1. HIV/AIDS/STD
Facts Clinics

2. Prof. Md. Nazrul Islam Chairman, Department of Virology
Bangabandhu Sheikh Mujib Medical University

3. 1981- 5 cases of Pneumocystis
carinii pneumonia in 8 months in
young homosexuals.
1967 to 1979 treatment was sought
for 2 cases.
1981- In 30 months time 26 cases of
Kaposi’s sarcoma in young
homosexual men.

4. Fever> 2 Months Diarrhoea > 2 Months
Fever> 2 Months
Diarrhoea > 2 Months
Loss of Weight > 10% of body
weight within short period of time.
Night sweat
Lymphadenopathy
All were associated with acquired immune deficiency
Acquired immune deficiency syndrome
or AIDS-1981

5. Lymphadenopathy in a homosexual in 1983-
New retrovirus from
Lymphadenopathy in a homosexual in 1983-
Prof Luc Montagnier Pasteur institute, Paris named Lymphadenopathy Associated Virus (LAV) (Barre-Sinoussi, F, et al, 1983)

6. Dr. Robert Gallo, National Cancer Institute confirmed that a retrovirus was the causative agent of AIDS in 1984,
named HTLV-III (Gallo, R. et al., 1984).

7. LAV = HTLV-III (Gallo et. al)
Human Retroviurs subcommittee of the international committee on taxonomy of viruses (ICTV).
Recommended the name Human Immunodeficiency virus (HIV) (Coffin, et al, 1986).

8. 1986-One HIV was isolated from
a west African patient in Pasteur
Institute.
1986-Another HIV was isolated from a patient from Senegal in Harvard School of Public health. .
Difference antigenicity and clinical manifestations between Western HIV and African HIV.

9. Human retrovirus sub committee on taxonomy of viruses (ICTV) subsequently recommended that HIV-isolated from western patient to be named-HIV-1.
HIV isolated from African patient was named HIV-2 (1986).

10. Transmission

11. Sexual
Parenteral
Perinatal

12. · Higher concentration of HIV in semen
Male Female
Sexual
·            Large surface area
·            Higher concentration of HIV in semen
·            Recipient of infectious material
·            Menstruation
·            Trauma is more frequent
·            Dendritic cell
·            Social cause

13. Female Male Male/Female Male/Female STD and Truma

14. Parenteral transmission
Blood and blood product
Syringe, needle, surgery, dentistry, tattooing ear-nose piercing, acupuncture, razor.

15. Perinatal
Intrauterine
During delivery
Breast feeding

16. Factors increase the rate of HIV transmission in STD
Concentration of HIV is increased in sexual fluid.
Disruption of normal barrier of skin and mucus membrane.

17. Increased risk of HIV infection associated with common
STDs and their curability
STD
Increased risk of HIV infection
Curability
Gonorrhoeae
+ +
Over 95%
Chlamydia
Syphilis
+ + +
Chancroid
Trichomoniasis +

18. Efficiency of HIV transmission by different routes
Efficiency %
Global infection%
Sexual transmission
0.1 -1
75-85
Blood and Blood project
> 90
5-10
Parenteral (Needle)
0.37
Rare
Mother to child
25-35 (33)

19. Following are the materials, which are capable of transmitting HIV from infected person:
Blood
Semen
Vaginal fluid
Breast milk
Saliva
Sweat
Stool
Urine
Tear

20. HIV can be inactivated by
-  Boiling-water in seconds (<Minute)  
- 70% Ethanol
-  2% Glutaraldehyde
-  1% House hold bleach
(available in the market as 3.5%)
- Soap and Water
- 5% Formaldehyde
- 10% Sodium hypochlorite
- 3% Hydrogen peroxide % Isopropyl alcohol
- 0.5% Lysol
- 2.5% Tween-20
30 minutes

21. Clinical Chronology after exposure to HIV

22. Exposure
Incubation period
(Window period)
Acute infection
Carrier state
Constitutional symptoms
Opportunistic infections
Malignancy

23. Exposure
Sexual
Parenteral
Perinatal

24. (Incubation period must not be confused with window period)
2 weeks to 12 weeks
(Incubation period must not be confused with window period)

25. Window period
This period covers the terminal part of the incubation period. Longer incubation period shows longer window period. This period is associated with appearance of HIV but not anti-HIV in patient serum.

