HIV & AIDS LCHS Mark Ewoldsen, Ph.D.
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? Fiction HIV is not transmitted by insects You can get AIDS from a mosquito bite
Fact or Fiction? 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. You can get AIDS by having oral sex with an infected person
Fact or Fiction? Fiction Scientists and medical authorities agree that HIV does not survive well in the environment - so forget about those toilet seats! HIV survives well in the environment, so you can get it from toilet seats and door knobs
Fact or Fiction? Fiction Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. You can get AIDS by hugging a person with HIV who is sweating
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 • 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? Fact Having a sexually transmitted disease (STI) can increase a person's risk of becoming infected with HIV up to 10x There is a connection between other STDS and HIV infection
Fact or Fiction? 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 Patients in a dentist or doctors office are at risk for getting HIV
HIV/AIDS Quick Facts
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
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
Domestic • 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
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
Balance between Infection and Immunity Infection Immunity
What are HIV and AIDS? • HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection • The destruction of these cells leaves people infected with HIV vulnerable to other infections, diseases and other complications
What are HIV and AIDS? • The acquired immunodeficiency syndrome (AIDS) is the final stage of HIV infection • A person infected with HIV is diagnosed with AIDS when he or she • has one or more opportunistic infections, such as pneumonia or tuberculosis, • has a dangerously low number of CD4+ T cells (less than 200 cells per cubic millimeter of blood)
How HIV Causes AIDS • Most people who are infected with HIV can carry the virus for years before developing any serious symptoms • HIV levels increase in the blood while the number of CD4+ T cells decline • Antiretroviral medicines • reduce the amount of virus in the body • preserve CD4+ T cells • slow the destruction of the immune system
How HIV Causes AIDS • Number of CD4 cells in blood provides a measure of immune system damage • CD4 count reflects phase of disease • CD4 count: 500 – 1200:Normal 200 – 500:Beginning of HIV illness < 200: AIDS
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 • After infecting a cell, HIV uses an enzyme called reverse transcriptase to convert its RNA into DNA (deoxyribonucleic acid) and then proceeds to replicate itself using the cell's machinery
Biology of HIV • Within the retrovirus family, HIV belongs to a subgroup known as lentiviruses, or "slow" viruses • Lentiviruses are known for having a long time period between initial infection and the beginning of serious symptoms • Many people are unaware of their HIV infection, and unfortunately, can spread the virus to others
HIV Hides • Antiretroviral drugs • capable of suppressing HIV, even to undetectable levels in the blood • cannot eliminate the virus hiding in these latent reservoirs
HIV Hides • HIV can hide in • Brain • Lymph nodes • Skin • peripheral blood • Reticuloendothelial system • Bone marrow • Gastrointestinal cells
Factors affecting Progression Mutations in HIV Co-receptors • People infected with HIV who have specific genetic mutations progress to AIDS slower • Rare individuals may be completely protected from HIV infection • Other mutations may influence the rate of disease progression
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
HIV Risk Factors Increased risk • Inject drugs or steroids & share needles/syringes • STD+ • Syphilis • Genital herpes • Chlamydia • Gonorrhea • Bacterial vaginosis or trichomoniasis
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
HIV Transmission • HIV cannot survive for very long outside of the body • HIV CAN NOT be transmitted • using a toilet seat • sharing food utensils • drinking glasses • shaking hands • kissing
HIV Transmission • The virus can be transmitted • person to person • not through animals or insect bites • People infected with HIV who are taking antiretroviral therapy can still infect others through unprotected sex and needle-sharing
EarlySymptoms • 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
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 • Memory loss, depression and other neurological disorders.
Opportunistic Diseases • HIV-associated malignancies • Kaposi's sarcoma • Lymphoma • Squamous cell carcinoma.
