1. 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

2. 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.

3. 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)

4. 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)

5. 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.

6. 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.

7. “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.

8. “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.

9. Through Sex
Unprotected Intercourse
Oral
Anal

11. NATURAL COURSE OF HIV/AIDS

12. NATURAL COURSE OF HIV/AIDS

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

14. 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

15. 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

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

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

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

20. Testing Options for HIV

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

22. 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

23. 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

24. 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!

25. Treatment Options

26. HAART = highly active anti-retroviral treatment

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

28. EFFECTIVENESS OF HAART IN REDUCING MORTALITY

29. 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

30. 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

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

32. 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

33. 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

34. 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

35. 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

36. 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

37. GLOBAL ESTIMATES 2008

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

39. 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.

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

41. Myths about transmission

42. Through Bodily Fluids
Blood products
Semen
Vaginal fluids

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

44. 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
India PMTCT feasibility studies initiated by NACO
2001
Indian pharmaceutical companies marketed ARV drugs with considerable price reduction

45. 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

46. 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

47. 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

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

49. Status of HIV epidemic in India

50. Distribution in States
Maharashtra
Gujarat
Karnataka
Tamil Nadu
Andhra Pradesh 2565
Manipur
Nagaland 298

51. 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%.

52. High Prevalent states HIV Prevalence STD% ANC% Andhra Pradesh 26.6 1.5
Karnataka
Maharashtra
Manipur
Nagaland
Tamil Nadu

53. Moderate Prevalent States
HIV Prevalence
STD% ANC%
Goa
Kerala
Mizoram

54. HIV Prevalence Trend in India
Prevalence New Infections
m -
m m
m m
3.97 m m m
Inference : New infections are declining

55. Sentinel Surveillance for HIV Infection in pregnant women in Pune

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

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

58. 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

59. 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

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

61. 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 Feb 12;12(3):309-13

62. 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

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