1. AIDS
Dr Naresh Gill,
Assistant Professor,
Dept of Community Medicine,
Govt Grant Medical College,
Byculla, Mumbai-08

2. Introduction
 AIDS- (Acquired Immuno-Deficiency
Syndrome) also known as slim disease,
caused by HIV infection.
 Last stage of HIV infection.
 Once infected, the person remains infected
for the rest of his life.
 Immunity is low, host is vulnerable to life
threatening infection.
 Modern pandemic- affecting both
Industrialized and developing countries.
Dr Naresh Gill, Dept of Community
Medicine

3. Problem statement: World
(2009)
 World wide approximately 33.3 million
population affected (People living with
HIV/AIDS).
 Every year 2.6 million people are
newly infected with HIV
 1.8 million deaths every year
Dr Naresh Gill, Dept of Community
Medicine

4. Types of HIV epidemics
1. Low level HIV epidemics: Infection is largely
confined to HRGs. HIV prevalence has not
consistently exceeded 5% in any defined sub-
population
2. Concentrated HIV epidemics: HIV prevalence is
consistently over 5% in at least one defined sub-
population but is below 1% in pregnant women in
urban areas. The future course of epidemic is
determined by the frequency and nature of links
between highly infected sub-populations and
general population.
3. Generalized HIV epidemics: HIV prevalence
consistently over 1% in pregnant women.
Dr Naresh Gill, Dept of Community
Medicine

5. INDIA
• CSW
• IDU
HRG • MSM
• Client of sex workers, STD patients,
• migrant population,
Bridge • population in conflict areas and partners of drug users
Population
• General population
• Shift occurs when prevalence in first group is 5%
General • Time lag of 2-3 years
Population
Dr Naresh Gill, Dept of Community
Medicine

6. India:-Patterns of HIV
epidemic
 ANC:- 0.49%  IDU: 9.2%
 STD: 2.5%  MSM: 7.4%
 Migrants: 3.61%  FSW:4.9%
 Trucker: 2.51%
Trends of HIV infection indicates that it is spreading
in two ways:
•Urban to rural population
•HRG to General population
Dr Naresh Gill, Dept of Community
Medicine

7. India
High • MH, TN,AP, KA, Manipur & Nagaland
prevalence
states • >5% in HRGs and >1% in Antenatal Women
Moderate • Gujarat, Goa, Pondicherry
prevalence
states • >5% in HRGs but <1% in Antenatal women
Low
prevalence • Remaining states
states • <5% in HRGs and <1% in Antenatal women
Dr Naresh Gill, Dept of Community
Medicine

8. HIV Burden in India
 Estimated adult prevalence in Adults:
0.31% (2010)
 Majority of HIV infected persons belongs
to 15-49 years age group (88.55%)
 31.8% are in age group 15-29 years
 In Northern Eastern states principle
cause of HIV epidemic is Injecting Drug
Users.
 Tuberculosis is most common
opportunistic infection and the leading
cause of death among HIV infected
people. Dr Naresh Gill, Dept of Community
Medicine

9. Epidemiological features
 HIV 1 virus: most common cause of
infection
 Retrovirus
 Rapidly killed by heat.
 Inactivated by ether, acetone and
alcohol but resists Ionization
 Reservoir of infection are cases and
carriers
 Source of infection: Blood, semen and
CSF
Dr Naresh Gill, Dept of Community
Medicine

10. Host factor
 Most cases occur among the sexually
active persons age group 20-49 years
(84%)
 Children under 15 years make up for
3.9%
 39% are women
 HIV prevalence more common in
HRGs
Dr Naresh Gill, Dept of Community
Medicine

11. Transmission of Infection
 Heterosexual route: 87.1%
 Homosexual :1.5%
 Parent to child: 5.4%
 Injecting drug users: 1.6%
 Blood and blood products: 1.0%
Dr Naresh Gill, Dept of Community
Medicine

