AIDS Acquired Immunodeficiency Syndrome Diagnosis Signs and Symptoms with Treatment | MedicScientist :: Total Health Portal

AIDS (Acquired Immunodeficiency Syndrome) Transmission of HIV Clinical features and Course of HIV infection

AIDS is an advanced stage of HIV infection with symp­toms and opportunistic infections, with the CD4 cell count below 200 cells / IJL. Most AIDS patients are typical progressors and have a median survival time of 10 years. Some AIDS pa­tients may have no symptoms for up to 7 years.

 

AIDS (Acquired Immunodeficiency Syndromehgbh
AIDS (Acquired Immunodeficiency Syndrome)

AIDS (Acquired Immunodeficiency Syndrome)

  • It was first reported in 1981 in US and is now a world­wide epidemic. It is caused by human immunodefi­ciency virus (HIV).
  • The HIV attacks the immune system of the body lead­ing to a multitude of serious infections and cancers.
  • An HIV positive individual is a patient who is in­fected with HIV but is asymptomatic.
  • AIDS is an advanced stage of HIV infection with symp­toms and opportunistic infections, with the CD4 cell count below 200 cells / IJL.
  • Most AIDS patients are typical progressors and have a median survival time of 10 years. Some AIDS pa­tients may have no symptoms for up to 7 years.
  • Antiretroviral therapy has reduced the morbidity and mortality of HIV infection.
AIDS (Acquired Im
human immunodefi­ciency virus (HIV)

 

AIDS (Acquired Immunodeficiency Syndrome)sd
Persons at increased risk of HIV infection

Persons at increased risk of HIV infection

  • · Injection drug users
  • · Recipients of blood products
  • · People with multiple sex partners
  • · Patients of sexually transmitted diseases
  • · Commercial sex workers and their partners
  • · Gay men – People who have sex with persons of same sex
  • · Sexual partners of persons with AIDS
  • · Travelers, who visit areas of increased preva­lence and are indiscrete
  • · Health care workers.
AIDS (Acquired Immuerg
Transmission of HIV

Transmission of HIV infection

  • 1. Sexual contact.
  • 2. Transfusion of infected blood and blood products.
  • 3. Mother to child – HIV is transmitted from infected mother to child during pregnancy, during deliv­ery, or after birth through breast- feeding.
  • 4. Contact with infected instruments and body flu­ids – needle-sharing among drug users, acupunc­ture, tattooing, occupational exposure, medical procedures, contact with body fluids.
  • Insects which feed on human blood cannot spread HIV.

Body fluids which transmit HIV infection

  • · Semen
  • · Vaginal secretions
  • · Cerebrospinal fluid
  • · Pleural fluid
  • · Peritoneal fluid
  • · Pericardial fluid
  • · Amniotic fluid.
Clinical features and Course of HIV infection aesd
Clinical features and Course of HIV infectionPrimary HIV

Clinical features and Course of HIV infection Primary HIV

  • There are non-specific, flu-like symptoms.
  • Fever
  • Lethargy
  • Sore throat
  • Malaise
  • Rash Lymphadenopathy Arthralgias
  • Myalgias Headache-Men i ng itis.
  • Symptoms occur within 2 to 6 weeks after virus en­ters the body. Symptoms usually resolve in 2 to 3 weeks.
Clinical features and Course of HIV infection fd
Clinical features and Course of HIV infectionPrimary HIV

From 2 to 6 weeks the person is very infectious and the virus is present in large quantities in genital flu­ids.

  • Severe symptoms occur after 10 years or more in adults.
  • The virus multiplies and kills the cells of the immune system especially CD4 T lymphocytes resulting in a decreasing number of CD4 cells.
  • There is immunodeficiency and increased suscepti­bility to opportunistic infections and cancers.
  • HIV infects the CNS, testes and other organs.

The virus remains latent in CD4 cells, hence it is not possible to eradicate HIV.

As immune function deteriorates, death becomes cer­tain.

