HIV is a virus that attacks the immune system and gradually destroys it. Over time, HIV infection can lead to AIDS. There are two main types of HIV - HIV-1 is more prevalent and virulent, while HIV-2 is less so. The virus is transmitted through unprotected sex, contaminated needles, or from mother to child. As the virus destroys CD4 cells, it progresses from primary infection to asymptomatic carrier state to AIDS-related complex and finally AIDS, making the individual vulnerable to opportunistic infections. Common opportunistic infections associated with AIDS include Pneumocystis pneumonia and Kaposi's sarcoma. Testing and preventive measures like condom use can help curb the spread of the virus.

2. HIV/AIDS & Its
Prevention

3. Maj Neamatullah Ahmed
MBBS, MPH( HM )
MO, BANBAT-6
Yambio TS

4. Learning points
 What is HIV ?
 What are the types of HIV?
 What is AIDS ?
 What is the difference between
HIV/AIDS ?
 What are the stages of HIV infection ?
 What are the ways of detecting whether
a
parson has HIV ?
 What is the window period ?
 How HIV Transmitted ?
 What are the main method of preventing
HIV transmission ?

5. HIV
H- Human
I- Immunodeficiency
V- Virus.
The virus attacks the immune system
and gradually destroys it.The body can not
defend itself against infections and the
result is a condition known as AIDS.

6. AIDS VIRUS

7. AIDS VIRUS

8. AIDS VIRUS

9. FACTS of HIV/AIDS

10. Adults and Children Estimated to Be Living with HIV,
2007 (UNAIDS, 2007 @ www.unaids.org)
Western & Eastern Europe
Central Europe & Central Asia
North America 730 000 1.5 million East Asia
1.2 million [580 000 – 1.0 million] [1.1 – 1.9 million]
[760 000 – 2.0 million]
740 000
Middle East & North [480 000 – 1.1 million]
Caribbean Africa South & South-East Asia
230 000 380 000 4.2 million
[210 000 – 270 000] [280 000 – 510 000] [3.5 – 5.3 million]
million]
Latin America Sub-Saharan Africa
Oceania
1.7 million 22.0 million
[1.5 – 2.1 million] [20.5 – 23.6 million] 74 000
[66 000 – 93 000]
Total: 33 million (30 – 36 million)

11. HIV
HIV is a virus : infection with HIV is likely to lead to
AIDS.
HIV disease has 4 stages, disease of HIV infection
does not mean AIDS, immediate or visible illness, or
impending death.
HIV infection is diagnosed by using specific test:-
a-ELISA
b-Western Blot.

12. Types of HIV
HIV-1 : Prevalent in American & Europian
countries, more virulent, normally found in the
body of Chimpanzees
HIV-2 : Prevalent in African countries, less
virulent, normally found in the body of some
types of monkeys and mongoose

13. History of the Disease:
African green monkeys to Human injecting blood of
green monkeys Haiti Carribean countries
USA Whole world.
• 1981 in Los Angeles : Cases of Kaposi sarcoma
and
P. jiroveci pneumonia in young homosexual males
and IV drug abusers.
• 1986 Chennai- first HIV positive case detected.
• 1987 Mumbai - first AIDS patient detected.

14. NATURE OF THE VIRUS
1. HIV is a single stranded RNA virus
2. It replicates by using an enzyme called
reverse transcriptase to translate its
genomic RNA into DNA copy
3. This DNA then copied again into viral RNA
to produce new virus particles.

15. Infection process
First the virus infect:
 T-helper lymphocytes,Monocytes (CD 4, T4) and
also cells of monocytes & macrophages
 HIV merges with the T4 cells & transcribed its
RNA genome into double stranded DNA.
 The viral DNA becomes incorporated into the
nucleus of the T4 cells & directs the production of
new virion particles.
 This virion particles bud from T4 cell membrane
infect other T4 cells.

16. Life cycle of HIV (AIDSInfo)
1. Binding and fusion
2. Reverse
transcription
3. Integration
4. Transcription
5. Assembly
6. Budding

17. AIDS
A- Aquired not inherited.
I- Immuno-relating to bodys immune system, which
provides protection from disease causing germs.
D- Deficiency- lack of immune response to germs.
S- Syndrome – a number of signs and symptoms
indicating a particular disease or condition.

