Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV)

1. Kuldeep Vyas
Asst. Prof. Community HealthHIV/ AIDS 1Kuldeep Vyas M.Sc. CHN

2. AIDS
 Acquired immuno deficiencysyndrome
 Fatal illness
 Caused by a retrovirusHIV
 It breaks down the body's immunesystem, leaving the
patient vulnerable to a host of life threatening
opportunistic infections, neurological disorders or
unusual malignancies.
2Kuldeep Vyas M.Sc. CHN

3. Structure of HIV
3Kuldeep Vyas M.Sc. CHN

4. Epidemiology
 Males>females
 Occurs in all ages and ethnic groups
 All areas of the country are affected
 AIDS is now the second leading cause of death for all men
aged 25-44 years
 (Unintended injuries is #1 and heart disease is #3 for this
age group)
4Kuldeep Vyas M.Sc. CHN

5. AIDS Worldwide
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6. AIDS
In
India
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Kuldeep Vyas M.Sc. CHN

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9. HIV- Agent
 It is a RNAvirus
 Which replicates in actively dividing T4lymphocytes.
 Uniqueability todestroyT4 Helpercells
 Reservoir- Once a person gets infected virus remains
in his body lifelong. And the person is a symptomless
carrier foryears before the symptomsactuallyappear.
9Kuldeep Vyas M.Sc. CHN

10.  Source – Thevirus is found in great concentrations in
blood, CSF and semen.
 Lower concentrations have been found in tears,saliva,
breast milk, urine, cervical and vaginalsecretions.
 Also isolated from brain tissue, lymph nodes,bone
marrow cells andskin.
 Howeveronly blood and semen are known totransmit
thevirus.
10Kuldeep Vyas M.Sc. CHN

11. HIV in Body Fluids
Semen
11,000 Vaginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids
11Kuldeep Vyas M.Sc. CHN

12. Host
 Age- Mostcasesareamong sexuallyactivepeopleaged
between age 20- 49years.
 High riskgroups-
Male homosexuals, hetero sexual partners, i.v. drug
abusers, blood transfusion recipients, haemophiliacs
and patients having STDs.
12Kuldeep Vyas M.Sc. CHN

13. 13
HIV Transmission
 HIV enters the bloodstreamthrough:
Open Cuts
Breaks in theskin
Mucous membranes
Direct injection
Kuldeep Vyas M.Sc. CHN

14. Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female orvice versa
Female-to-female
Blood Exposure: Injecting drug use/needlesharing
Occupational exposure
Transfusion of blood products
Perinatal: Transmission from mother tobaby
Breastfeeding
14Kuldeep Vyas M.Sc. CHN

15. 15
Routes of Transmission of HIV
Occupational Transmission
Health care worker/ hospitalstaff
Laboratory workers
Otherroutes
Organ transplantation
Artificial insemination
Needle-prick
Kuldeep Vyas M.Sc. CHN

16. Incubation Period
 The incubation period is from HIV infectiontill
development of AIDS.
 It is from a few months to 10 yearsoreven more.
 However it is estimated that 75% of people infected
with HIV will developAIDS at theend of 10 years.
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17. 17
HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus
Kuldeep Vyas M.Sc. CHN

18. Clinical Manifestations
I] Initial Infection
II] Asymptomatic CarrierState
III] AIDS-related Complex(ARC)
IV] AIDS
18Kuldeep Vyas M.Sc. CHN

19. I] Initial Infection
 Except fora generally mild illnessof fever, sore throat
and rash, which about 70% of the peopleexperience a
few weeks after the initial infection; Most HIV –
infected people have no symptoms for the first five
years.
 However they can infect others, Once, infectedthe
people a infected forlife.
 Antibody Response usually takes 2-12 weeks to appear
in the blood stream. This period is called ‘the window
period’. (Tests- Negative)
19Kuldeep Vyas M.Sc. CHN

20. 20
HIV Infection And Antibody Response
6 month ~ Years ~ Years ~ Years ~ Ye
Virus
Antibody
Infection
Occurs
AIDS Symptoms
Initial Stage---------------- --------Intermediate or Latent Stage-----------------Illness Stage
Flu-like Symptoms
Or
No Symptoms Symptom-free
<
----
Kuldeep Vyas M.Sc. CHN

21. 21
The Acute HIV Syndrome
Follows 3-6 wks following primary infection
Kuldeep Vyas M.Sc. CHN

22. Asymptomatic Carrier State
 Infected peoplewith antibodies butwithoutanyovert
signs of the disease, except persistent generalized
lymphadenopathy.
 It is howevernot firmlyclearabout how long does the
asymptomatic stagelasts.
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23. AIDS-Related Complex
 Has illnesses caused by damage to immune system,
butwithout theopportunistic infectionsand cancers
associated withAIDS.
 They mayexhibit-
Unexplained diarrhea(lasting more than a month),
fatigue, malaise, loss of body weight(>10%), fever,
night sweats.
Signs of Mild infections like oral thrush, generalized
lymphadenopathy, enlarged spleen.
23Kuldeep Vyas M.Sc. CHN

24. 24
Common manifestation of AIDS
Lung infection:
P.Cariniipneumonia
Gastrointestinal infection:
candidiasis of mouth
or oesophagus
Skin infection: Kaposi’s
sarcoma - red or violet
macules or papules
Central nervous
System Infection:
Toxoplasmosis
Dementia
Meningitis
Primary CNS Lymphomas.
Progressive Multifocal
Leucoencephalopathy.
Kuldeep Vyas M.Sc. CHN

