1. HIV/AIDS
Human Immunodeficiency Virus/ Acquired Immune
Deficiency Syndrome
Monica Epsky
Chandler Porter
Shambria Simmons

2. What Is HIV?

3. How Do You Get HIV?

4. Study Design
Case-control study
• Involves grouping people that are in a health-related state or
event as cases and controls and researching their past to see what
made them these cases
• The outcome is always recognized before the exposure
• Retrospective in nature

5. Case-Control Study
Strengths
• Effective for rare diseases
• Inexpensive
• Requires little time
Weaknesses
• Limited to examining one
outcome
• Prone to bias
• Does not offer relative risk or
incidence

6. Case Study #1
MR. T.R.-CHRONIC
ASYMPTOMATIC
HIV INFECTION
37-year-old African-American Male
Imprisoned for 18 years
Visited clinic as apart of the
aftercare set up by the HIV Liaison
Nurse in the prison
Most prisoners are infected in prison
while injecting drugs or having
unsafe sex
The way Mr. T.R. contracted the
disease is unknown

7. Case Study #2
MS. J.B. – ADVANCED HIV
DISEASE
28-year-old Caucasian female
Paramedics found her unconscious
lying in a pool of blood and sweat on
a stained mattress in the living room
Had injection marks on her hands,
neck, and feet
About 79% of women become infected
with HIV through unprotected sex
with men and 19% by injecting drugs
Ms. J.B. died while at the hospital
after suffering cardiac arrest

8. Case Study #3
46-year-old African-American
male
Visits private physician’s office
for routine tests and
monitoring every 3 months
Infected 15 years ago through
unsafe sex with other males
STDs, including hepatitis B and
gonorrhea
Began antiretroviral
medications 7 years ago
MR. C.S. – CHRONIC
ASYMPTOMATIC HIV
INFECTION

9. Case Study #4
MS. N.R. - PRIMARY
ACUTE INFECTION
29-year-old Hispanic female
Admitted through Emergency
Department after fainting in her
home
RPR test indicated syphilis. Patient
admitted to recent, unprotected
sex with new male partner.
HIV tests found to be positive.

10. Case Study #5
MR. A.B. – SEVERE IMMUNE
COMPROMISE
37-year-old Caucasian male
Admitted with fever and
respiration problems
First diagnosed with HIV 12
years ago. Started
antiretroviral treatment 5
years ago
Co-infected with hepatitis C
Diagnosed with PCP and
adenocarcinoma.
Scheduled for radiation
therapy and chemotherapy

11. Case Study #6
20-year-old Caucasian female;
junior in college
Visits Student Health Center
for persistent morning
vomiting
Admits getting drunk and
having unprotected sex
Positive pregnancy test and
positive HIV test
Decides to delay antiretroviral
medications until 2nd trimester
MS. D.D. – CHRONIC ASYMPTOMIC
HIV INFECTION COMPLICATED BY
PREGNANCY

12. Case Study #7
MR. O.S. – SEVERE IMMUNE
COMPROMISE
42-year-old African-American male
Diagnosed with HIV 10 years ago,
receives healthcare from outpatient
clinic
Says he did not verify if partners were
infected
Unable to work since 1997; receives
Social Security disability benefits due
to mental health problems.
Currently lives in a nursing facility
catering to mental health conditions.

13. Case Study #8
MRS. M.T.M. – CHRONIC
ASYMPTOMATIC HIV INFECTION
67-year-old Caucasian; 2
children
Diagnosed with HIV 5 years ago
after donating blood.
Husband died of stroke
Had unprotected intercourse
with boyfriend; boyfriend died
of heart attack
Admitted for mastectomy to
treat breast cancer;
uncomplicated surgery

