1. Different types of HIV epidemic as per WHO and UNAIDS? 2. UNAIDS 2016-2021 strategies? 3. High risk group, bridge population? Targeted intervention for the high risk groups? Number 4. Risk of contracting HIV in various mode of transmission? 5. Difference between AIDS related complex and AIDS? 6. Opportunistic infection in AIDS? 7. WHO case definition for AIDS surveillance? 8. WHO clinical staging of HIV disease for adults, adolescents and children? 9. Screening and confirmatory tests for HIV?AIDS/ 10. Haematological findings in HIV/AID? 11. WHO’s 5C’s in HIV counselling(ICTC)? 12. Prevention of HIV? 13. What are the antiretroviral treatment regime using in yourfacility? 14. Post exposure prophylaxis? 15. Use of co-trimoxazole in HIV related infection? 16. NACO structure? 17. HIV sentinel surveillance? 18. Level of HIV counselling and testing services in india? 19. Prevention of parent to child transmission in HIV? 20. Activities to reduce in HIV –TB mortality? 21. List out important side effects of Anti retro viral drugs.
Reading File
This is a broad HIV/AIDS syllabus covering epidemiology, program management, clinical staging, treatment, and prevention. Here's the map of what it covers:
1. Epidemiology & Classification
- Types of HIV epidemic (WHO/UNAIDS)
- UNAIDS 2016-2021 strategy
- High-risk groups, bridge population, targeted interventions
- Risk of transmission by mode/exposure
- HIV sentinel surveillance
2. Clinical Disease
- AIDS-related complex vs AIDS
- Opportunistic infections in AIDS
- WHO case definition for AIDS surveillance
- WHO clinical staging (adults/adolescents/children)
- Haematological findings in HIV/AIDS
3. Diagnostics & Counselling
- Screening and confirmatory tests for HIV
- WHO's 5 C's in HIV counselling (ICTC)
- Levels of HIV counselling/testing services in India
4. Treatment
- ART regimens
- Post-exposure prophylaxis (PEP)
- Co-trimoxazole use in HIV-related infection
- Side effects of antiretroviral drugs
5. Prevention & Program (India-specific)
- General HIV prevention
- Prevention of parent-to-child transmission (PPTCT)
- NACO structure
- HIV-TB mortality reduction activities
This looks like a Community Medicine/PSM exam question bank (very similar to standard India NACO/WHO-based curriculum). Given the scope, I'll go deep on one topic at a time rather than give shallow answers to all 21.
Asking for Preferences
Which topic should I go deep on first?
This is a broad HIV/AIDS syllabus covering epidemiology, program management, clinical staging, treatment, and prevention. Here's the map of what it covers:
1. Epidemiology & Classification
- Types of HIV epidemic (WHO/UNAIDS)
- UNAIDS 2016-2021 strategy
- High-risk groups, bridge population, targeted interventions
- Risk of transmission by mode/exposure
- HIV sentinel surveillance
2. Clinical Disease
- AIDS-related complex vs AIDS
- Opportunistic infections in AIDS
- WHO case definition for AIDS surveillance
- WHO clinical staging (adults/adolescents/children)
- Haematological findings in HIV/AIDS
3. Diagnostics & Counselling
- Screening and confirmatory tests for HIV
- WHO's 5 C's in HIV counselling (ICTC)
- Levels of HIV counselling/testing services in India
4. Treatment
- ART regimens
- Post-exposure prophylaxis (PEP)
- Co-trimoxazole use in HIV-related infection
- Side effects of antiretroviral drugs
5. Prevention & Program (India-specific)
- General HIV prevention
- Prevention of parent-to-child transmission (PPTCT)
- NACO structure
- HIV-TB mortality reduction activities
This looks like a Community Medicine/PSM exam question bank (very similar to standard India NACO/WHO-based curriculum). Given the scope, I'll go deep on one topic at a time rather than give shallow answers to all 21.
Finding Sources
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Searching the Web
NACO National AIDS Control Organisation structure organogram India
Searching the Web
UNAIDS 2016-2021 strategy fast track 90-90-90 targets
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HIV/AIDS — Community Medicine Viva Notes (Answers to All 21 Questions)
This is a standard PSM/Community Medicine question set on the NACO/WHO HIV programme. I've pulled key facts from Park's Textbook of Preventive and Social Medicine and UNAIDS sources, supplemented with standard clinical/programmatic knowledge.
