HIV

Presented by
Dr Jameela Al-Salman
Infectious Disease Consultant
American Board in internal Medicine, Infectious disease and Geraitrics
! The Immune System

T Cells (CD4 Cells) = Part of body’s immune system

CD4
The average person has between 800 & 1500 CD4
cells per cubic millimetre of blood

The immune system helps fight diseases

CD4 Disease Disease

IMMUNE ATTACKS DISEASE KILLS DISEASE

SYSTEM
 ? How can you get HIV?

1. Through these bodily fluids

VAGINAL BREAST
SECRETIONS MILK
BLOOD
CERVICAL
SECRETIONS
SEMEN

2. Through these acts:

H

INFECTED MOTHER: UNPROTECTED PENETRATIVE 1. INJECTION OR TRANSFUSION OR INFECTED

DURING INTERCOURSE (HOMOSEXUAL OR BLOOD / BLOOD PRODUCTS
1. PREGNANCY HETEROSEXUAL) WITH SOMEONE 2. SHARING UNSTERALISED NEEDLES WITH
2. BIRTH WHO IS INFECTED SOMEONE WHO IS INFECTED
3. BREAST FEEDING
 !
HIV Myths of transmission:
1. You cannot catch HIV from kissing.
2. You cannot catch HIV from sitting on a toilet seat
3. You cannot catch HIV from coughing or sneezing
4. You cannot catch HIV from sharing cutlery
5. You cannot catch HIV from drinking out of the same glass
6. You cannot catch HIV from holding hands
7. You cannot catch HIV from hugging
 Are some people more susceptible HIV?
Females are 3 times more easily infected compared to males as the vagina is more susceptible to
lesions allowing the virus to pass into the body, and semen can remain in the body for up to three
days.
People with other STIs are up to 10 times more at risk as many of the STI will result in cuts and
open sores giving the HIV more chance to enter the body.

! Some Statistics
●Worldwide 75% of HIV is transmitted sexually. ¾ of infections are through heterosexual sex
and ¼ are homosexual sex.
●In the UK in 2002 54% of infections were through heterosexual sex, 32% through homosexual
and 2% through drug use.
●300,000 young people (15-24) get infected with an STI every day.
●In the UK there has been a sharp rise in STIs in young people these include gonorrhoea, herpes,
thrush and Chlamydia. Chlamydia has risen 108% from 1996 to 2001.
 HIV and the Immune System
When HIV enters the body it must enter a cell to live and reproduce. The HIV
virus attacks CD4 cells, eventually killing them
CD4 HIV
HIV
HIV HIV CD4
HIV

HIV Enters CD4 Cells HIV Replicates Kills CD4

Cells

The newly produced HIV then moves into new CD4 cells and infects them. The
body’s immune system tries to replace the lost CD4 cells, but over time it is unable
to keep these levels up.
 When does HIV become AIDS?

1500 to 800 CD4 - Average healthy person

CD4 Below 500 CD4 - HIV+ person at risk from

COUNT Opportunistic Infections

200 CD4 Person is considered to have AIDS

In many developing countries they are unable to conduct the difficult

! CD4 count tests. In these countries AIDS is diagnosed by looking
at the symptoms that the person has.
 How long does it take for
HIV to turn into AIDS?
There is not just one straight forward answer. A lot depends on
what part of the world the HIV+ person is from.

 Developed World: On average a person can live for up to 10 years before they
get ill. Without treatment the time between AIDS and death is about 12-24
months. Now that there are anti-HIV drugs it is thought that people will be
able to live longer.

