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HIV/ AIDS The 21 st century pandemic Dr Soumar Dutta CDMO Guwahati Refinery Hospital

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A Acquired

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A Acquired I Immuno

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A Acquired I Immuno D Deficiency

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A Acquired I Immuno D Deficiency S Syndrome

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H Human

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H Human I Immunodeficiency

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H Human I Immunodeficiency V Virus

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HIV/AIDS refers to… <ul><li>“ A cquired I mmuno D eficiency S yndrome” (AIDS) or a set of symptoms and infections resulting from the damage to the human immune system caused by the H uman I mmunodeficiency V irus (HIV) . This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. </li></ul>

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Basic Definitions And Meanings <ul><li>What is HIV ? </li></ul><ul><li>HIV is “ Human Immunodeficiency Virus ”,it is the virus that cause AIDS. </li></ul><ul><li>Human means that it affects only humans and lives only in humans. </li></ul><ul><li>The virus does not live in toilets, mosquitoes, cups, spoons, on bed sheets or towels that people with HIV might have used. </li></ul><ul><li>Immunodeficiency refers to lack(deficiency) or breakdown of immune system. The “immune system” is the body’s resistance or the body’s defense force for fighting off infections. </li></ul>

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<ul><li>The virus attacks and eventually overcomes the body’s immune system. The immune system is usually able to defend the body against infections. </li></ul><ul><li>A virus is a germ. </li></ul><ul><li>What is AIDS ? </li></ul><ul><li>AIDS means “ Acquired Immunodeficiency Syndrome ” </li></ul><ul><li>To acquire means to “get or develop over a period of time” </li></ul><ul><li>The immune system breaks down gradually over time. </li></ul>

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<ul><li>It gets deficient or less and less efficient, under relentless attack by the multiplying number of virus in the body. </li></ul><ul><li>Syndrome refers to the group or collection of signs and symptoms of indication of diseases in a person who has AIDS. </li></ul><ul><ul><li>HIV is the infectious stage of the condition, AIDS is the disease phase. </li></ul></ul>

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The Origin of AIDS and HIV <ul><li>HIV came from a similar virus found in chimpanzees - SIV. </li></ul><ul><li>HIV probably entered the United States around 1970.the first recognized case of AIDS was in the early 1980s. </li></ul><ul><li>HIV is a lentevirus (slow virus),which in turn is a part of a larger group of viruses known as retro virus </li></ul>

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Epidemiology <ul><li>Males>females </li></ul><ul><li>Occurs in all ages and ethnic groups </li></ul><ul><li>All areas of the country are affected </li></ul><ul><li>In some city inner areas, as many as 50% of males are HIV positive </li></ul><ul><li>AIDS is now the second leading cause of death for all men aged 25-44 years </li></ul><ul><li>(Unintended injuries is #1 and heart disease is #3 for this age group) </li></ul>

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HIV Transmission <ul><li>HIV enters the bloodstream through: </li></ul><ul><ul><li>Open Cuts </li></ul></ul><ul><ul><li>Breaks in the skin </li></ul></ul><ul><ul><li>Mucous membranes </li></ul></ul><ul><ul><li>Direct injection </li></ul></ul>

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Routes of Transmission of HIV <ul><li>Sexual Contact: Male-to-male </li></ul><ul><li>Male-to-female or vice versa </li></ul><ul><li> Female-to-female </li></ul><ul><li>Blood Exposure: Injecting drug use/needle sharing </li></ul><ul><li> Occupational exposure </li></ul><ul><li> Transfusion of blood products </li></ul><ul><li>Perinatal: Transmission from mother to baby </li></ul><ul><li>Breastfeeding </li></ul>

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Routes of Transmission of HIV <ul><li>Occupational Transmission </li></ul><ul><li>Health care worker/ hospital staff </li></ul><ul><li>Laboratory workers </li></ul><ul><li>Other routes </li></ul><ul><ul><ul><li>Organ transplantation </li></ul></ul></ul><ul><ul><ul><li>Artificial insemination </li></ul></ul></ul><ul><ul><ul><li>Needle-prick </li></ul></ul></ul>

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HIV Transmission <ul><li>Common body fluids that are means of transmission: </li></ul><ul><ul><ul><li>Blood </li></ul></ul></ul><ul><ul><ul><li>Semen </li></ul></ul></ul><ul><ul><ul><li>Vaginal Secretions </li></ul></ul></ul><ul><ul><ul><li>Breast Milk </li></ul></ul></ul>

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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

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HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus

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Window Period <ul><li>This is the period of time after becoming infected when an HIV test is negative. </li></ul><ul><li>90 percent of cases test positive within three months of exposure </li></ul><ul><li>10 percent of cases test positive within three to six months of exposure </li></ul>

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Signs And Symptoms <ul><li>The clinical consequence of HIV infection comprises of a spectrum ranging from an acute syndrome with primary infection to a prolonged asymptomatic stage to adanced disease. </li></ul><ul><li> Incubation period: 2 to 10 yrs. </li></ul>

