AIDS

• Acquired Immune-Deficiency Syndrome also called Slim’s disease

is a modern Pandaemic.
• It is caused by HIV (Human Immunodeficiency virus) which makes
the body vulnerable to various life-threatning infections &
Neurological disorders.
•Once infected, a person will carry the syndrome for entire life.
•It is the last stage of HIV infection
•It can effect any sex, age, Nation.
 History of Aids
• First recognized on 1st Dec 1981 in Los Angeles,
New York & San Francisco in USA.
• But earlier cases of retrospective analysis shows
occurrence in late 1970’s in USA & Equatorial
Africa.
• Since, its discovery it has cause 28 millions of
lives till 1996 which increases to 40 millions in
2006.
• Billions of people worldwide are infected with
HIV.
• When 1st reported, patients showed Pneumocystic
Carinii Pneumonia (PCP) caused by Pneumocystis
Carinii and kaposi’s sarcoma.
Human Immunodeficiency Virus
(HIV)
• Few years after discovery of AIDS the virus
was recognized by Luc Montagnier in Paris
and Robert Gallo in Bethesda.
• At that time it was novel and called Retro
virus.
• Also called, HUMAN T-Lymphotropic
Virus-III (HTLV-II) or Lymphadenopathy-
associated virus (LAV).
Structure
 Infection
• HIV is Brain without body.
• For survival, it has to make now proteins.
• HIV attacks T4-Lymphocytes (T-helper cells)
which have CD4 receptors (Proteins).
• These proteins enables virus to bind to the cell.
• Virus hi-jack a cell and hide their own RNA in the
DNA of the cell.
• When cell tries to make new proteins, it
accidentally makes new viruses.
Step 1: Binding
Step 2: Reverse
Transcription.
Step 3: Integration
Step 4: Transcription
Step 5: Translation
Step 6: Viral Assembly and
Maturation
DIAGNOSIS
 CLINICAL :

• Weight loss ≥ 10% of body weight.

• Chronic diarrhoea, Prolonged fever,
Persistent cough for more than 1 month.
• History of herpes zoster.
• Generalized Lymphadenopathy.
• Pulmonary or extra-pulmonary tuberculosis.
• Kaposi's sarcoma.
• Oropharyngeal Candidiasis.
 LABORATORY TESTS
• HIV enzyme-linked immunosorbent assay
(ELISA).
• Western blot.
• DBC.
• Absolute CD4 lymphocyte count.
• CD4 lymphocyte percentage.
• HIV viral load tests.
• B2-Microglobulin.
• P24 antigen.
 Nucleoside analogs
Drug Dose Common side effects

Zidovudine (AZT) 500-600 mg orally daily in Anaemia, neutropenia,

(Retrovir) two or three divided closes nausea, headache
Didanosine (ddI) 12-300 mg orally twice daily Hepatitis, dry mouth
(Videx)
Zalcitabine (ddC) 0.375-0.75 mg orally three Peripheral neuropathy,
(Hivid) times a day aphthous ulcers, Hepatitis
Stavudine (d4T) 40 mg orally twice daily Peripheral neuropathy,
(Zerit) hepatitis, pancreatitis

Lamivudine (3TC) 300 mg orally twice daily Rash, peripheral

(Epivir) neuropathy,pancreatitis

Abacavir 300 mg orally once daily Rash, fever- if occur,

(ziagen) rechallenge may be fatal
 Nucleotide analog

Drug Dose Common side

effects

Tenofovir 300 mg orally Gastrointestinal

(Viread) once daily distress
Nonnucleoside reverse transcriptase
inhibitors (NNRTLs)
Nevirapine 200 mg orally daily Rash
(Viramune) for 2 weeks, then 200
mg orally twice daily
Delavirdine 400 mg orally three Rash
(Rescriptor) times daily

Efavirenz 600 mg orally daily Neurologic

(Sustiva) disturbancies
 Protease inhibitors
Saquinavir 600 mg orally three Gastrointestinal
(invirase) times daily distress, headache
Ritonavir 600 mg or 400 mg orally Gastrointestinal
twice daily combination with
(Novir) other protease inhibitors distress, peripheral
paresthesias
Indinavir 800 mg orally three Kidney stones
(Crizivan) times daily
Nelfinavir 750 mg orally three Diarrhoea
(Veracept) times daily
Amprenavir 1200 mg orally twice Gastrointestinal
(Agenerase) daily distress, rash
Lopnavir/ritonavir 400 mg. 100 mg Diarrhoea
(Kaletra) orally twice daily
 Combivir

• Combivir comes as a tablet that contains:

• 300 (mg) of Retrovir
• 150 mg of Epivir
• MOA :Combivir is NRTIs which block reverse transcriptase, a protein that
HIV needs to make more copies of itself.
• Dose: One tablet twice daily
• Interactions:Trizivir, Retrovir Epzicom, Truvada . avoid using alcohol .
• side effects :Nausea, Vomiting, Diarrhea, Loss of appetite, Headaches, Rash
Immune Reconstitution Syndrome (as a result of the immune system getting
stronger ).
 Atazanavir Sulfate (Reyataz)

