A REVIEW ON: HIV AIDS

Abstract

HIV/AIDS has always been one of the most thoroughly global of diseases. The human immunodeficiency virus (HIV) is a lent virus that causes HIV infection and AIDS. AIDS is a condition in humans in which progressive failure of the immune system allows life-threatening infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. HIV infects vital cells in the human immune system such as helper CD4 T cells, macrophages. HIV infection leads to low levels of T cells through a number of mechanisms, including pyroptosis of infected T cells. The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. There is some evidence to suggest that female condoms may provide an equivalent level of protection.

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*Corresponding Author: Arpita Kapila, L.R Institute of Pharmacy, Solan, Himachal Pradesh, India. E-Mail:
arpitakapila4@gmail.com 69
Indian J. Pharm. Biol. Res. 2016; 4(3):69-73
Review Article
A REVIEW ON: HIV AIDS
Kapila A1*, Chaudhary S1, Sharma RB1, Vashist H1, Sisodia SS2, Gupta A1,2
1L.R. Institute of Pharmacy, Solan (H.P.), India
2Department of Pharmacy, B.N. University, Udaipur (Raj.), India
ARTICLE INFO:
Article history:
Received: 10 July 2016
Received in revised form:
18 August 2016
Accepted: 20 August 2016
Available online: 30September 2016
Keywords:
AIDS,
Transmission,
Symptoms.
ABSTRACT
HIV/AIDS has always been one of the most thoroughly global of diseases. The human
immunodeficiency virus (HIV) is a lent virus that causes HIV infection and AIDS. AIDS is a
condition in humans in which progressive failure of the immune system allows life-threatening
infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal
fluid, breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus
within infected immune cells. HIV infects vital cells in the human immune system such as helper
CD4 T cells, macrophages. HIV infection leads to low levels of T cells through a number of
mechanisms, including pyroptosis of infected T cells. The symptoms of AIDS are primarily the
result of conditions that do not normally develop in individuals with healthy immune systems.
Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and
parasites that are normally controlled by the elements of the immune system that HIV damages.
When condoms are used consistently by a couple in which one person is infected, the rate of HIV
infection is less than 1% per year. There is some evidence to suggest that female condoms may
provide an equivalent level of protection.
Introduction
HIV stands for human immunodeficiency virus. AIDS stands
for acquired immuno deficiency syndrome.
HIV
H-It infects only human beings and also transmitted between
humans not from animals. It is not transmitted from bites of
mosquitoes, bats or any other species.
I-The body has immune system whose function is to protect our
body from germs, infections etc. But a person suffering from
HIV has inability to fight against diseases. However, immune
system becomes deficient.
V-Virus is a small, simplest thing which is in inactive form
outside the body and becomes active when it goes inside human
body.
AIDS
A-It is not inherited means it cannot be transmit from one
generation to another. It is transmitted to healthy person by
infected person.
I-It weakens the immune system.
D-Creates a deficiency of CD4+ cells in the immune system.
S-It is a collection of diseases.
HIV is a virus that causes AIDS. Normally, our body has
immune system that attack viruses and bacteria. Immune
system has white blood cells which protect us from infections.
White blood cells contain CD4+ cells which is also known as
helper cells or T cells. A person who is infected will be able to
develop. These infections take advantage of body’s immune
system. These infections cause several health problems and
even lead to death of a person. HIV has inability to protect
against diseases and count of CD4 cells also decreases in HIV.
There is no cure of AIDS but there are certain medicines which
are use to slow down the diseases so you stay healthier for long
time. There is no medicine to get rid of diseases [1].
HIV is a virus that causes AIDS. Normally, our body has
immune system that attack viruses and bacteria. Immune
system has white blood cells which protect us from infections.
White blood cells contain CD4+ cells which is also known as
helper cells or T cells. A person who is infected will be able to
develop. These infections take advantage of body’s immune
system. These infections cause several health problems and
even lead to death of a person. HIV has inability to protect
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Kapila et al / Indian J. Pharm. Biol. Res., 2016; 4(3):69-73
Review Article 70
against diseases and count of CD4 cells also decreases in HIV.
There is no cure of AIDS but there are certain medicines which are use to slow down the diseases so you stay healthier for long
time. There is no medicine to get rid of diseases [1].
Structure of HIV Virus
Fig.1: Structure of HIV Virus
Gp120
The 120 in its name comes from its molecular weight. It is
essential for virus entry into the cells as it plays vital role in
attachment to specific cell surface receptors.
GP41
It is a subunit of the envelope protein complex of retroviruses
including human immuno deficiencies virus. It is family of
enveloped viruses that replicate in host cell through process
of reverse transcriptase. It targets a host cell.
Viral envelope
It is envelope through which virus binds.
P17
Viral core is made from protein. It is bullet shaped. Three
enzymes required for HIV replication are reverse
transcription, integrase and protease.
P24
P24 is component of HIV capsid.
Protease
It is a retroviral aspartyl protease that is essential for life
cycle of HIV, the retrovirus that caused AIDS. This enzyme
cleaves newly synthesized polyproteins at appropriate place
to create nature protein components of infectious HIV virion.
Integrase
Enzyme produce by retrovirus that enables its genetic
material to be integrated into the DNA of infected cell.
RNA
All organisms including most viruses store their genetic
material on long strands of DNA. Retrovirus is exception
because their genes are composed of RNA [2].
Causes
It is caused by sexual contact from one person to another
person. HIV is a virus. When someone becomes infected with
HIV the virus weakens and damages their body’s defence
system (the immune system) so that it cannot fight off
infections.
It is cause by:
a. Sharing drug needles or syringes.
b. Sexual contact including oral, vaginal or oral who is HIV
positive.
c. Having other sexually transmitted diseases such as
syphilis, herpes, and gonorrhea seems to increase the risk of
being infected by HIV during unprotected sexual contact with
infected partner.
d. Babies can be infected by an HIV-positive mother during
pregnancy, birth and breast feeding.
Transmission
HIV is transmitted principally in three ways: By sexual
contact, by blood through transfusion, blood products or
contaminated needles or by passage from mother to child.
Although homosexual contact remains a major source of HIV
within the United States, “hetero sexual transmission is the
most important means of HIV spread worldwide today.”
Treatment of blood products and donor screening has
essentially eliminated the risk of HIV from contaminated
blood products in developed countries, but its spread
continues among intravenous drug users who share needles.
In developing countries, contaminated blood and
contaminated needles remain important means of infection.
Thirteen to thirty-five percent of pregnant women infected
with HIV will pass the infection on to their babies;
transmission occurs before as well as during birth. Breast
milk from infected mothers has been shown to contain high
levels of the virus also.
HIV is not spread by the fecal-oral route; aerosols; insects;
or casual contact, such as sharing household items or
hugging. The risk to health care workers is primarily from
direct inoculation by needle sticks. Although saliva can

