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Slide 2 - DR. S.K CHATURVEDI Lesson objectives Understand the global and local impact of the epidemic Know about HIV/AIDS in adults, children, and families Understand the natural history of HIV infection Understand the modes of HIV transmission Scope of the HIV/AIDS Pandemic Natural History and Transmission of HIV
Slide 3 - DR. S.K CHATURVEDI HIV Human Immunodeficiency Virus H = Infects only Human beings I = Immunodeficiency virus weakens the immune system and increases the risk of infection V = Virus that attacks the body
Slide 4 - DR. S.K CHATURVEDI AIDS Acquired Immune Deficiency Syndrome A = Acquired, not inherited I = Weakens the Immune system D = Creates a Deficiency of CD4+ cells in the immune system S = Syndrome, or a group of illnesses taking place at the same time
Slide 5 - DR. S.K CHATURVEDI HIV and AIDS When the immune system becomes weakened by HIV, the illness progresses to AIDS Some blood tests, symptoms or certain infections indicate progression of HIV to AIDS
Slide 6 - DR. S.K CHATURVEDI HIV-1 and HIV-2 • HIV-1 and HIV-2 are • Transmitted through the same routes• Associated with similar opportunistic infections • HIV-1 is more common worldwide • HIV-2 is found in West Africa, Mozambique, and Angola
Slide 7 - DR. S.K CHATURVEDI HIV-1 and HIV-2 HIV-2 is less easily transmitted HIV-2 is less pathogenic Duration of HIV-2 infection is shorter MTCT is relatively rare with HIV-2 MTCT of HIV-2 has not been reported from India
Slide 8 - DR. S.K CHATURVEDI Transmission of HIV HIV is transmitted by Direct contact with infected blood Sexual contact: oral, anal, or vaginal Direct contact with semen or vaginal and cervical secretions HIV-infected mothers to infants during pregnancy, delivery, or breastfeeding
Slide 9 - DR. S.K CHATURVEDI Transmission of HIV HIV is not transmitted by Public baths Handshakes Work or school contact Using telephones Sharing cups, glasses, plates, or other utensils Coughing, sneezing Insect bites Touching, hugging Water, food Kissing
Slide 10 - DR. S.K CHATURVEDI 00003 - E - 1 – December 2004 Global summary of the HIV and AIDS epidemic, December 2004 The ranges around the estimates in this table define the boundar ies within which the actual numbers lie, based on the best avail able information. Number of people living with HIV in 2004 Total 39.4 million (35.9 – 44.3 million) Adults 37.2 million (33.8 – 41.7 million) Women 17.6 million (16.3 – 19.5 million) Children under 15 years 2.2 million (2.0 – 2.6 million) People newly infected with HIV in 2004 Total 4.9 million (4.3 – 6.4 million) Adults 4.3 million (3.7 – 5.7 million) Children under 15 years 640 000 (570 000 – 750 000) AIDS deaths in 2004 Total 3.1 million (2.8 – 3.5 million) Adults 2.6 million (2.3 – 2.9 million) Children under 15 years 510 000 (460 000 – 600 000)
Slide 12 - DR. S.K CHATURVEDI Global HIV/AIDS in 2004 * 39.4 -40.0 million people are living with HIV/AIDS 2.2 million are children under 15 years 6,40,000 children were newly infected with HIV in 2004 5,10,000 children died of HIV in 2 * Source: UNAIDS,2004 5.1 m. Indian living with HIV
Slide 13 - DR. S.K CHATURVEDI Reported cases Reported AIDS cases (15,202) Estimated AIDS cases (219,400) People living with HIV/AIDS (2.2 million) Only a small number of PLWHA are reported
Slide 14 - DR. S.K CHATURVEDI Impact of Global HIV Negative economic impact on countries Overstrained healthcare systems Decreasing life expectancy Reversal of child survival gains Increased numbers of orphans
Slide 15 - DR. S.K CHATURVEDI HIV Estimates in India
Slide 16 - DR. S.K CHATURVEDI MCH Profile (India) Total Population 1027 M Crude Birth Rate 25/1000 Sex Ratio (F:M) 933 Annual Pregnancies 27 M ANC Coverage 65.4 % Institutional Deliveries [12.1% to 79.3%] 35.6 % Deliveries attended by skilled birth attendants 42.3 %
Slide 17 - DR. S.K CHATURVEDI Adult HIV Prevalence High Prevalence States: these are Tamil Nadu, Maharastra, Karnataka, Andhra Pradesh, Manipur and Nagaland
