Provider Initiated HIV Counseling and Testing Unit 1: Introduction to HIV/AIDS

1.1 Learning Objectives Describe the scope of HIV/AIDS pandemic Discuss the overview of HIV and AIDS Discuss the transmission and natural history of HIV Describe common opportunistic infections and HIV/AIDS staging

1.3 Scope of the HIV/AIDS Pandemic Global HIV/AIDS in million people are living with HIV/AIDS 2.3 million are children under 15 years 4.9 million people newly infected Over 20 million people died since million people died in 2005

1.4 Scope of the HIV/AIDS Pandemic Sub-Sahara Africa HIV/AIDS million people living with HIV/AIDS 3.2 million people became newly infected 2.4 million people died of AIDS

1.5 HIV/AIDS in Ethiopia HIV prevalence 2002Total 6.6%, U 13.7, R 3.7 HIV prevalence 2003Total 4.4%, U 12.6, R 2.6

1.6 HIV/AIDS in Ethiopia PLWHA in 2003 Adults : 1.4 million Children :95,000 The number of new AIDS cases in 2003 Adults : 98,000 Children : 25,000 AIDS deaths in 2003 Adults :90,000 Children : 24,000

1.7 Overview of HIV and AIDS Human Immunodeficiency Virus H= Human I = Immunodeficiency V = Virus

1.8 Overview of HIV and AIDS Acquired Immune Deficiency Syndrome A = Acquired, not inherited I = Weakens the immune system D = Creates a Deficiency of certain white blood cells in the immune system S = Syndrome, a group of symptoms or illnesses as a result of the illness

1.9 Overview of HIV and AIDS HIV breaks down the body’s defense against infection and disease by infecting specific white blood cells (CD4) When the immune system becomes weakened by HIV, the illness progresses to AIDS Some blood tests, symptoms or infections indicate progression of HIV to AIDS

1.10 Overview of HIV and AIDS Types and difference of HIV: HIV-1 and HIV-2 1: Transmitted through the same routes 2: Associated with similar opportunistic infections HIV-1 is more common worldwide HIV-2 is found primarily in West Africa, Mozambique and Angola

1.11 Overview of HIV and AIDS Types and difference of HIV cont’d: HIV-2 is less easily transmitted HIV-2 is less pathogenic MTCT is relatively rare with HIV-2

1.12 Transmission of HIV HIV is transmitted by 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 Direct contact with infected blood

1.13 Transmission of HIV HIV cannot be transmitted by Coughing, sneezing Insect bites Touching, hugging Water, food Kissing Public baths Handshakes Work or school contact Using telephones Sharing cups, glasses, plates or other utensils

1.14 Prevention of HIV Transmission Public Health strategies to prevent HIV transmission Screen all blood and blood products Follow standard precautions for infection prevention Educate safer sex practices Identify and treat STIs Provide referral for treatment of drug dependence Apply the comprehensive PMTCT approach to prevent perinatal transmission of HIV

1.15 Natural History of HIV HIV can be transmitted during each of the following stages: Primary Infection: Infection with HIV, antibodies develop Asymptomatic: No sings of HIV, immune system controls virus production Symptomatic: Physical signs of HIV infection, some immune suppression AIDS: Opportunistic infections, end-stage disease

1.16 Natural History of HIV

1.17 CD4 Count and Viral Load Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4 counts) The higher the viral load, the sooner immune suppression occurs

1.18 Natural History of HIV Infection: Summary HIV multiplies inside the CD4 cells, destroying them As CD4 cell count decreases and viral load increases, the immune defense 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

1.19 Opportunistic Infections and HIV/AIDS Staging Tuberculosis Peumocystis carinii pneumonia Toxoplasmosis Gastrointestinal manifestations Herpes zoster

1.20 TB/HIV Co-infection As high as 80% in some countries like Botswana Limited information in Ethiopia Co-infection rate ranges from 20-60%

1.21 Staging for HIV Infection Contribute to care of HIV-positive individuals Provide framework for follow-up and management Help define prognosis and guide appropriate patient counseling Be use to help evaluate new treatments

1.22 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 setting HIV is a virus that destroys the immune system, leading to opportunistic infection The progression from initial infection with HIV to end-stage AIDS varies from person to person and can take more that 10 years.

1.23 Key Points The most common route of transmission worldwide is heterosexual transmission HIV-positive women who are pregnant are at risk of passing HIV infection to their newborns HIV staging can contribute to the management, care and follow-up of HIV- positive individuals