Kapila et al / Indian J. Pharm. Biol. Res., 2016; 4(3):69-73
Review Article 71
contain small quantities of the virus, the virus cannot be
spread by kissing.
HIV can be transmitted from an infected person to another
through:
• Blood (including menstrual blood),
• Semen,
• Vaginal secretions,
• Breast milk.
Activities That Allow HIV Transmission
• Unprotected sexual contact
• Direct blood contact, including injection drug needles,
blood transfusions, accidents in health care settings or certain
health care products.
• Mother to baby (before or during birth) [2].
HIV is known to be transmitted only through:
• Contact of infected blood, semen, or vaginal and cervical
secretions with mucous membranes.
• Injection of infected blood or blood products.
• Vertical transmission (that is, from infected mother to fetus)
and from mother to infant via breast milk.
Contact of Sexual Fluids or Blood with Mucous
Membranes:
The virus cannot pass through undamaged skin. HIV can
enter the body through the mucous membranes that line the
vagina, rectum, urethra, and possibly, on rare occasions, the
mouth. Damage to a mucous membrane may increase the risk
of transmission of HIV but is not necessary for transmission
to occur.
Injection of Infected Blood:
HIV can be transmitted by infected blood getting directly into
the bloodstream through intravenous, intramuscular, or
subcutaneous injection.
Blood-to-blood transmission occurs in the following ways:-
• Transfusion of contaminated blood and blood products and
other blood recipients.
• Sharing of unsterilized hypodermic needles and syringes.
The risk of HIV Transmission is dependent on:
• The concentration of HIV in the infected fluid.
• The QUANTITY of fluid introduced into the body.
• The ACCESS of the infected fluid to the t4 cells.
Fluid with high concentration of HIV:
• Semen,
• Blood and blood components,
• Menstrual flow,
• Vaginal secretions,
• Pre ejaculatory fluid,
• Breast milk.
Fluids with LOW Concentration of HIV
• Pus,
• Saliva,
• Tears,
• Urine,
• Feces,
• Vomiting,
• Nasal mucosa.
Symptoms
Many people who are living with HIV have no obvious signs
and symptoms at all. Recent evidence shows that between
70% to 90% of people who become infected with HIV
experience flu-like symptoms within a few weeks after
infection. The most common symptoms are a fever, a rash
and a severe sore throat all occurring at the same time. These
symptoms in an otherwise healthy person may indicate recent
HIV infection.
HIV infected patients may get yeast infections (oral or
vaginal) that do not go away or that occur often. Frequent and
severe herpes infections that cause mouth, genital, or anal
sores are also common.
Herpes zoster (shingles) is more likely to occur in infected
patients. Other pulmonary infections (pneumonia) or so-
called atypical mycobacterial infections can be serious for
your loved one. Women may get pelvic inflammatory disease
that does not respond to treatment. The virus may attack the
nervous system (nerves, spinal cord or brain) and produce a
variety of symptoms ranging from tingling in the feet and
trouble walking to memory disturbances [3].
Symptoms
 large lymph nodes or "swollen glands" that may be
enlarged,
 for more than three months,
 frequent fevers and sweats skin rashes or flaky skin that
does not go away,
 short-term memory loss,
 slow growth or frequent illness in children,
 cough and shortness of breath,
 seizures and lack of coordination,
 difficult or painful swallowing,
 confusion and forgetfulness nausea, cramps diarrhea or
vomiting that do not go away,
 vision loss,
 Unexplained weight loss.

