HIV / AIDS

Dr.Gireesh kumar.K.P
AIMS cochin
HIV
• The etiologic agent of AIDS is HIV, which belongs to the family of human
retroviruses (Retroviridae) and the subfamily of lentiviruses
• The four recognized human retroviruses belong to two distinct groups: the
human T lymphotropic viruses (HTLV)-I and HTLV-II, and the human
immunodeficiency viruses, HIV-1 and HIV-2
• 1. HIV I – Most common HIV ,There are 3 groups of HIV I
– Group M(Major) – It is the most common HIV I , Sub types A,B,C,D,E,F,G,H,I,J and K -(C
in common in India)
– Group O (Outlier )
– Group N (New)
• 2. HIV II – HIV II is restricted mainly to Western Africa.
– The disease is less aggressive
– Slow CD4 fall,
– low rates of vertical transmission slow progression to AIDS
Transmission

• Sexual (> 75%) – Risk is 1%

• Homosexual, Heterosexual
• Parenteral – Blood, blood product transfusion - Risk is >
90%
• Mother to child - Risk is 0.5 to 1%
• Injection drug use - Risk 0.2 to 0.5%
Pathophysiology

• Qualitative and Quantitative deficiency of T. Helper /

Inducer cells (CD4 cells).
• Reduction in CD4 count leads to low immunity.
• Opportunistic infections can occur when the immunity is
low.
ELISA
• HIV antibodies - Enzyme-linked immunosorbent
assay(ELISA)
– High sensitivity ( >99.5%)
– The test is reported as reactive or nonreactive (Positive or
negative)
– Reactive tests should be repeated.
– Confirm reactive tests by western blot.
HIV Nucleic Acid (RNA or DNA) assay by PCR

• HIV DNA / RNA PCR – positivity > 98%

• Indications
• In window period
• In Neonates
• In case of indeterminate ELISA / Western Blot results
 CD4 COUNT

• CD4 < 200 cell/mm3 should receive “HAART”

• At all CD4 levels patient should be offered “HAART”
• If the infection is responding to treatment, there will be an
increase of 100 to 150 cells/mm3 per year
HIV - illnesses
• Oral hairy leukoplakia
• Recurrent oropharyngeal candidiasis
• Recurrent vaginal candidiasis
• Severe pelvic inflammatory disease
• Bacillary angiomatosis
• Cervical dysplasia
• Idiopathic thrombocytopenia
• Chronic diarrhea, weight loss
• Herpes zoster, peripheral neuropathy
• Low grade fever, night sweats
HIGHLY ACTIVE ANTI RETROVIRAL TREATMENT (HAART):Basic drugs
DRUGS COMMONLY USED IN HAART
NRTI NNRTI PI

Zidovudine (ZDV, AZT) 300 mg BD Nevirapine 200 mg OD for 1st Atazanavir

Lamivudine (3TC) 150 mg BD 14 days ,Then 200 mg BD Indinavir
Emtricitabine (FTC) 200 mg OD Efavirenz 600 HS, Lopinavir
Tenofovir 300 mg OD Delavirdine 400 TID, Nelfinavir
Zalcitabine 0.75 mg TID Ritonavir
Abacavir 300 mg BD Saquinavir
Didanosine (ddI) (400 OD if weight Darunavir
>60 kg, 250 OD weight < 60Kg)
Stavudine (d4T) (40 BD if weight >60
kg, 30 BD weight < 60Kg)

NRTI : Nucleoside reverse transcriptase inhibitors

NNRTI : Non Nucleoside reverse transcriptase inhibitors
PI : Protease Inhibitor
Newer Drugs
Entry inhibitors or fusion inhibitors are a class of ART drugs. This drugs interferes with the
binding, fusion and entry of an HIV virion to a human cell. By blocking this step in HIV's
replication cycle, such agents slow the progression from HIV infection to AIDS
Drugs : Maraviroc , Enfuvirtide
INSTIs : Integrase strand transfer inhibitors

HIV-1 integrase is a viral protein that has several roles. After the completion of reverse transcription of
the viral RNA genome into DNA, it appears in part, to be responsible for transporting the viral DNA into
the nucleus of the cell, a position where it has the ability to closely associate with one of the
chromosomes of the host cell.Then, integrase catalyzes the insertion, or integration, of viral DNA into
the host cellular DNA, a step of the viral lifecycle required for reprogramming the cell to produce more
copies of itself
HAART
• Most preferred NNRTI based regimen
– Efavirenz ( not to be given in pregnancy, give Nevirapine )
+ ( Lamivudine or Emtricitabine) + (Zidovudine or
Tenofovir)
• Most preferred PI based regimen
– (Atazanavir + RTV) + ( Lamivudine or Emtricitabine) +
(Zidovudine or Tenofovir)
INSTIs based regimen

• Most preferred INSTIs based regimen

• Dolutegravir 50 mg OD+ Lamivudine + Tenofovir
• Bictegravir + emtricitabine+ tenofovir
• Dolutegravir + Abacavir + Lamivudine
Basic HIV Postexposure Prophylaxis Regimen

• Tenofovir 300 mg PO OD
+
• Emtricitabine 200 mg PO OD
+
• Raltegravir 400 mg BD
• (Lamivudine may be substituted for emtricitabine.)