- 1.HUMAN IMMUNODEFICIENCY VIRUS SUBMITTED BY- GROUP D1 MEDICAL
WARD25.4.2006
2.
- Reported as lymphadenopathy associated virus (LAV) in paris
1983 at Pasteur Institute by Lue Montagrier and associates
- In U.S. , called human T lymphotropic virus type III (HTLV III)
by Robert Gallo and colleagues at National Institute of Health
- Assigned a uniform name, the Human Immunodeficiency virus (HIV)
by the International Committee on the Taxonomy of virus in
1986
3.
- HIV 1 has widest distribution , world wide
- HIV 2 found mostly in western Africa
- HIV 2 less aggressive than HIV 1
- Second leading cause of disease burden world-wide
- Leading cause of death in Africa( >20% of deaths
4.
- In 2000, WHO estimated that over 36 million people living with
HIV/AIDS, 5.3 million new infection and 3 million deaths
- Rising alarmingly in heavily populated parts of the world
including some Eastern European countries ( Ukraine , Russia) and
South East Asian countries (Thailand , Myanmar)
5. Mode of transmission 6. Major mode of spreads
- Sexual (vaginal , anal ,oral)
- parenteral (blood and blood product recipients, injection drugs
users and those experiencing occupational injury)
- Major route of transmission (>70%) world-wide is
hetrosexual
7. Transmission risk after exposure
- >90 % for blood and blood products
- 15-40 % for vertical transmission
- 0.5-1 % for injection drug users
- 0.2-0.5 % for genital mucous membrane
- (1) Pneumocystic carinii pneumonia most common AIDS defining
illness , rarely occur when CD4 counts more than 200cells/ mm3
- (2)Mycobacterium tuberculosis reactivating latent infection or
acquired from open contact develop progressive primary disease ,
disseminated , miliary or extra pulmonary tuberculosis
23. Cardiac
- (3)Bacterial infection -S pneumoniae , H influenzae ,Staph
aureus , pseudomonas and norcardia infection
- Myocarditis , cardiomyopathy (25 40 % of the patients ),
pericardial effusion , congestive cardiac failure
24. Renal Endocrine
- HIV associated nephropathy is the most important renal
condition usually present with nephrotic syndrome, chronic renal
disease or combination of both.
- Reduced level of testosterone , abnormal adrenal function
(hypoadrenalism in 25% of patients )
25. Mucocutaneous
- Seborrhoeic dermatitis (80%)
- Molluscum contagiosum ( 10%)
- Fungal infection ( candidiasis )
- Drug allergy Stephen Johnsons syndrome
- Recurrent apthous ulceration
26. Haematology
- Disorders of all 3 major cell lines may occur in HIV
- Most frequent in late-stage disease
27. Neoplasms
- Kaposi sarcoma and Non-Hodgkins lymphoma are most common
opportunistic malignancies associated with HIV and are considered
AIDS defining diagnosis
- Primary CNS lymphoma-usually complicate late stage HIV
- Genital cancer-anogenital (vulval, vaginal, anal, penile) and
cervical cancer closely associated with HPV is more frequently
observed in HIV
28.
- HIV associated lymphoma (non-Hodgkins lymphoma it is late
manifestation of HIV )
29. Opportunistic infection
- Protozoa toxoplasmosis , cryptosporidiosis ,
microsporidiosis,
- Virus CMV , Herpes , EBV , HPV , Papova virus ,
- Fungus PCP , Cryptococcus , Candida , Dermatophytes ,
Aspergillus , Histoplasma
- Bacteria Mycobacteria ,Staphylococci , Non-typhoidal
salmonellosis ,
- Others Disseminated strongyloidiasis , Giadiasis, Crustes (
Norwegian )scabes
30. Common AIDS defining condition
- Chronic cryptosporidial diarrhoea
- Chronic mucocutaneous herpes simplex
- Disseminated Mycobacterium avium intracellulare
- Miliary or extrapulmonary tuberculosis
- Progressive multifocal leuco-encephalopathy
31.
- Recurrent non-typhi salmonella septicaemia
- Primary cerebral lymphoma
32. CLINICAL COURSE 33. Primary infection
- Mild in most patients and only identify by retrospective
enquiry
- Symptoms appear 2 to 4 wks after exposure ( seroconversion
illness)
- Manifest as fever , erythematous or maculopapular rash over the
body , fatigue , pharyngitis , cervical lymphadenopathy , myalgia ,
arthralgia , retro-orbital headache, mucosal ulceration
34.
- Rarely present with aseptic meningitis, encephalitis, myelitis
, polyneuritis
- Coincides with surge in plasma HIV RNA level and fall in CED4
count .
- Recover after 1- 2 wks associated with fall in viral load and
rise in CD4 count but not to its previous value .
- HIV antibody appear at 3 12 wks
35. Asymptomatic infection (CD4> 500/cumm)
- Variable period in which infected individual remains well with
no evidence of disease
- May present with persistent generalized lymphadenopathy ( PGL)(
enlarged lymph nodes at two or more extra inguinal sites persists
for 3 months without any other causes of generalized
lymphadenopathy )
- Sustained viraemia with decline in CD 4 counts
36. Mildly symptomatic disease ( ARC)( CD4 200-500/cumm)
- Impaired cellular immunity median interval from infection is
7-10 yrs
- Chronic weight loss, fever , diarrhoea , oral or vaginal
candidiasis , oral hairy leucoplakia, recurrent herpes zoster
infection , severe pelvic inflammatory disease , bacillary
angiomatosis , ITP and cervical dysplasia
37. Acquired immune deficiency syndrome
- - 1) specified opportunistic infection ,
- Disease correlate with level of CD 4 count
38.
- CD 4 < 200 PCP pneumonia , mucocutaneous herpes simplex ,
cryptosporidiosis , microsporidiasis, oesophageal candidiasis,
miliary or extra pulmonary TB , wasting and peripheral
neuropathy
- CD 4 < 100 Cerebral toxoplasmosis , cryptococcal meningitis
, primary CNS lymphoma , non Hodgkins lymphoma , dementia and
progressive multifocal leucoencephalopathy
- CD 4 < 50 Cytomegalovirus retinitis , gastrointestinal
disease , disseminated mycobacterium avian intracellulare
39. Major signs
CRITERIA USED IN MYANMAR 40. Minor signs
- Persistent cough > 1 month ( not due to tuberculosis )
- Candidiasis ( oropharyngeal )
- Herpes zoster ( recurrent )
- Herpes simplex ( chronic progressive and disseminated)
- Generalized pruritic dermatitis
- Generalized lymphadenopathy
41. INVESTIGATION 42. laboratory confirmation
- Serology test using ELISA antibody testing { false positive are
rare but it is important that any (+)ve results are confirmed by
using other immunoassays ,e.g. immunoblot }
- Seroconversion ( HIV antibody negative ) and vertical
transmission ( HIV antibody positive ) , ELISA test is unhelpful
and HIV RNA must be measured by using PCR ( reverse transcriptase )
, b DNA , NASBA technique
43. Pre and post test counselling
- Prior to HIV antibody testing , the patient must see a
counsellor
- Pretest counselling involve assessment of the risk of exposure
and explore a persons knowledge about HIV infection
- Post-test counselling ( return +ve)- to provide emotional
support , organised continuous contact and medical follow up ,
safer sex and needle exchange
44. Baseline investigations
- -HBV surface antigen-HCV antibody
- -HBV core antibody-HAV IgG antibody
45.