1. AIDS (Acquired immune-deficiency syndrome)
• Fatal illness
• Caused by a retrovirus HIV
• It breaks down the body's immune system, leaving the patient vulnerable to a host of life- threatening
opportunistic infections, neurological disorders or unusual malignancies.
Epidemiology
• Males > females
• Occurs in all ages and ethnic groups
• All areas of the country are affected
• AIDS is now the second leading cause of death for all men aged 25-44 years
(Unintended injuries is #1 and heart disease is #3 for this age group)
HIV- Agent
• It is a RNA virus, which replicates in actively dividing T4 lymphocytes.
• Unique ability to destroy T4 Helper cells
• Reservoir - Once a person gets infected virus remains in his body lifelong. And the person is a
symptomless carrier for years before the symptoms actually appear.
• Source – The virus is found in great concentrations in blood, CSF and semen.
• Lower concentrations have been found in tears, saliva, breast milk, urine, cervical and vaginal secretions.
• Also isolated from brain tissue, lymph nodes, bone marrow cells and skin.
• However only blood and semen are known to transmit the virus.
HIV in body fluids
Average no. of HIV particles in 1 ml of these body fluids:
• Blood – 18,000
• Semen – 11,000
• Vaginal fluids – 7,000
• Amniotic fluids – 4,000
• Saliva - 1
Host
• Age - Most cases are among sexually active people aged between age 20- 49 years.
• High risk groups - Male homosexuals, hetero sexual partners, IV drug abusers, blood transfusion
recipients, haemophiliacs and patients having STDs.
HIV Transmission
HIV enters the bloodstream through:
• Open Cuts
• Breaks in the skin
• Mucous membranes
• Direct injection
Routes of Transmission of HIV
Sexual Contact
• Male-to-male
• Male-to-female or vice versa
• Female-to-female
Blood Exposure
• Injecting drug use/needle sharing
• Occupational exposure
• Transfusion of blood products
2. Perinatal
• Transmission from mother to baby
• Breastfeeding
Occupational Transmission
• Health care worker/ hospital staff
• Laboratory workers
Other routes
• Organ transplantation
• Artificial insemination
• Needle-prick
Incubation Period
• The incubation period is from HIV infection till development of AIDS.
• It is from a few months to 10 years or even more.
• However it is estimated that 75% of people infected with HIV will develop AIDS at the end of 10 years.
HIV-Infected T-Cell
HIV Virus → T-Cell → HIV Infected T-Cell → New HIV Virus
Clinical Manifestations
1. Initial Infection
2. Asymptomatic Carrier State
3. AIDS-related Complex (ARC)
4. AIDS
Initial Infection
• Except for a generally mild illness of fever, sore throat and rash, which about 70% of the people
experience a few weeks after the initial infection; Most HIV – infected people have no symptoms for the
first five years.
• However, they can infect others, Once, infected the people an infected for life.
• Antibody Response usually takes 2-12 weeks to appear in the blood stream. This period is called ‘the
window period’. (Tests- Negative)
HIV Infection and Antibody Response
The Acute HIV Syndrome
Follows 3-6 weeks following primary infection.
Main symptoms of acute HIV infection are:
3. • Systemic – Fever, Weight loss
• Central – Malaise, Headache, Neuropathy
• Pharyngitis
• Mouth – Sores, Thrush
• Lymph nodes – Lymphadenopathy
• Oesophagus – Sores
• Skin – Rash
• Muscles – Myalgia
• Liver and spleen – Hepatospleenomegaly
• Gastric - Nausea
Asymptomatic Carrier State
• Infected people with antibodies but without any overt signs of the disease, except persistent generalized
lymphadenopathy.
• It is however not firmly clear about how long does the asymptomatic stage lasts.
AIDS-Related Complex (ARC)
• Has illnesses caused by damage to immune system, but without the opportunistic infections and cancers
associated with AIDS.
• They may exhibit –
→ Unexplained diarrhoea (lasting more than a month), fatigue, malaise, loss of body weight (>10%),
fever, night sweats.
