1. Maternal, Newborn and Child Health
1

2. Maternal, Newborn and Child Health
2

3. Maternal, Newborn and Child Health
3

4. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment

5. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Introduction
By:
Mea’ad

6. Introduction
Miaad faiz

7. AIDS,
"Acquired immunodeficiency syndrome

8. What is AIDS?
• AIDS is a chronic life-threatening
condition is caused by
HIV (Human Immunodeficiency Virus)
Resulting in a defect in cell-mediated immune
response that is manifested by increased
susceptibility to opportunistic infections and
to certain rare cancers, especially Kaposi's
sarcoma.

9. AIDS is the name given to the later stages
of
an HIV infection .
when a person’s immune system is
severely damaged

10. What is HIV ?
• HIV is lentiviruses are in part
of large group of viruses
known as retroviruses
• They have been found in a
number of different Animals
including cats, sheep, horses
and cattle.

11. • There are two types of HIV, HIV-1 and HIV-2
• both of HIV viruses originated from Africa.
• scientists generally accept that the strains
of HIV-1 are most closely related to the simian
immunodeficiency viruses (SIVs) which effect
type of chimpanzee in West Africa

12. • SIV was transmitted to humans and mutated into
HIV when humans hunted these chimpanzees for
meat and came into contact with their infected
blood.
Over decades, the virus slowly spread across Africa
and later into other parts of the world.
• HIV-2 corresponds to SIVs found in the sooty
mangabey also known as( the white collared
monkey).

14. • in June 1981 CDC Centers for Disease Control
• was reported cases of Pneumocystis carinii
pneumonia and Kaposi's sarcoma among numerous
gay men in new york and southern California.
• and that reason why people first began to think that
HIV only infected gay people
• CDC reported the new outbreak they called it
"GRID" (gay-related immune deficiency)

15. • in December 1981, it was
clear that the disease
affected other population
groups, when the first
cases of Pneumocystis
carinii pneumonia were
reported in injecting drug
users

16. • In 1982
By the beginning of July a total of 452 cases,
from 23 states , had been reported to
Centers for Disease Control and Prevention (
CDC).
later that month CDC received its first report
of "AIDS in a person with hemophilia (from
a blood transfusion), and in infants born to
mothers with AIDS.

17. • The occurrence of the disease in nonhomosexuals mean that name such as GRID
were redundant.
• Later in 1982 the CDC gave name of AIDS to
this new out break.

18. scientists later found evidence that the
disease existed in the world for some
years prior, i.e., subsequent analysis of a
blood sample of a man, who died of an
unidentified illness in the Belgian Congo
in 1959, made him the first confirmed
case of an HIV infection.

19. Who are discovered HIV
• On January 23 ,1983
• Dr. Luc Montagnier of
the Pasteur Institute in
France announced the
isolation of the new
viruses named LAV
retrovirus
(lymphadenopathyassociated virus)

20. • And, on the other
side Dr. Robert Gallo of
the National Cancer
Institute isolated the
HTLV-III (Human T-Cell
Lymphotropic Virus III)
retrovirus

21. • on December 1983, he submitted a paper for
publication proposing the theory that an
HTLV-type retrovirus was the cause of AIDS
• Then, on April 23, 1984, Margaret Heckler,
the secretary of health and human services,
announced that Gallo had isolated the virus
which caused AIDS, that it was named HTLVIII

22. • The Journal of the American Medical
Association (JAMA) continued to
reference HTLV-III as the "primary
etiologic agent of the acquired
immunodeficiency syndrome (AIDS)"

23. • in 1985, was determined that HTLV-III
and LAV were the same virus.
• in May 1986, the International
Committee on the Taxonomy of Viruses
given the new designation of Human
Immunodeficiency Virus or HIV.

24. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Morphology
By:
Ahmed altegani

25. Morphology
Ahmed altegani

26. • HIV belongs to a special class of viruses called
retroviruses.
• Almost all organisms, including most viruses,
store their genetic material on long strands of
DNA. Retroviruses are the exception because
their genes are composed of RNA (Ribonucleic
Acid).

27. • RNA has a very similar structure to DNA.
However, small differences between the two
molecules mean that HIV's replication process
is a bit more complicated than that of most
other viruses

28. • Outside of a human cell, HIV exists as roughly
spherical particles (sometimes called virions).
• An HIV particle is around 100-150 billions of a
metre in diameter.
• Unlike most bacteria, HIV particles are much too
small to be seen through an ordinary microscope.
However they can be seen clearly with an
electron microscope .

