HIV AIDS

Dr.D.M.MOHAN IRT PMC

 The highlight of the 20th century has

been the pandemic of HIV/AIDS.

This disease has spread across all the

continents, countries & races breaking all natural or manmade barriers.

History
1981--- C.D.C IDENTIFY A disease
1983--- a virus was isolated 1984 - H.I.V virus was demonstrated 1985--- ELISA for diagnosis 332 laks--- patients 225laks ---in subsharan africa 95%--- living in developing countries

India: HIV Scenario

First case detected in 1986

Second highest number of HIV infected people next only to South Africa
Major mode of transmission - Heterosexual

HIV-1 is the predominant serotype

HIV-1 subtype C is the commonest

Global HIV Scenario

15,000 people are infected with HIV everyday

More than 220 lakhs people, including 36 lakhs children, have died from AIDS since the start of the epidemic

1986

1990

1994

First case of HIV detected in Chennai

HIV Prevalence reaches over 5% amongst high risk group in Maharashtra and Manipur

1.74 m infected

5.1 m. Indian living with HIV 4.58 m. Indians living with HIV
1998 2001

2003 2002

3.5 m. infected > 1 % antenatal women

4.01 m. infected > 5 % high risk groups

5.1 m. 4.58 m infected

< 5 % high risk groups

Known Modes of HIV Transmission, 2003

85.69

6.78 2.72 Sexual IDUs 2.57 2.24 Perinatal Unidentified

Source: NACO

Blood & blood proucts

 The human immunodeficiency virus (HIV) infects

What is HIV?

cells of the immune system,destroying or impairing their function. , leading to "immune deficiency." The immune system is considered deficient when it can no longer fulfill its role of fighting infection and disease. Infections associated with severe immunodeficiency are known as "opportunistic infections," because they take advantage of a weakened immune system.

What is AIDS?
The term AIDS applies to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20

opportunistic infections or HIV-related cancers.

 How is HIV transmitted

How quickly does a person infected with HIV develop AIDS?

The length of time can vary widely between

individuals. Left untreated, the majority of people infected with HIV will develop signs of HIV-related illness within 5-10 years. Antiretroviral therapy (ART) can slow the disease progression by decreasing an infected persons viral load.

Symptoms & Signs

Acute HIV syndrome
5070% of persons with HIV infection experience an acute clinical syndrome

approximately 36 weeks after primary infection. Usually persists for 1 to several weeks

General symptoms
Fever Pharyngitis Lymphadenopathy (70% of cases)

 Headache/retro-orbital pain
Arthralgias/myalgias Lethargy/malaise Weight loss Anorexia Mucocutaneous ulceration

o Nausea o Vomiting o Diarrhea Neurologic o Meningitis o Encephalitis o Peripheral neuropathy o Myelopathy Dermatologic o Erythematous maculopapular rash

Asymptomatic infection
The length of time between infection and development of disease varies, but the median is ~10 years. Active viral replication continues during this asymptomatic period, and CD4+ T-cell counts decrease. Rate of disease progression is directly correlated with plasma HIV RNA levels.

Symptomatic disease
Symptoms can develop at any time during

the course of HIV infection. More severe and life-threatening complications of HIV infection occur in patients with a CD4+ T-cell count <200/L. Persistent generalized lymphadenopathy Fever persisting for >1 month Involuntary weight loss of >10% of baseline Diarrhea for >1 month in absence of explainable cause

 HIV encephalopathy (AIDS dementia complex) Aseptic meningitis Myelopathy Peripheral neuropathy

Myopathy
Secondary infectious diseases

 Pneumocystis carinii pneumonia (m.c 80%) Candida albicans (oral thrush, esophagitis) Mycobacterium avium intracellulare (localized or disseminated infection) Mycobacterium tuberculosis Cryptococcus neoformans (meningitis, disseminated disease) Toxoplasma gondii (encephalitis, intracerebral mass lesion) Herpes simplex virus (severe mucocutaneous lesions, esophagitis)
Diarrhea due to Cryptosporidium species or Isospora belli Bacterial pathogens (especially in pediatric cases)

CANDIDIASIS

ADRs IN HIV

Secondary neoplasms
Kaposis sarcoma (cutaneous and visceral, more fulminant course than in nonHIVinfected patients) Lymphoid neoplasms (especially B cell lymphomas of brain, marrow, GI tract)
Organ-specific disease

KAPOSIS SARCOMA

What is the most common lifethreatening opportunistic infection affecting people living with HIV/AIDS?
Tuberculosis (TB) kills nearly a quarter of a

million people living with HIV each year. It is the number one cause of death among HIV-infected people in Africa, and a leading cause of death in this population worldwide

How many people are living with HIV?

According to estimates by WHO and UNAIDS, 332 laks people were living with HIV at the end of 2008. That same year, some 27 laks

people became newly infected, and 2.0 million died of AIDS, including 280 000 children. Two thirds of HIV infections are in sub-Saharan Africa.

