3. Acquired immunodeficiency syndrome
End stage of HIV infection
Synonym= SLIM DISEASE
1ST DISCOVERED IN 1981 SUMMER IN US
1983 – first isolated
African- American origin
India- 1st in Chennai sex worker in 1986
5. State
No. of ART
Centres
Total (Adult)
Total
(Paediatric)
Total
Andhra
Pradesh
31 60,328 3,304 63,832
Karnataka 33 36,220 3,003 39,223
Maharashtra 43 65,409 5,102 70,511
Tamil Nadu 36 36,947 2,439 39,586
Gujarat 9 12,765 669 13,678
Uttar Pradesh 10 10,039 594 10,633
Grand Total 2,81,453 18,889 3,00,743
6. World- 37 million people are living with AIDS
25 million have died of AIDS related disease
around the world
2009- 2.6 million people have been newly
infected
African countries have the highest prevalence
India- 2.5 million people infected as per
2007 report
Majority in Manipur
Regionally varied causes of infection
7. Human Immunodeficiency Virus- 1 &2
Family – Retroviridae
Subfamily – Lentiviruses
HIV-1- American population
HIV-2 – West African population
Many subspecies
India- HIV-1 C subtype
8. Cylindrical core
2 ss RNAs
Nucleocapsid - p24
Core- Reverse transcriptase p66 & p55
Envelope proteins- gp120 & gp41
RNA is bound to enzymes- RT, protease,
integrase & ribonuclease
2 layers of lipid membrane- PL taken human cell
membrane
11. 75% - sexual intercourse
15%- blood Drug abusers
Infected needle
Blood transfusion
10-20% Through placenta
During parturition
Breast milk
12. gp120 of virus binds with
CD4 molecule on the surface
of target cells (mostly TH cells)
AA 397-439 in gp120 & AA
16-84 of CD4 take part in the
binding
Macrophages, monocytes,
Langerhans cells, follicular
dendritic cells and glial cells
also susceptible
Monocytes / Macrophages –
act as the reservoir of the
virus
13. Very high rate
Over 10 billion particles/ day inside the
host
gp120 binds to CD4 cells (co-receptors
CCR5 & CXCR4) ↓
Conformation of viral envelope changes
↓
Fusion with host cell membrane
↓
gp41 penetrates plasma membrane
14.
15. HIV RNA uncoated and enters host cell
↓
RT catalyzes reverse transcription of ssRNA to
dsDNA
↓
Integrates to host cell DNA randomly with help
of Integrase
↓
Provirus may become active or remain latent
↓
Viral proteins synthesised, assembled & bud
out
18. Short, flu-like illness - occurs 1-6 weeks
after infection
no symptoms at all
Infected person can infect other people
p24 Ag only detectable
19.
20. Lasts for an average of 10 years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to very low
levels
HIV antibodies are detectable in the blood
For each AIDS patient, there are 100 seropositive
persons in population
21. The symptoms are mild
The immune system deteriorates
Without opportunistic infections and cancers
22. The immune system
weakens
The illnesses become
more severe leading to an
AIDS diagnosis
Usually death within 2
years
25. CD4+ T-cell count < 200 cells/µl (or a CD4+
T-cell percentage of total lymphocytes of less
than 15%)
OR
the patient has one of the defining illnesses
26. 1987 definition
Candidiasis of bronchi, trachea, or lungs
Candidiasis esophageal
Coccidioidomycosis, disseminated or
extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal for longer
than 1 month
Cytomegalovirus disease (other than liver, spleen
or lymph nodes)
Cytomegalovirus retinitis (with loss of vision)
Encephalopathy (HIV-related)
Herpes simplex: chronic ulcer(s) (for more than 1
month); or bronchitis, pneumonitis, or
esophagitis
Histoplasmosis, disseminated or extrapulmonary
Isosporiasis, chronic intestinal (for more than 1
month)
Kaposi's sarcoma
27. Lymphoma, Burkitt's
Lymphoma, immunoblastic (or equivalent term)
Lymphoma, primary, of brain
Mycobacterium avium complex or Mycobacterium
kansasii, disseminated or extrapulmonary
Mycobacterium, other species, disseminated or
extrapulmonary
Mycobacterium tuberculosis, any site
(extrapulmonary)
Pneumocystis jiroveci pneumonia (formerly
Pneumocystis carinii)
Progressive multifocal leukoencephalopathy
Salmonella septicemia (recurrent)
Toxoplasmosis of the brain
Tuberculosis, disseminated
Wasting syndrome due to HIV
28. Added in 1993
Cervical cancer (invasive)
Mycobacterium tuberculosis, any site
(pulmonary)
Pneumonia (recurrent)
Children < 13 years
Additional conditions are included for
children less than 13
Bacterial infections, multiple or recurrent
Lymphoid interstitial pneumonia or
pulmonary lymphoid hyperplasia complex
29.
30. ELISA- Ab against gp120
Confirmatory test- Western blot
Virus isolation- from cultured
lymphocytes
CD4 lymphocyte count
31.
32.
33. RT inhibitors- nucleoside analogues e.g. AZT,
Zalcytabine, Lamivudin
RT inhibitors- Non-nucleoside analogues e.g.
Nevirapine, Loviride
RT inhibitors- nucleotide analogues e.g. Adefovir
Protease inhibitors- Block final assembly &
package of HIV particles e.g. Sequinavir,
Ritonavir, Indinavir
Antisense therapy- Experimental stage
Pregnancy- Nevirapine
34. AIDS THEMES
1988 Communication
1989 Youth
1990 Women and AIDS
1991 Sharing the Challenge
1992 Community Commitment
1993 Act
1994 AIDS and the Family
1995 Shared Rights, Shared Responsibilities
1996 One World. One Hope.
1997 Children Living in a World with AIDS
1998 Force for Change: World AIDS Campaign With Young People
1999 Listen, Learn, Live: World AIDS Campaign with Children & Young People
2000 AIDS: Men Make a Difference
2001 I care. Do you?
2002 Stigma and Discrimination
2003 Stigma and Discrimination
2004 Women, Girls, HIV and AIDS
2005 Stop AIDS. Keep the Promise
2006 Stop AIDS. Keep the Promise – Accountability
2007 Stop AIDS. Keep the Promise – Leadership
2008 Stop AIDS. Keep the Promise – Lead – Empower – Deliver[18]
2009 Universal Access and Human Rights[19]
2010 Universal Access and Human Rights[20]
2011 Getting to Zero[21]
2012 Getting to Zero[22]
2013 Getting to Zero[17]
2014 Getting to Zero[17]
2015 Getting to Zero[17]
36. Consider blood, saliva and gingival fluid from
all dental patients as infective.
Use rubber dams in restorative dentistry
whenever possible
Report immediately suspect fluid exposure,
or a needle-stick or sharp injury to a
designated person because if post-exposure
chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours
after exposure.
37. Double gloves
All disposable material
Wear apron and visors
Sterilize instruments that can’t be disposed
off
Use absorbent paper towelling to remove
blood or saliva.
Use a medical grade disinfectant to disinfect
all potentially contaminated objects and
surfaces.
Follow safe work procedures as stated in the
material safety data sheets (MSDS) for
handling and disposal.