18. EPIDEMIOLOGY
 First AIDS case reported in – 1981
California and NY –USA
 The term AIDS first officially adopted in
1982
 The virus first identified (LAV-
lymhadenopathy associated virus) by
Barre- Sinoussi, Montagnier and others
in Paris in 1983 ( Pasteur Institute).
 The virus infected so far – 62 million

19. EPIDEMIOLOGY cont…
 Died so far –> 20 million
 Living with HIV/AIDS – 33.2 million,
two-third of which is living in sub Saharan
Africa
 Newly infected case in 2007- 2.5 million
 Total deaths more than 2.1 millions in
2007.
 14,000 getting infected in everyday.

20. AIDS
Definition:
A case of AIDS in adult is defined as a patient
with no known underlying cause of cellular
immunodeficiency and who presents with at
least two of the major signs associated with
at least one minor sign:

21. AIDS
Major signs :
1. weight loss of >10% of body weight within one
month
2. Chronic diarrhoea > 1 month
3. Prolonged fever > 1 month (intermittent or
constant)
M inor signs:
1. Persistent cough > 1 month
2. Generalized lymph adenopathy
3. Fungal irruption
4. Herpes zoster
5. Persistent fatigue
6. Night sweats

22. HIV (Human Immunodeficiency Virus ) infects
cells of the immune system and destroys or
impairs their function.
HIV Infection progressive deterioration of the
immune system breaking down the body's
ability to fight out infections & diseases by
opportunistic bacteria, viruses and fungi.
AIDS (Acquired Immune Deficiency Syndrome )
refers to the most advanced stages of HIV
infection and a collection of signs and symptoms
caused by more than 20 opportunistic infections
or related cancers.

23. CD4 facts
What CD4 cells do?
CD4 cells/T-cells/T-helper cells : Organize the immune
system’s response to bacterial, fungal and viral infections.
CD4 cell counts in people without HIV:
HIV-negative man : 400-1600/ml of blood
HIV-negative women : 500-1700/ml of blood.
Menstruation: Women’s CD4 cell counts go up and down
during the menstrual cycle.
OCP: Oral contraceptives lowers woman’s CD4 cell count.
Smoking: Smokers tend to have higher CD4 cell counts (by
about 140).
Sleep: A lower CD4 cell count in the early morning which rises
in the afternoon.

24. Modes of Transmission
Vaginal, oral or anal sex with an infected person.
Transfusion of infected blood.
Sharing unclean needles or syringes to take drugs.
Unsterilized needles for tattooing, skin piercing or
acupuncture .
From mother to baby in uterus during Pregnancy,
childbirth (vertical transmission) or through
breastfeeding.
occupational exposure in health care settings.

25. Natural History of Disease
Primary infection
Asymptomatic carrier state
 AIDS related complex
AIDS

26. Primary Infection
• Primary infection is symptomatic in 70-80% of cases
and usually occurs 2-6 wks after exposure
• Fever with rash
• Pharyngitis with cervical lymphadenopathy
• Myalgia / arthralgia
• Headache
• Mucosal Ulceration
• D/D: (Pneumonic- SCEST )
• Streptococcal Pharyngitis
• CMV
• EBV
• Secondary Syphilis
• Toxoplasmosis

27. HIV Indicator Diseases
Weight loss
Chronic Diarrhoea
Herpes zoster
Peripheral neuropathy
Low-grade fever or night sweats
Idiopathic thrombocytopenic purpura
Oral hairy leucoplakia
Recurrent oropharyngeal candidiasis
Recurrent vaginal candidiasis
Cervical dysplasia

28. D/D of HIV related oral
disease
Early HIV • Gingivitis/Periodontitis
• Syphilis
• Oral hairy • Human Papilloma virus
leucoplakia • Herpes zoster
• Herpes Simplex
• Oropharyngeal
candidiasis
• Apthous ulcers
• Lymphoma
Late HIV
• CMV
• Kaposi’s sarcoma

29. ARC ( AIDS Related Complex )
1.Fever and mild weight loss.
2.Symmetrical lymph node enlargements.
3.Recurrent diarrhoea.
4.Malaise and fatigue.
5.Repeated episodes of oral candidiasis.
6.Herpes zoster.
7.Fungal skin eruptions.

