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HIV AIDS PowerPoint Presentation

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Description : This medical presentation gives a global history of HIV-AIDS.

Tags : HIV, virus, immune system, Human Immunodeficiency, AIDS, Acquired Immune Deficiency Syndrome, global history

Published on : Apr 12, 2021 | Views : 3666 | Downloads : 6

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HIV-AIDS Prof. OP rajoura
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HIV v/s AIDS HIV: Human Immuno-deficiency Virus AIDS: Acquired Immuno Deficiency Syndrome A= not inherited I= immune system D= deficiency- inability to protect against illness S= syndrome, a group of symptoms or illnesses that occur as a result of HIV infection 13-04-2021 2
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GLOBAL HISTORY 1981 – beginning of the epidemic in United States - Centers for Disease Control and Prevention (CDC) published a report about five previously healthy homosexual men becoming infected with Pneumocystis pneumonia - Because the disease appeared to affect mostly homosexual men, officials initially called it Gay-related immune deficiency, or GRID. - CDC noted that this type of pneumonia had never affected people with uncompromised immune systems. 1983 - Lymphadenopathy-Associated Virus (or LAV) retrovirus was discovered 1984 - National Cancer Institute found the cause of AIDS to be retrovirus HTLV-III. 3
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1985 - Food and Drug Administration licensed the first commercial blood test for HIV 1986 - the International Committee on the Taxonomy of Viruses officially named the virus as HIV (human immunodeficiency virus) 1988 - The World Health Organization declared December 1st to be World AIDS Day. 1991 - The red ribbon became an international symbol of AIDS awareness. 2008 - Luc Antoine Montagnier was awarded Nobel Prize in Physiology and medicine for his discovery of the human immunodeficiency virus (HIV). 4
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GLOBAL BURDEN- 2019 People living with HIV = 38 million [31.6 million–44.5 million] - 36.2 million  adults(>or=15 years) 1.8 million  children (<15 years) Newly infected with HIV = 1.7 million [1.2 million–2.2 million] 81% - knew their HIV status 6.9 lacs died due to AIDS related illness Antiretroviral therapy accessed = 25.4 million www.unaids.org/en/resources/fact-sheet [accessed on 6/07/19] 5
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INDIA Suniti Solomon-first AIDS case was diagnosed in Chennai in 1986. In 2009, she was awarded , “National Women Bio-scientist Award” by Ministry of Science and Technology, Govt. of India. On 25th January 2017, Govt. of India announced “Padma shri” award for her contribution towards Medicine “what has been killing people with AIDS more is the stigma and discrimination” 13-04-2021 6
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INDIA HIV/AIDS BURDEN-2017 8
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STATE/UTs WISE % DISTRIBUTION OF TOTAL PLHIV IN 2017 9
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ADULT HIV PREVALENCE IN INDIA 1981-2017 10
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STATEWISE ADULT HIV PREVALENCE -2017 11 Adult HIV Prevalence Higher than national average
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AIDS-RELATED DEATHS OVER THE YEARS 13
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13-04-2021 16
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KEY TERMS Key populations: are defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. men who have sex with men people who inject drugs people in prisons and other closed settings sex workers transgender people. Vulnerable populations are groups of people who are particularly vulnerable to HIV infection in certain situations or contexts, such as adolescents, orphans, street children, people with disabilities and migrant and mobile workers. Men who have sex with men refers to all men who engage in sexual relations with other men. 17
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People who inject drugs: people who inject psychotropic (or psychoactive) substances for non-medical purposes. Opioids, amphetamine-type stimulants, cocaine, hypno-sedatives and hallucinogens. Injection may be through intravenous, intramuscular, subcutaneous or other injectable routes. Transgender is an umbrella term for people whose gender identity and expression does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth. Includes people who are trans-sexual, transgender or otherwise gender non-conforming Sex workers include female, male and transgender adults (18 years of age and above) who receive money or goods in exchange for sexual services, either regularly or occasionally. 18 NOTE: People who self-inject medicines for medical purposes – referred to as “therapeutic injection” – are not included in this definition. The definition also does not include individuals who self-inject non-psychotropic substances, such as steroids or other hormones, for body shaping or improving athletic performance.
