![Clinical Manifestations
I] Initial Infection
II] Asymptomatic Carrier State
III] AIDS-related Complex(ARC)
IV] AIDS](https://image.slidesharecdn.com/aids-150808104852-lva1-app6892/85/HIV-AIDS-18-320.jpg)
![I] Initial Infection
Except for a generally mild illness of fever, sore throat
and rash, which about 70% of the people experience a
few weeks after the initial infection; Most HIV
infected people have no symptoms for the first five
years.
However they can infect others, Once, infected the
people a infected for life.
Antibody Response usually takes 2-12 weeks to appear
in the blood stream. This period is called the window
period. (Tests- Negative)](https://image.slidesharecdn.com/aids-150808104852-lva1-app6892/85/HIV-AIDS-19-320.jpg)
HIV AIDS
- 1. Dr. Nikhil Oza Intern BVDUMC A presentation on-
- 2. AIDS Acquired immuno deficiency syndrome Fatal illness Caused by a retrovirus HIV It breaks down the body's immune system, leaving the patient vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies.
- 4. 4 Epidemiology Males>females Occurs in all ages and ethnic groups All areas of the country are affected AIDS is now the second leading cause of death for all men aged 25-44 years (Unintended injuries is #1 and heart disease is #3 for this age group)
- 9. HIV- Agent It is a RNA virus Which replicates in actively dividing T4 lymphocytes. Unique ability to destroy T4 Helper cells Reservoir- Once a person gets infected virus remains in his body lifelong. And the person is a symptomless carrier for years before the symptoms actually appear.
- 10. Source The virus is found in great concentrations in blood, CSF and semen. Lower concentrations have been found in tears, saliva, breast milk, urine, cervical and vaginal secretions. Also isolated from brain tissue, lymph nodes, bone marrow cells and skin. However only blood and semen are known to transmit the virus.
- 11. 11 HIV in Body Fluids Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids
- 12. Host Age- Most cases are among sexually active people aged between age 20- 49 years. High risk groups- Male homosexuals, hetero sexual partners, i.v. drug abusers, blood transfusion recipients, haemophiliacs and patients having STDs.
- 13. 13 HIV Transmission HIV enters the bloodstream through: Open Cuts Breaks in the skin Mucous membranes Direct injection
- 14. 14 Routes of Transmission of HIV Sexual Contact: Male-to-male Male-to-female or vice versa Female-to-female Blood Exposure: Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Perinatal: Transmission from mother to baby Breastfeeding
- 15. 15 Routes of Transmission of HIV Occupational Transmission Health care worker/ hospital staff Laboratory workers Other routes Organ transplantation Artificial insemination Needle-prick
- 16. Incubation Period The incubation period is from HIV infection till development of AIDS. It is from a few months to 10 years or even more. However it is estimated that 75% of people infected with HIV will develop AIDS at the end of 10 years.
- 18. Clinical Manifestations I] Initial Infection II] Asymptomatic Carrier State III] AIDS-related Complex(ARC) IV] AIDS
- 19. I] Initial Infection Except for a generally mild illness of fever, sore throat and rash, which about 70% of the people experience a few weeks after the initial infection; Most HIV infected people have no symptoms for the first five years. However they can infect others, Once, infected the people a infected for life. Antibody Response usually takes 2-12 weeks to appear in the blood stream. This period is called the window period. (Tests- Negative)
- 20. 20 HIV Infection And Antibody Response 6 month ~ Years ~ Years ~ Years ~ Years Virus Antibody Infection Occurs AIDS Symptoms Initial Stage---------------- --------Intermediate or Latent Stage----------------- Illness Stage Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----
- 21. 21 The Acute HIV Syndrome Follows 3-6 wks following primary infection
- 22. Asymptomatic Carrier State Infected people with antibodies but without any overt signs of the disease, except persistent generalized lymphadenopathy. It is however not firmly clear about how long does the asymptomatic stage lasts.
- 23. AIDS-Related Complex Has illnesses caused by damage to immune system, but without the opportunistic infections and cancers associated with AIDS. They may exhibit- Unexplained diarrhea(lasting more than a month), fatigue, malaise, loss of body weight(>10%), fever, night sweats. Signs of Mild infections like oral thrush, generalized lymphadenopathy, enlarged spleen.
- 24. 24 Common manifestation of AIDS Lung infection: P. Carinii pneumonia Gastrointestinal infection: candidiasis of mouth or oesophagus Skin infection: Kaposis sarcoma - red or violet macules or papules Central nervous System Infection: Toxoplasmosis Dementia Meningitis Primary CNS Lymphomas. Progressive Multifocal Leucoencephalopathy.
