HIV/AIDS

WORKSHOP ON WORLD
AIDS DAY
H Human

I Immunodeficiency

V Virus
A Acquired

I Immuno

D Deficiency

S Syndrome
 HIV - 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

Blood
Semen
18,000 Vaginal
11,000
Fluid Amniotic
7,000 Fluid
4,000 Saliva
1

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

 Routes of Transmission of
HIV
Sexual Contact: Male-to-male
Male-to-female or vice versa
Female-to-female

Blood Exposure: Injecting drug use/needle sharing

Occupational exposure
Transfusion of blood products

Perinatal: Transmission from mom to baby

Breastfeeding
 HIV - life cycle
enter into cell
CD4+T cell is the major target cell

human HeLa human HeLa cells

cells transfected with
CD4 antigen

without infection infection

 HIV Infection and Antibody
Response
---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage---

Flu-like Symptoms
Or Symptom-free AIDS Symptoms
No Symptoms

Virus
Antibody ----

6 month ~ Years ~ Years ~ Years ~ Years

Infection
Occurs

----

<
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

HIV HIV Infected New HIV

T-Cell T-Cell Virus
Virus
 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
Where HIV testing is not available, patients can be diagnosed clinically
based on major and minor signs and symptoms
• 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.)
 WHO Case Definitions
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
 WHO Case Definitions
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 • HIV encephalopathy

• Cryptococcal meningitis • Esophageal candidiasis
• Tuberculosis • Life threatening or recurrent
• Kaposi’s sarcoma 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
System
Clinical 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
Clinical Stage 3
System
12.Oral hairy
leukoplakia
8.Unintention
al weight 13.Pulmonary
loss, >10%
9.Chronic tuberculosis
diarrhea
10.Prolonged
14.Severe bacterial
fever infections
11.Oral
candidiasis 15.Vulvovaginal
candidiasis
 WHO Clinical Staging System
Clinical
Stage 4
24. PML (progressive
multifocal
16. HIV wasting syndrome leukoencephalopathy)
17. PCP 25. Any disseminated
18. Toxoplasma of the brain endemic mycosis
19. Cryptosporidiosis with 26. Candidiasis of the
diarrhea esophagus, trachea,
bronchi, and lungs
20. Isosporiasis with diarrhea
21. Extrapulmonary 27. Atypical
cryptococcosis mycobacteriosis
22. Cytopmegaloviral disease 28. Non-typhoid Salmonella
of an organ other than septicemia
liver,spleen, or lymph node 29. Extrapulmonary TB
23. Herpes simplex virus 30. Lymphoma
infection
31. Kaposi’s sarcoma
32. 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

Lymphocyt CD4 Stage 1 Stage Stage 3 Stage
es* ** Asympto 2 Intermed 4
matic Early iate Late
A >2000 >50 1A PGL HIV
2A 3A(ARC)*** AIDS
4A
B 1000- 0
200- 1B 2B 3B 4B
2000 500
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

Lymphocyt CD4 Stage 1 Stage Stage 3 Stage
es* ** Asympto 2 Intermed 4
matic Early iate Late
A >2000 >50 1A PGL HIV
2A 3A(ARC)*** AIDS
4A
B 1000- 0
200- 1B 2B 3B 4B
2000 500
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;
 HIV Testing
EIA/ELISA
Test
Negative Positive

No HIV Exposure HIV Exposure Repeat

Low Risk High Risk Positive

Negative Repeat ELISA

Positive Run IFA
Every 3 months
Confirmation
for 1 year

Repeat every
6 months for continued
Indeterminate Negative Positive
High risk behavior

Repeat at Repeat at
End Testing Negative 3 weeks 2-4 months
HIV
+
 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. 
 HIV AIDS
• 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 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
 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
 HIV and Sexually
Transmitted Diseases

• 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
 HIV and Sexually
Transmitted Diseases
• 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
PREVENTION --- FIRST
• 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
 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