Epidemiological Study of Adis

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Saudi Arabia Ministry of Higher Education King Saud University in Riyadh College of Nursing

Epidemiological Study Of AIDS

MOHAMED ALHARBI BADER ALAHMADI SAMEER ALSAEDI TALAL ALRFAEI YAHYA ALNASHBA MOHAMED ALI SOLIMAN HOSAIN ALBRAHEEM MOZAFAR ALSHORFA HAMLAN ALGAMDI

PREPAERD BY :

Definition: Immune deficiency disease syndrome :is a disease of the human immune system caused by the human immunodeficiency virus (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors Symptoms and Signs Initially, primary HIV infection may be asymptomatic or cause transient nonspecific symptoms (acute retroviral syndrome). Acute retroviral syndrome usually begins within 1 to 4 wk of infection and usually lasts 3 to 14 days; it is characterized by fever, malaise, rash, arthralgia, generalized lymphadenopathy, and sometimes aseptic meningitis. Symptoms are often mistaken for infectious mononucleosis or benign, nonspecific viral syndromes. After the first symptoms disappear, most patients, even without treatment, have no symptoms or only a few, mild, intermittent, nonspecific symptoms for a highly variable time period (2 to 15 yr).

Symptoms and Signs
Symptoms may result from HIV directly or from opportunistic infections. The following are most common: •Lymphadenopathy •White plaques due to oral candidiasis •Painful rash due to herpes zoster •Diarrhea •Fatigue •Fever with intermittent sweats Asymptomatic, mild-to-moderate cytopenias (eg, leukopenia, anemia, thrombocytopenia) are also common. In some patients, progressive wasting occurs

Pathophysiology
HIV attaches to and penetrates host T cells via CD4+ molecules and chemokine receptors: Human Immunodeficiency Virus (HIV): Simplified HIV life cycle. ). After attachment, HIV RNA and enzymes are released into the host cell. Viral replication requires that reverse transcriptase (an RNA-dependent DNA polymerase) copy HIV RNA, producing proviral DNA; this copying mechanism is prone to errors, resulting in frequent mutations. These mutations facilitate the generation of HIV that can resist control by the host's immune system and by antiretroviral drugs. Proviral DNA enters the host cell's nucleus and is integrated into the host DNA in a process that involves HIV integrase. With each cell division, the integrated proviral DNA is duplicated along with the host DNA. Proviral HIV DNA is transcribed to viral RNA and translated to HIV proteins, including the envelope glycoproteins 40 and 120. The HIV proteins are assembled into HIV virions at the inner cell membrane and budded from the cell surface; each host cell may produce thousands of virions. After budding, protease, another HIV enzyme, cleaves viral proteins, converting the immature virion into a mature, infectious form.

Magnitude : AIDS is now a pandemic. In 2007, UNAIDS estimated: 33.2 million people worldwide had AIDS that year; AIDS killed an 2.1 million people in the course of that year, including 330,000 children, and 76% of those deaths occurred in sub-Saharan Africa. According to UNAIDS 2009 report, worldwide some 60 million people have been infected, with some 25 million deaths, and 14 million orphaned children in southern Africa alone since the epidemic began.Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.Although treatments for AIDS and HIV can slow the course of the disease, there is no known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needleexchange programmes in attempts to slow the spread of the virus.

Over 7400 new HIV infections a day in 2007

• • •

More than 96% are in low and middle income countries About 1000 are in children under 15 years of age About 6300 are in adults aged 15 years and older of whom: — almost 50% are among women — about 45% are among young people (15-24)

July 2008 e

9

Global estimates for adults and children, 2009

• People living with HIV • New HIV infections in 2007

33 million [30 – 36 million] 2.7 million [2.2 – 3.2 million]

• Deaths due to AIDS in 2007

2.0 million [1.8 – 2.3 million]

July 2008 e

2

Adults and children estimated to be living with HIV, 2009
Eastern Europe Western & Central Europe & Central Asia North America
[760 000 – 2.0 million]

1.2 million
230 000

[580 000 – 1.0 million]

730 000

[1.1 – 1.9 million]

1.5 million

East Asia

Caribbean
[210 000 – 270 000]

Middle East & North Africa
[280 000 – 510 000]

380 000

[480 000 – 1.1 million]

740 000

South & South-East Asia
[3.5 – 5.3 million]

Sub-Saharan Africa Latin America
[1.5 – 2.1 million]

4.2 million
Oceania

1.7 million

[20.5 – 23.6 million]

22.0 million

[66 000 – 93 000]

74 000

Total: 33 million (30 – 36 million)
July 2008 e 3

Reported AIDS Cases in Saudi Arabia – WHO data:
80 70 60 50 40 30 20 10 0

80

41 14
85-86

20

23

28 15
93-94 95-96

27

87-88

89-90

91-92

97-98

992000

Number of New Patients Reported from KFSH
80
80 70 60 50 40 30 20 10 0 85-86 87-88 89-90 91-92 93-94 95-96 97-98 99-2000

41 14 20 23 28 15 27

Cycle of Infection

:

HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.This transmission can involve anal, vaginal or oralsex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids.

High-risk Groups for HIV Transmission
•Homosexual or bisexual men •I.V. drug users •Transfusion and blood product recipients (before 1985) •Heterosexual contacts of HIV-positive individuals •Newborn babies of mothers who are HIV-positive

Essential Policy Actions for HIV Prevention:

1. Ensure that human rights are promoted, protected and respected and that measures are taken to eliminate discrimination and combat stigma. 2. Build and maintain leadership from all sections of society, including governments, affected communities, nongovernmental organizations, faith-based organizations, the education sector, media, the private sector and trade unions. 3. Involve people living with HIV, in the design, implementation and evaluation

3. Involve people living with HIV, in the design, implementation and evaluation of prevention strategies, addressing the distinct prevention needs. 4. Address cultural norms and beliefs, recognizing both the key role they may play in supporting prevention efforts and the potential they have to fuel HIV transmission. 5. Promote gender equality and address gender norms and relations to reduce the vulnerability of women and girls, involving men and boys in this effort. 6. Promote widespread knowledge and awareness of how HIV is transmitted and how infection can be averted. 7. Promote the links between HIV prevention and sexual and reproductive health. 8. Support the mobilization of community-based responses throughout the continuum of prevention, care and treatment. 9. Promote programmes targeted at HIV prevention needs of key affected groups and populations.
10. Mobilizing and strengthening financial, and human and institutional

capacity across all sectors, particularly in health and education. 11. Review and reform legal frameworks to remove barriers to effective, evidence based HIV prevention, combat stigma and discrimination and protect the rights of people living with HIV or vulnerable or at risk to HIV. 12. Ensure that sufficient investments are made in the research and development of, and advocacy for, new prevention technologies

WHO’s HIV/AIDS work for the period 2006-2010 is structured around five strategic

directions:

1- Enabling people to know their status through confidential HIV testing and counseling 2- Maximizing the health sector’s contribution to HIV prevention

3-Accelerating the scale-up of HIV/AIDS treatment and care 4- Strengthening decentralization and expanding health systems

5-Investing in strategic information to guide a more effective response

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