all about HIV and AIDS

1. HIV: THE GLOABAL AND INDIAN
SCENARIO
DR. KANUPRIYA CHATURVEDI
DR. S.K CHATURVEDI

2. Lesson objectives
• Understand the global and local impact of the epidemic
• Know about HIV/AIDS in adults, children, and families
• Understand the natural history of HIV infection
• Understand the modes of HIV transmission
DR. S.K CHATURVEDI
Scope of the HIV/AIDS Pandemic
Natural History and Transmission of HIV

3. HIV
•Human Immunodeficiency Virus
•H = Infects only Human beings
•I = Immunodeficiency virus weakens the immune system and
increases the risk of infection
•V = Virus that attacks the body
DR. S.K CHATURVEDI

4. AIDS
•Acquired Immune Deficiency Syndrome
•A = Acquired, not inherited
•I = Weakens the Immune system
•D = Creates a Deficiency of CD4+ cells in
the immune system
•S = Syndrome, or a group of illnesses
taking place at the same time
DR. S.K CHATURVEDI

5. HIV and AIDS
• When the immune system becomes
weakened by HIV, the illness
progresses to AIDS
• Some blood tests, symptoms or
certain infections indicate
progression of HIV to AIDS
DR. S.K CHATURVEDI

6. HIV-1 and HIV-2
• • HIV-1 and HIV-2 are
• Transmitted through the same routes
• Associated with similar opportunistic infections
 • HIV-1 is more common worldwide
 • HIV-2 is found in West Africa, Mozambique, and
Angola
DR. S.K CHATURVEDI

7. HIV-1 and HIV-2
• HIV-2 is less easily transmitted
• HIV-2 is less pathogenic
• Duration of HIV-2 infection is shorter
• MTCT is relatively rare with HIV-2
• MTCT of HIV-2 has not been reported from India
DR. S.K CHATURVEDI

8. Transmission of HIV
•HIV is transmitted by
• Direct contact with infected blood
• Sexual contact: oral, anal, or vaginal
• Direct contact with semen or vaginal and
cervical secretions
• HIV-infected mothers to infants during
pregnancy, delivery, or breastfeeding
DR. S.K CHATURVEDI

9. Transmission of HIV
DR. S.K CHATURVEDI
HIV is not transmitted by
• Public baths
• Handshakes
• Work or school contact
• Using telephones
• Sharing cups, glasses,
plates, or other utensils
• Coughing, sneezing
• Insect bites
• Touching, hugging
• Water, food
• Kissing

10. DR. S.K CHATURVEDI
00003 -E -1 – December 2004
Global summary of the HIV and AIDS epidemic,
December 2004
The ranges around the estimates in this table define the boundar
ies within which the actual numbers lie, based on the best avail
able information.
Number of people living
with HIV in 2004
Total 39.4 million (35.9–44.3 million)
Adults 37.2 million (33.8–41.7 million)
Women 17.6 million (16.3–19.5 million)
Children under 15 years 2.2 million (2.0– 2.6 million)
People newly infected
with HIV in 2004
Total 4.9 million (4.3– 6.4 million)
Adults 4.3 million (3.7– 5.7 million)
Children under 15 years 640 000 (570 000 –750 000)
AIDS deaths in 2004 Total 3.1 million (2.8– 3.5 million)
Adults 2.6 million (2.3– 2.9 million)
Children under 15 years 510 000 (460 000 – 600 000)

11. 00003-E-10 – December 2004
About 14 000 new HIV infections a day in 2004
 More than 95% are in low and middle income countries
 Almost 2000 are in children under 15 years of age
 About 12 000 are in persons aged 15 to 49 years, of
whom:
— almost 50% are women
— about 50% are 15–24 year olds
DR. S.K CHATURVEDI

12. Global HIV/AIDS in 2004 *
• 39.4 -40.0 million people are living with HIV/AIDS
• 2.2 million are children under 15 years
• 6,40,000 children were newly infected with HIV in 2004
• 5,10,000 children died of HIV in 2
• * Source: UNAIDS,2004
DR. S.K CHATURVEDI
5.1 m. Indian living with HIV

13. Reported cases
•Reported AIDS cases
• (15,202)
•Estimated AIDS cases
• (219,400)
•People living with
•HIV/AIDS (2.2 million)
Only a small number of PLWHA are reported
DR. S.K CHATURVEDI

14. Impact of Global HIV
• Negative economic impact on countries
• Overstrained healthcare systems
• Decreasing life expectancy
• Reversal of child survival gains
• Increased numbers of orphans
DR. S.K CHATURVEDI

15. HIV Estimates in India
DR. S.K CHATURVEDI

16. MCH Profile (India)
Total Population 1027 M
Crude Birth Rate 25/1000
Sex Ratio (F:M) 933
Annual Pregnancies 27 M
ANC Coverage 65.4 %
Institutional Deliveries [12.1% to 79.3%] 35.6 %
Deliveries attended by skilled birth attendants 42.3 %
DR. S.K CHATURVEDI