 Developing World: On average an HIV+ person can live up to between 6 and

8 years before they get ill. In most developing countries there is minimum
access to drugs and the time between illness and death is shorter. This is
because people in developing countries are unable to eat enough nutritious food;
they lead stressed filled lives and are often exposed to multiple infections.
 Natural History:
The Chronology of HIV-Induced
Disease
1. Primary HIV Infection and Seroconversion
 Clinical features
 Seroconversion illnesses

2. Stages of Disease Progression

 Early immune depletion
 Intermediate immune depletion
Primary HIV Infection
 Day 0 Exposure to HIV at
mucosal surface (sex)

Virus collected by
Day 0-2 dendritic cells, carried
to lymph node

HIV replicates in
Day 4-11 CD4 cells, released
into blood

Day 11 on Virus spreads to

other organs
Kahn JO, Walker BD. N Engl J
Med. 1998;339:33-39.
 Primary HIV Infection: Pathogenesis

CD4 Cell Count (cells/mm³)

Symptoms
10,000,000

1,000,000

100,000 Plasma RNA Viral Load

Plasm a H IV RNA

10,000

1,000 1,000
100
CD4 Cell Count
(copies

500
/m L

10
)

4-8 Weeks Up to 12 Years 2-3 Years

 Epidemiology of Primary HIV
Infection
 United States:
– 44,000 cases per year1
– 120 cases per day

 Globally:
 14,000 cases/day

1. Kahn JO, Walker BD. N Engl J Med. 1998;339:33-39.

2. WHO: UNAIDS, 2001
 WORLD VIEW
34 - 46 MILLION INFECTED
AT END OF 2003
AIDS HAS CLAIMED
JUST UNDER 25
MILLION LIVES SINCE
IT WAS DISCOVERED
SINCE HIV/AIDS WAS
Eastern Europe 20 YEARS AGO.
Western Europe & Central Asia
DISC0VERED 60 MILLION 520,000 – 680,000 1.2 – 1.8 Million
North America
PEOPLE 790,000 – 1.2 million East Asia & Pacific
(THE POPULATION OF North Africa & Middle 700,000 - 1.3 million
UK) HAVE BEEN Caribbean East
INFECTED 470,000 – 730,000 South
350,000 – 590,000
& South–East Asia
4.6 – 8.2 million
Latin America
1.3 – 1.9 million Sub-Saharan
Africa Australia
25.0 – 28.2 million & New Zealand
12,000 – 18,000

2.7 MILLION PEOPLE HALF OF NEW INFECTIONS

WITH AIDS ARE OCCUR IN 15-24 YEAR OLDS 17.6 MILLION PEOPLE WITH
AIDS ARE WOMEN.
CHILDREN UNDER 15.
 How often do people with PHI
seek health care?
 Swiss cohort
 87% of seroconverters (20/23) in cohort study had symptoms
 95% of these patients had medical evaluation
 PHI considered in only 5 of 19 patients

 PHI often leads to medical evaluation, but is under-

diagnosed

Schacker T et al. Ann Int Med 1996;125:257-64.

 Exposure Risks (average, per episode, involving HIV-
infected source patient)
Percutaneous (blood)1 0.3%
Mucocutaneous (blood)2 0.09%
Receptive anal intercourse3 0.3 - 3%
Insertive anal intercourse4 0.06%
Receptive vaginal intercourse5 0.1 – 0.2%
Insertive vaginal intercourse6 0.03 – 0.14%
Receptive oral (male)7 0.06%
Female-female orogenital8 4 case reports
IDU needle sharing9 0.67%
Vertical (no prophylaxis)10 24%
 Primary HIV Infection
and Seroconversion
Clinical Features
 On first exposure, there is a 2-4 week period of intense viral
replication before the onset of an immune response and
clinical illness.
 Acute illness lasts from 1-2 weeks and occurs in 53% to 93%
of cases.
 Clinical manifestations resolve as antibodies to the virus
become detectable in patient serum.
 Patients then enter a stage of asymptomatic infection lasting
months to years.
 Primary HIV Infection
and Seroconversion, continued

