INTRODUCTION TO HIV AND AIDS

• EMTCT MODULE OF MCPDP

BY
• MRS MONSURAT ABDULWAHAB
 OUTLINE
Objectives
Definition of HIV/AID
Epidemiology of HIV/AID pandemic
Natural history of HIV
infection/Seroconversion
Asymptomatic and Symptomatic HIV
Infection
HIV Transmission……………
 Objectives

After completing the module, the participant should be

able to:

 Describe the global and local impact of the HIV and

AIDS epidemic.

 Answer basic questions about HIV and AIDS.

 Discuss HIV transmission.

 Describe the progression from HIV infection to AIDS.

 DEFINITION
HIV stands for human immunodeficiency virus, the virus that
causes AIDS.
H: Human
I: Immunodeficiency
V: Virus
• HIV breaks down the body's defence against infection and
disease (the body's immune system) by infecting specific
white blood cells.
• As time passes, the immune system becomes unable to fight
the HIV infection and the person may develop serious and
deadly diseases, including other infections and some types of
cancer.
 AIDS
AIDS is an acronym for acquired immunodeficiency
syndrome and refers to the most advanced stage of HIV
infection.
A: Acquired, (not inherited) to differentiate from a
genetic or inherited condition that causes immune
dysfunction
I: Immuno-, because it attacks the immune system
and increases susceptibility to infection
D: Deficiency of certain white blood cells in the
immune system
S: Syndrome, meaning a group of symptoms or
illnesses
 GLOBAL AND LOCAL IMPACT
HIV and AIDS is a pandemic with worldwide effects
Global HIV statistics
• 39 million people globally were living with HIV in
2022.
• 1.3 million people became newly infected with
HIV in 2022.
• 630 000 people died from AIDS-related illnesses in
2022.
• 29.8 million people were accessing antiretroviral
therapy in 2022.
 cont…..
85.6 million people have become infected with HIV
and 40.4million people have died from AIDS-related
illnesses since the start of the epidemic
• 1.5 million children (0–14 years) are living with
HIV.
• 53% of all people living with HIV were women and
girls.
• 86% of all people living with HIV knew their HIV
status in 2022.
 HIV-related mortality
• In 2022, 630 000 people died from HIV-related causes
globally.
• Since 2010, HIV-related deaths have been reduced by
51%, from 1.3 million.
• The global HIV epidemic claimed 69% fewer lives in
2022 since the peak in 2004.
• 84 000 children died from HIV-related causes in 2022.
• HIV continues to be a major global public health
issue, claiming 40.4 million lives so far.
 African Region

• An estimated 25.6 million people were living with HIV in

2022, of which 90% knew their status, 82% were
receiving treatment and 76% had suppressed viral loads.
An estimated 20.9 million people were receiving
antiretroviral therapy in 2022.
• An estimated 660 000 people acquired HIV in 2022; and
the number of people acquiring HIV among all ages
decreased to 0.57

• 380 000 deaths were attributed to HIV-related causes in

2022, a decrease of 56% from 2010.
 IN NIGERIA
• First reported case was in 1986,
• Estimates from 2023 Spectrum placed the number of
people living with HIV in Nigeria at 1,910,405.
• The number of PLHIV with suppressed viral
• load is 1,585,167. Viral Load Suppression rate is
calculated using the number of patients on
treatment with documented viral load results as the
denominator.
• As Nigeria moves closer towards reaching the
UNAIDS 95-95-95 Fast track strategy,
 chat
• HIV Prevalence Trend in Nigeria (1991- 2014)

• Source: National HIV and AIDS Sentinel Sero-

prevalence Survey 2014
 Figure 2: HIV prevalence by state

• Source: National HIV and AIDS Sentinel Sero-

prevalence Survey 2014
 Natural history/Seroconversion
• People infected with HIV usually develop antibodies 4
to 6 weeks after being infected, but it may take as long
as 3 months for antibodies to develop.
• "window period.“ is the period of time between when
a person is infected with HIV and when the antibody
test result is positive.
• A person who tests HIV-negative but who has engaged
in risky behavior within the past 3 months—during the
window period—should be tested again in 3 months.
• Unlike for most diseases, having antibodies for HIV
does not indicate protection but indicates infection.
• When a recently-infected person develops enough
antibodies so they can be measured using a laboratory test,
seroconversion is occurring.
• Some people may experience a glandular illness (fever,
rash, joint pains, and enlarged lymph nodes) at the time of
seroconversion.

• HIV testing detects antibodies or antigens associated with

HIV in whole blood, saliva, or urine.
• A person whose HIV test results show HIV infection is said
to be sero-positive or HIV positive.
• A person whose HIV test results do not show HIV infection
is said to be sero-negative or HIV-negative.
 Asymptomatic HIV infection

• A person who is HIV-infected but looks and feels healthy is

asymptomatic.

