Re-emerging Infectious Diseases - HIV/AIDS

DR. Shomik Maruf

OBJECTIVES OF THE LECTURE 1

By the end of this lecture, you will be able to:

• Conceptualize
• HIV/AIDS, risky groups for getting HIV/AIDS
• Mode of transmission & prevention
• Current situation of HIV/AIDS in Bangladesh

• Understand the use of Anti-retroviral therapy in treating AIDS cases

 HIV & AIDS

• HIV or Human Immunodeficiency Virus is a retrovirus that primarily

weakens human immune system
• HIV transmission is possible at any stage of HIV infection—even if an HIV-
infected person has no symptoms of HIV

• AIDS or Acquired Immuno-Deficiency Syndrome is the end-stage of HIV

infection
• Less than 200 CD4+ T cells*/cubic mm of blood
• Opportunistic infections and severe weight loss

*CD4 cells, also known as T cells, are white blood cells that
fight infection and play an important role in our immune
system. A CD4 count is used to check the health of the immune
system in people infected with HIV (human immunodeficiency
virus). HIV attacks and destroys CD4 cells
 • In 1981, 5 young gay men in USA reported pneumonia from an
abnormal pathogen (Pneumocystis carinii) as well as some
abnormal cancer (Kaposi’s Sarcoma)
H I STO RY! ! !
• Branded as a “cellular-immune dysfunction related to a
common exposure” and a “disease acquired through
sexual contact”

• In 1983, the virus was

discovered in USA
(Robert Gallo) and
France (Luc
Montagnier)

• Retrospective
analysis revealed: It
has been present
since 1920s in Africa.
First retrospective
case of HIV infection
1959 in Kinshasa
 Structure of HIV & Key facts of AIDS

1. A major global public health issue. Claimed 36.3 million [27.2–47.8 million] lives so far. No cure.

2. Increased access to effective HIV prevention, diagnosis, treatment and care, including opportunistic
infections – has made the management better and increased life expectancy.

3. Estimated 37.7 million [30.2–45.1 million] people living with HIV at the end of 2020; >2/3rd (25.4
million) reside in the African Region.

4. In 2020, 680 000 [480 000–1.0 million] people died from HIV-related causes and 1.5 million [1.0–2.0
million] people acquired HIV.

5. To reach the new proposed global 95–95–95 targets set by UNAIDS, we will need to redouble our
efforts to avoid the worst-case scenario of a half million excess HIV-related deaths in sub-Saharan
Africa, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing
public health response to HIV.
 Some important terminologies

• PrEP: Pre-Exposure Prophylaxis is an HIV prevention option for people who don’t have HIV
but who are at high risk of becoming infected with HIV. PrEP involves taking a specific HIV
medicine every day. PrEP should always be combined with other prevention options, such as
condoms.
• PEP: Post-exposure prophylaxis involves taking antiretroviral (ARV) medicines very soon
(within 3 days) after a possible exposure to HIV to prevent becoming infected with HIV.
• ART: antiretroviral therapy is the use of HIV medicines to treat HIV infection. ART involves
taking a combination of HIV medicines every day. ART can’t cure HIV infection, but it can help
people infected with HIV live longer, healthier lives. HIV medicines can also reduce the risk of
transmission of HIV.
• VMMC: Voluntary Medical Male Circumcision– In 2020 WHO updated the 2007
recommendation of VMMC to continue as an additional preventive intervention among males
age 15 years and older. Over 15 million VMMC performed between 2015-2019.
 Sources of HIV/AIDS

Body fluids of a HIV infected person.

• 1. Fluids contain highly concentrated virus:
• a) CSF b) Semen c) Blood d) pre-semen
• 2. Fluids contain less concentrated virus
• a) Cervical secretion, b) Vaginal secretion c) Breast milk
3. Fluids contain very less concentrated virus:
a) Sweat) Saliva c) Tears etc.
 Risk factors

