Is the HIV / AIDS same

Also called Slim Disease

 HIV
• AIDS - Acquired immunodeficiency
syndrome
• Caused by Retrovirus known as Human
Immunodeficiency virus
• Breaks down the immune system leaving
the victim vulnerable to opportunistic
infection
• HIV invades the helper T cells to replicate
itself
 AIDS
• Acquired Immunodeficiency Syndrome
• HIV is the virus that causes AIDS
• Disease limits the body’s ability to fight
infection
• A person with AIDS has a very weak
immune system
• No Cure 100% DEATH WILL OCCUR
 PROBLEM STATEMENT
• Recognized as an emerging disease only in
the early 1980s.
• AIDS has evolved from a mysterious illness to
a global pandemic .
• Effecting >10million of people in less than
20yrs age.
• In many regions of the world incidence of HIV
are concentrated among young people (15-
24yrs) they accounted 40% in 2006 incidence
New HIV Infections in 2006 by Age Group
 Outline

Overview: HIV epidemiology in 2006

Emerging and ongoing epidemics: 3 Case studies

IDU in Eurasia

MSM trends

The Southern African epidemic

Summary and conclusions

 A global view of HIV infection, 2005

1.5 million
200,000 in ‘05
IDU

7.6 million
830,000 in
‘05
Heterosexual
MSM
IDU

12.1 million
1.3 million in ‘05
Heterosexual
Source: UNAIDS 2006 Report on the Global AIDS Pandemic
 Ecological Model for HIV Risk

Condom Usage, Circumcision, HSV-2/GUD, Viral Load, Acute

Infection, Age of Coital Debut, Marriage, ARV Status

Individual Risks for HIV Infection

Widening Risk Contexts for HIV Infection

 Agent factors
• HIV-I most commonly effecting virus
throught the globe
• HIV-II recently recognized virus
• The virus is easily killed by Heat, readily
inactivated by ether, acetone, ethanol.
• Relatively resistant to ionizing radiation
and ultraviolet light.
 Reservoir of infection

cases and carriers

Someone who is infected by HIV
may not show any signs (carriers) of
the illness for a long time.
 Source of infection of HIV
• Greater concentration:
• Blood
• Semen
• CSF
• Lower concentration:
• Vaginal, uterine, cervical Secretions
• Breast Milk
• HIV has been isolated from :
• Brain tissues
• Lymph node
• Bone marrow cells
• Skin
 Host factors
• Age : MC 24-49 yrs sexually activegroup
• Sex : male homosexuals bisexuals are
more common in North America, Australia
and Europe,
• Certain sexual practices increases the
disease pattern ex: Multiple sex partners
 Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female or vice versa
Female-to-female

Blood Exposure: Injecting drug use/needle sharing

Occupational exposure
Transfusion of blood products
transplanted organs
Perinatal: Transmission from mom to baby
Breastfeeding
 HIV in Body Fluids

Blood
Semen
18,000 Vaginal
11,000
Fluid Amniotic
7,000 Fluid
4,000 Saliva
1

Average number of HIV particles in 1 ml of these body fluids

 Incubation period
• 75% of HIV infected persons were
developing AIDS On average, 10
years Incubation period
• During this time, the virus is
seriously damaging the infected
person’s immune system.
• The virus can be silent in the body for many
years
 Pathogenesis of HIV / AIDS
Infected T-Cell

HIV HIV Infected New HIV

T-Cell T-Cell Virus
Virus
 Window Period

• This is the period of time after becoming

infected when an HIV test is negative

• 90 percent of cases test positive within

three months of exposure

• 10 percent of cases test positive within

three to six months of exposure
 HIV Infection and Antibody
Response
---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage---

Flu-like Symptoms
Or Symptom-free AIDS Symptoms
No Symptoms

----

Infection Virus
Occurs
Antibody

----

< 6 month ~ Years ~ Years ~ Years ~ Years

Four Stages of HIV
 Stage 1 - Primary
• Short, flu-like illness - occurs one to six
weeks after infection
• no symptoms at all
• Infected person can infect other people
 Stage 2 - Asymptomatic

• Lasts for an average of ten years

• This stage is free from symptoms
• There may be swollen glands
• The level of HIV in the blood drops to very
low levels
• HIV antibodies are detectable in the blood
 Stage 3 - Symptomatic

• The symptoms are mild

• The immune system deteriorates
• emergence of opportunistic infections
and cancers
 Stage 4 - HIV  AIDS

• The immune
system weakens

• The illnesses
become more
severe leading to
an AIDS diagnosis
Opportunistic Infections associated
with AIDS

• Bacterial
– Tuberculosis (TB)
– Strep pneumonia

• Viral
– Kaposi Sarcoma
– Herpes
– Influenza (flu)
Opportunistic Infections associated
with AIDS
• Parasitic
– Pneumocystis carinii

• Fungal
– Candida
– Cryptococcus
Modes of HIV/AIDS Transmission
 Through Bodily Fluids
• Blood products
• Semen
• Vaginal fluids
• Breast Milk
 Through IV Drug Use
• Sharing Needles
– Without sterilization
• Increases the chances of contracting HIV
 Through Sex
• Intercourse (penile penetration into the
vagina)
• Oral
• Anal
• Digital Sex
 Mother-to-Baby

