HIV AIDS

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By: pharmamangesh (113 month(s) ago)

a very informative & good presentation

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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There are no cures or vaccines for HIV/AIDS. Currently awareness/education is the only way to prevent infection. AIDS deaths in 2007, Estimate 2.0 million, while the Range is 8-2.3 million. More than 25 million people have died of AIDS since 1981. Why should i have to know about it?

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HIV came from a similar virus found in chimpanzees - SIV. HIV probably entered the United States around 1970 CDC in 1981 noticed unusual clusters of Kaposi’s sarcoma in gay men in NY and San Francisco, which led to the disease to be called GRID (Gay Related Immune Deficiency). By 1982 the disease was apparent in heterosexuals and was renamed AIDS (Acquired Immune Deficiency). 1984- Scientists(Dr. Luc Montagnier, Dr. Robert Gallo) identify HIV (initially called LAV or HTLV-III) as the cause of AIDS 1987- AZT is the first drug approved for treating AIDS http://www.avert.org/aids-timeline.htm

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The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (Ryan White Care Act, Ryan White, (enacted August 18, 1990) was an Act of the U.S. Congress named in honor of Ryan White, an Indiana teenager who contracted AIDS through a tainted hemophilia treatment in 1984, and was expelled from school because of the disease. White became a well-known advocate for AIDS research and awareness, until his death on April 8, 1990. http://www.avert.org/aids-photo-gallery.php?photo_id=431&gallery_id=7 History that becomes LEGEND Ryan White and his mother

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German Professor Harald zur Hausen (left), French Professor Luc Montagnier (centre) and virologist Francoise Barre-Sinoussi (right) were awarded Nobel Prizes for Medicine on October 6, 2008 Nobel Prizes for Medicine

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HIV/AIDS H – Human I – Immuno Deficiency V – Virus A – Acquired I - Immuno D – Deficiency S - Syndrome HIV IS A VIRUS & IS AN INFECTION AIDS IS A STAGE & NOT A DISEASE AIDS HIV

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HIV is short for Human Immuno-deficiency Virus. Once infected with HIV, a person is referred to as HIV positive. However, this does not necessarily mean that (s)he has symptoms or feels sick. An HIV positive person can feel and look healthy for a long time after first becoming infected. What is HIV?

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AIDS, or Acquired Immune Deficiency Syndrome, can take many years to develop. Eventually, the virus kills or impairs more and more cells in the immune system and the body loses the ability to fight off common infections, such as diarrhea or colds. People with AIDS can die from diseases that are usually not dangerous for people with healthy immune systems. What is AIDS?

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Aids is diagnosed when your CD 4 blood count is at 200 or lower and you have an opportunistic infection (i.e. Kaposi’s Sarcoma or PCP (This is a set point for medical diagnosis) A healthy blood count may range from 800 to 1200 CD4 From HIV to AIDS

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Unprotected sexual contact – be it vaginal, oral, or anal - with an infected partner Sharing unsterilized needles or syringes with an HIV positive person, for example, when using drugs or in a healthcare setting. During pregnancy or birth and through breastfeeding from an HIV positive mother to her baby. Blood transfusions with infected blood How HIV can be transmitted ?

India’s HIV/AIDS Profile : 

India’s HIV/AIDS Profile Demographically second largest country - 1.1 billion 3rd highest HIV infections - 2.47 million (after South Africa & Nigeria) Over 85% sexual transmission Concentrated epidemic, adult prevalence 0.36% (males-0.43%, females-0.29%) Epidemic driven by core groups and bridge population 140 of 611 districts report >1% ANC prevalence (15 districts >3%) (source: NACP-III) Over 60% PLHAs in 4 high prevalence states

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Males>females Occurs in all ages and ethnic groups All areas of the country are affected In some city inner areas, as many as 50% of males are HIV positive AIDS is now the second leading cause of death for all men aged 25-44 years Unintended injuries is #1 and heart disease is #3 for this age group

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HIV Prevalence Estimate Prevalence is the number of people living with HIV/AIDS in a given year. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24%-27% undiagnosed and unaware of their HIV infection.1 “Eighty percent of Americans with HIV do not know they are infected.” -Philip Emeagwali “One out of every 100 American men is HIV positive. The rate of infection has reached epidemic proportions in 40 developing nations.”-Philip Emeagwali

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Symptoms Pulmonary infections Gastrointestinal infections Neurological and psychiatric involvement Tumors and malignancies Other opportunistic infections There are basically 5 type of Symptoms as follows :-

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Symptoms List of symptoms of HIV/AIDS: Early infection: More common to develop a brief flu-like illness 2-4 weeks after becoming infected. Signs and symptoms may include: Fever Headache Sore throat Swollen lymph glands Rash

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Symptoms

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Symptoms 1.Pulmonary infections Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii. X-ray of Pneumocystis jirovecii caused pneumonia. There is increased white (opacity) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia

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Symptoms 2.Gastrointestinal infections Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.[18]

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Symptoms 3.Neurological and psychiatric involvement HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself. Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs.[21] Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

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Symptoms 4.Tumors and malignancies Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).[27][28] Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.

