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 (33.8–41.7 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 15–24 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 body’s 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