Modes of Transmission

Successful transmission of the human immunodeficiency virus (HIV) requires a viral source, a route of entry into the body and a receptive host cell to replicate in. Please click here for an in-depth interactive animation of the HIV replication process

There are a number of steps in the infection process:


Transmission

Researchers have found HIV in virtually every body fluid, including tears, saliva, urine, blood, semen, mucus, and vaginal and anal secretions. Despite that, HIV is not easily transmitted from one individual to another.

Successful transmission of HIV is dependent upon a number of factors. These factors include:

Taking all of these factors into consideration, 3 conditions must be met for disease transmission of HIV:

1. HIV must pass beyond the body's barrier protection, either cutaneous or membraneous .
2. HIV must contact and gain access to a receptive host cell
3. HIV must replicate.

Viral replication

Infection takes place only when the human immunodeficiency virus (HIV) enters the body and completes a specific set of processes:
1. Binding and fusion: The virus binds with receptors (CD4 and one additional) on the surface of a cell, then fuses with the host cell, inserting its RNA into the host cell.
2. Reverse transcription: An HIV enzyme (reverse transcriptase) uses the single-stranded HIV RNA to assemble a double-stranded HIV DNA molecule.
3. Integration: The HIV DNA enters the host cell's nucleus, where an HIV enzyme (integrase) integrates the HIV DNA into the host cell's own DNA. This now-integrated DNA is called a provirus and may remain inactive for several years, producing few or no new copies of HIV.
4. Transcription: When the host cells receives a signal to activate, the provirus uses a host enzyme called "RNA polymerase" to create copies of the HIV RNA. The RNA is used as a template by host ribosomes to create HIV protein strands.
5. Assembly: An HIV enzyme, called protease, cuts the long chains of HIV proteins at specific sites into smaller individual proteins. These small proteins come together with copies of HIV's RNA genetic material, to create a new viral particle.
6. Budding: The new virus pushes out, or buds, from the host cell. During budding, the new viruses take part of the cell's outer envelope, which acts as a covering, and is studded with protein/sugar combinations, called HIV glycoproteins. These HIV glycoproteins are necessary for the virus to bind CD4 and co-receptors on other host cells. The new copies of HIV can then move on and infect other cells.

The replication process destroys the CD4+ T-cells. HIV viral load increases rapidly until the CD4+ T-cell count begins to go down.


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HIV infection decreases the CD4 count and increases the viral load.
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Symptoms of acute infection

A person who is HIV positive does not automatically have AIDS. AIDS, by definition, is a syndrome with multiple specific symptoms. Approximately 50-90% of patients will have symptoms of acute retroviral syndrome within 1-4 weeks of infection. However, some individuals remain asymptomatic during this period.

Acute Signs
Flu-like symptoms:
  • Fever
  • Myalgia or arthralgia
  • Headache
  • Pharyngitis
  • Nausea and vomiting
  • Fatigue
  • Lymphadenopathy
  • Diarrhea
Rash (Erythematous maculopapular with lesions on face, trunk, and sometimes extremities, including palms and soles; mucocutaneous ulceration of mouth, esophagus, or genitals)
Elevated liver enzymes
Thrombocytopenia, leukopenia
Thrush
Neurologic symptoms:
  • Meningoencephalitis or aseptic meningitis
  • Peripheral neuropathy or radiculopathy
  • Facial palsy
  • Guillain-Barré syndrome
  • Brachial neuritis
  • Cognitive impairment or psychoses

Criteria for AIDS

A diagnosis of AIDS means that a patient's HIV disease has progressed to include .

  1. CD4 count below 200 cells/mm3 (cubic milliliter) and/or
  2. Development of an "AIDS-defining" condition which includes any of the following:

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A number of disorders are considered "AIDS-defining" for those who are HIV positive .
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