HIV

• Antigen


  A substance which is recognized as foreign by the immune system. Antigens can be part of an organism or virus, e.g., envelope, core (p24) and triggers antibody production.
• Antibody


  A protein (immunoglobulin) made by the body's immune system to recognize and attack foreign substances (WHO and CDC, n.d.).
• Viral Load


  Amount of HIV in the blood
• CD4 (T4) Count


  Number of white blood cells in the blood (Oklahoma State Department of Health, )
• HIV


  Human Immunodeficiency Virus: Infecting human beings, Immunodeficiency: Decrease or weakness in the body's ability to fight off infections and illnesses, Virus: A pathogen having the ability to replicate only inside a living cell (WHO and CDC, n.d.).
• HIV is a virus spread through body fluids that affects specific cells of the immune system, called CD4 cells, or T cells
• HIV kills the body's CD4 cells (T cells) and damages the immune system
• HIV replicates inside the human body. It must invade a healthy cell in the body to survive
• There is NO cure, but there is treatment
• AIDS


  Acquired: To come into possession of something new, Immune Deficiency: Decrease or weakness in the body's ability to fight off infections and illnesses, Syndrome: A group of signs and symptoms that occur together and characterize a particular abnormality
• AIDS is the final stage of the disease caused by infection with a type of virus called HIV
• HIV vs. AIDS


  HIV is the virus that causes AIDS, Not everyone who is infected with HIV has AIDS, Everyone with AIDS is infected with HIV, AIDS is result of the progression of HIV Infection, Anyone infected with HIV, although healthy, can still transmit the virus to another person (WHO and CDC, n.d.).
• HIV-1


  Most common in sub-Saharan Africa and throughout the world, Groups M, N, and O, Pandemic dominated by Group M, Group M comprised of subtypes A - J
• HIV-2


  Most often found in West Central Africa, parts of Europe and India (WHO and CDC, n.d.).
• Ways HIV can enter the body

  • Mouth
  • Vagina
  • Nose
  • Penis
  • Eyes
  • Anus
  • Ears
  • Break in Skin
• How HIV is passed on

  • During unprotected (skin to skin) sex (anal, vaginal or oral)
  • Contact with HIV infected blood or blood products
  • Sharing IV drug needles of HIV positive people
  • From HIV positive mother to child through natural birth
  • During breast feeding (National HIV/STI Programme and Ministry of Health, 2015).
• NOT transmitted through


  • Casual contact (shaking hands)
  • Hugging
  • Kissing
  • Sweat
  • Tears
  • Swimming Pools
  • Toilet seats
  • Telephones
  • Sharing bed linens, towels, eating utensils, or food
  • Insect bites (O'Gorman, Pettipas and Weir-Cotnoir, n.d.).
• Window Period


  Time from exposure to HIV to time when antibodies can be detected through an HIV test
• Four Stages of HIV

  • Stage 1 - Primary
  • Stage 2 - Asymptomatic
  • Stage 3 - Symptomatic
  • Stage 4 - HIV -> AIDS
• WHO HIV/AIDS Classification System

  • Stage I - Asymptomatic
  • Stage II - Minor Symptoms
  • Stage III - Moderate Symptoms
  • Stage IV - AIDS (WHO and CDC, n.d.).
• Virus can be transmitted during each stage of the natural history of HIV infection
• Immune suppression


  HIV attacks white blood cells, called CD4 cells, that protect body from illness. Over time, the body's ability to fight common infections is lost. Opportunistic infections occur (Chaturvedi, n.d.).
• Opportunistic Infections associated with AIDS

  • Bacterial: Tuberculosis (TB), Strep pneumonia
  • Viral: Kaposi Sarcoma, Herpes, Influenza (flu), Epstein Barr Virus
  • Parasitic: Pneumocystis carinii
  • Fungal: Candida (causes yeast infection), Cryptococcus (acquired by inhalation) (Hammoud, et.al, n.d.).
• Progression of HIV disease

  Measured by CD4+ count (degree of immune suppression) and viral load (amount of virus in the blood). Higher viral load means more immune suppression (Chaturvedi, n.d.).
• HIV can directly infect the brain (HIV dementia), gut (wasting), and heart (cardiomyopathy) (Chaturvedi, n.d.).
• Diagnostic Tests for HIV