The virus remains latent in CD4 cellshy
HIV virus remains latent in CD4 cell

Opportunistic infections in HIV

  • · Tuberculosis
  • · Oropharyngeal candidiasis
  • · Diarrhoea due to :
  • Salmonella Shigella – Campylobacter
  • – Clostridium difficile
  • – Giardia
  • – Amoeba
  • – Isospora belli
  • · Strongyloides
  • · Cytomegalovirus
  • – Herpes simplex j Varicella zoster virus
  • – Bacterial pneumonia
  • – Cryptococcal meningitis
  • – Toxoplasmosis
  • – Pneumonia due to Pneumocystis carinii
  • – Mycobacterium avium complex infections
  • – Cytomegalovirus retinitis
  • – Kaposi’s sarcoma
  • – Non-Hodgkin’s lymphoma
Clinical features and Course of HIV infection da
Opportunistic infections in HIV
Indications for HIV screening rtg
hiv Investigations

Investigations HIV infection

  • · ELISA +ve test is found within 3 months of getting the infection.
  • · HIV infection is diagnosed on the basis of 3 ELISA tests.
  • · AIDS is diagnosed on the basis of 2 ELISA rapid tests using different antigens.
  • · Western Blot is used for confirmation of indeter­minate ELISA results.
  • · Polymerase chain reaction (PCR) assays – Pres­ence of HIV DNA is diagnostic.
  • · Rapid oral HIV test.
Transmission of HIV h
Indications for HIV screening

Indications for HIV screening

  • · All individuals at high risk
  • · Pregnant women
  • · Donors of blood, semen, organs
  • · All hospitalized patients where HIV prevalence
  • rate is more than 1 per 1000
  • · Patients of STD (sexually transmitted diseases)
  • · Recurrent genital infections
  • · Generalized lymphadenopathy
  • · Recurrent herpes simplex or zoster
  • · Tuberculosis
  • · Unexplained weight loss or fever
  • · Chronic diarrhea and Encephalopathy
  • · Opportunistic infections.

Treatment HIV infection

  • Antiretrovirals – these inhibit the viral replica­tion
  • Treatment of opportunistic infections Psychosocial support. Antiretroviral therapy:
  • Antiretroviral therapy should be started when CD4 count goes below 350 to 200 cells jlJL or HIV RNA is above 55,000 copiesjml.
  • If CD4 counts are not available, total lympho­cyte count may be used.
  • All symptomatic patients must be given antiretroviral therapy.
  • Antiretroviral therapy must be continued indefi­nitely, with regular monitoring.

Highly active antiretroviral therapy (HAART) :

  • HAART is a triple or 4 drug antiretroviral regime to suppress HIV replication for a long time.
  • This leads to increased CD4 count and reduction in HIV RNA.
HIV IN WOMEN rf
HIV IN WOMEN

HIV IN WOMEN

  • Maternal HIV transmission can occur to the fetus dur­ing labour and delivery or after birth via breast feed­ing.
  • HIV transmission is common during late pregnancy, labour and delivery.
  • Maternal transmission of HIV occurs if there is low CD4 count, first-born twins, high viral loads.

OCCUPATIONAL EXPOSURE

  • Nurses, lab technicians, doctors, residents, paramedicals, medical students are at increased risk.
  • Pricks on the skin can result in AIDS more than mu­cous membrane exposure.
  • Direct contact with blood and body fluids during sur­gery or diagnostic procedures must be avoided.

POST EXPOSURE PROPHYLAXIS

  • PEP means treatment of a person after exposure, with antiretroviral therapy.
  • PEP should be started within 1-2 hours of exposure
  • to prevent HIV infection. –
  • – It should be started as early as possible after expo­sure.
  • PEP consists of 28 days of :
  • IZidovudine 300 mg BD + Lamivudine 150 mg BD OR
  • tavudine 30 mg BD + Lamivudine 150 mg BD
  • An expanded regimen consists of Indinavir 800 mg 8 hrly added to the above regime.
HIV AND TUBERCULOSIS r
HIV AND TUBERCULOSIS

HIV AND TUBERCULOSIS

  • AIDS patients are very prone to tuberculosis espe­cially MDR TB – Multidrug resistant tuberculosis. There is drug interaction between antiretrovirals and Rifampicin, hence special regimens have been de­vised.

Other infections

  • Infections with Salmonella, Shigella, Campylobacter and even atypical and low virulence pathogens are very common in AIDS patients.

Other measures for longer life in HIV patients

  • · Regular health checkup and monitoring
  • · Avoid uncooked food
  • · Use filtered water only
  • · Well-balanced diet
  • · Regular exercises
  • · Personal hygiene
  • · Avoid pets
  • · Quit smoking, alcohol, drugs
  • · Avoid stress
  • · Plenty of sleep and rest.