Introduction History of AIDS Prevalence Virology Immunopathogenesis Stages of AIDS HIV tests Oral...
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Introduction History of AIDS Prevalence Virology Immunopathogenesis Stages of AIDS HIV tests Oral Manifestation Manifestation in children Treatment options
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
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http://www.aids-india.org/hivbasics2.htm
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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
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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
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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.
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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.
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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
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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}
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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
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Prevalence 19983.5 m 19993.7 m 2000 3.86m 2001 3.97 m 2004 5.1
m 20062.45m Inference : infections are declining
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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
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Modes of HIV/AIDS Transmission
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HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
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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
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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
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Can Look healthy Be unaware of infection Live long productive
life Infect others
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Stage 1 - Primary Short, flu-like illness - occurs one to six
weeks after infection no symptoms at all Infected person can infect
other people
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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
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Stage 3 - Symptomatic The symptoms are mild The immune system
deteriorates Emergence of opportunistic infections and cancers
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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
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CLINICAL FEATURES -AIDS
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HIV TESTS
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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
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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.
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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
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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!
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Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid
4,000 Saliva 1 Average number of HIV particles in 1 ml
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OF AIDS
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Angular Cheilitis
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severe form
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Necrotizing Ulcerative Periodontitis
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Neutropenic Ulcerations
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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
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Parotitis
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Molluscum Contagiosum
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Monitor growth and development Immunisation Vitamin A
supplementation Co-trimoxazole prophylaxis Counsel nutrition Family
support/ Health of Caregivers Dental Care
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
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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
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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
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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