HIV affects millions of people worldwide, with over 35 million current patients and 2 million new cases annually. The highest prevalence is in Africa, which accounts for 25% of the global disease burden. While antiretroviral drugs have improved treatment, an estimated 70 million people will die of AIDS in the next 20 years. Prevention through education, condom use, circumcision, and reducing sexual partners/needle sharing is crucial to controlling the epidemic.

1. HIV
SATURDAY
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3. INTRODUCTION
 Retro Virus with 9 clad
 More than 35 million patients
 25 million new cases every year
 2.0 million deaths every year
 In UK alone incidence is > 9100 per year
 in UK Prevalence is ~ 73,000
 Most of the cases are in Africa
 25 % of the world’s disease burden
 3 % of the world’s health work force
 1 % of the world’s wealth share

4. FACT SHEET
HIV / AIDS Statistics
• * 25 million children will be orphans by 2010 because of
AIDS (called AIDS orphans). Africa has 12 million AIDS
Orphans.
• * 2.9 million people died from AIDS last year; nearly half
a million were children under the age of 15
• * 4.8 million people were newly infected with HIV last
year; that’s 14,000 a day!
• * 38 million people are currently living with HIV/AIDS
• * 70 million deaths from AIDS are estimated in the next
20 years
• (Sources: UNAIDS/WHO 2006 Report on the global AIDS epidemic)

5. GLOBAL HIV AND AIDS ESTIMATES
END OF 2009
The latest statistics of the global HIV and AIDS epidemic were published
by UNAIDS in November 2010, and refer to the end of 2009.
Estimate Range
People living with HIV/AIDS in 2009 33.3 million 31.4-35.3 million
Adults living with HIV/AIDS in 2009 30.8 million 29.2-32.6 million
Women living with HIV/AIDS in 2009 15.9 million 14.8-17.2 million
Children living with HIV/AIDS in 2009 2.5 million 1.6-3.4 million
People newly infected with HIV in 2009 2.6 million 2.3-2.8 million
Adults newly infected with HIV in 2009 2.2 million 2.0-2.4 million
AIDS deaths in 2009 1.8 million 1.6-2.1 million
Orphans (0-17) due to AIDS in 2009 16.6 million 14.4-18.8 million
At the end of 2009, women accounted for just over half of all adults living
with HIV worldwide.

6. GLOBAL TRENDS
Global trends

7. WORLD WIDE DISTRIBUTION
> 15000

8. HIV CASES IN THE KINGDOM
• HIV cases on the rise in the Kingdom
• By MD HUMAIDAN | ARAB NEWS
• Published: Dec 21, 2010 22:57 Updated: Dec 21, 2010 22:57
• JEDDAH: At a symposium on Sunday at King Fahd
Hospital regarding AIDS and HIV revealed that Saudi
Arabia registered 1,287 new cases of the infection in
2009, putting the total cases at 15,213, of which 4,019
are Saudis.
• The new cases included 481 Saudis and 806 foreigners who
were deported after being diagnosed as HIV positive. The
title of the symposium was “Towards Equal Rights With
AIDS Patients.”
• According to the symposium, sexual contact was
responsible for 95 % of the HIV cases among Saudi men.
There were 14 cases of in utero transfer of the virus from
mothers to their babies. 11 Saudis got AIDS from sharing
needles with infected users.

9. HIV - VIRUS

10. TRANSMISSION
• Sexual 75 % (Incl 3-7 % Oral Sex)
• Vertical (Peri-Natal) Child Deaths 600,000/ Year
• Infected blood In UK alone 1200 New cases/ Year
• Intravenous Drug Users

11. IMMUNOLOGY
HIV
Envelope
Glycoprotein
Macrophages
T Helper Cells
Monocytes
Neural cells
Lymphoid
Tissue
Billions of New
Virions
HIV

12. VIROLOGY
HIV IS RNA VIRUS
AFTER ENTRY INTO THE BODY
DNA COPY OF RNA GENOME
INTEGRATION INTO HOST DNA
SYNTHESIS OF POLYPEPTIDES
COMPLETED VIRIONS
REVERSE TRANSCRIPTASE
VIRAL DNA INTEGRASE
VIRAL PROTEASE

14. STAGES
• Acute Infection Asymptomatic
• Sero-conversion 2-6 weeks
• Persistent Gen Lymphadenopathy
– > 1.0 cm
– > 2 Extra Inguinal Lymph Nodes
– > More than three months duration
• AIDs Complex (Indicator Disease) Cd4 <200

