CCS: 010 HIV/AIDS

• AIDS - Acquired Immune Deficiency Syndrome.

• Late stages of infection with Human

Immunodeficiency Virus (HIV), a retrovirus.
HIV-1 — the cause of AIDS in eastern Africa
HIV-2 — the major cause of AIDS in west Africa

• The immune deficiency is caused by the loss of

the CD4+ T cells that are essential for the
functioning of the immune system.
 2. SEX AND SEXUALITY:
MALE AND FEMALE ANATOMY AND PHYSIOLOGY

 Sex- Sexual intercourse, Reproductive system or

Gender behavior
• Sexuality- shaped by a person's values, attitudes,
behaviors, physical appearance, emotions,
personality and spiritual values, as well as all the
ways in which one has been socialized.

• Anatomy-the branch of biology that deals with

the morphology (form and structure) of animals
• Physiology- the branch of the biological sciences
dealing with the functioning of organisms
 GENERAL COURSE OUTLINE
• A: GENERAL ORGANIZATION OF BODY
FUNCTIONS
• B: THE REPRODUCTIVE SYSTEM
• C: THE IMMUNE SYSTEM
• D: OTHER PHYSIOLOGICAL FACTORS IN
HIV/ AIDS
A: General Organization of Body Functions

• Body functions are the physiological or

psychological functions of body systems.
• The body's functions are ultimately its
cells' functions. Survival is the body's
most important business.
• Depends on maintaining or restoring
homeostasis, a state of relative constancy,
of its internal environment.
 General Organization of Body Functions

• Homeostasis-
• Its major activities or functions are responding to
changes in the body's environment

• exchanging materials between the environment

and cells, metabolizing foods, and integrating all
of the body's diverse activities.

• The body's ability to perform many of its

functions changes gradually over the years. In
general, the body performs its functions least
well at both ends of life - in infancy and in old
age.
 Body Systems in General
Body systems function as one whole and not
as isolated units. Every functional system in
the body is represented by a physical or
organ system. Characteristics:
1. Organization- Each component has its own
job to perform in cooperation with others.
2. Metabolism- All chemical reactions that
occur in the body (catabolic/energy and
anabolic/ growth).
3. Responsiveness (nervous system)-
Detecting changes in internal & external
environment.
 Body Systems in General

• 4. Movement- eg. Cellular, blood, diaphragm,

muscle contraction .
• 5. Reproduction- formation of a new person or
formation of new cells for replacement and
repair of old ones as well as for growth.
• 6. Growth- Increase in size thr’ increase in
number of cells or in size of each individual cell.
Anabolic processes > catabolic processes.
• 7. Differentiation- Unspecialized cells change
into specialized ones with distinctive structural
and functional characteristics (cellstissues 
organs)
 Body Systems in General

• 8. Respiration- all processes involved in

exchange of O2 and CO2 between cells and the
environment (ventilation,diffusion, transport,
cellular respiration).
• 9. Digestion- Breakdown of complex ingested
foods into simple molecules that can be
absorbed and utilized by the body.
• 10. Excretion- removal of waste products of
digestion and metabolism from the body.
• 11. In addition to all the above life depends on
availability of certain physical factors from the
environment eg water, O2, nutrients, heat and
pressure.
THE ENDOCRINE SYSTEM
Is a system in itself


Forms a major arm of control of body

system
Functions in collaboration with the
nervous system
 B: THE REPRODUCTIVE SYSTEM

• In women, this system includes

the ovaries, the fallopian tubes,
the uterus (womb), the cervix, and
the vagina (birth canal).
• The reproductive system in men
includes the prostate, the testes,
and the penis.
Anatomy of the male
reproductive tract
 Male Reproductive System

Seminal vesicle-semen
Ductus deferens-sperm
Prostate-semen
duct
Urethra-urine Penis
Epididymis-sperm maturation
Scrotum-cools testis
Testis-sperm formation

• Gonads, ducts, sex glands & supporting structures

Anatomy of the Female
reproductive tract
The female reproductive system enables a woman
to:
•produce eggs (ova)
•have sexual intercourse
•protect and nourish the fertilized egg until it is fully
developed
•give birth
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 Female Reproductive System
• Ovaries produce eggs
(oöcytes) & hormones
• Uterine tubes transport
the eggs Uterine Tube
• Uterus where fetal
development occurs Ovary
• Vagina or birth canal Uterus