Slide 18 - DR. S.K CHATURVEDI Mode of Transmission of HIV In India
Slide 19 - DR. S.K CHATURVEDI MTCT in 100 HIV+ Mothers The majority of children do not get infected even when we do nothing
Slide 20 - DR. S.K CHATURVEDI Risk of PTCT Transmission Globally: 15-45% India: 30-37% ( average)
Slide 21 - DR. S.K CHATURVEDI 0 20 40 60 80 100 Bihar Gujarat Uttar Pradesh Urban Male Urban Female Rural Male Rural Female % Source: National AIDS Control Organization, National Baseline General Population Behavioural Surveillance Survey 2001 Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact, Selected States in India 2004 Report on the Global AIDS Epidemic
Slide 22 - DR. S.K CHATURVEDI Prevention of HIV Transmission Strategies to prevent HIV transmission Personal strategies Public health strategies Safe practices: no risk of HIV transmission Risk reduction: reduces but does not eliminate risk
Slide 23 - DR. S.K CHATURVEDI Prevention of HIV Transmission Public health strategies to prevent HIV transmission Screen all blood and blood products Follow universal precautions Educate in safer sex practices Identify and treat STIs/other infections Provide referral for treatment of drug dependence Apply the comprehensive PPTCT approach to prevent vertical transmission of HIV
Slide 24 - DR. S.K CHATURVEDI Natural History of HIV Infection
Slide 25 - DR. S.K CHATURVEDI Natural History of HIV Infection Virus can be transmitted during each stage Seroconversion Infection with HIV, antibodies develop Asymptomatic No signs of HIV, immune system controls virus production Symptomatic Physical signs of HIV infection, some immune suppression AIDS Opportunistic infections, end-stage disease
Slide 26 - DR. S.K CHATURVEDI Natural History of HIV Infection Immune suppression HIV attacks white blood cells,called CD4 cells, that protect body from illness Over time, the body’s ability to fight common infections is lost Opportunistic infections occur
Slide 27 - DR. S.K CHATURVEDI HIV Disease Progression of HIV disease is measured by: CD4+ count Degree of immune suppression Lower CD4+ count means decreasing immunity Viral load Amount of virus in the blood Higher viral load means more immune suppression
Slide 28 - DR. S.K CHATURVEDI HIV Disease Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4+ counts) Higher the viral load, the sooner immune suppression occurs
Slide 29 - DR. S.K CHATURVEDI Progression of HIV Infection HIGH viral load (number of copies of HIV in the blood) LOW CD4 count (type of white blood cell) Increasing clinical symptoms (such as opportunistic infections)
Slide 30 - DR. S.K CHATURVEDI HIV Disease Direct infection of organ systems HIV can directly infect the: Brain (HIV dementia) Gut (wasting) Heart (cardiomyopathy)
Slide 31 - DR. S.K CHATURVEDI HIV Disease: Summary HIV multiplies inside the CD4+ cells, destroying them As CD4+ cell count decreases and viral load increases, the immune defences are weakened HIV-infected people become vulnerable to opportunistic infections HIV is a chronic viral infection with no known cure Without ARV treatment, HIV progresses to symptomatic disease and AIDS
Slide 32 - DR. S.K CHATURVEDI Key Points HIV is a global pandemic and the number of people living with HIV continues to increase worldwide. HIV epidemic is especially severe in resource-constrained settings HIV is a virus that destroys the immune system, leading to opportunistic infections. The progression from initial infection with HIV to end-stage AIDS varies from person to person and can take more than 10 years.
Slide 33 - DR. S.K CHATURVEDI Key Points (continued) The most common main route of transmission worldwide is heterosexual transmission. Women of childbearing age are at particular risk for acquiring HIV through unprotected sex HIV-positive women who are pregnant are at risk of passing HIV infection to their newborn. Risk of HIV transmission from mother-to-child can be greatly reduced through effective PMTCT programs