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Pharmacy Notes

Acquired Immune Deficiency Syndrome (AIDS)

Presentation25 slidesB.Pharm, Pharm.D

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Acquired Immunodeficiency Syndrome (AIDS) is a chronic condition caused by the Human Immunodeficiency Virus (HIV), first identified in the early 1980s.

  • HIV
  • AIDS
  • immunodeficiency
  • viral infection
  • disease progression

By Dr. Ayesha Fatima

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  1. Slide 1. ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) Dr Ayesha Fatima Pharm D Assistant Professor Dept of Pharmacy Practice
  2. Slide 2. INTRODUCTION 1. AIDS was first described in 1981 as a new disease. 2. In 1983, the causative agent was identified as Human Immunodeficiency Virus (HIV). 3. HIV is a retrovirus. It is classified into: a. HIV-1 (most common and virulent) b. HIV-2 (less virulent, mainly in West Africa) 4. HIV primarily attacks CD4+ helper T cells. 5. Leads to: Progressive immune system destruction 6. Increased susceptibility to: Opportunistic infections, Malignancies 7. According to Joint United Nations Programme on HIV/AIDS: Approximately 34 million people are living with HIV/AIDS. 8. High prevalence regions: Sub-Saharan Africa, Asia, South America 9. High-Risk Groups ▪ Individuals with: Multiple sexual partners , STIs ▪ Intravenous drug users ▪ Healthcare workers (occupational exposure) ▪ Infants born to HIV-positive mothers
  3. Slide 3. Modes of Transmission HIV is transmitted through three main routes : Sexual Transmission 1. Most common mode. 2. Includes: Receptive anal intercourse , Vaginal intercourse 3. Risk increases with: Existing sexually transmitted infections (STIs): 1. Syphilis 2. Gonorrhea 3. Chlamydia 4. Herpes simplex 5. Trichomoniasis 6. Chancroid 4. Condom use reduces risk by ~20-fold Parenteral Transmission 1. Through exposure to infected blood: 1. Sharing needles (common in drug addicts) 2. Blood transfusion with infected blood 2. Healthcare workers: 1. Risk via needle-stick injuries Perinatal (Vertical) Transmission 1. From mother to child 2. Occurs: During pregnancy, At delivery, Through breastfeeding 3. Risk without treatment: Approximately 40% 4. Key factor: Maternal viral load at delivery
  4. Slide 4. Morphologic Structure of HIV-1 1. Human Immunodeficiency Virus Type 1 belongs to the lentivirus subgroup of retroviruses. 2. Diameter: ~100 nm 3. Shape: Spherical, enveloped virus 4. Surrounded by a lipoprotein envelope derived from host cell membrane
  5. Slide 5. 1. Envelope (Outer Layer): Lipid bilayer obtained from host cell during budding Contains 72 glycoprotein spikes Important proteins: 1. gp120 (surface glycoprotein) : Responsible for attachment (adhesion) to CD4 receptors on host cells. Loosely attached → easily shed into serum & lymphatic tissues 2. gp41 (transmembrane glycoprotein) : Anchors gp120 to viral envelope. Helps in fusion of virus with host cell membrane 3. May incorporate host proteins: HLA class I & II 4. Adhesion molecules like ICAM-1 2. Matrix Layer: Located just beneath the envelope, Composed of: p17 protein Functions: 1. Maintains viral structure 2. Anchors envelope to capsid 3. Capsid (Core) Cone-shaped central structure Made of: p24 protein (core antigen): p24 is an important diagnostic marker in early HIV infection 4. Nucleocapsid: Inside the capsid 1. Two copies of single-stranded RNA 2. RNA is associated with: p7 nucleoprotein
