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 Public baths

Insect bites Handshakes

Work or school contact
Touching, hugging
Using telephones
Water, food
Sharing cups, glasses,
Kissing plates, or other utensils

DR. S.K CHATURVEDI

Global summary of the HIV and AIDS epidemic,
December 2004

Number of people living Total 39.4 million (35.9 44.3 million)

Adults 37.2 million (33.841.7 million)
with HIV in 2004 Women 17.6 million (16.3 19.5 million)
Children under 15 years 2.2 million (2.0 2.6 million)

People newly infected Total 4.9 million (4.3 6.4 million)

Adults 4.3 million (3.7 5.7 million)
with HIV in 2004 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

5.1 m. Indian living with HIV
* Source: UNAIDS,2004
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 25/1000

Sex Ratio (F:M) 933

Annual Pregnancies 27 M

ANC Coverage 65.4 %

Institutional Deliveries [12.1% to 79.3%] 35.6 %

Deliveries attended by skilled birth attendants 42.3 %

DR. S.K CHATURVEDI
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

2.7
2.07

3.45

5.95
85.83

Sexual IDUs Blood & blood proucts Perinatal Unidentified

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 # infected during
60 63
uninfected BF for 2 yrs
50
# infected during
40
30 15 delivery
20 #infants infected
15
10
0 7 during
pregnancy

DR. S.K CHATURVEDI

 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
Urban Male Urban Female Rural Male Rural Female
100

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