HIV/AIDS: Concepts, Principles & Interventions

Kwaku Oppong Asante

[email protected]
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HIV/AIDS
Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome

What Is HIV/AIDS?
 HIV stands for Human Immunodeficiency Virus.  This is the virus that causes AIDS. HIV is

different from most other viruses because it attacks the immune system.

 The immune system gives our bodies the ability

to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease.
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What Is HIV/AIDS?
 AIDS stands for Acquired Immunodeficiency

Syndrome.
 AIDS is the final stage of HIV infection. It can

take years for a person infected with HIV, even without treatment, to reach this stage.

 Having AIDS means that the virus has

weakened the immune system to the point at which the body has a difficult time fighting infections.
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What Is HIV/AIDS?
 The immune system of an HIV-infected person

becomes so weakened that it cannot protect itself from serious infections. When this happens, the person clinically has AIDS.
 AIDS may manifest as early as 2 years or as

late as 10 years after infection with HIV.

 When someone has one or more of these

infections and a low number of T cells, he or she has AIDS.

 Whereas there are symptoms of HIV, the only

way to know that you are living with the virus is to be tested.
 Everyone should know their HIV status to

protect themselves and others

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Global Status of HIV/AIDS (1998)

 33.4 million are living with HIV  Estimated 5.8 million newly infected in 1998
 

2.1 million of these are women 590,000 are children

 About 16,000 new infections occur daily  90% in developing countries  Majority of new HIV infected adults are < 25

years old  10.7 million adults and 3.2 million children have died since epidemic began
Source: UNAIDS/WHO 1998.

Global Status of HIV/AIDS (2007)

 Globally, there were an estimated 33 million

[30 million36 million] people living with HIV in 2007  The annual number of new HIV infections declined from 3.0 million in 2001 to 2.7 million in 2007.  Overall, 2.0 million people died due to AIDS in 2007, compared with an estimated 1.7 million in 2001.
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Source: UNAIDS 2008.

 While the percentage of people living with

HIV has stabilized since 2000, the overall number of people living with HIV has steadily increased as new infections occur each year, HIV treatments extend life, and as new infections still outnumber AIDS deaths

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Source: UNAIDS 2008.

 Southern Africa continues to bear a

disproportionate share of the global burden of HIV: 35% of HIV infections and 38% of AIDS deaths in 2007 occurred in that sub region.
 Altogether, sub-Saharan Africa is home to

67% of all people living with HIV.

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Source: UNAIDS 2008.

 Young people aged 1524 account for an

estimated 45% of new HIV infections worldwide.

 Women account for half of all people living

with HIV worldwide, and nearly 60% of HIV infections in sub-Saharan Africa

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Source: UNAIDS 2008.

 An estimated 370 000 [330 000410 000]

children younger than 15 years became infected with HIV in 2007.

 Globally, the number of children younger than

15 years living with HIV increased from 1.6 million in 2001 to 2.0 million in 2007.

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Source: UNAIDS 2008.

Number of People with HIV/AIDS by Region

North America 890,000 Caribbean 330,000 Western Europe 500,000 North Africa & Middle East 210,000 Sub-Saharan Africa 22.5 million Eastern Europe & Central Asia 270,000 East Asia & Pacific 560,000 South and South East Asia 6.7 million

Latin America 1.4 million

Australia and New Zealand 12,000

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Source: UNAIDS/WHO 1998.

Modes of HIV Transmission

 Sexual intercourse between:
 

Heterosexuals Homosexuals (males) No documented case of sexual transmission between women

 Accidental exposure to blood/blood products

(e.g., blood transfusions, shared needles, contaminated instruments)  Mother to child during:
  

pregnancy birth breastfeeding

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HIV Transmission Through Sexual Contact

 Sexual intercourse between:
 

Heterosexuals Homosexuals (males) vaginal anal, oral) with a person who has HIV Heterosexuals

 Having sex
   

**No documented case of sexual transmission between women

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HIV Transmission Through Sexual Contact

 Of every 100 HIV infected adults, 75 - 85

have been infected through unprotected intercourse



70% of these infections are from heterosexual intercourse

 STIs, especially ulcerative lesions in genitalia,

increase risk of transmission

Source: UNAIDS/WHO 1996.

