1. 2 About HIV: Teaching Tool

2. About HIV: A teaching tool © 2nd edition 2006 This tool was developed by the François-Xavier Bagnoud Center at the University of Medicine and Dentistry of New Jersey (UMDNJ), with the support of the Pediatric AIDS Clinical Trials Group. Excerpts from this publication may be freely reproduced or adapted with acknowledgement of the source, provided the material reproduced is for non-for-profit educational purposes only. Send comments or questions to: info@fxbcenter.orginfo@fxbcenter.org

3. Sections  Section 1: Understanding HIV infection  Section 2: Understanding HIV treatment

4. Section 1 Understanding HIV Infection

5. Learn about:  HIV  The immune system  CD4 cells  Checking how the immune system is working  Viral load  Why some people with HIV are well and others are very sick  How you get HIV

6. Our immune system

7. virus. HIV is a virus. ©2002 Boehringer Ingelheim GmbH H:Human I:Immunodeficiency V:Virus

8. CD4 cell ©2002 Boehringer Ingelheim GmbH

9. CD4 cells  CD4 cell are destroyed after HIV uses them to make more HIV.  The body’s immune system works hard making more CD4 cells. ©2002 Boehringer Ingelheim GmbH

10. Low CD4 cells

11. Measuring CD4 cells

12. Adult CD4 counts

13. Normal CD4 Counts in Children  Normal CD4 counts in children vary widely by age.  In children less than 5 years of age, instead of measuring the number of CD4 cells,CD4 percentage (%) is used to determine how much damage has been done to the immune system

14. Viral load test  The amount of HIV in an infected patient’s blood can be measured. It is called the viral load.  The viral load test shows how much virus is present in the body.

15. Understanding viral load  LOW viral load is less than 10,000 copies.  HIGH viral load is more than 10,000 copies.

16. Antibodies signal infection  Antibodies are special proteins in the blood made by the immune system to fight a specific infection.  People with HIV usually develop HIV antibodies 4–6 weeks after being infected. In some cases, it may take as long as 3 months for antibodies to develop.  To find out if a person has been infected with the virus, an HIV test is done that finds and measures antibodies in blood.

17.  A person whose blood test results shows HIV infection is HIV-positive.  A person whose blood test does not show HIV infection is HIV-negative

18. Early stages of HIV Infection  HIV enters the cell ©2002 Boehringer Ingelheim GmbH  HIV uses parts of the CD4 cell to make more virus (replicate). During this process the CD4 cell is destroyed.

19. Viral load and CD4 cells  Eventually, the immune system is unable to make enough CD4 cells to replace the ones killed by HIV.  The immune system gets weaker and disease symptoms may develop (symptomatic HIV infection).  As the viral load goes up, the number of CD4 cells goes down.

20. WHO HIV clinical stages

21. AAcquired—not inherited IImmuno—attacks the immune system DDeficiency— destroys CD4 cells SSyndrome—a group of symptoms or illnesses AIDS

22. HIV can be transmitted from one person to another by:

23. The risk of HIV transmission through sex can be reduced by:

24. HIV is NOT transmitted by:

25. Section 2 Understanding Antiretroviral Therapy

26. Learn about:  Highly active antiretroviral therapy (HAART)  How HAART works  Adherence  Resistance  Side effects  Why HAART sometimes doesn’t work well

27. What is antiretroviral therapy?

28. Goals of ARV therapy  Lower the amount of HIV in the blood  Save CD4 cells and allow the immune system to recover

29. “Classes”of ARV therapy  NRTIs  NNRTIs  PIs  Fls

30. HAART

31. When to start ARVs  Guidelines vary from one country to another

32. Take all doses  Taking ARV medicines lowers viral load

33. Missed doses  If doses are missed, medicines may cease to be effective.

34. Adherence  Doctors, nurses, counsellors, family and friends provide support for taking medicines.

35. Monitoring treatment

36. Side effects  Most side effects are mild and temporary, but others are more serious.  If side effects occur—talk to your clinician.

37. Treatment failure  Missed doses  Viral resistance  Medicines not taken due to side effects  Other medicines interfere  Advanced HIV disease

38. For antiretroviral therapy (ART) to succeed…  Keep all clinic appointments so clinicians can check your health  In between appointments, report any changes in health right away.  If a dose of an ARV medicine is missed, take the missed dose as soon as possible. But if it is close to the time when the next dose will be taken, don’t take the dose you missed, Two doses should never be taken at the same time.

39. For ART to succeed…  If vomiting occurs fewer than 30 minutes after taking a dose, repeat the dose. If the repeat dose is vomited, contact the clinician.  If side effects occur, discuss them with the clinician.  Do not stop taking ARV medicines, and do not start any new medicine or home remedy without first discussing changes with the clinician.

40. Thank you!