This document provides information about HIV and AIDS. It discusses that HIV is a retrovirus that infects and destroys T-cells of the immune system. Over time, this infection can develop into AIDS. The two main types of HIV that cause AIDS are HIV-1, which is most common worldwide, and HIV-2, which is mainly found in West Africa. HIV can be transmitted through unprotected sex, blood transmission, mother-to-child transmission, and sharing needles. While treatment with antiretroviral drugs can suppress the virus and prevent transmission, there is currently no cure for HIV/AIDS.

1. HUMAN
IMMUNODEFICIEN
CY
VIRUS
PREPARED BY :
NUR IZZATUL NAJWA
082015100036

2. INTRODUCTION
• HIV is a retrovirus, with two known strains that cause
Acquired Immunodeficiency Syndrome (AIDS) : HIV-1
and HIV-2 (mainly confined to West Africa)
• It infects T-helper cells, bearing the CD4 receptor
• The virus infects protective cells of the immune system,
destroying or impairing their function. As the infection
progresses, the immune system becomes progressively
weak and the individual becomes more susceptible to
life threatening opportunistic infections.

3. 3
WHAT IS AIDS?
• Acquired: To come into possession of something
new
• Immune Deficiency: Decrease or weakness in the
body’s ability to fight off infections and illnesses
• Syndrome: A group of signs and symptoms that
occur together and characterize a particular
abnormality
AIDS is the final stage of the disease caused by
infection with a type of virus called HIV.

4. 4
HIV vs. AIDS
• HIV is the virus that causes AIDS
• Not everyone who is infected with HIV has
AIDS
• Everyone with AIDS is infected with HIV
• AIDS is result of the progression of HIV
Infection
• Anyone infected with HIV, although healthy,
can still transmit the virus to another person

5. 5
TYPES OF HIV VIRUS
• HIV 1
– Most common in sub-Saharan Africa and
throughout the world
– Groups M, N, and O
• HIV 2
– Most often found in West Central Africa, parts of
Europe and India
Both produce the same patterns of illness. HIV2 causes a more slow progress of
disease than those with HIV 1.
It is important for tests to detect the HIV subtypes that are circulating in the region.
Otherwise, testing may lead to false negative results.

8. BREAK THE STIGMA!
Individuals cannot become infected
through ordinary day-to-day contact such
as kissing, hugging, shaking hands, or
sharing personal objects, food or water.

9. TRANSMISSION
• Can be isolated from :
– Blood, tissues, semen, saliva, breast milk, cervical and
vaginal secretions
• Through :
 Unprotected sexual intercourse
 Infected blood entering body
 Needle stick injury
 Artificial insemination, organ tranplantation
 Infected mothers (pregancy, labor, breastmilk)

11. MOTHER TO CHILD TRANSMISSION
(MTCT)
• About 15-25%, unless appropriate ART has been given.
• Breastfeeding is advisable because it doubles the risk
of vertical transmission
• Risk of transmission can be reduced to <5% if :
– By treatment with zidovudine prescribed for the mother
antenatally, during labour and to neonate for first 6weeks
postpartum
– By elective caesarean
– By avoiding breastfeeding

12. RISK FACTORS

13. SIGNS & SYPMTOMS
• Constant tiredness
• Unexplained weight loss
• Recurrent fever or night sweats
• Decreased appetite
• Persistent diarrhoea
• Persistent cough
• Swollen lumps (glands) in the neck, groin or armpit
• Unusual skin lumps or marks
• Recurrent thrush in the mouth
• Mouth sores
DxT : fever + severe malaise + lymphadenopathy = acute HIV

16. • EARLY SYMPTOMATIC STAGE IS REFERED AS
PRODORMAL TO AIDS / AIDS RELATED
COMPLEX – when pts develop opportunistic
infection
• Pneumocystic jiroveci (ex carinii) pneumonia
(PJP) is the commonest presentation of AIDS,
and carries high mortality!

