This presentation introduces the viewer to basic information about HIV: what it is, how it affects the human body, how it is transmitted, and how to prevent transmission.

1. HIV 101
Science, Clinical
Care and Prevention
Aaron Davis, B.S.
Program Manager
Maryland DHMH – Center
for HIV Prevention

2. OBJECTIVES
•What is HIV?
•How does it affect your immune
system?
•What happens when HIV is not
treated?
•How is HIV treated?
•How do we prevent HIV?
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3. To understand what HIV and AIDS are, let’s break it down:
Causative agent:
H – Human – This particular virus can only infect human
beings.
I – Immunodeficiency – HIV weakens your immune system by
destroying important cells that fight disease and infection. A
"deficient" immune system can't protect you.
V – Virus – A virus can only reproduce itself by taking over a
cell in the body of its host.
http://aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/
WHAT IS HIV?
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4. HIV – THE ENEMY
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5. WHAT IS AIDS?
Disease:
A – Acquired – AIDS is not something you inherit from your parents
like eye color. You acquire AIDS.
I – Immuno – Your body's immune system includes all the organs
and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is
"deficient," or isn't working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of
disease. AIDS is a syndrome, rather than a single disease. It is a
complex illness with a wide range of symptoms.
http://aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/ 5

6. OTHER DEFINITIONS
• Retrovirus: type of virus that changes it’s RNA to
DNA
• ARVs: anti-retrovirals – HIV medications
• HAART: Highly Active Anti-Retroviral Therapy –
using a combo of 3 or more ARVs to treat HIV (also
known as ART)
• CD4 T-Cell: type of white blood cell that HIV
targets
• Viral Load: the amount of HIV virus particles
(“copies”) in 1 milliliter of blood
• “Undectable”: A viral load of under 50
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7. What 5 Fluids Transmit HIV?
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7
Blood Vaginal
Fluids
Breast
Milk
Semen
& Pre-ejaculate

8. Ways HIV is Transmitted
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9. Timeline of discoveries
1981: Epidemic first identified
1983: Identification of the HIV virus
1985: First commercial test to detect HIV
1987: First antiretroviral drug approved
1995: Protease inhibitors approved
1997: Three-drug therapy (HAART) shown to delay
progression
2008: HIV patient “cured” of virus through bone marrow
transplant from Δ32 donor
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10. OBJECTIVES
•What is HIV? ✔
•How does it affect your immune
system?
•What happens when HIV is not
treated?
•How is HIV treated?
•How do we prevent HIV?
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11. Organs of the Immune System
Immune cells localize in secondary
lymphoid organs, such as the spleen,
lymph nodes, etc.
T cells are generated
in the thymus
The bone marrow contains
blood-forming Stem cells,
and makes B cells, innate
cells, and all other blood
cell types, except T cells.
Red-primary lymphoid organs
Blue-secondary lymphoid organs
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12. THE IMMUNE SYSTEM BATTLEGROUND
INNATE IMMUNITY ADAPTIVE IMMUNITY

13. ANTIGEN

14. ANTIGEN
Front-line Soldiers
(macrophages,
dendrites)

15. ???
VIRUS

16. VIRUS
APC
The General
CD4 Cell

17. VIRUS Snipers
CD8 T-
Killer Cells

18. VIRUS
Antibody
Look-Outs
B Cells

19. ???
HIV

20. HIV
APC
The General
CD4 Cell

22. ???
???

23. 23

24. HIV Lifecycle:
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25. gp120
p24
Viral RNA
RT & other
virion
proteins
HIV Lifecycle:
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26. gp120
p24
Viral RNA
RT & other
virion
proteins
CD4
CXCR4 or CCR5
Binding
HIV Lifecycle:
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27. gp120
p24
Viral RNA
RT & other
virion
proteins
Fusion & uncoating
HIV Lifecycle:
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28. gp120
p24
Viral RNA
RT & other
virion
proteins
Reverse
transcription
HIV Lifecycle:
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29. gp120
p24
Viral RNA
RT & other
virion
proteins
Nuclear
localization
& entry
HIV Lifecycle:
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30. gp120
p24
Viral RNA
RT & other
virion
proteins
HIV Lifecycle:
Integration
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31. gp120
p24
Viral RNA
RT & other
virion prteins
Integrated
provirus
HIV Lifecycle:
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32. gp120
p24
Viral RNA
RT & other
virion
proteins
Viral Gene
Transcription
HIV Lifecycle:
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33. gp120
p24
Viral RNA
RT & other
virion
proteins
Translation
HIV Lifecycle:
33

34. gp120
p24
Viral RNA
RT & other
virion
proteins
Post-translational
processing
HIV Lifecycle:
34

35. gp120
p24
Viral RNA
RT & other
virion
proteins
Assembly
HIV Lifecycle:
35

36. gp120
p24
Viral RNA
RT & other
virion
proteins
Budding
HIV Lifecycle:
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37. OBJECTIVES
•What is HIV? ✔
•How does it affect your immune
system? ✔
•What happens when HIV is not
treated?
•How is HIV treated?
•How do we prevent HIV?
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38. HIV Signs and Symptoms
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• Rapid weight loss
• Recurring fever or profuse
night sweats
• Extreme and unexplained
tiredness
• Prolonged swelling of the
lymph glands in the
armpits, groin, or neck
• Diarrhea that lasts for
more than a week
• Sores of the mouth, anus,
or genitals
• Pneumonia
• Red, brown, pink, or
purplish blotches on or
under the skin or inside the
mouth, nose, or eyelids
• Memory loss, depression,
and other neurologic
disorders.