29. • HIV particles surround themselves with a coat
of fatty material known as the viral envelope
(or membrane). Projecting from this are
around 72 little spikes, which are formed from
the proteins gp120 and gp41. Just below the
viral envelope is a layer called the matrix,
which is made from the protein p17.

30. • The viral core (or capsid) is usually bulletshaped and is made from the protein p24.
Inside the core are three enzymes required for
HIV replication called reverse transcriptase,
integrase and protease. Also held within the
core is HIV's genetic material, which consists
of two identical strands of RNA.

32. Genes of HIV
• HIV has just nine genes (compared to more
than 500 genes in a bacterium. Three of the
HIV genes, called gag, pol and env, contain
information needed to make structural
proteins for new virus particles.

33. • The other six genes, known as tat, rev, nef, vif,
vpr and vpu, code for proteins that control the
ability of HIV to infect a cell, produce new
copies of virus, or cause disease.
• At either end of each strand of RNA is a
sequence called the long terminal repeat,
which helps to control HIV replication.

34. Life cycle
• Entry
• HIV can only replicate inside human cells. The
process typically begins when a virus particle
bumps into a cell that carries on its surface a
special protein called CD4

35. • . The spikes on the surface of the virus particle
stick to the CD4 and allow the viral envelope
to fuse with the cell membrane. The contents
of the HIV particle are then released into the
cell, leaving the envelope behind.

36. Reverse Transcription and Integration
• Once inside the cell, the HIV enzyme reverse
transcriptase converts the viral RNA into DNA,
which is compatible with human genetic
material

37. • . This DNA is transported to the cell's nucleus,
where it is spliced into the human DNA by the
HIV enzyme integrase. Once integrated, the
HIV DNA is known as provirus.

38. Transcription and Translation
• HIV provirus may lie dormant within a cell for
a long time. But when the cell becomes
activated, it treats HIV genes in much the
same way as human genes

39. • . First it converts them into messenger RNA
(using human enzymes). Then the messenger
RNA is transported outside the nucleus, and is
used as a blueprint for producing new HIV
proteins and enzymes.

40. Assembly, Budding and Maturation
• Among the strands of messenger RNA
produced by the cell are complete copies of
HIV genetic material. These together with
newly made HIV proteins and enzymes to
form new viral particles.

41. • The HIV particles are then released or 'bud'
from the cell. The enzyme protease plays a
vital role at this stage of the HIV life cycle by
chopping up long strands of protein into
smaller pieces, which are used to construct
mature viral cores.

42. • The newly matured HIV particles are ready to
infect another cell and begin the replication
process all over again. In this way the virus
quickly spreads through the human body. And
once a person is infected, they can pass HIV
on to others in their body fluids.

44. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Epidemiology
By :
Samah ibrahem

45. Epidemiology
Samah ibrahem

46. • HIV infection is considered pandemic by the
World Health Organization (WHO) As in 2010
approximately 34 million people have HIV
globally.

47. • The number of people infected with HIV
continues to rise in most
parts of the world, despite
the implementation of
prevention strategies

48. facilitating factors in the transmission
of HIV
• Promiscuity,
scarification , unsafe blood
transfusions , drug abusers
poor state of nutrition ,
Poor economic conditions

49. • Since AIDS was first recognized in 1981 it has
lead to nearly 30 million deaths Despite recent
improved access to antiretroviral treatment

50. incidence

51. there is continued lack of access in the
continent of Africa, where is only less
than 10 percent of those
infected are reported to
have access to it

52. • Sub-Saharan Africa being by far the worstaffected region, with an estimated 68% of the
global total at the end of 2010
• South & South East Asia is the second most
affected this region contained 12% of all
people living with HIV

54. Africa

55. • Although only 11% of the world's population
lives in Africa, roughly 67% of those living with
HIV/AIDS are in Africa
• Between 1999 and 2000 more people died of
AIDS in Africa than in all the wars on the
continent

57. Sub-Saharan Africa
HIV infection is becoming
endemic in sub-Saharan Africa, which contain
over 12% of the
world’s population
but two thirds of all
people are infected
with HIV

58. Southern Africa
• South Africa has the
largest population of
people with HIV of any
country in the world

60. • in 2005 there were 12.4% of the population in
South Africa infected with HIV (5.5 million
people)
• adult prevalence rates
exceeding 20% in most
countries in the region

61. Botswana
23.9%
Swaziland
26.1%

62. Eastern Africa
• high levels of prevalence
above 10% in some
countries, although
there are signs that
the pandemic is
declining in this region.

