Module V.

HIV Infection and AIDS

• Epidemiology
• Transmission of HIV,
• Pathophysiology
• Clinical manifestations
• HIV infection and other diseases
• AIDS virus
• Dietary management, Prevention and Control
• Artificial neural network and data analysis

HIV/AIDS
• AIDS (acquired immunodeficiency syndrome) refers to a cluster of illnesses that are
caused by a retrovirus known as HIV (human immunodeficiency virus), which attacks
the body’s immune system, damaging its ability to protect the body against further
disease and infection.
• Since HIV/AIDS was first identified in the early 1980s, the scale of the epidemic has
steadily increased.
• The impact of HIV/AIDS varies across continents, regions, and countries, but the
effects of the epidemic are felt throughout the world.

AIDS VIRUS
What is HIV?
• HIV (human immunodeficiency virus) is a virus that attacks the body’s immune
system.
• There is currently no effective cure. Once people get HIV, they have it for life.
• But with proper medical care, HIV can be controlled.
• People with HIV who get effective HIV treatment can live long, healthy lives and
protect their partners.

Classification:
• HIV is a member of the genus Lentivirus part of the family Retroviridae.
• Lentiviruses have many morphologies and biological properties in common.
 • Many species are infected by lentiviruses, which are characteristically responsible for
long-duration illnesses with a long incubation period.
• Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA
viruses.

• Two types of HIV have been characterized: HIV-1 and HIV-2.

• HIV-1 is the virus that was initially discovered and termed both
lymphadenopathy associated virus (LAV) and human T-lymphotropic virus 3
(HTLV-III).
• HIV-1 is more infectious and more infective than HIV-2 and is the cause of the
majority of HIV infections globally.
• The lower infectivity of HIV-2, compared to HIV-1, implies that fewer of those
exposed to HIV-2 will be infected per exposure.
• Due to its relatively poor capacity for transmission, HIV-2 is largely confined to West
Africa.

Structure and genome

• HIV is different in structure from other retroviruses.
• It is roughly spherical with a diameter of about 120 nm, around 60 times smaller than
a red blood cell.
• It is composed of two copies of positive-sense single-stranded RNA that codes for
the virus's nine genes enclosed by a conical capsid composed of 2,000 copies of the
viral protein p24.
• The single-stranded RNA is tightly bound to nucleocapsid proteins, p7, and enzymes
needed for the development of the virion such as reverse transcriptase, proteases,
ribonuclease and integrase.

• A matrix composed of the viral protein p17 surrounds the capsid ensuring the integrity
of the virion particle.
• This is, in turn, surrounded by the viral envelope, that is composed of the lipid bilayer.
• The viral envelope contains proteins from the host cell and relatively few copies of
the HIV envelope protein.
• The envelope protein, encoded by the HIV env gene, allows the virus to attach to
target cells and fuse the viral envelope with the target cell's membrane releasing
the viral contents into the cell and initiating the infectious cycle.
Causes
• HIV is caused by a virus. It can spread through sexual contact, illicit injection drug
use or sharing needles, contact with infected blood, or from mother to child during
pregnancy, childbirth or breastfeeding.
• HIV destroys CD4 T cells — white blood cells that play a large role in helping our
body fight disease. The fewer CD4 T cells one have, the weaker our immune system
becomes.
How does HIV become AIDS?
• One can have an HIV infection, with few or no symptoms, for years before it turns
into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or one have
an AIDS-defining complication, such as a serious infection or cancer.
How HIV spreads?
To become infected with HIV, infected blood, semen or vaginal secretions must enter body.
This can happen in several ways:
 • By having sex. One may become infected if he/she have vaginal, anal or oral sex with
an infected partner whose blood, semen or vaginal secretions enter his/her body. The
virus can enter the body through mouth sores or small tears that sometimes develop in
the rectum or vagina during sexual activity.
• By sharing needles. Sharing contaminated injection drug paraphernalia (needles and
syringes) puts one at high risk of HIV and other infectious diseases, such as hepatitis.

