PRSENTATION ABOUT HIV BY -PARTH MONGA INFORMATION IS BASED UPON VARIOUS RESERCH MATERIALS, I HAVE ONLY COMPOSED IT .FOR THE PURPOSE OF CREATING AWARENESS-PARTH MONGA

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.

OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV)

OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV)

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.

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.

“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.

“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.

Through Sex Unprotected Intercourse Oral Anal

NATURAL COURSE OF HIV/AIDS

NATURAL COURSE OF HIV/AIDS

Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people

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

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

Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number.

Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma

Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma

Testing Options for HIV

Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous

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 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

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

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!

Treatment Options

HAART = highly active anti-retroviral treatment

Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)

EFFECTIVENESS OF HAART IN REDUCING MORTALITY

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

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

PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades

Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use

Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected

Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex

Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex

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

GLOBAL ESTIMATES 2008

ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO.

HIV PREVALENCE IN VARIOUS REGIONS Sub-Saharan Africa South/South-East Asia 42% Latin America Eurasia North America East Asia Western Europe North Africa/Middle East Total = 39.4 million Caribbean < Oceania Source: UNAIDS, AIDS Epidemic Update, December 2004.

NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS 63% Total = 4.9 million Source: UNAIDS, AIDS Epidemic Update, December 2004

Myths about transmission

Through Bodily Fluids Blood products Semen Vaginal fluids

Epidemiology of HIV/ AIDS in India National AIDS Research Institute, Pune, India

Indian HIV/ AIDS epidemic [Important milestones] 1986 First report of HIV infections in sex workers in Chennai, first report of AIDS in Mumbai 1989 HIV infection reported among intravenous drug users in Manipur State 1991 Indian National AIDS Control Programme was launched 2000-01 India PMTCT feasibility studies initiated by NACO 2001 Indian pharmaceutical companies marketed ARV drugs with considerable price reduction

Phases of spread of HIV epidemic in India Phase I At risk population Female sex workers Intravenous drug users Phase II Bridge population Male STD patients Other drug users Phase III Low/ No risk population Spouses of male STD pts Spouses of drug users Phase IV Children of HIV infected women Children of HIV infecteddrug users Commonest mode of HIV spread in India is by sexual route Mother to child transmission is on the rise HIV spread among intravenous drug users mostly in north-eastern states Blood transfusion associated spread is on the decline

Factors related to HIV infection [STD clinic attendees in Pune] * Practice of sex work * No. of sex partners * Receptive anal sex * Females in sex work (FSW) * Men having sex with FSW recently * Lack of formal education * Persons living away from family * Previous / present STDs * Absence of circumcision

HIV/AIDS IN MANIPUR HIV was first detected in Manipur in 1989 among intravenous drug users, HIV prevalence >70% in drug users 75.2% knew that needle sharing could lead to acquisition of AIDS, however, needle sharing was practiced by 96.8% Drug users: predominantly male (94.8%), between 15 and 35 years (95.3%) Median duration of drug use: 5 years, No. of times heroin used: 1 – 14 per day SKB ICMR

AIDS Epidemiology Modes of transmission Sexual 84.24% Perinatal 26.1% Blood 2.99% IDUs 2.83% Others 7.32%

Status of HIV epidemic in India

Distribution in States Maharashtra 10797 Gujarat 2141 Karnataka 1617 Tamil Nadu 18276 Andhra Pradesh 2565 Manipur 1238 Nagaland 298

High prevalent States States where HIV prevalence in antenatal women is 1% or more. Moderate prevalent States States where the HIV prevalence in antenatal women is less than 1% and prevalence in STD and other high risk groups is 5% or more. Low prevalent States less than 1% and HIV prevalence among STD and other high-risk group is less than 5%.

High Prevalent states HIV Prevalence STD% ANC% Andhra Pradesh 26.6 1.5 Karnataka 16.4 1.13 Maharashtra 9.2 1.75 Manipur 10.5 1.75 Nagaland 7.4 1.25 Tamil Nadu 12.6 1.13

Moderate Prevalent States HIV Prevalence STD% ANC% Goa 15.0 0.5 Kerala 6.42 0.08 Mizoram 2.2 0.33

HIV Prevalence Trend in India Prevalence New Infections 1998 3.5 m - 1999 3.7 m 0.2 m 2000 3.86 m 0.16 m 3.97 m 0.11 m 2003 5.1m Inference : New infections are declining

Sentinel Surveillance for HIV Infection in pregnant women in Pune

Sentinel surveillance for HIV Infection in tuberculosis patients in Pune HIV seroprealence % Tuberculosis is the most likely presentation of AIDS in India

Molecular epidemiology HIV-1 C is the commonest prevalent subtype in India

Clinical conditions and CD4 counts Patients Median CD4 p Sens Spec PPV NPV Oral candidiasis 16 151 0.007 0.29 0.96 0.75 0.82 Herpes zoster 18 179 0.34 0.23 0.91 0.55 0.73 Pulm. TB 29 195 0.26 0.36 0.85 0.60 Lymphadeno-pathy 47 291 0.32 0.38 0.67 0.71 Weight loss 13 157 0.015 0.24 0.97 0.77 0.81 Rash 9 210 0.66 0.07 0.94 0.33 0.70 Diarrhoea 167 0.11 0.19 0.95 0.62 Fever 6 184.5 0.695 0.50 * Oral candidiasis and weight loss were associated with and were highly predictive of low CD4 counts * Absence of clinical conditions were good predictors of high CD4 counts

Clinical Profile of AIDS in South India Pulmonary tuberculosis (49.1%; median duration of survival, 45 months) Pneumocystis carinii pneumonia(6.1%; median duration of survival, 24 months) Cryptococcal meningitis (4.7%; median duration of survival, 22 months) CNS toxoplasmosis (3%; median duration of survival, 28 months) Clinical Infectious Diseases 2003; 36:79–85

Median CD4 Counts in AIDS Cases in South India Pulmonary tuberculosis 111 cells/mL Extrapulmonary tuberculosis 122 cells/mL P. carinii pneumonia 87 cells/mL Cryptosporidiosis 133 cells/mL Cryptococcal meningitis 91 cells/mL CNS toxoplasmosis 35 cells/mL Cytomegalovirus retinitis 51 cells/mL Clinical Infectious Diseases 2003; 36:79–85

Autopsy finding in AIDS in Mumbai 85 adult brains studied with at least 21 sections from each using routine and special stains CNS lesions observed in 67 cases (79%) Opportunistic infections were present in 33 cases (39%) Toxoplasmosis (11 cases, 13%) Tuberculosis (10 cases, 12%), Cryptococcosis (seven cases, 8%) Cytomegalovirus infection (six cases, 7%) AIDS. 1998 Feb 12;12(3):309-13

Generic ART Medication in India Lamivudine+Zidovudine Efavirenz 600mg Nevirapine 200mg Didanosine-EC 250mg Didanosine-EC 400mg Stavudine 30mg Stavudine 40mg Lamivudine 150mg Zidovudine 300mg Indinavir 400 mg

Healthcare Resources National AIDS Cotrol Organization Hospitals (Government and Private) Researchers NGOs CBOs Free ART programme from the National AIDS Control Programme