HIV/AIDS is a growing concern in Pakistan. While prevalence is currently low, it is a high risk country. HIV attacks the immune system, eventually leading to AIDS if untreated. There is no cure for HIV/AIDS, but treatment can suppress the virus. Common transmission methods include unprotected sex and needle sharing. Prevention focuses on abstinence, monogamy, condoms and clean needles. Symptoms vary from flu-like illness to opportunistic infections as immunity declines. Testing and treatment are important to manage the disease. Research continues on vaccines and treatments to control the HIV/AIDS epidemic.

1. HIV /AIDS
Dr. Abdul.Ghafoor Shoro
Senior Family Physician Aga Khan University Karachi
Joint Secretary College of Family Medicine Pakistan
Member Executive Committee Pakistan Medical Association Karachi

2. © Aahung 2004
• Pakistan is not a high prevalence
country (adult prevalence rate 0.1 %)
but is regarded as a “high risk
country
HIV
Prevalence

3. Difference Between HIV & AIDS
• The difference between HIV and AIDS is that:
• HIV is the virus that causes AIDS
• HIV may or may not have symptoms
• AIDS is symptomatic
• AIDS is the condition of lowered immunity caused by the virus

4. Facts and Statistics
• African American Females are at higher risk
• 72% more likely to get HIV/AIDS

5. Facts and Statistics Contd.
• Leading cause heterosexual contact
• Next leading cause IV drug user
• Rising prevalence of men
• Leading cause for men: homosexual – heterosexual – IV drug use

6. Facts and Myths
• African American women are at higher risk ~ Fact
• Only homosexual people get it ~ Myth
• You can’t get AIDS if on birth control~ Myth
• Abstinence is the only 100% effective method~ Fact
• There is a treatment for HIV/AIDS~ Myth

7. Modes of Transmission
• Risky Sexual Behaviors
• Unprotected vaginal intercourse
• Unprotected anal intercourse
• Unprotected oral intercourse
• Unprotected intercourse with multiple partners

8. • Semen
• Blood & Blood components
• Menstrual Flow
• Vaginal Secretions
• Pre-Ejaculatory Fluid
• Breast Milk
• Cerebral Spinal Fluid

9. • Pus
• Saliva
• Tears
• Urine
• Feces
• Vomit
• Nasal Mucous

10. Vaginal Intercourse
• Vaginal/Penile secretions
• Cuts or soars on either the penis or
in/around the vagina
• Not only susceptible to HIV/AIDS, but
other STI’s

11. Anal Intercourse
• May cause tearing and exposure to
blood
• Seminal fluid
• Men on “down-low”

12. Oral Intercourse
• Cuts and Soars in mouth
• Seminal/Vaginal Fluids

13. Unprotected intercourse with multiple
partners
• More chances of transmission
• If using protection with everyone
• Conducting intercourse with one
unprotected is like having
intercourse with everyone

14. Modes of Transmission Contd.
• IV drug user
• Blood transfusion, unscreened
• Transfer through saliva in oral sex
• Enters through any cut,wounds, or
other open abrasion of skin from
infected person

15. Primary HIV infection
50% of individuals will develop a febrile, flu-like illness with some or all of the following
conditions:
- Swollen glands - Rash
- Oral ulcers - Muscle aches
- Sore throat - Headache
- Diarrhea - Nausea or vomiting

16. Prevention
• Abstinence
• Only 100% effective with ALL
STI’s
• Everyone has the right to abstain

17. Monogamy (Having single Partner)
• < partners = safer sex
• Trust /Honesty
• Knowledge about sexual
history
• Still get checked once a year,
regardless of monogamy or not

18. How quickly does a person infected with HIV develop AIDS?
• The length of time can vary widely between individuals.
• Left without treatment, the majority of people infected with HIV will develop
signs of HIV-related illness within 5–10 years, although this can be shorter.
• The time between acquiring HIV and an AIDS diagnosis is usually
between 10–15 years, but sometimes longer.
• Antiretroviral therapy (ART) can slow the disease progression by
preventing the virus replicating and therefore decreasing the amount of
virus in an infected person’s blood (known as the ‘viral load’).

19. Risk factors
• Behaviors and conditions that put individuals at greater risk of
contracting HIV include:
• Having unprotected anal or vaginal sex;
• Having another sexually transmitted infection such as syphilis, herpes,
chlamydia, gonorrhoea, and bacterial vaginosis;
• Sharing contaminated needles, syringes and other injecting equipment and
drug solutions when injecting drugs
• Receiving unsafe injections, blood transfusions, medical procedures that
involve unsterile cutting or piercing; and
• Experiencing accidental needle stick injuries, including among health
workers.

20. Signs and symptoms
The symptoms of HIV vary depending on the stage of infection.
Though people living with HIV tend to be most infectious in the first few months,
many are unaware of their status until later stages.
The first few weeks after initial infection, individuals may experience no symptoms
or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the person's immune system, the
individual can develop other signs and symptoms.
such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without
treatment, they could also develop severe illnesses such as tuberculosis,
cryptococcal meningitis, and cancers such as lymphomas and Kaposi's sarcoma,
among others.

