Dr.

Sachin Kapur
M.Phil, Phd

20+ years Teaching Experience

4,00,000 Students &

Teachers Mentored
 Reproductive Health

Lecture 6

Dr. Sachin Kapur 20+ years Teaching experience

M M.Phil, Phd 4,00,000 Students & Teachers Mentored
 Telegram
APP

tinyurl.com/neetlivechat
Tests
Quizzes
Doubt Sessions
More Personalized
PLUS Courses
Step 1 Step 2

INSTALL
Step 3 Step 4
Step 5 Step 6

NEETLIVE Apply
 Acquired Immune Deficiency Syndrome (AIDS):

➔ This means deficiency of immune system, acquired during the lifetime of an individual
indicating that it is not a congenital disease.
➔ ‘Syndrome’ means a group of symptoms.
 History of AIDS

1. AIDS was first discovered in homosexuals in USA (Hatai) in 1981.

2. In 1983, in Paris, Luc Montagnier discovered the AIDS virus and named it
Lymphadenopathy Associated virus (LAV).
3. In 1984, in USA, Robert Gallo discovered the AIDS virus independently and named it
Human T- Lymphocytotrophic Virus-3 (HTLV-3).
4. In India, AIDS virus was first found in a group of sexworkers in Chennai in 1986.
5. In 1986, the International Committee on Taxonomy of Virus named it Human
Immunodeficiency Virus (HIV).
 Causative organism of AIDS

➔ AIDS is caused by a virus, HIV – Human Immunodeficiency virus.

➔ HIV belongs to the family Retroviridiae (Capable of reverse transcription).
➔ It belongs to genus Lentivirus (Small virus causing slow viral disease) within the
Retroviridiae family.
 Structure of HIV

➔ HIV is spherical and appears like a soccer ball having a diameter of 100 nm or 10-9 m.
➔ HIV is made up of 4 parts:
1. Outer envelope
2. Inner core
3. Genetic material
4. Enzymes
 Structure of HIV- Outer Envelope

Outer envelope
➔ HIV has an outer envelope made up of lipids having many knob shaped glycoprotein
molecules placed at regular intervals.
➔ These glycoprotein molecules are of 2 types:
◆ gp 120 (surface glycoprotein)
◆ gp 41 (transmembrane glycoprotein)
 Structure of HIV- Inner Core, Genetic Material

Inner core
➔ Within the envelope, there is a protein core made of 2 coats:
◆ an outer p17 called matrix protein.
◆ an inner p24 called capsid protein: p24 is antigenic (capable of inducing immune
response). Hence it is also called p24 antigen.

Genetic material
➔ Within the protein core there are 2 strands of RNA.
 Structure of HIV- Enzymes

➔ Within the protein core there are 3 enzymes:

1. Reverse transcriptase:
◆ This is the main enzyme of HIV.
◆ Reverse transcriptase converts the RNA of HIV into DNA within the human cell.
◆ Conversion of RNA to DNA is called reverse transcription.
◆ Since HIV contains reverse transcriptase, HIV is called retrovirus
 Structure of HIV- Enzymes

2. Integrase helps in the integration of viral genome into the host DNA.
3. Protease helps in breakdown of complex proteins formed within the host cells.
 Types of HIV:

➔ Types of HIV:

HIV- 1 HIV- 2

It is highly virulent and easily It is less virulent and less transmissible.

transmissible.

It is more common and is seen in India It is seen in Africa.

(Aisa), America and Europe.

It is further categorized into 4 groups M, It is further categorized into 8 groups A-

N, O and P. H.

About 90% of AIDS cases in the world

are caused by HIV-1 group M.
 How did human beings get HIV?

1. The African green monkey contains Simian Immunodeficiency Virus which is very
similar to HIV.
2. It is believed that this monkey bit or scratched some human beings.
3. Thus the virus spread to humans through the wounds.
 How did human beings get HIV?

1. Some people believe that in 1950’s the kidney of the African monkey was used to
prepare a polio vaccine.
2. This vaccine was given to 3,25,000 African children and maybe this vaccine caused the
spread of SIV to humans.
3. SIV further mutated to form HIV.
 Source of infection of HIV

➔ HIV is present in large quantity in blood, semen, pre-seminal fluid which comes out
before ejaculation, vaginal fluid and C.S.F. of infected person.
➔ HIV is also present in smaller quantity in tears, saliva, breast milk and urine of infected
person.
 Modes of transmission of HIV

1. By intimate sexual contact

2. From infected blood or blood products
3. During procedures
4. From infected mother to child (Transplacental transmission)
 Modes of transmission of HIV

By intimate sexual contact

➔ HIV spreads by sexual contact with an infected person.
➔ The sexual contact could be
◆ Homosexual contact: Sexual contact between individuals of the same sex.
◆ Heterosexual contact: Sexual contact between individuals of the opposite sex.
◆ With multiple sexual partners:
● Maximum cases of AIDS are spread by sexual contact.
◆ It could also spread through oral or anal sex.
 Modes of transmission of HIV

