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AIDS

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AIDS stands for: Acquired Immune Deficiency Syndrome

AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections.

Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.3 million people living with HIV and AIDS worldwide.
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AIDS

  1. 1. *AIDS By-Dr.Mimosa Chatterjee http://www.pediatricdentists.blogspot.com/
  2. 2. Acquired Immuno Deficiency Syndrome INTRODUCTION: AIDS, the acquired immuno deficiency syndrome (some times called “ slim disease”) is a fatal illness caused by a retro virus known as human immuno deficiency virus (HIV) which breaks down the body’s immune system, leaving the victim vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies. Among the special feature of HIV infection are that once infected, probable that a person will be infected for life. Strictly speaking the term AIDS refers only to the last stage of the HIV infection. AIDS can be called our modern pandemic affecting both industrialized & developing countries.
  3. 3. Epidemiology*The first case of AIDS was detected in 1981 in USA & in India 1st case was detected in1986 in chennai. In 2004’ who estimated that there were 39.4 million people living with AIDS, 4.9 new infections & 3.1 million deaths. In India high prevalence states are MAHARASTRA, TAMIL NADU, KARNATAKA, ARUNACHAL PRADESH, MANIPUR & NAGALAND. Epidemiological feature Agent Host factor
  4. 4. EPIDEMIOLOGICAL FEATURES* 1) Agent Factor: when the virus was first identified, a FRENCH SCIENTEST called it lymphadenopathy-associated virus. Researchers in USA called it human T-cell lymphotropic virus III. In 1986, International committee of taxonomy gave it name HIV. HIV virus is spherical in shape with 100-140 nm in size. it has a core having core protein P24 &P18. It contains 2 stands of genomic RNA & a double layer of lipid membrane. The membrane is studded with 2 viral glycoprotein: gp120&gp41.the virus is able to spread through out the body. Two types of HIV- HIV1 & HIV2. Heat easily kills the virus. Readily get inactivated by ether, acetone, and ethanol but resistant to ionizing radiation & u-v radiation.a) Reservoir of infection: These are the case &carriers. Once person is a infected virus remains in body life long. HIV infection can take years to manifest it self.b) Source of infection: The virus has been found in greatest concentration in blood, semen &CSF &in lower concentration in tears, saliva, breast milk, urine &vaginal secretions. To date only blood & semen have been conclusively shown to transmit virus.
  5. 5. HIV Virus AIDS Virus
  6. 6. 2) Host factors(a) Age: 20-49yrs., children below 15 makes less than 3%(b) Sex: In North America, Europe &Australia about 70%arehomosexual or bisexual men. In Africa the sex ratio is equal.(c) High-risk groups: Male homosexual& bisexual, heterosexual partners, I.V drug abusers, transfusion recipients of blood & blood products, hemophiliacs.(d) Immunology: Immune system disorder occur primarily due to gradual depletion in CD4 cells. HIV selectively infects T-helper cells. Virus reproduce & infected T- helper cells are destroyed. There is overall low white blood cell count. There is profound lymphopenia with lymphocyte count below 500cmm. The alteration in T- cell function is responsible for development of neoplasm’s & opportunistic infections.
  7. 7. Pathogenesis* HIV infect CD4 immune cells chiefly T helper lymphocytes* Other cells like B-lymphocytes, monocytes, dendritic cells are also infected.* Glycoprotein GP120 present on surface has affinity for CD4 molecules present on surface of immune cells.* Co- receptor such as CXCR4 present on lymphocyte & CCR5 present on monocytes are also needed for binding.* HIV enters the cell.* Its genomic RNA is released in to cytoplasm & converted in to viral DNA by reverse transcriptase.* The viral DNA is integrated into host cells DNA & captures the genetic machinery of host cells.* This leads to rapid production of viral genome, which attains the shape of full virus with the help of protease enzyme
  8. 8. Pathogenesis of AIDS
  9. 9. Pathogenesis of AIDS
  10. 10. Mode Of Transmission* a) SEXUAL TRANSMISSION: It is first and fore most sexually transmitted disease.* b) PARENTRAL ROUTE:* i. BLOOD AND BLOOD PRODUCTS: Transmitted by contaminated blood transfusion of WBC, platelets & factor viii & ix.* ii. INJECTION &DRUG USERS* iii. OCCUPATIONAL INJURY* iv. EARPIERCING, TATTOING, ACUPUNCTURE.* C) MATERNAL-FOETAL TRANSMISSION: HIV can pass through an infected mother to her fetus, through placenta, during delivery or by breast-feeding.
