HIV and NACP for NEET PG PSM: India's Epidemic 2025, 95-95-95, TLD, PEP, Vertical Transmission and the HIV Act

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🎯 Exam priority: Medium–high. Expect a needlestick scenario, the first-line regimen, infant prophylaxis, and one current number. The epidemic figures here are from the 2025 estimation round.

CBME mapping: CM 8 (epidemiology of communicable diseases and national programmes).

India's Epidemic

India has a concentrated epidemic: prevalence is far higher in key populations than in adults overall.

In 2024-25, 73% of newly detected people reported heterosexual transmission. The subtype that predominates in India is HIV-1 subtype C.

These figures are model-based, using the UNAIDS-recommended Spectrum tool, so each comes with an uncertainty range.

NACP and 95-95-95

NACP Phase V ran from 1 April 2021 to 31 March 2026 as a central sector scheme. It aims to cut new infections and AIDS-related deaths by 80% from the 2010 baseline, reach universal STI services, eliminate vertical transmission of HIV and syphilis, and end stigma. SDG 3.3 aims to end AIDS as a public health threat by 2030.

95% of PLHIV should know their status, 95% of those on ART, and 95% of those virally suppressed. India's gap is largest at the first 95.

• ART access: 18.60 lakh people on ART in March 2025, through about 800 ART centres.

• Index testing: offering testing to spouses, biological children and partners of people with HIV.

• Sampoorna Suraksha: prevention services for at-risk people who test negative.

• Helpline: 1097.

Testing

Testing is voluntary, with pre-test and post-test counselling and informed consent. A person can opt out without losing other services.

• Strategy III, used for the general population, runs three different assays. A1 has high sensitivity; A2 and A3 have high specificity.

• A person is reported negative if the first test is non-reactive, and positive only when all three are reactive.

• The window period is the time between infection and when a test can detect it, so a negative test may need repeating.

• Infants under 18 months: maternal antibodies persist, so diagnosis uses a nucleic acid test, first at 6 weeks.

Treatment

• Treat All: everyone with HIV starts ART, regardless of clinical stage or CD4 count (national programme since 2017).

• Rapid initiation: within 7 days of diagnosis, preferably the same day, unless an active opportunistic infection needs treating first.

• First line (age over 10 years, weight over 30 kg): TLD, meaning tenofovir 300 mg + lamivudine 300 mg + dolutegravir 50 mg, one fixed-dose tablet once daily.

• Monitoring: viral load at 6 months, 12 months, then every 12 months.

• Suppression: below 1,000 copies/ml after at least 6 months on ART. Virological failure: two consecutive values of 1,000 copies/ml or more.

• HIV with TB: start ART within 2 weeks of starting TB treatment, regardless of CD4. With TB meningitis, delay ART at least 4 weeks. Give cotrimoxazole to all.

Opportunistic Infections

NACO's sequence: as CD4 falls, the list of infections widens. Levels are approximate.

Cotrimoxazole prophylaxis starts at CD4 below 350 cells/mm³ or WHO clinical stage 3 or 4. Start it first, then ART.

Needlestick: Post-Exposure Prophylaxis

Grading the exposure

Never recap a needle. Testing the source must not delay the first dose: start PEP, then seek advice.

Vertical Transmission (EVTHS)

India now aims for dual elimination of HIV and syphilis. Every pregnant or breastfeeding woman with HIV starts triple-drug ART, regardless of CD4 count and stage, and continues for life. Syphilis in pregnancy is treated with injection benzathine penicillin G.

A viral load between 32 and 36 weeks sets the infant's risk:

• All HIV-exposed infants get cotrimoxazole from 6 weeks, until HIV is reliably excluded.

• Early infant diagnosis is at 6 weeks of age or the earliest opportunity.

STI Kits Under NACP

NACP treats STIs by syndromic case management using pre-packaged, colour-coded kits. The 2024 national guidelines list eight kits:

The HIV and AIDS Act 2017

• Discrimination is prohibited, including in employment, health care and education (section 3).

• No test or treatment without informed consent (section 5), and consent includes pre-test and post-test counselling. A court order is one exception.

• Complaints Officer in establishments of 100 or more persons, and 20 or more in health care.

• Ombudsman: every state government must appoint one or more.

• Establishments where workers may be exposed must provide universal precautions.

Traps the Examiner Sets

• Prevalence is low (0.20%), but the absolute number is the world's second largest.

• Highest prevalence: Mizoram and Nagaland. Highest number: Maharashtra. Do not swap them.

• Highest in key populations: people who inject drugs, not sex workers or MSM.

• PEP is 28 days. Do not wait for the source's test before giving it.

• A high-risk breastfed infant gets 12 weeks of dual prophylaxis, not 6.

