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Hiv transmission

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Hiv transmission

  1. 1. HIV Transmission
  2. 2. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable.
  3. 3. WHAT IS AIDS ???  “Acquired Immunodeficiency Syndrome”  HIV is the virus that causes AIDS  Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death.
  4. 4. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS.
  5. 5. “THE VIRAL GENOME” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.
  6. 6. Modes of HIV/AIDS Transmission
  7. 7. Through Bodily Fluids Blood products Semen Vaginal fluids
  8. 8. IntraVenous Drug Abuse Sharing Needles  Without sterilization Increases the chances of contracting HIV Unsterilized blades
  9. 9. Through Sex Unprotected Intercourse  Oral  Anal
  10. 10. Mother-to-Baby Before Birth During Birth
  11. 11. Myths about transmission
  13. 13. Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection  Mild symptoms  Infected person can infect other people
  14. 14. Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood
  15. 15. Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear.
  16. 16. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number.
  17. 17. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma
  18. 18. Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma
  19. 19. CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia
  20. 20. TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10- 30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : 1. Subnormal clinical and roentgen presentation 2. High rate of MDR/XDR 3. High rate of treatment failure and relapse (5% vs < 1% in HIV)
  21. 21. Testing Options for HIV
  22. 22. Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous
  23. 23. Blood Detection Tests HIV enzyme-linked immunosorbent assay (ELISA) Screening test for HIV Sensitivity > 99.9% Western blot Confirmatory test Speicificity > 99.9% (when combined with ELIZA) HIV rapid antibody test Screening test for HIV Simple to perform Absolute CD4 lymphocyte count Predictor of HIV progression Risk of opportunistic infections and AIDS when <200 HIV viral load tests Best test for diagnosis of acute HIV infection Correlates with disease progression and response to HAART
  24. 24. Urine Testing Urine Western Blot  As sensitive as testing blood  Safe way to screen for HIV  Can cause false positives in certain people at high risk for HIV
  25. 25. Oral Testing Orasure  The only FDA approved HIV antibody.  As accurate as blood testing  Draws blood-derived fluids from the gum tissue.  NOT A SALIVA TEST!
  26. 26. Treatment Options
  27. 27. HAART = highly active anti-retroviral treatment
  28. 28. Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors  AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors  Viramune (Nevirapine) Protease inhibitors  Norvir (Ritonavir)
  29. 29. HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:  CD4 counts every 3–6 months  Viral load tests every 3–6 months and 1 month following a change in therapy  PPD  INH for those with positive PPD and normal chest radiograph  RPR or VDRL for syphilis  Toxoplasma IgG serology  CMV IgG serology  Pneumococcal vaccine  Influenza vaccine in season  Hepatitis B vaccine for those who are HBsAb-negative  Haemophilus influenzae type b vaccination  Papanicolaou smears every 6 months for women
  30. 30. For HIV-infected individuals with CD4 < 200 cells/mcL:      Pneumocystis jiroveci1  prophylaxis     For HIV-infected individuals with CD4 < 75 cells/mcL:      Mycobacterium avium complex prophylaxis    For HIV-infected individuals with CD4 < 50 cells/mcL:      Consider CMV prophylaxis
  31. 31. PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades
  32. 32. Abstinence It is the most effective method of not acquiring  HIV/AIDS.  Refraining from unprotected sex: oral, anal, or  vaginal. Refraining from intravenous drug use
  33. 33. Monogamous relationship A mutually monogamous relationship with a  person who is not infected with HIV  HIV testing before intercourse is necessary to  prove your partner is  not infected
  34. 34. Protected Sex Use condoms every time you have  sex Always use latex or polyurethane  condom (not a natural skin  condom) Always use a latex barrier during  oral sex
  35. 35. When Using A Condom Remember To: Make sure the package is  not expired Make sure to check the   package for damages Do not open the package  with your teeth for risk of  tearing Never use the condom  more than once Use water-based rather  than oil-based condoms
  36. 36. HIV PREVALENCE IN VARIOUS REGIONS 4% 4% 3% 3% 2% 1% 1% 1% 18% Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42%
  37. 37. NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS 6% 5% 4% 2% 1% 1% <1% <1% 18% Sub-Saharan Africa South/South-East Asia East Asia Latin America Eurasia North Africa/Middle East Caribbean North America Western Europe Oceania Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63%
  38. 38. WHAT WE CAN DO?? UNAIDS Outcome Framework 2009–2011: nine priority areas  We can reduce sexual transmission of HIV.  We can prevent mothers from dying and babies from becoming infected with  HIV.  We can ensure that people living with HIV receive treatment.  We can prevent people living with HIV from dying of tuberculosis.  We can protect drug users from becoming infected with HIV.  We can remove punitive laws, policies, practices, stigma and discrimination  that  block effective responses to AIDS.  We can stop violence against women and girls.  We can empower young people to protect themselves from HIV.  We can enhance social protection for people affected by HIV.

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