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HIV: THE GLOABAL AND INDIAN SCENARIO

DR. KANUPRIYA CHATURVEDI DR. S.K CHATURVEDI

Lesson objectives
Scope of the HIV/AIDS Pandemic Natural History and Transmission of HIV

Understand the global and local impact of the epidemic

Know about HIV/AIDS in adults, children, and families


Understand the natural history of HIV infection Understand the modes of HIV transmission
DR. S.K CHATURVEDI

HIV
Human Immunodeficiency Virus H = Infects only Human beings I = Immunodeficiency virus weakens the immune system and increases the risk of infection V = Virus that attacks the body
DR. S.K CHATURVEDI

AIDS
Acquired Immune Deficiency Syndrome A = Acquired, not inherited I = Weakens the Immune system D = Creates a Deficiency of CD4+ cells in the immune system S = Syndrome, or a group of illnesses taking place at the same time
DR. S.K CHATURVEDI

HIV and AIDS


When the immune system becomes weakened by HIV, the illness progresses to AIDS
Some blood tests, symptoms or certain infections indicate progression of HIV to AIDS
DR. S.K CHATURVEDI

HIV-1 and HIV-2


HIV-1 and HIV-2 are

Transmitted through the same routes


Associated with similar opportunistic

infections
HIV-1 is more common worldwide

HIV-2 is found in West Africa, Mozambique,


and Angola
DR. S.K CHATURVEDI

HIV-1 and HIV-2


HIV-2 is less easily transmitted
HIV-2 is less pathogenic Duration of HIV-2 infection is shorter MTCT is relatively rare with HIV-2 MTCT of HIV-2 has not been reported from India
DR. S.K CHATURVEDI

Transmission of HIV
HIV is transmitted by Direct contact with infected blood Sexual contact: oral, anal, or vaginal Direct contact with semen or vaginal and cervical secretions HIV-infected mothers to infants during pregnancy, delivery, or breastfeeding
DR. S.K CHATURVEDI

Transmission of HIV
HIV is not transmitted by
Coughing, sneezing
Insect bites Touching, hugging
Public baths

Water, food
Kissing

Handshakes Work or school contact Using telephones Sharing cups, glasses, plates, or other utensils

DR. S.K CHATURVEDI

Global summary of the HIV and AIDS epidemic,


December 2004
Number of people living with HIV in 2004 People newly infected with HIV in 2004 AIDS deaths in 2004

Total 39.4 million (35.9 44.3 million) 37.2 million (33.841.7 million) Adults Women 17.6 million (16.3 19.5 million) Children under 15 years 2.2 million (2.0 2.6 million) Total 4.9 million (4.3 6.4 million) Adults 4.3 million (3.7 5.7 million) Children under 15 years 640 000 (570 000 750 000) Total 3.1 million (2.8 3.5 million) Adults 2.6 million (2.3 2.9 million) Children under 15 years 510 000 (460 000 600 000)

The ranges around the estimates in this table define the boundar within which the actual numbers lie, based on the best avail information. ies able
00003 -E-1 December 2004

DR. S.K CHATURVEDI

About 14 000 new HIV infections a day in 2004

More than 95% are in low and middle income countries Almost 2000 are in children under 15 years of age About 12 000 are in persons aged 15 to 49 years, of whom: almost 50% are women about 50% are 1524 year olds

00003-E-10 December 2004

DR. S.K CHATURVEDI

Global HIV/AIDS in 2004 *


39.4 -40.0 million people are living with HIV/AIDS 2.2 million are children under 15 years 6,40,000 children were newly infected with HIV in 2004 5,10,000 children died of HIV in 2

5.1 m. Indian living with HIV

* Source: UNAIDS,2004
DR. S.K CHATURVEDI

Reported cases
Reported AIDS cases (15,202) Estimated AIDS cases (219,400) People living with HIV/AIDS (2.2 million)

Only a small number of PLWHA are reported


DR. S.K CHATURVEDI

Impact of Global HIV


Negative economic impact on countries
Overstrained healthcare systems

Decreasing life expectancy


Reversal of child survival gains

Increased numbers of orphans


DR. S.K CHATURVEDI

HIV Estimates in India

DR. S.K CHATURVEDI

MCH Profile (India)


Total Population 1027 M

Crude Birth Rate


Sex Ratio (F:M)

25/1000
933

Annual Pregnancies
ANC Coverage

27 M
65.4 %

Institutional Deliveries

[12.1% to 79.3%]

