32 NACP - TARGETS, DIAGNOSIS AND MANAGEMENT NACP # National AIDS Control Program, NACO : National AIDS Control Organization. NA\CO ‘mous ot Het Fey wares Garerment fa ‘worn eco gown Red ribbon : Symbol for Hiv/ AIDS. World AIDS day + !* December. HIV virus : Epidemiological features 00:01:57 ides eNA virus? Marrowedition6notes Two types : HIV I HIV a. Most common is HIV |. _ supe ghpoproten Proteins of host eal pd membrane IN metre poten G0c6b3eeaaBded0ededeSea7 i488 National Health = 32. Programmes modes of transmission + Seieney in'® | effective mode oF transmission (in ®) ‘elood 0-95 s-0 pernstali'OWPCitioiae nae: | s-10 a ee 7 ot” | 5-8 \v drug abuse ? vaginal secretions. Larger area. of exposure in females during intercourse. * nal intercourse is 3 times more dangerous. More chances of abrasions and injuries. i * menstruating Female. i * Adolescents and post menopausal women. Mucosal lining is thinner § so risk oF transmission is high, <'S years of age, or 7 45 years oF age. * Presence of other sexually transmitted diseases (more number of T ceils in the area). * Transmission is highest during the window period as the PSM + v4.0 + Marrow 6.0 + 2022ral load is higher than antibody load. * Needle stick injury among health care professionals is 32 NAcP- cor fiteies very less efficient and not 0 major source [email protected] transmission. Very low viral load in urine. Aimost albsent in salve: Deactivated by the salivary enzymes. HIV virus : Host and social factor Host: Peak age : a0 - So years. No gender predilection. Social : Social discrimination present. More in high risk occupational groups. Commercial sex workers. Truck drivers. Male migrants. WV drug abusers. of tiv: @marrowedition6notes 1 stage! | ecienete: Stage Il | Surface infection lixe oral candidiasis, dermatitis. Stage m | CO# count lou. Deep tissue infections + © Wepatite. * Pneumonia. * Ponereatitis. * Pulmonary tuberculosis (most common opportunistic infection). Stage IV. | Opportunistic infections + * Pneumocystis jrovecii * cmv retinitis. * Toxoplasmosis. * cryptococcal infection. * extra. pulmonary tuberculosis. * tan Hodgins lymphomas re Active space190 National Health Programmes 82 onde onnoy NACP National AIDS Control Program, Started by NACO. Started in the year 1993, 05 a. vertical program. Timeline : | ver | ace | 1998-1099 | Phase 108 ARCA. | 1999 - 200% Phase 1) of NACA, — - | 200% - a0" Phase IM of NACP. |aon- aor | Prose iv of nace | | | [aor - 2044 | National strategie Plan (SF) 40 end ADS epidemic. \n 20al, it has been merged with National Health mission World AIDS day is on Dec I every year. Theme of world AIDS day, 20a + WHO 90 - 90 - 90 strategy: * Outof alliv infected population, 90% shouldbe diagnosed. * out of all HIV patients diagnosed, 90% should be on treatment. * Out of all HIV patients on treatment, 7 90% should have decrease in viral load, Treat All Strategy + Gy WHO) Every patient to be given ART, irrespective of the CD4 count. Targets WHO 00:23:17 90 - 90 - 90 strategy, Sustainable Development Goals (Sde). * End HIV/ AIDS epidemic by the year 020. Nace: * > 60% reduction in HIV incidence by year a0a4 compared to 2010, PSM + v4.0 + Marrow 6.0 « 2022* 95-95 - 95 strategy. 95% patients should be diagnosed. 95% patients should be on treatment. The patients on treatment, 7 95% should have decrease in wiral load Statistics of HIV epidemiology in India + Incidence of HIV: S cases/ lakh/ year. Prevalence of HIV + Prevalence of HIV in AAC females during a. sero surveillance ore the proxy indicators for HIV prevalence in the country, because the exact numbers are not known, due to inadequate data follouing the social stigma. Prevalence of HIV in ANC females 10.42% DingnosisofHIV_________——eneas ——-80c6b3ecaaSded0ede7eSeay————— ‘Screening tests Confirmatory tests. a @me OUR ERET RES. . SIT tte Cup) * Lateral Sow * POR - HIV: For adults. ierenuno concentration/ * Viral islation/ viral load, Dot lot method. estimation * Particle agglutination test. * Pad viral antigen test. * Western blot + Confirmatory test of choice. Highly specie. Screening oF HIV : IcTC centres : Integrated Counselling and Testing Centres. Tests done here are &2S + ELISA test : most sensitive. Best screening tool Rapid test. Spot test. 22S done in * lod donation services. Any | positive result from £25 tests is labelled as HIV positive blood, and is discarded. * Symptomatic patients : Persistent diarrhea, chronic fever, moderate to severe weight loss ete, Any a out of three positive is HIV positive, and is sent for confirmation. PSM v4.0 + Marrow 6.0 « 2022 ° ilies* Asymptomatic patients. No clinical symptoms. Gut i oll 3 £25 tests are HIV positive, sent for confirmatory tests. Norther blot # RNA testing, Southern blot + PNA testing, Western blot : Protein testing, eastern blot Enzyme testing, CO4+ count: Reliable test to assess the response to treatment and Progression of disease. Best test to asses response to treatment is quantitative viral load estimation. Management of HIV 00:38:55, ‘Treatment services for HIV + Category Fest line ‘Second Line Adults and | Preferred | Tenotove + Lamivudine + | R2T + 8TC + ATV/+ adolescents ovo. fiternate | TDF + aTC + eFV 400. | A2T + 3TC + OTS, Chidren | Preferred | Abacave + Lamivudine + | A2T + 8TC + LPVv/+. Dolutegraw, Alternate | Aec + TC + Lev/+. #27 (or ROC) + BTC roTe Neonates | Preferred | Zidowudine +Lamnudine + eT GeO ere Rattegravie Lopinave/ | + OTS, Ritonavr combination). Alternate |A2T + 3TC + NVP. foc + TC + oTe TOF # Tenofovir. 3TC ! Lamivudine. OTE: Dolutegravir. eV: efavirenz. LPV/r + Lopinasir/ Ritonavir combination, S. aamoe i NVP } Nevirapine. AZT + Zidovudine. ATV : Atazanovir, AEC : Abacowir. PSM + v4.0 + Marrow 6.0 + 2022SESE Ul NACP- % Orolo Prevention of mother to child transmission (MTCT) 00:41:90 Child exposed to HIV = Child born to HIV positive mother. Nevirapine : 00C to prevent MTCT. Dose ! Omg once daily for & weeks. In case the mother took Nevirapine based ART during the pregnancy, Zidovudine is given, due to development of archived Nevirapine resistance. Mother has taken PRT during Nevirapine +) ( Nevrapine x la After 6 weeks, Early Infant Diagnosis (E10) is done. HIV ONA RTPCR is the IOC. 1f positive + ART is started, If negative : Follow up every & months upto a years. Breast feeding 00:51:29 i the chid s Hv pope breasttegdina santiqued fora years. If the child is Hiv negative, breastfeeding is given for | year. Despite the chance of transmission, itis given to prevent the immunodeficiency From not giving it. Avoid abrupt stopping oF breast milk, ‘Active space194 National Health Programmes coeds ono 32 Avoid abrupt changes in type of milk given Gormula mik and breast mil). Post exposure prophylaxis (PEP) + Needle stick injury # Primary level of prevention. Tenotovir + Lamivudine + Dolutegravir. < a hours of exposure. For a8 days, once daily (preferred at night). Prophylaxis for Tuberculosis + Isoniazid Preventive Therpay (IPT) + Given for all people living with HIV (PLHIV), after ruling out TE. OC: Isoniazid, Children ( - 10 yrs) : tsoniazid 10 ma/kg § Pyridoxine asmg, Adults + Isoniazid 300 mg § Pyridoxine SO mg, Given for @ months for everyone. Contraindicated in : * Tuberculosis in HIV. * Hepatitis. * Mok contact. Prophylaxis of Pneumocystis jirovecii + Primary prophylaxis : Cotrimoxazole Preventive Therapy (CPT) (D4 count < 350 cells/mm? and/ or HIV/AIDS stage IM or Iv. Drug : Double strength Cotrimoxazole (Tme/smX) tablets. Trimethoprim (Tme) + Koma § Sulfamethoxazole (Smo) : 800mg, ‘Stop + When CD4 count > 350 cells/mm? $ 10 HIG BSeUlsGEMdoede7esea7 Secondary prophylaxis is given when the patient has a. Pneumocystis jirovecii infection Double strength Cotrimoxazole for 3 weeks. Even if the CD4 count 2350 cells/mm’. SM + v4.0 « Marrow 6.0 + 2022