ppt on AIDS/HIV

1. HIV / AIDS
BINEE MATHEW
LECTURER
BELIEVERS COLLEGE OF
NURSING

2. INTRODUCTION
HIV ( Human Immunodeficiency Virus ) is a
virus that causes AIDS . A person may be “HIV
positive” but not have AIDS . The most common
type of HIV infections is known as HIV 1 and this
lead to world wide AIDS epidemic.
First clinically observed in 1981 in USA .
The term GRID ( Gay Related Immune Deficiency )
was coined later . This was later in 1982 renamed
by CDC and AIDS came into existence.

3. DEFINITION
AIDS ,the acquired immuno-deficiency
syndrome (“Slim disease”) is a fatal illness
caused by a retrovirus known as human
immunodeficiency virus (HIV ) which breaks
down the body’s immune system , leaving the
victim vulnerable to a host of life threatening
opportunistic infections, neurological
disorders or unusual malignancies .

4. Among the special features of HIV
infection are that once infected , it is
probable that a person will be infected for
life . The term AIDS refers only to the last
stage of HIV infection . AIDS can be called our
modern pandemic , affecting both
industrialized & developing countries.

5. PROBLEM STATEMENT
•In middle of 20th
century , the infection was
confined to green monkeys of Africa .
•Then , it spread to Haiti , Caribbean islands
and reached USA , where it spread to all
parts of the world like a devastating fire .
•In 1981 , the first case of a new syndrome
was recognized and reported by CDC ,
Atlanta , USA , a rare form of pneumonia .

6. INDIA
• The first case of HIV infection was
diagnosed in a sex worker, in Chennai , in
1986 .
•First case of AIDS was recognized in 1987 , in
a commercial sex worker in Mumbai .
•By 1996-97 , there were about 2 million HIV
infected persons and about 3500 cases of
AIDS .

7. •By 2003 , the total number of HIV cases
increased to 5.1 million , including 86028
cases of AIDS , by August 2004 .
•Globally , India is next to South Africa in
terms of the overall number of people
living with AIDS .

8. EPIDEMIOLOGICAL
DETERMINANTS
1.AGENT FACTORS
(a) Agent
When the virus was first identified it was called
“lymphadenopathy- associated virus (LAV)” by the
French scientists . Researchers in USA called it “
human T-cell lymphotropic virus III ( HTLV-III ) . In
May 1986, the International Committee on
Taxonomy gave it a new name: Human immuno
deficiency virus(HIV) .

9. (b) Reservoir of infection
There is only human reservoir - cases and
carriers. Once a person is infected , the virus
remains in the body life long. The risk of
developing AIDS increases with time . Since
HIV infection can take years to manifest itself,
the symptomless carriers can infect other
people for years .

10. Carriers are highly infectious
during the “ window period” , the period
between the onset of infection and the
production of antibodies . This period is
about 6-12 weeks after infection .

11. (c) Source of infection
* Greater concentration in blood, semen &
CSF .
* Lower concentrations in tears , saliva ,
breast milk , urine and cervical & vaginal
secretions .
* Also isolated in brain tissues, lymph nodes
bone marrow cells and skin .

12. 2.HOST FACTORS
(a) Age
Most cases have occurred among
sexually active persons aged 20-40 years.
This group represents the most productive
members of the society, and those
responsible for child bearing &child

13. (b) Sex
* In North America, Europe & Australia, about 50
% of cases are homosexual/ bisexual man.
* In Africa, sex ratio is equal.
* Certain sexual practices also increase the risk of
infection more than others.
E.g.: Multiple sexual partners, anal intercourse &
male homosexuality.
* Higher rate of infection is seen in prostitutes .

14. ( c) High risk groups
•Male homosexuals
•Bisexuals
•Heterosexual partners( prostitutes)
•IV drug abusers
•Transfusion recipients of blood & blood
products
•Hemophiliacs
•Clients of STD

15. (d) Immunology
• HIV selectively infects T-helper cells .
•The infected T helper cells are destroyed .
•People with AIDS tend to have low overall
white blood cell count .
•Healthy individual – twice as many helper
cells as suppressor cells
•It is reversed in AIDS patients.

