HIV AND AIDS

March 14-16,2011.
Mae Tao Clinic.
 HIV/AIDS
HIV
AIDS AIDS
HIV

ART ART
Services
VCT
PMCT
PEP
 HIV/AIDS

HIV/AIDS
 WORLD VIEW
33 million persons infected in 2007
AIDS HAS CLAIMED
JUST UNDER 25
MILLION LIVES
SINCE IT WAS
SINCE HIV/AIDS WAS
Eastern Europe DISCOVERED 20
Western Europe & Central Asia
DISC0VERED 60 YEARS AGO.
520,000 – 680,000 1.2 – 1.8 Million
North America
MILLION PEOPLE 790,000 – 1.2 million East Asia & Pacific
(THE POPULATION OF North Africa & 700,000 - 1.3 million
UK) HAVE BEEN Caribbean Middle East
South
INFECTED 350,000 – 590,000 470,000 – 730,000
& South–East Asia
4.6 – 8.2 million
Latin America
1.3 – 1.9 million Sub-Saharan
Africa Australia
25.0 – 28.2 million & New Zealand
12,000 – 18,000

2.7 MILLION PEOPLE HALF OF NEW

WITH AIDS ARE INFECTIONS OCCUR IN 15- 17.6 MILLION PEOPLE
24 YEAR OLDS WITH AIDS ARE WOMEN.
CHILDREN UNDER 15.
 HIV ?
H Human

I Immuno-deficiency :
Immune :

Deficiency :

V Virus: (HIV
HIV AND HUMAN BODY
 HIV
HIVReceptors
Receptors
HIV and Cellular Receptors

Copyright © 1996 Massachusetts Medical Society. All rights reserved.

HOW HIV ATTACK OUR HEALTH
HOW BODY DEFEAT DISEASES
HOW BODY DEFEAT DISEASES
! The Immune System

T Cells (CD4 Cells) = Immune system

CD4
CD4
800-1500/ml

CD4 Disease Disease

 HIV and the Immune System
HIV
CD4 CD4

CD4 HIV
HIV
HIV HIV CD4
HIV

HIV Enters CD4 Cells HIV Kills CD4

Cells
HIV CD4
CD4
CD4
Progression of HIV Infection
 CD4 800-1500/ml

HIV CD4 HIV

CD4

CD4
AIDS
 HIV and the CD4 Count
HIV CD4

CD4
Amount in Body

HIV

CD4
HIV AIDS
?

1500 to 800 CD4 -

CD4 Below 500 CD4 - Opportunistic Infections

COUNT

200 CD4 AIDS

CD4
! AIDS
HIV
 HIV AIDS
?

• Developed World:
ART

HIV

• Developing World:
 AIDS ?
A Acquired:
I Immune:
D Deficiency:

S Syndrome: AIDS
 Opportunistic Infections(OIs)
?
HIV CD4

opportunistic
infections
HIV opportunistic infections
 AIDS
opportunistic infections (OIs)

• Extensive skin lesion

• Oral thrush
• Chronic unexplained fever
• Chronic diarrhoea
• TB, dissiminated TB
• PCP pneumonia
• Wasting Syndrome
• Meningitis

• CMV:
• Cancer and other many other infections and disorders
 Clinical Staging of HIV/AIDS

• Stage I; Asymptomatic

• Stage II; Herpes zoster

• Stage III &IV; Features of AIDS

 Brain storm.1
• HIV (+) man,35yr old, he knew his status
recently.
• He ask you how long he can live.
What points will you check?
How would you answer?
HIV ?
 ?
HIV ?

H
! HIV
HIV
HIV
HIV
HIV
HIV
HIV
HIV
 HIV
HIV HIV
 HIV
?

HIV

HIV

!
Some Statistics
HIV

-UK
 HIV
?
?

HIV

HIV
HIV (ART)

HIV

Programme

UK HIV
 Whom of them are high risk
people?
• Sex worker
• Sexually promiscuous man

• House wife
• Highway driver
• Old lady
• Sex worker

• Sexually promiscuous man

• House wife
• Highway driver
• Old lady
 Brain Storm
• A friend of you though that HIV infected
people are bad people and he would avoid
them.
• Are you agree with him?
• What will you tell him?
 Anti Retroviral (ARV’s) Drugs

?
CD4 Cells HIV
HIV
HIV

HIV

NRTI NNRTI PI
AZT NVP Lopinavir
3TC FEV Ritonavir
D4T Saquinavir
ABC
The Science Bit!

enzymes HIV
NRTI & NNRTI Reverse Transcriptase enzyme

PI Protease enzyme

HIV
combination therapy regime
*2NRTIs+1NNRTI
*2NRTIs+PI
 ARV’s ?

