Define HIV Predisposing factors 5 mode of transmission Life cycle Progression staging according to who Sign and symptoms according to stages Management ( history, physical examination, laboratory investigation according to Zambian) Treatment ( in Zambia) Pillars 90 90 90 treatment strategy HIV work policy

Define HIV

• The Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system, specifically the CD4 T cells, which are crucial for fighting off infections. Over time, it weakens the immune system, leading to Acquired Immunodeficiency Syndrome (AIDS), a severe stage where the body becomes highly vulnerable to opportunistic infections and certain cancers.

Predisposing factors

• Unprotected sexual intercourse (vaginal, anal, oral)
• Having multiple sexual partners
• Presence of other sexually transmitted infections (STIs)
• Sharing contaminated needles or syringes (e.g., for drug use)
• Mother-to-child transmission (during pregnancy, childbirth, or breastfeeding)

5 mode of transmission

• Sexual transmission: Through unprotected sexual contact with an infected person.
• Blood-to-blood transmission: Sharing contaminated needles, transfusions of infected blood (rare now due to screening), or accidental needle-stick injuries.
• Mother-to-child transmission (MTCT): From an HIV-positive mother to her child during pregnancy, childbirth, or breastfeeding.
• Organ/tissue transplantation: Receiving an organ or tissue from an HIV-positive donor (also rare due to screening).
• Occupational exposure: Healthcare workers exposed to infected blood or body fluids through cuts or needle sticks.

Life cycle

• Binding and Fusion: HIV attaches to CD4 receptors and co-receptors on the host cell, then fuses with the cell membrane.
• Reverse Transcription: The viral RNA is converted into viral DNA by the enzyme reverse transcriptase.
• Integration: The viral DNA enters the cell's nucleus and integrates into the host cell's DNA.
• Replication: The integrated viral DNA uses the host cell's machinery to produce new viral RNA and proteins.
• Assembly and Budding: New viral components assemble into new HIV particles, which then bud off from the host cell, ready to infect other cells.

Progression staging according to WHO

• Stage 1 (Asymptomatic): No symptoms, or persistent generalized lymphadenopathy.
• Stage 2 (Mild Symptoms): Minor mucocutaneous manifestations, recurrent upper respiratory tract infections.
• Stage 3 (Advanced Symptoms): Unexplained chronic diarrhea, severe bacterial infections, pulmonary tuberculosis, unexplained anemia.
• Stage 4 (Severe Symptoms/AIDS): HIV wasting syndrome, Pneumocystis pneumonia (PCP), Kaposi's sarcoma, toxoplasmosis of the brain, cryptococcal meningitis.

Sign and symptoms according to stages

• Stage 1: Often asymptomatic, but persistent generalized lymphadenopathy (swollen lymph nodes) may be present.
• Stage 2: Herpes zoster (shingles), recurrent oral ulcers, papular pruritic eruptions, fungal nail infections.
• Stage 3: Unexplained chronic diarrhea (lasting >1 month), severe bacterial infections (e.g., pneumonia, pyomyositis), pulmonary tuberculosis, oral hairy leukoplakia, unexplained anemia.
• Stage 4: HIV wasting syndrome (unexplained weight loss >10% of body weight), Pneumocystis pneumonia (PCP), Kaposi's sarcoma, toxoplasmosis of the brain, cryptococcal meningitis, extrapulmonary tuberculosis.

Management (history, physical examination, laboratory investigation according to Zambian)

• History: Detailed sexual history, history of drug use, previous STIs, current symptoms, family history of HIV/TB.
• Physical Examination: General appearance, assessment of lymph nodes, skin, oral cavity, respiratory, gastrointestinal, and neurological systems.
• Laboratory Investigation (Zambia):
  • HIV rapid diagnostic tests (RDTs) for screening, followed by confirmatory tests.
  • CD4 count (though less critical for ART initiation due to "Test and Treat").
  • Viral load monitoring (to assess treatment effectiveness).
  • Full blood count, liver and kidney function tests (to monitor drug side effects and overall health).
  • TB screening (e.g., GeneXpert, sputum smear).
  • STI screening (e.g., syphilis, gonorrhea).
  • Hepatitis B and C screening.

Treatment (in Zambia)

• Zambia provides Antiretroviral Therapy (ART) free of charge to all diagnosed individuals.
• The country follows a "Test and Treat" policy, meaning anyone diagnosed with HIV is immediately eligible for ART, regardless of their CD4 count or clinical stage.
• Common first-line regimens include combinations of drugs like Tenofovir, Lamivudine, and Dolutegravir (TLD).
• Emphasis is placed on adherence to medication and regular viral load monitoring to ensure treatment effectiveness and achieve viral suppression.

Pillars (of HIV response)

• Prevention: Comprehensive sexuality education, condom promotion, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), voluntary medical male circumcision (VMMC), harm reduction for people who inject drugs.
• Testing and Diagnosis: Widespread access to HIV testing services.
• Treatment: Universal access to Antiretroviral Therapy (ART).
• Care and Support: Psychosocial support, nutrition, management of opportunistic infections.
• Elimination of Mother-to-Child Transmission (EMTCT).

90 90 90 treatment strategy

• This is a UNAIDS target aiming to end the AIDS epidemic by 2030. It seeks to achieve:
  • 90% of all people living with HIV know their HIV status.
  • 90% of all people with diagnosed HIV infection receive sustained antiretroviral therapy.
  • 90% of all people receiving antiretroviral therapy achieve viral suppression.

HIV work policy

• An HIV work policy is a framework designed to protect the rights of employees living with HIV, prevent discrimination, ensure confidentiality, and promote a safe and supportive work environment. Key aspects include non-discrimination, confidentiality, reasonable accommodation for employees living with HIV, education and awareness programs, and provisions for access to information and services.