17. PROGRESSION TO AIDS
• The risk of HIV progressing to AIDS varies widely
between individuals and depends on many
factors, including:
– the age of the individual
– the body's ability to defend against HIV
– access to high-quality, sanitary healthcare
– the presence of other infections
– the individual's genetic inheritance resistance to
certain strains of HIV
– drug-resistant strains of HIV

18. WINDOW PERIOD
• It is the seroconversion from acquiring HIV
infection to a positive antibody test.
• It means that people have antibodies to HIV in
their bloodstream and have been infected at
some stage.
• It does not mean they have the illness of AIDS,
but means that they carry the virus and could
pass it on through their blood or by sex.
• It may take up to 3 months to become positive
after contact.

20. DIAGNOSIS OF HIV
• ANTIBODY TESTING (two stage process)
– ELISA
– Western blot technique ( used for confirmation)
• IMMUNE FUNCTION TESTING
– CD4 lymphocyte count : strongest predictor
– Low CD4 cells (counts <500cell/µL = defective cell
immunity
– Counts <200cells/µL = severe immunodeficiency

21. • VIRAL LOAD
– Measure of serum level of RNA of HIV virus –
correlates with response to treatment and
progression to AIDS and death
• TEST FOR OPPORTUNISTICS INFECTION
– EBV, CMV, Hepatitis, Herpes, TB

22. ELISA Test
• ELISA positive, the Western blot test is usually
administered to confirm the diagnosis.
• ELISA negative, if HIV is suspected, tested
again in one to three months.
• ELISA is quite sensitive in chronic HIV infection

24. Viral Load Test
• This test measures the amount of HIV in your blood.
• It's used to monitor treatment progress or detect early
HIV infection.
• Method used:
1. Reverse transcription polymerase chain reaction (RT-
PCR)
2. Branched DNA (bDNA)
3. Nucleic acid sequence-based amplification assay
(NASBA).
• HIV is detected using DNA sequences that bind
specifically to those in the virus.

26. • Home Tests — The only home test approved by
the U.S. Food and Drug Administration is called
the Home Access Express Test, which is sold in
pharmacies.
• Saliva Tests — A cotton pad is used to obtain
saliva from the inside of your cheek. The pad is
placed in a vial and submitted to a laboratory for
testing. Results are available in three days.
Positive results should be confirmed with a blood
test.

27. MANAGEMENT
• COUNSELLING
• MEDICATION (HIGHLY ACTIVE
ANTIRETROVIRAL THERAPY - HAART)

28. INITIAL- COUNSELLING
1. Establish why the patient is presenting ‘now’ for
the test.
2. Explore the ‘hidden component’ of the patient’s
consultation.
3. Take a full sexual, medical and drug-taking
history.
4. Establish a supportive, non-judgmental
atmosphere.
5. Encourage disclosure of history and patterns of
partners and sexual practices in a gender-
neutral situation.

29. 6. Make no assumptions about sexual preferences.
7. Stress the importance of disclosure of prior, known
infections with STIs. Assess the patient’s risk for an
STI.
8. Assess the patient’s coping strategies and social
network.
9. Discuss legal requirements (check with state laws).
10. Advise of need for informed consent (not only for HIV
test but other STIs).
11. Make arrangements to discuss the test results face to
face.

30. ENCOURAGE POSITIVE LIFESTYLE
• Very healthy balanced diet
• Toxic avoidance : processed foods, caffeine,
illicit drugs, alchol cig
• Relaxation and meditation
• Appropriate sleep and exercise
• Consider supplementary antioxidants
• Supports groups and continue counselling

31. PRE-TEST COUNSELLING
• Give information on the test
• Explain about the false negative and window period
• Give approppriate information about HIV and STIs
• Dispel any myths about transmission of infection
• Give preventive advice on safer practice ; CONDOM USAGE!
• Assess the possible coping mechanism
• Assess patients social support networks and interpersonal bonds
• Reassure about confidentiality. This is legal requirement
• Discuss who to tell
• Offer the tests
Finally :
• Disccuss how the patient will cope with the test result
• Discuss legal requirements
• Advise of need of informed consent
• Make arrangement to discuss the test result face to face

32. POST- TEST COUNSELLING
NEGATIVE TEST RESULT
• Provide reassurance.
• Emphasise the safe sex information.
• Counter any suggestion that current risk-taking
behaviour is safe.
• Retest if in high-risk category or known HIV
contact or in a ‘window period’ of 12 weeks.
• A test in 3 months helps rule out recent
acquisition.
• Maintain confidentiality.

