This document provides a summary of the history and epidemiology of HIV/AIDS. It discusses the initial cases reported in 1979 and the evolving understanding and naming of the virus. Key points include: HIV is classified into two types, HIV-1 being more easily transmitted than HIV-2; it is transmitted via bodily fluids and progresses from primary infection to asymptomatic infection to symptomatic AIDS if untreated; common opportunistic infections associated with AIDS are also outlined. The document then focuses on the epidemiology of HIV/AIDS globally and nationally in Bangladesh.

1. Md Limon Mia
MBBS,4TH year
Abdul Malek Ukil Medical College
Noakhali,Chittagong,Bangladesh
gmail:mdlimonmia1952@gmail.com

3. HISTORY OF HIV

4. 1979
CDC reported unexplained pcp in 5 previously
healthy homosexual men
CDC reported kaposi’s sarcoma in 26 healthy
homosexual men
The disease was named GRID(GAY RELATED
IMMUNE
1981-aids was recognized as separate disease
1981-1982 increased association with IV drug
use,recepiants blood transfusion ,hemophiliacs

5. • 1983
• Virus isolated then named LAV-lymphadenopathy
associated virus
• 1984
• Named HTLV-HUMAN T-cell lymphotrophic virus
• 1985 named –ARV(aids related virus)
• 1986-named HIV international committee on the
toxonomy of virus

6. AIDS: final stage of HIV infection in which the
body is unable to fight opportunistic infections
such as pneumonia, tuberculosis, Kaposi’s
sarcoma among others.
.

7. In Bangladesh HIV positive cases
was 1st dected in 1989 in
Chittagong

8. Type of HIV
HIV-1
HIV-2
HIV-1 is more easily transmitted and more
virulent than HIV-2.

9. Classification
HIV
HIV-1 HIV-2
Group-N Group-M Group-O

12. Retrovirus means that its
genetic information is
stored on single-stranded
RNA instead of double-
stranded DNA found in
most organisms.

13. Structuren of HIV
• `

14. ENZYMES
•Polymerase
•Integrase
•Protease

15. Reverse transcriptase
RNA DNA

16. REPLICATION OF HIV

20. AGE RELATED VARIABLE
Source - UNAID
AGE PERSENTAGE
<15 YEARS 16%
(15-24) 42%
25-ABOVE 42%

21. Primary Stage
ed person can infect other people
• flu-like illness - occurs one to six weeks
after infection called Seroconversion
illness or acute phase. characterized by
transient swelling of the lymph nodes,
sore throat and fever. In its severe
form, patients may complain of a rash
and diarrhea.

22. Secondary stage-Asymptomatic
• Lasts for an average of ten 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

23. Stage-3 Symptomatic
• The symptoms are mild
• The immune system deteriorates
• emergence of opportunistic infections and
cancers

24. Stage 4:HIV TO AIDS
• The immune system weakens
• The illnesses become more severe leading to
an AIDS diagnosis

25. SPECTRUM of HIV/AIDS
window period : 6 weeks to 6 months.
the person may remain in the carrier stage for more than
10 years without developing any symptoms.
Approximately 50% of HIV carriers develop AIDS after
8 to 10 years.

30. • According to WHO Bangldesh is one of the
fortunate countries 111 countries where the
infection rate has not yet reached 1
adult/1000

31. Who are most affected person
• Commercial sex worker sex
• MSM
• IDU(Injecting Drug User)
• rickshaw pullers
• injecting drug users
• men who have sex with men(MSM)
• Patient with sexually transmitted disease(STDs)
• migrant workers.
• Transgender people/Hijras
• Long distance Truck Driver
• Professional blood donar
• Sailor
• Non –resident
• Garment worker
Source-
ICDDR,B

32. Opportunistic Infections associated
with AIDSBacterial
• Tuberculosis (TB)
• Strep pneumonia
Viral
• Kaposi Sarcoma
• Herpes
• Influenza (flu
Parasitic
• Pneumocystis carinii
Fungal
• Candida
• Cryptococcu

33. Provisional diagnosis of AIDS
recommended by WHO
MAJOR SIGNS:
1. weight loss more than 10% within last 6 months.
2. fever for longer than 1 month.
3. Chronic diarrhea for longer than 1 month.

