •[1.7 – 2.0 million]
•[37 000 – 58 000]
 HIV EPIDEMIOLOGY
Estimated deaths in children (<15 years) from AIDS, 2007

•North America

•4400
•[2600 – 7300]

•Sub-Saharan Africa
•Latin America •1.8 million
•44 000 •[1.7 – 2.0 million]
•[37 000 – 58 000]
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