Understanding HIV/AIDS: Prevention, Transmission, and Treatment

1. H.I.V.

2. 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.

3. 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)

4. 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.

5. 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.

6. “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.

7. Modes of HIV/AIDS Transmission

8. Exchange of Bodily Fluids • Blood products • Semen • Vaginal fluids

9. IntraVenous Drug Abuse • Sharing Needles • Without sterilization Increases the chances of contracting HIV • Unsterilized blades

10. Through Sex • Unprotected Intercourse • Oral • Anal

11. Mother-to-Baby • Before Birth • During Birth

12. Myths about transmission

14. NATURAL COURSE OF HIV/AIDS

15. Stage 1 - Primary • Short, flu-like illness - occurs one to six weeks after infection • Mild symptoms • Infected person can infect other people

16. 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

17. Stage 3 - Symptomatic • The immune system deteriorates • Opportunistic infections and cancers start to appear.

18. Stage 4 - HIV  AIDS • The immune system weakens too much as CD4 cells decrease in number.

19. Opportunistic Infections associated with AIDS CD4<500 • Bacterial infections • Tuberculosis (TB) • Herpes Simplex • Herpes Zoster • Vaginal candidiasis • Hairy leukoplakia • Kaposi’s sarcoma

20. Opportunistic Infections associated with AIDS CD4<200 • Pneumocystic carinii • Toxoplasmosis • Cryptococcosis • Coccidiodomycosis • Cryptosporiosis • Non hodgkin’s lymphoma

21. CD4 <50 • Disseminated mycobacterium avium complex (MAC) infection • Histoplasmosis • CMV retinitis • CNS lymphoma • Progressive multifocal leukoencephalopathy • HIV dementia

22. 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 roentgenpresentation • High rate of MDR/XDR • High rate of treatment failure and relapse (5% vs < 1% in HIV)

24. Testing Options for HIV

25. 23659874515 Anonymous Anonymous Testing • No name is used • Unique identifying number • Results issued only to test recipient

26. Blood Detection Tests

27. 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

28. 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!

29. Treatment Options

30. HAART = highly active anti-retroviral treatment

31. Antiretroviral Drugs (HAART) • Nucleoside Reverse Transcriptase inhibitors • AZT (Zidovudine) • Non-Nucleoside Transcriptase inhibitors • Viramune (Nevirapine) • Protease inhibitors • Norvir (Ritonavir)

32. EFFECTIVENESS OF HAART IN REDUCING MORTALITY

33. 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

34. 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

35. PRIMARY PREVENTION:Five ways to protect yourself? • Abstinence • Monogamous Relationship • Protected Sex • Sterile needles • New shaving/cutting blades

36. 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

37. 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

38. 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

39. 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

40. GLOBAL ESTIMATES 2008

41. ESCALATING EPIDEMIC !!! Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO.

42. HIV PREVALENCE IN VARIOUS REGIONS Sub-Saharan Africa South/South-East Asia 42% Latin America Eurasia North America East Asia Western Europe Total = 39.4 million North Africa/Middle East Caribbean < Oceania Source: UNAIDS, AIDS Epidemic Update, December 2004.

43. NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS 63% Total = 4.9 million Source: UNAIDS, AIDS Epidemic Update, December 2004

44. 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

45. ESCALATING EPIDEMIC OF HIV IN HIGH RISK GROUPS IN PAKISTAN

46. 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.

47. 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.

48. 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.

49. 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.

50. 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.