HIV: THE GLOABAL AND INDIAN SCENARIO

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HIV THE GLOABAL AND INDIAN SCENARIO

• DR. KANUPRIYA CHATURVEDI
• DR. S.K CHATURVEDI

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Lesson objectives
Scope of the HIV/AIDS Pandemic Natural History
and Transmission of HIV

• Understand the global and local impact of the
  epidemic
• Know about HIV/AIDS in adults, children, and
  families
• Understand the natural history of HIV infection
• Understand the modes of HIV transmission

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HIV

• Human Immunodeficiency Virus
• H Infects only Human beings
• I Immunodeficiency virus weakens the immune
  system and increases the risk of infection
• V Virus that attacks the body

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AIDS

• Acquired Immune Deficiency Syndrome
• A Acquired, not inherited
• I Weakens the Immune system
• D Creates a Deficiency of CD4 cells in the
  immune system
• S Syndrome, or a group of illnesses taking
  place at the same time

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HIV and AIDS

• When the immune system becomes weakened by HIV,
  the illness progresses to AIDS
• Some blood tests, symptoms or certain infections
  indicate progression of HIV to AIDS

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HIV-1 and HIV-2

• HIV-1 and HIV-2 are Transmitted through the
  same routes Associated with similar
  opportunistic infections
• HIV-1 is more common worldwide
• HIV-2 is found in West Africa, Mozambique, and
  Angola

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HIV-1 and HIV-2

• HIV-2 is less easily transmitted
• HIV-2 is less pathogenic
• Duration of HIV-2 infection is shorter
• MTCT is relatively rare with HIV-2
• MTCT of HIV-2 has not been reported from India

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Transmission of HIV

• HIV is transmitted by
• Direct contact with infected blood
• Sexual contact oral, anal, or vaginal
• Direct contact with semen or vaginal and
  cervical secretions
• HIV-infected mothers to infants during
  pregnancy, delivery, or breastfeeding

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Transmission of HIV
HIV is not transmitted by

• Coughing, sneezing
• Insect bites
• Touching, hugging
• Water, food
• Kissing

• Public baths
• Handshakes
• Work or school contact
• Using telephones
• Sharing cups, glasses, plates, or other
  utensils

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Global summary of the HIV and AIDS epidemic,
December 2004
Number of people living with HIV in 2004
Total
39.4 million (35.9
44.3 million)

37.2 million (33.8
Adults
41.7 million)

Women
17.6 million (16.3
19.5 million)

Children under 15 years
2.2 million (2.0
2.6 million)

People newly infected with HIV in 2004
Total
4.9 million (4.3
6.4 million)

Adults
5.7 million)
4.3 million (3.7

Children under 15 years
640 000 (570 000
750 000)

AIDS deaths in 2004
Total
3.1 million (2.8

3.5 million)
Adults
2.6 million (2.3
2.9 million)

Children under 15 years
510 000 (460 000

600 000)
The ranges around the estimates in this table
define the boundar
ies within which the actual numbers lie, based on
the best avail
able information.
00003
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E
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1

December 2004
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Global HIV/AIDS in 2004

• 39.4 -40.0 million people are living with
  HIV/AIDS
• 2.2 million are children under 15 years
• 6,40,000 children were newly infected with HIV in
  2004
• 5,10,000 children died of HIV in 2
• Source UNAIDS,2004

5.1 m. Indian living with HIV
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Reported cases

• Reported AIDS cases
• (15,202)
• Estimated AIDS cases
• (219,400)
• People living with
• HIV/AIDS (2.2 million)
• Only a small number of PLWHA are reported

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Impact of Global HIV

• Negative economic impact on countries
• Overstrained healthcare systems
• Decreasing life expectancy
• Reversal of child survival gains
• Increased numbers of orphans

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HIV Estimates in India
                                   
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MCH Profile (India)