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ETIOLOGY 13-04-2021 19
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HIV Enveloped ssRNA Virus, Genus: Lentivirus, Family Retroviridae, Lentiviruses (HIV 1 and 2) Attacks CD4+ cells Replicates in actively dividing T4 lymphocytes. The virus can remain in lymphoid tissues in latent phase until it is activated. Unique ability to destroy T4 Helper cells Once a person gets infected, HIV remains in his body lifelong. The person is a symptomless carrier for years before the symptoms actually appear. 13-04-2021 20
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HIV STRUCTURE HIV is composed of three main layers: Envelope Viral Matrix Core 13-04-2021 21
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HIV-1 AND HIV-2 HIV-1 and HIV-2 Transmitted though the same routes Associated with similar opportunistic infections HIV-1 is more common worldwide Groups M, N, and O Pandemic dominated by Group M Group M comprised of subtypes A – J HIV-2 is found primarily in West Africa, Mozambique and Angola less easily transmitted is develops more slowly MTCT is relatively rare with HIV-2 13-04-2021 22
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ROUTE OF TRANSMISSION *Not transmitted by urine, faeces, sputum, nasal secretion, saliva, sweat, tears, or vomit that does not contain blood that is visible to the naked eye, human bite 13-04-2021 23 RISK OF TRANSMISSION
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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
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PATHOGENESIS 13-04-2021 25
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DISEASE PROGRESSION THROUGH DIFFERENT STAGES 13-04-2021 26
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Incubation period - Few months to 10 years or even more 75% of people infected with HIV develop AIDS at the end of 10 years Severity of illness determined by: amount of virus in the blood (viral load) and the degree of immune suppression (decreasing CD4 count) Higher the viral load, sooner immune suppression occurs 13-04-2021 27
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Window period: Time between potential exposure to HIV infection and appearance of Antibodies in blood: 4-12 weeks Sero-conversion: Development of evidence of antibody response to a disease Viral Load: The amount of HIV in the blood. 13-04-2021 28
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CLINICAL FEATURES 13-04-2021 29
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RISK FACTORS FOR TRANSMISSION OF HIV 1. Unsafe sex. 2. MSM (Men having Sex with Men). 3. IDU (Injection Drug User). 4. Migration & Mobility. 5. Low status of women. 6. Widespread stigma. 13-04-2021 30
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CDC CLASSIFICATION OF HIV INFECTION Acute HIV infection Asymptomatic or Latent infection Persistent generalized lymphadenopathy (PGL) AIDS related complex ( without opprtunistic infections) Full blown AIDS (Last stage) 13-04-2021 31
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13-04-2021 32
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WHO CLINICAL STAGING Primary HIV Infection: Asymptomatic Acute retroviral syndrome Clinical stage 1: Asymptomatic Persistent generalised lymphadenopathy 13-04-2021 33
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Clinical stage 2: Moderate unexplained weight loss (<10% of presumed or measured body weight) Recurrent respiratory tract infections (sinusitis, bronchitis, otitis media, pharyngitis) Herpes zoster Angular cheilitis Recurrent oral ulcerations Papular pruritic eruptions Seborrhoeic dermatitis Fungal nail infections of fingers 13-04-2021 34
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Clinical stage 3: Severe weight loss (>10% of presumed or measured body weight) Unexplained chronic diarrhoea for longer than one month Unexplained persistent fever (intermittent or constant for longer than one month) Oral candidiasis Oral hairy leukoplakia Pulmonary tuberculosis (TB) diagnosed in last two years Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia) Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis Unexplained Anaemia(<8gm/dL), Neutropenia (<0.5x10*9/L) And/Or Chronic Thrombocytopenia (50x10*9/L) 13-04-2021 35
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Clinical stage 4: HIV wasting syndrome Pneumocystis carinii pneumonia (PCP) Recurrent severe bacterial pneumonia Chronic Herpes Simplex infection ( Orolabial, Genital or ano-rectal of <1 months duration or visceral at any site) Candidiasis (Esophageal/ Trachea/ Bronchi/Lungs) EPTB Kaposis Sarcoma CMV infection (Retina or other organs) CNS Toxoplasmosis HIV Encephalopathy 13-04-2021 36
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13-04-2021 37 Extra-Pulmonary Cryptoccocosis Disseminated Mycosis Recurrent Septicaemia Lymphoma (B-cell Non Hodgkins) Invasive Cervical Carcinoma Atypical disseminated Leishmaniasis Symptomatic HIV-associated Nephropathy or Cardiomyopathy.
