2. DEFINITION
• AIDS - a fatal illness caused by a retrovirus
known as 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.
• “Slim disease”
• AIDS – last stage of HIV infection.
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3. WHO/NACO definition of AIDS
Clinical AIDS in an adult
Positive test for HIV antibody – 2 separate tests using
2 different antigens and one of these criteria,
• Weight loss >10% ; Chronic diarrhoea >1 month.
• Disseminated, miliary or extra pulmonary TB.
• Neurological impairment.
• Candidiasis of the esophagus with diagnosable
Dysphagia along with oral Candidiasis.
• Kaposi’s sarcoma
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4. WHO/NACO defn of AIDS
Clinical AIDS in children
2 major & 2 minor signs in absence of known cases of
immuno-suppression.
Major signs
• Weight loss or abnormal slow growth.
• Failure to thrive or recurrent/persistent diarrhoea
or recurrent infections or recurrent fever >1 month.
• Candidiasis or TB or Herpes zoster
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5. Contd…
Minor signs
• Generalized lymphadenopathy.
• Oro-pharyngeal candidiasis.
• Repeated infections like otitis, pharyngitis.
• Persistent cough >1 month.
• Generalized dermatitis.
• Confirmed maternal HIV infection
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6. INDIA – HIV/AIDS
HISTORY
• 1986-1st case of HIV in FSW of Chennai.
• 1987 – 1st case of AIDS in Mumbai.
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7. Spread of HIV epidemic in India
High risk population (FSW,MSM,IDU)
Bridge population(clients of sex workers, STD
patients, IDU partners, Migrants etc)
General population
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8. Classification of states in India
a) High prevalent States
• Prevalence in antenatal women >1%
• Prevalence in high risk groups >5%.
• Maharashtra, TN, AP, Karnataka, Manipur, Nagaland.
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9. b) Moderate prevalent States
• Prevalence in antenatal women <1%
• Prevalence in high risk groups >5%.
• Gujarat, Goa, Puducherry.
c) Low prevalent States
• Prevalence in antenatal women <1%
• Prevalence in high-risk groups <5%
• Rest of the states.
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10. EPIDEMIOLOGICAL FACTORS
AGENT FACTORS
• Human Immuno-deficiency Virus.
• Cases and carriers – reservoir of infection.
• Blood, semen, CSF, tears, saliva, breast milk, urine,
cervical and vaginal secretions – sources of infection.
HOST FACTORS
• Sexually active persons (20-49 years).
• High risk groups
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11. Strains
HIV1 HIV2
• HIV1 is more virulent than HIV2
• HIV1 – present world wide
• HIV2 – more in West Africa
• India – HIV1 & HIV2
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12. Characteristics of HIV
• Fragile
• Alive in air : 7-8 seconds
• At room temp (20-250c) – in dried blood- survives for
7 days.
• Found in dead body -16th day
• Killed at 560c – 30 minutes
• Killed at 600c – 10 minutes
• Killed at 1000c – in seconds
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13. High-risk groups
• Male homosexuals, bisexuals
• IV drug abusers
• Multiple sex partners
• Prostitutes, both male and female
• Clients of STD
• Migrants
• Newborn of infected mothers
• Transfusion recipients of blood and blood products
• Medical and para-medical staff
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14. Modes of transmission
a) Sexual transmission
• Vaginal, anal or oral.
• More risk- presence of abrasions of skin or mucous
membrane in vagina, anus or oral cavity
b) Blood
• High risk – fresh frozen plasma, fibrinogen, anti-
haemophilic factor VIII & IX.
• Mod risk – gamma globulin, immunoglobulins of
rabies, hep B & anti-D .
• No risk – human albumin, hep vaccine, prothrombin
complex
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15. c) Sharing needles and syringes
d) Mother to child transmission
• During pregnancy : 5-10 %
• During delivery : 10 %
• During breast feeding : 5-20 %
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16. Risk of transmission of HIV through different
modes
Route Efficiency
• Trans. of blood/ products > 90%
• Mother to child transmission 25-35%
• Sharing needles/syringes 3-5%
• Sexual route 0.01 -1.0%
• Percutaneous exposure 0.4%
• Muco-cutaneous exposure 0.05%
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17. Body Fluids
CAN TRANSMIT MAY NOT TRANSMIT
HIGH LOW NONE
Blood Saliva Tears
Rectal Secretions Vomit Sweat
Vaginal Secretions Urine Feces
Semen
Pre-cum
Breast Milk
Menstrual Blood
Brain/Spinal fluid
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18. CLINICAL SPECTRUM OF HIV INFECTION
Primary
Infection
Asymptomatic
Period
Pre AIDS
syndrome AIDS
Fever, Rash,
Arthralgia, LNE
2- 6 wks
Generalized
Lymphadenopathy
Fever, Weight loss
Opportunistic
Infection
Malignant
diseases
Acquisition of virus
Incubation Period
DEATH
34. HIV Diagnostic Tests
• Tests that detect antibody
• Tests that detect antigen
• Tests that detect viral nucleic acid
• Tests that detect the whole virus
35. • Antibody Detection
most widely used
most effective way
• Tests divided into two broad groups
Screening assays
Supplemental assays
36. Screening Tests
• Screening tests (ELISA, Rapid, Simple)
– ELISA (2-3 hours)
– Rapid tests (minutes)
• Dot blot assays
• Particle agglutination
• HIV Spot tests
– Simple (½ hour )
• Based on ELISA principle
37. Lab diagnosis during window period
P24 antigen assay (<40%)
PCR
Viral Culture
Need of lab. Diagnosis in window period
Untested blood transfusion
Risky heterosexual / homosexual exposure
Needle stick injury (contaminated)
38. HAART
Highly active antiretroviral therapy refers to the use
of combinations of various antiretroviral drugs with
different mechanisms of action to treat HIV
Harder for HIV drug to become resistant
Ex: Atriplais
39. Control of AIDS
There are 4 basic approaches :
1.Prevention
2.ART
3.Specific prophylaxis
4.Primary health care
43. Mother-to-child transmission
Is the main cause of HIV infection in children
It can occur during:
• Pregnancy 5-10%
• Delivery 10 %
• Post natal period 5 – 20%
44. Categories of exposure
Mild exposure Mucus membrane and non-
intact skin with small
volume,eg.small bore needle
Moderate
exposure
Mucus membrane and non-
intact skin with large volume
Severe
exposure
Percutaneous with large
exposure
Exposure with >18 bore needle,
deep wound,
45. 4.Primary health care
• Because of wide range health implications
AIDS touches all aspects of primary health
care
• So AIDS control programmes are not
developed in isolation
• Integration into country’s primary health
care system is essential
47. National AIDS Control Programme phaseIV
• Aiming at accelerating reversal and integrating
response, the fourth National AIDS Control
Programme (NACP-IV) has now aimed at zero
infection, zero stigma and zero death.
