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HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
HIV and AIDS - Facts, Prevention and Treatment
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HIV and AIDS - Facts, Prevention and Treatment

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HIV and AIDS can be prevented by having some awareness in this regard.

HIV and AIDS can be prevented by having some awareness in this regard.

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  • Trainer Notes: The slide shall be used to emphasise the new classification based on district wise ANC prevalence rates rather than state wise prevalence as before. The trainer may use a pointer to show the different ANC prevalence rates as per the colour codes.
  • Trainer Notes: Initiation of free ART services was made in April 2004. At the end of NACP III (March, 2012), it was planned to have 250 ART centres in the country to take care 3.4 lakh PLHIV, including 40,000 children By end of March 2011, the country had 300 ART centres providing care and support to more than 4 lakh PLHIV; that includes 22,000 CLHIV.
  • Transcript

    • 1. HIV / AIDS Dr Jaya Chakravarty Assistant Professor Department of Medicine IMS, BHU
    • 2. Introduction • In 1981- CDC reported PCP pneumonia & kaposi’s sarcoma in homosexual males. • In 1983- Human immunodeficiency virus was isolated. • In 1984- HIV virus was shown to be the causative agent. • In 1985- ELISA was developed to diagnose HIV infection. • In 1987- First drug Zidovudine produced
    • 3. HIV/ AIDS – Indian scenario • The first AIDS case in India was detected in 1986 • Till 2005 around 5.2 million people were estimated to be living with HIV in India. • In 2007-People living with HIV/AIDS2.31million • Third highest burden in the world • Adult (15 years or above) HIV prevalence 0.34%
    • 4. District-wise Scenario of HIV/AIDS Category / Districts A B C D 156 NACP-III Definition >1% ANC prevalence in any of the sites in the last 3 years 39 <1% ANC prevalence in all the sites during last 3 years with >5% prevalence in any HRG site (STD/FSW/MSM/IDU) 296 <1% ANC prevalence in all sites during last 3 years with <5% in all STD clinic attendees or any HRG, with known hot spots 118 <1% ANC prevalence in all sites during last 3 years with <5% in all STD clinic attendees or any HRG OR no or poor HIV data with no known hot spots New Districts: 30 Total Districts: 609 National AIDS Control Programme 13
    • 5. Modes of HIV Transmission Sharing Semen and Vaginal Fluids Through Infected Blood Natural Staging and Clinical History of HIV Sharing Needles & Syringes Needle Stick Injury During Pregnancy or Birth Breast Feeding 6 Images Courtesy HIV Basics Course for Nurses, I-TECH
    • 6. HIV Transmission Risk Exposure Route HIV Transmission Blood transfusion Perinatal 90-95% 20-40% Sexual intercourse Vaginal Anal Oral Injecting drugs use Needle stick exposure Mucous membrane splash to eye, oro-nasal Natural Staging and Clinical History of HIV 0.1 to 10% 0.05-0.1% 0.065-0.5% 0.005-0.01% 0.67% 0.3% 0.09% Source: NACO PEP Guidelines 7
    • 7. Human Immunodeficiency virus • HIV is a RNA virus. • HIV-1 is more common worldwide • HIV-2 is restricted to West Africa. • The virus has an enzyme reverse transcriptase which transcribes the RNA genome to double stranded DNA and is incorporated into host cell. • The target for HIV is the CD-4+ Helper T-Cells, which are the backbone of the immune system.
    • 8. Structure of HIV
    • 9. HIV Lifecycle
    • 10. How HIV affects our body Virus enters the immune cells (CD4 cells) ↓ Gets integrated to the cells nucleus ↓ Replicates inside the cells ↓ Ultimately destroys the immune cells ↓ Immunodeficiency ↓ Multiple infections
    • 11. Is HIV & AIDS the same thing? Acute seroconversion (2-3 wks) ↓ Asymptomatic HIV (8-10 yrs) ↓ Symptomatic HIV ↓ Acquired immuno deficiency syndrome (AIDS) – Severe immunosuppression associated with opportunistic infection.
    • 12. Typical Course of Untreated HIV Infection Acute HIV 800 10^6 HIV antibodies Asymptomatic CD4 count cells/µl Minor HIV-related symptoms Virologic set-point Varies from patient to patient 200 1 3 about 6mths // HIV RNA Copies /ml Opportunistic infections 10^2 5yrs 10 yrs † Time Source: NACO
    • 13. Opportunistic Infections Among Reported AIDS Cases in India Source: NACO Approach to OIs: Fever and Respiratory Infections 16
    • 14. When should you suspect HIV? • Persistent fever • Persistent loose stool • Weight loss • High Risk - in a high risk population Female sex workers MSM(men having sex with men) Intravenous drug abuse Sexually transmitted disease Migrant population H/o blood transfusion
