The document discusses World AIDS Day which is held annually on December 1st to raise awareness about HIV/AIDS and show support for those living with the disease. It provides information about the themes, transmission, stages of HIV infection, testing, and treatment. The document also outlines the goals of increasing HIV testing and treatment to work towards eliminating HIV/AIDS by 2030.

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BY,
VINDHYA .V.V
ASST. PROFESSOR
MSC MLT MICROBIOLOGY
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 World AIDS day is an annual HIV awareness
campaign,that lands on the 1st
of December
 The campaign aims to show support for those
living withHIV,and a chance to remember those
killed by AIDS related illnesses
 World leaders use the occasion to reaffirm their
commitment OF eradicating the disease,UN
hopes to achieve this by 2030.
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The theme of this year’s World AIDS Day is “Know
your status”
 This is the 30th anniversary of World AIDS day.
This theme realize us that,HIV testing is essential for
expanding treatment and also empowers people to make
choices about HIV prevention, so that they can protect
themselves and their loved ones.
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 “The Epidemics of HIV not only affects the health
and life of individuals,it impacts
households,communities,and the development
and economic growth of entire nations.”
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• Human: Infecting human beings
• Immunodeficiency: Decrease or weakness of
body’s ability to fight off infections and illnesses
• Virus: A pathogen having the ability to replicate
only inside a living cell
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 Scientist believe that HIV came from a particular
kind of chimpanzee in West Africa.
 Humans probably came in contact with HIV when
they hunted and ate infected animals.
 Recent studies indicate that HIV may have
jumped from monkeys to humans as far back as
the late 1800s.
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 Discovered independently by Luc Montagnier of
France and Robert Gallo of the US in 1983-84.
 This virus involved in the Retroviridae family,and
in Lenti virus sub family
 Former names of the virus include:
◦ Human T cell lymphotrophic virus (HTLV-III)
◦ Lymphadenopathy associated virus (LAV)
◦ AIDS associated retrovirus (ARV)
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
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
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AIDS is the final stage of the disease caused by
infection with a type of virus called HIV.
AIDS is the final stage of the disease caused by
infection with a type of virus called HIV.

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 Unprotected sexual
contact with an infected
partner
 Exposure of broken skin
or wound to infected blood
or body fluids
 Transfusion with HIV-
infected blood
 Injection with
contaminated objects
 Mother to child during
pregnancy, birth or
breastfeeding
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 Attachment of gp 120 to cd4 receptor
 Nucleocapsid enter into host cell
 Nucleocapsid release RNA
 Reverse transcriptase convert RNA to DNA
copy,ssDNA….then which converts to ds DNA
 Which reaches nucleus
 Fuse with host DNA and forms provirus
 Produce latent infection
 Activation of infection
 Then virus buds out from cell surface
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 1.acute infection or seroconversion illnes
 2.asymptomatic infection
 3.persistant generalised lymphadenopathy
 4.AIDS related complex(ARC)
 5.AIDS
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 Mononucleosis-like, cold or flu-like symptoms may
occur 6 to 12 weeks after infection.
 Includes:
◦ Thrush
◦ Persistent vaginal candidiasis
◦ Fever
◦ Diarrhea
◦ Oral Hairy Leukoplakia
◦ Herpes Zoster
◦ Bacillary Angiomatosis
◦ Cervical dysplasia/carcinoma in situ
◦ Peripheral neuropathy
◦ Pelvic inflammatory Disease
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 Absence of significant symptoms
 This stage shows positive HIV Ab test
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 Found in 25%of patients
 Enlarged lymph nodes ,about 1cm in diameter at
two or more extra inguinal sites.
 Which persists for 3months
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 Characterized by fever ,dysphagia,apetite,loss of
body weight more than 10%of actual body weight.
 Accompanied by other opportunistic infections
mainly bacterial,viral,fungal,and parasitic.
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 Respiratory system
◦ Pneumocystis Carinii Pneumonia (PCP)
◦ Tuberculosis (TB)
◦ Kaposi's Sarcoma (KS)
 Gastro-intestinal system
◦ Cryptosporidiosis
◦ Candida
◦ Cytomegolavirus (CMV)
◦ Isosporiasis
◦ Kaposi's Sarcoma
 Central/peripheral Nervous system
◦ Cytomegolavirus
◦ Toxoplasmosis
◦ Cryptococcosis
◦ Non Hodgkin's lymphoma
◦ Varicella Zoster
◦ Herpes simplex
 Skin
◦ Herpes simple
◦ Kaposi's sarcoma
◦ Varicella Zoster
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 AIDS is considered as the end stage of infection
characterised by irreversible breakdown of host
immune defence mechanism.affect all systems
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 CD4 count drops below 200 person is considered to
have advanced HIV disease
 If preventative medications not started the HIV infected
person is now at risk for:
◦ Pneumocystis carinii pneumonia (PCP)
◦ cryptococcal meningitis
◦ toxoplasmosis
 If CD4 count drops below 50:
◦ Mycobacterium avium
◦ Cytomegalovirus infections
◦ lymphoma
◦ dementia
◦ Most deaths occur with CD4 counts below 50.
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 If plaques wiped off with gauze, erythematous,
often bleeding mucosa will be revealed.
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WHO HIV/AIDS Classification System
Stage I
Asymptomatic
Stage I
Asymptomatic
Stage II
Minor
Symptoms
Stage II
Minor
Symptoms
Stage III
Moderate
Symptoms
Stage III
Moderate
Symptoms
Stage IV
AIDS
Stage IV
AIDS

