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Dr. Nikhil Oza
Intern
BVDUMC
A presentation on-
AIDS
 Acquired immuno deficiency syndrome
 Fatal illness
 Caused by a retrovirus HIV
 It breaks down the body's immune...
Structure of HIV
4
Epidemiology
 Males>females
 Occurs in all ages and ethnic groups
 All areas of the country are affected
 AIDS is no...
5
AIDS Worldwide
AIDS
In
India
6
HIV- Agent
 It is a RNA virus
 Which replicates in actively dividing T4 lymphocytes.
 Unique ability to destroy T4 Help...
 Source – The virus is found in great concentrations in
blood, CSF and semen.
 Lower concentrations have been found in t...
11
HIV in Body Fluids
Semen
11,000 Vaginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV pa...
Host
 Age- Most cases are among sexually active people aged
between age 20- 49 years.
 High risk groups-
Male homosexual...
13
HIV Transmission
 HIV enters the bloodstream through:
Open Cuts
Breaks in the skin
Mucous membranes
Direct injection
14
Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female or vice versa
Female-to-female
Blood Exposure...
15
Routes of Transmission of HIV
Occupational Transmission
Health care worker/ hospital staff
Laboratory workers
Other rou...
Incubation Period
 The incubation period is from HIV infection till
development of AIDS.
 It is from a few months to 10 ...
17
HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus
Clinical Manifestations
I] Initial Infection
II] Asymptomatic Carrier State
III] AIDS-related Complex(ARC)
IV] AIDS
I] Initial Infection
 Except for a generally mild illness of fever, sore throat
and rash, which about 70% of the people e...
20
HIV Infection And Antibody Response
6 month ~ Years ~ Years ~ Years ~ Years
Virus
Antibody
Infection
Occurs
AIDS Sympto...
21
The Acute HIV Syndrome
Follows 3-6 wks following primary infection
Asymptomatic Carrier State
 Infected people with antibodies but without any overt
signs of the disease, except persistent...
AIDS-Related Complex
 Has illnesses caused by damage to immune system,
but without the opportunistic infections and cance...
24
Common manifestation of AIDS
Lung infection:
P. Carinii pneumonia
Gastrointestinal infection:
candidiasis of mouth
or o...
25
Source: NACO
Opportunistic Infections Among Reported AIDS Cases in India
26
27
Kaposi sarcoma
Candidiasis Of Mouth
Swollen parts of the body
Deterioration of the body tissues
30
Extreme Wt loss
Lymphadenopathy
31
P. Carinii pneumonia
Primary CNS Lymphoma
Causes/Contributors of HIV Risk
Structural Level
Resource Availability
Physical Environment
Organizational Systems
Laws/Po...
Primary
• Primary HIV prevention refers to activity focused on
preventing uninfected people becoming infected.
Secondary
•...
Diagnosis of HIV
• HIV antibody test – using different antigen &/ or with
different principle of the test
• Viral antigen ...
Testing-
 ICTC centre (Integrated Counseling & Testing
Centre)
 District Hospitals
 Medical colleges
 Free HIV testing...
ANTIRETROVIRAL DRUGS
NRTI NNRTI PI
Zidovudine (AZT)* Nevirapine(NVP)* Indinavir(IDV)*
Lamivudine (3TC)* Efavirenz(EFV)* Ne...
PREVENTION
 Avoid multiple partners – use Condoms.
 Use sterile needles each time for injection
 Never share needles
 ...
Prevention
 Use standard work precautions – hand hygiene,
personal protective gear.
 Proper disposal of biomedical waste...
Occupational Exposure
HCW comes in contact with potentially infectious body
fluids due to –
 A percutaneous injury ( need...
Management of Exposure site
 Do not panic
 Skin
 Wash wound & surrounding with soap/water
 Rinse well
 Do not scrub
...
Management of Exposure site
 Splash of Blood/OPIM
 Eye
 Eye irrigation with water or Saline
 If using contact lens lea...
PEP Prescription
 Contact ART specialist
 Decision of starting PEP based on Exposure type &
HIV status of source
 Decid...
Post Exposure Prophylaxis
 In India recommended for occupational exposure
 It should be started as early as possible (wi...
HIV from being a
VIRTUAL DEATH SENTENCE
has been brought down to being a
CHRONIC MANAGABLE DISEASE
Thank you!
HIV AIDS
HIV AIDS
HIV AIDS
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HIV AIDS

  1. 1. Dr. Nikhil Oza Intern BVDUMC A presentation on-
  2. 2. AIDS  Acquired immuno deficiency syndrome  Fatal illness  Caused by a retrovirus HIV  It breaks down the body's immune system, leaving the patient vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies.
  3. 3. Structure of HIV
  4. 4. 4 Epidemiology  Males>females  Occurs in all ages and ethnic groups  All areas of the country are affected  AIDS is now the second leading cause of death for all men aged 25-44 years  (Unintended injuries is #1 and heart disease is #3 for this age group)
  5. 5. 5 AIDS Worldwide
  6. 6. AIDS In India 6
  7. 7. HIV- Agent  It is a RNA virus  Which replicates in actively dividing T4 lymphocytes.  Unique ability to destroy T4 Helper cells  Reservoir- Once a person gets infected virus remains in his body lifelong. And the person is a symptomless carrier for years before the symptoms actually appear.
