1. HIV: THE GLOABAL AND INDIAN SCENARIO DR. KANUPRIYA CHATURVEDI DR. S.K CHATURVEDI

2. Lesson objectives Understand the global and local impact of the epidemic Know about HIV/AIDS in adults, children, and families Understand the natural history of HIV infection Understand the modes of HIV transmission Scope of the HIV/AIDS Pandemic Natural History and Transmission of HIV

3. DR. S.K CHATURVEDI HIV Human Immunodeficiency Virus H = Infects only Human beings I = Immunodeficiency virus weakens the immune system and increases the risk of infection V = Virus that attacks the body

4. DR. S.K CHATURVEDI AIDS Acquired Immune Deficiency Syndrome A = Acquired, not inherited I = Weakens the Immune system D = Creates a Deficiency of CD4+ cells in the immune system S = Syndrome, or a group of illnesses taking place at the same time

5. DR. S.K CHATURVEDI HIV and AIDS When the immune system becomes weakened by HIV, the illness progresses to AIDS Some blood tests, symptoms or certain infections indicate progression of HIV to AIDS

6. DR. S.K CHATURVEDI HIV-1 and HIV-2 HIV-1 and HIV-2 are Transmitted through the same routes Associated with similar opportunistic infections  HIV-1 is more common worldwide  HIV-2 is found in West Africa, Mozambique, and Angola

7. DR. S.K CHATURVEDI HIV-1 and HIV-2 HIV-2 is less easily transmitted HIV-2 is less pathogenic Duration of HIV-2 infection is shorter MTCT is relatively rare with HIV-2 MTCT of HIV-2 has not been reported from India

8. DR. S.K CHATURVEDI Transmission of HIV HIV is transmitted by Direct contact with infected blood Sexual contact: oral, anal, or vaginal Direct contact with semen or vaginal and cervical secretions HIV-infected mothers to infants during pregnancy, delivery, or breastfeeding

9. DR. S.K CHATURVEDI Transmission of HIV HIV is not transmitted by Public baths Handshakes Work or school contact Using telephones Sharing cups, glasses, plates, or other utensils Coughing, sneezing Insect bites Touching, hugging Water, food Kissing

10. DR. S.K CHATURVEDI 00003-E-1–December 2004 Global summary of the HIV and AIDS epidemic, December 2004 The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Number of people living with HIV in 2004 Total39.4 million (35.9 – 44.3 million) Adults 37.2 million (33.8 – 41.7 million) Women17.6 million (16.3 – 19.5 million) Children under 15 years2.2 million (2.0 – 2.6 million) People newly infected with HIV in 2004 Total4.9 million (4.3 – 6.4 million) Adults 4.3 million (3.7 – 5.7 million) Children under 15 years640 000 (570 000 – 750 000) AIDS deaths in 2004 Total3.1 million (2.8 – 3.5 million) Adults2.6 million (2.3 – 2.9 million) Children under 15 years510 000 (460 000 – 600 000)

11. DR. S.K CHATURVEDI

12. Global HIV/AIDS in 2004 * 39.4 -40.0 million people are living with HIV/AIDS 2.2 million are children under 15 years 6,40,000 children were newly infected with HIV in 2004 5,10,000 children died of HIV in 2 * Source: UNAIDS,2004 5.1 m. Indian living with HIV

13. DR. S.K CHATURVEDI Reported cases Reported AIDS cases (15,202) Estimated AIDS cases (219,400) People living with HIV/AIDS (2.2 million) Only a small number of PLWHA are reported

14. DR. S.K CHATURVEDI Impact of Global HIV Negative economic impact on countries Overstrained healthcare systems Decreasing life expectancy Reversal of child survival gains Increased numbers of orphans

15. DR. S.K CHATURVEDI HIV Estimates in India

16. DR. S.K CHATURVEDI MCH Profile (India) Total Population 1027 M Crude Birth Rate 25/1000 Sex Ratio (F:M) 933 Annual Pregnancies 27 M ANC Coverage 65.4 % Institutional Deliveries [12.1% to 79.3%] 35.6 % Deliveries attended by skilled birth attendants42.3 %