• Behaviors and conditions that put individuals at greater risk of contracting

HIV include:
1. having unprotected anal or vaginal sex;
2. having another sexually transmitted infection (STI) such as syphilis,
herpes, chlamydia, gonorrhoea and bacterial vaginosis;
3. sharing contaminated needles, syringes and other injecting equipment
and drug solutions when injecting drugs;
4. receiving unsafe injections, blood transfusions and tissue
transplantation, and medical procedures that involve unsterile cutting or
piercing; and
5. experiencing accidental needle stick injuries, including among health
workers
High risk group or Key
populations
Key populations:
1. MsM (Men having Sex with Men)
2. CSWs with clients (Commercial Sex Worker)
3. People in Prison/jail/goal and other closed setting
4. IDUs (Injectable Drug Users)
5. Transport workers
6. Migrant population
7. Female garments workers in Dhaka city etc.
 Mode of Transmission

• 1. Sexual transmission: Unsafe

sexual act. Anal sex.
• 2.Perentral transmission: infected
blood and blood products

3.Perinatal transmission: from an

infected mother to her offspring during,
before or after delivery. 25%-50%
4. Accidental transmission: Infected
needles, syringes, organ transplants,
semen and other tissues can occur in
medical settings
Once inside a Hoooomaaan!

1. Virus attaches to cell

2. Part of it enters the cell
3. Virus gene integrates
4. Many viral parts
manufactured
5. Viral parts are put together
6. New viruses leave the cell
 Signs and symptoms

• The symptoms of HIV vary depending on the stage of infection. Though people
living with HIV tend to be most infectious in the first few months after being
infected, many are unaware of their status until the later stages.

• Acute or Initial Infection (1-3 months): Asymptomatic or Fever, headache,

tiredness, generalized swollen glands.

• Latent Infection (1-10 years): No symptoms. HIV is still active but reproduces at
very low levels. People can still transmit HIV to others.

AIDS: Immune system compromised, opportunistic infections (tuberculosis (TB), cryptococcal

meningitis, severe bacterial infections), cancers, severe weight loss. CD4+ T cell <200/mm3, Viral
load HIGH. Without treatment, people with AIDS typically survive about 3 years.
Diagnosis & Treatment

Diagnosis
1. Based on detection of antibody (your body’s response to HIV infection) which
becomes positive after 28 days
2. Detection of Antigen (viral part) in blood (can be detected immediately)

Treatment
1. There is NO cure for HIV infection currently, it can only be controlled by
lifelong medication
2. Drugs can prevent or lower viral replication and reduce transmission
3. ART or Anti Retroviral Therapy means the treatment to suppress viral
replication
 Prevention

1. Health education
2. Condom promotion
3. VCT: rapid test and self test.
4. Pre-Ep (The formula is 2+1+1):
a. 1st pill 2-24 hours before sex
b. 2nd pill 2-24 hours before sex
c. 3rd pill after 24 hours of first 2 pills
d. 4th pill 48 hours after first 2 pills

5. DVR# Dapivirine vaginal Ring (LMIC)

*There is IM injection (on Trial) CAB-LA (cabotegravir) will be available at the end of 2022.
This is one every 8 weeks.
Prevention
Prevention

Male and female condom use

• Correct and consistent use of male and female condoms during vaginal or anal
penetration can protect against the spread of sexually transmitted infections, including
HIV
• Evidence shows that male latex condoms have an 85% or greater protective effect
against HIV and other sexually transmitted infections (STIs)
 Prevention

Voluntary medical male circumcision (VMMC)

• Medical male circumcision, reduces the risk of heterosexually acquired HIV infection in men by
approximately 60%

• here is no evidence that male circumcision decreases a woman’s risk of getting HIV

• Evidence about the benefits of circumcision among gay and bisexual men is inconclusive

By reducing viral load in HIV positive person By eliminating mother to child transmission (MTCT)

If an HIV-positive person adheres to an Mother-to-child transmission can be nearly/fully

effective ART regimen, the risk of transmitting prevented if both the mother and the baby are
the virus to their uninfected sexual partner provided with ART drugs as early as possible in
can be reduced by 96% pregnancy and during the period of breastfeeding
 Prevention

PrEP should be used by people, who:

• Have an HIV-positive partner

• Have Multiple Partners
• share needles or equipment to inject drugs

PEP is ideal for people, who:

• Exposed to HIV during sex (for example, condom break)

• Shared needles or works to prepare drugs
• Were sexually assaulted
Situation in Bangladesh
Situation in
Bangladesh
No Stigma !!!
Thank You