AIDS & Narcotics - Freemicrobiology.free.fr/Presentations/AN.pdfChildren living with HIV/AIDS New...
Transcript of AIDS & Narcotics - Freemicrobiology.free.fr/Presentations/AN.pdfChildren living with HIV/AIDS New...
HIV/AIDS & Narcotics
Prepared by: Dr.H.M.Naimi
Lecturer of Microbiology department
Faculty of Pharmacy, Kabul University
Date: 14/12/1384
AIDSAcquired Immune Deficiency Syndrome
1981 : The explosion of AIDS in young homosexual males in the USA
Acquired immunodeficiency syndrome
• Prolong fever
• Flu like symptoms
• Pneumonia called pneumocystis
• Kaposis’s sarcoma
• Sudden weight loss
History
History
• 1984 : Institut Pasteur of France(L.Montagnier)
discovered HIV virus
• 1985 : Dr.Robert Gallo (USA) confirmed that HIV was
the cause of AIDS
• 1987: There were 71.000 confirmed cases of AIDS,
resulting in 40.000 deaths.
• It’s hypothesized that first this virus contracted from
monkeys in central Africa(benign to monkeys)
History
L Montagnier R Gallo
Structure
• HIV (Human Immunodeficiency Virus)
• Family Retroviridae
• A RNA Virus
• Enveloped
• Reverse transcriptase (RT)
• 2 serotypes : HIV 1 (1984) & HIV 2 (1986)
• HIV 1 global
• HIV 2 Principally in west Africa, more virulent
110nm
Replication of HIV
• Principle cell T lymphocyte T CD4
• Attachment of gp120 to CD4 receptor
• Fusion of viral envelope with cell membrane
• Capside enters into cell and librate 2 RNA associated with
RT
• RT : synthesize DNA as a complementry strand of RNA and
synthesize second strand of DNA
• Integrase permit the integration of viral DNA with Cellular genome
00002-E-12 – 1 December 2003
� Children living with HIV/AIDS
� New HIV infections in 2003
� Deaths due to HIV/AIDS in 2003
End-2003 global HIV/AIDS estimatesChildren (<15 years)
2.5 million [2.1 – 2.9 million]
700 000 [590 000 – 810 000]
500 000 [420 000 – 580 000]
00002-E-2 – 1 December 2003
Global summary of the HIV/AIDS epidemic,
December 2003
The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges
are more precise than those of previous years, and work is under way to increase even further the precision of the estimates that will be published mid-2004.
Number of people living with HIV/AIDS Total 40 million (34 – 46 million)
Adults 37 million (31 – 43 million)
Children under 15 years 2.5 million (2.1 – 2.9 million)
People newly infected with HIV in 2003 Total 5 million (4.2 – 5.8 million)
Adults 4.2 million (3.6 – 4.8 million)
Children under 15 years 700 000 (590 000 – 810 000)
AIDS deaths in 2003 Total 3 million (2.5 – 3.5 million)
Adults 2.5 million (2.1 – 2.9 million)
Children under 15 years 500 000 (420 000 – 580 000)
About 14 000 new HIV infections a About 14 000 new HIV infections a
day in 2003day in 2003
�� More than 95% are in low and More than 95% are in low and
middle income countriesmiddle income countries
�� Almost 2000 are in children under Almost 2000 are in children under
15 years of age15 years of age
�� About 12 000 are in persons aged 15 About 12 000 are in persons aged 15
to 49 years, of whom:to 49 years, of whom:—— almost 50% are womenalmost 50% are women
—— about 50% are 15about 50% are 15––24 year olds24 year olds
Global estimates forGlobal estimates for adults and adults and
children end 2003 children end 2003
�� People living with HIV/AIDSPeople living with HIV/AIDS
�� New HIV infections in 2003New HIV infections in 2003
�� Deaths due to HIV/AIDS in 2003Deaths due to HIV/AIDS in 2003
40 million [34 – 46 million]
5 million [4.2 – 5.8 million]
3 million [2.5 – 3.5 million]
Adults and children estimated to be Adults and children estimated to be
living with HIV/AIDS as of end 2003 living with HIV/AIDS as of end 2003
Total: 34 – 46 million
