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HIV & AIDS
LCHS
Mark Ewoldsen, Ph.D.
Immunology
2
Significance of the Immune System
• Beneficial
–Protection from Invaders
–Elimination of Altered Self
• Detrimental
–Discomfort
• inflammation
• allergies
–Damage to self (autoimmunity)
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Pathogens
• Microbes that cause disease
–constantly in the environment
–evolved to spread in a variety of ways
• Four types
–Bacteria
–Fungi
–Viruses
–Protozoa
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Bacteria Concentrations
Part of body
Bacteria
Head (scalp)
1,000,000 /cm2
Surface of skin
1000 /cm2
Saliva
100,000,000 /g
Nose mucus
10,000,000 /g
Feces
over 100,000,000 /g
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Antigen
• Non-self molecule
–on the surface of every foreign cell
–unique set of characteristics
–generally fragments of protein or
carbohydrate molecules
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Balance between Infection
and Immunity
Infection
Immunity
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Innate vs Adaptive
Innate
Adaptive
Antigen
independent
No time lag
Not antigen specific
No Immunological
memory
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Eyes
• Tears
–wash out pathogens
–contain enzyme that can kill bacteria
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Nose
• Mucus traps pathogens
–swallowed
–blown out in coughs and sneezes
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Mouth
• Friendly bacteria help to prevent the
growth of harmful pathogens
• Saliva cleans and removes
bacteria.
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Lungs
• Mucus in lungs traps
–bacteria
–fungal spores
–Tiny hairs, called cilia move mucus
• up to the back of the throat
• it is swallowed
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Stomach
• Acid helps to sterilize the food
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Skin
• Outer layer of skin
–dead
–difficult for pathogens
• grow on
• Penetrate
• Cuts allow pathogens to gain entry
to the body
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Reproductive system
• Slightly acid conditions
–vagina
– urethra
–help to stop the growth of pathogens
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Large intestine
• Friendly bacteria
– stop the growth of harmful pathogens
• Feces contains over 30% live
bacteria
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http://www.abpischools.org.uk/res/coResourceImport/resources04/immune/immune3.cfm
Innate vs Adaptive
Innate
Adaptive
Antigen
independent
No time lag
Not antigen specific
No Immunological
memory
Antigen dependent
A lag period
Antigen specific
Development of
memory
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What is HIV?
HIV (human
immunodeficiency virus) is
the virus that causes AIDS.
+
HIV
= AIDS
A positive HIV test result does not
mean that a person has AIDS.
A diagnosis of AIDS is made by a
physician using certain clinical
criteria
I Heard It through
the Grapevine
AIDS Mythology
Fact or Fiction?
You can get AIDS from a mosquito bite
Fact or Fiction?
You can get AIDS from a mosquito bite
Fiction
HIV is not transmitted by insects
Fact or Fiction?
You can get AIDS by having oral sex
with an infected person
Fact or Fiction?
You can get AIDS by having oral sex
with an infected person
Fact
It is possible for either partner to become
infected with HIV through performing or
receiving oral sex. While no one knows
exactly what the degree of risk is, evidence
suggests that the risk is less than that of
unprotected anal or vaginal sex.
Fact or Fiction?
HIV survives well in the environment,
so you can get it from toilet seats and
door knobs
Fact or Fiction?
HIV survives well in the environment,
so you can get it from toilet seats and
door knobs
Fiction
Scientists and medical authorities agree
that HIV does not survive well in the
environment - so forget about those
toilet seats!
Fact or Fiction?
You can get AIDS by hugging a
person with HIV who is sweating
Fact or Fiction?
You can get AIDS by hugging a
person with HIV who is sweating
Fiction
Contact with saliva, tears, or sweat has
never been shown to result in
transmission of HIV.
Fact or Fiction?
You can get AIDS by kissing
someone who is HIV infected
Fact or Fiction?
You can get AIDS by kissing
someone who is HIV infected
Fiction
It would be extremely unlikely to get HIV
from kissing, even open-mouth deep kissing.
HIV is transmitted through blood, semen,
vaginal fluids, and breast milk and these
fluids are not usually present during kissing.
Fact or Fiction?
Condoms are not really effective in
preventing HIV transmission
Fact or Fiction?
Condoms are not really effective in
preventing HIV transmission
Fiction
•The protection that proper use of latex condoms provides against HIV
transmission is most evident from studies of couples in which one member is
infected with HIV and the other is not.