26. Acute infection
Manifestation- Flue like syndrome in 65%
Self limiting

27. Carrier state
Variable, HIV and HIV antibody both present, CD4 cell count < normal but not very low.
No manifestation but gradually the immune system is depleted indicated by decrease in CD4 cell count.

28. Constitutional symptoms
Fever for >2 months
Diarrhoea for >2 months
Loss of weight > 10% of body wait within short period.
Night sweat
Loss of appetite
CD4 cell count low
P24 positive

29. Opportunistic infections of AIDS
1. Protozoal infections:
a)      Pneumocystis carinii
b)     Toxoplasma gondii
c)      Cryptosporidium
d) Isospora belli
e) Malaria

30. Opportunistic infections of AIDS
2. Fungal infections:
a) Candida
b)  Cryptococcus
c) Aspergillus

31. Opportunistic infections of AIDS
3. Bacterial infections:
a)      Mycobacterium
b)      Salmonella
c) Pyogenic bacteria

32. Opportunistic infections of AIDS
4. Viral infections:
a)      Herpes simplex virus (HSV)
b)      Herpes zoster virus
c)      Cytomegalovirus (CMV)

33. Malignancy
1.      Kaposi’s sacoma
2.      Non-hodgkin’s lymphoma

34. Care and support of HIV infected persons

35. Psychological support. Nutritional support. Clinical support:
Management of constitutional symptoms
Management of opportunistic infection.
Management of HIV malignancy
Anti-retroviral therapy.
Management of HIV pregnancy
Management of accidental inoculation.

36. Detected case in Bangladesh

37. Yearly cases detection (National)
Male (380)
Female (77)
Total (465)
1989 1
1990 2
1991 4 6
1992
1993 10 12
1994 9 13
1995
1996 23 29
1997 17 19
1998 11
1999 16 20
2000 8 31
2001 22 5
31 (4 unknown)
2002 47 60
2003
112 3
115
2004 72 26
102 (4 unknown)

38. National AIDS/STD programme reported HIV and AIDS cases
Number as off end 2003
Number in 2004
Total
New HIV cases
363
102
465
AIDS cases 57 30 87
AIDS deaths 14 44

39. Age Distribution of HIV/AIDS patients detected till 1st December, 2004 (BSMMU)
Male
Female
Total
0-4 1 2 3
5-9
10-14
15-19 9 11
20-24 8 16 24
25-29 53 62
30-34 60 4 64
35-39 32 34
40-44 20 22
45-49
50-54
55-59
60-64
Not available 36
219 51
270

40. Immunity of Bangladesh
Religion
Social norm
Familial bondage
Safe blood transfusion
Improvement in syringe and needle

41. Susceptibility of Bangladesh
Porous border with high prevalent county
Low awareness level
High prevalence of STD
High incidence of high risk behavior
Large number SW
Highest number of client in the region.
Lowest rate of condom use
Large rate of emigrant workers
Large number of women trafficked

42. Sentinel surveillance of HIV prevalence in IVDU
2000
2001
2003
I.4%
1.7%
4.0%

43. Indicators of vulnerability
IVDU
CSW
MSM
STI
Anti-Natal Patients
HIV 4%
<1%
Syphilis % % %
3.8%
1% %

44. Students 50% of male STD patients are students
80% of the students acquired STD from CSWs
Syphilis- Rural : Around 1%
Syphilis- Urban, slums:
Male: 11.8%
Female: 5.2

45. Thank you