HIV/AIDSHuman Immunodeficiency Virus/ Acquired Immune

Deficiency Syndrome

Monica Epsky

Chandler Porter

Shambria Simmons

What Is HIV?

How Do You Get HIV?

Study Design

Case-control study

• Involves grouping people that are in a health-related state or event as cases and controls and researching their past to see what made them these cases

• The outcome is always recognized before the exposure

• Retrospective in nature

Case-Control Study

Strengths• Effective for rare diseases

• Inexpensive

• Requires little time

Weaknesses• Limited to examining one

outcome

• Prone to bias

• Does not offer relative risk or incidence

Case Study #1

MR. T.R.-CHRONIC ASYMPTOMATICHIV INFECTION

37-year-old African-American Male

Imprisoned for 18 years

Visited clinic as apart of the aftercare set up by the HIV Liaison Nurse in the prison

Most prisoners are infected in prison while injecting drugs or having unsafe sex

The way Mr. T.R. contracted the disease is unknown

Case Study #2

MS. J.B. – ADVANCED HIV DISEASE

28-year-old Caucasian female

Paramedics found her unconscious lying in a pool of blood and sweat on a stained mattress in the living room

Had injection marks on her hands, neck, and feet

About 79% of women become infected with HIV through unprotected sex with men and 19% by injecting drugs

Ms. J.B. died while at the hospital after suffering cardiac arrest

Case Study #3

46-year-old African-American male

Visits private physician’s office for routine tests and monitoring every 3 months

Infected 15 years ago through unsafe sex with other males

STDs, including hepatitis B and gonorrhea

Began antiretroviral medications 7 years ago

MR. C.S. – CHRONIC ASYMPTOMATIC HIV

INFECTION

Case Study #4

MS. N.R. - PRIMARY ACUTE INFECTION

29-year-old Hispanic female

Admitted through Emergency Department after fainting in her home

RPR test indicated syphilis. Patient admitted to recent, unprotected sex with new male partner.

HIV tests found to be positive.

Case Study #5

MR. A.B. – SEVERE IMMUNE COMPROMISE

37-year-old Caucasian male

Admitted with fever and respiration problems

First diagnosed with HIV 12 years ago. Started antiretroviral treatment 5 years ago

Co-infected with hepatitis C

Diagnosed with PCP and adenocarcinoma.

Scheduled for radiation therapy and chemotherapy

Case Study #6

20-year-old Caucasian female; junior in college

Visits Student Health Center for persistent morning vomiting

Admits getting drunk and having unprotected sex

Positive pregnancy test and positive HIV test

Decides to delay antiretroviral medications until 2nd trimester

MS. D.D. – CHRONIC ASYMPTOMIC HIV

INFECTION COMPLICATED BY PREGNANCY

Case Study #7

MR. O.S. – SEVERE IMMUNE

COMPROMISE

42-year-old African-American male

Diagnosed with HIV 10 years ago, receives healthcare from outpatient clinic

Says he did not verify if partners were infected

Unable to work since 1997; receives Social Security disability benefits due to mental health problems.

Currently lives in a nursing facility catering to mental health conditions.

Case Study #8

MRS. M.T.M. – CHRONIC ASYMPTOMATIC HIV

INFECTION

67-year-old Caucasian; 2 children

Diagnosed with HIV 5 years ago after donating blood.

Husband died of stroke

Had unprotected intercourse with boyfriend; boyfriend died of heart attack

Admitted for mastectomy to treat breast cancer; uncomplicated surgery

Results

Case Study #1

MR. T.R. – Chronic Asymtomatic HIV Infection

• No treatment was required because he is asymtomatic

• Had negative test result for Hepatitis B surface antigen and positive for Hepatitis B core antibody which indicated that he was infected in the past and has recovered.

• Failed to return to his next clinic appointment and the emergency number he gave the clinic was disconnected

Case Study #2

MS. J.B. – Advanced HIV Disease• Had very low CD4+ lyphocyte count, which

showed that Ms. J.B. is in third stage of HIV infection

• Not able to give a list of her past behaviors

• Most likely got the disease from having unprotected sex with HIV infected men or sharing needles

• Suffered a cardiac arrest on the way to the radiology department

• Five hours later she died after several attemps to resuscitate her failed

Results

Case Study # 3

MR. C.S. – Chronic Asymptomatic HIV Infection

• Mr. C.S. had an elevated fasting total cholesterol so he was prescribed atorvastatin (Lipitor)

• During his next visit he complained about moderate to severe pain and burning in both legs

• He was told to discontinue using atorvastatin because of this and was given some antiretrovirals to combine

• This allows Mr. C.S. to take all his antiretroviral medications once daily

Case Study # 4

MS. N.R. – Primary Acute Infection• Started treatment early in the course of

infection

• Started having terrifying dreams almost every night which was a side effect of one of the medications

• Scheduled for a follow up visit when her HIV resistance test results come in

Results

Case Study # 5

MR. A.B. – Severe Immune Compromise

• In the last stage of the HIV disease which makes him more susceptible to infections

• His lung cancer continured to spread and is down to 132 pounds.