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
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
Prevention • No Vaccine, so… • Get tested regularly for HIV • Practice abstinence • Remain faithful to your spouse or partner • Consistently use male latex or female polyurethane condoms • Do not share needles • Blood or blood products are tested
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
Bibliography • ‘Sexually Transmitted Disease Program,’ Los Angeles County Department of Health Services - Public Health @ http://lapublichealth.org/std, 4/22/04 • “Access Excellence @ the national health museum”, http://www.accessexcellence.org/AB/GG/Antibody.html • “Averting AIDS and HIV”, www.avert.org • “Bio 160, Development of Vaccines to Infectious Disease” Brown University, http://www.brown.edu/Courses/Bio_160/Projects1999/hiv/ • “Centers for Disease Control and Prevention”, http://www.cdc.gov/hiv/graphics/images/l178/l178-3.htm • “Free Graphics”, http://www.freegraphics.com/images/downloads/worldaids/index3.html • “Galaxy Goo, An Online Exploration of Science and Community”, http://www.galaxygoo.org/hiv/hiv_lifecycle.html • “Health”, AllRefer.com, http://health.allrefer.com • “MSN Encarta: Multimedia”, http://ca.encarta.msn.com/media • “Population Reference Bureau”, http://www.prb.org • “The HIV/AIDS Search Engine”, http://www.hivaidssearch.com/hiv-aids-links.asp • “Yahoo Health” http://health.yahoo.com/health/ency/adam/000821/i9478 • Ambroziak J, Levy JA. 1999. In: Holmes KK, et al. • Ashley RL, Wald A. 1999. Clin Microbiol Rev. • Burstein GR, Gaydos CA, Diener-West M, Howell MR, Zenilman JM, Quinn TC. Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA 1998; 280:521-596 • Campbell and Reece, Biology, 6th edition http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43 • CDC. 2002. STD Surveillance 2002. • CDC. 2003. Chlamydia Fact Sheet. • CHLAMYDIA and GONORRHEA Los Angeles County Rates, 1991-2000, http://www.ph.ucla.edu/epi/Faculty/Visscher/Epi230/2006/Javanbakht_Chlamydia_04-06.ppt • Corey L, Handsfield HH. 2000. JAMA. • Fleming DT, et al. 1997. N Engl J Med. • Gaydos CA, Howell MR, Pare B, et al. Chlamydia Trachomatis Infection in female military recruits. N Engl J Med 1998; 339:739-744 • Global AIDS Program : Strategieshttp://www.cdc.gov/nchstp/od/gap/strategies/default.htm, 1/30/05 • Have a Sore Throat? Daily Texan, University of Texas at Austin. May 11, 2004 @ http://www.dailytexanonline.com/media/paper410/news/2004/05/11/TopStories/Have-A.Sore.Throat.Uhs.May.Run.Tests.For.Gonorrhea-680752.shtml?norewrite&sourcedomain=www.dailytexanonline.com • Horan PF, et al. 1998. J HIV/AIDS Prev and Educ for Adolesc and Children • http://ca.encarta.msn.com/media_461519550/Lymphocyte.html
Bibliography • http://www.accessexcellence.org/AB/GG/Antibody.html • http://www.cdc.gov/EPO/DPHSI/annsum/1998/98graphs/9826.htm • http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm • http://www.cdc.gov/std/BV/STDFact-Bacterial-Vaginosis.htm#diagnosed • http://www.cdc.gov/std/HPV/STDFact-HPV.htm • http://www.cdcnpin.org/images/HPV.jpg • http://www.emanet.org/safety/media/1_risk_gp_03b.jpg • http://www.gardasil.com/risk-for-hpv.html?WT.srch=1&WT.mc_id=GL047 • http://www.health-science-report.com/cgi-bin/alotek.cgi?topics=3&article=19# • http://www.nhsborders.org.uk/view_item.aspx?item_id=16108 • http://www.ph.ucla.edu/epi/Faculty/Visscher/Epi230/2006/Higgins_GC_04-06.ppt • http://www.prb.org/presentations/d_growth-aids-epidemic.ppt • http://www.rit.edu/~photo/IFS/index-pages/IFS-37.html • http://www2.hu-berlin.de/sexology/ECE4/s_hpv4.jpg • Image from http://ca.encarta.msn.com/media_461518877/TLymphocyte_Infected_With_HIV.html • IMAGE