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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