• None of the physical signs or symptoms that indicate HIV infection is

present.

• Whether they have symptoms or not, people who are HIV-positive

can still pass the virus to others.

• The duration of the asymptomatic phase varies greatly from person

to person.

• Some adults may develop symptoms of HIV as quickly as a few

months after primary infection; others may take as long as 15 years
or more to develop symptoms.
 Asymptom…..
• NOTE that HIV disease is different in children
compare to adults.

• For children infected with HIV through MTCT

during pregnancy, labor and delivery, and
breastfeeding, the asymptomatic phase is shorter.

• A few infants who are HIV-positive will become ill

within the first weeks of life. Many children start
to develop symptoms before their first birthday;
a few remain well for several years.
 Symptomatic HIV infection

• A person who has developed physical signs of

HIV and reports symptoms related to HIV is
symptomatic.
• The immune system weakens and the CD4
count decreases during this phase.
• The progression of HIV depends on
the type of virus and
specific host characteristics including general
health, nutritional, and immune status.
• The transition from the stages of asymptomatic
infection to symptomatic infection to AIDS occurs
when CD4 counts decrease and immune function
deteriorates.

• Note that HIV infects many organ systems and

causes a range of symptoms and opportunistic
infections.

• High viral load and low CD4 counts play a role in

the development of clinical symptoms.
 PROGRESSION TO AIDS
• Almost all people who are HIV-positive will ultimately develop HIV-
related diseases and AIDS, the end stage of HIV infection.
• As HIV infection progresses, the CD4 count continues to decrease and
the infected person becomes susceptible to opportunistic infections.
• An opportunistic infection is an illness caused by a germ that might
not cause illness in a healthy person, but will cause illness in a person
who has a weakened immune system. Eg herpes zoster (shingles) is
very common in people infected with HIV.
• People living with advanced HIV infection suffer from opportunistic
infections of the lung, brain, eyes, and other organs.
• Common opportunistic infections in persons diagnosed with AIDS are
tuberculosis (TB), severe diarrhea, oropharyngeal candidiasis and
some types of cancers, such as Kaposi's sarcoma.
• ARV treatment and treatment of opportunistic infections help
preserve the CD4 cells, lower viral load, and prolong the time it takes
for HIV to progress to the symptomatic phase and, ultimately, to AIDS.
 ROUTE OF TRANSMISSION
• Heterosexual transmission is the primary mode of acquiring
HIV in developing countries. Women, especially young girls,
are more likely than men to become infected following
heterosexual intercourse due to biological, socioeconomic,
and cultural reasons. Cases of HIV infection resulting from
sexual abuse of children, and even infants, have been
reported.
• Blood-to-blood transmission
Transfusion with HIV-infected blood
Direct contact with HIV-infected blood
Re-use of unsterilized sharps (needles, surgical blades, razors
used in scarification practices)
 transmission……..
Needle stick injury
• Organ Transplant
Transplant of HIV infected tissues
Drug use
Injection of drugs with needles or syringes
contaminated with HIV
• Vertical transmission (MTCT)
From mothers who are HIV-positive to their infants
during pregnancy, labor and delivery, and breastfeeding
• High maternal viral load increases the risk of mother-to-
child transmission of HIV; so early detection and
commencement of appropriate ARVs is a CRITICAL
intervention for EMTCT.
 Transmission of HIV in children

• Children can become infected with HIV through the same modes
as those by which adults are infected (exposure to contaminated
blood or other body fluids, e.g., through transfusions of infected
blood products, contact with needles or other instruments
contaminated with infected blood or other body fluids), and also
through MTCT.
• Vertical transmission encompasses MTCT before delivery
(antepartum), during labor and delivery (intrapartum), or
through breastfeeding.
• Without interventions to prevent transmission, the risk of MTCT
of HIV ranges from 15-30% among non-breastfeeding
populations, and from 30-45% among breastfeeding
populations.
• Untreated HIV infection proceeds through three phases:
• 1) acute infection,
 2) latent infection, and
3) chronic infection progressing to AIDS.
• MTCT is an important route of transmission that can be
interrupted with the use of EMTCT programmes.
Timing of MTCT
• MTCT of HIV occurs during three different time periods:
antepartum, intrapartum, and postpartum through
breastfeeding.
• With the advent of highly sensitive techniques for detecting the
virus in the peripheral circulation of the infant, it is possible to
estimate the timing of MTCT more accurately.
• In the absence of breastfeeding, an estimated 50 to 70% of
transmissions occur around the time of delivery, with the
remainder occurring in utero.
 Risk Factors for MTCT

• Risk factors for MTCT of HIV can be classified into:

 Viral
 Maternal
 Obstetrical
 Foetal
 Infant-related factors
 HIV is not transmitted by:

• Coughing or sneezing
Being bitten by an insect
Touching or hugging
Holding a baby
Kissing
Going to a public bath/pool
Using a public toilet
Shaking hands
Working or going to school with a person who is HIV infected
Using telephones
Drinking water or preparing or eating food
Sharing cups, glasses, plates, or other utensils
• HIV transmission is not a risk in casual contact with
family, friends, or the community.

