CASE PRESENTATION and PREVENTIVE STRATEGIES OF AIDS including ... (1) primary and secondary prevention of aids (2) Pre-Exposure Prophylaxis (PrEP) POST-exposure prophylaxis ( PEP)

1. Dr. Pushpendra Bairwa
Resident doctor (Psm)
SMS MC Jaipur
CASE PRESENTATION and PREVENTIVE
STRATEGIES OF AIDS

2. PATIENT DEMOGRAPIC DATA
. Name-XXXX XXXX
. Sex- FEMALE
. Age- 47yr
. Religion - Hindu
. Resid- Aam ka talab Ajmer ( Rajasthan)
. confirmed HIV Diagnosed -13/8/2008
. date of registration – 23/8/2008
.
.

3. CHIEF COMPLAINTS
1. Mild fever
2. Chronic diarrhea
3. Weakness
4. Headache
5. Weight loss
6. Chronic cough

4. PERSONAL HISTORY
. MARRIED
. HOUSE WIFE
. HETROSEXUAL
. Non-alcoholic
. Non-smoker.

5. FAMILY HISTORY
FAMILY MAMBERS
AND AGE
1. XXX XXX 40yr
(HUSBAND)
2. AMERPRIT (15yr)
3.HARMPRIT (13yr)
HIV STATUS
+VE
-ve
-ve
CURRUNT STATUS
DIED ON 2016
No other significant family history

6. G.P EXAMINATION
• CNS -Pt was conscious ,alert oriented to name, time and place at the time of registration
• CVS- S1 and S2 normal
- no murmer
- H/R 75/Mnt
-RESPI-2008
-no added sound
-clear B/L lung field
R/R 15/mnt
2009–
mild b/l crapts, decreased tactile fremitus, and asymmetrical chest expansion
-Abdomen- PA soft , mild spleenomegaly
-Lymphadenopathy

7. Deferential diagnosis
• AIDS
• Malignancy
• SLE
• APLASTIC ANAEMIA
• LEUKEMIA

8. LAB INVESTIGATIONS
2008 2012 2014 2016 2018 2019
HB 13g/dl 11 11.5 11.2 10.5 10
RBC 5.5m/
dl
5.4m/dl 5m/dl 4.5m/dl 4.5m/dl 4.2m/dl
HC 49% 48.7% 47% 48% 47% 47%
WBC 5.5K 4.5K 5200 5100 5200 5000/UL
MCV 75FL 77FL 77FL 76FL 88.8FL 80FL
PLT 1.5lac 2lac 2.5lac 3lac 3lac 2.5lac
Blood urea - 17 31 20 19 18.13
S.Bilirubin - - 0.5 0.7 0.7 1.1
C.Creatinin - - 0.89 0.84 0.87 0.71
SGOT 20.2 21 28.5 36.71

9. 2008 2012 2014 2016 2018 2019
VDRL -VE -VE -VE -VE -VE -VE
HBsAG -VE -VE -VE -VE -VE -VE
ANTI HCV -VE -VE -VE -VE -VE -VE
PEP - - -VE -- - -VE
ELISA +VE
WESTERN
BLOT
+VE

10. CD4 COUNT
159
350
700
1000
943
1213
1172
1360
1507 1500
1552
1358
0
200
400
600
800
1000
1200
1400
1600
1800
2006 2008 2010 2012 2014 2016 2018 2020
AxisTitle
Axis Title
Y-Values

11. XRAY- FINDINGS
• 2008- normal lung field and
clear margins
• 2010- mild left plueral effusion

12. COMFIRM DIAGNOSIS
• AIDS

13. TREATMENT
DATE FUNCTION
AL STATUS
WHO
CLINICAL
STAGE
OPPORTUNI
STIC INF
TREATMENT ADHER
TO ART
2008 W III TB EFV+LAMIVUDINE+
STAVUDINE+NAVIRAPINE
+ATT
95%
2009 W III TB EFV+LAMIVUDINE+
STAVUDINE+NAVIRAPINE
+ATT
90%
2010 W III TB EFV+LAMIVUDINE+
STAVUDINE+NAVIRAPINE
+ATT
90%
2011 W I NO TDF+3TC+NVP 85%