63. West Africa
• west Africa has been
much less affected
by the pandemic

64. North Africa
• The HIV prevalence
rates in North Africa are
among the lowest in the
world.
• This is primarily
attributed to the
salient role of Islam
in the region's societies

65. Egypt
0.1%
Tunisia
0.2%
Morocco
0.1%
Sudan
1.1%

66. Asia

67. • The total number of people living with HIV in
Asia is thought to be nearly 4.8 million.
• Around half of these cases were in India
followed by China Thailand and Myanmar

68. India
China
Thailand
Myanmar
1.4%
0.1%
1.3%
1.2%

69. India
• around 5 million
people were
living with HIV
in India

70. • HIV epidemics are more severe in the
southern half of the country
• The highest estimated
adult HIV prevalence
is found in Manipur (1.40%)

71. china
There are currently an
estimated 740,000 people
living with HIV in China

72. • in 2009 when China reported that
AIDS had become the country’s
leading cause of death among
infectious diseases for the first
time ever

73. Americas

74. • more than one million people are living with
HIV in the USA
• that more than half
a million have died after
developing AIDS

75. • In 2009 blacks/African Americans
made up an estimated
50% of new HIV diagnoses
and whites only 27%

76. Caribbean
• The region's adult prevalence rate is 1.6%
• The rate of HIV in the Caribbean is four times
that of North America and South Asia
• The UNAIDS informed that by the year 2020
HIV/AIDS will cause 75% of death in the
Caribbean

77. United States and Canada
• The adult prevalence rate in
this region is 0.7% with over
1 million people currently
infected with HIV

78. • the death rate from AIDS in North America
fell sharply with the introduction of
combination AIDS therapies

79. • In Canada, nearly 60,000 people were living
with HIV/AIDS in 2005.
• The HIV-positive population continues to
increase in Canada, with the greatest
increases amongst aboriginal Canadians

80. Sudan

81. AIDS in Sudan
 The first cases in sudan were
reported in 1986.
 Reported cases until 2005 was
17.000 cases
 AIDS prevalence in Sudan is
expected to be 1.67 % of
population.

82. All patterns of transmission are
reported but 97% are sexually
transmitted

83. About
70%
are
women

84.  Areas affected
mostly
are,
Gedarif,
Port
Sudan,
Khartoum,
Kosti
and
Rebek
in
white Nile .

85. Khartoum
• The cases in Khartoum
has reached 88.000 case
this year (2012)

86. • And these are only the diagnosed cases with a
percentage of 11%
• This due to decrease the awareness of the
diagnostic measure that the community
should fallow

87. wars,
migration
and poverty
and
ignorant.
Risks
contributing
to
spreading
of HIV in
Sudan are :

88. WARS:

89. MIGRATION:

90. South Sudan

91. • Juba is the most area effected with aids in
south Sudan
• Most infection are sexually transmitted
• the Mortality rate is on increasing due to lack
of education about the preventive measures

93. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Transmission
by :
Aanab badr

94. Mode of transmission
Aanab badr

95. How HIV is transmitted?
HIV is transmitted through body
fluids ; if the quantity of HIV in
the fluid is high enough

96. Mode of transmission
sexual
blood
needles
mother
to child
through all forms of un protected
sexual intercourse with an infected
person.
this includes vaginal, anal & oral sex.

97. Mode of transmission
sexual
blood
needles
mother
to child
- anal intercourse poses
the greatest risk of
infection.
-the next highest risk is
vaginal intercourse.

98. Mode of transmission
sexual
blood
needles
mother
to child
unprotected oral sex involves some
risk if there
are mouth or throat injuries .

99. Mode of transmission
sexual
blood
needles
mother
to child
contaminated blood or
blood products:
- 5% of all HIV
infections
may be caused by
blood transfusion
& organ
transplantation.

