2. Occurrence
AIDS was first recognized as a distinct clinical entity
in 1981;, however, isolated cases appear to have o
ccurred during the 1970s and even earlier in severa
l areas (Africa, Europe, Haiti, USA).
Of the estimated 40 million persons (34–46 million) l
iving with HIV infection or AIDS (HIV/AIDS) worldwi
de in 2003, the largest elements were estimated at
25–28.2 million in sub-Saharan Africa, 4.6–8.2 milli
on in south and southeastern Asia, 13–1.9 million in
Latin America and 800 000–1 million in North Ameri
ca.
3. Globally, AIDS caused an estimated 3.1 milli
on deaths in 2003 (2.5–3.5 million)
The epidemic has continued growing, with e
stimates of 5 million new infections (4.2–5.8
million) and 2.5 million children (2.1–2.9 milli
on) living with HIV/AIDS.
4. Identification
Emergence was in 1981 of a cluster of disea
ses associated with loss of cellular immunity
in adults who had no obvious reason for pre
senting such immune deficiencies.
Within several weeks to several months afte
r infection with HIV, many persons develop
an acute self-limited mononucleosis-like illn
ess lasting for a week or two. They may the
n be free of clinical signs or symptoms for m
onths or years before other clinical manifest
ations develop.
5. AIDS Associated Disease Categories
1. Gastrointestinal: Cause most of illness and
death of late AIDS.
Symptoms:
Diarrhea
Wasting (extreme weight loss)
Abdominal pain
Infections of the mouth and esophagus.
Pathogens: Candida albicans, cytomegaloviru
s, Microsporidia, and Cryptosporidia.
6. AIDS Associated Disease Categories
2. Respiratory: 70% of AIDS patients develop
serious respiratory problems.
Partial list of respiratory problems associated with
AIDS:
Bronchitis
Pneumonia
Tuberculosis
Lung cancer
Sinusitis
Pneumonitis
7. AIDS Associated Disease Categories
3. Neurological: Opportunistic diseases and
tumors of central nervous system.
Symptoms many include: Headaches, peri
pheral nerve problems, and AIDS dementi
a complex (Memory loss, motor problems,
difficulty concentration, and paralysis).
8. AIDS Associated Disease Categories
4. Skin Disorders: 90% of AIDS patients devel
op skin or mucous membrane disorders.
Kaposi’s sarcoma
1/3 male AIDS patients develop KS
Most common type of cancer in AIDS patients
Herpes zoster (shingles)
Herpes simplex
Thrush
Invasive cervical carcinoma
5. Eye Infections: 50-75% patients develop ey
e conditions.
CMV retinitis
Conjunctivitis
Dry eye syndrome
9. Infectious agent
Human immunodeficiency virus (HIV),
Retrovirus.
Two serologically and geographically distinc
t types with similar epidemiological characte
ristics, HIV-1 and HIV-2, have been identifie
d.
The pathogenicity of HIV-2 may be lower tha
n that of HIV-1
lower rates of mother-to-child transmission f
or HIV-2.
10. Structure of the Human Immunodeficiency Virus HI
V is a Retrovirus
11. Mode of transmission
Person to person transmission through unpr
otected (heterosexual or homosexual) interc
ourse;
Contact of abraded skin or mucosa with bod
y secretions such as blood, CSF or semen;
The use of HIV-contaminated needles and s
yringes, including sharing by intravenous dr
ug users; transfusion of infected blood or its
components
12. Mode of transmission (cont.)
Transplantation of HIV-infected tissues or or
gans.
The presence of a concurrent sexually trans
mitted disease, especially an ulcerative one,
can facilitate HIV transmission.
Unprotected intercourse (no condom— unpr
otected sex) with many concurrent or overla
pping sexual partners.
13. Mode of transmission (cont.)
HIV can be transmitted from mother to child (MTCT
or vertical transmission).
From 15% to 35% of infants born to HIV-positive mothers
are infected through placental processes at birth.