• Total Population 1027 M
• Crude Birth Rate
  25/1000
• Sex Ratio (FM) 933
• Annual Pregnancies
  27 M
• ANC Coverage
  65.4
• Institutional Deliveries 12.1 to 79.3
  35.6
• Deliveries attended by skilled birth
  attendants 42.3

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Adult HIV Prevalence
High Prevalence States these are Tamil Nadu,
Maharastra, Karnataka, Andhra Pradesh, Manipur
and Nagaland
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Mode of Transmission of HIV In India
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MTCT in 100 HIV Mothers
The majority of children do not get infected even
when we do nothing
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Risk of PTCT Transmission

• Globally 15-45
• India 30-37 ( average)

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Proportion of Respondents Stating That HIV
can be Transmitted Through Sexual Contact,
Selected States in India
2004 Report on the Global AIDS Epidemic
Urban Male
Urban Female
Rural Male
Rural Female
100
80
60

40
20
0
Bihar
Gujarat
Uttar Pradesh
Source National AIDS Control Organization,
National Baseline General Population Behavioural
Surveillance Survey 2001
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Prevention of HIV Transmission

• Strategies to prevent HIV transmission
• Personal strategies
• Public health strategies
• Safe practices no risk of HIV transmission
• Risk reduction reduces but does not eliminate
  risk

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Prevention of HIV Transmission

• Public health strategies to prevent HIV
  transmission
• Screen all blood and blood products
• Follow universal precautions
• Educate in safer sex practices
• Identify and treat STIs/other infections
• Provide referral for treatment of drug dependence
• Apply the comprehensive PPTCT approach to prevent
  vertical transmission of HIV

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Natural History of HIV Infection
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Natural History of HIV Infection

• Virus can be transmitted during each stage
• Seroconversion
• Infection with HIV, antibodies develop
• Asymptomatic
• No signs of HIV, immune system controls virus
  production
• Symptomatic
• Physical signs of HIV infection, some immune
  suppression
• AIDS
• Opportunistic infections, end-stage disease

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Natural History of HIV Infection

• Immune suppression
• HIV attacks white blood cells,called CD4 cells,
  that protect body from illness
• Over time, the bodys ability to fight common
  infections is lost
• Opportunistic infections occur

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HIV Disease

• Progression of HIV disease is measured by
• CD4 count
• Degree of immune suppression
• Lower CD4 count means decreasing immunity
• Viral load
• Amount of virus in the blood
• Higher viral load means more immune suppression

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HIV Disease

• Severity of illness is determined by amount of
  virus in the body (increasing viral load) and
  the degree of immune suppression (decreasing CD4
  counts)
• Higher the viral load, the sooner immune
  suppression occurs

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Progression of HIV Infection

• HIGH viral load (number of copies of HIV in the
  blood)
• LOW CD4 count (type of white blood cell)
• Increasing clinical symptoms (such as
  opportunistic infections)

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HIV Disease

• Direct infection of organ systems
• HIV can directly infect the
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)

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HIV Disease Summary

• HIV multiplies inside the CD4 cells, destroying
  them
• As CD4 cell count decreases and viral load
  increases, the immune defences are weakened
• HIV-infected people become vulnerable to
  opportunistic infections
• HIV is a chronic viral infection with no known
  cure
• Without ARV treatment, HIV progresses to
  symptomatic disease and AIDS

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Key Points

• HIV is a global pandemic and the number of
  people living with HIV continues to increase
  worldwide.
• HIV epidemic is especially severe in
  resource-constrained settings
• HIV is a virus that destroys the immune system,
  leading to opportunistic infections.
• The progression from initial infection with HIV
  to end-stage AIDS varies from person to person
  and can take more than 10 years.

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Key Points (continued)

• The most common main route of transmission
  worldwide is heterosexual transmission.
• Women of childbearing age are at particular risk
  for acquiring HIV through unprotected sex
• HIV-positive women who are pregnant are at risk
  of passing HIV infection to their newborn.
• Risk of HIV transmission from mother-to-child can
  be greatly reduced through effective PMTCT
  programs