14. AIDS AND ITS PREVENTIVE STRATEGIE
• Aids is a global pandemic d/s recognized as an emerging d/s in the early 1980
• HIV 1 is the most common cause of aids in the world
• In India HIV-1,group-M .subtype-c is most common
• Global summary of the aids epidemic(2017)-
• 1)No. of people living with HIV were-36.9M
• 2)newly infected in 2017 globally were 1.8M
And in India
India is 3rd largest epidemic in the world
. In 2017 total no people living with HIV were-21.4lac
. there were 88000 new HIV +VE and 69000 AIDS related death in 2017

15. - prevalence of HIV in India is 0.22%
- Highest prevalence state is Mizoram(2%)
- Highest no. of HIV +VE are in Maharastra
- No. of new cases per year 87500
- (40%female and 60% male)

16. HIV PREVALENCE

17. Modes of transmission
• Sexual transmission- it is a most common MOT(more then 70%) but
risk of transmission is least(0.4-0.6%)
• By blood and its products
• Perinatal transmission (risk 30%)
• By needle exchange

18. Relationship of CD4 count and
opportunistic infection

19. PREVENTIONS
• 1). PRIMARY PREVENTION
• AIM- reduce incidence of d/s
(A) - health education
a) health education material and guideline should be widely
available for about nature of HIV, mod of transmission of HIV and
preventive measure of HIV
(b) aware the people by mass media education coverage( incl. social media)

20. (B)Prevention of blood borne HIV transmission
(C) Combination HIV prevention
- by IMPLEMENTATION of ARV in
-post exposure prophylaxis
-infant prophylaxis
-oral substitution therapy with methadone or buprenorphine for
dependent IDU
(D)Health programs
(E)avoiding indiscriminate sex
--promotion use of condoms

21. HEALTH PROGRAMS
. National aids control program was launched in India in 1987
. In 1992 NACP-I launched – to slow down the spread of HIV
infection
- NACO set up
. In 1999 NACP-II launched – increased decentralization
- NGOs involvement
. In 2004 Anti retroviral t/t initiated
. In 2007 NACP-III launched for 5yr(2007-2012)
. In 2014 NACP-IV launched for five yr(2012-2017)
. In 2017 national strategic plans for HIV/STD 2017-2024

22. COMPONANTS OF NACP-VI
.1) Needle syringe exchange programme
.2) Opioid substitution therapy
.3) Blood safety promotion
.4) condoms promotion
.5) social mobilization, youth interventions and adolescence education
.6) Link worker scheme
.7) HIV counselling and testing services

23. The country has adopted fast track target of 90-90-90
Which aims to ending AIDS as public health threat
by2030
Main points are
1) 90% of PLHIV know their status
2) 90% of PLHIV are should on ART
3) 90% of PLHIV have viral suppression

24. POST EXPOSURE PROPHYLAXIS
Preferred ART regimen for adult
TDF+3TC or (FTC) FOR 28 DAY
FOR children FOR 28DAY
AZT+3TC OR
ABC+3TC
All individuals potentially exposed to HIV should be undergo HIV testing 3
month following exposure.

25. INFANT PROPHYLAXIS
(A) Infants born from mother with HIV +ve status
should be receive
Dual prophylaxis with
AZT(bd) + NVP once daily for 6week
(B) Breastfeeding infant should be receive
AZT(bd) + NVP once daily for 12week
or
NVP alone for 12week

26. SECONDARY PREVENTION
• AIM-REDUCE THE PREVALENCE BY-
• Early diagnosis and t/t and Implementation of ART
• measure available to individuals and community for early diagnosis and t/t to
control the d/s (e.g. screening programs)
• western blot
• Other d/g test are-(a) Viral culture
• (B)antigen detection p-24 ( earliest virus marker)
• (c)polymerase chain reaction (PCR) (gold standard)
• (d)Genotyping of viral DNA/RNA

27. MY RESPOSIBILITIES AS A PHE
• make Aware my friends my family member from HIV nature and mode of transmission
• Promote public health on social media
• Conduct heath promotion camp at remote area where social and other media coverage not
set up
• Counselling the high risk pt
• Promote use of condoms
• Feedback counselling
• Research
•

28. Thank you