• He refused additional cancer treatments

• Entered a home hospice program and moved into his parents house

• Two months later Mr. A.B. died in the Emergency Department after his mother called 911 when she was unable to wake him up

Case Study # 6MS. D.D. – Chronic Asymptomic HIV Infection Complicated by Pregnancy

• Decided not to terminate her pregnancy

• Started taking antiretroviral medications during her second trimester

• Went into labor at 38 weeks and received zidovudine

• The baby continued to receive zidovudine for 6 weeks and repeated testing showed that she was uninfected with HIV

Results

Case Study # 7

MR. O.S. – Severe Immune Compromise

• In the last stage of the HIV disease

• Two months later, he disappeared from his care facility and was found looking through the dumpsters behind a nearby hospital.

• He was hospitalized for mental-health services

Case Study # 8

MRS. M.T.M. – Chronic Asymptomatic HIV Infection

• In the stage called “Chronic Asymptomatic HIV Infection”

• She decided not to tell her children and started going to a support group but quit going after the third time because it was to depressing

• She developed a friendship with one of the women in the group and they accompanied eachother to their doctor appoitments

• Her surgery had no complications and was discharged three days post-op

Pathophysiology of HIV/AIDS

In 1993, the CDC outlined 6 stages of infection regarding the pathophysiology of HIV.

Stage 1

Seroconversion illness 

Occurs 1-6 weeks after infection. Once virus enters target host cell in the body, it undergoes a period of rapid viral replication. During this time, HIV can grow to several million particles per milliliter of blood

Stage 1 Continued

• Seroconversion illness 

Flu-like symptoms may occur. Additionally, the number of circulating CD4 T-lymphocyte cells drops as a result of CD8 T-lymphocyte cells (which target HIV-infected cells) being activated. This is the stage where the majority of CD4 cells are depleted; mostly in the intestinal mucosa. HIV targets the T-cells by their CCR5 receptors.

Stage 2

Asymptomatic infection 

The virus levels fall, but replication is continuous. CD4 and CD8 T-lymphocyte levels are normal. This stage has no symptoms and can persist for years. CD8 T cells slow the disease progression, but don’t eliminate the virus.

Stage 3

Persistent generalized lymphadenopathy (PGL)

The lymph nodes swell for a few weeks, or even months.

Stage 4

Symptomatic infection 

Symptoms manifest. Because the immune system is compromised, there is a greater risk for opportunistic infections. This stage of symptoms is referred to as the AIDS-related complex (ARC) and is regarded as the precursor to AIDS.

The virus continues to keep T lymphocytes that are essential to immune response at a low number.

Stage 4 Continued

Symptomatic infection 

A normal human gut harbors many microbial agents and bacteria, which are normally kept in check by the mucosal immune system. Without it, the threat of exposure to other sources of illness are greatly increased.

Stage 5

AIDS

Characterized by severe immunodeficiency. There are signs of life-threatening infections and unusual tumors. This stage is characterized by CD4 T-cell count below 200 cells per cubic millimeter.After diagnosis, life expectancy without treatment ranges from 6-19 months

Stage 6

Nonprogressors

There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors.

Treatments

A cure for HIV/AIDS has yet to be created, but there are several medications that can help control HIV and the many complications.

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)• Nucleoside reverse transcriptase inhibitors (NRTIs)• Protease inhibitors (PIs)• Entry or fusion inhibitors• Integrase inhibitors

Medications

Non-nucleoside reverse transcriptase

inhibitors

NNRTIs immobilize a protein that is necessary for HIV to duplicate

Nucleoside reverse transcriptase

inhibitors

NRTIs are broken down forms of building blocks that HIV duplicate

Protease inhibitors

PIs incapacitate protease, another protein that HIV needs to duplicate

Medications

These drugs block HIV's entry into CD4 cells

Integrase inhibitors

Protein that HIV uses to insert its genetic material into CD4 cells

Entry or fusion inhibitors

Diagnosis

HIV is diagnosed by testing your blood or saliva for the antibodies to the virus.

These types of HIV tests are not correct immediately after you contract the infection.

It normally takes up to 12 weeks for the antibodies to become present. Some cases can take up to 6 months for an HIV test to become positive.

The latest test checks for HIV antigen, a protein created by the virus immediately after infection. This test can confirm a diagnosis within days of infection.

The earlier you get tested, the sooner you can take the precautions to save your life and avoid spreading the disease to others.

HIV Test

Tests to Customize Treatment

CD4 countCD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.

Viral loadThis test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.

