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HIV 101

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This presentation introduces the viewer to basic information about HIV: what it is, how it affects the human body, how it is transmitted, and how to prevent transmission.

Publié dans : Santé & Médecine
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HIV 101

  1. 1. HIV 101 Science, Clinical Care and Prevention Aaron Davis, B.S. Program Manager Maryland DHMH – Center for HIV Prevention
  2. 2. OBJECTIVES •What is HIV? •How does it affect your immune system? •What happens when HIV is not treated? •How is HIV treated? •How do we prevent HIV? 2
  3. 3. To understand what HIV and AIDS are, let’s break it down: Causative agent: H – Human – This particular virus can only infect human beings. I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you. V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host. http://aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/ WHAT IS HIV? 3
  4. 4. HIV – THE ENEMY 4
  5. 5. WHAT IS AIDS? Disease: A – Acquired – AIDS is not something you inherit from your parents like eye color. You acquire AIDS. I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease. D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should. S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease. It is a complex illness with a wide range of symptoms. http://aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/ 5
  6. 6. OTHER DEFINITIONS • Retrovirus: type of virus that changes it’s RNA to DNA • ARVs: anti-retrovirals – HIV medications • HAART: Highly Active Anti-Retroviral Therapy – using a combo of 3 or more ARVs to treat HIV (also known as ART) • CD4 T-Cell: type of white blood cell that HIV targets • Viral Load: the amount of HIV virus particles (“copies”) in 1 milliliter of blood • “Undectable”: A viral load of under 50 6
  7. 7. What 5 Fluids Transmit HIV? 7 7 Blood Vaginal Fluids Breast Milk Semen & Pre-ejaculate
  8. 8. Ways HIV is Transmitted 8
  9. 9. Timeline of discoveries 1981: Epidemic first identified 1983: Identification of the HIV virus 1985: First commercial test to detect HIV 1987: First antiretroviral drug approved 1995: Protease inhibitors approved 1997: Three-drug therapy (HAART) shown to delay progression 2008: HIV patient “cured” of virus through bone marrow transplant from Δ32 donor 9
  10. 10. OBJECTIVES •What is HIV? ✔ •How does it affect your immune system? •What happens when HIV is not treated? •How is HIV treated? •How do we prevent HIV? 10
  11. 11. Organs of the Immune System Immune cells localize in secondary lymphoid organs, such as the spleen, lymph nodes, etc. T cells are generated in the thymus The bone marrow contains blood-forming Stem cells, and makes B cells, innate cells, and all other blood cell types, except T cells. Red-primary lymphoid organs Blue-secondary lymphoid organs 11
  12. 12. THE IMMUNE SYSTEM BATTLEGROUND INNATE IMMUNITY ADAPTIVE IMMUNITY
  13. 13. ANTIGEN
  14. 14. ANTIGEN Front-line Soldiers (macrophages, dendrites)
  15. 15. ??? VIRUS
  16. 16. VIRUS APC The General CD4 Cell
  17. 17. VIRUS Snipers CD8 T- Killer Cells
  18. 18. VIRUS Antibody Look-Outs B Cells
  19. 19. ??? HIV
  20. 20. HIV APC The General CD4 Cell
  21. 21. ??? ???
  22. 22. 23
  23. 23. HIV Lifecycle: 24
  24. 24. gp120 p24 Viral RNA RT & other virion proteins HIV Lifecycle: 25
  25. 25. gp120 p24 Viral RNA RT & other virion proteins CD4 CXCR4 or CCR5 Binding HIV Lifecycle: 26
  26. 26. gp120 p24 Viral RNA RT & other virion proteins Fusion & uncoating HIV Lifecycle: 27
  27. 27. gp120 p24 Viral RNA RT & other virion proteins Reverse transcription HIV Lifecycle: 28
  28. 28. gp120 p24 Viral RNA RT & other virion proteins Nuclear localization & entry HIV Lifecycle: 29
  29. 29. gp120 p24 Viral RNA RT & other virion proteins HIV Lifecycle: Integration 30
  30. 30. gp120 p24 Viral RNA RT & other virion prteins Integrated provirus HIV Lifecycle: 31
  31. 31. gp120 p24 Viral RNA RT & other virion proteins Viral Gene Transcription HIV Lifecycle: 32
  32. 32. gp120 p24 Viral RNA RT & other virion proteins Translation HIV Lifecycle: 33
  33. 33. gp120 p24 Viral RNA RT & other virion proteins Post-translational processing HIV Lifecycle: 34
  34. 34. gp120 p24 Viral RNA RT & other virion proteins Assembly HIV Lifecycle: 35
  35. 35. gp120 p24 Viral RNA RT & other virion proteins Budding HIV Lifecycle: 36
  36. 36. OBJECTIVES •What is HIV? ✔ •How does it affect your immune system? ✔ •What happens when HIV is not treated? •How is HIV treated? •How do we prevent HIV? 37
