EPIDEMIOLOGY OF HIV & AIDS - JIMEE BORAH

Epidemiology of HIV and AIDS:

Global Statistics:

- 38.4 million people living with HIV (2021)
- 1.7 million new infections (2021)
- 690,000 AIDS-related deaths (2021)

Key Epidemiological Features:

1. Mode of Transmission: Sexual contact (75-80%), blood-to-blood contact (10-15%), mother-to-child transmission (5-10%)
2. Risk Groups: Men who have sex with men (MSM), sex workers, injecting drug users (IDUs), people in correctional facilities
3. Age: 15-49 years old (most affected)
4. Gender: Males (slightly higher prevalence)
5. Geographic Distribution: Sub-Saharan Africa (most affected region), followed by Asia, Latin America, and Eastern Europe

Epidemiological Trends:

1. Increasing Prevalence: In Eastern Europe, Central Asia, and the Middle East
2. Declining Prevalence: In Sub-Saharan Africa, North America, and Western Europe
3. Stable Prevalence: In Latin America, the Caribbean, and Oceania

Challenges:

1. Late Diagnosis: Many cases diagnosed at advanced stages
2. Treatment Adherence: Variable adherence to antiretroviral therapy (ART)
3. Stigma and Discrimination: Hindering prevention, testing, and treatment efforts
4. Funding and Resources: Inadequate in some regions

Opportunities:

1. Prevention: Effective interventions like pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision
2. Treatment: ART scale-up, improving treatment outcomes
3. Testing: Expanded access to HIV testing services

1. EPIDEMIOLOGY OF HIV/AIDS AND ROLE OF COMMUNITY HEALTH NURSE FOR ITS PREVENTION BY JIMEE BORAH M.Sc NURSING COMMUNITY HEALTH NURSING

2. Pre-test: What is AIDS ? What is the causative organism of AIDS? What are the mode of transmission for HIV infection? What is ART? What is PEP? What are the role of community health nurse for prevention of HIV/AIDS?

3. INTRODUCTION: AIDS , the acquired immune-deficiency syndrome is a fatal illness caused by a retrovirus known as the human immune-deficiency virus (HIV) which breaks down the body’s immune system, leaving the victim vulnerable to a host of life-threatening opportunistic infections, neurological disorders, or unusual malignancies.

4. MAGNITUDE OF THE PROBLEM: AIDS knows no geographic, social, racial or cultural boundaries. It was recognised as an emerging disease in the early 1980s. AIDS has rapidly established itself throughout the world, and is likely to endure and persist well into the 21 st century.

5. AIDS in India: According to the estimates for the year 2015, 2.1 million people were living with HIV in India, with estimated 86,300 new HIV infections (a 66% reduction since 2000). The HIV prevalence in adults was 0.26% (0.30% in men and 0.22% in women). Children account for 12% of the total new cases. It is estimated that about 4.5 lac lives were saved from year 2004 to 2014 in the country.

6.   Mode Of Transmission: HIV (Human Immunodeficiency Virus) is transmitted through : Unprotected Sexual Contact: Vaginal, anal, or oral sex without condoms or other barrier methods . 2 . Blood-to-Blood Contact: - Sharing needles, syringes, or other injection equipment. - Blood transfusions (rare in countries with screening). - Accidental needlesticks or sharps injuries (healthcare workers ). 3 . Mother-to-Child Transmission: - During pregnancy (in utero ). - During childbirth (perinatal). - Through breastfeeding (postnatal ). 4 . Contaminated Blood Products: Rarely, through: - Transfusions of unscreened blood. - Organ or tissue transplants . 5 . Sharing Personal Care Items: Rarely, through: - Sharing razors or toothbrushes contaminated with infected blood.

7. Incubation Period: The incubation period for HIV, from exposure to the onset of symptoms, can range from :- 2-4 weeks: Some people may experience a flu-like illness, known as acute retroviral syndrome (ARS), which can include symptoms like fever, fatigue, and rash . 2-15 years: This is the average incubation period, during which the virus multiplies and gradually weakens the immune system . - 10-20 years: In some cases, the incubation period can be longer, and symptoms may not appear until decades after initial exposure.

8. Clinical Manifestations: The clinical features of HIV infection have been classified into four broad categories: Initial infection with the virus and development of antibodies. Asymptomatic carrier state AIDS-related complex AIDS

9. a. Initial infection: HIV antibodies usually take 2 to 12 weeks to appear in the blood stream, though they have been known to take longer. The period before antibodies are produced is the “window period” during which, although the person is particularly infectious because of the high concentration of virus in the blood test, he will test negative on the standard antibody blood test. All the infected case with or without symptoms can transmit the virus to others.

10. b. Asymptomatic carrier state: Infected people has antibodies, but no overt signs of disease, except persistent generalized lymphadenopathy. It is not clear how long the asymptomatic carrier state lasts.

11. c. AIDS-related complex : A person with ARC has illnesses caused by damage to the immune system, but without the opportunistic infections and cancers associated with AIDS, they may exhibit one or more of the following clinical signs; unexplained diarrhoea lasting longer than a month, fatigue, malaise, loss of more than 10% body weight, fever, night sweats, or other milder opportunistic infections such as oral thrush, generalized lymphadenopathy or enlarged spleen.

12. d. AIDS : AIDS is the end-stage of HIV infection. A number of opportunist infections commonly occur at this stage, and cancers that occur in people with otherwise unexplained defects in immunity. Death is due to uncontrolled and untreatable infection. Tuberculosis and Kaposi sarcoma are usually seen relatively early. Serious fungal infections such as Candida esophagitis, Cryptococcus meningitis and penicillosis, and parasitic infections such as Pneumocystis carinni pneumonia or Toxoplasma gondii encephalitis tend to occur, when T-helper cell count has dropped to around 100.