Seroconversion Illness
 Manifests as a flu-like syndrome: fever, myalgia, etc.
 Neurological symptoms: HIV in CSF, aseptic
meningoencephalitis, etc.
 Gastrointestinal symptoms: mucocutaneous ulceration,
pharyngeal edema, etc.
 Dermatological symptoms: rash, urticaria, etc.
 Primary HIV Infection and
Seroconversion, continued
 Laboratory Findings
 First 1-2 weeks:
 Profound reduction in CD4, CD8 lymphocyte counts
 Peripheral lymphocytosis
 Mild thombocytopenia

 First 2-6 weeks:

 Antibodies to HIV detected

 HIV antigen may be detected in serum before

antibodies
 Primary HIV Infection:
Common Signs & Symptoms
fever 86

lethargy 74

myalgias 59

rash 57

headache 55 N = 160 patients with PHI in

Geneva, Seattle, and Sydney
pharyngitis 52

adenopathy 44

0 10 20 30 40 50 60 70 80 90 100
% of patients

Vanhems P et al. AIDS 2000; 14:0375-0381. 

 Primary HIV Infection:
Other Signs & Symptoms
aseptic meningitis 24

oral ulcers 15

genital ulcers 10

thrombocytopenia 45

leukopenia 40

transaminitis 21

0 20 40 60 80 100
% of patients

Kahn JO, Walker BD. N Engl J Med. 1998;339:33-39.

 Primary HIV Infection
Rash Mucosal Lesions

Trunk and face > limbs Oral ulcers, thrush

Small pink macules
(Kahn, NEJM, 1998)
Oral Ulcers in Acute HIV Infection

From: Walker, B. 40th IDSA, Chicago 2002.

Genital Ulcer in Acute HIV Infection

From: Walker, B. 40th IDSA, Chicago 2002.

 Modes of Transmission
 Sexual contact
• Male-to-female, female-to-male, male-to-male, and female-to-female
 Parenteral
• Blood transfusion, IDU through needle-sharing, needle stick
accidents
 Perinatal
• In utero, during labor/delivery, postpartum through BF
 Worldwide, sexual transmission is the predominant mode
 HIV cannot be transmitted by casual contact, surface contact, or insect
bites
 Spread of HIV in sub-Saharan Africa, 1987

Estimated
Estimated percentage
percentage of
adults
adults (15–49)
(15–49) infected
infected with
with
HIV
HIV 16.0% – 32.0%
8.0% – 16.0%
2.0%
2.0% –– 8.0%
8.0%
0.5%
0.5% –– 2.0%
2.0%
0%
0% – 0.5%0.5%
trend
trend data
data unavailable
unavailable
outside
outside region
World Health
Organization UNAIDS–Addis–May
UNAIDS–Addis–May 1999
1999
 Spread of HIV in sub-Saharan Africa, 1997

Estimated
Estimated percentage
percentage of
of
adults
adults (15–49)
(15–49) infected
infected with
with
HIV
HIV 16.0%
16.0% – 32.0%
32.0%
8.0%
8.0% –– 16.0%
16.0%
2.0% – 8.0%
0.5% – 2.0%
0% – 0.5%
trend
trend data
data unavailable
unavailable
outside region
World Health
Organization UNAIDS–Addis–May
UNAIDS–Addis–May 1999
1999
Leading causes of death in Africa,
1999
Rank % of total

20.6
 1 HIV/AIDS
10.3
 2 Acute lower respiratory infections
9.1
 3 Malaria
7.3
 4 Diarrhoeal diseases
5.9
 5 Perinatal conditions
4.9
 6 Measles
3.4
 7 Tuberculosis
3.2
 8 Cerebrovascular disease
3.0
 9 Ischaemic heart disease
2.4
 10 Maternal conditions
Source: The World Health Report 2000, WHO
 HIV: Two Types Recognized

HIV-1 HIV-2
Both transmitted through sexual contact, blood, from
mother to child, and cause indistinguishable AIDS

Predominant virus Less easily transmittable

Due to high rate of Period between initial

replication, mutates rapidly infection and illness longer
into subtypes than HIV-1
Sx
Model: Viral Dynamics

CD4

IgG EIA

IgM EIA

WB
HIV RNA

p24 Ag
Weeks Months
Little 9/97
Natural History of HIV Disease Progression
and Viral Loads/CD4 Counts
 Likelihood of Developing AIDS in 3 Years

CD4+ cells/µL
100
>750
Percent progressing

80 501-750
351-500
60 201-350
<200
40

20

0
>30,000 10,000- 3,000- 501- <500
30,000 10,000 3,000
Plasma HIV RNA (copies/mL)

Adapted from: Mellors J et al. Ann Intern Med. 1997.