• From blood transfusions. In some cases, the virus may be transmitted through blood
transfusions. The risk may be higher in low-income countries that are not able to
screen all donated blood.
• During pregnancy or delivery or through breastfeeding. Infected mothers can pass
the virus on to their babies. Mothers who are HIV-positive and get treatment for the
infection during pregnancy can significantly lower the risk to their babies.
Epidemiology and Burden of Disease
• The vast majority of individuals infected with HIV live in developing countries, with
sub-Saharan Africa carrying the greatest burden.
• Globally, the incidence of HIV/AIDS has in fact been declining for roughly the past
decade, largely in response to public health efforts.
• According to the 2013 Global Report prepared by the Joint United Nations
Programme on HIV/AIDS (UNAIDS), the number of new HIV infections worldwide
in 2012 (2.3 million) represented a decline of 33% since 2001 (3.4 million).
• The mortality rate has also been decreasing, from an estimated 2.3 million deaths in
2005 down to 1.6 million deaths in 2012 .
• Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults
(4.9%) living with HIV and accounting for 69% of the people living with HIV
worldwide.
• In 2011, an estimated 23.5 million people in that region were living with HIV.
• The greatest concentration is in Southern Africa. The region with the second highest
number (4 million) is South and South-East Asia (UNAIDS, 2012)
• Between 2001 and 2011, the incidence of new infections fell by 25% or more in 39
of the world’s countries.
• The most significant decreases occurred in the Caribbean (42%) and in sub-Saharan
Africa (25%), although the latter still accounted for 71% of all new cases.
• However, during the same years the incidence of HIV increased in several regions
including Eastern Europe/Central Asia and North Africa/Middle East (UNAIDS,
2012).
Transmission
• The likelihood that an adult person will be exposed to the HIV virus is primarily,
although by no means exclusively, a function of lifestyle, coupled with the
prevalence of HIV/AIDS in the region in which the person lives.
• The virus is carried in the blood (including menstrual blood), in semen and vaginal
secretions, and in breast milk.

• The virus most commonly enters the body through contact with the mucous
membranes in the genitals, anus, rectum, mouth, or eyes or when body fluids in which
the virus is present come into contact with an open cut or sore.
• HIV is not transmitted through insect bites or by contact with saliva, tears, sweat,
feces, or urine.

• HIV is transmitted in three ways: sexual, parenteral (by ways of syringes), and
mother-to-child transmission.
• Sexual intercourse – vaginal, anal, or oral – involves a direct exchange of body fluids.
• The risk of infection is greatest during anal sex which explains the association
between HIV/AIDS and homosexual men.
• Nonetheless, most HIV infections are the result of heterosexual intercourse.
• People can also be infected with HIV by non-sexual means, such as blood
transfusions or a contaminated needle or other sharp object.
• This is known as parenteral transmission, and it generally involves the passage of the
HIV virus directly into the bloodstream.
• In developed countries, this form of transmission is most closely associated with
intravenous drug use.
• Blood transfusion is another possible route but is now rare because the blood used in
transfusions is carefully screened.
• Health workers can become infected with HIV through needle pricks.
• Vertical transmission, or mother-to-child transmission (MTCT), occurs when a HIV-
positive mother passes the virus to her infant.
• This can occur in utero and/or during labor and delivery, but the virus can also be
transmitted in the mother’s breast milk.
• Once a person has been exposed to the HIV virus, the likelihood of infection depends
on several factors.
• One is the type of HIV: some strains are more virulent than others.
 • In the case of sexual transmission, another factor is the specific form of sexual
behavior. In addition, overall health and nutritional status influences a person’s
vulnerability to infection.
• Someone whose immune system has already been weakened by illness or malnutrition
is at greater risk of infection (of any sort) than is a healthy person.
• Finally, hereditary factors also play a role: some people are inherently more resistant
to infection than others.