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Review Article 72
Life Cycle of HIV AIDS
Fig. 2: Life cycle of HIV AIDS
Entry to human cells
HIV is the only viruses which make new copies of itself
inside the human cells. This process begins when this virus
enters into cell that carries on its surface a protein that is cd4.
The HIV virus stick to the cd4 receptor and allow them to
fuse.HIV mainly infect immune cells i.e. T-helper cells that
forms the body immune system. HIV infects more cells,
therefore immune system becomes weak.
Reverse transcription
There is an enzyme reverse transcriptase which helps in
reverse Transcription. The main function of reverse
transcriptase is conversion of viral RNA into DNA. After that
DNA is transported to cell’s nucleus where insertion of DNA
is done by enzyme integrase.
Transcription and translation
Now, transcription takes place. HIV virus converts HIV virus
into messenger RNA.
Assembly, budding and maturation
Copies of HIV gather together with newly made HIV protein
and enzymes to form new viral particle which are then bud
off from the original CD4 cell. The enzyme protease break
the long chains of HIV protein into smaller pieces. These
newly virus has ability to target and infect other CD4 cells
[4].
Diagnosis
HIV is most commonly diagnosed by testing your blood or
saliva for antibodies to the virus. Unfortunately it takes time
for your body to develop these antibodies-usually up to 12
week. A newer type of test that checks for HIV antigen, a
protein produced by the virus immediately after infection,
can quickly confirm a diagnosis soon after infection [5].
Following are the tests for detection of HIV AIDS:
Home Test
A Food and Drug Administration-approved home test. To do
the test, you swab fluid from your upper and lower gums. If
the test is positive, you need to see your doctor to confirm the
diagnosis. If the test is negative, it needs to be repeated in
three months to confirm the results.
Tests To Tailor Treatment
If you receive a diagnosis of HIV/AIDS, several types of
tests can be done. These tests include:
 CD4 count
CD4 cells are a type of white blood cell that's specifically
targeted and destroyed by HIV.
 Viral load
This 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 resistance
This blood test determines whether the strain of HIV you
have will be resistant to certain anti-HIV medications [6].
Treatment
Antiretroviral drugs are used to treat HIV. These are the
drugs active against human immunodeficiency virus (HIV)
which is a retrovirus. They are useful in prolonging and
improving a quality of life. Antiretroviral drugs are classified
as following:

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Review Article 73
Nucleoside reverse transcriptase inhibitors (NRTIs):
Zidovudine (AZT), Didanosine,Lamivudine, Tenofovir.
Nonnucleoside reverse transcriptase inhibitors:
Nevirapine, Delavirdine, Efavirenz.
Protease inhibitors:
Indinavir, Nelfinavir, Amprenavir, Lopinavir, Atazanavir.
Nucleoside analogue reverse transcriptase inhibitors
(NRTIs) were the first type of drug available to treat HIV
infection in 1987. When HIV infects a cell, it copies its own
genetic code into the cell’s DNA, and the cell is then
programmed to create new copies of HIV.
To reproduce, HIV must first convert its RNA into DNA
using the enzyme reverse transcriptase.
These inhibitors act like false building blocks and compete
with the cell’s nucleosides, thereby preventing DNA
synthesis.
Non nucleoside reverse transcriptase inhibitors (NNRTIs)
started to be approved in 1997. These also interfere with
HIV’s ability to infect cells by targeting reverse transcriptase.
In contrast to nucleoside analogue reverse transcriptase
inhibitors, non nucleosides bind directly to the enzyme [7].
HAART
It is highly active antiretroviral therapy. HIV can also be
treated by HAART. It is a combination of three drugs.
Conclusion
Historically, HIV prevention programs have focused
primarily on developing risk reduction interventions for those
at high risk for becoming infected with HIV. In 1999, a
review of 55 state and city applications to the CDC for funds
for HIV prevention programs demonstrated that only 18
(32.7%) listed HIV-infected individuals as a priority
population for HIV prevention programs. Although there are
millions of people in the United States at "behavioral risk"
for HIV infection, transmission can occur only from people
who are infected with the virus. As the number of individuals
with HIV continues to increase because of ART, so does the
urgency for lifelong prevention strategies customized for
them.
Conflict of interest: We declare that we have no conflict of
interest.
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