Hiv aids seminar communti

Maternal, Newborn and Child Health

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COMMUNITY MEDCINE DEPARTMENT


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BATCH 12


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GROUP 6

HIV /AIDSintroductionmorphology

epidemiologytransmission

Clinical featureLabrotary diagnosis

HIV in prgnancycomplication

Control & preventiontreatment

pathogenesis






pathogenesisIntroduction

By:Mea’ad

Introduction

Miaad faiz

,AIDS

"Acquired immunodeficiency syndrome

What is AIDS?

• AIDS is a chronic life-threatening condition is caused by HIV (Human Immunodeficiency Virus) Resulting in a defect in cell-mediated immune response that is manifested by increased susceptibility to opportunistic infections and to certain rare cancers, especially Kaposi's sarcoma.

AIDS is the name given to the later stages of

an HIV infection . when a person’s immune system is

severely damaged

What is HIV ?• HIV is lentiviruses are in part

of large group of viruses known as retroviruses

• They have been found in a number of different Animals including cats, sheep, horses and cattle.

Where did HIV COM from?• There are two types of HIV, HIV-1 and HIV-2• both of HIV viruses originated from Africa.• scientists generally accept that the strains of

HIV-1 are most closely related to the simian immunodeficiency viruses (SIVs) which effect type of chimpanzee in West Africa

http://en.wikipedia.org/wiki/HIV-1

• SIV was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood.

Over decades, the virus slowly spread across Africa and later into other parts of the world.

• HIV-2 corresponds to SIVs found in the sooty mangabey also known as( the white collared monkey).

History of AIDS• in June 1981 CDC Centers for Disease Control• was reported cases of Pneumocystis carinii

pneumonia and Kaposi's sarcoma among numerous gay men in new york and southern California.

• and that reason why people first began to think that HIV only infected gay people

• CDC reported the new outbreak they called it "GRID" (gay-related immune deficiency)

• in December 1981, it was clear that the disease affected other population groups, when the first cases of Pneumocystis carinii pneumonia were reported in injecting drug users

http://www.avert.org/injecting.htm

• In 1982 By the beginning of July a total of 452

cases, from 23 states , had been reported to Centers for Disease Control and Prevention ( CDC).

later that month CDC received its first report of "AIDS in a person with hemophilia (from a blood transfusion), and in infants born to mothers with AIDS.

• The occurrence of the disease in non-

homosexuals mean that name such as GRID were redundant.

• Later in 1982 the CDC gave name of AIDS to this new out break.

scientists later found evidence that the disease existed in the world for some years prior, i.e., subsequent analysis of a blood sample of a man, who died of an unidentified illness in the Belgian Congo in 1959, made him the first confirmed case of an HIV infection.

Who are discovered HIV• On January 23 ,1983• Dr. Luc Montagnier of

the Pasteur Institute in France announced the isolation of the new viruses named LAV retrovirus (lymphadenopathy-associated virus)

• And, on the other side Dr. Robert Gallo of the National Cancer Institute isolated the HTLV-III (Human T-Cell Lymphotropic Virus III) retrovirus

• on December 1983, he submitted a paper for publication proposing the theory that an HTLV-type retrovirus was the cause of AIDS

• Then, on April 23, 1984, Margaret Heckler, the secretary of health and human services, announced that Gallo had isolated the virus which caused AIDS, that it was named HTLV-III

• The Journal of the American Medical Association (JAMA) continued to reference HTLV-III as the "primary etiologic agent of the acquired immunodeficiency syndrome (AIDS)"

• in 1985, was determined that HTLV-III and LAV were the same virus.

• in May 1986, the International Committee on the Taxonomy of Viruses

given the new designation of Human Immunodeficiency Virus or HIV.






pathogenesis MorphologyBy:

Ahmed altegani

Morphology

Ahmed altegani

• HIV belongs to a special class of viruses called retroviruses.

• Almost all organisms, including most viruses, store their genetic material on long strands of DNA. Retroviruses are the exception because their genes are composed of RNA (Ribonucleic Acid).

• RNA has a very similar structure to DNA. However, small differences between the two molecules mean that HIV's replication process is a bit more complicated than that of most other viruses

• Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions).

• An HIV particle is around 100-150 billions of a metre in diameter.

• Unlike most bacteria, HIV particles are much too small to be seen through an ordinary microscope. However they can be seen clearly with an electron microscope .