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HIV Transmission Through Blood, Blood Products and Body Fluids

 Shared/contaminated needles by drug users


Accounts for 5-10% of all adult infections

 Transfusion of contaminated blood or blood

products


Accounts for 3 - 5% of all adult infections

 Contaminated surgical instruments  Traditional practices (tattooing, ear piercing,

circumcision) with non-sterile instruments  Donated semen from an HIV infected male
Source: UNAIDS/WHO 1996.
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Body Fluids
HIV can be found in body fluids, including:  blood  semen  vaginal fluids  breast milk  some body fluids sometimes handled by healthcare workers (fluids surrounding the brain and spinal cord, bone joints, and around an unborn baby)
Source: AIDS.gov (United States)
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HIV Transmission from Mother to Infant

 Antenatal

In utero by trans-placental passage  Intranatal  Exposure to maternal blood and vaginal secretions during labor and delivery  Postnatal  Postpartum through breastfeeding


 25 - 35% of all infants born to HIV-infected women

in developing countries become infected

 90% of HIV-infected infants and children were

infected by mother
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Source: UNAIDS/WHO 1996; 1998.

HIV Transmission from Mother to Infant

 90% of HIV-infected infants and children were

infected by their mother

 2/3 of babies born to HIV infected women are

NOT infected
 Of infected infants:
 

2/3 infected in the womb or at birth 1/3 infected via breastfeeding

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Risk of HIV Transmission from Breastfeeding

Risk is increased if:


Mother acquires infection while pregnant or during lactation Mother has cracked nipples, abscesses or other breast problems Mother is symptomatic for HIV-related disease Baby has sores in mouth or inflamed gut
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HIV and Breastfeeding

WHO, UNAIDS and UNICEF recommend that all women:


be informed of the risk of HIV transmission through breastfeeding, have access to voluntary counseling and testing to find out their HIV status, and be supported in their choice of breastfeeding or replacement feeding.

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Effect of AIDS on Pregnancy

 Infertility  Repeated abortions  Pre-maturity  Intrauterine growth retardation  Stillbirths  Congenital abnormalities  Embryopathies

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AIDS and Infants

 Symptoms generally develop by 6 months of

age
 

Diarrhea Failure to thrive

 Most of these children die before their second

birthday  Children born to HIV-infected parents are likely to become orphans

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Immunization of HIV-Infected Infants

 All asymptomatic HIV-infected infants should

receive standard immunizations  All symptomatic HIV-infected infants with AIDS-related complex (ARC) or AIDS should receive inactivated vaccines

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HIV Transmission
HIV cannot be transmitted by:


   

Casual person to person contact at home or work or in social or public places Food, air, water Insect/mosquito bites Coughing, sneezing, spitting Shaking hands, touching, dry kissing or hugging Swimming pools, toilets, etc.
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Signs and Symptoms of AIDS

 Fever of unknown origin  Enlarged lymph glands  Skin rash and cough  Persistent diarrhea  Severe weight loss  Skin lesions  Loss of appetite and fatigue

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Who Is High Risk for AIDS

A person who:


    

Uses shared/contaminated needles and syringes Has a sexually transmitted disease Has anal sex with her/his partner(s) Exchanges sex for money or drugs Has many sex partners Leads life separated from spouse due to professional obligations (e.g., truck drivers, laborers, migrants)
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Women and HIV

Social Risk Factors
 

Illiteracy Lack of awareness of preventive measures Twice as easy for women to contract HIV from men Physiology of women (e.g., menstruation, intercourse) Pregnancy-associated conditions (e.g., anemia, menorrhagia and hemorrhage) increase the need for blood transfusion

Biological risk factors



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Protecting HCWs from HIV During Labor and Delivery

 Precautions during labor:
 

Protection from blood and amniotic fluids Protection from sharp instruments No mouth to mouth suction No mouth to mouth breathing Proper disinfection of instruments Proper disposal of placenta and other items
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 Resuscitation of baby:
 

 Precautions following labor:

 

HIV Transmission to Healthcare Workers

r e f ex re eedle i k r Sk contact (intact) Splashes in mucous membrane (eye, nose or mouth)

V% . -0.4 < 0.1 0.1

Source: CDC 1996, Gerberding 1995; Seelf 1978.

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HIV and Healthcare Workers

 Most exposures do not result in infection  Risk varies by:
  

type of exposure amount of blood involved amount of virus in the patients blood at time of exposure whether post exposure treatment was taken

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Post Exposure Treatment of Healthcare Workers

 Intact skin, mouth or nose: immediately

wash with soap and water and rinse thoroughly to remove all potentially infectious particles.  Cut or punctured skin: allow to bleed fully.  Eye: flush immediately with water, then irrigate with normal saline for 30 minutes.  Consider post exposure prophylaxis (PEP) if high risk of transmission:
  ource: CDC 1996.

4 week course of zidovudine (ZDV) preferable to start within 1-2 hours

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Post Exposure Treatment of Healthcare Workers continued

 HIV testing immediately, 6 weeks, 6 months

and 12 months  Treatment, if started, should continue for 4 weeks. Any or all drugs may be declined by exposed worker.  For lesser exposures, prophylaxis is not recommended.

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