HIV: epidemilogy, diagnosis and treatment

1. Epidemiology, Diagnosis &
Treatment of HIV/AIDS
Supervisor : Dr. N.K. Saini
Presented By: Dr. Ashok & Dr. Palak
UCMS & GTB Hospital
1

2. Outline
1. Magnitude of Problem
• Global
• India
• Delhi
2. Agent
3. Reservoir
4. Source
5. Mode of Transmission
6. Host Factors
7. Lab Diagnosis
8. Treatment
2

3. 3

4. People living with HIV(2016)
• About 64% are in sub-Saharan Africa
• New HIV infections in 2016 -1.8
million [1.6 million–2.1 million]
• About 5000 new HIV infections (adults
and children) a day
• 17.8 million [15.4 million–20.3 million]
women
• 2.1 million [1.7 million–2.6 million]
children (<15 years)
Source: UNAIDS factsheet 2016
4

5. Source: UNAIDS factsheet 2016
5

6. AIDS related deaths
Total estimated deaths since
1981 – 36 million
Deaths in 2016 – 1 million [830
000–1.2 million]
Source: UNAIDS factsheet 2016
6

7. INDIA
National adult (15–49 years) HIV
prevalence estimated at 0.26%
(0.22%–0.32%)
0.30% among males
0.22% among females
Manipur (1.15%) > Mizoram
(0.80%) >Nagaland (0.78%)>
Andhra Pradesh & Telangana
(0.66%),
Prevalence of HIV in India (1990-2015)
SOURCE : NACO ANNUAL REPORT 2016-177

8. People living with
HIV in India
• Estimated at 21.17 lakhs
(17.11 lakhs–26.49 lakhs)
compared with 22.26 lakhs
(18.00 lakhs-27.85 lakhs) in
2007.
• New infections in 2015
estimated to be around 86
(56–129) thousand
• Selected state distribution of
people living wit HIV AIDS.
Source : NACO ANNUAL REPORT 2016-17
8

9. 9

10. EXPANSION OF HSS SITES IN INDIA
2017
800+
500+
1300+
10SOURCE : HSS 2014

11. 11

12. • High risk groups :
• Intravenous drug users (9.9%)
• Trans genders (8.82%)
• MSM (men having sex with
men)(4.3%)
• Truckers (2.59%)
• Female sex workers (2.2%)
• Migrants (0.99%)
• ANC (0.29%)
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00%
ANC
Migrants
FSW
Truckers
MSM
Transgenders
IDUs
Prevalence of HIV in high risk groups in India
SOURCE : NACO ANNUAL REPORT 2016-17
12

13. AIDS Related Deaths
An estimated 67.6 [46.4–106.0]
thousand people died of AIDS-
related causes nationally
Since 2007 the annual number
of AIDS- related deaths has
declined by 54%
Decline consistent with the
rapid expansion of access to
ART.
Source : NACO ANNUAL REPORT 2016-17
13

14. New Delhi (2015)
• Estimated Prevalence – 0.23% (
0.10-0.50)
• People living with HIV (adults and
children – 30,216 (11,874 – 67,917)
• Annual new infections – 1,591(641-
3365)
• AIDS related deaths – 331(182-744)
Source : NACO state fact sheet 2014
14

15. AGENT : HUMAN IMMUNO DEFICIENCY VIRUS
• Icosahedral (20 sided), enveloped
virus of the lentivirus subfamily of
retroviruses.
• Two viral strands of RNA found in
core surrounded by protein outer
coat.
• Outer envelope contains a lipid matrix
within which specific viral
glycoproteins are imbedded.
• These knob-like structures responsible
for binding to target cell. 15

16. HIV I : More virulent and widespread (M
subtype)
HIV 2 : Less virulent and mostly concentrated in
west African region
16

