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AIDS Management

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15 views17 pages

AIDS Management

Short presentation covering all main points from K Park 27 Ed

Uploaded by

avanigarg191
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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GSVM MEDICAL COLLEGE,KANPUR

DEPARTMENT OF COMMUNITY MEDICINE

AIDS- MANAGEMENT

Under the guidance of Presented by:-


DR. S.K. BARMAN SIR Avani Garg
HEAD OF DEPARTMENT Roll no 42
Para-P2
CONTROL OF AIDS
There are 4 basic approaches:
1. Prevention
2. Anti-Retroviral Treatment ( ART)
3. Specific Prophylaxis
4. Primary Health Care
PREVENTION
A) EDUCATION
• Use of Condoms
• Avoid the use of shared Razors and Toothbrushes
• Risk of sharing needles and syringes in IV Drug users
• Avoid pregnancy in women suffering or at high risk of AIDS
• Educational material and Guidelines for prevention should be
made
• Involvement of Mass Media in educating people
B) COMBINATION HIV PREVENTION
• ARV drugs
• Male & Female condoms
• Condom compatible lubricant
• Voluntary medical male circumcision

Opiod substitution therapy with


Needle & Syringe programmes
Methadone or Buprenorphine
C) Prevention of Blood-Borne HIV Transmission:

• All blood should be screened for both HIV 1 & HIV 2 before
transfusion
• People in high-risk group should be urged to refrain from
donating blood , body organs or other tissues.
• Pre-sterilized disposable syringes and needles should be use
ANTI-RETROVIRAL TREATMENT
• There has been a rapid decline in • The GOALS of ART are:-
HIV-related mortality and morbidity
d/t wider availability of Affordable,
More efficacious and Less toxic
ARVs over the last 2 decades.
• At present there is no vaccine or
cure for treatment of AIDS.
• Since 2016, WHO recommended
that all people living with HIV be
provided with lifelong ART,
regardless of clinical status or CD4
cell count.
Rapid ART Initiation for newly diagnosed PLHIV
Drugs used for ART:
Anti-Retroviral Therapy Regimens:
• The basic principle for first-line ART is to use a Triple drug combination
{FDCs} from 2 different classes of ARVs
• The first line ART essentially comprises of a NRTI backbone, preferably
TENOFOVIR + LAMIVUDINE and one INSTI, preferably DOLUTEGRAVIR.
Alternative first-line ART:
General Guidance : Monitoring of Patients :
• A single pill of TLD should be
taken preferably at bed time.
• Additional doses of DTG
should be taken preferably at
morning.
• Patient with severe diabetes
and HTN should be monitor
closely for TDF toxicity.
• Patients starting on DTG
should be monitored for blood
glucose (six monthly) and
weight gain (on monthly visits).
Occupational HIV postexposure prophylaxis :
Recommended for health care personnel-
Types of Exposure: Infectious Body Fluids: Non Infectious
• Percutaneous injury – a a) Semen and Fluids:
needlestick or cut with a vaginal i. Faeces
secretions
sharp object ii. Nasal
b) CSF secretions
• Contact of mucous
c) Synovial fluid iii. Saliva
membranes or non-intact
skin – exposed skin that is d) Pleural fluid iv. Sputum
chapped, abraded, or e) Peritoneal fluid v. Sweat
irritated d/t dermatitis– with f) Pericardial vi. Tears
infectious fluids. fluid
vii.Urine
g) Amniotic fluid viii.Vomitus
Any body fluid contaminated with “visible blood”
shall be considered “at-risk”
Occupational HIV postexposure prophylaxis :
Treatment Recommendations: Preffered regimens:
HIV PEP should be initiated as soon o Raltegravir 400mg BD + Tenofovir
as possible, preferably within hours. 300mg OD for 4 weeks
The rationale behind this :- o Dolutegravir 50mg OD + Tenofovir
300mg OD for 4 weeks
a) PEP is likely to be less effective
when started >72 hrs after
exposure. NOTE:
Dolutegravir has been accepted in patients
b) In the absence of PEP, HIV who intend to become pregnant and those
replication occurs within 48-72 hrs who initiate therapy during 1st trimester.
in regional lymph nodes close to However, patients should be advised of small
site of exposure; f/b Viremia within risk of teratogenicity when given in 1st
72-120 hrs trimester.
SPECIFIC PROPHYLAXIS
Opportunistic Infections Drug Regimens
P. Carinii pneumonia Trimethoprim-sulfamethoxazole
Aerolised Pentamidine and
Dapsone
M. avium Rifabutin

M. tuberculosis Isoniazid 300mg daily for 9


months to 1yr
Kaposi’s sarcoma Interferon, Chemotherapy or
radiation
CMV Retinitis Ganciclovir

Cryptococcal meningitis Fluconazole

Candidiasis (Esophageal or Fluconazole or Ketoconazole


recurrent vaginal)
Herpes simplex/ Herpes Acyclovir
zoster infection
PRIMARY HEALTH CARE
• Because of its wide ranging health implications, AIDS control
Programmes are not developed in isolation.
• Integration into country’s primary health care system is essential.

NATIONAL AIDS CONTROL PROGRAMME


Launched in India in 1987.
The MoHFW has set up NATIONAL AIDS CONTROL ORGANISATION
(NACO) as a separate wing to implement and closely monitor various
components of the programme.
NATIONAL AIDS CONTROL PROGRAMME
The Care, Treatment and Support (CST) component of NACP aims to
provide services to PLHIV to improve their survival and quality of life.
The country has adopted 95-95-95 target which aims at ending AIDS as
public health threat by 2030:
1. 95 % of PLHIV know their status, of which
2. 95 % of PLHIV are on ART, of which
3. 95 % of PLHIV have viral suppression.

CST services are provided through:

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