1. IMMUNODEFICIENCIES HIV2 324 PHT Dr. Sarah I. Bukhari PhD in Clinical Microbiology Department of Pharmaceutics Office: 06 - 3 rd floor sbukhari@ksu.edu.sa

2. Objective:  Describe immunodeficiency  Types of immunodeficiency diseases  HIV  Origin and history  Structure  Pathogeneicity  Stages of HIV infection

3. Resistance to HIV Infection HIV stimulates an initial strong and effective immune response A few months after infection, virus level decline HIV infection progress Virus proliferates

4. Survival with HIV Infection

5.  Exposed, But Not Infected, Population  Deletion in CCR5  Effective CTLs  Long-Term Nonprogressors  Free of symptoms and do not progress to the stage of AIDS  Unknown mechanism

6. Diagnostic methods  ELISA: detecting HIV antibodies  Western blot  Plasma viral loads detect viral RNA use methods such as PCR

7. HIV Transmission  HIV survives 6 h outside a cell and < 1.5 d inside a cell  Infected body fluids transmit HIV via  Sexual contact  Breast milk  Transplacental infection of fetus  Blood-contaminated needles  Organ transplants  Artificial insemination  Blood transfusion In developed countries, blood transfusions are not a likely source of infection anymore

8. AIDS Worldwide

9. AIDS Prevention  Condoms and sterile needles!  Health care workers use Universal Precautions:  Wear gloves, gowns, masks, and goggles  Do not recap needles  Risk of infection from infected needle stick injury is 0.3%

10. Treatments

11. HIV vaccines  Vaccine difficulties due to  quickly integrate into the DNA of the host cell  Mutations  Geographical clades  Antibody-binding sites “hidden”  Infected cells not susceptible to CTLs  Proviruses and latent viruses

12. AIDS Chemotherapy Treatment has much improved with HAART Highly Active Anti-Retroviral Therapy-drug combinations)  Nucleoside reverse transcriptase inhibitors NRTIs (mostly nucleoside analogs,e.g azidothymidine,AZT)  Non-nucleoside reverse transcriptase inhibitors NNRTI, e.g efavirenz  Protease inhibitors e.g indinavir  Cell Entry Inhibitors: Fusion inhibitors e.g enfuvirtide CCR5 blocker e.g maraviroc  Integrase Inhibitors e.g Raltegravir

13. Thank you