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  1. 1. AIDSDr Naresh Gill,Assistant Professor,Dept of Community Medicine,Govt Grant Medical College,Byculla, Mumbai-08
  2. 2. Introduction AIDS- (Acquired Immuno-Deficiency Syndrome) also known as slim disease, caused by HIV infection. Last stage of HIV infection. Once infected, the person remains infected for the rest of his life. Immunity is low, host is vulnerable to life threatening infection. Modern pandemic- affecting both Industrialized and developing countries. Dr Naresh Gill, Dept of Community Medicine
  3. 3. Problem statement: World(2009)  World wide approximately 33.3 million population affected (People living with HIV/AIDS).  Every year 2.6 million people are newly infected with HIV  1.8 million deaths every year Dr Naresh Gill, Dept of Community Medicine
  4. 4. Types of HIV epidemics1. Low level HIV epidemics: Infection is largely confined to HRGs. HIV prevalence has not consistently exceeded 5% in any defined sub- population2. Concentrated HIV epidemics: HIV prevalence is consistently over 5% in at least one defined sub- population but is below 1% in pregnant women in urban areas. The future course of epidemic is determined by the frequency and nature of links between highly infected sub-populations and general population.3. Generalized HIV epidemics: HIV prevalence consistently over 1% in pregnant women. Dr Naresh Gill, Dept of Community Medicine
  5. 5. INDIA • CSW • IDU HRG • MSM • Client of sex workers, STD patients, • migrant population, Bridge • population in conflict areas and partners of drug usersPopulation • General population • Shift occurs when prevalence in first group is 5% General • Time lag of 2-3 yearsPopulation Dr Naresh Gill, Dept of Community Medicine
  6. 6. India:-Patterns of HIVepidemic ANC:- 0.49%  IDU: 9.2% STD: 2.5%  MSM: 7.4% Migrants: 3.61%  FSW:4.9% Trucker: 2.51%Trends of HIV infection indicates that it is spreadingin two ways:•Urban to rural population•HRG to General population Dr Naresh Gill, Dept of Community Medicine
  7. 7. India High • MH, TN,AP, KA, Manipur & Nagaland prevalence states • >5% in HRGs and >1% in Antenatal Women Moderate • Gujarat, Goa, Pondicherry prevalence states • >5% in HRGs but <1% in Antenatal women Lowprevalence • Remaining states states • <5% in HRGs and <1% in Antenatal women Dr Naresh Gill, Dept of Community Medicine
  8. 8. HIV Burden in India Estimated adult prevalence in Adults: 0.31% (2010) Majority of HIV infected persons belongs to 15-49 years age group (88.55%) 31.8% are in age group 15-29 years In Northern Eastern states principle cause of HIV epidemic is Injecting Drug Users. Tuberculosis is most common opportunistic infection and the leading cause of death among HIV infected people. Dr Naresh Gill, Dept of Community Medicine
  9. 9. Epidemiological features HIV 1 virus: most common cause of infection Retrovirus Rapidly killed by heat. Inactivated by ether, acetone and alcohol but resists Ionization Reservoir of infection are cases and carriers Source of infection: Blood, semen and CSF Dr Naresh Gill, Dept of Community Medicine
  10. 10. Host factor Most cases occur among the sexually active persons age group 20-49 years (84%) Children under 15 years make up for 3.9% 39% are women HIV prevalence more common in HRGs Dr Naresh Gill, Dept of Community Medicine
  11. 11. Transmission of Infection Heterosexual route: 87.1% Homosexual :1.5% Parent to child: 5.4% Injecting drug users: 1.6% Blood and blood products: 1.0% Dr Naresh Gill, Dept of Community Medicine
  12. 12. Clinical manifestation1. Initial Infection2. Asymptomatic carrier state3. AIDS-related complex4. AIDS Dr Naresh Gill, Dept of Community Medicine
  13. 13. Stage 1: Initial Infection After infection with HIV, 70% people have mild symptoms (Fever, sore throat and rashes). HIV antibodies usually take 2-12 weeks to appear in the blood stream. Window period: person is particularly infectious because of high viral load in the blood but he tests negative on standard antibody detection test. Diagnosis in window period:?? Dr Naresh Gill, Dept of Community Medicine
  14. 14.  Stage 2: Asymptomatic carrier state ◦ Antibodies are there but infected persons do not show any overt sign of infection, except PGL (Persistent Generalized Lymphadenopathy) Stage 3: AIDS- related complex ◦ Person have illnesses caused by damaged immune system but without the OI and cancers associated with AIDS. ◦ Unexplained diarrhea (>1 month) ◦ Loss of body weight (>10%) ◦ Fever, night sweat, fatigue and malaise ◦ Mild Ois such as oral thrush , generalized lymphadenopathy or enlargedGill, Dept of Community Dr Naresh spleen. Medicine
  15. 15. Stage 4: AIDS End stage of HIV infections Many OIs and Cancer specific to immuno- deficiency state occurs Also known as Slim disease because of presence of chronic diarrhea and weight loss. Most common opportunistic infection is TB, commonly extrapulmonary and sputum smear negative. Kaposi sarcoma, Oro-pharyngeal candidiasis, Cytomegalo Retinitis, Toxoplasma encephalitis, Hairy leukoplakia, Pneumocystis Carini Pneumonia etc are associated with HIV infection Dr Naresh Gill, Dept of Community Medicine
  16. 16. CD4 Count and OIs Dr Naresh Gill, Dept of Community Medicine
  17. 17. Diagnosis of AIDS Major signs ◦ Weight loss- > 10% of Body weight ◦ Chronic diarrhea of > 1 month ◦ Prolonged fever of > 1 month Minor signs ◦ Persistent cough (>1 month duration) ◦ Generalized Pruritic dermatitis ◦ Oropharyngeal candidiasis ◦ Chronic progressive or disseminated herpes simplex infection ◦ Generalized Lymphadenopathy Dr Naresh Gill, Dept of Community Medicine
  18. 18. Expanded WHO case definitionfor AIDS surveillance HIV antibody positive plus one or more following conditions present ◦ >10% body weight loss with diarrhea or fever or both for at least one month ◦ Cryptococcal meningitis ◦ Pulmonary or Extrapulmonary TB ◦ Kaposi sarcoma ◦ Candidiasis of oesophagus ◦ Invasive cervical Ca ◦ Life threatening pneumonia ◦ Neurological impairment Dr Naresh Gill, Dept of Community Medicine
  19. 19. Laboratory diagnosis Screening test: detects antibodies to HIV, tests with high sensitivity are used for screening ◦ Confirmation can be done with specific test such as Western Blot test Virus Isolation P24 antigen detection Dr Naresh Gill, Dept of Community Medicine
  20. 20. Control of AIDSA. Prevention: 1. Education 2. Prevention of blood borne HIV transmissionB. ART (Anti Retroviral Therapy) Dr Naresh Gill, Dept of Community Medicine
  21. 21. Dr Naresh Gill, Dept of CommunityMedicine
  22. 22. Occupational Post ExposureProphylaxis First aid care Counseling and Risk assessment HIV testing and counseling ART for 28days ◦ Start as soon as possible , within 72 hours ◦ If first test is negative. Repeat the test at 3 and 6 months Dr Naresh Gill, Dept of Community Medicine
  23. 23. C. Specific prophylaxis: CPT should be given to patients with CD4 count <200 And all the TB patients Specific prophylaxis against fungal infectionD. Primary Health Care Dr Naresh Gill, Dept of Community Medicine