This presentation discusses:
Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
Glomerular Filtration rate and its determinants.pptx
HIV Prevention and Treatment Explained
1. HIV – Another virus to talk about!
Dr Venkatesh Karthikeyan
PG Resident
Department of Community and Family Medicine
AIIMS Patna
www.drvenkateshkarthikeyan.com
15. Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
16. Why it is a Global public health
issue?
3.3 crores have lost their lives
3.8 crores are living with HIV (2019)
17. However, with increasing access to effective HIV
prevention, diagnosis, treatment and care, including
for opportunistic infections, HIV infection has become
a manageable chronic health condition, enabling
people living with HIV to lead long and healthy
lives.
18. Coverage of Services
In 2019, 68% of adults and 53% of children living with
HIV globally were receiving lifelong antiretroviral
therapy (ART).
A great majority (85%) of pregnant and breastfeeding
women living with HIV also received ART, which not
only protects their health, but also ensures prevention
of HIV transmission to their newborns.
19. 81% of people living with HIV knew their status
67% were receiving antiretroviral therapy (ART)
59% had achieved suppression of the HIV virus with
no risk of infecting others
20. Impact of COVID on HIV
The number of new people starting treatment is far
below expectation due to the reduction in HIV-
testing and treatment initiation and ARV
disruptions that occurred during the COVID-19
pandemic.
21. Nevertheless, between 2000 and 2019,
new HIV infections fell by 39%
HIV-related deaths fell by 51%
with 15.3 million lives saved due to ART
22. Who are at risk?
Men who have sex with men
People who inject drugs
People in prisons and other closed settings
Sex workers and their clients
Transgender people
23. What is HIV?
HIV stands for Human Immunodeficiency Virus
Targets the immune system and weakens people's
defense against many infections and some types of
cancer.
As the virus destroys and impairs the function of
immune cells, infected individuals gradually become
immuno-deficient.
24. Immunodeficiency results in increased susceptibility
to a wide range of infections, cancers and other
diseases that people with healthy immune systems can
fight off.
25. Is HIV and AIDS the same?
The most advanced stage of HIV infection is acquired
immunodeficiency syndrome (AIDS), which can take
many years to develop if not treated, depending on the
individual.
AIDS is defined by the development of certain cancers,
infections or other severe long term clinical
manifestations.
26. Signs and symptoms
Vary depending on the stage of infection
Most infectious in the first few months
In the first few weeks after initial infection people may
experience
no symptoms
an influenza-like illness including fever, headache, rash
or sore throat.
28. Without treatment, they could also develop severe
illnesses such as
Tuberculosis (TB)
Cryptococcal meningitis
Severe bacterial infections
Cancers such as lymphomas and Kaposi's
sarcoma.
29. How it is transmitted?
Blood
Breast milk
Semen
Vaginal secretions
Mother to her child during pregnancy and delivery.
30. How it is not transmitted?
Kissing
Hugging
Shaking hands
Sharing personal objects, food or water.
31. It is important to note that people with HIV who are
taking ART and are virally suppressed do not transmit
HIV to their sexual partners.
Early access to ART and support to remain on
treatment is therefore critical not only to improve the
health of people with HIV but also to prevent HIV
transmission.
32. Risk factors
Unprotected anal or vaginal sex
Another STI
Sharing contaminated needles, syringes and other
injecting equipment
Receiving unsafe injections, blood transfusions and
tissue transplantation, and medical procedures that
involve unsterile cutting or piercing
Needle stick injuries
33. Diagnosis
Rapid diagnostic tests that provide same-day results.
This greatly facilitates early diagnosis and linkage with
treatment and care.
People can also use HIV self-tests to test themselves.
34. However, no single test can provide a full HIV
diagnosis
Confirmatory testing is required, conducted by a
qualified and trained health or community worker at a
community centre or clinic.
Most widely-used HIV diagnostic tests detect
antibodies produced by the person as part of their
immune response to fight HIV
35.
36. ICTC Center
Conducting HIV diagnostic tests
Providing basic information on the modes of HIV
transmission
Promoting behavioral change to reduce vulnerability.
Link people with other HIV prevention, care and
treatment services.
37.
38. Window period
In most cases, people develop antibodies to HIV
within 28 days of infection.
“Window” period – when HIV antibodies haven’t
been produced in high enough levels to be detected by
standard tests and when they may have had no signs of
HIV infection, but also when they may transmit HIV to
others.
39. Following a positive diagnosis, people should be
retested before they are enrolled in treatment and
care to rule out any potential testing or reporting error.
Notably, once a person diagnosed with HIV and has
started treatment they should not be retested.