34. Provisional diagnosis of AIDS
recommended by WHO
MINOR SIGNS:
-Persistent cough for longer than 1 month.
- Generalized dermatitis
- Recurrent herpes zoster.
-Recurrent Oro-pharyngeal candidiasis.
-Chronic progressive herpes simplex infection.
-Generalized lymphadenopathy.

35. Modes of Transmission of HIV
Sexual Transmission.
Transmission through blood/blood products.
Mother-to-child Transmission.
HIV-contaminated instruments.
Other possible Modes of Transmission.

36. Modes of HIV/AIDS Transmission

37. Through Bodily Fluids
• Blood products
• Semen
• CSF
• Saliva and tear
• Vaginal fluids
• Breast Milk

38. Through IV Drug Use
• Sharing Needles Without sterilization
• IV drug abuse

39. SEXUAL TRANSMISSION(75%-85%)
 Vaginal sex
 Anal sex
 Oral sex
 Deep kiss
 Homosexual contact
 Bisexual contact
 Heterosexual contact

42. Vertical transmission
(Mother-to-Baby)
• Before Birth
• During Birth
• Postpartum
• After the birth
• Breast feeding

44. Other transmission
• Ear and nose piercing
• Tattooing
• acupuncture
• Scarification
• Ulcerated mucous membrane and gum
bleeding
• Shared razor , tooth brushes , combs ,
circumcision,dental care procedure

45. Incubation period

46. HIV is NOT spread through:
• Sharing food, drinks, clothing and utensils.
• swimming in ponds
• Being bitten by a mosquito.
• casual living with AIDS patient.
• Sharing toilets
• Shaking hands
• Kissing with HIV/AIDS
• Coughing or sneezing.
• Urine, stool, saliva

48. MDG 6: Targets with indicators
Source: MDG Progress Report 2015
Target
indicators
Base year
1990/91
Current
status
Target by
2015
Hiv
prevalence
among
population
.005 <.1(2013 Halting

49. • Prevalence of HIV/AIDS in
Bangladesh currently is <0.1%
• below an epidemic level

50. Diagnosis of HIV
 Clinical diagnosis
 Lab diagnosis

51. Clinical diagnosis
Major sign :
• Weight loss
• Chronic diarrhoea
• Prolonged
Minor sign:
• Persistent cough
• History of herpes zoster
• Generalized lymphadenopathy
• Oropharyngeal candidiasis

52. • Blood
• Urine
• Oral

53. Blood Detection Tests
• Enzyme-Linked Immunosorbent Assay/Enzyme
Immunoassay (ELISA/EIA)
• Radio Immunoprecipitation Assay/Indirect
Fluorescent Antibody Assay (RIP/IFA)
• Polymerase Chain Reaction (PCR)
• Isolation of virus and culture

54. Confirmatory test
 Western Blot
test

56. Urine Testing
• Urine Western Blot
• As sensitive as testing blood
• Safe way to screen for HIV
• Can cause false positives in
certain people at high risk for HIV

57. Oral Testing
• Orasure
• The only FDA approved HIV
antibody.
• As accurate as blood testing
• Draws blood-derived fluids
from the gum tissue.
• NOT A SALIVA TEST!

60. Tests commonly used to diagnose
HIV infection
Screening test:
 ELISA (Enzyme linked immuno-sorbent
assay)
 PAT (Particle Agglutination Test)
- sensitivity -99.9%
 Confirmatory test:
 Western Blot or Immunoblot.
(Detection of viral nucleic acid )
Specificity-99.9%
• PCR (Polymerase chain reaction)
• absolute CD 4 lymphocyte count- < 200
• HIV viral load test

61. False negative results of
HIV testing.
1.Testing performed too early
(window period).
2. Testing performed during advanced stages of the
disease when ability to form antibodies is impaired.
3. Technical errors.