17. HISTORY :
• 1981 – beginning of the epidemic in united states
• 1983 - Discovery of a new retrovirus called Lymphadenopathy-
Associated Virus (or LAV)
• 1984- National Cancer Institute found the cause of AIDS, the
retrovirus HTLV-III.
• I1986 - the International Committee on the Taxonomy of Viruses
officially named HIV (human immunodeficiency virus)
• 2008- Luc Antoine Montagnier received Nobel Prize in
Physiology and medicine for his discovery of the human
immunodeficiency virus (HIV).
17

18. Origin of HIV
18

19. • First step, HIV attaches to
susceptible host cell.
• Site of attachment is the CD4
antigen found on a variety of
cells:
• macrophages
• monocytes
• B cells
• microglial brain cells
• intestinal cells
• T cells (infected later on)
Viral Replication
19

20. Early Phase HIV Infection
• In early phase HIV infection, initial
viruses are M-tropic. Their
envelope glycoprotein gp120 is
able to bind to CD4 molecules and
chemokine receptors called CCR5
found on macrophages
20

21. • In late phase HIV infection, most
of the viruses are T-tropic, having
gp120 capable of binding to CD4
and CXCR4 found on T4-
lymphocytes.
21

22. Reservoir
• All cases and carriers are
reservoir for the infection
• Once a person is infected
the virus remains in the
body life long
• The risk of developing AIDS
increases with lifetime
• Symptomless carriers can
infect other people for
years
22

23. Source of infection
Virus can be isolated from :
Brain tissue Lymph nodes
Bone marrow cells Skin
high low none
Blood Cervical and vaginal
secretions
Tears
Semen Breast milk Saliva
CSF Urine Feaces
23

24. Modes Of Transmission
• Transmission through
sexual route
Homosexual
Heterosexual
• Transmission through
infected blood and
blood products
• Intravenous drug
injection
• Vertical transmission –
mother to child
Transmission percentage in India
Heterosexual
blood and blood products
intavenous drug injection
Mother to child
Homosexual
24

25. Sexual Transmission
• Unprotected Vaginal Anal or oral sex with an infected person exposes the
uninfected partner to the risk of infection
• A European study suggests that transmission of HIV infection from male to female
is twice as likely from female to male
• Anal intercourse carries higher risk of transmission than vaginal
• Exposed adolescent girls and women aged above 45 years more prone to get
infected
• Associated STD in either partner facilitates risk of transmission 8 to 10 times
• HIV positive partners more infectious during “window period” and when infection
is well advanced
25

26. Blood contact
• Contaminated blood cells, platelets and factor VIII and IX derived from human plasma
• Risk of contracting HIV infection from transfusion of a unit of infected blood is over 95%
• Significant route of transmission in intravenous drug users because of repeated exposure
• Any skin piercing
• Injection
• Ear piercing
• Tattooing
• Accupuncture
• scarification
26

27. Vertical Transmission
Through placenta
During delivery
During breast feeding
Rate of transmission - 20-25%(without intervention)
27

28. Host Factors
High risk groups :
Intravenous drug users
(9.9%)
Trans Genders(8.82%)
MSM(men having sex with
men)(4.3%)
Truckers(2.59%)
Female sex workers(2.2%)
ANC (0.29%)
Bridge population :
Migrants
Long Distance Truckers
Source : NACO Annual Report 2016- 2017
28

29. Some Definitions
• ARV (antiretroviral) drugs refer to the medicines used to treat HIV.
• ART (antiretroviral therapy) refers to the use of a combination of
three or more ARV drugs for treating HIV infection. ART involves
lifelong treatment.
• Viral suppression refers to a viral load below the detection threshold
using viral assays.
• Viral failure is defined by a persistently detectable viral load
exceeding 1000 copies/mL (two consecutive viral load
measurements within a 3-month interval) after at least 6 months of
using ART.
29

30. • Universal access to ART is defined broadly as a high level of
treatment coverage (80% or more of the eligible population)
that is accessible and affordable. It does not necessarily
mean 100% coverage
• Substantial risk of HIV infection: is provisionally defined as
HIV incidence around 3 per 100 person-years or higher in
the absence of PrEP.
• HIV incidence higher than 2 per 100 person-years is
considered sufficient to warrant offering oral PrEP in the
recommendations issued by the International Antiviral
Society
30