• ARV’s regime HIV expert

OIs
HIV expert
• combination therapy HIV expert

• exact timing correct dose

• ARV’s HIV expert

• How long we must take ARV’s?

• Life long
Don’t forget that;
• ARV’s HIV
• ARV’s HIV
 ARV’s ?

regime (e.g one or two

drugs combination)
dosage
• Timing

ARV’s (ART)
 Side effects
( ?
YES!

General side effects:

• Tiredness.
• Nausea.
• Vomiting.
• Diarrhoea.
• Muscle pains.
• Headaches.
• Skin rashes.

Side effects specific to certain drugs:

• Numbness or pain in the hands or feet. (d4T)
• Skin rashes and liver problems.
(NVP.EFV)
• Increased blood sugar levels (PI)
• Increased levels of fats in the blood. (PI)
• Anaemia (AZT)
• Mental disorders (EFV)
 Brain Strom-1
• 40yr old man, HIV(+)
• CD4-50/ml
• Very healthy
• Do you believe?
• How would you predict his prognosis?
 Brain Storm-2
• 26yr man, HIV Status is unknown.
• He heard about ART. So he said that no
need to worry about HIV.
• What would tell him?
 HIV Mae-Taw
Service
• Voluntary Counseling and Testing (VCT)

• Preventing Maternal to Child Transmission (PMTCT)

• Home-based Care (HBC)

(
– Social support (
– Opportunistic Infections
– WV (for TB)
• Medical Inpatient Care
 Voluntary Counseling and Testing (VCT)

• HIV

• HIV Serial Protocol Rapid Tests

Rapid Test Quality control Mae Sod
Hospital
 Rapid Test Kits
• Mae Tao Clinic uses the Serial 3 Protocol:
– Determine
• if negative stop, test is negative
• If positive, do next test Capillus
– Capillus
• If positive, stop, test is positive
• If negative, do next test Doublecheck

– Doublecheck
• If positive, test is positive
• If negative, test is negative
ELISA
 Laboratory Tests for HIV
• EIA – Enzyme Immunosorbent Assay
– Same as ELISA = Enzyme-Linked Immuno-Sorbent
Assay
• WB – Western Blot (confirmatory test)

These are the standard laboratory tests.

They are >98% sensitive and specific
The window period for EIA is 10-14 days, but
some people do not convert for 3-4 weeks or
longer
 Common Tests for HIV
• Viral Load - Quantitative Plasma HIV RNA
– virus PCR Technique
– Changes of >50% are significant

• CD4 Count

– Normal = 800-1050 cells/mm3

– <200 cells/mm3 HIV infection
• HIV
B
• HIV PMCT Programme
ART

• B
B C HIV (Ag &Ab)

HIV
 Post-Exposure Prophylaxis (PEP)
• Occupational Exposure
– Needle stick and Percutaneous

– Mucous Membrane and Non-intact Skin

• Non-Occupational Exposure
– Sexual Assault Survivors

– Children
– Prisoners
– Pregnant Women
 Case Study for VCCT
• Case. 1
• 35 yr man, single, has high risk behavior
• Now very worried for his status
• His close friend died of AIDS recently
• Concerned with discrimination from friends
and family member
• Has girl friend and has sex without
condom
 Points for Case. 1
• Explain implication of HIV test.
• Explain how we will keep confidentiality
not to be discriminated.
• Discuss about safe sex & disclosure
depend on test result.
 Case. 2
• 35yr old man, married
• Now ill with s/s of AIDS.
• Already tested at private clinic arranged by
family without pretest counseling. Result is
positive. Family didn’t disclose him as pt is
very angry when family suggest to test
HIV.
• Now family brought him to meet you
 Points for case.2
• First try to understand pt’s feeling and how
he understand his condition.
• Try to build rapport with pt, and help to find
the best way for him.
 Case.3
• 28 yr lady come with STI complaints.
• Her husband has mobile job and has to
travel frequently.
• She trust her husband for extramarital sex.
She herself had never had extramarital
sex. So they never used condom.
 Points to discuss
• First, to confirm is it pure STI
• If it is pure STI, & it is sure that she had
never had extramarital sex, Explain nature
of men.
• Be careful not to blame on husband and
assess her respond while discussing on
extramarital sex.
• Suggest to bring husband, offer VCT.
 Case.4
• Pregnant woman 36 yr old, G1P0, at 36
wks, come to clinic for AN care.
• Husband traveled to border to find a job.
• Lives with in-laws and depend on them.
• Now she is in front of you for PMCT.
 Caes.5
• Pregnant woman,28yr,G2P3,30 wks
comes to clinic with complaint of prolong
fever, chronic cough, sore mouth d/t
thrush. How you proceed?
 Case.6
• In post test counseling of 23yr lady, the
result is HIV (-).Is it necessary to test
again? When? How many times?