# HIV and NACP for NEET PG PSM: India's Epidemic 2025, 95-95-95, TLD, PEP, Vertical Transmission and the HIV Act Source: https://tracknation.in/story/hiv-and-nacp-for-neet-pg-psm-india-s-epidemic-2025-95-95-95-tld-pep-vertical-transmission-and-the-hiv-act (TrackNation β€” free UPSC notes with PYQs) > NEET PG Community Medicine: India's HIV numbers from the 2025 estimates, 95-95-95 progress, the three-test strategy, Treat All and TLD, viral load monitoring, opportunistic infections by CD4 count, cotrimoxazole, PEP after a needlestick, infant prophylaxis under EVTHS 2024 and the HIV and AIDS Act 2017, from NACO documents, with two diagrams, hooks, MCQs and cards. ## Start Here 🎯 **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 | **Indicator (2024)** | **Value** | | People living with HIV (PLHIV) | **25.61 lakh**, second largest number in the world | | Adult prevalence (15–49 years) | **0.20%** (male 0.21%, female 0.19%) | | Incidence | 0.05 per 1,000 uninfected population | | New infections, 2010 to 2024 | Down **48.70%** | | AIDS-related deaths, 2010 to 2024 | Down **81.40%** | | Vertical transmission rate | **10.25%** (target below 5%) | | Highest PLHIV number | Maharashtra 3.99 lakh, then Andhra Pradesh 3.10 lakh | | Prevalence above 1% | Mizoram and Nagaland | | Highest incidence | Mizoram (0.90 per 1,000) | India has a **concentrated** epidemic: prevalence is far higher in key populations than in adults overall. | **Group** | **Sero-prevalence (2024)** | | People who inject drugs | **8.79%** (highest) | | Hijra/transgender persons | 2.84% | | Men who have sex with men | 2.12% | 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/mmΒ³** or WHO clinical stage 3 or 4. Start it first, then ART. ## Needlestick: Post-Exposure Prophylaxis | **Step** | **What to know** | | Timing | First dose ideally within **2 hours**, preferably within **72 hours**; do not wait for the source's result | | Duration | **28 days** | | Adult regimen | **TLD**, one tablet once daily (over 10 years and over 30 kg) | | Alternative | Tenofovir + lamivudine with lopinavir/ritonavir, or tenofovir + lamivudine + efavirenz | | Risk | Average seroconversion after percutaneous exposure: **0.3%** | | Who gets it under NACP | All occupational exposures and victims of sexual assault, not unprotected sex or other high-risk exposure | | Follow-up | HIV test at 6 weeks, 3 months and 6 months | **Grading the exposure** | **Category** | **Example** | | Mild | Small volume on a mucous membrane or non-intact skin; subcutaneous injection with a small-bore needle | | Moderate | Large volume on a mucous membrane; superficial cut or needlestick with a solid needle | | Severe | Large-volume percutaneous exposure: high-calibre needle (>18 G) visibly contaminated with blood, a deep wound, or material used in a vein or artery | 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: | **Infant risk** | **When** | **Prophylaxis** | **Duration** | | **Low** | Mother's viral load suppressed (below 1,000 copies/ml) any time after 32 weeks | Syrup nevirapine | Birth to 6 weeks | | **High** | Mother not on ART; viral load not done or not suppressed after 32 weeks; mother newly diagnosed within 6 weeks of delivery | Syrup nevirapine + syrup zidovudine | 6 weeks if replacement fed; **12 weeks if breastfed** | - 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: | **Kit** | **Contents** | **Syndrome** | | 1 Grey | Azithromycin 1 g + cefixime 800 mg, single dose | Urethral discharge, cervicitis, painful scrotal swelling | | 2 Green | Secnidazole 2 g + fluconazole 150 mg, single dose | Vaginitis | | 3 White | Benzathine penicillin G 2.4 MU + azithromycin 1 g | Genital ulcer: syphilis and chancroid | | 4 Blue | Doxycycline for 14 days + azithromycin 1 g | As kit 3, when penicillin is unavailable or the patient is allergic | | 5 Red | Acyclovir 400 mg three times a day for 7 days | Genital ulcer: herpes | | 6 Yellow | Cefixime 800 mg + metronidazole and doxycycline for 14 days | Lower abdominal pain, PID | | 7 Black | Doxycycline for 21 days | Inguinal bubo; LGV proctitis | | 8 Brown | Cefixime 800 mg + doxycycline for 7 days | Anorectal discharge | ## 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** β€” 25.61 lakh people, 0.20% prevalence - 🧠 **Know, Take, Suppress** β€” the three 95s in order - 🧠 **2-72-28** β€” PEP: ideally 2 hours, within 72 hours, for 28 days - 🧠 **TLD = one pill for all** β€” first-line ART, and PEP in adults - 🧠 **6-12-then yearly** β€” viral load schedule - 🧠 **Breast doubles it** β€” high-risk infant: 6 weeks with replacement feeds, 12 with breastfeeding - 🧠 **100, but 20 in hospitals** β€” Complaints Officer threshold ## Rapid-Revision Cards - 25.61 lakh; second largest number globally. - 0.20% (male 0.21%, female 0.19%). - Mizoram and Nagaland. - Maharashtra 3.99 lakh, then Andhra Pradesh 3.10 lakh. - Down 48.70%. - Down 81.40%. - 10.25%; target below 5%. - People who inject drugs, 8.79%. - 83.9–86.6–97.6. - 80% fewer new infections and AIDS deaths than 2010. - ART regardless of stage or CD4, since 2017. - Within 7 days, preferably same day. - TLD: tenofovir + lamivudine + dolutegravir, once daily. - 6 months, 12 months, then every 12 months. - Two consecutive values β‰₯1,000 copies/ml. - Within 2 weeks of TB treatment; delay β‰₯4 weeks in TB meningitis. - CD4 <350 or WHO stage 3–4. - PCP, oesophageal candidiasis, mucocutaneous herpes. - Ideally within 2 hours, preferably within 72 hours; 28 days. - TLD once daily in adults. - 0.3%. - Syrup nevirapine, birth to 6 weeks. - Nevirapine + zidovudine: 6 weeks ERF, 12 weeks EBF. - Cotrimoxazole + early infant diagnosis. - Three assays; A1 sensitive, A2 