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Aids
- 3. Acquired immunodeficiency syndrome End stage of HIV infection Synonym= SLIM DISEASE 1ST DISCOVERED IN 1981 SUMMER IN US 1983 – first isolated African- American origin India- 1st in Chennai sex worker in 1986
- 4. State Antenatal clinic HIV prevalence 2007 (%)[12] STD clinic HIV prevalence 2007 (%) [12] IDU HIV prevalence 2007 (%)[12] MSM HIV prevalence 2007 (%)[12] Female sex worker HIV prevalence 2007 (%)[12] Andhra Pradesh 1.00 17.20 3.71 17.04 9.74 Gujarat 0.25 2.40 ... 8.40 6.53 Karnataka 0.50 8.40 2.00 17.60 5.30 Maharashtra 0.50 11.62 24.40 11.80 17.91 Manipur 0.75 4.08 17.90 16.4 13.07 Mizoram 0.75 7.13 7.53 ... 7.20 Nagaland 0.60 3.42 1.91 ... 8.91 Tamil Nadu 0.25 8.00 16.80 6.60 4.68 Delhi 0.25 5.20 10.10 11.73 3.15 Chandigarh 0.25 0.42 8.64 3.60 0.40
- 5. State No. of ART Centres Total (Adult) Total (Paediatric) Total Andhra Pradesh 31 60,328 3,304 63,832 Karnataka 33 36,220 3,003 39,223 Maharashtra 43 65,409 5,102 70,511 Tamil Nadu 36 36,947 2,439 39,586 Gujarat 9 12,765 669 13,678 Uttar Pradesh 10 10,039 594 10,633 Grand Total 2,81,453 18,889 3,00,743
- 6. World- 37 million people are living with AIDS 25 million have died of AIDS related disease around the world 2009- 2.6 million people have been newly infected African countries have the highest prevalence India- 2.5 million people infected as per 2007 report Majority in Manipur Regionally varied causes of infection
- 7. Human Immunodeficiency Virus- 1 &2 Family – Retroviridae Subfamily – Lentiviruses HIV-1- American population HIV-2 – West African population Many subspecies India- HIV-1 C subtype
- 8. Cylindrical core 2 ss RNAs Nucleocapsid - p24 Core- Reverse transcriptase p66 & p55 Envelope proteins- gp120 & gp41 RNA is bound to enzymes- RT, protease, integrase & ribonuclease 2 layers of lipid membrane- PL taken human cell membrane
- 9. p17
- 10. 3 structural genes – gag, pol, env 3 regulatory genes- tat, rev, nef 5 accessory genes – vif, vpr, vpu, vpt, tev/ tnv LTR – long terminal repeats – regulatory elements for transcription
- 11. 75% - sexual intercourse 15%- blood Drug abusers Infected needle Blood transfusion 10-20% Through placenta During parturition Breast milk
- 12. gp120 of virus binds with CD4 molecule on the surface of target cells (mostly TH cells) AA 397-439 in gp120 & AA 16-84 of CD4 take part in the binding Macrophages, monocytes, Langerhans cells, follicular dendritic cells and glial cells also susceptible Monocytes / Macrophages – act as the reservoir of the virus
- 13. Very high rate Over 10 billion particles/ day inside the host gp120 binds to CD4 cells (co-receptors CCR5 & CXCR4) ↓ Conformation of viral envelope changes ↓ Fusion with host cell membrane ↓ gp41 penetrates plasma membrane
- 15. HIV RNA uncoated and enters host cell ↓ RT catalyzes reverse transcription of ssRNA to dsDNA ↓ Integrates to host cell DNA randomly with help of Integrase ↓ Provirus may become active or remain latent ↓ Viral proteins synthesised, assembled & bud out
- 16. Electron micrograph showing HIV budding out from CD4+ T lymphocytes Lipid rafts
- 18. Short, flu-like illness - occurs 1-6 weeks after infection no symptoms at all Infected person can infect other people p24 Ag only detectable
- 20. Lasts for an average of 10 years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to very low levels HIV antibodies are detectable in the blood For each AIDS patient, there are 100 seropositive persons in population
- 21. The symptoms are mild The immune system deteriorates Without opportunistic infections and cancers
- 22. The immune system weakens The illnesses become more severe leading to an AIDS diagnosis Usually death within 2 years
- 23. Bacterial ◦ Tuberculosis (TB) ◦ Strep pneumonia Viral ◦ Kaposi Sarcoma ◦ Herpes ◦ Influenza (flu)
