Acquired Immune Deficiency Syndrome (AIDS) cases were first reported in 1981 in the United States of America when individuals presented with symptoms of rarer diseases like Kaposis Sarcoma and Pneumocystis Carnii Pneumonia, specially in males who were having male-to-male sexual practices. Subsequently, such cases were reported in other European countries and Africa, in male, female and children.
In 1983, two scientists namely Louis Montaignier of Institute of Louis Pasteur, Paris and Robert Gallo of United States reported that Human Immuno Deficiency virus (HIV) was the causative organism for HIV infection, leading to AIDS.
One of the hypotheses, which are given much credence about the origin of the HIV virus, is that the HIV virus originated from African green monkeys through species jump. 2. HIV EPIDEMIOLOGY
 It is estimated that 40 million people are now living with HIV infection  About 4 million individuals are supposed to have been infected with HIV  So far worldwide, it is estimated that 25 Million people have already died due to AIDS in the past 20 years and orphaned 13 million children, worldwide.
 It is estimated that HIV infects 16000 individuals everyday.
Global summary of the HIV/AIDS epidemic: December 2001 Particulars
No. Of People
People newly
AIDS deaths
living with
infected with
during 2001
HIV during 2001
40 Million
5 Million
3 Million
37.2 million
4.3 Million
2.4 Million
17.6 million
1.8 Million
1.1 million
Children below 15 years
2.7 million
 The first HIV/AIDS case was reported in India from Chennai and Mumbai in  India stands next to South Africa in number of HIV infected cases.
 It is estimated that more than 4 million people are living with HIV infection in  As on 31st October 2003, 56151 AIDS cases in India were reported (NACO).
 89% of total reported AIDS cases come under 15 to 44 years age group, which is sexually active and economically productive.
 One of the characteristic features of Indian HIV scenario is its heterogeneousity. While the whole country is afflicted with HIV infection, its prevalence varies from State to State. The most populous States of India are least affected (for example Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Orissa etc.) while States like Maharashtra, Tamilnadu, Karnataka, Andhra Pradesh, Manipur and Nagaland are the most affected. In these states HIV infection has even started percolating into the general population leading to intense mother-to-child transmission of HIV.
HIV is the name of the virus that produces immune deficiency in human body.
Immuno Deficiency (creating deficiency in immune system) It is a micro organism called virus, which is 1 in 10,000 parts of a millimeter in size HIV belongs to Retrovirus group and slow acting (Lenti-Virus) in nature.
It lives only in the human body cells. It has an affinity for the white blood cells called CD4 cells, which play major role in guarding the immunity of the human Infected CD4 cells get destroyed in a course of time leading to lower immunity.
There are two types of HIV virus: Type1 and Type2 Both types are prevalent in India, Type 1 is more frequently reported. HIV type 2 is generally milder, slower in progress and poorly transmitted vertically.
HIV Type 1 is a more virulent pathogen than type 2 The virus can be found in almost all body fluids and organs of an infected person.
The virus is present in very large numbers in the semen, vaginal and cervical secretions and in blood.
The central nervous system, testes, lymph nodes act as reservoirs of HIV.
The highest concentration of HIV among the body fluids is found in cerebrospinal fluid.
89% of the infected population belongs to the reproductive and economically productive age group of 15 to 45.
On exposure to room temperature or any ordinary anti- septic, HIV will die within 30 seconds.
HIV finds easy entry from an infected person to another person through mucus membranes and abraded skin (eg. Wounds, small cut injuries) More than 85 percent of HIV Infections in India are due to unsafe sex-practices.
AIDS is a stage where a collection of diseases surfaced in the HIV infected person due to low-immunity level.
A = ACQUIRED: means that the disease is acquired as opposed to being
I = IMMUNE: describes that it affects the body’s immune system
D = DEFICIENCY: the immune system is so depleted so that it is unable to
defend itself
S = SYNDROME: a group of signs & symptoms caused by multiple illnesses.
 A virus called HIV, which is the infectious agent, enters into the body and creates  A person with lowered immunity is exposed to various communicable diseases affecting various organs and organs system, leading to complications and ultimately to AIDS and culminates in death of the individual.
