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  • High prevalence in South …… High vulnerabilities in the North Loss of all HDI gains -- if action is not taken

Transcript

  • 1. Introduction to HIV/AIDS M O D U L E 1
  • 2. Module 1: Outline
    • Session 1: Scope of the HIV/AIDS Pandemic
    • Session 2: Natural History and Transmission of HIV
  • 3. Module 1: Objectives
    • After completing this module, the participants will be able to:
      • Describe the global and local impact of the epidemic
      • Answer basic questions about HIV/AIDS in adults, children, and families
      • Describe the natural history of HIV infection
      • Describe the modes of HIV transmission
  • 4.
    • Scope of the HIV/AIDS Pandemic
    S E S S I O N 1
  • 5. Scope of the HIV/AIDS Pandemic
  • 6. Global HIV/AIDS in 2004*
    • Effect on Children
    • 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 2004
    • * Source: UNAIDS,2004
  • 7. Estimated Number of Adults Infected with HIV, according to the Region, 1980 through 2003
  • 8. HIV/AIDS Pyramid (2001)
    • Reported AIDS cases
    • (15,202)
    • Estimated AIDS cases
    • (219,400)
    • People living with
    • HIV/AIDS (2.2 million)
    • Key message:
    • Only a small number of PLWHA are reported
  • 9. Impact of Global HIV
    • Global outcomes of the HIV pandemic
      • Negative economic impact on countries
      • Overwhelmed healthcare systems
      • Decreasing life expectancy
      • Deteriorating child survival rates
      • Increased numbers of orphans
  • 10. 2003 5.1 m 5.1 m. Indian living with HIV
  • 11. HIV Estimates in India                                    
  • 12. New Challenges…...New Opportunities HIV + U5MR
  • 13. Adult HIV Prevalence High Prevalence States
  • 14. Karnataka 0 1 2 3 4 5 1998 1999 2000 2001 2002 2003 % HIV prevalence Year * Data from consistent sites Median HIV prevalence in ANC population in AP, Karnataka, Maharashtra and Tamil Nadu, India, 1998−2003* Source: National AIDS Control Organization Andhra Pradesh Maharashtra Tamil Nadu 2004 Report on the Global AIDS Epidemic
  • 15. HIV
    • H uman I mmunodeficiency V irus
    • H = Infects only H uman beings
    • I = I mmunodeficiency virus weakens the immune system and increases the risk of infection
    • V = V irus that attacks the body
  • 16. AIDS
    • A cquired I mmune D eficiency S yndrome
    • A = A cquired, not inherited
    • I = Weakens the I mmune system
    • D = Creates a D eficiency of CD4+ cells in the immune system
    • S = S yndrome, or a group of illnesses taking place at the same time
  • 17. 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
  • 18. 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
  • 19. HIV-1 and HIV-2
    • Differences between 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
  • 20. Introduction to HIV/AIDS
    • Session 2
    • Natural History and Transmission of HIV
  • 21. 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
  • 22. Transmission of HIV HIV is not transmitted by
    • Public baths
    • Handshakes
    • Work or school contact
    • Using telephones
    • Sharing cups, glasses, plates, or other utensils
    • Coughing, sneezing
    • Insect bites
    • Touching, hugging
    • Water, food
    • Kissing
  • 23. Mode of Transmission among AIDS cases in India: December 2004 (n=96978)
  • 24. MTCT in 100 HIV+ Mothers The majority of children do not get infected even when we do nothing 0 10 20 30 40 50 60 70 80 90 100 # uninfected # infected during BF for 2 yrs # infected during delivery #infants infected during pregnancy 63 uninfected 15 15 7
  • 25. Risk of PTCT Transmission
    • Globally: 15-45%
    • India : 30-37% ( average)
  • 26. 0 20 40 60 80 100 Bihar Gujarat Uttar Pradesh Urban Male Urban Female Rural Male Rural Female % Source: National AIDS Control Organization, National Baseline General Population Behavioural Surveillance Survey 2001 Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact, Selected States in India 2004 Report on the Global AIDS Epidemic
  • 27. 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
  • 28. 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
    • Provide referral for treatment of drug dependence
    • Apply the comprehensive PPTCT approach to prevent vertical transmission of HIV
  • 29. Rationale for PPTCT in India 27 million pregnancies per year 1,62,000 infected pregnancies Cohort of 55,425 infected newborns per year 0.6% prevalence 30% transmission Most of these children die within 2-5 years
  • 30. Natural History of HIV Infection
  • 31. 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
  • 32. Natural History of HIV Infection
    • Immune suppression
      • HIV attacks white blood cells,called CD4 cells, that protect body from illness
      • Over time, the body’s ability to fight common infections is lost
      • Opportunistic infections occur
  • 33. 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
  • 34. 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
  • 35. 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)
  • 36. HIV Disease
    • Direct infection of organ systems
      • HIV can directly infect the:
      • Brain (HIV dementia)
      • Gut (wasting)
      • Heart (cardiomyopathy)
  • 37. HIV Disease _______________Head__________________ Toxoplasmosis (Toxo) Cryptococcal meningitis _______________Eyes__________________ Cytomegalovirus (CMV) ___________Mouth and Throat__________ Candidiasis (Yeast) ________________Lungs________________ Pneumocystis carinii pneumonia (PCP) Tuberculosis (TB) Histoplasmosis _________________Gut_________________ Cytomegalovirus (CMV) Cryptosporidiosis Mycobacterium avium complex (MAC) ________________Skin_________________ Herpes simplex Shingles _______________Genitals______________ Genital herpes Human papillomavirus (HPV) Vaginal candidiasis (Yeast)
  • 38. 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
  • 39. Module 1: 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.
  • 40. Module 1: 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 with an infected male partner.
      • 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 PPTCT programs