Acquired Immune Deficiency Syndrome AIDS/ HIV

Dr. Mustapha Mneimne General and colorectal surgeon LAU- 2011- 2012

Outline
What is HIV and AIDS Epidemiology of HIV/AIDS How does it spread What are the effects of the virus on the body Methods of treatment Methods of prevention

HIV/AIDS
The Human Immunodeficiency Virus (HIV) is a retrovirus and also the term often applied to the infection before the deterioration of the immune system to produce a full-blown picture of AIDS:

Acquired Immune deficiency Syndrome

What is AIDS?
AIDS stands for Acquired Immunodeficiency Syndrome' and is a surveillance definition based on signs, symptoms, infections, and cancers associated with the deficiency of the immune system that stems from infection with HIV.

World HIV/AIDS

People living with HIV/AIDS in 2007 Adults living with HIV/AIDS in 2007 Women living with HIV/AIDS in 2007

Estimate 33 million 30.8 million

15.5 million

Children living with HIV/AIDS in 2 2007 People newly infected with HIV in 2.7 2007 Children newly infected with HIV 0.37 in 2007 AIDS deaths in 2007 2 Child AIDS deaths in 2007

0.27

Epidemiology/ Worldwide Contd

6 out of 11 African countries reported declines of 25% or more in HIV prevalence among 15-24 yearolds in capital cities. Condom use with a non-regular partner increased in 8 out of 11 countries , although overall use of condoms remains below 50%. Use of HIV testing and counseling, increased to 16.5 million people tested in 2005. In 58 countries reporting, 74% of primary schools and 81% of secondary schools now provide AIDS education.

Population 3,981000 /2008

Epidemiology in Lebanon

In year 2006, 3577 people with HIV/ AIDS were reported by the ministry of health and UN.

HIV/AIDS Incidence in Lebanon, 2010

There are 21 new cases of AIDS and 72 HIV reported to the National AIDS Program (NAP) till November 2010, 29% of whom have a recent travel history and 18% have an age less than 30. Number of new Reported Cases up to November 2010
is 93

Number of cumulative Cases till November 2010: 1346

Source: Ministry of Health, Lebanon http://www.moph.gov.lb

AIDS is defined as an illness

AIDS is diagnosed in people infected with HIV when they develop certain opportunistic infections or cancers for the first time. The Centre for Disease Control (CDC) in the USA accepts all
patients with a CD4 count of less than 200 /mm3 as having AIDS irrespective of the presence of an indicator disease.

AIDS is defined as an illness

AIDS is a surveillance term defined by the United States Centers for Disease Control and Prevention (CDC) and by the European Centre for the Epidemiological Monitoring of AIDS (EuroHIV):

The term AIDS applies to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers. In addition, the CDC defines AIDS on the basis of a CD4 positive T cell count of less than 200 per mm3 of blood.

HIV
HIV infection can be diagnosed in a routine test, as for blood donation, in pregnancy, or after counseling a person with a life style that puts him at risk, there is not usually full AIDS but just infection with HIV. Once the diagnosis is made, managing HIV positive individuals in primary care becomes relevant.

Modes of transmission /Spread

Sex between men ( Homosexuals) Sex between men and women ( oral, anal ,vaginal) Injecting drug users Mother to child (Breast feeding) Blood products and blood transfusion Contamination with body fluids(blood).

Modes of transmission /Spread

Tears and saliva poses theoretical risks Deep kissing can transmit the virus if there are sores in the mouth Hugging and shaking hands do not transmit the disease as also Swimming in the same pool with people who have HIV/AIDS does not pose a risk

Course of infection
Some people get fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash for one or two weeks. Most people think it's the flu. Some people have no symptoms. The virus will multiply in the body for a few weeks or even months before the immune system responds.
During this time, HIV test will be negative but the person can infect other people.

Course of infection
When the immune system responds, it starts to make antibodies. When this happens the test will be positive for HIV.

After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer. But during this time, HIV is damaging the immune system.

Course of infection
One way to measure the damage to the immune system is to count the CD4 cells. These cells, also called "T-helper" cells, are an important part of the immune system.(N= 500 and 1,500 CD4 cells /mm3) Without treatment, CD4 cell count will most likely go down. Signs of HIV disease like fevers, night sweats, diarrhea, or swollen lymph nodes. these problems will last more than a few days, and probably continue for several weeks.

HIV Testing
Most HIV tests measure the antibodies the body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect and this time period can vary from person to person. This time period is commonly referred to as the window period. Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days).

HIV Testing
if the initial negative HIV test was conducted within the first 3 months after possible exposure, repeat testing should be considered >3 months after the exposure occurred to account for the possibility of a false-negative result. 97% will develop antibodies in the first 3 months following the time of their infection. However, it can take up to 6 months or even longer to develop antibodies to HIV in some individuals.

Rapid or point-of-care tests

Rapid antibody tests are qualitative immunoassays intended for use as a point-of-care test to aid in the diagnosis of HIV infection. If no antibodies to HIV are detected, this does not mean the person has not been infected with HIV. It may take several months after HIV infection for the antibody response to reach detectable levels, during which time rapid testing for antibodies to HIV will not be indicative of true infection status.

Course of infection
HIV disease becomes AIDS when the immune system is seriously damaged and CD4 is less than 200 cells, or the patient develops so called opportunistic infections. AIDS-related diseases also includes serious weight loss, brain tumors, and other health problems. Without treatment, Death is inevitable

Oppurtunistic infections and cancers

PCP (Pneumocystis Carini pneumonia), a lung infection; KS (Kaposi's sarcoma), a skin cancer; CMV (Cytomegalovirus), an infection that usually affects the eyes Candida, a fungal infection that can cause thrush (mouth) or infections in the throat , vagina ,or the gastrointestinal tract.

Treatment
There is no cure Antiretroviral drugs to slow the virus Highly Active Antiretroviral Therapy (HAART) Drugs to treat the associated infections Vaccines are under research Prevention is the best treatment HIV/AIDS is likely to result in death

THE BOTTOM LINE/ Prevention

1. Use condoms during sexual activity 2. Do not share drug injection equipment 3. HIV-infected and pregnant women should talk with health care provider about taking ARVs. 4. HIV-infected woman should not breast feed. 5. Protect cuts, open sores, eyes and mouth from contact with blood or other body fluids.

6. If you think you've been exposed to HIV, get tested and ask your health care provider about taking ARVs.

THE BOTTOM LINE/ Prevention

Monogamy: Loyalty to one partner Abstain from sex with high risk people Stay sober ( drugs & alcohol). Healthcare providers should apply universal precautions.

References
www.AIDsmeds.com WHO; Media Centre HIV; AIDS news and links HIV and AIDS - Health Protection Agency (HPA).