HIV-infected women can transmit infection to their infants t
hrough breastfeeding and this can account for up to half of
mother-to-child HIV transmission.
Giving pregnant women antiretrovirals such as zidovudine
results in a marked reduction of MTCT.
14. Mode of transmission (cont.)
After direct exposure of health care workers
to HIV-infected blood through injury with nee
dles and other sharp objects, the rate of ser
oconversion is less than 0.5%, much lower t
han the risk of hepatitis B virus infection afte
r similar exposures (about 25%).
Unsafe injections may account for up to 5%
of transmission.
15. Drugs Against HIV
Reverse Transcriptase Inhibitors: Competiti
ve enzyme inhibitors. Example: AZT, ddI, dd
C.
Protease Inhibitors: Inhibit the viral proteas
es. Prevent viral maturation.
Problem with individual drug treatments: R
esistance.
Drug combinations: A combination of:
One or two reverse transcriptase inhibitors
One or two protease inhibitors.
Drug cocktails have been very effective in s
uppressing HIV replication and prolonging t
he life of HIV infected individuals, but long t
erm effectiveness is not clear.
16. Methods of control
A. Preventive measures:
HIV/AIDS prevention programs can be
effective only with full community and
political commitment to change and/or
reduce high HIV-risk behaviours.
17. Methods of control (cont.)
Public and school health education mu
st stress that having multiple and espe
cially concurrent and/or overlapping se
xual partners or sharing drug parapher
nalia both increase the risk of HIV infe
ction.
18. Methods of control (cont.)
The only absolutely sure way to avoid infecti
on through sex is to abstain from sexual inte
rcourse or to engage in mutually monogamo
us sexual intercourse only with someone kn
own.
In other situations, latex condoms must be u
sed correctly every time a person has sexua
l intercourse.
19. Methods of control (cont.)
Expansion of facilities for treating drug users reduce
s HIV transmission.
HIV testing and counselling is an important interven
tion for raising awareness of HIV status, promoting
behavioural change and diagnosing HIV infection. H
IV testing and counselling can be undertaken for:
a) persons who are ill or involved in high-risk behaviours,
b) attenders at antenatal clinics, to diagnose maternal infe
ction and prevent vertical transmission;
c) couple counselling (marital or premarital);
d) anonymous and/or confidential HIV counselling and test
ing for the “worried well”.
20. Methods of control (cont.)
Care must be taken in handling, using and d
isposing of needles or other sharp instrume
nts.
Health care workers should wear latex glove
s, eye protection and other personal protecti
ve equipment in order to avoid contact with
blood or with fluids.
21. B. Control of patient, contacts and
the immediate environment:
1) Report to local health authority: Offi
cial reporting of AIDS cases is obligato
ry in most countries.
Official reporting of HIV infections is re
quired in some areas, Class 2
22. 2) Isolation: Isolation of the HIV-positiv
e person is unnecessary, ineffective an
d unjustified.
Universal precautions apply to all hosp
italized patients.
23. 3) Concurrent disinfection: Of equipme
nt contaminated with blood or body flui
ds and with excretions and secretions
visibly contaminated with blood and bo
dy fluids by using bleach solution or ge
rmicides
24. 4) Quarantine: Not applicable.
5) Immunization of contacts: Not applicable.
6) Notification of contacts and source of infe
ction: The infected patient should ensure not
ification of sexual and needlesharing partner
s whenever possible.
25. Management
AIDS must be managed as a chronic diseas
e; antiretroviral treatment is complex, involvi
ng a combination of drugs: resistance will ra
pidly appear if a single drug is used.
The drugs are toxic and treatment must be li
felong.
In addition; treatment of other additional ass
ociated conditions
26. C. Epidemic measures: HIV is currently pa
ndemic, with large numbers of infections rep
orted in the Africa, the Americas, southeaste
rn Asia, and Europe.
D. Disaster implications: Emergency pers
onnel should follow the same universal prec
autions as health workers.