30. AIDS defining Diseases/ AIDS
Oesophageal Invasive cervical cancer
Candidiasis Extra pul histoplasmosis
Cryptococcal meningitis Kaposi’s sarcoma
Ch Cryptosporidial Non-Hodgkin lymphoma
Diarrhoea HIV associated wasting
Ch mucocutaneous HIV associated dementia
herpes simplex
Disseminated Myco
avium intracellulare
Pul/extra pul. TB
Pneumocystis
jiroveci(carinii)

31. Opportunistic Infections Associated With AIDS
Categories of
Opportunistic
Infections or Diseases
• Bacterial &
Mycobacterial
• Fungal
• Malignancies or
cancers
• Protozoal
• Viral
• Neurological conditions

32. Oppurtunistic infections in HIV
CD4+ Lymphocyte count
Herpes zoster
Oral candidiasis
Pneumocystis pneumonia
Esophageal candidiasis
Mucocutaneous herpes
Toxoplasmosis, Cryptococcosis, Coccidioidomycosis
Mycobacterium avium complex
Cytomegalovirus
Cryptosporidiosis
time

33. Routine Blood Tests
Blood for Hb% :Severe Anaemia: 70%
cases presents
TLC : Lecopenia:50% cases presents
DLC : Lymphopenia is a good marker of
HIV ( normal lymphocyte count: 20-40%)
Total Platelet Count :Thrombocytopenia:
40% cases presents

34. White Blood Cell of blood
Total Count : 4000-11000/ cu mm
Profile
Types:
• Neutrophil : 50-70%
• Eosinophil : 01-04%
• Basophil : 0-01%
• Lymphocyte : 20-40%
 B lymphocyte
 T lymhocyte
o T Killer cell
o T Helper cell / CD4 cell /T4 cell
• Monocyte : 02-08%

35. Transmission of HIV

36. ROUTES
• Sexual
• Parenteral
• Perinatal

37. Sexual
Male Female
• Large surface area
• Higher concentration of HIV in semen
• Recipient of infectious material
• Menstruation
• Trauma is more frequent
• Dendritic cell
• Social cause

38. Parenteral transmission
 Blood and blood product
 Syringe
 Needle
 Surgery
 Dentistry
 Tattooing
 Ear-nose piercing
 Acupuncture
 Razor

39. Perinatal
• Intrauterine
•During delivery
• Breast feeding

40. Increased risk of HIV infection associated
with common STDs
STD Increased risk Remarks
ofHIVinfection
Gonorrhoeae + +
Chlamydia + +
Syphilis + + +
Chancroid + + + +
Trichomoniasi +
s

41. Efficiency of HIV transmission by different
routes
Efficiency Global
% infection
%
Sexual
0.1 -1 75-85
transmission
Blood & blood
> 90 5-10
product
Parenteral Rare
(Needle) 0.37
Mother to child 5-10
25-35 (33)

42. Following are the materials, which are
capable of transmitting HIV from infected
person:
Blood
Semen
Vaginal fluid
Breast milk
Saliva
Sweat
Stool
Urine
Tear

43. Window period
The period before the development of an
antibody response between 6-12 weeks
is often referred to as the “Window
Period”
 HIV in blood
 No HIV antibody

44. Bangladesh Situation
First detection of HIV in 1989
Low prevalent till today
More then 850 cases reported so far till
December2006
187 cases of AIDS detected so far of which 44
have already died due to TB till 2006
The estimated number of HIV is around 13000

45. HIV prevalence Among IDUs
in South Asia
( The figure is not static )
INDIA 2-63%
PAKISTAN (Larkana) 11%
NEPAL(Kathmandu) 68%
BANGLADESH (Dhaka) 4.9%
MYANMAR (median prevalence) 37.1%

46. Factors Affecting the Spread of HIV
Among IDUs in Dhaka
1. Needle/syringe sharing is high: 70.2%
2. Average # of sharing partners per session:
2.3
3. Injecting drug users are sexually active and
have multiple sex partners
4. Drug users are often engaged in sex work to
support their addiction
5. Low condom use
6. Poor understanding of how HIV is
transmitted and prevented among IDUs
resulting in low levels of risk perception
7. Almost none are aware of their HIV status.

