Overview Notes (8) Related Modules

ungian r i e a n 45
Programmes

NACP - TARGETS, DIAGNOSISAND

MANAGEMENT

NACP: National AlDS Control Program

NACO National ADS Control Orgoanization

Nco
National AIDS Control Organisation
India's Voice against AIDS
Ministry of Health & Family Welfare, Government of Ihdia
www.naco-gov.in

Red ribbon : Symbol for HIV/AIDS.

worid AlDS day : December.

HIVvirus : Epidemiological features 00:01:57

Family i Lentevirus.
Single stranded RNAVirus.
Two tupes HIVI HIV a.
most conmon is HIV I.
evelope
Glycosujation 9ycoprotein
Gp 4! ornplex
comy
Proteins of host
cel
63cbb7bd99ab33c614cd0ffa Lipid menmbrane
Atrix protein

Capsid
rotease
acleocapsid

Tat

Viral RA Genoe
Active
space

integyase Reverse
trau ierptase

Community Medicine·y40" Marrow 6.5· 2023

Overview Notes (8) Related Modules

45 NACP- Targets, 25
Diagnosis and
Management

b.

m(major)
most (most
common conon)
HIV I N(neither). d.
HIV.
HIV a o(outlier). e, ete

(probable).
Sensitive to alcoho/ deterqent sovents.
Resistant to radiations.
63cbb7bd99ab33c614cdOffa
modes of transmisSion:

Route eficiency Cin ) tective mode o

transmission in )

Slood 90- 95

Perinatal ao - 4O

Sexual 75 - 8O

vdrug abuse <I 5- I0

Needle stick injury

most etective node of transmission Sexual.
most eficient mode of transmission : Blood transtusion.

High risk transmisSion :

Chances of male to temale transrnission is higher
compared to the opposite.
Concentration of HIV :Semen >> vaginal secretions,
Larqer area of exposure in ernales during intercourse.
" Anal itercourse is 3times more dangerous.
space
Actve
more chances of abrasions and injuries.
menstruatng female.
" Adolescents and post menopausal women
mucosal lining is thinner so risk of transmission is high,
<I5 years of age, or> 45 years o age.
Presence of other sexualy transmitted diseases
(more number of T cells in the area).
Transmission is highest during the windouw period as the
Community Medicine v4.0 " Marrow 6.5 2023
Overview Notes (8) Related Modules

Page_2/8
L

Indian Health 45
Programmes

vral load is higher than antibody load.

Needle stick injury among health care professionals is
very less eficient and not a major source of HIV
transmiSsion.
Very low Viral load in urine.
Almost absent in saliva :Deactivated by the salivary enzymes.

HIV virus : Host and social factor 00:11:54

Host :
Peak age:ao - S0 years.
No gender predilection.
Social :
Social diserimination present.
more in high risk occupational groups.
Commercial sex workers.
Truck drivers.
male migrants.
V drug abusers.
Stages of HIV:
Stage i Asymptomatic.
Generali2ed lymphadenopathy.
preetheeshsurana2210@gmail.com
|Stage i Surface infection like oral candidiasis,dermatitis.

Stage M COA count low.

Deep tissue infections:
Hepatitis.
" Preunonia.
Parereatitis.
Punonary tuberculosis (most common opportunistie
infection).
Stage Iv. opportunistic infections :
Preumocystsjroveci.
Active
space " cmv retinitis.
Toxoplasrosis.
Cryptococccal infection
" tra pumonary tuberculoss.
malignancies :
" Non Hodgkin's lymphomas mc malgnancy.
haposi sarcoma (strongest association with HIV).
Overview Relaled Modules

Diagnosis and
NACP Management
00:17:26

Niathonal AIDS Control Aroaram

Started by NIACO.
Started in the year 993, asa vertical proqram.
Tmeline:

Year NACA

198 First reported case in India.

Phase 1of NACA.
Iaoo Phase I of NACA
Phase l of NACA
aon-ao7 Phase V of NACA
aor-aoa4 National Strategie Plan s to end AIDS epidemic.

inpeethees hseraaz210dghránrebtealth mission.

worlid AIDs day is on Dec i" every year.
Theme of worid AIDS day, aol:
End inequalities.
End AIDS.
End pandenics.
wHO 90 -90- 90 strotegy
Out of al HiVinfected population, 90% should be diagnosed
Out of all HIV patients diognosed, 90% should be on
treotment.
Out of all HIV patients on treatnent, > 90% should have
decrease in viral load.
Treot AllStrategy :(BywHO)
Every patient to be given ART, irrespective of the CD4 count.
00:23:17
Targets
WHO:
space
Active
" 90- 90 -90stroteqy
Sustainable Develbpment Goals (soe).
" end HIV/ AIDS epidemic by the year ao0.
NACP:
" >80% reduction in HIV incidence by year aoa4
compared to aao.

2023
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 Overview Note Related Modules

8 Indian Health 45
Programmes
5- 5- 95 strateqy
5% patients shoukd be diagnosed.
5% patients should be on treatment.
The patients on treatment, > 93% should have decrease
in vral load.

statistics of HIV epideioloqy in India!