31. Continuum of linkage to care and prevention
Create
demand
for HIV
testing and
treatment
Link to
HIV testing
Deliver
pre-test
information
HIV
diagnosis
Post test
counselling
Refer and
link to
other
health
services
31

32. Contents of Pre test Counselling
• Information on HIV and AIDS
• Benefits of HIV testing
• “Opt out” testing
• Risk assessment of the individual
• Information on genital, menstrual and sexual hygiene
• Information on spouse/sexual partner testing
• Conduct symptomatic screening for STI/RTI
• Conduct verbal screening (4 Symptom Screening) for tuberculosis
32

33. Diagnosis of HIV Infection
• Laboratory diagnosis by HIV testing is the only method of
determining the HIV status
• HIV diagnosis is made by either demonstrating the presence
of virus or viral products in the host
• Serological assays to detect HIV specific antibodies or by
• Nucleic Acid Amplification Test (NAAT) to detect HIV
nucleic acids
33

34. Serological Diagnosis of HIV Infection
• These tests are used as screening tests and/or confirmatory
tests.
• Commonly used screening tests are:
1. Enzyme Linked Immunosorbent Assay (ELISA)
2. Rapid tests
• Immunoconcentration /Dot Blot assay (vertical flow)
• Agglutination assay
• Immunochromatographic assay (lateral flow)
• Dipstick and comb assay based on Enzyme Immune Assay
(EIA)
34

35. • Rapid Anti-HIV Tests
• Visual point of care tests, do not require any special equipment.
Available in smaller test packs.
• Suitable for a laboratory that tests small number of specimens.
• Technically simple to perform. Most of them have sensitivity and
specificity comparable to an ELISA.
• Western Blot Test
• WB tests detect the presence of antibodies against specific HIV
proteins, similar to ELISA test, except that the product is insoluble
• WB tests are a highly specific conformational test. NACO is presently
providing it at the National Reference Laboratory level
35

36. Limitations of Antibody Assays
• Window period
• Children below 18 months of age.
• NACO is now promoting the use of the DBS technique for
early infant diagnosis, based on the detection of HIV-1 DNA
viral nucleic acid
36

37. EID
• Maternal HIV antibody can persist for as long as 18 months
in children born to HIV-infected mothers.
• Breastfed children have ongoing risk for HIV transmission,
HIV infection can only be excluded after 6 weeks of complete
cessation of breast-feeding.
• In the current Early Infant Diagnosis (EID) program,
virological tests i.e. HIV-1 DNA PCR by Dried Blood Spot
(DBS) and on Whole Blood Sample (WBS) are being done for
infants and children below 18 months of age.
37

38. 38

39. Detection of Acute HIV Infection
• NAT
• NATs include tests for the qualitative detection of HIV-1 DNA or RNA,
as well as the quantitative detection of HIV-1 RNA (viral load
determination) through various assays
39
qualitative quantitative
• Qualitative Polymerase Chain
Reaction for HIV DNA
• Qualitative Polymerase Chain
Reaction for HIV RNA
1) Quantitative HIV-1 RNA assays
detect plasma (cell-free) viral RNA by
using various techniques
2) Signal amplification by branched-
chain DNA technique (Bdna)

40. • Other Assays
• Virus Isolation
• p24 Antigen Detection
40

41. WHO Testing strategy for HIV diagnosis in low-prevalence settings
41

42. WHO Testing strategy for HIV diagnosis in high-prevalence settings
42

43. NACO HIV Testing Strategies
• Strategy 1 : Blood
transfusion/transplant safety
• Strategy 2 A: used in sentinel
surveillance
43

44. • Strategy 2 B: used for diagnosis in
symptomatic patients
• Strategy 3 (used for diagnosis in
asymptomatic patients)
44

45. • Assays A1, A2, A3 represent 3 different assays based on different
principles or different antigenic compositions. Assay A1 should be of
high sensitivity and A2 and A3 should be of high specificity.
45

