This document provides information about HIV/AIDS, including: - HIV/AIDS was first identified in the 1980s and has since spread worldwide, but treatments now allow for a long and healthy life if diagnosed early. - HIV attacks and destroys CD4 cells of the immune system, weakening the body's ability to fight infections and disease. - HIV is most often transmitted sexually or through blood exposure, and from mother to child during pregnancy or birth. - As the virus progresses it can be detected through antibody tests and a declining CD4 count, eventually causing AIDS without treatment. - Prevention focuses on awareness, safe sexual practices, sterilization of medical equipment, and universal precautions for healthcare workers.

1. HIV/AIDS
• HIV/AIDS was first identified in the early 1980’s. Since then the
number of people infected with HIV has increased rapidly throughout
the world.
• If left untreated, HIV can progress to a serious, disabling disease,
however today there are many treatments available to ensure a long
and healthy life.
• HIV/AIDS can be treated and there is a lot that can be done to
improve health if diagnosed early.
• Medications can reduce the virus while vitamins, good nutrition, and
exercise can play a critical role in keeping your body strong and
healthy.

2. What is HIV?
• HIV (Human Immuno Deficiency Virus) is a virus that enters blood. In HIV positive
people, the virus can be found in the blood, sex fluids (such as sperm and vaginal
fluids) and breast milk.
• Structure
HIV belongs to the retrovirus group. They are RNA-containing viruses that
replicate with the help of the reverse transcriptase (RT) or RNA dependent
DNA polymerase.

3. What is AIDS?
• HIV causes AIDS (Acquired Immuno Deficiency Syndrome).
• HIV slowly damages the immune system (the army) if it gets into a
person’s body. This means that the body starts to lose its ability to
defend itself against germs, infections and bacteria such as TB.

4. Transmission
1. 80% of the total patients got the infection as a sexually transmitted disease.
2. In about 15% of patients, the disease was transmitted through blood.
The drug abusers usually use the same needle without any sterilization for
intravenous injection. The risk of getting HIV is high in patients who receive
blood transfusion many times, e.g. hemophilia patients.
3. In the rest 5% cases, virus may be transmitted from mother to fetus
through placenta. About 30% of infants born to HIV positive mothers may
get the infection.

5. Natural Course of the Disease
1. Window Period. When the virus enters the body, it is multiplied in the body cells, but it
cannot be detected easily. This is called the window period . The viralcapsid antigen
p24 can be detected in the blood during this time.
2. Seropositive Stage. After a few months, antibodies are seen in circulation. This is called
seropositivity .During this period, the person is completely normal. However, this
person is a carrier of the disease, and can transmit the disease to others.
About 10% seropositive individuals will go for the 3rd stage of AIDS disease within 5
years, about 50% will get AIDS within 10 years and about 90% enter into the
disease state within 15 years.
For each AIDS patient, there are 100 seropositive persons in the general population.

6. Natural Course of the Disease
3. AIDS Disease
The third stage is when the clinical manifestations start.
By this time, the immune status of the individual is depressed.
Therefore, commensal microbes will start multiplication inside the body.
Patient usually succumbs to death within about 2 years after entering this stage.
4. Clinical Presentations
Lymphadenopathy and fever may be seen by the end of the second stage.
The AIDS related symptoms (ARS) are wide. Since the immunity is deficient, nonpathogenic
microorganisms enter into the body and produce lesions in skin, gastrointestinal tract,
lungs, urinary tract and brain.
Gastroenteritis and tuberculosis are the predominant pattern.
In all the cases, there will be weight reduction.

7. Laboratory Analysis
I. The antibodies in the blood are detected by the ELISA test . In ELISA, antibody against only one antigen
(gp 120) is being tested; so there is probability of false results. ELISA positive blood is then confirmed with
Western blot analysis .
2. In Western blot analysis, antibodies against 6 different components of the virus are analysed; so it is
confirmatory.
3. T-helper count is lowered. The normal level is more than 400/cmm. In AIDS patients, the level is always
below 300. As the disease progresses, the helper cell count is correspondingly lowered.
4. In the last stages, the antigen, especially, p24 starts to rise.
5. By Real time PCR (RTPCR) , the number of HIV particles in blood can be estimated. A value of less than
5000 copies per ml of blood has good prognosis, while a count more than 1 lakh per ml means very bad
prognosis.