Pathophysiology and Clinical Presentation

• There are two different types of HIV. The most common type, which occurs
worldwide, is HIV-1; the other, HIV-2 is chiefly found in West Africa.
• The two viruses are closely related, but HIV-2 is less pathogenic than HIV-1, which
is characterized by high rates of virus production.
• Infection with HIV is the underlying cause of AIDS.
• HIV invades the genetic core of the CD4 or T-helper lymphocyte cells, causing
their progressive depletion and leading to immune deficiency, constitutional
disease, neurologic complications, opportunistic infections, and certain forms of
cancer.
PATHOLOGY OF AIDS
HIV infection passes through a series of steps or stages before it turns into AIDS. These
stages of infection as outlined in 1993 by the Centers for Disease Control and prevention are:
1. Seroconversion illness – this occurs in 1 to 6 weeks after acquiring the infection. The
feeling is similar to a bout of flu.
2. 2. Asymptomatic infection – After seroconversion, virus levels are low, and
replication continues slowly. CD4 and CD8 lymphocyte levels are normal. This
stage has no symptoms and may persist for years together.
3. 3. Persistent generalized lymphadenopathy (PGL) – The lymph nodes in these
patients are swollen for three months or longer.
4. 4. Symptomatic infection – This stage manifests with symptoms. In addition, there
may be opportunistic infections. This collection of symptoms and signs is referred to
as the AIDS-related complex (ARC) and is regarded as a prodrome or precursor to
AIDS.
5. 5. AIDS – this stage is characterized by severe immunodeficiency. There are signs of
life-threatening infections and unusual tumors. This stage is characterized by CD4 T-
cell count below 200 cells/mm3.
6. 6. There is a small group of patients who develop AIDS very slowly, or never at all.
These patients are called non-progressors.
 • AIDS is a diagnostic term applied to HIV-infected persons who have at least one well-
defined, life-threatening clinical condition that is clearly linked to HIV-induced
immunosuppression.
• HIV is a slow-acting virus; even in the absence of treatment, it can take around ten
years for an HIV-infected adult to develop full-blown AIDS.
• The length of this infection depends on various factors including the general
health and nutritional status at and during the time of infection.
• The primary indicators of disease progression during HIV infection are plasma HIV
load and circulating CD4 lymphocyte counts.
• Periodically measuring plasma HIV load is essential in individuals on long-term
antiretroviral (ARV) therapy, as this serves to monitor viral resistance to treatment.
Initial infection
• When a person comes into contact with an infectious agent, antibodies begin to build
up in the blood.
• Someone infected with HIV begins to develop antibodies relatively soon after
infection, but it takes time before these antibodies can be detected in the blood.
• The time from initial infection to the point at which a person tests positive for HIV
(sero-conversion) is known as the “window period.”
 • In most cases, this period lasts from 3 to 6 weeks, although its duration depends in
part on the sensitivity of the test.
• By the end of 6 weeks, most HIV-positive individuals will have developed enough
antibodies to produce a positive test, although, in rare cases, the window period can
last 6 months or more.
• During the period, flu-like symptoms may appear, including fever, rash, joint
pains, and enlarged lymph nodes.
• Acute infections of the nervous system, such as aseptic meningitis.
Progression from HIV infection to AIDS
• Following initial infection, a symptom-free period generally follows before the
disease progresses to full-blown AIDS.
• An adult infected with HIV may have no symptoms for ten years or more.
• The rate of progression from HIV infection to AIDS depends on the type and strain
of the virus, as well as on certain characteristics of the person who is infected.
• The presence of other infections, as is frequently seen in malnourished individuals,
tends to shorten the symptom-free period, and genetic factors probably also play a
role.

