COMM 801: BASIC EPIDEMIOLOGY

MPH Distance Learning, ABU Zaria

Facilitation Session 9

HIV/AIDS

Dr Mukhtar Danmallam
Outline
Introduction
• HIV (Human Immunodeficiency Virus) is a virus that
attacks the body's immune system, specifically
targeting CD4 cells, which are crucial for fighting
infections.
• AIDS (Acquired Immunodeficiency Syndrome) is the
most advanced stage of HIV infection, characterized by
severe immune suppression and the presence of
opportunistic infections or cancers.
• HIV infection refers to the presence of the virus in the
body, while AIDS diagnosis is made when the immune
system is significantly compromised, leading to specific
clinical manifestations.
History of HIV/AIDS
• Discovery of HIV: HIV was first identified in the early 1980s
when clusters of unusual infections and cancers were
observed among previously healthy individuals, primarily in
the United States.
• Origins of HIV: HIV is believed to have originated from non-
human primates in Central and West Africa, with the transfer
of the virus to humans likely occurring through bushmeat
hunting or animal-to-human contact.
• Spread of HIV/AIDS: The spread of HIV/AIDS was initially
concentrated among specific populations, such as men who
have sex with men (MSM) and people who inject drugs, before
becoming a global pandemic.
Types of HIV
• HIV-1 and HIV-2: HIV-1 is the most common and
widespread strain of HIV globally, responsible for the
majority of HIV infections worldwide. HIV-2 is less
common and primarily found in West Africa.
• Subtypes and recombinant forms: HIV-1 is classified into
multiple subtypes (A, B, C, etc.) and recombinant forms,
each with distinct genetic characteristics and
geographic distributions.
Structure of HIV
• Viral structure: HIV is a retrovirus with a lipid envelope
surrounding its protein capsid, which contains the viral
RNA genome and associated enzymes.
• Structural proteins: HIV contains structural proteins,
including the envelope glycoproteins (gp120 and gp41)
involved in viral entry, and the capsid protein (p24) that
encloses the viral RNA.
• Enzymes: Key enzymes include reverse transcriptase,
integrase, and protease, which are essential for viral
replication and maturation.
Replication in HIV
• Attachment and entry: HIV attaches to host cells expressing CD4
receptors and co-receptors (e.g., CCR5 or CXCR4), facilitating viral
entry into the cell.
• Reverse transcription: The viral RNA genome is reverse transcribed
into double-stranded DNA by the enzyme reverse transcriptase.
• Integration: The viral DNA is integrated into the host cell genome
by the enzyme integrase, forming a provirus.
• Transcription and translation: The provirus is transcribed into viral
RNA and translated into viral proteins.
• Assembly and maturation: Viral RNA and proteins are assembled
into new virions, which bud from the host cell membrane and
mature into infectious virions.
Natural History of HIV