35.6 %
42.3 %

Deliveries attended by skilled birth attendants


DR. S.K CHATURVEDI

Adult HIV Prevalence

High Prevalence States: these are Tamil Nadu, Maharastra, Karnataka, Andhra Pradesh, Manipur and Nagaland

DR. S.K CHATURVEDI

Mode of Transmission of HIV In India


2.7 2.07 3.45 5.95 85.83

Sexual

IDUs

Blood & blood proucts

Perinatal

Unidentified

DR. S.K CHATURVEDI

MTCT in 100 HIV+ Mothers


The majority of children do not get infected even when we do nothing
100 90 80 70 60 50 40 30 20 10 0
15 15
7

uninfected

63
uninfected

# infected during

BF for 2 yrs
# infected during

delivery
#infants infected

during pregnancy

DR. S.K CHATURVEDI

Risk of PTCT Transmission

Globally: 15-45% India: 30-37% ( average)

DR. S.K CHATURVEDI

Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact, Selected States in India
2004 Report on the Global AIDS Epidemic
100 80 60 % 40 20 0 Urban Male Urban Female Rural Male Rural Female

Bihar

Gujarat

Uttar Pradesh

Source: National AIDS Control Organization, National Baseline General


Population Behavioural Surveillance Survey 2001
DR. S.K CHATURVEDI

Prevention of HIV Transmission


Strategies to prevent HIV transmission

Personal strategies
Public health strategies
Safe practices: no risk of HIV transmission Risk reduction: reduces but does not eliminate risk
DR. S.K CHATURVEDI

Prevention of HIV Transmission


Public health strategies to prevent HIV transmission Screen all blood and blood products Follow universal precautions Educate in safer sex practices Identify and treat STIs/other infections Provide referral for treatment of drug dependence Apply the comprehensive PPTCT approach to prevent vertical transmission of HIV
DR. S.K CHATURVEDI

Natural History of HIV Infection

DR. S.K CHATURVEDI

Natural History of HIV Infection


Virus can be transmitted during each stage

Seroconversion Infection with HIV, antibodies develop Asymptomatic No signs of HIV, immune system controls virus production Symptomatic Physical signs of HIV infection, some immune suppression AIDS Opportunistic infections, end-stage disease DR. S.K CHATURVEDI

Natural History of HIV Infection


Immune suppression
HIV attacks white blood cells,called
CD4 cells, that protect body from

illness
Over time, the bodys ability to fight

common infections is lost


Opportunistic infections occur
DR. S.K CHATURVEDI

HIV Disease
Progression of HIV disease is measured by: CD4+ count Degree of immune suppression Lower CD4+ count means decreasing immunity Viral load Amount of virus in the blood Higher viral load means more immune suppression
DR. S.K CHATURVEDI

HIV Disease
Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4+ counts) Higher the viral load, the sooner immune suppression occurs
DR. S.K CHATURVEDI

Progression of HIV Infection


HIGH viral load (number of copies of HIV in the blood) LOW CD4 count (type of white blood cell) Increasing clinical symptoms (such as opportunistic infections)
DR. S.K CHATURVEDI

HIV Disease
Direct infection of organ systems
HIV can directly infect the:
Brain (HIV dementia) Gut (wasting) Heart (cardiomyopathy)
DR. S.K CHATURVEDI

HIV Disease: Summary


HIV multiplies inside the CD4+ cells, destroying them

As CD4+ cell count decreases and viral load increases, the immune defences are weakened
HIV-infected people become vulnerable to opportunistic infections HIV is a chronic viral infection with no known cure Without ARV treatment, HIV progresses to symptomatic disease and AIDS
DR. S.K CHATURVEDI

Key Points
HIV is a global pandemic and the number of people living with HIV continues to increase worldwide. HIV epidemic is especially severe in resource-constrained settings

HIV is a virus that destroys the immune system, leading to opportunistic infections.
The progression from initial infection with HIV to end-stage AIDS varies from person to person and can take more than 10 years.
DR. S.K CHATURVEDI

Key Points (continued)


The most common main route of transmission worldwide is heterosexual transmission.

Women of childbearing age are at particular risk for


acquiring HIV through unprotected sex HIV-positive women who are pregnant are at risk of passing HIV infection to their newborn. Risk of HIV transmission from mother-to-child can be greatly reduced through effective PMTCT programs
DR. S.K CHATURVEDI