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HIV antibody ELISA – if positive, is always followed by a confirmatory
Western Blot
Rapid HIV antibody test
◦ Sensitivity and Specificity 99%!
◦ Results in 5 to 40 minutes usually
◦ Used in:
 Occupational Exposure
 Pregnant women presenting in labor with no previous HIV testing
 Patients who are unlikely to return for results of HIV test
HIV viral load
◦ First choice for diagnosing possible acute HIV
HIV p24 Antigen
◦ Is the first antigen to be elevated in acute HIV
◦ Can be used for diagnosis of primary (acute) HIV
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 Time from initial infection with HIV until antibodies
are detected by a single test
 Usually 3-8 weeks before antibodies are detected
 May test false-negative for HIV antibodies during
this time period
 For HIV 1 virus average window period is 22days,
 For Ag testing WP is 16days
 For nucleic acid detection 12 days
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 First serological test developed to detect HIV
infection.
◦ Easy to perform.
◦ Easily adapted to batch testing.
◦ Highly sensitive and specific.
 Antibodies detected in ELISA include those
directed against: p24, gp120, gp160 and gp41,
detected first in infection and appear in most
individuals
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ELISA tests useful for:
◦Screening blood products.
◦Diagnosing and monitoring patients.
◦Determining prevalence of infection.
◦Research investigations.
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 Different types of ELISA techniques used:
◦ indirect
◦ competitive
◦ sandwich
 ELISAs are for screening only, false positives do
occur and may be due to AI disease, alcoholism,
syphilis, and immunoproliferative diseases.
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 Agglutination tests using latex particles, gelatin
particles or microbeads are coated with HIV antigen
and will agglutinate in the presence of antibody.
 Dot-Blot Testing utilizes paper or nitrocellulose
impregnated with antigen, patient serum is filtered
through, and anti-antibody is added with enzyme
label, color change is positive.
◦ A rapid, cost-effective and may become an alternative to
standard ELISA and Western blot testing.
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 Most popular confirmatory test.
◦ Utilizes a lysate prepared from HIV virus.
◦ The lysate is electrophoresed to separate out the HIV
proteins (antigens).
◦ The paper is cut into strips and reacted with test sera.
◦ After incubation and washing anti-antibody tagged with
radioisotope or enzyme is added.
◦ Specific bands form where antibody has reacted with
different antigens.
◦ Most critical reagent of test is purest quality HIV
antigen.
◦ The following antigens must be present: p17, p24, p31,
gp41, p51, p55, p66, gp120 and gp160.
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 Antibodies to p24 and p55 appear earliest but
decrease or become undetectable.
 Antibodies to gp31, gp41, gp 120, and gp160
appear later but are present throughout all stages
of the disease.
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Interpretation of results.
◦ No bands, negative.
◦ In order to be interpreted as positive a
minimum of 3 bands directed against the
following antigens must be present: p24, p31,
gp41 or gp120/160.
 CDC criteria require 2 bands of the
following: p24, gp41 or gp120/160.
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 Expensive – $ 80 - 100
 technically more difficult
 visual interpretation
 lack standardisation
◦ - performance
◦ - interpretation
◦ - indeterminate reactions –
resolution of ??
 ‘Gold Standard’ for
confirmation
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Window Period