13. People whose count are below 50 have the late opportunistic infections such as cytomegalovirus retinitis. Many people with AIDS are affected by a wasting syndrome that is known, especially in Africa, as “slim disease”. It involves chronic diarrhoea and severe weight loss. Another condition, seen worldwide, is AIDS encephalopathy or AIDS dementia, which is caused by HIV crossing “blood-brain barrier”.

14. CONTROL OF AIDS:

15. PREVENTION Sexual Discretion Blood and blood products should be kept free from AIDS infection Blood transfusion should be given only when strictly indicated. Haemophiliacs should be given heat treated preparations instead of coagulation factors concentrates Appropriate health education should be given to public and to school and college students. Treatment facilities for drug users should be expanded to include AIDS related health education, particularly as regards use of safe needles.

16. Free and anonymous or confidential HIV testing, counselling and referral services should be routinely made available at places such as ( i ) STD clinics (ii) Drug treatment clinics (iii) Antenatal clinics (iv) Family planning centres (v) Facilities for gay men, prostitutes and hizras (eunuchs), and (vi) Communities or places frequented by persons at high risk of HIV infection (such as high way resting points for truck drivers.

17. Health care workers should be careful in handling needles, sharp instruments and blood. Latex gloves should be used whenever one has to handle blood or fluids that are visibly bloody. If patient’s blood comes in contact with the health worker’s skin, it should be immediately washed away with soap and water.

18. ANTIRETROVIRAL TREATMENT: 1 . Neucleoside reverse transcriptase inhibitors (NRTIs) Abacavir (ABC) Didanosine ( ddi ) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4T) Zidovudine (AZT)

19. 2 . Neucleotide reverse transcriptase inhibitors ( NtRTIs )   Tenofovir (TDF) 3 . Non- neucleoside reverse transcriptase inhibitors (NNRTIs) Efavirenz (EFV) Etravirine (ETV) Nevirapine (NVP)

20. 4 . Protease inhibitors (PIs )   Atazanavir + ritonavir (ATV/r) Darunavir + ritonavir ( DRV/r) Fos-emprinavir + ritonavir ( FPV+ r) Indinavir + ritonavir (IDV/r) Lopinavir + ritonavir (LPV/r) Saquinavir + ritonavir ( SQV/r ) 5. Integrase strand transfer inhibitors (INSTIs )   Raltegravir (RAL)

21. POST-EXPOSURE PROPHYLAXIS (PEP): PEP for HIV consists of a comprehensive set of services to prevent infection developing in an exposed person, including: first aid care; counselling and risk assessment; HIV testing and counselling; and, depending on the risk assessment, the short term (28days) provision of antiretroviral drugs, with support and follow-up.  

22. INDICATION : Needle stick injury Cuts from other sharps Contact of eye, nose, mouth OBJECTIVE: To prevent HIV infection of cells.

23. PROMPT MEASURES Not to do panic, not to put finger into mouth. Affected part is washed with soap and water. Antiretroviral drugs should be started as early as possible within 2 hours and it is not recommended beyond 72 hours.

24. REGIMEN: Zidovudine (300mgBD)+ Lamivudine (150mgBD) If source individual has advanced AIDS, then nelfinvir is added. If source has failed on Zidovudine + Lamivudine therapy, then Stavudine and Didanosine combination is used.

25. DURATION: Therapy is continued for 4 weeks. If HIV antibody test is found to be positive at any time within 12 weeks, then treatment of HIV infection is started. If blood test if found to be negative, then the blood examination is repeated after 3 to 6 months.

26. HIV AND TUBERCULOSIS: Despite being preventable and curable, TB is the leading cause of HIV-associated mortality. Expert MTB/RIF should be used rather than conventional microscopy, culture and drug susceptibility testing as the initial diagnostic test in adults and children suspected of having HIV-associated TB or multidrug resistant TB. Isoniazid preventive therapy and ART, given together, can reduce the risk of TB among people living with HIV by up to 97%.  

27. ROLE OF COMMUNITY HEALTH NURSE FOR PREVENTION OF HIV/AIDS:

28. Post test: What is AIDS ? What is the causative organism of AIDS? What are the mode of transmission for HIV infection? What is ART? What is PEP? What are the role of community health nurse for prevention of HIV/AIDS?

29. CONCLUSION: The spread of HIV among injection drug users, their sexual partners, and offspring accounts for a major proportion of new HIV infections in the United States, and the resultant propagation of the AIDS epidemic. The epidemiology of HIV and AIDS differs, depending on geography, inherent differences in the population at risk and the distribution of risk behaviours associated with transmission. There is no any vaccine or cure for AIDS, the only means at present available is health education to enable people to make life-saving choices .. All mass media channels should be involved in educating the people on AIDS, its nature, transmission and prevention.

30. BIBLIOGRAPHY: Roy Rabindra Nath “textbook of preventive and social medicine”. Fourth edition. Jaypee brothers medical punlishers (p) ltd Page no.27-292 Park. K. “ textbook of preventive and social medicine”. 24 th edition m/s banarsidas bhanot publishers, 2015. Page no.361-373 Kamalam S “Essentials in Community Health Nursing Practices”, 3 rd edition, Jaypee The Health Science Publishers, New Delhi, Page no.112 Basavnthappa BT “community health nursing” second edition. Jaypee brothers medical punlishers (p) ltd Page no 787-791 http://en.m.wikipedia.org>wiki>AIDS

31. Thank you