HIV/AIDS NCM109

WARD CLASS

PRESENTED BY
GROUP 2
 T A B L E O F

c o n t e n t s
Objectives
Introduction of HIV (General)
History of HIV/AIDS
Introduction of HIV in pregnancy
Three Stages of HIV
Clinical Diagnostic
Causes
Signs and Symptoms
Route of Transmission
Risk factors in MTCT
Diagnostic Examination
Prevention
Medical Management and Interventions
The students should be able to:

1. Recite the most likely causes of HIV/AIDS

OBJECTIVES
and how this viral infection is usually acquired
2. Describe how the virus attaches to human
cells
3. Describe the three different HIV/AIDS
disease stages and what happens to the
immune system during those disease stages
4. Discuss the risk factors for the MTCT
5. Describe the various means of diagnosing
HIV/AIDS and when to use which test
6. List ways of preventing HIV infections
 Definition of
Terms
H I V ( H U M A N I M M U N O D E F I C I E N C Y

S E X U A L L Y T R A N S M I T T E D D I S E A S E S
V I R U S )

( S T D S )
It attacks a person’s immune system cells, and if
left untreated, it severely damages their also known as sexually transmitted infections
immune system and their ability to fight off (STIs) - is a very common disease and can be
infections. passed from one person to another through
vaginal, oral, and anal sex.
A I D S ( A C Q U I R E D I M M U N O D E F I C I E N C Y

S Y N D R O M E )
A N T I R E T R O V I R A L T R E A T M E N T ( A R T )

is a set of symptoms and illnesses that occur at
the very final stage of HIV infection. It’s
diagnosed when someone’s immune system is
severely damaged, and can no longer fight off
infections.
is the treatment for HIV – a combination of
three or more antiretroviral drugs that target
different stages of the HIV lifecycle
 Definition of
Terms
P E R I N A T A L T R A N S M I S S I O N /

M O T H E R - T O - C H I L D T R A N S M I S S I O N C D 4 C O U N T

( M T C T ) Your CD4 count is the number of CD4 cells (or

T-helper cells) in your blood, measured by a
also known as when a mother with HIV simple blood test. This tells you how healthy
passes the virus to her infant during pregnancy, your immune system is – your CD4 count
labor and delivery, or breastfeeding (through should go up when you have HIV treatment. It’s
breast milk). often talked about at the same time as viral load
F E M A L E C O N D O M ( I N T E R N A L (the amount of HIV virus in your blood).
Generally when your CD4 count is high, your
C O N D O M )
viral load is low and vice versa.
is a thin pouch that is worn inside the vagina or
anus during sex. It works by forming a barrier
to protect against sexually transmitted
infections (STIs) including HIV, and unplanned
pregnancy.
 HISTORY OF HIV/AIDS
● Reported as ● In U.S. called ● Assigned a uniform
● It was first lymphadenopathy name, the Human
human T
described in associated virus lymphotropic virus Immunodeficiency
1981 (LAV) in paris type III (HTLV III) virus (HIV) by the
1983 at Pasteur by Robert Gallo International
Institute by Lue and colleagues at Committee on the
Montagrier and National Institute Taxonomy of virus in
associates of Health 1986
INTRODUCTION:

Human Immunodeficiency Virus(HIV)
HIV (human immunodeficiency virus) is a virus that attacks the body's immune
system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency
syndrome). There is currently no effective cure. Once people get HIV, they
have it for life. But with proper medical care, HIV can be controlled

In relation to pregnancy, HIV passes through the placenta and infect the fetus. During

labor and delivery, the baby may be exposed to the virus from a woman's blood and

other fluids. When a woman goes into labor, the amniotic sac breaks (her water

breaks). Once this occurs, the risk of transmitting HIV to the baby increases.

All pregnant women with HIV should take HIV medicines throughout pregnancy for

their own health and to prevent perinatal transmission of HIV. (HIV medicines are

called antiretrovirals). Perinatal transmission of HIV is also called mother-to-child