Western Europe
520 000 520 000 –– 680 000680 000
North Africa & Middle East
470 000 470 000 –– 730 000730 000
Sub-Saharan Africa
25.0 25.0 –– 28.2 million28.2 million
Eastern Europe & Central Asia
1.2 1.2 –– 1.8 million1.8 million
South & South-East Asia
4.6 4.6 –– 8.2 million8.2 million
Australia & New Zealand
12 000 12 000 –– 18 00018 000
North America
790 000 790 000 –– 1.2 million1.2 million
Caribbean
350 000 350 000 –– 590 000590 000
Latin America
1.3 1.3 –– 1.9 million1.9 million
East Asia & Pacific
700 000 700 000 –– 1.3 million1.3 million
Estimated number of adults and Estimated number of adults and
children newly infected with HIV children newly infected with HIV
during 2003 during 2003
Total: 4.2 – 5.8 million
Western Europe
30 000 30 000 –– 40 00040 000
North Africa & Middle East
43 000 43 000 –– 67 00067 000
Sub-Saharan Africa
3.0 3.0 –– 3.4 million3.4 million
Eastern Europe & Central Asia
180 000 180 000 –– 280 000280 000East Asia & Pacific
150 000 150 000 –– 270 000270 000South & South-East Asia
610 000 610 000 –– 1.1 million1.1 million
Australia & New Zealand
700 700 –– 1 0001 000
North America
36 000 36 000 –– 54 00054 000
Caribbean
45 000 45 000 –– 80 00080 000
Latin America
120 000 120 000 –– 180 000180 000
Estimated adult and child deaths Estimated adult and child deaths
from HIV/AIDS during 2003from HIV/AIDS during 2003
Total: 2.5 – 3.5 million
Western Europe
2 600 2 600 –– 3 4003 400
North Africa & Middle East
35 000 35 000 –– 50 00050 000
Sub-Saharan Africa
2.2 2.2 –– 2.4 million2.4 million
Eastern Europe & Central Asia
23 000 23 000 –– 37 00037 000East Asia & Pacific
32 000 32 000 –– 58 00058 000South & South-East Asia
330 000 330 000 –– 590 000590 000
Australia & New Zealand
<100<100
North America
12 000 12 000 –– 18 00018 000
Caribbean
30 000 30 000 –– 50 00050 000
Latin America
49 000 49 000 –– 70 00070 000
ChildrenChildren (<15 years)(<15 years) estimated to be estimated to be
living with HIV/AIDS as of end 2003 living with HIV/AIDS as of end 2003
Western Europe
5 000 5 000 –– 7 0007 000
North Africa& Middle East
31 000 31 000 –– 49 00049 000
Sub-Saharan Africa
2.0 2.0 –– 2.2 million2.2 million
Eastern Europe &Central Asia
9 000 9 000 –– 15 00015 000East Asia & Pacific
6 000 6 000 –– 12 00012 000South & South-East Asia
110 000 110 000 –– 190 000190 000
Australia & New Zealand
< 200< 200
North America
8 000 8 000 –– 12 00012 000
Caribbean
19 000 19 000 –– 31 00031 000
Latin America
37 000 37 000 –– 50 00050 000
Total: 2.1 – 2.9 million
Estimated number of children Estimated number of children (<15 years)(<15 years)
newly infected with HIV during 2003 newly infected with HIV during 2003
Western Europe
< 500< 500
North Africa& Middle East
8 000 8 000 –– 12 00012 000
Sub-Saharan Africa
580 000 580 000 –– 660 000660 000
Eastern Europe &Central Asia
800 800 –– 1 2001 200East Asia & Pacific
2 500 2 500 –– 5 0005 000South & South-East Asia
32 000 32 000 –– 58 00058 000
Australia & New Zealand
< 100< 100
North America
< 500< 500
Caribbean
5 000 5 000 –– 9 0009 000
Latin America
8 000 8 000 –– 12 00012 000
Total: 590 000 – 810 000
Epidemiology
37.2 millions adults & 3.1 millions children < 15 years infected
= total 40.3 million people around the world are living
with AIDS/HIV in 2005 ,
29 million in Africa
4.9 million poeple were newly infected with HIV in 2005
3.1 million people lost their lives in 2005
Number of total deaths since 1981 > 27 million
Number of total orphans = 14 million and in 2010 will be 25 million
Stages in HIV infection, AIDS
Pathogenicity
• Incubation period of up to 10 years
• A combination of complaints is more
suggestive of HIV infection than any one
symptom.
