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Introduction History of AIDS Prevalence Virology Immunopathogenesis Stages of AIDS HIV tests Oral Manifestation Manifestation in children Treatment options Dental procedures at risk Universal precautions Conclusion References

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http://www.aids-india.org/hivbasics2.htm

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40 million people in 2007(W.H.O) Two thirds present in Sub-Saharan Africa New infections 2.6 millions in 2004 4.3 millions in 2006 2.7 millions in 2007 DEATH due to AIDS - 2 million in 2007. Every 15 seconds, another person dies of HIV; every 13 seconds, another person contacts AIDS UNAIDS http://www.globalhealthreporting.org/julyhttp://www.globalhealthreporting.org/july 2008

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Person is diagnosed with AIDS when their CD4 count is below 200 & they have been diagnosed with an AIDS defining condition or an opportunistic infection Decreased bodys ability to fight infection Weak immune system Weak immune system No Cure No Cure

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Sushruta 800 b.c. and later Charaka - loss of muscle mass, fever, skin eruption, ulcers, neurological disorders, exhaustion, coma and death, manifestations similar to syndrome AIDS. In 1956 in central Africa, - gay fever. In 1981 - first recognized Cases in New York, Los Angeles and San Francisco.

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1981 - 1 st report on AIDS morbidity and mortality by USCDC. 1982 - human T lymphotropic virus-I (HTLV-I) isolated in Japan. 1983-HTLV-II isolated in US, (Miyoshi et.al) related to Asian money. 1983 - first case of unexplained immuno - deficiency in children. 1983 - first case of unexplained immuno - deficiency in children.

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1983- Luc Montognier group at the Pasteur institute, Paris isolated retrovirus from west African patients with manifestation of AIDS. Named as (LAV) 1984-Groopman isolated from saliva. 1985 First test available In 1986, International Committee on Taxonomy of virus proposed & was universally accepted as HIV

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1986-1 st case reported in Mumbai WHO & NACO. 1993-survey - AIDS epidemic in India by NACO 1997 - first case in India was through blood transfusion during an open heart surgery conducted in USA. {WHO &NACO stated } 2004 - INDIA had 5.1m CHINA had 1m CHINA had 1m 2006 -2.45 million { half of the previous}

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Status of HIV epidemic in India High Prevalent states Maharashtra Manipur Andhra Pradesh Nagaland Highest- Tamil Nadu Karnataka Manipur Andhra Pradesh Nagaland Highest- Tamil Nadu Karnataka

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Prevalence 19983.5 m 19993.7 m 2000 3.86m 2001 3.97 m 2004 5.1 m 20062.45m Inference : infections are declining

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react with HIV type 1 antiserum HIV-I not react at all HIV-II HIV-1 most common cause worldwide. Group M (major)- A to J Other groups - O and N. Dominant subtype in western India - C

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Modes of HIV/AIDS Transmission

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HIV Virus T-Cell HIV Infected T-Cell New HIV Virus

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Earlier thought- HIV is labile virus. Now it has been confirmed that HIV can survive up to many hours/days out side the body. ---- Dr. Harold Jaffe HIV Exposure and Infection exposed one time & becomes infected exposed one time & becomes infected multiple exposures without infected multiple exposures without infected

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Period of time after becoming infected when an HIV test is negative Period of time after becoming infected when an HIV test is negative 90 percent of cases test positive within three months of exposure 90 percent of cases test positive within three months of exposure 10 percent of cases test positive within three to six months of exposure 10 percent of cases test positive within three to six months of exposure

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Can Look healthy Be unaware of infection Live long productive life Infect others

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Stage 1 - Primary Short, flu-like illness - occurs one to six weeks after infection no symptoms at all Infected person can infect other people

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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 very low levels HIV antibodies are detectable in the blood

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Stage 3 - Symptomatic The symptoms are mild The immune system deteriorates Emergence of opportunistic infections and cancers

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Stage 4 - HIV AIDS The immune system weakens The illnesses become more severe leading to an AIDS diagnosis

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Not universally accepted Not universally accepted Composite of clinical signs and symptoms Not a diagnostic stage Not a diagnostic stage ARC includes presentation of- Chronic pyrexia Chronic diarrhea, Chronic weight loss and Some opportunistic infection like thrush

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CLINICAL FEATURES -AIDS

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HIV TESTS

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No name is used No name is used Unique identifying number Unique identifying number Results issued only to test recipient Results issued only to test recipient 23659874515 Anonymous

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1. Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay (ELISA/EIA). 2. Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIA/IFA). 3. Polymerase Chain Reaction (PCR). (PCR). 4. Western Blot test.

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Urine Western Blot As sensitive as testing blood As sensitive as testing blood Safe way to screen for HIV Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV Can cause false positives in certain people at high risk for HIV

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Orasure FDA app.HIV antibody FDA app.HIV antibody Accurate as blood testing Accurate as blood testing Draws blood-derived fluids from the gum. Draws blood-derived fluids from the gum. NOT A SALIVA TEST! NOT A SALIVA TEST!

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Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml

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OF AIDS

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Angular Cheilitis

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severe form

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Necrotizing Ulcerative Periodontitis

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Neutropenic Ulcerations

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The probability that an HIV positive womans baby will become infected if no anti- retrovirals are administered to mother or child is as high -as 35%.