62. Four ways to protect yourself?
• Abstinence
• Monogamous Relationship
• Protected Sex
• Sterile needles

64. Global estimate 2008

66. HIV and AIDS estimates IN BANGLADESH (2014)
Number of people living with HIV 8,900 [8,000 - 9,800]
Adults aged 15 to 49 prevalence rate <0.1% [<0.1% - <0.1%]
Adults aged 15 and up living with HIV 8,600 [7,700 - 9,400]
Women aged 15 and up living with HIV 2,900 [2,600 - 3,100]
Children aged 0 to 14 living with HIV <500 [<500 - <500]
Deaths due to AIDS <1000 [<1000 - 1,200]
Orphans due to AIDS aged 0 to 17 N/A

67. COMMON AIDS-DEFINING CONDITIONS
Oesophageal candidiasis.
meningitis.
Chronic diarrhoea.
CMV retinitis.
Chronic herpes simplex.
Miliary and extrapulmonary tuberculosis.
pneumonia.
Progressive leucoencephalopathy.
Kaposi’s sarcoma.
Non-Hodgkin’s lymphoma.
cerebral lymphoma.
wasting

68. organs/systems may be affected in HIV
infection. But the skin is the first organ affected
in HIV infection.

69. Neoplasm associated with AIDS
• Kaposi’s sarcoma in homosexuals
• B-cell lymphoma
• Cerebral lymphooma
• High grade non-Hodgkin’s lymphoma
• Burkitt’s lymphoma

70. AIDS:
Multiple ulcers of herpes simplex

71. AIDS
Marked wasting and cachexia

72. AIDS
Marked wasting and cachexia

73. AIDS:
Herpes Zoster

74. AIDS:
Pruritic papular eruption. Note cervical
lymphadenopathy.

75. AIDS:
Seborrheic dermatitis of the face.

76. Norwegian scabies. Crusted scabies,
previously a rarity, is not unusual in HIV
positive. Ears particularly affected.

77. AIDS: Kaposi’s sarcoma- reddish-brown
plaques on the face.

78. AIDS: Kaposi’s sarcoma.

79. AIDS: Bacillary angiomatosis (BA).
Dome-shaped papules and nodules.

80. AIDS: Multiple lesions of cryptococcosis

81. Control measure of AIDS
Preventive measure
Health and sex education
Prevention of blood borne STD,transmissoin
Control of prostitution
Social welfare measures
Abiding by the law of religion

82. Antiretroviral treatment
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIHITOR:
Zidovudine
Stavudine
Lamivudine
Didanosine
Zalcitabine
Non-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIHITOR:
Nevirapine
Efavirenz
Delavirdine
Protease inhibitors:
Indinavir
Nelfinavir
Ritonavir

83. THERAPY OF HIV

84. Specific prophylaxis
Primary health care
- Mother –child health care
- Family planning and education

85. Aids Related Complex(ARC)
• Unexplained diarrhoea
• Fatigue
• Malaise
• Weight loss more than 10%
• Fever
• Night sweats
• Generalized lymphadenopathy

86. Why can’t HIV infection be eradicated?
-HIV infects CNS, testes, lymphoid tissue, CD4 cells etc.
-The virus lived resting memory CD4 cells.
-Antiretroviral therapy is not effective against HIV
VACCINE:NO VACCINE

87. National strategy for the prevention and
control of HIV/AIDS in Bangladesh
Prevention of sexual transmission.
Prevention of transmission through blood/blood
products.
Prevention of transmission through IVD use.
Reduction of risk-generating environment.
Reduction of personal, social and economic
impact.
Mobilization of national, regional and
international efforts.

94. The 12th International Congress on AIDS in Asia and the Pacific (ICAAP12)
Dhaka, Bangladesh from 20 to 23 November 2015 under the theme “Be the
Change for an AIDS Free Generation, Our right to health.”

96. THEME World AIDS DAY
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”
2009 -“Universal Access and Human Rights”.
2010 -“Universal Access and Human Rights”.
2011 to 2015- “Getting to zero: zero new HIV infections. Zero
discrimination. Zero AIDS related deaths”

101. THANK YOU