From infected blood

➔ HIV spreads by contact with infected blood. Infected blood can spread:
◆ During blood transfusion
◆ From infected instruments, needles and syringes during surgery, acupuncture,
tattooing, ear piercing, intravenous drug abuse.
◆ Sharing infected razors and toothbrushes
 Modes of transmission of HIV

During Procedures
➔ HIV may also spread during certain procedures like
◆ Organ transplantation.
◆ Dialysis (procedure done during kidney failure in which waste products are
removed from circulating blood).
◆ Artificial insemination using infected semen.
 Modes of transmission of HIV

From infected mother to child (Transplacental transmission)

◆ HIV may also spread from mother to child through placenta during labour
(delivery).
◆ Spread of infection from mother to child is called vertical / transplacental
transmission.
◆ A nursing mother can transmit HIV to her baby from her breast milk.
 Can Mosquitoes spread HIV?

➔ Mosquitoes cannot spread HIV because

◆ HIV is destroyed in the alimentary canal of mosquitoes
◆ After biting one person mosquitoes never bite another person immediately. These
relax and digest their meal.
◆ While biting a person, mosquitoes release their saliva and not the previously
sucked blood.
You Can’t Get HIV From
Mechanism of action of HIV

➔ HIV infects only those cells that have CD4 receptors.

➔ CD4 receptors are present on
1. helper T lymphocytes (in blood)
2. alveolar macrophages (in lungs)
3. microglia (neuroglia in central nervous system).
4. The virus can also infect other lymphoid cells such as B cells and lymphoid cells of the
brain and testes.
 Mechanism of action of HIV

➔ After getting into the body of the person, the virus enters into macrophages where
RNA genome of the virus replicates to form viral DNA with the help of reverse
transcriptase enzyme.
➔ This viral DNA gets incorporated into host cell’s DNA and directs the infected cells to
produce virus particles.
 Mechanism of action of HIV

➔ The macrophages continue to produce virus and in this way acts like a HIV factory.
➔ Simultaneously, HIV enters into helper T-lymphocytes, replicates and produce
progeny viruses.
➔ The progeny viruses released in the blood attack other helper T-lymphocytes leading to
a progressive decrease in the number of helper T-lymphocytes.
 Symptoms of HIV

➔ During this period, the person suffers from bouts of fever, diarrhoea and weight loss.
➔ Due to decrease in the number of helper T lymphocytes, the person starts suffering
from infections that could have been otherwise overcome such as those due to bacteria
especially Mycobacterium, viruses, fungi and even parasites like Toxoplasma.
➔ The patient becomes so immuno-deficient that he/she is unable to protect
himself/herself against these infection.
 Incubation period of AIDS

1. It is the period between the infection (i.e. entry of causative agent) and the appearance
of the first symptom of disease.
2. Incubation period of AIDS is 5-10 years.
3. During this period the patient is HIV+ but doesn’t suffer from AIDS. AIDS is last stage
of disease.
 Clinical features of AIDS

Initial infection stage

➔ It starts 2-3 weeks after HIV infection.
➔ Only 3-5% of those newly infected have symptoms that include fever, chills, aches,
swollen lymph glands, and an itchy rash.
➔ These symptoms disappear, and there are no other symptoms for many months.
 Clinical features of AIDS

Asymptomatic carrier stage

➔ It continues for 5-9 years and during this phase the patient is HIV positive but has not
developed AIDS.
➔ In this phase the individual is infected with HIV but does not show any symptom hence
it’s called asymptomatic phase.
 Clinical features of AIDS

Asymptomatic carrier stage

➔ Although the individual exhibits no symptoms during this stage, he or she is highly
infectious.
➔ In this phase, it is very difficult to say whether the person has AIDS or not.
➔ Therefore, it is also called blind phase.
 Clinical features of AIDS

Early Symptomatic HIV infection (AIDS Related Complex)

➔ Major Signs:
◆ Weight Loss (more than 10% of body weight). Due to excessive loss of body
weight, this disease in also called Slim disease or Wasting syndrome.
◆ Persistent diarrhoea for more than 1 month.
◆ Persistent fever for more than 1 month
 Clinical features of AIDS

Early Symptomatic HIV infection (AIDS Related Complex)

➔ Minor Signs:
◆ Lymphadenopathy (swelling of lymph nodes)
● The patient has enlarged lymph nodes at least 1 cm in diameter all over the
body especially in the neck, armpits and groin that persist for 3 months or
more.
◆ Persistent cough for more than 1 month:
● Excessive coughing is due to lung infections like Tuberculosis (bacterial) and
Pneumocystis carinii pneumonia (fungal).
 Clinical features of AIDS

Early Symptomatic HIV infection (AIDS Related Complex)