33. POST- TEST COUNSELLING
POSITIVE TEST RESULT
• Result should be stated clearly
• Give reassurance ; “you are not dying”
• Informed improve prognosis by combination drug therapy
• Educate about difference of HIV and AIDS
• Discuss to whom the patient want to tell, supporting groups
• Ask what is he/she going to do next
• Give support line number for overnight telephone support
• Discuss the issue of contact tracing
• Avoid information overload ; come for few more appointments to
undergo full clinical assessment and blood test.
• Advice for HAART

34. Examination—to set a base level
• Full examination, skin, CNS—especially chest,
abdomen and genitals
• Urine and lung function test
• Monitor temperature and weight

35. Blood tests—to set a base level and
check
immune status
• Repeat HIV antibody test (if any possibility of
error)
• CD 4 cells with FBE and a differential WCC
• Viral load test
• G-6-PD screen for enzyme deficiency
• Serology for syphilis (RPR), hepatitis A, B and C
(very important), toxoplasmosis, CMV
• Test for gonorrhoea and Chlamydia, herpes and
thrush (if indicated)
• Mantoux test for tuberculosis

36. POST-EXPOSURE PROPHYLAXIS (PEP)
(recommended for high risk group. Ie: needle stick injury)
COUNSELLING
1. Wash affected site with soap and water without scrubbing. Also
irrigate any areas of eyes or mucous membrane exposed
2. Do not suck or squeeze blood
3. Encourage bleeding
4. Reassure the patient that risk of viral infection is very low ( 1 in
300)
5. Obtain information about the blood source person. It will facilitate
decision making.
6. Note that it takes 3 months to have antibody positive result.
7. Consider the exposed person’s wishes after discussing benefits/
risks of PEP including adverse effects.

38. ART

40. PRIMARY PREVENTION OF HIV/AIDS
• Community & school education on drugs and sex
• Safe sex
• Regular health check up
• Avoid using same needle
• Screening of blood set up in primary health
centre.
• Community education
• Test and treat!

42. HIV IN GLOBAL ASPECT

45. HIV IN MALAYSIA

46. Estimated people living with HIV, new HIV
infections and AIDS-related deaths, 1990-2017
46
87 000
7 800
4 400
Number
PLHIV New HIV infections AIDS-related deaths
Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2018). UNAIDS 2018 HIV Estimates

47. Key population size estimates, 2014-2017
47
Key population size estimates
Populations Estimate Year of estimate
People who inject drugs (PWID) 120 000 2017
Female sex workers (FSW) 21 000 2014
Men who have sex with men (MSM) 140 000 2017
Transgender 24 000 2014
Source: Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2018

48. HIV prevalence among key
populations, 2017
48Source: Prepared by www.aidsdatahub.org based on Serological surveys and Global AIDS Monitoring 2018
Series1,
National ,
10.9
Series1,
Kuala
Lumpur, 23.9
Series1,
National ,
21.6
Series1,
Kuala
Lumpur, 43.3
Series1,
National…
Series1,
Kelantan…
Series1,
National , 6.3
Series1,
Kuala
Lumpur, 16.9
PEOPLE WHO
INJECT DRUGS (2017)
MEN WHO HAVE SEX
WITH MEN (2017)
TRANSGENDER PEOPLE
(2017)
FEMALE
SEX WORKERS (2017)

49. HIV prevalence among key populations
by age group, 2012-2014
49
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
2012, PWID <25 yr,
4.8
2012, PWID 25+ yr,
19.4
2012, MSM <25 yr,
6.16
2012, MSM 25+ yr, 16
2012, FSW <25 yr, 1.1
2012, FSW 25+ yr, 5
2014, PWID <25 yr, 0
2014, PWID 25+ yr,
17.2
2014, MSM <25 yr, 5.9
2014, MSM 25+ yr,
11.6
2014, FSW <25 yr, 3.6
2014, FSW 25+ yr, 8.4
% 2012 2014

