Hiv transmission
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HIV is a retrovirus that causes AIDS by destroying CD4 cells and weakening the immune system. It can be transmitted through unprotected sex, contaminated blood or needles, or from mother to child. While not curable, HIV is manageable with antiretroviral treatment. People progress through acute, asymptomatic, symptomatic, and AIDS stages over many years without treatment. Opportunistic infections often cause death in late stage AIDS when CD4 counts drop very low. Testing and prevention strategies like abstinence, monogamy, condoms and sterile needles can help control the epidemic.
Hiv transmission
- 2. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable.
- 3. WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death.
- 4. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS.
- 5. “THE VIRAL GENOME” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.
- 7. Through Bodily Fluids Blood products Semen Vaginal fluids
- 8. IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades
- 9. Through Sex Unprotected Intercourse Oral Anal
- 12. NATURAL COURSE OF HIV/AIDS
- 13. Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people
- 14. Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood
- 15. Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear.
- 16. Stage 4 - HIV AIDS The immune system weakens too much as CD4 cells decrease in number.
- 17. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma
- 18. Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma
- 19. CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia
- 20. TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10- 30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : 1. Subnormal clinical and roentgen presentation 2. High rate of MDR/XDR 3. High rate of treatment failure and relapse (5% vs < 1% in HIV)
- 22. Testing Options for HIV
- 23. Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous
- 24. Blood Detection Tests HIV enzyme-linked immunosorbent assay (ELISA) Screening test for HIV Sensitivity > 99.9% Western blot Confirmatory test Speicificity > 99.9% (when combined with ELIZA) HIV rapid antibody test Screening test for HIV Simple to perform Absolute CD4 lymphocyte count Predictor of HIV progression Risk of opportunistic infections and AIDS when <200 HIV viral load tests Best test for diagnosis of acute HIV infection Correlates with disease progression and response to HAART
- 25. Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV
- 26. Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST!
- 28. HAART = highly active anti-retroviral treatment
- 29. Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)
- 30. HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals: CD4 counts every 3–6 months Viral load tests every 3–6 months and 1 month following a change in therapy PPD INH for those with positive PPD and normal chest radiograph RPR or VDRL for syphilis Toxoplasma IgG serology CMV IgG serology Pneumococcal vaccine Influenza vaccine in season Hepatitis B vaccine for those who are HBsAb-negative Haemophilus influenzae type b vaccination Papanicolaou smears every 6 months for women
- 31. For HIV-infected individuals with CD4 < 200 cells/mcL: Pneumocystis jiroveci1 prophylaxis For HIV-infected individuals with CD4 < 75 cells/mcL: Mycobacterium avium complex prophylaxis For HIV-infected individuals with CD4 < 50 cells/mcL: Consider CMV prophylaxis
- 32. PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades
- 36. 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 with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms
- 37. HIV PREVALENCE IN VARIOUS REGIONS 4% 4% 3% 3% 2% 1% 1% 1% 18% Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42%
- 38. NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS 6% 5% 4% 2% 1% 1% <1% <1% 18% Sub-Saharan Africa South/South-East Asia East Asia Latin America Eurasia North Africa/Middle East Caribbean North America Western Europe Oceania Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63%
- 39. WHAT WE CAN DO?? UNAIDS Outcome Framework 2009–2011: nine priority areas We can reduce sexual transmission of HIV. We can prevent mothers from dying and babies from becoming infected with HIV. We can ensure that people living with HIV receive treatment. We can prevent people living with HIV from dying of tuberculosis. We can protect drug users from becoming infected with HIV. We can remove punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS. We can stop violence against women and girls. We can empower young people to protect themselves from HIV. We can enhance social protection for people affected by HIV.
Editor's Notes
- #40: Vulnerable and High-risk Groups: -Expand knowledge, access, and coverage of vulnerable populations—particularly in large cities—to a package of high impact services, through combined efforts of the government and NGOs. -Implement harm-reduction initiatives for IDUs and safe sex practices for CSWs. -Make effective and affordable STD services available for high-risk groups and the general population. General Awareness and Behavioral Change: -Undertake behavioral change communications with the following behavioral objectives: (i) use of condoms with non-regular sexual partners; (ii) use of STI treatment services when symptoms are present and knowledge of the link between STIs and HIV; (iii) use of sterile syringes for all injections; (iv) reduction in the number of injections received; (v) voluntary blood donation (particularly among the age group 18 to 30); (vi) use of blood for transfusion only if it has been screened for HIV; and (vii) display of tolerant and caring behaviors towards people living with HIV/AIDS and members of vulnerable populations. -Increase interventions among youth, police, soldiers, and migrant laborers. Blood and Blood Product Safety: -Ensure mandatory screening of blood and blood products in the public and private sectors for all major blood-borne infections. -Conduct education campaigns to promote voluntary blood donation -Develop Quality Assurance Systems for public and private blood banks to ensure that all blood is properly screened for HIV and Hepatitis B. Surveillance and Research: -Strengthen and expand the surveillance and monitoring system. -Implement a second-generation HIV surveillance that tracks sero-prevalence and changes in HIV-related behaviors, including the spread of STIs and HIV, sexual attitudes and behaviors, and healthcare-seeking behaviors related to STIs. Building Management Capacity -Continue to build management capacity within provincial programs and local NGOs to ensure evidence-based program implementation. -Identify gaps in existing programs and continue phased expansion of interventions.