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Symptoms 5.Other opportunistic infections AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Cause Sexual transmission Exposure to blood-borne pathogens Parental transmission Misconceptions There are basically 4 type of Cause as follows :-

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Cause Sexual transmission Age : MC 24-49 yrs sexually activegroup Sex : male homosexuals bisexuals are more common in North America, Australia and Europe, Certain sexual practices increases the disease pattern ex: Multiple sex partners Sexual Contact: Male-to-male Male-to-female or vice versa Female-to-female

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Cause 2. Exposure to blood-borne pathogens This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with HIV.

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Cause 3. Parental transmission The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during pregnancy, labor and delivery is 25%. Breastfeeding also increases the risk of transmission by about 4 %.

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Cause 4. Misconceptions A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between gay men can lead to AIDS infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Pathophysiology The pathophysiology of AIDS is complex, as is the case with all syndromes.[60] Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes. This weakens the immune system and allows opportunistic infections.During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. Thus virus affecting cells are:- Cells affects :- The virus, entering through which ever route, acts primarily on the following cells:[66] * Lymphoreticular system: o CD4+ T-Helper cells o CD4+ Macrophages o CD4+ Monocytes o B-lymphocytes * Certain endothelial cells * Central nervous system: o Microglia of the nervous system o Astrocytes o Oligodendrocytes o Neurones - indirectly by the action of cytokines and the gp-120

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Pathophysiology The effect The virus has cytopathic effects but how it does it is still not quite clear. It can remain inactive in these cells for long periods, though. This effect is hypothesized to be due to the CD4-gp120 interaction The CD4-gp120 interaction (vide supra) is also permissive to other viruses like Cytomegalovirus, Hepatitis virus, Herpes simplex virus, etc. These viruses lead to further cell damage i.e. cytopathy.

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Pathophysiology Molecular basis :-

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HIV infects CD-4 positive cells CD4+ T-cell lymphocytes Macrophages Lymph node follicular dendritic cells Langerhans cells Binding to CD4 by gp120 Entry into cell by fusion requires gp41 and coreceptors CCR5 (Beta chemokine receptor) CXCR4 (alpha chemokine receptor)

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Envelope lost and RNA uncoated DNA made from RNA using reverse transcriptase DNA and Integrase migrate to nucleus forming a provirus by integrating viral DNA to host DNA

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Rate of viral replication regulated by the activity of regulatory proteins (tat/rev, nef, etc) Co-infections (e.g., Mycobacterial) stimulate the HIV-infected cells to produce more virus Transcription and translation produces necessary polyprotiens which are cleaved by the HIV protease Assembly

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Maturation/release of virus. The half-life of this processing of HIV into mature virions is about 90 minutes. Each infected cell can produce an average of 250 new virions by budding before it fails and dies.

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Depends on: Viral load (no. of RNA copies/ml plasma) Genetics Mode of transmission Viral load is the most important marker to determine prognosis and effectiveness of treatment

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Category A (A1-A3: > 500 to <200 CD4+ T cells/µl): Acute and asymptomatic HIV infection +persistent generalized lymphadenopathy Category B (B1-B3: 500 to <200 CD4+ T cells/µl) : symptomatic but not conditions in C Category C (C1-C3: 500 to <200 CD4+ T cells/µl) : AIDS defining conditions AIDS: A3, B3, or C1-3

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Diagnosis The diagnosis of AIDS in a person infected with HIV is based on the presence of certain signs or symptoms. Since June 5, 1981, many definitions have been developed for epidemiological surveillance. It can be divided in three Methods :- WHO disease staging system CDC classification system HIV test

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Diagnosis WHO disease staging system In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.[67] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people. Stage I: HIV infection is primary and not categorized as AIDS Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

Stage 1 - Primary : 

Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection no symptoms at all Infected person can infect other people

Stage 2 - Asymptomatic : 

Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to very low levels HIV antibodies are detectable in the blood

Stage 3 - Symptomatic : 

Stage 3 - Symptomatic The symptoms are mild The immune system deteriorates emergence of opportunistic infections and cancers

Stage 4 - HIV  AIDS : 

Stage 4 - HIV  AIDS The immune system weakens The illnesses become more severe leading to an AIDS diagnosis

