Jas-world Aids Day Ppt

HIV/AIDS

WORKSHOP ON WORLD AIDS DAY

H Human

I Immunodeficiency

V Virus

A Acquired

I Immuno

D Deficiency

S Syndrome

HIV - virusHIV - virusHIV - virusHIV - virus

membrane:derived from the host cell membrane

two kinds of glycoproteins: gp160 gp120 and gp41

gp41 is a transmembrane protein, and gp120 is an external protein, noncovalently associated with membrane.

HIV Transmission

• Common fluids that are a means of transmission:

– Blood

– Semen

– Vaginal Secretions

– Breast Milk

epidemiology 、 prevention and cure

major group at risk ： homosexual 、 drug abusers、

infected blood or blood products

spread manner ： sexual contact 、 blood 、 mother-to-

child transmission

HIV Transmission

• HIV enters the bloodstream through:

– Open Cuts

– Breaks in the skin

– Mucous membranes

– Direct injection

HIV in Body Fluids

Semen11,000 Vaginal

Fluid7,000

Blood18,000

Amniotic Fluid4,000 Saliva

1

Average number of HIV particles in 1 ml of these body fluids

Routes of Transmission of HIV

Sexual Contact: Male-to-maleMale-to-female or vice versaFemale-to-female

Blood Exposure: Injecting drug use/needle sharing Occupational exposure Transfusion of blood products

Perinatal: Transmission from mom to babyBreastfeeding

HIV - life cycleHIV - life cycleHIV - life cycleHIV - life cycle

enter into cell

CD4+T cell is the major target cell

human HeLa cells

human HeLa cells transfected with

CD4 antigen

without infection infection

HIV Infection and Antibody Response

6 month ~ Years ~ Years ~ Years ~ Years

VirusAntibody

InfectionInfectionOccursOccurs

AIDS Symptoms

---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage---

Flu-like SymptomsOr

No SymptomsSymptom-free

<

----

----

Clinical features

Latent period ： 6 month—4 year

Infection phase： influenza-like symptom 、 infectious

Abs production ： 3-20 weeks

symptom ： AIDS related complex ARC

（ 1） opportunistic infections

（ 2） malignant tumors ： Kaposi’s sarcoma 、malignant , lymphoma

（ 3） abnormal of the central nervous system

PATHOGENESIS

• Hallmark of HIV disease is a profound immunodeficiency resulting primarily from a progressive quantitative & qualitative deficiency of the subset of T lymphocytes referred to as helper T cells or inducer T cells.

HIV-Infected T-Cell

HIVVirus

T-CellHIV Infected

T-Cell

New HIVVirus

Window Period

• This is the period of time after becoming infected when an HIV test is negative

• 90 percent of cases test positive within three months of exposure

• 10 percent of cases test positive within three to six months of exposure

WHO Case Definitions

• Case definition for HIV/AIDS is fulfilled in the presence of at least 2 major signs and at least 1 minor sign:– Major signs (weight loss, chronic diarrhea,

prolonged fever)– Minor signs (persistent cough, herpes

zoster, oropharyngeal candidiasis, etc.)

Where HIV testing is not available, patients can be diagnosed clinically based on major and minor signs and symptoms


Where HIV testing is available• The case definition for HIV/AIDS is fulfilled if

an HIV test is positive and one or more of the following conditions is present:

• HIV encephalopathy• Esophageal candidiasis• Life threatening or recurrent

pneumonia• Invasive cervical cancer


Where HIV testing is available• The case definition for HIV/AIDS is fulfilled if

an HIV test is positive and one or more of the following conditions is present:

• Weight loss • Cryptococcal meningitis• Tuberculosis• Kaposi’s sarcoma

• HIV encephalopathy• Esophageal candidiasis• Life threatening or recurrent

pneumonia• Invasive cervical cancer

WHO Clinical Staging System

• The WHO clinical staging system includes: – a clinical classification system– a laboratory classification to categorize the

immunosuppression of adults by their total lymphocyte counts

• This staging system has proven reliable for predicting morbidity and mortality in infected adults