transmission of HIV.
ACUTE HIV INFECTION AIDS
CHRONIC HIV INFECTION
Acute HIV infection is The final, most severe
the earliest stage of During this stage, HIV stage of HIV infection.
HIV infection, and it continues to multiply in the Because HIV has
generally develops body but at very low severely damaged the
within 2 to 4 weeks levels. People with chronic immune system, the
after infection with HIV. HIV infection may not have body cannot fight off
any HIV-related symptoms. opportunistic infections
ELISA TEST ELISA, WHICH STANDS FOR
ENZYME-LINKED IMMUNOSORBENT
ASSAY, IS USED TO DETECT HIV
INFECTION. IF AN ELISA TEST IS
POSITIVE, THE WESTERN BLOT TEST IS
USUALLY ADMINISTERED TO CONFIRM
THE DIAGNOSIS. IF AN ELISA TEST IS
Clinical
NEGATIVE, BUT YOU THINK YOU MAY
HAVE HIV, YOU SHOULD BE TESTED
Diagnosis
AGAIN IN ONE TO THREE MONTHS.
ELISA IS QUITE SENSITIVE IN CHRONIC
HIV INFECTION, BUT BECAUSE
ANTIBODIES AREN'T PRODUCED
IMMEDIATELY UPON INFECTION, YOU
MAY TEST NEGATIVE DURING A
WINDOW OF A FEW WEEKS TO A
FEW MONTHS AFTER BEING INFECTED.
EVEN THOUGH YOUR TEST RESULT
MAY BE NEGATIVE DURING THIS
WINDOW, YOU MAY HAVE A HIGH
LEVEL OF THE VIRUS AND BE AT RISK
OF TRANSMITTING INFECTION.
 SALIVA TESTS A COTTON
PAD IS USED TO OBTAIN
Home Tests The only SALIVA FROM THE
INSIDE OF YOUR CHEEK.
home test approved by THE PAD IS PLACED IN A
the U.S. Food and Drug VIAL AND SUBMITTED TO
Administration is called A LABORATORY FOR
the Home Access TESTING. RESULTS ARE
Express Test, which is AVAILABLE IN THREE
sold in pharmacies. DAYS. POSITIVE RESULTS
SHOULD BE CONFIRMED
WITH A BLOOD TEST.
 VIRAL LOAD TEST

THIS TEST MEASURES THE AMOUNT OF HIV IN YOUR BLOOD. GENERALLY,

IT'S USED TO MONITOR TREATMENT PROGRESS OR DETECT EARLY HIV
INFECTION. THREE TECHNOLOGIES MEASURE HIV VIRAL LOAD IN THE
BLOOD: REVERSE TRANSCRIPTION POLYMERASE CHAIN REACTION (RT-
PCR), BRANCHED DNA (BDNA) AND NUCLEIC ACID SEQUENCE-BASED
AMPLIFICATION ASSAY (NASBA). THE BASIC PRINCIPLES OF THESE TESTS
ARE SIMILAR. HIV IS DETECTED USING DNA SEQUENCES THAT BIND
SPECIFICALLY TO THOSE IN THE VIRUS. IT IS IMPORTANT TO NOTE THAT
RESULTS MAY VARY BETWEEN TESTS.
 Western Blot
THIS IS A VERY SENSITIVE BLOOD TEST USED TO CONFIRM A POSITIVE ELISA TEST
RESULT.
THE WESTERN BLOT TEST SEPARATES THE BLOOD PROTEINS AND
DETECTS THE SPECIFIC PROTEINS (CALLED HIV ANTIBODIES) THAT
INDICATE AN HIV INFECTION. THE WESTERN BLOT IS USED TO CONFIRM
A POSITIVE ELISA, AND THE COMBINED TESTS ARE 99.9% ACCURATE.
 CAUSES
CAUSED BY HUMAN IMMUNODEFICIENCY VIRUS (HIV), TRANSMITTED
THROUGH CERTAIN BODILY FLUIDS.
IT CAN BE TRANSMITTED THROUGH SEXUAL CONTACT
THROUGH BLOOD CONTACT OR FROM THE MOTHER TO CHILD DURING
PREGNANCY (MOTHER TO CHILD TRANSMISSION CAN BE PREVENTED)
CHILDBIRTH OR BREAST-FEEDING
THROUGH BLOOD TRANSFUSIONS
BY SHARING NEEDLES
UNPROTECTED SEX WITH INFECTED PERSON
SEX WITH MULTIPLE PARTNERS
ANY OTHER SEXUALLY TRANSMITTED INFECTION
SHARING IV DRUGS NEEDLES
 H I V / A I D S

s i g n s a n d s y m p t o m s

In general... In pregnancy...
HIV: AIDS:
Occurs after 2-6 Body ache, joint pains, nausea,
Develop after 10 years
weeks after vomiting, and diarrhea.
infection if not controlled
Fever, Most common initial

headache, conditions are Thus, the symptoms of an HIV

Sore throat pneumocystis
Fatigue positive pregnancy are not different
pneumonia
Rash Cachexia in the form of from flu during pregnancy. Later,
Night sweats and
Muscle ache
HIV wasting syndrome after the symptoms are gone, the virus
Esophageal candidiasis
Diarrhea, nausea continues to multiply and attack the
and recurrent
and vomiting,
respiratory tract immune system silently, until it
Mouth or genetal
ulcer infections breaks down.