 Though so far, no medicines have been discovered to eliminate the virus from the human system, medicines like anti-retrovirals are available to check the multiplication of the virus which can prolong the life of the infected individual.
 The infected person taking anti-retroviral therapy can have a prolonged and healthier life and carry out his routine activities. However, the medicines have to be consumed for life long.  As on today there is no vaccine to prevent the disease  Apart from the drugs, Care & Support by family & society can extend the life of 4. ROUTES OF TRANSMISSION
 Unprotected Sexual intercourse (heterosexual or homosexual), when one of the  Use of contaminated needles/ syringes.
 From an infected mother to her baby (vertical).
Needle stick exposure (health care Less than 0.1% settings, needle stick injury, tattooing etc.) 5. HOW HIV INFECTION WILL NOT SPREAD?
 Coughing or sneezing by the infected  Sharing cups / glasses / plates / eating utensils with the infected  Mosquitoes and other insect bites of the infected and then the non -infected  Wearing clothes of the infected people  Going to swimming pools or public baths used by the infected 6. HIGH RISK POPULATION TO ACQUIRE HIV
 Any one who indulges in unsafe sexual behaviour is at the risk of getting STI  Having many partners  Having sex with an infected partner without the use of condom.
 Sex with commercial sex workers without the use of condoms.
 Sharing of needles among injecting drug users.
 Frequent blood receivers (hemophiliacs, Thalassemics etc.)  Men having sex with men specially the anal sex, without using condoms  Trans gender community who have sex with many partners without using  Partners of the transgender community who have sex without using condoms 7. RISK FACTORS FACILITATING THE HIV ACQUISITION
 Local HIV prevalence rates among vulnerable groups, bridge population, etc.
 Inconsistent use of condoms in high risk sexual encounters.  Presence of sexually transmitted diseases in any one of the partners 8. MORE INFORMATION ABOUT TRANSMISSION
 People infected with HIV are infectious life long.  The HIV infected person may remain asymptomatic for 5-10 years & subsequent to this period, develop AIDS.  Even during this asymptomatic period they are infectious.
INITIAL STAGE Individual is infected with HIV
WINDOW PERIOD HIV is not known in common blood tests
HIV POSITIVE STAGE known through common blood tests
AIDS RELATED COMPLEX -ARC STAGE (Heavy weight loss & prolonged fever, diarrhoea)
AIDS STAGE (persistent Infectious Disease & other Metabolic complications)
HIV positive: The presence of antibodies against HIV in human body is termed as HIV
positivity and the person infected who develops HIV positivity in blood is called HIV
positive (sero positive)
Window Period: It takes 6-12 weeks between acquiring the infection and becoming HIV
positive. This duration is known as the window period.
Many people do not develop any symptoms when they first become infected with HIV. Some people however, get a flu-like illness within three to six weeks after exposure to the virus. This illness called Acute HIV syndrome, may include fever, headache, tiredness, nausea, diarrhea and enlarged lymph nodes (organs of the immune system that can be felt in the neck, armpits and groin). These symptoms usually disappear within a week to a month and are often mistaken for another viral infection.
During this period, the quantity of the virus in the body will be high and it spreads to different parts, particularly the lymphoid tissues. At this stage, the infected person is more likely to pass on the infection to others. The viral quantity then drops as the body’s immune system launches an orchestrated fight.
More persistent or severe symptoms may not surface for several years may be for even a decade or more, after HIV first enters the body in adults or within two years in children born with the virus. This period of “asymptomatic” infection varies from individual to individual. Some people may begin to have symptoms as soon as a few months, whileothers may be symptom-free for more than 10 years. However, during the “asymptomatic” period, the virus will be actively multiplying, infecting, and killing cells of the immune system 11. WHAT HAPPENS INSIDE THE BODY FOLLOWING THE INFECTION
Once the HIV enters the human body through any of the routes, it attaches itself to a
particular White Blood Cell (WBC) called CD
4. Also called T4
soldiers (disease fighters) of the body. After attaching itself on to the CD4 cell, the virus transmits its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell’s genetic material. It is a virtual takeover of the cell. Using the cell’s division mechanism, the virus now replicates and produces thousands of its own copies, destroying the CD4 cell. These viruses then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises while that of the CD4 cells declines.