• The WHO Clinical Staging System is based on clinical markers believed to have prognostic significance resulting in four categories

WHO Clinical Staging SystemClinical Stage 1

1. Asymptomatic infection

2. Persistent generalized lymphadenopathy (PGL)

3. Acute retroviral infection

Clinical Stage 2

4. Unintentional weight loss, < 10%

5. Minor mucocutaneous manifestations

6. Herpes zoster, within previous 5 years

7. Recurrent upper respiratory tract infections

WHO Clinical Staging System

8. Unintentional weight loss, >10%

9. Chronic diarrhea

10.Prolonged fever

11.Oral candidiasis

12.Oral hairy leukoplakia

13.Pulmonary tuberculosis

14.Severe bacterial infections

15.Vulvovaginal candidiasis

Clinical Stage 3

WHO Clinical Staging SystemClinical

Stage 4

16. HIV wasting syndrome17. PCP18. Toxoplasma of the brain19. Cryptosporidiosis with

diarrhea20. Isosporiasis with diarrhea21. Extrapulmonary

cryptococcosis22. Cytopmegaloviral disease

of an organ other than liver,spleen, or lymph node

23. Herpes simplex virus infection

24. PML (progressive multifocal leukoencephalopathy)

25. Any disseminated endemic mycosis

26. Candidiasis of the esophagus, trachea, bronchi, and lungs

27. Atypical mycobacteriosis

28. Non-typhoid Salmonella septicemia

29. Extrapulmonary TB30. Lymphoma31. Kaposi’s sarcoma32. HIV encephalopathy

WHO Clinical Staging System• WHO Improved Clinical Staging System: A further refinement of

the WHO clinical staging system includes a laboratory axis. The laboratory axis subdivides each category into 3 strata (ABC) depending on the number of CD4 cells. If this is not available, total lymphocytes can be used as an alternative marker

Laboratory axis Clinical axis

Lymphocytes* CD4** Stage 1

AsymptomaticPGL

Stage 2Early

HIV

Stage 3Intermediate

(ARC)***

Stage 4Late

AIDSA >2000 >500 1A 2A 3A 4AB 1000- 2000 200-

5001B 2B 3B 4B

C <1000 <200 1C 2C 3C 4C

WHO Clinical Staging System• WHO Improved Clinical Staging System: A further

refinement of the WHO clinical staging system includes a laboratory axis. The laboratory axis subdivides each category into 3 strata (ABC) depending on the number of CD4 cells. If this is not available, total lymphocytes can be used as an alternative marker

Laboratory axis Clinical axis

Lymphocytes* CD4** Stage 1

AsymptomaticPGL

Stage 2Early

HIV

Stage 3Intermediate

(ARC)***

Stage 4Late

AIDSA >2000 >500 1A 2A 3A 4AB 1000- 2000 200-

5001B 2B 3B 4B

C <1000 <200 1C 2C 3C 4C

Importance of Early Testing and Diagnosis

• Allows for early treatment to maintain and stabilize the immune system response

• Decreases risk of HIV transmission from mother to newborn baby

• Allows for risk reduction education to reduce or eliminate high-risk behavior

HIV Testing

• Requires a blood or oral fluid sample

• HIV test detects the body’s antibody response to HIV infection

• The test does NOT detect the HIV virus

HIV testing policy

• No mandatory testing.• HIV testing should not be imposed as a precondition

for employment /providing health care facilities.• Voluntary HIV testing should be done with pretest and

post test counseling.• Strict confidentiality of result should be maintained .

HIV testing policy conttt….

• Person should be encouraged to share the information with hi s family members.

• In case of marriage (If one partner insists on marriage ) the test should be done by

• The contracting party to the satisfaction of the person cocerned.

LABORATORY DIAGNOSIS

• IMMUNOLOGICAL TEST.• SPECIFIC TEST.

