PULSE Assignment

Interactive Module

Beyond the Virus:

Understanding HIV

Breaking myths, sharing facts, and promoting awareness

Our Patient

- 40-year-old male - No significant past medical history - Sexually active with multiple partners - Presenting with: - Weight loss- Chronic diarrhea - Chronic fever - Skin rash - Oral hairy leukoplakia

Disease Progession

Acute HIv

cHRONIC hiv

aids

Chronic HIV infection is a stage where the virus remains active at low levels and may not cause noticeable symptoms, even though it is still present in the body. Without treatment, this stage can progress to AIDS over time, while consistent ART can keep individuals in this stage for decades.¹

Acute HIV infection is the earliest stage, occurring 2–4 weeks after exposure, during which the virus replicates rapidly, causing flu-like symptoms and a sharp drop in CD4 cells. At this stage, the viral load is very high, which greatly increases the risk of transmission.¹

AIDS is the most severe stage of HIV infection, characterized by a CD4 count below 200 cells/mm³ and significant immune system damage, making the body vulnerable to opportunistic infections. At this stage, the viral load is typically high, and without treatment, survival is significantly reduced.¹

Index

5) Treatment

1) Signs & Symptoms

2) Clinical Images

6) Prevention

7) Medical & Social Progression

3) Testing

4) Transmission

8) Quiz

Signs & Symptoms

Primary Infection (Early Stage)

Asymptomatic Stage

• Many individuals show no visible symptoms for a long period of time¹

Major Signs

• Main indicators of advanced HIV disease and the development of AIDS¹

Minor Signs (Common Opportunistic Symptoms)

• Accompanying symptoms that, in combination with major signs, indicate severe immune system damage²

Clinical Images

• Kaposi sarcoma: Kaposi sarcoma is an endothelial cancer caused by HHV-8 (human herpesvirus 8), occurring mainly in immunosuppressed people³
• Herpes Simplex: is a viral infection caused by HSV (herpes simplex virus), spread through skin contact, causing oral (HSV-1) or genital (HSV-2) sores and managed (not cured) with antivirals⁴
• HIV rash: can appear as a flat, red rash and is often one of the first symptoms of the virus⁵
• Oral hairy leukoplakia: is an EBV (Epstein-Barr virus)–related condition causing white, hairy-looking patches on the tongue⁶

TESting - how it works

• Detects both HIV p24 antigen and antibodies11

Antibodies

• Detects IgM
• Detects IgG

• Antibodies bind HIV antigens for detection

Blood sample is collected and sent to a lab

Detects HIV by identifying viral RNA9

Uses RT-PCR to convert RNA → DNA and amplify it 9

• Detects HIV antigen, specifically the p24 protein 10
• Antigen triggers an immune response

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Nucleic acid amplification tests (NAT)

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Antigen-antibody tests

Antigen Tests

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Transmission

• Transmitted through direct contact with certain body fluids 12

• Entry routes: mucous membranes, broken skin, injection
• Common transmission: unprotected vaginal/anal sex, sharing needles or syringes12

• Mother-to-child: pregnancy, childbirth, breastfeeding

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Timeline for transmission

Immune System Impact

Attachment & Fusion

Assembly

Integration

Reverse Transcription

Budding & Maturation

Replication

Binding

Latency

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AntiRetroviral Therapy (ART)

• HIV is treated using a combination of medications called ART, typically consisting of at least two different drug classes.

• This treatment:
• Reduces the viral load in your blood to the point where it’s undetectable on a standard lab test, meaning the virus is untransmittable.
• This can be achieved within 6 months after starting treatment.
• People with an undetectable viral load can live long, healthy lives.15

ANtiRetroviral Therapy (ART) - Cont'd

Early treatMent

ADHERENCE & RESISTANCE

WHAT TO EXpect

Early treatment with ART should begin as soon as possible after diagnosis, even if the person feels healthy. Starting treatment is especially important in cases of recent infection, AIDS-defining conditions, or pregnancy.15

It is very important to take ART exactly as prescribed and not miss doses. Poor adherence allows HIV to replicate and mutate, which can lead to drug resistance and make the treatment less effective or stop working over time.15

ART is not a cure, but it can keep HIV well controlled when taken consistently. It helps maintain a low viral load and prevents disease progression.15

Different Levels of Prevention

Primary Prevention: Aims to prevent HIV acquisition before exposure occurs 16

Secondary Prevention: Aims for early diagnosis of HIV 16

Tertiary Prevention: Aims to improve quality of life for those living with HIV 16

Social Progression

Medical Progression

Before: HIV was a death sentence in the 1980s and early 1990s. No effective treatment existed. Now: The arrival of ART transformed HIV from a terminal illness to a managable chronic condition.