Because of this process, immediately after infection, the viral load of infected individual will be very high and the number of CD4, low. But after a while, the body’s immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast replicating virus, as many as a billion CD4 cells are produced every day, but the number of the virus also rises on a similar scale. The battle between the virus and the CD4 cells continues even as the infected persons remains symptom-free.
But after a few years, which can last up to a decade or even more, when the number of
the virus in the body rises to very high levels, the body’s immune mechanism finds it
difficult to carry out the battle. The balance shifts in favour of the virus and the persons
becomes more susceptible to various infections. These infections are called opportunistic
because they infect the body using the opportunity of its low immunity. At
this stage, the number of CD4 cells per milliliter of blood (called CD4 count), Which
ranges between 500 and 1,500 in a healthy individual, falls below 200. The viral load,
which is the quantity of the virus in the blood, will be very high at this stage.
Tuberculosis and oro-pharyngeal candidiasis are the most common opportunistic infection. It is estimated that 60-70% of HIV infected persons in India, develop tuberculosis in their lifetime. 12. THE LATER SYMPTOMS OF HIV/AIDS
 A thick, whitish coating of the tongue or mouth (thrush) that is caused by a fungus and sometimes accompanied by a sore throat.
 Severe or recurring vaginal Fungal infections  Chronic pelvic inflammatory disease, severe and frequent infections like herpes  Periods of extreme and unexplained fatigue that may be combined with headaches, lightheadedness, and dizziness  Rapid loss of more than 10 pounds of weight loss more easily than normal.
 Swelling or hardening of lymph nodes located in the throat, armpit, or groin.
 Periods of continued, deep, dry coughing.
 The appearance of discoloured or purplish growths on the skin or inside the  Unexplained bleeding from growths on the skin, from mucous membranes, or  Recurring or unusual skin rashes.
 Severe numbness or pain in the hands or feet, loss of muscle control and reflex, paralysis or loss of muscular strength.
 An altered state of consciousness, personality change, or mental deterioration.
 Children may grow slowly or fall sick frequently.  HIV positive persons are also found to be more vulnerable to some cancers like 13. PREVENTION
 Because there is no effective vaccine and no cure for HIV, the only way to protect  People should either abstain from having sex or use latex condoms, during oral, anal, or vaginal sex. Condoms made with latex offer best protection.  The risk of HIV transmission from a pregnant woman to her baby is significantly reduced if she takes AZT during pregnancy, labour and delivery and if her baby takes it for the first six weeks of life. Nevirapine is also found to be useful. But, one should seek expert medical assistance in such situations.
B. METHODS OF PREVENTION FROM HIV/AIDS INFECTION:  Abstinence till marriage is good prevention.
 Being faithful to the partner after marriage and avoiding multiple sex partners. If not possible, use condoms correctly in every other penetrative sexual encounters.
 HIV- tested blood only to be used for infusion purposes even during emergency surgical procedures and in accidents cases.
 Using disposable or sterilized syringes – needles which is free of HIV Infection.  If suffering from sexually transmitted disease, complete treatment has to be ensured along with partner treatment.
 Men having sex with men (MSM) should use condoms, possibly with KY jel lubricants for extra lubrication during anal intercourse.
A. VOLUNTARY COUNSELLING AND TESTING CENTRE (VCTC):  VCTC services provide a facility for people who seek counseling and testing voluntarily to know their HIV status. Based on the test results, they can protect themselves and their partners appropriately.
 The main purpose of the VCTC is not to test all those who come there but to provide them an opportunity to decide on whether to take-up or not to take up the test through appropriate counseling and through informed consent.