16. •A decreased ratio of T-helper to T-suppressor
cells may be an indirect indicator of reduced
cellular immunity .
•One of the most striking features of the
immune system of patients with AIDS is
profound lymphopenia, with a total
lymphocyte count often below 500/ cu. mm

17. MODE OF TRANSMISSION
1. By sexual transmission
2. By blood transfusion
3. By percutaneous route
4. Trans placental transmission

18. 1.Sexual transmission
•By direct physical contact
•Any vaginal , anal & oral sex can spread
AIDS
•Acquired mainly through heterosexual
contact, i.e. , through infected men to
women & infected women to men .
•Women are more vulnerable for HIV
infection than men ( women have a larger
surface area of vagina being exposed and

19. •Anal intercourse carries a greater risk of
HIV transmission than vaginal intercourse
( it can cause injury to the tissues of
receptive partner) .
•Exposed adolescent girls and women above
45 years are more prone to get the HIV
infection .
•An STDs is either the HIV –ve or the HIV +ve
partner facilitates the HIV transmission.

20. 2. Blood transfusion
Transfusion of HIV infected blood &
blood products i.e., platelets , whole blood
cells, factor viii & ix derived from human
plasma also transmit HIV .

21. 3. Percutaneous route
• HIV may be transmitted through
percutaneous route by using contaminated
syringe , needle to inject drugs .
•Use of any other infected skin-piercing
instrument
•Tattooing , acupuncture or scarification can
also transmit infection ( if the instrument
used is unsterile ) .

22. 4. Transplacental transmission
•HIV may be transmitted from the HIV
infected mother to her fetus through the
placenta or to her infant during delivery or
through breast feeding .
•Transmission from HIV infected mother to
child can be prevented by antiretroviral drug
prophylaxis, elective cesarean section before
the rupture of membranes and by avoiding
breastfeeding .

23. INCUBATION PERIOD
•Current data suggests that the incubation
period is uncertain – from a few months to 10
years or even more from HIV infection to the
development of AIDS .
•75 % of those infected with HIV will develop
AIDS by the end of 10 years .

24. CLINICAL FEATURES
Classified into 4 broad categories :
1. Initial infection with the virus and
development of antibodies
2. Asymptomatic carrier state
3. AIDS related complex
4. AIDS

25. 1. INITIAL INFECTION
•Infection begins as soon as the HIV virus
enters the body of a susceptible person
about 70% of people experience mild and
viral fever like symptoms . E.g.: fever , sore
throat & rash , after a few weeks of
infection .
•Most people affected with HIV have no
symptoms for first 5 years or so . But they
can transmit infection to others.

26. •Antibodies usually appear between 2- 4
weeks after infection , but they can take
longer time for this . During the period
before the antibodies produced ( “window
period” ) , although the person is infectious
to others , his/her HIV test is –ve on the
standard antibody blood test .

27. 2. ASYMPTOMATIC CARRIER STATE
Infected people have antibodies, but
there are no clearly manifest symptoms .
This stage may last for 5 to 7 years . There
may be persistent lymphadenopathy.
There is leukopenia and
thrombocytopenia. HIV test is +ve in this .

28. 3. AIDS - RELATED COMPLEX
•Unexplained diarrhea lasting longer than a
month
•Fatigue
•Malaise
•Loss of more than 10 % body weight
•Fever – low grade/ intermittent
•Night sweats
•Skin rashes

29. •Persistent cough for more than one month
•Other milder opportunistic infections – oral
thrush, herpes zoster , generalized
lymphadenopathy and who have a
decreased no. of T helper lymphocytes are
considered to have AIDS related complex .

30. 4.AIDS / LATE CHRONIC INFECTION
It is the late manifestation of
HIV infection . Many opportunistic infections
, malignancies , serious fungal infections ,
e.g.: candidiasis & parasitic infections like
pneumocystis , carinii pneumonia or
Toxoplasma gondii encephalitis can occur ,
when T helper cells falls to around 100.