47. High Risk Population
• Injecting Drug Users
• Sex Workers : Street, hotel & residence Based.
• MSM
• MSW & Hijra group
• Truckers
• Transport Workers

48. Association of AIDS with 5 Hs
Homosexuals
Heterosexuals
Habitual drug abusers
Health workers – i.e. doctors,
nurses:~3% risk with accidental
puncture
Haitian immigrants

49. Conditions for rapid HIV
expansion are in place
• Many people do not even know they are at risk:
e.g. 90% of SBSWs could not name 2 correct
modes of transmission
- Sex Work: Many partners, not many condoms
• More than 80% of truckers clients never use
condoms
* 67% of men buying sex from men never use
condoms
- Needle sharing is routine among IDUs
* 85% of IDUs share needles

50. HIV SITUATION IN OUR CLOSE
NEIGHBORS
* India : 5.1 million
* Myanmar: 2,00, 000
* Pakistan : 76 000
* China : 1 million

51. High Risk cause
1. Close neighbouring country (Central African Republic, Congo, Uganda )
has the highest HIV prevalence rate.
2. Lack of knowledge about the epidemic.
3. Sexual promiscuity, commercial sex worker & more STI/STD
4. More high risk group having interaction with general population
5. Poverty linked risk factors: (large overseas migration of workers to
Uganda,Kenya etc,seasonal migration within country, extensive
trafficking, child sexual abuse etc)
6. Increasing trend of intravenous drug abuse
7. Gaps in health care delivery system:
- Blood transfusion- no proper screening facility
-Increased voluntary blood donation
- Biomedical safety are not maintained
-private health care facilities & diagnostic labs are not regularly
monitored

52. Preventive Policy for AIDS
We know, - for curable diseases
“Prevention is better than Cure”
• For Uncurable disease like AIDS –
“Prevention is the only way to keep us
disease free and alive”

53. How we can protect ourselves
a. Abstinence-is an absolute way to prevent sexual
transmission and Public awareness campaigns for HIV
b. Behaviour modification – Sex aluring / arousal
behaviour should be avoided among public.Avoiding of
enjoying Hot movies specially during isolated stay from
family.
c. Comprehensive sex education programmes in schools
and Councelling
d. Discreet / easily accessible testing centres
e. Peer education & Effective treatment of HIV
Infected individuals
f. Safe sex practices i.e. use of condom,fewer sexual
partners etc
g. Post sexual exposure prophylaxis

54. Management of HIV Infection
-Eliminate Negative Factors :
-Poor diet
-Stress
-Toxins, drugs
-Negative attitude(psycoimmunity)
-Hopelessness
-Accentuate positive Factors:
-Healthy diet
-Nutritional supplement
-Stress reduction
-Energy therapy, Psychotherapy
-Psycoimmunity, positive thinking, hope
-Counseling, expressing your feeling
-Fun, joy
-Exercise
-Rest
-Support system
-spirituality

55. AIDS Drugs
•NNRTIs
Non nucleoside
Reverse
Transcriptase
Inhibitors
•Protease Inhibitors
•Fusion Inhibitor

56. Time to start treatment
When CD4 cell(T4) count is less than 500
(Normal T4 cell count is more than 500. Between 200 to 500 indicates
immunodeficiency & less then 200 indicates severe immunodeficiency)
Or
Viral load is greater than 10000 copies
per ml