  37. 37. HIV Signs and Symptoms 38 • Rapid weight loss • Recurring fever or profuse night sweats • Extreme and unexplained tiredness • Prolonged swelling of the lymph glands in the armpits, groin, or neck • Diarrhea that lasts for more than a week • Sores of the mouth, anus, or genitals • Pneumonia • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids • Memory loss, depression, and other neurologic disorders.
  38. 38. HIV Progression to AIDS 39
  39. 39. Untreated HIV infection is a constant battle between the virus and the host immune system, with BILLIONS of new infected cells and virus particles produced and cleared EVERY DAY in each infected person. http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Biology/pages/clinicalcourse.aspx http://www.healthhype.com/cd4-count-dropping-viral-load-stable-in-hiv-infection-graph.html 40
  40. 40. OPPORTUNISTIC INFECTIONS 41
  41. 41. Examples of Opportunistic Infections 42 •Candidiasis •Invasive cervical cancer •Coccidioidomycosis •Cryptococcosis •Cryptosporidiosis •Cytomegalovirus disease •Encephalopathy, HIV-related •Herpes simplex: chronic ulcer •Bronchitis, pneumonitis, or esophagitis •Histoplasmosis •Isosporiasis •Kaposi's sarcoma •Lymphoma •Mycobacterium avium complex •Tuberculosis •Pneumocystis carinii pneumonia •Pneumonia, recurrent •Progressive multifocal leukoencephalopathy •Salmonella septicemia, recurrent •Toxoplasmosis of brain •Wasting syndrome due to HIV
  42. 42. What does it mean to be “AIDS-Defined?” • A CD4 T-cell count of 200 or below; OR • CD4 T-cells make up less than 14% of all white blood cells; OR • The presence of 1 or more opportunistic infections 43
  43. 43. CASCADE OF HIV TREATMENT IN THE U.S. 44
  44. 44. WHAT CAN WE DO??? 45
  45. 45. OBJECTIVES •What is HIV? ✔ •How does it affect your immune system? ✔ •What happens when HIV is not treated? ✔ •How is HIV treated? •How do we prevent HIV? 46
  46. 46. HAART• Use a combo of 3 ARVs from a minimum of 2 classes of HIV medications • Some pills contain multiple medications taken once daily • Recommendation is to start treatment early to reduce HIV numbers • Resistance occurs when medication not taken daily 47
  47. 47. HIV DRUG TARGETS 48
  48. 48. OBJECTIVES •What is HIV? ✔ •How does it affect your immune system? ✔ •What happens when HIV is not treated? ✔ •How do medications help? ✔ •How do we prevent HIV? 49
  49. 49. PREVENTION TOOLS HIV TESTING BEHAVIORAL INTERVENTIONS CONDOM DISTRIBUTION NEEDLE EXCHANGE 50
  50. 50. BIOMEDICAL INTERVENTIONS PrEP PEP Treatment as Prevention Vaccines Microbicides 51
  51. 51. 52 • PrEP involves an HIV-negative person taking antiretroviral (ARV) medications to reduce the risk of infection before HIV exposure • Current approved regimen is taken in a single pill once a day, every day • Truvada is currently the only drug approved by the Food and Drug Administration (FDA) for PrEP
  52. 52. PrEP 53 • Studies have shown PrEP can reduce risk of getting HIV by 92- 99% if taken everyday. • PrEP can be used for heterosexual men and women, bisexual, gay and transgender individuals, injection drug users, and pregnant women. • It is important to know that PrEP is not a cure for HIV and it cannot protect you from pregnancy or other sexually transmitted infections (STI), like gonorrhea or
  53. 53. PrEP 54 For anal sex, an individual needs to take 7 days of Truvada before enough drug is “on board” for protection in the rectum (it is not the morning after pill).For vaginal sex it takes 21 days to build up a protective Truvada presence in the vagina. The key is adherence - a pill every day.
  54. 54. PrEP 55  PrEP is not just a pill, it’s a program that should include comprehensive HIV and STI prevention interventions ◦Testing for HIV every 3 months ◦Regular STI screenings ◦Kidney/liver function ◦Risk-reduction counseling ◦Condom promotion
  55. 55. Post-Exposure Prophylaxis (PEP) 56
  56. 56. Treatment as Prevention (TaSP) • Study looked at HIV transmission between serodiscordant heterosexual couples (HPTN 052) • People taking ARVs and virally suppressed reduce HIV transmission by 96% • TREAT EARLY AND HARD! 57
  57. 57. CONTACT INFORMATION Aaron Davis Program Manager Maryland Prevention and Health Promotion Administration Infectious Disease Prevention and Health Services Bureau Center for HIV Prevention and Health Services (410) 767-5699 aaron.davis@maryland.gov 58

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