17. DR. S.K CHATURVEDI Adult HIV Prevalence High Prevalence States: these are Tamil Nadu, Maharastra, Karnataka, Andhra Pradesh, Manipur and Nagaland

18. DR. S.K CHATURVEDI Mode of Transmission of HIV In India

19. DR. S.K CHATURVEDI 0 10 20 30 40 50 60 70 80 90 100 # uninfected # infected during BF for 2 yrs # infected during delivery # infants infected during pregnancy 63 uninfected 15 7 MTCT in 100 HIV+ Mothers The majority of children do not get infected even when we do nothing

20. DR. S.K CHATURVEDI Risk of PTCT Transmission Globally: 15-45% India: 30-37% ( average )

21. DR. S.K CHATURVEDI 0 20 40 60 80 100 BiharGujaratUttar Pradesh Urban MaleUrban FemaleRural MaleRural Female % Source: National AIDS Control Organization, National Baseline General Population Behavioural Surveillance Survey 2001 Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact, Selected States in India 2004 Report on the Global AIDS Epidemic

22. DR. S.K CHATURVEDI Prevention of HIV Transmission Strategies to prevent HIV transmission Personal strategies Public health strategies Safe practices: no risk of HIV transmission Risk reduction: reduces but does not eliminate risk

23. DR. S.K CHATURVEDI Prevention of HIV Transmission  Public health strategies to prevent HIV transmission Screen all blood and blood products Follow universal precautions Educate in safer sex practices Identify and treat STIs/other infections Provide referral for treatment of drug dependence Apply the comprehensive PPTCT approach to prevent vertical transmission of HIV

24. DR. S.K CHATURVEDI Natural History of HIV Infection

25. DR. S.K CHATURVEDI Natural History of HIV Infection Virus can be transmitted during each stage Seroconversion Infection with HIV, antibodies develop Asymptomatic No signs of HIV, immune system controls virus production Symptomatic Physical signs of HIV infection, some immune suppression AIDS Opportunistic infections, end-stage disease

26. DR. S.K CHATURVEDI Natural History of HIV Infection Immune suppression HIV attacks white blood cells,called CD4 cells, that protect body from illness Over time, the body’s ability to fight common infections is lost Opportunistic infections occur

27. DR. S.K CHATURVEDI HIV Disease Progression of HIV disease is measured by: –CD4+ count Degree of immune suppression Lower CD4+ count means decreasing immunity –Viral load Amount of virus in the blood Higher viral load means more immune suppression

28. DR. S.K CHATURVEDI HIV Disease Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4+ counts) Higher the viral load, the sooner immune suppression occurs

29. DR. S.K CHATURVEDI Progression of HIV Infection HIGH viral load (number of copies of HIV in the blood) LOW CD4 count (type of white blood cell) Increasing clinical symptoms (such as opportunistic infections)

30. DR. S.K CHATURVEDI HIV Disease Direct infection of organ systems HIV can directly infect the: Brain (HIV dementia) Gut (wasting) Heart (cardiomyopathy)

31. DR. S.K CHATURVEDI HIV Disease: Summary HIV multiplies inside the CD4+ cells, destroying them As CD4+ cell count decreases and viral load increases, the immune defences are weakened HIV-infected people become vulnerable to opportunistic infections HIV is a chronic viral infection with no known cure Without ARV treatment, HIV progresses to symptomatic disease and AIDS

32. DR. S.K CHATURVEDI Key Points HIV is a global pandemic and the number of people living with HIV continues to increase worldwide. HIV epidemic is especially severe in resource-constrained settings HIV is a virus that destroys the immune system, leading to opportunistic infections. The progression from initial infection with HIV to end-stage AIDS varies from person to person and can take more than 10 years.

33. DR. S.K CHATURVEDI Key Points (continued) The most common main route of transmission worldwide is heterosexual transmission. Women of childbearing age are at particular risk for acquiring HIV through unprotected sex HIV-positive women who are pregnant are at risk of passing HIV infection to their newborn. Risk of HIV transmission from mother-to-child can be greatly reduced through effective PMTCT programs