Dr.N.Bayapa Reddy MBBS,(MD)Dept.of Community MedicineS.V.Medical CollegeTirupati (AP)- 517507 INDIA :Dr.N.Bayapa Reddy MBBS,(MD)Dept.of Community MedicineS.V.Medical CollegeTirupati (AP)- 517507 INDIA


Slide 2:HIV / AIDS


Is the HIV / AIDS same Also called Slim Disease :Is the HIV / AIDS same Also called Slim Disease


HIV :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 :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 :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 :New HIV Infections in 2006 by Age Group


Outline :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


Slide 9:A global view of HIV infection, 2005 Source: UNAIDS 2006 Report on the Global AIDS Pandemic 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


Slide 10:Ecological Model for HIV Risk Individual Risks for HIV Infection Widening Risk Contexts for HIV Infection Condom Usage, Circumcision, HSV-2/GUD, Viral Load, Acute Infection, Age of Coital Debut, Marriage, ARV Status HIV Epidemic Stage Human Rights Contexts, The Condom Gap, Sexual Health Education Autonomy of Women and Girls, Stigma, Mobility, VCT Access, Sexual Norms and Beliefs, ARV Access Intimate Partner Violence, STI, Labor Migration Condom Usage, Concurrent Partnerships


Agent factors :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 :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 :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 :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 :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 :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


Incubation period :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 :Pathogenesis of HIV / AIDS Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus


Window Period :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 :HIV Infection and Antibody Response Infection Occurs AIDS Symptoms ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----


Four Stages of HIV :Four Stages of HIV


Stage 1 - Primary :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 :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 :Stage 3 - Symptomatic The symptoms are mild The immune system deteriorates emergence of opportunistic infections and cancers


Stage 4 - HIV  AIDS :Stage 4 - HIV  AIDS The immune system weakens The illnesses become more severe leading to an AIDS diagnosis


Opportunistic Infections associated with AIDS :Opportunistic Infections associated with AIDS Bacterial Tuberculosis (TB) Strep pneumonia Viral Kaposi Sarcoma Herpes Influenza (flu)


Opportunistic Infections associated with AIDS :Opportunistic Infections associated with AIDS Parasitic Pneumocystis carinii Fungal Candida Cryptococcus


Modes of HIV/AIDS Transmission :Modes of HIV/AIDS Transmission


Through Bodily Fluids :Through Bodily Fluids Blood products Semen Vaginal fluids Breast Milk


Through IV Drug Use :Through IV Drug Use Sharing Needles Without sterilization Increases the chances of contracting HIV


Through Sex :Through Sex Intercourse (penile penetration into the vagina) Oral Anal Digital Sex


Mother-to-Baby :Mother-to-Baby Before Birth During Birth Postpartum After the birth


Testing Options for HIV :Testing Options for HIV


Importance of Early Testing and Diagnosis :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 :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 :Administration Blood Urine Oral


Blood Detection Tests :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 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 :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!


Slide 42:EIA/ELISA Test Positive Negative Run IFA Confirmation Repeat Positive Positive End Testing Repeat ELISA Every 3 months for 1 year Negative Positive Negative Indeterminate Repeat at 2-4 months Repeat at 3 weeks HIV Testing No HIV Exposure Low Risk HIV Exposure High Risk Negative HIV + Repeat every 6 months for continued High risk behavior


Counseling :Counseling


Pre-test Counseling :Pre-test Counseling Transmission Prevention Risk Factors Voluntary & Confidential Reportability of Positive Test Results


Post-test Counseling :Post-test Counseling Clarifies test results Need for additional testing Promotion of safe behavior Release of results


Treatment Options :Treatment Options


Antiretroviral Drugs :Antiretroviral Drugs Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)


Opportunistic Infection Treatment :Opportunistic Infection Treatment Issued in an event where antiretroviral drugs are not available


Prevention and control of HIV :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? :Four ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles


Abstinence :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 :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 :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 CondomRemember To: :When Using A CondomRemember 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 :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 :Needle Exchange Program Non-profit Organization, which provides sterile needles in exchange for contaminated ones


HIV Post Exposure Prophylaxis :HIV Post Exposure Prophylaxis


HIV Occupational Exposure :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 :HIV Non-Occupational Exposure 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 PREVENTION --- FIRST


Slide 64:Why the world needs an AIDS vaccine


Slide 66:ANY QUestions?


Thank You! :Thank You!