HIV, AIDS - , pharmacology , B.pharmacy , project - AIDS, Antiretroviral drugs, Anti-Retroviral drugs , Structure of HIV , AIDS- Aquired immunodeficiency syndrome , HIV - Hummo deficiency virus

1. INTRODUCTION
HIV is the abbreviation used for the “Human Immunodeficiency Virus”. HIV attacks the body’s
immune system and cause AIDS- “Acquired immunodeficiency syndrome”. Normally, the immune
system produces white blood cells and antibodies that attack viruses and bacteria. The infection
fighting cells are called T-cell lymphocytes. Months to years after a person is infected with HIV,
the virus destroys all the T-cell lymphocytes. This disables the immune system to defend the body
against diseases and tumors. Various infections will be able to develop, these opportunistic
infections take advantage of the body's weakened immune system. These infection which
normally won't cause severe or fatal health problems will eventually cause the death of the HIV
patient.
A likely source of HIV has been more difficult to pin down. The closest
virus to HIV discovered in certain chimpanzees. Scientists have long recognized the ability of
certain viruses and other diseases to pass from animals to humans. This process is referred to as
zoonosis. Once an animal disease has infected people, it may then be passed from human to
human. Although it has not been proven that HIV came from primates, an SIV has been known to
infect humans. With the rapidly until development of AIDS is estimated at approximately 10 years
for young adults. The estimate varies with the age at which infection occurs and is significantly
shorter in infants and in older adults and varies even between infection at age 20 and infection at
age 40.

2. ABOUT HIV VIRUS:
HIV is a single stranded RNA retrovirus which carriers unique enzymes. HIV first
attaches to CCR-5(chemokine-co-receptor-5) by help GP-120 and get fused into
host cell’s membrane by help GP-40. HIV releases RNA, the genetic code of the
virus, into the cell. For the virus to replicate, its RNA must be converted to DNA .
The RNA is converted to viral DNA by an enzyme called Reverse Transcriptase
(produced by HIV).The viral DNA enters the cell’s nucleus with the help of an
enzyme called Integrase (also produced by HIV), the viral DNA becomes integrated
with the host cell’s DNA. The DNA of the infected cell under go transcription and
produce viral mRNA. And mRNA translated into proteins that are needed to
assemble a new HIV. A new virus is assembled from two proteins: *Structural
protein & *Genetic protein. Then these two proteins get merged to produce new
HIV virus by help of Protease(also produced by HIV) then the virus pushes (buds)
through the membrane of the cell, wrapping itself in a fragment of the cell
membrane and pinched off from the infected cell. And ready to infect other cells.

3. STRUCTURE OF HIV VIRUS

4. Transmission of HIV Infection
• Sexual contact with an infected person, when the mucous
membrane lining the mouth, vagina, penis, or rectum is exposed to
body fluids such as semen or vaginal fluids that contain HIV, as
occurs during unprotected sexual intercourse.
• Injection of contaminated blood, as can occur when needles are
shared or a health care worker is accidentally pricked with an HIV-
contaminated needle.
• Transfer from an infected mother to a child before birth, during
birth, or after birth through the mother’s milk.
• Medical procedures, such as transfusion of blood that contains HIV,
procedures done with inadequately sterilized instruments,
or transplantation of an infected organ or tissues.

5. Symptoms:-
• Swollen lymph nodes, felt as small, painless lumps in the neck, under
the arms, or in the groin
• White patches in the mouth (thrush) due to candidiasis (a yeast
infection)
• Shingles
• Diarrhea
• Fatigue
• Fever sometimes with sweating
• Progressive loss of weight
• Anemia
• progressively lose weight and have a mild fever or diarrhea.
• CD4 count of less than 200 cells per microliter of blood.
• Decreased levels of sex hormones, which may cause fatigue and sexual
dysfunction in men

6. Diagnosis:-
• ELISA(enzyme-linked immunosorbent assay) to detect HIV antibodies and
then confirm positive results using a separate, more accurate.
• AIDS is diagnosed when the CD4 count falls below 200 cells per microliter
of blood.
• Bone marrow aspiration and biopsy: To check for low blood cell counts
(including anemia), which may be due to lymphomas, cancers, and
opportunistic infections.
• Computed tomography (CT) with a contrast agent or magnetic resonance
imaging (MRI): To check for damage to the brain or spinal cord.
• screening test tests for two things that suggest HIV infection:
*Antibodies to HIV ,*HIV antigens (p24 antigen).