 Primary HIV Infection:
Conclusions
 PHI is under-diagnosed
 May represent a critical opportunity to intervene
 A high index of suspicion, recognition of key
signs & symptoms, and lab testing are required
for the diagnosis
 ART may provide opportunity for improved long-
term virologic control of HIV
Patient assessment
 Patient Assessment

1. Initial Assessment Interview Addresses:

a. Information gathering
b. Emotion handling
c. Behavior management
d. History specific to HIV/AIDS
2. Taking a Sexual History
3. Role Plays
 History Specific to HIV/AIDS

 Previous tests for HIV  Family history

 Presence of HIV-  Medications taken
associated signs and regularly
symptoms  Social history
 History of sexually
 Sources of support
transmitted diseases and
other infectious diseases  Sexual history
 Other medical diagnoses
 Mental health history
 The Physical Exam

 General  Lungs
 Skin  Gastrointestinal
 Eyes
 Neurology
 Oropharynx
 Lymph nodes  Pelvic Exam
 Baseline Laboratory Tests
 Following confirmation of an HIV diagnosis, a baseline laboratory
evaluation is important to establish the stage of the disease and
exposure to other infectious diseases, as quantified by the CD4 cell
count.
 Other recommended baseline tests include:

• CBC • PPD skin testing

• Serum Chemistry Panel • PAP smears
• LFT, LIPIDS, AMYLASE • Serology for Hep B (HBV), Hep
• Syphilis serology A,hep c
• Chest X-ray
• CMV Serology
• Toxoplasmosis • HSV
 Baseline Laboratory Tests,
continuedCD4 cell count

 Normal range: 500-  Staging of HIV

1400/mm
 CD4 depletion is the
most consistent and
notable laboratory
abnormality observed
in HIV disease.
infection,
recommendations for
ARV treatment, and
prophylaxis against
OIs are based on the
degree of
immunosuppression.

 This is the most useful

test for assessing
immune function.
 Patient Clinical Presentation

 A good clinical examination and thorough interview of

the patient is needed
 WHO AIDS case definition and staging system is useful
–it has been adapted for countries with limited clinical
and laboratory diagnostic facilities
 A further refinement of the WHO staging system is also
proposed for settings where laboratory monitoring is not
available
 Where HIV testing is not available, patients can be
diagnosed clinically based on major and minor
signs and symptoms
 Case definition for HIV/AIDS is fulfilled in the presence
of at least 2 major signs and at least 1 minor sign:
– Major signs (weight loss, chronic diarrhea, prolonged fever)
– Minor signs (persistent cough, herpes zoster, oropharyngeal
candidiasis, etc.)
 WHO Case Definitions
Where HIV testing is available
 The case definition for HIV/AIDS is fulfilled if an HIV
test is positive and one or more of the following
conditions is present:

• Weight loss • HIV encephalopathy

• Cryptococcal meningitis
• Tuberculosis
• Kaposi’s sarcoma
• Esophageal candidiasis
• Life threatening or recurrent
pneumonia
• Invasive cervical cancer
 WHO Clinical Staging System
 The WHO clinical staging system includes:
– a clinical classification system
– a laboratory classification to categorize the
immunosuppression of adults by their total
lymphocyte counts
 WHO Clinical Staging System
Clinical Stage 1
1. Asymptomatic infection
2. Persistent generalized lymphadenopathy (PGL)
3. Acute retroviral infection
Clinical Stage 2
4. Unintentional weight loss, < 10%
5. Minor mucocutaneous manifestations
6. Herpes zoster, within previous 5 years
7. Recurrent upper respiratory tract infections
 WHO Clinical Staging System
Clinical Stage 3
 Unintentional weight loss, >10%
 Chronic diarrhea
§ Prolonged fever
§ Oral candidiasis
§ Oral hairy leukoplakia
§ Pulmonary tuberculosis
§ Severe bacterial infections
§ Vulvovaginal candidiasis
 WHO Clinical Staging System
Clinical Stage 4