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The Acute HIV Syndrome <ul><li> Follows 3-6 wks following primary infection </li></ul>

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Signs And Symptoms <ul><li>Second phase- </li></ul><ul><li>Asymptomatic contact </li></ul><ul><ul><li>Initial HIV inf. or after illness of inf. </li></ul></ul><ul><ul><li>No symptoms </li></ul></ul><ul><ul><li>Last 2 to 10 yrs. </li></ul></ul>

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Signs And Symptoms <ul><li>Third phase- </li></ul><ul><li>PGL (Persistent Generalized Lymphadenopathy) </li></ul><ul><ul><ul><li>Enlargement of lymph nodes. </li></ul></ul></ul><ul><ul><ul><ul><li>outside the inguinal area </li></ul></ul></ul></ul><ul><ul><ul><ul><li>more than 2 areas </li></ul></ul></ul></ul><ul><ul><ul><ul><li>more that 3 months </li></ul></ul></ul></ul>

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Signs And Symptoms <ul><li>Fourth phage-Overt Manifestation of AIDS </li></ul><ul><li>ARC(AIDS-related complex): fever, loss of weight, anorexia, diarrhea plus PGL </li></ul><ul><li>Nervous system symptoms: headache, convulsion, paralysis, progressive dementia </li></ul><ul><li>Rare opportunistic infection. </li></ul><ul><li>Unusual malignant tumors. </li></ul><ul><li>Pneumonia. </li></ul>

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HIV Infection And Antibody Response Infection Occurs AIDS Symptoms Initial Stage---------------- -------- Intermediate or Latent Stage- ------------- --- Illness Stage Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----

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Common manifestation of AIDS

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Kaposis sarcoma Candidiasis Of Mouth

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Extreme Wt loss Lymphadenopathy

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P. Carinii pneumonia <ul><li>Primary CNS Lymphoma </li></ul>

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AIDS Worldwide

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AIDS In India

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Prevention Of HIV/AIDS <ul><ul><ul><ul><li>Risk factors </li></ul></ul></ul></ul><ul><li>Anyone of any age, race, sex or sexual orientation can be infected with HIV, but you're at greatest risk of HIV/AIDS if you: </li></ul><ul><li>Have unprotected sex with multiple partners. Unprotected sex means having sex without using a new latex or polyurethane condom every time. </li></ul><ul><li>Have unprotected sex with someone who is HIV-positive. </li></ul><ul><li>Have another sexually transmitted disease, such as syphilis, herpes, Chlamydia, gonorrhea or bacterial vaginosis. </li></ul><ul><li>Share needles during intravenous drug use. </li></ul><ul><li>Received a blood transfusion or blood products before 1985. </li></ul>

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Prevention Of HIV/AIDS <ul><li>Newborns or nursing infants whose mothers tested positive for HIV but did not receive treatment also are at high risk. </li></ul><ul><li>Fastest growing method of HIV transmission: heterosexual contact. </li></ul><ul><li>Heterosexual transmission is easier from men to women than from women to men </li></ul><ul><li>Risk of acquiring for men is greater if contact occurs during menstruation </li></ul><ul><li>Uncircumcised men are more likely to be seropositive and contract HIV during sex </li></ul>

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Prevention Of HIV/AIDS <ul><li>If mother is HIV positive, 100% of children will test positive at birth </li></ul><ul><li>Breast feeding increases transmission rate </li></ul>

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Prevention Of HIV/AIDS <ul><li>There's no vaccine to prevent HIV infection and no cure for AIDS. Prevention includes educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body. </li></ul><ul><li>HIV-negative Individual prevention: </li></ul><ul><li>Educate yourself and others. </li></ul><ul><li>Know the HIV status of any sexual partner. </li></ul><ul><li>Use a new latex or polyurethane condom every time you have sex. </li></ul><ul><li>Consider male circumcision. </li></ul><ul><li>Use a clean needle. </li></ul><ul><li>Be cautious about blood products. </li></ul><ul><li>Get regular screening tests. </li></ul>

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Prevention Of HIV/AIDS <ul><li>HIV positive individual prevention: </li></ul><ul><li>Follow safe-sex practices. </li></ul><ul><li>Tell your sexual partners you have HIV. </li></ul><ul><li>If your partner is pregnant, tell her you have HIV. </li></ul><ul><li>Tell others who need to know. </li></ul><ul><li>Don't share needles or syringes. </li></ul><ul><li>Don't donate blood or organs. </li></ul><ul><li>Don't share razor blades or toothbrushes. </li></ul><ul><li>If you're pregnant, get medical care right away. </li></ul>

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Prevention Of HIV/AIDS Traditionally, prevention is described as being at three levels:

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Prevention Of HIV/AIDS Traditionally, prevention is described as being at three levels:

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Prevention Of HIV/AIDS Traditionally, prevention is described as being at three levels:

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Two Approaches To Disease Prevention

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Risk Avoidance & Risk Reduction

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What is the ABC Approach?

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ABC Strategy