AIDS/%20HIV%20

1
AIDS/ HIV Current Senario

• S. Jonathan Nimal
• Department of Biotechnology
• Pondicherry University
• India

2
Objectives

• Basic concepts of HIV has been dwelt.
• Current statistics of HIV/AIDS
• Current therapy available on the market
• Current Vaccines on trial

3
Purified Human Immunodeficiency Virus
4
Types of HIV

• HIV 1
• Subtype A D found in sub Sahara Africa
• Subtype B found in US Canada
• Subtype C found in South Africa India
• Subtype E found in south east Asia
• Subtype G H - found in Russia Central
  Africa
• Subtype I found in Cyprus
• HIV 2

5
HIV Life cycle

• Entry
• Reverse Transcription
• Integration
• Cleavage
• Assembly Budding

6
WHO classification of clinical stages of infection

• Children Three stages
• Adults Adolescents Four stages

7
WHO Clinical stage I
in Children

• Asymptomatic
• Generalized lymphadenopathy

8
WHO Clinical stage II
in Children

• Unexplained chronic diarrhoea
• Severe persistent or recurrent candidiasis
  outside the neonatal period
• Weight loss or failure to thrive
• Persistent fever
• Recurrent severe bacterial infection

9
WHO Clinical stage III in
Children

• AIDS defining opportunistic infections
• Severe failure to thrive
• Progressive encephalopathy
• Malignancy
• Recurrent septicaemia or meningitis

10
WHO Clinical stage I
in Adults Adolescents

• Asymptomatic
• Persistent generalized lymphadenopathy
• Performance scale 1
  asymptomatic, normal activity

11
WHO Clinical stage II in
Adults Adolescents

• Weight loss, lt10 of the body weight
• Minor mucocutaneous manifestations
• Herpes Zoster within the last 5 years
• Recurrent upper respiratory tract infections
• Performance scale 2 symtomatic, normal activity

12
WHO Clinical stage III in
Adults Adolescents

• Weight loss, gt10 of the body weight
• Unexplained chronic diarrhoea gt1 month
• Unexplained prolonged fever (interminant or
  constant) gt1 month
• Oral candidiasis (thrush)
• Pulmunary tuberculosis
• Severe bacterial infection
• Performance scale 3 bed-ridden, gt50 of the day
  during the last month

13
WHO Clinical stage IV in
Adults Adolescents

• HIV wasting syndrome
• Pneumocystis carinii pneumonia
• Toxoplasmosis of the brain
• Cryptosporidiosis with diarrhoea
• Cryptococcosis, extra pulmonary
• Atypical mycobacteriosis
• Salmonella septicaemia
• Progressive multifocal leukoencephalopathy
• Performance scale 4 bed-ridden, gt50 of the day
  during the last month

14
WHO Clinical stage IV in
Adults Adolescents (Cond.)

• Cytomegalovirus disease of an organ other than
  liver, spleen or lymph nodes.
• Hepes simplex virus infection, mucateneous gt1
  month, or visceral any duration
• Progressive multifocal leukoencephalopathy
• Any disseminated endemic mycosis
  (I.e. histoplasmosis, coccidiodomycosis)
• Candidiasis of the oesophagus, trachea, bronchi
  or lungs
• Lymphoma
• Kaposis sarcoma

15
Global Estimates for adults and children, end 2003

• People living with HIV/AIDS
  40 million (34 46 million)
• New HIV infections in 2003
  5 million (4.2 5.8 million)
• Deaths due to HIV/AIDS in 2003
  3 million (2.5 3.5 million)

16
Estimated number of newly infected adults and
children with HIV during 2003
Eastern Europe central Asia
180 000 280 000
Western Europe 30 000 40 000

• North America
• 36 000 50 000

East Asia Pacific 150 000- - 270 000
North Africa Middle East 43 000 67 000
South South East Asia 610 000- 1.1 million
Caribbean 45 000 80 000
SubSaharan Africa 3.0 3.4 million
South America 120 000 180 000
Australia New Zealand 700 1 000
17
Estimated number of adults and children with
HIV/AIDS, end 2003
Eastern Europe central Asia
1.2 1.8 million
Western Europe 520 000 680 000
North America 790 000 1.2 million
East Asia Pacific 700 000 1.3 million
North Africa Middle East 470 000 730 000
South South East Asia 4.6 8.2
million
Caribbean 350 000 590 000
Sub Saharan Africa 25.0 28.2 million
Latin America 1.3 1.9 million
Australia New Zealand
12 000 18 000
18
Estimated adult and child deaths due to HIV/AIDS
during 2003
Eastern Europe central Asia
23 000 37 000
Western Europe 2 600 3 400
North America 12 000 18 000
East Asia Pacific 32 000 58 000
North Africa Middle East 35 000 50 000
Caribbean 30 000 50 000
South South East Asia 330 000 590 000
Sub Saharan Africa 2.2 2.4 million
Latin America 49 000 70 000
Australia New Zealand
lt 100
19
Types of HIV Drugs

• Entry inhibitors
• Reverse Transcriptase inhibitors
• Integrase inhibitors (On study)
• Protease inhibitors
• Assembly budding inhibitors (On
  study)

20
Entry inhibitors

• Fusion inhibitor
• Fuzeon (enfuvirtide, or T-20)

21
Reverse Transcriptase Inhibitors

• Nucleoside reverse transcriptase inhibitors
  (NsRTIs)
• Zidovudine(ZDV, AZT)
• Didanosine (ddl)
• Stavudine (d4T)
• Lamivudine (3TC)
• Abacavir (ABC)
• Non - nucleoside reverse transcriptase inhibitors
  (NsRTIs)
• Nevirapine (NVP)
• Efavirenz (EFZ)
• Nucleotide reverse transcriptase inhibitors
  (NtRTIs)
• Tenofovir disoproxil fumarate

22
Protease Inhibitors

• Saquinavir (SQV)
• Ritnovir (RTV)
• Indinavir (IDV)
• Nelfinavir (NFV)
• Lopinavir/retinavir (LPV/r)

23
AIDS Vaccine

• Two vaccines on trial
• AIDSVAX B/B tested in North America Amsterdam
• AIDSVAX B/E tested in Thailand
• Each mixed the surface proteins (gp120) from two
  strains of HIV

24
New vaccines on human trial

• tgAAC09 begun in Belgium
• Single shot vaccine
• Uses Targeted Genetics rAAV (recombinant adeno
  associated viral vector) Technology

25
New DNA vaccines on human trial

• Vaccine - ADVAX
• Vaccine is tailored for C strain of HIV
• Worked by The Aron Diamond AIDS ResearchCenter
  International AIDS Vaccine initiative
• Trail in New York Rochester
• Developed on synthetic DNA based on the genetic
  material available
• Safe to use