25. 25
Source: NACO
Opportunistic Infections Among Reported AIDS Cases in India
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26. 26
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27. 27
Kaposi sarcoma
Candidiasis Of Mouth
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28. Swollen parts of the body
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29. Deterioration of the body tissues
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30. 30
Extreme Wt loss
Lymphadenopathy
Kuldeep Vyas M.Sc. CHN

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P.Carinii pneumonia
Primary CNS Lymphoma
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32. Causes/Contributors of HIV Risk
Structural Level
Resource Availability
Physical Environment
Organizational Systems
Laws/Policies
Individual Susceptibility
Macro Level
Racism, Stigma, Poverty, Gender Inequality, Migration
Community Level
Community Norms
Social Networks
Social Capital/Collective
Efficacy
Relationships
Individual Level
Behavior
Attitudes
Knowledge
Perceptions
Biology
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34. Primary
• Primary HIV prevention refers to activity focused on
preventing uninfected people becoming infected.
Secondary
• Secondary HIV prevention aimed at enabling people
with HIV to stay well (e.g. testing to allow people to
know their status; welfare rights advice; lifestyle
behaviour ; anti–discriminatory lobbying).
Tertiary
• Tertiary HIV prevention aims to minimise the effects
of ill–health experienced by someone who is
symptomatic with HIV disease (e.g. the prophylactic
use of drugs and complementary therapies )
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Kuldeep Vyas M.Sc. CHN

35. Diagnosis of HIV
• HIV antibody test – using different antigen &/ orwith
different principle of thetest
• Viral antigen test - used forscreening blood donors in
USA
• Detection of viral nucleic acid inblood.
• Determining the CD4 counts toassess thedisease
progression.
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36. Testing-
(Integrated Counseling & Testing ICTC centre
Centre)
 District Hospitals
 Medical colleges
 Free HIV testing
 Confidential counseling
 Referral to nearest ART (Anti Retroviral Therapy)
centre .
36Kuldeep Vyas M.Sc. CHN

37. ANTIRETROVIRAL DRUGS
NRTI NNRTI PI
Zidovudine (AZT)* Nevirapine(NVP)* Indinavir(IDV)*
Lamivudine (3TC)* Efavirenz(EFV)* Nelfinavir(NFV)*
Stavudine (d4T)* Delavirdine(DLV) Saquinavir(SQV)*
Didanosine (ddl)*
INTEGRASE
INHIBITORS Ritonavir(RTV)*
Zalcitabine(ddC)* Raltegravir Amprenavir(APV)
Abacavir(ABC)* CCR5 antagonists Lopinavir(LPV)*
Tenofovir(TFV)* Maraviroc Atazanavir(ATV)*
Emtricitabine(FTC) Foseamprenavir
MAMC- Feb2009
FusionInhibitor:Enfuvirtide(T-20)
* Available in India , available under national programme
Cost of Therapy reduced from Rs.30,000 in 1998 to Rs1000 per month in 2006, no. of pills from 32 to 1 or 2 per day,37Kuldeep Vyas M.Sc. CHN

38. PREVENTION
 Avoid multiple partners – useCondoms.
 Use sterile needles each time for injection
 Never share needles
 Avoid unnecessary blood transfusions
 All pregnant women should be testedfor
HIV
38Kuldeep Vyas M.Sc. CHN

39. Prevention
 Use standard work precautions – handhygiene,
personal protectivegear.
 Proper disposal of biomedicalwaste.
 Immunization againstHBV
 Education
39Kuldeep Vyas M.Sc. CHN

40. Occupational Exposure
HCW comes in contactwith potentially infectious body
fluids due to–
 A percutaneous injury ( needlestick, cutwith sharp
object)
 Contact with mucousmembrane
 Contactwith non intactskin (abraded, chapped,
dermatitis )
40Kuldeep Vyas M.Sc. CHN

41. Management of Exposure site
 Do notpanic
 Skin
 Wash wound & surrounding withsoap/water
 Rinsewell
 Do notscrub
 Do not use Antisepticor Skin washes
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42. Management of Exposure site
 Splash of Blood/OPIM
 Eye
 Eye irrigation with wateror Saline
 If using contact lens leave them in place while irrigating
.Removeonceeye is cleaned remove them & clean
 Mouth
 Spit fluid immediately
 Rinse mouth thoroughlywith water / saline repeatedly
 Do not use soap ordisinfectant
42Kuldeep Vyas M.Sc. CHN

43. PEP Prescription
 Contact ARTspecialist
 Decision of starting PEP based on Exposure type&
HIV status of source
 Decide PEP regimens
 Basic regimen
 Expanded regimen
2 drugcombination
3 drug combination
 If source person is on ART drugs expert should be
consulted after starting 2drugs
43Kuldeep Vyas M.Sc. CHN

44. Post Exposure Prophylaxis
 In India recommended for occupationalexposure
 It should be started as early as possible (within 72
hours)
 ARV is given for 4weeks
 HIV testing should be done at baseline, 6wks, 3mths &
6mths
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45. HIV from beinga
VIRTUAL DEATH SENTENCE
has been brought down to being a
CHRONIC MANAGABLE DISEASE
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46. Thank you!
46Kuldeep Vyas M.Sc. CHN