HIV: THE GLOABAL AND

INDIAN SCENARIO

DR. KANUPRIYA CHATURVEDI

DR. S.K CHATURVEDI

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

DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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

DR. S.K CHATURVEDI

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 (33.841.7 million)
Adults
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
4.3 million (3.7 5.7 million)
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 boundaries within which the actual numbers lie, based on the best available information.
00003 -E-1 December 2004

DR. S.K CHATURVEDI

About 14 000 new HIV infections a day in 2004

More than 95% are in low and middle income countries

Almost 2000 are in children under 15 years of age

About 12 000 are in persons aged 15 to 49 years, of

whom:
almost 50% are women
about 50% are 1524 year olds

00003-E-10 December 2004

DR. S.K CHATURVEDI

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

DR. S.K CHATURVEDI

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

DR. S.K CHATURVEDI

Impact of Global HIV

Negative economic impact on countries
Overstrained healthcare systems
Decreasing life expectancy
Reversal of child survival gains
Increased numbers of orphans
DR. S.K CHATURVEDI

HIV Estimates in India

DR. S.K CHATURVEDI

MCH Profile (India)

Total Population

1027 M

Crude Birth Rate

Sex Ratio (F:M)

25/1000
933

Annual Pregnancies

27 M

ANC Coverage

65.4 %

Institutional Deliveries

[12.1% to 79.3%]

Deliveries attended by skilled birth attendants

DR. S.K CHATURVEDI

35.6 %
42.3 %

Adult HIV Prevalence

High Prevalence
States: these are
Tamil Nadu,
Maharastra,
Karnataka, Andhra
Pradesh, Manipur and
Nagaland

DR. S.K CHATURVEDI

Mode of Transmission of HIV In India

DR. S.K CHATURVEDI

MTCT in 100 HIV+ Mothers

The majority of children do not get
infected even when we do nothing
100
#

90

uninfected

80
70

63

60
50

uninfected

40
30
20
10
0

15
15
7

DR. S.K CHATURVEDI

# infected during

BF for 2 yrs

# infected during

delivery

#infants infected

during
pregnancy

Risk of PTCT Transmission

Globally: 15-45%
India: 30-37% ( average)

DR. S.K CHATURVEDI

Proportion of Respondents Stating That HIV

can be Transmitted Through Sexual Contact,
Selected States in India
2004 Report on the Global AIDS Epidemic
100

Urban Male

Urban Female

Rural Male

Rural Female

80
60
%
40
20
0

Bihar

Gujarat

Uttar Pradesh

Source: National AIDS Control Organization, National Baseline General

Population Behavioural Surveillance Survey 2001

DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

Natural History of HIV Infection

DR. S.K CHATURVEDI

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 DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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)
DR. S.K CHATURVEDI

HIV Disease
Direct infection of organ systems
HIV can directly infect the:
Brain (HIV dementia)
Gut (wasting)
Heart (cardiomyopathy)
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI

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.
DR. S.K CHATURVEDI

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
DR. S.K CHATURVEDI