15. DIAGNOSIS
 Serum or Saliva HIV Antibodies by ELISA
Confirmed by Western Blot
 Window Period HIV RNA (PCR)/ Core P24 Ag
OR
Repeat after 6 weeks & 12 weeks
 4th
Generation Kits Over The Counter
 HIV-A & B ( UK ) HIV-D (Africa)
 Hybrid form is more fatal

16. SERO-CONVERSION
 Early Identification Matters
 Signs are like “Glandular Fever” **
 Flue like Symptoms
 Fever
 Malaise
 Myalgia
 Pharyngitis
 Maculo-papular Skin Lesions **
 Meningoencephalitis (Rare)
 Generalized Lymphadenopathy
 History Taking is Extremely Important
 Other Direct Effects
 Osteoporosis
 Dementia

17. COMPLICATIONS
• All Newly Diagnosed must under go
– Tuberculin test To identify past
– Toxoplasmosis Serology or current infections
– CMV that may progress with
– Hepatitis B & C immunosuppression
– Syphilis
– Chest infections Incl Various
Pneumonias

18. PRVENTION

19. PREVENTION
• Blood Screening
• Disposable Surgical Equipment
• Perinatal anti retro-viral agents for HIV +ve
mothers
• Caesarian Section Births
• Encourage Bottle feeding

20. STOP HIV MANIFESTO
• Good Information
• HIV tests
• Use of Condoms
• Redefining Sexual Skills
• Abstinence
• Fewer Sexual Partners
• Discourage Use of Alcohol
• Circumcision

21. WHAT A DOCTOR MUST KNOW
• Good Communication Skills
• Be Comfortable to talk about sex and sexuality and requesting
HIV test or STD serology at early stage if suspected
• Warn about ‘sexual tourism” dangers
• Negative role of Alcohol use
• Human Rights
• Guide drug users about dangers of needle sharing
• Relationship of HIV & STD
• Encourage HIV testing in pregnancy
• Early Diagnosis of HIV

22. HIGH INDEX OF SUSPISCION
• Patients with
– Tuberculosis
– Pneumonia
– Prolonged Diarrhea
– Meningitis
– Lympadenopathies/ Lymphoma
– Weight Loss
– Repeated Fungal Infection e.g Candidiasis

23. POST EXPOSURE PROPHYLAXIS
• Sero-conversion rate of needle stick injury
– HIV 0.4 %
– HBV 30 %
• Wash well
• Note down complete profile of donor
• Store blood from both parties
• Immunization both active and passive.
• Council test recipient 3 months and 6 months
• Follow up testing at 12 weeks and 24 weeks
• Before Prophylaxis do “Pregnancy Test”

24. WHOM TO TREAT
• History of AIDS defining illness or Cd4 count ≤ 350
cells /µL
• In following groups regardless of cd4 counts
– Pregnant
– HIV associated nephropathy
– Pts co-infected with HBV, when treatment is indicated for
HBV
• Retroviral therapy can be considered even if Cd4
count is ≥ 350 cells /µL if Cd4 count is falling very
rapidly

25. ANTI RETREOVIRAL AGENTS
• NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)
– Zidovudine (AZT) 250 – 300 mg/ 12hr
– Didonosine 250 mg / 24 hr
– Lamivudine 150 mg /12 hr
– Emtricitabine
– Stavudine 30 – 40 mg /12 hr
– Tenofovir 245 mg / 24 hr
– Abacovir 300 mg/ 12 hr
• PROTEASE INHIBITORS
– Indinavir 800 mg 8 hr
– Ritonavir 300 – 600 mg /12 hr
– Soquinovir 1 G 12 hr
• NON NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI)
– Nevirapine 200 mg / 24 hr - 200 mg /12 hr
– Efavirenz 600 mg / 24 hr
• INTEGRASE INHIBITORS Reltegravir 245 mg /24hr
• CCR5 ANTAGONISTS Maraviroc 300 mg /12 hr
• BEYOND PHARMACOLOGY

26. MONITORING
• Routine tests
– Cd4 T cell count (every 3 – 6 months)
– Cd4 T cell counts are expensive hence an alternative is
TLC ( TLC of 1400 ≈ Cd4 count of 200 cells /micro liter)
• Other Tests
– Pregnancy test
– Drug resistance tests

27. QUESTIONS

28. THAN - Q