14. Results
Case Study #1
MR. T.R. – Chronic Asymtomatic HIV
Infection
• No treatment was required because he is
asymtomatic
• Had negative test result for Hepatitis B
surface antigen and positive for Hepatitis B
core antibody which indicated that he was
infected in the past and has recovered.
• Failed to return to his next clinic
appointment and the emergency number he
gave the clinic was disconnected
Case Study #2
MS. J.B. – Advanced HIV Disease
• Had very low CD4+ lyphocyte count, which
showed that Ms. J.B. is in third stage of HIV
infection
• Not able to give a list of her past behaviors
• Most likely got the disease from having
unprotected sex with HIV infected men or
sharing needles
• Suffered a cardiac arrest on the way to the
radiology department
• Five hours later she died after several attemps
to resuscitate her failed

15. Results
Case Study # 3
MR. C.S. – Chronic Asymptomatic HIV
Infection
• Mr. C.S. had an elevated fasting total
cholesterol so he was prescribed atorvastatin
(Lipitor)
• During his next visit he complained about
moderate to severe pain and burning in both
legs
• He was told to discontinue using atorvastatin
because of this and was given some
antiretrovirals to combine
• This allows Mr. C.S. to take all his
antiretroviral medications once daily
Case Study # 4
MS. N.R. – Primary Acute Infection
• Started treatment early in the course of
infection
• Started having terrifying dreams almost every
night which was a side effect of one of the
medications
• Scheduled for a follow up visit when her HIV
resistance test results come in

16. Results
Case Study # 5
MR. A.B. – Severe Immune Compromise
• In the last stage of the HIV disease which
makes him more susceptible to infections
• His lung cancer continured to spread and is
down to 132 pounds.
• He refused additional cancer treatments
• Entered a home hospice program and moved
into his parents house
• Two months later Mr. A.B. died in the
Emergency Department after his mother
called 911 when she was unable to wake him
up
Case Study # 6
MS. D.D. – Chronic Asymptomic HIV Infection
Complicated by Pregnancy
• Decided not to terminate her pregnancy
• Started taking antiretroviral medications
during her second trimester
• Went into labor at 38 weeks and received
zidovudine
• The baby continued to receive zidovudine for
6 weeks and repeated testing showed that she
was uninfected with HIV

17. Results
Case Study # 7
MR. O.S. – Severe Immune Compromise
• In the last stage of the HIV disease
• Two months later, he disappeared from his
care facility and was found looking through
the dumpsters behind a nearby hospital.
• He was hospitalized for mental-health services
Case Study # 8
MRS. M.T.M. – Chronic Asymptomatic
HIV Infection
• In the stage called “Chronic Asymptomatic HIV
Infection”
• She decided not to tell her children and
started going to a support group but quit going
after the third time because it was to
depressing
• She developed a friendship with one of the
women in the group and they accompanied
eachother to their doctor appoitments
• Her surgery had no complications and was
discharged three days post-op

18. Pathophysiology of HIV/AIDS
In 1993, the CDC outlined 6 stages of infection regarding the pathophysiology of HIV.

19. Stage 1
Seroconversion illness
Occurs 1-6 weeks after infection.
Once virus enters target host cell in the body, it
undergoes a period of rapid viral replication. During
this time, HIV can grow to several million particles per
milliliter of blood

20. Stage 1 Continued
• Seroconversion illness
Flu-like symptoms may occur. Additionally, the number of circulating CD4 T-lymphocyte cells drops as a result of
CD8 T-lymphocyte cells (which target HIV-infected cells) being activated. This is the stage where the majority of
CD4 cells are depleted; mostly in the intestinal mucosa. HIV targets the T-cells by their CCR5 receptors.

21. Stage 2
Asymptomatic infection
The virus levels fall, but replication is continuous.
CD4 and CD8 T-lymphocyte levels are normal. This
stage has no symptoms and can persist for years. CD8
T cells slow the disease progression, but don’t
eliminate the virus.

22. Stage 3
Persistent generalized
lymphadenopathy (PGL)
The lymph nodes swell for a few weeks, or even
months.

23. Stage 4
Symptomatic infection
Symptoms manifest. Because the immune system is
compromised, there is a greater risk for opportunistic
infections. This stage of symptoms is referred to as the
AIDS-related complex (ARC) and is regarded as the
precursor to AIDS.
The virus continues to keep T lymphocytes that are
essential to immune response at a low number.

