Introduction History of AIDS Prevalence Virology Immunopathogenesis Stages of AIDS HIV tests Oral...
Preview:
Citation preview
- Slide 1
- Slide 2
- Introduction History of AIDS Prevalence Virology
Immunopathogenesis Stages of AIDS HIV tests Oral Manifestation
Manifestation in children Treatment options Dental procedures at
risk Universal precautions Conclusion References
- Slide 3
- http://www.aids-india.org/hivbasics2.htm
- Slide 4
- 40 million people in 2007(W.H.O) Two thirds present in
Sub-Saharan Africa New infections 2.6 millions in 2004 4.3 millions
in 2006 2.7 millions in 2007 DEATH due to AIDS - 2 million in 2007.
Every 15 seconds, another person dies of HIV; every 13 seconds,
another person contacts AIDS UNAIDS
http://www.globalhealthreporting.org/julyhttp://www.globalhealthreporting.org/july
2008
- Slide 5
- Person is diagnosed with AIDS when their CD4 count is below 200
& they have been diagnosed with an AIDS defining condition or
an opportunistic infection Decreased bodys ability to fight
infection Weak immune system Weak immune system No Cure No
Cure
- Slide 6
- Sushruta 800 b.c. and later Charaka - loss of muscle mass,
fever, skin eruption, ulcers, neurological disorders, exhaustion,
coma and death, manifestations similar to syndrome AIDS. In 1956 in
central Africa, - gay fever. In 1981 - first recognized Cases in
New York, Los Angeles and San Francisco.
- Slide 7
- 1981 - 1 st report on AIDS morbidity and mortality by USCDC.
1982 - human T lymphotropic virus-I (HTLV-I) isolated in Japan.
1983-HTLV-II isolated in US, (Miyoshi et.al) related to Asian
money. 1983 - first case of unexplained immuno - deficiency in
children. 1983 - first case of unexplained immuno - deficiency in
children.
- Slide 8
- 1983- Luc Montognier group at the Pasteur institute, Paris
isolated retrovirus from west African patients with manifestation
of AIDS. Named as (LAV) 1984-Groopman isolated from saliva. 1985
First test available In 1986, International Committee on Taxonomy
of virus proposed & was universally accepted as HIV
- Slide 9
- 1986-1 st case reported in Mumbai WHO & NACO. 1993-survey -
AIDS epidemic in India by NACO 1997 - first case in India was
through blood transfusion during an open heart surgery conducted in
USA. {WHO &NACO stated } 2004 - INDIA had 5.1m CHINA had 1m
CHINA had 1m 2006 -2.45 million { half of the previous}
- Slide 10
- Status of HIV epidemic in India High Prevalent states
Maharashtra Manipur Andhra Pradesh Nagaland Highest- Tamil Nadu
Karnataka Manipur Andhra Pradesh Nagaland Highest- Tamil Nadu
Karnataka
- Slide 11
- Prevalence 19983.5 m 19993.7 m 2000 3.86m 2001 3.97 m 2004 5.1
m 20062.45m Inference : infections are declining
- Slide 12
- Slide 13
- react with HIV type 1 antiserum HIV-I not react at all HIV-II
HIV-1 most common cause worldwide. Group M (major)- A to J Other
groups - O and N. Dominant subtype in western India - C
- Slide 14
- Modes of HIV/AIDS Transmission
- Slide 15
- HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
- Slide 16
- Earlier thought- HIV is labile virus. Now it has been confirmed
that HIV can survive up to many hours/days out side the body. ----
Dr. Harold Jaffe HIV Exposure and Infection exposed one time &
becomes infected exposed one time & becomes infected multiple
exposures without infected multiple exposures without infected
- Slide 17
- Period of time after becoming infected when an HIV test is
negative Period of time after becoming infected when an HIV test is
negative 90 percent of cases test positive within three months of
exposure 90 percent of cases test positive within three months of
exposure 10 percent of cases test positive within three to six
months of exposure 10 percent of cases test positive within three
to six months of exposure
- Slide 18
- Can Look healthy Be unaware of infection Live long productive
life Infect others
- Slide 19
- Slide 20
- Stage 1 - Primary Short, flu-like illness - occurs one to six
weeks after infection no symptoms at all Infected person can infect
other people
- Slide 21
- Stage 2 - Asymptomatic Lasts for an average of ten years This
stage is free from symptoms There may be swollen glands The level
of HIV in the blood drops to very low levels HIV antibodies are
detectable in the blood
- Slide 22
- Stage 3 - Symptomatic The symptoms are mild The immune system
deteriorates Emergence of opportunistic infections and cancers
- Slide 23
- Stage 4 - HIV AIDS The immune system weakens The illnesses
become more severe leading to an AIDS diagnosis
- Slide 24
- Not universally accepted Not universally accepted Composite of
clinical signs and symptoms Not a diagnostic stage Not a diagnostic
stage ARC includes presentation of- Chronic pyrexia Chronic
diarrhea, Chronic weight loss and Some opportunistic infection like
thrush
- Slide 25
- CLINICAL FEATURES -AIDS
- Slide 26
- HIV TESTS
- Slide 27
- No name is used No name is used Unique identifying number
Unique identifying number Results issued only to test recipient
Results issued only to test recipient 23659874515 Anonymous
- Slide 28
- 1. Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay
(ELISA/EIA). 2. Radio Immunoprecipitation Assay/Indirect
Fluorescent Antibody Assay (RIA/IFA). 3. Polymerase Chain Reaction
(PCR). (PCR). 4. Western Blot test.