Drug resistanceThis blood test determines whether the strain of HIV you have will be resistant to certain anti-HIV medications and the ones that may work better

Pertinent Epidemiology

Click icon to add picture• AIDS was first recognized in the United States in June of 1981

• First recognized in homosexual men

• HIV is sexually transmitted, blood borne, and can be passed down from mother to child during child birth or through breastfeeding

Pertinent Epidemiology

Click icon to add picture• An estimated 34 million

people were living with HIV worldwide by the end of 2010

• The number of deaths caused from AIDS in 2010 were 1.8 million

• 1,000 children are newly infected with HIV everyday

Pertinent Epidemiology

Click icon to add pictureHow to protect yourself

• Practice safe sex by using condoms

• Limit the amount of alcohol you consume

• Do not share syringes or any type of injection equipment

• Use sterile equipment when getting tattoos or piercings

How has this study helped?

This particular study has been used to help educate aspiring and current healthcare professionals as a course in the different stages, treatments and complications of HIV.

Many older Americans with HIV are typically diagnosed during the final stages of HIV infection. As a result, they are often too late to benefit from antiretroviral medications. Studies like these serve as public service announcements to inform an unassuming and at-risk population.

How has this study helped?

Studies also help establish a cross-section into the lives of individuals affected by HIV. The studies spotlight risky behaviors, sources of illness and prevalent modes of transmission among exposed and at-risk individuals. These studies highlight the significance of access to care, the benefits of safe sex and the dangers of drug use.

How has this study helped?

"When you treat HIV you want to suppress the virus and get the virus level in the blood so low that it can’t be transmitted to another person. This not only treats and benefits the patient but it is also prevents new cases.”

- Anne Spaulding, MD at Rollins School of Public Health

The U.S. First Confirmed Case

In 1968, a 15-year-old black male who lived in St. Louis was hospitalized

He died of an aggressive case of Kaposi's sarcoma (KS)

His tissue and serum samples tested HIV positive.

This appears to be the first confirmed case of HIV infection in the United States.

Historical Figures

First clinical observation of AIDS – 1981

CDC called HIV “lymphadenopathy”, or Kaposi’s Sarcoma and Opportunistic Infections

CDC called it the 4H disease, as it affected Haitans, Homosexuals, Hemophiliacs and heroin users

Robert Gallo and Luc Montagnier

1983Two teams, led by Gallo and Montagnier published their findings in Science journal

Robert Gallo Luc Montagnier

Gallo isolated a virus from an AIDS patient which looked similar to human T-lymphotropic viruses (HTLVs). He called it HTLV-III.

Montagnier isolated a virus from a patient with swollen lymph nodes and lethargy. He showed that core proteins of the virus were different from HTLV-1

Robert Gallo and Luc Montagnier

The two viruses turned out to be the same

1986 – LAV and HTLV-III were renamed HIV

Historical Figures

Elizabeth GlaserShe was recognized through her battle with HIV

Co-founder of one of the top AIDS charities (Elizabeth Glaser Pediatric AIDS Foundation)

Died in 1994

Robert ReedTested HIV positive in 1991

Died in 1992 from colon cancer

Played Mike Brady on The Brady Bunch show

Historical Figures

Magic JohnsonNovember 7, 1991 was the day Mr. Johnson told the world he was HIV Positive

One of the greatest NBA players of all time

Freddie MercuryTested positive in 1987

Died 4 years after from AIDS related pneumonia

Lead singer of British group Queen

Eric “Eazy – E” Wright

Died at age 31, a month after he was diagnosed with AIDS

He gained notoriety from the group N.W.A., which he cofounded with Dr. Dre

Citations

• Mandal, A. AIDS Pathophysiology. News-medical.net. Online. July 3, 2013. http://www.news-medical.net/health/AIDS-Pathophysiology.aspx

• Sharp, P. M., & Hahn, B. H. (2010). The evolution of HIV-1 and the origin of AIDS. Philosophical Transactions of the Royal Society B: Biological Sciences,365(1552), 2487-2494.

• The Body. Fame and hiv: 15 of histor'ys biggest hiv-positive celebrities. http://www.thebody.com/content/64374/fame-and-hiv-10-of-historys-biggest-hivpositive.html

• Osmond, D. H. (2003, March). Epidemiology of HIV/AIDS in the United States. http://hivinsite.ucsf.edu/InSite?page=kb-01-03

• Mayo Clinic Staff. Treatments and drugs. Mayo Foundation for Medical Education and Research. (11 August 2012). http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=treatments-and-drugs

• Mayo Clinic Staff. HIV/ AIDS: tests and diagnosis. Mayo Foundation for Medical Education and Research. (11 August 2012). http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=tests-and-diagnosis

Citations

• Joint United Nations Programme on HIV/AIDS (UNAIDS) (2011)How to get to zero: Faster. Smarter. Better. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/jc2216_worldaidsday_report_2011_en.pdf

• United States Fund for UNICEF (2013) Join our Fight Againt AIDS http://www.unicefusa.org/work/hivaids/?gclid=CJbK9KXQmLgCFWhp7AodLScAMg

• amfAR (2013) Basic facts about HIV/AIDS http://www.amfar.org/facts-about-hiv-and-aids/

• Merrill, R. M. (2013). Introduction to epidemiology (6th ed.). Burlington, Mass.: Jones & Bartlett Learning.