HUMAN IMMUNODEFICIENCY VIRUS & THE IMPACT OF ANTI HIV DRUGS

Name- Chandralekha Ghosh

Collage name- Bengal School Of Technology

INTRODUCTION:-

HIV is one kind of retrovirus. They can replicate in host cell by reverse transcriptase process. No vaccines are used in this HIV infection but there are some therapies that help to slow disease development.

         HIV can show harmful effect to our immune system. As a result of it, unusual infection and certain type of cancer occurs. [1]

PATHOGENESIS OF HIV RELATED DISEASE: 

Human Immunodeficiency Virus is one kind of lent viruses which is a family of mammalian retroviruses amplified to set up chronic persistent infection with progressive onset of clinical symptoms.

       HIV has two major families. Mostly HIV-1 and HIV-2 which are involved epidemic. They are similar to simian immunodeficiency virus and is concentrated in Western Africa. HIV-1 is genetically diverse, with minimum five distinct subfamilies or clades. HIV-1 and HIV-2 both are closely related in vitro sensitivity to most antiretroviral drugs; non nucleoside reverse transcriptase inhibitors are HIV-1 specific and have no effect against HIV-2.

  The worldwide spread of HIV-1 indicates that the virus effectively counteracts innate, adapted, and intrinsic immunity. Despite its modest genome size(less than 10kb) and its few genes, HIV-1 excels in taking advantage of cellular pathways while neutralizing and hiding from the different components of the immune system. Notably our understanding of pathogenesis is often derived from studies of subtype B viruses and non- human primate studies.[2]

 ANTIRETROVIRAL AGENTS APPROVED FOR USE IN THE U.S.[3]

Nucleoside Reverse Transcriptase Inhibitors:

Zidovudine          Stavudine

Non-nucleoside Reverse Transcriptase Inhibitors:

Efavirenz          Nevirapine

Protease Inhibitor:

Saquinavir        Indinavir

Entry Inhibitor:

Enfuvirtide    

Integrase Inhibitor:

Raltegravir

HOW HIV SPREADS?

     HIV is caused by virus by spreading through sexual contact or blood or from mother to child during pregnancy, child birth or breast feeding.

     HIV is attack on our white blood cells that are helping to fight disease and destroyed. AIDS is characterized when the CD4 T cell count falls below 200.

Firstly HIV is spread into blood, semen or vaginal secretions into our body. This can occur in several ways:-

1.    By Having sex:If a person has vaginal, anal or oral sex with an infected partners whose blood, semen or vaginal secretion enters this person body, this person may become infected. The virus can enter our body via mouth sores or small tears that sometime found in the rectum or vagina during sexual activity.
2.     From blood transfusion: Sometimes the virus may be transferred through blood transfusion. Now-a-days American hospitals and blood banks screen the blood sample to supply for HIV antibodies. So this risk is small.
3.         By Sharing needles:- Giving the intravenous drug  with contaminated needles or syringe puts a person who does not affected. There is a chance of HIV and other intravenous disease such as hepatitis.
4.     During pregnancy or delivery or through breast feeding:- This virus can easily transfer babies from their infected mothers. Mother who has HIV positive an treatment for the infection during pregnancy can significantly lower the risk to their babies.[4] 

Signs and Symptoms:-[5]

      For the most part, infections by other bacteria, viruses, fungi, or parasites cause the more severe symptoms of HIV. These conditions tend to progress further in people who live with HIV than in individuals with healthy immune systems. A correctly functioning immune system would protect the body against the more advanced effects of infections, and HIV disrupts this process.

Early symptoms of HIV Infection- Some people with HIV don’t show their symptoms until months or even years after contracting the virus. Around 80% people have flu-like symptoms called as acute retroviral syndrome around 2-6 weeks after the virus enters the body.

      The early symptoms of HIV infection may include:

     

Ø Fever

Ø Joint pain

Ø A red rash

Ø Enlarged glands

Ø Sweats, particularly at night

Ø Tiredness

Ø Weakness

However, people experienced about these symptoms, they must go through the test, and they might have risk of contracting HIV over last 6 weeks.

