Lecture 10 - HIV 2024 2 Oct 2022

HIV/AIDS
Barnali Chakraborty, PhD, MPH, MSc

North South University (Dept. of Public Health),
Dhaka, Bangladesh
Objective of the Lecture
▪ By the end of this lecture, you will be able to learn:

▪ HIV/AIDS, risky groups for getting HIV/AIDS
▪ Mode of transmission & prevention
▪ Current situation of HIV/AIDS in Bangladesh
▪ Prevention approach
HIV & AIDS
▪ HIV or Human Immunodeficiency Virus is a retrovirus (having RNA instead of DNA as
its genetic material) that primarily weakens human immune system
▪ HIV transmission is possible at any stage of HIV infection—even if an HIV-infected

person has no symptoms of HIV
▪ AIDS or Acquired Immuno-Deficiency Syndrome is the end-stage of HIV infection
▪ Less than 200 CD4+ T cells*/cubic mm of blood (CD4 cells, also known as T cells, are white
blood cells that fight infection and play an important role in our immune system. A CD4
count is used to check the health of the immune system in people infected with HIV (human
immunodeficiency virus). HIV attacks and destroys CD4 cells
▪ Opportunistic infections and severe weight loss

History!!!
History!!!
▪ In 1981, 5 young gay men in USA reported pneumonia from an abnormal pathogen
(Pneumocystis carinii) as well as some abnormal cancer (Kaposi’s Sarcoma)
▪ Branded as a “cellular-immune dysfunction related to a common exposure” and a

“disease acquired through sexual contact”
▪ In 1983 , the virus was discovered in USA (Robert Gallo) and France (Luc
Montagnier)
▪ Retrospective analysis revealed: It has been present since 1920s in Africa. First
retrospective case of HIV infection 1959 in Kinshasa (DR Congo)
Key facts of AIDS
• HIV remains a major global public health issue, having claimed 40.4 million lives so
far with ongoing transmission in all countries globally
• There were an estimated 39.0 million [33.1–45.7 million] people living with HIV at
the end of 2022, two thirds of whom (25.6 million) are in the WHO African Region
• In 2022, 630,000 people died from HIV-related causes and 1.3 million people
acquired HIV
• There is no cure for HIV infection. However, with access to effective HIV prevention,
diagnosis, treatment and care, including for opportunistic infections, HIV infection
has become a manageable chronic health condition, enabling people living with HIV
to lead long and healthy lives
Some important terminologies
▪ PrEP: Pre-Exposure Prophylaxis

▪ An HIV prevention option for people who don’t have HIV but who are at high risk of becoming
infected with HIV.
▪ PrEP involves taking a specific HIV medicine every day.
▪ PrEP should always be combined with other prevention options, such as condoms.
▪ PEP: Post-exposure prophylaxis

It involves taking antiretroviral (ARV) medicines very soon (within 3 days) after a possible
exposure to HIV to prevent becoming infected with HIV.
Some important terminologies
▪ ART
Antiretroviral therapy is the use of HIV medicines to treat HIV infection.
ART involves taking a combination of HIV medicines every day.
ART can’t cure HIV infection, but it can help people infected with HIV live longer, healthier lives.
HIV medicines can also reduce the risk of transmission of HIV.
▪ VMMC: Voluntary Medical Male Circumcision

In 2020 WHO updated the 2007 recommendation of VMMC to continue as an additional
preventive intervention among males age 15 years and older
Sources of HIV
Body fluids of a HIV infected person;

▪ 1. Fluids contain highly concentrated virus:
a) CSF (cerebrospinal fluid) b) Semen c) Blood d) Pre-semen
▪ 2. Fluids contain less concentrated virus
a) Cervical secretion, b) Vaginal secretion c) Breast milk
▪ 3. Fluids contain very less concentrated virus:
a) Saliva, Tears etc.
Risk factors
Behaviors and conditions that put individuals at greater risk of contracting HIV include:
1. Having unprotected anal or vaginal sex;
2. Having another sexually transmitted infection (STI) such as syphilis, herpes,
chlamydia, gonorrhoea and bacterial vaginosis;
3. Sharing contaminated needles, syringes and other injecting equipment and drug
solutions when injecting drugs;
4. Receiving unsafe injections, blood transfusions and tissue transplantation, and
medical procedures that involve unsterile cutting or piercing; and
5. Experiencing accidental needle stick injuries, including among health workers
High risk group or Key populations
Key populations:
1. MsM (Men having Sex with Men)
2. CSWs with clients (Commercial Sex Worker)
3. People in Prison/jail/goal and other closed setting
4. IDUs (Injectable Drug Users)
5. Transport workers
6. Migrant population
7. Female garments workers in Dhaka city etc.
Mode of Transmission
1. Sexual transmission: Unsafe sexual
act. Anal sex.
2. Perentral transmission: infected
blood and blood products
3. Perinatal transmission: from an
infected mother to her offspring
during, before or after delivery. 25%-
50%
4. Accidental transmission: Infected
needles, syringes, organ transplants,
semen and other tissues can occur in
medical settings
Signs and symptoms
• The symptoms of HIV vary depending on the stage of infection.
• Though people living with HIV tend to be most infectious in the first few months after being
infected, many are unaware of their status until the later stages.
• Acute or Initial Infection (1-3 months): Asymptomatic or Fever, headache, tiredness,