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OPPORTUNISTIC INFECTIONS 13-04-2021 38
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MAJOR SIGNS 1. Weight loss > 10% body wt. 2. Chronic Diarrhoea for > 1 month. 3. Prolonged fever for > 1 month MINOR SIGNS 1. Persistent cough for > 1 month. 2. Generalized pruritic dermatitis. 3. History of herpes zoster. 4. Oropharyngeal candidiasis. 5. Chronic herpes simplex infection. 6. Generalized lymphadenopathy. 13-04-2021 39 CLINICAL DIAGNOSIS WHO case definition for AIDS surveillance- 2 major signs in combination with 1 minor sign.
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LABORATORY DIAGNOSIS Evidence of HIV infection Virus isolation Measurement of viral nucleic acid Detection of viral antigen Detection of viral antibody Recognition of immunodeficiency CD4+ T cell count Recognition of AIDS related disease 13-04-2021 40
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LABORATORY DIAGNOSIS Viral infection Viral Load p24 Antigen Immune response Antibody (IgG, IgM) Cellular response (CD4) 13-04-2021 41
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TREATMENT 13-04-2021 42
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GOALS OF ART Clinical goals : Prolongation of life and improvement in quality of life Virological goals : Greatest possible reduction in viral load for as long as possible Immunological goals : Immune reconstitution that is both quantitative and qualitative Therapeutic goals : Rational sequencing of drugs in to achieve: clinical, virological and immunological goals while maintaining treatment options, limiting drug toxicity and facilitating adherence Reduction of HIV transmission in individuals : by suppression of viral load 13-04-2021
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ANTI-RETROVIRAL DRUGS 13-04-2021
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INITIATION OF ART BASED ON CD4 COUNT AND WHO CLINICAL STAGING 13-04-2021 45
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First-line ART regimens for adults (Fixed dose combinations) Principles: 1. Choose 3TC (Lamivudine) in all regimens 2. Choose one NRTI to combine with 3TC {AZT (Zidovudine or TDF(Tenofavir)} 3. Choose one NNRTI (NVP or EFV) E.g. Tenofovir + Lamivudine + Efavirenz If TDF + 3TC or FTC(Emitricitabin) + EFV contraindicated/not available AZT (Zidovudine) + 3TC (Lamivudine) + EFV (Efavirenz) AZT + 3TC + NVP (Nevirapine) TDF + 3TC (or FTC (Emtricitabine)) + NVP TREATMENT REGIMEN 13-04-2021 46
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MONITORING OF EFFICACY OF ART 1. Clinical improvement Weight gain. Decrease severity of HIV related disease. 2. Increase in Total Lymphocyte count. 3. Improvement in biological markers of HIV. CD 4 + T – Lymphocyte count. Plasma HIV – RNA levels. 13-04-2021 47
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PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS HIV infected adults with CD4 <250 cells/mm3 OR WHO clinical stage 3 or 4 irrespective of CD4 count Recommendation: 13-04-2021 48
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Thank you 13-04-2021 49