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HIV and AIDS

HIV and AIDS. What are HIV and AIDS? HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise noted, the term “HIV” primarily refers to HIV-1.

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HIV and AIDS

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  1. HIV and AIDS

  2. What are HIV and AIDS? • HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. • There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise noted, the term “HIV” primarily refers to HIV-1. • Both types of HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases. Source CDC, 2011

  3. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. • Before the development of certain medications, people with HIV could progress to AIDS in just a few years. • Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s. Source CDC

  4. Source CDC, 2011 HIV-1

  5. Symptoms and Pathogenesis Source MDH 2011 HIV/AIDS in M Minnesota : Annual Review

  6. Within a few weeks of being infected (initial or acute HIV infection )with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. • Symptoms of acute HIV may or may not manifest after an initial exposure. These symptoms usually dissipate spontaneously in a few weeks Source CDC

  7. Source Wikimedia

  8. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting their bodies. • After initial symptoms, the disease often goes into a period of remission. This window period, known as asymptomatic HIV, can last for months or up to ten years. • It is important to note that a person with an asymptomatic HIV infection can still pass the disease to other people. Source CDC

  9. When the HIV infection manifests again, a person's T4 cells and CD4 cells, which are the body's main fighters of infection, have been compromised, weakening the individual. • Symptoms of early symptomatic HIV infection include: • Loss of weight • Lethargy, malaise, fatigue • Fevers and sweats • Memory loss • Frequent yeast infections • Skin rashes • Herpes infections causing sores in the anus, genitalia and mouth Source CDC

  10. The mean time from seroconversion to onset of disease is approximately 9 years. The time is similar whether the virus was acquired by sexual behavior or the use of clotting agents. Source: University of South Carolina

  11. Untreated HIV Infection: Average Time Course for Stages and Evolution of CD4 Count and VL 106 HIV RNA 1000 105 800 104 600 103 400 HIV Antibodies 102 200 CD4 + T cells 10 6 months ? 2 years 10 years Asymptomatic Chronic Infection Primary infection AIDS

  12. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. • Patients with AIDS (HIV infection with less than 200 CD4 cells/ml of blood) manifest with: • Weight loss • Extreme fatigue • Fever • Confusion and loss of memory • Severe headaches • Neck stiffness • Seizures • Loss of coordination • Dysphagia (difficulty in swallowing) • Shortness of breath, chronic cough • Coma • Tuberculosis Source :Vitals.com

  13. Leukoplakia

  14. atopic eczema

  15. Psoriasis - Exfoliative Erythroderma

  16. Weight loss

  17. Epidemiology Source MDH 2011 HIV/AIDS in M Minnesota : Annual Review

  18. Three (3) million people around the world die of AIDS each year and, so far, more than 25 million people have died of the disease. • At least 33 million people are infected • More than 14,000 new infections every day. • In sub-Saharan Africa, more than 22 million people are living with HIV infection. Source CDC

  19. In 2009, the estimated number of diagnoses of HIV infection in the 40 states and 5 U.S. dependent areas was 42,959. • In the 40 states, diagnoses of HIV infection among adults and adolescents totaled 41,845 with 31,872 diagnoses in males and 9,973 diagnoses in females. • Among children under age 13 years, there were an estimated 166 diagnoses of HIV infection in 2009. Source CDC

  20. Overview of HIV/AIDS in Minnesota Source MDH 2011 HIV/AIDS in M Minnesota : Annual Review

  21. Minnesota HIV/AIDS Surveillance:Cumulative Cases • As of December 31, 2011, a cumulative total of 9,785* persons have been diagnosed and reported with HIV infection in Minnesota. Of these: • 3,788 persons have been diagnosed with HIV infection (non-AIDS) • 5,997 have progressed to AIDS • Of these 9,785 persons, 3,347 are known to be deceased * This number includes only persons who reported Minnesota as their state of residence at the time of their HIV and/or AIDS diagnosis.