and A3 specific; positive only if all three reactive. - Eight colour-coded kits: grey, green, white, blue, red, yellow, black, brown. - Kit 6, yellow. - Kit 5, red, acyclovir. - 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 β€” NACO and ICMR-NIRDHDS, 2025 (link) - Sankalak: Status of National AIDS & STD Response, Seventh Edition β€” NACO, 2025 (link) - National Guidelines for HIV Care and Treatment β€” NACO, MoHFW, 2021 (link) - National Guidelines for Elimination of Vertical Transmission of HIV and Syphilis β€” NACO, MoHFW, 2024 (link) - National HIV Counselling and Testing Services Guidelines β€” NACO, MoHFW, 2024 (link) - National Technical Guidelines on Sexually Transmitted Infections and Reproductive Tract Infections β€” NACO, MoHFW, 2024 (link) - The HIV and AIDS (Prevention and Control) Act, 2017 (No. 16 of 2017) β€” 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, βˆ’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 **Answer: (b)** β€” First dose ideally within 2 hours. HIV testing of the source must not delay the decision to start PEP. **Q2.** The duration of HIV post-exposure prophylaxis is - (a) 3 months - (b) 28 days - (c) 14 days - (d) 7 days **Answer: (b)** β€” PEP continues for 28 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 **Answer: (b)** β€” One fixed-dose tablet of TLD once daily for adolescents and adults over 10 years and over 30 kg. **Q4.** The average risk of HIV seroconversion after a percutaneous exposure is - (a) 0.03% - (b) 30% - (c) 0.3% - (d) 3% **Answer: (c)** β€” NACO quotes 0.3%; the real risk depends on the amount of virus transmitted. **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 **Answer: (a)** β€” Moderate includes a superficial cut or needlestick with a solid needle. Severe involves a large-volume percutaneous exposure. **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 **Answer: (c)** β€” NACP covers all occupational exposures and victims of sexual assault, not unprotected sexual behaviour or other high-risk exposure. **Q7.** A 30-year-old is newly diagnosed with HIV. CD4 is 620 cells/mmΒ³ 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 **Answer: (c)** β€” Treat All: ART regardless of clinical stage or CD4 count, ideally same-day or within 7 days. **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 **Answer: (b)** β€” TLD as a single fixed-dose tablet once a day for those over 10 years and over 30 kg. **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 **Answer: (b)** β€” Viral load is done at 6 months, 12 months, and then every 12 months. **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 **Answer: (d)** β€” Two consecutive HIV-1 viral load values of 1,000 copies/ml or more, after 6 months on ART. **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 **Answer: (b)** β€” ART as soon as possible within two weeks of starting TB treatment, except in TB meningitis, where it is delayed at least 4 weeks. **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 **Answer: (a)** β€” Among PLHIV with TB meningitis, ART should be delayed at least 4 weeks. **Q13.** Cotrimoxazole prophylaxis in adults under NACO starts at a CD4 count below - (a) 100 cells/mmΒ³ - (b) 350 cells/mmΒ³ - (c) 200 cells/mmΒ³ - (d) 500 cells/mmΒ³ **Answer: (b)** β€” CD4 below 350 cells/mmΒ³, or WHO clinical stage 3 or 4. **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 **Answer: (d)** β€” High-risk infant: dual prophylaxis; 12 weeks with breastfeeding, 6 weeks with replacement feeding. **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 **Answer: (a)** β€” Low-risk infants get single-drug prophylaxis from birth till 6 weeks. **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 **Answer: (a)** β€” All exposed infants get cotrimoxazole at 6 weeks; the nucleic acid test is done at 6 weeks or at the earliest opportunity. **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 **Answer: (a)** β€” A1 is highly sensitive; A2 and A3 are highly specific. **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 **Answer: (d)** β€” HIV-positive when all three tests show reactive results. **Q19.** According to the 2025 estimates, adult HIV prevalence in India is - (a) 0.50% - (b) 2.0% - (c) 0.20% - (d) 0.02% **Answer: (c)** β€” 0.20% in 2024 (uncertainty bound 0.17–0.24), with 25.61 lakh PLHIV. **Q20.** The state with the largest estimated number of PLHIV is - (a) Andhra Pradesh - (b) Mizoram - (c) Maharashtra - (d) Uttar Pradesh **Answer: (c)** β€” Maharashtra 3.99 lakh, then Andhra Pradesh 3.10 lakh. Mizoram has very high prevalence, not the largest number. **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 **Answer: (c)** β€” People who inject drugs: 8.79%, ahead of H/TG persons (2.84%) and MSM (2.12%). **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% **Answer: (a)** β€” Up from 70.7-82.5-84.9 in 2020-21. The first 95, knowing one's status, is the biggest gap. **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 **Answer: (c)** β€” The Complaints Officer requirement applies at 100 or more persons, but at 20 or more in health care establishments. **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 **Answer: (c)** β€” No HIV test shall be performed without informed consent, which includes pre-test and post-test counselling. **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) **Answer: (d)** β€” Kit 6 contains cefixime, metronidazole and doxycycline for lower abdominal pain and PID. **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 **Answer: (a)** β€” Kit 5 contains acyclovir for herpetic ulcers; kit 3 is for syphilis and chancroid. ### 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.