- 24. Parasitic ◦ Pneumocystis carinii Fungal ◦ Candida ◦ Cryptococcus
- 25. CD4+ T-cell count < 200 cells/µl (or a CD4+ T-cell percentage of total lymphocytes of less than 15%) OR the patient has one of the defining illnesses
- 26. 1987 definition Candidiasis of bronchi, trachea, or lungs Candidiasis esophageal Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal for longer than 1 month Cytomegalovirus disease (other than liver, spleen or lymph nodes) Cytomegalovirus retinitis (with loss of vision) Encephalopathy (HIV-related) Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis, chronic intestinal (for more than 1 month) Kaposi's sarcoma
- 27. Lymphoma, Burkitt's Lymphoma, immunoblastic (or equivalent term) Lymphoma, primary, of brain Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary Mycobacterium, other species, disseminated or extrapulmonary Mycobacterium tuberculosis, any site (extrapulmonary) Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii) Progressive multifocal leukoencephalopathy Salmonella septicemia (recurrent) Toxoplasmosis of the brain Tuberculosis, disseminated Wasting syndrome due to HIV
- 28. Added in 1993 Cervical cancer (invasive) Mycobacterium tuberculosis, any site (pulmonary) Pneumonia (recurrent) Children < 13 years Additional conditions are included for children less than 13 Bacterial infections, multiple or recurrent Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
- 30. ELISA- Ab against gp120 Confirmatory test- Western blot Virus isolation- from cultured lymphocytes CD4 lymphocyte count
- 33. RT inhibitors- nucleoside analogues e.g. AZT, Zalcytabine, Lamivudin RT inhibitors- Non-nucleoside analogues e.g. Nevirapine, Loviride RT inhibitors- nucleotide analogues e.g. Adefovir Protease inhibitors- Block final assembly & package of HIV particles e.g. Sequinavir, Ritonavir, Indinavir Antisense therapy- Experimental stage Pregnancy- Nevirapine
- 34. AIDS THEMES 1988 Communication 1989 Youth 1990 Women and AIDS 1991 Sharing the Challenge 1992 Community Commitment 1993 Act 1994 AIDS and the Family 1995 Shared Rights, Shared Responsibilities 1996 One World. One Hope. 1997 Children Living in a World with AIDS 1998 Force for Change: World AIDS Campaign With Young People 1999 Listen, Learn, Live: World AIDS Campaign with Children & Young People 2000 AIDS: Men Make a Difference 2001 I care. Do you? 2002 Stigma and Discrimination 2003 Stigma and Discrimination 2004 Women, Girls, HIV and AIDS 2005 Stop AIDS. Keep the Promise 2006 Stop AIDS. Keep the Promise – Accountability 2007 Stop AIDS. Keep the Promise – Leadership 2008 Stop AIDS. Keep the Promise – Lead – Empower – Deliver[18] 2009 Universal Access and Human Rights[19] 2010 Universal Access and Human Rights[20] 2011 Getting to Zero[21] 2012 Getting to Zero[22] 2013 Getting to Zero[17] 2014 Getting to Zero[17] 2015 Getting to Zero[17]
- 35. Fungal infections Chronic periodontitis Candiadis Oral cheilitis Oral hairy leukoplakia Oral ulcers due to CMV infection Necrotizing oral stomatitis Aphthous ulcers Oral Kaposi’s sarcoma xerostomia
- 36. Consider blood, saliva and gingival fluid from all dental patients as infective. Use rubber dams in restorative dentistry whenever possible Report immediately suspect fluid exposure, or a needle-stick or sharp injury to a designated person because if post-exposure chemoprophylaxis is to be implemented, it should begin preferably within 1 to 2 hours after exposure.
- 37. Double gloves All disposable material Wear apron and visors Sterilize instruments that can’t be disposed off Use absorbent paper towelling to remove blood or saliva. Use a medical grade disinfectant to disinfect all potentially contaminated objects and surfaces. Follow safe work procedures as stated in the material safety data sheets (MSDS) for handling and disposal.
- 38. It is the darkest before daw
Editor's Notes
- gp12