Incidence of HIV: S cases/ lakh/ year.
Arevalence of HIV :
Prevalence of HIV inANC emales during a sero
Surveillance are the proxy indicators for HIV prevalence
in the country, because the exact numbers are not
Knoun, due to inadequate data following the social
stigma
Prevalenbb7 bd99&b38e614cdoffa
Diagnosis of HIV 00:27:56

Screening tests Contrmatory tests

" LISA test. HIV DNA RTPCR: I0C in
Immunochromatography
Loteral Mo
children, usually intants (< lyr).
qPCR- HIV I:For aduts.
imnuno concentration Viral isolation Viral load
Dot Blot method estimation.
Particle agalutination test. Pas viral antiqen test.
western blot :Conirmatory
test of choice. Highluy specite.
Sereening of HIV:
ICTC centres: Inteorated Counselling and Testing Centres.
Tests done here are ERS:
LISA test : most sensitive, Best screening tool.
Rapid test.
Spot test.
RS done in :
Active
space Blood donation services.
Anyi positive result rom ERS tests is labelled as HIV
positive blbod, ond is disearded
Symptomatic patients Persistent diarrhea,
chronie tever, moderate to severe weight loss etc,
Any a out of three positive is HIV positive, and is sent or
conArmoation.

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 Overview Notes (8) Related Modules
contrmation.

Community Medicine v40 Maow 652023

Pago

45 NACP- Targets, 25
Diagnosis and
Managerment
Asyptonvatie patients.
Nio clinical sunyptons But all 3e2S testsare HIV
positve, sent Por conftrmatory tests.
Northen blot: RNA testing,
Soutthen blot : DA testing.
western blot : Arotein testing,
Eastern blot :enzume testing
CD4+ count:

Reliable test to assess the response to treatment and

prooression of Scb7bd99ab33c614cdOffa
Best test to asses response to treatment is quantitative viral
ioad estinmation.

Management of HIV 00:38:55

Treatment services for HIV:

First line Second Line

Category
Aduts oand Preferred Tenofovir +Lamivudine + A2T + 3TC +ATV/
adolescents Dolutegravir. Cor LAv/.
Alternate TOF +3TC +EFV 40O. A2T + 3TC + DTE,

Chiidren Prelerred Albacavir t Lamivudine + A2T + 3TC + LAV.

Dolutegravi.
Alternate ABC + 3TC + LPV/r. A2T (or Aec)+ 8TC
+ DTE,

Neonates Prekerred Zidovudine*LamiudineA2T (or Aec) +3TC

Raltegravir Lopinavir/ + DTG.
Ritonavir combination).
Alternote A2T + 8TC + NVe ABC + 3TC + DTa

TOF: Terofovir.
3TC LOmivudine.
DTE: Dolutegravir.
eFV: eavirenz.
eQDdCK space
Active
LAVle : Lopinavr/ Ritonavir combinaton
RAL:Rategravr.
NVP :Nevirapine.
A2T :Zidovudine.
ATV :Atazanavir.

MARK COMPLETE
Overview Notes (8) Related Modules

Prevention of mother to child

transmission (MTCT) 00:41:30

Chid exposed to HIV = Child born to HIV positive mother.

preetheeshsurana2210@gmail.com
Nevirapine D0C to prevent mTCT.
Dose : 1Og once daily for b weeks.
In case the motther took Nevirapine based ART during
the pregnancy 2idovudine is given, due to development
of archived Nevirapine resistance.
mother has taken
ART during
pregnarey

ART Suicient. ART insuficient.

(64 weeKs). (< 4 weeks).

Nevirapine x o In case of High risk of No high risk

weeks. Nevirapine transmnission. transmission.
based ART,
Zidovudine x o
weeks.

Nevirapine+ Nevirapine x ia
Zidovudine for ia weeks.
weeks.

APter b weeks, tarly Infant Diagnosis (elD) is done.

HIV DNA RTPCR is the IOC.
I positive : ART iS started
negative : Follouw up very o months upto a years.
Breast feeding 00:51:29
Active
space
f the chikd is HIV positive,
breastfeeding continued for a years.
the child is HIV negative, breastfeeding is given tor l
Despite the year.
chance of transmission, it is qiven to prevent the
immunode tciency rom not giving it.
Avoid abrupt stopping of breast milk.

Community Medicine y4.0 - Marrow 6.5 2023

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Overview Notes (8) Related Modules

45 NACP- Targets, 261

Diagnosis and
Managerment
Avoid abrupt changes in type of mik qiven (@ormula milk and
breast mik).
Post exposure prophulaxs (PeP):
Needle stck injury:fArimary level of prevention.
Tenofovir +Lamidine +Doutegravir.
<a hours of exposure.
For a8 daus, once daiy (preferred at night.
Arophylaxs Por Tuberculosis :
Isoniazid Areventive Therpay GP):
Given for all people living witth HIv (PLHI), ater ruling out Te.
DOC: ISoniazid.
children 6-10 yr)i Isoniazid io mg/kg1 Pyridoxine asmg
Acults : Isoniazid 300 mg Puridoxine SO mg
Given tor b months for everyone.
Contraindicated in :
Tuberculosis in HIV.

Hepatitis.
moR contact.

Prophylaxis of Pheumocystis jiroveci :

Arimary prophylaxis : Cotrimoxa2oe Preventive Therapy cer)
CO4 count < 350 cels/mm and/ or
HIV/AIDS Stage illor IV.
Drug Double strength Cotrimoxa20le (Tmp/smd toablets.
Trimethoprim (Tmp): loOmg
Sulfametthoxazole (sm): 800mg
Stop : whencchb7bd99 ab33c614cdOffa
no HIV stage ll or IV.
Secondary Prophylaxis is given when the patient has a
Pneumocystis jiroveci infection.
Double strength Cotrimoxazole for 3 weeks
Even if the CO4 count >350 cels/mm.
space
Active