• Death rates dropped from 121 per 1000 person to 16.
• The median age of death in 1994 was 39 years, compared to 54 years in 2017. 17

Before: HIV was first seen as a "life-style" disease, government response was slow and fear of thinking it was contagious fueled discrimination. Now: science has driven destigmatization, particularly through U=U, which has reduced fear of transmission.

• Activism, awareness and education has led to improvements in how people percieve HIV. 18

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Check Your Understanding

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You Have completeDThis MOdule!

8. Immune System Impact

• CD4+ T cells are damaged and depleted through HIVs actions 13
• Immune system weakens → increases risk of opportunistic infections

4. Integration

• Viral DNA enters nucleus
• Integrase (enzyme) inserts DNA into host genome → provirus formed 13

9. Latency

• Some infected cells become dormant
• Virus persists and evades immune detection 13

6. Assembly

• Viral components assemble at the cell membrane to form new viral particles 13

Secondary Prevention

Increased access to HIV testing is central in identifying HIV infections early, to prevent complications and reduce transmission Testing should be:

• Confidential
• Voluntary
• Accessible

Providing different testing methods is critical:

• Community testing: accessible and local services
• Self-Testing: test is perfromed entirely by the user
• Self-Sampling: sample is collected by the user and returned to the lab for testing16

Primary Infection Signs & symptoms

• Mild fever
• Muscle aches
• Fatigue
• Headaches
• Enlarged lymph nodes
• Skin rashes
• Sore throat
• Mild diarrhea¹

Minor signs

• Respiratory Symptoms
• Persistent cough
• Shortness of breath
• Skin and Oral Symptoms
• Itchy (pruritic) rashes
• Recurrent herpes zoster (shingles)
• Oral candidiasis (thrush)
• Oral Hairy leukoplakia

• Extensive herpes simplex infections
• Neurological Symptoms
• Memory loss or confusion (AIDS dementia complex)
• Meningitis caused by opportunistic pathogens²

Major Signs

• Significant weight loss
• Chronic diarrhea (lasting more than a month)
• Prolonged fever (lasting more than a month)¹

3. REverse transcription

• Viral RNA is released
• HIV uses reverse transcriptase to convert RNA → double-stranded DNA 13

Tertiary Prevention

Antiretroviral therapy (ART): supresses viral replication, maintains immune function and reduces morbidity and mortality. Adherence support: ongoing medical care, counselling and peer/community support programs to ensure consistent treatment use.16

5. Replication

• Virus hijacks host cell machinery to produce viral RNA and proteins 13

2. Attachment & Fusion

• gp120 protein on HIV binds to CD4 receptor + co-receptor (CCR5 or CXCR4)13
• Viral and cell membranes fuse → virus enters cell13

7. Budding & Maturation

• Immature virions bud off
• Protease (enzyme) processes virions → mature, infectious virus 13

Primary Prevention

1. Behavioural Intervention:

• Increase education and knowledge
• Promote safe sex and consistent condom use (~80% reduction in HIV transmission)

2. Biomedical Intervention:

• Pre-exposure prophylaxis (PrEP): ART medication taken before/after sex by HIV individuals
• Post-exposure prophylaxis (PEP): ART medication taken after potential exposure
• Treatment as prevention (TasP): undetectable viral load = no sexual transmission (U=U)
• Voluntary male medical circumcision (VMMC): ~60% reduction in heterosexual HIV acquisition in men

3. Harm Reduction Intervention

• Opiod subsitution programs reduce injection frequency
• Needle & syringe exchange programs provide sterile equipment 16

1. ENtry

HIV enters the body and targets CD4+ T cells13