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Microbiology lecture class for medical students.

Anoop Sinha

on 18 November 2012

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Transcript of HIV/AIDS

HIV/AIDS Dr. Anoop Sinha
Associate Professor
Dept. of Microbiology
SNIMS Worldwide Scenario:
2009 Total cases: 33.3 million
New cases: 2.6 million
Deaths: 1.8 million Total cases: 24,00,000 Indian Scenario:
2009 1930s SIV crosses over to humans (Congo) 1959 First known case of
HIV 1964 Azidothymidine
synthesised 1966 HIV enters
the Americas 1975 Opportunistic
infections in
Africans 1981 Opportunistic
infections in
American gays 1982 CDC names the
disease AIDS 1983 Luc Montagnier
isolates the retrovirus 1984 Robert Gallo
isolates the retrovirus 1985 Worldwide spread
First licenced test 1986 Named HIV
First case in India 1987 Zidovudine (AZT)
approved for
treatment 1994 AZT approved for
prevention of
transmission 1995 Saquinavir approved
for treatment,
enables HAART 1996 HAART lowers
AIDS death rate
(USA) 1999 13 million dead so far
(4th biggest killer) 2003 5 million new cases
3 million dead Structure of HIV gp120 gp41 gp160 { p17 p24 RNA Reverse transciptase
(p51) Integrase (p31) Protease (p15) p53 p15, p18 and p24
gp160 gp120 and gp41
p31, p51 and p66 Viral Genes Viral Replication CD4 gp120 Adsorption Penetration Reverse Transcription RNA-DNA ds-DNA Integration Transcription Translation Assembly
Release reverse transcriptase integrase Host
DNA mRNA mRNA protease Viral protein CD4+ cell Nucleus HIV Routes of Transmission Clinical Features Clinical stage 1 (asymtomatic)
Clinical stage 2 (mild)
Clinical stage 3 (advanced)
Clinical stage 4 (severe) WHO Clinical Staging System Clinical Stage 1 Asymptomatic
Acute HIV infection
PGL Weight loss (<10%)
Recc. RTI
Herpes Zoster
Minor muco-cutaneous manifestations Clinical Stage 2 Clinical Stage 3 Weight loss (>10%)
C/c diarrhoea
Prolonged fever
Oral candidiasis
Oral hairy leukoplakia
Pulmonary tuberculosis
Severe bacterial infections HIV wasting syndrome
Toxoplasmosis (CNS)
Cryptosporidiosis diarrhoea (>1 month)
CMV (other than liver/spleen/lymph nodes)
Candidiasis (oesophagus/trachea/bronchi)
Cryptococcosis (extra-pulmonary) Clinical Stage 4 Clinical Stage 4 Atypical mycobacteriosis (disseminated)
HSV (mucocutaneous: >1 month)
HSV (visceral)
Extra-pulm. tuberculosis
Nontyphoidal septicaemia
Lymphoma, Kaposi's sarcoma
HIV encephalopathy First recognised in 1981
Pathogen isolated in 1983-84 History HIV Timeline gag: pol: tat, nef, rev, vpu, vpr env: Salmonella P. jirovecii Pathogenesis CD4+ cells infected
CXCR4 & CCR5 act as co-receptors
Initial viraemia & dissemination
Estt. of c/c, persistent infection
Reservoirs of HIV-infeccted cells
Progressive decrease in CD4+ cells
Opportunistic diseases (CD4+ cell count < 200/ L)
Death Diagnosis
Monitoring progress
Detection of opportunistic infections Laboratory Tests Laboratory Diagnosis Antibody detection: Immunochromatographic tests
Western blot p24 antigen detection CD4+ T cell count Indicator of immunological competence Monitoring Progress HIV RNA levels (RT-PCR) Progession of disease
Indicator of drug resistance NRTI (Zidovudine, Lamivudine, Abacavir)
NtRTI (Tenofovir)
NNRTI (Efavirenz, Nevirapine)
PI (Saquinavir, Indinavir, Nelfinavir)
Integrase inhibitors (Raltegravir)
Entry inhibitors (Maraviroc, Enfuviritide) Drugs for Treatment Clinically advanced disease
Stage 4 disease
Stage 3 disease with CD4 cell count <350
Stage 1/2 disease with CD4 cell count <200

HAART: 2 NRTI + 1 NNRTI/PI/II Indications for HAART Prophylaxis Safe sex (condom use) Screening of blood donors
Needle exch. programmes
PEP 2 NRTIs for 28 days For Mother Zidovudine from 28 weeks
Single-dose nevirapine at labour
Lamivudine for one week For newborn Single-dose nevirapine at birth
Zidovudine for one week Other measures CS and formula feeds
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