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HIV-a retrovirus
Etiology
Epidemiology
• Modes of Transmission
Clinical Presentation
• HIV infection / Diagnosis
• Aids Infection / Diagnosis
Treatment
Preventive Measures
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The Human Immunodeficiency Virus
(HIV) causes Acquired
Immunodeficiency Syndrome (AIDS)
HIV attacks the immune system, resulting
in a chronic, progressive illness and
leaving infected people vulnerable to
opportunistic infections and cancers
The median time from infection to AIDS
diagnosis now exceeds 10 years
AIDS can be fatal
HIV searches for immune system cells that have CD4
surface receptors, because this particular receptor
enables the virus to bind to the cell.
Although HIV infects a variety of immune system cells,
its key target is the T-lymphocyte, a white blood cell
that has numerous CD4 receptors
Once HIV binds to a CD4+ cell, it transfers its genetic
material and vital enzymes into the cell where it
integrates with the genetic material of the host cell,
=> new “batch” of HIV is produced.
Although CD4+ T cells appear to be HIV's
main target, other immune system cells
with CD4 molecules on their surfaces are
infected as well:
• Monocytes
• Macrophages
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CD4+ T cells also serve as important
reservoirs of HIV: a small proportion of
these cells harbor HIV in a stable,
inactive form.
Normal immune processes may activate
these cells, resulting in the production of
new HIV virions.
**AIDS defining illness:
-CD4<200 (15%)
-Resp or esophageal Candidiasis
-Cervical Ca
-Coccidioides
-Cryptococcus
-Cryptosporidium
-Cytomegalovirus
-Encephalopathy (HIV)
-HSV (ulcer >1mo or esophagus or resp)
-Histoplasma (dissem or extrapulm)
-Isospora
-Kaposi sarcoma
-Lymphoma (Burkitt’s)
-Mycobacterium avium complex
-Mycobacterium, other sp, (dissem or extrapulm)
-PCP
-Pneumonia (recurrent)
-Progressive multifocal leukoencephalopathy
-Salmonella
-Toxoplasma
-TB (disseminated)
-Wasting syndrome due to HIV.
Retrovirus
-depends on reverse transcriptase to
replicate within host cells.
HIV genome has 3 basic structural
proteins and 5 other regulatory
proteins:
Gag codes = group antigen proteins
Pol codes = polymerase
Env codes = external envelope protein (
greatest variability)
Risky behaviors, such as:
- sharing needles and syringes,
- buying sex
- male-to-male sex without the use of
condoms
anal, oral.
Reliable data on HIV prevalence in
Afghanistan is sparse.
 About 650 HIV cases registered by the MoPH
 number of people living with HIV/AIDS
estimated at 3,000,
 Afghanistan is as yet relatively unscathed, but
remains vulnerable.
 HIV epidemic is at an early stage and
concentrated among high-risk groups, mainly
injecting drug users and their partners.
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Needle stick injury risk is 1: 300
Factors increasing risk:
 Depth of penetration
 Hollow bore needles
 Visible blood on the needle
 Advanced stage of disease in the source
 Mucosal splash risk unknown but
assumed
to be lower.
HIV not been shown to be spread by:
 Respiratory droplet spread
 Vectors such as mosquitos
 Casual non-sexual contact
 Shaking hands
Acute HIV Infection
 Primary or acute HIV infection may be
associated with symptoms resembling
mononucleosis or the flu within 2 to 4
weeks of exposure
 HIV
seroconversion (converting from HIV
negative to HIV positive) occurs within 3
months of exposure
Symptoms:
 Many individuals can be asymptomatic for years
 Sx’s can be very non-specific
 Combination of complaints is more suggestive of HIV
infection than any one symptom.
Physical exam:
Non-specific to very specific:
 Hairy leukoplakia of the tongue
 Disseminated Kaposi’s sarcoma
 Cutaneous bacillary angiomatosis
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sore throat
muscular stiffness or aching
headache
diarrhea
lymphadenopathy
fever
fatigue
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rash of various types
joint pain
elbow pain
hip pain
knee pain
ankle pain
CERVICAL LYMPHADENOPATHY
ACUTE HIV RASH
PALATAL ULCERATIONS
Constitutional Sxs:
Fever night sweats and weight loss
common and can occur without
opportunistic infections.
Weight loss
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Loss of muscle mass being the most distressing.
Anorexia, nausea, vomiting
Varying degrees of malabsorption
Increased metabolic rate
Decreased protein synthesis
Note the severe weight loss
Oral lesions:
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Oral candidiasis
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Hairy leukoplakia (Epstein-Barr virus)
• White lesion on lateral aspect of the tongue
• Parallel lines that have a raised or “hairy apperance”.
These patients have a high rate of progression to AIDS
despite CD4 counts
Angular chelitis, gingival infections, and aphthous
ulcers are also common.
APHTHOUS ULCER TONGUE
THROAT CANDIDIASIS
ENT:
 Chronic Sinusitis
 Candidiasis: oropharygeal and
esophageal
GI:
 Hepatic disease
 Biliary Disease
GI cont’d:
Enterocolitis:
 Bacteria (campylobacter, salmonella,
shigella)
 Viruses (Cytomegalovirus, adenovirus)
 Protozoans (Cryptosporidium, giardia,
entamoeba hystolytica)
 Gastropathy – decreased stomach acid
 Malabsorption syndromes
Respiratory:
Pneumocystis carinii pneumonia
Most common opportunistic infection associated with
AIDS is difficult to diagnosis
Fever, cough, SOB – all non-specific
Symptoms can be mild to full blown respiratory
distress.