• Before Birth
• During Birth
• Postpartum
– After the birth
Testing Options for HIV
 Importance of Early Testing
and Diagnosis
• Allows for early treatment to maintain and
stabilize the immune system response

• Decreases risk of HIV transmission from

mother to newborn baby

• Allows for risk reduction education to

reduce or eliminate high-risk behavior
 HIV Testing
• Those recently exposed should be retested at
least six months after their last exposure
• Screening test (EIA/ELISA) vs. confirmatory
test (IFA)
EIA/ELISA (Reactive)

Repeat EIA/ELISA (Reactive)

IFA (Reactive)

Positive for HIV

 Administration

• Blood
• Urine
• Oral
 Blood Detection Tests
• Enzyme-Linked Immunosorbent Assay/Enzyme
Immunoassay (ELISA/EIA)
• Radio Immunoprecipitation Assay/Indirect
Fluorescent Antibody Assay (RIP/IFA)
• Polymerase Chain Reaction (PCR)
• Western Blot Confirmatory test
 Urine Testing

• Urine Western Blot

– As sensitive as testing blood
– Safe way to screen for HIV
– Can cause false positives in
certain people at high risk for
HIV
 Oral Testing
Orasure
– The only FDA approved
HIV antibody.
– As accurate as blood
testing
– Draws blood-derived
fluids from the gum
tissue.
– NOT A SALIVA TEST!
 HIV Testing
EIA/ELISA
Test
Negative Positive

No HIV Exposure HIV Exposure Repeat

Low Risk High Risk Positive

Negative Repeat ELISA

Positive Run IFA
Every 3 months
Confirmation
for 1 year

Repeat every
6 months for continued
Indeterminate Negative Positive
High risk behavior

Repeat at Repeat at
End Testing Negative 3 weeks 2-4 months
HIV
+
Counseling
 Pre-test Counseling
• Transmission
• Prevention
• Risk Factors
• Voluntary & Confidential
• Reportability of Positive Test Results
 Post-test Counseling
• Clarifies test results
• Need for additional testing
• Promotion of safe behavior
• Release of results
Treatment Options
 Antiretroviral Drugs
• Nucleoside Reverse Transcriptase
inhibitors
– AZT (Zidovudine)
• Non-Nucleoside Transcriptase inhibitors
– Viramune (Nevirapine)
• Protease inhibitors
– Norvir (Ritonavir)
 Opportunistic Infection Treatment

• Issued in an event where antiretroviral

drugs are not available
 Prevention and control of HIV
• Education
• Prevention of blood born HIV transmission
• Anti Retro Viral treatment
• Combination therapy
• Post exposure prophylaxis
• Specific prophylaxis
• Primary health care
 Four ways to protect yourself?
• Abstinence
• Monogamous Relationship
• Protected Sex
• Sterile needles
 Abstinence
• It is the only 100 % effective method of not
acquiring HIV/AIDS.
• Refraining from sexual contact: oral, anal,
or vaginal.
• Refraining from intravenous drug use
 Monogamous relationship
• A mutually monogamous (only one sex partner)
relationship with a person who is not infected
with HIV
• HIV testing before intercourse is necessary to
prove your partner is not infected
 Protected Sex

• Use condoms (female or male) every time

you have sex (vaginal or anal)
• Always use latex or polyurethane condom
(not a natural skin condom)
• Always use a latex barrier during oral sex
 When Using A Condom
Remember To:
• Make sure the package is not expired
• Make sure to check the package for damages
• Do not open the package with your teeth for
risk of tearing
• Never use the condom more than once
• Use water-based rather than oil-based
condoms
 Sterile Needles
• If a needle/syringe or cooker is shared, it
must be disinfected:
– Fill the syringe with undiluted bleach and wait
at least 30 seconds.
– thoroughly rinse with water
– Do this between each person’s use
Needle Exchange Program

• Non-profit
Organization, which
provides sterile
needles in
exchange for
contaminated ones
HIV Post Exposure
Prophylaxis
 HIV Occupational Exposure
• Review facility policy and report the incident
• Medical follow-up is necessary to determine
the exposure risk and course of treatment
• Baseline and follow-up HIV testing
• Four week course of medication initiated
one to two hours after exposure
• AZT (200mg)-TID +lamivudine(3TC)
(150mg)BID x 4days
• Nelfinavir (750 mg) TID ,AZT/3TC
• Exposure precautions practiced
 HIV Non-Occupational
Exposure
PREVENTION --- FIRST
• No data exists on the efficacy of antiretroviral
medication after non-occupational exposures
• The health care provider and patient may
decide to use antiretroviral therapy after
weighing the risks and benefits
• Antiretrovirals should not be used for those
with low-risk transmissions or exposures
occurring more than 72 hours after exposure
Why the world needs an AIDS vaccine

Despite the international community's best efforts,

the HIV pandemic continues unabated. In 2006,
more than 39 million people were living with HIV
worldwide. Over four million people became newly
infected with HIV and an estimated 2.8 million lost
their lives to AIDS.
Thank You!