HIV Midterm

HIV Cell Diagram

(See drawn picture in study guide)

HIV Life Cycle Diagram

(See drawn picture in study guide)

Alternative Theories

- Government merged biowarfare department with National Cancer Institute in order to create a virus to wipe out unwanted minorities Hepatitis B vaccine was tested on gay men in New York in the early 1970's who *mysteriously* showed symptoms of AIDS about 10 years later. This "vaccine" was also tested on monkeys in central - -Africa where some scientists say that HIV *coincidentally* came from -Created by the governments of Israel and South Africa to attack and wipe out nonwhites. The AIDS virus originated from domestic cats (specifically the Feline Immunodeficiency Virus)

What is HAART? (Highly Active Antiretroviral Therapy)

- HAART is a customized combination of different classes of medications that a physician prescribes based on such factors as the patient's viral load (how much virus is in the blood), the particular strain of the virus, the CD4+ cell count, and other considerations (e.g., disease symptoms). - It must be taken every day for life. HAART can control viral load, delaying or preventing the onset of symptoms or progression to AIDS, thereby prolonging survival in people infected with HIV.

What life with HIV/AIDS looks like now compared to the 1980s

- Then, most reported cases were caused by male-to-male sexual contact -Now, with proper ART, those with HIV/AIDS can have a long life. HIV/AIDS is no longer a death sentence

What is PreP?

- Truvada - Pre-exposure prophylaxis When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. When taken consistently, PrEP has been shown to reduce the risk of HIV infection by up to 92%. 4 - much less effective if not taken consistently. PrEP is a powerful and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day

HIV Life Cycle Steps

1. Virus binds itself to CD4 cell receptors on CD4 cell membrane. 2. HIV envelope and CD4 cell membrane fuse and allow viral HIV RNA to enter the Cell 3. Reverse Transcriptase converts viral RNA genetic material to viral DNA inside the cell. 4. Inside the CD4 cell nucleus, HIV releases integrase and inserts its viral DNA into cell DNA chromosomes of CD4 cell. 5. Production of viral RNA for viral mRNA and genomic RNA 6. HIV begins to use machinery of CD4 cell to make long chains of viral HIV Protein and are building blocks of new HIV Cell through protease cleavage. 7. New HIV Proteins and HIV RNA move to the surface of the cell and assemble into noninfectious HIV. 8 Newly formed HIV pushes out of host and uses protease, forming the protease cleavage, to break up protein chains forming the virus. Small HIV proteins join together to make mature HIV cells.

Symptoms of HIV AIDS

Acute Infection Stage Symptoms Within the first 2-4 weeks of infection 40-90% of people have flu-like symptoms such as: · Fever · Chills · Rash · Night Sweats · Sore Throat · Mouth Ulcers · Swollen lymph nodes · Headache · Joint and muscle pain · Nausea/ vomiting · Fatigue Clinical Latency Stage After the acute HIV infection stage has passed and the patient becomes HIV positive, they will eventually move into the clinical latency stage where the virus is still active but present with no HIV related symptoms, or, very mild ones. This stage will continue for many years until HIV declines into AIDS. AIDS · Rapid weight loss · Recurring fever · Profuse night sweats · Extreme and unexplained tiredness · Prolonged swelling of the lymph glands (armpit, groin, neck) · Diarrhea lasting more than a week · Sores in the mouth, anus, or genitals · Pneumonia · Red, brown, pink, purple blotches on or under the skin, inside the mouth, nose or eyelids · Memory loss · Depression · Other neurologic disorders

Most effective means for preventing spread

Condoms (and other barrier methods) Avoid sex with multiple partners Pre-exposure prophylaxis (PrEP) Use clean needles Test blood transfusions for HIV in the blood

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Differ from NRTIS in structure and mechanism of action NNRTIs bind to active center of reverse transcriptase and cause direct inhibition Efavirenz (Sustiva) Only NNRTI recommended for first-line therapy of HIV infection Pharmacological class: Antiviral Mechanism of action: attaches to and blocks the enzyme reverse transcriptase Use: Take through tablet/capsule

Legal Elements to the Disease

Employer cannot discriminate against someone with AIDS Can be classified as an assault if they knew they are HIV+ and knew it could be transmitted through sex/ whatever action they are partaking in\ HIV needles given to drug addicts Closing Bath Houses to gay men Forcing HIV testing Firing someone who has the disease

What is the difference between HIV 1 and HIV 2?