16. PCP 24. PML (progressive multifocal

17. Toxoplasma of the brain leukoencephalopathy)
18. Cryptosporidiosis with diarrhea 25. Any disseminated endemic
mycosis
19. Isosporiasis with diarrhea 26. Candidiasis of the esophagus,
20. Extrapulmonary cryptococcosis trachea, bronchi, and lungs
21. Cytopmegaloviral disease of 27. Atypical mycobacteriosis
an organ other than 28. Non-typhoid Salmonella
liver,spleen, or lymph node septicemia
22. Herpes simplex virus infection
29. Extrapulmonary TB
30. Lymphoma
31. Kaposi’s sarcoma
32. HIV encephalopathy
 WHO Clinical Staging System
 WHO Improved Clinical Staging System: A further refinement of
the WHO clinical staging system includes a laboratory axis. The
laboratory axis subdivides each category into 3 strata (ABC)
depending on the number of CD4 cells. If this is not available,
total lymphocytes can be used as an alternative marker
Laboratory axis Clinical axis
Lymphocytes* CD4** Stage 1 Stage 2 Stage 3 Stage 4
Asymptomatic Early HIV Intermediate Late AIDS
PGL
A >2000 >500 1A 2A 3A 4A
B 1000- 2000 200-500 1B 2B 3B 4B
C <1000 <200 1C 2C 3C 4C
 Conditions
of the
Respiratory System
 Pulmonary involvement is among the most common complaints in
AIDS patients
 Bacterial pneumonia and tuberculosis can occur early in the course
of HIV infection---when the CD4 count is >500
 Pneumocystis carnii or p.jiroveci pneumonia (PCP) almost always
occurs when the CD4<200
 Toxoplasmosis, CMV and Mycobacterium avium complex (MAC)
usually occur at CD4 count is <100
 In the advanced stage of the disease, more than one pathogen can
be found
 Mycobacterial M. tuberculosis, M.avium complex
infection
Toxoplasmosis gondii
Protozoal infection
Streptococcus pneumoniae,
Haemphilus influenzae,
Bacterial infection Staphylococcus aureus, Moraxella
cattharalis, Klebsiella pneumoniae,
Pseudomonas aeruginosa
Pneumocystis carinii or p.jiroveci
(PCP), Penicillium marneffei,
Fungal Infection Cryptococcus neoformans,
Histoplasmosis,
Coccidioidomycosis, Aspergillosis
Strongyloides stercoralis,
Helminthic infection
 Conditions
of the
Neurological System
 Protozoal infection Toxoplasma Gondii (toxoplasmosis)
 Mycobacterial infection M. tuberculosis (TB meningitis)
 Bacterial Strep pneumoniae,
 Neisseria meningitis (bacterial meningitis)
 Fungal infection Cryptococcus neoformans
 (cryptococcal meningitis)
 Viral infection Cytomegalovirus (CMV)
 Other: Progressive multifocal leukoencephalopathy (PML)
– Primary CNS lymphoma
   HIV-associated dementia (HAD)
 Painful sensory and motor peripheral neuropathies
 Neurosyphilis
 Conditions of the
Gastrointestinal System
 Major Pathogens
Bacterial infection Campylobacter, Shigella, and Salmonella
Protozoal infection Cryptosporidium species, Giardia lamblia,
Isospora belli, Entamoeba histolitica, Microsporidium species
Toxin induced E. coli and Clostridium difficile
Mycobacterial infection M. tuberculosis, M. Avium complex
Helminthic infection Strongyloides stercoralis
Fungal infection Candida species (seldom a ` cause of diarrhea)
Conditions of the Lymph System
 Major Pathogens
HIV- related persistent generalized
lymphadenopathy (PGL)
Opportunistic infections tuberculous lymphadenitis, CMV,
toxoplasmosis, infections with Nocardia
species, fungal infections
(histoplasmosis, penicilliosis,
cryptococcus, etc.)
Reactive Lymphadenopathy pyomyositis, pyogenic skin infections,
ear, nose, and throat (ENT) infections
STIs syphilis, inguinal lymphadenopathy due
to donovanosis, chancroid or
lymphogranuloma venereum (LGV)
(see WHO or MSF guidelines)