- 25. 25 Source: NACO Opportunistic Infections Among Reported AIDS Cases in India
- 26. 26
- 27. 27 Kaposi sarcoma Candidiasis Of Mouth
- 28. Swollen parts of the body
- 29. Deterioration of the body tissues
- 31. 31 P. Carinii pneumonia Primary CNS Lymphoma
- 32. Causes/Contributors of HIV Risk Structural Level Resource Availability Physical Environment Organizational Systems Laws/Policies Individual Susceptibility Macro Level Racism, Stigma, Poverty, Gender Inequality, Migration Community Level Community Norms Social Networks Social Capital/Collective Efficacy Relationships Individual Level Behavior Attitudes Knowledge Perceptions Biology
- 34. Primary Primary HIV prevention refers to activity focused on preventing uninfected people becoming infected. Secondary Secondary HIV prevention aimed at enabling people with HIV to stay well (e.g. testing to allow people to know their status; welfare rights advice; lifestyle behaviour ; antidiscriminatory lobbying). Tertiary Tertiary HIV prevention aims to minimise the effects of illhealth experienced by someone who is symptomatic with HIV disease (e.g. the prophylactic use of drugs and complementary therapies ) 34
- 35. Diagnosis of HIV HIV antibody test using different antigen &/ or with different principle of the test Viral antigen test - used for screening blood donors in USA Detection of viral nucleic acid in blood. Determining the CD4 counts to assess the disease progression.
- 36. Testing- ICTC centre (Integrated Counseling & Testing Centre) District Hospitals Medical colleges Free HIV testing Confidential counseling Referral to nearest ART (Anti Retroviral Therapy) centre .
- 37. ANTIRETROVIRAL DRUGS NRTI NNRTI PI Zidovudine (AZT)* Nevirapine(NVP)* Indinavir(IDV)* Lamivudine (3TC)* Efavirenz(EFV)* Nelfinavir(NFV)* Stavudine (d4T)* Delavirdine(DLV) Saquinavir(SQV)* Didanosine (ddl)* INTEGRASE INHIBITORS Ritonavir(RTV)* Zalcitabine(ddC)* Raltegravir Amprenavir(APV) Abacavir(ABC)* CCR5 antagonists Lopinavir(LPV)* Tenofovir(TFV)* Maraviroc Atazanavir(ATV)* Emtricitabine(FTC) Foseamprenavir MAMC- Feb 2009 FusionInhibitor:Enfuvirtide(T-20) * Available in India , available under national programme Cost of Therapy reduced from Rs.30,000 in 1998 to Rs1000 per month in 2006, no. of pills from 32 to 1 or 2 per day,
- 38. PREVENTION Avoid multiple partners use Condoms. Use sterile needles each time for injection Never share needles Avoid unnecessary blood transfusions All pregnant women should be tested for HIV
- 39. Prevention Use standard work precautions hand hygiene, personal protective gear. Proper disposal of biomedical waste. Immunization against HBV Education
- 40. Occupational Exposure HCW comes in contact with potentially infectious body fluids due to A percutaneous injury ( needle stick, cut with sharp object) Contact with mucous membrane Contact with non intact skin (abraded, chapped, dermatitis )
- 41. Management of Exposure site Do not panic Skin Wash wound & surrounding with soap/water Rinse well Do not scrub Do not use Antiseptic or Skin washes
- 42. Management of Exposure site Splash of Blood/OPIM Eye Eye irrigation with water or Saline If using contact lens leave them in place while irrigating .Remove once eye is cleaned remove them & clean Mouth Spit fluid immediately Rinse mouth thoroughly with water / saline repeatedly Do not use soap or disinfectant
- 43. PEP Prescription Contact ART specialist Decision of starting PEP based on Exposure type & HIV status of source Decide PEP regimens Basic regimen 2 drug combination Expanded regimen 3 drug combination If source person is on ART drugs expert should be consulted after starting 2 drugs
- 44. Post Exposure Prophylaxis In India recommended for occupational exposure It should be started as early as possible (within 72 hours) ARV is given for 4 weeks HIV testing should be done at baseline, 6wks, 3mths & 6mths
- 45. HIV from being a VIRTUAL DEATH SENTENCE has been brought down to being a CHRONIC MANAGABLE DISEASE
- 46. Thank you!