CXR:
Diffuse or perihilar infiltrates in 2/3 of pts
Definite diagnosis.:
 Induced sputum collection 50-80% of cases
 Bronchiolar lavage – 95% of cases
Other Infectious Pulmonary disease:
 Community acquired pneumonia
 Mycobacterium Tuberculosis
 Viral pneumonias
Non-infectious pulmonary disease:
 Kaposi’s sarcoma
 Non-Hodgkins lymphoma
 Interstitial pneumonitis
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An HIV ELISA/Western blot may show positive HIV
antibody; if negative, the test should be repeated in 3
months.
CD4 count may show suppression of the immune
system
A blood differential may show abnormalities.
Tests will depend greatly upon local resources.
Consult the plan established by your command for
instance MoD, MoPH, MoI.
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HIV antibody test ELISA (Enzyme Linked
Immunoabsorbent Assay) and Western Blot are positive
absolute CD4 lymphocyte count is less than 200
p24 antigen is abnormal
T (thymus derived) lymphocyte count is abnormal
Immunodeficiency is the defining characteristic of AIDS
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 prolonged, unexplained fatigue
 swollen glands (lymph nodes)
 fever lasting more than 10 days
 chills
 excessive sweating especially night
sweats
 mouth lesions including yeast lesions
and painful, swollen gums
 sore throat
 cough
 ( sounds like malaria!!!)
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 shortness of breath
 changes in bowel habits
including
constipation
 frequent diarrhea
 symptoms of a specific opportunistic
infection (such as candida, pneumocystis,
and so on)
 tumor (Kaposi sarcoma)
 skin rashes or lesions of various types
 unintentional weight loss
 general discomfort or uneasiness
(malaise)
 headache
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 Additional
symptoms that may be
associated with this disease:
• speech impairment
• muscle atrophy
• memory loss
• decreasing intellectual function
• joint swelling
• joint stiffness
• joint pain
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• cold intolerance
• bone pain or tenderness
• unusual or strange behaviour
• slow, sluggish, lethargic movement
• anxiety, stress, and tension
• groin lump
• generalized itching (pruritus)
• genital sores (female)
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• genital sores (male)
• blurred vision
• double vision (diplopia)
• light sensitivity
• blind spots in the vision
• decreased vision or blindness
• chest pain
• flank pain or pain in the sides
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• back pain
• abdominal pain
• loss of appetite, indigestion, or other
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gastrointestinal upset
muscle pain
bone pain or tenderness
numbness and tingling
seizures
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Protozoal infections
• pneumocystis carinii pneumonia
• toxoplasmosis
• cryptosporidium enterocolitis
• giardiasis
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Fungal infections
• esophagitis candida
• cryptococcal meningitis
• coccidioidomycosis
• histoplasmosis
• aspergillosis
ORAL CANDIDIASIS
FUNGAL INFECTIONS
• esophagitis candida
• cryptococcal meningitis
• coccidioidomycosis
• histoplasmosis
• aspergillosis
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Bacterial infections
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pulmonary tuberculosis
atypical mycobacterial infection
disseminated tuberculosis
recurrent bacterial pneumonias
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herpes simplex virus
cytomegalovirus
Epstein-Barr
varicella - herpes zoster
Viral infections
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Malignancies
• Kaposi's sarcoma
• Lymphoma
• Non-hodgkins and Hodgkins
• Anal dysplasia and Squamous cell cancer
(cervical)
Lesions may appear anywhere.
Remember: eyelids, conjunctiva, pinnae,
palate, and web spaces.
40% of pts with skin lesions also have
visceral disease (Gastrointestinal,
Respiratory)
Kaposi’s Sarcoma can range from disfiguring to …..
organ and limb threatening …
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Do not worry about
memorizing these drugs,
the treatment of HIV/AIDS
will be decided by experts
in the disease.
SO MANY
DRUGS!!!!
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Refers to a method of infection control in
which all human blood and other
potentially infectious materials are
treated as if known to be infectious for
HIV and HBV and HCV
Do not apply to faeces, nasal secretions,
sputum, sweat, tears, urine or vomitus
unless they contain visible blood
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 Using
protective equipment when
applicable to protect the skin and
mucous membranes
 The
mandatory use of gloves, gowns,
masks and eye protection if handling biohazardous waste
 The
washing of hands after handling biohazardous waste
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Proper use of Personal Protective Equipment
(PPE)
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Effectively cleaning blood spills
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Proper disposal of bio-hazardous waste
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Proper handling of sharps
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Appropriate response to occupational
exposures
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Gloves should be worn when …
• there is contact or potential for contact with
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blood and/or body fluids
there is contact or potential for contact with
mucous membranes, non-intact skin
there is contact or potential for contact with
items/surfaces soiled with blood and/or body
fluids
performing venipuncture
starting IV’s
any invasive procedures
change gloves after contact with each patient
wash hands after gloves are removed
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Impervious gowns should be worn during procedures
that are likely to generate splashes of blood and/or
body fluids onto your clothing or exposed skin
Masks and protective eyewear (or masks with attached
face shield or full face shield) should be worn during
procedures that are likely to generate splashing of
blood and/or body fluids into the mucous membranes
of the mouth, nose, or eyes
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Avoid unsafe sexual practices
 number and frequency of sexual contacts
Avoid high risk practices, e.g., anal intercourse
Use barrier protection
Avoid use of shared needles
Seek help if addicted to IV opium