AIDS

PROF. (DR.) V.P.ACHARYA MBBS, MD. PhD

Are HIV and AIDS the
same thing?
 AIDS
 Acquired immunodeficiency syndrome
 End stage of HIV infection
 Synonym= SLIM DISEASE
 1ST DISCOVERED IN 1981 SUMMER IN US
 1983 – first isolated
 African- American origin
 India- 1st in Chennai sex worker in 1986
Recent trend (updated till 2015)
 Globally- estimated 36.7 million people living
with AIDS
 Newly infected- 2.1 million across the globe
 New infections among children - ↓50%
 No decline in new infections in adults
 As of June 2016- 18.2 million (46%) access to

antiretroviral therapy
 77% pregnant women- access to ART
 AIDS related death have fallen by 45%
 TB remains the leading cause of death
 Where does India stand??
 2005- 5.2 million people in country
had the infection- adult prevalence-
0.91%
 India portrays a concentrated
epidemic
 2015 – adult prevalence is 0.26%
 Males (0.30%) >Females (0.22%)
 Steady decline
 2015- Manipur has highest prevalence
 People living with HIV- 21.17 lakhs
 86,000 new infections
 Urban>rural, Male >female, young
adults
 Indian Statistics
Antenatal Female sex
STD clinic HIV IDU HIV MSM HIV
clinic HIV worker HIV
State prevalence prevalence prevalence
prevalence prevalence
2007 (%) [12]
2007 (%) [12]
2007 (%) [12]
2007 (%)[12] 2007 (%)[12]
Andhra
1.00 17.20 3.71 17.04 9.74
Pradesh
Gujarat 0.25 2.40 ... 8.40 6.53
Karnataka 0.50 8.40 2.00 17.60 5.30
Maharashtra 0.50 11.62 24.40 11.80 17.91
Manipur 0.75 4.08 17.90 16.4 13.07
Mizoram 0.75 7.13 7.53 ... 7.20
Nagaland 0.60 3.42 1.91 ... 8.91
Tamil Nadu 0.25 8.00 16.80 6.60 4.68
Delhi 0.25 5.20 10.10 11.73 3.15
Chandigarh 0.25 0.42 8.64 3.60 0.40
Number of ART centres and patients alive and
on ART by state, January 2010

No. of ART Total

State Total (Adult) Total
Centres (Paediatric)
Andhra
31 60,328 3,304 63,832
Pradesh

Karnataka 33 36,220 3,003 39,223

Maharashtra 43 65,409 5,102 70,511

Tamil Nadu 36 36,947 2,439 39,586

Gujarat 9 12,765 669 13,678

Uttar Pradesh 10 10,039 594 10,633

Grand Total 2,81,453 18,889 3,00,743

Perseverance is the hard
work you do after you get
tired of doing the hard
work you already did…….
Etiology
 Human Immunodeficiency Virus- 1 &2
 Family – Retroviridae
 Subfamily – Lentiviruses
 HIV-1- American population
 HIV-2 – West African population
 Many subspecies
 India- HIV-1 C subtype
 Morphology of HIV
 Cylindrical core
 2 ss RNAs
 Nucleocapsid - p24
 Core- Reverse transcriptase p66

& p55
 Envelope proteins- gp120 &

gp41
 RNA is bound to enzymes- RT,

protease, integrase &

ribonuclease
 2 layers of lipid membrane- PL

taken human cell membrane

p17
 HIV genome
3 structural genes – gag, pol, env
 3 regulatory genes- tat, rev, nef
 5 accessory genes – vif, vpr, vpu, vpt,

tev/ tnv
LTR – long terminal repeats – regulatory
elements for transcription
 Mode of transmission
 75% - sexual intercourse
 15%- blood Drug abusers
Infected needle
Blood transfusion
 10-20% Through placenta
During parturition
Breast milk
 Viral entry
 gp120 of virus binds with CD4
molecule on the surface of
target cells (mostly TH cells)
 AA 397-439 in gp120 & AA
16-84 of CD4 take part in the
binding
 Macrophages, monocytes,
Langerhans cells, follicular
dendritic cells and glial cells
also susceptible
 Monocytes / Macrophages –
act as the reservoir of the
virus
 Replication of HIV
 Very high rate
 Over 10 billion particles/ day inside the

host
gp120 binds to CD4 cells (co-receptors
CCR5 & CXCR4) ↓
Conformation of viral envelope changes
↓
Fusion with host cell membrane
↓
gp41 penetrates plasma membrane
HIV RNA uncoated and enters host cell
↓
RT catalyzes reverse transcription of ssRNA to
dsDNA
↓
Integrates to host cell DNA randomly with help
of Integrase
↓
Provirus may become active or remain latent
↓
Viral proteins synthesised, assembled & bud
out
 Lipid rafts

Electron micrograph showing HIV budding

out from CD4+ T lymphocytes
Four Stages of HIV
 Stage 1 – Window period
 Short, flu-like illness - occurs 1-6 weeks
after infection
 no symptoms at all
 Infected person can infect other people
 p24 Ag only detectable
Natural course of AIDS
 Stage 2 – Seropositive stage

 Lasts for an average of 10 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
 For each AIDS patient, there are 100 seropositive
persons in population
 Stage 3 – AIDS related complex

