Know the FACTS

HIV/AIDS

Fact 1

HIV (human immunodeficiency virus) infects cells of the immune system and destroys or impairs their function. Infection results in the progressive deterioration of the immune system, breaking down the body's ability to fend off infections & diseases. AIDS (Acquired immune deficiency syndrome) refers to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or related cancers.

Adults and Children Estimated to Be Living with HIV, 2007

1.2 million 230 000

East Asia [580 000 1.0 million] [1.1 1.9 million]

730 000

1.5 million

740 000

Caribbean
[210 000 270 000]

Latin America
[1.5 2.1 million]

1.7 million

Sub-Saharan Africa
[20.5 23.6 million]

[3.5 5.3 million]

4.2 million
Oceania

22.0 million

[66 000 93 000]

74 000

Total: 33 million (30 36 million)

Brief history of HIV

AIDS was first recognized in the US in the summer of 1981 In the period October 1980-May 1981 in the US, 5 young homosexual men (ages 29-36 years) were treated for biopsy-confirmed Pneumocystis carinii pneumonia (PCP) in 3 different hospitals in LA, California All men had laboratory-confirmed cytomegalovirus (CMV) infection (or virus shedding) within 5 months of PCP diagnosis, and also had candidal mucosal infection

Since that report, 10 additional cases of biopsyconfirmed PCP were identified in homosexual men (4 in LA and 6 in in the San Francisco Bay area)
Kaposis sarcoma was diagnosed in 26 homosexual men (ages 26-51 years), 20 in New York and 6 in California

Human immunodeficiency virus (HIV)

HIV belongs to the family of human retroviruses and the subfamily of lentiviruses (Harrisons Principles of Internal Medicine, 17
2008)

th

Edition,

The four recognized human retroviruses belong to two groups: the human T lymphotropic viruses (HTLV)-I and HTLV-II; and the human immunodeficiency viruses, HIV-1 and HIV-2 Cause of AIDS (acquired immunodeficiency syndrome) is HIV HIV-1 most common cause of HIV/AIDS throughout the world

Some Key Definitions

CD4 receptor: A protein present on the outside of infection- fighting white blood cells. CD4 receptors allow HIV to bind to and enter cells Co-receptor: In addition to binding a CD4 receptor, HIV must also bind either a CCR5 or CXCR4 co-receptor protein to get into a cell

T-lymphocyte: A type of white blood cell that detects and fights foreign invaders of the body

Life cycle of HIV

(AIDSInfo)

1. 2.

3.
4.

Integration
Transcription

5.

Assembly
Budding

6.

Life cycle of HIV

(AIDSInfo)

Binding and Fusion: HIV begins its life cycle when it binds to a CD4 receptor and one of two co-receptors on the surface of a CD4+ T- lymphocyte. The virus then fuses with the host cell. After fusion, the virus releases RNA, its genetic material, into the host cell

2.

Reverse Transcription: An HIV enzyme called reverse transcriptase converts the single-stranded HIV RNA to double-stranded HIV DNA
Integration: The newly formed HIV DNA enters the host cell's nucleus, where an HIV enzyme called integrase "hides" the HIV DNA within the host cell's own DNA. The integrated HIV DNA is called provirus. The provirus may remain inactive for several years, producing few or no new copies of HIV Transcription: When the host cell receives a signal to become active, the provirus uses a host enzyme called RNA polymerase to create copies of the HIV genomic material, as well as shorter strands of RNA called messenger RNA (mRNA). The mRNA is used as a blueprint to make long chains of HIV proteins Assembly: An HIV enzyme called protease cuts the long chains of HIV proteins into smaller individual proteins. As the smaller HIV proteins come together with copies of HIV's RNA genetic material, a new virus particle is assembled Budding: The newly assembled virus pushes out ("buds") from the host cell. During budding, the new virus steals part of the cell's outer envelope. This envelope, which acts as a covering, is studded with protein/sugar combinations called HIV glycoproteins. These HIV glycoproteins are necessary for the virus to bind CD4 and co- receptors. The new copies of HIV can now move on to infect other cells

3.

4.

5.

6.

Modes of transmission

Vaginal, oral or anal sex Sharing unclean needles or syringes to take drugs Unsterilized needles for tattooing, skin piercing or acupuncture Pregnancy (from mother to baby) in uterus, during childbirth (vertical transmission), or through breastfeeding occupational exposure in health care settings

Key populations at risk of HIV have included:

Heterosexuals (developing countries) Men who have sex with men (MSM) Injection drug users (IDU) Commercial sex workers (CSW) Aboriginals Prisoners Sexually transmitted infections (STI) clinic attendees Adolescents

Fact 2

Ways of HIV transmission:

unprotected sexual intercourse (vaginal or anal) or oral sex with an infected person; transfusions of contaminated blood; sharing of contaminated needles, syringes or other sharp instruments; from mother to her baby during pregnancy, childbirth & breastfeeding.

Fact 3

33 million people live with HIV/AIDS worldwide, the vast majority of whom are in low & middle-income countries. An estimated 2.7 million people were newly infected with the virus in 2007.

Fact 4

HIV/AIDS is the worlds leading infectious killer. Claimingto datemore than 25 million lives.

2 million people die every year from HIV/AIDS.

Fact 5

Combination antiretroviral therapy (ART) prevents the HIV virus from multiplying in the body. If the reproduction of the HIV virus stops, then the body's immune cells are able to live longer and provide the body with protection from infections.

Fact 6

About 4 million HIV-positive people had access to antiretroviral therapy (ART) in low- and middle-income countries in 2008. This is a 36% increase in treatment coverage compared to 2007 and a 10-fold increase over 5 years. Global coverage of ART is still low, reaching only 42% of the estimated 9.5 million people who need it.

Fact 7

More than 2 million children are living with HIV/AIDS, according to 2007 figures. Most of the children live in sub-Saharan Africa & were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. 1000 children become newly infected with HIV each day. The number of children receiving ART increased from about 75,000 in 2005 to 276,000 in 2008.

Fact 8

Mother-to-child-transmission is almost entirely avoidable,. Access to preventive interventions remains low in most developing low- & middle-income countries. However, progress has been made. In 2008, 45% of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of the virus, up from 10% in 2004.

Fact 9

In 2007, more than 450,000 deaths from tuberculosis occurred among people living with HIV. This is equal to nearly a quarter of the estimated 2 million deaths from HIV in that year. Majority of people living with both HIV & TB reside in subSaharan Africa (about 80% of cases worldwide), of whom around 1 quarter are in South Africa.

Fact 10

Some key ways to prevent HIV transmission:

abstain from sex, or practice safe sexual behaviors like using condoms; get tested & treated for sexually transmitted infections, including HIV; avoid injecting drugs, or if you do, always use new & disposable needles & syringes; and ensure that any blood or blood products that you might need are tested for HIV.

HIV Prevention Strategy

Broadening HIV testing and counseling Decreasing multiple sexual partners Condom distribution, STI treatment Harm reduction programs, such as needle/syringe exchange, opioid substitution therapy, safe injection sites Drug dependence treatment programs Male circumcision: in countries in sub-Saharan Africa with a high prevalence of HIV and low rates of circumcision HAART as prevention: viral load and transmission, reduces mother to child transmission Vaccines / microbicides