HIV-2 is more than 55% genetically different from HIV-1. Due to this genetic difference, HIV-1 and HIV-2 antigens are distinct enough that if a test is developed only to detect HIV-1, it will not reliably detect HIV-2.

High Risk Groups

In the U.S, gay/bisexual men, African American, and Latino populations are disproportionately affected. Also trans women who have sex with men. IV Drug users. African Women most likely to be affected worldwide, especially ages 15-19 In Order: In the U.S · Black MSM (10,312) · White MSM (7,570) · Hispanic/Latino MSM (7,013) · Black Heterosexual Women (4,142) · Black Heterosexual Men (1,926) · Hispanic/Latina Heterosexual Women (1,010) · White Heterosexual Women (968)

Common medical treatments/ how they work

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) · NRTIs, contain faulty versions of the building blocks (nucleotides) needed for reverse transcriptase to convert RNA to DNA. So when reverse transcriptase uses these faulty RNA, the new DNA cannot be built correctly. so no new virus can be produced. Ex: zidovudine + lamivudine; emtricitabine + tenofovir alafenamide Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) · NNRTIs acts like a gum and blocks HIV reverse transcriptase. Reverse transcriptase is used to convert RNA to DNA. By blocking reverse transcriptase and reverse transcription; it prevents HIV from replicating. Example: Sustiva, efavirenz Protease Inhibitors (PIs) · Protease inhibitors block the activity of the protease enzyme, used by the HIV virus to break up large polyproteins into small pieces required to make new viral particles. HIV can still replicate with protease inhibitors, but the resulting versions are immature and therefore aren't able to infect new cells. Example: Invirase® (saquinavir)

Origin and Historical Background

Origins/ historical background · Both HIV-1 and HIV-2 are believed to be derived from ancestral Simian Immunodeficiency Virus (SIV) strains located in distinct regions and species. Scientists have identified a specific type of chimpanzee in West Africa as the source of the SIV that was transmitted into humans and mutated into HIV through contact with the chimpanzee's infected blood. Over time the virus spread over Africa and into the rest of the world. · The earliest known case of infection with HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of the Congo. Genetic analysis of this blood sample suggested that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s. HIV-2 is believed to have jumped into humans around 1940, with its first reported case occurring in Guinea-Bissau in the 1960s. · Initial Cases of HIV/AIDS: o First reported cases of HIV/AIDS occurred in 1981 among five homosexual men treated for Pneumocystis pneumonia; first actual cases were between 1975 and 1981 among heterosexual women, in which five heterosexual women were treated for extreme immune deficiencies between 1975 and 1981, but this information wasn't published until October 1982 (and HIV/AIDS was believed to be in the U.S. as early as 1965). o In July of 1981, the CDC reported on Kapos's Sarcoma being diagnosed in 26 homosexual men living in New York and California. o In 1985, the first cases of HIV-2 were discovered in West African prostitutes.

Disease progression

Stage 1: HIV with no symptoms Stage 2: HIV with symptoms such as fatigue, fever, headache, rash, weight loss, muscle pain Stage 3: HIV infection with AIDS-defining opportunistic infections

Different strains of HIV/AIDS

There is HIV And HIV 2. Tests are sensitive to both HIV 1: Has 4 groups: M,N,O, and P, with M being the most common global Group with subtypes A-K with sub-type B being the most researched. HIV 2: Uncommon, bu tin West African Countries. NNRTIs like nevirapine and efavirenz do not work against it. The best strategy with which to treat HIV-2 has been less clearly defined than HIV-1.

When HIV turns into AIDS?

When the CD4 cell count is below 200 T4 lymphocytes/uL of blood, or a T4 lymphocyte percentage less than 14% of total lymphocytes. . The immune system becomes so weak that opportunistic diseases begin to occur.