  11. 11. CLINICAL MANIFESTATIONS* IT CAN BE CLASSIFIED IN TO FOUR BROAD CATEGORIES: -* 1. INITIAL INFECTION WITH THE VIRUS & THE DEVELOPMENT OF ANTIBODIES: - Except for a generally mild illness like fever, sore throat & rash about 70% of people have no symptoms for the first five years. They look healthy & well although they can transmit virus to others. Antibodies usually take between 2-12 weeks to appear in the blood stream.* 2. ASYMTOMATIC CARRIER STATE: Infected people have antibodies. Persistent generalized lymphadenopathy. It is not clear that how long this stage last.* 3. AIDS RELATED COMPLEX: - A person in this phase has illness caused due to immune system, but without the opportunistic infections but they exhibit one or more of the following clinical signs: - unexplained diarrhoea lasting longer then months, fatigue, malaise, loss of more than 10% body weight, fever, night sweats or other mild opportunistic infections such as oral thrush, generalized lymphadenopathy or enlarged spleen.* 4. AIDS: - AIDS is the end stage of HIV infection. A number of opportunistic infection commonly occurs at this stage. death is due to uncontrolled or untreated infections. There is significant decrease in CD4 count. Important opportunistic infections are tuberculosis, oroesophageal candidiasis, pneumonia etc.
  12. 12. Oral Manifestations1) Fungal 3) Viral· Candidiasis · Varicella zoster· Aspergillosis · Epstein-Barr including hairy leukoplakia· Histoplasmosis · HPV virus· Cryptococcus neoformans · CMV virus· Geotrichosis 4) Neoplasm2) Bacterial · Kaposi’s sarcoma· HIV gingivitis · Non-Hodgkin lymphoma· HIV periodontitis · Squamous cell carcinoma· Necrotizing gingivitis 5) Lymphadenopathy· Mycobacterium avium intracellulare 6) Neurologic disorders· Klebsiella pneumonia · Paraesthesia· Enterobacterium cloacae · Facial palsy· E.coli · Hyperesthesia· Salmonella enteritidis · Dysphagia· Sinusitis· Exacerbation of apical periodontistis· Submandibular cellulitis
  13. 13. Oral Manifestations7) Miscellaneous· Recurrent apthous ulceration· Progressive necrotizing ulceration· Toxic epidermolysis· Delayed wound healing· Thrombocytopenia Xerostomia & sicca type syndrome Herpes Simplex· HIV embryopathy· Hyperpigmentation· Granuloma annulare· Exfoliative cheilitis· Lichenoid & other drug Reaction
  14. 14. Diagnosis LABORATORYCLINICAL FINDINGS
  15. 15. DiagnosisClinical1) WHO CASE DEFINATION OF AIDS SURVEILLANCE: -An adult or adolescent is considered to have aids it at least 2 major &attest one minor signs are present & if these signs are not known to be dueto a condition unrelated to HIV infection. MAJOR MINOR Presence of either Kaposi sarcoma or cryptococcal meningitis –diagnosis of AIDS Wt loss > 10% of body Persistent cough for more for surveillance. weight than months Chronic diarrhoea for more Generalised pruritic than month dermatitis Prolonged fever for more H/o herpes zostor then one month Oropharyngeal candidiasis Generalized lymphadenopathy
  16. 16. Diagnosis2) Expanded WHO case definition for AIDS surveillance: -. HIV antibody test positive. One or more of the following condition present.1. WT LOSS > 10% OF BODY WEIGHT or cachexia with diarrhea orfever or both, intermittent or constant for at least 1 month.2. Cryptococcal meningitis3. Tuberculosis4. Kaposi sarcoma5. Neurological impairment6. Candidiasis of Oesophagus7. Recurrent episodes of Pneumonia8. Invasive cervical cancer
  17. 17. DiagnosisLABORATORY DIAGNOSISa) Screening test: ELISAb) Specific test: Western blotc) Non-specific test: anemia, leucopoenia, thrombocytopenia, andabsolute CD4 count.
  18. 18. Control Of AIDS1. Prevention:a. Education: Health education• Avoiding indiscriminate sex• Use of condoms• Avoid sharing razors and tooth brushes• Comprehensive sex education programmers in school.• Public awareness campaigns for HIV.• Educational material and guideline for prevention shouldbe made wide available.• All mass media channels should be involved in educatingthe people on AIDS, its nature of transmission & prevention.
  19. 19. Control Of AIDSb. Prevention of blood borne HIV transmission: People with high risk should be urged to refrain from donating blood,body organs, sperm or other tissues. All blood should be screened before transfusion Transmission of infection to haemophiliacs can be reduced byintroducing heat treatment of factor viii & ix.c. Strict sterilization practice in hospitals and clinicsd. Disposable needles and syringes should be usede. Universal precautions by health care workers.