7. TREATMENT – Anti-Retroviral Therapy
Classification of drugs:-
1. Nucleoside reverse transcriptase inhibitors (NRTIs)
2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
3. Retroviral protease inhibitors (PIs)
4. Entry (fusion) inhibitor
5. CCR5 receptor inhibitor
6. Integrase inhibitor

8. Nucleoside reverse transcriptase
inhibitors (NRTIs) :- Zidovudine , Stavudine , Lamivudine ,
Tenofovir , Abacavir .
MECHANISM :-
Single-stranded viral RNA
(Virus directed REVERSE TRANSCRIPTASE)
inhibited by NRTI’S
Double-stranded proviral DNA
Zidovudine Stavudine
Lamivudine Tenofovir

9. Non-nucleoside reverse transcriptase
inhibitors (NNRTIs) :- Nevirapine , Efavirenz
• MECHANISM :-
These are nucleoside unrelated
compounds which directly inhibit
HIV reverse transcriptase without
the need for intracellular
phosphorylation.
Nevirapine
Efavirenz

10. Retroviral protease inhibitors (PIs):- Indinavir,Nelfinavir,
Saquinavir,Ritonavir.
Mechanism:-
• Protease enzyme encoded by
HIV is involved in the production
of structural proteins and
enzymes.
• PI’s bind to the active site of
protease molecule, interfere
with its cleaving function.
Indinavir Nelfinavir
Saquinavir Ritonavir

11. Entry (fusion) inhibitor:- Enfuvirtide
Mechanism:-
• This HIV-derived synthetic peptide acts by
binding to HIV-1 envelope transmembrane
glycoprotein (gp41)
• which is involved in fusion of viral and
cellular membranes.
Fusion of the two membranes is thus
prevented and entry
of the virus into the cell is blocked by ENTRY
(fusion) INHIBITORS.
Enfuvirtide

12. CCR5 receptor inhibitor:- Maraviroc
Mechanism:-
• The gp120 of the HIV envelope
anchors to the CD4 site of host
cell by binding to a cell
membrane receptor, which is the
CCR5 chemokine-co-receptor-5.
• Maraviroc is a novel anti-HIV
drug which targets the host cell
CCR5 receptor and blocks
Attachment of the virus.
Maraviroc

13. THERAPEUTIC REGIMENS AND TREATMENT DOSE

14. Conclusion:-
 Treatment with antiretroviral drugs is recommended for almost all people with HIV infection because without
treatment, HIV infection can lead to serious complications and because newer, less toxic drugs have been
developed. For most people, early treatment has the best results. Research has shown that people who are
promptly treated with antiretroviral drugs are less likely to develop AIDS-related complications and to die of them.
 Treatment cannot eliminate the virus from the body, although the HIV level often decreases so much that it cannot
be detected in blood or other fluids or tissues. The goals of treatment are:-
*Reducing HIV level to undetectable.
*Restoring CD4 count to normal.
 If treatment is stopped, the HIV level increases, and the CD4 count begins to fall. Thus, people need to take
antiretroviral drugs for their lifetime.
 Before starting a treatment regimen, people are taught about the necessity of the following:
*Taking drugs as directed.
*Not skipping any doses.
*Taking the drugs for the rest of their life.
 Taking the drugs as directed for a life time is demanding. Some people skip doses or stop taking the drugs for a
time (called a drug holiday). These practices are dangerous because they enable HIV to develop resistance to the
drugs.
 Because taking HIV drugs irregularly often leads to drug resistance, health care practitioners try to make sure that
people are both willing and able to adhere to the treatment regimen. To simplify the drug schedule and to help
people take the drugs as directed, doctors often prescribe treatment that combines two or more drugs in one
tablet that can be taken only once a day……