•In a study of discordant couples in Europe, among 123 couples who reported
consistent condom use, none of the uninfected partners became infected.
•In contrast, among the 122 couples who used condoms inconsistently, 12 of
the uninfected partners became infected
Fact or Fiction?
There is a connection between other
STDS and HIV infection
Fact or Fiction?
There is a connection between other
STDS and HIV infection
Fact
Having a sexually transmitted
disease (STI) can increase a
person's risk of becoming infected
with HIV up to 10x
Fact or Fiction?
Patients in a dentist or doctors office
are at risk for getting HIV
Fact or Fiction?
Patients in a dentist or doctors office
are at risk for getting HIV
Fiction
Studies of more than 22,000 patients of 63
health care providers who were HIV-infected
have found no evidence of transmission from
provider to patient in health care settings
HIV/AIDS
Quick Facts
QuickTime™ and a
BMP decompressor
are needed to see this picture.
38
Global
• 33 million people worldwide living
with HIV/AIDS in 2007
• 2.7 million people newly infected
with HIV in 2008
• Deaths
–more than 27 million lives to date
–2 million people die every year
• More than 95% in developing
countries
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Global
• Children living with HIV/AIDS
–2 million, 2008 figures
–Most in sub-Saharan Africa
• infected by their HIV-positive mothers
–childbirth
–breastfeeding
• Almost 1200 children newly infected
each day
44
Percentage of children under 18 who
have lost one or both parents, in
countries with HIV prevalence
greater than 1 per cent, 2003-2007
45
Domestic
• The U.S. HIV/AIDS epidemic began in
1981 and continues to disproportionately
affect minorities, men who have sex with
men of all races, women and youth
• More than 1 million people in the U.S.
currently are living with HIV/AIDS
• 21 percent of those infected with HIV are
unaware of their infection
46
Domestic
• 1 million affected, with as many as
53,600 new AIDS cases reported each
year.
• Since the U.S. epidemic began,
565,927 people have died of AIDS
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HIV Biology
50
Biology of HIV
• HIV belongs to a class of viruses
known as retroviruses
• Retroviruses are viruses that
contain RNA (ribonucleic acid)
as their genetic material
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HIV Devastates the Immune System
• Every day, HIV
destroys billions of
CD4+ T cells
• Overwhelming the
immune system's
capacity to regenerate
or fight other infections
53
X
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• Virus can hide within
–the cytoplasm
–integrate into DNA
• HIV can hide in
–Brain
–Lymph nodes
–Skin
–peripheral blood
–Reticuloendothelial
system
–Bone marrow
–Gastrointestinal cells
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Risk Factors
56
HIV Risk Factors
HIV is found in
• blood, semen or vaginal fluid
Increased risk
• Engage in anal, vaginal or oral sex
with
–men who have sex with men
–multiple partners
–anonymous partners without the use
of a condom
57
HIV Risk Factors
Increased risk
• Inject drugs or steroids & share
needles/syringes
• STD+
– Syphilis
– Genital herpes
– Chlamydia
– Gonorrhea
– Bacterial vaginosis or trichomoniasis
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HIV Risk Factors
Increased risk
• Have hepatitis, tuberculosis or malaria
• Exchange sex for drugs or money
• Exposed to the virus as fetus or infant before
or during birth or through breastfeeding from a
HIV+ mother
• Received a blood transfusion or clotting factor
in US from 1978-1985
• Engage in unprotected sex with someone who
has any of the risk factors
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Factors affecting Progression
High Viral Load
• People with high viral loads are more
likely to progress to AIDS faster
Viral Set Point
• HIV level of in a person’s blood after the
first few months of infection
• Higher viral set point are much more
likely to get sick faster
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Testing and Diagnosis
• Routine HIV Testing
–1.1 million Americans HIV+
–21% do not know
• CDC recommends HIV testing
–Adults
–Adolescents
–Pregnant women
• prevent mother-to-child HIV transmission
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Testing and Diagnosis
• Types of Testing
–sample of blood for HIV antibodies
• ELISA
• Western blot
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Testing and Diagnosis
• Types of Testing
–sample of blood for HIV antibodies
• ELISA
• Western blot
• antibody tests may not detect HIV
–recently infected with HIV (within one to
three months of infection)
• HIV DNA test
64
Treatment
• Early 1980s people with AIDS were not
likely to live longer than a few years
65
Treatment
• Early 1980s people with AIDS were not
likely to live longer than a few years
• Today
– 31 antiretroviral drugs (ARVs)
