传染病学英文版课件：HIV THE GLOABAL AND INDIAN SCENARIO

HIV:THEGLOABALANDINDIANSCENARIO

DR.S.KCHATURVEDILessonobjectivesUnderstandtheglobalandlocalimpactoftheepidemicKnowaboutHIV/AIDSinadults,children,andfamiliesUnderstandthenaturalhistoryofHIVinfectionUnderstandthemodesofHIVtransmission

ScopeoftheHIV/AIDSPandemicNaturalHistoryandTransmissionofHIVDR.S.KCHATURVEDIHIVHumanImmunodeficiencyVirus

H=InfectsonlyHumanbeingsI=ImmunodeficiencyvirusweakenstheimmunesystemandincreasestheriskofinfectionV=VirusthatattacksthebodyDR.S.KCHATURVEDIAIDSAcquiredImmuneDeficiencySyndromeA=Acquired,notinheritedI=WeakenstheImmunesystemD=CreatesaDeficiencyofCD4+cellsintheimmunesystemS=Syndrome,oragroupofillnessestakingplaceatthesametimeDR.S.KCHATURVEDIHIVandAIDSWhentheimmunesystembecomesweakenedbyHIV,theillnessprogressestoAIDS

Somebloodtests,symptomsorcertaininfectionsindicateprogressionofHIVtoAIDSDR.S.KCHATURVEDIHIV-1andHIV-2•

HIV-1andHIV-2are

•Transmittedthroughthesameroutes

•Associatedwithsimilaropportunisticinfections•HIV-1ismorecommonworldwide•HIV-2isfoundinWestAfrica,Mozambique,andAngolaDR.S.KCHATURVEDIHIV-1andHIV-2

HIV-2islesseasilytransmittedHIV-2islesspathogenicDurationofHIV-2infectionisshorterMTCTisrelativelyrarewithHIV-2MTCTofHIV-2hasnotbeenreportedfromIndiaDR.S.KCHATURVEDITransmissionofHIVHIVistransmittedbyDirectcontactwithinfectedbloodSexualcontact:oral,anal,orvaginalDirectcontactwithsemenorvaginaland

cervicalsecretionsHIV-infectedmotherstoinfantsduring

pregnancy,delivery,orbreastfeedingDR.S.KCHATURVEDITransmissionofHIVHIVisnottransmittedby

PublicbathsHandshakesWorkorschoolcontactUsingtelephonesSharingcups,glasses,

plates,orotherutensilsCoughing,sneezingInsectbitesTouching,huggingWater,foodKissing

DR.S.KCHATURVEDI00003-E-1–December2004GlobalsummaryoftheHIVandAIDSepidemic,December2004Therangesaroundtheestimatesinthistabledefinetheboundarieswithinwhichtheactualnumberslie,basedonthebestavailableinformation.NumberofpeoplelivingwithHIVin2004Total39.4million(35.9–44.3million)Adults37.2million(33.8

–41.7million)Women17.6million(16.3–19.5million)Childrenunder15years2.2million(2.0–2.6million)PeoplenewlyinfectedwithHIVin2004Total4.9million(4.3–6.4million)Adults4.3million(3.7–5.7million)Childrenunder15years640000(570000–750000)AIDSdeathsin2004Total3.1million(2.8–3.5million)Adults2.6million(2.3–2.9million)Childrenunder15years510000(460000–600000)DR.S.KCHATURVEDIDR.S.KCHATURVEDIGlobalHIV/AIDSin2004*39.4-40.0millionpeoplearelivingwithHIV/AIDS2.2millionarechildrenunder15years6,40,000childrenwerenewlyinfectedwithHIVin20045,10,000childrendiedofHIVin2*Source:UNAIDS,20045.1m.IndianlivingwithHIVDR.S.KCHATURVEDIReportedcasesReportedAIDScases(15,202)EstimatedAIDScases(219,400)PeoplelivingwithHIV/AIDS(2.2million)OnlyasmallnumberofPLWHAarereportedDR.S.KCHATURVEDIImpactofGlobalHIVNegativeeconomicimpactoncountriesOverstrainedhealthcaresystemsDecreasinglifeexpectancyReversalofchildsurvivalgainsIncreasednumbersoforphansDR.S.KCHATURVEDIHIVEstimatesinIndia