• The focus now is on prevention of HIV, especially
among female sex workers, men having sex with
men, intravenous drug abusers, truck drivers and
migrants,”
48. Soil-transmitted helminthiases
• Soil-transmitted helminthiases (STH) refer to a group
of parasitic diseases caused by nematode worms
• Transmitted to humans by faecally contaminated soil.
• The soil-transmitted helminths of major concern to
humans are –
Ascaris lumbricoides
Trichuris trichiura
Necator americanus
Ancylostoma duodenale.
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49. Burden of disease
• India and South Asia accounts for: Ascariasis 237
million cases (29 % of global burden — 0.4 — 3.0
million DALY)
• Trichuriasis 147 million cases (24 % of global burden
— 0.5 — 1.5 million DALY)
• Hookworm infection 130 million cases (23 % of
global burden — 0.6 - 5.6 million DALY).
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50. Transmission
• Soil transmitted helminthes are transmitted by eggs
that are passed in the faeces of infected people.
• Adult worms live in the intestine where they produce
thousands of eggs each day.
• In areas that Lack adequate sanitation, these eggs
contaminate the soil.
• People become infected with A. Iambricoides and T
trichura by ingesting infective parasite eggs.
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51. This can happen in several ways.
• Eggs that are attached to vegetables are ingested
when the vegetables are not carefully cooked,
washed or peeled.
• Eggs are ingested from contaminated water sources.
• Eggs are ingested by children who play in soil and
then put their hands in their mouths without
washing them.
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52. • Hookworm eggs hatch in the soil, releasing larvae
that mature into a form that can actively penetrate
the skin.
• People become infected with hookworm primarily by
walking barefoot on the contaminated soil.
• There is no direct person-to-person transmission, or
infection from fresh faeces
• Eggs need three weeks to mature in the soil before
they become infective.
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53. • These worms do not multiply in the human host.
• Reinfection occurs only as a result of contact with
infective stages in the environment.
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54. Signs and symptoms
• Morbidity is related to the number of worms
harbored.
• People with light infections usually have no
symptoms.
• Heavier infections can cause a range of symptoms
including intestinal manifestations( diarrhea,
abdominal pain) general malaise and weakness
impaired cognitive and physical development.
• Hookworms cause chronic intestinal blood loss that
can result in anemia.
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55. Nutritional effects
Soil-transmitted helminthes impair the nutritional
status of the people they infect in multiple ways.
• The worms feed on host tissues, including blood,
which leads to a loss of iron and protein
• The worms increase malabsorption of nutrients.
• In addition, roundworm may possibly compete for
vitamin A in the intestine.
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56. • Some soil-transmitted helminths also cause loss of
appetite and therefore a reduction of nutritional
intake and physical fitness.
• In particular, T trichiura can cause diarrhoea and
dysentery.
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57. Global strategy for controlling
STH and neglected tropical diseases:
• Relatively low mortality compared with the "big
three" (HIV/AIDS, malaria and tuberculosis.)
• Many of these diseases had been neglected in the
global public health agenda .
• In 2003, a historical paradigm shift occurred for a
number of chronically endemic tropical diseases,
now known collectively as neglected tropical
diseases (NTDs).
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58. • In 2005 in Berlin, Germany, WHO convened a
meeting of partners and experts to secure strategic
and technical guidance and take this agenda forward.
• A NTD control strategy was defined by WHO in 2006.
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59. Controlling morbidity:
• The strategy recommended by WHO to control
morbidity from STH
• Involves the periodic administration of anthelminthic
medicines
• Mainly single-dose albendazole (400 mg) and
mebendazole (500 mg):
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60. Recommended strategy for STH control
• Integration within existing public-health activities -
reduces costs and increase effectiveness.
• Integrated preventive chemotherapy.
• A rational approach to control STH,lymphatic
filariasis onchocerciasis, schistosomiasis and blinding
trachoma.
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61. Types of Interventions available for STH
control:
• Health care dependent
Drugs
Diagnostics Vaccines
Others (e.g. male circumcision, behavior change)
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62. • Health care Independent
Environment
Water, Sanitation
Air pollution - Indoor & Outdoor
• Safety
• Vector Control
• Behavior Change
• Others?
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63. • Providing sanitary latrine is an integral part of STH
control.
• Use of protective foot ware.
• Use of safe drinking water
• Washing of food articles, especially vegetables in
clean running water
• Clipping of nails.
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