power point presentation on AIDS/HIV. causes

ppt on AIDS/HIV

1. HIV / AIDS BINEE MATHEW LECTURER BELIEVERS COLLEGE OF NURSING THIRUVALLA

2. INTRODUCTION HIV ( Human Immunodeficiency Virus ) is a virus that causes AIDS . A person may be “HIV positive” but not have AIDS . The most common type of HIV infections is known as HIV 1 and this lead to world wide AIDS epidemic. First clinically observed in 1981 in USA . The term GRID ( Gay Related Immune Deficiency ) was coined later . This was later in 1982 renamed by CDC and AIDS came into existence.

3. DEFINITION AIDS ,the acquired immuno-deficiency syndrome (“Slim disease”) is a fatal illness caused by a retrovirus known as human immunodeficiency 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. Among the special features of HIV infection are that once infected , it is probable that a person will be infected for life . The term AIDS refers only to the last stage of HIV infection . AIDS can be called our modern pandemic , affecting both industrialized & developing countries.

5. PROBLEM STATEMENT In middle of 20 th century , the infection was confined to green monkeys of Africa . Then , it spread to Haiti , Caribbean islands and reached USA , where it spread to all parts of the world like a devastating fire . In 1981 , the first case of a new syndrome was recognized and reported by CDC , Atlanta , USA , a rare form of pneumonia .

6. INDIA The first case of HIV infection was diagnosed in a sex worker, in Chennai , in 1986 . First case of AIDS was recognized in 1987 , in a commercial sex worker in Mumbai . By 1996-97 , there were about 2 million HIV infected persons and about 3500 cases of AIDS .

7. By 2003 , the total number of HIV cases increased to 5.1 million , including 86028 cases of AIDS , by August 2004 . Globally , India is next to South Africa in terms of the overall number of people living with AIDS .

8. EPIDEMIOLOGICAL DETERMINANTS AGENT FACTORS (a) Agent When the virus was first identified it was called “ lymphadenopathy- associated virus ( LAV )” by the French scientists . Researchers in USA called it “ human T-cell lymphotropic virus III ( HTLV-III ) . In May 1986, the International Committee on Taxonomy gave it a new name: Human immuno deficiency virus ( HIV ) .

9. (b) Reservoir of infection There is only human reservoir - cases and carriers. Once a person is infected , the virus remains in the body life long. The risk of developing AIDS increases with time . Since HIV infection can take years to manifest itself, the symptomless carriers can infect other people for years .

10. Carriers are highly infectious during the “ window period” , the period between the onset of infection and the production of antibodies . This period is about 6-12 weeks after infection .

11. (c) Source of infection * Greater concentration in blood, semen & CSF . * Lower concentrations in tears , saliva , breast milk , urine and cervical & vaginal secretions . * Also isolated in brain tissues, lymph nodes, bone marrow cells and skin .

12. 2.HOST FACTORS (a) Age Most cases have occurred among sexually active persons aged 20-40 years . This group represents the most productive members of the society, and those responsible for child bearing &child rearing .

13. (b) Sex * In North America, Europe & Australia, about 50 % of cases are homosexual/ bisexual man. * In Africa, sex ratio is equal. * Certain sexual practices also increase the risk of infection more than others. E.g.: Multiple sexual partners, anal intercourse & male homosexuality. * Higher rate of infection is seen in prostitutes .

14. ( c) High risk groups Male homosexuals Bisexuals Heterosexual partners( prostitutes) IV drug abusers Transfusion recipients of blood & blood products Hemophiliacs Clients of STD

15. (d) Immunology HIV selectively infects T-helper cells . The infected T helper cells are destroyed . People with AIDS tend to have low overall white blood cell count .
Healthy individual – twice as many helper cells as suppressor cells
It is reversed in AIDS patients.

16. A decreased ratio of T-helper to T-suppressor cells may be an indirect indicator of reduced cellular immunity . One of the most striking features of the immune system of patients with AIDS is profound lymphopenia, with a total lymphocyte count often below 500/ cu. mm

17. MODE OF TRANSMISSION By sexual transmission By blood transfusion By percutaneous route Trans placental transmission

18. Sexual transmission By direct physical contact Any vaginal , anal & oral sex can spread AIDS Acquired mainly through heterosexual contact, i.e. , through infected men to women & infected women to men . Women are more vulnerable for HIV infection than men ( women have a larger surface area of vagina being exposed and semen has high concentration of HIV ) .

19. Anal intercourse carries a greater risk of HIV transmission than vaginal intercourse ( it can cause injury to the tissues of receptive partner) . Exposed adolescent girls and women above 45 years are more prone to get the HIV infection . An STDs is either the HIV –ve or the HIV +ve partner facilitates the HIV transmission.

20. 2. Blood transfusion Transfusion of HIV infected blood & blood products i.e., platelets , whole blood cells, factor viii & ix derived from human plasma also transmit HIV .

21. 3. Percutaneous route HIV may be transmitted through percutaneous route by using contaminated syringe , needle to inject drugs . Use of any other infected skin-piercing instrument Tattooing , acupuncture or scarification can also transmit infection ( if the instrument used is unsterile ) .