 VCTC service is provided by the Government of India, at all District headquarters hospitals and HIV/AIDS specialized hospitals. NGOs can provide the essential link between the VCTC and the community while providing care and support of people infected.  VCTC team consists of a Medical Doctor, a Counselor, a Lab-technician, a Nurse  Serve as a link between prevention and care  Be a team effort geared towards a client-centered approach  Be accessible to the service seekers at appropriate timings  Ensure clear treatment links for people tested positive for HIV  Provide support links to affected individuals and families through  Creating an atmosphere for the patients to decide on different options and appropriate medical help makes a VCTC, patient friendly. Periodical meeting among the VCTC team members to review the processes and issues arising, make it more effective in operation. Standardization of procedures and processes within the VCTC make is more viable and ensures qualitative service.
 Maintenance of confidentiality by the team and the department as a whole ensures a safe environment for those who access this service.
 The constant link with the community through the out-reach programs and publicity of the services offered provides a considerable in-flow of clients who seek services.
Blood and blood products safety. this is achieved by mandatory testing of all donated blood units and blood products.
Diagnosis of HIV infection in clinically suspected cases Screening of donors of sperms, organs and tissues Epidemiological surveillance using unlinked anonymous HIV testing, where the result of test cannot be linked with the identity of the persons Type of testing:
 The most widely used tests for the diagnosis of HIV infection, available in India are RAPID TESTS and ELISA, which have high specificity/sensitivity.
 HIV infection is diagnosed by blood tests for antibodies and antigens.
 ELISA test is specific, sensitive and less expensive. Commonly used for screening at blood banks, voluntary counseling and testing centers for diagnostic purpose.
 RAPID test is a quick test. Results could be obtained within 30 minutes and it does not need elaborate laboratory procedures  Western Blot test, a confirmatory test, though more specific, is costly. Confirmation can also be done by using results from 2/3 consecutive ELISA tests from different kits, as situation warrants HIV antigen tests:
 PCR test positive after 72 hours of infection  Viral load assessment test like NASBA positive after 72 hours of infection P24 antigen test positive after 2 weeks of infection Use these tests has minimized the Window period but these tests are available only in few places in Tamil Nadu and are expensive.
15. Anti-Retroviral Therapy (ART)
 Anti-retroviral drugs check further multiplication of HIV. Anti-viral drugs in current  Since viral replication occurs at an extremely rapid rate, no single drug is able to inhibit this degree of viral replication. Therefore a combination of drugs belonging to different classes is to be used.
When a patient is exposed to one drug only instead of combination of drugs, the HIV develop resistance to the drug used and continue viral replication inspite of the drug administration. Hence no single drug therapy or two-drug therapy should be prescribed (except in PMTCT & PEP). Always three or more drugs to be used. Drug resistance and side –effects of drugs are to be monitored.
 In this way the fresh white blood cells get spared from HIV infection and the blood cells responsible for defense of the body are spared and the patients escape from getting infected by opportunistic infections and malignancies.
 Anti-retroviral drugs need to be administered to the patients under the supervision of  To start with, the drugs were very expensive and now they are available at moderate 16. SOCIO ECONOMIC ASPECT OF HIV/AIDS
 Lower earning capacity due to loss of employment / frequent illnesses  Economic burden for taking medical treatment  Economic productivity affected (as mostly the production age group of 15-  Difficulty in rendering medical treatment  Problems in looking after affected/infected widows  Problems in looking after affected/infected orphaned children B. MAGICAL REMEDIES
In the context of absence of drugs in the allopathic system to completely eradicate the HIV virus from the infected person, many magical remedies claims cure for the HIV/AIDS and this message is being given wide coverage in the media. They talk about cent percent cure of the AIDS disease and reversal of HIV status. Many of the patients get cheated by these messages and spend their hard-earned money believing these advertisements. It is a pity that there is no open challenge to these exploiters either from Government machinery or from positive networks.
Some Important latest developments are: Various medicines are available in the market, which will prolong the life of HIV It is possible to reduce mother to child transmission (Vertical transmission) from 30% to till 7% through available latest medicine Schedule.
HIV Infected Individual Need not required to take medicine and today only when the CD4 count of the patient in below200 per micro litre (normal 800-1200) or viral load exceeds 55,000 copies per ml of the blood. For HCPs if they accidentally have needle pricks they could go through Post Researches are going on in developing vaccines as prophylactic & therapeutic


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