Acquired Immune-Deficiency

Syndrome (AIDS)

Dr Nabil ABUAMER
 Objectives of the lecture
• By the end of this presentation we should be
able to:
• Understand the causing agent, pathogenesis
and transmission routes of HIV/AIDS
• The history of the problem and where are we
now from its control
• HIV Epidemiological picture, globally and its
burden locally
 HIV, Human Immunodeficiency Virus

The causative agent of AIDS is:

• HIV, Human Immunodeficiency Virus
• A retroviruses, (Lentiviruses) special class of
viruses
• RNA Virus (100-120 nm)
 HIV 1 (groups M, N, and O) is most common
in sub-Saharan Africa and throughout the
world.

 HIV 2 (Mostly in West Central Africa)

produce same patterns of illness
 History
1981:
5 cases of an unusual pneumonia, pneumocystis, 41 cases of Kaposi’s
Sarcoma (CDC)
NE J. Med – harmless viruses and bacteria can cause fatal illnesses in
homosexual men, 121 deaths

1983:
Pasteur Institute - new virus in patient with symptoms preceding AIDS
named it lymphadenopathy-associated virus (LAV)
Women can catch it too

1985:
Blood test made available to blood banks

1987:
WHO makes global map of AIDS cases (17,000 deaths)
1989:
AZT starts

1998:
Benghazi children hospital 420 children injected with HIV virus.

2000;
Antiviral drugs appear to be working – but cost too much

2001:
Romanian AIDS orphans(3000 children infected with HIV).
 Pathogenesis
• HIV gradually eliminates T Cells (helper T-
cells)Th1 & Th2 cells
• Th1&2 helping Cytotoxic T-cells and antibody
producing B-cells
• HIV has a surface protein gp120 which binds to
CD4+ receptor on Th1 & Th2
• Immune system keeps producing T-cells,
however, without treatment and after some
years, the body can’t keep up with the rate of cell
death and AIDS begins.
 Healthy CD4 cell counts from 500 to 1,800 /cu.ml of
blood.

 AIDS is diagnosed when CD4 cell count goes below

200/cu.ml

 Even if CD4 cell count is over 200, AIDS can be

diagnosed if patient has HIV and certain diseases
such as TB or Pneumocystis pneumonia (PCP) (fungal “P.
Jerovecii” infection)
 New medications and treatments have
extended the lives of people with HIV and
many can live a normal life span.

With early intervention you may be able to

prevent HIV from becoming AIDS.
 Routes of HIV transmission
• Sexual: Consensual, commercial, rape.

• Blood and blood products: Blood or blood

Product, transfusions, needle sticks in hospitals,
needle sharing by IV drug users, contaminated skin
piercing equipment

• Vertical: Transmission from mother to child

during pregnancy, delivery, or subsequent
breast-feeding

• Combinations of the above

 Level of risk of infection
• Needle stick injury (e.g. to health worker) 3/1000 incidents
(0.3% per incident) with post-exposure prophylaxis less than
0.1%

• Unprotected receptive vaginal intercourse 0.1 – 0.2% per

sexual act

• Unprotected anal intercourse 0.5-3%

• Infant born vaginally to HIV+ mother 30-45% with therapy less

than 2%

• Blood transfusion: 95% per transfusion of infected blood

 Course of infection
 Incubation period: symptoms of acute infection may
appear within 2-6 weeks

 Window period:
• period from acquiring the infection until the
appearance of antibodies (6 weeks to 3 Months)
• During this period, patient may test negative by ELISA
but positive by PCR
• Patient is highly infectious during this period
due to high viral load.
 Immune suppression may take 8-15 years to develop
• Acute HIV syndrome:
Flu like illness, Headache, fever, myalgias, atypical
meningitis, acute encephalitis, lymphadenopathy (1-2
weeks)

• Asymptomatic carrier state:

Seroconversion ( antibodies positive)

• AIDS-Related Complex (ARC):hyperactive B-Cells, follicular or mixed

hyperplasia of lymph nodes. Clinical use of this term was widely discontinued by the year 2000 after
having been replaced by modern laboratory criteria

• Late Stage (AIDS)

Opportunistic infections
 HIV testing
• HIV diagnosis (Antibody/Antigen testing)
– Enzyme Immunoassays (EIAs)
– Rapid tests (AB/Ag Combo test)
– Western blot (WB)

• Early diagnosis in infants

– p24
– DNA/RNA PCR

• Initiation and monitoring of ART

– CD4
– Viral Load
 Epidemiology of HIV
• Since the start of HIV epidemic (in the 80s); 78 million
have become infected and 39 million died
• There were 35 million people living with HIV (PLHIV) in
2013
• During 2013, 2.1 million new infection,
240,000 were children
• About 1.5 million died from AIDS-related illnesses in
2013
• Only 37% of those have access to ART and only 24% of
children living with HIV receiving life saving medicine
• TB still the leading cause of death in PLHIV
 Epidemiology of HIV
• In 2013, about 60% of the new infections in
youths (15-24 years old) were females
• Every hour 50 young women are newly infected
with HIV
• HIV prevalence:
• 12 times more among sex workers
• 49 times more among transgender
• 28 times more among people who inject drugs
(PWID)
Globally, are we getting better?

33% decrease in new HIV infections since 2001

29% decrease in AIDS-related deaths (adults and

children) since 2005

52% decrease in new HIV infections in children

since 2001

40-fold Increase in access to antiretroviral therapy

(ART) 2002–2012
The world continues to close in on the goal
of ending the AIDS epidemic by stopping
HIV transmission and halting AIDS-related
deaths.

Nevertheless, endemic stigma and

discrimination, violence against women
and girls and unjust laws continue to hamper
efforts to achieve global AIDS targets.
 What about our region,
Middle East and North Africa

Between year 2001 and 2012:

• The estimated number of people dying from
AIDS-related illness more than doubled (from
8300 to 17000)

• The estimated number of people acquiring

HIV increased by more than 50% (21000 to
32000)

http://www.unaids.org/sites/default/files/media_asset/JC2571_AIDS_by_the_numbers_en_1.pdf
 HIV burden in Libya
Three major health services related incidents:
• 1986 ( 24 hemophiliacs infected through
contaminated factor VIII).
• 1996 (Banning the sale of needles and
syringes in private pharmacies).
• 1998 (Benghazi children hospital infection)
 Concentrated HIV epidemic
Definition:
• If in general population prevalence less than 1%
(and prevalence in any of high risk groups is more
than 5%.
----------------------------------------------------------------
• Libyan Sero-prevalence 0.13% in 2004

• In Tripoli (2010), HIV prevalence among PWID

78%
In Libya:

• Total number of registered PLHIV (Cumulative

number is about 5000 pt)
• Of those registered, about 3000 pt on ART
• Patient enrolled for ART treatment in 2013: 807
pt.
• Patient enrolled for ART treatment from Jan -
June 2014: 310 pt.
• Children: 112 registered (Have medical files)
• Of those registered: 75 children on ART
In Libya
Cause of infection:
According to medical history (of the registered PLHIV
following up at hospitals):

• Drug use blamed by 52% of cases.

• Sexual transmission in about 36.5% (in and out of marriage

& MSM)

• Blood transfusion and Nosocomial infection in 5% of pt.

• The rest are unknown cause.

In Prisons

• PLHIV in prisons (2014): 125 inmates are

registered and all on ART. Of those, 10 are
females inmates
Thank you
NABIL ABUAMER