• M.O.A: Reyataz is a type of anti-HIV medicine called a protease

inhibitor. Reyataz helps to block HIV protease, an enzyme that is
needed for the HIV virus to multiply. Reyataz may lower the amount
of HIV in your blood, help your body keep its supply of CD4 (T) cells,
and reduce the risk of death and illness associated with HIV
• Limitation : Reyataz does not cure HIV infection or AIDS you may
still pass HIV to other people
• Tell your healthcare provider if you are pregnant, have diabetes,
breast-feeding
• Side effects :
> yellowing of skin or white part of eye
> Lactic acidosis syndrome
 Fusion Inhibitors
• They block Step 2 of the life cycle i.e Reverse
Transcription by blocking enzyme reverse transcriptase
.
• Enfuvirtide (T-20, Fuzeon®)

Prenox-D7

• This product is not intended to be used as a treatment for AIDS, rather

as a supplement to help replenish nutritional deficiencies caused by
AIDS
• Prenox-D7 has Vitamin A as one of the many vital ingredients
 Integrase Inhibitors

• As their name implies, integrase inhibitors

work by blocking Integration process.
• Bevirimat
• hydroxyurea
 THERAPIES
• COMBINATION THERAPY : It prolongs the life of
AIDS patients. Removes drug resistance and reduce
toxicity of drugs with these
objectives.Eg:ZDV+DdC/Ddl/3TC/ PI’s.
• TRIPLE THERAPY : Two NRTls+NNRTls , Two
NRTIs+ one Pis, Three NRTls,even two NTRIs and two
PI’s (PI’s being to improve pharmacokinetics.)
• Natural therapy : Amino acid lysine + vitamin C inhibit
the action of protease
• Immune-Based Therapy :To reproduce "cytokines to
regulate Immune system fights against virus, drugs used are
called anti- virals
 Vaccines

• IR103, which contains the therapeutic vaccine

Remune (stimulate an immune response to the virus) and the
adjuvant Amplivax (increases immune response )
• Immunitin is similar to the naturally occurring
hormone DHEA and is currently being studied as
a immune-based therapy
• Serostim (human growth hormone), a medication
approved for the treatment of Aids related
wasting syndrome,weight loss
 PIDEMIOLOGICAL FEATURES

• Agent factors :
• The virus is able to spread throughout the body. It can pass through the blood-
brain barrier and can then destroy some brain cells.
• virus has been found in greatest concentration in blood, semen and CSF.
• Host factor :
• AGE : Most cases have occurred among sexually active persons aged 20-49
years
• SEX : In Europe and Australia, about 51 per cent of cases are homosexual or
bisexual men. In Africa,; the sex ratio is equal.
• HIGH RISK GROUPS:Male homosexuals and bisexuals,
heterosexual partners (including prostitutes), intravenous drug
abusers, transfusion recipients of blood and blood products,
haemophiliacs and clients of STD.
 Mode of transmission

• Sexual transmission : Any vaginal, anal,oral sex,

homosexual or heterosexual men can spread HIV.
• Blood contact : Blood transfusion, drug users, needle
sharing, skin piercing, tatooing, organ transplantation.
• Maternal – Foetal transmission :HIV may pass
from an infected mother to her foetus, through the placenta
or to her infant during delivery or by breast-feeding.
• Treatment of infected mother with a course of
(AZT)&Nevirapine for several months prior to delivery,
and treatment of a infant for six weeks after birth
 Incubation period

:
• Initial infection The period before antibodies are produced is the
“window period” during which, although the person is particularly
infectious because of the high concentration of virus in the blood, he
will test negative.
• Asymptomatic carrier state : No symptoms for first five years.
• AIDS-related complex :Damage to the immune system,
Fever.Fatigue, ,loss >10 per cent body weight,, diarrhoea
>month,, night sweats.
• AIDS : Pneumocystis carinni pneumonia or Toxoplasma gondii
encephalitis tend to occur, when T-helper cell count has dropped to
around 100. people whose counts are below 50 have cytomegaloviral
retinitis.
 Control of AIDS:

• Prevention:Condoms,avoid sharing razors,

needles,health education,awareness via media,informing
Prostitutes,HIV+ mothers,testing blood for blood & organ
transfer. Primary health careprogrammes are not developed
in isolation.

• Antiretroviral treatment :An

approach to currently available
antiretroviral therapy includes some
drugs like, (AZT),(ddI),(ddC),(d4t)etc
 Counselling a Role of Pharmacist

• Issues such as reducing the risk of infection,

family planning, relationships, sexuality and
sexual problems re discussed.
• The counselor/Pharmacist can help the
patient to view HIV infection as something
that can be managed, and develop a positive
attitude about life
STATISTICS
 Globally :

• 40 million infected.
• Ranks 4
• Aids death 28,00,000
• Children 2,300,000
• Women 17,300,000 .
 INDIA
Category Percentage

Sexual
73747(85.72%)

Blood transfusion
1863(2.17%)

Intravenous drug addicts

2539(2.95%)

Perinatal Transmission
2704(3.14)

Others
5175(6.02)
 CONCLUSION

• 1) The Research scenario for AIDS is very Bright due the fact that
these virus replicate at an enormous and eqile speed and has resistance
to various drugs at various biding site as explained.
• 2) Prevention is the only cure is what can be concluded from the
existing data and drugs like,Combivir,Tenofovir,Reyataz,Fuzeon etc.
No drugs has claimed for complete cure of almost 40 million lives
throughout the world.
• 3) Indian MNC’s, companies and great contributor like Bill Gates,
who has donated huge amount, of almost 400 crores for the
research.are the key to permanent solution of this pandemic.