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HIV: THE GLOABAL AND INDIAN SCENARIO

HIV: THE GLOABAL AND INDIAN SCENARIO. DR. KANUPRIYA CHATURVEDI DR. S.K CHATURVEDI. Lesson objectives. Scope of the HIV/AIDS Pandemic Natural History and Transmission of HIV. Understand the global and local impact of the epidemic Kn ow about HIV/AIDS in adults, children, and families

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HIV: THE GLOABAL AND INDIAN SCENARIO

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  1. HIV: THE GLOABAL AND INDIAN SCENARIO DR. KANUPRIYA CHATURVEDI DR. S.K CHATURVEDI

  2. Lesson objectives Scope of the HIV/AIDS Pandemic Natural History and Transmission of HIV • 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 DR. S.K CHATURVEDI

  3. 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 DR. S.K CHATURVEDI

  4. 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 DR. S.K CHATURVEDI

  5. 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 DR. S.K CHATURVEDI

  6. 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 DR. S.K CHATURVEDI

  7. 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 DR. S.K CHATURVEDI

  8. 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 DR. S.K CHATURVEDI

  9. Transmission of HIV HIV is not transmitted by • Coughing, sneezing • Insect bites • Touching, hugging • Water, food • Kissing • Public baths • Handshakes • Work or school contact • Using telephones • Sharing cups, glasses, plates, or other utensils DR. S.K CHATURVEDI

  10. Global summary of the HIV and AIDS epidemic, December 2004 44.3 million) Number of people living with HIV in 2004 Total 39.4 million (35.9 – 37.2 million (33.8 Adults 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 5.7 million) 4.3 million (3.7 – 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) 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. 00003 - E - 1 – December 2004 DR. S.K CHATURVEDI

  11. DR. S.K CHATURVEDI

  12. 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 DR. S.K CHATURVEDI

  13. 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 DR. S.K CHATURVEDI

  14. Impact of Global HIV • Negative economic impact on countries • Overstrained healthcare systems • Decreasing life expectancy • Reversal of child survival gains • Increased numbers of orphans DR. S.K CHATURVEDI

  15. HIV Estimates in India DR. S.K CHATURVEDI

  16. 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 % DR. S.K CHATURVEDI

  17. Adult HIV Prevalence High Prevalence States: these are Tamil Nadu, Maharastra, Karnataka, Andhra Pradesh, Manipur and Nagaland DR. S.K CHATURVEDI

  18. Mode of Transmission of HIV In India DR. S.K CHATURVEDI

  19. 100 # uninfected 90 80 70 # infected during 63 BF for 2 yrs 60 uninfected 50 # infected during 40 delivery 15 30 #infants infected 20 15 during 10 7 pregnancy 0 MTCT in 100 HIV+ Mothers The majority of children do not get infected even when we do nothing DR. S.K CHATURVEDI

  20. Risk of PTCT Transmission • Globally: 15-45% • India: 30-37% ( average) DR. S.K CHATURVEDI

  21. Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact, Selected States in India 2004 Report on the Global AIDS Epidemic Urban Male Urban Female Rural Male Rural Female 100 80 60 % 40 20 0 Bihar Gujarat Uttar Pradesh Source: National AIDS Control Organization, National Baseline General Population Behavioural Surveillance Survey 2001 DR. S.K CHATURVEDI

  22. 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 DR. S.K CHATURVEDI

  23. 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 DR. S.K CHATURVEDI

  24. Natural History of HIV Infection DR. S.K CHATURVEDI

  25. 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 DR. S.K CHATURVEDI

  26. 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 DR. S.K CHATURVEDI

  27. 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 DR. S.K CHATURVEDI

  28. 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 DR. S.K CHATURVEDI

  29. 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) DR. S.K CHATURVEDI

  30. HIV Disease • Direct infection of organ systems • HIV can directly infect the: • Brain (HIV dementia) • Gut (wasting) • Heart (cardiomyopathy) DR. S.K CHATURVEDI

  31. 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 DR. S.K CHATURVEDI

  32. 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. DR. S.K CHATURVEDI

  33. 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 DR. S.K CHATURVEDI

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