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uses
-detect status of patient
-progression of disease
-monitor effectiveness of anti retroviral therapy
1.HIV nucleic acid assay
Detect pro viral DNA,Viral RNA,and total nucleic acid.
Mainly done for 1.Identify acute HIV infection,
2,asuurance of blood safety
3,Early infant diagnosis
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 FDA approves 1st
NAT system for screening donors of
whole blood and blood components intended for use
in transfusion.
 This test s/m can detect RNA from HIV 1 and HCV
 Samples-plasma,saliva,csf,seminal plasma,dried
blood spots etc
 Other methods are-CRISPR based technology
 RT-PCR
 NASBA(Na seq.based amplification)
 APTIMA HIV 1 RNA qualitative assay
 Procleix HIV 1 assay
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1. STRATEGY 1
 Serum tested by one screening test.
 If positive should be considered as positive and
if negative considered as negative .
USE
Used in blood bank for transfusion safety
2. STRATEGY 2
. Serum tested by one screening test
.if positive retested by another test based on
different Ag preparation or Principle
.If positive in second test –reported as positive
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Use
 For HIV surveillance
3.STRATEGY3
 Serum tested by 2 screening tests.
 If positive,retested by third test
 If positive in all 3 tests reported as positive and negative
in third considered as equivocal and retested after
3weeks
 If again gives equivocal result person declared as
negative
Use
For diagnosis.
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Post-exposure prophylaxis (PEP)
Pre-exposure prophylaxis (PrEP)
Treatment as prevention (TasP)
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-Recent sexually-transmitted infection
HIV-infected partner
-Heterosexual adults-
-Condomless sex with a partner who injects drugs
or is a bisexual man
-HIV-infected partner
-Injection drug users-
Use of shared injection equipment
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 Types of exposures include percutaneous (needle
stick), splash, bite, sexual contact
 And contact with following fluids like,Blood,blood
stained saliva,breast milk,genital
secretions,CSF,Amniotic fluid,peritoneal
fluid,pericardial ,pleural fluid
 Immediate PEP
 Skin-wash with soap and water
 Mucous membrane-flishout with water
 The use of therapeutic agents to prevent infection
following exposure to a pathogen
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Antiretroviral –
When to Start Therapy

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1.Nucleoside/Nucleotide Reverse Transcriptase
Inhibitors (NRTI’s)
Include:
 Abacavir (ABC)
 Didanoside (ddI)
 Emtricitabine (FTC)
 Lamivudine (3TC)
 Stavudine (d4T)
 Tenofovir (TDF)
 Zalcitabine (ddC)
 Zidovudine (AZT, ZDV)
Side Effects:
◦ Lactic Acidosis
◦ Hepatic Steatosis
◦ Peripheral neuropathy
◦ ***Hypersensitivity reaction with Abacavir
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 Include:
◦ Nevirapine (NVP)
 Side effects:
 Rash (can cause Stevens Johnson)
 Hepatotoxicity in women with CD4 ≤ 250
◦ Efavirenz (EFV)
 Side Effects:
 CNS side effects: dizziness, insomnia, hallucinations
 Can cause fetal malformations, neural tube defects
◦ Dilavirdine (DLV)
 Side Effects
 Rash
 Increased transaminases
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 Include:
 Amprenavir (APV)
 Atazanavir (ATV)
 Fosamprenavir (f-APV)
 Indinavir
 Lopinavir + Ritonavir (Kaletra)
 Nelfinavir
 Ritonavir
 VERY IMPORTANT – Is able to boost levels of other protease inhibitors!
 Saquinavir
 Side Effects
 Inhibit CYP450 system
 Hyperlipidemia
 Hyperglycemia
 GI upset
 Kidney stones -- Indinavir
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 Tenofovir
 Lamivudin or Emtricitabine
 Efavirenz
 Most popular initial regimens:
◦ Efavirenz + (lamivudine or emtricitabine) + (zidovudine or
tenofovir)
◦ Lopinavir/Ritonavir + (lamivudine or emtricitabine) + zidovudine
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