- Slide 29
- Urine Western Blot As sensitive as testing blood As sensitive
as testing blood Safe way to screen for HIV Safe way to screen for
HIV Can cause false positives in certain people at high risk for
HIV Can cause false positives in certain people at high risk for
HIV
- Slide 30
- Orasure FDA app.HIV antibody FDA app.HIV antibody Accurate as
blood testing Accurate as blood testing Draws blood-derived fluids
from the gum. Draws blood-derived fluids from the gum. NOT A SALIVA
TEST! NOT A SALIVA TEST!
- Slide 31
- Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid
4,000 Saliva 1 Average number of HIV particles in 1 ml
- Slide 32
- OF AIDS
- Slide 33
- Angular Cheilitis
- Slide 34
- Slide 35
- severe form
- Slide 36
- Slide 37
- Necrotizing Ulcerative Periodontitis
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Neutropenic Ulcerations
- Slide 42
- Slide 43
- The probability that an HIV positive womans baby will become
infected if no anti- retrovirals are administered to mother or
child is as high -as 35%.
- Slide 44
- HIV DNA PCR HIV culture HIV RNA PCR P24 Antigen
- Slide 45
- Total CD4 counts in normal infants are considerably higher than
adults. Therefore, CD4 Percentage should be used to monitor disease
Clinical Progression of HIV in children Average70% Rapid 20% Long
Term 10% AIDS Education and Training Centers National Resource
Center,2003
- Slide 46
- Stage1 Asymptomatic Generalized Lymphadenopathy Stage 2 Chronic
Diarrhea, Fever Recurrent Candidiasis Failure to Thrive/Weight Loss
Recurrent Bacterial Infections Stage 3 Severe Failure to Thrive
Encephalopathy Malignancy AIDS Defining Opportunistic Infection
Progressive encephalopathy
- Slide 47
- Suspected Symptomatic HIV Infection 3 or More of the Following
Pneumonia Low Weight for Age Ear Discharge Unsatisfactory Weight
Gain Persistent Diarrhea Enlarged Lymph Nodes Oral Thrush Parotid
Enlargement
- Slide 48
- Slide 49
- Parotitis
- Slide 50
- Molluscum Contagiosum
- Slide 51
- Monitor growth and development Immunisation Vitamin A
supplementation Co-trimoxazole prophylaxis Counsel nutrition Family
support/ Health of Caregivers Dental Care
- Slide 52
- Antiretroviral Drugs Nucleoside Reverse Transcriptase
inhibitors Nucleoside Reverse Transcriptase inhibitors AZT
(Zidovudine) AZT (Zidovudine) Non-Nucleoside Transcriptase
inhibitors Non-Nucleoside Transcriptase inhibitors Viramune
(Nevirapine) Viramune (Nevirapine) Protease inhibitors Protease
inhibitors Norvir (Ritonavir) Norvir (Ritonavir)
- Slide 53
- Lamivudine+Zidovudine Efavirenz 600mg Nevirapine 200mg
Didanosine-EC 250mg Didanosine-EC 400mg Stavudine 30mg Stavudine
40mg Lamivudine 150mg Zidovudine 300mg Indinavir400 mg
- Slide 54
- Slide 55
- Report the incident, Medical follow-up & HIV testing Four
week course medication- Zidovudine (AZT) (200 mg TDS) + Lamivudine
(3TC) (150 mg BD) x 4 weeks Liver function tests to monitor
medication tolerance If source has advanced AIDS, protease
inhibitor Nelfinavir (750 mg TDS) should be added to AZT+3TC If
AZT/3TC therapy fails, Stavudine (D4t) ( 40 mg BD)+
Didanosine(ddI)(12 to 300 mg BD) should be used instead.