    • 15. Diagnosis of HIV • HIV antibody test – using different antigen &/ or with different principle of the test • Viral antigen test - used for screening blood donors in USA • Detection of viral nucleic acid in blood. • Determining the CD4 counts to assess the disease progression.
    • 16. Where should you get yourself tested? • ICTC centre (Integrated Counseling & Testing Centre) – District Hospitals – Medical colleges • Free HIV testing • Confidential counseling • Referral to nearest ART (Anti Retroviral Therapy) centre ,DOTS,PPTCT, STD.
    • 17. Is HIV curable? • NO, HIV is treatable but not curable. • Anti retroviral (ARV) drugs suppress the virus and improve immune status. However, the patient remains HIV positive for life and can transmit the disease to others.
    • 18. What is ART ? • Anti-retroviral therapy (ART) is a combination of least three drugs from different groups. at • It works to control HIV replication in the body and prevent the destruction of CD4 Cells. Hence it delays disease progression, prevents OIs, reduces hospitalization, reduces transmission of HIV. • ART increases survival & quality of life. • It is a life long therapy, requires high adherence, similar to treatment taken for high BP and diabetes. • They have certain side-effects should be prescribed by specialized physicians .
    • 19. Why should I get tested/treated if there is no cure? Early diagnosis • Early treatment of opportunistic infection • Improved survival • Better quality of life • Start of ARV at the appropriate time • Decreased chance of transmission of HIV to others.
    • 20. TREATMENT • All HIV +ve patients do not require T/t immediately. • T/t is started depending on the patients level of immunosuppression. • Degree of immunosuppression depends on patients CD4 count. • Even if they do not require T/t they need to be followed up regularly.
    • 21. Where are ARV drugs available ? • ART programme started on 1st April 2004 at 8 institutions • Target under NACP-III: 300 Centres functioning • Currently, 4.07 lakh PLHIV including 22,000 children alive and on treatment • ART centers – Provides free ARV drugs – Free drugs for OI – Counseling As on March 2011 National AIDS Control Programme 36
    • 22. 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) Fusion Inhibitor: Enfuvirtide (T-20) ANTIRETROVIRAL DRUGS Foseamprenavir * Available in India , available under national programme MAMC- Feb 2009 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,
    • 23. PREVENTION • Avoid multiple partners – use CONDOMS • Use sterile needles each time for injection • Never share needles • Avoid unnecessary blood transfusions • Never buy blood from professional donors. • Donate blood • All pregnant women should be tested for HIV
    • 24. Prevention • Use standard work precautions – hand hygiene, personal protective gear. • Proper disposal of biomedical waste. • Immunization against HBV • Education
    • 25. Potentially Infectious Body Fluid Exposure to body fluid considered “at risk” Exposure to body fluid considered “not at risk” Blood Tear Semen Sweat Vaginal Secretion Urine / Faeces CSF Saliva Synovial, Pleural, Pericardial, Peritoneal fluid Sputum Amniotic fluid Vomitus Any body fluid contaminated with “visible blood” shall be considered “at risk” PEP
    • 26. Occupational Exposure HCW comes in contact with potentially infectious body fluids due to – • A percutaneous injury ( needle stick, cut with sharp object) • Contact with mucous membrane • Contact with non intact skin (abraded, chapped, dermatitis ) PEP
    • 27. Relative Risk of Seroconversion with Percutaneous Injury Seroconversion % 50 AZT + 3TC 50% 40 30 30% 20 10 2% 0.3% 0 HIV HCV HBsAg+ HBeAg-HBsAg+ HBeAg+ Source: CDC. MMWR 2001; 50 (RR11): 1-42 PEP
    • 28. Management of Exposure site • Do not panic • Skin – Wash wound & surrounding with soap/water – Rinse well – Do not scrub – Do not use Antiseptic or Skin washes PEP
    • 29. Management of Exposure site • Splash of Blood/OPIM – Eye • Eye irrigation with water or Saline • If using contact lens leave them in place while irrigating .Remove once eye is cleaned remove them & clean – Mouth • Spit fluid immediately • Rinse mouth thoroughly with water / saline repeatedly • Do not use soap or disinfectant PEP
    • 30. PEP Prescription • Contact ART specialist • Decision of starting PEP based on Exposure type & HIV status of source • Decide PEP regimens – Basic regimen 2 drug combination – Expanded regimen 3 drug combination • If source person is on ART drugs expert should be consulted after starting 2 drugs PEP