• HIV particles surround themselves with a coat of fatty material known as the viral envelope (or membrane). Projecting from this are around 72 little spikes, which are formed from the proteins gp120 and gp41. Just below the viral envelope is a layer called the matrix, which is made from the protein p17.

• The viral core (or capsid) is usually bullet-shaped and is made from the protein p24. Inside the core are three enzymes required for HIV replication called reverse transcriptase, integrase and protease. Also held within the core is HIV's genetic material, which consists of two identical strands of RNA.

Genes of HIV

• HIV has just nine genes (compared to more than 500 genes in a bacterium. Three of the HIV genes, called gag, pol and env, contain information needed to make structural proteins for new virus particles.

• The other six genes, known as tat, rev, nef, vif, vpr and vpu, code for proteins that control the ability of HIV to infect a cell, produce new copies of virus, or cause disease.

• At either end of each strand of RNA is a sequence called the long terminal repeat, which helps to control HIV replication.

Life cycle• Entry • HIV can only replicate inside human cells. The

process typically begins when a virus particle bumps into a cell that carries on its surface a special protein called CD4

• . The spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to fuse with the cell membrane. The contents of the HIV particle are then released into the cell, leaving the envelope behind.

Reverse Transcription and Integration

• Once inside the cell, the HIV enzyme reverse transcriptase converts the viral RNA into DNA, which is compatible with human genetic material

• . This DNA is transported to the cell's nucleus, where it is spliced into the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is known as provirus.

Transcription and Translation

• HIV provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human genes

• . First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used as a blueprint for producing new HIV proteins and enzymes.

Assembly, Budding and Maturation

• Among the strands of messenger RNA produced by the cell are complete copies of HIV genetic material. These together with newly made HIV proteins and enzymes to form new viral particles.

• The HIV particles are then released or 'bud' from the cell. The enzyme protease plays a vital role at this stage of the HIV life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores.

• The newly matured HIV particles are ready to infect another cell and begin the replication process all over again. In this way the virus quickly spreads through the human body. And once a person is infected, they can pass HIV on to others in their body fluids.






pathogenesis EpidemiologyBy :

Samah ibrahem

Epidemiology

Samah ibrahem

• HIV infection is considered pandemic by the World Health Organization (WHO) As in 2010 approximately 34 million people have HIV globally.

• The number of people infected with HIV continues to rise in most

parts of the world, despite the implementation of prevention strategies

facilitating factors in the transmission of HIV

• Promiscuity, scarification , unsafe blood transfusions , drug abusers poor state of nutrition , Poor economic conditions

• Since AIDS was first recognized in 1981 it has lead to nearly 30 million deaths Despite recent improved access to antiretroviral treatment

incidence

there is continued lack of access in the continent of Africa, where is only less

than 10 percent of those infected are reported to have access to it

• Sub-Saharan Africa being by far the worst-affected region, with an estimated 68% of the global total at the end of 2010

• South & South East Asia is the second most affected this region contained 12% of all people living with HIV

Africa

• Although only 11% of the world's population lives in Africa, roughly 67% of those living with HIV/AIDS are in Africa

• Between 1999 and 2000 more people died of AIDS in Africa than in all the wars on the continent

Sub-Saharan Africa

HIV infection is becoming endemic in sub-Saharan Africa, which contain

over 12% of the world’s population but two thirds of all people are infected with HIV

Southern Africa

• South Africa has the largest population of people with HIV of any country in the world

• in 2005 there were 12.4% of the population in South Africa infected with HIV (5.5 million people)

• adult prevalence rates exceeding 20% in most countries in the region

Botswana 23.9% Swaziland 26.1%

Eastern Africa• high levels of prevalence above 10% in some countries, although there are signs that the pandemic is declining in this region.

West Africa

• west Africa has been much less affected by the pandemic

North Africa• The HIV prevalence

rates in North Africa are among the lowest in the world.

• This is primarily attributed to the

salient role of Islam in the region's societies

Egypt 0.1% Tunisia 0.2% Morocco 0.1% Sudan 1.1%

• The total number of people living with HIV in Asia is thought to be nearly 4.8 million.