• In addition, the disease generally progresses more quickly in people over the age of
40.
• HIV infects both the central and the peripheral nervous system early in the course of
the infection, which can produce a variety of neurological and neuropsychiatric
conditions.
• As HIV infection progresses and immunity declines, people become more susceptible
to opportunistic infections.
SYMPTOMS:
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection (Acute HIV):
Some people infected by HIV develop a flu-like illness within 2 to 4 weeks after the virus
enters the body. This illness, known as primary (acute) HIV infection, may last for a few
weeks.
Possible signs and symptoms include:
• Fever
• Headache
• Muscle aches and joint pain
 • Rash
• Sore throat and painful mouth sores
• Swollen lymph glands, mainly on the neck
• Diarrhea
• Weight loss
• Cough
• Night sweats

These symptoms can be so mild that one might not even notice them. However, the amount
of virus in bloodstream (viral load) is quite high at this time. As a result, the infection spreads
more easily during primary infection than during the next stage.
Clinical latent infection (Chronic HIV):
• In this stage of infection, HIV is still present in the body and in white blood cells.
However, many people may not have any symptoms or infections during this time.
• This stage can last for many years if a person is not receiving antiretroviral therapy
(ART). Some people develop more severe disease much sooner.
Symptomatic HIV infection:
As the virus continues to multiply and destroy immune cells — the cells in body that help
fight off germs — one may develop mild infections or chronic signs and symptoms such as:
• Fever
• Fatigue
• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Oral yeast infection (thrush)
• Shingles (herpes zoster) - viral infection that causes a painful rash
• Pneumonia
Progression to AIDS:
When AIDS occurs, immune system gets severely damaged. One will be more likely to
develop diseases that wouldn't usually cause illness in a person with a healthy immune
system. These are called opportunistic infections or opportunistic cancers.
The signs and symptoms of some of these infections may include:
• Sweats
 • Chills
• Recurring fever
• Chronic diarrhea
• Swollen lymph glands
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Persistent, unexplained fatigue
• Weakness
• Weight loss
• Skin rashes or bumps
HIV in Children
• The vast majority of HIV-positive children are infected in the perinatal period, that
is, during pregnancy and childbirth.
• While the progression of HIV infection in children is variable, it is typically more
rapid than in adults.
• Although relatively few children become actively ill during the first few weeks of life,
without treatment, roughly a third of HIV-positive children do not live to see their first
birthday, and half die before the age of 2.
• Beginning antiretroviral treatment before the child reaches the age of 12 weeks
can reduce early HIV mortality by as much as 75%.
• As in adults, the rate of progression varies according to the particular strain of HIV, as
well as on the efficiency of the child’s immune response.
• In developing countries, where a high proportion of children are malnourished, the
infection tends to progress faster, thereby shortening the survival period.
• The WHO staging system mentioned above includes clinical criteria for the
progression of the disease in children under the age of 15.
Diagnosis
• The laboratory diagnosis of HIV infection in adults and children over the age of 18
months is made primarily by testing for the presence of the antibodies formed to
fight the virus.
• These antibodies can usually be detected somewhere between 3 to 6 weeks following
infection, but the window period can vary.
• If an initial antibody test is negative, it should therefore be repeated, preferably 3
months after the initial test.
• A pregnant woman usually passes on HIV antibodies to her child, which remains in
the infant’s blood for some time following birth.
 • Without PCR testing, it is not possible to test for HIV in infants with any degree of
reliability until they have reached the age of at least 18 months.
NUTRITIONAL MANAGEMENT OF HIV/AIDS
The nutritional management of HIV-positive individuals has a number of goals:
• To improve nutritional status by maintaining weight and preventing loss of weight
and muscle mass.
• To ensure adequate nutrient intake by improving eating habits and building stores
of essential nutrients
• To prevent foodborne illnesses by promoting good hygiene and food safety.
• To provide palliative care during the advanced stages of HIV disease.
• To enhance quality of life by managing symptoms that affect food intake.

• Nutrition care and support for AIDS patients should include:

1. Nutritional assessment and counseling,
2. Supplementation and food provision,
3. Advice should be provided about nutritional practices that can help to manage
medication side effects and increase drug efficacy,
4. Approaches to implementing nutrition care and support in food-insecure
contexts.

