Dr' VIJAYA MOHAN KALAKOTLA MD Int'Med Consultant Physician Divine Touch Hospital Suryapet, Nalgonda,

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Dr. VIJAYA MOHAN KALAKOTLA
MD (Int.Med)Consultant Physician Divine
Touch HospitalSuryapet, Nalgonda, APNONI Help
Line Consultant Founder Trustee - Research
Scientist World NONI Research Foundation,
Chennai.

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Clinical and cellular Improvement with NONI in
patients with HIV / AIDS
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HIV / AIDS

• Caused by Immunodeficiency virus belongs to
  Lentivirus subfamily in the retroviral family.
• First reported in 1981
• -Los Angeles and San Francisco.
• -In Homosexuals
• Virus Identified in 1983
• - By Luc Montagnier
• - Robert Gallo.
• Origin In 1999 Scientist found same virus in sub
  species of Chimpanzees in Africa. Researchers
  believe HIV1 was introduced into the Human
  population when hunters were exposed to infected
  blood.

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HIV / AIDS

• EPIDEMIOLOGY
• Most serious public health problem all over the
  world, more with developing countries like India.
• Estimated HIV / AIDS patients about 50 millions.
• Approximately 20 millions thought to have died of
  AIDS since 1981.
• As of today 15,000 infections are estimated to be
  taking place every day.
• - 95 from the Developing countries
• S Africa has the largest number of HIV / AIDS
  patients in the world.
• Second largest is India.
• China and India share 36 of patients

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HIV / AIDS

• High In-come Nations HIV / AIDS due to drug
  abusers and Homosexuals.
• In India mostly due to
• - Heterosexuals
• - Blood Transfusions
• - MTCT
• In India first case recorded 1984
• - Tamil Nadu
• - Large number of cases
• - Maharastra
• - Andhra Pradesh
• - TamilNadu
• - Less number of cases
• - Gujurat and Goa
• - Pondichery

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HIV / AIDS

• PATHOPHYSIOLOGY
• HIV essentially causes infection of Immune
  system.
• Categorized HIV-1 and HIV 2
• - with many sub types.
• HIV 1 is more virulent.
• Disease Progression
• (A) Typical - 80 to 90 of infected persons
  median survival time approx. 10 yrs.
• (B) Rapid - 5 of infected develop AIDS in 3 to
  4 yrs.
• (C) Long Term 5 of infected do not
  experience the disease progression for an
  extended period of at least 7 yrs.

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HIV / AIDS

• CELL INFECTED BY HIV
• Its Polytrophic virus - invade many cells in the
  body.
• Mainly - CD4 cells macrophages, dendrite cells
  microglial and astrocyts in the brain and mucosa
  of bowel.
• Major cellular receptor sites for HIV is CD4.
• Resistant to HIV infection.
• Homozygous mutation in CCR-5 gene (Delta 32)

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HIV / AIDS

• CELL ATTACHMENT AND ENTRY
• HIV attaches cellular receptors and
  co-receptors and enter CD4 cells.
• - Uncoated viral RNA is converted to
  Complementary DNA (cDNA) by
• - Reverse transcriptase.
• cDNA enters CD4 cell nucleus and eventually
  incorporated into host cell chromosomes
• - Integrase enzyme

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HIV / AIDS

• This integrated DNA is transcribed into messenger
  RNA, which comes out into cytoplasm, which in
  synthesize viral proteins (Progeny RNA )
• Progeny RNA and protein together packed and newly
  formed viral particals comes out from infected
  CD4 cells by budding process.
• - Protease enzyme.

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HIV / AIDS

• Who is at risk of HIV
  infection?
• Injection drug addicts.
• Recipients of blood and its products
• - Not screened for HIV
• People with multiple sex partners.
• History of STD.
• CSW
• Gay men
• Health care workers.
• Children borned to HIV infected mothers.
• Insets like Mosquitoes and bed bugs
• which fed on human blood do not spread HIV

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HIV / AIDS

• CLINICAL STAGES OF INFECTION
• HIV pathogen involves 3 major clinical stages of
  infections.
• 1. Early period
• - High viraemia
• - Large number of infected cells in peripheral
  blood.
• - High titers of virus in the plasma and lymph
  node.
• Natural immunity
• - Viral titers decrease dramatically due to
  viral specific immunity development in the body.
• - They include HIV specific cytotoxin,
• T-

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HIV / AIDS

• lymphocyte response
• - Ab-dependent cellular toxicity
• - HIV specific CD4 cell response.
• These causes stabilization of viral levels and
  CD4 cell count for many years. This is called
  Set Point.
• This set point is predictor of prognosis of
  disease.
• Higher the set point worse is the prognosis
• 2. Persistent Period
• - Chronic phase of disease
• - Viral levels are low
• - CD4 count getting low _at_ 25 to
• 60 cells per

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HIV / AIDS

• Cum per year.
• Cellular and humoral immune response to HIV is
  detected during this phase, which decrease the
  set point and delay the disease progration.
• Citotoxin T-lymphocyte response inhibit viral
  replication by killing directly or producing
  chemo kines that inhibit.
• Nutralizing anti-bodies help to wipe out the
  virus.
• 3. Symptomatic period
• - Immune exhaustion lack of adequate
  T-helper self function
• By this time individual develops symptoms. CD4
  cell count usually drop to 300/ mm.
  

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HIV / AIDS

• CLINICAL FEATURES OF HIV / AIDS
• Primarily non specific symptoms are
  manifested-fever, lethergy, sore throat rash and
  enlargement of LN.
• Occurs during 2 to 6 weeks after acquiring virus.
• Resolve with in 2 to 3 weeks.
• In AIDS s/s are dependent on the infection in
  the body.

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HIV / AIDS

• INVESTIGATIONS
• Spot test Tridot, slip test.
• Elisa for HIV.
• W. Blot
• P24
• PCR-DNA