100. Mode of transmission
sexual
blood
needles
mother
to child
contaminated needles , syringes or
other piercing instruments :-

101. Mode of transmission
sexual
blood
needles
mother
to child
Procedures like tattooing ,
male & female circumcision
and traditional scarification
can all contribute to
infection

102. Mode of transmission
sexual
mother to child
transmission ( MTCH)
blood
needles
mother
to child
-the virus can be
-transmitted during
- pregnancy and delivery
-or later by breast feeding

103. Mode of transmission
sexual
blood
needles
mother
to child
The probability of a new born to getting
infection from HIV-positive mother. 12-35

104. Mode of transmission
sexual
blood
needles
mother
to child

105. Mode of transmission
How HIV is NOT transmitted
-shaking hands
-cough or sneezing
-sharing food , eating or drinking
-using toilet seats , swimming pools or showers
- mosquito or insect bite

106. Mode of transmission
How HIV is NOT transmitted
So
family , friends and co-workers should not fear
becoming infected with HIV through causal contact with
an HIV positive person in family , work or socially.

107. Mode of transmission
HIV & work
the work place & most occupations do not pose a
risk of acquiring HIV . The exception is health
workers , dentists and laboratory technicians who
are exposed to blood while doing their duties.

108. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Pathogenesis
By:
Aanab bader

109. Pathogenesis
Aanab badr

110. Pathogenesis
The Human immunodeficiency virus is made up
of Genetic material, Chemicals and a coating.
The Genetic material is RNA and the Chemicals
are enzymes which help the virus enter and use
other cells to make copies of itself.

111. Pathogenesis
HIV mainly infects white blood cells called Tlymphocyte cells (T-cells). The virus infects a Tcell by attaching to a protein on the cell's
surface called CD4+. Not all T-cells have this
protein. The ones that do are called CD4+ cells,
T4 cells, or T-helper cells.

112. Pathogenesis
After binding with the CD4+ cell, the virus
enters the cell and, using an enzyme called
reverse transcriptase).. Another enzyme called
protease helps the new viruses form. The new
viruses then "bud" off the infected cells into the
body, where they infect more CD4+ cells.

113. Pathogenesis
The presence of the virus causes a person's
immune system to react by attacking the virus
itself and any HIV-infected cells. This process
results to formation of antibodies . A person is
said to be HIV-positive if antibodies to the virus
are detected by tests, indicating infection.

114. Pathogenesis
As HIV-infected CD4+ cells are destroyed or impaired,
the person's immune system becomes less and less
effective at fighting infection and disease. The person
is said to be "immunocompromised" or
"immunodeficient." Such people are more likely to
develop unusual diseases called Opportunistic
infections that they would not get if their immune
systems were healthy.

115. Pathogenesis
As the number of CD4+ cells decreases, the
person is more likely to get sick and have more
serious illnesses. When this is the case, a person
is usually diagnosed with acquired
immunodeficiency syndrome (AIDS).

116. THANKS

118. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Clinical feature
by :
Wddah

119. Clinical feature
Wddah

120. The clinical picture of HIV can
be divided into:
Five stages

121. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5

122. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
•
1.
2.
3.
4.
5.
6.
7.
Begin 2_4 weeks after infection
Fever
Joint pain
Very high viremia
headache
rigors
Leukpenia
Rash in the trunk and the arm

123. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
It usually follow blood transfuusion
It’s a flu like disease
Acute stage resolve typically after 2-4 weeks
In early stage they are –AB
Antibody typically appears 10-14 days after
infection

124. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
And +ve AB care called sero conversion
The period between _ve and +ve AB are
called window period
P24 +ve when the virus isolated
After this period the patient become well

125. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Latent or symptomatic stage
In this stage the virus integrate into the
chromosome.
From 2-5 years
During this period virus is a sleep

126. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
The patiant is asymptomatic during this piriod
And ……. Is low or absent
But the patient is infectious
Its chronic persistant infection

127. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Persistant generalyzed lymphoadenopathy
Lymphnode should be :
1. > 1 cm large
2. Its more than 3 places
3. >3 mounth duration

128. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
The more frequint manifestation:
Persistant fever
Weight loss
Fatigue
Cd4 lymphocyte level diminish become
300/cumm

129. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
This stage divided into 2 parts:
1- constitutional symptoms:
Persistant fever
Malaise
Chronic diarrhea
Loss of weight

130. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
2- opportunstic infection:
Immunocomproised stage
Mainly TB
Salmonella
Herpes
Oral thrush
leukoplakia

131. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
All infections all malignant can occur
Most common malignancy like:
kaposi,s sarcoma
Cervical carcinoma
lymphomas

132. Clinical feature
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5

134. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Labrotary diagnosis
By :
Mishkat abdalatife

