Overview

1. Dr. Nikhil Oza
Intern
BVDUMC
A presentation on-

2. AIDS
 Acquired immuno 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.

3. Structure of HIV

4. 4
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)

5. 5
AIDS Worldwide

6. AIDS
In
India
6

9. 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.

10.  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.

11. 11
HIV in Body Fluids
Semen
11,000 Vaginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids

12. Host
 Age- Most cases are among sexually active people aged
between age 20- 49 years.
 High risk groups-
Male homosexuals, hetero sexual partners, i.v. drug
abusers, blood transfusion recipients, haemophiliacs
and patients having STDs.

13. 13
HIV Transmission
 HIV enters the bloodstream through:
Open Cuts
Breaks in the skin
Mucous membranes
Direct injection

14. 14
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
Perinatal: Transmission from mother to baby
Breastfeeding

15. 15
Routes of Transmission of HIV
Occupational Transmission
Health care worker/ hospital staff
Laboratory workers
Other routes
Organ transplantation
Artificial insemination
Needle-prick

16. 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.

17. 17
HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus

18. Clinical Manifestations
I] Initial Infection
II] Asymptomatic Carrier State
III] AIDS-related Complex(ARC)
IV] AIDS

19. I] 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 a 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)

20. 20
HIV Infection And Antibody Response
6 month ~ Years ~ Years ~ Years ~ Years
Virus
Antibody
Infection
Occurs
AIDS Symptoms
Initial Stage---------------- --------Intermediate or Latent Stage----------------- Illness Stage
Flu-like Symptoms
Or
No Symptoms Symptom-free
<
----
----

21. 21
The Acute HIV Syndrome
Follows 3-6 wks following primary infection

22. 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.

23. AIDS-Related Complex
 Has illnesses caused by damage to immune system,
but without the opportunistic infections and cancers
associated with AIDS.
 They may exhibit-
Unexplained diarrhea(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.

24. 24
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
Leucoencephalopathy.

25. 25
Source: NACO
Opportunistic Infections Among Reported AIDS Cases in India

26. 26

27. 27
Kaposi sarcoma
Candidiasis Of Mouth

28. Swollen parts of the body

29. Deterioration of the body tissues

30. 30
Extreme Wt loss
Lymphadenopathy

31. 31
P. Carinii pneumonia
Primary CNS Lymphoma

32. Causes/Contributors of HIV Risk
Structural Level
Resource Availability
Physical Environment
Organizational Systems
Laws/Policies
Individual Susceptibility
Macro Level
Racism, Stigma, Poverty, Gender Inequality, Migration
Community Level
Community Norms
Social Networks
Social Capital/Collective
Efficacy
Relationships
Individual Level
Behavior
Attitudes
Knowledge
Perceptions
Biology

34. Primary
• Primary HIV prevention refers to activity focused on
preventing uninfected people becoming infected.
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 )
34

35. 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.

36. Testing-
 ICTC centre (Integrated Counseling & Testing
Centre)
 District Hospitals
 Medical colleges
 Free HIV testing
 Confidential counseling
 Referral to nearest ART (Anti Retroviral Therapy)
centre .

37. ANTIRETROVIRAL DRUGS
NRTI NNRTI PI
Zidovudine (AZT)* Nevirapine(NVP)* Indinavir(IDV)*
Lamivudine (3TC)* Efavirenz(EFV)* Nelfinavir(NFV)*
Stavudine (d4T)* Delavirdine(DLV) Saquinavir(SQV)*
Didanosine (ddl)*
INTEGRASE
INHIBITORS
Ritonavir(RTV)*
Zalcitabine(ddC)* Raltegravir Amprenavir(APV)
Abacavir(ABC)* CCR5 antagonists Lopinavir(LPV)*
Tenofovir(TFV)* Maraviroc Atazanavir(ATV)*
Emtricitabine(FTC) Foseamprenavir
MAMC- Feb 2009
FusionInhibitor:Enfuvirtide(T-20)
* Available in India , available under national programme
Cost of Therapy reduced from Rs.30,000 in 1998 to Rs1000 per month in 2006, no. of pills from 32 to 1 or 2 per day,

38. 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

39. Prevention
 Use standard work precautions – hand hygiene,
personal protective gear.
 Proper disposal of biomedical waste.
 Immunization against HBV
 Education

40. 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 )

41. 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

42. Management of Exposure site
 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

43. 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

44. 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

45. HIV from being a
VIRTUAL DEATH SENTENCE
has been brought down to being a
CHRONIC MANAGABLE DISEASE

46. Thank you!