• External genitalia
constitute the vulva Vagina
• Mammary glands
produce milk

Vulva
Multifactorial Drivers of MSM HIV/STI Risk
Biology
• Anal intercourse ↑susceptibility to HIV and STI
• Role versatility: receptive can be insertive, ↑ efficiency
Individual Behavior
• Number of partners over time
Social Networks (↑ risk of encountering HIV/STI)
• Sexual venues, e.g. bathhouses, social media
• Assortative mixing in sub-groups, e.g. minorities
Structural/Societal
• Homophobia → early developmental stress → syndemics
→ depression, lack of self-efficacy, and risk
• Criminalization and discrimination in health care settings
delay receipt of timely health services
 Natural History of HIV Infection
• HIV infection is probably lifelong, and severe immune
deficiency will develop in up to half of HIV-infected adults
within 8 years after infection.
• Once severe immune damage develops, the infected
person is susceptible to many opportunistic infections and
cancers, and these illnesses are surrogate/indirect
indicators of the immunodeficiency due to HIV and
collectively they constitute the diagnosis of
Acquired ImmunoDeficiency Syndrome (AIDS).
• Annual progression rates from HIV infection to the
development of AIDS is similar in Haiti, Thailand, Uganda,
and “Western” countries (median of 8 years).
• Survival after the onset of AIDS is, in the absence of anti-
HIV treatment, short, and is usually less than 1 year
in developing countries.
 HIV Transmission
 HIV is transmitted from person to person primarily via
blood or other body fluids that may contain some blood.
 The risk of HIV transmission for any exposure/contact is
directly related to the amount of blood exchanged.
 The risk of transmitting HIV infection via blood transfusion
from an infected donor is close to 100%, whereas the risk
of an HIV-infected female transmitting HIV to her sex
partner can be as low as 1 per several thousand episodes
of vaginal intercourse.
 In the absence of facilitating factors, sexual HIV
transmission is several hundred times less infectious
compared to most other sexually transmitted agents.
 Anal intercourse is more efficient for HIV transmission
because of increased tissue trauma, but is still very low
compared to agents such as syphilis and gonorrhea.
 HORMONAL CYCLES

• Menstrual cycle (or period) refers to the

recurring physiological changes in a
female's body that are under the
influence of hormones.
• During puberty, hormones are released
from the brain that stimulate the ovaries.
• The ovaries then produce estrogen and
progesterone - hormones that cause the
eggs in the ovaries to mature.
 HORMONAL CYCLES

• Every month, one egg leaves one of the

ovaries on its way to the uterus via the
fallopian tube.
• In preparation for the egg, the uterus starts
to develop a thicker lining and its walls
become cushiony (the endometrial lining).
“MSM” is an epidemiological term
People’s lives are more complex
MSM Cosmology in
One size does not fit all Mumbai
25
26
 HORMONAL CYCLES
• Most of the time the egg just passes right
through without fertilization.
• Since the uterus no longer needs the
extra blood and tissue which made the
walls thick, it sheds them by way of the
vagina.
• This cycle will happen nearly every
month until the ovaries stop releasing
eggs, usually several decades later.
(Menopause).
E: THE IMMUNE SYSTEM
Composed of many interdependent cell types
that collectively protect the body from
bacterial, parasitic, fungal, viral infections and
from the growth of tumor cells.

Many of these cell types have specialized

functions- can engulf bacteria, kill parasites
or tumor cells, or kill viral-infected cells.

Often, these cells depend on the T helper

subset for activation signals in the form of
secretions formally known as cytokines,
lymphokines (or interleukins).
GENERAL SCHEME OF
THE
IMMUNE SYSTEM
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THE ORGANS OF THE IMMUNE SYSTEM (IS)

1. Bone Marrow -All the cells of the immune system are initially derived
from the bone marrow (hematopoiesis).

Hematopoiesis- bone marrow-derived stem cells differentiate-mature cells

of the IS or precursors of cells that continue their maturation elsewhere.

The bone marrow produces B cells, natural killer cells, granulocytes and
immature thymocytes, in addition to red blood cells and platelets.
2. Thymus
Produces mature T cells. Immature thymocytes from bone marrow and
migrate into the thymus.

Through maturation process referred to as thymic education, T cells that

are beneficial to the immune system are spared, while those T cells that
might evoke a detrimental autoimmune response are eliminated.