9
HIV/AIDS Global Burden
• In 2022, there were 39m PLHIV
- 37.5m adults (15 years and above)
- 1.5m children (0-14 years)
- 55% of all PLHIV were women and girls
(UNAIDS 2023)
• Sub-Saharan Africa remains the most affected region, with nearly two-
thirds of all HIV infections globally.
• Impact on health: HIV/AIDS is a leading cause of morbidity and mortality
worldwide, particularly in low- and middle-income countries with limited
access to healthcare and resources.
• Social and economic impact: HIV/AIDS has profound social and economic
consequences, including stigma and discrimination, orphanhood, caregiver
burden, and loss of productivity.
Impact of HIV/AIDS
• Individual impact: HIV/AIDS has significant physical, psychological, and social
impacts on affected individuals. Physical effects include opportunistic infections,
AIDS-related illnesses, and medication side effects. Psychological effects include
depression, anxiety, and stigma-related stress. Social impacts include stigma,
discrimination, social isolation, and loss of social support.
• Community impact: HIV/AIDS affects families, communities, and societies at
large, leading to caregiver burden, orphanhood, economic loss, and social
disruption. Communities with high HIV/AIDS prevalence may experience reduced
productivity, decreased life expectancy, and increased healthcare costs.
• Healthcare system impact: HIV/AIDS places a significant burden on healthcare
systems, including increased demand for HIV-related services, such as HIV
testing, treatment, and care, and allocation of resources to support HIV/AIDS
programs. Healthcare systems may face challenges in providing comprehensive
and integrated care to individuals living with HIV/AIDS, particularly in resource-
limited settings.
Epidemiology of HIV/AIDS in Nigeria
• First case of AIDS in 1986.
• Prevalence in 15-64yrs – 1.4%, with estimated HIV burden of
19million people (NAIIS 2018)
• Incidence estimated at 8 per 10,000 persons (NAIIS)
• Prevalence varied across regions and states: Highest in South-
South (3.1%), and lowest in North-West (0.6%)
• Akwa Ibom state had highest prevalence (5.5%), while Katsina had
lowest prevalence (0.3).
• Transmission routes: Heterosexual transmission is the primary
mode of HIV transmission in Nigeria, accounting for the majority of
new infections. Other transmission routes include mother-to-child
transmission, injecting drug use, and same-sex sexual activity.
HIV Prevalence by States in Nigeria
HIV Sentinel Surveillance in Nigeria
• Sentinel surveillance: HIV sentinel surveillance involves
monitoring HIV prevalence and trends among key populations and
geographic areas through periodic surveys and data collection.
• Importance of surveillance: Sentinel surveillance data are
essential for guiding HIV/AIDS prevention, treatment, and care
programs, identifying high-risk populations and geographic areas,
and monitoring progress towards national and global HIV/AIDS
targets.
• Data collection methods: Sentinel surveillance data are collected
through various methods, including antenatal care (ANC) clinics,
sexually transmitted infection (STI) clinics, and key population
surveys.
HIV Test
• Types of HIV tests: HIV testing can be performed using various
methods, including rapid diagnostic tests (RDTs), enzyme
immunoassays (EIAs), and nucleic acid tests (NATs). RDTs provide
rapid results in minutes, while EIAs and NATs require laboratory
testing and may take longer to obtain results.
• Importance of HIV testing: HIV testing is crucial for early diagnosis,
timely initiation of treatment, prevention of transmission, and
access to care and support services. Testing also plays a key role in
HIV surveillance and monitoring of the epidemic.
• Confidentiality and consent: HIV testing should be conducted with
informed consent and confidentiality to protect the rights and
privacy of individuals seeking testing.
Testing Infants for HIV
• Early infant diagnosis (EID): Testing infants for HIV is
essential for early detection of infection and timely
initiation of treatment to prevent disease progression
and improve outcomes. EID involves testing infants born
to HIV-positive mothers using molecular assays (e.g.,
PCR) to detect HIV DNA or RNA in blood samples.
Possible HIV Test Results
• Positive result: A positive HIV test result indicates the presence of HIV
antibodies or viral RNA/DNA in the blood, confirming HIV infection.
Individuals with a positive test result require further confirmatory
testing, linkage to HIV care and treatment services, and support for
coping with the diagnosis.
• Negative result: A negative HIV test result indicates the absence of
detectable HIV antibodies or viral RNA/DNA in the blood at the time
of testing. However, individuals with recent HIV exposure may have