8. THE HUMAN IMMUNODEFICIENCY VIRUS
• Immunology of AIDS
1.The CD4 (T-helper) lymphocytes are decreased in number, leading to immunodeficiency. The gp120 surface
unit could specifically attach with CD4 molecule present on the surface of T-helper cells. Therefore HIV
preferentially enters into the T-helper cells and they are lysed.
2. Macrophages and monocytes act as the reservoir of HIV infection, which disseminate the virus to various
organs, including CNS. In turn, macrophage activity is also reduced.
3. Since T-helper cells play a pivotal role in the immunological system, their deficiency will lead to suppression of
almost all the immunological effectors.
4. T-helper (CD4) count is less than 400/cu.mm.of blood. T-killer cytotoxic activity is reduced.
5. Antibody response against a foreign antigen is poor. Lymphokines such as interferon, interleukin-2, etc. are lowered.
6. When all the effector mechanisms of immunity are thus paralysed, opportunistic pathogens get entry into the body.

9. Prevention
• Since there is no cure for AIDS, and vaccines are still decades away, public education and awareness
are the only means to limit the spread of HIV infection. Since the major method of transmission
is through sexual contact, avoidance of extramarital relationships will stop the spread.
• All the blood samples should be tested for the presence of HIV antibodies before transfusion.
• Syringes and needles should be properly sterilized. Disposable syringes and needles are to be used
and destroyed immediately after use. Boiling for 10 minutes will inactivate the virus. Ordinary
autoclaving at 120oC for 20 min is effective to sterilize instruments and gloves.
• Blood spills can be decontaminated by washing with 1% sodium hypochlorite solution, containing
10,000 ppm chlorine.
• Heat sensitive instruments may be decontaminated by immersing in 2% glutaraldehyde (cidex) for
3 hours.

10. Prevention
• General measures to prevent occupational transmission of blood-borne viruses
1. Apply good basic hygiene practices with regular hand washing, before and after contact with
each patient, and before putting on and after removing gloves. Change gloves between
patients.
2. For all clinical procedures, cover existing wounds, skin lesions and all breaks in exposed skin
with waterproof dressings, or with gloves if hands extensively affected.
3. Health care workers with chronic skin disease such as eczema should avoid those invasive
procedures which involve sharp instruments or needles when their skin lesions are active, or if
there are extensive breaks in the skin surface. A non-intact skin surface provides a potential
route for blood-borne virus transmission, and blood-skin contact is common through glove
puncture that may go unnoticed.

11. General measures
4.Use protective clothing as appropriate, including protection of mucous membranes
of eyes, mouth and nose from blood and body fluid splashes. Open footwear should
not be worn in situations where blood may be spilt, or where sharp instruments or
needles are handled.
5. Prevent puncture wounds, cuts and abrasions and, if present, ensure that they are not
exposed
6. Avoid sharps usage wherever possible and consider the use of alternative instruments,
cutting diathermy and laser.

12. General measures
7. Where sharps usage is essential, exercise particular care in handling and
disposal, following approved procedures and using approved sharps
disposal containers.
8.Clear up spillages of blood and other body fluids promptly and disinfect
surfaces.
9. Follow approved procedures for sterilization and disinfection of
instruments and equipment.
10. Follow approved procedures for safe disposal of contaminated waste

13. Prevention
• Procedures where the hands and fingertips of the worker are visible and
outside the patient’s body at all times, and internal examinations or
procedures that do not involve possible injury to the worker’s gloved hands
from sharp instruments and/or tissues, are considered not to be exposure
prone provided routine infection control procedures are adhered to at all
times. Examples of such procedures include:
• Taking blood (venipuncture);
• Setting up and maintaining intravenous lines or central lines.
• Minor surface suturing;
• The incision of external abscesses;
• Routine vaginal or rectal examinations;
• Simple endoscopic procedures.

14. THANK YOU