HIV and AIDS: Basic Elements and Priorities

CONTENTS......Page 5
PREFACE......Page 13
SECTION ONE – FUNDAMENTALS......Page 15
1.1 The new \"Plague\"......Page 16
1.2 Global situation......Page 17
1.4 The Caribbean......Page 18
1.5 South and South-East Asia......Page 19
1.6 Eastern Europe and Central Asia......Page 30
1.8 North America......Page 32
1.9 East Asia......Page 33
1.10 Other regions......Page 34
1.11 Situation in India......Page 36
1.12 Economic cost of the epidemic......Page 37
1.13 Challenges......Page 38
2.1 Introduction......Page 40
2.2 Host defence mechanisms......Page 41
2.3 Immunoglobulins......Page 42
2.5 Active immunity......Page 44
2.6 Humoral immunity......Page 45
2.7 Cell-mediated immunity......Page 47
2.8 Mucosal immune system......Page 48
2.10 Herd immunity......Page 49
2.12 Immune deficiency......Page 50
3.1 Retroviruses and HIV......Page 52
3.2 Structure of HIV......Page 54
3.3 Variants of HIV......Page 56
3.4 Target cells and organs......Page 59
3.6 Routes of transmission......Page 61
3.7 Replication......Page 62
3.8 Origin of HIV......Page 63
3.9 Immunity to HIV?......Page 64
4.1 Social factors......Page 68
4.2 Biological factors......Page 70
4.3 Behavioural factors......Page 71
4.4 Socio-political factors......Page 73
4.5 Armed conflicts and natural calamities......Page 74
4.6 Religion and HIV/AIDS......Page 76
5.1 Primary infection......Page 79
5.3 Advanced HIV infection and AIDS......Page 80
5.4 Opportunistic infections......Page 81
5.5 Hypersensitivity reactions......Page 84
5.7 Malignancies......Page 86
5.8 Autoimmune disorders......Page 88
6.1 Progression of HIV infection......Page 91
6.2 WHO clinical staging classification......Page 92
6.3 CDC classification......Page 93
6.5 Long-term non-progressors......Page 94
7.1 Definitions......Page 96
7.2 Kinetics of sterilisation and disinfection......Page 97
7.3 Physical methods......Page 100
7.4 Chemical methods......Page 106
7.6 Universal biosafety precautions......Page 118
7.7 Personal protective equipment (PPE)......Page 124
7.8 Management of biomedical waste......Page 126
7.9 Infection control checklist......Page 127
SECTION TWO – DIAGNOSTIC ASPECTS......Page 131
8.1 Introduction......Page 132
8.2 NACO case definition for children (Upto 12 years of age)......Page 133
8.4 WHO clinical case definitions......Page 134
8.6 Systemic manifestations......Page 135
9.1 Purpose of HIV testing......Page 137
9.2 Types of tests......Page 138
9.3 Specific tests......Page 139
9.4 Testing protocols......Page 147
9.5 Strategies for HIV testing......Page 148
9.6 Quality assurance and safety......Page 149
10.1 Bacterial vaginosis......Page 151
10.3 Infections in pregnant women......Page 153
10.5 Tests for vaginal discharge......Page 154
10.6 Tests for urethral and endocervical discharge......Page 157
10.7 Laboratory tests for syphilis......Page 160
SECTION THREE – CLINICAL ASPECTS......Page 167
11.1 Introduction......Page 168
11.2 Risk of HIV infection......Page 169
11.4 Management of accidental exposure......Page 170
11.5 Seeking specialist opinion......Page 175
12.1 AIDS dementia complex......Page 178
12.2 Vacuolar myelopathy......Page 179
12.4 Peripheral neuropathy......Page 180
12.6 Seizures......Page 181
12.7 Cerebrovascular disease......Page 182
13.1 Psychological reactions to diagnosis......Page 184
13.3 Effect of social stigma......Page 185
13.5 Role of the doctor......Page 186
13.7 Psychological impact on providers......Page 187
14.1 Magnitude......Page 189
14.3 Host factors......Page 191
14.4 Natural history of tuberculosis......Page 192
14.5 Pathogenesis and immunopathology......Page 193
14.7 Directly observed treatment, short course......Page 195
14.8 HIV-tuberculosis co-infection......Page 197
14.9 Multidrug-resistant tuberculosis (MDR-TB)......Page 200
14.10 Antiretroviral therapy in co-infection......Page 201
14.12 Research......Page 202
15.1 Introduction......Page 205
15.2 Co-infection with HIV with STIs......Page 206
15.3 Syndromic management of STIs......Page 207
15.4 Managing STIs in HIV-infected individuals......Page 209
15.5 Clinical aspects......Page 210
16.1 Introduction......Page 217