- Slide 56
- Abstinence Monogamous relationship Protected Sex Sterile
Needles
- Slide 57
- Hand-wash - plain soap & water Hand-wash - plain soap &
water Antiseptic hand-wash Antiseptic hand-wash Alcohol-based
hand-rub Alcohol-based hand-rub Surgical antisepsis- antiseptic
soap or an alcohol-based hand-rub Surgical antisepsis- antiseptic
soap or an alcohol-based hand-rub Before & after patient
treatment (before & after glove)
- Slide 58
- Masks, Protective Eyewear, Face Shields Masks, Protective
Eyewear, Face Shields Wear a surgical mask and either eye
protection with solid side shields or a face Wear a surgical mask
and either eye protection with solid side shields or a face Change
masks between patients. Change masks between patients. Clean
reusable face protection Clean reusable face protection between
patients; if visibly soiled. between patients; if visibly
soiled.
- Slide 59
- Undocumented modes of transmission a) Aerosols b) Dental rotary
instruments c) Sweat d) Saliva e) Impressions
- Slide 60
- Previously suctioned fluids might be retracted into the
patients mouth when a seal is created Do not advise patients to
close their lips tightly around the tip of the saliva ejector
- Slide 61
- Intended for use on one patient during a single procedure
Usually not heat-tolerant Cannot be reliably cleaned Examples:
Syringe needles, prophylaxis cups, and plastic orthodontic
brackets
- Slide 62
- Place biopsy in sturdy, leak proof container Avoid
contaminating the outside of the container Label with a biohazard
symbol
- Slide 63
- Considered regulated medical waste Considered regulated medical
waste Do not incinerate extracted teeth containing amalgam Do not
incinerate extracted teeth containing amalgam Clean and disinfect
before sending to lab for shade comparison Clean and disinfect
before sending to lab for shade comparison Can be given back to
patient Can be given back to patient
- Slide 64
- Dental prostheses, appliances, and items used in their making
are potential sources of contamination Handle in a manner that
protects patients and auxiliaries from exposure to
microorganisms
- Slide 65
- Indian Constitution - rights such as equality Three most
important rights in the HIV scenario: Right to Informed Consent
Right to Confidentiality Right against Discrimination One can seek
remedy in a court of law if tested for HIV without informed
consent, or your confidentiality is breached, or any of your rights
have been violated. NACO
- Slide 66
- World's deadliest infection World's deadliest infection Fourth
leading cause of death worldwide. Fourth leading cause of death
worldwide. Over 13 million children have been orphaned Over 13
million children have been orphaned 40 million people living with
HIV or AIDS worldwide. (UNAIDS) 40 million people living with HIV
or AIDS worldwide. (UNAIDS)
- Slide 67
- Thank You.
- Slide 68
- 1. Ananthanarayan R, Paniker Jayaram CK. Textbook of
Microbiology; seventh edition 1. Ananthanarayan R, Paniker Jayaram
CK. Textbook of Microbiology; seventh edition 2. Ayliffe G.A.J,
Fraise A.P., Geddes A.M., Mitchell K. Control of Hospital acquired
infection A practical handbook 3. Davidson S. Principles and
Practice of Medicine; 19th edition;. 4. Dental Clinics of North
America. Vol. 34; No.1; January 1990. 5. Madan Gautam. Infection
control in the dental clinic-part 5. Madan Gautam. Infection
control in the dental clinic-part 6. Harris M., McGowan D.A.,
Seward G. 6. Harris M., McGowan D.A., Seward G. 7. Mehta P.J.
Practical Medicine; 16th edition. 7. Mehta P.J. Practical Medicine;
16th edition. 8. Aids and Oral Health NS Yadav And Rupam Sinha 9.
http://www.hopkins-hivguide 9. http://www.hopkins-hivguide
http://www.hopkins-hivguide 10. http://www.thebody.comA 11.
http://www.globalhealthreporting.org/diseaseinfo.asp?id=23