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Slide 1 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V.
Slide 2 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable.
Slide 3 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV)
Slide 4 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death.
Slide 5 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS.
Slide 6 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.
Slide 7 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission
Slide 8 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids
Slide 9 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades
Slide 10 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal
Slide 11 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth
Slide 12 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission
Slide 13 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission
Slide 14 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS
Slide 15 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people
Slide 16 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood
Slide 17 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear.
Slide 18 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number.
Slide 19 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma
Slide 20 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma
Slide 21 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia
Slide 22 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV)
Slide 23 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV)
Slide 24 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV
Slide 25 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous
Slide 26 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests
Slide 27 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV
Slide 28 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST!
Slide 29 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options
Slide 30 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment
Slide 31 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)
Slide 32 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY
Slide 33 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women
Slide 34 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis
Slide 35 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades
Slide 36 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use
Slide 37 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected
Slide 38 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex
Slide 39 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms
Slide 40 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008
Slide 41 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO.
Slide 42 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42%
Slide 43 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63%
Slide 44 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100
Slide 45 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN
Slide 46 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees.
Slide 47 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners.
Slide 48 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done.
Slide 49 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done. NON GOVERNMENTAL ORGANIZATIONS 54 NGOs are involved in HIV/AIDS public awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population.
Slide 50 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done. NON GOVERNMENTAL ORGANIZATIONS 54 NGOs are involved in HIV/AIDS public awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population. WORLD BANK RESPONSE Largest financer of HIV/AIDS program in Pakistan Providing 37.1 million US dollars Enhanced program is making encouraging progress with expansion of coverage.
Slide 51 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done. NON GOVERNMENTAL ORGANIZATIONS 54 NGOs are involved in HIV/AIDS public awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population. WORLD BANK RESPONSE Largest financer of HIV/AIDS program in Pakistan Providing 37.1 million US dollars Enhanced program is making encouraging progress with expansion of coverage. WHAT WE CAN DO?? UNAIDS Outcome Framework 2009–2011: nine priority areas We can reduce sexual transmission of HIV. We can prevent mothers from dying and babies from becoming infected with HIV. We can ensure that people living with HIV receive treatment. We can prevent people living with HIV from dying of tuberculosis. We can protect drug users from becoming infected with HIV. We can remove punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS. We can stop violence against women and girls. We can empower young people to protect themselves from HIV. We can enhance social protection for people affected by HIV.
Slide 52 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done. NON GOVERNMENTAL ORGANIZATIONS 54 NGOs are involved in HIV/AIDS public awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population. WORLD BANK RESPONSE Largest financer of HIV/AIDS program in Pakistan Providing 37.1 million US dollars Enhanced program is making encouraging progress with expansion of coverage. WHAT WE CAN DO?? UNAIDS Outcome Framework 2009–2011: nine priority areas We can reduce sexual transmission of HIV. We can prevent mothers from dying and babies from becoming infected with HIV. We can ensure that people living with HIV receive treatment. We can prevent people living with HIV from dying of tuberculosis. We can protect drug users from becoming infected with HIV. We can remove punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS. We can stop violence against women and girls. We can empower young people to protect themselves from HIV. We can enhance social protection for people affected by HIV. LIVING WITH HIV/AIDS
Slide 53 - Dr Azam Mushtaq MBBS, DTCD, FCPS Assistant professor Chest Deptt Nishtar Hospitial Multan. H.I.V. WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic. Preventable, managable but not curable. OTHER NAMES FOR HIV Former names of the virus include: Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV) WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death. AIDS (definition) Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS. “The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell. Modes of HIV/AIDS Transmission Through Bodily Fluids Blood products Semen Vaginal fluids IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades Through Sex Unprotected Intercourse Oral Anal Mother-to-Baby Before Birth During Birth Myths about transmission NATURAL COURSE OF HIV/AIDS Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection Mild symptoms Infected person can infect other people Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to low levels HIV antibodies are detectable in the blood Stage 3 - Symptomatic The immune system deteriorates Opportunistic infections and cancers start to appear. Stage 4 - HIV  AIDS The immune system weakens too much as CD4 cells decrease in number. Opportunistic Infections associated with AIDS CD4<500 Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma Opportunistic Infections associated with AIDS CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia TB & HIV CO-INFECTION TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB : Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV) Testing Options for HIV Anonymous Testing No name is used Unique identifying number Results issued only to test recipient 23659874515 Anonymous Blood Detection Tests Urine Testing Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Oral Testing Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST! Treatment Options HAART = highly active anti-retroviral treatment Antiretroviral Drugs (HAART) Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir) EFFECTIVENESS OF HAART IN REDUCING MORTALITY HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS For all HIV-infected individuals:     CD4 counts every 3–6 months    Viral load tests every 3–6 months and 1 month following a change in therapy    PPD    INH for those with positive PPD and normal chest radiograph    RPR or VDRL for syphilis   Toxoplasma IgG serology    CMV IgG serology    Pneumococcal vaccine    Influenza vaccine in season    Hepatitis B vaccine for those who are HBsAb-negative    Haemophilus influenzae type b vaccination     Papanicolaou smears every 6 months for women For HIV-infected individuals with CD4 < 200 cells/mcL:     Pneumocystis jiroveci1 prophylaxis   For HIV-infected individuals with CD4 < 75 cells/mcL:     Mycobacterium avium complex prophylaxis   For HIV-infected individuals with CD4 < 50 cells/mcL:     Consider CMV prophylaxis PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected Protected Sex Use condoms every time you have sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex When Using A Condom Remember To: Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms GLOBAL ESTIMATES 2008 ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO. HIV PREVALENCE IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America < 42% NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million 63% ESTIMATED HIV BURDEN IN PAKISTAN 0.1% of the adult population in Pakistan Total Population (2008) = 180,800,000 People living with HIV/AIDS (2008) = 96,000 Women (aged 15+) with HIV/AIDS (2008) = 27,000 Children with HIV/AIDS (2008) = nd Adult HIV prevalence(%) (2008) = 0.1% AIDS deaths (2008) = 5,100 ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN POTENTIAL THREATS IN PAKISTAN 100,000 commercial sex workers with poor safe sex awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees. UNDER-REPORTING Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners. NATIONAL RESPONSE TO HIV/AIDS Pakistan’s Federal Ministry of Health initiated a National AIDS Prevention and Control Program (NACP) in 1987 In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus The government has indicated in the recent scaling up of its response to HIV/AIDS, more needs to be done. NON GOVERNMENTAL ORGANIZATIONS 54 NGOs are involved in HIV/AIDS public awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population. WORLD BANK RESPONSE Largest financer of HIV/AIDS program in Pakistan Providing 37.1 million US dollars Enhanced program is making encouraging progress with expansion of coverage. WHAT WE CAN DO?? UNAIDS Outcome Framework 2009–2011: nine priority areas We can reduce sexual transmission of HIV. We can prevent mothers from dying and babies from becoming infected with HIV. We can ensure that people living with HIV receive treatment. We can prevent people living with HIV from dying of tuberculosis. We can protect drug users from becoming infected with HIV. We can remove punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS. We can stop violence against women and girls. We can empower young people to protect themselves from HIV. We can enhance social protection for people affected by HIV. LIVING WITH HIV/AIDS