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ID32 Infectious Diseases
HIV and AIDS
Toronto Notes 2019
gp41 & gp120
(A)
1. BINDING CD4
TARGET SITES FOR ANTIRETROVIRAL DRUGS (A) Fusion inhibitor
(B) CCR5 antagonist
(C) Nucleoside reverse transcriptase inhibitors (NRTIs) (C) Nucleotide reverse transcriptase inhibitors
(C) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) (D) Integrase strand transfer inhibitors (INSTIs)
(E) Protease inhibitors (PIs)
CCR5
T-cell
(B)
4. INTEGRATION
3. REVERSE TRANSCRIPTION
(C)
RT
Figure 11. Mechanism of HIV replications
7. MATURATION
Protease
(E)
6. ASSEMBLY AND BUDDING
©Stuart Jantzen 2012
Prevention of HIV Infection
• education,includingharm-reduction
■ safer sexual practices: condoms for vaginal and anal sex, barriers for oral sex ■ harm reduction for IVDU: avoid sharing needles
(D)
Integrase mRNA
5. TRANSLATION
Gag
• preventionofverticalHIVinfection:treatmentwithARTshouldbeinitiatedpriortopregnancyor
as early as possible during pregnancy. The risk of vertical HIV transmission can be reduced to <1% if maternal ART is started in a timely manner and the maternal viral load is undetectable prior to delivery
• universalbloodandbodyprecautionsforhealthcareworkers
■ post-exposure prophylaxis (PEP) after occupational (e.g. needle-stick injury) and non-occupational
(e.g. consensual sex, sexual assault) exposure to HIV: 2- or 3-drug regimen initiated immediately
(<72 h) after exposure and continuing for 4 wk
• recentdatahasdemonstratedefficacyofpre-exposureprophylaxis(oralPrEPortopicalmicrobicides)
in preventing HIV
• ARTassociatedwith96%reductioninriskoftransmittingHIVtosexualpartners
• screeningofbloodandorgandonation
2. FUSION AND UNCOATING
PROCESS OF MULTIPLICATION 1. Binding
2. Fusion and uncoating
3. Reverse transcription
4. Integration
5. Translation
6. Assembly and budding
7. Maturation