1. Types of HIV epidemic (WHO/UNAIDS)
| Type | Definition |
|---|---|
| Low-level epidemic | HIV never spread to significant levels in any sub-population; prevalence <5% in any defined sub-population |
| Concentrated epidemic | Prevalence consistently >5% in one or more high-risk groups (FSW, MSM, IDU) but <1% in pregnant women in urban areas (general population) |
| Generalized epidemic | Prevalence consistently >1% in pregnant women — infection well established in general population, independent of high-risk groups |
India as a whole is a concentrated epidemic, though a few states/districts show generalized epidemic patterns.
2. UNAIDS 2016–2021 Strategy
The Fast-Track Strategy to end AIDS by 2030, built on two pillars — Speed (accelerating scale-up of services) and Saturation (delivering full-intensity services to prioritized locations/populations). Key 2020 milestones:
- 90-90-90 targets: 90% of PLHIV know their status; 90% of those diagnosed on ART; 90% of those on ART virally suppressed
- Reduce new adult infections to <500,000/year globally (75% reduction vs 2010)
- Zero discrimination This has since been superseded by the Global AIDS Strategy 2021–2026 ("End Inequalities, End AIDS") and 95-95-95 targets for 2025.
3. High-risk groups, bridge population, targeted intervention & numbers
High-risk groups (HRGs): Female sex workers (FSW), men who have sex with men (MSM), transgender/hijra, people who inject drugs (PWID/IDU).
Bridge population: Groups that have sexual contact with both HRGs and the general population, transmitting infection from the high-prevalence pool into the general community — e.g., clients of FSWs, truck drivers, migrant labourers. NACO specifically categorizes truck drivers as a bridge population because of unprotected sex with FSWs plus regular partners (Park's PSM).
Targeted Interventions (TI) under NACP are peer-led, outreach-based packages for HRGs/bridge populations covering: behaviour change communication, condom promotion, STI treatment, needle-syringe exchange (for IDUs), and linkage to ICTC/ART. As per NACO, a standard TI project typically covers a target of around 1,000–2,000 core HRG members (varies by category/geography) run through NGOs/CBOs.
4. Risk of contracting HIV by mode of transmission
| Route | Approximate risk per exposure |
|---|---|
| Blood transfusion (infected unit) | >90% (~92-95%) |
| Mother-to-child (no intervention) | 15-45% (in-utero + intrapartum + breastfeeding) |
| Needle-stick injury (occupational) | ~0.3% |
| Receptive anal intercourse | ~0.5-3% (highest sexual risk) |
| Insertive anal intercourse | ~0.06% |
| Receptive vaginal intercourse | ~0.08-0.3% |
| Insertive vaginal intercourse | ~0.04-0.1% |
| Needle-sharing (IDU) | ~0.6-0.8% |
| Receptive oral sex | very low (<0.04%), difficult to quantify |
Risk rises with: high viral load in source, genital ulcer disease/STIs, absence of male circumcision, menstruation, anal intercourse, and advanced disease stage in the source partner (Park's PSM).
5. AIDS-Related Complex (ARC) vs AIDS
ARC is an older (largely obsolete) term for a symptomatic but pre-AIDS stage of HIV infection — persistent generalized lymphadenopathy, fatigue, weight loss, night sweats, intermittent fever, diarrhoea — without the AIDS-defining opportunistic infections/malignancies. Essentially corresponds to what is now covered by WHO Clinical Stage 2/3.
AIDS is the advanced, end-stage of HIV infection defined by a CD4 count <200 cells/mm³ and/or occurrence of AIDS-defining illnesses (opportunistic infections, malignancies like Kaposi sarcoma, or wasting syndrome) — corresponding to WHO Clinical Stage 4.
The distinction (ARC vs AIDS) has been replaced in modern practice by the CDC/WHO staging systems using CD4 counts and clinical stage.