Nutritional Assessment
• A nutritional assessment gathers information to help guide decisions about
nutrition care and support and to monitor the effectiveness of interventions.
• Especially because food insecurity, inadequate protein intake, general
malnutrition, and specific micronutrient deficiencies are endemic in many areas
with a high prevalence of HIV, a thorough nutritional assessment should form a
routine part of the treatment and care of people who have become infected.
• An initial assessment should be followed by appropriate interventions and ongoing
monitoring.
A complete nutritional assessment for includes the following:
1. Anthropometric measurements: Record weight and weight change, height, body
mass index (BMI), and mid-upper-arm circumference.
2. Biochemical information: Arrange for laboratory tests to evaluate vitamin and
mineral profiles, possible anemia, and evidence of metabolic complications (such as
lactic acidosis and hyperglycemia), as well as body composition and viral load.
 Alterations in nutrition-related laboratory values may reflect an inflammatory
response as well as nutritional compromise.
3. Clinical information: Aim to identify symptoms and illnesses associated with
HIV/AIDS infection that can affect nutritional status. Collect information about
appetite change, fever, nausea, vomiting, and alcohol intake, as well as symptoms
related to appetite change, difficulty with swallowing, mouth and/or throat sores, oral
thrush, muscle wasting, TB, fatigue, lethargy, and the effects of drug-food
interactions.
4. Dietary information: Assess dietary intake to ensure adequate protein and
micronutrients for energy needs and the avoidance of potential drug-food interactions.
5. Food security status: Gather information about food availability and access, and
evaluate individual and household food security.

Nutritional Requirements
• Evidence suggests that as the HIV infection progresses, nutrient requirements change.
• Increased nutritional needs among AIDS patients are associated with increased resting
energy expenditure, accelerated protein turnover, decreased food intake, diarrhea, and
malabsorption.
• Nutritional requirements are the same regardless of whether a person is taking ARV
drugs, but they differ for the two distinct phases of HIV infection: asymptomatic and
symptomatic.
• The former corresponds to WHO Clinical Stage I and the latter to Clinical Stages II to
IV.
Moreover, if an HIV-infected individual has a history of malnutrition, additional
micronutrients and/or macronutrients (energy and protein) may be required.
Energy
• Energy requirements increase by 10% during the asymptomatic phase and by 20%
to 30% during the symptomatic phase.
• These increased needs for energy apply equally to pregnant and lactating women
living with HIV/AIDS, on top of the already higher nutritional needs that
accompany pregnancy and lactation.
• When possible, this need for additional energy should be met by increasing
consumption of foods with high nutrient densities, as opposed to foods that are high
in energy but low in protein and micronutrients, such as foods high in fat and sugar.
• When weight loss occurs during the symptomatic phase in children, energy needs
increase by 50% to 100%.
• It is often difficult for children with opportunistic infections and weight loss to
consume 50% to 100% more energy than normal.
 • It is therefore important to encourage children to consume additional food after
periods of illness and weight loss.
Protein
• Protein requirements for all including children and pregnant and lactating women, are
the same as for healthy individuals .
Micronutrients
• Micronutrient deficiencies are common in HIV-positive individuals and become more
pronounced as the disease process advances.
• Daily multivitamin supplementation has been recommended for HIV- positive
individuals.
• Randomized trials in the USA ,Thailand, and Tanzania have reported associations
between multivitamin and/or mineral supplementation and improvements in the
immunological and clinical status of people with HIV.
• This RDA is best provided by food, but HIV-positive individuals whose diets are
inadequate in micronutrients should be given a daily multivitamin and mineral
supplement equivalent to the RDA (WHO, 2008).
Nutritional support and supplements:
According to the WHO, nutritional support should be provided to HIV-positive individuals
whose BMI indicates malnourishment:
• Malnourished adults with HIV are at an elevated and progressive risk of HIV disease
progression and mortality as BMI decreases, especially below 18.5.
• The WHO recommends providing supplementary feeding for mild-to-moderately
malnourished adults (BMI <18.5), regardless of HIV status.
• The most common and cheapest supplementary food is micronutrient-fortified,
blended flour (e.g., corn-soy blend or CSB) that can be prepared as a porridge, but
other forms (e.g., biscuits or pastes) may be used.
• Severely malnourished adults (BMI <16) should be provided with a therapeutic food
that is formulated to be nutritionally equivalent to the therapeutic F-100 milk.
• F-100 milk is a formula that provides 100 kcal/100 ml and is used to treat severely
malnourished children.
• As the WHO notes, F-100 milk is commercially available in powdered form but can
also be prepared from basic ingredients: dried skimmed milk, sugar, cereal flour, oil,
mineral mix, and vitamin mix.
• The WHO further recommends that supplemental feeding be continued until the
person’s BMI has remained stable for 2 to 3 months above 18.5 (WHO, 2008).
• The standard recommendations for nutrient intake and nutritional support for pregnant
and lactating women should be followed, regardless of HIV status (WHO, 2008).
Nutritional guidelines and food safety
• Nutritional guidelines and dietary management of HIV-related symptoms should be
integrated into health services and outreach activities.
• Health workers and counselors can use counseling to assess how clients are managing
symptoms and identify alternative options when needed (ECSA-HC & FANTA,
2008).
• PLWHA (People living with HIV/AIDSshould also be provided with practical
dietary strategies for addressing common nutrition-related problems, bearing in mind
local and personal food habits, food availability, and individual food preferences.
• Proper food safety and hygiene are especially crucial for PLWHA because their
immune systems have already been weakened, making them more vulnerable to
infection.
• Such infections may lead to diarrhea and vomiting, which can deplete nutrients and
decrease absorption.
• Safe handling of food and water is therefore essential so as to avoid infections caused
by bacteria and viruses present in contaminated food and water.
• Health workers should thus ensure that HIV-positive individuals are provided with
guidelines about food safety.

