Dr.Ameer Kadhim Hussein
M.B.Ch.B. FICMS (Community Medicine)
Acquired Immunodeficiency
Syndrome (AIDS)
Introduction
The human immunodeficiency virus (HIV) is a
retrovirus that infects cells of the immune system
and destroying or impairing their function.
As the infection progresses, the immune system
becomes weaker, and the person becomes more
susceptible to infections. The most
advanced stage of HIV infection
is acquired immunodeficiency
syndrome (AIDS).
It can take 10-15 years for
an HIV-infected person to develop
AIDS.
HIV/AIDS
Epidemiology of HIV/AIDS
HIV disease continues to be a serious health issue for parts of
the world.
Worldwide, there were about 2.5 million new cases of HIV in
2011. About 34 million people are living with HIV around the
world. In 2011, there were about 17 million deaths in persons
with AIDS, and nearly 30 million people with AIDS have died
worldwide since the epidemic began. Even though Sub-Saharan
Africa bears the biggest burden of HIV/AIDS.
Countries in South and South east Asia,
Eastern Europe and Central Asia, and
those in Latin America are significantly
affected by HIV and AIDS.
Clinical spectrum of HIV infection
In addition to sexual contact
Mode of transmission
Mode of transmission
1. HIV is transmitted through unprotected sexual
intercourse. Anal sex is the highest-risk sexual behavior.
Vaginal sex is the second highest-risk sexual behavior.
Having multiple sex partners or having other sexually
transmitted infections can increase the risk of infection
through sex.
2.Transfusion of blood, blood products, or organ/tissue
transplants that are contaminated with HIV.
3.Sharing of contaminated needles.
4.Mother to her baby during pregnancy, childbirth and
breastfeeding.
Reservoir
The reservoir of infection is human. Although there are
related viruses in animals, there is no evidence of
naturally occurring zoonotic infection.
The infective agent is present in blood and is excreted
in various body fluids (saliva, semen, breast milk) of
infected persons even during the latent phase when the
patient is asymptomatic.
Incubation period and period of
communicability
Incubation period : Time from HIV infection to
development of detectable antibodies less than
one month . The time from HIV infection to
diagnosis of AIDS was between (less than one
year to 15 years or longer).
Period of communicability: unknown began
early after onset of infection and extends
throughout the life , it is related to viral load.
Antiretroviral Drugs
1. Nucleoside Reverse Transcriptase inhibitors.
eg : AZT (Zidovudine)
2. Non-Nucleoside Transcriptase inhibitors.
eg: Viramune (Nevirapine)
3. Protease inhibitors.
eg: Norvir (Ritonavir)
Successful treatment is not cure
but suppression of viral replication.
CONTROL
The most logical approach to the control of the
infection is to reduce transmission while providing care
for patients. The role of chemotherapy in the control of
the disease is expanding but it is limited in developing
countries because of the high cost of the drugs and the
complexity of the schedules as well as the demanding
close monitoring of the patients. The most important
tool is modification of human behavior through
education directed at each of the four modes of
transmission.
Control
A. Sexual behavior:
1. Avoidance of exposure :
Ideally, sexual activities should be
confined to persons who are in permanent
relationships– one man, one wife for life.
2. Reducing the risk of infection:
Whenever sexual activity does not confined to
ideal, measures should be taken to reduce the risk
of infection, for example by the use of male or
female condoms. Such measures do not assure
absolute protection.
Control
B. Perinatal infection
1. Infected women at childbearing age should be
counseled on avoidance of pregnancy through
the use of contraceptives.
2. Using antiretroviral therapy.
3. Breast is always best, even for HIV-positive
mothers.
Control
If the mother is HIV positive, more uncertainty is added.
“Some counsellors are themselves confused about what
is correct practice regarding HIV and feeding practices.
Until recently, the World Health Organization (WHO)
advised HIV-positive mothers to avoid breastfeeding if
they were able to afford, prepare and store formula milk
safely. But research has since emerged, particularly
from South Africa, that shows that a combination of
exclusive breastfeeding and the use of antiretroviral
treatment can significantly reduce the risk of
transmitting HIV to babies through breastfeeding.
Control
Control
C. Blood transfusion
Donors who belong to high-risk groups and their sexual
partners should be excluded.
Donated blood should be screened to avoid transfusing
infected specimens.
D. Contaminated needles and other
equipment
Instruments should be carefully disinfected and when
feasible disposable needles and syringes should be used.
SEXUALLY
TRANSMITTED
DISEASES
STDS
SEXUALLY TRANSMITTED
DISEASES
These are infections which are transmitted during
sexual intercourse. Although various other infections
may be transmitted during sexual intercourse, the
commonly recognized sexually transmitted diseases
include:
1.Viral and rickettsial infections :eg. HIV/AIDS and
herpes genitalis.
2.Bacterial infections: lymphogranuloma venereum,
soft chancre, granuloma inguinale, gonorrhoea and
syphilis.
3. Protozoal infections: Trichomoniasis.
SEXUALLY TRANSMITTED DISEASES
Transmission occurs through:
1. Genital contact.
2. Extra genital sexual contact, e.g. kissing.
3. Non-sexual transmission, e.g. mother to child
transmission eg: HIV infection and syphilis, gonococcal
ophthalmia neonatorum, or accidental contact as when
doctors, dentists or midwives handle tissues infected with
syphilis.
4. Fomites, e.g. soiled moist clothing such as wet towels,
may transmit vulvovaginitis to prepubescent girls.
5. Blood and blood products, e.g. HIV infection.
SEXUALLY TRANSMITTED DISEASES
Control:
The general guidelines for the control of
sexually transmitted diseases include
action at the level of :
1. Infective agent.
2. Transmission.
3. Host.
INFECTIVE AGENT
By Eliminate the reservoir of infection:
The reservoir is exclusively human; it includes
untreated sick patients or in apparent infection
especially in women which represents the most
important part of the reservoir.
Regular medical examination and treatment of known
commercial sex workers is of great importance in
control of sexual transmitted diseases.
TRANSMISSION
1. Discourage sexual promiscuity through sex
education, make the community aware of the dangers
of sexual promiscuity.
2. Encourage local protection by the use of the male
condom or female condoms which diminish the risk of
acquiring sexually transmitted diseases. Careful toilet
of the genitals with soap and antiseptic creams
immediately after sexual exposure may give partial
protection.
HOST
1. Specific prophylaxis
Measure of protection can be obtained by using
antibiotic chemoprophylaxis, this approach can be
dangerous for the individual and the community.
Chemoprophylaxis may suppress the acute clinical
manifestations but the disease may remain latent and
progress silently to late complications.
HOST
2. Early diagnosis and treatment
a. For patients:
This is one of the most important measures for the
control of sexually transmitted diseases. Facilities
for the diagnosis and treatment of those diseases
must be freely accessible to all infected persons.
b. For contacts:
In addition to treating the patient, sexual contacts
must be investigated and treated.