22. 4. Transplacental transmission HIV may be transmitted from the HIV infected mother to her fetus through the placenta or to her infant during delivery or through breast feeding . Transmission from HIV infected mother to child can be prevented by antiretroviral drug prophylaxis, elective cesarean section before the rupture of membranes and by avoiding breastfeeding .

23. INCUBATION PERIOD Current data suggests that the incubation period is uncertain – from a few months to 10 years or even more from HIV infection to the development of AIDS . 75 % of those infected with HIV will develop AIDS by the end of 10 years .

24. CLINICAL FEATURES Classified into 4 broad categories : Initial infection with the virus and development of antibodies Asymptomatic carrier state AIDS related complex AIDS

25. INITIAL INFECTION Infection begins as soon as the HIV virus enters the body of a susceptible person about 70% of people experience mild and viral fever like symptoms . E.g.: fever , sore throat & rash , after a few weeks of infection . Most people affected with HIV have no symptoms for first 5 years or so . But they can transmit infection to others.

26. Antibodies usually appear between 2- 4 weeks after infection , but they can take longer time for this . During the period before the antibodies produced ( “window period” ) , although the person is infectious to others , his/her HIV test is –ve on the standard antibody blood test .

27. 2. ASYMPTOMATIC CARRIER STATE Infected people have antibodies, but there are no clearly manifest symptoms . This stage may last for 5 to 7 years . There may be persistent lymphadenopathy. There is leukopenia and thrombocytopenia. HIV test is +ve in this .

28. 3. AIDS - RELATED COMPLEX Unexplained diarrhea lasting longer than a month Fatigue Malaise Loss of more than 10 % body weight Fever – low grade/ intermittent Night sweats Skin rashes

29. Persistent cough for more than one month Other milder opportunistic infections – oral thrush, herpes zoster , generalized lymphadenopathy and who have a decreased no. of T helper lymphocytes are considered to have AIDS related complex .

30. 4.AIDS / LATE CHRONIC INFECTION It is the late manifestation of HIV infection . Many opportunistic infections , malignancies , serious fungal infections , e.g.: candidiasis & parasitic infections like pneumocystis , carinii pneumonia or Toxoplasma gondii encephalitis can occur , when T helper cells falls to around 100.

31. Other common opportunistic infections are: Tuberculosis : occurs when the immune system breaks down in HIV infection . Persistent generalized lymphadenopathy : lymph nodes get larger than 1 cm in diameter , in two or more sites other than the groin area for a period of at least 3 months . Kaposi sarcoma : A tumor featuring reddish brown/ purplish plaques or nodules on the skin & mucous membranes .

32. Oral pharyngeal candidiasis: Caused by a common yeast , fungus , oral thrush presents with soreness & redness , with white plaques on the tongue , and in the mouth & throat; sometimes a white fibrous layer covering the tonsils & back of the mouth .

33. Cytomegalovirus retinitis: Inflammation of the eye retina which may lead to blindness .

34. Pneumocystosis carinii pneumonia : Symptoms can include a dry , non productive cough ; inability to take a full breath and occasional pain on breathing; and weight loss and fever .

35. Toxoplasma encephalitis: Protozoal infection in CNS , presenting with focal neurological signs such as mild hemiplegia or stroke , resulting from damage to the part of brain , seizures or altered mental status . Cryptococcal meningitis: A fungal infection in CNS which usually presents with fever , headache , vomiting and neck stiffness .

36. Hairy leukoplakia : White patches on the sides of the tongue , in vertical folds resembling corrugations .

37. Herpes zoster / shingles : Viral inflammation of the CNS , presenting with localized pain and burning sensations followed by vesicle eruption & ulceration.

38. Severe prurigo / Pruritic dermatitis: Chronic skin inflammation in the form of a very itchy rash of small flat spots developing into blisters .

39. Severe/recurrent skin infections : Warts ; dermatophytosis or ringworm ; and folliculitis .

40. DIAGNOSIS WHO Case definition for AIDS surveillance * Adolescent/adult They considered to have AIDS if at least 2 of the major signs are present in combination with at least 1 of the minor signs , if these signs are not known to be due to a condition unrelated to HIV infection .

41. Major Signs Weight loss more than 10% of body weight . Chronic diarrhea for more than 1 month . Prolonged fever for more than 1 month (intermittent/constant ) .

42. Minor Signs Persistent cough for more than 1 month . Generalized pruritic dermatitis . History of herpes zoster . Oropharyngeal candidiasis . Chronic progressive or disseminated herpes simplex infection . Generalized lymphadenopathy .

43. *Children The case definition for AIDS is fulfilled if at least 2 major signs& 2 minor signs are present . Major Signs Weight loss or abnormally slow growth . Chronic diarrhea for more than 1 month . Prolonged fever for more than 1 month .

44. Minor Signs Generalized lymph node enlargement . Oropharyngeal candidiasis . Recurrent common infections like ear infection, pharyngitis . Persistent cough . Generalized rash .