24. Stage 4 Continued
Symptomatic infection
A normal human gut harbors many microbial agents
and bacteria, which are normally kept in check by
the mucosal immune system. Without it, the threat
of exposure to other sources of illness are greatly
increased.

25. Stage 5
AIDS
Characterized by severe immunodeficiency.
There are signs of life-threatening infections
and unusual tumors. This stage is
characterized by CD4 T-cell count below 200
cells per cubic millimeter.
After diagnosis, life expectancy without
treatment ranges from 6-19 months

26. Stage 6
Nonprogressors
There is a small group of patients who develop AIDS very slowly, or never at all. These patients are
called nonprogressors.

27. Treatments
A cure for HIV/AIDS has yet to be created, but there are several medications that can help control HIV and the many
complications.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Protease inhibitors (PIs)
• Entry or fusion inhibitors
• Integrase inhibitors

28. Medications
Non-nucleoside reverse
transcriptase inhibitors
NNRTIs immobilize a protein that is
necessary for HIV to duplicate
Nucleoside reverse
transcriptase inhibitors
NRTIs are broken down forms of
building blocks that HIV duplicate
Protease inhibitors
PIs incapacitate protease, another
protein that HIV needs to duplicate

29. Medications
These drugs block HIV's entry into
CD4 cells
Integrase inhibitors
Protein that HIV uses to insert its
genetic material into CD4 cells
Entry or fusion inhibitors

30. Diagnosis
HIV is diagnosed by testing your blood or saliva for the antibodies to
the virus.
These types of HIV tests are not correct immediately after you
contract the infection.
It normally takes up to 12 weeks for the antibodies to become
present. Some cases can take up to 6 months for an HIV test to
become positive.
The latest test checks for HIV antigen, a protein created by the virus
immediately after infection. This test can confirm a diagnosis within days
of infection.
The earlier you get tested, the sooner you can take the precautions to
save your life and avoid spreading the disease to others.

31. HIV Test

32. Tests to Customize Treatment
CD4 count
CD4 cells are a type of white blood
cell that's specifically targeted and
destroyed by HIV. A healthy person's
CD4 count can vary from 500 to
more than 1,000. Even if a person
has no symptoms, HIV infection
progresses to AIDS when his or her
CD4 count becomes less than 200.
Viral load
This test measures the amount of
virus in your blood. Studies have
shown that people with higher viral
loads generally fare more poorly
than do those with a lower viral
load.
Drug resistance
This blood test determines whether
the strain of HIV you have will be
resistant to certain anti-HIV
medications and the ones that may
work better

33. Pertinent Epidemiology
• AIDS was first recognized in
the United States in June of
1981
• First recognized in
homosexual men
• HIV is sexually transmitted,
blood borne, and can be
passed down from mother to
child during child birth or
through breastfeeding

34. Pertinent Epidemiology
• An estimated 34 million
people were living with HIV
worldwide by the end of
2010
• The number of deaths
caused from AIDS in 2010
were 1.8 million
• 1,000 children are newly
infected with HIV everyday

35. Pertinent Epidemiology
How to protect yourself
• Practice safe sex by using
condoms
• Limit the amount of alcohol
you consume
• Do not share syringes or any
type of injection equipment
• Use sterile equipment when
getting tattoos or piercings

36. How has this study helped?
This particular study has been used to help educate
aspiring and current healthcare professionals as a
course in the different stages, treatments and
complications of HIV.
Many older Americans with HIV are typically
diagnosed during the final stages of HIV infection.
As a result, they are often too late to benefit from
antiretroviral medications. Studies like these serve
as public service announcements to inform an
unassuming and at-risk population.

37. How has this study helped?
Studies also help establish a cross-section into the
lives of individuals affected by HIV. The studies
spotlight risky behaviors, sources of illness and
prevalent modes of transmission among exposed
and at-risk individuals. These studies highlight the
significance of access to care, the benefits of safe
sex and the dangers of drug use.