  6. Slide 6. 5. Viral Genome: Contains 2 identical strands of RNA . Carries genetic information required for replication 6. Enzymes (Essential for Replication) HIV contains enzymes necessary for its life cycle: 1. Reverse Transcriptase (p66) : Converts viral RNA → DNA 2. Integrase (p32) : Integrates viral DNA into host genome 3. Protease (p11) Cleaves viral proteins → maturation of virus 7. Additional Features 1. During budding, virus may carry host cell components 2. gp120 shedding contributes to: 1. Immune evasion 2. Circulating viral proteins in blood 1. gp120 → Attachment to CD4 cells 2. gp41 → Fusion with host membrane 3. p17 → Structural matrix protein 4. p24 → Core antigen (diagnostic marker) 5. p7 → RNA binding protein 6. RT, Integrase, Protease → Replication machinery
  7. Slide 7. HIV Exposure ↓ Binding to CD4 T-cell (gp120 + CD4 receptor) ↓ Co-receptor Binding (CCR5 / CXCR4) ↓ Fusion with Host Cell (gp41 mediated) ↓ Release of Viral RNA + Enzymes into Cytoplasm ↓ Reverse Transcription (RNA → Double-stranded DNA by Reverse Transcriptase) ↓ Integration into Host Genome (by Integrase enzyme) ↓ Transcription & Translation (using host cell machinery) ↓ Formation of Immature Viral Particles ↓ Budding from Host Cell ↓ Maturation of Virus (Protease action) ↓ New Infectious Virions Released ↓ Infection of New CD4 Cells Pathophysiology
  8. Slide 9. 1. Cell may be destroyed due to: Direct viral damage ( cytolysis ) , Immune attack ( cytotoxic T-cells ) Natural cell death 2. Viral Distribution ~ 99% of HIV is present in: Lymph nodes, Immune-rich tissues 3. Acute Phase (Acute Retroviral Syndrome) : Often misdiagnosed or unnoticed Initial Infection ↓ Rapid Viral Replication (High Viremia) ↓ Drop in CD4 Cells ↓ Immune Response Begins (Antibody Production) ↓ Symptoms Appear: Fever Rash Lymphadenopathy Fatigue Night sweats
  9. Slide 10. Viral Set Point Phase (Chronic Phase) ▪ Immune System Partially Controls Virus ↓ Balance Achieved: Virus Produced = Virus Destroyed ↓ Establishment of "Viral Set Point" ▪ Higher set point → Faster disease progression ▪ Lower set point → Slower progression
  10. Slide 11. 1. Primary (Acute) HIV Infection Common early symptoms (Acute Retroviral Syndrome): a. Fever b. Pharyngitis (sore throat) c. Lymphadenopathy (adenopathy) Other associated features: a. Rash b. Fatigue c. Night sweats Clinical Presentation
  11. Slide 12. Disease Progression : Progression to AIDS depends on: Viral RNA load ▪ Higher viral load → Faster progression to AIDS Clinical Features in Children: Most HIV-infected children are asymptomatic initially Common physical findings: 1. Lymphadenopathy 2. Hepatomegaly 3. Splenomegaly 4. Failure to thrive 5. Weight loss / low birth weight 6. Fever of unknown origin
  12. Slide 13. 1. ELISA Test (Screening) Detects: Antibodies against HIV-1 , Highly sensitive and specific False Positive may occur in: Multiparous women , Recent infections: Hepatitis B , Influenza and After rabies vaccination False Negative : Early infection (window period) 2. Western Blot Assay 3. Viral Load Testing: Measures: Amount of HIV RNA (viremia) Methods: 1. RT-PCR (Reverse Transcriptase PCR) 2. Branched DNA assay 3. Nucleic acid sequence-based amplification 4. CD4 Count Normal range: 500 – 1600 cells/μL Important marker for: 1. Disease progression 2. Immune status Diagnosis
  13. Slide 14. WHO Disease Staging System
  14. Slide 17. 1. General Principle HIV-infected individuals may remain asymptomatic when: CD4+ count is within normal range (500–1600 cells/μL) Goal: Maintain immune strength , Delay disease progression 2. Lifestyle Modifications a. Practice safe sexual behavior: Limit to one sexual partner , Consistent condom use b. Avoid exposure to infection: Do not share blades, razors, needles, or sharps c. Maintain personal hygiene: Regular handwashing, Clean surroundings 3. Dietary Measures Consume a nutritious, balanced diet, Well-cooked foods . Properly washed fruits and vegetables Avoid: Contaminated or raw foods (to prevent infections) Treatment Non-Pharmacological
