Dr. Anjum HashmiMBBS,CCS(USA),MPH

Infection Control Director

MCH Najran

AIDS (Acquired immune deficiency syndrome) is an infectious disease caused by the human immunodeficiency virus (HIV).

It has affected tens of millions of people around the world.

RED RIBBON is most widely recognized symbol for HIV & AIDS and the people who live with these conditions.

The symbol was presented by the Visual AIDS Artists Caucus in 1991.

Red ribbon Symbol is used to raise consciousness & support for HIV & AIDS.

The United Nations' (UN) World AIDS Day is Started on 1st December 1988.

It is held each year on Dec 1st to honour the victims of AIDS pandemic and to focus attention on the prevention and treatment of HIV & AIDS related conditions.

Between 2011-2015, World AIDS Days will have the theme "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths".

Stigma and discrimination are primary barriers to universal access to HIV treatment, care and prevention.

People living with HIV often face discrimination from health providers, employers, family members & friends.

1981

1985

1987

1994

1995-1999

2000-present

Documented presence of a new disease

Causative agent identified i.e. HIV.AIDS determined as end stage disease.Antibody test developed.Routes of transmission conformed.

Drug therapy become available.Oklahoma become first US state to mandate AIDS education.

Development of new diagnostic lab tests.Production of new drugs.Approval of Combination drug therapy.Test for antiretroviral drug resistance.Treatment to decrease risk of transmission from mother to baby.

Protease inhibitors drugs approved.Home testing available; Antigen & viral load testing developed

New drug formulas approved; 1st generic drug approved.Rapid HIV testing become available.HIV genotyping approved.

PEOPLE WITH NO HOPE

Dark coloured areas in world map are high prevalent regions, the most important issue world is facing today.

WHO estimates that 34 million [31.6–35.2 million] people living with HIV globally and 1.9 million newly infected in 2010 with 50,000 in the United States.

1.8 million people died of AIDS-related illnesses worldwide in 2010.

40 percent of all new HIV infections occur among young people world wide.

In 2009 US youth prevalence was 69.5 cases per 0.1 million youth.

In 2010 youth accounted for 12,200 (25.7%) new cases in US.

More than half of youths with HIV i.e., 59.5% were unaware of their infection.

EPIDEMIOLOGYEPIDEMIOLOGY• Family : Retroviridae

• Subfamily : Lentivirus

• There are two types of HIV viruses. HIV-1 & HIV-2

• HIV virus is RNA virus containing reverse

transcriptase

• It contain two major envelop proteins.

1. gp 120 – external

2. gp 41 - transmembrane

Risk of HIV transmission from needle stick injury is 0.3%.

Risk of HIV transmission after a mucous membrane exposure is 0.09%.

HIV infection can be transmitted from an infected mother to her fetus

During pregnancy. During delivery. By breast-feeding (Low risk). In the absence of prophylactic

therapy probability of transmission of HIV from mother to fetus /infant ranges from 15 to 25% in industrialized countries and from 25 to 35% in developing countries.

HIV present in saliva at low titer, but there is no evidence that saliva can transmit HIV infection, even either through kissing.

Breast-fed infants were associated with a low risk of HIV transmission through breast milk.

There is no evidence that HIV transmission can occur as a result of exposure to tears, sweat and urine.

The hallmark of HIV disease is profound immunodeficiency resulting in the progressive quantitative and qualitative deficiency of the subset of T lymphocytes referred as the helper T cells or inducer T cells.

T cells has CD4 molecule on its surface, which serves as the primary cellular receptor for HIV.

CD4 Receptors present onLymphocytesMonocytes/macrophages Helper T cellsAstrocytesOligodendrocytes

Normal adults has800 to 1200 cells per microliter (µl) of bloodNormal life span : 100 days

Person is healthy until 500 CD4+ T cells/µlProblems start at 200 to 499 CD4+ T cells/µlSevere problems start at less than 200

CD4+ T cells/µl

Category 1 CD4 count more

than 500

• Asymptomatic or acute

HIV infection• Early Chronic Infection

Category 2 CD4 count 200 – 499 • Symptomatic disease

• Intermediate Chronic

Infection

Category 3CD4 count less than 200

• AIDS Conditions• Late Chronic Infection

Acute retroviral syndrome Seroconversion Occurs in 1 to 3 weeks

Lasts 1 to 2 weeks, to months High viral load CD4+ T Cells fall temporarily

Symptoms may be mistaken for flu Fever, swollen lymph glands, sore throat, headache,

malaise, nausea, muscle and joint pain, diarrhea, diffuse rash

Neurologic complications Aseptic meningitis, peripheral neuropathy, facial palsy,

Guillian-Barre syndrome

It can lasts for 10 years. CD4+ T lymphocyte cells remain

above 500 cells/µl Viral load in blood is low Patient may be asymptomatic OR Fatigue, headache, low-grade fever,

nightsweats, generalized

lymphadenopathy. Patient may be unaware of the

infection.

