HIV / AIDS

  1. What is HIV/AIDS
  2. Mode of Transmission
  3. Risk factor for acquiring HIV infection
  4. How HIV can be prevented
  5. HIV is not transmitted
  6. Natural History
  7. Some common Opportunistic Infections in HIV/AIDS patient
  8. Common Symptoms and Signs of AIDS
  9. Dynamics of HIV Epidemic
  10. Levels of HIV Epidemic
  11. Antiretroviral Treatment
  12. The goals for ARV treatment are

  1. What is HIV/AIDS? 

AIDS is an acronym of Acquired Immune Deficiency Syndrome. It is caused by a virus known as Human Immune-deficiency Virus (HIV).HIV is an RNA virus belonging to the family retroviridae and subfamily lentiviridae. It has two types, HIV-1 which is prevalent all over the world including Pakistan and HIV-2, which is less virulent and is prevalent only in some parts of Africa. AIDS is a late clinical condition (disease) due to immunodeficiency resulting from gradual damage to immune system caused by HIV. HIV is found in all body fluids of infected person, including blood, Semen, vaginal fluids, infected mother’s milk, urine, saliva, sweat and tears, but transmission usually occurs only through blood, sexual secretions and infected mother’ milk.


  2. Mode of Transmission: 

  • During unprotected sex (sex without condom) from infected person to others


  • Vaginal
  • Oral
  • Anal

  • By sharing contaminated needles /syringes.


  • Needles/Syringes for Injection, to shoot Drugs, Pierce Ears, make Tatoos.
  • Blades or Razors

  • Through infected blood/blood products

  • Transfusion of HIV infected blood or blood products
     
  • From infected mother to baby
  • During pregnancy
  • During child birth
  • Through breast feeding


Infected blood

Infected needles/Syringes

Multiple Partners

Infected mother to her baby before birth

Inject able Drug Abuse

  3. Risk factor for acquiring HIV infection 
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  • Sexual Promiscuity
  • Exchange of sex for money / Anal sex
  • Homosexuality (at least some segment of population)
  • Out of marriage Sex
  • Unprotected sex (without condom)
  • Sharing of needles / syringes
  • Use of drugs
  • Age (Young people)
  • Living away from family
  • Being member of Marginalized Population


  4. How HIV can be prevented? 
  • Avoid Sexual Promiscuity
  • Avoid Extra Marital/Premarital Sex
  • Practice Safe Sex (use Condom)
  • Avoid Drugs
  • Avoid Sharing of contaminated Needles/Syringes
  • Avoid unnecessary injections, always use disposable syringes when injection is necessary
  • Ensure Screening of Blood before Transfusion
  • Don’t buy blood
  • Don’t buy blood
  • Donate blood

  5. HIV is not transmitted: 
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  • Shaking hands
  • Mosquito bites
  • Swimming in the same pond, pool or river
  • Kissing or hugging
  • Eating from the same plate
  • Caring for an infected person
  • Working & living together

Shaking Hands

Eating Together


Mosquito Bites

Toilet Seats

  6. Natural History
 
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HIV Transmission:

It is flu like condition, which usually remains un-noticed and is clinically characterized by fever, body ache and generalized lymph adinitis_and or skin rash. Incubation period is 2-4 weeks but may vary from six days to six weeks. There is intense viral replication and subsequent immune response (decline in CD4 cell counts). It is self-limiting condition and usually symptoms disappear within 1 to 2 weeks.

Primary HIV Infection (Acute Retroviral Syndrome):

HIV infection begins with the bindings HIV virus to host cells with CD4 receptors; mainly T-lymphocytes and monocytes derived macro-phases. The HIV virus is retro RNA virus, after entering the CD4+ cell, converts its RNA into DNA by using an enzyme reverse transcripts. The HIV DNA enters the nucleus of CD4 + cell and integrates itself with the host cell DNA. HIV DNA then instructs the host cell to make many copies of HIV virus.New virus particles are assembled and leave the cell ready to infect other CD4+ cells.

Seroconversion:

It means appearance of detectable antibodies. Antibodies usually appear after six week to six months. This period is called window period, although during this period virus is present in the body but there are no detectable Antibodies.

Several types of laboratory tests are available for detection of antibodies, such as ELISA.

Asymptomatic HIV Infection:

The asymptomatic period varies from 6 months to 10 years or even more in some cases. On an average it is 8 to 10 years. During this period the patient appears completely healthy, although HIV replication and destruction of CD4 cells continues, and patient can transmit infection to others through routes mentioned earlier. Asymptomatic HIV infected person is commonly known as HIV +ve person.

Symptomatic HIV Infection (AIDS):

The symptomatic stage starts once T4+ cells (CD4 cells) starts falling to less then 500/cumm. (the normal range is 600-1200). T4+ cells are the most important cells of the immune system, and their deficiency leads to development of opportunistic infection, malignancy or flare up of latent or sub-clinical infections.