• Asymptomatic HIV: If no medicine is used for the treatment of HIV infection this virus can damage our organ and immune system. This could be a slow process for an average of 10 years. During this time, the virus continues to develop therefore immune system and organs are damaged. Complying rigidly to a course a ART can disrupt this phase and suppress the virus completely. Taking effective antiretroviral medications for life can halt on-going damage to the immune system.
• Late stage of HIV infection: The person becomes serious illnesses. This stage is known as Aids or Stage 3 HIV.

Symptoms of late-stage HIV infection may include:

Ø Blurred vision

Ø Diarrhea, which is usually persistent or chronic

Ø Dry cough

Ø A fever of over 100^◦F (37^◦C) lasting for weeks

Ø Night sweats

Ø Permanent tiredness

Ø Shortness of breath

Ø Unintentional weight loss

Ø White spots on the tongue or mouth

During late-stage HIV infection, the risk of developing a life-threatening illness increases greatly. A person with late-stage HIV can control, prevent and treat serious conditions by taking other medication alongside HIV treatment.

Fig: Diagram of temporal course of an untreated HIV infection[6]

Prevention:-[7]

There’s no vaccine is used to treat HIV infection and no cure for AIDS. To help control the spread of HIV:

I.            Always use external protection during sex.

II.            Starting treatment for HIV and keep administered HIV medicine. When HIV medicine is taking connect HIV treatments can lower or even stop there is chances of spreading the virus to sexual partners.

III.            Don’t sharing needles or syringe for blasting drugs or tattoos.

In July 2012, the FDA approved pre-exposure prophylaxis (PrEP). PrEP is a medication shown to lower the risk of contracting HIV from sexual activity or needle use. The treatment requires taking the medication on a daily basis.

Doctors recommend PrEP for people who are in a relationship with someone who has HIV.

Others who may benefit from PrEP include:

·        People in a non-monogamous relationship with a partner who is HIV-negative (PrEP reduces the risk of transmitting HIV to a partner).

·        People who have had anal sex without external protection or who have contacted a sexually transmitted disease (STD) in the past six month.

·        People, who have injected drugs, have been in drug treatment, or shared needles in the past six months.

·        People who regularly have different sexual partners of unknown HIV status, especially if they inject drugs.

PrEP is shown to reduce the risk of HIV infection by greater than 90%.

Role of ART to prevent HIV: Antiretroviral therapy helps to slow down the effects of HIV in body and it combines of medicine. It can also provide healthy for long time. It can lower or even stop chances of getting HIV to anyone else.ART decreases the amount of HIV in body. In some cases, HIV can not show up on standard blood tests. When viral load is low, certain test can’t show it. This is called as undetectable. When a person carries an undetectable, they can’t transfer HIV to alter during sex.

      It’s important to inform that with undetectable viral load, HIV is present in body. If treatment is stop, the viral load increases, making it possible to pass HIV to others.

     The major adverse effects of ART can be grouped into the following categories:

1.    Gastrointestinal: Nausea, diarrhea, vomiting, taste perversion, constipation, dyspepsia, abdominal pain, hepatotoxicity, and pancreatitis.

2.    Central nervous System: Headache, vision problems, dizziness, peripheral neuropathy, excessive sleep at night, memory problems, hearing impairment.

3.    Hematological: Anemia, increased urate, and blood in the urine.

4.    Psychological: Anxiety, confusion, depression, nightmares.

5.    Metabolic: Abnormal fat distribution, weight gain.

6.    Dermatological: Skin rash, facial discoloration

7.    Miscellaneous: Hypersensitive reaction, oral ulceration, fever, and irregular     menstrual cycles.

DIAGNOSIS:-[8]

   What tests are applied to diagnoses HIV?

Some different test can be applied to diagnoses HIV. Healthcare allows determine which test is best for each person.

• Antibody/Antigen Tests: These tests are most commonly used test to determine. Within 18-45 days they can show positive results after someone initially contracts HIV.

The blood is checked by this test for antibodies and antigens. Antibody fights an infection and this is one kind of protein the body makes. On other hand an antigen is part of the virus that activates the immune system.

• Antibody Tests: Only blood is checked in this test for antibodies. Most people will develop detectable HIV antibody in blood or saliva between 23 to 90 days after transmission.

