Story of a Doctor

1. Story of a Doctor

2. HIV/AIDS Dr. Pracheth R. Assistant Professor-Community Medicine

3. Outline • Problem statement • Epidemiology • Clinical features • Drugs • Treatment • Prevention and Control

4. Problem statement-World • Emerging disease: early 1980s • 34.2 million PLHVA • Resurgence of TB • 1996: ART • 2010: CD4<350 cells/cu.mm

5. India • Group I: Maharashtra, Karnataka, Tamil Nadu, Andhra: 5%-high risk, 1%-antenatal women • Group II: Gujarat, Goa: 5%-high risk, <1%-antenatal • Group III: Low prevalence

6. Epidemiology • Agent factors: • Agent: • LAV, two short strands: RNA • Destroy T4 helper cells: subset of human T-lymphocytes • Reservoir: case/carriers

8. Continued…. • Source of infection: blood , semen , CSF, saliva, tears, breast milk • Host factors: • Age • Gender • High risk groups

9. Immunology • Healthy: twice-helper cells> suppressor cells • Ratio is reversed in AIDS • Total lymphocyte count< 500 cells/cu.mm • Opportunistic infections

11. Mode of transmission • Sexual transmission: • Women: larger surface area exposed, semen more HIV • Anal intercourse: abrasions on mucous membrane • Teenagers: cervix less efficient • Menopause: thinning of mucosa. • STD: 8-10 times- inflammation: T cells concentrate-genital area: easy spread

12. Continued….. • Blood contact: • Contaminated blood transfusion-whole blood cells, platelets, factors VIII, IX • Infected blood: risk-95% • Dose of virus • Contaminated needle , syringes lower • Drug abusers: exposure repeated.

14. Continued…. • Mother-to-child transmission: • Through placenta: delivery, breast feeding • Rates: 20-25% • Risk : high-newly infected

15. Incubation period • Uncertain: few months-10 years • Can be silent : many years • 75% infected-AIDS: 10 years

16. WHO Case Definition (2 major, 1 minor) • Major signs: • Weight loss ≥ 10% body weight • Chronic diarrhoea > 1 month • Prolonged fever > 1 month

17. Continued…. • Minor signs: • Persistent cough > 1month • Generalized dermatitis • H/O herpes zoster • Oropharyngeal candidiasis • Generalized lymphadenopathy

18. Expanded case definition • Adult/adolescent (>12 years) • HIV antibody test positive, 1/more: • ≥ 10% body weight loss/diarrhoea/fever-1 month • Cryptocoocal meningitis • Pulmonary/extrapulmonary TB

19. Continued…. • Kaposi sarcoma • Neurological impairment: daily activities • Oesophagial candidiasis • Recurrent pneumonia • Invasive cervical cancer

20. Clinical manifestations • Initial: 70%: no symptoms-5 years • Window period: before antibodies formed • Asymptomatic carrier state: • No signs, generalized lymph nodes +

21. Continued…. • AIDS related complex: • Damage-immune system: with/without opportunistic infections • Clinical signs

22. AIDS • End stage HIV infection • Opportunistic infections occur • Death: uncontrolled effects

23. Opportunistic infections

24. Tuberculosis

25. Herpes simplex

26. Oesophageal candidiasis

27. Kaposi sarcoma

28. Toxoplasmosis

29. CMV retinitis

30. Laboratory diagnosis • Screening tests: • Sensitive: ELISA • Specific: Western Blot-confirmatory • Virus isolation: expensive, slow • CD4 count: trend, every three months, < 350 cells/cu.mm

31. Counseling

32. Counseling • Counseling: meaning • Pre-test • Post-test • Follow-up counseling

33. ART • Nucleoside Reverse Transcriptase Inhibitors (NRTI): Zidovudine, Didanosine, Stavudine, Lamuvidine • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI): Nevirapine, Delavirdine, Efavirenz • Protease inhibitors (PI): Indinavir, Saquinavir, Ritonavir

34. Regimens First line (2NRTIs +1 NNRTI) • Zidouvidne+Lamivudine+Nevirapine • Stavuidne+Lamivudine+Nevirapine • Stavudine+Lamivudine+Efavirenz Second line • Protease Inhibitor+2 NRTI

35. Post-exposure prophylaxis • Combat occupational exposure • Primary prevention fails • First aid care: • Skin: wash soap, water • No antiseptics • Eye: irrigate: saline • Mouth: spit fluid, rinse thoroughly

36. Post-exposure prophylaxis • Establish eligibility: • First: within 72 hours, ideally : 2 hours • Counseling • Prescribe • Two NRTI, add Protease Inhibitor • For 28 days • Follow up

37. Standard precautions • Prevent cross infection • Safeguard health personnel • Avoid infection: society: hospital wastes

39. Specific prophylaxis • If CD4 < 200 : Pnemocystiscarnii • Cotrimoxazole, aerosolized pentamidine • M. avium complex: Rifabutin: if CD4< 200 • M. tuberculosis: 300 mg INH daily -9 months • Prevention of Parent to Child Transmission

40. Prevention of Parent to Child Transmission

41. Continued…. • Lifelong ART irrespective of CD4 • 6 weeks of Nevirapine syrup newborn, 12 weeks if duration ART < 24 weeks in mother

42. National AIDS Control Programme • In 1986: First case detected • In 1992: AIDS Control Programme I • In 1999: II • In 2007: III • In 2012: IV

43. NACP • First case detected ? • Total 99% population free • Reduce impact, zero transmission • Blood Safety • Counseling and HIV Testing • STD Control • Condom Promotion

44. Nacp • School AIDS Education • Ante-retroviral drugs (ART) • Prevention of Parent to Child Transmission (PPTCT) • HIV Testing for TB Patients

45. Magic Johnson

46. Summary

47. PORTIONS INTERNALS (6TH TERM) • Respiratory Infections: • Small Pox and Chicken Pox • Measles and Rubella • Diphtheria and Whooping Cough • Acute Respiratory Infections • Tuberculosis and RNTCP • Vector-borne diseases: • Malaria, dengue, filariasis, Japanese Encephalitis, Leishmaniasis, Chikungunya • NVBDCP

48. PORTIONS INTERNALS (6TH TERM) • Sexually Transmitted Infections: • STDs • HIV/AIDS and National Programme • Non-Communicable Diseases: • Diabetes • Hypertension

49. THANKS 