Biology Research Work

AIDS(acquired immune deficiency

syndrome)

Made by: Sarah Iftikhar

Submitted to : Dr. Nusrat Fatima
Date of sub.: 8th October 2010
Class: Senior II C
 AIDs(acquired immune deficiency syndrome)
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is
a disease of the human immune system caused by the human immunodeficiency virus (HIV).
This condition progressively reduces the effectiveness of the immune system and leaves
individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct
contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as
blood, semen, vaginal fluid, preseminal fluid, and breast milk.This transmission can involve anal,
vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between
mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the
above bodily fluids.

Although treatments for AIDS and HIV can slow the course of the disease, there is currently no
known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of
HIV infection, but these drugs are expensive and routine access to antiretroviral medication is
not available in all countries. Due to the difficulty in treating HIV infection, preventing infection
is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and
needle-exchange programmes in attempts to slow the spread of the virus.

History
AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC)
recorded a cluster of Pneumocystis carinii pneumonia in five homosexual men in Los Angeles.
In the beginning, the CDC did not have an official name for the disease, often referring to it by
way of the diseases that were associated with it, for example, lymphadenopathy, the disease after
which the discoverers of HIV originally named the virus. They also used Kaposi's Sarcoma and
Opportunistic Infections, the name by which a task force had been set up in 1981.

In the general press, the term GRID, which stood for Gay-related immune deficiency, had been
coined. The CDC, in search of a name, and looking at the infected communities coined “the 4H
disease,” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users.
However, after determining that AIDS was not isolated to the homosexual community, the term
GRID became misleading and AIDS was introduced at a meeting in July 1982. By September
1982 the CDC started using the name AIDS, and properly defined the illness. The earliest known
positive identification of the HIV virus comes from the Congo in 1959 and 1960 though genetic
studies indicate that it passed into the human population from chimpanzees around fifty years
earlier. A recent study states that HIV probably moved from Africa to Haiti and then entered the
United States around 1969.

A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS
epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's
research into a poliomyelitis vaccine. According to scientific consensus, this scenario is not
supported by the available evidence.
Symptoms

Main symptoms of AIDS

The symptoms of AIDS are primarily the result of conditions that do not normally develop in
individuals with healthy immune systems. Most of these conditions are infections caused by
bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune
system that HIV damages.

Opportunistic infections are common in people with AIDS. These infections affect nearly every
organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's
sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally,
people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at
night), swollen glands, chills, weakness, and weight loss. The specific opportunistic infections
that AIDS patients develop depend in part on the prevalence of these infections in the geographic
area in which the patient lives.

Causes
AIDS is the ultimate clinical consequence of infection with HIV. HIV is a retrovirus that
primarily infects vital organs of the human immune system such as CD4+ T cells macrophages
and dendritic cells. It directly and indirectly destroys CD4+ T cells.

Once HIV has killed so many CD4+ T cells that there are fewer than 200 of these cells per
microliter of blood, cellular immunity is lost. Acute HIV infection progresses over time to
clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS,
which is identified either on the basis of the amount of CD4+ T cells remaining in the blood,
and/or the presence of certain infections, as noted above.

In the absence of antiretroviral therapy, the median time of progression from HIV infection to
AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2
months. However, the rate of clinical disease progression varies widely between individuals,
from two weeks up to 20 years.
Many factors affect the rate of progression. These include factors that influence the body's ability
to defend against HIV such as the infected person's general immune function. Older people have
weaker immune systems, and therefore have a greater risk of rapid disease progression than
younger people.

Poor access to health care and the existence of coexisting infections such as tuberculosis also
may predispose people to faster disease progression. The infected person's genetic inheritance
plays an important role and some people are resistant to certain strains of HIV. An example of
this is people with the homozygous CCR5-Δ32 variation are resistant to infection with certain
strains of HIV. HIV is genetically variable and exists as different strains, which cause different
rates of clinical disease progression.

Sexual transmission

Sexual transmission occurs with the contact between sexual secretions of one person with the
rectal, genital or oral mucous membranes of another. Unprotected sexual acts are riskier for the
receptive partner than for the insertive partner, and the risk for transmitting HIV through
unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex.

However, oral sex is not entirely safe, as HIV can be transmitted through both insertive and
receptive oral sex. Sexual assault greatly increases the risk of HIV transmission as condoms are
rarely employed and physical trauma to the vagina or rectum occurs frequently, facilitating the
transmission of HIV. Drug use has been studied as a possible predictor of HIV transmission.

Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection,
because they cause the disruption of the normal epithelial barrier by genital ulceration ; and by
accumulation of pools of HIV-susceptible or HIV-infected cells in semen and vaginal secretions.

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the
uninfected partner. Infectivity seems to vary during the course of illness and is not constant
between individuals. An undetectable plasma viral load does not necessarily indicate a low viral
load in the seminal liquid or genital secretions.

However, each 10-fold increase in the level of HIV in the blood is associated with an 81%
increased rate of HIV transmission. Women are more susceptible to HIV-1 infection due to
hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of
sexually transmitted diseases.

People who have been infected with one strain of HIV can still be infected later on in their lives
by other, more virulent strains.

Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern of
overlapping long-term sexual relationships. This allows the virus to quickly spread to multiple
partners who in turn infect their partners. A pattern of serial monogamy or occasional casual
encounters is associated with lower rates of infection.
Exposure to blood-borne pathogens

This transmission route is particularly relevant to intravenous drug users, hemophiliacs and
recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated
with HIV-infected blood represents a major risk for infection with HIV.

This route can also affect people who give and receive tattoos and piercings. Universal
precautions are frequently not followed in both sub-Saharan Africa and much of Asia because
of both a shortage of supplies and inadequate training.

The risk of transmitting HIV to blood transfusion recipients is extremely low in developed
countries where improved donor selection and HIV screening is performed. However,
according to the WHO, the overwhelming majority of the world's population does not have
access to safe blood and between 5% and 10% of the world's HIV infections come from
transfusion of infected blood and blood products.

Perinatal transmission

The transmission of the virus from the mother to the child can occur in uterus during the last
weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate
between a mother and her child during pregnancy, labor and delivery is 25%.

However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the
rate of transmission is just 1%. The risk of infection is influenced by the viral load of the
mother at birth, with the higher the viral load, the higher the risk. Breastfeeding also increases
the risk of transmission by about 4 %.

Misconceptions

A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are
that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure
AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are
that any act of anal intercourse between gay men can lead to AIDS infection, and that open
discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality
and AIDS

Prevention
The three main transmission routes of HIV are sexual contact, exposure to infected body fluids
or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in
the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by
these secretions, and the risk of infection is negligible. Anti-retroviral treatment of infected
patients also significantly reduces their ability to transmit HIV to others, by reducing the amount
of virus in their bodily fluids to undetectable levels.
Sexual contact

The majority of HIV infections are acquired through unprotected sexual relations between
partners, one of whom has HIV. The primary mode of HIV infection worldwide is through
sexual contact between members of the opposite sex.

During a sexual act, only male or female condoms can reduce the risk of infection with HIV and
other STDs. The best evidence to date indicates that typical condom use reduces the risk of
heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is
likely to be higher if condoms are used correctly on every occasion.

The male latex condom, if used correctly without oil-based lubricants, is the single most
effective available technology to reduce the sexual transmission of HIV and other sexually
transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum
jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making
the condoms porous. If lubrication is desired, manufacturers recommend using water-based
lubricants. Oil-based lubricants can be used with polyurethane condoms.

Female condoms are commonly made from polyurethane, but are also made from nitrile and
latex. They are larger than male condoms and have a stiffened ring-shaped opening with an inner
ring designed to be inserted into the vagina keeping the condom in place; inserting the female
condom requires squeezing this ring. Female condoms have been shown to be an important HIV
prevention strategy by preliminary studies which suggest that overall protected sexual acts
increase relative to unprotected sexual acts where female condoms are available. At present,
availability of female condoms is very low and the price remains prohibitive for many women.

Exposure to infected body fluids

Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of
exposure to contaminated blood. These precautions include barriers such as gloves, masks,
protective eyeware or shields, and gowns or aprons which prevent exposure of the skin or
mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin
immediately after being contaminated with blood or other bodily fluids can reduce the chance of
infection. Finally, sharp objects like needles, scalpels and glass, are carefully disposed of to
prevent needlestick injuries with contaminated items.

Mother-to-child transmission (MTCT)

Current recommendations state that when replacement feeding is acceptable, feasible, affordable,
sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if
this is not the case, exclusive breast-feeding is recommended during the first months of life and
discontinued as soon as possible.

Education, health literacy and cognitive ability

One way to change risky behavior is health education. Education works only if it leads to higher
health literacy and general cognitive ability. This ability is relevant to understand the relationship
between own risky behavior and possible outcomes like HIV-transmission.