1.Prominent systemic complaints:
Fever, nigh sweets, weight loss,
diarrhea, and wasting
2.infections opportunistesinfections opportunistes : Pneumocystis pneumonia
Toxoplasmosis,Cryptococosis,Tuberculosis,CMV retinitis ZonaCandidosis
3. Cancers associated with immunodeficiencyCancers associated with immunodeficiency : Kaposis’s sarcoma
Lymphoma
• 4. Neurologic manifestations including:
dementia
aseptic meningitis
neuropathy
Oral candidiosis
Zona
Kaposis’s sarcoma
Treatment
• Therapy for opportunistic infections and
malignancies
• Anti retroviral treatment
• Hematopoetic stimulant factors
• Prophylaxis for opportunistic infections
Antiretroviral chemothrapy
•• 20 drugs have been approved by FDA to treat HIV20 drugs have been approved by FDA to treat HIV
• Categories of anti retroviral drugs :
– Reverse transcriptase inhibitors
– Protease inhibitors
– Fusion inhibitors
Anti retroviral chemotherapy
Antiprotease
Inhibiteurs de fusion
Group : Reverse transcriptase
• 1 – Inhibits the RT activityBlocks the elongation of DNA strand– AZT, zidovudine, Retrovir®
– ddI, didanosine, Videx®
– ddC, zalcitabine, Hivid®
– d4T, stavudine, Zerit®
– 3TC, lamivudine, Epivir®
– Abacavir
– tenofovir
– Zidovudine et lamivudine : Combivir ®
– NVP, nevirapine, Viramune®
– DLV, delavirdine, Rescriptor®
– EFV, efavirenz, Sustiva®
group : Protease
• Protease of HIV :
� proteins active for assembly of virus
• Protease inhibitors (PI)
– indinavir, Crixivan®
– ritonavir, Norvir®
– saquinavir, Invirase®, Fortonase®
– nelfinavir, Viracept®
– Amprenavir
– Nelfinavir
– Lopinavir
– Atazanavir
– Entricitabine
– Fosamprenavir calcium
• Fusion inhibitors:
Interfer with the virus’ ability to fuse with
the cellular membrane
-Enfuvirtide
Use of antiretrovirals
•• Becaus HIV can become resistant to any Becaus HIV can become resistant to any
one drug, so combination of at least two one drug, so combination of at least two
classes of drugs should be prescribed.classes of drugs should be prescribed.
• Certain exceptions :
• Zidovudine + Stavudin = antagonist
• Zalcitabine + Lamivudine = antagonist
• Zalcitabine + Didanosine or Stavudine = neurotoxic
Effects of therapy
Althoug the use antiretroviral drugs has greatly
reduced the number of deaths due to HIV, this
powerfull combination of drugs cannot
supress the virus completely .
People infected with HIV who recieve
antiretroviral drugs can still transmitt HIV to
others.
