HIV / AIDS

HIV / AIDS By Dr. Madhup Kaushal &   Dr. Mamta Kaushal

 One of the major achievments of the twentieth century science is the triumph of medical fraternity over many infections disease that have plagued mankind through the ages.  The modern medicine has assured a  in thegood quality of life to mankind, but this happy scenario was rudely shattered in early eighties when a new virus, later identified as Human Immunodeficiency Virus, (HIV) struck the human race.  Till date all the ingenuity of man, money, effort and power has not found a way to counter the refentless onslaught of HIV which respects territorial boundries, makes no distinction between race, creed or colour, and spares neither the rich nor the poor, the old or the youngh.

As the world enters the third decade of AIDS epidemic, the evidence of its impact is underiable.  Wherever epidemic has spread unchecked, it is robbing countries of the resources and capacities on which human security and development depends.

HIV/AIDS in India

Since the detection of HIV infection in Commercial Sex Workers in Tamil Nadu (South India) in 1986, there has been a steady increase in the AIDS patients.  India accounts for the major global burden, and 65 % of that of South East Asia.  Both HIV-1 and HIV-2  are found in India.  The majority of infection is 91 % of HIv 1 subtype-C.

EPIDEMIOLOGIACL FEATURES

Agent Factors

HIV, the virus causing AIDS is a Lentivirus, one of the subfamilies of retrovirus.  They have a unique enzyme called Reverse Transcriptase, which copies the viral RNA unto DNA which eventuallyintegrate into cell cromosomes.

Rerservoir of Infection

People harbouring HIV in the body are the source of infection.  

Source of infection:

Infected blood, semen, vaginal fluid are the prime source.  Infected breast milk is also a source of infection from mother to child.

Host Factors

• Age and sex :  Dispropotionally affecting young people, early sexul life.
• High Risk Group :    1. Injecting drug users. 2. Commercial Sex workers.  3.  Truck Drivers etc.
• Mixing pattern of population
• Immunity.  In a healthy immune system specially T-cells called "helper -T-cells".  (CD4 cells) assist B cells and antibodies to fight infection with their counterparts "Suppressor T cells" inhibit this activity.  Healthy individualshave twice as many "Helper-T-cells" as supressor T cells. In AIDS patients ratio is reserved.

Political and Cultural Factors

•  Acceptability of certain indegenous sexual practices
• War and civil disturbances
• Limitations on interventions
• Social unacceptanceof condoms
• Woman status
• National policies
• Norms and Practicies
• Culture and ethnic practices
• Marginalized Populations 

Social and Economic Factors

• Low literacy
• Urbanization
• ImprisonmentHigh Mobility
• Migration and separation from families
• Drugs use
• alcohol use

Modes of HIV Transmission

1. Sexual Intercourse, The risk of becomming infected through an act of unprotected sexual intercourse depend om four main factors:  

       a.  The likelihood that the sexpartner is infected.  

       b.  The type of sex act.,"Receptive" partner at a 

       greater risk               the "insortive"  partners in act of intercourse. 

       c.  The amount of virus present in the blood or 

       sexual secreions     of the infected partnet

      d.  The presence of other sexual transmitted disease an/or 

       genital  lesions in either partners

2.  Blood borne Infections

3.  Mother to child transmision :  An HIV positive mother  

     can transmitt  HIV infection to her foetus or infant before, during  

     and after delivery.

Natural History of HIV/AIDS

People infected with HIV are both infected and infectious for life, even when they look healthy and feel healthy, they can transmit the virus to others.  Four stages of HIV infection can be described :

 1.  Primary Infection  a)  Rapid Proliferation

                                   b)  Seroconversion, illness which usually  

                                         resolves within weeks.  

2.  Early Immune Defeciency

     ( CD4 cell count > 500 cells / mm3)

     In this phase the immune system has controlledthe virus, which is   

     largely restricted  to lymphoid tissue.  People are usually without 

     symptoms.

3.  Intermediate Immune Defeciancy

     (CD4 cellcount, 200-500/mm3)

      Viral replication is very high as CD4 cells turnover  is rapid.  Signs 

      and symptoms of compromising immune system starts to appear.

4.  Advance Immune Defeciancy

      (CD4 cell count < 200/mm3)

      Virus overcomes the immunesystem.  

      Major opportunistic infection and malignancies become 

      increasingly common.

STAGES :

Viral tranmission  > 2-3 weeks > acute retroviral syndrome

>>  2-3 weeks >  Recovery + seroconversion

>> 2-4 weeks Asymptomatic chronic HIV Infection 

>> average 8 yrs.>>AIDS >> Symptomatic HIV Infection 

>> 1-3 years >>Death.