  20. 20. Control Of AIDS2. ANTIRETROVIRAL TREATMENT: - It will not cure the disease but can prolong the life of severely ill patients. HIV infected with viral load > 5000-1000 or CD4 < 500/ul zidovudi Didanosin Zidovudine Zidovudine 1st lin ne Lami e Didanosine vudine Zalcitabine 1dt line treatment
  21. 21. Control Of AIDSIntolerance to regime Progression of diseases or viral load does not decrease by >.5 log with initiation of treatment or increase of viral load by >. 5log while onChange to alternative treatmentfirst line treatment 2nd line treatmentSaquinqv Ritonavi Indinavir Stavudin Stavudineir Zidov r Zidovudin e Lamiv Didnosinudine Zidovudi e udine e ne
  22. 22. Control Of AIDS Progression of diseases or viral load does not decrease by >.5 log with initiation of treatment or increase of viral load by >. 5log while on treatment3rd line treatment Saquinqvir Indinavir Nelfinavir Indinavir Zidovudine Zidovudine Zidovudine Didnosine Antiretroviral combination therapy
  23. 23. Control Of AIDS3. POST EXPOSURE PROPHYLACTIC TREATMENT:• It refers to anti retroviral drug therapy with in hrs. Following accidentalexposure to virus.• Following needle stick injury, the part should be thoroughly washed with soap& water. The injured finger should not be reflex to put in the mouth. Open woundsshould be irrigated with saline. Antiseptic agent can be applied but caustic agentsshould be avoided.• Following treatment is recommended by the US center for disease controland prevention for health care workers accidentally exposed to HIV: -• zidovudine( 200mg three times daily) +Lamivudine (150 mg twice daily) for4 weeks• if “ source individual have advance aids : Nelfinavir(750 mg 3 times daily)+zidovudine +lamivudine• if “ source” individual failed on zidovudine +lamivudine therapy thenstavudine +didanosine
  24. 24. Control Of AIDS4. PREVENTION OF INFECTION TO BABY BY HIV POSITIVE MOTHER: -a) zidovudine( 300mg three times daily) –to pregnant mothers from 10-12th week of pregnancy or immediately after diagnosis.b) During labour- zidovudine I.Vc) New born -Syrup zidovudine( three times daily for 6 weeks)d) Single dose of Neverpin (200 mg) at the time of labour.
  25. 25. Control Of AIDS6. PRIMERY HEALTH CARE: -* Because of its wide range of implication, AIDS touches all aspects of primary health care including mother & child health, Family planning & education.* It is important that AIDS control programmes should not be developed in isolation.* Integration in to country’s primary health care system is essential.
  26. 26. Conclusion Aids is caused by HIV virus which breaks down the body’s immune system leading to cause of opportunistic infections like tuberculosis, herpes simplex & zoster, hairy leukoplakia, pneumonia etc. Death in aids is actually because of opportunistic infections. Aids don’t pass on by: -• Sharing crockery and cutlery.• Touching, hugging or shaking hands.• Using same toilets.• Insect and animal bites• In can only pass on by having sex with infected person, from infectedblood and injections and infected mother to her child As it is said that mouth is the mirror of once health. Patient of aids have many oral manifestations.
  27. 27. ConclusionA wide increase in the awareness about this disease is required.Much advancement has now been made in field of science & medicine. Many types of therapy & drugs have been introduced but still then…………. We have not been able to cure AIDS Prevention is only cure for AIDSIn the present day awareness campaign through multimedia has made easy the efforts to reach large segment of people. The print medias, electronic media, press campaign holds the key to successA massive media campaign was launched by NACO in 1996, through well defined generic materials, posters, pamphlets, booklets, newspapers, advertisement, film clippings, TV spots, wall paintings and cinema slides were prepared in Hindi and all regional languages.
  28. 28. ConclusionEthics/moral duty of a doctor towards HIV ve patient• He should educate the patient• He should never refuse treatment to HIV positive patient. A dentistwho refuses treatment is in violation of law and subject to penalties. Every year on 1st December world AIDs day is celebrated
  29. 29. Thank you http://www.pediatricdentists.blogspot.com/

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