Treatment
There is currently no publicly available vaccine for HIV or cure for HIV or AIDS. The only
known methods of prevention are based on avoiding exposure to the virus or, failing that, an
antiretroviral treatment directly after a highly significant exposure, called post-exposure
prophylaxis (PEP). PEP has a very demanding four week schedule of dosage. It also has very
unpleasant side effects including diarrhea, malaise, nausea and fatigue.

Antiviral therapy

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.
This has been highly beneficial to many HIV-infected individuals since its introduction in 1996
when the protease inhibitor-based HAART initially became available. Current optimal HAART
options consist of combinations consisting of at least three drugs belonging to at least two types,
or "classes," of antiretroviral agents.

Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or
NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor
(NNRTI). Because HIV disease progression in children is more rapid than in adults, and
laboratory parameters are less predictive of risk for disease progression, particularly for young
infants, treatment recommendations are more aggressive for children than for adults. In
developed countries where HAART is available, doctors assess the viral load, CD4 counts,
rapidity of CD4 decline and patient readiness while deciding when to recommend initiating
treatment. Traditionally, treatment has been recommended for otherwise asymptomatic patients
when CD4 cell counts fall to 200-250 cells per microliter of blood. However, beginning
treatment earlier may significantly reduce the risk of death.

Standard goals of HAART include improvement in the patient’s quality of life, reduction in
complications, and reduction of HIV viremia below the limit of detection, but it does not cure the
patient of HIV nor does it prevent the return, once treatment is stopped, of high blood levels of
HIV, often HAART resistant. Moreover, it would take more than the lifetime of an individual to
be cleared of HIV infection using HAART.

Despite this, many HIV-infected individuals have experienced remarkable improvements in their
general health and quality of life, which has led to the plummeting of HIV-associated morbidity
and mortality. In the absence of HAART, progression from HIV infection to AIDS occurs at a
median of between nine to ten years and the median survival time after developing AIDS is only
9.2 months. HAART is thought to increase survival time by between 4 and 12 years.

For some patients, which can be more than fifty percent of patients, HAART achieves far less
than optimal results, due to medication intolerance/side effects, prior ineffective antiretroviral
therapy and infection with a drug-resistant strain of HIV. Non-adherence and non-persistence
with therapy are the major reasons why some people do not benefit from HAART. The reasons
for non-adherence and non-persistence are varied. Major psychosocial issues include poor access
to medical care, inadequate social supports, psychiatric disease and drug abuse. HAART
regimens can also be complex and thus hard to follow, with large numbers of pills taken
frequently.

Side effects can also deter people from persisting with HAART, these include lipodystrophy,
dyslipidaemia, diarrhoea, insulin resistance, an increase in cardiovascular risks and birth defects.
Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not
have access to medications and treatments for HIV and AIDS.

Experimental and proposed treatments

It has been postulated that only a vaccine can halt the pandemic because a vaccine would
possibly cost less, thus being affordable for developing countries, and would not require daily
treatments. However, even after almost 30 years of research, HIV-1 remains a difficult target for
a vaccine.

Research to improve current treatments includes decreasing side effects of current drugs, further
simplifying drug regimens to improve adherence, and determining the best sequence of regimens
to manage drug resistance. A number of studies have shown that measures to prevent
opportunistic infections can be beneficial when treating patients with HIV infection or AIDS.
Vaccination against hepatitis A and B is advised for patients who are not infected with these
viruses and are at risk of becoming infected.[131] Patients with substantial immunosuppression are
also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and
many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus
meningitis as well.

Researchers have discovered an abzyme that can destroy the protein gp120 CD4 binding site.
This protein is common to all HIV variants as it is the attachment point for B lymphocytes and
subsequent compromising of the immune system.

Reactivation of the retrocyclin pseudogene has been proposed as a possible prevention method,
as was demonstrated in a proof-of-concept study in tissue culture cells.

In Berlin, Germany, a 42-year-old leukemia patient infected with HIV for more than a decade
was given an experimental transplant of bone marrow with cells that contained an unusual
natural variant of the CCR5 cell-surface receptor. This CCR5-Δ32 variant has been shown to
make some cells from people who are born with it resistant to infection with some strains of
HIV. Almost two years after the transplant, and even after the patient reportedly stopped taking
antiretroviral medications, HIV has not been detected in the patient's blood.