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. http://www.pediatricdentists.blogspot.com

1. *AIDS
By-Dr.Mimosa Chatterjee
http://www.pediatricdentists.blogspot.com/

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.

4. 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

5. 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.

6. HIV Virus
AIDS Virus

7. 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.

8. 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

9. Pathogenesis of AIDS

10. Pathogenesis of AIDS

12. 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.

13. 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.

14. Oral Manifestations
1) Fungal 3) Viral
· Candidiasis · Varicella zoster
· Aspergillosis · Epstein-Barr including hairy leukoplakia
· Histoplasmosis · HPV virus
· Cryptococcus neoformans · CMV virus
· Geotrichosis 4) Neoplasm
2) 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

15. Oral Manifestations
7) 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

16. Diagnosis
LABORATORY
CLINICAL
FINDINGS

17. Diagnosis
Clinical
1) 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 due
to 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

18. Diagnosis
2) 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 or
fever or both, intermittent or constant for at least 1 month.
2. Cryptococcal meningitis
3. Tuberculosis
4. Kaposi sarcoma
5. Neurological impairment
6. Candidiasis of Oesophagus
7. Recurrent episodes of Pneumonia
8. Invasive cervical cancer

19. Diagnosis
LABORATORY DIAGNOSIS
a) Screening test: ELISA
b) Specific test: Western blot
c) Non-specific test: anemia, leucopoenia, thrombocytopenia, and
absolute CD4 count.

20. Control Of AIDS
1. 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 should
be made wide available.
• All mass media channels should be involved in educating
the people on AIDS, its nature of transmission & prevention.

21. Control Of AIDS
b. 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 by
introducing heat treatment of factor viii & ix.
c. Strict sterilization practice in hospitals and clinics
d. Disposable needles and syringes should be used
e. Universal precautions by health care workers.

22. Control Of AIDS
2. 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

23. Control Of AIDS
Intolerance 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 on
Change to alternative treatment
first line treatment
2nd line treatment
Saquinqv Ritonavi Indinavir Stavudin Stavudine
ir Zidov r Zidovudin e Lamiv Didnosin
udine Zidovudi e udine e
ne

24. 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
treatment
3rd line treatment
Saquinqvir Indinavir Nelfinavir
Indinavir Zidovudine Zidovudine
Zidovudine Didnosine
Antiretroviral combination therapy

25. Control Of AIDS
3. POST EXPOSURE PROPHYLACTIC TREATMENT:
• It refers to anti retroviral drug therapy with in hrs. Following accidental
exposure 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 wounds
should be irrigated with saline. Antiseptic agent can be applied but caustic agents
should be avoided.
• Following treatment is recommended by the US center for disease control
and prevention for health care workers accidentally exposed to HIV: -
• zidovudine( 200mg three times daily) +Lamivudine (150 mg twice daily) for
4 weeks
• if “ source individual have advance aids : Nelfinavir(750 mg 3 times daily)
+zidovudine +lamivudine
• if “ source” individual failed on zidovudine +lamivudine therapy then
stavudine +didanosine

26. Control Of AIDS
4. 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.V
c) New born -Syrup zidovudine( three times daily for 6 weeks)
d) Single dose of Neverpin (200 mg) at the time of labour.

27. Control Of AIDS
6. 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.

28. 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 infected
blood 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.

29. 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.

30. 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 dentist
who refuses treatment is in violation of law and subject to penalties.
Every year on 1st December world AIDs day is celebrated

31. Thank you
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