generalized swollen glands.
• Latent Infection (1-10 years): No symptoms. HIV is still active but reproduces at very low
levels. People can still transmit HIV to others.
AIDS: Immune system compromised, opportunistic infections (tuberculosis (TB), cryptococcal meningitis,
severe bacterial infections), cancers, severe weight loss. CD4+ T cell <200/mm3, Viral load HIGH. Without
treatment, people with AIDS typically survive about 3 years.
Diagnosis & Treatment
Diagnosis
1. Based on detection of antibody (your body’s response to HIV infection) which becomes
positive after 28 days
2. Detection of Antigen (viral part) in blood (can be detected immediately)
Treatment
1. There is NO cure for HIV infection currently, it can only be controlled by lifelong medication
2. Drugs can prevent or lower viral replication and reduce transmission
3. ART or Anti Retroviral Therapy means the treatment to suppress viral replication
Prevention
1. Health education
2. Condom promotion
3. Rapid test
4. Pre-Ep (The formula is 2+1+1):
a. 1st pill 2-24 hours before sex
b.2nd pill 2-24 hours before sex
c. 3rd pill after 24 hours of first 2 pills
d.4th pill 48 hours after first 2 pills
5. DVR# Dapivirine vaginal Ring
Prevention
HIV Negative HIV positive

Educate yourself and others Safe sex practice
Know the HIV status of the sex Tell your partner that you are positive
partners
Safe sex and condom Don’t share needles or syringes
Use clean needle Don’t donate blood or organs
Be cautious while using blood Don’t share razorblades or toothbrushes
products
Regular screening If you are pregnant get medical care right away
Male circumcision Tell others who need to know
Prevention
Male and female condom use

• Correct and consistent use of male and female condoms during vaginal or anal
penetration can protect against the spread of sexually transmitted infections, including
HIV
• Evidence shows that male latex condoms have an 85% or greater protective effect against
HIV and other sexually transmitted infections (STIs)
Prevention
Voluntary medical male circumcision (VMMC)
• Medical male circumcision, reduces the risk of heterosexually acquired HIV infection in men
by approximately 60%
• Here is no evidence that male circumcision decreases a woman’s risk of getting HIV
• Evidence about the benefits of circumcision among gay and bisexual men is inconclusive
By reducing viral load in HIV positive person By eliminating mother to child transmission (MTCT)
If an HIV-positive person adheres to an Mother-to-child transmission can be nearly/fully

effective ART regimen, the risk of transmitting the prevented if both the mother and the baby are
virus to their uninfected sexual partner can be provided with ART drugs as early as possible in
reduced by 96% pregnancy and during the period of breastfeeding
Prevention
PrEP should be used by people, who:

• Have an HIV-positive partner
• Have Multiple Partners
• Share needles or equipment to inject drugs
PEP is ideal for people, who:

• Exposed to HIV during sex (for example, condom break)
• Shared needles or works to prepare drugs
• Were sexually assaulted
Situation in Bangladesh
Bangladesh has a low prevalence of HIV/AIDS (less than 1%
among the general population), low rates of condom use and
low level of awareness about HIV/AIDS have far-reaching
implications on HIV transmission to vulnerable segments of the
society
Problem solving exercise
• What is the association between HIV and TB?
• Who are at risk of having HIV?
• How HIV can be transmitted?
• PrEP, PEP and ART

Lecture 10 - HIV 2024 2 Oct 2022

Uploaded by

Copyright:

Available Formats

Lecture 10 - HIV 2024 2 Oct 2022

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lecture 10 - HIV 2024 2 Oct 2022

Uploaded by

Copyright:

Available Formats

HIV/AIDS

Barnali Chakraborty, PhD, MPH, MSc

▪ By the end of this lecture, you will be able to learn:

▪ Mode of transmission & prevention

▪ Current situation of HIV/AIDS in Bangladesh

▪ HIV transmission is possible at any stage of HIV infection—even if an HIV-infected

▪ AIDS or Acquired Immuno-Deficiency Syndrome is the end-stage of HIV infection

▪ Opportunistic infections and severe weight loss

▪ Branded as a “cellular-immune dysfunction related to a common exposure” and a

▪ PrEP: Pre-Exposure Prophylaxis

▪ PEP: Post-exposure prophylaxis

▪ VMMC: Voluntary Medical Male Circumcision

Body fluids of a HIV infected person;

• The symptoms of HIV vary depending on the stage of infection.

• Acute or Initial Infection (1-3 months): Asymptomatic or Fever, headache, tiredness,

HIV Negative HIV positive

Male and female condom use

If an HIV-positive person adheres to an Mother-to-child transmission can be nearly/fully

PrEP should be used by people, who:

PEP is ideal for people, who:

• Who are at risk of having HIV?

• How HIV can be transmitted?

• PrEP, PEP and ART

You might also like