aids

AIDS

Dr Naresh Gill,Assistant Professor,Dept of Community Medicine,Govt Grant Medical College,Byculla, Mumbai-08

Dr Naresh Gill, Dept of Community Medicine

IntroductionAIDS- (Acquired Immuno-Deficiency

Syndrome) also known as slim disease, caused by HIV infection.

Last stage of HIV infection.Once infected, the person remains

infected for the rest of his life.Immunity is low, host is vulnerable to

life threatening infection.Modern pandemic- affecting both

Industrialized and developing countries.


Problem statement: World (2009)

World wide approximately 33.3 million population affected (People living with HIV/AIDS).

Every year 2.6 million people are newly infected with HIV

1.8 million deaths every year


Types of HIV epidemics 1. Low level HIV epidemics: Infection is largely

confined to HRGs. HIV prevalence has not consistently exceeded 5% in any defined sub-population

2. Concentrated HIV epidemics: HIV prevalence is consistently over 5% in at least one defined sub-population but is below 1% in pregnant women in urban areas. The future course of epidemic is determined by the frequency and nature of links between highly infected sub-populations and general population.

3. Generalized HIV epidemics: HIV prevalence consistently over 1% in pregnant women.


INDIA

HRG •CSW

•IDU•MSM

Bridge Population

•Client of sex workers, STD patients,

•migrant population,

•population in conflict areas and partners of drug users

General Population

•General population

•Shift occurs when prevalence in first group is 5%

•Time lag of 2-3 years


India:-Patterns of HIV epidemic

ANC:- 0.49%STD: 2.5%Migrants: 3.61%Trucker: 2.51%

IDU: 9.2%MSM: 7.4%FSW:4.9%

Trends of HIV infection indicates that it is spreading in two ways:

•Urban to rural population

•HRG to General population


India•MH,

TN,AP, KA, Manipur & Nagaland

•>5% in HRGs and >1% in Antenatal Women

High prevalence states

•Gujarat, Goa, Pondicherry

•>5% in HRGs but <1% in Antenatal women

Moderate prevalence states

•Remaining states

•<5% in HRGs and <1% in Antenatal women

Low prevalence states


HIV Burden in IndiaEstimated adult prevalence in Adults:

0.31% (2010)Majority of HIV infected persons belongs

to 15-49 years age group (88.55%)31.8% are in age group 15-29 yearsIn Northern Eastern states principle cause

of HIV epidemic is Injecting Drug Users.Tuberculosis is most common

opportunistic infection and the leading cause of death among HIV infected people.


Epidemiological featuresHIV 1 virus: most common cause of

infectionRetrovirusRapidly killed by heat.Inactivated by ether, acetone and

alcohol but resists IonizationReservoir of infection are cases and

carriersSource of infection: Blood, semen

and CSF


Host factorMost cases occur among the

sexually active persons age group 20-49 years (84%)

Children under 15 years make up for 3.9%

39% are womenHIV prevalence more common in

HRGs


Transmission of Infection

Heterosexual route: 87.1%

Homosexual :1.5%

Parent to child: 5.4%

Injecting drug users: 1.6%

Blood and blood products: 1.0%


Clinical manifestation

1. Initial Infection

2. Asymptomatic carrier state

3. AIDS-related complex

4. AIDS


Stage 1: Initial InfectionAfter infection with HIV, 70% people

have mild symptoms (Fever, sore throat and rashes).

HIV antibodies usually take 2-12 weeks to appear in the blood stream.

Window period: person is particularly infectious because of high viral load in the blood but he tests negative on standard antibody detection test.

Diagnosis in window period:??


Stage 2: Asymptomatic carrier state◦Antibodies are there but infected persons do

not show any overt sign of infection, except PGL (Persistent Generalized Lymphadenopathy)

Stage 3: AIDS- related complex◦Person have illnesses caused by damaged

immune system but without the OI and cancers associated with AIDS.

◦Unexplained diarrhea (>1 month)◦Loss of body weight (>10%)◦Fever, night sweat, fatigue and malaise◦Mild Ois such as oral thrush , generalized

lymphadenopathy or enlarged spleen.


Stage 4: AIDSEnd stage of HIV infectionsMany OIs and Cancer specific to immuno-

deficiency state occursAlso known as Slim disease because of

presence of chronic diarrhea and weight loss.Most common opportunistic infection is TB,

commonly extrapulmonary and sputum smear negative.

Kaposi sarcoma, Oro-pharyngeal candidiasis, Cytomegalo Retinitis, Toxoplasma encephalitis, Hairy leukoplakia, Pneumocystis Carini Pneumonia etc are associated with HIV infection


CD4 Count and OIs


Diagnosis of AIDSMajor signs

◦Weight loss- > 10% of Body weight◦Chronic diarrhea of > 1 month◦Prolonged fever of > 1 month

Minor signs◦Persistent cough (>1 month duration)◦Generalized Pruritic dermatitis◦Oropharyngeal candidiasis◦Chronic progressive or disseminated

herpes simplex infection◦Generalized Lymphadenopathy


Expanded WHO case definition for AIDS surveillanceHIV antibody positive plus one or

more following conditions present◦>10% body weight loss with diarrhea or

fever or both for at least one month◦Cryptococcal meningitis◦Pulmonary or Extrapulmonary TB◦Kaposi sarcoma◦Candidiasis of oesophagus◦ Invasive cervical Ca◦Life threatening pneumonia◦Neurological impairment


Laboratory diagnosisScreening test: detects

antibodies to HIV, tests with high sensitivity are used for screening◦Confirmation can be done with

specific test such as Western Blot test

Virus IsolationP24 antigen detection


Control of AIDS

A. Prevention:

1. Education

2. Prevention of blood borne HIV

transmission

B. ART (Anti Retroviral Therapy)


Occupational Post Exposure ProphylaxisFirst aid careCounseling and Risk assessmentHIV testing and counselingART for 28days

◦Start as soon as possible , within 72 hours

◦If first test is negative. Repeat the test at 3 and 6 months


C. Specific prophylaxis: CPT should be given to patients with CD4 count <200

And all the TB patientsSpecific prophylaxis against fungal

infection

D. Primary Health Care

aids

Documents

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