 The symptoms are mild

 The immune system deteriorates
 Without opportunistic infections and cancers
 Stage 4 - HIV  AIDS
 The immune system
weakens

 The illnesses become

more severe leading to an
AIDS diagnosis
 Usually death within 2
years
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
AIDS disease- WHO definition
 CD4+ T-cell count < 200 cells/µl (or a CD4+
T-cell percentage of total lymphocytes of less
than 15%)
OR
the patient has one of the defining illnesses
 1987 definition
 Candidiasis of bronchi, trachea, or lungs
 Candidiasis esophageal
 Coccidioidomycosis, disseminated or extrapulmonary
 Cryptococcosis, extrapulmonary
 Cryptosporidiosis, chronic intestinal for longer than 1 month
 Cytomegalovirus disease (other than liver, spleen or
lymph nodes)
 Cytomegalovirus retinitis (with loss of vision)
 Encephalopathy (HIV-related)
 Herpes simplex: chronic ulcer(s) (for more than 1 month); or
bronchitis, pneumonitis, or esophagitis
 Histoplasmosis, disseminated or extrapulmonary
 Isosporiasis, chronic intestinal (for more than 1 month)
 Kaposi's sarcoma
 Lymphoma, Burkitt's
 Lymphoma, immunoblastic (or equivalent term)
 Lymphoma, primary, of brain
 Mycobacterium avium complex or Mycobacterium kansasii,
disseminated or extrapulmonary
 Mycobacterium, other species, disseminated or extrapulmonary
 Mycobacterium tuberculosis, any site (extrapulmonary)
 Pneumocystis jiroveci pneumonia (formerly Pneumocystis
carinii)
 Progressive multifocal leukoencephalopathy
 Salmonella septicemia (recurrent)
 Toxoplasmosis of the brain
 Tuberculosis, disseminated
 Wasting syndrome due to HIV
 Added in 1993
 Cervical cancer (invasive)

 Mycobacterium tuberculosis, any site

(pulmonary)
 Pneumonia (recurrent)

 Children < 13 years

 Additional conditions are included for

children less than 13

 Bacterial infections, multiple or recurrent

 Lymphoid interstitial pneumonia or

pulmonary lymphoid hyperplasia complex
 Laboratory diagnosis
 ELISA- Ab against gp120
 Confirmatory test- Western blot
 Virus isolation- from cultured

lymphocytes
 CD4 lymphocyte count
Immunological parameters
Prevention???
 Treatment- Any cure really???
 RT inhibitors- nucleoside analogues e.g. AZT,
Zalcytabine, Lamivudin
 RT inhibitors- Non-nucleoside analogues e.g.

Nevirapine, Loviride
 RT inhibitors- nucleotide analogues e.g. Adefovir
 Protease inhibitors- Block final assembly &

package of HIV particles e.g. Sequinavir,

Ritonavir, Indinavir
 Antisense therapy- Experimental stage
 Pregnancy- Nevirapine
 World is committed to end AIDS epidemic by 2030
2001 I care. Do you?
 AIDS THEMES 2002 Stigma and Discrimination
1988 Communication 2003 Stigma and Discrimination
1989 Youth 2004 Women, Girls, HIV and AIDS
1990 Women and AIDS 2005 Stop AIDS. Keep the Promise
1991 Sharing the Challenge 2006 Stop AIDS. Keep the Promise
1992 Community Commitment – Accountability
1993 Act 2007 Stop AIDS. Keep the Promise
1994 AIDS and the Family – Leadership
1995 Shared Rights, Shared Responsibilities 2008 Stop AIDS. Keep the Promise
1996 One World. One Hope. – Lead – Empower – Deliver[18]
1997 Children Living in a World with AIDS 2009 Universal Access and
1998 Force for Change: World AIDS Campaign With Human Rights[19]
Young People 2010 Universal Access and
1999 Listen, Learn, Live: World AIDS Campaign with Human Rights[20]
Children & Young People 2011 Getting to Zero
2000 AIDS: Men Make a Difference 2012 Together we will end AIDS
2013 Zero Discrimination[
2014 Close the gap
2015 On the fast track to end
AIDS
2016 Hands up for HIVprevention
2017 My Health, My Right
2018 Know your status
Oral diseases in AIDS
 Fungal infections
 Chronic periodontitis
 Candiadis
 Oral cheilitis
 Oral hairy leukoplakia
 Oral ulcers due to CMV infection
 Necrotizing oral stomatitis
 Aphthous ulcers
 Oral Kaposi’s sarcoma
 xerostomia
Precautions in dentistry
 Consider blood, saliva and gingival fluid from
all dental patients as infective.
 Use rubber dams in restorative dentistry

whenever possible
 Report immediately suspect fluid exposure,

or a needle-stick or sharp injury to a

designated person because if post-exposure
chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours
after exposure.
 Double gloves
 All disposable material
 Wear apron and visors
 Sterilize instruments that can’t be disposed

off
 Use absorbent paper towelling to remove

blood or saliva.
 Use a medical grade disinfectant to disinfect

all potentially contaminated objects and

surfaces.
 Follow safe work procedures as stated in the

material safety data sheets (MSDS) for

handling and disposal.
It is the darkest before dawn
For more ppt on Medical Biochemistry
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