UNPROTECTED SHARING OF CONTAMINATED PASSED FROM

SEX INJECTING BLOOD MOTHER TO
EQUIPMENTS TRANSFUSION BABY
 RISK
A BABY CAN BECOME INFECTED
WITH HIV IN THE WOMB, DURING
DELIVERY OR WHILE BREASTFEEDING.
FACTORS
IF THE MOTHER DOES NOT RECEIVE Smoking
TREATMENT, 25 PERCENT OF BABIES Substance abuse
BORN TO WOMEN WITH HIV WILL BE
INFECTED BY THE VIRUS. Vitamin A deficiency
Malnutrition
Infections such as STD’s
Clinical stage of HIV, including
viral load (quantity of HIV virus
IF A WOMAN IS INFECTED WITH HIV, HER
RISK OF TRANSMITTING THE VIRUS TO HER
in the blood)
BABY IS REDUCED IF SHE STAYS AS HEALTHY Factors related to labor and
AS POSSIBLE. ACCORDING TO THE MARCH
OF DIMES, NEW TREATMENTS CAN REDUCE childbirth
THE RISK OF A TREATED MOTHER PASSING
HIV TO HER BABY TO A 2 PERCENT OR LESS Breastfeeding
CHANCE.

DIAGNOSTIC
EXAMINATION
BLOOD TESTS ARE THE MOST COMMON
WAY TO DIAGNOSE HIV. OTHER TESTS
CAN CHECK FOR HIV IN SALIVA. BUT
THESE ARE GENERALLY NOT AS ACCURATE
AS BLOOD TESTS. WHEN A TEST IS
POSITIVE, YOU’LL HAVE MORE TESTS TO
CHECK THE RESULTS OF THE FIRST TEST.
T H R E E T Y P E S O F
"diagnostic test"
NUCLEIC ACID TESTS (NATS) LOOK FOR THE
ACTUAL VIRUS IN THE BLOOD. A NAT CAN
USUALLY DETECT HIV INFECTION 10 TO 33
DAYS AFTER AN EXPOSURE.
ANTIGEN/ANTIBODY TESTS LOOK FOR BOTH
HIV ANTIBODIES AND ANTIGENS. AN
ANTIGEN/ANTIBODY TEST PERFORMED BY A
LABORATORY ON BLOOD FROM A VEIN CAN
USUALLY DETECT HIV INFECTION 18 TO 45
DAYS AFTER AN EXPOSURE. THERE IS ALSO A
RAPID ANTIGEN/ANTIBODY TEST AVAILABLE
THAT IS DONE WITH A FINGER PRICK.
ANTIBODY TESTS ( IMMUNOASSAY) LOOK
FOR ANTIBODIES TO HIV IN YOUR BLOOD OR
ORAL FLUID. ANTIBODY TESTS CAN TAKE 23
TO 90 DAYS TO DETECT HIV INFECTION AFTER
AN EXPOSURE.
PREVENTION IN ACQUIRING
HIV INFECTION
AVOID MULTIPLE PARTNERS-USE ALL PREGNANT WOMEN
01 CONDOMS. 04 SHOULD
BE TESTED FOR HIV.

USE STANDARD WORK

USE STERILE NEEDLES EACH TIME
02 FOR INJECTION. 05 PRECAUTIONS- HAND HYGIENE,
PERSONAL PROTECTIVE GEAR.

NEVER SHARE NEEDLES,

PROPER DISPOSAL OF
03 AVOID UNNECESSARY BLOOD 06 BIOMEDICAL WASTE.
TRANSFUSIONS.
PREVENTION OF
MOTHER TO • RECEIVE ANTENATAL SERVICES AND
HIV TESTING DURING PREGNANCY.
CHILD
TRANSMISSION • HAVE ACCESS TO ANTIRETROVIRAL
(MTCT) TREATMENT (ART).

• PRACTICE SAFE CHILDBIRTH

PRACTICES AND APPROPRIATE
INFANT FEEDING.

• MAKE USE OF INFANT HIV TESTING

AND OTHER POST-NATAL
HEALTHCARE SERVICES.
 INTERVENTION:

COMBINATION
PREVENTION
Combination prevention advocates for a holistic approach whereby HIV prevention is
not a single intervention (such as condom distribution) but the simultaneous use of
complementary behavioral, biomedical and structural prevention strategies.

Combination prevention programs consider factors specific to each setting, such as

levels of infrastructure, local culture and traditions as well as populations most
affected by HIV. They can be implemented at the individual, community and
population levels.
 BEHAVIOURAL
INTERVENTIONS
BEHAVIOURAL INTERVENTIONS SEEK TO REDUCE THE RISK OF HIV TRANSMISSION BY
ADDRESSING RISKY BEHAVIOURS. EFFECTIVE BEHAVIOUR INTERVENTIONS ADDRESS THE
CULTURAL CONTEXTS WITHIN WHICH RISK BEHAVIOURS OCCUR. THEY AIM TO
STIMULATE UPTAKE OF HIV PREVENTION SERVICES (OFTEN REFERRED TO AS 'DEMAND
GENERATION'. THESE PROGRAMMES OFTEN FEATURE INTENSIVE APPROACHES
INVOLVING A COMBINATION OF ACTIVITIES.

