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  • Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade. Since its discovery, AIDS has caused an estimated 36 million deaths (as of 2012). As of 2012, approximately 35.3 million people are living with HIV globally.HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.


  • 1. Human immunodeficiency virus infection / acquired immunodeficiency syndrome(HIV/AIDS)
  • 2. What is AIDS? O AIDS or Acquired immunodeficiency syndrome is defined in terms of either a CD4+ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV (human immunodeficiency virus) infection.
  • 3. O During the initial infection, a person may experience a brief period of influenzalike illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumors that do not usually affect people who have working immune systems.
  • 4. O There is no cure for AIDS. However, there are new treatments that could slow down its progression. O There are about 33 million people in the world who have HIV/ AIDS.
  • 5. What is HIV? O HIV or human immunodeficiency virus is the virus that causes AIDS. O Since AIDS is an advanced form of HIV infection, everyone who has AIDS also has HIV.
  • 6. Unprotected sexual intercourse (including anal and oral sex) O Risk of transmission increases in the presence of many sexually transmitted infections and genital ulcers. O Genital ulcers appear to increase the risk approximately fivefold. O Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.
  • 7. Contaminated blood transfusions O The second most frequent mode of HIV transmission is via blood and blood products. Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment.
  • 8. Hypodermic needles
  • 9. From mother to child during pregnancy, delivery, or breastfeeding O HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk. This is the third most common way in which HIV is transmitted globally. In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%.As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%. Preventive treatment involves the mother taking antiretroviral during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. Many of these measures are however not available in the developing world. If blood contaminates food during pre-chewing it may pose a risk of transmission.
  • 10. O Some bodily fluids, such as saliva and tears, do not transmit HIV. O Prevention of HIV infection, primarily through safe sex and needle-exchange programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications from the disease, these medications are expensive and may be associated with side effects.
  • 11. What’s the difference between HIV and AIDS?
  • 12. Common diseases brought about by HIV as it progresses to AIDS: O Gastroenteritis (a digestive illness) O Encephalitis (inflammation of the brain) O Candidiasis (or thrush, a fungal infection of O O O O O the mouth or vagina) Meningitis Pneumonia Herpes Kaposi’s sarcoma(a kind of skin cancer) Tuberculosis
  • 13. This HIV/AIDS patient presented with a secondary acute oral pseudomembranous candidiasis infection.
  • 14. Candidiasis
  • 15. Transmission
  • 16. Virology O Two types of HIV: O HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more virulent, more infective and is the cause of the majority of HIV infections globally. O The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.
  • 17. Classifications of HIV infection O Two main clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease and the CDC classification system for HIV infection. The CDC's classification system is more frequently adopted in developed countries. Since the WHO's staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical purposes. O The World Health Organization first proposed a definition for AIDS in 1986.Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007. The WHO system uses the following categories:
  • 18. O Primary HIV infection: May be either asymptomatic or O O O O associated with acute retroviral syndrome. Stage I: HIV infection is asymptomatic with a CD4+ T cell count (also known as CD4 count) greater than 500 per microlitre (µl or cubic mm) of blood. May include generalized lymph node enlargement. Stage II: Mild symptoms which may include minor mucocutaneous manifestations and recurrent upper respiratory tract infections and CD4 count of less than 500/µl. Stage III: Advanced symptoms which may include unexplained chronic diarrhea for longer than a month, severe bacterial infections including tuberculosis of the lung and a CD4 count of less than 350/µl. Stage IV or AIDS: severe symptoms which include toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma. A CD4 count of less than 200/µl.
  • 19. O The United States Center for Disease Control and O O O O O Prevention also created a classification system for HIV, and updated it in 2008. This system classifies HIV infections based on CD4 count and clinical symptoms and describes the infection in three stages: Stage 1: CD4 count ≥ 500 cells/µl and no AIDS defining conditions Stage 2: CD4 count 200 to 500 cells/µl and no AIDS defining conditions Stage 3: CD4 count ≤ 200 cells/µl or AIDS defining conditions Unknown: if insufficient information is available to make any of the above classifications For surveillance purposes, the AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.
  • 20. Prevention
  • 21. Sexual contact O Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term. When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year.There is some evidence to suggest that female condoms may provide an equivalent level of protection. Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce infection rates by approximately 40% among African women. By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation. Circumcision in Sub-Saharan Africa“ reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007.
  • 22. Pre-exposure O Treating people with HIV whose CD4 count ≥ 350cells/µL with anti-retrovirals protects 96% of their partners from infection. This is about a 10 to 20 fold reduction in transmission risk. O Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. It may also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years. O Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV. Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programmes and opoid substitution therapy appear effective in decreasing this risk.