➔ Minor Signs:
◆ Oropharyngeal Infection like Candidiasis is an infection of mouth and throat
caused by a fungus Candida albicans. It causes curdy white coating on tongue.
◆ Skin Infection: like Herpes zoster (shingles).
◆ Night sweats:Excessive sweating at night.
 Clinical features of AIDS

➔ Full blown AIDS stage:

◆ Helper T cell count (CD4 count) reduces below 200mm3 of blood.
◆ Severe Opportunistic infections:
● These infections are called opportunistic because the body can usually
prevent them with normal immunity but due to an immunocompromised
state in AIDS, they can easily occur.
● These infections include infections with Mycobacterium, Viruses, Fungi &
even parasites like Toxoplasma.
 Clinical features of AIDS

➔ Full blown AIDS stage:

◆ The following cancers (malignancies) develop:
● Kaposi sarcoma: It is the cancer of inner lining of blood vessels below skin..
It is thought to be caused by Human Herpes virus 8.
● Lymphoma: It is the cancer of lymph nodes.
 Clinical features of AIDS

➔ Full blown AIDS stage:

◆ Dementia (Loss of memory): HIV kills brain cells, resulting in memory loss,
inability to think clearly, loss of judgment and/or depression.
◆ Finally death occurs.
Clinical features of AIDS
 Clinical features of AIDS

➔ Few patients are called Non-progressors as in them AIDS develop very slowly or
never at all due to a genetic difference that prevents the virus from damaging their
immune system, only an impaired immune system gives them the opportunity to get
started.
 Diagnosis of AIDS

E.L.I.S.A. (Enzyme Linked Immuno Sorbent Assay)- Screening test.

➔ This test is used to detect antibodies produced by the human body against HIV.
➔ The principal enzyme used in ELISA is alkaline phosphatase.
➔ After entry of HIV in the body, a period of 3-6 months is required by the human body
to produce the antibodies.
➔ During this period ELISA test is possibly negative.
 Diagnosis of AIDS

➔ The period when the person is infected by HIV but ELISA in negative is called window
period.
➔ If ELISA is negative, either the patient does not have disease or may be in the window
period.
➔ If ELISA is positive, the person may or may not have HIV.
➔ ELISA test may shows a positive result in some other conditions like Leprosy, T.B.,
Malaria, Cancer, Hepatitis B, Rheumatoid arthritis, Haemophilia, Pregnancy, Kidney
failure, Flu, etc.
 Diagnosis of AIDS

Western blot test -Confirmatory test for ELISA positive cases

➔ Western Blot is more specific and more reliable for HIV but it is expensive.
➔ It is also detects the antibodies against HIV.
➔ This test also has a window period of 3-6 months.
 Diagnosis of AIDS

PCR (Polymerase chain reaction) to detect viral genome

➔ Polymerase chain reaction (PCR) doesn’t have window period.
➔ It is the fastest test for HIV.
 Treatment of AIDS

➔ AIDS is a fatal viral disease without cure.

➔ Drugs can only give temporary relief and prolong life.
➔ These drugs do not destroy the HIV but only stop/slow down its multiplication and
growth in human body by inhibiting the important enzymes which are necessary for
viral replication.
Treatment of AIDS

➔ These drugs are called viristatic drugs.

➔ Reverse transcriptase inhibitors: Reverse transcriptase inhibitors
bind to enzyme reverse transcriptase and prevent connection of
RNA to DNA.
◆ They are:
● AZT (Azidothymidine or Zidovudine) It is most
popular drug against HIV
● Nevirapine : Nevirapine alone or in combination with
zidovudine is normally advised by the doctors to
pregnant women to ensure that their babies do not get
infected.
 Treatment of AIDS

➔ Protease inhibitors:
◆ Protease inhibitors bind to enzyme protease and inhibit its action. eg. Foscarnet,
Indinavir.
 Treatment of AIDS

➔ Integrase inhibitors:
◆ Integrase inhibitors bind to enzyme Integrase and inhibit its action. eg. Raltegravir
 Treatment of AIDS

➔ Interferon enhancement drugs:

◆ Interferons are antiviral substances and are used in viral diseases.
◆ Ribavirin is a drug which enhances the action of interferons and increases the
number of T helper cells.
➔ A combination of several anti-retro viral drugs called HAART-Highly Active Anti-
Retroviral Therapy has been very effective in reducing the viral load.
 AIDS Awareness Programmes

➔ India started National AIDS Control Programme in 1987 by National AIDS Control
Organization (NACO).
➔ WHO started various programmes to create awareness.
➔ 1st Dec is declared as World AIDS day.
AIDS Awareness Programmes
11th Grade
Monday
Tuesday
Wednesday
Subjects Timings
Biology 4 PM
Physics 5 PM
Chemistry 6 PM
12th Grade
Friday
Saturday
Sunday
Subjects Timings
Biology 4 PM
Physics 5 PM
Chemistry 6 PM
 Telegram
APP

tinyurl.com/neetlivechat