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objectives
Historical aspects Mode of transmission of HIV Pathogenesis of HIV infection Investigations Clinical staging Complications
Historical Background
June, 1981 : 5 cases of homosexual men with P. carinii pneumonia in Los Angeles, USA June27, 1982 : CDC names the new disease as AIDS Acquired Immuno- deficiency Syndrome April, 1984 : Viral aetiology of AIDS identified by two groups of scientists. March, 1985 :Tests Kits developed to detect antibodies to HIV 1986 : International Committee on Taxonomy of Viruses named the virus as Human Immunodeficiency Virus (HIV) 1986 HIV2: Probable origin: monkeys in West Africa. 1987 : Zidovudine marketed under the brand name of Retrovir.
HIV classified as lentivirus , subfamily of retroviruses. HIV two distinct groups HIV-1 and HIV-2
Efficacy of different routes of HIV of transmission and their contribution to total number of cases
2
3
Perinantal
Sexual intercourse
20 40%
.01- 1.0 %
10
75
0.7
81
4
5 6
IDU
Needle exposure Others
0.5 1.0%
0.5%
10
0.1
5.2
7.6
Occupational transmission
Small
but definite risk of occupational transmission. Following skin puncture from needle, chance is 0.3%. Following mucous membrane exposure, chance is .09%. Transmission through intact skin not documented.
Indicators Conditions in Case Definition of AIDS (Adults)Candidiasis of esophagus,trachea, bronchi, or lungs. Herpes simplex more than one month Cervical cancer Coccidioidomycosis- extra pulmonary Cryptococcosis
MAC
Mycobacterium Tuberculosis PCP
ICCTC
Pretest counseling Informed consent HIV testing Post test counseling Follow up counseling
Diagnostic Tests for HIV Infection HIV antibody(IgG) testing is performed by using enzyme-linked immunosorbent assay (ELISA), which is highly sensitive If result is negative, the test is reported as negative If result is positive, the ELISA is repeated If the repeat test is positive, a Western blot (WB) assay is performed for confirmation
If WB assay result is positive, the test is reported as positive WB results are occasionally described as indeterminate; supplemental testing may be recommended Standard HIV antibody testing may not detect HIV-2, which is common in West Africa A low CD4 cell count is not diagnostic of HIV disease IgG not reliable for babies
Clinical stage 1
Asymptomatic Persistent generalized lymphadenopathy (PGL):defined as lymphadenopathy (>1 cm) at two or more extra inguinal sites for more than 3 months in the absence of causes other than HIV infection.
CLINICAL STAGE : 4
HIV wasting syndrome : weight loss of > 10%, plus either unexplained chronic diarrhoea > 1 month, or
Cryptococcosis, extrapulmonary
Cytomegalovirus (CMV) disease of an organ other
CLINICAL STAGE : 4
Herpes simplex virus (HSV) infection, mucocutaneous > 1 month, or visceral Progressive multifocal leukoencephalopathy (PML) Any disseminated endemic mycosis ( I.e.) histoplasmosis, coccidioidmycosis Candidiasis of the oesophagus, trachea, bronchi or lungs
CLINICAL STAGE : 4
Extrapulmonary tuberculosis Lymphoma
Oral complications
Candidiasis Herpes Simplex Kaposis Sarcoma Oral Hairy Leukoplakia
Gastrointestinal Complications
Anorxia, nausea, vomiting Aphthous ulcers Esophageal Candidiasis Diarrhoea
Liver Diseases
Viral hepatitis B,C Cholangiopathy Pancreatitis
Dermatlogic Complications
Pulmonary Complications
Pneumonia Pulmonary Tuberculosis Pneumocystis Carinni Histoplasmosis Crytococcosis MAC Lymphocylic interstitial Pneumonia
Neurological Complications
Distal Sensory Neuropathy Polyradiculitis Myelopathy AIDP Monneuritis multiplex Dementia Toxoplasmosis Cryptococcal Meningitis Primary CNS lymphoma Tubercular Meningitis
Genitourinary Complications
HIV Nephropathy Renal Stone UTI Vulvo- vaginal candidiasis
HAEMATOLOGICAL COMPLICATIONS
Anaemia Thrombocytopenia Persistent generalised lymphadenopathy Lymphopenia Neutropenia Pancytopenia Drug induced
Malignancies
Kaposi Sarcoma Non-Hodgkin,s lymphoma Primary CNS lymphoma
Ophthalamological Complications
CMV Retinitis Acute retinal necrosis syndrome Chorioretinitis due to toxoplasma
conclusion
HIV is a lente virus, subfamily of retrovirus It has varied modes of transmission, most important being blood transfusion, sexual and perinatal All the cells with CD4 molecule are affected by HIV Clinical staging is important for both therapeutic and prognostic reasons Any system may be involved in HIV infection