SOURCES: All images were obtained from the web between the dates of 7/13/04 – 7/22/04 • Kaiser Family Foundation, Medicare and HIV/AIDS, 9/05; Kaiser Family Foundation, Medicare at a Glance, 9/05. Medicare HIV/AIDS spending estimate from CMS, Office of the Actuary, 2005, and HHS Office of the Budget, 2005. • Klausner JD, McFarland W, Bolan G, et al. Knock-knock: a population based survey of risk behavior, health care access, and Chlamydia trachomatis infection among low-income women in the San Francisco bay area. J Infect Dis 2001; 183:1087-1092 • Lue, Dr. Robert, “Evasion and Destruction of the Immune System by HIV”, Department of Molecular and Cellular Biology, Harvard University. Lecture July 16, 2004, July 22, 2004. • Mangione-Smith R, McGlynn EA, Hiatt L. Screening for Chlamydia in adolescents and young women. Arch Pediatr Adolesc Med. 2000; 154:1108 -1113 • Mertz KJ, McQuillian GM, Levine WC, et al. A pilot study of the prevalence of Chlamydia infection in a national household survey. Sex Transm Dis 1998; 25:225-228 • Progress in Reproductive Health Research, Sexual Health, A New Focus for WHO No. 67, 2004. • Pubic Lice or "Crabs” Pthirus pubis (THEER-us pu-bis), CDC @ http://www.cdc.gov/ncidod/dpd/parasites/lice/factsht_pubic_lice.htm, 4/22/04 • Rochester Institute of Technology, http://www.rit.edu/~photo/IFS/index-pages/IFS-37.htmleluxe.html • Simms I, Stephenson J. 2000. Sex Transm Infect.
Bibliography • Spencer S. Eccles Health Sciences Library, University of Utah, http://medlib.med.utah.edu/WebPath/TUTORIAL/AIDS/AIDS001.html • Spiderbytes: A New Spin on Sexual Health for Teens, http://www.spiderbytes.ca/Health/Health_STIs_STIsByNames.shtml, 1/30/05 • Starnbach, Dr. Michael, “Adaptive Immune responses to bacterial pathogens”, Department of Microbiology and Molecular Genetics, Harvard Medical School. Lecture July 13, 2004. • Teachers’ Domain, Multimedia Resources for the Classroom and Professional Development”, www.teachersdomain.org/9-12/sci/life/gen/hivimmunity/index.html • The Syphilis Program, www.ph.ucla.edu/epi/faculty/Visscher/Epi230/2006/Tolbert_Syphilis_04-06.ppt • Thyng, Kristine, outreach.mcb.harvard.edu/site_update/ teachers/KristineThyng/HIVAIDSpresentation.ppt , 2/2/2005 • UNAIDS. 2003. AIDS Epidemic Update: 2003. • Westrom L, et al. 1999. Sex Transm Dis • Whittington WLH, Kent C, Kissinger P, et al. Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicententer cohort study. Sex Transm Dis 2001; 28:117 – 123 • Wolner-Hanssen P. 2000. In: Mead PB, et al. • Xu F, Schillinger JA, Markowitz LE, et al. Repeat Chlamydia trachomatis infection in women: analysis through a surveillance registry in Washington State, 1993 – 1998. Am J Epidemiol 2000; 152:1164 – 1170 • http://www.aegis.com/news/mh/2002/MH021003.html • http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Pages/symptoms.aspx • The Syphilis Program, www.ph.ucla.edu/epi/faculty/Visscher/Epi230/2006/Tolbert_Syphilis_04-06.ppt • Thyng, Kristine, outreach.mcb.harvard.edu/site_update/ teachers/KristineThyng/HIVAIDSpresentation.ppt , 2/2/2005 • UNAIDS. 2003. AIDS Epidemic Update: 2003. • Westrom L, et al. 1999. Sex Transm Dis • Whittington WLH, Kent C, Kissinger P, et al. Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicententer cohort study. Sex Transm Dis 2001; 28:117 – 123 • Wolner-Hanssen P. 2000. In: Mead PB, et al. • Xu F, Schillinger JA, Markowitz LE, et al. Repeat Chlamydia trachomatis infection in women: analysis through a surveillance registry in Washington State, 1993 – 1998. Am J Epidemiol 2000; 152:1164 – 1170 • http://www.aegis.com/news/mh/2002/MH021003.html • http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Pages/symptoms.aspx