1. HIV INFECTION D - preventive Medicine

2. HIV INFECTION LEARNING OBJECTIVES  Describe the pathophysiology of HIV infection.  Describe the principal mechanisms of transmission of HIV infection.  Describe the diagnostic algorithm for HIV infection.  Describe measures for prevention and treatment of HIV infection.

3. HIV INFECTION VIRAL STRUCTURE

4. HIV INFECTION VIROLOGY  RNA retrovirus  Two major strains - HIV 1 and HIV 2

5. HIV INFECTION VIRAL STRUCTURE

6. HIV INFECTION KEY VIRAL ENZYMES  Reverse transcriptase  Integrase  Protease

7. HIV INFECTION PATHOPHYSIOLOGY

9. HIV INFECTION GENETIC DIVERSITY

10.  Replication cycle - 2.5 days  1 billion virions each day  10 trillion virions during course of illness

11. STAGES OF HIV INFECTION  Acute retroviral illness  Latent phase  Symptomatic phase  AIDS

12. MOST COMMON SERIOUS OPPORTUNISTIC DISEASES  Pneumocystis jiroveci(carinii) pneumonia  Kaposi’s sarcoma  MAC

13. OTHER IMPORTANT OPPORTUNISTIC DISEASES  TB  Toxoplasmosis  CMV infection  Candidiasis  Non-Hodgkin’s lymphoma

14. PRINCIPAL MECHANISMS OF TRANSMISSION  Sexual contact  IVDU  Perinatal

15. EPIDEMIOLOGY OF HIV INFECTION Million cases

16. EPIDEMIOLOGY OF HIV INFECTION IN THE U.S.

17. EPIDEMIOLOGY OF HIV INFECTION IN MEN IN THE U.S.

19. EPIDEMIOLOGY OF HIV INFECTION IN WOMEN

21. RISK FACTORS FOR SEXUAL TRANSMISSION  Multiple sexual partners  Receptive anal intercourse  Unprotected intercourse  IVDU

22. RISK FACTORS FOR SEXUAL TRANSMISSION  Crack cocaine use  Ulcerated genital lesions  Uncircumcised male

23. RISK FACTORS FOR SEXUAL TRANSMISSION  Severity of illness in index case  Sex during menstruation  Bleeding during intercourse

24. DIAGNOSIS OF HIV INFECTION  Screening test – enzyme immunoassay (EIA)  Confirmatory test  Western blot  Immunofluorescent assay (IFA)

25. ETIOLOGY OF PEDIATRIC HIV INFECTION

26. MECHANISMS OF PERINATAL TRANSMISSION OF HIV

27. FREQUENCY OF VERTICAL TRANSMISSION OF HIV Percent

28. HIV INFECTION MANAGEMENT  Antiretroviral therapy  Prophylactic antibiotics  Immunizations

29. HIV INFECTION ANTIRETROVIRAL AGENTS  Nucleoside reverse transcriptase inhibitors  Non-nucleoside reverse transcriptase inhibitors  Protease inhibitors  Entry (fusion) inhibitors

30. HIV INFECTION CRITERIA FOR TREATMENT  Early symptomatic illness  CD 4 count < 200/mm 3  Relatively high viral load (> 30,000 copies/ml)  Later symptomatic illness  Pregnancy – prevention of perinatal transmission

31. HIV INFECTION EFFECTS OF TREATMENT  Prolonged survival  Improved quality of life Level I evidence

32. HIV INFECTION PROPHYLACTIC ANTIBIOTICS ORGANISMANTIBIOTICPCPTMP-SMX ToxoplasmosisTMP-SMX MACAzithromycin

33. ORGANISMANTIBIOTICHSVAcylovir CandidiasisFluconazole CryptococcusFluconazole

34. HIV INFECTION VACCINATIONS  Hepatitis A  Hepatitis B  Meningococcal vaccine

35. HIV INFECTION VACCINATIONS  Pneumococcal vaccine  Influenza vaccine

36. PREVENTION OF HIV INFECTION

37.  Avoid IVDU  Avoid occupational injury

38. PREVENTION OF HIV INFECTION

39. PREVENTION OF INFECTION

40. POST SEXUAL EXPOSURE PROPHYLAXIS  Drugs - ZDV + 3TC + nelfinavir  Duration - 28 days  Cost – approximately $1000 Level III evidence

41. RISK FACTORS FOR OCCUPATIONAL INFECTION  Deep injury  Visible blood on the device  Indwelling needle in artery or vein  Terminal illness in source patient  Failure to receive prophylaxis

42. PROPHYLAXIS FOR OCCUPATIONAL EXPOSURE  High risk - ZDV + 3TC + nelfinavir  Low risk - ZDV + 3TC Level II evidence

43. HIV INFECTION CONCLUSIONS  Enormity of the public health problem  Mechanisms of transmission  Treatment and preventive measures