135. Labrotary diagnosis
Mishkat abdalatife

136. Learning Objectives
Describe the role of laboratory tests in:
The diagnosis of HIV infection
Ongoing monitoring of HIV’s effect on
the body
Monitoring response to treatment

137. Body Fluids Used for HIV Testing
Serum .
Plasma.
Whole blood.
Cervical secration.
Saliva.
Breast milk.
Breast milk.

139. Test type
General test
Flowcytometry
Serological
CBC:We found leukopenia
Low lymphocyte( 20_25%) Normal value( 20_40%)

140. Test type
General test
We do
Flowcytometry
Serological
flowcytometry to detect CD4
level , also we use CD4 to follow up the effect of treatment.
Normal value (CD4+) count = 1000cellmm
T suppressor (CD8+) cell count = 400-800

141. Test type
General test
Flowcytometry
Serological
In AIDS patient CD4+ count = <200cellmm.
Aids related complex= 300 cellmm

142. Test type
General test
Flowcytometry
Serological
_Tests are based on a reaction between HIV
antigens and antibodies in the patient’s serum
_Tests use viral antigen extracts as a testing
material

143. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
Virus isolation.
PCR
Detection of HIV AB
-Done by direct ELISA for detection of core antigen P24 .
-The core antigen P24 is the 1st antigen for the virus.
-Appear within 3 weeks of massive infection (blood
transfusion). in sexual cotact it takes more time.

144. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
Virus isolation.
PCR
Detection of HIV AB
P24 Antigen Test
Detected during acute phase of primary HIV infection:Sensitivity in adults: 50-75%
Sensitivity in children: 20%
Specificity: 95%
Following seroconversion, antigen is less detectable
(sensitivity declines)

145. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
Virus isolation.
PCR
Detection of HIV AB
Done by indirect ELISA very useful after seroconversion.

146. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
Virus isolation.
PCR
Detection of HIV AB
The advantge of ELISA:Cheap simplerapid

147. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
The disadvantage of ELISA:1.Takes time to develop in
sexual contact 6mnth,
blood transfusion 2mnth
Virus isolation.
PCR
Detection of HIV AB
2. False +ve in:
-Rhmatiod artheritis.
- Autoimmune AB.
-Sever liver disease.
-Sticky serum

148. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
-For all of this reasons
ELISA must be
confirmed .
-No pateint must be
Consider as HIV +ve
before doing
confirmatory test.
Virus isolation.
PCR
Detection of HIV AB

149. Diagnostic Tests
ELISA
Western blot
Detection of HIV AG
Virus isolation.
Detection of HIV AB
After several incubation and wash
steps, a color reaction occurs if HIV
antibody is present
PCR

150. “Window Period” Following HIV Infection

151. Diagnostic Tests
ELISA
Western blot
Virus isolation.
-Confirmatory test for all positive ELISA assays
-Detect AB to specific HIV AG in cellulose strip
-Two or more “key” bands indicate a positive test
-Should not be used alone for HIV diagnosis
PCR

152. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR
Western Blot Result Interpretation
Results are interpreted as follows:
-Negative: no bands
-Positive: reactivity to gp120/160, plus either gp41 or
p24
-Indeterminate: one reactive band
-The test should be repeated at a later time, e.g., 1-3
months later
-Repeatedly indeterminate: no HIV infection

153. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR

154. Case Study

155. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR
Best sample is peripheral blood, but
can use CSF, saliva, cervical secretions,
semen, tears or material from organ
biopsy

156. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR
We take T-lympocyte of infected blood and
culture it on normal T-lympocyte Cultures
incubated one month, infection confirmed by
detecting reverse transcriptase or p24 antigen in
supernatant or observation of cytopathogenis
effect in the normal cells.

157. Diagnostic Tests
ELISA
Western blot
Virus isolation.
We do it for detection of virus RNA DNA
Rapid tests:
1. Immuno-chromatoraphy.
2. Coated particles agglutination.
3. Dip stick test.
PCR

158. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR
We do it for reverse transcriptase and also use in AG
detection.
Rapid tests:
1. Immuno-chromatoraphy.
2. Coated particles agglutination.
3. Dip stick test.

159. Diagnostic Tests
ELISA
Western blot
Virus isolation.
Dip stick test.
PCR

160. Diagnostic Tests
ELISA
Western blot
Virus isolation.
PCR

162. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
HIV in prgnancy
By :
Abd algader

163. HIV in prgnancy
Abd algader

164. HIV IN PREGENANCY:
If a pregnant woman is infected with HIV and
does not recieve any intervention or
treatment, she can transmit the virus to her
baby during:
i. pregnancy.
ii. delivery
iii. breastfeeding.

