2. CONTENTS
• Introduction.
• Prevalence.
• HIV virus.
• Immunopathogenesis.
• Modes of transmission
• Classification of HIV infection.
• Clinical stages and manifestations in AIDS
• Treatment.
• Prevention
• Universal precaution
• conclusion
• References
2
3. INTRODUCTION
• Over the past 2 decades have
witnessed a profound transformation
in the challenges facing the world with regard to
HIV/AIDS infection.
• This fatal disease is the 4th most common cause
of the death (UNAIDS/ WHO 1998).
• Globally 47 million people are HIV positive
with 40% infection found in developing
countries.
3
4. • The estimated number of persons living with HIV
worldwide in 2007 was 33.2 million [30.6–36.1
million], a reduction of 16% compared with the
estimate published in 2006 (39.5 million [34.7–47.1
million]). (UNAIDS/WHO, 2006)
• The single biggest reason for this reduction was the
intensive exercise to assess India’s HIV epidemic,
which resulted in a major revision of that country’s
estimates.
4
5. Status of HIV epidemic in India
High Prevalent states
Maharashtra
Manipur
Andhra Pradesh
Nagaland
Tamil Nadu
Karnataka
11. THE STRUCTURE OF HIV
• Spherical particles
called Virions.
• studded with lots of little
spikes.
• particle is 100-150
billionths of a metre in
dia.
11
The proteins gp120 and gp41 together make up the spikes
that project from HIV particles, while p17 forms the
matrix
and p24 forms the core.
14. THE VIRUSES ACTS PRIMARILY ON
14
•Lymphoreticular system:
CD4+ T-Helper cells
Macrophages
Monocytes
B-lymphocytes
•Certain endothelial cells
•Central nervous system:
Microglia of the nervous system
Astrocytes
Oligodendrocytes
Neurones - indirectly by the action of cytokines
and the gp-120.
17. HIV in Body Fluids
Semen
11,000 Vaginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids
18. HIV enters the bloodstream
through:
Open Cuts
Breaks in the skin
Mucous membranes
Direct injection - Sharing Needles
Without sterilization.
18
20. Mother-to-Baby
• Perinatal- in utero or
intrapatrum due to
maternal disease or high
viral load,
choriamnionitis(13-52%
• Postpartum-
breastfeeding
– After the birth(7-22%)
20
HIV and AIDS : Update for Dentistry,aug 2006, by James little,NL
Rhodus
21.
22. CLINICAL STAGES OF HIV INFECTION
• RECENT INFECTION- no signs and
symptoms
• Lab findings- nucleic acid test positive
• Positive P24 antigen , positive DNA
&PCR
• But negative ELISA and Western blot
test.
• Patients are unknown carriers.
22
23. Window Period
• This is the period of time after becoming
infected when an HIV test is negative
• 90 percent of cases test positive within
three months of exposure
• 10 percent of cases test positive within
three to six months of exposure
23
24. HIV Infection and Antibody
Response
6 month ~ Years ~ Years ~ Years ~ Years
Virus
AntibodyInfection
Occurs
AIDS Symptoms
---Initial
Stage----
---------------Intermediate or Latent Stage--
------------
---Illness
Stage---
Flu-like Symptoms
Or
No Symptoms
Symptom-free
<
----
----
25. AIDS-related complex, or ARC,
• ARC is "A prodromal phase of effects phase of infection with
the human immunodeficiency virus ( HIV).
• Laboratory criteria separating AIDS-related complex ( ARC)
from AIDS include elevated or hyperactive B-cell humoral
immune responses, compared to depressed or normal
antibody reactivity in AIDS; follicular or mixed hyperplasia in
ARC lymph nodes, leading to lymphocyte degeneration and
depletion more typical of AIDS
25
26. 26
REVISED WHO CLINICAL
STAGING OF HIV/AIDS FOR
INFANTS AND CHILDREN
INTERIM WHO CLINICAL STAGING OF HIV/AIDS
AND
HIV/AIDS CASE DEFINITIONS FOR SURVEILLANCE
27. Stage 1 – Primary (Acute
febrile illness)
• Short, flu-like illness - occurs one to six
weeks after infection
• Asymptomatic
• Persistent generalized
lymphadenopathy (PGL
• Infected person can infect other people.
27
28. Stage 2 - Asymptomatic
• Lasts for an average of ten years
• This stage is free from symptoms
• There may be swollen glands
• The level of HIV in the blood drops to
very low levels
• HIV antibodies are detectable in the
blood
28
29. • Moderate unexplained weight loss (<10% of
presumed or measured body weight).
• Recurrent respiratory tract infections ( eg.,
sinusitis, bronchitis, otitis media, pharyngitis).
• Herpes zoster.