Blood test or mouth swabs are using in this test and there’s no preparation is required. Some tests contribute results in 30minutes or less and can be performed in health care provider’s office or clinic.

Other antibody test can be performed at home:

• OraQuick HIV Test: There is one kind of test swab provides results within 20minutes.
• Home Access HIV-1 Test System: After pricks finger of this person, they deliver a blood sample to a licensed laboratory. They can unidentified and call for results the next working day.

          If someone doubts they have been exposed to HIV but tested negative in a home test. They should be repeating the test in 3 months. If they have a positive result, they should follow with their healthcare provider to confirm.

• Nucleic Acid Test: This test is very expensive. It is applied people who have early symptoms of HIV or have a known risk factor. This test does not look for antibodies; this test looks for virus itself. It’s detectable in blood within 5-21 days. An antibody test confirms this test usually. 

    CLINICAL TRIALS:-[9]

 Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect treat or manage this disease.

     Lifestyle and home remedies:

Along with receiving medical treatment, it’s essential to take an active role in your care. The following suggestion may help to stay healthy longer:

ü Eat healthy foods: Fresh fruits and vegetables, whole grains, and lean protein help keep strong, giving more energy and maintain immune system.

ü Avoid raw meat, eggs and more: Foodborne illness can be especially server in people who are infected with HIV. Cook meat until it’s well done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi.

ü Get the right immunizations: These may prevent infections such as pneumonia and the flu. Make sure the vaccines don’t dangerous for people with weakened immune system.

ü Take care with companion animals: Some animals may carry parasites that can cause infection in people who HIV positive. Cat faces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box.

Alternative medicine: - People who are infected with HIV sometime try dietary supplements that clam to boost the immune system or counteract side effects of anti-HIV drugs. However there is no scientific evidence that any nutritional supplement improves immunity, and many times interfere with other medication.

     CONCLUSION:

 After studying HIV from differ views, we are concluded that it is a pandemic disease. It is mainly spreading sexually and person of the age group of 25-45 years are the most affected group. These are the some methods like ‘Antiretroviral Therapy’ which brings some hope that even then no specific treatment has been found so for and morality form is virtually 100%. So only prevention in the test medicine care. 

  REFERENCE:

1.    AIDS.gov.https://www.hiv.go/hiv-basics/overview/about-hiv-and aids/what -are-hiv-and-aids. [Dec. 15, 2017].

2.    Introduction to Viruses Biology Libre Texts [bio.libretexts.orgimages.app.goo.gl]

3.    Sharp PM, Hahn BH, ’Originis HIV and the AIDS pandemic’.[Dec;2015]

4.    HIV virion labeled with comp.[https://aidsinfo,nih.gov/understanding-hiv-aids/glossary/325/human-immunodefficiencyvirus#]

5.    H.P.Rang, J.M Ritter, R.J. Flower, G.Henderson, Rang & Dale’s Pharmacology ‘Antiviral Drugs’, Elsevier Churchill Livingstone, eighth edition,page-  642.

6.    Barin F,M’Boup S, Denis F, Allan JS, Lee TH, Essex M. Lancet,Serological evidence for virus related to simian T-lymphotropic retrovirus residents of West Africa1985;2:1387-1389.

7.    H.P.Rang, J.M Ritter, R.J. Flower, G.Henderson, Rang & Dale’s Pharmacology ‘Antiviral Drugs’, Elsevier Churchill Livingstone, eighth edition,page-  643.

8.    Luciw P.A.’Human immunodeficiency Viruses and their replication In’: Fields BN, editor. Virology. 3^rd ed. Philadelphia Lippincolt-Raven;1996. PP.1881-1952.

9.    Goa F, Bails E, Robertson DL, Chen Y, Rodenburg CM, Michael SF, Cummins LB, Arthur LO, Hahn BH. Origin of HIV-1 in the chimpanzee Pan troglodytes. Nature 1999; 397:436-441.

10.           Laurence L. Brunton, Bruce A. Chabner, Goodman & Gilman’s The Pharmacological Basis of THERAPEUTICS, ’Antiretroviral Agents and Treatment of HIV Infection’, Mc Grow-Hill companies 12^th edition,pg-1623.