6. Opportunistic Infections in AIDS
- Protozoal: Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis (CNS), cryptosporidiosis, isosporiasis
- Fungal: Oesophageal/tracheal candidiasis, cryptococcal meningitis, disseminated histoplasmosis/coccidiomycosis
- Viral: CMV retinitis/colitis, chronic herpes simplex, progressive multifocal leukoencephalopathy (JC virus), HPV-related cancers
- Bacterial: Pulmonary & extrapulmonary TB, disseminated non-tuberculous mycobacteria (MAC), recurrent severe bacterial pneumonia, salmonella septicaemia
- Malignancies associated: Kaposi sarcoma, non-Hodgkin lymphoma, invasive cervical cancer
(Full list per WHO Clinical Stage 4 criteria — Park's PSM)
7. WHO Case Definition for AIDS Surveillance
Simple (original, resource-limited) definition — presence of at least 2 major + 1 minor sign, in absence of other causes of immunosuppression:
- Major: weight loss >10% body weight, chronic diarrhoea >1 month, prolonged fever >1 month
- Minor: persistent cough >1 month, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic progressive/disseminated herpes simplex, generalized lymphadenopathy (+ Kaposi sarcoma or cryptococcal meningitis alone are sufficient)
Expanded WHO case definition (adults/adolescents >12 years): HIV-antibody positive plus one or more of — ≥10% weight loss/cachexia with diarrhoea/fever ≥1 month, cryptococcal meningitis, pulmonary/extrapulmonary TB, Kaposi sarcoma, disabling neurological impairment, oesophageal candidiasis, recurrent/life-threatening pneumonia, or invasive cervical cancer (Park's PSM, p. ~??? — "Expanded WHO case definition for AIDS surveillance").
8. WHO Clinical Staging of HIV Disease
Adults & Adolescents:
- Stage 1: Asymptomatic; persistent generalized lymphadenopathy
- Stage 2: Moderate weight loss (<10%), recurrent respiratory infections, herpes zoster, angular cheilitis, recurrent oral ulcers, seborrhoeic dermatitis, fungal nail infections
- Stage 3: Severe weight loss (>10%), unexplained chronic diarrhoea/fever >1 month, oral candidiasis, oral hairy leukoplakia, pulmonary TB, severe bacterial infections, unexplained anaemia (<8g/dl)/neutropenia/thrombocytopenia
- Stage 4 (AIDS-defining): HIV wasting syndrome, PCP, recurrent severe bacterial pneumonia, chronic HSV, oesophageal candidiasis, extrapulmonary TB, Kaposi sarcoma, CMV disease, CNS toxoplasmosis, HIV encephalopathy, extrapulmonary cryptococcosis, disseminated NTM, PML, chronic cryptosporidiosis/isosporiasis, disseminated mycosis, invasive cervical cancer, atypical disseminated leishmaniasis, HIV-associated nephropathy/cardiomyopathy (Park's PSM, Table 2)
Children: Uses analogous 4-stage system, with paediatric-specific minor criteria (oropharyngeal candidiasis, recurrent ear infections, pharyngitis, persistent cough, generalized rash) and confirmed maternal HIV counted as a minor criterion in the simple definition.
9. Screening and Confirmatory Tests for HIV/AIDS
Screening (highly sensitive, done first):
- ELISA (3rd/4th generation, detects Ag+Ab)
- Rapid tests (immunochromatographic/dot-blot, e.g., Tri-Dot, Comb Aids) — used widely at ICTCs
Confirmatory strategy (NACO uses a 3-test strategy with different antigen/principle assays, not Western blot, for cost-effectiveness in India):
- Sample reactive on Test 1 (screening ELISA/rapid) → repeat on Test 2 (different antigen/principle) → if both reactive, Test 3 (third different kit) confirms positive
- Western blot / line immunoassay — traditional gold-standard confirmatory test in resource-rich settings
- NAT/PCR (HIV RNA/DNA PCR) — for early infection (window period), infants <18 months (maternal antibody interferes with ELISA)
10. Haematological Findings in HIV/AIDS
- Profound lymphopenia (often <500/cu mm), reversed CD4:CD8 (helper:suppressor) ratio
- Anaemia (normocytic/normochromic, often <8g/dl in advanced disease) — from marrow suppression, chronic disease, zidovudine, or opportunistic infection
- Neutropenia (<0.5×10⁹/L) and thrombocytopenia (<50×10⁹/L, sometimes immune-mediated ITP-like)
- Bone marrow hypocellularity/dysplastic changes, hypergammaglobulinemia
- These cytopenias are part of the WHO clinical Stage 3 criteria (Park's PSM)
11. WHO's 5 C's of HIV Counselling (ICTC)
- Consent — informed, voluntary consent before testing
