Vous êtes sur la page 1sur 25

HIV: THE Global & South

African Indaba/ Agenda

 Understand the global and local impact of the
 Know about HIV in children and its effects on
 Understand the natural history of HIV infection
 Understand the modes of HIV transmission
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
Acquired Immune Deficiency
• 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
• 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
HIV-1 and HIV-2
• HIV-1 and HIV-2 are
• Transmitted through the same routes
• Associated with similar opportunistic

 • HIV-1 is more common worldwide

 • HIV-2 is found in West Africa, Mozambique,

and Angola
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
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
Transmission of HIV
HIV is not transmitted by:
 Coughing and  Public baths
sneezing  Handshakes
 Insect bites  Work or school
 Touching and contacts
hugging  Using telephones
 Water and food  Sharing cups,
 Kissing glasses, spoons,
plates and other
Global summary of the HIV and AIDS epidemic,
December 2004

Number of people living 44.3
39.4 million (35.9
– millio
Adults 37.2 million (33.8
– million
with HIV in 2004 Women 17.6 million (16.3
– millio
Children under 15 years
2.2 million (2.0
– million

People newly infected Total 4.9 million (4.3

– million
Adults 5.7
4.3 million (3.7
– million
with HIV in 2004 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
– million
Children under 15 510
000 (460 000–
600 000)

The ranges around the estimates in this table ies

the actual numbers lie, based on the

00003-E-1 – December 2004

About 14 000 new HIV infections a day in 20

● More than 95% are in low and middle incom e countrie

● Almost 2000 are in children under 15 years of age

● About 12 000 are in persons aged 15 to 49 years, of

— almost 50% are w om en
— about 50% are 15 –24 year olds

00003-E-10 – December 2004

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
Modes of Transmission
 MTCT accounts for the majority of infections in children
(> 95%) either perinatally or through breastfeeding
 Sexual abuse: at Tygerberg hospital it accounted or 1%
of infections at the Family clinic for HIV
 Transfusion of Blood and related products: a small
number infected due to failure to determine viraemic
donors prior to antibody production
 Horizontal: usually in seronegative parents, consider
parents, expressed milk given to hospitalized babies,
Nosocomial spread due to razor use.
Impact of Global HIV

• Negative economic impact on countries

• Overstrained healthcare systems
• Decreasing life expectancy
• Reversal of child survival gains
• Increased numbers of orphans
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

Prevention of
HIV Transmission
 Public health strategies to prevent HIV
• 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
Natural History of HIV Infection
Natural History of HIV Infection

Immune suppression
• HIV attacks white blood cells,called
CD4 cells, that protect body from
• Over time, the body’s ability to fight
common infections is lost
• Opportunistic infections occur
HIV Disease
Progression of HIV disease is measured by:
 CD4+ count
Degree of immune suppression
Lower CD4+ count means decreasing
 Viral load
Amount of virus in the blood
Higher viral load means more immune
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
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)
HIV Disease
•Direct infection of organ systems
• HIV can directly infect the:
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)
HIV Disease: Summary
• HIV multiplies inside the CD4+ cells, destroying
• 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
Key Points
• HIV is a global pandemic and the number of
people living with HIV continues to increase
• 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.
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