false-negative results due to the window period. Repeat testing is
recommended for individuals at continued risk of HIV exposure.
• Indeterminate result: An indeterminate HIV test result occurs when
the test outcome is inconclusive or equivocal, requiring repeat
testing and further evaluation to confirm HIV status.
Prevention, Treatment, and Control
of HIV/AIDS 1
• Prevention strategies: HIV/AIDS prevention efforts include
behavioural interventions (e.g., condom use, risk reduction
counselling), biomedical interventions (e.g., pre-exposure
prophylaxis [PrEP], post-exposure prophylaxis [PEP]), and
structural interventions (e.g., promoting gender equality,
reducing stigma and discrimination).
• Treatment and care: Antiretroviral therapy (ART) is the
cornerstone of HIV/AIDS treatment, suppressing viral
replication, preserving immune function, and improving health
outcomes for individuals living with HIV/AIDS. ART should be
initiated as soon as possible after HIV diagnosis, regardless of
CD4 count, and continued lifelong.
Prevention, Treatment, and Control
of HIV/AIDS 2
• Combination therapy: Combination ART involves using
multiple antiretroviral drugs from different drug classes
to target different stages of the HIV lifecycle, reduce
viral replication, prevent drug resistance, and improve
treatment efficacy and tolerability.
Prevention, Treatment, and Control
of HIV/AIDS 3
• Adherence to treatment: Adherence to ART is critical for
achieving and maintaining viral suppression, preventing
treatment failure, and reducing the risk of drug
resistance. Adherence support services, such as
medication reminders, counseling, and peer support,
can help individuals adhere to their treatment regimen.
• HIV/AIDS care continuum: The HIV care continuum
consists of sequential steps, including diagnosis, linkage
to care, initiation of ART, retention in care, and viral
suppression. Each step is essential for achieving optimal
health outcomes and reducing HIV transmission.
Preventive Measures for Medical
Personnel
• Universal precautions: Healthcare workers should adhere
to universal precautions to prevent occupational
exposure to HIV and other bloodborne pathogens,
including wearing personal protective equipment (e.g.,
gloves, masks, goggles), practicing hand hygiene, and
safely handling sharps and contaminated materials.
• Post-exposure prophylaxis (PEP): Healthcare workers
exposed to HIV through occupational injuries (e.g.,
needlestick injuries, mucous membrane exposure) should
receive immediate post-exposure prophylaxis (PEP) with
antiretroviral drugs to reduce the risk of HIV transmission.
Preventive Measures for the General
Public
• Behavioral interventions: The general public can reduce their risk of HIV
infection by adopting safer sexual behaviors, including condom use,
reducing the number of sexual partners, and avoiding high-risk sexual
activities (e.g., unprotected anal intercourse, transactional sex).
• HIV testing and counseling: Regular HIV testing and counseling are
recommended for individuals at increased risk of HIV infection, including
sexually active individuals, people who inject drugs, and individuals with
multiple sexual partners. Knowing one's HIV status allows for early
detection, timely linkage to care, and access to prevention and treatment
services.
• Community-based interventions: Community-based HIV prevention
programs, including peer education, outreach, and social mobilization, can
increase awareness, promote HIV testing, reduce stigma and
discrimination, and empower communities to address HIV/AIDS collectively.
PrEP and PEP
• Pre-exposure prophylaxis (PrEP): PrEP involves taking
antiretroviral drugs (e.g., tenofovir/emtricitabine) daily to
prevent HIV acquisition among individuals at high risk of HIV
infection, such as HIV-negative individuals in serodiscordant
relationships, men who have sex with men (MSM),
transgender individuals, and people who inject drugs.
• Postexposure prophylaxis (PEP): PEP is a short-term course
of antiretroviral drugs taken within 72 hours of potential HIV
exposure to reduce the risk of HIV transmission. PEP should
be initiated promptly after exposure and continued for 28
days, with close follow-up and monitoring for adverse
effects.
UNAIDS 95-95-95 Strategy
• UNAIDS targets: The 95-95-95 targets aim to ensure
that by 2030, 95% of people living with HIV know their
HIV status, 95% of people diagnosed with HIV receive
sustained antiretroviral therapy (ART), and 95% of
people receiving ART achieve viral suppression.
• Achieving the 95-95-95 targets is critical for ending the
HIV/AIDS epidemic by reducing HIV transmission,
improving health outcomes for individuals living with
HIV/AIDS, and achieving global targets for HIV/AIDS
prevention, treatment, and care.