• Around half of these cases were in India followed by China Thailand and Myanmar

India1.4%

China 0.1%

Thailand 1.3%

Myanmar1.2%

India

• around 5 million people were living with HIV in India

• HIV epidemics are more severe in the southern half of the country

• The highest estimated adult HIV prevalence is found in Manipur (1.40%)

china

There are currently an estimated 740,000 people living with HIV in China

• in 2009 when China reported that AIDS had become the country’s leading cause of death among infectious diseases for the first time ever

Americas

• more than one million people are living with HIV in the USA

• that more than half a million have died after developing AIDS

• In 2009 blacks/African Americans made up an estimated 50% of new HIV diagnoses and whites only 27%

Caribbean• The region's adult prevalence rate is 1.6%

• The rate of HIV in the Caribbean is four times that of North America and South Asia

• The UNAIDS informed that by the year 2020 HIV/AIDS will cause 75% of death in the Caribbean

United States and Canada

• The adult prevalence rate in this region is 0.7% with over 1 million people currently infected with HIV

• the death rate from AIDS in North America fell sharply with the introduction of combination AIDS therapies

• In Canada, nearly 60,000 people were living with HIV/AIDS in 2005.

• The HIV-positive population continues to increase in Canada, with the greatest increases amongst aboriginal Canadians

AIDS in Sudan

The first cases in sudan were reported in 1986.

Reported cases until 2005 was 17.000 cases

AIDS prevalence in Sudan is expected to be 1.67 % of population.

All patterns of transmission are reported but 97% are sexually transmitted

About 70% are women

Areas affected mostly are, Gedarif,

Port Sudan, Khartoum, Kosti and Rebek in white Nile .

Khartoum

• The cases in Khartoum has reached 88.000 case this year (2012)

• And these are only the diagnosed cases with a percentage of 11%

• This due to decrease the awareness of the diagnostic measure that the community should fallow

Risks contributin

g to spreading of HIV in

Sudan are : wars, migration

and poverty

and ignorant.

MIGRATION:

South Sudan

• Juba is the most area effected with aids in south Sudan

• Most infection are sexually transmitted

• the Mortality rate is on increasing due to lack of education about the preventive measures






pathogenesis Transmission by :

Aanab badr

Mode of transmission

Aanab badr

How HIV is transmitted?

HIV is transmitted through body fluids ; if the quantity of HIV in

the fluid is high enough

Mode of transmissionsexual

blood

needles

mother to child

through all forms of un protected sexual intercourse with an infected person. this includes vaginal, anal & oral sex.


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- anal intercourse poses the greatest risk of infection.-the next highest risk is vaginal intercourse.


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unprotected oral sex involves some risk if there are mouth or throat injuries .


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contaminated blood or blood products:- 5% of all HIV infections may be caused by blood transfusion & organ transplantation.


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contaminated needles , syringes or other piercing instruments :-


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Procedures like tattooing , male & female circumcision and traditional scarification can all contribute to infection


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mother to child transmission: ( MTCH)

-the virus can be -transmitted during- pregnancy and delivery -or later by breast feeding


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The probability of a new born to getting infection from HIV-positive mother.%12-35


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How HIV is NOT transmitted

-shaking hands-cough or sneezing-sharing food , eating or drinking-using toilet seats , swimming pools or showers- mosquito or insect bite


How HIV is NOT transmitted

So family , friends and co-workers should not fear becoming infected with HIV through causal contact with an HIV positive person in family , work or socially.


HIV & work

the work place & most occupations do not pose a risk of acquiring HIV . The exception is health workers , dentists and laboratory technicians who are exposed to blood while doing their duties.






pathogenesis PathogenesisBy:

Aanab bader

Pathogenesis

Aanab badr

Pathogenesis

The Human immunodeficiency virus is made up of Genetic material, Chemicals and a coating. The Genetic material is RNA and the Chemicals are enzymes which help the virus enter and use other cells to make copies of itself.

Pathogenesis

HIV mainly infects white blood cells called T-lymphocyte cells (T-cells). The virus infects a T-cell by attaching to a protein on the cell's surface called CD4+. Not all T-cells have this protein. The ones that do are called CD4+ cells, T4 cells, or T-helper cells.

Pathogenesis

After binding with the CD4+ cell, the virus enters the cell and, using an enzyme called reverse transcriptase).. Another enzyme called protease helps the new viruses form. The new viruses then "bud" off the infected cells into the body, where they infect more CD4+ cells.