46. HIV testing for Adults and Children (above the age of 18 months)
• In view of the low prevalence of HIV in India, it is recommended to
use three different principles or antigen-based rapid tests to confirm
the diagnosis.
• Screening: At an F-ICTC, PPP–ICTC, mobile F-ICTC, community-based
screening etc. - using a single rapid test kit.
• Confirmation: Confirmation is done at an SA-ICTC using three rapid
tests of three different antigens or principles.
• Individual is considered HIV-negative if the first test is nonreactive
And
• HIV-positive when all two/ three tests show reactive results.
46

47. Linkage
• HIV Testing is the entry point for those at risk and PLHIV, so it must be
linked to various other service providers to meet the need of better
preventive services and a quality life to PLHIV.
47

48. UNAIDS: 90-90-90 Targets
• Reach the following goals by
2020.
o90% of PLHIV should know
HIV status
o90% of diagnosed to receive
ART
o90% of those on ART to have
suppressed viral load.
48

49. Goals of ARV therapy
• Clinical goal : Prolongation of life and improvement in quality
of life
• Virological goal : Greatest possible reduction in viral load.
• Immunological goal : Immune reconstitution.
• Therapeutic goal : Rational sequencing of drugs to achieves
clinical, virological and immunological goals, limiting drug
toxicity and facilitating adherence
• Reduction of HIV transmission in individuals : by suppression
of viral load
49

50. Classification of drugs used for ART
NRTI
Abacavir (ABC)
Didanosine (ddl)
Emtricitabine (FTC)
Lamivudine (3TC)
Stavudine (D4t)
Zalcitabine (ddC)
Zidovudine (AZT)
NtRTI- Tenofovir (TDF)
NNRTI
Efavirenz (EFV)
Delavirdine (DLV)
Etravirine (ETV)
Nevirapine (NVP)
PI
Atazanavir (ATV)
Darunavir (DRV)
Fos- amprenavir (FPV)
Indinavir (IDV)
Nelfinavir* (NFV)
Lopinavir (LPV)
Saquinqvir (SQV)
Ritonavir (RTV)
Integrase
strand transfer
inhibitors
Raltrgarvir (RAL)
CCR5 Entry Inhibitor
Maraviroc
50

51. 2016 WHO GUIDELINES ON WHEN TO START ART
Target
population
Specific recommendation
Adults ART to be initiated in all adults living with HIV at any CD4 cell count
As a priority, initiation in WHO clinical stage 3 or 4 and individuals with CD4 count less
than equal to 350 cells/mm3
Adolescent ART to be initiated in all adolescents living with HIV at any CD4 cell count
As a priority, initiation in WHO clinical stage 3 or 4 and individuals with CD4 count less
than equal to 350 cells/mm3
Pregnant &
BFW
ART should be initiated in all pregnant and BFW living with HIV at any CD4 cell count
and continued lifelong
51

52. Children (1-
10 yrs)
ART to be initiated in all mentioned group living with HIV at any CD4
cell count
As a priority, ART should be initiated among all children <2 yrs old and in WHO
clinical stage 3 or 4 and individuals with CD4% <25% ( if < 5 yrs old )or CD4 count
less than equal to 350 cells/mm3 ( if greater than equal to 5 yrs old)
Children (<1 yr) ART to be initiated in all mentioned group living with HIV at any CD4
cell count
Recommendation: Oral pre-exposure prophylaxis to prevent HIV infection
HIV negative
individuals at
substantial risk
of HIV infection
Oral PrEP ( containing TDF) should be offered as an additional
prevention choice as part of combination prevention approaches
52

