HIV/AIDS Dr. Asif Rehman

What is HIV/AIDS HIV stands for Human Immunodeficiency Virus. It weakens a person’s immune system by destroying important cells (antibodies) that fight disease and infection. No effective cure exists for HIV. But with proper medical care, HIV can be controlled. What is the difference between HIV and AIDS

WHO case definition for AIDS For the purpose of AIDS surveillance an adult above 12 years of age is considered to have AIDS if at least two of the following major signs are present in combination with at least one of the minor sign listed below & if these signs are not known to be due to a condition unrelated to HIV infection: Major signs (weight loss more than 10% of body weight, Chronic diarrhea for more than 1 month, prolonged fever for more than 1 month) Minor signs (Persistent cough for more than 1 month, generalized pruritic dermatitis, history of Herpes Zooster, oropharyngeal candidiasis, Herpes simplex, generalized lymphadenopathy)

Mode of Transmission Only certain body fluids—blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.

Mode of Transmission Having sexual intercourse with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV. HIV can live in a used needle up to 42 days depending on temperature and other factors. From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine. Recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV. (CDC, 2016)

Mode of Transmission Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This was more common in the early years of HIV, but now the risk is extremely small because of rigorous testing of blood supply and donated organs and tissues. Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from an infected person mouth mixes with food while chewing. The only known cases are among infants (CDC, 2016)

Mode of Transmission Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

How well does HIV survives outside body HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host. It is not spread by: Mosquitoes, ticks, or other insects. Saliva, tears, or sweat that is not mixed with the blood of an HIV-positive person. Hugging, shaking hands, sharing toilets, sharing dishes.

Taking medicine after being potentially exposed to HIV Taking medicine after being potentially exposed to HIV, called Post Exposure Prophylaxis (or PEP), can keep a person from becoming infected. But PEP must be started within 72 hours after a possible exposure

Any Vaccine for HIV/AIDS There is currently NO vaccine that will prevent HIV infection or treat those who have it.

Do people still die from HIV Yes. Only in the United States, 6,955 people died from HIV/AIDS in 2013. HIV remains a significant cause of death for certain populations. In 2013, it was the 8th leading cause of death for those aged 25- 34, 9th for those aged 35-44, and 10th for those aged 45-54

HIV/AIDS Globally Worldwide, there were about 2.1 million new cases of HIV in 2015. About 36.7 million people are living with HIV around the world, and as of June 2016, 17 million people living with HIV were receiving medicines to treat HIV, called antiretroviral therapy (ART). An estimated 1.1 million people died from AIDS-related illnesses in 2015. Sub-Saharan Africa, which bears the heaviest burden of HIV/AIDS worldwide, accounts for 65% of all new HIV infections. Other regions significantly affected by HIV/AIDS include Asia and the Pacific, Latin America and the Caribbean, and Eastern Europe and Central Asia.

Year wise trend showing number of patients registered with ART center & on ARV’s in Pakistan

HIV in Pakistan Number of people living with HIV: 125, 000 Adults aged 15 to 49 prevalence rate: <0.1% Adults aged 15 and over living with HIV: 100 000 Women aged 15 and over living with HIV: 30 000 Children aged 0 to 14 living with HIV: 2500 Deaths due to AIDS: 3600 Orphans due to AIDS aged 0 to 17: 18 000

HIV Global Factsheet Adults and children living with HIV 36’700000 Adults aged 15 and over living with HIV 3’490000 Women aged 15 and over living with HIV 17’800000 Men aged 15 and over living with HIV 17’200000 Children aged 0 to 14 living with HIV 1’800000

People living with HIV (Globally)

People living with HIV by Region

Compare by Region

Prevention Abstinence: Abstinence means not having sex. An abstinent person is someone who's never had sex or someone who's had sex but has decided not to continue having sex for some period of time. Abstinence is the only 100% effective way to prevent HIV and other sexually transmitted diseases (STDs).

Prevention Injective drug use: In 2010, 8% (3,900) of the estimated 47,500 new HIV infections in the United States were attributed to injection drug use (IDU)

Prevention Safe Sexual intercourse Condoms, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and antiretroviral therapy (ART) can reduce risk of getting or transmitting HIV through sexual intercourse.. Unsafe sex may also expose individuals to other sexually transmitted diseases or other infections.

Prevention Pre exposure prophylaxis (PrEP) Pre-exposure prophylaxis is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. A combination of medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. PrEP is much less effective if it is not taken consistently.

Prevention Post exposure prophylaxis (PEP) PEP is the use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion. PEP must be started as soon as possible to be effective and always within 72 hours of a possible exposure. seroconversion is the time period during which a specific antibody develops and becomes detectable in the blood

HIV Treatment as a Prevention Treatment for HIV includes anti-retroviral therapy (ART) which is medication people living with HIV take to stay healthy. These medications reduce the amount of virus in the body which keeps the immune system functioning and prevents illness. Another benefit of reducing the amount of virus in the body is that it helps prevent transmission to others through sex, needle sharing, and from mother-to-child during pregnancy and birth. This is sometimes referred to as “ART as prevention” or “treatment as prevention”. ART isn't a cure, but it can control the virus so that a person can live a longer, healthier life and reduce the risk of transmitting HIV to others. ART involves taking lifelong a combination of HIV medicines (called an HIV regimen) every day, exactly as prescribed

National AIDS Control Program National AIDS Control Program Pakistan was established in 1986-87 with a focus on diagnosis of cases that came to hospitals, but progressively began to shift towards a community focus. Since that The Government of Pakistan has maintained a sustained response to the HIV epidemic through a close collaboration between the National AIDS Control Program (NACP), Provincial AIDS control program, UN agencies and NGO.

National AIDS Control Program Goals: To prevent a generalized epidemic in Pakistan by containing the spread of HIV and AIDS and elimination of stigma and discrimination against those infected and effected Objectives Prevention of HIV transmission Safe Blood Transfusion & Reduction of Sexually Transmitted Diseases transmission Establishment of surveillance & Reducing Stigma attached with disease Training of Health Staff & Research and Behavioral studies Development of Program Management. Create an enabling environment Build the right capacity & Strengthen the institutional framework

Exercise: Interpret the graph in 5 steps with conclusions

THANK YOU