ROLE OF NUTRITION IN IMMUNITY AND INFECTIOUS DISEASE

ROLE OF NUTRITION IN IMMUNITY AND INFECTIOUS DISEASE
• The immune system consists of two main tiers: non-specific and antigen-specific.
• Non-specific immunity is innate – that is, we are born with it.
• In contrast, antigen-specific immunity, also known as acquired or adaptive
immunity, develops as a result of exposure to particular pathogens and thus varies
from one individual to another.
• The non-specific defenses include the skin and mucous membranes, phagocytic cells
(which consume potentially harmful microorganisms), mucus, cilia, the complement
system, lysozymes, and other humoral factors.
• These innate mechanisms act as the first line of protection and slow down the
establishment of active infection.
• Antigen-specific mechanisms, which include the B cell system of antibody
production and the T cell system of cell-mediated immunity, target specific
pathogens and are effective in curbing the spread of infection and eradicating
invading organisms.
 • With this system the host’s response adapts to a specific pathogen (e.g., the measles
virus) to develop immunologic memory that will respond more quickly and more
efficiently the next time the same pathogen is encountered.
• Non-specific and antigen-specific defenses act in synergy in the body.
• Malnutrition is associated with a reduction of the integrity of the immune system
and thus with an increased risk of infection.
• Generalized malnutrition can explain about immune dysfunction.
• Nutrient can meaningfully modulate the immune system.
• Nutrition-related deficiencies (deficiencies of trace elements and vitamins to protein-
energy malnutrition) interfere with both non-specific and antigen-specific immune
responses.
• Most immune responses involve the production of proteins (which have a variety of
specific functions) and many nutrients are involved, directly or indirectly, in protein
synthesis.
• Dietary protein is crucial for the maintenance of the immune system and body cell
mass.
• Additionally, the action of all types of immune cells and their products (such as
interleukins, interferon's, and complements) depends on various metabolic pathways
in which various nutrients play a critical role.
• Lymphoid tissues are especially vulnerable to the damaging effects of malnutrition.
• Lymphoid atrophy is a prominent feature of nutritional deprivation.
• An optimal nutritional status therefore supports the efficient functioning of all
components of the immune system.
• Infection is a common precipitating factor, for malnutrition.
• Infectious disease can lead to anorexia, diarrhea, and an inflammatory response, and
can lead to the rapid loss of lean body mass and increased dysfunction of the immune
system.
• This results in greater nutrient requirements and poor use of the nutrients by the body.
• Infection undermines nutritional health, the impaired immune response that results
from malnutrition predisposes the body to infections, including HIV and TB.
• Malnutrition and infection thus interact synergistically and are associated with poorer
clinical outcomes.
HIV INFECTION AND OTHER DISEASES
Complications
• HIV infection weakens our immune system, making much more likely to develop
many infections and certain types of cancers.
Infections common to HIV/AIDS
• Pneumocystis pneumonia (PCP). This fungal infection can cause severe illness.
• Candidiasis (thrush). Candidiasis is a common HIV-related infection. It causes
inflammation and a thick, white coating on mouth, tongue, esophagus or vagina.
• Tuberculosis (TB). TB is a common opportunistic infection associated with HIV.
Worldwide, TB is a leading cause of death among people with AIDS.
• Cytomegalovirus. This common herpes virus is transmitted through body fluids such
as saliva, blood, urine, semen and breast milk.
• A healthy immune system inactivates the virus, and it remains dormant in our body.
