Introduction
· Acquired: The virus is not inherited. You can catch it.
· Immune: Virus attacks a portion of a person’s immune system. The immune system is the body’s natural protection against infection and disease.
· Deficiency: Defect in the immune system. These viruses destroy the T4 Lymphocytes in the blood leaving them susceptible to certain infections.
· Syndrome: A group of signs and symptoms that make a disease.
· World AIDS day- 1st December
· December is the AIDS awareness month.
· The Red Ribbon is the global symbol for solidarity (unity or agreement of feeling or action) with HIV-positive people and those living with AIDS.
· AIDS is one of the most serious communicable viral diseases in the World.
· It is the disorder of the cell-mediated immune system of the human body.
· There is a reduction in the number of helper T cells that stimulate the antibody production by B cells. This results in the loss of natural defence against infections.
· The disease is characterized by various symptoms. The patient suffering from AIDS becomes unable to defend against the infection and after a few years becomes a victim of recurrent opportunistic life-threatening infections and after a few becomes a victim of death.
· December is the AIDS awareness month.
· The Red Ribbon is the global symbol for solidarity (unity or agreement of feeling or action) with HIV-positive people and those living with AIDS.
· AIDS is one of the most serious communicable viral diseases in the World.
· It is the disorder of the cell-mediated immune system of the human body.
· There is a reduction in the number of helper T cells that stimulate the antibody production by B cells. This results in the loss of natural defence against infections.
· The disease is characterized by various symptoms. The patient suffering from AIDS becomes unable to defend against the infection and after a few years becomes a victim of recurrent opportunistic life-threatening infections and after a few becomes a victim of death.
Distribution (Occurrence)
· AIDS is a modern pandemic disease, affecting both industrialized and developing countries.
· The two countries of the world with maximum AIDS infected individuals are South Africa and India.
· It is worldwide in distribution.
· AIDS was first of all reported in the USA amongst homosexuals in 1981 AD.
· Later in 1983 AD, French Physician Luc Montagnier isolated a virus from the lymph node of a West African homosexual male and named it LAV (Lymphadenopathy Associated Virus).
· Similarly in 1984AD, American Scientist Dr Robert Gallo and his friends isolated a virus from the infected person which was named HTLV-III (Human T-cell Lymphotropic Virus –III).
· In 1985 AD, the AIDS virus was found among the African green monkeys was transferred to man due to eating their uncooked brain. In 1986 AD, the “International Committee on viral nomenclature” gave the name HIV.
· It was named AIDS since then. World AIDS Day was started to observe from 1988 AD on 1st December.
· AIDS is a modern pandemic disease, affecting both industrialized and developing countries.
· The two countries of the world with maximum AIDS infected individuals are South Africa and India.
· It is worldwide in distribution.
· AIDS was first of all reported in the USA amongst homosexuals in 1981 AD.
· Later in 1983 AD, French Physician Luc Montagnier isolated a virus from the lymph node of a West African homosexual male and named it LAV (Lymphadenopathy Associated Virus).
· Similarly in 1984AD, American Scientist Dr Robert Gallo and his friends isolated a virus from the infected person which was named HTLV-III (Human T-cell Lymphotropic Virus –III).
· In 1985 AD, the AIDS virus was found among the African green monkeys was transferred to man due to eating their uncooked brain. In 1986 AD, the “International Committee on viral nomenclature” gave the name HIV.
· It was named AIDS since then. World AIDS Day was started to observe from 1988 AD on 1st December.
World AIDS day Themes
1988: Communication
1989: Youth
1990: Human and AIDS
1991: Sharing the challenge
1992: Community Commitment
1993: Act
1994: AIDS and the Family
1995: Shared Rights, Shared Responsibilities
1996: One world. One Hop
1997: Children Living in a World with AIDS
1998: Force for Change: World AIDS Campaign With Young People
1999: Listen, Learn, Live: World AIDS Campaign With Children and Young People
2000: AIDS: Men Make a Difference
2001: I care. Do you?
2002: Stigma and Discrimination
2003: Stigma and Discrimination
2004: Women, Girls, HIV and AIDS
2005: Stop AIDS. Keep the Promise
2006: Stop AIDS. Keep the Promise- Accountability
2007: Stop AIDS. Keep the Promise- Leadership
2008: Stop AIDS. Keep the Promise-Lead- Empower- Deliver
2009: Universal Access and Human Rights
2010: Universal Access and Human Rights
2011: Getting to Zero
2012: Getting to Zero
2013: Getting to Zero
2014: Getting to Zero
2015: Getting to Zero
· It has been estimated that around 40 million people are infected with AIDS and more than 20 million people have already died.
· Out of them, around 2 million patients with AIDS were found only in the USA.