CD4+ T cell count is 200 - 499 µl Viral load rises Early phase symptoms become worse

persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches and fatigue which is severe enough to interrupt normal life.

New symptoms localized infections,

lymphadenopathy, nervous system manifestations and opportunistic infections.

Oropharyngeal candidiasis (thrush)

Varicella zoster virus (shingles)

Vaginal candidal infections

Oral or genital herpes

Oral hairy leukoplakia Epstein-Barr virus

CD4+ T cell count below 200 µl Absolute number of lymphocytes increases. Percentage of lymphocytes also increases.

Development of opportunistic infection (OI).

Development of opportunistic cancer. Wasting Syndrome loss of 10% or

more of body weight. Dementia.

Research presented at EUROECHO 2012 at Athens, Greece, finds that children with HIV have a 2.5-fold increased risk of atherosclerosis.

According to pediatrician, many antiretroviral drugs increase bad (LDL) cholesterol and lower good (HDL) cholesterol, so that children with HIV have high cholesterol for a long period of time.

HIV virus also causes chronic inflammation of arteries.

The both conditions are bad for the arteries.

Depends on detection of antibodies to HIV and/or direct detection of HIV or one of its components.

Antibodies to HIV generally appear in the circulation 2 to 12 weeks following the infection.

The standard screening test for HIV infection is ELISA.

Enzyme immunoassay (EIA) is also extremely good screening test with a sensitivity of 99.5%.

Enzyme immunoassay (EIA) tests results as positive (highly reactive), negative (nonreactive), or indeterminate (partially reactive).

1. Decreases HIV RNA levels to less than 50 copies/µl.

2. Maintain or raise CD4+ T cell counts to greater than 200 cells/µl. Which is also known as Immune reconstitution.

3. Delay development of HIV-related symptoms

Opportunistic diseases

History and physical examination. Routine chemistry and hematology. CD4 T lymphocyte count. Two plasma HIV RNA levels. RPR (Rapid Plasma Reagin) test for

syphilis. Anti-Toxoplasma antibody titer. PPD skin test. Mini-mental status examination.

Tests for hepatitis A, B & C. Immunization with pneumococcal and

influenza vaccines. Immunization with hepatitis A and B

vaccines. Counseling regarding natural history and

transmission. Help others people who might be at risk of

getting infection.

Drug treatment guidelines for HIV/AIDS change frequently as new drugs are approved and new drug regimens developed.

Two principles currently guides doctors in developing drug regimens for AIDS patients.

Combinations of drugs should be used rather than one medication.

Treatment decisions should be based on the results of the patient's viral load tests.

Antiretroviral therapy to mother during pregnancy and infant during the first weeks of life dramatically decreasing mother to child transmission of HIV.

A single dose of one drug of antiretroviral therapy to the mother during labor and to the infant within 48 hr of birth has also been successful in decreasing the incidence of mother to child transmission of HIV.

Education, counseling and behavior

modification are the cornerstones of an

HIV prevention strategy.

Restricting sexual activity to a single

partner.

Practicing safer sex i.e., always use a

condom. Use of condoms can markedly

decrease the chances of HIV transmission

but not 100%, as condoms has a failure

rate of 15 percent .

Avoiding needle sharing among intravenous drug users.

Donating one's own blood before planned major surgery to prevent risk of infection from a blood transfusion.

Practicing standard precautions when handling blood and body fluids.

Proper disposal of sharps. Test for HIV infection for anyone who

is suspected of having infection.

Currently, there are condoms treated with antimicrobial called Nonoxynol-9, which are effective against HIV, but can cause inflammation and genital ulcers, which may make infection more likely.

At University of Manitoba Canada researcher found condoms embedded with silver nanoparticles killed all HIV and herpes viruses.

The world's largest HIV/Aids vaccine trial conducted by National Institute of Allergy & Infectious Diseases USA, on more than 16,000 volunteers, showed that HIV infection has been prevented.

A study on HIV vaccine conducted by Swedish Institute for Infectious Disease Control has showed promising results.

Over 90 per cent of the subjects in the phase 1 trials developed an immune response to HIV.

Researchers from the Scripps Institute in California USA, has discovered two new antibodies that could lead to an HIV vaccine.

Texas Biomedical Research Institute (Texas Biomed) has applied for a patent in November 2012, for a genetically-engineered vaccine for HIV prevention.

The vaccine is designed to be administered in a single dose that will last for lifetime.

The vaccine targets the outer layers of the body structures that come first in contact with HIV virus.

This vaccine restricts viral replication at the mucosal level of entry may be the best hope of controlling HIV.

As life-long stimulation of the immune system by this vaccine will be sufficient to achieve long-term protection.

HELP PLWA

Happy Little Crater on Planet Mercury Snap in 2012 by Messenger Spacecraft

Satellite View ofEarth At Night Lights On

THANK YOU