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AcquiredImmuneDeficiencySyndrome(AIDS) ByJenniferOsita Disease ThediseaseIamstudyingisAIDS(AcquiredImmuneDeficiencySyndrome)whichiswhentheimmune systemistooweaktofightoffmanyinfections. (1) Etiologicagent TheetiologicagentforAIDSisHIV(Humanimmunodeficiencyvirus)whichiswhenthevirusdestroysa typeofwhitebloodcellcalledaT-helpercellandmakescopiesofitselfinsidethem.T-helpercellsare alsoreferredtoasCD4cells.(1) Transmission HIVisspreaddirectlyfrompersontopersonthroughcertainbodyfluids-blood,semen(cum),preseminalfluid(pre-cum),rectalfluids,vaginalfluids,andbreastmilk.Thesefluidsmustcomeincontact withamucousmembraneordamagedtissueorbedirectlyinjectedintothebloodstream(fromaneedle orsyringe)fortransmissiontooccur.Mucousmembranesarefoundinsidetherectum,vagina,penis, andmouth.HIVcanalsobespreadfrommothertochildduringpregnancy,birth,orbreastfeedingwhich islesscommon.Lastlyreceivingbloodtransfusions,bloodproducts,ororgan/tissuetransplantsthatare contaminatedwithHIV.ThiswasmorecommonintheearlyyearsofHIV,butnowtheriskisextremely smallbecauseofrigoroustestingoftheUSbloodsupplyanddonatedorgansandtissues.(2) Reservoirs HIVisabletoremainachronic,life-longinfectionduetoitsabilitytostayhiddenwithininfectedblood cells.LatentreservoirsofHIVarelocatedthroughoutthebody,includingthebrain,lymphoidtissue, bonemarrow,andthegenitaltract.(3) GeneralcharacteristicsofMicroorganism HIVisaretroviruswithagenomeconsistingoftwoidenticalRNAmoleculeslinkedinadimericstructure. RetrovirusesuseanenzymecalledreversetranscriptasetosynthesizeDNAthatisthenincorporated intothegenomeofthehostcell,formingaprovirus.HIVbelongstoasubgroupknownaslentiviruses (“slow”viruses)thathavealongperiodoftimebetweentheinitialinfectionandtheonsetofserious symptoms.HIVisasphericalviruswithanenvelopecomprisedofalipidbilayerandsurface glycoproteins,gp120andgp41,thatattachtohostcellreceptors,CD4andCCR5.(4) Keytestsforidentification HIVisdiagnosedbybloodtestsinvolvingtwoormorepositiveELISA(enzymelinkedimmunosorbent assay)teststhathavebeenconfirmedbyaWesternblotassay.ThelevelofCD4+helperTcellsis countedaswell.AnormalCD4+countis800-1200cells/mm3,butforpeoplewithHIVthecountis usuallyunder350cells/mm3inHIVpatients.AIDSisgenerallyconsideredthestateatwhichtheCD4+ countdropsbelow200cells/mm3.(4) Signsandsymptomsofdisease DuringtheearlystagesofHIVsignsandsymptomsincludefever,chill,nightsweats,rash,muscleaches, sorethroat,fatigue,swollenlymphnodes,andmouthulcers.Thenthevirusundergoesalatentphase untilitbeginsitsprogressiontoAIDSwhomsignsandsymptomsincluderapidweightloss,pneumonia, soresofthemouth,analandgenitals,memoryloss,depression,andotherneurologicdisorders,red, brown,pink,orpurplishblotchesonorundertheskinorinsidethemouth,nose,oreyelids,recurring feverorprofusenightsweats,extremeandunexplainedtiredness,prolongedswellingofthelymph glandsinthearmpits,groin,orneck,anddiarrheathatlastsformorethanaweek.(5) Historicalinformation In1999,astrainofSIV(calledSIVcpz)wasfoundinachimpanzeethatwasalmostidenticaltoHIVin humans.Themostcommonlyacceptedtheoryisthatofthe'hunter'.Inthisscenario,SIVcpzwas transferredtohumansasaresultofchimpsbeingkilledandeaten,ortheirbloodgettingintocutsor woundsonthehumanhunter.TheirstudiesconcludedthatthefirsttransmissionofSIVtoHIVin humanstookplacearound1920inKinshasaintheDemocraticRepublicofCongo(DRCongo).Thearea aroundKinshasaisfulloftransportlinks,suchasroads,railwaysandrivers.Italsohadagrowingsex tradearoundthistime.ThehighpopulationofmigrantsandsextrademightexplainhowHIVspread alongtheseinfrastructureroutes,firstlytoBrazzavilleby1937.