Malignancies lymphoma, Kaposi’s sarcoma

 Conditions
of the
Mouth and Throat
 Major Pathogens

Bacterial infection anerobic infections causing

gingivitis

Fungal infection Candida albicans

Viral infection Epstein-Barr virus (hairy

leukoplakia), Herpes
simplex virus, CMV

Oncologic conditions Kaposi’s sarcoma

Differential Diagnosis
and Follow-Up
 Differential Diagnosis

 Initial diagnosis of HIV may be difficult

 The more general signs and symptoms of HIV are
common to many infections
 Patients may have acquired both HIV and other
sexually transmitted or blood-borne diseases at the
same time
 It is important to consider HIV testing when testing
for other infections that have similar presentation
 Differential Diagnosis
 The following diseases have a similar presentation:

• Epstein-Barr virus • Viral hepatitis

mononucleosis
• Primary herpes simplex
• Cytomegalovirus
virus infection
mononucleosis
• Disseminated
• Toxoplasmosis gonococcal infection
• Rubella • Other viral infections
• Syphilis
 Follow-Up Visits
 After being informed about their results, patients may need closer
follow-up (weekly or monthly) for psychological support and
informational needs
 It is important that a system of referrals be accessed and that the
clinician does not fall into three common errors of thinking —
(1)that they must provide for all of the patient’s needs
(2)that the patient only needs what they can provide
(3)that follow-up means care for acute problems only

 Once the relationship is established and the patient understands

his/her situation and the condition is stable, the interval may be
extended to every 3 months
 Follow-Up Visits, continued

 Should include the following tests:

– Complete blood count every 3 months

– CD4 cell count or lymphocytes every 6 months
– HIV viral load every 6 months
– Other examinations according to symptoms
 What are Anti Retroviral (ARV’s)
Drugs and how do they work?
They stop HIV replicating in the CD4 Cells and stop newly produced HIV from
infecting other cells. This means that the amount of HIV in the body is reduced
and the damage that it can do to the immune system is limited.
!
The Science Bit!
Chemicals, called enzymes, are important in making the HIV copies.
There are two important enzymes involved in HIV:
Reverse Transcriptase: drugs that stop this enzyme from working stop
HIV from being made.
Protese: drugs that stop this enzyme from working results in ‘bad’ HIV being
made. This HIV is unable to infect CD4 cells

Most people will take a combination of these drugs known as Combination

therapy, as this works better than just taking one.
 Does Combination therapy always
work?
Combination therapy can fail for a number of reasons. In order for the drug to
work effectively the person has to keep a certain level of the drug in their blood.
If a person misses doses, doesn’t take drugs on time and doesn’t follow dietary
instructions, then the levels of the drug in their blood will fall and the drug will
be unable to work.

The problem of Resistance:

 A person’s body may develop resistance to one the drugs in the combination therapy.
Studies have shown that resistance is growing.
 How? The HIV in the body can change (mutate) slightly which means that it can carry
on replicating and damaging the CD4 cells even when the person is taking the drug.
 Cross- resistance: if HIV is resistant to one type of drug it may also be resistant to all
drugs in the same group.
 Drug-resistant HIV infection: some people have become infected with drug-resistant
HIV which means that their treatment options are limited.
 Are there side effects?
Yes! Some are general and others vary depending on the drugs that are being taken.