• Angular cheilitis.
• Recurrent oral ulcerations.
• Papular pruritic eruptions.
• Seborrhoeic dermatitis.
• Fungal nail infections of fingers.
29
30. Stage 3 - Symptomatic
• The symptoms are mild
• The immune system deteriorates
• Emergence of opportunistic infections
and cancers
30
31. • Conditions where a presumptive diagnosis can be made :-
• Severe weight loss (>10% measured body weight)
• Unexplained chronic diarrhoea more than one month
• Unexplained persistent fever (intermittent or constant for longer
than one month)
• Oral candidiasis, Oral hairy leukoplakia.
• TB - in last two years
• Bacterial infections (e.g. pneumonia, empyema,
pyomyositis, bone or
• Joint infection, meningitis, bacteraemia)
• Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis31
32. Conditions where confirmatory diagnostic
testing is necessary
• Unexplained anaemia (< 8 g/dl),
• Neutropenia (<500/mm3) and or
• Thrombocytopenia (<50 000/ mm3)
For more than one month
32
33. Stage 4 - HIV AIDS
• The immune
system weakens
• The illnesses
become more
severe leading to
an AIDS
diagnosis
33
34. Conditions where a presumptive diagnosis can be made on
the basis of clinical signs or simple investigations
• HIV wasting syndrome.
• Pneumocystis pneumonia.
• Recurrent severe or radiological bacterial pneumonia.
• Chronic herpes simplex infection (orolabial, genital or
anorectal of more than one month’s duration).
• Oesophageal candidiasis.
• Extrapulmonary TB, Kaposi’s sarcoma.
• Central nervous system (CNS) toxoplasmosis.
• HIV encephalopathy. 34
35. Confirmatory diagnostic testing is :-
• Extrapulmonary cryptococcosis including meningitis.
• Disseminated non-tuberculous mycobacteria infection.
• Progressive multifocal leukoencephalopathy (PML).
• Candida of trachea, bronchi or lungs.
• Visceral herpes simplex infection.
• Cytomegalovirus (CMV) infection.
• Any disseminated mycosis (e.g. histoplasmosis,
coccidiomycosis, penicilliosis)
• Recurrent non-typhoidal salmonella septicaemia.
• Lymphoma (cerebral or B cell non-Hodgkin).
• Invasive cervical carcinoma.
• Visceral leishmaniasis.
35
36. ADVANCED HIV/AIDS DISEASE
DEFINITIONS FOR
SURVEILLANCE FOR ADULTS
Any clinical stage 3 or stage 4
disease
or,
where CD4 is available, any clinical
stage and CD4 <350/mm3
36
37. ADVANCED HIV/AIDS DISEASE DEFINITIONS FOR
SURVEILLANCE FOR
INFANTS AND CHILDREN
Clinical stage 3 or stage 4 disease at any age.
where CD4 is available, any clinical stage with
• CD4 % <25% in children aged under 12 month
• CD4 % <20% in children aged 12 -59 month
• CD4 <350/mm3 in children aged 5 years
and above.
37
38. IMMUNOLOGICAL STAGING OF HIV INFECTION
Immune status Upto 12
months age
13 to 59 months 5 yrs or more
Not significant >35% >25% >500%/ mm3
Mild 25-34% 20-24 350-499/ mm3
Advanced 20-24% 15-19 200-349
Severe <20% <25% <200/mm3
38
41. Importance of Early Testing
and Diagnosis
• Allows for early treatment to maintain
and stabilize the immune system
response
• Decreases risk of HIV transmission from
mother to newborn baby
• Allows for risk reduction education to
reduce or eliminate high-risk behavior.41
42. Anonymous Testing
• No name is used
• Unique identifying number
• Results issued only to test recipient
23659874515
Anonymous
42
43. Confidential Testing
• Person’s name is recorded along with
HIV results
– Name and positive results are reported to
the State Department and the Centers for
Disease Control and Prevention
• Results issued only to test recipient
43
45. Blood Detection Tests
• Enzyme-Linked Immunosorbent
Assay/Enzyme Immunoassay (ELISA/EIA)
• Radio Immunoprecipitation Assay/Indirect
Fluorescent Antibody Assay (RIP/IFA)
• Polymerase Chain Reaction (PCR)
• Western Blot Confirmatory test.
45
46. Urine Testing
• Urine Western Blot
– As sensitive as testing
blood
– Safe way to screen for HIV
– Can cause false positives
in certain people at high
risk for HIV
46
47. Oral Testing
• Orasure
– The only FDA
approved HIV
antibody.
– As accurate as blood
testing
– Draws blood-derived
fluids from the gum
tissue.
– NOT A SALIVA TEST!