· In Nepal, the first case of AIDS was reported in 1988 AD and still now about 93,500 patients are suffering from AIDS.
· It is very common in sex workers (25-30%) and intravenous drug abusers (about 70%).
· According to the National Centre for AIDS and STD control, there are 14,787 HIV positives in Nepal (17 October 2009).
· According to the National Centre for AIDS and STD control, there are 14,787 HIV positives in Nepal (17 October 2009).
· The reasons behind the spread of AIDS are poverty, illiteracy and lack of awareness.
· Latest data, 2012 AD- 51,000 HIV positives in Nepal. As of Ahahd 2070, 22.994 (Ministry of Health and Population, National centre for AIDS and STD control)
Causative Organism
· HIV or retrovirus (a group of RNA viruses), which contains RNA as its genetic material.
· It produces an enzyme reverse transcriptase inside infected host cells.
· It transfers RNA into DNA.
· This new DNA (called provirus) is incorporated into the host cell DNA.
· The host cell then produces new copies of viruses that pass out in the tissue fluid and blood and infect other host cells.
· At the time of host cell division, copies of proviruses are integrated into the DNA of daughter cells.
Incubation Period: It is variable ranging few months to 6 years or 10 years.
II) Asymptomatic Carrier Stage: It occurs after 2 or more years. In this stage, the infected person transmits the disease without showing any symptoms except Lymphodenopathy (enlargement of lymph nodes).
III) AIDS-Related Complex (ARC): In this stage, the infected person exhibits one or more symptoms. It includes the following symptoms.
i) Continuous diarrhoea for more than a month.
ii) Loss of more than 10% of body weight.
iii) Malaise, fatigue, fever more than a month and night sweating, anaemia, leucopenia.
iv) Swollen lymph glands and spleen (Lymphadenopathy and Splenomegaly)
AIDS (CD4 count less than 200/Ml, normal 600-1200 cells/Ml)
· This is the last stage of HIV infection in which the patient loses all the natural defence mechanisms and the system is collapsed and never recovers.
Diagnosis
1. ELISA (Enzyme-Linked Immuno-Sorbent Assay) test to confirm HIV antibodies in the blood
2. Western Blot test and Viral load test are also used.
Control
· AIDS is very difficult to control because there is no cure with drug treatment and no vaccine has been successful.
· HIV is spherical with a diameter of about 90-120nm.
· It has a diploid genome composed of two identical single-stranded RNA copies.
· The envelope consists of a lipid bilayer derived from the host cell membrane and the projecting knob-like Glycoprotein spikes with pedicels formed of virus coded glycoprotein.
· It contains two protein coats.
· It can replicate in actively dividing T4 Lymphocytes and remains latent for lifelong in lymphoid cells.
· It destroys human helper T4 Lymphocytes.
Reservoir Sources of Infection
· The infected person by HIV virus is a source of infection or carrier.
· The infected person by HIV virus is a source of infection or carrier.
· The virus resides in the blood and tissue fluid of the infected person and the virus remains inside the body throughout life.
Mode of Transmission
· In the blood and body fluids like semen, vaginal fluid, breast milk, tears, saliva, urine, CSF, plasma etc. and is transmitted by various modes.
· In the blood and body fluids like semen, vaginal fluid, breast milk, tears, saliva, urine, CSF, plasma etc. and is transmitted by various modes.
· Infection is spread by:
A) Sexual contact: It is the most common mode of transmission either vaginal or anal (i.e. in homosexuals).
A) Sexual contact: It is the most common mode of transmission either vaginal or anal (i.e. in homosexuals).
· During sexual contact (without a condom), there is the exchange of vaginal fluid and semen leading to transmission of the virus.
· The chance of infection from male to female is more than from female to male.
B) Blood and blood products: HIV is also transmitted during the transfusion of contaminated blood and blood products to the recipient.
C) Maternal-foetal Route: It is also transmitted through the placenta before, during childbirth and possibly by breast milk from infected mother to child.
D) Contaminated equipment: AIDS is also transmitted by the use of contaminated needles and syringes to inject drugs or vaccines. Use of contaminated razors, use of contaminated needles for boring pinnae etc.
E) Organ transplant, Artificial insemination
Incubation Period: It is variable ranging few months to 6 years or 10 years.
Symptoms
· The symptoms of HIV infected persons range from asymptomatic infections to full-blown AIDS.
· The symptoms of HIV infected persons range from asymptomatic infections to full-blown AIDS.
· Around (25-30%) of the infected patients may develop ARC (AIDS Related Complex) and 10-30% develop AIDS during their lifetime.
Window period
· It is the time period between HIV infection and the reappearance of antibodies in serum.
· It is the time period between HIV infection and the reappearance of antibodies in serum.
