📌 HIV – Key Points For NORCET-2025 (Based on 2024 National HIV Counselling & Testing Guidelines)
एचआईवी: टेस्ट, स्क्रीनिंग, काउंसलिंग और ट्रीटमेंट – नॉरसेट 2025 की तैयारी
🔹 Basics of HIV
HIV = Human Immunodeficiency Virus → destroys CD4 T-helper cells.
AIDS = Acquired Immune Deficiency Syndrome (late stage with Opportunistic Infections).
🔹 Transmission Risk
- Blood transfusion / unsafe blood → >98%
- Perinatal (Mother to Child) → 20–40%
- Sexual Transmission (0.1–1%)
- Vaginal → 0.05–0.1%
- Anal → 0.065–0.5%
- Oral → 0.005–0.01%
Needle-stick / Injection drug use → 0.3–0.67%
NOT spread by hugging, kissing, mosquito bite, food, utensils, toilets.
🔹 Normal Laboratory Values
Normal CD4 count: 500–1500 cells/mm³
Severe immunosuppression (risk of AIDS OIs): CD4 <200 cells/mm³
HIV viral load (undetectable): <50 copies/mL (may vary by assay).
🔹 HIV Testing & Screening
🔹 Laboratory Network (5-tier system in India)
- Apex Lab → ICMR-NARI (Indian Council of Medical Research – National AIDS Research Institute).
- NRLs → National Reference Laboratories (13).
- SRLs → State Reference Laboratories (117).
- ICTCs → Integrated Counselling & Testing Centres (4657+ confirmatory).
- Screening sites → 30,000+ across India.
🔹 Tests
ELISA = Enzyme-Linked Immunosorbent Assay (screening/diagnosis).
RDT = Rapid Diagnostic Test.
HIV-Syphilis Dual Test = detects both HIV & Syphilis.
Self-Testing = screening only → must confirm at ICTC.
🔹 Strategies
Index Testing = test partners & family of HIV+ clients.
SNS = Social Network Strategy → test wider social contacts.
PITC = Provider Initiated Testing & Counselling → by doctors during hospital visits.
🔹 HIV Counselling
🔹 Five Cs of Testing
1. Consent
2. Confidentiality
3. Counselling
4. Correct test results
5. Connection to care
🔹 Types of Counselling
Pre-test counselling → Explain procedure, obtain consent, risk reduction.
Post-test counselling → Give results, emotional support, link to ART care.
🔹 Special Situations
- HIV+ pregnant women
- Adolescents
- Victims of sexual assault
- Co-infections: TB, Hepatitis B, Hepatitis C
🔹 HIV Prevention & Treatment
ART = Antiretroviral Therapy → combination of 3+ drugs to suppress HIV.
Current 1st-line regimen (India): TLD = Tenofovir + Lamivudine + Dolutegravir.
Test & Treat Policy (2017 onwards): ART for ALL HIV+, regardless of CD4 count.
U=U = Undetectable = Untransmittable (no transmission if viral load suppressed).
🔹 Preventive Therapy
PrEP = Pre-Exposure Prophylaxis → daily ARV pill for high-risk HIV-negative persons.
PEP = Post-Exposure Prophylaxis:Start within 2 hours (max 72 hrs).Continue 28 days.
Follow-up HIV test → at 6, 12, 24 weeks.
🔹 Mother-to-Child Transmission
EVTHS = Elimination of Vertical Transmission of HIV & Syphilis.
HIV+ pregnant women → lifelong ART.
Infants → Nevirapine prophylaxis + Cotrimoxazole preventive therapy (CPT).
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🔹 Safety Guidelines (Healthcare & Community)
HCWs (Healthcare Workers):
- Use Exposure Codes (type of injury) + Source Codes (HIV status of source) for risk assessment.
- After needle-stick: wash with soap & water, start PEP immediately.
- Avoid blood donation, pregnancy, breastfeeding until follow-up testing is clear.
Biomedical Waste Disposal:
- Yellow/Red/Blue/Black colour-coded bags/containers for segregation.
General Safety: Condom promotion, safe sex, safe injection, no needle sharing.
✅ Quick Memory Aid
5 Cs = Consent, Confidentiality, Counselling, Correct result, Connection to care.
Normal CD4 = 500–1500; AIDS if <200.
PEP = within 72 hrs, 28-day ART.
PrEP = prevention for HIV-negative high-risk.
U=U = Undetectable = Untransmittable.
EVTHS = Elimination of Vertical Transmission of HIV & Syphilis.