  8. 8.  Source – The virus is found in great concentrations in blood, CSF and semen.  Lower concentrations have been found in tears, saliva, breast milk, urine, cervical and vaginal secretions.  Also isolated from brain tissue, lymph nodes, bone marrow cells and skin.  However only blood and semen are known to transmit the virus.
  9. 9. 11 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
  10. 10. Host  Age- Most cases are among sexually active people aged between age 20- 49 years.  High risk groups- Male homosexuals, hetero sexual partners, i.v. drug abusers, blood transfusion recipients, haemophiliacs and patients having STDs.
  11. 11. 13 HIV Transmission  HIV enters the bloodstream through: Open Cuts Breaks in the skin Mucous membranes Direct injection
  12. 12. 14 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 Perinatal: Transmission from mother to baby Breastfeeding
  13. 13. 15 Routes of Transmission of HIV Occupational Transmission Health care worker/ hospital staff Laboratory workers Other routes Organ transplantation Artificial insemination Needle-prick
  14. 14. Incubation Period  The incubation period is from HIV infection till development of AIDS.  It is from a few months to 10 years or even more.  However it is estimated that 75% of people infected with HIV will develop AIDS at the end of 10 years.
  15. 15. 17 HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
  16. 16. Clinical Manifestations I] Initial Infection II] Asymptomatic Carrier State III] AIDS-related Complex(ARC) IV] AIDS
  17. 17. I] Initial Infection  Except for a generally mild illness of fever, sore throat and rash, which about 70% of the people experience a few weeks after the initial infection; Most HIV – infected people have no symptoms for the first five years.  However they can infect others, Once, infected the people a infected for life.  Antibody Response usually takes 2-12 weeks to appear in the blood stream. This period is called ‘the window period’. (Tests- Negative)
  18. 18. 20 HIV Infection And Antibody Response 6 month ~ Years ~ Years ~ Years ~ Years Virus Antibody Infection Occurs AIDS Symptoms Initial Stage---------------- --------Intermediate or Latent Stage----------------- Illness Stage Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----
  19. 19. 21 The Acute HIV Syndrome Follows 3-6 wks following primary infection
  20. 20. Asymptomatic Carrier State  Infected people with antibodies but without any overt signs of the disease, except persistent generalized lymphadenopathy.  It is however not firmly clear about how long does the asymptomatic stage lasts.
  21. 21. AIDS-Related Complex  Has illnesses caused by damage to immune system, but without the opportunistic infections and cancers associated with AIDS.  They may exhibit- Unexplained diarrhea(lasting more than a month), fatigue, malaise, loss of body weight(>10%), fever, night sweats. Signs of Mild infections like oral thrush, generalized lymphadenopathy, enlarged spleen.
  22. 22. 24 Common manifestation of AIDS Lung infection: P. Carinii pneumonia Gastrointestinal infection: candidiasis of mouth or oesophagus Skin infection: Kaposi’s sarcoma - red or violet macules or papules Central nervous System Infection: Toxoplasmosis Dementia Meningitis Primary CNS Lymphomas. Progressive Multifocal Leucoencephalopathy.
  23. 23. 25 Source: NACO Opportunistic Infections Among Reported AIDS Cases in India
  24. 24. 26
  25. 25. 27 Kaposi sarcoma Candidiasis Of Mouth
  26. 26. Swollen parts of the body
  27. 27. Deterioration of the body tissues
  28. 28. 30 Extreme Wt loss Lymphadenopathy
  29. 29. 31 P. Carinii pneumonia Primary CNS Lymphoma
  30. 30. Causes/Contributors of HIV Risk Structural Level Resource Availability Physical Environment Organizational Systems Laws/Policies Individual Susceptibility Macro Level Racism, Stigma, Poverty, Gender Inequality, Migration Community Level Community Norms Social Networks Social Capital/Collective Efficacy Relationships Individual Level Behavior Attitudes Knowledge Perceptions Biology
  31. 31. Primary • Primary HIV prevention refers to activity focused on preventing uninfected people becoming infected. Secondary • Secondary HIV prevention aimed at enabling people with HIV to stay well (e.g. testing to allow people to know their status; welfare rights advice; lifestyle behaviour ; anti–discriminatory lobbying). Tertiary • Tertiary HIV prevention aims to minimise the effects of ill–health experienced by someone who is symptomatic with HIV disease (e.g. the prophylactic use of drugs and complementary therapies ) 34
  32. 32. 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.
  33. 33. Testing-  ICTC centre (Integrated Counseling & Testing Centre)  District Hospitals  Medical colleges  Free HIV testing  Confidential counseling  Referral to nearest ART (Anti Retroviral Therapy) centre .
  34. 34. ANTIRETROVIRAL DRUGS 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) Foseamprenavir MAMC- Feb 2009 FusionInhibitor:Enfuvirtide(T-20) * Available in India , available under national programme 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,
  35. 35. PREVENTION  Avoid multiple partners – use Condoms.  Use sterile needles each time for injection  Never share needles  Avoid unnecessary blood transfusions  All pregnant women should be tested for HIV
  36. 36. Prevention  Use standard work precautions – hand hygiene, personal protective gear.  Proper disposal of biomedical waste.  Immunization against HBV  Education
  37. 37. 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 )
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. 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 done at baseline, 6wks, 3mths & 6mths
  42. 42. HIV from being a VIRTUAL DEATH SENTENCE has been brought down to being a CHRONIC MANAGABLE DISEASE
  43. 43. Thank you!
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