165. about15-30% of babies born to HIVinfected women will become infected
with HIV during pregnancy and delivery.
A further 5-20% will become infected
through breastfeeding.

166. How to Reduce Mother-toChild pregnancy.
Transmission:
 HIV testing in

Antenatal care.

Antiretroviral agents.

Obstetric procedure.

Newborn feeding.

167. HIV Testing during
• Advantages:
Pregnancy:
– Possible treatment of mother
– Reduce risk of mother-to-child transmission
– Future family planning issues
– Precautions against further spread
– If negative, advise about HIV prevention

168. Antenatal Care:

Most HIV-infected women will be
asymptomatic.

Watch for signs/symptoms of AIDS and
pregnancy-related complications.

Unless complication develops, no need to
increase number of visits.

169. 
Treat STDs and other coinfections.

Counsel against unprotected intercourse

Avoid invasive procedures.

Give antiretroviral agents, if available.

Counsel about nutrition.

170. Obstetric Procedures:
Avoid use of the obestetric procedures ,Because of
increased fetal exposure to infected maternal blood
and secretions, increased transmission may come
from:
–
–
–
–
–
Amniotomy.
Fetal scalp electrode/sampling.
Forceps/vacuum extractor.
Episiotomy.
Vaginal tears.

171. Mode of delivery:
• vaginal delivery: incerase risk of mother to
child transmission
• A caesarean section: reduces the risk of a baby
catching HIV during the birth.
• A combination of anti-retroviral therapy and
caesarean section reduces the risk of your
baby to catching HIV less than 1%

172. Newborn feeding:
• breastfeeding is the best way to be fed, but
unfortunately breastfeeding can also transmit
HIV. If no antiretroviral drugs are being
taken, breastfeeding for two or more years can
double the risk of the baby becoming infected
to around 40%

173. 2010 WHO Infant Feeding
Guidelines:
Mother takes ARVs from 14th week of
pregnancy until 1 week
after labour.
Long ARV during breastfeeding period for either
mother and infant .

174. Exclusive breastfeeding for 6 months .
Gradually wean from breastmilk .
Mixed (complementary) feed after 6 months .
Recommended to breastfeed and mix feed in
conjunction with ARVs .

175. HIV IN CHILDREN

176. The number of children
directly affected by HIV :
• At the end of 2010, there were 3.4 million
children living with HIV around the world.
• An estimated 390,000 children became newly
infected with HIV in 2010.

177. • 1.8 million people who died of AIDS during
2010, one in seven were children.
• Every hour, around 30 children die as a result
of AIDS.Most children living with HIValmost 9
in 10 live in sub-Saharan Africa.

178. • There are more than 16
million children under
the age of 18 who have
lost one or both parents
to AIDS.

179. Symptoms of HIV in
Children:
• Symptoms of HIV infection vary by age and individual
child, but following are some of the more common
symptoms:
• Failure to thrive.
• Seizure.
• Diffuclt to walking.
• ear infection .
• Diarrhea
• Pneumonia

180. THANK
YOU

182. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Complication
By:
rawia

183. Complication
rawia

184. Complications of HIV Infection
Most complications of HIV are as a result of
suppression of T-cell mediated immunity.
Antiretroviral therapy (HART) is available to
inhibit the replication of the human
immunodeficiency virus. H ART helps to prolong
life, restore the patient's immune system to
something approaching normal activity and
reduce the chances of opportunistic infection.

185. Pulmonary complications:Pneumocystis carinii pneumonia:• It has been one of the hallmarks of late-stage
HIV disease but is now less common because
of antiretroviral therapy (ART) and primary
prophylaxis.
• Presentation: typically, develops over a few
weeks and includes shortness of breath, dry
cough and fever. There may also be malaise,
fatigue, weight loss and chest pain.

188. Bacterial pneumonia:The most common causes are Streptococcus
pneumoniae, Haemophilus influenzae and
Moraxella catarrhalis. In advanced cases, causative
organisms may include Staphylococcus aureus,
Klebsiella spp. and other Gram-negative rods. The
presentation may be atypical, with diffuse
infiltrates appearing on the X-ray.