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Diagnosis 2. CDC classification system :- There are two main definitions for AIDS, both produced by the Centers for Disease Control and Prevention (CDC). The older definition is to referring to AIDS using the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[68][69] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes.[70] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

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Diagnosis 3. HIV test :- Many people are unaware that they are infected with HIV.[71] Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities. HIV tests divided in following 4 categories :- Antibody tests Antigen tests Nucleic acid based tests (NAT) Other tests used in HIV treatment

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Prevention Sexual contact Exposure to infected body fluids Mother-to-child transmission (MTCT) The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible. These are as follows :-

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Prevention Sexual contact :- Use condoms (female or male) every time you have sex (vaginal or anal) Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex

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Prevention 2. Exposure to infected body fluids If a needle/syringe or cooker is shared, it must be disinfected: Fill the syringe with undiluted bleach and wait at least 30 seconds. thoroughly rinse with water Do this between each person’s use

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Prevention 3. Mother-to-child transmission (MTCT) Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.[97] It should be noted that women may breastfeed other children who are not their own.

Prevention by Common Sense : 

ABC rule Abstinence, Be faithful (one partner), Condom “It is bad enough that people are dying of AIDS, but no one should die of ignorance.” Prevention by Common Sense

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Treatment HAART: Highly Affective Anti-Retro Viral Therapy: Anti-retro viral therapy is recommended if: Patient is asymptomatic/ symptomatic + CD4 count of <350/µl / any AIDS defining condition / plasma HIV RNA greater than 100,000 copies/ml HAART combines two types of antiretroviral drugs: Triple cocktail 2NRTI’S + 1PI or 2NRTI’S + 1NNRTI

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RTI’s (Nucleoside Reverse Transcriptase Inhibitors): Zidovudine (AZT/ZDV), Didanosine (DDI), Zalcitabine (DDC), Stavudine (D4T), Lamivudine (3TC) NNRTI’s (Non-Nucleoside RTI’S) : Delavirdine, Nevirapine, Efavirenz Nucleotide Reverse Transcriptase Inhibitor: Adefovir Tenofovir Protease Inhibitors: Indinavir, Ritonavir Treatment

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Entry inhibitors/Fusion inhibitors: Maraviroc, Enfuvirtide Integrase inhibitors: Raltegravir Maturation Inhibitors under trails: Bevirimat & vivicon Treatment

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For needle stick: Postexposure Prophylaxis ZDV+3TC 28 days, but in high risk (high viral RNA copies) a combination of ZDV+3TC+Indinavir Pregnancy: ZDV full dose, trimester 2 and 3+ 6 weeks to neonate reduces vertical transmission by 80% ZDV restricted to intrapartum period + NEVIRAPINE- 1 dose at onset of delivery+ AZT+3TC for 1 week after delivery Neonate: 1 dose of Nevirapine within 24-72 hrs after birth + ZDV for 1 week Symptomatic tx and antibiotics/antivirals/glucocorticoids/thalidomide /antifungals/metronidazole for bacterial, viral, autoimmune, fungal and parasitic infections. Treatment

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Why the world needs an AIDS vaccine Conclusion

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“HIV does not make people dangerous to know, so you can shake their hands and give them a hug: Heaven knows they need it.” Princess Diana “HIV infection and AIDS is growing - but so too is public apathy. We have already lost too many friends and colleagues.” David Geffen Conclusion

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“I recommend the same therapies for all humans with HIV. There is no reason to believe that physiologic responses to therapy will vary across lines of class, culture, race or nationality.” -Paul Farmer “No war on the face of the Earth is more destructive than the AIDS pandemic.” -Colin Powell Conclusion

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HIV / AIDS A TECHNICAL APPROACH TO UNDERSTAND UNCURE GREEN ENEMY ! INDEX 1. General Introduction of HIV/AIDS. 2. Symptoms 4. Pathophysiology 5. Diagnosis 6. Prevention 7. Treatment Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte. 3. Cause 8. Conclusion

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Any question ? or Doubt !

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http://www.avert.org/aids-timeline.htm http://www.cdc.gov/hiv/topics/surveillance/basic.htm#hivest http://www.cdc.gov/nchhstp/stateprofiles/Louisiana/Louisiana_Profile.htm Ingelheim, B. (2004). Additional information on clinical trials with nevirapine in pMTCT [PDF document]. Retrieved October 14, 2008, from http://www.boehringer- ingelheim.com/hiv/news/download/medical_attach_HIVNET.pdf

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National Institutes of Health. (2008). AIDS. Retrieved October 14, 2008, from http://www.nlm.nih.gov/medlineplus/aids.html Chan-Tack, K. M. (2007). Early symptomatic HIV infection. Retrieved October 14, 2008 , from http://www.emedicine.com/med/topic86.htm

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