12. Clinical manifestation
1. Initial Infection
2. Asymptomatic carrier state
3. AIDS-related complex
4. AIDS
Dr Naresh Gill, Dept of Community
Medicine

13. Stage 1: Initial Infection
 After infection with HIV, 70% people
have mild symptoms (Fever, sore
throat and rashes).
 HIV antibodies usually take 2-12
weeks to appear in the blood stream.
 Window period: person is particularly
infectious because of high viral load in
the blood but he tests negative on
standard antibody detection test.
 Diagnosis in window period:??
Dr Naresh Gill, Dept of Community
Medicine

14.  Stage 2: Asymptomatic carrier state
◦ Antibodies are there but infected persons do
not show any overt sign of infection, except
PGL (Persistent Generalized
Lymphadenopathy)
 Stage 3: AIDS- related complex
◦ Person have illnesses caused by damaged
immune system but without the OI and
cancers associated with AIDS.
◦ Unexplained diarrhea (>1 month)
◦ Loss of body weight (>10%)
◦ Fever, night sweat, fatigue and malaise
◦ Mild Ois such as oral thrush , generalized
lymphadenopathy or enlargedGill, Dept of Community
Dr Naresh spleen.
Medicine

15. Stage 4: AIDS
 End stage of HIV infections
 Many OIs and Cancer specific to immuno-
deficiency state occurs
 Also known as Slim disease because of
presence of chronic diarrhea and weight loss.
 Most common opportunistic infection is TB,
commonly extrapulmonary and sputum
smear negative.
 Kaposi sarcoma, Oro-pharyngeal candidiasis,
Cytomegalo Retinitis, Toxoplasma
encephalitis, Hairy leukoplakia, Pneumocystis
Carini Pneumonia etc are associated with
HIV infection Dr Naresh Gill, Dept of Community
Medicine

16. CD4 Count and OIs
Dr Naresh Gill, Dept of Community
Medicine

17. Diagnosis of AIDS
 Major signs
◦ Weight loss- > 10% of Body weight
◦ Chronic diarrhea of > 1 month
◦ Prolonged fever of > 1 month
 Minor signs
◦ Persistent cough (>1 month duration)
◦ Generalized Pruritic dermatitis
◦ Oropharyngeal candidiasis
◦ Chronic progressive or disseminated herpes
simplex infection
◦ Generalized Lymphadenopathy
Dr Naresh Gill, Dept of Community
Medicine

18. Expanded WHO case definition
for AIDS surveillance
 HIV antibody positive plus one or more
following conditions present
◦ >10% body weight loss with diarrhea or fever
or both for at least one month
◦ Cryptococcal meningitis
◦ Pulmonary or Extrapulmonary TB
◦ Kaposi sarcoma
◦ Candidiasis of oesophagus
◦ Invasive cervical Ca
◦ Life threatening pneumonia
◦ Neurological impairment
Dr Naresh Gill, Dept of Community
Medicine

19. Laboratory diagnosis
 Screening test: detects antibodies to
HIV, tests with high sensitivity are
used for screening
◦ Confirmation can be done with specific
test such as Western Blot test
 Virus Isolation
 P24 antigen detection
Dr Naresh Gill, Dept of Community
Medicine

20. Control of AIDS
A. Prevention:
1. Education
2. Prevention of blood borne HIV
transmission
B. ART (Anti Retroviral Therapy)
Dr Naresh Gill, Dept of Community
Medicine

21. Dr Naresh Gill, Dept of Community
Medicine

22. Occupational Post Exposure
Prophylaxis
 First aid care
 Counseling and Risk assessment
 HIV testing and counseling
 ART for 28days
◦ Start as soon as possible , within 72 hours
◦ If first test is negative. Repeat the test at 3
and 6 months
Dr Naresh Gill, Dept of Community
Medicine

23. C. Specific prophylaxis: CPT should be
given to patients with CD4 count
<200
And all the TB patients
Specific prophylaxis against fungal infection
D. Primary Health Care
Dr Naresh Gill, Dept of Community
Medicine