Information provision (such as sex education)

counselling and other form of psycho-social support
safe infant guidelines
stigma and discrimination reduction programmes
cash transfer programmes
 BIOMEDICAL
INTERVENTION
MALE CIRCUMCISION HAS BEEN SHOWN TO REDUCE THE RISK OF HIV TRANSMISSION BY
UP TO 60% DURING UNPROTECTED HETEROSEXUAL SEX. BIOMEDICAL INTERVENTIONS
USE A MIX OF CLINICAL AND MEDICAL APPROACHES TO REDUCE HIV TRANSMISSION.
THEY ARE RARELY IMPLEMENTED INDEPENDENTLY AND ARE OFTEN USED IN
CONJUNCTION WITH BEHAVIOURAL INTERVENTIONS.

Male and female condoms

sex and reproductive health services
HIV testing and counselling
testing and treatment of sexually transmitted infections
needle and syringe programmes
opioid substitution therapy
blood screening.
 STRUCTURAL
INTERVENTIONS
HIV-RELATED VULNERABILITIES ARE FUELED BY INEQUALITIES AND PREJUDICES IN SOCIETY. BY
SUCCESSFULLY ADDRESSING THESE STRUCTURAL BARRIERS, INDIVIDUALS ARE EMPOWERED TO ACCESS
HIV PREVENTION SERVICES. EMPOWERING WOMEN AND GIRLS, YOUNG PEOPLE AND PEOPLE FROM
GROUPS MOST AFFECTED BY HIV IS A REQUISITE COMPONENT OF COMBINATION HIV PREVENTION.

Gender inequalities, including gender-based violence, exacerbate women and girls’ vulnerability to HIV and block their
access to HIV services.
Requirements of parental/carer consent remains an important barrier to uptake of HIV and sexual and reproductive
health services among adolescents and young people.
Key populations face specific challenges and barriers, including violence and violations of their human rights, with
women in key populations particularly affected.
Homophobia is a barrier to HIV services for gay men and other men who have sex with men.
Criminalisation and stigmatisation of same-sex relationships, cross-dressing, sex work and drug-use block HIV
prevention services and increase risky behaviours.
Stigma and discrimination related to HIV and towards key populations in healthcare settings undermine access to HIV
prevention and other health services.
 Medical
Management
ANTIRETROVIRAL
THERAPY (ART)
The treatment of HIV/AIDS with medicines
is called antiretroviral therapy (ART). It is
recommended for everyone who has HIV.
The medicines do not cure HIV infection,
but they do make it a manageable chronic
condition. They also reduce the risk of
spreading the virus to others.
 How do HIV/AIDS medicines
work?
HIV/AIDS medicines reduce the amount of HIV (viral
load) in your body, which helps by:
Giving your immune system a chance to recover. Even though there is still some
HIV in your body, your immune system should be strong enough to fight off
infections and certain HIV-related cancers.

Reducing the risk that you will spread HIV to others

What are the types of HIV/AIDS

medicines?
There are several different types of HIV/AIDS
medicines. Some work by blocking or changing
enzymes that HIV needs to make copies of itself. This
prevents HIV from copying itself, which reduces the
amount of HIV in the body. Several medicines do this:
Nucleoside reverse transcriptase inhibitors (NRTIs) block an enzyme called
reverse transcriptase
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and later change
reverse transcriptase
Integrase inhibitors block an enzyme called integrase
Protease inhibitors (PIs) block an enzyme called protease
SOME HIV/AIDS MEDICINES INTERFERE
WITH HIV'S ABILITY TO INFECT CD4
IMMUNE SYSTEM CELLS:

Fusion inhibitors block HIV from entering the cells

CCR5 antagonists and post-attachment inhibitors
block different molecules on the CD4 cells. To infect a
cell, HIV has to bind to two types of molecules on the
cell's surface. Blocking either of these molecules
prevents HIV from entering the cells.
Attachment inhibitors bind to a specific protein on the
outer surface of HIV. This prevents HIV from entering
the cell.
IN SOME CASES, PEOPLE TAKE MORE THAN
ONE MEDICINE:
Pharmacokinetic enhancers boost the effectiveness of
certain HIV/AIDS medicines. A pharmacokinetic
enhancer slows the breakdown of the other medicine.
This allows that medicine to stay in the body longer at
a higher concentration.
Multidrug combinations include a combination of two
or more different HIV/AIDS medicines