TRAINING MANUAL FOR ANTIRETROVIRAL THERAPY (ART) CENTER STAFF

TRAINING MANUAL FOR ANTIRETROVIRAL THERAPY (ART) CENTER STAFF.

LEARNING OBJECTIVES. By the end of this session the participants will learn; Basic information about HIV/AIDS HIV virus, its structure, and HIV infection Natural history of AIDS Modes of transmission Risk factors and risky behaviors Pathogenesis and diagnosis Epidemiology, global, regional and current situation in Pakistan UNAIDS fast track 95% 95% 95% strategy to end HIV/AIDS by 2030.

WHAT IS HIV/AIDS?. HIV human immunodeficiency virus is an RNA virus Retrovirus and subfamily of Lentiviridae . It has two types : HIV - 1(prevalent all over the world) and HIV - 2 (less virulent and is prevalent mostly in some parts of Africa).

WHAT IS HIV/AIDS?. AIDS (Acquired Immune Deficiency Syndrome) is the late stage of HIV infection. HIV infected person develops signs and symptoms of disease, (life-threatening infection and cancers) due to irreversible damage to the immune system. It usually takes about 10 years for someone with HIV to develop AIDS..

STRUCTURE OF THE HIV VIRUS. It is about 100 nm in diameter and spherical in shape It has a lipid envelope, having glycoprotein gp41 and glycoprotein gp120 (spikes) These two viral proteins are responsible for attachment to the host cell. Genome of the HIV Virus contains two strands of RNA molecules Reverse transcriptase convert RNA into DNA Integrase helps virus genome to integrate with host cell HIV virus replicates along with cellular receptors (host cell) Enzyme protease helps to form new mature HIV virus.

STRUCTURE OF THE HIV VIRUS (Diagram). Diagram of the HIV virus. Image: US National Institute of Health/Wikipedia.

MODES OF TRANSMISSION. HIV is found in all body fluids of an infected person. But transmission usually occurs only through blood, sexual secretions, and infected mother's milk. During unprotected sex (sex without condoms) from an infected person to others By sharing contaminated needles/syringes Through infected blood/blood products From infected mother to baby, during pregnancy, labor and when mother feeds her baby with her milk..

HOW HIV IS TRANSMITTED?. Infected blood Contaminated needles/ syringes Multiple Sex Partners Infected mother to her baby Injectable Drug Abuse.

HOW HIV IS NOT TRANSMITTED. Shaking hands Mosquito bites Using the same toilet Kissing or hugging Caring for an infected person Working and living together Swimming in the same pond, pool or river.

NATURAL HISTORY OF HIV TRANSMISSION:. HIV infection begins with the binding of the HIV virus to host cells with CD4 receptors M ainly T-lymphocytes and monocyte-derived macrophages. A fter entering the CD4 + cell, converts its RNA into DNA by using an enzyme reverse transcriptase..

NATURAL HISTORY OF HIV TRANSMISSION:. The HIV DNA enters the nucleus of the CD4 + cell and integrates itself with the host cell DNA. ( Integrase helps virus genome to integrate with host cell ) HIV DNA then instructs the host cell to make many copies of the HIV virus. New virus particles are assembled and leave the cell ready to infect other CD4 + cells 2 ..

SEROCONVERSION:. It means the appearance of detectable antibodies . Antibodies usually appear after six weeks to six months. This period is called the window period During this period virus is present in the body but there are no detectable antibodies ..

ACUTE RETROVIRAL SYNDROME (ARS). Clinically presents with fever, lymph, adenopathy, sore, throat, rash, body pain HIV viral load transitory increase and CD4 cell count decreases. Mostly not recognized in our setup Symptoms similar to common viral infection Person is highly infectious.

ASYMPTOMATIC HIV INFECTION:. It varies from 6 months to 10 years or even more in some cases. During this period the infected person appears completely healthy ( HIV replication and destruction of CD4 cells continues, and the person can transmit the infection to others through the routes mentioned earlier) An asymptomatic HIV-infected person is commonly known as HIV positive person..

SYMPTOMATIC HIV INFECTION (AIDS):. The symptomatic stage starts once CD4 cells start falling to less than 500 mm 3 (The normal range is 600-1200) CD4 cells are the most important cells of the immune system, and their deficiency leads to the development of opportunistic infections, malignancies, or flare ups of latent or sub-clinical infections..

SYMPTOMATIC HIV INFECTION (AIDS):. The human immunodeficiency virus is approximately 100 nm in diameter. It has a lipid envelope, having glycoprotein gp41 and glycoprotein gp120. These two viral proteins are responsible for attachment to the host cell. Beneath the envelope, is the matrix protein p17, the core proteins p24 and p6..

SOME COMMON OPPORTUNISTIC INFECTIONS IN HIV/AIDS PATIENTS:.

DIAGNOSIS OF HIV. HIV is always diagnosed on the basis of test (laboratory or rapid test) Cannot be diagnosed on the basis of history and clinical examination WHO recommended three test strategy for diagnosis.