→ Signs of Mild infections like oral thrush, generalized lymphadenopathy, enlarged spleen.
Common manifestation of AIDS
Lung infection: P. Carinii pneumonia
Gastrointestinal infection: Candidiasis of mouth or oesophagus
Skin infection: Kaposi’s sarcoma - red or violet macules or papules
Central nervous System Infection: Toxoplasmosis, Dementia, Meningitis, Primary CNS Lymphomas,
Progressive Multifocal Leuco-encephalopathy.
• Deterioration of body tissues, Extreme weight loss, Lymphadenopathy
Causes/Contributors of HIV Risk
Prevention
Primary - Primary HIV prevention refers to activity focused on preventing uninfected people becoming
infected.
4. Secondary - Secondary HIV prevention aimed at enabling people with HIV to stay well (e.g. testing to
allow people to know their status; welfare rights advice; lifestyle behaviour; anti–discriminatory
lobbying).
Tertiary - Tertiary HIV prevention aims to minimise the effects of ill–health experienced by someone
who is symptomatic with HIV disease (e.g. the prophylactic use of drugs and complementary therapies)
Diagnosis of HIV
• HIV antibody test – using different antigen &/ or with different principle of the test
• Viral antigen test - used for screening blood donors in USA
• Detection of viral nucleic acid in blood.
• Determining the CD4 counts to assess the disease progression.
Testing
• ICTC centre (Integrated Counselling & Testing Centre)
→ District Hospitals
→ Medical colleges
• Free HIV testing
• Confidential counselling
• Referral to nearest ART (Anti-Retroviral Therapy) centre.
ANTIRETROVIRAL DRUGS
NRTI NNRTI PI
Zidovudine (AZT) Nevirapine (NVP) Indinavir (IDV)
Lamivudine (3TC) Efavirenz (EFV) Nelfinavir (NFV)
Stavudine (d4T) Delavirdine (DLV) Saquinavir (SQV)
Didanosine (ddI) Integrase Inhibitors Ritonavir (RTV)
Zalcitabine (ddC) Raltegravir Amprenavir (APV)
Abacavir (ABC) CCR5 Antagonists Lopinavir (LPV)
Tenofovir (TFV) Maraviroc Atazanavir (ATV)
Emtricitabine (FTC) Foseamprenavir
PREVENTION
• Avoid multiple partners – use Condoms.
• Use sterile needles each time for injection
• Never share needles
• Avoid unnecessary blood transfusions
• All pregnant women should be tested for HIV
• Use standard work precautions – hand hygiene, personal protective gear.
• Proper disposal of biomedical waste.
• Immunization against HBV
• Education
Occupational Exposure
HCW comes in contact with potentially infectious body fluids due to –
• A percutaneous injury (needle stick, cut with sharp object)
• Contact with mucous membrane
• Contact with non-intact skin (abraded, chapped, dermatitis)
5. Management of Exposure site
• Do not panic
• Skin
→ Wash wound & surrounding with soap/water
→ Rinse well
→ Do not scrub
→ Do not use Antiseptic or Skin washes
• Splash of Blood/OPIM
• Eye
→ Eye irrigation with water or Saline
→ If using contact lens leave them in place while irrigating. Remove once eye is cleaned remove them &
clean
• Mouth
→ Spit fluid immediately
→ Rinse mouth thoroughly with water / saline repeatedly
→ Do not use soap or disinfectant
PEP Prescription
• Contact ART specialist
• Decision of starting PEP based on Exposure type & HIV status of source
• Decide PEP regimens
→ Basic regimen - 2 drug combination
→ Expanded regimen - 3 drug combination
• If source person is on ART drugs expert should be consulted after starting 2 drugs
Post Exposure Prophylaxis
• In India recommended for occupational exposure
• It should be started as early as possible (within 72 hours)
• ARV is given for 4 weeks
• HIV testing should be done at baseline, 6wks, 3mths & 6mths