• Complaints Officer threshold: 100 generally, 20 in health care.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 25-20 — 25.61 lakh people, 0.20% prevalence

• 🧠 Know, Take, Suppress — the three 95s in order

• 🧠 2-72-28 — PEP: ideally 2 hours, within 72 hours, for 28 days

• 🧠 TLD = one pill for all — first-line ART, and PEP in adults

• 🧠 6-12-then yearly — viral load schedule

• 🧠 Breast doubles it — high-risk infant: 6 weeks with replacement feeds, 12 with breastfeeding

• 🧠 100, but 20 in hospitals — Complaints Officer threshold

Rapid-Revision Cards

• PLHIV in India, 2024

  25.61 lakh; second largest number globally.

• Adult prevalence, 2024

  0.20% (male 0.21%, female 0.19%).

• Prevalence above 1%

  Mizoram and Nagaland.

• Most PLHIV

  Maharashtra 3.99 lakh, then Andhra Pradesh 3.10 lakh.

• New infections 2010–24

  Down 48.70%.

• AIDS deaths 2010–24

  Down 81.40%.

• Vertical transmission rate 2024

  10.25%; target below 5%.

• Highest key population

  People who inject drugs, 8.79%.

• 95-95-95 in 2024-25

  83.9–86.6–97.6.

• NACP-V goal

  80% fewer new infections and AIDS deaths than 2010.

• Treat All

  ART regardless of stage or CD4, since 2017.

• Rapid ART

  Within 7 days, preferably same day.

• First-line ART

  TLD: tenofovir + lamivudine + dolutegravir, once daily.

• Viral load schedule

  6 months, 12 months, then every 12 months.

• Virological failure

  Two consecutive values ≥1,000 copies/ml.

• ART with TB

  Within 2 weeks of TB treatment; delay ≥4 weeks in TB meningitis.

• Cotrimoxazole start

  CD4 <350 or WHO stage 3–4.

• OIs around CD4 200

  PCP, oesophageal candidiasis, mucocutaneous herpes.

• PEP timing

  Ideally within 2 hours, preferably within 72 hours; 28 days.

• PEP regimen

  TLD once daily in adults.

• Percutaneous HIV risk

  0.3%.

• Infant prophylaxis, low risk

  Syrup nevirapine, birth to 6 weeks.

• Infant prophylaxis, high risk

  Nevirapine + zidovudine: 6 weeks ERF, 12 weeks EBF.

• Exposed infant at 6 weeks

  Cotrimoxazole + early infant diagnosis.

• Strategy III

  Three assays; A1 sensitive, A2 and A3 specific; positive only if all three reactive.

• STI kits under NACP

  Eight colour-coded kits: grey, green, white, blue, red, yellow, black, brown.

• Kit for PID

  Kit 6, yellow.

• Kit for herpetic ulcer

  Kit 5, red, acyclovir.

• HIV Act 2017

  Consent; no discrimination; Complaints Officer at 100 (20 in health care); state Ombudsman.

Sources

Facts in this article were checked against these documents.

• India HIV Estimation 2025: Technical Report — NACO and ICMR-NIRDHDS, 2025 (link)

• Sankalak: Status of National AIDS & STD Response, Seventh Edition — NACO, 2025 (link)

• National Guidelines for HIV Care and Treatment — NACO, MoHFW, 2021 (link)

• National Guidelines for Elimination of Vertical Transmission of HIV and Syphilis — NACO, MoHFW, 2024 (link)

• National HIV Counselling and Testing Services Guidelines — NACO, MoHFW, 2024 (link)

• National Technical Guidelines on Sexually Transmitted Infections and Reproductive Tract Infections — NACO, MoHFW, 2024 (link)

• The HIV and AIDS (Prevention and Control) Act, 2017 (No. 16 of 2017) — Gazette of India, 2017 (link)

Test Yourself: Practice Questions

Twenty-six questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A nurse has a deep needlestick from a large-bore needle used on an HIV-positive patient. The most appropriate immediate step is to

• (a) wait for the source's viral load before deciding

• (b) start PEP at once, without waiting for the source's test results

• (c) give hepatitis B immunoglobulin alone

• (d) test the nurse and start PEP only if positive

Q2. The duration of HIV post-exposure prophylaxis is

• (a) 3 months

• (b) 28 days

• (c) 14 days

• (d) 7 days

Q3. The preferred adult PEP regimen under NACO is

• (a) zidovudine + lamivudine + nevirapine

• (b) tenofovir + lamivudine + dolutegravir

• (c) tenofovir + emtricitabine alone

• (d) stavudine + lamivudine + efavirenz

Q4. The average risk of HIV seroconversion after a percutaneous exposure is

• (a) 0.03%

• (b) 30%

• (c) 0.3%

• (d) 3%

Q5. A doctor has a superficial cut from a solid needle. Under NACO's categories this exposure is

• (a) moderate

• (b) not an exposure

• (c) severe

• (d) mild

Q6. NACP provides PEP for

• (a) only source-positive exposures

• (b) any high-risk sexual exposure

• (c) occupational exposures and victims of sexual assault

• (d) only health workers

Q7. A 30-year-old is newly diagnosed with HIV. CD4 is 620 cells/mm³ and she is well. The correct action is to

• (a) start only after a WHO stage 3 illness

• (b) wait until CD4 is below 200

• (c) start ART now, preferably the same day

• (d) wait until CD4 is below 350

Q8. The preferred first-line ART regimen for adults in India is

• (a) zidovudine + lamivudine + efavirenz

• (b) tenofovir + lamivudine + dolutegravir

• (c) lopinavir/ritonavir monotherapy

• (d) tenofovir + lamivudine + nevirapine

Q9. A patient on first-line ART had a viral load 6 months after starting. When is the next routine viral load?

