HIV: THE Global & South

African Indaba/ Agenda

MD TSHABALALA
2009
 LECTURE OBJECTIVES
 Understand the global and local impact of the
epidemic
 Know about HIV in children and its effects on
families
 Understand the natural history of HIV infection
 Understand the modes of HIV transmission
 HIV
Human Immunodeficiency Virus

H = Infects only Human beings

I = Immunodeficiency virus weakens
the immune system and increases the
risk of infection
V = Virus that attacks the body
 AIDS
Acquired Immune Deficiency
Syndrome
• A = Acquired, not inherited
• I = Weakens the Immune system
• D = Creates a Deficiency of CD4+
cells in the immune system
• S = Syndrome, or a group of illnesses
taking place at the same time
 HIV and AIDS
• When the immune system
becomes weakened by HIV, the
illness progresses to AIDS

• Some blood tests, symptoms or

certain infections indicate
progression of HIV to AIDS
 HIV-1 and HIV-2
• HIV-1 and HIV-2 are
• Transmitted through the same routes
• Associated with similar opportunistic
infections

 • HIV-1 is more common worldwide

 • HIV-2 is found in West Africa, Mozambique,

and Angola
 HIV-1 and HIV-2

• HIV-2 is less easily transmitted

• HIV-2 is less pathogenic

• Duration of HIV-2 infection is shorter
• MTCT is relatively rare with HIV-2
• MTCT of HIV-2 has not been reported from
India
 Transmission of HIV
HIV is transmitted by
• Direct contact with infected blood
• Sexual contact: oral, anal, or vaginal
• Direct contact with semen or vaginal and
cervical secretions
• HIV-infected mothers to infants during
pregnancy, delivery, or breastfeeding
 Transmission of HIV
HIV is not transmitted by:
 Coughing and  Public baths
sneezing  Handshakes
 Insect bites  Work or school
 Touching and contacts
hugging  Using telephones
 Water and food  Sharing cups,
 Kissing glasses, spoons,
plates and other
utensils
 Global summary of the HIV and AIDS epidemic,
December 2004

Total
Number of people living 44.3
39.4 million (35.9
– millio
Adults 37.2 million (33.8
41.7
– million
with HIV in 2004 Women 17.6 million (16.3
19.5
– millio
Children under 15 years
2.2 million (2.0
2.6
– million

People newly infected Total 4.9 million (4.3

6.4
– million
Adults 5.7
4.3 million (3.7
– million
with HIV in 2004 Children under 15 years
640 000 (570 000 750
– 000
–
AIDS deaths in 2004 Total 3.1 million (2.8
3.5 million
Adults 2.6 million (2.3
2.9
– million
Children under 15 510
years
000 (460 000–
600 000)

The ranges around the estimates in this table ies

define
within
thewhich
boundar
the actual numbers lie, based on the
able
best
information.
avail

00003-E-1 – December 2004

About 14 000 new HIV infections a day in 20

● More than 95% are in low and middle incom e countrie

● Almost 2000 are in children under 15 years of age

● About 12 000 are in persons aged 15 to 49 years, of

whom:
— almost 50% are w om en
— about 50% are 15 –24 year olds

00003-E-10 – December 2004

 Global HIV/AIDS in 2004 *
• 39.4 -40.0 million people are living with HIV/AIDS
• 2.2 million are children under 15 years
• 6,40,000 children were newly infected with HIV in 2004
• 5,10,000 children died of HIV in 2

• * Source: UNAIDS,2004
 Modes of Transmission
 MTCT accounts for the majority of infections in children
(> 95%) either perinatally or through breastfeeding
 Sexual abuse: at Tygerberg hospital it accounted or 1%
of infections at the Family clinic for HIV
 Transfusion of Blood and related products: a small
number infected due to failure to determine viraemic
donors prior to antibody production
 Horizontal: usually in seronegative parents, consider
parents, expressed milk given to hospitalized babies,
Nosocomial spread due to razor use.
 Impact of Global HIV

• Negative economic impact on countries

• Overstrained healthcare systems
• Decreasing life expectancy
• Reversal of child survival gains
• Increased numbers of orphans
 Prevention of
HIV Transmission
• Strategies to prevent HIV transmission
• Personal strategies

• Public health strategies

• Safe practices: no risk of HIV transmission

• Risk reduction: reduces but does not eliminate

risk
 Prevention of
HIV Transmission
 Public health strategies to prevent HIV
transmission
• Screen all blood and blood products
• Follow universal precautions
• Educate in safer sex practices
• Identify and treat STIs/other infections
• Provide referral for treatment of drug dependence
• Apply the comprehensive PPTCT approach to
prevent vertical transmission of HIV
Natural History of HIV Infection
 Natural History of HIV Infection

Immune suppression
• HIV attacks white blood cells,called
CD4 cells, that protect body from
illness
• Over time, the body’s ability to fight
common infections is lost
• Opportunistic infections occur
 HIV Disease
Progression of HIV disease is measured by:
 CD4+ count
Degree of immune suppression
Lower CD4+ count means decreasing
immunity
 Viral load
Amount of virus in the blood
Higher viral load means more immune
suppression
 HIV Disease
Severity of illness is
determined by amount of
virus in the body
(increasing viral load) and
the degree of immune
suppression (decreasing
CD4+ counts)
Higher the viral load, the
sooner immune
suppression occurs
 Progression of HIV Infection
• HIGH viral load (number of copies
of HIV in the blood)

• LOW CD4 count (type of white

blood cell)

• Increasing clinical symptoms (such

as opportunistic infections)
 HIV Disease
•Direct infection of organ systems
• HIV can directly infect the:
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)
 HIV Disease: Summary
• HIV multiplies inside the CD4+ cells, destroying
them
• As CD4+ cell count decreases and viral load
increases, the immune defences are weakened
• HIV-infected people become vulnerable to
opportunistic infections
• HIV is a chronic viral infection with no known cure
• Without ARV treatment, HIV progresses to
symptomatic disease and AIDS
 Key Points
• HIV is a global pandemic and the number of
people living with HIV continues to increase
worldwide.
• HIV epidemic is especially severe in resource-
constrained settings
• HIV is a virus that destroys the immune
system, leading to opportunistic infections.
• The progression from initial infection with HIV
to end-stage AIDS varies from person to
person and can take more than 10 years.
 Key Points (continued)
• The most common main route of transmission
worldwide is heterosexual transmission.

• Women of childbearing age are at particular risk for

acquiring HIV through unprotected sex

• HIV-positive women who are pregnant are at risk of

passing HIV infection to their newborn.

• Risk of HIV transmission from mother-to-child can be

greatly reduced through effective PMTCT programs