    • 31. Post Exposure Prophylaxis • In India recommended for occupational exposure • It should be started as early as possible (within 72 hours) • ARV is given for 4 weeks • HIV testing should be baseline, 6wks, 3mths & 6mths done at
    • 32. What is the risk for environmental transmission of HIV? – No environmental transmission reported – HIV inactivated quickly outside the body – HIV does not multiply outside the body – Infectivity is lost quickly after fluid dries PEP
    • 33. MYTHS • HIV is not transmitted by mosquito bites or bites of other insects. • Not transmitted through casual every day contact. • Not transmitted from contact with non-bloody sweat, tears or urine. • HIV can affect people children, housewives etc. around you e.g.
    • 34. Take home message • HIV epidemic is spreading from high risk to low risk population. • Most important factor for spread is LACK OF KNOWLEDGE. • It is associated with social stigma and misconceptions. • HIV is no longer synonymous with death. • HIV is a preventable disease, so TAKE PRECAUTIONS.
    • 35. Universal Precautions Prevention is the key step! Always use protective gear Follow universal precaution PEP Consider all blood samples infectious Safe Handling of Sharps Use needle destroyer
    • 36. Where are ARV drugs available? • • • • • At ART centers established by NACO. 300 ART centers all over India, in U.P. ART center, IMS, BHU – established in 2005. 11000 registered HIV +ve patients. ART centers – Provides free ARV drugs – Free drugs for OI – Counseling
    • 37. ART Scale up in India ART Scale up 2004- 2009 250000 200 200000 150 150000 100 100000 50 50000 0 0 Months ART Centres No of Patients on ART Patients on ART No of ART Centres 250
    • 38. THE NATIONAL HIV TESTING POLICY • No mandatory HIV testing should be imposed as a precondition for – Employment – Providing health care services and facilities. • Any HIV testing must be accompanied by a pretest and post test counseling services (through ICTC) • Testing without consent – hindrance to the control of the epidemic
    • 39. Classes of ARV Drugs NRTI NNRTI PI Azidothymidine (AZT), Zidovudine Nevirapine (NVP) Indinavir (IDV) Lamivudine (3TC) Efavirenz (EFV) Nelfinavir (NFV) Stavudine (d4T) Delavirdine (DLV) Saquinavir (SQV) Integrase Inhibitors Didanosine (ddI) Ritonavir (RTV) Raltegravir Zalcitabine (ddC) Amprenavir (APV) Abacavir (ABC) Fosamprenavir CCR5 antagonists Emtricitabine (FTC) Lopinavir (LPV) Maraviroc NtRTI: Tenofovir (TFV) Atazanavir (ATZ) Fusion Inhibitor Enfuviritide (T-20) * The highlighted drugs are NOW available in the NACO ART program: AZT, 3TC, d4T, NVP and EFV Clinical Pharmacology of ARV Drugs 42
    • 40. Some facts about ART  ART has changed the outlook of HIV/AIDS from a ‘virtual death sentence’ to a ‘chronic manageable disease’.  1996 was watershed year for ART when PIs were introduced and the era of HAART came in.  The problems were high costs, large number of pills and side effects of these drugs.  Cost of Therapy reduced from Rs.30,000 in 1998 to Rs1200 per month in 2004 and Rs.550/- per month in 2005..  Over 20 drugs available world wide, 14 in India.  When ‘3 by 5’ initiative was launched, over 6 million people in developing countries were in need of ART, only 2,70,000 were getting it, and half of these were in one country (Brazil). MAMC- Feb 2009
    • 41. Testing strategies • Surveillance – ELISA by two different antigen preparations • Transfusion safety – Single ELISA. • Voluntary – 3 different ELISA/Rapid/Simple (E/R/S) by three different antigens. • Research – According to the specific objectives and decided by the researcher
    • 42. Testing strategies • Unlinked and anonymous – Surveillance • Voluntary and confidential Asymptomatic AIDS cases Research • Mandatory – Transfusion safety
    • 43. Regimen under National Programme-2006 Zidovudine / Lamivudine / Nevirapine Or Stavudine / Lamivudine / Nevirapine * Efavirenz in place of Nevarapine if coinfected with TB or side effects with NVP, Tenofovir under consideration for special situations only * The Zidovudine & Stavudine based combinations are procured in 50:50 proportion. * NVP & Efv are procured in 80:20
    • 44. Global summary of the AIDS epidemic Number of people living with HIV in 2007 • Total 33.2 million [30.6–36.1 million] • Adults 30.8 million [28.2–33.6 million] • Children under 15 years 2.5 million [2.2–2.6 million] People newly infected with HIV in 2007 • Total 2.5 million [1.8–4.1 million] • Adults 2.1 million [1.4–3.6 million] • Children under 15 years 420 000 [350 000–540 000] AIDS deaths in 2007 Total 2.1 million [1.9–2.4 million] • Adults 1.7 million [1.6–2.1 million] • Children under 15 years 330 000 [310 000–380 000]

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