53. NATIONAL GUIDELINES ON WHEN TO START ART
53

54. SUMMARY OF FIRST LINE ART REGIMEN (WHO,2016)
First line ART Preferred First line
Regimen
Alternative First line
Regimen
Adults and
adolescents
TDF+XTC{3TC or FTC)+EFV600 AZT+3TC+NVP > AZT+3TC+EFV600
TDF+XTC+NVP
TDP+XTC+DTG (Dolutegravir)
TDF+XTC+EFV400
Pregnant & BFW TDF + 3TC (or FTC) + EFV AZT + 3TC + EFV (or NVP)
TDF + 3TC (or FTC) + NVP
Children 3 yrs
to>10 yrs and
adolescents
<35 kg
ABC + 3TC + EFV ABC + 3TC + NVP
AZT + 3TC + EFV (or NVP)
TDF + 3TC (or FTC) + EFV (or NVP
Children < 3 yrs ABC (or AZT) + 3TC + LPV/r ABC (or AZT) + 3TC + NVP
54

55. 55

56. 56

57. HIV & TB Co- infection
• CBNAAT for rapid diagnosis of TB among PLHIV.
• ART should be started in all TB patients living with HIV,
regardless of CD4 cell count.
• TB treatment should be initiated first, followed by ART,
possibly within the first 8 weeks of treatment.
• HIV-positive TB patients with profound immunosuppression
(e.g. CD4 counts less than 50 cells/mm3) should receive ART
within the first two weeks of initiating TB treatment.
57

58. Patient flow for initial TB screening and for IPT at ART Centre
58

59. Opportunistic Infections
Clinical Picture Actions
Any undiagnosed active
infection with fever
Diagnose and treat first; start ART when stable
TB Treat TB first; start ART as recommended
PCP Treat PCP first; start ART when PCP treatment is completed
Invasive fungal diseases:
oesophageal
candidiasis, cryptococcal
meningitis, penicilliosis,
histoplasmosis
Treat esophageal candidiasis first; start ART as soon as the patient can swallow
comfortably
Treat cryptococcal meningitis, penicilliosis, histoplasmosis first; start ART
when patient is stabilized or OI treatment is completed
Bacterial pneumonia Treat pneumonia first; start ART when treatment is
completed
Malaria Treat malaria first; start ART when treatment is completed
59

60. Opportunistic Infections
Drug reaction Do not start ART during an acute reaction
Acute diarrhoea which may
reduce absorption of ART
Diagnose and treat first; start ART when diarrhoea is stabilized or
controlled
Non-severe anaemia (Hb <
8 g/litre)
Start ART if no other causes for anaemia are found (HIV is often the cause
of anaemia); avoid AZT
Skin conditions such as
dermatitis, psoriasis, HIV-
related exfoliative
dermatitis
Start ART (ART may resolve these problems)
Suspected MAC,
cryptosporidiosis and
microsporidiosis
Start ART (ART may resolve these problems)
Cytomegalovirus infection Treat if drugs available; if not, start ART
Toxoplasmosis Treat; start ART after 6 weeks of treatment and when patient is stabilized
60

61. Opioid Substitution Therapy
• Drugs recommended
• Methadone and buprenorphine
• OST programmes in India use buprenorphine sublingual tablets
• Methadone based OST launched recently at RIMS, Imphal.
61

62. Post Exposure Prophylaxis for HIV
Eligibility of post-exposure prophylaxis
• Commencement within 72 hrs of possible
infection
• Based on HIV status of the source whenever
possible
• Parenteral or mucus membrane exposure and
certain body fluids like blood, breast milk, genital
secretions etc. can pose risk
• PEP not required when the exposed individual is
already HIV positive and source is established to
be HIV negative and exposure to bodily fluids that
does not pose a risk like tears, non blood stained
saliva, urine, sweat.
Preferred
regimen
Preferred third
drug or
alternative
regimen
For adults and
Adolescents
TDF +3TC ( or
FTC)
LPV/r or ATV/r
is the
preferred third
drug
EFV in India
For Children ≤
10 yrs
old
AZT+3TC ABC+3TC or
TDF
+3TC(or FTC) as
alternative.
LPV/r recom.
as third drug
A 28 day prescription of AR drugs should be
provided for HIV post exposure prophylaxis
following initial risk assessment 62