- Confidentiality — test results kept confidential
- Counselling — pre-test and post-test counselling provided
- Correct test results — accurate, quality-assured testing
- Connection to care/treatment/prevention services — linkage to ART, PPTCT, TI, prevention services
12. Prevention of HIV
- Primary prevention: Health education/BCC, condom promotion, safe sexual behaviour, STI treatment, blood/blood product safety, safe injection practices, harm reduction (needle-syringe exchange, opioid substitution for IDUs), targeted interventions in HRGs, PrEP for high-risk individuals
- PPTCT for HIV-positive pregnant women
- PEP after occupational/non-occupational exposure
- Secondary prevention: Early diagnosis (ICTC), treatment as prevention (ART reduces transmission via viral suppression), partner testing
- Tertiary: OI prophylaxis, ART to prevent progression/mortality, palliative/rehabilitative care
13. Antiretroviral Treatment Regimens (NACO/WHO standard first-line, India)
Standard practice in India follows the NACO ART guidelines (aligned with WHO):
- First-line (adults): TLD — Tenofovir (TDF) 300mg + Lamivudine (3TC) 300mg + Dolutegravir (DTG) 50mg, once daily fixed-dose combination (current preferred regimen)
- Older first-line: TDF + 3TC + Efavirenz (EFV)
- Second-line: Zidovudine (AZT)/TDF + 3TC + boosted Protease Inhibitor (Atazanavir/r or Lopinavir/r)
- Third-line: Darunavir/r or Raltegravir-based salvage regimens
- ART is now initiated for all PLHIV regardless of CD4 count ("Test and Treat" policy)
14. Post-Exposure Prophylaxis (PEP)
- Offer to anyone with potential HIV exposure, ideally within 72 hours (as early as possible)
- Includes first aid, risk assessment, HIV testing/counselling, and 28-day course of ARVs
- Eligible exposures: parenteral/mucosal exposure to blood, blood-stained fluids, semen, vaginal secretions, breast milk, CSF, amniotic/synovial/pleural/pericardial/peritoneal fluid
- Not needed for: exposed person already HIV+, source confirmed HIV-negative, or exposure to non-risk fluids (urine, sweat, tears, non-bloody saliva)
- Preferred 3-drug regimen: TDF + 3TC/FTC + Raltegravir or Dolutegravir, for 28 days
- Pregnancy testing recommended before starting DTG-based PEP in women of childbearing age (Park's PSM)
15. Co-trimoxazole Use in HIV-Related Infection
Co-trimoxazole (CPT) prophylaxis prevents PCP and toxoplasmosis, and reduces bacterial infections/malaria in HIV patients (per WHO 2016 guidance):
- Adults (incl. pregnant women): Start at WHO stage 3/4 and/or CD4 ≤350; in high malaria/bacterial-infection settings, start regardless of stage/CD4; may stop once stable on ART with immune recovery + viral suppression (unless in high-malaria settings, continue regardless)
- Children <5 years: Started irrespective of clinical/immune status; priority for all under-5s
- HIV-exposed infants: Start at 4-6 weeks of age, continue until HIV infection excluded after complete cessation of breastfeeding
- HIV-TB coinfection: Routine CPT for all HIV patients with active TB regardless of CD4 count
16. NACO Structure
National AIDS Control Organisation (NACO), established 1992, is a division under the Ministry of Health & Family Welfare, and is India's nodal body for HIV/AIDS policy formulation and programme implementation. Structure (broadly):
- National level: NACO (Director General) → oversees National AIDS Control Programme (currently NACP-V)
- State level: State AIDS Control Societies (SACS) in each state/UT
- District level: District AIDS Prevention & Control Units (DAPCU)
- Implements through 35 HIV/AIDS Prevention & Control Societies, works jointly with ICMR for HIV estimations (biennial), and coordinates blood-bank licensing/transfusion safety with drug control authorities.
17. HIV Sentinel Surveillance
NACO conducts HIV Sentinel Surveillance (HSS) annually/biennially across designated sentinel sites to track prevalence trends:
- High-risk group sentinel sites: FSW, MSM, IDU, transgender
- General population sentinel sites: Antenatal clinic (ANC) attendees (proxy for general population prevalence), STI clinic attendees
- Data used to classify districts/states by epidemic level (low-level/concentrated/generalized) and guide resource allocation for targeted interventions.
