Jul 24, 2010
STATUS OF HIV AND AIDS IN NEPAL
AIDS (Acquired Immune Deficiency Syndrome) is one of the most serious communicable diseases of present day, caused by a HIV (Human Immune deficiency Virus). It affects the immune system and makes the patients unable to defend against any type of infections.The Red ribbon is a symbol for solidarity with HIV-positive people and those living with AIDS.
T4 lymphocytes are the cells that are responsible for development of immune system in human. AIDS is a disorder which impairs the body’s T4 lymphocytes cells’ immune system. Thus, these T4 lymphocytes cell can no longer help to induce other T cells, called Killers. The body’s immune system breaks down leaving the patient exposed to a variety of diseases. Hence, AIDS is considered as a very dangerous and fatal disease.
Origin of AIDS
AIDS is thought to have originated somewhere in Central Africa, possibly sharing an ancestor with a virus found in several species of African monkey. The virus then appears to have migrated to Haiti and then to USA, and has subsequently been identified from almost all countries throughout the world. It has already infected an estimated in million people. In Nepal, first case was diagnosed in 1988. Now, approximately 50,000 people are suffering from AIDS in Nepal.
AIDS was first reported on June 5, 1981 when the UD centers for Disease Control and Prevention recorded a cluster of Pneumocystis Carinii Pneumonia (now still classified as PCP but known to be caused by Pneumocystis Jirovecii) in five homosexual men in Los Angeles.
Three of the earliest known instances of HIV infection are:
- A plasma sample taken in 1959 from an adult male, living in what is now the Democratic Republic of Congo.
- HIV found in tissue samples from the 15 years old African-American teenagers who died in St. Louis in 1969.
- HIV found in tissue samples from a Norwegian sailor who died around 1976.
Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted, originated from the Central Common Chimpanzee (Pan Troglodytes Troglodytes) found in Southern Cameroon. HIV-2 is not as easily transmitted and is largely confined to West Africa, originated from the Sooty Mangabey (Cercocebusatyn), an old world monkey of Guinea Bissau, Gibbon, and Cameroon.
Causative Agent
AIDS was first recognized in the USA in 1981. Doctors reported a number of deaths which were associated with a breakdown of the body’s immune system.
HIV Virus
In 1983, a French physician Dr. Luc Montagnier identified the virus in the lymph nodes of a male homosexual. He termed the virus Lymphadenopathy Virus or LAV. In Britain, Abraham Karpas working at Cambridge University also isolated the virus (C-LAV) from an AIDS patient.
Shortly after-wards Dr. Robert Gallo, National Cancer Research Institute of USA isolated an almost identical virus which he called ‘Human T cell Lymphotropic Virus’ or HTLV-III.
These viruses are all essentially the same, and now the virus is internationally known as the ‘Human Immune deficiency Virus’, symbol being HIV. It is an RNA virus.
Infection by HIV
AIDS is the most severe acceleration of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4+T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+T cells. CD4+T cells are required for the proper functioning of the immune system. When HIV kills CD4+T cells so that there are fewer than 200 CD4+T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified on the basis of the amount of CD4+1 cells in the blood and the presence of certain infections. In absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate progression. These include factors that influence the body’s ability to defend against HIV such as the infected person’s general immune function. Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may be predispose people to faster disease progression. The infected person’s genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with CCR5-32 mutation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression. The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.
According to WHO, the infection of HIV has following steps:
Stage I : HIV infection is asymptomatic and not categorized as AIDS.
Stage II : includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections.
Stage III : includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis.
Stage IV : includes toxoplasmasis of the brain, candidiasis of the oesophagus, trachea, bronchi or lungs and kaposi’s sarcoma; these diseases are indicators of AIDS.
Transmission
According to WHO, the major transmitting agents are as following and the data alongside is of the number of people per (20000):
Blood Transfusion 9,000
Childbirth 2,500
Needle-sharing injection drug use 67
Receptive anal intercourse 50
Percutaneous needle stick 30
Receptive penile-vagical intercourse 10
Insertive anal intercourse 6.5
Insertive penile-vaginal intercourse 5
Receptive oral intercourse 1
Insertive oral intercourse 0.5
As the above data states, the three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to foetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.
1. Intimate sexual contact
The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom was HIV. Heterosexual intercourse is the primary mode of HIV infection worldwide. Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oval mucous membranes of another. Unprotected receptive sexual acts are riskier than unprotective insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected anal intercourse greater than the risk for transmission through vaginal intercourse or oral sex. Oral sex is not without its risk as HIV is transmissible through both insertive and receptive oral sex. The risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen; contrary to popular belief, one would have to swallow gallons of saliva from a carrier to seen a significant risk of becoming infected.