39. HIV Progression to AIDS
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40. Untreated HIV infection is a constant battle between the virus and the host immune system,
with BILLIONS of new infected cells and virus particles produced and cleared EVERY DAY in
each infected person.
http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Biology/pages/clinicalcourse.aspx
http://www.healthhype.com/cd4-count-dropping-viral-load-stable-in-hiv-infection-graph.html
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41. OPPORTUNISTIC INFECTIONS
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42. Examples of Opportunistic Infections
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•Candidiasis
•Invasive cervical cancer
•Coccidioidomycosis
•Cryptococcosis
•Cryptosporidiosis
•Cytomegalovirus disease •Encephalopathy, HIV-related
•Herpes simplex: chronic ulcer
•Bronchitis, pneumonitis, or esophagitis
•Histoplasmosis
•Isosporiasis
•Kaposi's sarcoma
•Lymphoma
•Mycobacterium avium complex
•Tuberculosis
•Pneumocystis carinii pneumonia
•Pneumonia, recurrent
•Progressive multifocal leukoencephalopathy
•Salmonella septicemia, recurrent
•Toxoplasmosis of brain
•Wasting syndrome due to HIV

43. What does it mean to be “AIDS-Defined?”
• A CD4 T-cell count of 200 or below; OR
• CD4 T-cells make up less than 14% of all
white blood cells; OR
• The presence of 1 or more opportunistic
infections
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44. CASCADE OF HIV TREATMENT IN THE U.S.
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45. WHAT CAN WE
DO???
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46. OBJECTIVES
•What is HIV? ✔
•How does it affect your immune
system? ✔
•What happens when HIV is not
treated? ✔
•How is HIV treated?
•How do we prevent HIV?
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47. HAART• Use a combo of 3 ARVs from a minimum of
2 classes of HIV medications
• Some pills contain multiple medications
taken once daily
• Recommendation is to start treatment early
to reduce HIV numbers
• Resistance occurs when medication not
taken daily
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48. HIV DRUG TARGETS
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49. OBJECTIVES
•What is HIV? ✔
•How does it affect your immune
system? ✔
•What happens when HIV is not
treated? ✔
•How do medications help? ✔
•How do we prevent HIV?
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50. PREVENTION TOOLS
HIV TESTING
BEHAVIORAL
INTERVENTIONS
CONDOM DISTRIBUTION NEEDLE EXCHANGE
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51. BIOMEDICAL
INTERVENTIONS
PrEP
PEP
Treatment
as
Prevention
Vaccines
Microbicides
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52. 52
• PrEP involves an HIV-negative person taking
antiretroviral (ARV) medications to reduce the risk
of infection before HIV exposure
• Current approved regimen is taken in a single pill
once a day, every day
• Truvada is currently the only drug approved by the
Food and Drug Administration (FDA) for PrEP

53. PrEP
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• Studies have shown PrEP can
reduce risk of getting HIV by 92-
99% if taken everyday.
• PrEP can be used for heterosexual
men and women, bisexual, gay
and transgender individuals,
injection drug users, and pregnant
women.
• It is important to know that PrEP is
not a cure for HIV and it cannot
protect you from pregnancy or
other sexually transmitted
infections (STI), like gonorrhea or

54. PrEP
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For anal sex, an individual needs to take 7 days of
Truvada before enough drug is “on board” for
protection in the rectum (it is not the morning after
pill).For vaginal sex it takes 21 days
to build up a protective Truvada
presence in the vagina.
The key is adherence - a pill every
day.

55. PrEP
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 PrEP is not just a pill, it’s a program that should
include comprehensive HIV and STI prevention
interventions
◦Testing for HIV every 3
months
◦Regular STI screenings
◦Kidney/liver function
◦Risk-reduction counseling
◦Condom promotion

56. Post-Exposure Prophylaxis
(PEP)
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57. Treatment as Prevention
(TaSP)
• Study looked at HIV transmission between
serodiscordant heterosexual couples (HPTN
052)
• People taking ARVs and virally suppressed
reduce HIV transmission by 96%
• TREAT EARLY AND HARD!
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58. CONTACT INFORMATION
Aaron Davis
Program Manager
Maryland Prevention and Health Promotion Administration
Infectious Disease Prevention and Health Services Bureau
Center for HIV Prevention and Health Services
(410) 767-5699
aaron.davis@maryland.gov
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