31. Other common opportunistic infections are:
•Tuberculosis : occurs when the immune
system breaks down in HIV infection .
•Persistent generalized lymphadenopathy :
lymph nodes get larger than 1 cm in
diameter , in two or more sites other than
the groin area for a period of at least 3
months .
•Kaposi sarcoma : A tumor featuring reddish
brown/ purplish plaques or nodules on the
skin & mucous membranes .

34. •Oral pharyngeal candidiasis: Caused by a
common yeast , fungus , oral thrush
presents with soreness & redness , with
white plaques on the tongue , and in the
mouth & throat; sometimes a white fibrous
layer covering the tonsils & back of the
mouth .

36. •Cytomegalovirus retinitis: Inflammation of
the eye retina which may lead to
blindness .

37. •Pneumocystosis carinii pneumonia : Symptoms
can include a dry , non productive cough ;
inability to take a full breath and occasional
pain on breathing; and weight loss and fever .

38. •Toxoplasma encephalitis: Protozoal infection in CNS ,
presenting with focal neurological signs such as mild
hemiplegia or stroke , resulting from damage to the
part of brain , seizures or altered mental status .
•Cryptococcal meningitis: A fungal infection in CNS
which usually presents with fever , headache ,
vomiting and neck stiffness .

39. •Hairy leukoplakia : White patches on the sides of
the tongue , in vertical folds resembling
corrugations .

40. •Herpes zoster / shingles : Viral inflammation of the
CNS , presenting with localized pain and burning
sensations followed by vesicle eruption &
ulceration.

41. •Severe prurigo/ Pruritic dermatitis: Chronic
skin inflammation in the form of a very
itchy rash of small flat spots developing into
blisters .

42. •Severe/recurrent skin infections : Warts ;
dermatophytosis or ringworm ; and
folliculitis .

44. DIAGNOSIS
WHO Case definition for AIDS surveillance
* Adolescent/adult
They considered to have AIDS if
at least 2 of the major signs are present in
combination with at least 1 of the minor
signs , if these signs are not known to be
due to a condition unrelated to HIV
infection .

45. Major Signs
•Weight loss more than 10% of body weight .
•Chronic diarrhea for more than 1 month .
•Prolonged fever for more than 1 month
(intermittent/constant ) .

46. Minor Signs
•Persistent cough for more than 1 month .
•Generalized pruritic dermatitis .
•History of herpes zoster .
•Oropharyngeal candidiasis .
•Chronic progressive or disseminated herpes
simplex infection .
•Generalized lymphadenopathy .

47. *Children
The case definition for AIDS is
fulfilled if at least 2 major signs& 2 minor
signs are present .
Major Signs
•Weight loss or abnormally slow growth .
•Chronic diarrhea for more than 1 month .

48. Minor Signs
•Generalized lymph node enlargement .
•Oropharyngeal candidiasis .
•Recurrent common infections like ear
infection, pharyngitis .
•Persistent cough .
•Generalized rash .

49. Expanded WHO case definition for AIDS
surveillance
An adult/adolescent is considered to
have AIDS if a test for HIV antibody gives a
positive result , and one or more of the
following conditions are present:
•More than 10% body weight loss or
cachexia , with diarrhea or fever
( intermittent/constant) , for at least 1

50. •Cryptococcal meningitis .
•Pulmonary/ extra pulmonary tuberculosis .
•Kaposi sarcoma .
•Neurological impairment ( trauma or
CVA ) .
•Invasive cervical cancer .
•Candidiasis of esophagus .
•Life threatening/ recurrent episodes of
pneumonia .

51. LABORATORY FINDINGS
• ELISA
• Western blot
• CBC
• Absolute CD4 lymphocyte count
• HIV viral load tests
• B2- Microglobulin
• P24 antigen

52. CONTROL OF AIDS
• There are four basic approaches to the control of AIDS
1.PREVENTION
A. EDUCATION
• Until a vaccine or cure for AIDS is found, the only mean at present
available is health education to enable people to make life saving
choices eg. Using condoms
• Avoid the use of shared razors and toothbrushes

53. • Intravenous drug users should be informed that
the sharing of needles and syringes involve
special risk
• Women suffering from AIDS and who are at high
risk of infection should avoid becoming
pregnant since infection can be transmitted to
the newborn