16.2 Clinical and laboratory monitoring......Page 219
16.3 ARV therapy for adults and adolescents......Page 220
16.4 ARV therapy for women......Page 223
16.5 ARV therapy for infants and children......Page 224
16.7 ARV therapy for injecting drug users......Page 226
16.8 Adherence to ARV therapy......Page 227
16.9 Surveillance of drug resistance......Page 229
16.10 Limitations of ARV therapy......Page 230
Appendices 1 – 6......Page 234
17.1 Introduction......Page 256
17.2 Types of \"alternative\" therapies......Page 257
17.3 Intricacies......Page 258
17.5 Ayurveda......Page 259
17.6 Siddha medicine......Page 260
17.7 Unani-Tibb......Page 261
17.8 Chinese medicine......Page 262
17.10 Herbal therapies......Page 265
17.11 Yoga......Page 269
17.12 Other alternative therapies......Page 271
17.13 Side effects and interactions......Page 272
17.14 Approach to alternative therapies......Page 273
SECTION FOUR – PREVENTION AND CONTROL......Page 277
18.1 Information, education and communication......Page 278
18.2 Preventing sexual transmission......Page 280
18.4 Preventing blood-borne transmission......Page 283
18.6 Specific prophylaxis......Page 285
18.9 Targeted interventions......Page 286
19 Surveillance for HIV......Page 289
19.2 Types of HIV surveillance......Page 290
19.4 Case reporting......Page 292
19.5 HIV sentinel surveillance in India......Page 294
19.6 HIV sentinel surveillance–2005......Page 295
20.1 Introduction......Page 298
20.2 Fundamentals of counselling......Page 299
20.3 HIV-related counselling......Page 300
20.5 Post-test counselling......Page 302
20.6 Partner counselling......Page 306
20.7 Counselling in special situations......Page 308
20.8 Referrals......Page 310
20.9 Evaluation of counselling......Page 311
20.10 Improving counselling services......Page 312
21.1 Introduction......Page 314
21.2 Utility of VCT services......Page 315
21.5 Assessment of the community......Page 316
21.7 Operational assessment......Page 317
21.8 Models for VCT service delivery......Page 319
22.1 HIV infection in women......Page 323
22.2 Risk factors in pregnancy......Page 325
22.3 Probable timings for transmission......Page 326
22.4 Factors affecting MTCT......Page 327
22.6 Possible intervention strategies......Page 329
23.1 Concepts......Page 336
23.2 Ethics in provision of health care......Page 337
23.3 Ethics in public education......Page 338
23.5 Legal aspects......Page 339
23.6 Confidentiality......Page 341
23.7 Informed consent......Page 343
23.8 HIV testing and reporting......Page 344
23.10 Issues pertaining to dying......Page 345
23.11 HIV and marriage......Page 346
23.12 Ethical issues in HIV/AIDS research......Page 347
24.1 Expectations from health care providers......Page 353
24.2 Continuing HIV education......Page 355
24.4 Peer support organisations......Page 356
25 Preventive HIV Vaccine......Page 359
25.1 Introduction......Page 360
25.2 Study of immune responses......Page 361
25.3 Scientific obstacles......Page 362
25.4 Programme-related obstacles......Page 363
25.5 Various approaches......Page 364
25.6 Ethical issues......Page 366
25.8 Conclusion......Page 367
26.1 Government\'s response......Page 370
26.2 National level programme management......Page 371
26.4 First phase of NACP......Page 372
26.5 Second phase of NACP......Page 375
26.6 National HIV policy......Page 376
26.8 Private sector\'s response......Page 377
26.9 Conclusion......Page 378
27.1 Introduction......Page 380
27.3 Current situation......Page 381
27.4 Conclusion......Page 382
28.1 Introduction......Page 384
28.2 Phases of China\'s epidemic and response......Page 385
28.3 Geographical variations......Page 386
28.4 High-risk groups......Page 387
28.5 Conclusion......Page 389
29.1 Early years of the epidemic......Page 391
29.2 Theories about aetiology......Page 392
29.4 AIDS activism......Page 393
29.6 Advent of HAART......Page 394
29.7 Effect on blood-banking......Page 395
29.8 The global response......Page 396
29.9 Two epidemics......Page 397
29.10 Strategies for prevention......Page 398
29.11 The future......Page 399
A......Page 403
C......Page 404
G......Page 405
I......Page 406
O......Page 407
S......Page 408
U......Page 409
Z......Page 410