HIV101.ppt by UmarFarooq50


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									Dr Umar Farooq Qureshi
H   Human

I   Immunodeficiency

V   Virus
A   Acquired

    I       Immuno

        D    Deficiency

            S   Syndrome
   HIV enters the bloodstream

    ◦ Open Cuts

    ◦ Breaks in the skin

    ◦ Mucous membranes

    ◦ Direct injection
   Common fluids that are a means of

    ◦ Blood

    ◦ Semen

    ◦ Vaginal Secretions

    ◦ Breast Milk
18,000                    Vaginal
                           Fluid        Amniotic
                           7,000         Fluid
                                         4,000        Saliva

Average number of HIV particles in 1 ml of these body fluids
Sexual Contact:   Male-to-male
                  Male-to-female or vice versa

Blood Exposure:   Injecting drug use/needle sharing
                  Occupational exposure
                  Transfusion of blood products

Perinatal:        Transmission from mom to baby
HIV              HIV Infected   New HIV
        T-Cell     T-Cell        Virus
   40% to 90% with primary HIV infection
    develop an acute mononucleosis-like
    syndrome within 2 to 6 weeks following the
    initial infection.
   The duration of illness is usually less than 2
 Progressive loss of CD4 lymphocytes
 Average time---10 years,(Variable)
 Factors contributing to the rate of
 Plasma HIV RNA viral load
 CD4 cell count
 Age
 Host genetics
 Socioeconomic status
   On average, an infected person loses 50 to
    80 CD4 cells/µL per year.
     Long-term non-progression or to be elite
    controllers (persons who are infected with
    HIV but who maintain a plasma HIV RNA viral
    load of less than 50 copies/mL without
    antiretroviral therapy).
   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
     ---Initial Stage---- ---------------Intermediate or Latent Stage--------------   ---Illness Stage---

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



                      6 month                    ~ Years      ~ Years       ~ Years       ~ Years----

   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
   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
   Those recently exposed should be retested
    at least six months after their last
   Screening test (EIA/ELISA) vs. confirmatory
    test (IFA)
            EIA/ELISA   (Reactive)

            Repeat EIA/ELISA         (Reactive)

            Wesetran Blot    (Reactive)

            Positive for HIV
                             HIV Testing
                      Negative                                           Positive

No HIV Exposure                   HIV Exposure                            Repeat
   Low Risk                        High Risk                              Positive

                  Negative        Repeat ELISA                           Run IFA
                                  Every 3 months      Positive
                                     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
   A change in viral load significant-- 0.5-
    log(threefold copies/ml)
   An “undetectable” viral load--50 copies/ml
   Viral load should be checked 4 weeks after
    start antiretroviral therapy
   90% to 99% reduction in the plasma HIV RNA
    load within 2 weeks of initiating therapy
   .
   Target a viral load of less than 50
    copies/ml(should be achieved within 6
    months of beginning effective therapy)
   Once undetectable,monitored every 3 to 4
   Viral load should also be measured every 3 to
    4 months in patients who are not on
    antiretroviral therapy
         HIV                      AIDS
   Once a person is infected they are always

   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
   1. Candidiasis of esophagus, trachea,
    bronchi, or lungs
    2. Cryptococcosis, extrapulmonary
    3. Cryptosporidiosis with diarrhea persisting
    for >1 month
    4. Cytomegalovirus infection of an organ
    other than the liver, spleen, or lymph nodes
    5. Herpes simplex virus infection causing a
    mucocutaneous ulcer that persists >1 month,
    or bronchitis, pneumonia, or esophagitis of
    any duration
   6. Kaposi sarcoma in a patient <60 years
   7. Lymphoma of the brain (primary) in a
    patient <60 years
   8. Mycobacterium avium complex or
    Mycobacterium kansasii infection,
   9. Pneumocystis jirovecii pneumonia
   10. Progressive multifocal
   11. Toxoplasmosis of the brain
   1. Coccidioidomycosis, disseminated
   2. HIV encephalopathy
   3. Histoplasmosis, disseminated (at a site
    other than or in addition to the lungs or
    cervical or hilar lymph nodes)
   4. Isosporiasis with diarrhea persisting >1
   .5. Kaposi sarcoma at any age
   6. Lymphoma of the brain (primary) at any
   7. Other non-Hodgkin lymphoma of B-cell or
    unknown immunologic phenotype
    8. Any mycobacterial disease caused by
    mycobacteria other than Mycobacterium
    tuberculosis, disseminated
   9. Disease caused by extrapulmonary M.
   10. Salmonella (nontyphoid) septicemia,
    11. HIV wasting syndrome
   12. CD4 cell count <200/µL or a CD4
    lymphocyte percentage below 14%
   13. Recurrent pneumonia

   14. Invasive cervical cancer

   15.Pulmonary TB
   Avoid unprotected sexual contact
   Use barriers such as condoms and dental
   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
   Avoid drug and alcohol use to maintain good
   Don’t share needles used by others for:
            Body piercing
   Avoid exposure to blood products
Using condoms is not 100 percent
effective in preventing transmission of
sexually transmitted infections including

      Condoms = Safer sex

      Condoms ≠ Safe sex
   Should be used consistently and correctly
   Should be either latex or polyurethane
   Should be discussed with your partner
    before the sexual act begins
   Should be the responsibility of both
    partners for the protection of both partners
   Male and female condoms are available
 Can  look healthy
 Can be unaware of their
 Can live long productive lives
  when their HIV infection is
 Can infect people when they
  engage in high-risk behavior
 Some people have had multiple
 exposures without becoming

 Some people have been exposed
 one time and become infected
“When you have sex with
someone, you are having sex
with everyone they have had
sex with for the last ten

        Former Surgeon General
              C. Everett Koop
   Preventive care

   Immunizations

   Cervical cancer screening
   When to start

   AIDS defining illness
   CD4 count less tha 350/ul
   HIV asso nephropathy
   Coinfection with Hep B
   Pregnant
Nucleoside/tide reverse transcriptase inhibitors
 Abacavir
 Didanosine
 Emtricitabine
 Lamivudine
 Tenofovir
 Zidovudine
   Non- nucleoside
   Delavirdine
   Efavirenz
   Nevirapine
   Protease inhibitors
   Indinavir
   Nelfinavir
   Atazanavir

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