38. How has this study helped?
"When you treat HIV you want to suppress the virus and get the virus
level in the blood so low that it can’t be transmitted to another
person. This not only treats and benefits the patient but it is also
prevents new cases.”
- Anne Spaulding, MD at Rollins School of Public Health

39. The U.S. First Confirmed Case
In 1968, a 15-year-old black male who
lived in St. Louis was hospitalized
He died of an aggressive case of
Kaposi's sarcoma (KS)
His tissue and serum samples tested HIV
positive.
This appears to be the first confirmed
case of HIV infection in the United
States.

40. Historical Figures
First clinical observation of AIDS – 1981
CDC called HIV “lymphadenopathy”, or Kaposi’s Sarcoma and
Opportunistic Infections
CDC called it the 4H disease, as it affected Haitans, Homosexuals,
Hemophiliacs and heroin users

41. Robert Gallo and Luc Montagnier
1983
Two teams, led by Gallo and
Montagnier published their findings in
Science journal
Robert Gallo Luc Montagnier
Gallo isolated a virus from an AIDS
patient which looked similar to human
T-lymphotropic viruses (HTLVs). He
called it HTLV-III.
Montagnier isolated a virus from a
patient with swollen lymph nodes
and lethargy. He showed that core
proteins of the virus were different
from HTLV-1

42. Robert Gallo and Luc Montagnier
The two viruses turned
out to be the same
1986 – LAV and HTLV-III
were renamed HIV

43. Historical Figures
Elizabeth Glaser
She was recognized through her battle
with HIV
Co-founder of one of the top AIDS
charities (Elizabeth Glaser Pediatric
AIDS Foundation)
Died in 1994
Robert Reed
Tested HIV positive in 1991
Died in 1992 from colon cancer
Played Mike Brady on The Brady Bunch
show

44. Historical Figures
Magic Johnson
November 7, 1991 was the day Mr.
Johnson told the world he was HIV
Positive
One of the greatest NBA players of all
time
Freddie Mercury
Tested positive in 1987
Died 4 years after from AIDS related
pneumonia
Lead singer of British group Queen
Eric “Eazy – E” Wright
Died at age 31, a month after he was
diagnosed with AIDS
He gained notoriety from the group
N.W.A., which he cofounded with Dr.
Dre

45. Citations
• Mandal, A. AIDS Pathophysiology. News-medical.net. Online. July 3, 2013. http://www.news-
medical.net/health/AIDS-Pathophysiology.aspx
• Sharp, P. M., & Hahn, B. H. (2010). The evolution of HIV-1 and the origin of AIDS. Philosophical
Transactions of the Royal Society B: Biological Sciences,365(1552), 2487-2494.
• The Body. Fame and hiv: 15 of histor'ys biggest hiv-positive celebrities.
http://www.thebody.com/content/64374/fame-and-hiv-10-of-historys-biggest-hivpositive.html
• Osmond, D. H. (2003, March). Epidemiology of HIV/AIDS in the United States.
http://hivinsite.ucsf.edu/InSite?page=kb-01-03
• Mayo Clinic Staff. Treatments and drugs. Mayo Foundation for Medical Education and Research. (11
August 2012). http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=treatments-and-
drugs
• Mayo Clinic Staff. HIV/ AIDS: tests and diagnosis. Mayo Foundation for Medical Education and
Research. (11 August 2012). http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=tests-
and-diagnosis

46. Citations
• Joint United Nations Programme on HIV/AIDS (UNAIDS) (2011)How to get to zero: Faster. Smarter.
Better.
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/jc221
6_worldaidsday_report_2011_en.pdf
• United States Fund for UNICEF (2013) Join our Fight Againt AIDS
http://www.unicefusa.org/work/hivaids/?gclid=CJbK9KXQmLgCFWhp7AodLScAMg
• amfAR (2013) Basic facts about HIV/AIDS http://www.amfar.org/facts-about-hiv-and-aids/
• Merrill, R. M. (2013). Introduction to epidemiology (6th ed.). Burlington, Mass.: Jones & Bartlett
Learning.