General side effects:

 Tiredness.
 Nausea.
 Vomiting.
 Diarrhoea.
 Muscle pains.
 Headaches.
 Skin rashes.

Side effects specific to certain drugs:

 Numbness or pain in the hands or feet.
 Skin rashes and liver problems.
 Increased blood sugar levels
 Increased levels of fats in the blood.
 Is combination therapy
available to everyone?
Although the price of these drugs has been lowered due to public
pressure and generic drug companies (which make cheaper versions of
the drug) they are still too expensive for many people in less developed
countries.

Some statistics
 Only 5% of those people who require treatment in these developing countries
have access to the medicines.
 In Africa only 1 in 1000 HIV+ people are receiving the drug.

Is combination therapy a cure for HIV and AIDS?

 NO! It only reduces the amount of HIV, and allows them to manage the infection
and delay the onset of death. No drug has been found which eliminates or
destroys HIV. That is why it important to protect yourself against the disease.
 Current Antiretroviral Medications
NRTI PI
 Abacavir ABC  Amprenavir APV
 Didanosine DDI  Atazanavir ATV
 Emtricitabine FTC  Fosamprenavir FPV
 Lamivudine 3TC  Indinavir IDV
 Stavudine D4T  Lopinavir LPV
 Zidovudine ZDV  Nelfinavir NFV
 Zalcitabine DDC  Ritonavir RTV
 Tenofovir TDF  Saquinavir SQV
– soft gel SGC
– hard gel HGC
NNRTI
– tablet INV
 Delavirdine DLV
 Tipranavir TPV
 Efavirenz EFV
 Nevirapine NVP
Fusion Inhibitor
10/05
 Enfuvirtide T-20
 Initial Treatment for Previously
Untreated Patients: Choosing
Regimens
 Three categories:
– 1 NNRTI + 2 NRTIs
– 1 PI + 2 NRTIs
– 3 NRTIs
 Few clinical endpoints to guide choices
 Advantages and disadvantages to each type of regimen
 Individualize regimen choice
10/05
The current practices in Bahrain in regard
to the HIV management
 The initial stage
 1. the testing :
– Screening for HIV : pre-employment , pre marital ,
before surgery, pregnancy
– Suspected cases
– High risk groups
 The public health lab
 1. do the initial testing and the confirmation
( ELISA, western blot)
 2. call the patient
 3. do the initial counseling
 4. refer to SMC clinics for treatment
 In SMC
 1. booked in the clinic for early evaluation
 2. do the necessary work up
 3. counseling : prognosis , options of treatment
and the follow up
 4. to start the treatment
 SMC committee
 - medical infectious disease
 - virologist
 - Pharmacists
 - public health
 National committee
 Under formulation headed by the minster of
health
 Epidemiology of HIV and AIDS in Bahrain.
al-Haddad MK, Ebrahim RA
Psychiatric Hospital, Bahrain, Arabian Gulf.
The Journal of Communicable Diseases [1997, 29(4):321-328

 Between 1986 and 1996, 378 HIV cases were identified in Bahrain, of whom 51% were
foreign nationals. Intravenous drug abuse was a major risk factor (38.8%) among
Bahraini nationals, while transmission through sexual contact was more common
(45.7%) among foreigners. Other well known risk factors were also represented in the
two communities. The male to female ratio for the two communities were very different
with 10:1 for nationals compared to 1:1.4 for foreigners. Among the AIDS defining
manifestations, Pneumocystis carinii pneumonia was the commonest (50%), followed by
tuberculosis (21%), oro-esophageal candidiasis, cryptosporidiosis and toxoplasmosis.
Transmission through sex and maternal-foetus route could emerge as significant
contributors in the spread of AIDS in Bahrain unless appropriate preventive steps are
taken.
Thank You