54. B) COMBINATION HIV PREVENTION
• ARV drugs play a key role in HIV
prevention
•Male and female condom use
•Voluntary medical male circumcision
•Needle and syringe programmes

55. C ) PREVENTION OF BLOOD BORNE HIV
TRANSMISSION
• People in high risk group should be urged to refrain from
donating blood, body organ, sperm, or other tissue
• All blood should be screened for HOV1 and HOV 2 before
transmission
• Strict sterilization practices should be ensured in hospitals
and clinics

56. 2.ANTIRETROVIRAL TREATMENT
• At present there is no vaccine or cure for
treatment of HIV infection/ AIDS. However the
development of drug that suppress the HIV
infection

57. CLASSIFICATION OF DRUGS USED
FOR ART

58. FIRST LINE ART IN TREATMENT
First line ART for Adults Consist of two nucleoside reverse
transcriptase inhibitor s(NRTIs) plus a
non nucleoside reverse transcriptase
inhibitor (NNRTI) or an integrase
inhibitor
TDF+3TC+EFV
First line ART for adolescents Two NRTIs+NNRTI or an INSTI
TDF+3TC+EFV
First line ART for children aged 3 to 10
yrs
For children 3 to less than 10 years of
age, the NRTI backbone should be given,
in prefrential order
ABC +3TC

59. First line ART for children
Yoinger than 3 years of age
NRTI ahould be given
ABC+3 TC
Infant prophylaxis Infant born to mothers with HIV who are at high
risk of acquring HIV Should recieve dual
prophylaxis with AZT (twice daily) and NCP ( once
daily) for the first 6 weeks of life, whether they are
breast fed to formula fed
Infants of mothers who are receiving ART and are
breastfeeding should receive 6 weeks of infant
prophylaxis with daily NVP.

60. Second line treatment for adults and
adolescents
Two NRTIs + a protease inhibitor
Second line treatment for children After failure of first line regimen of ABC
or TDF+3TC, the second line ART is
AZT+3TC
Third line ART Third line regimen should include new
drug with minimal risk of cross
resistance to previously used regimen

61. POST- EXPOSURE PROPHYLAXIS (PEP)
• Antiretroviral therapy starts within 72 hours of exposure to
prevent infection
PEP comprises:
• Counselling
• First aid care
• HIV testing
• 28 day course of ARV Drugs
• Follow up care

62. USE OF COTRIMOXAZOLE PROPHYLAXIS
FOR HIV RELATED INFECTIONS
• Co-trimaxazole is a fixed dose combination of two
antimicrobial drugs(sulfamethaxazole and trimethoprim)
that covers a variety of bacterial, fungal and protozoal
infections
• The therapy is feasible, well tolerated and inexpensive
intervention for people living with HIV to reduce HIV-related
morbidity and mortality.

63. MONITORING THE EFFICACY OF ART
• Efficacy is monitored by
A)Clinical improvement
-gain in body weight
-decrease in occurence and severity of HIV related diseases
(infections and malignancies)
B) Increase in total lymphocyte count
C) Improvement in biological markers of HIV(when available)
-CD4+T lymphocyte counts
- plasma HIV RNA levels

64. 3. SPECIFIC PROPHYLAXIS
Prophylaxis against M. Tuberculosis is 300 mg
isoniazid daily for 9 months to one year. It
should be given to all HIV infected patients with
positive PPD reactions.

65. 4.PRIMARY HEALTH CARE
• Because of its wide-ranging health implications, AIDS
touches all aspects of primary health care, including
mother and child health, family planning and
education.
• It is important, therefore, that AIDS control
programmes are not developed in isolation.
Integration into country's primary health care system
is essential.

66. ELIMINATION OF MOTHER TO
CHILD TRANSMISSION OF HIV
• The HIV positive mother may transmit infection to her child
during pregnancy, labor, delivery or breastfeeding and this is
referred to vertical transmission or mother to child
transmission
• WHO recommends preventive strategies for MTCT which is
referred to”prevention of mother to child transmission “(PITCH)
:
• Giving ARVs to mothers and infants during pregnancy,
labor and the postnatal period
• Offering life long treatment to HIV positive pregnant
women regardless of their CD4 count