· It lasts for 2-3 weeks and rarely longer than six months.
I) Initial Symptoms: Most of the infected persons do not show any symptoms till 6 months or a few years. Some may show general symptoms in 2-3 months after infection i.e. headache, fever, malaise, tiredness, loss of appetite etc. which may last up to two weeks.
I) Initial Symptoms: Most of the infected persons do not show any symptoms till 6 months or a few years. Some may show general symptoms in 2-3 months after infection i.e. headache, fever, malaise, tiredness, loss of appetite etc. which may last up to two weeks.
II) Asymptomatic Carrier Stage: It occurs after 2 or more years. In this stage, the infected person transmits the disease without showing any symptoms except Lymphodenopathy (enlargement of lymph nodes).
III) AIDS-Related Complex (ARC): In this stage, the infected person exhibits one or more symptoms. It includes the following symptoms.
i) Continuous diarrhoea for more than a month.
ii) Loss of more than 10% of body weight.
iii) Malaise, fatigue, fever more than a month and night sweating, anaemia, leucopenia.
iv) Swollen lymph glands and spleen (Lymphadenopathy and Splenomegaly)
AIDS (CD4 count less than 200/Ml, normal 600-1200 cells/Ml)
· This is the last stage of HIV infection in which the patient loses all the natural defence mechanisms and the system is collapsed and never recovers.
· Finally, the patients show the following complex symptoms, which may lead to the death of the infected person.
i) Kaposi’s sarcoma (Tumour of skin and mucus membrane)
ii) Cytomegalovirus retinitis (Inflammation on the retina of eyes leading to blindness)
iii) Pneumonia by Pneumocystis carinii.
iv) Infection of the brain (Toxoplasma encephalitis)
v) Cryptococcal meningitis causes meningitis.
vi) Hairy leukoplakia (White patches on the surface of the tongue)
vii) Recurrent skin infection (Ringworm, folliculitis etc.)
viii) Non-specific enlargement of lymph nodes (generalized Lymphadenopathy)
ix) Lymphomas i.e. tumours of lymph nodes
x) Damage of the Nervous system (forgetfulness, loss of concentration, confusion), limb weakness and death.
i) Kaposi’s sarcoma (Tumour of skin and mucus membrane)
ii) Cytomegalovirus retinitis (Inflammation on the retina of eyes leading to blindness)
iii) Pneumonia by Pneumocystis carinii.
iv) Infection of the brain (Toxoplasma encephalitis)
v) Cryptococcal meningitis causes meningitis.
vi) Hairy leukoplakia (White patches on the surface of the tongue)
vii) Recurrent skin infection (Ringworm, folliculitis etc.)
viii) Non-specific enlargement of lymph nodes (generalized Lymphadenopathy)
ix) Lymphomas i.e. tumours of lymph nodes
x) Damage of the Nervous system (forgetfulness, loss of concentration, confusion), limb weakness and death.
Diagnosis
1. ELISA (Enzyme-Linked Immuno-Sorbent Assay) test to confirm HIV antibodies in the blood
2. Western Blot test and Viral load test are also used.
Control
· AIDS is very difficult to control because there is no cure with drug treatment and no vaccine has been successful.
· Drug treatment decreases the severe effect and increases the quality and life span.
A) Treatment
· Although there is no cure for AIDS, the use of certain drugs can prolong the life of AIDS patients.
· Although there is no cure for AIDS, the use of certain drugs can prolong the life of AIDS patients.
· They are Zalcitabine, AZT (Azidothymidine), Ribavarian, DDI (Dideoxyinosine), Ritonavir, Indinavir, Saquinavir and Antiviral drug, “Sumarin” which checks the activity of reverse transcriptase.
· Anti-retroviral treatment (ART) was started in Nepal in February 2004 AD.
· The government is providing free of cost ART services for those in need.
B) Preventive Measures or Prophylaxis
a) High-risk group people should be educated about AIDS transmission and blood donating.
b) Avoid unsafe sexual contact with multiple sexual partners and homosexuals for which condoms should be used.
c) Using disposable syringes and needles.
d) Early diagnosis and treatment of disease.
e) To avoid pregnancy by women suffering from AIDS.
f) Screening of blood and blood products before transfusion.
g) Avoiding sharing of same instruments like a blade, razor, toothbrush etc.
a) High-risk group people should be educated about AIDS transmission and blood donating.
b) Avoid unsafe sexual contact with multiple sexual partners and homosexuals for which condoms should be used.
c) Using disposable syringes and needles.
d) Early diagnosis and treatment of disease.
e) To avoid pregnancy by women suffering from AIDS.
f) Screening of blood and blood products before transfusion.
g) Avoiding sharing of same instruments like a blade, razor, toothbrush etc.
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