Epidemiology, prevention & control of hiv

Intro to HIV

1. Dr . Abhishek Tiwari, Assistant Professor Department of Community Medicine MLN Medical College, Prayagraj Epidemiology, Prevention & Control of HIV

2. Learning Objectives To understand why HIV is a Public Health Concern To understand the Epidemiology of HIV – Agent, Host, Environment What all could be done to Prevent infection? What are the ways available to Control HIV? 11-10-2021 2

3. Introduction AIDS – Acquired immunodeficiency syndrome Also known as “slim disease” Fatal disease caused by retrovirus (RNA) known as human immunodeficiency virus (HIV) Breaks down the body’s immune system and it becomes vulnerable to a host of life threatening complications Opportunistic infections Neurological disorders Malignancies 11-10-2021 3

4. Introduction Special feature : Person is infected for LIFE AIDS is technically the last stage of HIV infection It is also called modern pandemic, affecting both industrialized and developing countries . 2011 Theme – Getting Zero, 0 discrimination, 0 new infection & 0 AIDS related deaths United Nations, Sustainable development Goal 2030 target – Fast track, end AIDS epidemic UNAIDS ambitious target code named 90-90-90 11-10-2021 4

5. Types of HIV Epidemic Low-level  infection confined to individuals with high risk. E.g. Drug injectors. Prevalence not exceeded 5% in any defined sub population Concentrated  Spread rapidly in a defined sub population. Prevalence > 5 % in at least 1 defined sub population but < 1% in pregnant women in urban areas Generalized  I nfection present in general population. Prevalence consistently over 1% in pregnant women 11-10-2021 5

6. India’s Epidemic 3 rd largest in World 2017 – HIV Prevalence was 0.2% among adults. For our 1.3 billion population it becomes 2.1 million people living with HIV – HUGE 27% decline in new infections & 56 % decline in AIDS related deaths (2010-2017) 2017  88,000 new infection, 69000 related death 2017  79% were aware of their status & 56% were on ART (Anti-retroviral therapy) 11-10-2021 6

7. Epidemiology Agent  Virus is 1/10,000 th of a millimeter in diameter Protein capsule, containing 2 short strands of genetic material (RNA) and enzymes Replicates in actively dividing T4 lymphocytes & can remain in lymphoid cell in a latent state. Destroys human helper T cells, (T-lymphocytes) Spreads throughout the body & can cross blood brain barrier to destroy brain cells. 11-10-2021 7

8. Epidemiology HIV mutates rapidly, new strains are continually developing. 2 types HIV 1 & HIV 2 11-10-2021 8

9. Epidemiology Agent  easily killed by heat Inactivated by ether, acetone, ethanol 20% & B- propiolactone (1:400 dilution) Resistant to ionizing radiation & UV light Reservoir – Cases & Carriers Virus remains in infected person life-long Symptomless carriers infect people for years before infection manifests itself Source – virus found in Blood, semen & CSF (high) Low concentration in tears, saliva, breast milk, urine 11-10-2021 9

10. Epidemiology Host factors Age- sexually active person aged 20-49 (Mind it that they are the most productive members of society) High Risk Groups – Male homosexuals, Bisexuals, heterosexual multiple partners , injectable drug users, recipients of blood & products, hemophiliacs & clients of STD 11-10-2021 10

11. Epidemiology Mode of Transmission - Person to person Sexual transmission (most common) Blood contact Maternal- foetal transmission (MTCT) 11-10-2021 11

12. Prevention Methods Four approaches to control AIDS Prevention Antiretroviral treatment Specific prophylaxis Primary health Care 11-10-2021 12

13. Prevention Health Education – only means available before the vaccine or cure To enable people to make life-saving choices Avoid indiscriminate sex, use condom, avoid shared razor & toothbrushes IDU to be explained about No needle, syringe sharing Women suffering or at risk should avoid getting pregnant 11-10-2021 13

14. Prevention Health Education material & guidelines should be widely available to the beneficiaries All mass media channels (Print, electronic & social media) should be involved in educating people on AIDS, its nature, transmission & Prevention 11-10-2021 14

15. Antiretroviral treatment WHO has been providing guidelines for ART 2016 guidelines are based on public health approach to further expand the use of ARV It gives a detail flowchart of when to start and what to start as first or second line of treatment Post exposure prophylaxis have also been modified in 2016. 11-10-2021 15

16. A 11-10-2021 16

17. Specific prophylaxis Primary prophylaxis against p.carini pneumonia should be offered to patients with CD4 count below 200 cells/µL 11-10-2021 17

18. Primary health Care Wide ranging health implications Touches all aspect of primary health care including the most important Mother & child health, Family planning and education Essential to integrate Aids control program into primary care system 11-10-2021 18

19. Thank you all 11-10-2021 19