Pathogenesis

The presence of the virus causes a person's immune system to react by attacking the virus itself and any HIV-infected cells. This process results to formation of antibodies . A person is said to be HIV-positive if antibodies to the virus are detected by tests, indicating infection.

Pathogenesis

As HIV-infected CD4+ cells are destroyed or impaired, the person's immune system becomes less and less effective at fighting infection and disease. The person is said to be "immunocompromised" or "immunodeficient." Such people are more likely to develop unusual diseases called Opportunistic infections that they would not get if their immune systems were healthy.

Pathogenesis

As the number of CD4+ cells decreases, the person is more likely to get sick and have more serious illnesses. When this is the case, a person is usually diagnosed with acquired immunodeficiency syndrome (AIDS).

THANKS






pathogenesis Clinical feature by :

Wddah

Clinical feature

Wddah

Five stages

The clinical picture of HIV can be divided into:

Clinical featureStage 1

Stage 2

Stage 3

Stage 4

Stage 5


Stage 2

Stage 3

Stage 4

Stage 5

• Begin 2_4 weeks after infection 1. Fever 2. Joint pain3. Very high viremia 4. headache 5. rigors6. Leukpenia 7. Rash in the trunk and the arm


Stage 2

Stage 3

Stage 4

Stage 5

It usually follow blood transfuusionIt’s a flu like diseaseAcute stage resolve typically after 2-4 weeks In early stage they are –ABAntibody typically appears 10-14 days after infection


Stage 2

Stage 3

Stage 4

Stage 5

And +ve AB care called sero conversionThe period between _ve and +ve AB are called window period P24 +ve when the virus isolatedAfter this period the patient become well


Stage 2

Stage 3

Stage 4

Stage 5

Latent or symptomatic stage In this stage the virus integrate into the chromosome.From 2-5 yearsDuring this period virus is a sleep


Stage 2

Stage 3

Stage 4

Stage 5

The patiant is asymptomatic during this piriodAnd ……. Is low or absent But the patient is infectiousIts chronic persistant infection


Stage 2

Stage 3

Stage 4

Stage 5

Persistant generalyzed lymphoadenopathyLymphnode should be :1. > 1 cm large2. Its more than 3 places3. >3 mounth duration


Stage 2

Stage 3

Stage 4

Stage 5

The more frequint manifestation:Persistant feverWeight lossFatigueCd4 lymphocyte level diminish become 300/cumm


Stage 2

Stage 3

Stage 4

Stage 5

This stage divided into 2 parts:1- constitutional symptoms:Persistant feverMalaiseChronic diarrheaLoss of weight


Stage 2

Stage 3

Stage 4

Stage 5

2- opportunstic infection:Immunocomproised stageMainly TBSalmonellaHerpesOral thrushleukoplakia


Stage 2

Stage 3

Stage 4

Stage 5

All infections all malignant can occurMost common malignancy like: kaposi,s sarcomaCervical carcinomalymphomas


Stage 2

Stage 3

Stage 4

Stage 5






pathogenesis Labrotary diagnosisBy :

Mishkat abdalatife

Labrotary diagnosis

Mishkat abdalatife

Learning Objectives

Describe the role of laboratory tests in:The diagnosis of HIV infection Ongoing monitoring of HIV’s effect on the bodyMonitoring response to treatment

Body Fluids Used for HIV TestingSerum .

Plasma.

Whole blood.

Cervical secration.

Saliva.

Breast milk.

Breast milk.

Test typeSerological

CBC:-We found leukopeniaLow lymphocyte( 20_25%) Normal value( 20_40%)

General test Flowcytometry


We do flowcytometry to detect CD4 level , also we use CD4 to follow up the effect of treatment.Normal value (CD4+) count = 1000cell\mm

T suppressor (CD8+) cell count = 400-800



In AIDS patient CD4+ count = <200cell\mm.Aids related complex= 300 cell\mm



_Tests are based on a reaction between HIV antigens and antibodies in the patient’s serum_Tests use viral antigen extracts as a testing material


Diagnostic Tests

-Done by direct ELISA for detection of core antigen P24 .-The core antigen P24 is the 1st antigen for the virus.-Appear within 3 weeks of massive infection (blood

transfusion). in sexual cotact it takes more time.