40. Can I be forced into HIV Testing?
Voluntary
Right to decline
41. WHO recommends voluntary assisted HIV partner
notification services as a simple and effective way to
reach these partners – many of whom are undiagnosed
and unaware of their HIV exposure and may welcome
support and an opportunity to test for HIV.
42. 5 C’s of HIV Testing services
Informed Consent
Confidentiality
Counseling
Correct test results
Connection (linkage to care, treatment and other
services)
43. Prevention
Individuals can reduce the risk of HIV infection by
limiting exposure to risk factors.
Key approaches for HIV prevention, which are often
used in combination.
44. Male and female condom use
85% or greater protective effect against HIV and other
STIs.
45.
46. Harm reduction for people who inject and use
drugs
Sterile injecting equipment
Not sharing drug-using equipment and drug solutions
Treatment of drug dependence(opioid substitution
therapy)
47. Testing and counselling for HIV
and STIs
Strongly advised for all people exposed to any of the risk
factors.
This enables people to learn of their own HIV status
and access necessary prevention and treatment services
without delay.
WHO also recommends offering testing for partners or
couples.
48.
49. TB and HIV
TB is the most common illness among people living
with HIV.
Fatal if undetected or untreated, responsible for
nearly 1 in 3 HIV-associated deaths.
Early detection of TB and prompt linkage to TB
treatment and ART can prevent these deaths.
50. TB screening should be offered routinely at HIV care
services, and routine HIV testing should be offered to
all patients with presumptive and diagnosed TB.
TB preventive therapy should be offered to all people
living with HIV who do not have active TB.
Individuals who are diagnosed with HIV and active TB
should urgently start effective TB treatment (including
for multidrug-resistant TB) and ART.
53. Secondary prevention benefits of
ART
ART virally suppressed do not transmit HIV
to their uninfected sexual partners
WHO recommended that all people living with HIV
should be offered ART with the main aim of saving
lives and contributing to reducing HIV transmission.
55. “Event driven” PrEP
This is taking two pills sex between two and 24 hours
in before sex;
then, a third pill 24 hours after the first two pills, and a
fourth pill 48 hours after the first two pills.
This is often known as the 2+1+1.
56. Post-exposure prophylaxis for HIV
(PEP)
Within 72 hours
Counseling
First aid care
HIV testing
Administration of a 28-day course of ARV drugs with
follow-up care.
WHO recommends PEP use for both occupational and
non-occupational exposures, and for adults and children.
57. Mother-to-child transmission of HIV
In the absence of any interventions during these
stages, rates of HIV transmission from mother-to-
child can be between 15% and 45%.
The risk of MTCT can almost be eliminated if both
the mother and her baby are provided with ARV drugs
as early as possible in pregnancy and during the period
of breastfeeding.
58. WHO recommends lifelong ART for all people living
with HIV, regardless of their CD4 count and the
clinical stage of disease; this includes pregnant and
breastfeeding women.
59. For people living with HIV who are not diagnosed or
taking ART, signs of HIV-related illness may develop
within 5–10 years, although it can be sooner.
The time between HIV transmission and an AIDS
diagnosis is usually 10-15 years, but sometimes
longer.
60. Evidence from several studies show that people living
with HIV who have an “undetectable” viral load
cannot pass HIV on to others.
Risk of transmitting HIV is greatly reduced when they
adhere to treatment, and when treatment is started
without delay.
61.
62.
63. Addressing Structural barriers
Antidiscrimination and protective laws to address
stigma and discrimination
Available, accessible and acceptable health services for
key populations
Enhanced community empowerment
Addressing violence against people from key
populations
Expanding access to treatment is at the heart of a set of
targets for 2020, which aims to bring the world back
on track to end the AIDS epidemic by 2030.
65. However, effective prevention interventions are
available:
preventing mother-to-child-transmission
male and female condom use
harm reduction interventions
pre-exposure prophylaxis
post exposure prophylaxis
voluntary medical male circumcision (VMMC)
antiretroviral drugs (ARVs) which can control the virus
and help prevent onward transmission to other people.
Appreciate the organizers for choosing this topic – while the whole world is panicking about covid 19, we have forgetten about the other killer diseases.