57. Acute HIV Infection: Rash

58. Acute HIV Infection: Oral Manifestations

59. Oral Candidiasis

60. Histoplasmosis

61. Hairy leukoplakia

62. Herpes Simplex Virus (HSV)

63. Varicella-Zoster Virus
(Shingles)

64. Human Papilloma Virus (HPV)

65. Angular cheilitis

66. Necrotizing Ulcerative Periodontitis
(NUP)

67. Mucomycosis

68. Apthous ulcers

69. Kaposi`s Sarcoma

70. Non-Hodgkin’s Lymphoma

71. Wasting syndrome

72. Tuberculosis

73. Molluscum contagiosum

74. Pulmonary and extra pulmonary Tuberculosis

75. Fig:A patient with ARC.

76. Fig:Cutaneous candidiasis in a patient with
AIDS.

77. Fig: Cutaneous candidiasis in a patient with
AIDS.

78. Fig: A malnourished AIDS patients with chronic
diarrhoea.

79. Fig: A malnourished AIDS patients with chronic
diarrhoea.

80. Fig: Giant condylomata acuminata in female
patient with ARC.

81. Fig: Giant condylomata acuminata
in female patient with ARC.

82. Fig:Extensive venereal warts.

83. Fig :Extensive venereal warts.

84. Fig: Maltidermatoma herpes zoster has a positive
predictive value for HIV infection on of almost 90%.

85. Herpes zoster

86. Fig:20-years-old man with AIDS presented with
Multidermatomal herpes zoster and buccal candidiasis.

87. Fig:20-years-old man with AIDS presented with
Multidermatomal herpes zoster and buccal candidiasis.

88. Fig: Keloids from herpes zoster in an HIV patients.

89. P .jiroveci pneumonia
“Ground glass appearance”

90. Diarrhoea in AIDS Microsporidia
Giardiasis
Isospora belli
cryptosporidia

91. Toxoplasmosi
s

92. Fig:This hand was ulcerated,
immobile and grossly enlarged.

93. Fig:At this site tumour
showed an excellent
response to chemotherapy
over a period of four months.

94. Fig:Endemic Keposi’s
sarcoma restricted to
one hand.

95. Fig: This young man with AIDS
presented with primary chancre.

96. Fig: Classical chancroid showing multiple,
superficial, tender ulcers with an erythematous halo.

97. Fig: Classical condylomata acuminata(venereal warts)

98. Fig:23-year-old patient with HIV related disease.

99. A Case History
Ah Long – 6 yrs old.
Living in foothill village of Malu – mountain in Liuzhou in Guanxi
Province, China

105. Social welfare agencies giving 70
Yuan monthly now.Govt will give 70
Yuan from Nov this year and 100
Yuan from next year

106. 84 year old grand mother refused to live with him

112. Playing with dog Lao Hei

115. Playing himself alone in the front portion of
his small tinshed house-totally monotonous

121. The future is unclear for A-Long. No one knows what will
happen.
THE INABILITY TO RECONCILE REALITY AND
EXPECTATION
RESULTS IN SUICIDAL TENDENCIES.........SO
If you see someone without a smile today give them one of
yours!
Live simply,
Love seriously,
Care deeply,
Speak kindly.

122. One question to our conscience :
For getting temporary
gratification only, is it justified to
produce such inhuman
permanent problems to an
innocent child like Ah-Long and
also to the parents as well as to
the society ?

123. References
Davidson’s Principles & Practice of
Medicine-21st Edition(2010)
Harrison’s Manual of Medicine- 16th Edition
A textbook of microbiology by Maj Gen M R
Choudhury ( Retd )- 5th Edition
www.medlineplus
www.i-base.org.uk
www.bhiva.org
www.medscape.com
www.pubmed.com

124. আল্লাহ নঅইপরাইওনতা, সদাচরন, এবং
আত্মীয়সব নেক দান করার আেদশ েদন এবং িতিন
্জ
অশ্লীলতা , অসংগত কাজ এবং অবাধয া করেত বারণ
্ত
কেরন। িতিন েতামােদরেক উপেদশ েদন – যােত েতামরা
স্মরণ রাখ.
সুরা নাহলঃ 90

125. Surah Nahl: 90
Verily, Allah enjoins justice, good behaviour
and giving monetary help to the relatives
and forbids all evil deeds e.g. illegal sexual
acts, disobedience of parents, polytheism,
to tell lies, to give false witness, to kill a life
without right and all that is prohibited by
Islamic law. He advices you, so that you
remember.

126. যারা সৎক ্ েরেছ তােদর জনযরেয়েছ কলয এবং
কমর ্ ্াণ
তারও েচেয় েবশী। আর তােদর মুখমণ্ডলেক আবৃত
করেবনা মিলনতা িকংবা অপমান। তারাই হল
জান্নাতবাসী , এেতই তারা বসবাস করেত থাকেব
অনন্তকাল।
সুরা ইউনুস:26

127. Surah Yunus : 26
For those who have done good is the
best and even more. Neither darkness
nor dust nor any humiliating disgrace
shall cover their faces. They are the
dwellers of paradise, they will abide
therein forever.

128. Support People Living with
HIV/AIDS.
Know HIV, No AIDS

129. ?

130. Thank
you

131. Concluding Speech