18. Levels of HIV Counselling & Testing Services in India
- ICTC (Integrated Counselling & Testing Centre) — standalone/facility-integrated centres offering free confidential HIV testing + counselling (fixed ICTC, mobile ICTC/Facilitated ICTC for outreach)
- PPTCT centres — integrated with ANC/maternity services
- Community-Based Testing — outreach via TI projects, mobile vans for HRGs
- Facility-Integrated Counselling and Testing (F-ICTC) — at PHC/CHC/District hospital level, linked to OPD/IPD, TB, STI clinics
- Confirmed positives are linked to ART centres / Link ART centres (LAC) for treatment initiation and follow-up.
19. Prevention of Parent-to-Child Transmission (PPTCT)
- Universal HIV screening offered to all pregnant women at ANC (opt-out testing)
- HIV-positive pregnant women started on lifelong ART (Option B+) as soon as diagnosed, regardless of CD4/clinical stage
- Safe delivery practices (avoid prolonged labour/unnecessary invasive procedures)
- Infant prophylaxis: Nevirapine syrup (or AZT+NVP) from birth for 6 weeks depending on maternal ART duration/viral status
- Early Infant Diagnosis via DNA-PCR at 6 weeks; confirmatory antibody test at 18 months
- Counselling on infant feeding (exclusive breastfeeding with maternal ART preferred in India, given cost/access to formula and infection risk from mixed feeding)
- Family planning counselling for HIV-positive women
20. Activities to Reduce HIV-TB Mortality
- Intensified TB case-finding in all HIV care settings at every visit
- Isoniazid Preventive Therapy (IPT) for PLHIV without active TB
- Infection control measures in health facilities
- Xpert MTB/RIF as first-line diagnostic (rather than smear microscopy) for faster, more sensitive diagnosis in PLHIV
- Early ART initiation in all HIV-TB coinfected patients (within 2-8 weeks of starting TB treatment depending on CD4)
- Routine co-trimoxazole prophylaxis in HIV-TB coinfection regardless of CD4
- Integrated/collaborative TB-HIV service delivery (cross-referral between ART centres and DOTS centres), joint monitoring under National TB Elimination Programme and NACO
21. Important Side Effects of Antiretroviral Drugs
| Drug class/drug | Key side effects |
|---|---|
| Zidovudine (AZT) | Anaemia, neutropenia, myopathy, GI intolerance |
| Tenofovir (TDF) | Nephrotoxicity, reduced bone mineral density, Fanconi syndrome |
| Lamivudine/Emtricitabine | Generally well tolerated; rare pancreatitis |
| Efavirenz (EFV) | CNS effects (vivid dreams, dizziness, psychiatric symptoms), rash, hepatotoxicity, teratogenic concerns |
| Nevirapine (NVP) | Hepatotoxicity, severe rash/Stevens-Johnson syndrome |
| Dolutegravir/Raltegravir (Integrase inhibitors) | Weight gain, insomnia, headache; rare neural tube defects if taken at conception (DTG) |
| Protease inhibitors (Lopinavir/r, Atazanavir/r) | GI upset, dyslipidaemia, insulin resistance/lipodystrophy, jaundice (Atazanavir - indirect hyperbilirubinemia) |
| Abacavir | Hypersensitivity reaction (test HLA-B*5701 if available) |
| Class-wide (long-term ART) | Lipodystrophy, metabolic syndrome, lactic acidosis (older NRTIs), immune reconstitution inflammatory syndrome (IRIS) on ART initiation |
Note on Q13: Since I don't have access to your specific clinical facility's protocol, I've given the current standard NACO/WHO first-line regimen (TLD) used across Indian government ART centres — please substitute with your actual institution's protocol if it differs from this.
A recent quick check of systematic reviews/meta-analyses on 90-90-90/95-95-95 target achievement (PMC12067493, 2024) confirms these targets remain the current framework, consistent with what's summarized above — no contradictions found.
If you want, I can go deeper into any single topic (e.g., a labelled diagram of WHO clinical staging, the full ART drug-class mechanism table, or a step-by-step PPTCT flowchart) — just tell me which one.
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