Lecture 30 HIV and AIDS Treatments The Physical Toll of HIV AIDS AIDS Causes death in 2 major ways exam question 1 Wasting disease HIV effects metabolism hard to absorb proper nutrients treatments sometimes need to be taken with an empty stomach 2 Opportunistic Infection Have you Tested Positive for HIV yes no Get physical exam s women Gyn pap get key tests CD4 cell count viral load get other blood tests as needed Starting HIV medicines is recommended for everyone with HIV regardless of of CD4 count In addition to CD4 and viral load tests general health evaluative tests are performed such as CBC chemistry panel liver and kidney function tests Early Stage CD4 above 500 and viral load below 5 000 Middle stage CD4 200 500 and viral load 5 000 100 000 Advanced Stage CD4 below 200 and viral load above 100 000 No unusual conditions likely Emphasize good health habits and health care What Do CD4 Cell Counts Mean Above 500 CD4 cells maintenance including vaccines and nutrition Anti HIV therapy recommended 200 500 CD4 cells Increased risk for shingles thrush skin infections bacterial sinus and lung infections and TB Life threatening Ols such as PCP MAC and CMV they are rare 50 200 CD4 Cells Increased risk for PCP and other opportunistic infections Preventative treatment for PCP is indicated If counts are below 100 consider preventive treatment for MAC CMV and invasive fungal infections Below 50 CD4 Cells Increased risk for opportunistic infections including MAC and CMV Continue preventive medication What about Viral Load Tests Establish baseline 2 tests should be taken 2 4 weeks apart then every 3 4 months Avoid viral load tests during active infection a cold after a vaccination or during flare ups of infection like a cold sore Can cause HIV levels to briefly increase but return to normal in a few weeks Tests 3 4 weeks after starting or changing therapies Trend of viral loads over time is the most important and not an individual result Low stable and decreasing viral load good High or increasing levels call for attention as it may point to the failure of a regimen Viral load below 10 000 copies is generally considered low Viral load above 100 000 is generally considered high Women may have a naturally lower viral load than men especially in early HIV infection Therefore women should be aware that a viral load above 30 000 or even 60 000 might indicate a high viral load for them People with undetectable viral load should remember that it does not mean that their HIV is gone HIV may actually be there but just in too small of a quantity to detect World Health Organization has new treatment guidelines as of September 2015 Antiretroviral therapy should be started with no delay even with high cd4 cell counts Routine Screens for Opportunistic Infections do not need to be done as often as cd4 cell counts and viral load tests HIV patients need to screen and prevent manage opportunistic Infections PPD Skin Test and Chest X Rays Tuberculosis TB If you ve been exposed the PPD causes a bump to appear within several days at the site of the test A positive or inconclusive PPD is followed up by a chest X ray and sputum culture to determine active TB disease Pap Smears Anal Pap Women living with HIV may need to get a Pap test done more often than every 3 years based upon your health and risk factors This test can be done in the anus to look for damage caused by HPV High rates of anal HPV occur in HIV positive men and women including those who do not report having anal intercourse For this reason it s important that all HIV positive people have an anal Pap If the results are abnormal more tests may be needed Hepatitis Serology Liver function tests can show Hepatitis infection Other tests can be done to find antibodies to Hepatitis B HBV and C HCV diseases that affect the liver These tests should be done after first learning your HIV status if you have not been tested before Toxoplasmosis Serology IgG antibody This test may be done to detect antibodies to the toxoplasmosis toxo cat scratch organism Toxo can cause problems in the brain and central nervous system A positive test result may help to decide on preventive therapy The test is usually done when people first find out their HIV status That way if they re negative for toxo they can take precautions to prevent contact with it Interventions Against HIV General health maintenance lab work eat healthy exercise Support Therapies complementary and alternative therapies Anti HIV treatment strategy meds specialist Immune therapies enhance or inhibit immune function Opportunist infection strategy safe sex food prep good hygiene Goals of HIV Treatment HIV therapy should Prolong life and improve quality of life Suppress HIV levels viral load below the limit of detection 50 copies HIV RNA or as low as possible for as long as possible Optimise and extend the use of current therapy and minimize drug toxicity and manage side effects and drug interactions The Replication Cycle of HIV HIV binds to CD4 cell surface molecules entry into the cell also requires binding to co receptors CXCR4 and CCR5 This step can be inhibited by fusion entry inhibitors HIV is uncoated inside the cell and reverse transcriptase copies genomic RNA into DNA making errors at a frequency of about one per replication cycle Reverse transcriptase RT inhibitors were the first class of HIV inhibitors to be used as drugs Viral DNA can integrate into host DNA and become a part of the cellular genome This step makes the infection irreversible and may mean that eliminating the virus from an infected individual is not possible Integrase inhibitors 2 are designed to block this step of infection The virus uses cellular machinery to synthesize viral proteins Several of these are long amino acid chains which must be cleaved by a specific protease before new viral particles can become active Protease inhibitors PI block viral maturation at this step Major Classes of Anti retroviral Drugs Reverse transcriptase RT inhibitors interfere with the critical step during the HIV life cycle known as reverse transcription During this step RT an HIV enzyme convert HIV RNA to HIV DNA There are two main types of RT inhibitors Nucleoside Nucleotide RT Inhibitors or Analogues NRTIs are faulty DNA building blocks When these faulty pieces are incorporated into the HIV DNA during the proves when the HIV RNA is converted to HIV DNA the DNA chain cannot be completed thereby blocking HIV from replicating in a cell Non Nucleoside
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