Lab diagnosis
Screening test-ELISA

(99.5%) WESTERN BLOT-confirmatory In window period22 days- ----antibody test 16 days------ P24 antigen tests 12 days------nucleic acid testing 3 days------C.D.C & A.F.M.C (india)

What is the benefit of an HIV test?

Knowing your HIV status can have two important benefits: If learn that they are HIV positive, they can

take the necessary steps before symptoms appear to access treatment, care and support, thereby potentially prolonging their life for many years. If he know that he is infected, he can take precautions to prevent the spread of HIV to others.

What are antiretroviral drugs?

Antiretroviral drugs are used in the treatment and prevention of HIV infection.
They fight HIV by stopping or interfering with

the reproduction of the virus in the body.

 Standard antiretroviral therapy (ART)

consists of the use of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease.

Is there a cure for HIV?

No, there is no cure

But with good and continued adherence to

antiretroviral treatment, the progression of HIV in the body can be slowed to a near halt. Increasingly, people living with HIV are kept well and productive for extended periods of time, even in low-income countries

Comparing the "Natural History" Pre- and Post-HAART

Untreated true natural history
9 yrs (8-11 yrs) 1.5 yrs

|
HIV Infection

|
AIDS

|
Death

Treated history

> 11 yrs HIV Infection

> 4 yrs

AIDS

Death

What other kinds of care do people living with HIV need?

In addition to antiretroviral treatment, people with HIV often need counselling and psychosocial support. Access to good nutrition, safe water and basic hygiene can also help an HIV-infected person maintain a high quality of life

How to prevent -------------------HIV infection:

How can limit risk of HIV transmission through sex?

 Use male or female condoms correctly each time you have sex.
Practice only non-penetrative sex.

 Remain faithful in a relationship with an

uninfected equally faithful partner with no other risk behaviour.

Prevention
Effective HIV prevention interventions include condom use, Provision of clean injecting equipment, Treatment of sexually transmitted infections, HIV testing and counselling. A set of interventions to prevent mother-tochild transmission of HIV has virtually eliminated paediatric HIV in a number of countries.

How to use a condom:

You can use a condom to avoid getting infected with HIV or other sexually transmitted diseases (STDs). It is very risky for you to be exposed to other sexually transmitted diseases if you already have HIV. It is also important that you use the condom correctly.

1 Always hold the space at the end of the condom and gently roll it on the penis. 2. After you have finished remove it while the penis is still stiff enough. 3. Dispose it in a safe place such as an enclosed container and later on in a pit latrine or toilet. 4. As a must always use the condom only once for every round of sex and dispose it thereafter.

 In health care settings, transmission of HIV can be prevented through primary prevention measures such as standard precautions, blood safety, injection safety, and safe waste disposal, as well as secondary prevention measures, such as post-exposure prophylaxis for occupational or certain non-occupational exposures to HIV such as in health-care settings, post-rape, and in case of condom breakage.

1. Do not share instruments such as razor blades, needles and syringes. If sharing can not be avoided, then insist on using sterilized instruments.

2. Cover cuts and wounds with water-proof plasters or a piece of clean cloth.

Traditional customs and HIV.

shaving with unsterilized blades or knives can spread HIV...

Circumcision or body tattooing or

Modify risky traditional customs to avoid the spread of HIV.

 In addition, there is increasing evidence indicating that antiretroviral therapy programmes can be implemented in a way

that emphasizes HIV prevention.

Current research on new prevention technologies such as microbicides, topical and oral antiretroviral pre-exposure prophylaxis in preventing the transmission of HIV and AIDS vaccines is ongoing.

WHAT IS A MICROBICIDE?

A women-controlled method applied before sex that could kill, neutralize, or block HIV and other sexually transmitted infections An effective topical microbicide could be on the market by 2008

REGISTERED MARRIAGES
2003
MAHARASHTRA ENACTED A LAW

MANDATORY TESTING --OF------------- ---- -

------------------- BRIDE AND GROOM ------------------------------------FOR HIV STATUS

HIV and AIDS

Epitope variation allows more and more HIV t escape from immune response just as response wanes High Mutation rate RT is highly error prone 1/30,000bp 1/3 copy 10 Billion HIV particles per day Virus half life of 5.7 hrs So difficult to discover new drug

Progression to AIDS/Death
30 25 20 15 10 5 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

No therapy

Mono-therapy Dual-therapy Triple therapy (HAART)

Months
JAMA 1998 & CMAJ 1999

It is important to get proper care and treatment!

Red ribbon
The red ribbon is a symbol for both drug prevention and for the fight against AIDS.
The Red Ribbon Foundation is an

organization founded in 1993 whose main purpose is the education about prevention of the Human Immunodeficiency Virus or HIV, Acquired Immune Deficiency Syndrome Related Complex and AIDS.