(6) Virulencefactors HIVprimarilyattacksCD4+helperTcellsbyrecognizingandbindingtheCD4receptoronthesurfaceof theTcells.ItcansometimesinvademonocytesandmacrophagesaswellsincetheyalsohavesomeCD4 receptorsontheirsurfaces.Tumornecrosisfactoralpha(TNF-a)andinterleukin-6(IL-6)aresecretedat higherlevelsininfectedindividuals,andthismayhelpactivatetheHIVproviruses(latentviruses).HIV hasahighmutationrateduringreplicationwiththereversetranscriptase,whichiswhyitisableto readilyevadeourimmuneresponse.(4) Control/Treatment Oneproposederadicationstrategyistoactivatetheselatentlyinfectedcellsinthecontinuedpresence ofHAART.Therationaleforthestrategyistwo-fold.Bystimulatinglatentlyinfectedcellstoreplicate andexpressthevirus,suchcellswilldiemorerapidly[HIV-inducedcelldeath].Oncethecellular reservoirsbeginproducingHIV,theinfectedcellswillberecognizedbytheimmunesystem.Thekeyto thisstrategyisthesimultaneousadministrationofanactivatingagentconcurrentlywithHAART,and perhapsothertherapiestopreventneworspreadinginfection.(3) Prevention/Vaccineinformation,newtrials? ThebestwaytopreventHIVistopracticesafesexandmakesureyouandyourpartner(s)aretested annually.Also,donotshareneedles.ThereiscurrentlynovaccinethatwillpreventHIVinfectionortreat thosewhohaveit.AstheleadNationalInstitutesofHealth(NIH)InstituteforHIVvaccineresearch, NIAIDconductsand/orsupportsvaccineclinicalresearchprimarilythroughtheVaccineResearchCenter andtheNIAID-sponsoredHIVVaccineTrialsNetwork.Todate,NIAIDhassupported143vaccinetrials involving98differentproductsand27adjuvants.(7) Localcasesoroutbreaks(withincidencefigures) Anestimatednumberof73,959arelivingwithHIV/AIDSinTexasasof2016.Anestimatednumberof 931,526arelivingwithHIV/AIDSintheUnitedStates.(8).InTravisCountyalone,itissaidthatsomeone ininfectedwithHIV/AIDSevery35hoursalone,andasofnowthetotalcountofpeoplelivingwiththis diseaseisat4,138.(9) Globalcasesoroutbreaks(withincidencefigures) AccordingtoWorldHealthOrganizationtherewereapproximately36.9millionpeopleworldwideliving withHIV/AIDSattheendof2015.Ofthese,2.6millionwerechildren(<15yearsold).Sub-SaharanAfrica accountsforalmost70percentoftheglobaltotalofnewHIVinfections.(10) References 1. "What Are HIV and AIDS? | AVERT." What Are HIV and AIDS? | AVERT. Web. 30 Apr. 2016. 2. "HIV Transmission." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2015. Web. 30 Apr. 2016. 3. "Join the Alliance." AIDS Research Alliance: Eradicating HIV Reservoirs. Web. 30 Apr. 2016. 4. "HIV." HIV. Web. 30 Apr. 2016. 5. "Symptoms of HIV." Symptoms of HIV. Web. 30 Apr. 2016. 6. "Origin of HIV & AIDS | AVERT." Origin of HIV & AIDS | AVERT. Web. 30 Apr. 2016. 7. "Clinical HIV Vaccine Research." Clinical HIV Vaccine Research. Web. 30 Apr. 2016. 8. "AIDS." AIDS. Web. 30 Apr. 2016. 9. "Austin/ Travis County Health and Human Service Department." Health and Human Service Department, 22 Apr. 2015. Web. 30 Apr. 2016. 10. "Global Statistics." Global Statistics. Web. 30 Apr. 2016. Hyperlinks 1. http://www.avert.org/about-hiv-aids/what-hiv-aids 2. http://www.cdc.gov/hiv/basics/transmission.html 3. http://aidsresearch.org/cure-research/eradicating-hiv-reservoirs 4. http://web.uconn.edu/mcbstaff/graf/Student%20presentations/HIV/HIV.html 5. https://www.aids.gov/hiv-aids-basics/hiv-aids-101/signs-and-symptoms/ 6. http://www.avert.org/professionals/history-hiv-aids/origin 7. http://www.niaid.nih.gov/topics/HIVAIDS/Research/vaccines/Pages/clinical.aspx 8. http://www.austincc.edu/microbio/2704y/hiv.htm 9. http://www.austintexas.gov/sites/default/files/files/Health/Info_to_Post/Critical_Health_In dicators_2015.pdf 10. https://www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/