Approximately 30% of women in ten countries representing “diverse cultural, geographical and urban/rural setting” report that their first sexual experience was forced or coerced, making sexual violence a key driver of the HIV/AIDS pandemic. Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vaginal cavity frequently occurs which facilitates the transmission of HIV.
2. Infected blood entering the bloodstream
a) AIDS can also be contracted by intravenous drug users practicing self-injection by means of unsterilized needles and syringes. HIV has spread rapidly amongst intravenous drug users.
b) Transfusion or donating blood infected with HIV can also infect the recipient.
c) Close contact between infected and non-infected people through cuts and open wounds has also been known to pass on the virus.
d) An infected pregnant woman can pass on the virus to her baby through the placenta, at birth or through breast milk during sucking, called MTCT (Mother-To-Child-Transmission). Chance of infection being transmitted from mother to her baby is estimated to be 25.20%.
Incubation Period
Incubation period varies from few months to 6 years or more.
Symptoms (ARC – AIDS Related Complex)
A person with AIDS Related Complex has illness caused by damage to the immune system, but without the opportunistic infections and cancer associated with AIDS. They exhibit one or more of the following clinical features:
i> Unexplained diarrhea for more than a month
ii> Malaise, fatigue, fever for more than a month and night sweats
iii> Weight loss of more than 10% of the body weight
iv> Lymphadenopathy (lymph node enlargement) and splenomegaly (Spleen Swelling)
v> Septicaemia (Blood Poisoning)
AIDS is the end stage of HIV infection. Death is due to uncontrolled or untreatable infection. The severe form of features described under ARC:
i> Kaposi Sarcoma – a type of tumor of skin and mucous membranes
ii> Cytomegalovirus Retinitis – inflammation of retina may lead to blindness
iii> Pneumonia and hairy leukoplakia
iv> Cryptococcal Meningitis
v> Preeritic Desmatitis and Recurrent skin infections
Test for the disease
Blood test is used to tell whether or not a person has been infected by AIDS virus. Blood of a person can be tested with HIV proteins which have been commercially prepared.
If there are anti-HIV antibodies in the blood sample, they will bind to the viral protein. This union of antibody to HIV protein indicates that the blood is from infected person who is then designated HIV+. However, if the test proves negative that person may still be infected. Sophisticated technique being used for detection of anti-HIV antibodies in human blood is ELISA (Enzyme Linked Immuno- Sorvbent Assay).
Control
Enormous international efforts are being made to devise methods of treating and preventing the disease. There are two lines of research, one into developing drugs and another into developing a vaccine. Azidothymidine (AZT) or Zidovudine, Ribavarian, Sumarin, and antiparasitic drug are used to treat other viral infection which has been found to suppress the AIDS virus under laboratory conditions and slow progression of the disease.
Other antiviral agents like Didonosine (DDS) and Zalcitabine are used to prolong life and to increase the quality of life.
HIV/AIDS in Nepal
Nepal is facing increases in HIV prevalence among high risk groups such as sex workers, injecting drug users, men who have sex with men, and migrants. In addition, injecting drug use appears to significantly overlap with commercial sex. There is an urgent need to scale up effective interventions, especially among IDUs. The first case of AIDS in Nepal was reported in 1988. Since then the numbers have risen among the country’s 27 million people. By the end of 2005, more than 950 cases of AIDS and over 5,800 cases of HIV infection were officially reported, with three times as many men reported to be infected as women. However, given the limitations of Nepal’s public health surveillance system, the actual number of infections is expected to be much higher. UN AIDS estimates that 75,000 people were living with HIV at the end of 2005.
Present Status of AIDS in Nepal
Number of children with HIV : 75,000 (2005)
Rate of infected adults (15-49) : 0.5% (2005)
Number of women infected from HIV (15+) : 16,000 (2005)
Deaths due to HIV/AIDS : 19 (2005)
(per 100,000 populations per year)
Deaths due to tuberculosis among HIV+ people : 1 (2005)
Deaths among children under five years of age : 0.2 (2000)
due to HIV/AIDS (%)
Deaths due to HIV in adult and children : 5100 (2005)
HIV in injecting drug users : 50% (2002)
HIV in female sex workers : 2% (2005)
As we can see from the above data that the number of infection and death in Nepal due to HIV is also high and it is increasing. So, all of us should be aware of it.
Prevention
i> Sex education
ii> Screening before blood transfusion
iii> Use of condoms
iv> Rehabilitation of drug addicts
v> Early diagnosis and treatment of other sexually transmitted diseases
Many other preventive measures can be used but the main thing is the awareness.
AIDS do not transmit by
1. Kissing
2. Hugging
3. Shaking hands
4. Using the same thing (towel, toilet)
5. Eating in same place
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