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HIV AND AIDS

Human immunodeficiency virus is the causative organism of AIDS, known as


Acquired Immune Deficiency Syndrome.
HIV is an RNA retrovirus discovered 1983.
AIDS was first recognized in 1981 amongst IV drugs abusers who were also
homosexuals on death row.
Estimated 42 million people living with HIV/AIDS in 2002
5 million new infections per year
3 million deaths per year
Parts of Africa 25-40% of adults are infected
85% heterosexual transmission worldwide
HIV and AIDS is the 2nd leading cause of disease burden worldwide and the
leading cause of death in Africa.
People ages 20 to 49 accounted for almost three-fifths of all deaths in Africa
The impact of HIV/AIDS on women and girls has been particularly
devastating. Women and girls now comprise 50 percent of those aged 15 and
older living with HIV

Transmission of HIV
There following represent the mode of transmission of HIV
Blood, semen, breast milk, saliva
Sexual, parenteral, vertical
Risk of contracting infection dependent on
1. Viral load
2. Integrity of the exposed site
3. Type of body fluid

4. Volume of body fluid


Risk after a single exposure
>90% blood or blood products
14% vertical
0.5-1% injection drug use
0.2-0.5% genital mucous membrane
<0.1% non-genital mucous membrane

Immunology
HIV causes gradual reduction in number of circulating CD4 cells
and it inversely correlates with the viral load
Any depletion in numbers of CD4 cells renders the body
susceptible to opportunistic infections
Lymphatic tissue (spleen, lymph nodes, tonsils/adenoids) are the
main reservoir of HIV.

PRIMARY INFECTION
Primary infection or acute seroconversion illness occur about 2
12 weeks post exposure with a median period of 9 weeks and it
comprises of flu like illness or infectious mononucleosis.
70-80% is symptomatic,
Symptoms include
Fever, rash, cervical lymphadenopathy, aseptic meningitis,
encephalitis, myelitis, polyneuritis
Surge in viral RNA copies to >1 million
Fall in CD4 count to 300-400

Recovery is usually in 7-14 days

Sero conversion
Seroconversion occurs in 3-12 weeks, median time is 8 weeks
Level of viral load post seroconversion correlates with risk of
progression of disease
Differential diagnosis for this syndrome: EBV(epsten bar virus),
CMV(cytomegalovirus), Strep pharyngitis, toxoplasmosis,
secondary syphilis
This is followed by

ASYMPTOMATIC PHASE
During this phase the patient remain well with no sign of the
disease except for generalized lymphadenopathy which is defined
as the presence of an enlarged lymph node in 2 or more extra
inguinal sites for more than 3 months
With no other cause of such lymph enlargement, the lymph gland
is usually firm and rubbery and non-tender measuring about 2cm
in diameter.
During this time the fall in CD4 count is about 50-150 cells per
year

SYMPTOMAYIC PHASE
This stage is between 7 and 15 years with an average of 10 years
Lower in Africans because of low socioeconomic status and
malnutrition.
Mild impairment of immune system
Chronic weight loss: unexplained weight loss for more than 1
month of more than 5 % of body weight.

Fever more than 1 month usually low grade pyrexia.


Diarrhea for more than 3 weeks
Cough for more than 3- 4 weeks
Mild candida infections: of the tongue called oral thrush,
esophagus etc
Recurrent herpes infections: herpes Zoster and herpes simplex
infection. Herpes simplex is cold sores. Herpes Zoster is otherwise
known as shingles.
Recurrent Aphthous ulcers
Pelvic inflammatory disease
Cervical dysplasia: leading to cancer of the cervix

AIDS
End stage of the disease laden with several opportunistic
infections During this time the CD4 <200 and they may have the
following ailments
Pneumocystis pneumonia
Esophageal Candidiasis
Mucocutaneous herpes simplex
Miliary/extrapulmonary TB
Cryptosporidium
HIV-associated wasting
Microsporidium
Peripheral neuropath
When CDcount <100

Cerebral toxoplasmosis
Non-Hodgkins lymphoma
Cryptococcal meningitis
HIV-associated dementia
Primary CNS Lymphoma
Progressive multifocal leukoencephalopathy
When CD4<50
CMV retinitis, gastroenteritis
Disseminated Mycobacterium avium complex

AIDS-Defining Conditions
Bacterial infections, multiple or recurrent*
Candidiasis of bronchi, trachea, or lungs
Candidiasis of esophagus
Cervical cancer, invasive
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal (>1 month's duration)
Cytomegalovirus disease (other than liver, spleen, or nodes),
onset at age >1 month
Cytomegalovirus retinitis (with loss of vision)
Encephalopathy, HIV related
Herpes simplex: chronic ulcers (>1 month's duration) or
bronchitis, pneumonitis, or esophagitis (onset at age >1 month)

Histoplasmosis, disseminated or extrapulmonary


Isosporiasis, chronic intestinal (>1 month's duration)
Kaposi sarcoma
Lymphoid interstitial pneumonia or pulmonary lymphoid
hyperplasia complex*
Lymphoma, Burkitt (or equivalent term)
Lymphoma, immunoblastic (or equivalent term)
Lymphoma, primary, of brain
Mycobacterium avium complex or Mycobacterium kansasii,
disseminated or extrapulmonary
Mycobacterium tuberculosis of any site, pulmonary,
disseminated, or extrapulmonary
Mycobacterium, other species or unidentified species,
disseminated or extrapulmonary
Pneumocystis jirovecii pneumonia
Pneumonia, recurrent
Progressive multifocal leukoencephalopathy
Salmonella septicemia, recurrent
Toxoplasmosis of brain, onset at age >1 month
Wasting syndrome attributed to HIV

Skin and Oral disease


Seborrheic dermatitis
Xeroderma
Itchy folliculitis

Scabies
Tinea
Herpes zoster
Papillomavirus
Oral and vaginal candidiasis
Oral hairy leukoplakia
Aphthous ulcers
Herpes simplex
Gingivitis
Kaposis sarcoma
Molluscumcontagiosum
Bacillary angiomatosis

Gastrointestinal
Esophageal candidiasis
Large bowel disease (bloody diarrhea)
C. diff
CMV
Small bowel disease (watery diarrhea)
Cryptosporidium
Microsporidium
Giardia
MAC

CMV

Pulmonary
Pneumocystis pneumonia
Bacterial pneumonia
Nocardia
Management
Treatment recommended when
symptomatic or CD4 count below 200
Earlier if high viral load, rapidly falling
CD4 count, hepatitis C co-infection
ARV
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
R5/X4 inhibitors

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