Introduction to HIV.pptx class of medicine

Introduction of Hiv

1. Module 1: Introduction to HIV

2. Broad objective At the completion of this module, participants shall acquire information and knowledge on HIV infection, transmission, progression, management and prevention according to the national HTC (HIV testing and counselling) curriculum.

3. Specific Objectives Define HIV, HIV infection and AIDS Describe the epidemiology of HIV in Adults and Children Describe the basics of the human immune system; Describe the modes of HIV transmission; Describe the biology and natural progression of HIV in adults and children; Describe common HIV-related conditions Describe HIV prevention strategy, including stigma reduction

4. Definitions What is HIV? HIV stands for H uman I mmunodeficiency V irus. It is a retrovirus. HIV Infection is the state where the virus is in the body. In most instances, this is the asymptomatic state, which is a prelude to AIDS. AIDS stands for A cquired I mmune D eficiency S yndrome. “Acquired” means it is transmissible, and “Immune-Deficiency” means it damages the body’s defence system “Syndrome” refers to a group of illnesses. Antiretroviral therapy or ART: The medicines used to treat HIV.  Viral load: Amount of HIV in their blood.

5. Unit 1: Overview and Epidemiology

6. Where did HIV come from? Scientists identified a type of chimpanzee in Central Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Studies show that HIV may have jumped from apes to humans as far back as the late 1800s Over decades, the virus slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid to late 1970

7. The origin of HIV The virus was initially named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy-associated virus). A closely related but not identical strain of the virus was identified in 1985 from West Africa. This second virus was named human T-cell lymphotropic virus, type IV (HTLV-IV). By the mid-1980s, HIV had spread into most parts of the world. In 1986, HTLV III was renamed HIV type 1, which is more aggressive and more easily transmitted and has caused the majority of infections worldwide. HTLV IV was renamed HIV type 2, which is less transmittable, with most infections being found in certain countries in West Africa. However, pockets of HIV-2 infection are also found in other parts of the world, including Kenya.

8. Is there a cure for HIV? No effective cure currently exists for HIV. However, with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy or ART. If people with HIV take ART as prescribed, their viral load (amount of HIV in their blood) can become undetectable. If it stays undetectable, they can live long, healthy lives and have effectively no risk of transmitting HIV to an HIV-negative partner through sex. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS (the last stage of HIV infection) in a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

9. Historical background of HIV 1981 – Doctors in the United States recognized Kaposi’s sarcoma (KS) in homosexual males, a condition previously unreported in healthy adults. Later, they recognized that all these patients were immuno-suppressed. 1983/4 – Scientists described the cause of this acquired immunodeficiency syndrome (AIDS) as a retrovirus:

10. Cont : Historical background The first case of Acquired Immune Deficiency Syndrome (AIDS) was recognized in 1981 by the Centre for Disease Control in the USA when they reported a rare lung infection - Pneumocystis jiroveci (carinii) pneumonia and Kaposis sarcoma in homosexual men. In 1983, Human Immunodeficiency Virus (HIV) was first isolated, while its link with AIDS was demonstrated in 1984.

11. Historical background of HIV cont’d 1984 – The first case in Kenya was described 1986 – Human Immunodeficiency Virus (HIV) was accepted as the international designation for the retrovirus in a WHO consultative meeting. 1996 – ARVs became available in the world. 1997 – ARVs became available in the private sector in Kenya. 2003 – ARVs became available in the public sector in Kenya. 2006 – Approximately 90,000 Kenyans are taking ARV treatment.

12. GLOBAL AIDS INDICATORS (UNAIDS 2016) Globally, there were an estimated 36.7 million The annual number of new HIV infections declined from 2.2 million in 2010 to 2.1 million in 2015. Overall, 1.1 million people died due to AIDS in 2015, compared with an estimated 1.5 million in 2010. The WHO African Region is the most affected region, with 25.6 million people living with HIV in 2015. The African region also accounts for almost two-thirds of the global total of new HIV infections.

13. Epidemiology of HIV in Kenya In Kenya the first diagnosis of AIDS was made in 1984. The disease prevalence peaked to around 10% in the late 1990s. As of 2015, the HIV prevalence in Kenya was 5.9% which translates to 1,517,707 people estimated to be living with HIV in Kenya. Of these 98,170 were estimated to be children between 0-14 years of age. However, prevalence is much higher in key populations, with Sex Workers having a prevalence of 29.3%, men who have sex with men 18.2%, and people who inject drugs 18.3%. (Kenya AIDS Response Progress Report, 2016)

14. Adult HIV Prevalence by County

15. Age and Gender Differences A higher proportion of adult women (6.3%) than men (5.5%) are infected with HIV. Young people (15-24 years) contributed 51% of adult new HIV infections in 2015. Young male adults accounted for 16% of total new HIV infections, whilst young female adults 33% of the total new HIV infections (Kenya AIDS Response Progress Report, 2016).

16. Estimated Number of Women, Young, Children Newly Infected With HIV During 2016 Women account for half of all people living with HIV worldwide and nearly 60% of HIV infections in sub-Saharan Africa. Over the last 10 years, the proportion of women among people living with HIV has remained stable globally but has increased in many regions. 2.1 million were children under 15, and about 18.8 million were women and girls.

17. HIV among children It is estimated that more than 90% of children living with HIV acquired the virus during pregnancy, birth or breastfeeding—forms of HIV transmission that can be prevented. A small fraction of HIV infections in children are caused by contaminated injections, the transfusion of infected blood or blood products, sexual abuse, sexual intercourse (although this is a significant mode of transmission among adolescents), or scarification In 2007, an estimated 270 000 HIV-infected children younger than 15 years died because of AIDS—more than 90% of them in sub-Saharan Africa

18. Epidemic update: Kenya

19. Epidemiology of HIV/AIDS in Children (under 15 yrs )

20. Epidemiology/Impact of HIV/AIDS in Kenya 60% medical beds- HIV/AIDS 40% Paediatric beds-HIV/AIDS >50% TB patients – HIV + >25% STI patients – HIV Health workers face both the medical and social challenges of HIV/AIDS on a daily basis

21. HIV transmission modes HIV is mainly transmitted:- through unprotected sexual intercourse with an infected person through exposure to blood, blood products, body fluids and other tissues, e.g. organ transplants and during pregnancy, birth, or breastfeeding from infected mother to child   The fluids from an infected person that can potentially transmit HIV include: Blood Semen Vaginal fluid Breast- milk

22. Transmission modes

23. Incidence and modes of transmission

24. Summary Over the past 2 decades, HIV has spread worldwide with devastating epidemiological consequences, particularly in Sub-Saharan Africa MTCT (mother-to-child transmission of HIV) is the main mode of transmission of HIV infection to children. HIV/AIDS is a major cause of morbidity and mortality.