  • Combination Test (antigen and antibodies of HIV)
  • Antibody HIV Test (antibodies of HIV)
  • Nucleic Acid Test (assess for the virus, hence its RNA)
  • CD4 Count (measures the helper t cells) (RN, 2022)
• HIV multiplies inside the CD4+ cells, destroying them. As CD4+ cell count decreases and viral load increases, the immune defences are weakened. HIV-infected people become vulnerable to opportunistic infections. HIV is a chronic viral infection with no known cure. Without ARV treatment, HIV progresses to symptomatic disease and AIDS (Chaturvedi, n.d.).
• Life Cycle of HIV virus

  1. Interaction between viral envelope proteins and CD4 receptor and co-receptors leads to binding of the viral envelope and host cytoplasmic membrane

  2. Viral reverse transcriptase catalyses the conversion of viral RNA into DNA

  3. Proviral DNA enters the nucleus and becomes integrated into chromosomal DNA of host cell (catalyzed by integrase)

  4. Expression of viral genes leads to production of viral RNA and proteins

  5. Protease enzyme cleaves proteins into functional mature products

  6. Viral proteins and viral RNA are assembled at the cell surface into the new viral particles and leave the host through budding (Ritter, n.d.).
• HIV- Early Symptomatic Infection

  • Thrush
  • Persistent vaginal candidiasis
  • Fever
  • Diarrhea
  • Oral Hairy Leukoplakia
  • Herpes Zoster
  • Bacillary Angiomatosis
  • Cervical dysplasia/carcinoma in situ
  • Peripheral neuropathy
  • Pelvic inflammatory Disease (Ritter, n.d.).
• Life Cycle of HIV virus

  1. Interaction between viral envelope proteins and CD4 receptor and co-receptors leads to binding of the viral envelope and host cytoplasmic membrane

  2. Viral reverse transcriptase catalyses the conversion of viral RNA into DNA

  3. Proviral DNA enters the nucleus and becomes integrated into chromosomal DNA of host cell (catalyzed by integrase)

  4. Expression of viral genes leads to production of viral RNA and proteins

  5. Protease enzyme cleaves proteins into functional mature products

  6. Viral proteins and viral RNA are assembled at the cell surface into the new viral particles and leave the host through budding
• HIV infection


  • Without ARV treatment, HIV progresses to symptomatic disease and AIDS
• HIV- Early Symptomatic Infection

  • Thrush
  • Persistent vaginal candidiasis
  • Fever
  • Diarrhea
  • Oral Hairy Leukoplakia
  • Herpes Zoster
  • Bacillary Angiomatosis
  • Cervical dysplasia/carcinoma in situ
  • Peripheral neuropathy
  • Pelvic inflammatory Disease
• Strategies to prevent HIV transmission

  • Personal strategies
  • Public health strategies
• Personal strategies to prevent HIV transmission

  • Safe practices: no risk of HIV transmission
  • Risk reduction: reduces but does not eliminate risk
• Public health strategies to prevent HIV transmission

  • Screen all blood and blood products
  • Follow universal precautions
  • Educate in safer sex practices
  • Identify and treat STIs/other infections
  • Provide referral for treatment of drug dependence
  • Apply the comprehensive PPTCT approach to prevent vertical transmission of HIV
• Testing for Viral Infection and Immune Response

  • Viral infection
  • Viral Load
  • p24 Antigen (structural protein that makes up most of the HIV viral core)
  • Immune response
  • Antibody (IgG, IgM)
  • Cellular response (CD4)
• Anonymous Testing


  No name is used, Unique identifying number, Results issued only to test recipient
• Confidential Testing


  Person's name is recorded along with HIV results, Name and positive results are reported to the State Department and the Centers for Disease Control and Prevention, Results issued only to test recipient
• Blood Detection Tests


  • Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay (ELISA/EIA)
  • Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIP/IFA)
  • Polymerase Chain Reaction (PCR)
  • Western Blot Confirmatory test
• Urine Testing


  Urine Western Blot, As sensitive as testing blood, Safe way to screen for HIV, Can cause false positives in certain people at high risk for HIV