63. USE OF CO-TRIMOXAZOLE FOR HIV RELATED INFECTIONS
For adults (Including
PW)
 Any WHO clinical stage and CD4 <250 cells/mm3 or
 Any WHO clinical stage, CD4 <350 cells/mm3 and if patient is
symptomatic or
 WHO stage 3 or 4 irrespective of CD4 countDosage: 960 (800+160)
mg OD
Infants, children and
adolescents
Recommended to all
but priority to children <5 yrs regardless of CD4 count or clinical
stage and to children with WHO clinical stage 3 or 4 and for CD4
count ≤350 cells/mm3
When to stop: If CD4 count >250 for at least 6 months ,
AND If patient is on ART for at least 6 months and is asymptomatic
It should be administered to all HIV-infected people with active TB disease
regardless of CD4 cell.
63

64. Infant Prophylaxis
Infants Recommendation
Infants of mothers, who started ART
during intrapartum period
AZT (twice daily) plus NVP (once daily) for
first 6 weeks
AZT (twice daily) plus NVP (once daily) or
NVP (once daily) ALONE for next 6 weeks
Infants of mothers, who are on ART since AP
period
daily NVP for 6 weeks
Daily dose of NVP: <2000g- 2 mg/kg, 2000-2500g – 10 mg, >2500g – 15 mg
Live vaccines should be avoided in all severely immune compromised infants (CD4
%< 25% or WHO stage 3 and 4).
64

65. Monitoring Progression of HIV Infection and the response
to Antiretroviral Therapy
• The laboratory tests currently available for monitoring the stage and
progression of HIV infection can be classified into:
• Immunologic tests
• CD4 T cell enumeration
• Virological assays
• HIV RNA load assays
• Other Assays - Measurement of HIV p24, Reverse Transcriptase
(RT) activity assay
65

66. Recommended tests for HIV screening and monitoring
Phase of HIV management Recommended Desirable
HIV diagnosis Serology
EID for <18 months children
CD4 count
TB symptom screening
HBV, HCV, STIs
Cryptococcal screening (if count
<100)
Pregnancy test, NCD screening
Follow up before ART CD4 count
Initiation of ART CBC, LFT, RFT, Pregnancy test
Receiving ART HIV viral load q 12 months
CD4 count q 6 months
S. Cr, pregnancy test
Suspected treatment failure S. Cr, pregnancy test HBV
For HIV/HBV coinfected individuals who are already using TDF-containing regimens and develop ART
failure, this NRTI should be maintained regardless of the selected second-line regimen.
66

67. NACO: Routine Monitoring of Patients on ART
67

68. 68

69. New initiatives under NACO CST
• Viral load testing scale up: Monitoring with VL instead of CD4 count provides an
early and more accurate indication of treatment failure and switching to second
line ART.
10 VL testing facility across the country.
• Launch of third line ART: Darunavir 300mg/ Ritonovir 100mg BD and Raltegravir
400 mg BD.
Presently 109 patients are on 3rd line ART.
• Linking PLHIV data to ADHAAR
• National programe on EID for children upto18 months: current test of choice is
HIV-1 PCR
69

70. 70

71. ART Failure
• Clinical failure: New or recurrent WHO stage 4 condition, after at
least 6 months of ART
• Immunological failure: • Fall of CD4 count to pre-therapy
• 50% fall from the on-treatment peak value
• Persistent CD4 levels below 100 cells/mm
• Virological Failure: Plasma viral load >5,000 copies/ml after at least 6
months of ART
71

72. WHO CLINICAL STAGING OF HIV DISEASE IN ADULTS, ADOLESCENTS AND
CHILDREN
• Clinical stage 1
• Adults
• Asymptomatic
• PGL
• For children
• Asymptomatic
• PGL
• Clinical stage 2 (Adults)
• Moderate unexplained weight loss ( under
10% of BW)
• Recurrent RTI
• Herpes zoster/Angular cheilitis
• Recurrent oral infections
• Papular pruritic eruptions
• Seborrhoeic dermatitis
• Fungal nail infections
• For children
• Unexplained chronic diarrhoea
• Severe persistent candidiasis outside the
neonatal period
• Weight loss or FTT
• Persistent fever
• Recurrent Severe bacterial infections
72