ELISA PCRVirus isolation.Western blot

Detection of HIV AG Detection of HIV AB

Diagnostic Tests

P24 Antigen TestDetected during acute phase of primary HIV infection:-Sensitivity in adults: 50-75%Sensitivity in children: 20%Specificity: 95%Following seroconversion, antigen is less detectable (sensitivity declines)



Diagnostic Tests

Done by indirect ELISA very useful after seroconversion.



Diagnostic Tests

The advantge of ELISA:-Cheap\ simple\rapid



Diagnostic Tests

The disadvantage of ELISA:-1.Takes time to develop in sexual contact 6mnth, blood transfusion 2mnth



2. False +ve in: -Rhmatiod artheritis. - Autoimmune AB. -Sever liver disease. -Sticky serum

Diagnostic Tests

-For all of this reasons ELISA must be confirmed .-No pateint must be Consider as HIV +ve before doing confirmatory test.



Diagnostic Tests

After several incubation and wash

steps, a color reaction occurs if HIV

antibody is present



“Window Period” Following HIV Infection

Diagnostic Tests

-Confirmatory test for all positive ELISA assays-Detect AB to specific HIV AG in cellulose strip-Two or more “key” bands indicate a positive test-Should not be used alone for HIV diagnosis


Diagnostic Tests

Western Blot Result InterpretationResults are interpreted as follows:

-Negative: no bands-Positive: reactivity to gp120/160, plus either gp41 or p24-Indeterminate: one reactive band-The test should be repeated at a later time, e.g., 1-3 months later-Repeatedly indeterminate: no HIV infection


Diagnostic TestsELISA PCRVirus isolation.Western blot

Case Study

Diagnostic Tests

Best sample is peripheral blood, but can use CSF, saliva, cervical secretions, semen, tears or material from organ biopsy


Diagnostic Tests

We take T-lympocyte of infected blood and culture it on normal T-lympocyte Cultures incubated one month, infection confirmed by detecting reverse transcriptase or p24 antigen in supernatant or observation of cytopathogenis effect in the normal cells.


Diagnostic Tests

We do it for detection of virus RNA \ DNA

Rapid tests:1. Immuno-chromatoraphy.2. Coated particles agglutination.3. Dip stick test.


Diagnostic Tests

We do it for reverse transcriptase and also use in AG detection.

Rapid tests:1. Immuno-chromatoraphy.2. Coated particles agglutination.3. Dip stick test.


Diagnostic Tests

Dip stick test.


Diagnostic TestsELISA PCRVirus isolation.Western blot






pathogenesis HIV in prgnancyBy :

Abd algader

HIV in prgnancy

Abd algader

HIV IN PREGENANCY:

If a pregnant woman is infected with HIV and does not recieve any intervention or treatment, she can transmit the virus to her baby during:

i. pregnancy.ii. delivery iii. breastfeeding.

about15-30% of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding.

How to Reduce Mother-to-Child Transmission:

HIV testing in pregnancy.Antenatal care.Antiretroviral agents.Obstetric procedure.Newborn feeding.

HIV Testing during Pregnancy:

• Advantages:– Possible treatment of mother– Reduce risk of mother-to-child transmission– Future family planning issues– Precautions against further spread– If negative, advise about HIV prevention

Antenatal Care:Most HIV-infected women will be

asymptomatic.Watch for signs/symptoms of AIDS and

pregnancy-related complications.Unless complication develops, no need to

increase number of visits.

Treat STDs and other coinfections.Counsel against unprotected intercourseAvoid invasive procedures.Give antiretroviral agents, if available.Counsel about nutrition.

Obstetric Procedures:Avoid use of the obestetric procedures ,Because of increased fetal exposure to infected maternal blood and secretions, increased transmission may come from:

– Amniotomy.– Fetal scalp electrode/sampling.– Forceps/vacuum extractor.– Episiotomy.– Vaginal tears.

Mode of delivery:• vaginal delivery: incerase risk of mother to

child transmission• A caesarean section: reduces the risk of a baby

catching HIV during the birth.• A combination of anti-retroviral therapy and

caesarean section reduces the risk of your baby to catching HIV less than 1%

Newborn feeding:• breastfeeding is the best way to be fed, but

unfortunately breastfeeding can also transmit HIV. If no antiretroviral drugs are being taken, breastfeeding for two or more years can double the risk of the baby becoming infected to around 40%

2010 WHO Infant Feeding Guidelines:

Mother takes ARVs from 14th week of pregnancy until 1 weekafter labour.

Long ARV during breastfeeding period for either mother and infant .