189. TB:This is very common in areas where TB is endemic.
Many cases represent reactivation of previous
infection. HIV-positive patients with TB are less likely
to be sputum-positive with X-rays that show less
cavitation and more involvement of lower lobes. They
are more likely to relapse after completion of
treatment and die prematurely.

190. • Treatment is the standard 3-4 drug regimen
but multidrug-resistant TB strains are
becoming more frequent. One study found
that TB preventative therapy

191. • (e.g. isoniazid, co-trimoxazole) was useful in
reducing the incidence of infection and death
in children with HIV.

192. Fungal infections
These include Cryptococcus spp. In
disseminated infection other fungi may be
involved.

193. CRYPTOSPORIDIOSIS
Cryptosporidium is a germ that can
sometimes cause severe diarrhea and fevers
in people with a weak immune system.

194. HISTOPLASMOSIS
It lives in the soil and is spread by bird and bat
droppings. It is very common in the state of Indiana.
Most of the time, histoplasmosis does not cause
illness in healthy people.

195. In people with an abnormal immune system,
histoplasmosis can be very severe and affect any
organ in the body. The symptoms include fever,
weight loss, cough, and swollen lymph glands. It is
important that all people with low CD4 counts
avoid activities that increase their chance of
getting histoplasmosis.

196. • This includes activities that disturb the soil
such as digging or raking, or being exposed to
bird or bat droppings such as playing in an
uncovered sandbox or exploring caves.

197. Oesophageal candidiasis:This presents with retrosternal pain on
swallowing and is usually caused by Candida
albicans. This is a common complication of latestage HIV disease.

198. Mycobacterium avium complex:This is seen In late-stage HIV disease. Patients with CD4
<50/mm3 are at high risk. In industrialised countries, it is
reported in 40% of patients with AIDS.
Presentation: infection is disseminated and presents
with fever, night sweats, weight loss, diarrhoea,
abdominal pain, anaemia or hepatic dysfunction

199. HERPES VIRUSES:Herpes simplex virus can show up as either cold
sores, infections of the eye, or genital infections.
Varicella (the virus responsible for chicken pox and
also a member of the herpes virus family). People
with weakened immune systems can get very severe
infections with these germs.

200. Cytomegalovirus or CMV is one of the herpes
viruses that can affect different organs of the body
but most often affects the eyes. A warning sign of
CMV infection in the eyes is the increased
complaint of "floaters" in the eye. While CMV is
very common in all people it usually only causes
significant problems in people with HIV who have
CD4 counts less than 100.

201. Central nervous system complications:Cerebral toxoplasmosis:Toxoplasmosis is less common than it was, since the
advent of ART, although is still prevalent in resource-poor
countries. Cerebral toxoplasmosis is the most frequent
central nervous system (CNS) infection when CD4
<200/mm3. It usually occurs due to reactivation of cysts
in the brain, causing local lesions, typically multiple.
Presentation: subacute symptoms include focal
neurological disturbances, headache, confusion, fever
and seizures.

203. FATIGUE:
Fatigue is another complication of HIV, some patients of HIV
complaint of extreme fatigue of being tired whereas some
patients may not experience fatigue. There are different
strains of HIV, and it widely various from patient to patient
in the ways it affects different individuals.

205. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Control & prevention
By :
M.Bassam daqaq

206. Control & prevention
M.Bassam daqaq

207. Control and prevention
That mean any activity which
reduces morbidity and mortality
rate with hiv .

208. How HIV is prevented?
By prevented all form of HIV
transmission through body fluids.

209. Control and prevention
sexual
blood
needles
mother
to child

210. Control and prevention
sexual
blood
needles
mother
to child
By prevention all forms of un
protected sexual intercourse with an
infected or unknown person status .
this includes vaginal, anal & oral sex.

211. Control and prevention
sexual
blood
needles
mother
to child
HIV testing before marrege is
necessary to prove your marrege is
save

212. Control and prevention
sexual
blood
needles
mother
to child
• Use condoms (female or male)
every time having sex (vaginal or
anal)
• Always use latex or polyurethane
condom (not a natural skin
condom)
• Always use a latex barrier during
oral sex

213. Control and prevention
sexual
blood
needles
mother
to child

214. Control and prevention
sexual
blood
needles
mother
to child
When Using A Condom
Remember To:
• Make sure the package is not expired
• Make sure to check the package for
damages
• Do not open the package by teeth for
risk of tearing
• Never use the condom more than once
• Use water-based rather than oil-based
condoms

215. Control and prevention
sexual
blood
needles
mother
to child
Health Education
Since the main source of information is
the mass media and news paper which
is accessible to the majority there is a
gap in the knowledge which can be
filled by dissemination of information
using schools ,health institutions , social
gatherings ,local clubs ,video show ,and
religious ceremonies

216. Control and prevention
sexual
blood
needles
mother
to child
By testing donar
blood before blood
transfusion & organ
transplantation.