We will see why HIV is an equally important problem in the upcoming slides
So first of congrats to organizing such a topic, which is less spoken about
We should start talking about in our mid teens
Rather than fantasizing it, it is essential to make our teenagers and youth understand that it is a normal physiological process – which is there for every creature in this world
When we get this realisation that sex is just another basic need like food, water and shelter – we will stop giving too much importance to it – and we will start valuing the higher functions that we are blessed with, like our intellect and start to explore newer dimensions of life
Imagine a happy teenage girl from a typical indian background
Lets see the story of devi – an IT student – one night stand – how life spoilt – aiims patna counselling – sti/pregnancy/stigma/childs future – all would have been prevented with a simple condom - I am not here to preach about what should you do in your personal life – but as a doctor it is my duty to create awareness about how to protect yourself
As we know, talking about sex and even mensturation is stigmatized in our community – this girl is no exception to it
Fantasizing about sex all her life she decides to have physical intercourse, without any knowledge about protection
And she finally ends up turning HIV positive – Does she deserve to such a kind of beginning to her life?
And what if she becomes pregnant?
What about the future of this child
All these would haven’’t happened if the girl was aware that something called condom exists and it would prevent from STI like HIV as well as it serves as a contraceptive
Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until the later stages.
How many days – how much percentage
Accuracy of rapid diagnostic tests?
Rapid tests are a simplified version of antibody ELISA tests. They look for HIV antibodies in the blood. The antigens for HIV are fixed on one particular strip along the rapid test stick. Towards the end of the testing stick are control antigens to show that the test worked
Approximately 1.5% (15 out of every 1000) antibody tests are a false positive. The fourth generation tests have a much lower chance of a false positive. This means that a small percentage of people who test positive on a rapid test (where the results are given within an hour) may turn out to be HIV negative.
Ideally, a health facility should have one Integrated Counselling and Testing centre for all groups of people. However, an ICTC is located in facilities that serve specific categories such as high risk group, pregnant women, STI cases, TB Patients, HIV/ AIDS symptomatic patients. Accordingly, an ICTC is located in the General OPD or Obstetrics and Gynaecology Department of a medical college or a district hospital or in a maternity home where the majority of clients can access counselling and testing services.
WHO Testing services info
After infection, an individual may transmit HIV transmission to a sexual or drug-sharing partner or for pregnant women to their infant during pregnancy or the breastfeeding period.
Where to get tested
When necessary, exceptions to confidentiality are appropriate for protecting public health and individuals (including healthcare workers) who are endangered by persons infected with HIV. If a physician knows that a HIV seropositive individual is endangering a third party, the physician should, within the constraints of the local law: 1) attempt to persuade the infected patient to cease endangering the third party; 2) if persuasion fails, notify authorities, and 3) if the authorities take no action, notify the endangered third party. Disclosure: Ideally, the disclosure of a person’s HIV status should not in any way affect their Some state statutes make exceptions to confidentiality laws with regard to the spouse and sexual partners of the patient. Other state statutes make no such exceptions. The decision about whether to breach the confidentiality remains with the physician and are not imposed as a matter of law. However, confidentiality is central to the control programme. Maintaining confidentiality encourages more and more people at risk to access the testing services and helps to instill faith in the community’s public health system.
Which should be done first
Treatment of TB first, followed by treatment of HIV
Male circumcision reduces the risk of sexual transmission from a woman to a man by around 60%. A one-time intervention, medical male circumcision provides life-long partial protection against HIV, as well as other sexually transmitted infections. It should always be considered as part of a comprehensive HIV prevention package, and should never replace other known methods of prevention, such as female and male condoms.
Long acting PrEP products including an intramuscular injection of cabotegravir (CAB-LA), which is given every eight weeks, has recently been shown to be highly effective in preventing HIV acquisition in two randomised trials
The Dapivirine vaginal ring (DVR) was found to have a modest HIV prevention effect but with a good safety profile for women, from two RCTs
There a very small number of people who have managed to control the HIV infection without ART and are called ‘elite-controllers’. This situation is very rare and most people will need ART to avoid becoming ill.
A person is “undetectable” when ART has reduced the level of virus in their body to such low levels that it cannot be detected by normal viral load tests. Monitoring of viral load, and confirmation of an undetectable viral load, needs to be undertaken by a healthcare professional as part of the routine medical care for people with HIV. In many low- and middle-income countries, viral load tests are not consistently or routinely available, so many people do not benefit from the knowledge that they are undetectable. They can be assured, however, that the
Science is moving at a fast pace, and there have been two people who have achieved a ‘functional cure’ by undergoing a bone marrow transplant for cancer with re-infusion of new CD4 T cells that are unable to be infected with HIV. However, neither a cure nor a vaccine is available to treat and protect all people currently living with or at risk of HIV.
All should be used in a combination to avoid transmission
So the final slide is here! Be merciful to Patients living with HIV – don’t stigmatize them – And also merci means thank you in French! Since I have consumed enough time of yours, I am ending my presentation with this slide. Probably this fast track watch sums up the core of this webinar.
Any questions?