· The virus through its envelope proteins attaches to the CD4 receptor and co-receptors found on the surface of T lymphocytes and macrophage to gain entry to the host cells.
· Following entry of the HIV into a susceptible host cell using the enzyme reverse transcriptase, the viral genome copies itself from RNA to DNA genetic material.
· The viral DNA copy enters the nucleus of the host cell and becomes intimately incorporated into the host cell’s own DNA using the enzyme integrase.
· The virus thus becomes a permanent part of an infected person’s nuclear proteins.
· There follows a latent period during which the provirus in the infected nucleus waits for an external stimulus to start reproducing.
· CD4+ T lymphocytes, when stimulated by new HIV, other infections and infestations which would normally result in the CD4+ T lymphocyte reproducing itself, now responds to these stimuli by manufacturing HIV.
As more and more viruses are produced and leave the host cell, the cell membrane
· weakens leading eventually to the death of the infected CD4+ T lymphocytes
· The multiple steps in replication of HIV provide multiple opportunities for intervention.
· Therapeutic regimens may be directed at one or several of the following stages essential for viral replication:
o Attachment of HIV to the host cell;
o Reverse transcription of viral RNA to DNA;
o Integration of the pro-viral DNA into the host cells’ DNA; or
o Expression of the viral gene after it has been integrated into host cell DNA, including the transcription of more viral RNA and the translation of viral proteins.
Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill.
DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th ed): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach: New York, NY: McGraw-Hill.
Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7th ed): New York, NY: McGraw-Hill.