47
48. Adults and children 18 months or older
• Positive HIV antibody testing (rapid or laboratory-based
enzyme immunoassay). This is confirmed by a second HIV
antibody test (rapid or laboratory-based enzyme
immunoassay) relying on different antigens.
• Positive virological test for HIV or its components (HIV-RNA
or HIV-DNA or ultrasensitive HIV p24 antigen) confirmed by a
second virological test.
48
49. Children younger than 18 months
• Positive virological test for HIV (HIV-RNA or
HIV-DNA or ultrasensitive HIV p24 antigen)
confirmed by a second virological test obtained
from a separate determination taken more than
four weeks after birth.
• Positive HIV antibody testing is not
recommended for definitive or confirmatory
diagnosis of HIV infection in children until 18
months of age
49
55. • Lamivudine -Trade Names
EPIVIR- (3TC) plus zidovudine RETROVIR-
(ZDV). Use of either drug as monotherapy
quickly results in resistance, but the mutation
that produces resistance in response to 3TC
increases the susceptibility of HIV to ZDV. Thus,
used together, they are synergistic.
• Such combinations called as HAART.
55
56.
57. Four ways to protect yourself?
• Abstinence
• Monogamous Relationship
• Protected Sex
• Sterile needles
57
58. Dental management
• Case history
• Clinical examination done before
treatment.
• Invasive procedure should be avoided
• Proper precautions should be taken
before treating aids suspected patient.
58
59. The Universal Precautions
Use of Personal protective equipment (PPE)
and techniques such as gowns, face masks,
protective eyewear, gloves.
Immunization- CDC recommends a booster
dose of hepatitis B vaccine every three years
after initial dose.
Routine handwashing 59
60. Postexposure Prophylaxis Recommendation
Infection Status of Source
• HIV-positive
• class 1*
• HIV-positive
• class 2§
• HIV- negative
• .
• Prophylaxis
• 2-drug PEP for less severe
exposure†
• 3-drug PEP for more severe
exposure‡
• 3-drug PEP
• Unknown HIV status of source or
unknown source
• No PEP warranted
60
* Class 1: Asymptomatic HIV infection or known low viral load (< 1500 RNA copies/mL).
† Less severe exposure may involve a solid needle or superficial injuries.
‡.
§Class 2: Symptomatic HIV infection, AIDS, acute seroconversion, or known high viral load.
Adapted from Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and
HIV and recommendations for postexposure prophylaxis. Morbidity and Mortality Weekly Report 50 (RR11): 1–42, June 29, 2001
62. VACCINATIONS
• There are various approaches considered for
development of HIV 1 VACCINE.
• Includes- whole virus vaccine, envelop protein
vaccine, synthetic peptide vaccine, live vector
type, nucleic acid vaccine, live attenuated
vaccine.
62
HIV vaccine, by barouch DH,Baden, dolin R; principles and practices of
infectious diseases 6th edition 2005.
63. Laws and Ethical Considerations
Indian Constitution.
Three most important rights in the HIV
scenario:
Right to Informed Consent
Right to Confidentiality
Right against Discrimination
One can seek remedy in a court of law if tested for
HIV without informed consent, or your
confidentiality is breached, or any of your rights
have been violated.
63
64. CONCLUSION
AIDS is the greatest masquerader of
our time. This can alter the clinical
presentation of many other diseases and
has multitude of different clinical
appearances.
64
“KNOW AIDS TO NO AIDS”
65. REFRENCES
1. World health organization. Acquired immunodeficiency
syndrome (AIDS) WHO/CDC case. Definition for surveillance
weekly epidemiological record. 1986 ;7 march.
2. Who case definitions of HIV for surveillance and revised
clinical staging and Immunological classification of HIV-
related disease in adults and children,2007
3. "Health and survival in the 21st century" book, by Ross
horne.
4. Dental management of medically compromised patients, by
little JW, Falace DA, Rhodus Nl.edition 7, 2007.
65
66. 5. Aids and Oral Health NS yadav And Rupam sinha.
6. Ananthanarayan R, Paniker Jayaram CK. Textbook of Microbiology; 7th
edition.
7. Ayliffe G.A.J, Fraise A.P., Geddes A.M., Mitchell K. Control of Hospital
acquired infection – A practical handbook.
8. HIV and AIDS : Update for Dentistry,aug 2006, by James little,NL
Rhodus.
9. www.agd.org.
10. U.S. Public Health Service guidelines for the management of
occupational exposures to HBV, HCV, and HIV and recommendations
for postexposure prophylaxis. Morbidity and Mortality Weekly Report 50
(RR11): 1–42, June 29, 2001
11. HIV vaccine, by barouch DH,Baden, dolin R; principles and practices of
infectious diseases 6th edition 2005.
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