217. Control and prevention
sexual
blood
needles
mother
to child
needles , syringes or other piercing
instruments
If a needle/syringe is shared, it must be
disinfected:
Fill the syringe with undiluted bleach
and wait at least 30 seconds.
thoroughly rinse with water
Do this between each person’s use

218. Control and prevention
sexual
blood
needles
mother
to child
Non-profit Organization, which
provides sterile needles in exchange
for contaminated ones

219. Control and prevention
sexual
blood
needles
mother
to child
Procedures like tattooing ,
male & female circumcision
and traditional scarification
must be sterile

220. Control and prevention
sexual
blood
needles
mother
to child
the risk of HIV transmission from
mother to unborn child is about 26%
without any treatment or intervention.
But fortunately, there is a way to
reduce the risk of HIV transmission
during pregnancy.

221. Control and prevention
sexual
blood
needles
mother
to child
during pregnancy:
Treating the HIV +ve mother with a
Retrovir (AZT, zidovudine) containing
regimen. Guidelines state the
treatment of the pregnant woman
may start as early as 14 weeks into
the pregnancy.

222. Control and prevention
sexual
blood
needles
mother
to child
during delivery:
Giving the mother a dose of
intravenous (IV) Retrovir.

223. Control and prevention
sexual
blood
needles
mother
to child
after birth:
Treating the newborn with oral
Retrovir for six weeks.
The mother should never lactate her
baby

224. Control and prevention
sexual
blood
needles
mother
to child

225. HIV /AIDS
introduction
morphology
epidemiology
transmission
pathogenesis
Clinical feature
Labrotary diagnosis
HIV in prgnancy
complication
Control & prevention
treatment
Treatment
By:
basheer

226. Treatment
basheer

227. • There is no cure for HIV/AIDS, but a variety of
drugs can be used in combination to control the virus.
Each of the classes of anti-HIV drugs blocks the virus in
different ways. It's best to combine at least three drugs
from two different classes to avoid creating strains of HIV
that are resistant to single drugs .

228. The classes of anti-HIV drugs include :
1 - Non-nucleoside reverse transcriptase inhibitors
(NNRTIs).
2 - Nucleoside reverse transcriptase inhibitors (NRTIs
3 - Protease inhibitors (PIs).
4 - Entry or fusion inhibitors
5 - Integrase inhibitors

229. 1- Nonnucleoside Reverse Transcriptase Inhibitors
(NNRTIs), such as nevirappine (Viramune) and efavirenz
(Sustiva), bind to and block the action of reverse
transcriptase , which is a protein that HIV needs to reproduce
.
2- Nucleoside Reverse Transcriptase Inhibitors (NRTIs),
such as zidovudine (Retrovir), and stavudine .

230. 3-Protease inhibitors (PIs). disable protease, another protein that HIV
needs to make copies of itself. Examples include atazanavir, darunavir
.
4- Entry or fusion inhibitors. These drugs block HIV's entry into CD4+
cells. Examples include enfuvirtide and maraviroc.
5-Integrase inhibitors. Raltegravir (Isentress) works by disabling
integrase, a protein that HIV uses to insert its genetic material into
CD4+ cells .

231. When to start treatment
- Current guidelines indicate that treatment should started
if :
- You have severe symptoms
- Your CD4+ count is under 500
- You're pregnant
- You have HIV-related kidney disease
- You're being treated for hepatitis B

232. Side effects of antiviral drug include :
- Nausea, vomiting or diarrhea
- Abnormal heartbeats
- Shortness of breath
- Skin rash
- Weakened bones
- Bone death, particularly in the hip joints

233. Treatment response
Your response to any treatment is measured by your viral
load and CD4 counts .
Viral load should be tested at the start of treatment and
then every three to four months while you're undergoing
therapy. CD4 counts should be checked every three to
six months .

234. Treatment can be difficult because HIV
treatment regimens may involve taking
multiple pills at specific times every day
for the rest of your life .