final pptct mod 1

Revised PPTCT Training Curriculum — India Module 1 Slide 1

Introduction to HIV/AIDS

M O D U L E 1


Module 1: Outline

Session 1: Scope of the HIV/AIDS Pandemic

Session 2: Natural History and Transmission of HIV


Module 1: Objectives

After completing this module, the participants will be able to:

• Describe the global and local impact of the epidemic

• Answer basic questions about HIV/AIDS in adults, children, and families

• Describe the natural history of HIV infection

• Describe the modes of HIV transmission


Scope of the HIV/AIDS Pandemic

S E S S I O N 1


Scope of the HIV/AIDS Pandemic


Global HIV/AIDS in 2004*

Effect on Children

• 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 2004

* Source: UNAIDS,2004


Estimated Number of Adults Infected with HIV, according to the Region, 1980 through 2003


HIV/AIDS Pyramid (2001)

• Reported AIDS cases (15,202)• Estimated AIDS cases (219,400)• People living with

HIV/AIDS (2.2 million)

Key message: Only a small number of

PLWHA are reported


Impact of Global HIV

Global outcomes of the HIV pandemic

• Negative economic impact on countries

• Overwhelmed healthcare systems

• Decreasing life expectancy

• Deteriorating child survival rates

• Increased numbers of orphans


2003

5.1 m

5.1 m. Indian living with HIV


HIV Estimates in India


New Challenges…...New Opportunities

Pondichery

Gujarat

KarnatakaGoa

Lakshwadeep

Dadra Nagar HaveliMaharashtra

Madhya Pradesh

Kerala

Tamil Nadu

Andhra Pradesh

Punjab

Rajasthan

Daman & Diu

Jammu & Kashmir

Haryana

Uttar Pradesh

Himachal Pradesh

Delhi

Chandigarh

Bihar

West Bengal

Orissa

Andaman & Nicobar

Mizoram

Meghalaya

Assam

Sikkim

Manipur

Tripura

Arunachal Pradesh

Nagaland

HIV + U5MR

Adult HIV Prevalence

High Prevalence States


Karnataka

0

1

2

3

4

5

1998 1999 2000 2001 2002 2003

% H

IV p

revale

nce

Year

* Data from consistent sites

Median HIV prevalence in ANC population in AP, Karnataka, Maharashtra and Tamil Nadu,

India, 1998−2003*

Source: National AIDS Control Organization

Andhra Pradesh Maharashtra Tamil Nadu

2004 Report on the Global AIDS Epidemic


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


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


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


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


HIV-1 and HIV-2

Differences between 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


Introduction to HIV/AIDS

Session 2

Natural History and Transmission of HIV


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

• Public baths• Handshakes• Work or school contact• Using telephones• Sharing cups, glasses, plates, or other utensils

• Coughing, sneezing

• Insect bites

• Touching, hugging

• Water, food

• Kissing


Mode of Transmission among AIDS cases in India:

December 2004 (n=96978)


0

10

20

30

40

50

60

70

80

90

100# uninfected

# infected duringBF for 2 yrs

# infected duringdelivery

#infants infectedduringpregnancy

63

uninfected

15

15

7

MTCT in 100 HIV+ Mothers

The majority of children do not get infected even when we do nothing


Risk of PTCT Transmission

Globally: 15-45%

India : 30-37% ( average)


0

20

40

60

80

100

Bihar Gujarat Uttar Pradesh

Urban Male Urban Female Rural Male Rural Female

%

Source: National AIDS Control Organization, National Baseline General Population Behavioural Surveillance Survey 2001

Proportion of Respondents Stating That HIV can be Transmitted Through Sexual Contact,

Selected States in India

2004 Report on the Global AIDS Epidemic


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


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• Provide referral for treatment of drug dependence• Apply the comprehensive PPTCT approach to prevent

vertical transmission of HIV


Rationale for PPTCT in India

27 million pregnancies per year

1,62,000 infected pregnancies

Cohort of 55,425 infected newborns per year

0.6% prevalence

30% transmission

Most of these children die within 2-5 years


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



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


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


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

_______________Head__________________

Toxoplasmosis (Toxo)Cryptococcal meningitis

_______________Eyes__________________Cytomegalovirus (CMV)

___________Mouth and Throat__________Candidiasis (Yeast)

________________Lungs________________

Pneumocystis carinii pneumonia (PCP)Tuberculosis (TB)

Histoplasmosis

_________________Gut_________________Cytomegalovirus (CMV)

CryptosporidiosisMycobacterium avium complex (MAC)

________________Skin_________________Herpes simplex

Shingles

_______________Genitals______________Genital herpes

Human papillomavirus (HPV)Vaginal candidiasis (Yeast)


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


Module 1: 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.


Module 1: 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 with an infected male partner.

• 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 PPTCT programs

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