HIV and AIDS

HIV AND AIDS

1. HIV AND AIDS

2. Human Immuno Deficiency Virus (HIV) A retrovirus that causes AIDS by infecting helper T cells of the immune system. The most common serotype, HIV-1, is distributed worldwide, while HIV-2 is primarily confined to West Africa.

3. Acquired Immuno Deficiency Syndrome (AIDS) A severe immunological disorder caused by the retrovirus HIV, resulting in a defect in cell-mediated immune response that is manifested by increased susceptibility to opportunistic infections and to certain rare cancers, especially Kaposi's sarcoma. It is transmitted primarily by exposure to contaminated body fluids, especially blood and semen.

4. RISK FACTORS Unprotected sexual contact Inject drugs or steroids where needles/syringes are shared Sexually Transmitted Disease (STDs) - syphilis, genital herpes, chlamydia , gonorrhea , bacterial vaginosis , or trichomoniasis Have been diagnosed with hepatitis, tuberculosis, or malaria From infected mother to fetus Through breast feeding Infected blood transfusion Engage in unprotected sex with someone who has any of the risk factors listed above

5. PATHOPHYSIOLOGY

6. STAGES OF HIV INFECTION Stage I – Primary HIV Infection Stage II – HIV Asymptomatic Stage III – HIV Symptomatic Stage IV - AIDS

7. STAGE I : Primary HIV infection This stage lasts for a few weeks Accompanied by a short flu-like illness Diagnosis of HIV infection is frequently missed. During this stage there is a large amount of HIV in the peripheral blood Immune system begins to respond to the virus by producing HIV antibodies and cytotoxic lymphocytes. This process is known as seroconversion . CD4(Cluster of differentiation 4) cell + T Lymphocyte count will be normal i.e., 500 – 1500 cells/cubic mm

8. Clinical Manifestations: Asymptomatic Persistent generalized lymphadenopathy

9. STAGE II : HIV Asymptomatic This stage lasts for an average of ten years Free from major symptoms, although there may be swollen glands People remain infectious and HIV antibodies are detectable in the blood, so antibody tests will show a positive result. CD4 cells + T lymphocytes – little above 500 cells/cubic mm

10. Clinical Manifestations: Moderate unexplained weight loss Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis ) Herpes zoster Angular chelitis Recurrent oral ulceration Papular pruritic eruptions Seborrhoeic dermatitis Fungal nail infections

11. STAGE III : HIV Symptomatic Immune system becomes severely damaged by HIV. The lymph nodes and tissues become damaged HIV mutates and becomes more pathogenic - more T helper cell destruction The body fails to keep up with replacing the T helper cells that are lost Immune system fails and symptoms develop Initially many of the symptoms are mild, but as the immune system deteriorates the symptoms worsen. Multi-system disease and infections can occur in almost all body systems CD4 cells + T lymphocytes – 200 – 499 cells/cubic mm

12. Clinical Manifestations: Unexplained severe weight loss Chronic diarrhoea for longer than one month Unexplained* persistent fever (intermittent or constant for longer than one month) Persistent oral candidiasis Oral hairy leukoplakia Pulmonary tuberculosis Severe bacterial infections (e.g. pneumonia, empyema , bone or joint infection, meningitis, bacteraemia) Acute necrotizing ulcerative stomatitis , gingivitis or periodontitis Unexplained* anaemia (below 8 g/dl), neutropenia (below 0.5 billion/l) and/or chronic thrombocytopenia (below 50 billion/l)

13. STAGE IV : AIDS Individual develops increasingly severe opportunistic infections and cancers CD4 cells + T lymphocytes - <200 cells/cubic mm

14. Clinical Manifestations: HIV wasting syndrome Pneumocystis pneumonia Recurrent severe bacterial pneumonia Chronic herpes simplex infection ( orolabial , genital or anorectal of more than one month’s duration or visceral at any site) Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs) Extrapulmonary tuberculosis Kaposi sarcoma Cytomegalovirus infection (retinitis or infection of other organs) HIV encephalopathy Meningitis Progressive multifocal leukoencephalopathy Recurrent septicaemia Invasive cervical carcinoma Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy

15. DIAGNOSIS ELISA – Enzyme Linked Immuno Sorbent Assay EIA – Enzyme Immuno Assay Western Blot Viral Load CD4/CD8 Ratio

16. MEDICAL MANAGEMENT HAART – Highly Active Anti Retroviral Therapy Antibacterials Antidiarrheals Immunotherapy Chemotherapy Nutrition Therapy Antidepressant Therapy

17. HAART Nucleoside Reverse Transcriptase Inhibitors (NRTI) e.g. Stavudine Non Nucleoside Reverse Transcriptase Inhibitors (NNRTI) e.g. Nevirapine Protease Inhibitors (PI) E.g. Indinavir Fusion Inhibitors E.g. Zidovudine

18. Quick Facts About HIV Transmission HIV cannot survive for very long outside of the body HIV cannot be transmitted through routine daily activities such as using a toilet seat, sharing food utensils or drinking glasses, shaking hands, or through kissing. The virus can only be transmitted from person to person, not through animals or insect bites People infected with HIV who are taking antiretroviral therapy can still infect others through unprotected sex and needle-sharing