Transcript HIV and AIDS

HIV and AIDS
S4S MARCH 2015
Some
background
on HIV
DAPSICAMP
Stigma- in
HIV and other
illnesses.
HIV: what you need to
know…
In intermediates they can throw a
question on HIV in, whether the
biology of it (we had it) or in a social
sense, so stigma.
It’s a topic that is so important to
know about for your future career
too, you may never have any more
teaching on HIV.
Everyday nearly 7000 people contract HIV,
that’s nearly 300 per hour.
In 2013 there were 107,000 HIV-positive
people in the UK, 26% were unaware of their
status.
530 deaths in 2013 in UK
1990-2008: 14,000 HIV positive people in the
UK have taken their own lives.
1981unexplained
cases of enlarged
lymph nodes in
homosexual men
in NYC.
The condition is
initially called
Gay-Related
Immune
Deficiency
(GRID).
http://sichange.org/sic-uk/
1984- The
virus HIV is
first isolated
as the cause of
AIDS.
1985- Ryan
White, a 13year-old
haemophiliac
is barred from
school.
Definition
What does HIV stand for?
What does AIDS stand for?
What is the difference?
HIV= Human Immunodeficiency
Virus
HUMAN- Can
only live in
humans
IMMUNODEFICIENCYCauses the immune
system to weaken by
destroying CD4 cells (T
helper cells)
VIRUS- Cannot
replicate
autonomously
therefore hijack
the replication
equipment of
the CD4 cells.
AIDS- Acquired Immunodeficiency
Syndrome
ACQUIRED= This stage
only occurs after HIV
has been in the body
for a long time.
SYNDROME= Collection of
symptoms.
Characterised by either
AIDS-defining illnesses or a
CD4 count of under 200
cells/mm3
IMMUNODEFICIENCY=
Prolonged attacking of the
CD4 cells has led to very low
immunocompetence.
Aetiology and Pathophysiology
T helper cells (CD4 cells)
Amount
Antibody Levels
Virus Levels
Time
STAGE 1:
PRIMARY
INFECTION
STAGE 2: QUIET PERIOD
STAGE 3: EARLY HIV
DISEASE
STAGE 4: AIDS
1-12 WEEKS
5-7 YEARS
VARIABLE
MONTHS – 2
YEARS
http://sichange.org/sic-uk/
The HIV virus
HIV virus
gp120
gp41
CD4
T helper cell
http://sichange.org/sic-uk/
Dendritic cells transport HIV to lymph nodes.
CD4 molecule recognised by GP120
CD4 cells produce HIV copies for 2 days and then die.
The cycle continues making more HIV copies and
attacking CD4 cells
Loss of activated CD4
T-lymphocytes, decreased immunocompetence .
How the virus works
1.
2.
3.
4.
5.
6.
7.
Attachment - gp120 binds to CD4 receptor on body cell
Uptake – gp41 changes shape, allowing fusion of viral and cell membranes
Nucleic acid synthesis – reverse transcriptase
Integration of HIV genome into host – viral DNA inserted into cell’s DNA
Synthesis of new HIV proteins – cell produces new viral proteins
Assembly of new viruses
Release via budding – new viruses released
AIDS-defining illnesses
Toxoplasmosis
HSV
Oesophageal Candidiasis
CMV
Kaposi’s Sarcoma
Pneumocystis pneumonia
Tuberculosis
http://sichange.org/sic-uk/
Symptoms
Early infection:
Seroconversion illness at start of infection- Non-specific flu-like symptoms for 3
weeks.
Very high levels of HIV in blood and genital tract, very infectious.
Others have no symptoms at all.
P24 protein may be detectable on tests but not always.
Late infection:
Most have a 10 year gradual decline of CD4 between HIV (usually asymptomatic) and
AIDS- very variable.
Persistent tiredness
Diarrhoea (gut mucosa is particularly affected by HIV)
Weight loss
Night sweats
AIDS- defining illnesses
Unprotected
vaginal sex
Blood to
blood
contact
Transmission
Mother to
Baby
Not transmitted by
kissing, and low risk
from oral sex.
Unprotected
Anal sex
Investigations
Take a sexual history with focus on HIV risk.
Blood transfusions/medical procedure abroad?
IV drug use?
HIV Test:
The most reliable is an antibody test. 3 Month window period
though.
Fourth generation tests screen antibodies and the p24 viral
proteins on HIV. Used as first line testing. 11 day window.
Home testing kits are available but not reliable and not
recommended.
Always repeat tests after 3 months regardless of initial result.
Complications
Complications of HIV:
Drug-related; Side effects, resistance-need 95% adherence for
medication.
Psychological- Stigma
Physical- Neurological (AIDS dementia complex), eye disease (CMV
retinitis), GI (villous atrophydiarrhoea), Renal (nephrotic and nephrotoxic
drugs), Cardiac (ARVs cause hyperlipidaemia). Almost every system is
affected though!
Complications of AIDS:
Life threatening illnesses, but unlikely in UK today.
Alternative Diagnosis
I wouldn’t worry too much as unlikely to be asked this but…
Seroconversion can also be EBV
Cytomegalovirus
Influenza
Viral Hepatitis
Secondary Syphilis
Start when CD4 count
is below 350
cells/mm3.
Serious side effects.
Management
ANTIRETROVIRALS
4) Protease
Inhibitors
Stop viral proteins
being assembled
into a virion
1) Fusion/entry
inhibitors
Stop the virus getting
into the cell.
2) Reverse transcriptase
Inhibitors
Stop viral RNA
converting into viral
DNA
3) Integrase Inhibitors
Stop viral DNA integrating
into human DNA
USE THREE OF
THESE- HAART
3
2
4
1
http://sichange.org/sic-uk/
Prognosis
Almost normal life expectancy if ARVs work well.
Focus is on psychological impact of living with HIV.
Diagnosis causes
Biographical
disruption
Narrative
constructs change.
Rethink biography
and self-concept
Body is physically
disrupted
Things for a doctor to
consider
Medication
taking
Disclosure
Stigma and
mental health
Coping
mechanisms
Enacted stigma
Stigmatisation
Felt stigma
Reverse stigmatisation
Goffman’s stigmaVisibility of disability
Obtrusiveness
Knowledge of illness
Perceived threat of illness
Sympathy aroused?
Perceived responsibility
Any questions?
Email: [email protected]
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