  7. Some common Opportunistic Infections in HIV/AIDS patient: 
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  • Candidiasis (Ovel, Oesphogal)
  • Tuberculosis
  • Penumocystis Carani Pneumonia
  • Toxo Plasmosis
  • Cryptococced Infection
  • Mycobacterium avium
  • Cytomegalo Virus infection

  8. Common Symptoms and Signs of AIDS: 
  • Loss of weight
  • Prolonged fever without known cause
  • Prolonged diarrhea
  • Opportunistic Infections such as, Penumocystis, Carani Pneumonia
  • Skin Infections
  • Oral / Oesophasal Thrush

Diarrhea

Fever

Loss of weight

  9. Dynamics of HIV Epidemic: 
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  • Core transmitters (Female Sex Workers (FSWs), Injecting Drug Users (IDUs), Men who have sex with Men (MSM), Hijras)
  • Bridging population clients of FSWs, Truckers
  • General Population

  10. Levels of HIV Epidemic:
  • Low Prevalence
  • Concentrated Epidemic
  • Generalized Epidemic

  11. Antiretroviral Treatment
 

Currently there is no cure for AIDS. However, there are drugs that can slow down the progress of HIV and thus slow down the damage to the immune system. These drugs are called antiretroviral (ARV's). ARV's slow down the reproduction rate of HIV. Once the virus is reproducing at a slower rate, it is less able to harm the immune system.

The goals for ARV treatment are:

  1. To ensure maximum and lasting suppression of the amount HIV in the body;


  2. To restore and protect the immune functioning of the body by allowing the CD4 cells to replenish their numbers;


  3. To reduce HIV-related illnesses and deaths;


  4. In the long run to improve the quality of life for people living with AIDS

 HIV/ AIDS GLOBAL PICTURE

IN YEAR 2005 ALONE, 3.1 MILLION PEOPLE DIED DUE TO AIDS IN THE WORLD, AND 4.9 MILLION NEW INFECTIONS OCCURRED AROUND THE GLOBE.

Global estimates for adults and children, End 2005
 
PEOPLE LIVING WITH HIV/AIDS 40.3 million
(36.7 – 45.3 Million)
ADULTS 38 million
(34.5 – 42.6) Million)
WOMEN 17.5 million
(16.2 – 19.3 Million
CHILDREN UNDER 15 YEARS AGE 2.3 Million
(2.1 – 2.8 million)
PEOPLE NEWLY INFECTION WITH HIV/AIDS 4.9 million
(4.3 – 6.5 Million)
ADULTS 4.2 million
(3.6 – 5.8 Million)
CHILDREN UNDER 15 YEARS AGE 0.70 million
(0.63 - 0.82 million
AIDS DEATHS 3.1 million
(2.8 – 3.5 Million)
ADULTS 2.6 million
(2.3 – 2.9 Million)
CHILDREN UNDER 15 YEARS AGE 0.57 Million
(0.51 – 0.67 million)
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 HIV / AIDS IN SOUTH  & SOUTH EAST ASIA

  • ALTHOUGH UP TILL NOW SUB SAHARAN AFRICA HAS REMAINED WORST AFFECTED REGION IN THE WORLD WHERE MAXIMUM NUMBER OF HIV INFECTIONS HAS OCCURRED.

  • BUT RECENT EPIDEMIOLOGICAL TRENDS SHOW PERHAPS ASIA, PARTICULARLY SOUTH ASIA WILL BE EPICENTER OF HIV PANDEMIC.


  • OUR NEXT DOOR NEIGHBOR INDIA IS ALREADY EXPERIENCING A WORST TYPE OF EPIDEMIC AT LEAST IN SOME OF ITS STATES WHERE MORE THAN 5 MILLION CASES OF HIV/AIDS HAVE BEEN ESTIMATED.


  • South & South East Asia Estimates by end 2005
    ADULTS & CHILDREN LIVING WITH HIV/AIDS 8.3   Million
    NUMBER OF WOMEN LIVING WITH HIV/AIDS 2.0   Million
    DEATH OF ADULTS & CHILDREN IN 2005 0.52 Million
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 HIV / AIDS IN PAKISTAN

  • PAKISTAN WAS CONSIDERED AS HIGH RISK AND LOW PREVALENCE COUNTRY UNTIL RECENTLY BUT AFTER HIV OUTBREAK AMONG INJECTING DRUG USERS I LARKANA JUNE 2003 AND KARACHI JANUARY 2004.


  • CURRENTLY PAKISTAN IS EXPERIENCES CONCENTRATED EPIDEMIC AND THERE IS SERIOUS THREAT OF GENERALIZE EPIDEMIC.


  • MORE THAN 5% HIV PREVALENCE AMONG HIGH RISK POPULATIONS SUCH AS; INJECTING DRUG USERS, FEMALES SEX WORKERS, MALE SEX WORKERS, HIJRAS ETC IS CONSIDERED CONCENTRATED EPIDEMIC.