• If our immune system weakens, the virus resurfaces — causing damage to our eyes,
digestive tract, lungs or other organs.
• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid
surrounding our brain and spinal cord (meninges). Cryptococcal meningitis is a
common central nervous system infection associated with HIV, caused by a fungus
found in soil.
• Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a
parasite spread primarily by cats. Infected cats pass the parasites in their stools, which
may then spread to other animals and humans.
• Toxoplasmosis can cause heart disease, and seizures occur when it spreads to the
brain.
Cancers common to HIV/AIDS:
• Lymphoma. This cancer starts in the white blood cells. The most common early sign
is painless swelling of the lymph nodes in our neck, armpit or groin.
• Kaposi's sarcoma. A tumor of the blood vessel walls, Kaposi's sarcoma usually
appears as pink, red or purple lesions on the skin and mouth. In people with darker
skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the
internal organs, including the digestive tract and lungs.
• HPV-related cancers. These are cancers caused by human papillomavirus (HPV)
infection. They include anal, oral and cervical cancer.
OTHER COMPLICATIONS:
• Wasting syndrome. Untreated HIV/AIDS can cause significant weight loss, often
accompanied by diarrhea, chronic weakness and fever.
• Neurological complications. HIV can cause neurological symptoms such as
confusion, forgetfulness, depression, anxiety and difficulty walking. HIV-associated
neurocognitive disorders (HAND) can range from mild symptoms of behavioral
changes and reduced mental functioning to severe dementia causing weakness and
inability to function.
 • Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny
filters in your kidneys that remove excess fluid and wastes from your blood and pass
them to your urine. It most often affects Black or Hispanic people.
• Liver disease. Liver disease is also a major complication, especially in people who
also have hepatitis B or hepatitis C.
PREVENTION & CONTROL
• There's no vaccine to prevent HIV infection and no cure for HIV/AIDS. But one can
protect him/her and others from infection.
To help prevent the spread of HIV:
• Consider preexposure prophylaxis (PrEP).
• The combination of oral drugs can reduce the risk of sexually transmitted HIV
infection in people at very high risk.
• PrEP can reduce risk of getting HIV from sex by about 99% and from injection drug
use by at least 74%.
• Use post-exposure prophylaxis (PEP): If a person been exposed to HIV through
sex, needles or in the workplace, he/she should contact health care provider or go to
the emergency department.
• Taking PEP as soon as possible within the first 72 hours can greatly reduce the risk of
becoming infected with HIV. The person need to take medication for 28 days.
• Use a new condom every time a person have sex. Use a new condom every time a
person have anal or vaginal sex. Women can use a female condom. If using a
lubricant, make sure it's water-based. Oil-based lubricants can weaken condoms and
cause them to break. During oral sex use a nonlubricated, cut-open condom or a
dental dam — a piece of medical-grade latex.
• Tell your sexual partners if you have HIV. It's important to tell all your current and
past sexual partners that you're HIV-positive. They'll need to be tested.
• Use a clean needle. If you use a needle to inject illicit drugs, make sure it's sterile and
don't share it.
• If you're pregnant, get medical care right away. If you're HIV-positive, you may
pass the infection to your baby. But if you receive treatment during pregnancy, you
can significantly cut your baby's risk.
• Consider male circumcision. There's evidence that male circumcision can help
reduce the risk of getting HIV infection. (Circumcision is the surgical removal of the
skin covering the tip of the penis.)