50. Reported HIV cases by mode of
transmission,1990-2014
50Source: Prepared by www.aidsdatahub.org based on Ministry of Health Malaysia. (2014). HIV/AIDS Reporting System and HIV/STI Section. Disease Control Division.
Ministry of Health Malaysia. (2015). Global AIDS Response Progress Report 2015 (Country narrative report).
Number
PWID Homo/bisexual Heterosexual Blood transfusion
Organ recipient Mother-to-child No data

51. MANDATORY PRE-MARITAL HIV TEST
• Mandatory pre-marital HIV screening for Muslim couples was made
mandatory by the Religious Department of State Government in 9
states, beginning in November 2001 in Johor, followed
by Perak, Perlis, Kelantan, Terengganu, Kedah, Pahang, Selangor,
and possibly Melaka. Beginning January 2009, Muslim couples in
the entire country are required to submit to premarital HIV testing.
• In 2018, the Ministry of Women, Family and Community
Development mulls to make HIV testing mandatory for non-Muslim
couples seeking marriage as well.The proposal is strongly opposed
by NGOs such as the Malaysian AIDS Council and the Sarawak AIDS
Concern Society (SACS) citing the stance of World Health
Organization (WHO) and UNAIDS that do not support compulsory
screening of individuals for HIV.

52. WHY OPPOSING?
• In screening a person for HIV, one's personal choice must be
respected while adhering to ethical and human rights principles,"
• The risk of getting infected still exists if one continues to be
involved in high-risk activities associated with HIV transmission
after screening," it said.
• SACS said instead of making HIV testing compulsory, Malaysians
should be encouraged to get tested on a voluntary basis complete
with pre- and post-testing counselling.

53. HIV IN INDIA

54. India HIV/AIDS Epidemic Status (2017)
Indicator Global India
People living with HIV
(All ages)
36.9
M
2.14 M
New HIV Infections
(All ages)
1.8 M 88,000
PLHIV on ART 21.7
M
1.23 M
AIDS-Related Deaths 0.940
M
69,000
 Low Prevalence Country (0.22%);
concentrated epidemic
 3rd Largest No. of PLHIV in the world
 Female: 42% of PLHIV; Children: 3%
of PLHIV
Series
1,
IDU,
6.26
Series
1, TG,
3.14
Series
1,
MSM,
2.69
Series
1,
FSW,
1.58
Series
1,
Truck
ers,
0.86
Series
1,
Migra
nts,
0.51
Series
1,
ANC,
0.28
Source: HIV Sentinel Surveillance 2016-
HIV Prevalence (%) in different
population groups

55. State wise Adult HIV Prevalence in 2017,
HIV Estimations 2017

56. • Since 2005, when the number of AIDS related deaths (ARD) started
to show a declining trend, the annual number of AIDS related
deaths has declined by almost 71%. In 2017 an estimated 69.11
(29.94 –140.84) thousand people died of AIDS-related causes
nationally. AIDS-related deaths have dropped in all of India’s
States/UT with the exception of Assam, Bihar, Jharkhand, Haryana,
Delhi, and Uttarakhand.
AIDS Related deaths over years, HIV Estimations 2017

58. • Countries around the world have committed
to meeting the Sustainable Development Goal
of ending the AIDS epidemic by 2030, and
according to the World Health Organization
(WHO), “the world has come a long way since
2000, achieving the global target of halting
and reversing the spread of HIV.”

59. REFERENCES
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424423/
• https://www.aidsdatahub.org/Country-Profiles/Malaysia
• http://digjamaica.com/m/blog/world-aids-day-2015-getting-to-zero/
• http://www.naco.gov.in/hiv-facts-figures
• https://www.thestar.com.my/news/nation/2018/12/21/ngo-opposes-mandatory-
hiv-screening-for-non-muslim-couples/