  • 23. Post-exposure O A course of anti-retrovirals administered within 48 to 72 hours after exposure to HIV-positive blood or genital secretions is referred to as post-exposure prophylaxis (PEP). The use of the single agent zidovudine reduces the risk of a HIV infection fivefold following a needle-stick injury. As of 2013, the prevention regimen recommended in the United States consists of three medications— tenofovir, emtricitabine and raltegravir—as this may reduce the risk further. O PEP treatment is recommended after a sexual assault when the perpetrator is known to be HIV positive, but is controversial when their HIV status is unknown. The duration of treatment is usually four weeks[and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea (24%), fatigue (22%), emotional distress (13%) and headaches (9%).
  • 24. Opportunistic infections O Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with anti-retrovirals reduces the risk of developing additional opportunistic infections. O Vaccination against Hepatitis A and B is advised for all people at risk of HIV before they become infected; however it may also be given after infection. O Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age and ceasing breastfeeding in infants born to HIV positive mothers is recommended in resource limited setting. It is also recommended to prevent PCP when a person's CD4 count is below 200 cells/uL and in those who have or have previously had PCP. O People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and Cryptococcus meningitis. Appropriate preventive measures have reduced the rate of these infections by 50% between 1992 and 1997.
  • 25. Management O There is currently no cure or effective HIV vaccine. Treatment consists of high active antiretroviral therapy (HAART) which slows progression of the disease[and as of 2010 more than 6.6 million people were taking them in low and middle income countries. Treatment also includes preventive and active treatment of opportunistic infections.
  • 26. Are there any medicines that can help an HIV positive person to delay AIDS?
  • 27. Vaccination O As of 2012 there is no effective vaccine for HIV or AIDS. A single trial of the vaccine RV 144 published in 2009 found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine. Further trials of the RV 144 vaccine are ongoing.
  • 28. Alternative medicine O In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine, even though the effectiveness of most of these therapies has not been established. With respect to dietary advice and AIDS some evidence has shown a benefit from micronutrient supplements. Evidence for supplementation with selenium is mixed with some tentative evidence of benefit. There is some evidence that Vitamin A supplementation in children reduces mortality and improves growth. Dietary intake of micronutrients at RDA levels by HIVinfected adults is recommended by the World Health Organization. The WHO further states that several studies indicate that supplementation of Vitamin A, Zinc, and Iron can produce adverse effects in HIV positive adults. There is not enough evidence to support the use of herbal medicines.
  • 30. HIV Test Performance
  • 31. REPUBLIC ACT NO. 8504 “Philippine AIDS Prevention and Control Act of 1998” O An act promulgating policies and prescribing measures for the prevention and control of HIV/AIDS in the Philippines, instituting a nationwide HIV/AIDS information and educational program, establishing a comprehensive HIV/AIDS monitoring system, strengthening the Philippine National AIDS Council and for other purposes. O A.K.A.
  • 32. Article I, Section 4 O HIV/AIDS Education in SchoolsThe Department of Education, Culture and Sports (DECS), the Commission on Higher Education (CHED) and the Technical Education and Skills Development Authority (TESDA) shall integrate instructions regarding the causes, modes of transmission and ways of preventing HIV/AIDS in subjects taught in public and private schools.
  • 33. Article II, Section 12 O Requirement on the Donation of Blood, Tissue or Organ- No laboratory or institution shall accept donation of tissue or organ unless the sample of the donor has been tested negative for HIV. All donated blood shall also be subjected to HIV Testing .
  • 34. Article II, Section 14 O Penalties for Unsafe Practices and Procedures- Any person who knowingly or negligently causes another to get infected with HIV through unsafe and unsanitary practice is liable to suffer a penalty of imprisonment from 6-12 years.
  • 35. Article V, Section 27 O AIDSWATCH- A comprehensive HIV/AIDS monitoring program under the DOH that monitors the magnitude and progression of HIV infection in the Philippines.
  • 36. Article VI, Section 30 O Medical ConfidentialityAll heath professionals and other custodian of any medical record, file, date and test results are directed to strictly observe confidentiality in the handling of all medical information particularly the identity and status of the persons with HIV. Any violation of medical confidentiality shall suffer 6 months to 4 years of imprisonment, suspension or revocation of license and cancellation to operate any business entity.
  • 37. Article VIII The Philippine National AIDS Council O The Philippine National AIDS Council created last December 3, 1992 oversees an integrated and comprehensive approach to HIV/AIDS prevention and control in the Philippines. O An amount of twenty million pesos (P 20, 000, 000) shall be initially appropriated out of the funds of the National Treasury to be provided in the annual budget of the DOH.