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Tide of Epidemic
Syed Amin Tabish
What is HIV ?
Human Immunodeficiency Virus is the virus that
HIV harms the body's immune system by attacking
certain kinds of cells, known as helper T cells or
CD4 cells, which are a part of the body's natural
line of defense against illness.
As time goes by, HIV destroys so many of these
cells that the body is no longer able to defend itself
against certain cancers, viruses, bacteria, or
parasites. If left untreated, HIV can lead to AIDS
What is AIDS ?
• AIDS occurs when an individual's
immune system is weakened by
HIV to the point where they
develop any number of diseases or
• People who haven't had one of these
diseases or cancers, but whose
immune system is shown by a
laboratory test to be severely damaged
are also considered to have progressed
to an AIDS diagnosis.
How HIV is transmitted
HIV is spread by:
• Sexual contact with an infected person
• Sharing needles and/or syringes (primarily for drug
injection) with someone who is infected
• Through transfusions of infected blood or blood
• Babies born to HIV-infected women may become
infected before or during birth or through breastfeeding after birth.
• In the health care setting, workers have been
infected with HIV after being stuck with needles
containing HIV-infected blood
AIDS was first recognized in 1981 and has
since become a major worldwide
AIDS is caused by the human
immunodeficiency virus (HIV) , which was
discovered in 1983.
By leading to the destruction and/or
functional impairment of cells of the
immune system, notably CD4+ T cells, HIV
progressively destroys the body's ability to
fight infections and certain cancers.
Epidemiology & Trends
• At the end of 2002, although the adult
prevalence rate in Southeast Asia was a
relatively low 0.6%, approx. 6 million
adults and children were living with
HIV/AIDS in the region.
• An estimated 700,000 adults and children were
newly infected with HIV during 2002 and there
were 440,000 AIDS related deaths.
Approximately 36% of infected adults were
• In South and Southeast Asia, the
major HIV transmission mode is
heterosexual, followed by
injecting drug use.
• Unsafe blood is also a factor in
• Throughout the region, injecting
drug use offers the epidemic huge
scope for growth.
• HIV is found in varying concentrations or
amounts in blood, semen, vaginal fluid,
breast milk, saliva, and tears.
• HIV does not survive well in the environment,
making the possibility of environmental
• Although HIV has been transmitted between
family members in a household setting, this
type of transmission is very rare.
• These transmissions are believed to have
resulted from contact between skin or
mucous membranes and infected blood.
Risk of transmission of HIV to HCW
Percutaneous Exposure: .05%-0,4%
Mucocutaneous Exposue: 0.006-0.05%
Hepatitis B Virus
Percutaneous Exposure: 9-30%
Hepatitis C Virus
Percutaneous Exposure: 3-10%
• Casual contact through closedmouth or "social" kissing is
not a risk for transmission of
HIV. Because of the potential for
contact with blood during
"French" or open-mouth kissing,
CDC recommends against
engaging in this activity with a
person known to be infected
Casual Contact - II
• HIV has been found in saliva and tears
in very low quantities from some AIDS
• It is important to understand that
finding a small amount of HIV in a
body fluid does not necessarily mean
that HIV can be transmitted by that
• HIV has not been recovered from the
sweat of HIV-infected persons.
Course of HIV Disease
• Untreated HIV disease typically progresses
relentlessly in almost all infected persons from
clinically silent infection detectable only by
laboratory tests to severely damaged
immunologic function, resulting in AIDS.
• Without treatment, the disease progresses
over a median interval of about 10 years,
although with great individual variation, and
eventually causes death in most, if not all,
• During the course of HIV disease, a variety of
clinical syndromes may occur.
• CDC lists numerous opportunistic
infections and cancers that, in
the presence of HIV infection,
constitute an AIDS diagnosis.
• In 1993, CDC expanded the
criteria for an AIDS diagnosis in
adults and adolescents to include
CD4 + T cell count at or below
200 cells per microliter in the
presence of HIV infection
Diagnosing HIV - II
•Persons living with AIDS often
have infections of the lungs,
brain, eyes, and other organs,
and frequently suffer
debilitating weight loss,
diarrhea, and a type of cancer
called Kaposi’s Sarcoma.
•RNA viral load: up
•CD4 Cell Count:
Count 200–350 cu m
Events critical in determining the ultimate
course of HIV disease include: HIV spread
to tissues and cells that ultimately may
represent hard to eradicate viral
reservoirs; Extensive damage to lymph
node cellular architecture; Stimulation of
an immune response against HIV; and
Loss of HIV-specific CD4+ and possibly
CD8+ cell clones that may be effective in
controlling HIV infection
Altering the Natural Course of HIV
• Interventions include:
- prophylaxis against opportunistic
- antiretroviral therapy, and
- strategies to restore immune
Antimicrobial medications is now widely
used for prevention or clinical
suppression of Pneumocystis carinii
pneumonia and Mycobacterium avium
• Appropriate regimens can
significantly decrease the
incidence of each infection.
• Appropriate prophylaxis is now
the standard of care for HIV
• These interventions improve
quality of life, prolong survival,
and decrease hospitalizations.
Although the advent of highly effective
antiretroviral therapy has resulted in
significant increases in survival for HIVinfected individuals, the impact of
combination antiretroviral therapy will
be largely confined to the industrialized
world, which at present constitutes less
than 10% of the worldwide HIV-infected
Given the scope of the AIDS epidemic,
even an imperfect AIDS vaccine could
potentially save millions of lives.
Vaccine-induced protection against HIV
disease could be achieved by:
• Complete protection from infection (sterile
• Clearance of virus and infected cells
• Persistent infection without disease
• Because HIV may induce AIDS even after
a long asymptomatic period, the desired
goal of most AIDS vaccine trials to date
has been to induce sterile immunity.
Ways to reduce the Risk of HIV Transmission
• Choosing not to have sex, or making
an agreement with a partner who is
not HIV-positive to be sexually faithful
to each other.
• Using a condom or barrier methods
• Not sharing needles for injection drug
• Getting tested! And asking partners
to do the same.
Focus on AIDS
• India is a pluralistic society with
1.04 billion population.
• With the diverse sociocultural
dimensions (including 4000
languages and dialects) and in the
absence of AIDS vaccine,
prevention is the absolute
• AIDS is a behavioural problem and
needs to be tackled in that
HIV prevention saves
Fighting HIV where it ’s hitting hardest
• More critical than ever
• More diverse than ever
• More hope than ever
- We are entering a new era in HIV prevention, one
in which scientific research provides cutting-edge
behavioral and biomedical approaches to
- Effective risk reduction strategies, combined with
new treatments for HIV and other sexually
transmitted diseases, offer more hope than ever of
further reducing the spread of HIV.
- HIV prevention means using every effective
weapon to stop new HIV infections from occurring.
• Recent advances in basic and clinical
research in HIV disease have
dramatically changed the perspective of
patients, clinicians, and researchers.
• In the absence of a credible vaccine there
is a need to effect a change in the
behaviour of high risk groups.
• Prevention is an absolute necessity. HIV
prevention means using every effective
weapon to stop new HIV infections from
Stemming the Tide of
• The 'natural' course of the
epidemic can be changed by
consistent political commitment at
• A well-funded, politically supported
and comprehensive prevention
programmes can save millions of
lives by reducing the number of
new HIV infections.
You can see
HIV/AIDS as part of
Not life as part of