• There are effective strategies to block every route of

transmission.

• As PLWHIV are more accepted in the community, the

risk of sexual transmission because someone does not
know or cannot admit their HIV status may be
decreased.
 Testing and treatment targets (95–95–95)

• The treatment for HIV is called antiretroviral

therapy, involves combination of HIV drugs taken
daily
• Recent infection testing algorithm (RITA) combines
results of the recent infection assay and viral load
and, if available, information on testing history for
final interpretation of recency status.
• By using VL testing, persons who are (likely) on
ART at time of diagnosis can be re-classified as
having long-term infection.
 Treatment………
95 – 95 – 95 was launched by UNAID in 2014 . The
aim was to diagnose 95% of all HIV- positive
individuals, provide antiretroviral therapy (ART) for
95% of those diagnosed and achieve viral
suppression for 95% of those treated by 2030
• In Nigeria in 2022, 86% of all people living with
HIV knew their HIV status.
• Among people who knew their status, 89% were
accessing treatment
• Among people accessing treatment, 93% were
virally suppressed.
 95…….
• Generally among all people living with HIV, 86%
knew their status, 76% were accessing treatment
and 71% were virally suppressed in 2022.

• Five African countries— Botswana, Eswatini,

Rwanda, the United Republic of Tanzania, and
Zimbabwe had achieved the 95-95-95 targets by
2022.
 Public health strategies to prevent HIV
infection
Sexual contact
• Promote abstinence or being faithful to one uninfected
partner.
• Provide instruction on the consistent and correct use of
barrier methods.
• Promote use of male or female condoms for vaginal
intercourse
Condoms for anal intercourse
• Prevent, identify, and provide early treatment for sexually
transmitted infections (STIs).
• Provide access to HIV testing services
• Condoms provide protection from HIV transmission as well as
other sexually transmitted infections (STIs) when used
 Prevention…….
• Blood-to-blood transmission
Screen all blood and blood products for HIV.
Follow standard precautions which include:
Use of protective equipment
Safe use and disposal of sharps
Sterilization of equipment
Safe disposal of contaminated waste products.
Safety and Supportive Care in the Work Environment.
Avoid sharing needles or razors
• Drug use
Educate about the risks of infection through drug
use with contaminated needles and syringes.
 Prevent……
Provide referral for treatment of drug dependence.
• Drug use in any form may increase the risk of HIV infection
by limiting judgment and facilitating engagement in risky
behaviors.
• Even occasional use of alcohol, marijuana, and other
recreational drugs may increase risk of HIV infection.

• Vertical transmission from mothers who are HIV-positive

• Provide appropriate ARVs to Mother-baby pair.
• Follow safer delivery practices.
• Provide linkages to treatment, care, and social support for
mothers and families with HIV infection.
• Provide infant-feeding counselling..
 SUMMARY
HIV is a global pandemic.
 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 15 years.
 The most common route of HIV transmission
worldwide is heterosexual transmission.
• Globally 46% of all new HIV infections were among
women and girls in 2022.
 SUMMARY………
 In sub-Saharan Africa, adolescent girls and young
women accounted for more than 77% of new infections
among young people aged 15-24 years in 2022.
 Women of childbearing age are at particular risk for
acquiring HIV.
 The main behavior that places them at risk is
unprotected sex with an infected male partner.
 Pregnant women who are HIV-infected are at risk of
passing HIV infection to their newborns.
 Risk of HIV transmission from mother-to-child can
be greatly reduced through effective EMTCT
programs.
 BIBLIOGRAPHY
• Nursing and Midwifery Council of Nigeria. Elimination of mother To
child transmission Of HIV (eMTCT) module of Mandatory Continuing
Professional Development Programme Mandatory Continuing
Professional Development Programme Manual.
• Onovo AA, Adeyemi A, OnimeD et al, Estimation of HIV prevalence
and burden in Nigerria. EclinicalMedicine 2023 ;62: 102098
• WHO. Epidemiological fact sheet HIV statistics globally WHO region,
2023. Available at https:www.who.int. Accesses 12th Deember 2023.
• The path that ends AIDS 2023 UNAIDS global AIDS update
• HIV/AIDS Epidemic control r e p o r t june 2023 april - june 2023
edition (Quarter 2)
• UNAIDS, World AIDS fact sheet, 2023
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