The mature T cells are then released into the bloodstream.

3. Spleen
It is made up of B cells, T cells, macrophages, dendritic
cells, natural killer cells and red blood cells.
In addition to capturing foreign materials (antigens)
from the blood that passes through the spleen
Migratory macrophages and dendritic cells bring
antigens to the spleen via the bloodstream.

An immune response is initiated when the macrophage

or dendritic cells present the antigen to the appropriate
B or T cells.

In the spleen, B cells become activated and produce

large amounts of antibody. Also, old red blood cells are
destroyed in the spleen.
4. Lymph Nodes
The lymph nodes function as an immunologic filter
for the bodily fluid known as lymph. Lymph nodes
are found throughout the body.

Composed mostly of T cells, B cells, dendritic cells

and macrophages, the nodes drain fluid from most
of our tissues. Antigens are filtered out of the lymph
in the lymph node before returning the lymph to the
circulation.

As in the spleen, the macrophages and dendritic

cells that capture antigens present these foreign
materials to T and B cells, consequently initiating
an immune response.
The Cells of the Immune System

T-Cells - CD8+ T cells and CD4+ T cells

Natural Killer Cells -- NK cells, are similar to the
killer T cell subset (CD8+ T cells). They function as
effector cells that directly kill certain tumors such
as melanomas, lymphomas and viral-infected cells.

B Cells - The major function of B lymphocytes is

the production of antibodies in response to foreign
proteins of bacteria, viruses, and tumor cells.
Granulocyte Leukocytes (white blood cells)
Granulocytes are composed of three cell
types identified as neutrophils, eosinophils
and basophils, based on their staining
characteristics with certain dyes.

These cells are predominantly important in

the removal of bacteria and parasites from
the body. They engulf these foreign bodies
and degrade them using their powerful
enzymes.
Macrophages - Macrophages are important in
the regulation of immune responses. They
are often referred to as antigen-presenting
cells (APC) because they pick up and ingest
foreign materials and present these antigens
to other cells of the immune system such as
T cells and B cells.

Dendritic Cells -Dendritic cells, which also

originate in the bone marrow, function as
antigen presenting cells (APC). In fact, the
dendritic cells are more efficient apcs than
macrophages.
The human body can respond to antigen in many
different ways. These fall into two major categories:
•antibody-mediated immunity. Antibodies,
dissolved in blood, lymph, and other body fluids
bind the antigen and trigger a response to it. (This
form of immunity is also called humoral
immunity.)

•cell-mediated immunity (CMI). T-

cells(lymphocytes) bind to the surface of other
cells that display the antigen and trigger a
response. The response may involve
oother lymphocytes and
oany of the other white blood cells (leukocytes
 F: OTHER PHYSIOLOGICAL
FACTORS IN HIV/ AIDS
• Sexually Transmitted Diseases (STDs)
• STDs can affect the sex partners, fetus,
and newborn infants.
• STDs are grouped into three categories.
CATEGORY 1

STDs that produce inflammation of the

urethra, epididymis, cervix, or oviducts.

Gonorrhea and chlamydia are the most

common STDs in this category.
Both diseases can be treated and cured with
antibiotics, once diagnosed.
Category 2
STDs that produce sores on the external
genitals.
Genital herpes is the most common disease in
this class, affecting more than 25 million
individuals in the US. Symptoms of herpes can
be treated by antiviral drugs, but the infection
cannot be cured.

Syphilis is a bacterially caused infection, and

can, if left untreated, cause serious symptoms
and death. However, the disease is curable
with antibiotics.
Category 3

This class of STDs includes viral diseases that

affect organ systems other than those of the
reproductive system.

AIDS and hepatitis B are in this category.

Both can be spread by sexual contact or blood.

Infectious individuals may appear symptom-
free for years after infection.
 OTHER FACTORS
•Bacterial Vaginosis
•Gender/ Sex
•Age

REFERENCES
1. TEXTBOOK OF MEDICAL PHYSIOLOGY
By Arthur C. Gyton &John E. Hall
2. Cellular and Molecular Immunology
Abul K. Abbas & Andrew H. Litchman
3. Review of Medical Physiology
William Ganong
4. INTERNET
Conclusion

"Unlike microbial scourges, such

as malaria and tuberculosis
(among many others), for which
there is very little that people can
do to prevent infection, HIV
infection in adults is entirely
preventable by behavior
modification"