HIV/AIDS Control Program

HIV/AIDS: Epidemiology & Pathogenesis - Viral Vitals

• Virus: Retrovirus (Lentivirus); two ssRNA strands.
• Key Enzymes: Reverse Transcriptase, Integrase, Protease (📌 RIP).
• Proteins: Envelope (gp120 for CD4 binding, gp41 for fusion), Capsid (p24 antigen - early marker).
• Transmission: Sexual, Parenteral (blood), Perinatal (mother-to-child).
• Pathogenesis: Infects CD4+ T-cells, macrophages, dendritic cells → progressive CD4 depletion → immunodeficiency.
  • Normal CD4 count: 500-1500 cells/mm³.
  • AIDS: CD4 count < 200 cells/mm³ or AIDS-defining illness.

⭐ HIV primarily targets CD4+ T-lymphocytes, leading to their destruction and severe immunodeficiency.

NACP: Phases & Objectives - India's Shield

India's National AIDS Control Programme (NACP) is the cornerstone of its HIV/AIDS response, evolving through several phases:

• Core Objectives:
  • Reduce new infections (Prevention).
  • Provide comprehensive Care, Support & Treatment (CST).
  • Reduce stigma & discrimination.
  • Strengthen surveillance & monitoring systems.

⭐ NACP V aims to achieve the 95-95-95 targets: 95% of people living with HIV (PLHIV) know their status, 95% of diagnosed PLHIV receive sustained Antiretroviral Therapy (ART), and 95% of all people receiving ART achieve viral suppression by 2025.

HIV Prevention & Diagnosis - Detect & Protect

• Prevention Pillars:
  • Safe Sex: Condom promotion, reduce partners.
  • Blood Safety: Mandatory screening of blood products.
  • PPTCT: ART for HIV+ pregnant women; infant Nevirapine prophylaxis for 6 weeks.
  • Harm Reduction: Needle exchange for IDUs.
  • PEP: Start within 72 hrs (ideally <2 hrs), 28-day regimen.
  • PrEP: For high-risk individuals.
• Diagnosis:
  • Screening: ELISA (4th gen detects p24 Ag & Ab).
  • Confirmatory: Western Blot or 2 different rapid tests (serial testing).
  • Early Infant Diagnosis (EID): HIV DNA PCR at 6 weeks, 6 months, 12 months.

⭐ Window period for HIV antibody detection is typically 3 weeks to 3 months; 4th gen tests & NAT reduce this.

HIV Treatment & OI Prophylaxis - Treatment Tactics

• ART Initiation:
  • "Treat All" policy. Goal: ↓VL, ↑CD4, ↓morbidity/mortality.
• Preferred Regimens (NACO):
  • First-line: TLD (Tenofovir 300mg + Lamivudine 300mg + Dolutegravir 50mg).
• Adherence:
  • Critical for success (>95%).
• Monitoring:
  • Viral Load (VL): Primary efficacy marker. Target < 50 copies/mL. Check at 6, 12 months, then annually.
  • CD4 count: Monitors immune recovery. Baseline, then 6-monthly.
• OI Prophylaxis (CD4-guided):
  • TB: IPT (6 months) for all (rule out active TB).
  • PCP (PJP): CD4 < 200 cells/µL → Cotrimoxazole.
  • Toxoplasmosis: CD4 < 100 cells/µL (IgG+) → Cotrimoxazole.

⭐ Dolutegravir (DTG) based regimens are preferred first-line ART due to high efficacy, good tolerability, and high barrier to resistance.

High-Yield Points - ⚡ Biggest Takeaways

• NACO is the apex body for India's HIV/AIDS control program.
• NACP-V (2021-2026) targets UNAIDS 95-95-95 targets by 2025; aims for epidemic elimination by 2030.
• "Test and Treat" policy: ART for all PLHIV, regardless of CD4 count/clinical stage.
• PPTCT program is vital for preventing vertical HIV transmission.
• Targeted Interventions (TIs) focus on High-Risk Groups (HRGs) and vulnerable populations.
• HIV/AIDS Act, 2017 safeguards rights and prohibits discrimination against PLHIV.