73. • Clinical stage 3 (Adults)
 Moderate unexplained weight loss
(over 10% of BW)
 Unexplained chronic diarrhoea for
more than 1 month
 Unexplained persistent fever for
more than 1 month
 Oral candidiasis/oral hairy
leukoplakia/PTB
 Bacterial infections
 Stomatitis, gingivitis or periodontitis
 Unexplained anaemia (< 8g/dl),
neutropenia, thrombocytopenia
• For children
 AIDS-defining opportunistic
infections
 Severe failure to thrive
 Progressive encephalopathy
 Malignancy
 Recurrent Septicaemia or meningitis
• Clinical stage 4 (Adults)
 HIV wasting syndrome
 Pneumocystis jiroveci pneumonia
 Several bacterial pneumonia
 Chronic herpes simplex infections
 Oesophageal candidiasis
 EPTB/ Kapsoi Sarcoma
 CMV disease, CNS toxoplasmosis
 HIV encephalopathy
 Extra pulmonary cyptococcosis including
meningitis
 Disseminated nontuberculous mycobacteria
infection
 Progressive multifocal leukoencephalopathy
 Chronic cryptosporidiosis, Chronic isosporiasis
 Disseminated mycosis
 Septicemia/lymphoma
 Invasive cervical carcinoma
 Atypical disseminated Leishmaniasis
73

74. Nutritional Aspects of HIV
Food items to avoid: Special effects
• Raw eggs
• Food that has not been thoroughly
cooked,
• Unboiled water or juices made with
unboiled water
• Alcohol and coffee
• Stale food
• Nuts and oil seed: Protein, energy,
vitamin B
• Fiber
• Garlic : contains Allicin,
antibacterial, antiviral and
antioxidant properties.
• Turmeric : contains polyphenol;
antioxidant properties- ability to
fight inflammation.
74

75. Palliative care
• Pain Management: Analgesics
• Symptom Management: Pharmacological and non- pharmacological.
• End of life care: Comfort measures near the end of life
• Moisten lips, mouth, eyes
• Keep the patient clean and dry and prepare for incontinence of bowel
and bladder
• Only give essential medications—pain relief, antidiarrheal, treat fever
and pain
• Eating less is OK. Ensure hydration
• Skin care/turning every 2 hours or more frequently to prevent bed
sores
• Bereavement counselling
75

76. 76

77. UNIVERSAL PRECAUTIONS
• Universal Precautions are control guidelines designed to protect
workers from exposure to diseases spread by blood and other body
fluids.
• Now, Standard precautions to reduce the risk of transmission of
blood borne and other pathogens from both recognized and
unrecognized sources to a susceptible host.
Hand washing.
Safe collection and disposal of needles.
Wearing gloves.
Wearing a mask and a gown.
Covering all cuts and abrasions.
Using safe system for health care waste management and
disposals
77

78. AIDS VACCINE
• Major Challenges towards the
development of an effective HIV/AIDS
vaccine
• Genetic diversity: HIV multiplies at very
rapid pace and is different from the parent
virus.
• Failure in formation of virus neutralizing
antibodies
• Lack of proper animal model since
infection can occur with SIV
78

79. 79

80. SUMMARY
HIV continue to be major public health
issue globally claiming more than 36
million lives so far.
• Can be transmitted via exchange of
variety of body fluids from infected
individuals
• Risk Factors
 Unprotected vaginal or anal sex
and having STI
 Sharing contaminated needles,
syringe, receiving unsafe
injections and Needle stick
injury
• All HIV testing services must include 5
C's recommended by WHO; consent,
confidentiality, Counselling, Correct
test result and connection
• Prevention
 Male and female condom use
 Testing and counselling for HIV
and STI
 ART for prevention
80