STI and HIV/AIDS

HIV/AIDS
• Definition
• HIV is a condition caused by Human
immunodeficiency Virus.
• AIDS- HIV infection virus infection presenting
with various signs and symptoms and
development of opportunistic infections and
or malignant lesions.
 PATHOGENESIS
• HIV destroys the cells of the immune system
known as T –Helper cell/ CD4 cell.
• Transmission
• Sexual relations
• Mother to baby
• Blood transfusion
• Blood contaminated products
 Risk behavior and risk groups
• Multiple sexual partners, wife inheritance
• Early onset of sexual activity
• Sexual acts
• Unprotected sexual contact
• Commercial sexual workers, beach boys
• Migrants
• Adolescent and youth
• Drug abusers
• Confined groups ( prisoners, boarding, refugees)
 Routes of Infection
• Sexual intercourse
• Mother to child
• Self infection
• Contaminated formites
• Blood
 Presentations
• Clinical staging
• Stage I Asymptomatic
– Persistent generalized lymphadenopathy
• Stage II Early (Mild ) disease
– Weight loss >10%
– Minor skin infections
– Herpes Zoster
– Recurrent URTI
• Stage III Intermediate (moderate) disease
– Weight loss >10%
– Chronic diarrhea
– Fever
– Oral candidiasis
– TB
– Severe bacterial infections
• Stage IV: Late (Severe) disease,
– HIV wasting
– CMV
– Pneumocystis Carinii Pneumonia
– Toxoplasmosis
– Kaposi's Sarcoma
– HIV encephalopathy
• Stage V: Last stage : AIDS
 Diagnosis
• Clinical
• Laboratory
• Viral antibody testing
• Viral antigen rapid tests
• Viral load tests
• Screening for STIs
 Treatment
• Psychological assessment and support
• Treat STI
• Nutritional support
• Life style change
• ARVs
• Treat specific infections and conditions
• Home based care
• Appropriate FP methods
 Prevention
• Responsible sexual habits
• Early medical seeking, diagnosis and effective
treatment
• The 4Cs: Counseling, Condoms, Compliance,
Contact treatment.
• PMCT
 Drawbacks
• Treatment of partners and contacts
• Discriminatory
• Gender biased
• Punitive
 PREVENTION OF MOTHER TO CHILD
TRANSMISSION
Effective prevention of mother-to-child transmission
(PMTCT) requires a three-fold strategy.
• Preventing HIV infection among prospective parents -
making HIV testing and other prevention interventions
available in services related to sexual health such as
antenatal and postpartum care.
• Avoiding unwanted pregnancies among HIV positive
women - providing appropriate counseling and support
to women living with HIV to enable them to make
informed decisions about their reproductive lives.
• Preventing the transmission of HIV from HIV
positive mothers to their infants during
pregnancy, labour, delivery and breastfeeding.
• Integration of HIV care, treatment and support
for women found to be positive and their
families.
• The last of these can be achieved by the use of
antiretroviral drugs, safer infant feeding
practices and other interventions. 
 WHO guidelines for PMTCT drug regimens in
resource-limited settings
Pregnancy Labour After birth: After
mother birth:
mother
Daily NVP
until 1
2010 single dose
AZT after 14 AZT+3TC for seven week after
Recommendations nevirapine;
weeks days breastfeedi
option A AZT+3TC
ng has
finished
Triple ARVs until 1
2010
Triple ARVs week after 6 weeks of
Recommendations Triple ARVs
after 14 weeks breastfeeding has daily NVP
option B
finished
single dose
single dose
2006 AZT after 28 AZT+3TC for seven nevirapine;
nevirapine;
Recommendations weeks days AZT for
AZT+3TC
seven days
 single dose
Alternative
AZT after 28 single dose nevirapine;
(higher risk of -
weeks nevirapine AZT for seven
drug resistance)
days
single dose
Minimum (less AZT+3TC for single dose
- nevirapine;
effective) seven days nevirapine
AZT+3TC
Minimum (less
effective; single dose single dose
- -
higher risk of nevirapine nevirapine
drug resistance)