HIV CARE CONTINUUM. The human immunodeficiency virus is approximately 100 nm in diameter. It has a lipid envelope, having glycoprotein gp41 and glycoprotein gp120. These two viral proteins are responsible for attachment to the host cell. Beneath the envelope, is the matrix protein p17, the core proteins p24 and p6..

EPIDEMIOLOGY OF HIV/AIDS:. Global Situation: In 2021, 38.4 million people were living with HIV in the world 1.7 million were children and 54% were women 1.5 million people became newly infected with HIV (650,000 died) 85% of people living with HIV in the world knew their HIV status 28.7 % of people living with HIV were accessing treatment in 2021.

21. Estimated people living with HIV, new HIV infections and AIDS-related deaths, 1990-2021.

Key population size estimates, 2016. Source: Prepare d by www.aidsdatahub.org based on Global AIDS Monitoring.

23. HIV prevalence among key populations, 2005-2017.

24. HIV prevalence among key populations, 2016-2017.

HIV/AIDS SITUATION IN ASIA:. Asia is second only to sub-Saharan Africa as the region with the greatest number of people with HIV In 2020, there were about 2.3 million people living with HIV in India ( www.naco.gov.in ) 1.045 million people living with HIV in China. UNAIDS data shows new HIV infections in Asia and pacific The world’s most populated regions are increasing.

HIV/ AIDS IN PAKISTAN :. Currently Pakistan is experiencing concentrated HIV epidemic HIV prevalence among several key populations is more than 5% HIV epidemic moved from low prevalence to concentrated epidemic P redominant mode of HIV transmission is through injecting drug use Estimated number of HIV/AIDS cases in the country in 2021 is 210,000 25,000 new infections occurred in 2021 HIV prevalence among women is lower than in men (<30%) HIV prevalence among children is also low B ut In 2019 HIV outbreak discovered in Ratodero , more than 900 children tested HIV + ve ..

UNAIDS FAST-TRACK STRATEGY TO END AIDS BY 2030:. 95% of those living with HIV to know their status, 95% of those who know their status to be on treatment, and 95% of those on treatment to be virally suppressed. Where are we? People living with HIV 240,000 Who knows their status or registered 49,584 (about 20%) Who are on ART 29626 (60%) Virally suppressed ???.

KEY POINTS TO REMEMBER. HIV, Human Immunodeficiency Virus is an RNA virus. There are two types, HIV -1 which is prevalent all over the world, and HIV- 2 virus which is less virulent and is prevalent in Africa AIDS-Acquired Immune Deficiency Syndrome is the terminal stage of HIV infection when the immune system is weakened by the loss of CD4 cells and count decreases below 200 per ml of blood and the affected person develops opportunistic infections and certain cancers.

KEY POINTS TO REMEMBER. HIV testing is the only way to know if you have HIV. It’s not possible to diagnose HIV by looking at the patient or on basis of comprehensive history. HIV is not diagnosed on the basis single test. Screening and confirmatory tests are required for diagnosis. If HIV is left untreated overtime it will seriously damage the persons immune system and leave his/her open to life threatening infection cause even death. HIV virus is fragile and can not survive outside the body or when expose to the sunlight.

KEY POINTS TO REMEMEBER. Can you get HIV from oral sex? Yes, there is a possible risk of getting HIV from oral sex. But risk is, however much more than vaginal and anal sex People living with HIV are disproportionally affected by STI, reasons include modes of transmission of STI and HIV are similar and behaviors that put someone at risk for STI and HIV are also similar..

KEY POINTS TO REMEMBER. Moreover people living with HIV are more likely to shed HIV when they have ulceration and non ulceration STI. Some activities can put people at unusual risk for both STI and HIV Understanding how to manage STI, Co-infection in people living with HIV is vital for reducing mortality and mortality in this patient populations..

REFERENCES:. https://www.who.int/news-room/fact-sheets/detail/hiv-aids (accessed on August 1 , 2022) Centers for Disease Control and Prevention’s Public Health Image Library https://www.unaids.org/en/resources/fact-sheet (accessed on 1 August 2022) www. https://www.unaids.org/en/regionscountries/countries/pakistan (access on August 1, 2022) https:/nacp.gov.pk/repository/ whatwedo /surveillance/Final%20IBBS%20Report%20Round%205.pdf (accessed on August 1, 2022) https://nacp.gov.pk/repository/whatwedo/surveillance/Final%20IBBS%20Report%20Round%205.pdf (accessed on August 1, 2022) Mahathir M. Women at greater risk of HIV infection. Arrows Change. 1997 Apr;3(1):1-2. PMID: 12292992. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/ hiv /prevention/ mother-to-child-transmission-of- hiv (access on August 1, 2022) https://www.euro.who.int/__data/assets/pdf_file/0006/78180/E90840_Chapter_10.pdf (access on August 1, 2022) https://www.cdc.gov/hiv/group/gender/pregnantwomen/opt-out.html#:~:text=Since%201995%2C%20 CDC% 20 has%20recommended,the%20virus%20to%20their%20infant (access on August 1, 2022) https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf access on August 1 , 2022).