AIDS Part-1 https://www.youtube.com/@Commedsimplified Introduction - Problem statement - HIV epidemics - SDG and UNAIDS Fast track strategy 90-90-90 -India- Key population affected - Epidemiology - Agent factors - Host factors - Immunology - Modes of transmission - Incubation period - Clinical stages - AIDS - Opportunistic infections

1. Dr Jazeela Mohamed Siddique
Senior Resident
Department of Community Medicine

2. INTRODUCTION
• AIDS – Acquired Immunodeficiency syndrome (or) slim disease
• Destroys body’s immune system  opportunistic infections
• No cure for HIV infection
• Last stage of HIV infection
• Modern pandemic

3. PROBLEM STATEMENT
• Early 1980s – emerging disease to 21st century global pandemic
• Increased access to effective treatment and prevention programmes

4. HIV Epidemics
HIV prevalence HIV prevalence
Defined sub-population Pregnant
Low level HIV
epidemic
Not consistently >5%
Concentrated HIV
epidemic
Consistently >5% in atleast 1/3rd <1%
Generalized HIV
epidemic
Consistently >1%
[WHO and UNAIDS]

5. Universal access to
effective HIV –
prevention, treatment,
care and support
HIV incidence

6. • SDG target
• UNAIDS Global strategy
90% PLHIV aware of their infection
90% aware HIV infection initiated ART
90% receiving ART have viral suppression

7. India

8. Key population affected in India
• Sex workers (FSW)
• Injecting Drug Users (IDUs)
• Hijras / Transgenders
• Migrant workers
• Truck drivers
• ANC attendees : proxy prevalence among general population
0.28
0.2
1.6
0.2
2.7
3.1
6.3
0 1 2 3 4 5 6 7
ANC
MIGRANTS
FSW
TRUCKERS
MSM
TG
IDU
HIV prevalence for ANC attendees and among different
high risk groups, India ,2017

9. Agent : Human Immunodeficiency Virus (HIV)
• HIV 1 / HIV 2
• Genus Lentivirus, ssRNA retrovirus
• Replicates in actively dividing T4 lymphocytes
• Remain in lymphoid cells in a latent state
• Destroy T4 helper cells
• Killed by heat
• Inactivated by ether, acetone, ethanol, betapropiolactone
• Resistant to ionizing radiation, UV rays
EPIDEMIOLOGICAL FEATURES
Agent factors

10. Reservoir of infection
• Cases and carriers
• Once infected, virus in body life long
• Symptomless for years
Source of infection
• Higher concentration : Blood, semen, CSF
• Lower concentration : tears, saliva, breast milk, urine, cervical and vaginal secretions
Agent factors

11. Age
• 20 – 49 years ; sexually active persons
Sex
• Homosexual or bisexual men in North America, Europe, Australia
• Sex ratio equal in Africa
High risk groups
• Male homosexuals and bisexuals, heterosexual partners (including prostitutes),
intravenous drug abusers, transfusion recipients, hemophiliacs, clients of STD
Host factors

12. • Overall WBC count
• T-helper to T suppressor cells ratio
• Lymphopenia (500/cu.mm)
• Neoplasms
• Opportunistic infections
• Inability to mount delayed hypersensitivity response
Immunology

13. Sexual transmission
• HIV epidemic in India – 67% of new cases
• Window period more infectious – levels of virus in blood high
Blood contact
• Transfusion of blood and products
• Needle sharing – IDUs
• Skin piercing – tattoo, ear piercing , acupuncture
Mother to child transmission
• Through placenta, delivery or breast feeding
Modes of transmission

14. • Uncertain – few months to 10 years
• Initial infection with the virus and development of antibodies
• Asymptomatic carrier state
• AIDS related complex
• AIDS
Incubation period
Clinical manifestations

15. Initial infection Mild illness (fever, sore throat, rash)
No symptoms – first 5 years
Highly infectious
Asymptomatic carrier state Infected people with antibodies
Persistent generalised lymphadenopathy
AIDS related complex Damage to immune system
Without opportunistic infections and cancers
≥1 clinical signs
• Unexplained diarrhoea lasting >1 month
• Fatigue, Malaise
• >10 % loss of body weight
• Fever, night sweats
• Milder opportunistic infections (oral thrush, generalised
lymphadenopathy, enlarged spleen)
• Patients from high risk groups with ≥2 signs and decreased
T lymphocytes  ARC

16. AIDS
• End stage of HIV infection
• Opportunistic infections
• Wasting syndrome / slim disease
• Tuberculosis – increasing link with HIV infection

17. 0
50
100
150
200
250
300
350
400
450
500
Absolute
CD4
lymphocyte
count
(/microL)
Relationship of CD4 count with development of opportunistic infections
Bacterial infections
Tuberculosis
Herpes simplex
Herpes zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposi’s sarcoma
Pneumocystosis
Toxoplasmosis
Cryptococcosis
Coccidiomycosis
Cryptosporidiosis Disseminated MAC infection
Histoplasmosis
CMV retinitis
CNS lymphoma

18. Telegram – t.me/Commedsimplified
YouTube – ComMed simplified
Slideshare Link : https://www.slideshare.net/JazeelaMohamedSiddiq