  22. HIV/AIDS in Minnesota:New HIV Infection, HIV (non-AIDS) and AIDS Cases by Year, 1996-2011 *Includes all new cases of HIV infection (both HIV (non-AIDS) and AIDS at first diagnosis) diagnosed within a given calendar year. ^Includes all new cases of AIDS diagnosed within a given calendar year, including AIDS at first diagnosis. This includes refugees in the HIV+ Resettlement Program, as well as, other refugee/immigrants diagnosed with AIDS subsequent to their arrival in the United States.

  23. HIV/AIDS in Minnesota:Number of Prevalent Cases, and Deaths by Year, 1996-2011 *Deaths among MN AIDS cases, regardless of location of death and cause. ^Deaths in Minnesota among people with HIV/AIDS, regardless of location of diagnosis and cause.

  24. Diagnosis of HIV Infection • Detection and quantization of HIV : p24 antigen, viral culture and PCR • HIV Antibody Tests • Rapid tests : can diagnose HIV infection within 20-30 minutes

  25. Risk factors

  26. Potentially infectious body fluids • Blood • Bloody body fluids • Semen • Vaginal secretions • Breast milk Low risk: not considered potentially infectious unless bloody: • Saliva, sputum • Feces, urine • Sweat, tears

  27. Major Transmission Routes • Sexual intercourse with infected person: includes anal, vaginal and oral • Blood/blood products: • previously transfusion of blood and blood products • currently injection drug use (needles and syringes) • transmission in health care setting (unusual) • Mother to infant: during pregnancy, labor and delivery and breast feeding • Not casual contact : mosquitoes bites

  28. Sexual transmission of HIV • Risk varies for different practices • Factors facilitating transmission include: • Trauma • STDs • Viral load

  29. Sexual transmission of HIV : Risk varies for different practices Estimates of per-act risk of acquisition of HIV are approximate and vary widely depending on the viral load of the source contact, the presence of sexually transmitted diseases, and other factors (CDC)

  30. HIV and Sexually Transmitted Diseases • Individuals with STDs are at least 2-5 times more likely to acquire HIV if exposed to HIV through sexual contact. • If an HIV-infected individual is also infected with another STD, they are more likely to transmit HIV through sexual contact.

  31. HIV and Sexually Transmitted Diseases • Genital ulcers (syphilis, herpes…) result in breaks in genital tract lining or skin, creating portal of entry for HIV • Non-ulcerative STDs (Chlamydia and gonorrhea) increase concentration of cells in genital secretions that can serve as targets for HIV (e.g., CD4+ cells).

  32. Prevention

  33. Prevention • Know your HIV status by getting tested. Everyone between the ages of 13 and 64 should be tested for HIV at least once. • Abstain from sexual activity or Be faithful (be in a long-term mutually monogamous relationship with an uninfected partner). • Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with HIV or another STD.

  34. Prevention • Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually transmitted diseases. • Get tested and treated for STDs and insist that your partners do too. • Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex.

  35. Prevention • Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop injecting drugs, use clean needles and works when injecting. • Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly.

  36. Prevention • Participate in risk reduction programs: programs exist to help people make healthy decisions, such as negotiating condom use or discussing HIV status. Health department can refer you to programs. • Female condom: protects vagina, cervix and external • genitalia, offering extensive barrier protection. • Microbicide: gel, cream, suppository, film lubricant, sponge or vaginal ring that reduces sexually transmitted disease transmission

  37. Source: Coates T. Intl AIDS Conf 2008; Mexico City Abs TUSS020

  38. Treatment Source MDH 2011 HIV/AIDS in M Minnesota : Annual Review

  39. All people with HIV should be seen on a regular basis by a health care provider experienced with treating HIV infection. • Many people with HIV, including those who feel healthy, can benefit greatly from current medications used to treat HIV infection. • These medications can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to transmit HIV. Source CDC

  40. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer. • Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk behavior, and find needed services. Source CDC

  41. While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person’s life, need to be carefully monitored, and come with costs and potential side effects. • At this time, there is no cure for HIV infection. Source CDC

  42. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer. • Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk behavior, and find needed services. Source CDC

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