20971INTRODUCTION_TO_HIV&AIDS for nursing students

1. HIV: THE GLOABAL AND MALAWIAN
SCENARIO
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2. Lesson objectives
• Understand the global and local impact of the epidemic
• Know about HIV/AIDS in adults, children, and families
• Understand the natural history of HIV infection
• Understand the modes of HIV transmission
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Scope of the HIV/AIDS Pandemic
Natural History and Transmission of HIV

3. HIV
•Human Immunodeficiency Virus
•H = Infects only Human beings
•I = Immunodeficiency virus weakens the immune system and
increases the risk of infection
•V = Virus that attacks the body
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4. AIDS
•Acquired Immune Deficiency Syndrome
•A = Acquired, not inherited
•I = Weakens the Immune system
•D = Creates a Deficiency of CD4+ cells in
the immune system
•S = Syndrome, or a group of illnesses
taking place at the same time
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5. HIV and AIDS
• When the immune system becomes
weakened by HIV, the illness
progresses to AIDS
• Some blood tests, symptoms or
certain infections indicate
progression of HIV to AIDS
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6. HIV-1 and HIV-2
• • HIV-1 and HIV-2 are
• Transmitted through the same routes
• Associated with similar opportunistic infections
 • HIV-1 is more common worldwide
 • HIV-2 is found in West Africa, Mozambique, and
Angola
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7. HIV-1 and HIV-2
• HIV-2 is less easily transmitted
• HIV-2 is less pathogenic
• Duration of HIV-2 infection is shorter
• MTCT is relatively rare with HIV-2
• MTCT of HIV-2 has not been reported from Malawi
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8. Transmission of HIV
•HIV is transmitted by
• Direct contact with infected blood
• Sexual contact: oral, anal, or vaginal
• Direct contact with semen or vaginal and
cervical secretions
• HIV-infected mothers to infants during
pregnancy, delivery, or breastfeeding
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9. Transmission of HIV
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HIV is not transmitted by
• Public baths
• Handshakes
• Work or school contact
• Using telephones
• Sharing cups, glasses,
plates, or other utensils
• Coughing, sneezing
• Insect bites
• Touching, hugging
• Water, food
• Kissing

10. Global HIV/AIDS in 2004 *
• 39.4 -40.0 million people are living with HIV/AIDS
• 2.2 million are children under 15 years
• 6,40,000 children were newly infected with HIV in 2004
• 5,10,000 children died of HIV in 2
• * Source: UNAIDS,2004
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5.1 m. Indian living with HIV

11. Reported cases
•Reported AIDS cases
• (15,202)
•Estimated AIDS cases
• (219,400)
•People living with
•HIV/AIDS (2.2 million)
Only a small number of PLWHA are reported
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12. Impact of Global HIV
• Negative economic impact on countries
• Overstrained healthcare systems
• Decreasing life expectancy
• Reversal of child survival gains
• Increased numbers of orphans
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13. omero
Mode of Transmission of HIV In MALAWI

14. omero
0
10
20
30
40
50
60
70
80
90
100
# uninfected
# infected during
BF for 2 yrs
# infected during
delivery
#infants infected
during
pregnancy
63
uninfected
15
15
7
MTCT in 100 HIV+ Mothers
The majority of children do not get
infected even when we do nothing

15. Prevention of
HIV Transmission
• Strategies to prevent HIV transmission
• Personal strategies
• Public health strategies
• Safe practices: no risk of HIV transmission
• Risk reduction: reduces but does not eliminate
risk
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16. Prevention of
HIV Transmission
 Public health strategies to prevent HIV transmission
• Screen all blood and blood products
• Follow universal precautions
• Educate in safer sex practices
• Identify and treat STIs/other infections
• Provide referral for treatment of drug dependence
• Apply the comprehensive PPTCT approach to prevent
vertical transmission of HIV
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17. Natural History of HIV Infection
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18. Natural History of HIV Infection
•Virus can be transmitted during each stage
• Seroconversion
•Infection with HIV, antibodies develop
• Asymptomatic
•No signs of HIV, immune system controls
virus production
• Symptomatic
•Physical signs of HIV infection, some
immune suppression
• AIDS
•Opportunistic infections, end-stage disease
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19. Natural History of HIV Infection
• Immune suppression
• HIV attacks white blood cells,called CD4
cells, that protect body from illness
• Over time, the body’s ability to fight
common infections is lost
• Opportunistic infections occur
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20. HIV Disease
•Progression of HIV disease is measured by:
• CD4+ count
•Degree of immune suppression
•Lower CD4+ count means decreasing immunity
• Viral load
•Amount of virus in the blood
•Higher viral load means more immune
suppression
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21. HIV Disease
• Severity of illness is determined
by amount of virus in the body
(increasing viral load) and the
degree of immune suppression
(decreasing CD4+ counts)
• Higher the viral load, the sooner
immune suppression occurs
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22. Progression of HIV Infection
• HIGH viral load (number of copies of HIV
in the blood)
• LOW CD4 count (type of white blood
cell)
• Increasing clinical symptoms (such as
opportunistic infections)
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23. HIV Disease
•Direct infection of organ systems
• HIV can directly infect the:
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)
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24. HIV Disease: Summary
• HIV multiplies inside the CD4+ cells, destroying them
• As CD4+ cell count decreases and viral load increases, the immune defences are weakened
• HIV-infected people become vulnerable to opportunistic infections
• HIV is a chronic viral infection with no known cure
• Without ARV treatment, HIV progresses to symptomatic disease and AIDS
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25. Key Points
• HIV is a global pandemic and the number of people living with HIV continues to
increase worldwide.
• HIV epidemic is especially severe in resource-constrained settings
• HIV is a virus that destroys the immune system, leading to opportunistic
infections.
• The progression from initial infection with HIV to end-stage AIDS varies from
person to person and can take more than 10 years.
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26. Key Points (continued)
• The most common main route of transmission worldwide is
heterosexual transmission.
• Women of childbearing age are at particular risk for acquiring
HIV through unprotected sex
• HIV-positive women who are pregnant are at risk of passing
HIV infection to their newborn.
• Risk of HIV transmission from mother-to-child can be greatly
reduced through effective PMTCT programs
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