Transcript HIV / AIDS

Dr. VIJAYA MOHAN KALAKOTLA
MD (Int.Med)
Consultant Physician
Divine Touch Hospital
Suryapet, Nalgonda, AP
NONI Help Line Consultant
Founder Trustee - Research Scientist
World NONI Research Foundation,
Chennai.
Clinical and cellular
Improvement with NONI in
patients with HIV / AIDS
HIV / AIDS
• Caused by Immunodeficiency virus belongs to Lentivirus subfamily
in the retroviral family.
• First reported in 1981
-Los Angeles and San Francisco.
-In Homosexuals
• Virus Identified in 1983
- By Luc Montagnier
- Robert Gallo.
• Origin: In 1999 Scientist found same virus in sub species of
Chimpanzees in Africa. Researchers believe HIV1 was introduced
into the Human population when hunters were exposed to infected
blood.
HIV / AIDS
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EPIDEMIOLOGY
Most serious public health problem all over the world,
more with developing countries like India.
Estimated HIV / AIDS patients about 50 millions.
Approximately 20 millions thought to have died of AIDS
since 1981.
As of today 15,000 infections are estimated to be taking
place every day.
- 95% from the Developing countries
S Africa has the largest number of HIV / AIDS patients in
the world.
Second largest is India.
China and India share 36% of patients
HIV / AIDS
• High In-come Nations HIV / AIDS due to drug abusers
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and Homosexuals.
In India – mostly due to
- Heterosexuals
- Blood Transfusions
- MTCT
In India – first case recorded – 1984
- Tamil Nadu
- Large number of cases
- Maharastra
- Andhra Pradesh
- TamilNadu
- Less number of cases
- Gujurat and Goa
- Pondichery
HIV / AIDS
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PATHOPHYSIOLOGY
HIV essentially causes infection of Immune system.
Categorized HIV-1 and HIV – 2
- with many sub types.
HIV – 1 is more virulent.
Disease Progression
(A) Typical - 80 to 90% of infected persons median
survival time approx. 10 yrs.
(B) Rapid - 5% of infected develop AIDS in 3 to 4
yrs.
(C) Long Term – 5% of infected do not experience
the disease progression for an extended period of at least 7 yrs.
HIV / AIDS
CELL INFECTED BY HIV
• Its Polytrophic virus - invade many cells in the body.
• Mainly - CD4 cells macrophages, dendrite cells microglial
and astrocyts in the brain and mucosa of bowel.
• Major cellular receptor sites for HIV is CD4.
• Resistant to HIV infection.
– Homozygous mutation in CCR-5 gene (Delta
32)
HIV / AIDS
CELL ATTACHMENT AND ENTRY
• HIV attaches – cellular receptors and co-receptors and
enter CD4 cells.
- Uncoated – viral RNA is converted to
“Complementary DNA (cDNA)” by
- Reverse transcriptase.
• cDNA enters CD4 cell nucleus and eventually
incorporated into host cell chromosomes
- Integrase enzyme
HIV / AIDS
• This integrated DNA is transcribed into messenger RNA,
which comes out into cytoplasm, which in synthesize
viral proteins (Progeny RNA )
• Progeny RNA and protein together packed and newly
formed viral particals comes out from infected CD4 cells
by budding process.
- Protease enzyme.
HIV / AIDS
Who is at risk of HIV infection?
1. Injection drug addicts.
2. Recipients of blood and its products
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- Not screened for HIV
People with multiple sex partners.
History of STD.
CSW
Gay men
Health care workers.
Children borned to HIV infected mothers.
* Insets like Mosquitoes and bed bugs
which fed on human blood do not spread HIV
HIV / AIDS
CLINICAL STAGES OF INFECTION
• HIV pathogen involves 3 major clinical stages of
infections.
1. Early period:
- High viraemia
- Large number of infected cells in peripheral
blood.
- High titers of virus in the plasma and lymph
node.
• Natural immunity:
- Viral titers decrease dramatically due to viral
specific immunity development in the body.
- They include – HIV specific cytotoxin,
T-
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lymphocyte response
- Ab-dependent cellular toxicity
- HIV specific CD4 cell response.
These causes – stabilization of viral levels and CD4 cell
count for many years. This is called “Set Point”.
This set point is predictor of prognosis of disease.
Higher the set point – worse is the prognosis
2. Persistent Period
- Chronic phase of disease
- Viral levels are low
- CD4 count getting low @ 25 to
60 cells per
HIV / AIDS
Cum per year.
Cellular and humoral immune response to HIV is detected
during this phase, which decrease the set point and
delay the disease progration.
Citotoxin T-lymphocyte response inhibit viral replication by
killing directly or producing chemo kines that inhibit.
Nutralizing anti-bodies help to wipe out the virus.
3. Symptomatic period
- Immune exhaustion – lack of adequate Thelper self function
By this time individual develops symptoms. CD4 cell count
usually drop to 300/ mm.
HIV / AIDS
CLINICAL FEATURES OF HIV / AIDS
• Primarily non specific symptoms are manifested-fever,
lethergy, sore throat rash and enlargement of LN.
• Occurs during 2 to 6 weeks after acquiring virus.
• Resolve with in 2 to 3 weeks.
• In AIDS – s/s are dependent on the infection in the
body.
HIV / AIDS
INVESTIGATIONS
• Spot test – Tridot, slip test.
• Elisa for HIV.
• W. Blot
• P24
• PCR-DNA