21. Clinical presentation
• Gradual onset; symptoms progress over several weeks, may
be acute in HIV positive patients
• Fever
• Dry cough
• Shortness of breath on exertion
• Tachypnea
• Crackles, Rhonchi, Wheezing
• Acute Respiratory Distress Syndrome

22. Psychological Aspects of HIV Infection
• HIV infection has a major psychological impact on:
• The infected person
• The infected person’s family
• The infected person’s friends
• The economic status of affected
• persons

23. Examples of Psycho-Social Issues associated with HIV
• Isolation
• Denial
• Guilt
• Bereavement
• Anger
• Fear
• Confusion

24. DR. S.K CHATURVEDI
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

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

26. DR. S.K CHATURVEDI
HIV and AIDS
• When the immune system becomes
weakened by HIV, the illness
progresses to AIDS

27. OPPURTUNISTIC INFECTIONS
• An infection by a microorganism
• That normally does not cause disease
• But pathogenic when the body's immune system is impaired
and unable to fight off infections

28. Common Opportunistic infections in HIV
• Tuberculosis ( Pulmonary and extra pulmonary)
• Candidiasis
• Herpes Zoster
• Toxoplasmosis
• Cryptococcal meningitis
• Pneumocystis jirovecii pneumonia
• Cytomegalovirus
• Cryptosporidiasis
• Mycobacterium avium
• Kaposi’s sarcoma

29. When HIV testing is recommended
• Routinely recommend HIV screening in settings with high HIV
prevalence (>1%)
• Targeted testing based on risk assessment(IDU, IDP)
• Routinely recommend HIV Testing seeking treatment for STDs
• Annual testing for sexually active MSM
• Pregnant females
• Patients with clinical suspicion of HIV

30. DR. S.K CHATURVEDI
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

31. Stage 1
• Asymptomatic
• Current or past history of Persistent generalized
lymphadenopathy
Performance scale 1: Asymptomatic, normal activity

32. WHO Stage II
Current or past history of;
• Weight loss, < 10% of body weight
• Minor mucocutaneous manifestations (seborrheic dermatitis,
prurigo, fungal nail infections, recurrent oral ulcerations,
angular chelitis)
• Herpes zoster within the last 5 years
• Recurrent upper respiratory tract infections (i.e. bacterial
sinusitis)
Performance scale 2: Symptomatic, normal activity

33. Pruritic eruptions

34. Apthous ulcers

35. Herpes zoster

36. Fungal nail infection

37. WHO stage III
Current or past history of:
• Weight loss > 10% of body weight
• Unexplained chronic diarrhea > 1 month
• Unexplained prolonged fever (intermittent or constant) > 1 month
• Oral candidiasis (thrush)
• Oral hairy leukoplakia
• Pulmonary tuberculosis within the past year
• Severe bacterial infection (i.e. pneumonia, pyomyositis) Performance
scale 3: bed-ridden < 50% of the day during the past month

38. Oral candidiasis

39. Hairy leukoplakia

40. Oropahryngeal Candidiasis

41. Kaposi Sarcoma

42. Gum Diseaese

43. Oral Hairy Leukoplakia

44. Psoriasis

45. Sebborheic Dermatitis

46. Scabies

47. Oral Thrush

48. Mouth cancer

49. Mouth cancers

50. Warts

51. Syphills

52. Syphils

53. Syphils in Women

54. Yeast Infection in Women

55. Yeast Infection in Women

56. Yeast Infection at Armpit

57. Yeast Infection in Hands

58. Syphils

59. Gonorrhea

60. Gonorrhea

61. Genital Warts

62. Genital

63. Reiter's Syndrome

64. Herpes

65. Herpes Zoster

66. Herpes Zoster

67. Skin Lesions (cancers lesions)

68. Enlarged Lymph nodes

69. Enlarged Lymph node

71. Lymph nodes

72. Did You Just Test HIV+?

73. Recommendations:
• Although the overall prevalence of HIV/AIDS is presently low in
Pakistan, it is evolving rapidly as a concentrated epidemic.
• We should do HIV testing in any patient who presents with
chronic diarrhea, wasting, oral candidiasis or atypical
pneumonia.
• Antiretroviral therapy (ART) is available in Pakistan free of cost
and patients can recover well with good management of their
opportunistic infections and ART.

74. Hope for Tomorrow
Scientists are continuing to work on an HIV vaccine. A
study conducted in Thailand in 2009 shows promise that a
vaccine may provide some protection from the virus.
Clinical trials of the vaccine are expected to begin in South
Africa in 2015. Another area of study is microbicides,
which are gels, films, or suppositories that can kill viruses
and bacteria. Several studies of vaginal microbicides have
shown positive results and further clinical trials are
underway.
Hope for Tomorrow
Scientists are continuing to work on an HIV vaccine. A
study conducted in Thailand in 2009 shows promise that a
vaccine may provide some protection from the virus.
Clinical trials of the vaccine are expected to begin in South
Africa in 2015. Another area of study is microbicides,
which are gels, films, or suppositories that can kill viruses
and bacteria. Several studies of vaginal microbicides have
shown positive results and further clinical trials are
underway.
Hope for Tomorrow
Scientists are continuing to work on an HIV vaccine.
 A study conducted in Thailand in 2009 shows promise that a
vaccine may provide some protection from the virus.
 Clinical trials of the vaccine are expected to begin in South Africa
in 2015.
 Another area of study is microbicides, which are gels, films, or
suppositories that can kill viruses and bacteria.
 Several studies of vaginal microbicides have shown positive results
and further clinical trials are underway.

75. HIV is a chronic manageable disease rather
than a fatal disease
I live my rights, I respect other people's rights