Longevity of patient without treatment

Without treatment, some people see their CD4 count drop to under 200 within a few years of infection, while others people can go for 5-10 years or longer before they need treatment.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Zidovudine Retrovir): Inhibits HIV replication by suppressing synthesis of viral DNA Adverse (Side) effects: Hematologic (blood) toxicity Lactic acidosis with hepatomegaly Myopathy (muscle soreness/discomfort)

When and by who was HIV discovered by?

o In January of 1983, French scientist Luc Montagnier isolated the virus that causes AIDS, and in May of the same year, published the first report on a T-cell retrovirus found in a patient with lymphadenopathy, calling it lymphadenopathy-associated virus (LAV). o In December of 1983, Robert Gallo submitted a paper proposing the theory that an HTLV-type (Human T-cell Leukemia Virus) virus was the cause of AIDS, calling it HTLV-III. o The two viruses Montagnier and Gallo discovered were very similar, and actually just slightly different strains of the same virus, named Human Immunodeficiency Virus in 1984, and accepted by the scientific community as the cause of AIDS later that same year.

Diseases associated with AIDS

· Dementia · Tuberculosis · HIV Wasting Syndrome: chronic diarrhea and weight loss with no identifiable cause · Pneumonia (PCP) · Kaposi's Sarcoma · Candida (yeast infection)

Specific biological details

· HIV is a retrovirus. A retrovirus is a virus that takes over the host, inserts its DNA, and takes over the cell to make a "virus factory". o Retrovirus has viral RNA, which is later converted to DNA · Reverse Transcriptase: enzyme that converts RNA to DNA · Diagnosis occurs when body doesn't produce as many antibodies o Antibodies: occur naturally in body to protect against infection · CD4 T-Cells: White blood cells inside the circulatory system used to fight off infection · Protease: Enzyme that "cuts" long protein strands into individual functional units

Acronyms of HIV and AIDS

· HIV- Human Immunodeficiency Virus. AIDS- Acquired Immune Deficiency Syndrome.

When was the first HIV test and treatment created?

· In 1985, Robert Gallo developed the first HIV blood test. · By the end of 1985 over 900,000 people in the U.S. had been infected with HIV, and 13,000 had died from AIDS. · In 1996, the first effective HIV/AIDS treatment drug was created.

How AIDS affects pregnant women and how to treat them/ baby

· Mother can have HIV and not pass it on to baby by using ART drugs, and having a C-section birth · Same principles that guide ART in non-pregnant adults · Mother is treated with ART and so is the baby HIV transmission from mother to child during pregnancy, labor, delivery or breastfeeding is called perinatal transmission. With appropriate treatment during pregnancy, baby's risk is reduced to less than 1 percent It can take a while for HIV to be detectable in your baby's blood, and this can't be confirmed until he's at least 4 months old.)

Disease progression

· Stage 1: Acute HIV with flulike symptoms · Stage 2: Asymptomatic · Stage 3: HIV infection with AIDS-defining opportunistic infections

When did HIV gain media coverage?

· The death of movie star Rock Hudson from HIV/AIDS in 1985 gave the syndrome its first major coverage by newspapers and tv networks, sparking the national conversation.

Research efforts that led to improvement of conditions

· The introduction of Highly Active Antiretroviral Therapy (HAART) · PreP drug

Most common side effects of the drugs used for treatment

· The most common side effects of drugs used for HIV/AIDs treatment includes Hyperglycemia/diabetes, Fat redistribution, Hyperlipidemia, Reduced bone density, Increased bleeding in people with hemophilia, Reduced bone mineral density, Elevation of serum transaminase. · Diabetes, hyperglycemia, bad cholesterol, soreness, CNS reactions

How is AIDS perceived in different countries

· The opportunistic infections in a geographic region reflect the pathogens that are common in the area. in Africa key populations remain insufficient and many face stigma, discrimination and legal barriers that prevent them from accessing HIV services, Women are disproportionately affected by HIV in the region,

How it is contracted?

· Through exchange of bodily fluids especially blood and semen. Often through unprotected sex, or sharing of dirty needles. Six bodily fluids that transmit HIV/AIDS: o Blood o Semen(extremely rare) o pre-seminal fluid (extremely rare) o rectal fluids o vaginal fluids (extremely rare) o breast milk. · Blood borne virus (The virus has to enter the blood through blood-to-blood contact or through mucous pores) · Transmitted through sex, shared drug paraphernalia, and mother to child transmission (MTCT) o Occur during birth or breast feeding · AIDS caused by infection with HIV-1 or HIV-2