• (1) ELISA plate is coated with a capture antibody; • (2) Sample is added, and the respective antigen

present binds to capture antibody;• (3) Biotin-conjugated secondary detection

antibody is added, and binds to the antigen captured by the first antibody;

(4) Streptavidin-HRP is added and binds to the biotin conjugated detection antibody;

(5) Colored product is formed in proportion to the amount of antigen present in the sample; The reaction is terminated by addition of acid and absorbance is measured at 450 nm;

EIA/ELISATest

PositiveNegative

Run IFAConfirmation

RepeatPositive

Positive

End Testing

Repeat ELISAEvery 3 months

for 1 year

Negative

PositiveNegativeIndeterminate

Repeat at 2-4 months

Repeat at 3 weeks

HIV Testing

No HIV ExposureLow Risk

HIV ExposureHigh Risk

NegativeHIV

+

Repeat every 6 months for continued

High risk behavior

PRESENTED BY:-GAGAN DEEP KAUR

PREVENTION OF AIDS

• Avoiding AIDS as easy as...• A bstain• B e faithful• C ondomise

PREVENTION OF AIDS

• Don't share needles.• Limit your number of sexual partners. • Know that not all types of birth control will

protect you from HIV. • Don't use nonoxynol-9. .• Get screened for STIs. • Talk with your partner. • Don't douche.

• Once a person is infected they are always

infected

• Medications are available to prolong life but they do not cure the disease

• Those who are infected are capable of infecting others without having symptoms or knowing of the infection

HIV AIDS

HIV Risk Reduction

• Avoid unprotected sexual contact

• Use barriers such as condoms and dental dams

• Limit multiple partners by maintaining a long-term relationship with one person

• Talk to your partner about being tested before you begin a sexual relationship

HIV Risk Reduction

• Avoid drug and alcohol use to maintain good judgment

• Don’t share needles used by others for:Drugs

Tattoos Body piercing

• Avoid exposure to blood products

Condoms

Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV

Condoms = Safer sex

Condoms ≠ Safe sex

People Infected with HIV

• Can look healthy• Can be unaware of their infection• Can live long productive lives when

their HIV infection is managed• Can infect people when they engage in

high-risk behavior

HIV Exposure and Infection

• Some people have had multiple exposures without becoming infected

• Some people have been exposed one time and become infected

•COLOUR CODING TO PREVENT INFECTION

HIV and Sexually Transmitted Diseases


STDs increase infectivity of HIV

– A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding

– More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection


• STDs increase the susceptibility to HIV– Ulcerative and inflammatory STDs compromise

the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV

– Ulcerative STDs include: syphilis, chancroid, and genital herpes

– Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis


• The effect of HIV infection on the immune system increases the the risk of STDs

A suppressed immune response due to HIV can:

• Increase the reactivation of genital ulcers• Increase the rate of abnormal cell growth • Increase the difficulty in curing reactivated or

newly acquired genital ulcers• Increase the risk of becoming infected with

additional STDs

HIV Post Exposure Prophylaxis

HIV Occupational Exposure

• Review facility policy and report the incident• Medical follow-up is necessary to determine

the exposure risk and course of treatment• Baseline and follow-up HIV testing• Four week course of medication initiated one to

two hours after exposure • Liver function tests to monitor medication

tolerance• Exposure precautions practiced

HIV Non-Occupational Exposure

• No data exists on the efficacy of antiretroviral medication after non-occupational exposures

• The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits

• Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure

PREVENTION --- FIRSTPREVENTION --- FIRST

HIV Non-Occupational Exposure

• Provider Considerations:

– Evaluate HIV status of patient and risk history of source patient

– Provide necessary medical care and counseling– Evaluate risk event and factors for exposure– Determine elapsed time from exposure– Evaluate potential for continuous HIV exposure– Obtain informed consent for testing and treatment– Evaluate pregnancy status of females– Monitor for drug toxicity and acute infection

Jas-world Aids Day Ppt

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