Huda A.K.

Hamouda 09090116 3rd year MBBS RAKMHSU PBL : Internal Medicine

Prevention
These are as follows :1. Sexual contact 2. Exposure to infected body fluids 3. Mother-to-child transmission (MTCT)

ABC rule Abstinence, Be faithful (one partner), Condom

It is bad enough that people are dying of AIDS, but no one should die of ignorance.

Prevention
1. Sexual contact :-

*Use condoms (female or male) every time you have sex

(vaginal or anal)

*Always use latex or polyurethane condom (not a natural

skin condom)

*Always use a latex barrier during oral sex

Prevention
2. Exposure to infected body fluids

*If a needle/syringe or cooker is shared, it must be

disinfected:
seconds.

* Fill the syringe with undiluted bleach and wait at least 30 * thoroughly rinse with water * Do this between each persons use

Prevention
3. Mother-to-child transmission (MTCT)
Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.t should be noted that women may breastfeed other children who are not their own.

Treatment
HAART: Highly Affective Anti-Retro Viral Therapy: Anti-retro viral therapy is recommended if: Patient is asymptomatic/ symptomatic + CD4 count of <350/l / any AIDS defining condition / plasma HIV RNA greater than 100,000 copies/ml

HAART combines two types of antiretroviral drugs: Triple cocktail

2NRTIS + 1PI or 2NRTIS + 1NNRTI

* HIV ELISA positive, confirmed with Western blot * HIV RNA >55,000 copies/ml * CD4 <350 cells/mm3 * Special considerations:
* Pregnant women * Acute HIV infection * Exposed healthcare workers

Treatment and Prevention of AIDS

Treatment
*RTIs (Nucleoside Reverse Transcriptase Inhibitors):
Zidovudine (AZT/ZDV), Didanosine (DDI), Zalcitabine (DDC), Stavudine (D4T), Lamivudine (3TC)

*NNRTIs (Non-Nucleoside RTIS) : Delavirdine, Nevirapine,

Efavirenz

*Nucleotide Reverse Transcriptase Inhibitor: Adefovir Tenofovir

*Protease Inhibitors: Indinavir, Ritonavir

Treatment

Entry inhibitors/Fusion inhibitors: Maraviroc, Enfuvirtide

*Integrase inhibitors: Raltegravir

*Maturation Inhibitors under trails: Bevirimat & vivicon

Treatment
For needle stick: Postexposure Prophylaxis ZDV+3TC 28 days, but in high risk (high viral RNA copies)
combination of ZDV+3TC+Indinavir a

Pregnancy: ZDV full dose, trimester 2 and 3+ 6 weeks to neonate reduces vertical
transmission by 80%

ZDV restricted to intrapartum period + NEVIRAPINE- 1 dose at onset of

delivery+ AZT+3TC for 1 week after delivery Neonate: 1 dose of Nevirapine within 24-72 hrs after birth + ZDV for 1 week

Symptomatic tx

and antibiotics/antivirals/glucocorticoids/thalidomide /antifungals/metronidazole for bacterial, viral, autoimmune, fungal and parasitic infections.

HIV/AIDS Prevention: What Works?

Prevention of: Sexual transmission Parenteral transmission Mother-to-child-transmission

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Preventing Sexual Transmission: ABC-Plus Strategy

A..Abstain/delay sexual debut BBe faithful/partner reduction CUse Condoms Plus Male Circumcision Avoid illicit Drug use Empower women (educationally/economically) Increase male/youths involvement Prevent MTCT Identify and treat STIs
HIV/AIDS

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Abstinence: Increasing Proportion of Primary 7 School Pupils Delaying Sexual Debut in Soroti District, Uganda, 1994-2001

100 90

A factor in Ugandas success story?