• do not cure people of HIV or AIDS
– suppress the virus
» even to undetectable levels
» does not eliminate HIV from the body
– lead longer and healthier lives
– can still transmit the virus
– must continuously take antiretroviral drugs
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Vaccine Problem
• HIV continually
–mutates
–recombines
–evolve
–new strains of virus that differ slightly
from the original infecting virus
• Vaccine not cover all 1500 types in body
• Increase risk of partners
67
Progression of
HIV → AIDS
68
Clinical Progression of HIV
Typical course of HIV infection that shows the
relationship between the levels of HIV (viral load) and
CD4+ T cell counts over the average course
of
69
untreated HIV infection
Acute Primary Infection
• HIV enters the body
• Virus infects a large number of CD4+
T cells and replicates rapidly
• Blood has a high number of HIV
copies (viral load)
– spread throughout the body
– seeding in various organs, particularly the
lymphoid organs such as the thymus,
spleen, and lymph nodes
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Acute Primary Infection
• Virus may integrate and hide in the
cell’s genetic material
• Shielded from the immune system,
the virus lies dormant for an
extended period of time
• Up to 70 percent of HIV-infected
people suffer flu-like symptoms
71
Early Symptoms
• Initial stages - very few or none
• Within a month or two after infection
– Fever
– Headache
– Tiredness
– Enlarged lymph nodes in the neck and groin area
• Disappear within a week to a month
• Highly infectious
– HIV is present in large quantities in genital fluids and
blood
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Early Symptoms
• Highly infectious
–HIV is present in large quantities in
genital fluids and blood
73
Clinical Progression of HIV
Typical course of HIV infection that shows the
relationship between the levels of HIV (viral load) and
CD4+ T cell counts over the average course
of
74
untreated HIV infection
Immune System Strikes Back
• Two to four weeks after exposure
– immune system fights back with killer T
cells (CD8+ T cells)
– B-cell-produced antibodies
• HIV levels in the blood are
dramatically reduced
• CD4+ T cell counts rebound and
number may rise to original level
75
Clinical Progression of HIV
Typical course of HIV infection that shows the
relationship between the levels of HIV (viral load) and
CD4+ T cell counts over the average course
of
76
untreated HIV infection
Clinical Latency
• Free of HIV-related symptoms for
several years despite the fact that
HIV continues to replicate in the
lymphoid organs where it initially
seeded
77
Clinical Progression of HIV
Typical course of HIV infection that shows the
relationship between the levels of HIV (viral load) and
CD4+ T cell counts over the average course
of
78
untreated HIV infection
Progression to AIDS
• Immune system eventually deteriorates to
the point that the human body is unable to
fight off other infections
– HIV viral load in the blood dramatically
increases
– Number of CD4+ T cells drops to dangerously
low levels
• AIDS diagnosis
– one or more opportunistic infections
– fewer than 200 CD4+ T cells per cubic
millimeter of blood
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Later Symptoms
• Virus severely weakens immune system
• Symptoms:
–
–
–
–
–
–
–
–
–
Rapid weight loss
Recurring fever or profuse night sweats
Extreme and unexplained fatigue
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
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Memory loss, depression and other neurological disorders.
Clinical Progression of HIV
Typical course of HIV infection that shows the
relationship between the levels of HIV (viral load) and
CD4+ T cell counts over the average course
of
81
untreated HIV infection
Opportunistic Diseases
• Bacterial
– Tuberculosis
– MAC
– bacterial pneumonia
– Septicaemia (blood poisoning)
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Opportunistic Diseases
• Protozoal diseases
– Toxoplasmosis
– Microsporidiosis
– Cryptosporidiosis
– Isopsoriasis
– Leishmaniasis
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QuickTime™ and a
BMP decompressor
are needed to see this picture.
Toxoplasmosis
86
QuickTime™ and a
CryptosporidiosisBMP
decompressor
are needed to see this picture.
87
Leishmaniasis
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Opportunistic Diseases
• Fungal diseases
– PCP
– Candidiasis
– Cryptococcosis
– Penicilliosis
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Thrush
Thrush
Opportunistic Diseases
• Viral diseases
– Cytomegalovirus
– Herpes simplex
– Herpes zoster virus
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Opportunistic Diseases
• HIV-associated malignancies
– Kaposi's sarcoma
– Lymphoma
– Squamous cell carcinoma.
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Kaposi’s
Sarcoma
155
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