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Introduction
AIDS is a retroviral disease
Caused by the Human Immunodeficiency Virus
(HIV)
Characterised by profound Immunosuppression
Opportunistic infections,
Secondary neoplasms, and
Neurological manifestations
Introduction
Truly staggering epidemic
HIV-1 and HIV-2
HIV-1 global and HIV-2 discovered in West
Africa and found principally in West Africa
HIV-2 more virulent, faster progression
and associated with greater morbidity
Introduction
According to the U.N. by the year 2000
there were 40,000,000 people infected with HIV.
90% of these people were in the developing
countries.
More than 600,000 cases were reported
in the United States as at 1999
60% of these people were dead
Despite modern research and a frantic
search for cure, mortality rate was approaching 100%
In the U.S. leading cause of death in
men between the ages of 25 and 44.
Epidemiology
Although first described in the U.S. the
pool of people with AIDS in Africa and Asia is expanding
First described as GRIDS in gay men in
San Francisco in 1983
Was mainly spread through promiscuous
homosexual men, intravenous drug users and also haemophiliacs.
Epidemiology
Heterosexual mode of transmission is now
rising in the US and is the main mode of transmission in Africa and Ghana.
In Ghana main modes of transmission have
been through sexual contact, recipients of blood and blood components and
mother to child transmission in children.
Routes of spread
Sexual Contact – 75%
Parental Inoculation – intravenous drug
abusers and recipients of blood and blood products.
Passage of virus from Infected mothers
to children through the placenta or through breast milk.
Sexual Contact
Virus is carried in the semen and enters
the recipient's body through abrasions in the rectal mucosa.
Virus also enters the body of the female
through sexual contact.
Female to male spread is 20 times less
than male to female spread
All forms of spread of HIV is aided and
abetted by all forms of sexually transmitted disease especially those associated
with genital ulcerations – syphilis, herpes and chancroid.
Sexual Contact
Other sexually transmitted diseases like
Gonorrhoea associated with increased transmission of HIV due to the increased
concentration of virus in the seminal fluid due to increased number of
inflammatory cells in the Semen.
Parental transmission
IV drug abusers
Haemophiliacs – factor VIII
Random recipients of blood
Screening of donated blood
Extremely small risk of acquiring infection
through sero-negative blood because of window period 1:493,000
Mother to Child
In utero by transplacental spread
During delivery by an infected birth canal
After birth through breast milk and handling
of the cord.
Spread Outside High Risk Groups
Not spread my casual personal contact
in the workplace, household or school.(hugging, kissing, food, water)
No convincing evidence that the virus
is spread by insect (mosquito) bites.
Small but definite risk of transmission
of HIV infection to health workers – accidental needle stick injury –
or exposure of non intact skin to infected blood.
Phases of HIV Infection (CDC)
Early, acute
Group I : Acute Infection
Middle, chronic
Group II: Asymptomatic Infection
Group III: Persistent generalised lymphadenopathy
Final, late
Group IV:
A: constitutional disease
B: Neurologic disease
C: Secondary infection
D: Secondary neoplasm
E: Other conditions
CDC Classification
Initial response of the person – 50-70%
show sore throat, fever, muscle pain, weight loss, fatigue, diarrhoea and
vomiting
Middle phase CDC group II and III asymptomatic
or generalised lymphadenopathy
Final phase is characterised by the breakdown
of the host immune system – long lasting fever(> I month), fatigue weight
loss and diarrhoea
CDC Classification cont’d
In the absence of treatment, most but not
all patients with HIV infection progress to AIDS after a chronic phase
lasting 7 – 10 years. Exceptions to this typical course are Long term
progressors and Rapid progressors.
Long term progressors are HIV – 1 positive
individuals who remain asymptomatic for 10 years or more and maintain stable
CD4 counts with low plasma viremia.
Rapid progressors the middle phase is telescoped
to 2-3 years after the primary infection.
Late stage is diagnosed clinically and then
confirmed by a positive HIV test.
Diagnosis
2 major signs and 1 minor sign for clinical
diagnosis followed by a positive HIV test.
Major Signs
Weight loss >10% of body weight
Chronic diarrhoea >1 month
Prolonged fever >1 month (int or perm)
Minor Signs
Persistent cough >1 month
Generalised pruritic dermatitis
Recurrent herpes zoster
Oro-pharyngeal candidiasis
Chronic progressive and disseminated herpes
simplex infection
Generalised lymphadenopathy
Treatment
No cure known, prevention.
ABC Abstinence, faithfulness and Condom use.
Drugs
Azidothymidine (AZT, zidovudine, Retrovir)
prolongs survival but does not eliminate the virus, Inhibits proviral DNA
synthesis but does not eliminate the virus.
Dideoxyinosine(ddI, didanosine, videx) mechanism
of action is similar to AZT
Clinical trials vaccine has been found in
monkeys but none yet available for human use.
Prevention
Abstinence
Sexually active: stick to one sexual partner.
Condom use
Never use
Used needles
Used syringes
Used blades
Progression
Prevalence rate of 3.6%.
Geometric progression after the 4.0% mark
Going lower and credited to intensive marketing
campaign on Condoms and safe sexual practices.
Reference Texts
Medical Microbiology & Immunology. Levinson
and Jawetz Department of Microbiology, University of Carlifornia.1998,
Appleton and Lange.
Pathologic Basis of Disease Cotran, Kumar
et al. Professors of pathology. Harvard Medical School. 1999, W.B. Saunders.
Standard Treatment Guidelines 2000 Ministry
of Health Ghana National drugs program.
Thank You
Any Questions???
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