• (a) At 7 months

• (b) At 12 months

• (c) At 24 months

• (d) Only if symptomatic

Q10. Virological failure in the national programme is defined as

• (a) CD4 below 200

• (b) any new opportunistic infection

• (c) a single viral load above 50 copies/ml

• (d) two consecutive viral loads of 1,000 copies/ml or more

Q11. A man with HIV and pulmonary TB has just started TB treatment. ART should begin

• (a) after TB treatment ends

• (b) within 2 weeks, regardless of CD4

• (c) only if CD4 is below 200

• (d) after the intensive phase

Q12. A man with HIV has TB meningitis. ART should be

• (a) delayed at least 4 weeks

• (b) never started

• (c) started the same day

• (d) started within 2 weeks

Q13. Cotrimoxazole prophylaxis in adults under NACO starts at a CD4 count below

• (a) 100 cells/mm³

• (b) 350 cells/mm³

• (c) 200 cells/mm³

• (d) 500 cells/mm³

Q14. A breastfed infant is born to a mother whose viral load was not suppressed after 32 weeks. The infant needs

• (a) syrup nevirapine alone for 6 weeks

• (b) syrup zidovudine alone for 28 days

• (c) no prophylaxis

• (d) syrup nevirapine plus zidovudine for 12 weeks

Q15. An infant's mother had a suppressed viral load at 34 weeks. The prophylaxis is

• (a) syrup nevirapine from birth till 6 weeks

• (b) syrup nevirapine plus zidovudine for 12 weeks

• (c) none

• (d) syrup zidovudine for 28 days

Q16. An HIV-exposed infant comes for the 6-week visit. Which is correct?

• (a) Start cotrimoxazole and do early infant diagnosis

• (b) Antibody test at 6 weeks confirms infection

• (c) Stop routine vaccines

• (d) Wait until 18 months to test

Q17. In HIV testing Strategy III, the first assay should have

• (a) high sensitivity

• (b) high specificity

• (c) the longest window period

• (d) low cost only

Q18. Under Strategy III, a person is reported HIV-positive when

• (a) the fourth-generation test is reactive

• (b) the first test is reactive

• (c) any two tests are reactive

• (d) all three tests are reactive

Q19. According to the 2025 estimates, adult HIV prevalence in India is

• (a) 0.50%

• (b) 2.0%

• (c) 0.20%

• (d) 0.02%

Q20. The state with the largest estimated number of PLHIV is

• (a) Andhra Pradesh

• (b) Mizoram

• (c) Maharashtra

• (d) Uttar Pradesh

Q21. Among key populations in India, HIV sero-prevalence is highest in

• (a) hijra/transgender persons

• (b) men who have sex with men

• (c) people who inject drugs

• (d) truckers

Q22. India's progress on 95-95-95 in 2024-25 was

• (a) 83.9%-86.6%-97.6%

• (b) 70.7%-82.5%-84.9%

• (c) 95%-95%-95%

• (d) 60%-70%-80%

Q23. A hospital with 40 employees must, under the HIV and AIDS Act 2017, have a

• (a) National AIDS Tribunal

• (b) Blood Bank Officer

• (c) Complaints Officer

• (d) State Ombudsman

Q24. A hospital tests a patient for HIV before surgery without telling him. Under the HIV and AIDS Act 2017 this is

• (a) allowed for any planned surgery

• (b) the surgeon's choice

• (c) a breach of the informed consent requirement

• (d) allowed if the result is kept secret

Q25. A woman has lower abdominal pain and pelvic inflammatory disease. Under NACP's colour-coded STI kits she receives

• (a) Kit 2 (green)

• (b) Kit 5 (red)

• (c) Kit 1 (grey)

• (d) Kit 6 (yellow)

Q26. A man has a painful genital ulcer with grouped vesicles, suggesting herpes. The NACP kit is

• (a) Kit 5 (red), acyclovir

• (b) Kit 7 (black), doxycycline

• (c) Kit 3 (white), benzathine penicillin

• (d) Kit 1 (grey), azithromycin and cefixime

Active Recall

From memory: state India's HIV burden, the highest-prevalence group and the 95-95-95 progress; the rule for starting ART and the first-line regimen; the viral load schedule; how to manage a needlestick; how to choose infant prophylaxis; and the main duties under the HIV and AIDS Act 2017.