17. DR. S.K CHATURVEDI
Adult HIV Prevalence
High Prevalence States:
these are Tamil Nadu,
Maharastra, Karnataka,
Andhra Pradesh, Manipur
and Nagaland

18. DR. S.K CHATURVEDI
Mode of Transmission of HIV In India
5.95
3.45
2.07
2.7
85.83
Sexual IDUs Blood & blood proucts Perinatal Unidentified

19. DR. S.K CHATURVEDI
0
10
20
30
40
50
60
70
80
90
100
# uninfected
# infected during
BF for 2 yrs
# infected during
delivery
#infants infected
during
pregnancy
63
uninfected
15
15
7
MTCT in 100 HIV+ Mothers
The majority of children do not get infected
even when we do nothing

20. Risk of PTCT Transmission
• Globally: 15-45%
• India: 30-37% ( average)
DR. S.K CHATURVEDI

21. DR. S.K CHATURVEDI
0
20
40
60
80
100
Bihar Gujarat Uttar Pradesh
Urban Male Urban Female Rural Male Rural Female
%
Source: National AIDS Control Organization, National Baseline General
Population Behavioural Surveillance Survey 2001
Proportion of Respondents Stating That HIV
can be Transmitted Through Sexual Contact,
Selected States in India
2004 Report on the Global AIDS Epidemic

22. Prevention of
HIV Transmission
• Strategies to prevent HIV transmission
• Personal strategies
• Public health strategies
• Safe practices: no risk of HIV transmission
• Risk reduction: reduces but does not eliminate risk
DR. S.K CHATURVEDI

23. Prevention of
HIV Transmission
 Public health strategies to prevent HIV transmission
• Screen all blood and blood products
• Follow universal precautions
• Educate in safer sex practices
• Identify and treat STIs/other infections
• Provide referral for treatment of drug dependence
• Apply the comprehensive PPTCT approach to prevent
vertical transmission of HIV
DR. S.K CHATURVEDI

24. Natural History of HIV Infection
DR. S.K CHATURVEDI

25. Natural History of HIV Infection
•Virus can be transmitted during each stage
• Seroconversion
•Infection with HIV, antibodies develop
• Asymptomatic
•No signs of HIV, immune system controls
virus production
• Symptomatic
•Physical signs of HIV infection, some immune
suppression
• AIDS
•Opportunistic infections, end-stage disease
DR. S.K CHATURVEDI

26. Natural History of HIV Infection
• Immune suppression
• HIV attacks white blood cells,called CD4
cells, that protect body from illness
• Over time, the body’s ability to fight
common infections is lost
• Opportunistic infections occur
DR. S.K CHATURVEDI

27. HIV Disease
•Progression of HIV disease is measured by:
• CD4+ count
•Degree of immune suppression
•Lower CD4+ count means decreasing immunity
• Viral load
•Amount of virus in the blood
•Higher viral load means more immune
suppression
DR. S.K CHATURVEDI

28. HIV Disease
• Severity of illness is determined
by amount of virus in the body
(increasing viral load) and the
degree of immune suppression
(decreasing CD4+ counts)
• Higher the viral load, the sooner
immune suppression occurs
DR. S.K CHATURVEDI

29. Progression of HIV Infection
• HIGH viral load (number of copies of HIV
in the blood)
• LOW CD4 count (type of white blood cell)
• Increasing clinical symptoms (such as
opportunistic infections)
DR. S.K CHATURVEDI

30. HIV Disease
•Direct infection of organ systems
• HIV can directly infect the:
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)
DR. S.K CHATURVEDI

31. HIV Disease: Summary
• HIV multiplies inside the CD4+ cells, destroying them
• As CD4+ cell count decreases and viral load increases, the immune defences are weakened
• HIV-infected people become vulnerable to opportunistic infections
• HIV is a chronic viral infection with no known cure
• Without ARV treatment, HIV progresses to symptomatic disease and AIDS
DR. S.K CHATURVEDI

32. Key Points
• HIV is a global pandemic and the number of people living with HIV continues to
increase worldwide.
• HIV epidemic is especially severe in resource-constrained settings
• HIV is a virus that destroys the immune system, leading to opportunistic
infections.
• The progression from initial infection with HIV to end-stage AIDS varies from
person to person and can take more than 10 years.
DR. S.K CHATURVEDI

33. Key Points (continued)
• The most common main route of transmission worldwide is
heterosexual transmission.
• Women of childbearing age are at particular risk for acquiring
HIV through unprotected sex
• HIV-positive women who are pregnant are at risk of passing
HIV infection to their newborn.
• Risk of HIV transmission from mother-to-child can be greatly
reduced through effective PMTCT programs
DR. S.K CHATURVEDI