45. Expanded WHO case definition for AIDS surveillance An adult/adolescent is considered to have AIDS if a test for HIV antibody gives a positive result , and one or more of the following conditions are present: More than 10% body weight loss or cachexia , with diarrhea or fever ( intermittent/constant) , for at least 1 month .

46. Cryptococcal meningitis . Pulmonary/ extra pulmonary tuberculosis . Kaposi sarcoma . Neurological impairment ( trauma or CVA ) . Invasive cervical cancer . Candidiasis of esophagus . Life threatening/ recurrent episodes of pneumonia .

47. LABORATORY FINDINGS ELISA Western blot CBC Absolute CD4 lymphocyte count HIV viral load tests B2- Microglobulin P24 antigen

48. CONTROL OF AIDS There are four basic approaches to the control of AIDS 1. PREVENTION A. EDUCATION Until a vaccine or cure for AIDS is found, the only mean at present available is health education to enable people to make life saving choices eg. Using condoms Avoid the use of shared razors and toothbrushes

49. Intravenous drug users should be informed that the sharing of needles and syringes involve special risk Women suffering from AIDS and who are at high risk of infection should avoid becoming pregnant since infection can be transmitted to the newborn

50. B) COMBINATION HIV PREVENTION ARV drugs play a key role in HIV prevention Male and female condom use Voluntary medical male circumcision Needle and syringe programmes

51. C ) PREVENTION OF BLOOD BORNE HIV TRANSMISSION People in high risk group should be urged to refrain from donating blood, body organ, sperm, or other tissue All blood should be screened for HOV1 and HOV 2 before transmission Strict sterilization practices should be ensured in hospitals and clinics

52. 2.ANTIRETROVIRAL TREATMENT At present there is no vaccine or cure for treatment of HIV infection/ AIDS. However the development of drug that suppress the HIV infection

53. CLASSIFICATION OF DRUGS USED FOR ART

54. FIRST LINE ART IN TREATMENT First line ART for Adults Consist of two nucleoside reverse transcriptase inhibitor s(NRTIs) plus a non nucleoside reverse transcriptase inhibitor (NNRTI) or an integrase inhibitor TDF+3TC+EFV First line ART for adolescents Two NRTIs+NNRTI or an INSTI TDF+3TC+EFV First line ART for children aged 3 to 10 yrs For children 3 to less than 10 years of age, the NRTI backbone should be given, in prefrential order ABC +3TC

55. First line ART for children Yoinger than 3 years of age NRTI ahould be given ABC+3 TC Infant prophylaxis Infant born to mothers with HIV who are at high risk of acquring HIV Should recieve dual prophylaxis with AZT (twice daily) and NCP ( once daily) for the first 6 weeks of life, whether they are breast fed to formula fed Infants of mothers who are receiving ART and are breastfeeding should receive 6 weeks of infant prophylaxis with daily NVP.

56. Second line treatment for adults and adolescents Two NRTIs + a protease inhibitor Second line treatment for children After failure of first line regimen of ABC or TDF+3TC, the second line ART is AZT+3TC Third line ART Third line regimen should include new drug with minimal risk of cross resistance to previously used regimen

57. POST- EXPOSURE PROPHYLAXIS (PEP) Antiretroviral therapy starts within 72 hours of exposure to prevent infection PEP comprises: Counselling First aid care HIV testing 28 day course of ARV Drugs Follow up care

58. USE OF COTRIMOXAZOLE PROPHYLAXIS FOR HIV RELATED INFECTIONS Co-trimaxazole is a fixed dose combination of two antimicrobial drugs(sulfamethaxazole and trimethoprim) that covers a variety of bacterial, fungal and protozoal infections The therapy is feasible, well tolerated and inexpensive intervention for people living with HIV to reduce HIV-related morbidity and mortality.

59. MONITORING THE EFFICACY OF ART Efficacy is monitored by Clinical improvement -gain in body weight -decrease in occurence and severity of HIV related diseases (infections and malignancies) B) Increase in total lymphocyte count C) Improvement in biological markers of HIV(when available) -CD4+T lymphocyte counts - plasma HIV RNA levels

60. 3. SPECIFIC PROPHYLAXIS Prophylaxis against M. Tuberculosis is 300 mg isoniazid daily for 9 months to one year. It should be given to all HIV infected patients with positive PPD reactions.

61. 4.PRIMARY HEALTH CARE Because of its wide-ranging health implications, AIDS touches all aspects of primary health care, including mother and child health, family planning and education. It is important, therefore, that AIDS control programmes are not developed in isolation. Integration into country's primary health care system is essential.

62. ELIMINATION OF MOTHER TO CHILD TRANSMISSION OF HIV The HIV positive mother may transmit infection to her child during pregnancy, labor, delivery or breastfeeding and this is referred to vertical transmission or mother to child transmission WHO recommends preventive strategies for MTCT which is referred to”prevention of mother to child transmission “(PITCH) : Giving ARVs to mothers and infants during pregnancy, labor and the postnatal period Offering life long treatment to HIV positive pregnant women regardless of their CD4 count