Exclusive breastfeeding for 6 months .

Gradually wean from breastmilk .

Mixed (complementary) feed after 6 months .

Recommended to breastfeed and mix feed in conjunction with ARVs .

HIV IN CHILDREN

The number of children directly affected by

HIV :

• At the end of 2010, there were 3.4 million children living with HIV around the world.

• An estimated 390,000 children became newly infected with HIV in 2010.

• 1.8 million people who died of AIDS during 2010, one in seven were children.

• Every hour, around 30 children die as a result of AIDS.Most children living with HIValmost 9 in 10 live in sub-Saharan Africa.

• There are more than 16 million children under the age of 18 who have lost one or both parents

to AIDS.

Symptoms of HIV in Children:

• Symptoms of HIV infection vary by age and individual child, but following are some of the more common symptoms:

• Failure to thrive.• Seizure.• Diffuclt to walking.• ear infection .• Diarrhea• Pneumonia• Oral thrush or severe diaper rash due to Candida

THANK YOU






pathogenesis ComplicationBy:

rawia

Complication

rawia

Complications of HIV Infection Most complications of HIV are as a result of suppression of T-cell mediated immunity. Antiretroviral therapy (HART) is available to inhibit the replication of the human immunodeficiency virus. H ART helps to prolong life, restore the patient's immune system to something approaching normal activity and reduce the chances of opportunistic infection.

Pulmonary complications:-Pneumocystis carinii pneumonia:-

• It has been one of the hallmarks of late-stage HIV disease but is now less common because of antiretroviral therapy (ART) and primary prophylaxis.

• Presentation: typically, develops over a few weeks and includes shortness of breath, dry cough and fever. There may also be malaise, fatigue, weight loss and chest pain.

Bacterial pneumonia:-The most common causes are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In advanced cases, causative organisms may include Staphylococcus aureus, Klebsiella spp. and other Gram-negative rods. The presentation may be atypical, with diffuse infiltrates appearing on the X-ray.

TB:-This is very common in areas where TB is endemic. Many cases represent reactivation of previous infection. HIV-positive patients with TB are less likely to be sputum-positive with X-rays that show less cavitation and more involvement of lower lobes. They are more likely to relapse after completion of treatment and die prematurely.

• Treatment is the standard 3-4 drug regimen but multidrug-resistant TB strains are becoming more frequent. One study found that TB preventative therapy

• (e.g. isoniazid, co-trimoxazole) was useful in reducing the incidence of infection and death in children with HIV.

Fungal infectionsThese include Cryptococcus spp. In disseminated infection other fungi may be involved.

CRYPTOSPORIDIOSISCryptosporidium is a germ that can sometimes cause severe diarrhea and fevers in people with a weak immune system.

HISTOPLASMOSISIt lives in the soil and is spread by bird and bat droppings. It is very common in the state of Indiana. Most of the time, histoplasmosis does not cause illness in healthy people.

In people with an abnormal immune system, histoplasmosis can be very severe and affect any organ in the body. The symptoms include fever, weight loss, cough, and swollen lymph glands. It is important that all people with low CD4 counts avoid activities that increase their chance of getting histoplasmosis.

• This includes activities that disturb the soil such as digging or raking, or being exposed to bird or bat droppings such as playing in an uncovered sandbox or exploring caves.

Oesophageal candidiasis:-This presents with retrosternal pain on swallowing and is usually caused by Candida albicans. This is a common complication of late-stage HIV disease.

Mycobacterium avium complex:-This is seen In late-stage HIV disease. Patients with CD4 <50/mm3 are at high risk. In industrialised countries, it is reported in 40% of patients with AIDS.Presentation: infection is disseminated and presents with fever, night sweats, weight loss, diarrhoea, abdominal pain, anaemia or hepatic dysfunction

HERPES VIRUSES:-Herpes simplex virus can show up as either cold sores, infections of the eye, or genital infections. Varicella (the virus responsible for chicken pox and also a member of the herpes virus family). People with weakened immune systems can get very severe infections with these germs.

Cytomegalovirus or CMV is one of the herpes viruses that can affect different organs of the body but most often affects the eyes. A warning sign of CMV infection in the eyes is the increased complaint of "floaters" in the eye. While CMV is very common in all people it usually only causes significant problems in people with HIV who have CD4 counts less than 100.