80 70

% Change

60 50 40 30 20 10 0

Boys
1994 1996 2001

Girls

HIV/AIDS

Source: Synergy Project. 22-14

Being faithful: Decline in % Reporting Multiple Sex Partners in Uganda (Zero-Grazing Strategy)
40 35 30 25 Percent 20 15 10 5 0 1989 1995 2000
Source: Daniel Halperins 2002 MAQ Mini-university Lecture. HIV/AIDS

Male Female

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Use of Condoms
The only effective FP

method to prevent HIV/STI transmission and acquisition is the condom Male and female condoms are available over the counter Clients should be instructed in proper use Consistent use must be emphasized
HIV/AIDS

Male Condom

Female Condom

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Dual Protection
Dual Protection means protection against

Pregnancy and HIV/STDs. Approaches include: Condom use alone* Condom use and another contraceptive method Mutual monogamy and another FP method Abstinence/delay Avoidance of all penetrative sex
* In typical users, condoms are 80-90% effective in protecting against HIV and STDs and 86% effective in preventing pregnancy. However, if condoms are used correctly and consistently with every act of sex, they are very effective, providing 98% protection against HIV and STD infection and 95-97% protection against pregnancy.

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STIs and HIV

Similar risk factors Unprotected

intercourse Multiple sexual partners Commercial sex work Alcohol abuse Drug abuse Presence of one increases risk of the other
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Control of STI and HIV prevalence

Improved case management of STIs in rural Mwanza,

Tanzania led to a 42% reduction in HIV incidence over a 2-year period Treatment of cervicitis in Mombasa, Kenya, led to a 72% decrease in HIV-1 RNA shedding, thereby reducing infectivity of sero-positive women Recent meta-analysis of 4 randomized controlled trials, however, have NOT shown a positive impact of community-based STI treatment on HIV prevalence. Further randomized controlled trials are needed to test the effect of alternative STI control strategies
Source: Grosskurth et al 1995; McClelland RS et al, 2001; Wilkinson D et al 2002. HIV/AIDS

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Male Circumcision
Conclusions Meta-analysis of 38 observational studies suggest that MC protects against HIV infection Although randomized clinical trials (RCTs) needed to validate this relationship are being conducted in 3 countries, this should not delay the initiation of SAFE (safety, acceptability, feasibility and program effectiveness) studies in selected countries

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Preventing Injection-Related Transmission of HIV

Factors Causing HIV Risk Among Injection Drug Users

Sharing of injection solutions Sharing of needles, syringes and other injection

equipment Unprotected sexual intercourse (often triggered by alcohol/drug use) Use of contamination equipment for skin-piercing procedures (e.g., tattooing, ear and nose rings) Contamination of drug solutions during production

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Prevention of HIV Transmission Among IDUs

HIV transmission among injection drug

users can be reduced through communitybased peer outreaches that are linked to:
Information, education and communication

(IEC) programs for high-risk groups Risk reduction counseling for injection and sexual behavior change Increased access to sterile injecting equipment Increased access to drug dependence treatment
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Prevention of Blood Transfusion-Related Infections

Prevent or treat causes of anemia and blood loss (e.g.,

malnutrition, malaria, parasitic infestation, pregnancyrelated anemia) promptly Minimize unnecessary transfusions: Use blood substitutes (crystalloid/colloid) for volume replacement when possible Select blood donors carefully: Paid or professional donors are a higher risk Create a national blood transfusion service Screen blood supply (and body organs and tissue earmarked for transplantation)
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Infection Prevention
Personal protective

equipment Hand washing Needle and sharps handling and disposal Disinfection of instruments Appropriate disposal of tissues and other contaminated items HBV immunization
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Prevention of Mother-To-ChildTransmission (MTCT) of HIV

HIV and Infant Feeding Options

HIV Status?
HIV Negative, OR Status Unknown HIV Positive
Counseling on infant feeding options Womans informed choice! Counseling on exclusive breastfeeding for 6 months Plan for early weaning at 46 months (if HIV positive) HIV/AIDS
Safe and affordable Formula feeding

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Post Exposure Prophylaxis (PEP) for Healthcare Workers

Intact skin, mouth or nose: immediately wash

with soap and water and rinse thoroughly to remove all potentially infectious particles. Cut or punctured skin: allow to bleed fully. Eye: flush immediately with water, then irrigate with normal saline for 30 minutes. Consider post exposure prophylaxis (PEP) if high risk of transmission:
4 week course of zidovudine (ZDV) preferable to start within 1-2 hours
Source: CDC 1996. HIV/AIDS

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Post Exposure Treatment of Healthcare Workers, continued

HIV testing immediately, 6 weeks, 6 months and 12

months Treatment, if started, should continue for 4 weeks. Any or all drugs may be declined by exposed worker. For lesser exposures, prophylaxis is not recommended.

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