DR.S.KCHATURVEDIMCHProfile

(India)TotalPopulation 1027MCrudeBirthRate25/1000SexRatio(F:M) 933AnnualPregnancies 27MANCCoverage 65.4%InstitutionalDeliveries[12.1%to79.3%] 35.6%Deliveriesattendedbyskilledbirthattendants 42.3%DR.S.KCHATURVEDIAdultHIVPrevalence

HighPrevalenceStates:theseareTamilNadu,Maharastra,Karnataka,AndhraPradesh,ManipurandNagalandDR.S.KCHATURVEDIModeofTransmissionofHIVInIndiaDR.S.KCHATURVEDI0102030405060708090100#uninfected#infectedduringBFfor2yrs#infectedduringdelivery#infantsinfectedduringpregnancy63uninfected15157MTCTin100HIV+MothersThemajorityofchildrendonotgetinfectedevenwhenwedonothingDR.S.KCHATURVEDI

RiskofPTCTTransmission

Globally:15-45%India:30-37%(average)DR.S.KCHATURVEDI020406080100BiharGujaratUttarPradeshUrbanMaleUrbanFemaleRuralMaleRuralFemale%Source:NationalAIDSControlOrganization,NationalBaselineGeneralPopulationBehaviouralSurveillanceSurvey2001

ProportionofRespondentsStatingThatHIVcanbeTransmittedThroughSexualContact,SelectedStatesinIndia2004ReportontheGlobalAIDSEpidemicDR.S.KCHATURVEDIPreventionof

HIVTransmissionStrategiestopreventHIVtransmissionPersonalstrategiesPublichealthstrategiesSafepractices:noriskofHIVtransmissionRiskreduction:reducesbutdoesnoteliminateriskDR.S.KCHATURVEDIPreventionof

HIVTransmissionPublichealthstrategiestopreventHIVtransmissionScreenallbloodandbloodproductsFollowuniversalprecautionsEducateinsafersexpracticesIdentifyandtreatSTIs/otherinfectionsProvidereferralfortreatmentofdrugdependenceApplythecomprehensivePPTCTapproachtopreventverticaltransmissionofHIVDR.S.KCHATURVEDINaturalHistoryofHIVInfectionDR.S.KCHATURVEDINaturalHistoryofHIVInfectionViruscanbetransmittedduringeachstageSeroconversionInfectionwithHIV,antibodiesdevelop

AsymptomaticNosignsofHIV,immunesystemcontrolsvirusproductionSymptomaticPhysicalsignsofHIVinfection,someimmunesuppressionAIDSOpportunisticinfections,end-stagediseaseDR.S.KCHATURVEDINaturalHistoryofHIVInfectionImmunesuppressionHIVattackswhitebloodcells,calledCD4cells,thatprotectbodyfromillnessOvertime,thebody’sabilitytofightcommoninfectionsislostOpportunisticinfectionsoccurDR.S.KCHATURVEDIHIVDiseaseProgressionofHIVdiseaseismeasuredby:CD4+countDegreeofimmunesuppressionLowerCD4+countmeansdecreasingimmunityViralloadAmountofvirusinthebloodHigherviralloadmeansmoreimmunesuppressionDR.S.KCHATURVEDIHIVDiseaseSeverityofillnessisdeterminedbyamountofvirusinthebody(increasingviralload)andthedegreeofimmunesuppression(decreasingCD4+counts)Highertheviralload,thesoonerimmunesuppressionoccursDR.S.KCHATURVEDIProgressionofHIVInfectionHIGHviralload(numberofcopiesofHIVintheblood)LOWCD4count(typeofwhitebloodcell)Increasingclinicalsymptoms(suchasopportunisticinfections)DR.S.KCHATURVEDIHIVDiseaseDirectinfectionoforgansystemsHIVcandirectlyinfectthe:Brain(HIVdementia)Gut(wasting)Heart(cardiomyopathy)DR.S.KCHATURVEDIHIVDisease:SummaryHIVmultipliesinsidetheCD4+cells,destroyingthemAsCD4+cellcountdecreasesandviralloadincreases,theimmunedefencesareweakenedHIV-infectedpeoplebecomevulnerabletoopportunisticinfectionsHIVisachronicviralinfectionwithnoknowncureWithoutARVtreatment,HIVprogressestosymptomaticdise