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HIV DNA PCR HIV culture HIV RNA PCR P24 Antigen

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Total CD4 counts in normal infants are considerably higher than adults. Therefore, CD4 Percentage should be used to monitor disease Clinical Progression of HIV in children Average70% Rapid 20% Long Term 10% AIDS Education and Training Centers National Resource Center,2003

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Stage1 Asymptomatic Generalized Lymphadenopathy Stage 2 Chronic Diarrhea, Fever Recurrent Candidiasis Failure to Thrive/Weight Loss Recurrent Bacterial Infections Stage 3 Severe Failure to Thrive Encephalopathy Malignancy AIDS Defining Opportunistic Infection Progressive encephalopathy

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Suspected Symptomatic HIV Infection 3 or More of the Following Pneumonia Low Weight for Age Ear Discharge Unsatisfactory Weight Gain Persistent Diarrhea Enlarged Lymph Nodes Oral Thrush Parotid Enlargement

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Parotitis

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Molluscum Contagiosum

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Monitor growth and development Immunisation Vitamin A supplementation Co-trimoxazole prophylaxis Counsel nutrition Family support/ Health of Caregivers Dental Care

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

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Lamivudine+Zidovudine Efavirenz 600mg Nevirapine 200mg Didanosine-EC 250mg Didanosine-EC 400mg Stavudine 30mg Stavudine 40mg Lamivudine 150mg Zidovudine 300mg Indinavir400 mg

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Report the incident, Medical follow-up & HIV testing Four week course medication- Zidovudine (AZT) (200 mg TDS) + Lamivudine (3TC) (150 mg BD) x 4 weeks Liver function tests to monitor medication tolerance If source has advanced AIDS, protease inhibitor Nelfinavir (750 mg TDS) should be added to AZT+3TC If AZT/3TC therapy fails, Stavudine (D4t) ( 40 mg BD)+ Didanosine(ddI)(12 to 300 mg BD) should be used instead.

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Abstinence Monogamous relationship Protected Sex Sterile Needles

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Hand-wash - plain soap & water Hand-wash - plain soap & water Antiseptic hand-wash Antiseptic hand-wash Alcohol-based hand-rub Alcohol-based hand-rub Surgical antisepsis- antiseptic soap or an alcohol-based hand-rub Surgical antisepsis- antiseptic soap or an alcohol-based hand-rub Before & after patient treatment (before & after glove)

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Masks, Protective Eyewear, Face Shields Masks, Protective Eyewear, Face Shields Wear a surgical mask and either eye protection with solid side shields or a face Wear a surgical mask and either eye protection with solid side shields or a face Change masks between patients. Change masks between patients. Clean reusable face protection Clean reusable face protection between patients; if visibly soiled. between patients; if visibly soiled.

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Undocumented modes of transmission a) Aerosols b) Dental rotary instruments c) Sweat d) Saliva e) Impressions

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Previously suctioned fluids might be retracted into the patients mouth when a seal is created Do not advise patients to close their lips tightly around the tip of the saliva ejector

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Intended for use on one patient during a single procedure Usually not heat-tolerant Cannot be reliably cleaned Examples: Syringe needles, prophylaxis cups, and plastic orthodontic brackets

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Place biopsy in sturdy, leak proof container Avoid contaminating the outside of the container Label with a biohazard symbol

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Considered regulated medical waste Considered regulated medical waste Do not incinerate extracted teeth containing amalgam Do not incinerate extracted teeth containing amalgam Clean and disinfect before sending to lab for shade comparison Clean and disinfect before sending to lab for shade comparison Can be given back to patient Can be given back to patient

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Dental prostheses, appliances, and items used in their making are potential sources of contamination Handle in a manner that protects patients and auxiliaries from exposure to microorganisms

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Indian Constitution - rights such as equality Three most important rights in the HIV scenario: Right to Informed Consent Right to Confidentiality Right against Discrimination One can seek remedy in a court of law if tested for HIV without informed consent, or your confidentiality is breached, or any of your rights have been violated. NACO

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World's deadliest infection World's deadliest infection Fourth leading cause of death worldwide. Fourth leading cause of death worldwide. Over 13 million children have been orphaned Over 13 million children have been orphaned 40 million people living with HIV or AIDS worldwide. (UNAIDS) 40 million people living with HIV or AIDS worldwide. (UNAIDS)

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Thank You.

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1. Ananthanarayan R, Paniker Jayaram CK. Textbook of Microbiology; seventh edition 1. Ananthanarayan R, Paniker Jayaram CK. Textbook of Microbiology; seventh edition 2. Ayliffe G.A.J, Fraise A.P., Geddes A.M., Mitchell K. Control of Hospital acquired infection A practical handbook 3. Davidson S. Principles and Practice of Medicine; 19th edition;. 4. Dental Clinics of North America. Vol. 34; No.1; January 1990. 5. Madan Gautam. Infection control in the dental clinic-part 5. Madan Gautam. Infection control in the dental clinic-part 6. Harris M., McGowan D.A., Seward G. 6. Harris M., McGowan D.A., Seward G. 7. Mehta P.J. Practical Medicine; 16th edition. 7. Mehta P.J. Practical Medicine; 16th edition. 8. Aids and Oral Health NS Yadav And Rupam Sinha 9. http://www.hopkins-hivguide 9. http://www.hopkins-hivguide http://www.hopkins-hivguide 10. http://www.thebody.comA 11. http://www.globalhealthreporting.org/diseaseinfo.asp?id=23