16. Hiv / Aids

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1. DR . BIJAY KR.YADAV Holly vision technical campus Shankhamul , Kathmandu HIV / AIDS

2. HIV / AIDs : The term AIDs ( Acquired immunodeficiency syndrome) refers to the most severe clinical manifestations of infection with the HIV (human immunodeficency virus) Caused by “Retrovirus” & belong to lentivirus family Million of people are affected around the world

3. Hiv - Aids

4. Virus classification Group: Group VI  ( ssRNA -RT) Family: Retroviridae Subfamily: Orthoretrovirinae Genus: Lentivirus

5. Characterized by : Infection & depletion of CD4+ T lymphocytes, Profound immunosuppression leading to Opportunistic infections Secondary neoplasm Neurological manifestations

6. Pathogenesis :

7. 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)

8. Natural History of HIV Infection-Summary HIV multiplies inside the CD4 cells, destroying them. As CD4 cell count decreases and viral load increases, the immune defences are weakened. People infected with HIV 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.

9. Transmission : HIV is transmitted by : Direct contact with infected blood Sexual contact: oral, anal or vaginal Direct contact with semen or vaginal and cervical secretions Mothers infected with HIV to infants during pregnancy, delivery and breast feeding

10. HIV is not transmitted by : Coughing, sneezing Insect bites Touching, hugging Water, food Kissing Public baths/pools Toilets Handshakes Work or school contact Telephones Cups, glasses, plates, or other utensils

11. Major group at risks : Homosexuals. Intravenous drug abusers. Haemophilic ( deficiency of clotting factor VIII which control blood) Recipients of blood & blood components. Heterosexual contacts.

12. Clinical features : The clinical manifestation of HIV infection ranges from a mild acute illness to severe disease. Patients presented with : Fever Weight loss Diarrhoea Generalized lymphadenopathy Multiple opportunistic infection Neurological diseases

13. Others features : Recurrent mucosal candidiasis CMV infection Perianal herpes simplex Infection with M.tuberculosis Toxomoplasmosis is the most common secondary Infection of the CNS

14. The Dermatological manifestation in AIDS patients are : Neoplastic : Viral infections : Kaposi’s sarcoma B-cells lymphoma Squamous cell carcinoma Basal cell carcinoma Herpes zoster Herpes simples Molluscum contagiosum Warts Condylomata acuminata CMV infection Oral hair leukoplakia

15. Bacterial infections : Candidiasis Fungal infections : Protozoal : Pyodermas Ulcers Dermatophytosis Histoplasmosis Amoebiasis cutis

16. Arthropod infections Vascular lesions Oral Hair Nails Papulosquamous Scabies Vasculitis Gingivitis Colour changes Deformities Premature greying Psoriasis Seborrhoeic dermatitis

17. Stages of HIV infection : I f left untreated, HIV progress in 3 stages Acute infection Clinical latency ( Chronic infection) AIDS

18. Prevention of HIV Transmission Public health strategies to prevent HIV transmission : Screen all blood and blood products. Follow universal precautions. Educate in safer sex practises . Identify and treat STIs. Provide referral for treatment of drug dependence. Apply the comprehensive PMTCT approach to prevent perinatal transmission of HIV

19. What is the “Window Period?” The time period between a person’s exposure & actual infection with HIV and until antibodies are detectable in the body. After three months there are usually enough antibodies to show on an AIDS test. Nearly all people (99%) develop antibodies by THREE months

20. Diagnosis : I nvestigations : ELISA Western blot Detection of p24 antigen Latex agglutination test to detect gp120 PCR ( Polymerase Chain Reaction) Viral culture

21. Lab Diagnosis-contd Standard screening test- ELISA Sensitivity ->99.5% EIA- Positive (highly reactive ) -Negative (Non reactive ) - Indeterminate (partially reactive) - Low specificity Western Blot- Confirmatory test

22. WHO case Definition of AIDs :

23. Management : Treatment : The symptomatic treatment of the dermatological manifestation are as follows : Treatment with ZIDOVUDINE 500-1500 mg /day in 4-5 divided doses indicated to slow the the progress of HIV infection . Ganciclovir & Foscarnet for CMV complication. Acyclovir for Herpes Simplex & Herpes Zoster. Fluconazole, Itraconazole & Ketoconazole are particularly useful for the serious & life threatening Candida Infections. Topical antifungal / Hydrocortisone cream & Ketoconazole shampoo for Seborrhoeic Dermatitis .

24. Curettage & cryotherapy for Molluscum Contagiosum Acyclovir for Oral Hair Leukoplakia. Permethrin , Malathion or Benzylbenzoate for Scabies Podophyllin , Imiquimod or cryotherapy for HPV Liposomal Daunorubicin or Vincristine & Bleomycin also useful for Kaposi’s Sarcoma

25. Highly active Antiretroviral Therapy ( HAART) Nucleoside Reverse Transcriptase Inhibitors : 1. Zidovudine (AZT, ZDV) 2. ddI ( didanosine ) 3. ddC ( zalcitabine ) 4. d4T ( stavudine ) 5. 3TC (lamivudine) Non-nucleoside Reverse Transcriptase Inhibitors : 1. Nevirapine 2. Delavirdine Protease Inhibitors (PI's) : 1. Indinavir ( Crixivan ) 2. Ritonavir ( Norvir ) 3. Nelfinavir mesylate ( Viracept ) 4. Saquinavir ( Invirase )

26. National strategy for the control of HIV/AIDs Vision : Nepal will become a place where new HIV infection are rare. When they do occur, every person will have access to high quality. Life extending care without any form of discrimination Goal : To achieve universal access to HIV prevention, Treatment, Care & Support.

27. Objectives : Reduce new HIV infection by 50% by 2016, compared to 2010. Reduce HIV related deaths by 25% by 2016. ( compared with 2010 baseline ) through Universal access on t/t care services & Reduce new HIV infections in children by 90% by 2016 ( compared with 2010 baseline )

28. National policy to control HIV/AIDs : Prevention of HIV transmission From + ve tested people to – ve or untested partners. From + ve tested mother to child To – ve tested people from + ve or untested partners Promote early uptake of services : Medical care ( Treatment & Prevention of opportunistic infection ) Family planning Emotional care Counselling for positive living people Social support Legal advice & future planning Promoting awareness Supporting human right

29. Prevention : Primary prevention : Attention to increase contraceptives devices Safe sex, use of Condoms (Male/Female) Dual protection Prevention of pregency Early diagnosis & treatment of STI & other infection

30. Secondary prevention : Early testing of HIV & giving him/her option of medical termination if positive in safe centres & if she wants to continue, all available care is given.

31. Thank you