ARTIFICIAL NEURAL NETWORK AND DATA ANALYSIS

Introduction:
 • It is inspired by the working of a human brain and therefore is a set of neural network
algorithms which tries to mimics the working of a human brain and learn from the
experiences.

Artificial Neural Networks and Its components

• Artificial Neural Networks are a special type of machine learning algorithms that are
modeled after the human brain.
• That is, just like how the neurons in our nervous system are able to learn from the past
data, similarly, the ANN is able to learn from the data and provide responses in the
form of predictions or classifications.
• ANNs are nonlinear statistical models which display a complex relationship between
the inputs and outputs to discover a new pattern.
• A variety of tasks such as image recognition, speech recognition, machine translation
as well as medical diagnosis makes use of these artificial neural networks.
• An important advantage of ANN is the fact that it learns from the example data sets.
• With these types of tools, one can have a cost-effective method of arriving at the
solutions that define the distribution.
• ANN is also capable of taking sample data rather than the entire dataset to provide the
output result.
• With ANNs, one can enhance existing data analysis techniques owing to their
advanced predictive capabilities.
Components / Architecture of Neural Network
A simple neural network consists of three components :
• Input layer
 • Hidden layer
• Output layer

Artificial Neural Networks Architecture

The functioning of the Artificial Neural Networks is similar to the way neurons work in our
nervous system.
In a neural network, there are three essential layers –
Input Layers
• The input layer is the first layer of an ANN that receives the input information in the
form of various texts, numbers, audio files, image pixels, etc.
Hidden Layers
• In the middle of the ANN model are the hidden layers.
• These hidden layers perform various types of mathematical computation on the
input data and recognize the patterns that are part of.
Output Layer:
• In the output layer, we obtain the result that we obtain through rigorous
computations performed by the middle layer.
• In a neural network, there are multiple parameters and hyperparameters that affect the
performance of the model.
• The output of ANNs is mostly dependent on these parameters.
• Some of these parameters are weights, biases, learning rate, batch size etc. Each node
in the ANN has some weight.
• Each node in the network has some weights assigned to it.
 • A transfer function is used for calculating the weighted sum of the inputs and the bias.
• After the transfer function has calculated the sum, the activation function obtains the
result.
• Based on the output received, the activation functions fire the appropriate result from
the node.
• For example, if the output received is above 0.5, the activation function fires a 1
otherwise it remains 0.
• Based on the value that the node has fired, we obtain the final output.
• Then, using the error functions, we calculate the discrepancies between the predicted
output and resulting output and adjust the weights of the neural network through a
process known as backpropagation.
Applications of Artificial Neural Network in AIDS Research and Therapy
• Based on neural network and nearest-neighbor algorithms, the secondary structure
of HIV-1 gp120 has been predicted using multiple alignment study.
• Neural networks have been used in determination of certain HIV proteins with
potential for vaccine development.
• Artificial neural networks are used to analyze and predict new inhibitors of the HIV-
1 reverse transcriptase.