  15. Slide 18. 4. Avoid Harmful Habits: Abstain from alcohol, Avoid smoking/tobacco , Avoid substance abuse 5. Infection Prevention Stay away from: Crowded or unhygienic environments and Situations increasing infection risk, Early management of minor infections 6. Overall Health Maintenance: Adequate rest and sleep, Regular physical activity (moderate), Stress management
  16. Slide 19. ▪ 1. Goal of Therapy Prevent viral replication ▪ Ultimate target: ▪ Undetectable viral load ▪ Benefits: ▪ Improves CD4+ count ▪ Reduces disease progression ▪ Prevents opportunistic infections ▪ 2. Guidelines ▪ Recommended by: ▪ International AIDS Society ▪ Centers for Disease Control and Prevention ▪ World Health Organization Treatment Pharmacological
  17. Slide 20. Class Full Form Mechanism of Action Examples NRTIs Nucleoside Reverse Transcriptase Inhibitors Inhibit reverse transcriptase enzyme and block conversion of RNA → DNA Zidovudine, Didanosine, Stavudine, Zalcitabine, Lamivudine, Abacavir NNRTIs Non-Nucleoside Reverse Transcriptase Inhibitors Directly inhibit reverse transcriptase enzyme ( non-competitive inhibition ) Nevirapine, Delavirdine, Efavirenz PIs Protease Inhibitors Inhibit protease enzyme and prevent formation of mature viral particles Saquinavir, Ritonavir, Indinavir, Nelfinavir, Amprenavir
  18. Slide 22. About the Disease 1. HIV is a chronic manageable infection , not a death sentence 2. Caused by Human Immunodeficiency Virus which weakens the immune system 3. Progresses slowly if untreated → may lead to AIDS 4. Transmission occurs via: 1. Unprotected sexual contact 2. Blood and needle sharing 3. Mother-to-child transmission 5. Patients may remain asymptomatic for years Patient Education
  19. Slide 23. About the Medication (ART) a) Antiretroviral therapy (ART): a) Controls viral replication b) Helps maintain/increase CD4 count b) Key counseling points: a) Strict adherence is essential (take medicines daily, same time) b) Missing doses → drug resistance & treatment failure c) Do not stop medication without consulting doctor d) Be aware of possible side effects and report them c) Goal: a) Achieve undetectable viral load
  20. Slide 24. A. Prevention of Transmission ▪ Use condoms consistently ▪ Maintain single sexual partner ▪ Do not share: ▪ Needles ▪ Razors/blades B. Healthy Living ▪ Eat nutritious, well-cooked food ▪ Maintain personal hygiene ▪ Regular exercise and adequate rest D. Infection Prevention • Avoid: • Unhygienic environments • Contaminated food/water • Seek early treatment for infections E. Psychosocial Support • Maintain positive mental health • Seek family and social support • Avoid stigma and discrimination C. Avoid Harmful Habits • No alcohol • No smoking/tobacco • Avoid substance abuse 3. Lifestyle Modifications
  21. Slide 25. Feature HIV Infection AIDS (Acquired Immunodeficiency Syndrome) Definition Infection caused by Human Immunodeficiency Virus Advanced stage of HIV infection Stage Early to chronic phase Final/advanced stage Immune Status CD4 count may be normal or mildly reduced Severely reduced CD4 (<200 cells/mm³) Symptoms Often asymptomatic or mild (fever, rash, lymphadenopathy) Severe symptoms due to opportunistic infections Opportunistic Infections Usually absent Common (TB, candidiasis, toxoplasmosis, etc.) Viral Load Variable, can be controlled with ART High if untreated Diagnosis HIV antibody/antigen tests (ELISA, etc.) HIV positive + AIDS-defining conditions Reversibility Can be controlled with ART Cannot be reversed, but can be managed Prognosis Good with treatment Poor if untreated

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