  • CURRENT STUDIES CONDUCTED IN KARACHI REVEAL 26% OF HIV PREVALENCE AMONG INJECTING DRUG USERS AND 7% AMONG MALE SEX WORKERS.


  • STUDIES CONDUCTED IN OTHER PROVINCES ALSO SHOW SIMILAR TREND (HIV PREVALENCE AMONG IDUS IN FAISALABAD 12%)

National HIV/AIDS Reported Cases Up to September 30, 2005

HIV SYMPTOMATIC CASES 2741
FULL BLOWN AIDS CASES 332
TOTAL 3073

Pakistan: Mode of Transmission of HIV Positive Cases up to September 30, 2005

MODE OF TRANSMISSION HIV %age
Heterosexual 991 36.72
Homosexual/ Bisexual 69 2.52
Blood/ Blood Products 318 11.60
injecting drug Users 596 21.74
Mother to Child 39 1.42
Unknown 728 26.56
Total 2741 100%
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 CHALLENGES

  • VULNERABLE POPULATIONS AND HIGH RISK GROUPS ARE DIFFICULT TO APPROACH FOR HIV/AIDS PREVENTION INTERVENTIONS IN PAKISTAN.


  • ILLEGAL STATUS/ MARGINAL SOCIAL STATUS/ LIMITED EDUCATION.


  • DIFFICULT TO TALK ABOUT SEX OPENLY.


  • DIFFICULTY IN ALLOCATION OF ALLOCATIONS OF RESOURCES OF FOR HIV/AIDS PREVENTION IN PRESENCE OF ENORMOUS VISIBLE HEALTH PROBLEMS.


  • PREVALENCE OF HBV AND HCV, IN PAKISTAN IS ONE OF HIGHEST IN THE WORLD. HIV ANOTHER BLOOD BORNE PATHOGEN HAS SIMILAR MODES OF TRANSMISSION.


  • PAKISTAN HAS LARGE DRUG USER POPULATION (MORE THAN FIVE MILLION) RECENT STUDIES INDICATE INCREASING NUMBER OF DRUG USERS ARE SHIFTING TO I/V DRUG USE.

  • HIGH RISK SEXUAL BEHAVIORS, SUCH AS SEXUAL PROMISCUITY EXCHANGE OF SEX FOR MONEY, HOMOSEXUALITY EXISTS IN THE COUNTRY, AT LEAST IN SOME SEGMENTS OF POPULATION USE OF CONDOM FOR DISEASE PREVENTION IS EXTREMELY LOW.


  • OVERSEAS PAKISTANI WORKERS HAS EMERGED AS HIGH RISK GROUP FOR HIV INFECTION AND MAJORITY OF REPORTED CASES OR DEPORTED PAKISTANIS WHO WERE WORKING IN GULF COUNTRIES.


  • BLOOD TRANSFUSION SERVICES BOTH IN PUBLIC AND PRIVATE SECTOR ARE STILL UNSAFE.


  • THERE IS IRRATIONAL USE OF INJECTIONS MULTIPLE USE OF SYRINGES AND NEEDLES IS COMMON.


  • THE STI MANAGEMENT SERVICES ARE NOT ACCESSIBLE, AFFORDABLE AND EASILY AVAILABLE.


  • HIV/AIDS IS SPREADING AT FASTER RATES IN SOUTH, AND SOUTH EAST ASIA THAN REST OF WORLD.

 HIV/ AIDS IN SINDH

CURRENT SITUATION OF HIV/AIDS IN SINDH

  • SINDH PROVINCE HAS UNIQUE POSITION IN THE COUNTRY DUE TO KARACHI BEING MOST POPULOUS CITY OF PAKISTAN WITH POPULATION MORE THAN 12 MILLION.


  • PEOPLE FROM ALL PARTS OF COUNTRY COME TO KARACHI FOR EMPLOYMENT OPPORTUNITIES AND BETTER DIAGNOSTIC AND TREATMENT FACILITIES.


  • LARGE POPULATION OF IMMIGRANT WORKERS, INJECTING DRUG USERS, SEX WORKERS, TRUCKERS, & PRISONERS.


  • ABOVE HIGH RISK POPULATIONS FREQUENTLY MOVE FROM SMALLER TOWNS TO BIG CITIES.


  • MORE CHALLENGES FOR HIV/AIDS PREVENTION IN SINDH THAN REST OF THE COUNTRY.


  • SINDH HAS REPORTED MAXIMUM NUMBER OF HIV/AIDS CASES IN THE COUNTRY. (1212 CASES OUT OF WHICH 1109 HIV+VE AND 103 AIDS CASES


  • HIV/AIDS Reported Cases in Sindh Up to September 30, 2005
     
    HIV SYMPTOMATIC CASES 1174
    FULL BLOWN AIDS CASES 104
    TOTAL 1278

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