Central nervous system complications:-Cerebral toxoplasmosis:-Toxoplasmosis is less common than it was, since the advent of ART, although is still prevalent in resource-poor countries. Cerebral toxoplasmosis is the most frequent central nervous system (CNS) infection when CD4 <200/mm3. It usually occurs due to reactivation of cysts in the brain, causing local lesions, typically multiple.Presentation: subacute symptoms include focal neurological disturbances, headache, confusion, fever and seizures.

FATIGUE:Fatigue is another complication of HIV, some patients of HIV complaint of extreme fatigue of being tired whereas some patients may not experience fatigue. There are different strains of HIV, and it widely various from patient to patient in the ways it affects different individuals.






pathogenesis Control & preventionBy :

M.Bassam daqaq

Control & prevention

M.Bassam daqaq

Control and prevention

That mean any activity which reduces morbidity and mortality

rate with hiv .

How HIV is prevented?

By prevented all form of HIV transmission through body fluids.

Control and preventionsexual

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By prevention all forms of un protected sexual intercourse with an infected or unknown person status . this includes vaginal, anal & oral sex.


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HIV testing before marrege is necessary to prove your marrege is save


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• Use condoms (female or male) every time having sex (vaginal or anal)

• Always use latex or polyurethane condom (not a natural skin condom)

• Always use a latex barrier during oral sex


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When Using A CondomRemember To:• Make sure the package is not expired• Make sure to check the package for

damages• Do not open the package by teeth for

risk of tearing• Never use the condom more than once• Use water-based rather than oil-based

condoms


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Health EducationSince the main source of information is the mass media and news paper which is accessible to the majority there is a gap in the knowledge which can be filled by dissemination of information using schools ,health institutions , social gatherings ,local clubs ,video show ,and religious ceremonies


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By testing donar blood before blood transfusion & organ transplantation.


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needles , syringes or other piercing instruments If a needle/syringe is shared, it must be disinfected:

Fill the syringe with undiluted bleach and wait at least 30 seconds.thoroughly rinse with waterDo this between each person’s use


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Non-profit Organization, which provides sterile needles in exchange for contaminated ones


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Procedures like tattooing , male & female circumcision and traditional scarification must be sterile


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the risk of HIV transmission from mother to unborn child is about 26% without any treatment or intervention. But fortunately, there is a way to reduce the risk of HIV transmission during pregnancy.


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during pregnancy:Treating the HIV +ve mother with a Retrovir (AZT, zidovudine) containing regimen. Guidelines state the treatment of the pregnant woman may start as early as 14 weeks into the pregnancy.


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during delivery:Giving the mother a dose of intravenous (IV) Retrovir.


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after birth:Treating the newborn with oral Retrovir for six weeks.The mother should never lactate her baby


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pathogenesisTreatment

By:basheer

Treatment

basheer

• There is no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are resistant to single drugs .

The classes of anti-HIV drugs include :

1 - Non-nucleoside reverse transcriptase inhibitors (NNRTIs).

2 - Nucleoside reverse transcriptase inhibitors (NRTIs

3 - Protease inhibitors (PIs). 4 - Entry or fusion inhibitors 5 - Integrase inhibitors

1- Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs), such as nevirappine (Viramune) and efavirenz (Sustiva), bind to and block the action of reverse transcriptase , which is a protein that HIV needs to reproduce .

2- Nucleoside Reverse Transcriptase Inhibitors (NRTIs), such as zidovudine (Retrovir), and stavudine .

3-Protease inhibitors (PIs). disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir, darunavir .

4- Entry or fusion inhibitors. These drugs block HIV's entry into CD4+ cells. Examples include enfuvirtide and maraviroc.

5-Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4+ cells .

When to start treatment- Current guidelines indicate that

treatment should started if :- You have severe symptoms - Your CD4+ count is under 500- You're pregnant - You have HIV-related kidney disease - You're being treated for hepatitis B

Side effects of antiviral drug include :

- Nausea, vomiting or diarrhea- Abnormal heartbeats - Shortness of breath - Skin rash - Weakened bones - Bone death, particularly in the hip

joints

Treatment responseYour response to any treatment is

measured by your viral load and CD4 counts .

Viral load should be tested at the start of treatment and then every three to four months while you're undergoing therapy. CD4 counts should be checked every three to six months .

Treatment can be difficult because HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life .

Thank you

Hiv aids seminar communti

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