HIV Infection: An Introduction

1. HIV Infection: An Introduction Amy V. Kindrick, M.D., M.P.H. National HIV/AIDS Clinicians’ Consultation Center akindrick@nccc.ucsf.edu Http://www.ucsf.edu/hivcntr 800 933-3413

3. Opportunistic Infections In The HAART Era

6. Eastern Europe & Central Asia 700 000 Western Europe 540 000 North America 920 000 East Asia & Pacific 640 000 North Africa & Middle East 400 000 South & South-East Asia 5.8 million Caribbean 390 000 Sub-Saharan Africa 25.3 million Latin America 1.4 million Australia & New Zealand 15 000 Adults and Children Living With HIV/AIDS, Year End 2000 Total: 36.1 million

7. Adults and children estimated to be living with HIV/AIDS as of end 2003 Eastern Europe & Central Asia 1.2 – 1.8 million Western Europe 520 000 – 680 000 North America 790 000 – 1.2 million East Asia & Pacific 700 000 – 1.3 million North Africa & Middle East 470 000 – 730 000 Caribbean 350 000 – 590 000 South & South-East Asia 4.6 – 8.2 million Sub-Saharan Africa 25.0 – 28.2 million Latin America 1.3 – 1.9 million Australia & New Zealand 12 000 – 18 000 Total: 34 – 46 million

8. Estimated number of adults and childrennewly infected with HIV during 2003 Eastern Europe & Central Asia 180 000 – 280 000 Western Europe 30 000 – 40 000 NorthAmerica 36 000 – 54 000 East Asia & Pacific 150 000 – 270 000 North Africa & Middle East 43 000 – 67 000 Caribbean 45 000 – 80 000 South & South-East Asia 610 000 – 1.1 million Sub-Saharan Africa 3.0 – 3.4 million Latin America 120 000 – 180 000 Australia & New Zealand 700 – 1 000 Total: 4.2 – 5.8million

9. Epidemiology: USA • Numbers of AIDS deaths are falling • Number of AIDS diagnosis are falling • Rates of HIV infection have NOT changed • Trends • Disease of the Marginalized • Younger People (25% under age 25) • IDU • Ethnic and racial minorities • Women • Young MSM of color

11. Dianna and her Sons, 1995

12. What Is HIV?

13. Human Immunodeficiency Virus

14. What is AIDS?

15. Acquired Immunodeficiency Syndrome • HIV infection + immune system damage • CD4 count < 200 • Pneumocystis carinii pneumonia • Toxoplasmosis • Kaposi’s sarcoma • Mycobacterium avium complex • Invasive cervical cancer • etc...

16. How Is HIV Transmitted?

17. HIV Transmission • Requires • Infected body fluid • Entry of infected fluid into the body

18. Modes of Transmission • Sexual • Anal, vaginal, oral • Receptive partner at greatest risk • Percutaneous • IDU • Occupational needle stick • Transfusion

19. Modes of Transmission, cont. • Cutaneous • Infected fluid to broken skin • Mucous Membrane • Infected fluid to eyes, nose, mouth • Maternal Child • In utero • Peripartum • Breastfeeding

20. Infection Route SexFemale to Male Male to FemaleMale to Male Needle Stick Needle Sharing Infected Blood Transfusion Mother to ChildNo AZTWith AZT Risk of Infection 1/700 to 1/30001/200 to 1/2000 1/10 to 1/1600 1/300 1/150 95/100 1/4<1/10 Transmission Probabilities

24. Post Exposure Prophylaxis • Treatment with antiretroviral drugs after an exposure to HIV. • Must be started within 72 hours (sooner the better) and continued for a month. • PEP showed a 80% reduction in HIV infections for occupational exposures. • Concerns for drug and sexual exposures • Preventing exposures is key

25. How Is HIV Diagnosed?

26. The Antibody Test • Highly reliable • Negative predictive value • 85% at 3-6 weeks • 99% at 3 months • May be negative during the “window period”

28. Stages of Infection • Exposure • Primary Infection/Antibody Development • Asymptomatic Period • 7-12 yrs average • AIDS

29. Natural History Of HIV Infection

31. Acute HIV Infection • Symptoms occur 2-6 wks after exposure • 75% - 90% have symptoms • Fever • Rash • Sore throat • Enlarged lymph nodes

33. Oral Thrush

35. Tinea Pedis

36. Oral Herpes Simplex Virus Infection

37. Perianal Herpes Simplex Virus

38. Zoster in Thoracic Distribution

39. Bacterial Pneumonia

41. PCP

42. Kaposi Sarcoma

43. Toxoplasmosis

44. CMV Retinitis

45. Other Common HIV-related Problems • Fatigue • Weight loss • Depression • Neuropathy • Nausea • Diarrhea

46. Measuring Plasma HIV RNA and CD4+ T Cells • At the time of diagnosis • Every 3-4 months in the untreated patient • Immediately prior to initiating therapy • 2-8 weeks after initiating therapy • Every 3-4 months in patients on therapy • As indicated in the opinion of the provider

47. HIV Treatments • Antiretrovirals • OI prophylaxis • OI treatment • Immune-based therapies • Vaccines • Complementary therapies

49. Antiretroviral Medications: 2004 • Nucleoside- and Nucleotide-analog Reverse Transcriptase Inhibitors (NRTIs) • Non-nucleoside analog Reverse Transcriptase Inhibitors (NNRTIs) • Protease Inhibitors (PIs) • Fusion Inhibitors