Diagnostic techincs
• Direct diagnosis
– Detection of P24 antigen (ELISA)
– Detection of RNA : PCR qualitative & PCR quantitative
– Western blot
–– GenotypingGenotyping = detection of resistant mutations
(sequincing)
• Indirect diagnosis = serologyserology
– Detection of HIV antibodies (ELISA)
– Rapid tests: immunochromatography
Determine® ++ --
JN-QC-SPOT Rapid HIV TestPerforming the Assay
Western-blot = detection of antibodies based on HIV proteins
Prevention
- Prevention of sexual transmission : Condom
- Prevention of contaminated blood or biologic products
( Plasma,serum, organ transplants)
- Prevention of contaminated syringes and needles,blades
( providing clean needles and syringes for injection users)
- Prevention of mother to infant through prescription of
Zidovudin(during pregnancy,labor and delivery)
-Prevention of breast feeding
-No effective vaccine available( due to rapid mutagenicity)
NARCOTICS
Definition
• Originally, any drug derived from opium or
opium-like compounds with potent
analgesic effects associated with both
significant alteration of mood and behavior
and potential for dependence and tolerance.
• More recently, any drug, synthetic or
naturally occurring, with effects similar to
those of opium and opium derivatives.
Four main clinical scenarios in
which opium based analgesics are
prescribed
• Cancer pain
• HIV/AIDS pain
• Acute post-operative pain
• Chronic pain
Narcotics of natural origin
• Poppy ( Papaver somniferum) is the source of natural narcotics
- Opium
- Morphine
- Codeine
- Thebain
- Papaverin
- Heroin(symesynthetic)
Synthetic narcotics-Opiods
• Darvon (dextropropoxyphen): mild to
moderate analgesic, it is potency one-half of
codeine,but ten times more potent than
aspirin(oral)
• Demerol (meperedine): moderate to sever
pain, similar to morphin (tablets, syrup and
injection)
Stronger narcotics
• Hydromorphone (Dilaud):8-10 times more potent than morphine (capsules and injections)
• Oxycodone: in combinatin with aspirin(percodan) or acetaminophen(Percocet)
• Benzomorphine(Pentazocine)
• Hydrocodone: 5-10 times more potent than morphine(incombination with other medications, as a tablet, capsule and syrup)
• Methadone:long acting and used in treatment of heroin addicts.
• Fentanyl: IV anaesthesia and analgesia
Importance of narcotics in medicine
• For treatment of moderate to sever pain
there is no equal
• Cough suppressant and anti-diarrheal
• Can produce euphoria and relief from pain
The typical side effects
• Drowsiness
• Inability to concentrate
• Apathy
• Lessened physical activity & constriction of pupils.
• Flushing of the head and neck
• Constipation
• Nausea and vomiting
• Respiratory depression (main cause of death in acute overdose)
• Addiction: habitual psychological and
physiological effects
on a substance or
practice that is beyond
voluntary control
Withdrawal symptoms
• Light symptoms: watery eyes, runny nose,
Yawning, insomnia
• Mild symptoms: restlessness, irritability, loss of
appetite, tremors, sever sneezing, nausea
• Sever symptoms: sever depression, vomiting,
panic, muscle cramps, chills and sweating, pain in
the bones and muscles, elevation in the blood
pressure, pulse, respiratory rate and temperature.
Complication of narcotics use during
pregnancy
• Dramatic increase in premature birth
• Low birth weight infants
• Stillborn infants
• Addicted babies
• Neonatal withdrawal syndrom
Risk of sharing needles
• High risk of
contracting variety of
diseases
Such as: AIDS,
Hepatitis, infectious
diseases, etc…
¼ AIDS patients are
drug users
The term”narcotic” generally refers to opium and to pain-killing drugs made of opium. These include heroin, morphine, and codeine. Codeine is legally, but not medically, classified in the United States, but is an illicit narcotic drug. Narcotics depress the brain and result in feelings of pleasure, strength and superiority, followed by lethargy, drowsiness, confusion, and depression of the heart rate.
Intravenous (IV) drug users risk exposure to the AIDS virus when they use or share contaminated needles. IV drug users form the group with the fastest growing number of persons with AIDS (PWAs).
Thank you